No / The purpose of this article is to investigate characteristics of cine phase contrast-calculated cerebrospinal fluid (CSF) flow and velocity measures in patients with relapsing-remitting (RR) multiple sclerosis (MS) receiving standard medical treatment who had been diagnosed with chronic cerebrospinal venous insufficiency (CCSVI) and underwent percutaneous transluminal angioplasty (PTA). This case-controlled, magnetic resonance (MR) imaging-blinded study included 15 patients with RR MS who presented with significant stenoses (>/=50% lumen reduction on catheter venography) in the azygous or internal jugular veins. Eight patients underwent PTA in addition to medical therapy immediately following baseline assessments (case group) and seven had delayed PTA after 6 months of medical therapy alone (control group). CSF flow and velocity measures were quantified over 32 phases of the cardiac cycle by a semiautomated method. Outcomes were compared between groups at baseline and at 6 and 12 months of the study by mixed-effect model analysis. At baseline, no significant differences in CSF flow or velocity measures were detected between groups. At month 6, significant improvement in flow (P<.001) and velocity (P = .013) outcomes were detected in the immediate versus the delayed group, and persisted to month 12 (P = .001 and P = .021, respectively). Within-group flow comparisons from baseline to follow-up showed a significant increase in the immediate group (P = .033) but a decrease in the delayed group (P = .024). Altered CSF flow and velocity measures were associated with worsening of clinical and MR outcomes in the delayed group. PTA in patients with MS with CCSVI increased CSF flow and decreased CSF velocity, which are indicative of improved venous parenchyma drainage.

Es wurde der Einsatz der Mehrschicht-Spiral-CT (MS-CT) zur zerebralen Perfusionsbildgebung und zur zerviko-zerebralen Angiographie bei Schlaganfallpatienten evaluiert. Bei 52 Patienten mit klinischen Zeichen einer akuten Ischämie wurde im Mittel 3,4 Stunden nach Symptombeginn an einem MS-CT Gerät eine CT-Perfusion (CTP) durchgeführt. Parameterbilder der zerebralen Blutperfusion (CBP), des zerebralen Blutvolumens (CBV) und der mittleren Transitzeit (MTT) wurden generiert, Perfusionsstörungen ermittelt und mit bildgebenden sowie klinischen Verlaufskontrollen korreliert. Eine CT-Angiographie (CTA) wurde initial bei 12 Patienten angewandt, um die Eignung des Untersuchungsprotokolls zu prüfen. Darüber hinaus wurden bei 45 Patienten mit Zeichen einer akuten zerebrovaskulären Insuffizienz die Ergebnisse der CTA mit denen anderer bildgebender Modalitäten (Magnetresonanz-Angiographie, digitale Subtraktionsangiographie, Dopplerultraschall) verglichen. Perfusionsbilder konnten von 44 Patienten generiert werden, hiervon entwickelten 22 Patienten einen im Verlauf gesicherten Infarkt. An Hand der MTT-Bilder konnten ischämische Veränderungen mit einer Sensitivität von 95 % erfasst werden, die Spezifität war mit 100 % für die CBV-Bilder am höchsten. Patienten mit Infarkt zeigten seitenvergleichend eine signifikante Reduktion der CBP in ischämischen Arealen. Die Ausdehnung der CBV Reduktion ergab die beste Korrelation mit dem endgültigen partiellen Infarktvolumen. Mit der CTA konnte anfänglich bei 12 / 12 Patienten, später bei 43 / 45 (96 %) eine umfassende Darstellung des zerviko-zerebralen Gefäßsystems erreicht werden, wobei in 22 Infarktpatienten die zu Grunde liegende Gefäßpathologie erkannt werden konnte. Das evaluierte Protokoll zur Perfusionsbildgebung mittels Mehrschicht-Spiral-CT ist zur frühzeitigen Erkennung und Quantifizierung einer akuten zerebralen Ischämie geeignet und bietet zusammen mit der CTA, welche das gesamte zerviko-zerebrale Gefäßsystem verlässlich visualisieren kann, die Möglichkeit einer umfassenden Bildgebung mittels MS-CT bei Schlaganfallpatienten. / The application of multi-slice spiral computed tomography (MS-CT) in the diagnostic assessment of stroke patients using cerebral perfusion imaging and cervicocerebral angiography was evaluated. Fifty-two patients with clinically suspected acute ischemia underwent CT perfusion (CTP), performed 3.4 hours, on average, after the onset of symptoms, by using MS-CT. Perfusion images of the cerebral blood perfusion (CBP), cerebral blood volume (CBV) and mean transit time (MTT) were calculated. The amount and extension of perfusion disturbances were measured and correlated with the outcome. CT angiography (CTA) was initially performed on twelve patients to verify the suitability of the examination protocol. In addition, forty-five patients with signs of acute cerebrovascular insufficiency underwent CTA. CTA findings were compared with those of other imaging modalities (magnetic resonance imaging, digital subtraction angiography, doppler ultrasonography). Of 44 patients in whom perfusion maps could be generated, 22 developed infarction confirmed at follow-up. On MTT-maps ischemic changes could be detected with the highest sensitivity (95%). Specificity was highest (100%) for CBV-maps. Patients with infarction showed significant reduction of CBP in ischemic tissue compared to the contra lateral hemisphere. Extension of CBV reduction showed the best correlation with final infarct volume. Initially in twelve out of twelve patients, later in 43 out of 45 (96%), the cervicocranial vascular system could be comprehensively visualized using CTA. In 22 stroke patients the underlying vascular pathology could be detected. CT perfusion using multi-slice CT is a suitable tool for the early identification and quantification of acute cerebral ischemia. Multi-slice CT angiography permits reliable visualization of the cervicocranial vascular system. Together these tools offer comprehensive assessment of stroke patients by means of multi-slice CT.

EINLEITUNG: Die CT- Angiographie (CTA) ist eine neue Methode zum anatomischen Nachweis pathologischer Veränderungen am Gefäßsystem. Die Wertigkeit der an unserem Institut durchgeführten CT- Angiographien bezüglich der Diagnostik von Nierenarterienstenosen sollte untersucht werden. Außerdem sollten die einzelne Rekonstruktionsarten auf ihren Nutzen geprüft werden. MATERIAL UND METHODEN: Die Nierenarterien von 23 Patienten wurden sowohl angiograpisch als auch mit CTA untersucht. Aus dem Datensatz jeder Untersuchung wurden Axiale Schnittbilder (AS), axiale und coronale multiplanare Reformationen (cMPRa, cMPRc), 3D- Oberflächenrekonstruktion (SSD) und Maximum- Intensitäts- Projektion (MIP) angefertigt. Ohne Kenntnis des Angiographie- Befundes wurden in der ersten Befundungssitzung alle CTA- Rekonstruktionen einzeln beurteilt. Dabei kam eine fünfteilige Stenosengraduierung zum Einsatz. In der zweiten Befundungssitzung wurde die Diagnose anhand aller CTA- Rekonstruktionen eines Falles gestellt. Sensitivität, Spezifität und Kappa ergaben sich aus dem Vergleich mit den Angiographie- Befunden. ERGEBNISSE: Die CTA konnte relevante Nierenarterienstenosen (Lumeneinengung >50%) mit einer Sensitivität von 92,9 % und einer Spezifität von 86,7 % nachweisen. Der CTA- Stenosegrad stimmte bei Anwendung einer Unterteilung in fünf Kategorien in 65,9 % der Fälle mit dem der Angiographie überein (kappa = 0,468). Bei der Beurteilung der einzelnen Rekonstruktion lieferten die AS (Sensitivität 78,6 %, Spezifität 90,0 %, kappa 0,692) und die MIP (Sensitivität 71,4 %, Spezifität 96,7 %, kappa 0,726) die besten Resultate. Die cMPRa und cMPRc besaßen durch die ausschließliche Filmbefundung eine deutlich niedrigere diagnostische Qualität. Tendenziell wurde der Stenosegad mittels CTA unterschätzt. SCHLUSSFOLGERUNG: Die CTA besitzt eine hohe Wertigkeit bei der Diagnostik von Nierenarterienstenosen. Unsere Ergebnisse decken sich mit denen anderer Studien. Der Einsatz der CTA bei Verdacht auf eine Nierenarterienstenose kann die Zahl unnötiger Angiographien deutlich reduzieren. Zur Befunderhebung sollten die AS und die MIP regelmäßig genutzt werden. / PURPOSE: To evaluate the accuracy of Computed Tomographic Angiography (CTA) in the detection of renal artery stenosis in our department and to investigate the role of the different reformattings in making the right diagnosis. MATERIALS AND METHODS: CTA and conventional Arteriography were performed on 23 Patients and axial slices (AS), curved axial multiplanar reformatting (cMPRa), curved coronal multiplanar reformatting (cMPRc), shaded surface display (SSD) and maximum intensity projections (MIP) were performed. During the first reading- session all blinded images were reviewed seperately, while all reformattings of one patient were analysed in the second reading session by one experienced radiologist, using a five- point- scale to determine the grade of the stenosis. RESULTS: Stenoses greater than 50% could be depicted by CTA with a sensitivity of 92,9 % and a specifity of 86,7 %. Applying a 5 five- point- scale, 65,9% of the diagnoses met the ones made by angiography (kappa= 0,468). MIP and AS were the most usefull reformattings with sensitivity, specifity and kappa reaching 71,4 %, 96,7 %, 0,726 and 78,6 %, 90 %, 0,692respectively. A tendency for underestimating the degree of the stenoses was notable. CONCLUSIONS: CTA has a high accuracy in diagnosing renal artery stenoses. Our results do not differ much from other studies on this technique. Applying CTA in suspected renal artery stenosis can reduce the amount of unnessecary arteriographies. For best results, MIP and AS should always be reviewed.

Die Thrombozytenaktivierung ist von zentraler Bedeutung für die Pathogenese der Arteriosklerose und wird bei Patienten mit instabiler Angina pectoris, Myokardinfarkt und TIA sowie nach koronarangioplastischen und operativen Eingriffen als Verursacher okklusiver vaskulärer Ereignisse in Betracht gezogen. Wir gingen der Frage nach, ob ein Zusammenhang zwischen peripherer arterieller Verschlußkrankheit (PAVK) und der Aktivierung zirkulierender Thrombozyten besteht und ob die intraarterielle digitale Subtraktionsangiographie (DSA) sowie die perkutane transluminale Angioplastie (PTA) im Bereich der unteren Extremitäten die Aktivierung zirkulierender Plättchen beeinflussen. Unsere Studie schloß 16 Kontrollprobanden mit PAVK, 25 gesunde Kontrollprobanden und 36 Patienten ein, von denen 14 einer DSA, 12 einer PTA und 10 beiden Eingriffen unterzogen wurden. Wir entnahmen Blutproben aus einer peripheren Vene oder aus Einführungsbestecken in der Arteria und Vena femoralis vor, direkt nach und 4 h nach den Interventionen. Die Plättchenaktivierung wurde anhand durchflußzytometrischer Messungen der Expression aktivierungsspezifischer Antigene (CD62 und CD63) bestimmt, die Sensibilität der Thrombozyten analysierten wir mittels einer zusätzlichen in-vitro-Aktivierung. Wir beobachteten 4 h nach der DSA einen Abfall der Aktivierung und eine erhöhte Sensibilität von Plättchen im arteriellen und venösen Strombereich (p < 0,02). Wir sehen diese Wirkungen als Kontrastmittel(KM)-induziert an und führen die Abnahme der Relativzahl aktivierter Thrombozyten hauptsächlich auf ihre verkürzte Lebensdauer zurück. 4 h nach der PTA kam es arteriell und venös zu einem Abfall der Relativzahl aktivierter Thrombozyten (p < 0,02). Weiterhin beobachteten wir unmittelbar nach der PTA eine Verringerung des prozentualen Anteils aktivierter Plättchen in der arteriellen Zirkulation (p = 0,021) in Korrelation mit zunehmenden Dilatationszeiten und Ballonlängen (p < 0,03). Diese Beobachtungen führen wir auf eine geringe Anlagerung bzw. reduzierte Lebensdauer aktivierter Thrombozyten zurück. Von geringer quantitativer Bedeutung waren Einflüsse des Heparins und KM. Die Wirkung der DSA und PTA auf die Thrombozytenfunktionen schien sich in den 4 postinterventionellen Stunden abzuschwächen. Unsere Ergebnisse zeigen, daß die Angioplastie in peripheren Gefäßen eine Aktivierung und vermutlich geringe Anlagerung bzw. verkürzte Lebensdauer zirkulierender Plättchen unmittelbar nach der PTA und 4 Stunden später verursacht. Diese Prozesse führen wir in erster Linie auf Endothelläsionen als Folge der Dilatation zurück. Die DSA führt 4 h nach dem Eingriff zu einer Aktivierung, Sensibilisierung und in wahrscheinlich sehr geringem Umfang zu einer Anlagerung bzw. verringerten Lebensdauer der Plättchen. PAVK-Patienten im Stadium II nach Fontaine mit kardiovaskulären Risikofaktoren wiesen im Vergleich zu gesunden Probanden eine höhere Relativzahl aktivierter und sensibilisierter Plättchen auf (p = 0,0001). Deshalb vermuten wir, daß präinterventionell aktivierte Plättchen besonders in die Prozesse Aktivierung, Sensibilisierung und Anlagerung involviert bzw. von einer verkürzten Lebensdauer betroffen sind. / Platelet activation plays a crucial role in the pathogenesis of artherosclerosis. Circulating activated platelets are thought to trigger thrombotic events in patients with instable angina pectoris, myocardial infarction and transient ischaemic attacks as well as after coronary angioplasty and surgery. We studied the effect of peripheral arterial disease (PAD) on activation of circulating thrombocytes and evaluated the influence on platelet activation of intraarterial digital subtraction angiography (DSA) and percutaneous transluminal angioplasty (PTA) in the area of the lower extremities. Our study included sixteen control subjects with PAD, twenty-five healthy control subjects and thirty-six patients, fourteen of whom were undergoing DSA, twelve were undergoing PTA and ten we examined during both interventions. Blood samples were obtained from a peripheral vein or from the arterial and venous catheter introducer before and directly and four ours after the procedures. To characterize platelet activation, the expression of activation-dependent platelet antigens (CD62 and CD63) was measured using flow cytometry. Platelet sensibility was analysed by an additional in-vitro-activation. Four hours after DSA, we observed a decrease in activation and an increase in sensibility of thrombocytes in both arterial and venous circulation (p < 0.02), most likely due the contrast medium (CM). We assume, that the relative decrease of platelet activation is caused by a reduced life-time. The relative number of activated thrombocytes decreased in both arterial and venous circulation (p < 0.02) four hours after PTA. Furthermore, we observed reduced amounts of activated platelets in the arterial circulation (p = 0.021) immediately after PTA, in correlation with increased times of dilatation and larger ballon-catheters (p < 0.03). This could be explained by slight migration or shortened life-time of activated thrombocytes. The amount of CM and heparin did not have a pronounced effect. The influence of both interventions on the platelet features and functions seemed to attenuate in the four postinterventional hours. Our results show that angioplasty in peripheral vessels causes activation and presumably slight migration or reduced life-time of circulating thrombocytes immediately and four hours after PTA. We postulate that this is mainly induced by dilatation. DSA was also found to be associated with platelet activation, sensibilisation and presumptive minor migration or shortened life-time of circulating platelets. More activated and sensitized thrombocytes circulated in patients with PAD (clinical stage II according to Fontaine) with cardiovascular risk-factors compared to healthy control subjects (p = 0.001). This supports our assumption that preactivated platelets are particularly involved in activation, sensitizing and migration processes or affected by a reduced life-time.

Die Magnetresonanztomographie (MRT), die Mehrschicht-Spiral-Computertomographie (MSCT) und die Elektronenstrahl-Computertomographie (EBCT) sind nichtinvasive diagnostische Verfahren, welche die bisherige kardiale Bildgebung zumindest in Teilbereichen ersetzen oder ergänzen können. MR-Perfusions- und MR-Funktionsuntersuchungen konnten in der vorgelegten Arbeit direkte Parameter der myokardialen Vitalität regional erfassen. Die Signalintensitäten im Blut und im Herzmuskel dienten zur quantitativen Bestimmung der Myokardperfusion. Die Ortsauflösung ermöglichte eine Differenzierung der subendo- und der subepikardialen Durchblutung. Zusätzliche Streßuntersuchungen steigerten die Sensitivität des Verfahrens. Relativ geringgradige Koronarstenosen ließen sich durch vornehmlich subendokardial lokalisierte Perfusionsdefekte nachweisen. MR-Tagging- Funktionsanalysen konnten durch ein artifizielles Markierungsgitter zwischen endokardial lokalisiertem Narbengewebe und epikardial liegendem vitalem Gewebe differenzieren. Die Dehnungen, Stauchungen und Rotationen des Myokardverbandes wurden registriert und ausgewertet. Die MSCT und die EBCT wurden als Röntgenverfahren für die nichtinvasive Koronarangiographie verglichen. Bei der Definition der Gefäßkonturschärfe über die Anstiegssteilheit der CT-Dichtewerte zeigte sich eine bessere Abbildungsqualität der MSCT gegenüber der EBCT. Die Bestimmung der Segmenterkennbarkeit zeigte, dass mit der MSCT signifikant mehr erkannt werden konnten. Die vorgestellten kardialen MR- und CT-Untersuchungen konnten aus Gründen der Reproduzierbarkeit sowie aufgrund des Strahlenschutzes nur tierexperimentell durchgeführt werden. Die Validität der unterschiedlichen Tiermodelle ist in vorausgegangenen Studien belegt worden. Die in der Literatur verfügbaren Ergebnisse am Menschen bestätigen in vieler Weise die vorgelegten Daten. / Magnetic resonance imaging (MRI), multislice spiral computed tomography (MSCT), and electron-beam computed tomography (EBCT) are noninvasive imaging modalities that may supplement or in part even replace established diagnostic procedures for assessment of the heart. MRI perfusion and functional studies were shown to enable determination of direct parameters of regional myocardial vitality. The signal intensities of blood and myocardium served to quantify myocardial perfusion. The spatial resolution allowed for differentiating subendocardial and subepicardial perfusion. Additional stress tests improved the sensitivity of the procedure. Relatively low-grade coronary artery stenoses were identified by the presence of perfusion gaps primarily in subendocardial location. Functional analysis by means of MRI tagging using an artificial grid allowed for differentiating endocardial scar tissue from epicardial vital tissue. Extension, compression, and rotation of the myocardial complex were recorded and analyzed. MSCT and EBCT were compared as radiographic procedures for noninvasive coronary angiography. MSCT was found to be superior to EBCT in terms of image quality defined as vascular contour sharpness determined as the steepness of the increase in CT densities. Assessment of segment identification showed that significantly more segments were visualized by MSCT. The cardiac MRI and CT studies presented here could only be performed in animals because of the radiation exposure involved and to ensure reproducibility of the results. The validity of the different animal models used has been demonstrated in preceding studies. The results of the present animal experiments are in agreement with many of the human data published in the literature.

Objetivos: O objetivo deste estudo é analisar a perviedade da artéria torácica interna direita (ATID) pediculada, anteroaórtica em anastomose para a região anterior do coração na cirurgia de revascularização do miocárdio (RM), em relação à artéria torácica interna esquerda (ATIE). Métodos: No período de dezembro de 2008 a dezembro de 2011, 100 pacientes foram selecionados para serem submetidos a cirurgia de RM sem circulação extracorpórea (CEC), de forma prospectiva. Eles foram agrupados em Grupo 1 (G-1) e Grupo 2 (G-2), cada um com 50 pacientes, com randomização por computador e conhecimento da técnica no início da cirurgia. No G-1, os pacientes receberam ATIE para a região anterior do coração e complementação da RM com a ATID livre para ramos da circunflexa (CX) e outros enxertos arteriais ou venosos para a coronária direita (CD) e/ou ramos. Os pacientes do G-2 receberam ATID pediculada para a região anterior do coração e complementação da RM com ATIE, pediculada, para ramos da CX e outros enxertos arteriais ou venosos para a CD e/ou ramos. A perviedade das artérias torácicas internas direita e esquerda foi avaliada através de angiotomografia coronária multislice, 64 canais, no 6º mês de pós-operatório. Resultados: Os dois grupos eram semelhantes quanto aos dados clínicos de pré-operatório, como exemplo: diabetes mellitus, hipertensão arterial sistêmica, obesidade. Os dois grupos apresentaram predominância do sexo masculino com 75,6% e 88% nos grupos 1 e 2, respectivamente. Cinco pacientes migraram do G-1 para o G-2 em virtude de doença ateromatosa na aorta ascendente e um deles foi excluído por ter que utilizar enxerto composto. A média de anastomoses distais no G-1 foi de 3,48 (DP=0,72), e no G-2 foi de 3,20 (DP=0,76). Não ocorreu mediastinite em nenhum paciente. Uma paciente do G-1 apresentou osteomielite, e necessitou de intervenção cirúrgica. Dois pacientes do G-1 foram submetidos a reoperação por sangramento. Os resultados das angiotomografias coronarianas com 96 pacientes re-estudados mostram que todas as ATIs, fosse a direita ou a esquerda, utilizadas pediculadas para a região anterior do coração encontravam-se sem oclusões ou estenoses, configurando 100% de perviedade. No G-1, um enxerto livre da ATID para ramos da CX apresentava oclusão total, em dois pacientes havia estenose leve, em um deles havia estenose moderada na anastomose proximal na aorta ascendente e outro apresentava diminuição de calibre na sua porção distal. Em três pacientes o enxerto de segmento de veia safena para ramos da CD se encontravam ocluídos. No G-2, dois pacientes apresentavam oclusão total na ATIE pediculada para ramos da CX, e outro apresentava estenose moderada na porção distal da ATIE utilizada sequencial para dois ramos marginais. Em dois pacientes o enxerto de segmento de veia safena para ramos da CD se encontravam ocluídos. Não houve óbitos em nenhum dos grupos. Conclusão: A cirurgia de RM com utilização da ATID pediculada, anterógrada para o RIA, apresenta resultado semelhante ao da ATIE utilizada para essa mesma coronária. / Objective: To analyze the patency of the pedicled, anteroaortic, right internal mammary artery (RIMA) anastomosed to the left anterior descending (LAD) and branches in coronary artery bypass graft surgery (CABG), in comparison with the left internal mammary artery (LIMA). Methods: From December 2008 to December 2011, 100 patients were selected to undergo a prospective off-pump coronary artery bypass graft surgery and were randomly divided by computer into Group 1 (G-1) and Group 2 (G-2), so that the technique was known at the beginning of the surgery. In each group, with 50 patients, the patency of both right and left internal mammary arteries, which were used pedicled to the LAD, was comparatively studied through coronary computed tomography angiography. G-1 had 50 patients who received the LIMA to the LAD or LAD/diagonal (sequential) and had the CABG complemented with the free RIMA to circumflex branches and other arterial or venous grafts to the right coronary artery (RCA) and/or branches. G-2 had 50 patients who received the pedicled RIMA to the LAD or LAD/diagonal (sequential) and had the CABG complemented with the pedicled LIMA to circumflex branches and other arterial or venous grafts to the RCA and/or branches. Results: Both groups were similar in pre-operative clinical data, such as: diabetes mellitus, systemic arterial hypertension, obesity. Also, there was predominance of males in both groups, with 75,6% and 88% in Groups 1 and 2 respectively. Five patients were switched from G-1 to G-2 owing to atheromatous disease in the ascending aorta, and one of them was dropped for having to use composite graft. The average of distal anastomosis in G-1 was 3,48 (standard deviation (SD=0,72) and in G-2 was 3,20 (SD=0,76). Mediastinitis didn\'t occur in any patient. A patient from G-1 had osteomyelitis that required surgical intervention. Two patients from G-1 underwent reoperation because of bleeding. The 64-slice coronary computed tomography angiography was performed in the 6th postoperative month; 96 patients have been re-studied so far and all pedicled IMAs to the LAD were patent. In G-1 a free RIMA graft to the circumflex branches presented total occlusion, another two had a discreet stenosis and in one moderate at the proximal anastomosis and one more had a string signal at the distal portion. In G-2 two patients had total occlusion of the pedicled LIMA to circumflex artery branches, and another one presented moderate stenosis at its distal portion. In two patients the saphenous vein graft to the RCA branches were occluded. There were no deaths in any of the groups. Conclusion: The CABG surgery using the pedicled, anteroaortic RIMA to the LAD has a similar outcome to that of the LIMA used for this same coronary.

Este estudo teve, por finalidade, estabelecer o valor da ressonância magnética em 30 doadores potenciais do lobo direito do fígado, na determinação dos seguintes fatores: esteatose hepática; anatomia biliar; anatomias arterial hepática, venosas portal e hepática, e volume hepático lobar, comparando-os, respectivamente, com os achados anatomopatológicos da biópsia hepática, da colangiografia intraoperatória, da angiografia digital e/ou com os achados cirúrgicos, e com o peso real do enxerto. A RM subestimou a infiltração gordurosa hepática; permitiu identificar a anatomia biliar, com concordância em 83% dos casos; apresentou 100% de concordância na avaliação das anatomias arterial e venosas portal e hepática, e superestimou, em pequeno grau, o volume hepático lobar / The purpose of this study was to establish the value of the magnetic resonance in 30 potential donors for right lobe living liver transplantation. The main goal was to determine the following factors: steatosis; biliar anatomy; hepatic arterial anatomy; portal and hepatic venous anatomy, and lobar liver volume, comparing them to liver biopsy results, to intraoperative colangiography, to digital angiography and/or surgical findings, and to the real graft weight, respectively. The MR has underestimated liver steatosis; it has identified biliar anatomy with 83% of agreement; it has had 100% of agreement in the evaluation of arterial and portal and hepatic venous anatomy, and it has overestimated with small degree the lobar liver volume

O uso do agente embolizante Onyx na oclusão de vazamentos pós-tratamento endovascular de aneurisma da aorta abdominal. São Paulo, 2003. 125p. Tese (Doutorado) – Faculdade de Medicina da Universidade de São Paulo. Departamento de Radiologia. Objetivos: Criar um modelo experimental para estudar os vazamentos de aneurisma da aorta abdominal (AAA) pós-tratamento endovascular, verificar a eficácia do agente embolizante Onyx na oclusão de vazamentos no modelo experimental, avaliar a oclusão do vazamento com Onyx após 5 semanas (fase tardia) e analisar a resposta tecidual e reação inflamatória local ao Onyx no modelo experimental. Materiais e métodos: Doze cães machos, provenientes do biotério da Cleveland Clinic Foundation, foram utilizados para criação de AAA, utilizando-se o stent Palmaz P4014. Endopróteses medindo 10 mm de diâmetro por 5 cm de comprimento e com orifício parietal de 4 mm no seu terço médio foram colocadas no interior da aorta abdominal (AA) com o intuito de criar um vazamento de endoprótese de aorta. Após uma semana foram realizadas tomografias e angiografias para constatação da presença de vazamento. Em seguida, os orifícios das endopróteses foram cateterizados e posteriormente Onyx foi injetado no interior do aneurisma e das artérias lombares. Após quatro semanas, todos os animais que sobreviveram ao procedimento foram submetidos a nova tomografia e angiografia para constatação da presença ou ausência de vazamento. Logo após, os cães foram sacrificados e tiveram suas aortas ressecadas e submetidas à análise histológica. Resultados: Três cães morreram por ruptura aórtica na criação do AAA Obteve-se sucesso na oclusão dos vazamentos em 9/12 cães. A oclusão foi confirmada através de angiografia realizada logo após a injeção de Onyx e pela tomografia a que os animais foram submetidos após uma semana da oclusão. A análise histológica revelou a presença de Onyx misturado com trombos em diferentes estágios de organização preenchendo o aneurisma e artérias lombares. Conclusão: Obteve-se sucesso na criação do modelo experimental em nove dos doze cães. A oclusão do vazamento com Onyx&#63194; foi efetiva e permaneceu durável durante o período de estudo. A análise histológica da AA demonstrou uma discreta reação inflamatória local à presença do Onyx. / Twelve mongrel dogs were used in this study to create abdominal aortic aneurysm (AAA) with endoleak after endovascular treatment. The next step was seal this endoleak with an embolic material called Onyx(R) The presence or occlusion of the endoleaks was proved by computer tomography and angiography. Succeed in the creation of the experimental model was observed in 9/12 dogs. OnyxÒ was capable to seal endoleaks in all nine dogs that survived from AAA creation. The occlusion was stable until the end of the study and the histological analysis showed minimal inflammatory response to Onyx(R).

Objetivos: O objetivo desse estudo foi comparar a perviedade da artéria torácica interna esquerda (ATIE) dissecada por videotoracoscopia robótica para revascularização minimamente invasiva do ramo interventricular anterior (RIA) com a revascularização do miocárdio convencional. Métodos: De 2007 a 2010, 36 pacientes foram randomizados para revascularização do miocárdio minimamente invasiva (RMMI) ou revascularização do miocárdio convencional (RMC). Pacientes randomizados para o grupo RMMI foram submetidos à dissecção da ATIE por videotoracoscopia auxiliada pelo braço robótico AESOP seguida de uma minitoracotomia anterior esquerda no 4º espaço intercostal para anastomose com o RIA. Pacientes randomizados para o grupo RMC foram submetidos a revascularização do miocárdio convencional com esternotomia mediana completa, dissecção aberta da ATIE e anastomose ao RIA. Fluxometria por tempo de trânsito (FTT) foi utilizada para avaliação da perviedade da ATIE imediata. Após 24 meses uma tomografia multislice foi utilizada para avaliar a perviedade a médio prazo da ATIE. Resultados: O tempo médio de dissecção da ATIE no grupo RMMI foi de 50,1 ± 11,2 vs. 22,7 ± 3,3 min no grupo RMC. Não houve diferença significativa no fluxo médio da ATIE para o RIA entre os grupos estudados (46,17 ± 20,11 vs. 48,61 ± 23,42 mL/min, p=0,86) respectivamente. Não houve diferença significante na incidência de infecção de ferida profunda (0 vs. 2, p=0,48) e necessidade de reoperação por sangramento (0 vs. 1, p=1,00) nos grupos RMMI e RMC respectivamente. A angiotomografia mostrou perviedade da ATIE em 100% dos pacientes do grupo RMMI vs. 94,1% no grupo RMC (p=1,00). Não houve mortalidade nos grupos estudados. Conclusão: A revascularização do miocárdio minimamente invasiva do ramo interventricular anterior com dissecção da artéria torácica interna esquerda por videotoracoscopia robótica foi segura e factível. A perviedade da artéria torácica interna esquerda imediata e a médio prazo foi similar entre ambas as técnicas / Objective: The aim of this study was to compare the patency of left internal mammary artery (LIMA) robotically harvested for left anterior descendent (LAD) artery minimally invasive bypass with conventional LIMA to LAD off-pump bypass. Method: From 2007 to 2010, 36 patients were randomized to either LIMA robotically harvested to LAD artery minimally invasive bypass or standard LIMA to LAD off-pump bypass. Patients assigned to robotic group underwent robotic endoscopic harvesting of LIMA with the AESOP system followed by a small left thoracotomy in the 4th intercostal space for off-pump LAD bypass. Patients assigned to standard group underwent full median sternotomy, open LIMA harvesting followed by off-pump LAD bypass. Transit time flow measurement was used for intraoperative evaluation of LIMA to LAD patency. After a mean 24-month follow-up, Multislice Computed Tomography was used to evaluate LIMA to LAD midterm patency. Results: The mean LIMA harvesting time in robotic group was 50.1 ± 11.2 min vs. 22.7 ± 3.3 min in conventional group. There was no significant difference in intraoperative LIMA to LAD flow between robotic and conventional groups (46.17 ± 20.11 mL/min vs. 48.61 ± 23.42 mL/min, p=0.86). There were no significant differences in incidence of wound infection (0 vs. 2, p=0,48) and reoperation for bleeding (0 vs. 1, p=1.00) between robotic and conventional groups respectively. In robotic group, Multislice CT revealed patent LIMA graft in 100% patients vs. 94.1% patients in conventional group (p=1.00). There was no mortality in the study group. Conclusions: Minimally invasive LAD bypass using LIMA graft robotically harvested was safe and feasible. Early and mid-term LIMA patency was similar between both techniques

Introdução: No momento, pouco se conhece sobre o desempenho diagnóstico da angiotomografia de coronárias com 64 colunas de detectores (Angio-TC 64) frente aos achados do ultrassom intracoronário com técnica de histologia virtual (USIC-HV). Este estudo compara a capacidade diagnóstica de ambos os métodos para a avaliação das dimensões vasculares e para avaliação da composição da placa aterosclerótica através da análise de toda extensão dos três vasos epicárdicos principais. Métodos e Resultados: Um total de 21 pacientes com diagnóstico de doença arterial coronária obstrutiva foi incluído neste estudo. Angio-TC 64 foi realizada em todos os pacientes antes da realização do USIC-HV, com intervalo<72horas entre os dois exames. No total, 70 vasos foram avaliados (3,3 vasos por paciente) e divididos em 641 subsegmentos de 4 mm de extensão cada. Um total de 5.972 cortes seccionais de USIC-HV e 5.233 cortes seccionais da Angio-TC 64 foram analisados. As medidas de área luminar, área do vaso, área da parede arterial e carga de placa à Angio-TC 64 e ao USIC-HV foram significativamente correlacionadas (r-Spearman: 0,81; 0,78; 0,55 e 0,49; respectivamente - p<0,001 para todas as correlações). A Angio-TC 64 subestimou a área luminar ao USIC-HV (em mediana: 0,4mm2 ,variando entre -5,6 mm2 e 10,2 mm2). A Angio-TC 64 superestimou a área do vaso, a área da parede arterial (placa+média) e a carga de placa (em mediana: 3,0 mm2; 3,2 mm2 e 13,9%, respectivamente). O aumento da densidade média da placa à Angio-TC 64 foi significativamente associado com o aumento da contribuição percentual dos componentes cálcio denso e núcleo necrótico ao USIC-HV. O aumento da densidade média da placa à Angio-TC 64 foi significativamente associado com a diminuição da contribuição percentual do componente fibro-lipídico ao USIC-HV. Parâmetros de qualidade da imagem (atenuação luminar, ruído da atenuação luminar e relação sinal ruído) influenciaram significativamente os resultados da Angio-TC 64. Conclusão: Nosso estudo demonstra que as imagens da Angio-TC 64 se correlacionam significativamente com as imagens do USIC-HV. Estes achados indicam que a Angio-TC 64 pode ser uma ferramenta útil para a avaliação quantitativa da luz arterial e da placa aterosclerótica; bem como para a avaliação da composição da placa aterosclerótica in vivo / Background: Currently, little is known about the comparative diagnostic performance for coronary assessment of 64-slice multidetector computed tomography (64-MDCT) versus virtual histology intravascular ultrasound technique (VH-IVUS). The present study compares the diagnostic ability of both methods for the evaluation of coronary lumen and vessel wall dimensions as well as plaque composition in a three-vessel whole-artery analysis protocol. Methods and Results: A total of 21 patients with diagnosed obstructive coronary artery disease was included. 64-MDCT was performed within 72 hours before the VH-IVUS examination. Overall, 70 vessels were imaged (3.3 vessels per patient), and divided into 641 subsegments of 4 mm each. A total of 5,972 VH-IVUS cross-sections and 5,233 64-MDCT cross-sections were analyzed. 64-MDCT and VH-IVUS measurements for luminar area, vessel area, arterial wall area (plaque plus media area) and plaque burden were significantly correlated (r-Spearman: 0.81; 0.78; 0.55 e 0.49; respectively - p<0,001 for all correlations). 64-MDCT underestimated VH-IVUS measurements for luminar area (median: 0.4mm2, range: -5.6 mm2 to 10,2 mm2). 64-MDCT overestimated VH-IVUS measurements for vessel area, arterial wall area, and plaque burden (median: 3.0 mm2; 3.2 mm2 e 13.9%, respectively). Increasing plaque density at 64-MDCT was significantly associated with increasing dense calcium and necrotic core percent composition at VH-IVUS. Increasing plaque density at 64-MDCT was significantly associated with decreasing fibrofatty percent composition, and decreasing necrosis-to-calcium ratio at VH-IVUS. Image quality parameters (i.e. lumen attenuation, image noise, signal-to-noise ratio) significantly influenced the results of 64-MDCT. Conclusion: Our study shows that 64-MDCT imaging significantly correlates with VH-IVUS. These findings indicate that 64-MDCT may be a useful non-invasive tool for quantitative evaluation of lumen and plaque parameters, as well as for the in vivo assessment of atherosclerotic plaque composition