Rationale and Objectives The study aimed to determine if intrathoracic fat volumes are associated with the presence and severity of systemic sclerosis (SSc), defined by the presence of pulmonary arterial hypertension (PAH). Materials and Methods A total of 265 patients were included in the study, 202 of whom had SSc (134 had SSc with no PAH and 68 had SSc-associated PAH) and who underwent high-resolution computed tomography, and 63 controls who underwent coronary computed tomography angiography with calcium scoring. Intrathoracic and epicardial (EFV) fat volumes were quantified by manual tracing of the mediastinum and the pericardium, the difference of which represents the extrapericardial fat volume. Associations between these three fat volumes and the presence and severity of SSc, adjusted for cardiovascular risk factors and interstitial lung disease, were evaluated by logistic regression analysis. Results Of the 202 patients with SSc, the mean age was 54 years (ranged from 20 to 86), and 79% (192 of 202) were women. Adjusted EFV (odds ratio [OR]: 1.065; 95% confidence interval [CI]: 1.046–1.084, P = < 0.0001), ≤extrapericardial fat volume (OR: 1.028, 95% CI: 1.017–1.038, P = < 0.0001), and intrathoracic fat volume (OR: 1.033, 95% CI: 1.023–1.043, P = 0.001) were associated with the presence of SSc. Only EFV was associated with SSc severity (adjusted OR: 1.010, 95% CI: 1.003–1.018, P = 0.007). Conclusion Increased epicardial fat volume is associated with the presence and severity of SSc, independent of cardiovascular risk factors and interstitial lung disease.
, "Water-fat magnetic resonance imaging quantifies relative proportions of brown and white adipose tissues: ex-vivo experiments," J. Med. Imag. 5(2), 024007 (2018), doi: 10.1117/1.JMI.5.2.024007. Abstract. Quantifying the amount of brown adipose tissue (BAT) within white adipose tissue (WAT) in human depots may serve as a target to combat obesity. We aimed to quantify proton density fat fraction (PDFF) of BAT and WAT in relatively pure and in mixed preparation using water-fat imaging. Three ex-vivo experiments were performed at 3 T using excised interscapular BAT and inguinal/subcutaneous WAT from mice. The first two experiments consisted of BAT and WAT in separate tubes, and the third used mixed preparation with graded quantities of BAT and WAT. To investigate the influence of partial volume on PDFF metrics, low (2.66 mm 3 ) and high spatial resolution (0.55 mm 3 acquired voxels) in two orthogonal three-dimensional sections were compared. The low-resolution acquisitions are corrected for T2* and multipeak lipid spectrum, thus considered "quantitative," whereas the high-resolution acquisitions are not corrected but were performed to better spatially segment BAT from WAT zones. As potential BAT metrics, we quantified the average PDFF and the volume of tissue having PDFF ≤50% (VOL PDFF≤50% ) based on the PDFF histogram. In the first experiment, the average PDFF of BAT was 23 AE 6% and 21 AE 7.6% and the average PDFF of WAT was 76 AE 7% and 87 AE 7% using high-and low-resolution techniques, respectively. A similar trend with excellent reproducibility in average PDFF of BAT and WAT was observed in the second experiment. In the third experiment over the four acquisitions, the BAT-dominant tube demonstrated lower PDFF (mean ± SD) of 55 AE 2% than WAT-dominant ð69 AE 4%Þ and WAT-only tubes ð88 AE 4%Þ. Estimating VOL PDFF≤50% , the BAT-dominant tube demonstrated higher volume of 0.26 cm 3 than WAT-dominant (0.16 cm 3 ) and WAT-only tubes (0.01 cm 3 ). The presence of BAT exhibits a lower PDFF relative to WAT, thus allowing segmentation of low PDFF tissue for quantification of volume representative of BAT. Future studies will determine the clinical relevance of BAT volume within human depots. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.
Patient: Female, 91Final Diagnosis: Nutcracker syndrome • celiacomesenteric trunkSymptoms: Dyspepsia • dysphagiaMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Congenital defects/diseasesBackground:Celiacomesenteric trunk (CMT) is a very rare anatomic finding in which the celiac artery and the superior mesenteric artery (SMA) originate from the abdominal aorta through a common trunk. Clinical associations with CMT include arterial aneurysm, thrombosis, and celiac artery compression. However, an association between CMT and abdominal venous congestion caused by left renal vein compression, or ‘nutcracker phenomenon,’ has not been previously reported.Case Report:A 91-year-old woman, who died from a cerebrovascular accident (CVA), underwent a cadaveric examination at our medical school. On examination of the abdomen, there was an incidental finding of CMT. The arterial and venous diameters were measured, and vascular histopathology was undertaken. The vascular anatomy was consistent with CMT type 1-b. Nutcracker phenomenon (NCP) (left renal vein compression) was seen anatomically as dilatation and engorgement of the left renal vein, relative to the right renal vein (10.77±0.13 mm vs. 4.49±0.56 mm, respectively), and dilatation and engorgement of the left ovarian vein, relative to the right ovarian vein (4.37±0.15 mm vs. 1.06±0.09 mm, respectively) with left ovarian varicocele. The aortoceliac angle (ACA) and the aortomesenteric angle (AMA) approached zero degrees.Conclusions:We have described a rare anatomic finding of CMT that created an acute AMA and NCP. Awareness of this rare association between CMT and NCP by clinicians, vascular surgeons, and radiologists may be of value in the future evaluation and surgical management of patients who present clinically with ‘nutcracker syndrome.’
Intrathoracic fat volume, more specifically, epicardial fat volume, is an emerging imaging biomarker of adverse cardiovascular events. The purpose of this work is to show the feasibility and reproducibility of intrathoracic fat volume measurement applied to contrast-enhanced multidetector computed tomography images. A retrospective cohort study of 62 subjects free of cardiovascular disease (55% females, age = 49 ± 11 years) conducted from 2008 to 2011 formed the study group. Intrathoracic fat volume was defined as all fat voxels measuring −50 to −250 Hounsfield Unit within the intrathoracic cavity from the level of the pulmonary artery bifurcation to the heart apex. The intrathoracic fat was separated into epicardial and extrapericardial fat by tracing the pericardium. The measurements were obtained by 2 readers and compared for interrater reproducibility. The fat volume measurements for the study group were 141 ± 72 cm3 for intrathoracic fat, 58 ± 27 cm3 for epicardial fat, and 84 ± 50 cm3 for extrapericardial fat. There was no statistically significant difference in intrathoracic fat volume measurements between the 2 readers, with correlation coefficients of 0.88 (P = .55) for intrathoracic fat volume and −0.12 (P = .33) for epicardial fat volume. Voxel-based measurement of intrathoracic fat, including the separation into epicardial and extrapericardial fat, is feasible and highly reproducible from multidetector computed tomography scans.
Every morning for three weeks, Isalita has sat at her patient Janet's bedside. As a thirdyear medical student on an oncology rotation, Isalita has the most time of anyone on the health care team to get to know her patients. Janet has talked to Isalita about her past medical experiences, both good and bad, saying that she appreciates physicians' being open and honest with her about her medical condition. She wants the chance to understand what is going on, she tells Isalita, even if in the end she asks for and takes the physician's recommendation. Janet's oncologist, Dr. Haveford, has been seeing Janet since her initial diagnosis and treatment for breast cancer. They have a trusting and comfortable relationship with one another. Dr. Haveford pays particular attention to each of his patient's preferences and values. In Dr. Haveford's experience, Janet, when presented with a number of choices, has appeared uncertain and ultimately asked him what he thinks would be best for her.
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