Dual-energy cardiac CT is a highly sensitive modality for detecting LAA thrombus and for differentiating thrombus from SEC in patients with stroke.

The prevalence of typical angina and that of MACE were significantly higher in patients with a high interarterial course than in those with a low interarterial course.

Background and Purpose-A noninvasive method with high reliability and accuracy comparable to transesophageal echocardiography for identification of left atrial appendage thrombus would be of significant clinical value. The aim of this study was to assess the diagnostic performance of a dual-enhanced cardiac CT protocol for detection of left atrial appendage thrombi and for differentiation between thrombus and circulatory stasis in patients with stroke. Methods-We studied 83 consecutive patients with stroke (56 men and 27 women; mean age, 62.6 years) who had high risk factors for thrombus formation and had undergone both dual-source CT and transesophageal echocardiography within a 3-day period. CT was performed with prospective electrocardiographic gating, and scanning began 180 seconds after the test bolus. Results-Among the 83 patients, a total of 13 thrombi combined with spontaneous echo contrast and 14 spontaneous echo contrasts were detected by transesophageal echocardiography. All 13 thrombi combined with spontaneous echo contrast were correctly diagnosed on CT. Using transesophageal echocardiography as the reference standard, the overall sensitivity and specificity of CT for the detection of thrombi and circulatory stasis in the left atrial appendage were 96% (95% CI, 78% to 99%), and 100% (95% CI, 92% to 100%), respectively. On CT, the mean left atrial appendage/ ascending aorta Hounsfield unit ratios were significantly different between thrombus and circulatory stasis (0.15 Hounsfield unit versus 0.27 Hounsfield unit, Pϭ0.001). The mean effective radiation dose was 3.11 mSv. Conclusions-Dual-enhanced cardiac CT with prospective electrocardiographic gating is a noninvasive and sensitive modality for detecting left atrial appendage thrombus with an acceptable radiation dose. (Stroke. 2011;42:2471-2477.)

BackgroundThe main pulmonary artery diameter (mPA), aortic diameter (Ao), and the mPA/Ao ratio, easily measured using chest computed tomography (CT), provide information that enables the diagnosis and evaluation of cardiopulmonary diseases. Here, we used CT to determine the sex- and age-specific distribution of normal reference values for mPA, Ao, and mPA/Ao ratio in an adult Korean population.MethodsData from non-contrast, ECG-gated, coronary-calcium-scoring CT images of 2,547 individuals who visited the Health Screening Center of the Severance Hospital were analyzed. Healthy individuals (n = 813) included those who do not have hypertension, diabetes, asthma, obstructive lung disease, ischemic heart disease, stroke, smoking, obesity, and abnormal CT findings. Both mPA and Ao were measured at the level of bifurcation of the main pulmonary artery.ResultsThe mean mPA and Ao were 25.9 mm and 30.0 mm in healthy participants, respectively, while the mean mPA/Ao ratio was 0.87. Medical conditions associated with a larger mPA were male, obesity, smoking history, hypertension, and diabetes. A larger mPA/Ao ratio was associated with female, the obese, non-smoker, normotensive, and normal serum level of lipids, while a smaller mPA/Ao ratio was associated with older age. In healthy individuals, the 90th percentile sex-specific mPA, Ao, and mPA/Ao ratio were, 31.3 mm (95% CI 29.9–32.2), 36.8 mm (95% CI 35.7–37.5), and 1.05 (95% CI 0.99–1.07) in males, and 29.6 mm (95% CI 29.1–30.2), 34.5 mm (95% CI 34.1–34.9), and 1.03 (95% CI 1.02–1.06) in females, respectively.ConclusionIn the Korean population, the mean mPA reference values in male and female were 26.5 mm and 25.8 mm, respectively, while the mean mPA/Ao ratio was 0.87. These values were influenced by a variety of underlying medical conditions.

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Percutaneous nephrolithotomy (PNL) is a minimally invasive technique for renal stone removal but can cause renal parenchymal injury. Renal stones can also affect renal function. We evaluated the risk factors for acute kidney injury (AKI) after PNL.The study cohort included 662 patients who underwent PNL. Patient characteristics, preoperative laboratory values, intraoperative data, and stone characteristics were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for AKI after PNL. Postoperative outcomes such as hospitalization, intensive care unit admission rate and stay duration, and chronic kidney disease were also evaluated.Of the total study series, there were 107 (16.2%) cases of AKI after PNL (AKI group), and 555 (83.8%) patients who showed no injury (no-AKI group). The risk factors for AKI after PNL were found to be a higher preoperative serum uric acid level [odds ratio (OR) = 1.228; 95% confidence interval (95% CI) = 1.065–1.415; P = .005], longer operation time (OR = 1.009; 95% CI = 1.004–1.014; P < .001), and intraoperative hypotension (OR = 12.713; 95% CI = 7.762–20.823; P < .001). Hospitalization and intensive care unit stay duration were significantly longer in the AKI group (8.7 ± 5.2 vs 6.6 ± 2.8 days, P < .001; 0.34 ± 1.74 vs 0.07 ± 0.48 days, P = .002, respectively). Chronic kidney disease was also significantly higher in the AKI group (63.6% vs 32.7%, P = .024).As intraoperative hypotension is an important risk factor for AKI after PNL, which leads to poor postoperative outcomes, it should be prevented or managed vigorously during PNL.

Mannitol, an osmotic diuretic, has been used to prevent acute kidney injury (AKI). However, studies have found divergent effects of intraoperative mannitol administration on postoperative AKI. We therefore evaluated the effects of intraoperative mannitol administration on AKI after robot-assisted laparoscopic radical prostatectomy (RALP) in prostate cancer patients.A total of 864 patients who underwent RALP were divided into mannitol (administered at 0.5 g/kg) and no-mannitol groups. Demographics, cancer-related data, preoperative laboratory values, intraoperative data, and postoperative outcomes such as AKI, chronic kidney disease at 12 months postoperation, duration of hospital stay, and intensive care unit admission rate and duration of stay were compared between the 2 groups using propensity score matching analysis. To determine the risk factors for AKI after RALP, univariate and multivariate logistic regression analyses were performed. Postoperative AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria.After performing 1:1 propensity score matching, the mannitol and no-mannitol groups included 234 patients each. The overall incidence of AKI after RALP was 5.1% and was not significantly different between the no-mannitol and mannitol groups in the propensity score-matched patients (13 [5.6%] vs. 11 [4.7%], P = .832). Univariate logistic regression analysis revealed that body mass index and operative time were associated with AKI in 864 patients who underwent RALP. However, intraoperative mannitol administration was not associated with AKI after RALP (P = .284). Multivariate logistic regression analysis revealed that operative time was significantly associated with AKI after RALP (odds ratio = 1.013, P = .001). The incidence of chronic kidney disease (13 [5.6%] vs. 12 [5.1%], P = 1.000) and other postoperative outcomes were not also significantly different between the no-mannitol and mannitol groups in the propensity score-matched patients.Intraoperative mannitol administration has no beneficial effect on the prevention of AKI after RALP in prostate cancer patients. This result provides useful information for clinical practice guidelines regarding intraoperative mannitol use.

Although intra-cardiac masses are rare, diagnosis and refined characterization of these masses are important because of the different therapeutic strategies used to treat these lesions. The purpose of this study was to evaluate the diagnostic value of dual-energy cardiac computed tomography (CCT) for differentiating cardiac myxomas from thrombi. Our institutional review board approved this study, and patients provided informed consent. We prospectively enrolled 37 patients who had an intra-cardiac mass on echocardiography or computed tomography (CT). All patients underwent dual-energy CCT. For quantitative analysis, the CT attenuation density and iodine concentration of the intra-cardiac mass were measured on CT images. The Mann-Whitney test was used to evaluate differences in the mean CT attenuation density and the mean iodine concentrations between the cardiac myxoma and thrombus groups. Pathological results or follow-up with echocardiography was used to make the final diagnosis. There were a total of 17 cardiac myxomas and 20 thrombi. On CT, the mean CT numbers were not significantly different between cardiac myxomas and cardiac thrombi (91.7 ± 11.6 HU vs. 85.2 ± 10.9 HU, respectively, P = 0.241), whereas, the mean iodine concentration (mg/ml) was significantly different between cardiac myxomas and cardiac thrombi (3.53 ± 0.72 vs. 1.37 ± 0.31, respectively, P < 0.001). Dual-energy CCT using a quantitative analytic methodology can be used to differentiate between cardiac myxomas and thrombi.