Search Results (529)

Background/Objectives: Coronary CT angiography (CCTA) is a cornerstone in evaluating stable coronary artery disease (CAD), but conventional energy-integrating detector CT (EID-CT) has limitations, including calcium blooming and limited spatial resolution. Photon-counting detector CT (PCD-CT) may overcome these drawbacks through enhanced spatial resolution and improved tissue characterization. Methods: In this retrospective, propensity score–matched study, we compared CCTA findings from 820 patients (410 per group) who underwent either EID-CT or PCD-CT for suspected stable CAD. Primary outcomes included stenosis severity, high-risk plaque features, and downstream invasive coronary angiography (ICA) referral and yield. Results: The matched cohorts were balanced in demographics and cardiovascular risk factors (mean age 67 years, 63% male). PCD-CT showed a favorable shift in stenosis severity distribution (p = 0.03). High-risk plaques were detected less frequently with PCD-CT (22.7% vs. 30.5%, p = 0.01). Median coronary calcium scores did not differ (p = 0.60). Among patients referred for ICA, those initially evaluated with PCD-CT were more likely to undergo revascularization (62.5% vs. 44.1%), and fewer underwent potentially unnecessary ICA without revascularization (3.7% vs. 8.0%, p = 0.001). The specificity in diagnosing significant stenosis requiring revascularization was 0.74 with EID-CT and 0.81 with PCD-CT (p = 0.04). Conclusions: PCD-CT improved diagnostic specificity for CAD, reducing unnecessary ICA referrals while maintaining detection of clinically significant disease. This advanced CT technology holds promise for more accurate, efficient, and patient-centered CAD evaluation. Full article

Objective: The purpose of this study was to report the clinical characteristics and prognosis of spontaneous isolated abdominal aortic dissection (SIAAD) based on the dissection length. Methods: Between March 2012 and September 2023, 159 of 7572 patients with aortic dissection were diagnosed with SIAAD and enrolled in the retrospective study. We proposed a new morphologic classification: extensive SIAAD (e-SIAAD) and focal SIAAD (f-SIAAD), based on whether the dissection length exceeds 50 mm or not. The clinical baseline, computed tomography angiography (CTA) findings, and long-term follow-up of the two types were compared. Results: SIAAD prevalence was 2.1%. Patients with f-SIAAD were significantly older (63.74 ± 10.97 vs. 50.70 ± 10.10 years, p < 0.001), had more atherosclerosis risk factors, arteriosclerosis, and penetrating aortic ulcers compared to e-SIAAD patients. Conversely, e-SIAAD presented more acutely (72.97% vs. 34.12%, p = 0.001), exhibited more frequent symptoms (85.14% vs. 61.18%, p = 0.0037), larger dissection diameters (31.89 ± 10.99 vs. 24.41 ± 11.28 mm, p = 0.001), and greater involvement of the renal and iliac arteries. Treatment involved medical management (30%), endovascular repair (65%), or surgery (2.5%), without significant differences between groups. In-hospital mortality was higher in f-SIAAD (six deaths vs. one in e-SIAAD). During median follow-up of 48 months (range, 6–148 months), mortality was higher in f-SIAAD (70% vs. 90% estimated 10-year survival). Conclusions: SIAAD classification by dissection length revealed significant differences in clinical presentation, CTA characteristics, and prognosis. Focal dissections correlated with advanced age, severe arteriosclerosis, and poorer long-term outcomes, emphasizing the need for tailored management approaches. Full article

Background/Objectives: In patients with intracranial arteriovenous malformation (AVM), the first diagnostic analysis is often performed in emergency conditions by Computed Tomography (CT) and multiphase CT angiography (CTA). Nevertheless, once ruptured, an AVM might be hardly recognized by an inexperienced neuroradiologist, due to the presence of hematoma or to the destructuring of the lesion. The aim of our study is to outline the utility of color-coded maps derived from multiphase CT angiography in the assessment of cerebral AVMs, evaluating inter-observer agreement between radiologists with different years’ experience and comparing the results with the gold standard, angiography. Methods: The color-coded maps were obtained retrospectively by multiphase CT angiography on a workstation using FastStroke software ColorViz (GE Healthcare, Milwaukee, WI, USA). The color-coded maps were evaluated, independently, by two neuroradiologists, and inter-observer agreement was evaluated. Finally, the AVM’s features (arterial feeders, nidus type, venous drainage type) obtained with color-coded maps were compared with angiographic analysis. The Ethical Committee for Research in Medical Imaging approved this study (Institutional Review Board number 6467). Informed consent was obtained for every patient. Results: A total of 26 patients with intracranial hemorrhage and arteriovenous malformation underwent multiphase CT angiography and were analyzed. Our statistical analysis showed the reproducibility of the color-coded maps and agreement with the angiographic findings, especially in the evaluation of venous drainage type. Conclusions: The ColorViz color-coded maps have proved to be an effective tool in the identification and assessment of AVMs, providing rapid and clear information on intracranial vascular dynamics, even for inexperienced radiologists. Full article

Background: The literature shows that anterior communicating artery (AcoA) aneurysms are the most common intracranial aneurysms. To date, there has only been one postmortem study focused on the correlations between autopsy findings and imaging results in cases of intracranial aneurysms associated with anatomical variants of the circle of Willis (CW). Methods: We investigated the anatomical variants of the CW associated with the occurrence and rupture of AcoA aneurysms by performing comparative analyses, in the same patients, of postmortem autopsy data with antemortem computed tomography–angiography (CTA) results obtained in the first 48 h after the onset of subarachnoid hemorrhage. Our retrospective observational study identified the anatomical variants of the CW at autopsy in 16 deceased adult Romanian patients with AcoA aneurysms over a 12-year period (2010–2022). Results: The autopsy findings revealed that the AcoA ruptured aneurysms had a mean external diameter of 9.50 mm, and 71.4% of them presented three or four anatomical variants inside the same CW. The initial antemortem CTA examination correctly located the AcoA aneurysms in all cases (100%), and an anatomical variant of the CW was only noted in 18.75% of patients. The final postmortem re-analyzed the same CTA images identified in all cases (100%), focusing on both the AcoA aneurysm and all anatomical variants of the CW found during the autopsies. Conclusions: Although it was previously thought that the occurrence of AcoA aneurysms is related only to the hemodynamic changes induced by the nearby arterial anatomical variants, we identified the simultaneous involvement of at least one hypoplastic artery and one or two PCA fetal-type anatomical variants that were located in both the anterior and posterior parts of the CW. Furthermore, if sufficient time is devoted to the CT–angiography analysis and interpretation of the images, anatomical variants of the circle of Willis associated with AcoA aneurysms can be identified as accurately as they are in invasive postmortem autopsy examinations. Full article

Background: Coronary artery calcium (CAC) scores are a widely used surrogate marker for atherosclerotic burden, but they do not fully reflect plaque vulnerability or coronary inflammation. This study aimed to evaluate the relationship between CACs, coronary plaque characteristics, and perivascular inflammatory activity using advanced CCTA and CaRi-Heart^® analysis. Methods: A total of 250 patients with no prior cardiovascular disease were retrospectively evaluated and stratified by CACs into three groups: 0 (n = 28), 1–100 (n = 121), and >100 (n = 101). Coronary plaque morphology, high-risk plaque (HRP) features, CAD-RADS scores, and AI-derived fat attenuation index (FAI) centiles were assessed. Results: Significant differences across CAC categories were observed for several key parameters. The number of diseased coronary segments increased markedly (from 1.39 ± 1.10 vs. 2.97 ± 1.57 vs. 3.94 ± 2.10; p < 0.0001, one-way ANOVA). A similar upward trend was seen for segment involvement scores, HRP prevalence, and the proportions of mixed and calcified plaque components. Regression analysis demonstrated that CACs correlated significantly with segment burden (r² = 0.2520), CAD-RADS (r² = 0.1352), and the FAI score centile (r² = 0.0568). Conclusions: This study highlights the limitations of CACs as a standalone risk stratification tool. Vulnerable and inflamed plaques may already be present in patients with low or zero CACs. Integrating CCTA with perivascular FAI mapping enables earlier detection of biologically active atherosclerosis and supports more precise clinical decision-making. Full article

A revolutionary non-invasive method for the thorough evaluation of coronary artery disease (CAD) is fractional flow reserve (FFR) obtained from coronary computed tomography angiography (CCTA). Computed tomography-derived FFR (FFR_CT) assesses both the anatomical and functional significance of coronary lesions simultaneously by utilizing sophisticated computational models, including computational fluid dynamics, machine learning (ML), and Artificial Intelligence (AI) methods. The technological development, validation research, clinical uses, and real-world constraints of FFR_CT are compiled in this review. Large multicenter trials and registries consistently show that FFR_CT is a reliable gatekeeper to invasive coronary angiography (ICA) and increases diagnostic accuracy significantly when compared to coronary Computed Tomography Angiography (CTA) alone, especially in patients with intermediate-risk anatomy. Additionally, FFR_CT has demonstrated benefits in populations with in-stent restenosis (ISR) and in virtual procedural planning. Notwithstanding its advantages, the technique still requires high-quality imaging, and its practical application is constrained by expenses, processing requirements, and image distortions. Continuous developments in automation and deep learning should improve accessibility, effectiveness, and workflow integration in clinical settings. FFR_CT is expected to become more and more important in the individualized treatment of CAD by minimizing unnecessary invasive procedures and improving patient selection for revascularization. Full article

Background/Objectives: Invasive coronary angiography (ICA) is the gold standard for the diagnosis of coronary artery disease (CAD), with various non-invasive imaging modalities also available. Machine learning (ML) methods are increasingly applied to overcome the limitations of diagnostic imaging by improving accuracy and observer independent performance. Methods: This meta-analysis (PRISMA method) summarizes the evidence for ML-based analyses of coronary imaging data from ICA, coronary computed tomography angiography (CT), and nuclear stress perfusion imaging (SPECT) to predict clinical outcomes and performance for precise diagnosis. We searched for studies from Jan 2012–March 2023. Study-reported c index values and 95% confidence intervals were used. Subgroup analyses separated models by outcome. Combined effect sizes using a random-effects model, test for heterogeneity, and Egger’s test to assess publication bias were considered. Results: In total, 46 studies were included (total subjects = 192,561; events = 31,353), of which 27 had sufficient data. Imaging modalities used were CT (n = 34), ICA (n = 7) and SPECT (n = 5). The most frequent study outcome was detection of stenosis (n = 11). Classic deep neural networks (n = 12) and convolutional neural networks (n = 7) were the most used ML models. Studies aiming to diagnose CAD performed best (0.85; 95% CI: 82, 89); models aiming to predict clinical outcomes performed slightly lower (0.81; 95% CI: 78, 84). The combined c-index was 0.84 (95% CI: 0.81–0.86). Test of heterogeneity showed a high variation among studies (I² = 97.2%). Egger’s test did not indicate publication bias (p = 0.485). Conclusions: The application of ML methods to diagnose CAD and predict clinical outcomes appears promising, although there is lack of standardization across studies. Full article

In the original randomised Dietary Intervention to Stop Coronary Atherosclerosis (DISCO-CT) trial, a 12-month Dietary Approaches to Stop Hypertension (DASH) project led by dietitians improved cardiovascular and metabolic risk factors and reduced platelet chemokine levels in patients with coronary artery disease (CAD). It is unclear whether these benefits are sustained. Objective: To determine whether the metabolic, inflammatory, and clinical benefits achieved during the DISCO-CT trial are sustained six years after the structured intervention ended. Methods: Ninety-seven adults with non-obstructive CAD confirmed in coronary computed tomography angiography were randomly assigned to receive optimal medical therapy (control group, n = 41) or the same therapy combined with intensive DASH counselling (DASH group, n = 43). After 301 ± 22 weeks, 84 individuals (87%) who had given consent underwent reassessment of body composition, meal frequency assessment, and biochemical testing (lipids, hs-CRP, CXCL4, RANTES and homocysteine). Major adverse cardiovascular events (MACE) were assessed. Results: During the intervention, the DASH group lost an average of 3.6 ± 4.2 kg and reduced their total body fat by an average of 4.2 ± 4.8 kg, compared to an average loss of 1.1 ± 2.9 kg and a reduction in total body fat of 0.3 ± 4.1 kg in the control group (both p < 0.01). Six years later, most of the lost body weight and fat tissue had been regained, and there was a sharp increase in visceral fat area in both groups (p < 0.0001). CXCL4 decreased by 4.3 ± 3.0 ng/mL during the intervention and remained lower than baseline values; in contrast, in the control group, it initially increased and then decreased (p < 0.001 between groups). LDL cholesterol and hs-CRP levels returned to baseline in both groups but remained below baseline in the DASH group. There was one case of MACE in the DASH group, compared with four cases (including one fatal myocardial infarction) in the control group (p = 0.575). Overall adherence to the DASH project increased by 26 points during counselling and then decreased by only four points, remaining higher than in the control group. Conclusions: A one-year DASH project supported by a physician and dietitian resulted in long-term suppression of the proatherogenic chemokine CXCL4 and fewer MACE over six years, despite a decline in adherence and loss of most anthropometric and lipid benefits. It appears that sustained systemic reinforcement of behaviours is necessary to maintain the benefits of lifestyle intervention in CAD. Full article

Background: Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic valve stenosis (AS). Balloon post-dilatation (PD) remains an important procedural step to optimize valve function by resolving incomplete valve expansion, which may lead to paravalvular regurgitation and other potentially adverse effects. There are only limited data on the predictors, incidence, and clinical impact of PD during TAVI. Methods: This retrospective, single-center study analyzed 585 patients who underwent TAVI (2016–2022). Pre-procedural evaluations included transthoracic echocardiography and CT angiography to assess key parameters, including the aortic valve calcium score (AVCS); aortic valve calcium density (AVCd); aortic valve maximal systolic transvalvular flow velocity (AV Vmax); and aortic valve mean systolic pressure gradient (AV MPG). We identified imaging predictors of PD and evaluated associated clinical outcomes by analyzing procedural endpoints (according to VARC-3 criteria) and long-term survival. Results: PD was performed on 67 out of 585 patients, with elevated AV Vmax (OR: 1.424, 95% CI: 1.039–1.950; p = 0.028) and AVCd (OR: 1.618, 95% CI: 1.227–2.132; p = 0.001) emerging as a significant independent predictor for PD in TAVI. Kaplan–Meier survival analysis revealed no significant differences in short- and mid-term survival between patients who underwent PD and those who did not. Interestingly, patients requiring PD exhibited a lower incidence of adverse events regarding major vascular complications, permanent pacemaker implantations and stroke. Conclusions: The study highlights AV Vmax and AVCd as key predictors of PD. Importantly, PD was not associated with increased procedural adverse events and did not predict adverse events in this contemporary cohort. Full article

Background: Renal trauma accounts for approximately 3–5% of all trauma cases, predominantly affecting young males. The most common etiology is blunt trauma, particularly due to road traffic accidents, and it frequently occurs as part of polytrauma involving multiple organ systems. Management strategies are primarily dictated by hemodynamic stability, overall clinical condition, comorbidities, and injury severity graded according to the AAST classification. This study aimed to evaluate the effectiveness of non-operative management (NOM) in high-grade renal trauma (AAST grades III–V), beyond its established role in low-grade injuries (grades I–II). Secondary endpoints included the identification of independent prognostic factors for NOM failure and in-hospital mortality. Methods: We conducted a retrospective observational study including patients diagnosed with blunt renal trauma who presented to the Emergency Department of Policlinico Umberto I in Rome between 1 January 2013 and 30 April 2024. Collected data comprised demographics, trauma mechanism, vital signs, hemodynamic status (shock index), laboratory tests, blood gas analysis, hematuria, number of transfused RBC units in the first 24 h, AAST renal injury grade, ISS, associated injuries, treatment approach, hospital length of stay, and mortality. Statistical analyses, including multivariable logistic regression, were performed using SPSS v28.0. Results: A total of 244 patients were included. Low-grade injuries (AAST I–II) accounted for 43% (n = 105), while high-grade injuries (AAST III–V) represented 57% (n = 139). All patients with low-grade injuries were managed non-operatively. Among high-grade injuries, 124 patients (89%) were treated with NOM, including observation, angiography ± angioembolization, stenting, or nephrostomy. Only 15 patients (11%) required nephrectomy, primarily due to persistent hemodynamic instability. The overall mortality rate was 13.5% (33 patients) and was more closely associated with the overall injury burden than with renal injury severity. Multivariable analysis identified shock index and active bleeding on CT as independent predictors of NOM failure, whereas ISS and age were significant predictors of in-hospital mortality. Notably, AAST grade did not independently predict either outcome. Conclusions: In line with the current international literature, our study confirms that NOM is the treatment of choice not only for low-grade renal injuries but also for carefully selected hemodynamically stable patients with high-grade trauma. Our findings highlight the critical role of physiological parameters and overall ISS in guiding management decisions and underscore the need for individualized assessment to minimize unnecessary nephrectomies and optimize patient outcomes. Full article

Coronary computed tomography angiography (CCTA) has emerged as the leading noninvasive imaging modality for the assessment of coronary artery disease (CAD), offering high-resolution visualization of the coronary anatomy and plaque characterization. The development of fractional flow reserve derived from CCTA (FFR-CT) has further transformed the diagnostic landscape by enabling the simultaneous evaluation of both anatomical stenosis and lesion-specific ischemia. FFR-CT has demonstrated diagnostic accuracy comparable to invasive FFR. The combined use of CCTA and FFR-CT is now pivotal in a broad range of clinical scenarios, including the evaluation of stable and acute chest pain, assessment of high-risk and complex plaque features, and preoperative planning. As evidence continues to mount, CCTA and FFR-CT are positioned to become the primary gatekeepers to the cardiac catheterization laboratory, potentially reducing the number of unnecessary invasive procedures. This review highlights the growing clinical utility of FFR-CT, its integration with advanced plaque imaging, and the future potential of these technologies in redefining the management of CAD, while also acknowledging current limitations, including image quality requirements, cost, and access. Full article

Background and Objectives: Visceral arterial pseudoaneurysms (VAPAs) are rare vascular lesions characterized by the disruption of partial disruption of the arterial wall, most commonly involving the intima and media. They have an estimated incidence of 0.1–0.2%, with the splenic artery most commonly affected. Their management poses unique challenges due to the high risk of rupture. Timely recognition is crucial, as unmanaged pseudoaneurysms have a mortality rate of 90%. This narrative review aims to synthesize current knowledge regarding the epidemiology, etiology, clinical presentation, diagnostic methods, and management strategies for VAPAs. Materials and Methods: A literature search was performed across Pubmed for articles reporting on VAPAs, including case reports, review articles, and cohort studies, with inclusion of manuscripts that were up to (date). VAPAs are grouped by embryological origin—foregut, midgut, and hindgut. Results: Chronic pancreatitis is a primary cause of VAPAs, with the splenic artery being involved in 60–65% of cases. Other causes include acute pancreatitis, as well as iatrogenic trauma from surgeries, trauma, infections, drug use, and vascular diseases. VAPAs often present as abdominal pain upon rupture, with symptoms like nausea, vomiting, and gastrointestinal hemorrhage. Unruptured pseudoaneurysms may manifest as pulsatile masses or bruits but are frequently asymptomatic and discovered incidentally. Diagnosis relies on both non-invasive imaging techniques, such as CT angiography and Doppler ultrasound, and invasive methods like digital subtraction angiography, which remains the gold standard for detailed evaluation and treatment. A range of management options exists that are tailored to individual cases based on the aneurysm’s characteristics and patient-specific factors. This encompasses both surgical and endovascular approaches, with a growing preference for minimally invasive techniques due to lower associated morbidity. Conclusions: VAPAs are a critical condition requiring prompt early recognition and intervention. This review highlights the need for ongoing research to improve diagnostic accuracy and refine treatment protocols, enhancing patient outcomes in this challenging domain of vascular surgery. Full article

Background/Objectives: This study aimed to prospectively assess the incidence of retinal embolization and to evaluate the vascular and structural changes in the retina and choroid in 52 patients with asymptomatic severe carotid artery disease who underwent carotid artery revascularization. Methods: In our study, 35 patients underwent carotid endarterectomy (CEA) and 17 underwent carotid artery stenting (CAS). Biomicroscopy, fundoscopy, optical coherence tomography (OCT), and OCT-angiography (OCTA) were performed at baseline and 1 month after revascularization. Results: The subfoveal choroidal thickness (SFCT), peripapillary choroidal thickness inferior to the optic nerve head (ppCTi), total overall average retinal vascular density (rVDtot), and total overall average choriocapillaris vascular density (ccVDtot) of the eyes ipsilateral to the operated carotid artery increased significantly after revascularization, whereas a statistically significant increase was also found in the SFCT, rVDtot, and ccVDtot of the contralateral eyes in the overall cohort. Comparing the two study groups, we found that the SFCT, superior and inferior peripapillary choroidal thicknesses (ppCTs, ppCTi), rVDtot, and ccVDtot increased in both groups after revascularization, but significantly only in the CEA group. Furthermore, the temporal choriocapillaris vascular density (ccVDt) increased significantly after revascularization in both groups to a similar degree. Conclusions: Carotid artery revascularization led to a statistically significant increase in retinal and choroidal vascular densities, which indicates significantly improved ocular perfusion. The analysis of the findings of the two study groups suggests the superiority of CEA in terms of improving ocular perfusion in asymptomatic severe carotid artery disease. The rate of retinal embolization was similar in both surgical groups. Full article

Background: Kawasaki disease (KD) is a systemic vasculitis and the leading cause of acquired heart disease in children. Early identification of coronary artery abnormalities (CAAs) is crucial to guide treatment and improve outcomes. While transthoracic 2D echocardiography (TTE) remains the first-line imaging modality, it has limitations, particularly in visualizing distal coronary artery segments and detecting thrombi. Computed tomography coronary angiography (CTCA) offers enhanced visualization, but its role at initial presentation of KD remains underexplored. Methods: We reviewed the records of 71 children with KD who underwent CTCA at their initial presentation at a tertiary center between November 2013 and December 2024. The CTCA findings were compared with those of TTE. CTCA was performed after stabilization using radiation-minimized protocols. Results: Of 71 patients, 62 had CAAs on baseline TTE. CTCA confirmed CAAs in 39 patients, identified additional lesions in 23, and detected distal aneurysms and coronary branch involvement missed by TTE. In 20 patients with initially abnormal TTE, CTCA demonstrated normal coronaries, facilitating treatment de-escalation. CTCA identified coronary thrombi missed on TTE in two patients and congenital coronary anomalies in three patients. CTCA findings led to modification of therapy in multiple cases. Conclusions: CTCA is a valuable adjunct to TTE in evaluating coronary artery involvement at the time of initial presentation of children with KD. Given its superior visualization of the entire length of coronary arteries, CTCA has a vital role in therapeutic decision-making in KD. Full article

The HepACAGA (Hepatic Arteriography and C-arm CT-Guided Ablation) technique, which integrates C-arm CT guidance with transcatheter C-arm CT hepatic arteriography (C-arm CTHA), significantly improves liver tumor ablation outcomes by enhancing tumor visualization, navigation, and the intraprocedural assessment of ablation margins. The two key advantages of using C-arm CT over conventional CT for image guidance are firstly that the entire procedure can be performed in the angiography suite, eliminating the need for patient transfer between the angiography suite (catheterization) and CT-room (ablation), and secondly, that integrated C-arm needle guidance software can greatly reduce the difficulty of needle placement. Beyond these advantages, the HepACAGA technique offers additional benefits across four domains: (1) the direct conversion of ablation to intra-arterial liver-directed therapies (e.g., radioembolization or chemoembolization) upon the intraprocedural detection of disease progression; (2) the direct combination of ablation with intra-arterial treatments or portal vein embolization in one session; (3) the enhanced ablation effect through heat sink effect reduction with adjunct bland embolization or balloon occlusion; and (4) the immediate hemorrhage control through direct embolization. This pictorial essay demonstrates the advantages of combining C-arm CT guidance with real-time C-arm CTHA in the percutaneous thermal ablation of liver tumors, with clinical cases illustrating each of the aforementioned four key domains. Full article