Publications by authors named "Pannu H"

121 Publications

Long-term combination antiretroviral therapy is associated with the risk of coronary plaques in African Americans with HIV infection.

AIDS Patient Care STDS 2009 Oct;23(10):815-24

Department of Pathology, Johns Hopkins School of Medicine , Baltimore, MD 21287, USA.

The aim of the study was to assess whether long-term antiretroviral therapy (ART) is associated with the risk of coronary plaques in HIV-infected cardiovascularly asymptomatic African Americans. Between August 2003 and December 2007, 176 HIV-infected cardiovascularly asymptomatic African Americans were consecutively enrolled in an observational study investigating the effects of ART on subclinical atherosclerosis in Baltimore, Maryland. Computed tomography coronary angiography was performed to detect coronary plaques. The overall prevalence rate of coronary plaques was 30%. After adjusting for gender, total cholesterol, and cocaine use, logistic regression analysis revealed that exposure to ART for more than 18 months (adjusted odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.01, 4.79) was independently associated with the presence of coronary plaques. A higher HIV viral load was univariately associated with the presence of noncalcified plaques. Use of ART (>18 months) was independently associated with the presence of noncalcified plaques (adjusted OR: 7.61, 95% CI: 1.67, 34.7), whereas cocaine use (>15 years) was independently associated with the presence of calcified plaques (adjusted OR: 2.51, 95% CI: 1.11, 5.67). This study suggests that long-term exposure to ART may be associated with coronary plaques. Because long-term use of ART and HIV replication may be associated with the presence of noncalcified plaques, some of which may be more vulnerable to rupture, an intensive lifestyle intervention to reduce traditional risk factors for coronary artery disease (CAD) is ultimately vital to those who are on ART. This study also suggests that cocaine cessation is the single most effective strategy to prevent CAD in HIV-infected cocaine users.
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http://dx.doi.org/10.1089/apc.2009.0048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2761979PMC
October 2009

Analysis of multigenerational families with thoracic aortic aneurysms and dissections due to TGFBR1 or TGFBR2 mutations.

J Med Genet 2009 Sep 18;46(9):607-13. Epub 2009 Jun 18.

Department of Internal Medicine and Department of Neurosurgery, University of Texas Health Science Center at Houston, Texas, USA.

Background: Mutations in the transforming growth factor beta receptor type I and II genes (TGFBR1 and TGFBR2) cause Loeys-Dietz syndrome (LDS), characterised by thoracic aortic aneurysms and dissections (TAAD), aneurysms and dissections of other arteries, craniosynostosis, cleft palate/bifid uvula, hypertelorism, congenital heart defects, arterial tortuosity, and mental retardation. TGFBR2 mutations can also cause TAAD in the absence of features of LDS in large multigenerational families, yet only sporadic LDS cases or parent-child pairs with TGFBR1 mutations have been reported to date.

Methods: The authors identified TGFBR1 missense mutations in multigenerational families with TAAD by DNA sequencing. Clinical features of affected individuals were assessed and compared with clinical features of previously described TGFBR2 families.

Results: Statistical analyses of the clinical features of the TGFBR1 cohort (n = 30) were compared with clinical features of TGFBR2 cohort (n = 77). Significant differences were identified in clinical presentation and survival based on gender in TGFBR1 families but not in TGFBR2 families. In families with TGFBR1 mutations, men died younger than women based on Kaplan-Meier survival curves. In addition, men presented with TAAD and women often presented with dissections and aneurysms of arteries other than the ascending thoracic aorta. The data also suggest that individuals with TGFBR2 mutations are more likely to dissect at aortic diameters <5.0 cm than individuals with TGFBR1 mutations.

Conclusion: This study is the first to demonstrate clinical differences between patients with TGFBR1 and TGFBR2 mutations. These differences are important for the clinical management and outcome of vascular diseases in these patients.
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http://dx.doi.org/10.1136/jmg.2008.062844DOI Listing
September 2009

Mutations in smooth muscle alpha-actin (ACTA2) cause coronary artery disease, stroke, and Moyamoya disease, along with thoracic aortic disease.

Am J Hum Genet 2009 May 30;84(5):617-27. Epub 2009 Apr 30.

The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.

The vascular smooth muscle cell (SMC)-specific isoform of alpha-actin (ACTA2) is a major component of the contractile apparatus in SMCs located throughout the arterial system. Heterozygous ACTA2 mutations cause familial thoracic aortic aneurysms and dissections (TAAD), but only half of mutation carriers have aortic disease. Linkage analysis and association studies of individuals in 20 families with ACTA2 mutations indicate that mutation carriers can have a diversity of vascular diseases, including premature onset of coronary artery disease (CAD) and premature ischemic strokes (including Moyamoya disease [MMD]), as well as previously defined TAAD. Sequencing of DNA from patients with nonfamilial TAAD and from premature-onset CAD patients independently identified ACTA2 mutations in these patients and premature onset strokes in family members with ACTA2 mutations. Vascular pathology and analysis of explanted SMCs and myofibroblasts from patients harboring ACTA2 suggested that increased proliferation of SMCs contributed to occlusive diseases. These results indicate that heterozygous ACTA2 mutations predispose patients to a variety of diffuse and diverse vascular diseases, including TAAD, premature CAD, ischemic strokes, and MMD. These data demonstrate that diffuse vascular diseases resulting from either occluded or enlarged arteries can be caused by mutations in a single gene and have direct implications for clinical management and research on familial vascular diseases.
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http://dx.doi.org/10.1016/j.ajhg.2009.04.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680995PMC
May 2009

IV contrast infusion for coronary artery CT angiography: literature review and results of a nationwide survey.

AJR Am J Roentgenol 2009 May;192(5):W214-21

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA.

Objective: The purpose of our study was to review investigations that evaluated contrast infusion using MDCT with submillimeter detector configuration for coronary artery CT angiography (CTA). Published data are supplemented with 2006 survey results from centers practicing 64-MDCT coronary artery angiography.

Conclusion: Literature and survey results suggest a consensus for the use of IV contrast volumes < 100 mL, infusion rate of 5 mL/s, and a saline chaser. A range of concentrations can be used to attain target coronary artery attenuation levels.
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http://dx.doi.org/10.2214/AJR.08.1347DOI Listing
May 2009

Sequencing of TGF-beta pathway genes in familial cases of intracranial aneurysm.

Stroke 2009 May 19;40(5):1604-11. Epub 2009 Mar 19.

Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA.

Background And Purpose: Familial aggregation of intracranial aneurysms (IA) strongly suggests a genetic contribution to pathogenesis. However, genetic risk factors have yet to be defined. For families affected by aortic aneurysms, specific gene variants have been identified, many affecting the receptors to transforming growth factor-beta (TGF-beta). In recent work, we found that aortic and intracranial aneurysms may share a common genetic basis in some families. We hypothesized, therefore, that mutations in TGF-beta receptors might also play a role in IA pathogenesis.

Methods: To identify genetic variants in TGF-beta and its receptors, TGFB1, TGFBR1, TGFBR2, ACVR1, TGFBR3, and ENG were directly sequenced in 44 unrelated patients with familial IA. Novel variants were confirmed by restriction digestion analyses, and allele frequencies were analyzed in cases versus individuals without known intracranial disease. Similarly, allele frequencies of a subset of known SNPs in each gene were also analyzed for association with IA.

Results: No mutations were found in TGFB1, TGFBR1, TGFBR2, or ACVR1. Novel variants identified in ENG (p.A60E) and TGFBR3 (p.W112R) were not detected in at least 892 reference chromosomes. ENG p.A60E showed significant association with familial IA in case-control studies (P=0.0080). No association with IA could be found for any of the known polymorphisms tested.

Conclusions: Mutations in TGF-beta receptor genes are not a major cause of IA. However, we identified rare variants in ENG and TGFBR3 that may be important for IA pathogenesis in a subset of families.
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http://dx.doi.org/10.1161/STROKEAHA.108.540245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678560PMC
May 2009

A novel proximity assay for the detection of proteins and protein complexes: quantitation of HER1 and HER2 total protein expression and homodimerization in formalin-fixed, paraffin-embedded cell lines and breast cancer tissue.

Diagn Mol Pathol 2009 Mar;18(1):11-21

Departments of Research and Development, Clinical Research, and Operations, Monogram Biosciences Inc., 345 Oyster Point Boulevard, South San Francisco, CA 94080, USA.

The availability of drugs targeting the EGFR/HER/erbB signaling pathway has created a need for diagnostics that accurately predict treatment responses. We have developed and characterized a novel assay to provide sensitive and quantitative measures of HER proteins and homodimers in formalin-fixed, paraffin-embedded (FFPE) cell lines and breast tumor tissues, to test these variables. In the VeraTag assay, HER proteins and homodimers are detected through the release of fluorescent tags conjugated to specific HER antibodies, requiring proximity to a second HER antibody. HER2 protein quantification was normalized to tumor area, and compared to receptor numbers in 12 human tumor cell lines determined by fluorescence-activated cell sorting (FACS), and with HER immunohistochemistry (IHC) test categories and histoscores in cell lines and 170 breast tumors. HER1 and HER2 expression levels determined by the VeraTag assay are proportional to receptor number over more than a 2 log10 range, and HER homodimer levels are consistent with crosslinking and immunoprecipitation results. VeraTag HER2 measurements of breast tumor tissue and cell lines correlate with standard IHC test categories (P<0.001). VeraTag HER2 levels also agree with IHC histoscores at lower HER2 protein levels, but are continuous and overlapping between IHC test categories, extending the dynamic range 5-fold to 10-fold at higher HER2 levels. The VeraTag assay specifically and reproducibly measures HER1 and HER2 protein and homodimers in FFPE tissues. The continuous measure of HER2 protein levels over a broad dynamic range, and the novel HER2 homodimer measure, are presently being assessed as predictive markers for responses to targeted HER2 therapy.
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http://dx.doi.org/10.1097/PDM.0b013e31818cbdb2DOI Listing
March 2009

Comparison of supine magnetic resonance imaging with and without rectal contrast to fluoroscopic cystocolpoproctography for the diagnosis of pelvic organ prolapse.

J Comput Assist Tomogr 2009 Jan-Feb;33(1):125-30

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.

Purpose: To compare supine magnetic resonance imaging (MRI), with and without rectal contrast, with fluoroscopic cystocolpoproctography (CCP) for the diagnosis of pelvic organ prolapse.

Materials And Methods: Supine MRI and CCP studies were reviewed in 82 patients. All patients were women with an average age of 58.8 years, and the studies were done a mean of 25 days apart. Magnetic resonance imaging was performed with rectal contrast (n = 35) and without rectal contrast (n = 47). Fluoroscopic cystocolpoproctography was performed with rectal (n = 82), vaginal (n = 82), small bowel (n = 81), and bladder (n = 78) contrast, and images were corrected for magnification. Each study was independently reviewed by 2 readers, and outcome variables were presence/absence of cystocele, vaginal prolapse, enterocele, sigmoidocele, and anterior rectocele. Sigmoidoceles were included with enteroceles for data analysis.

Results: For the entire patient group, the prevalence of cystoceles was 89% on CCP and 80% on MRI; vaginal prolapse was 81% on CCP and 56% on MRI; enteroceles, 38% on CCP and 24% on MRI; and anterior rectoceles, 45% on CCP and 37% on MRI. There were significantly more cystoceles (odds ratio [OR] 4.7, P = 0.003), vaginal prolapses (OR 5.2, P < 0.0005), and enteroceles (OR 3.8, P< 0.0005) on CCP than on MRI. For MRI with rectal contrast versus CCP, the prevalence of cystoceles was 94% on CCP and 91% on MRI; vaginal prolapse, 74% on CCP and 70% on MRI; enteroceles, 36% on CCP and 19% on MRI; and anterior rectoceles, 51% on CCP and 59% on MRI. There was statistical significance only for enteroceles, more of which were found on CCP (OR 7.4, P = 0.003). For MRI without rectal contrast versus CCP, the prevalence of cystoceles was 85% on CCP and 72% on MRI; vaginal prolapse, 86% on CCP and 46% on MRI; enteroceles, 40% on CCP and 28% on MRI; and anterior rectoceles, 39% on CCP and 21% on MRI. There were significantly more cystoceles (OR 6.6, P = 0.003), vaginal prolapses (OR 20.8, P < 0.0005), enteroceles (OR 2.9, P = 0.015), and rectoceles (OR 4.9, P = 0.001) on CCP than on noncontrast MRI.

Conclusions: Magnetic resonance imaging without rectal contrast showed statistically fewer pelvic floor abnormalities than CCP. Except for enteroceles, MRI with rectal contrast showed statistically similar frequency of pelvic organ prolapse as CCP.
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http://dx.doi.org/10.1097/RCT.0b013e318161d739DOI Listing
March 2009

Serum IL-6 levels are associated with significant coronary stenosis in cardiovascularly asymptomatic inner-city black adults in the US.

Inflamm Res 2009 Jan;58(1):15-21

Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Objectives And Design: The objective of this study was to explore whether increased levels of inflammatory cytokines are associated with the risk of clinically silent coronary artery disease.

Subjects: Three-hundred-fifty-six black adults aged 25-54 residing in inner city of Baltimore, Maryland, United States were included in this study.

Methods: Sociodemographics were assessed as were lipid profiles, IL-6, tumor necrosis factor-alpha (TNF-alpha), soluble intercellular adhesion molecule-1 (sICAM-1), and high-sensitivity C-reactive protein (hs-CRP) levels. Computed tomography (CT) coronary angiography was performed.

Results: Coronary calcification was identified in 22.5 % participants and 14 % had significant (>or=50 %) coronary stenosis. Multiple logistic regression analyses suggested that IL-6 levels were independently associated with the presence of coronary calcification and significant coronary stenosis, while TNF-alpha, sICAM-1 and hs-CRP levels were not.

Conclusions: This study underscores a critical role for IL-6 in atherosclerosis and suggests that IL-6 may be a marker for significant coronary stenosis in cardiovascularly asymptomatic individuals.
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http://dx.doi.org/10.1007/s00011-008-8150-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737269PMC
January 2009

Use of seclusion in an English high security hospital.

Authors:
H Pannu S Milne

Med Sci Law 2008 Oct;48(4):288-94

Chichester House, Langdon Hospital, Exeter Road, Dawlish EX7 ONR.

There is a paucity of information about the use of seclusion in secure settings. The aim of this paper was to establish if any significant trends could be found for its use in a high secure setting. A retrospective descriptive survey of seclusions occurring over a one-year period at Rampton Hospital was utilised. Of the 443 patients within the study sample, 131 (29.6%) were involved in episodes of seclusion. Forty-five per cent of women experienced episodes of seclusion as opposed to 27% of men (p = 0.004). Women were secluded at an average of 11.4 times, mostly following threatening behaviour, whereas males were secluded at an average of 4.3 times (p = 0.03). There were two peak times for initiation of seclusion--10.00 hrs and 17.00 hrs. The survey concluded that women were nearly twice as likely to be secluded as men and averaged three times as many episodes of seclusion. Younger patients were more likely to experience seclusion and spent longer periods of time in seclusion. No statistically significant differences were found between the use of seclusion and ethnicity. The observations related to female patients were particularly interesting and further studies on seclusion are required to inform upon strategies to minimise its use, with specific attention to female patients.
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http://dx.doi.org/10.1258/rsmmsl.48.4.288DOI Listing
October 2008

Early invasive cervical cancer: MRI and CT predictors of lymphatic metastases in the ACRIN 6651/GOG 183 intergroup study.

Gynecol Oncol 2009 Jan 20;112(1):95-103. Epub 2008 Nov 20.

Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.

Purpose: To compare MRI, CT, clinical exam and histopathological analysis for predicting lymph node involvement in women with cervical carcinoma, verified by lymphadenectomy.

Methods: A 25-center ACRIN/GOG study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT prior to attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist, and retrospectively by 4 independent offsite radiologists, all blinded to surgical, histopathological and other imaging findings. Likelihood of parametrial and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in 3 axes. Association with histologic lymph node involvement, scored as absent, pelvic only and common iliac or paraaortic, was evaluated using Cochran-Mantel Haenszel statistics, univariate and multivariate logistic regression, generalized estimating equations, accuracy statistics and ROC analysis.

Results: Lymphatic metastases were found in 34% of women; 13% had common iliac nodal metastases, and 9% had paraortic nodal metastases. Based on the retrospective multi-observer re-reads, the average AUC for predicting histologic lymph node involvement based on tumor size was higher for MRI versus CT, although formal statistic comparisons could not be conducted. Multivariate analysis showed improved model fit incorporating predictors from MRI, but not from CT, over and above the initial clinical and biopsy predictors, although the increase in discriminatory ability was not statistically significant.

Conclusion: MRI findings may help predict the presence of histologic lymph node involvement in women with early invasive cervical carcinoma, thus providing important prognostic information.
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http://dx.doi.org/10.1016/j.ygyno.2008.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2606919PMC
January 2009

64 Slice multi-detector row cardiac CT.

Emerg Radiol 2009 Jan 22;16(1):1-10. Epub 2008 Oct 22.

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Cardiac imaging is feasible with multi-detector row (MDCT) scanners. Coronary arterial anatomy and both non-calcified and calcified plaques are depicted at CT coronary angiography. Vessel wall pathology and luminal diameter are depicted, and secondary myocardial changes may also be seen. Diagnostic capacity has increased with technological advancement, and preliminary investigations confirm the utility of 64-MDCT in low- and intermediate-risk patients who present to the emergency department with acute chest pain. The clinical indications, 64-MDCT technique, and MDCT findings in coronary artery disease are reviewed.
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http://dx.doi.org/10.1007/s10140-008-0760-zDOI Listing
January 2009

Genetic basis of thoracic aortic aneurysms and dissections: focus on smooth muscle cell contractile dysfunction.

Annu Rev Genomics Hum Genet 2008 ;9:283-302

Department of Internal Medicine, University of Texas, Houston, Texas 77030, USA.

Thoracic aortic aneurysms leading to type A dissections (TAAD) can be inherited in isolation or in association with genetic syndromes, such as Marfan syndrome and Loeys-Dietz syndrome. When TAAD occurs in the absence of syndromic features, it is inherited in an autosomal dominant manner with decreased penetrance and variable expression, the disease is referred to as familial TAAD. Familial TAAD exhibits significant clinical and genetic heterogeneity. The first genes identified to cause TAAD were FBN1, TGFBR2, and TGFBR1. The identification and characterization of these genes suggested that increased TGF-beta signaling plays a role in pathogenesis. The recent discovery that mutations in the vascular smooth muscle cell (SMC)-specific beta-myosin (MYH11) and alpha-actin (ACTA2) can also cause this disorder has focused attention on the importance of the maintenance of SMC contractile function in preserving aortic structure and preventing TAAD.
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http://dx.doi.org/10.1146/annurev.genom.8.080706.092303DOI Listing
December 2008

Native aortic valve endocarditis caused by Candida sake.

J Heart Valve Dis 2008 Mar;17(2):194-6

Escorts Heart and Superspeciality Institute, Majitha Verka Byepss Road, Amritsar, Punjab, India.

The case is presented of a native valve endocarditis caused by Candida sake in a 34-year-old farmer with no history of intravenous drug abuse or pre-existing valvular abnormality. The patient presented with septicemia and multiorgan dysfunction syndrome (MODS). Clinical and diagnostic work-up revealed findings of severe aortic regurgitation and large vegetations on the aortic valve. Preoperatively, the patient was treated for three weeks with amphotericin B; when the MODS had improved, open-heart surgery with valve replacement was performed. Intravenous amphotericin B was continued postoperatively for three more weeks; a subsequent decision was taken to administer lifelong suppressive antifungal therapy.
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March 2008

Acanthamoeba encephalitis.

Indian J Med Microbiol 2008 Apr-Jun;26(2):182-4

Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana-141 001, Punjab, India.

Central nervous system infection with free-living amoebae is rare. We present a fatal case of Acanthamoeba encephalitis in a 63-year-old female from India where acanthamoebae were demonstrated and cultured from CSF. In spite of treatment with amphotericin B, fluconazole and rifampicin the patient did not survive. Amoebic infection should be suspected in a patient of encephalitis of unexplained aetiology as timely diagnosis can lead to a favourable outcome.
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http://dx.doi.org/10.4103/0255-0857.40539DOI Listing
August 2008

Evaluation of the effectiveness of oral Beta-blockade in patients for coronary computed tomographic angiography.

J Comput Assist Tomogr 2008 Mar-Apr;32(2):247-51

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.

Objective: To determine the effectiveness of oral medications in lowering the resting heart rate (HR) for coronary computed tomographic angiography (CTA).

Background: The protocol of premedication for cardiac CTA is variable in terms of type, dose, route, and timing of administration.

Methods: Nursing records were retrospectively reviewed in 238 consecutive patients having coronary CTA and 217 patients evaluated for type and amount of oral medication administered. The HR on arrival to computed tomography (CT) and 30 and 60 minutes after medication was noted.

Results: One hundred twenty-three patients (56.6%) had a mean HR of 78.3 +/- 9.4 beats per minute (bpm) on arrival and were given medication. One hundred fourteen patients (92.6%) were given 50 mg of oral metoprolol, with the remaining receiving 25 to 100 mg and 1 patient receiving 30 mg of oral diltiazem. Sixty-eight patients (55.2%) were monitored for less than 1 hour and had a mean HR of 73.1 +/- 5.1 bpm on arrival, a 9.8 +/- 4.7-bpm decrease in HR at 30 minutes, and an HR of 56.5 +/- 7.2 bpm during CT. Thirty-nine patients (31.7%) had a mean HR of 81.3 +/- 7.2 bpm on arrival, a 9.8 +/- 7.4-bpm decrease in HR at 30 minutes, a 16.9 +/- 6.3-bpm decrease in HR at 60 minutes, and an HR of 59.8 +/- 4.8 bpm during CT. Sixteen patients were monitored for more than 1 hour, followed by intravenous metoprolol. These patients had a baseline HR of 93.5 +/- 8.9 bpm, a 13.1 +/- 6.4-bpm decrease in HR at 30 minutes, a 15.9 +/- 6.8-bpm decrease in HR at 60 minutes, and an HR of 68.1 +/- 7.9 bpm during CT. There were no complications due to metoprolol.

Conclusion: Oral metoprolol given 1 hour before cardiac CT effectively and safely lowers the resting HR in most patients.
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http://dx.doi.org/10.1097/RCT.0b013e318075e759DOI Listing
May 2008

64-MDCT angiography of the coronary arteries: nationwide survey of patient preparation practice.

AJR Am J Roentgenol 2008 Mar;190(3):743-7

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N Caroline St., Rm. 3251, Baltimore, MD 21287, USA.

Objective: The purpose of this study was to evaluate the current practice of patient preparation for 64-MDCT angiography (CTA) of the coronary arteries.

Materials And Methods: Sites in the United States that perform 64-MDCT coronary angiography were surveyed by mail in 2006. Information requested included physician specialty; experience level; details about patient preparation, including the use, dose, route, and timing of premedication; and acceptable heart rate and rhythm. A total of 142 surveys were analyzed, with comparison of parameters across specialties (radiology, cardiology, or shared) and experience levels.

Results: All facets of the study (premedication, data acquisition, cardiac interpretation) are performed exclusively by radiologists in 49% of sites and by cardiologists in 14%. All sites administer beta-blockers. Target heart rate was reported as < or = 65 beats per minute (bpm) by 89% of responders. Despite most centers aiming for a heart rate of < or = 65 bpm, the maximum allowable heart rate is > 65 bpm in 80% of centers. Patients with arrhythmia are scanned in at least 25% of sites. Most sites (84%) administer nitroglycerin. Significant differences between specialties were noted for experience levels, timing and route of beta-blocker administration, and for target heart rate. The likelihood of scanning in the setting of arrhythmia and beta-blocker timing correlated with experience levels.

Conclusion: These 64-MDCT coronary artery data from 2006 reveal consensus for a range of patient preparation parameters. Use of beta-blockers and nitroglycerin is routine, and the target heart rate is usually < or = 65 bpm. However, differences were noted for beta-blocker protocols and acceptable heart rate and rhythm, and some differences in practice are associated with experience level and specialty.
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http://dx.doi.org/10.2214/AJR.07.2620DOI Listing
March 2008

Long-term cocaine use and antiretroviral therapy are associated with silent coronary artery disease in African Americans with HIV infection who have no cardiovascular symptoms.

Clin Infect Dis 2008 Feb;46(4):600-10

Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

Background: Long-term use of cocaine (⩾15 years) and antiretroviral therapy (ART) have been implicated in cardiovascular complications. Nevertheless, the individual and combined effects of ART and cocaine use on silent coronary artery disease have not been fully investigated.Methods: Computed tomography coronary angiography was performed for 165 human immunodeficiency virus (HIV)– infected African American study participants aged 25–54 years in Baltimore, Maryland, with contrast-enhanced 64-slice multidetector computed tomography imaging.Result: Significant (⩾50%) coronary stenosis was detected in 24 (15%) of 165 participants. The prevalence of significant stenosis among those who had used cocaine for ⩾15 years and had received ART for ⩾6 months was 42%. Exact logistic regression analysis revealed that long-term cocaine use(adjusted odds ratio, 7.75; 95% confidence interval, 2.26–31.2) and exposure to ART for ⩾6 months(adjusted odds ratio, 4.35; 95% confidence interval, 1.30–16.4) were independently associated with the presence of significant coronary stenosis. In addition, after controlling for confounding factors,both stavudine use for ⩾6 months or combivir use for ⩾6 months were independently associated with the presence of significant coronary stenosis.Conclusions: Long-term exposure to ART may be associated with silent coronary artery disease;however, the magnitude of increased risk associated with ART was much lower than the risk associated with cocaine use or traditional risk factors. Cardiovascular monitoring and aggressive modification of cardiovascular risk factors are essential for reducing the risk of coronary artery disease in HIV-infected individuals. Extensive efforts should also be made to develop effective cocaine use cessation programs for HIV-infected cocaine users.
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http://dx.doi.org/10.1086/526782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716694PMC
February 2008

Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections.

Nat Genet 2007 Dec 11;39(12):1488-93. Epub 2007 Nov 11.

Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.

The major function of vascular smooth muscle cells (SMCs) is contraction to regulate blood pressure and flow. SMC contractile force requires cyclic interactions between SMC alpha-actin (encoded by ACTA2) and the beta-myosin heavy chain (encoded by MYH11). Here we show that missense mutations in ACTA2 are responsible for 14% of inherited ascending thoracic aortic aneurysms and dissections (TAAD). Structural analyses and immunofluorescence of actin filaments in SMCs derived from individuals heterozygous for ACTA2 mutations illustrate that these mutations interfere with actin filament assembly and are predicted to decrease SMC contraction. Aortic tissues from affected individuals showed aortic medial degeneration, focal areas of medial SMC hyperplasia and disarray, and stenotic arteries in the vasa vasorum due to medial SMC proliferation. These data, along with the previously reported MYH11 mutations causing familial TAAD, indicate the importance of SMC contraction in maintaining the structural integrity of the ascending aorta.
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http://dx.doi.org/10.1038/ng.2007.6DOI Listing
December 2007

Early invasive cervical cancer: CT and MR imaging in preoperative evaluation - ACRIN/GOG comparative study of diagnostic performance and interobserver variability.

Radiology 2007 Nov;245(2):491-8

Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.

Purpose: To retrospectively compare diagnostic performance and interobserver variability for computed tomography (CT) and magnetic resonance (MR) imaging in the pretreatment evaluation of early invasive cervical cancer, with surgical pathologic findings as the reference standard.

Materials And Methods: This HIPAA-compliant study had institutional review board approval and informed consent for evaluation of preoperative CT (n = 146) and/or MR imaging (n = 152) studies in 156 women (median age, 43 years; range, 22-81 years) from a previous prospective multicenter American College of Radiology Imaging Network and Gynecologic Oncology Group study of 172 women with biopsy-proved cervical cancer (clinical stage > or = IB). Four radiologists (experience, 7-15 years) interpreted the CT scans, and four radiologists (experience, 12-20 years) interpreted the MR studies retrospectively. Tumor visualization and detection of parametrial invasion were assessed with receiver operating characteristic curves (with P < or = .05 considered to indicate a significant difference). Descriptive statistics for staging and kappa statistics for reader agreement were calculated. Surgical pathologic findings were the reference standard.

Results: For CT and MR imaging, respectively, multirater kappa values were 0.26 and 0.44 for staging, 0.16 and 0.32 for tumor visualization, and -0.04 and 0.11 for detection of parametrial invasion; for advanced stage cancer (> or =IIB), sensitivities were 0.14-0.38 and 0.40-0.57, positive predictive values (PPVs) were 0.38-1.00 and 0.32-0.39, specificities were 0.84-1.00 and 0.77-0.80, and negative predictive values (NPVs) were 0.81-0.84 and 0.83-0.87. MR imaging was significantly better than CT for tumor visualization (P < .001) and detection of parametrial invasion (P = .047).

Conclusion: Reader agreement was higher for MR imaging than for CT but was low for both. MR imaging was significantly better than CT for tumor visualization and detection of parametrial invasion. The modalities were similar for staging, sharing low sensitivity and PPV but relatively high NPV and specificity.
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http://dx.doi.org/10.1148/radiol.2452061983DOI Listing
November 2007

Efficacy of cell saver in reducing homologous blood transfusions during OPCAB surgery: a prospective randomized trial.

Transfus Med 2007 Aug;17(4):285-9

Escorts Heart and Superspeciality Institute, Verka Majitha Byepass, Amritsar, Punjab, India.

Despite the refinements in surgical technique, rates of homologous blood transfusion (HBT) in cardiac surgery remain high. The adverse effects of blood transfusion are well documented. Retransfusion of shed mediastinal blood reduces the requirement for HBTs during conventional coronary artery bypass grafting. However, some studies have found that autotransfusion leads to bleeding diathesis and paradoxical increase in blood transfusions. Through this prospective randomized trial, we have studied the safety and efficacy of this modality in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Fifty patients enrolled in the study and 49 fulfilled the study criteria. They were randomly divided into group C (cell saver) and group N (non-cell saver). Whereas the cell saver group received processed shed autologous blood and homologous blood if necessary, the non-saver group was transfused homologous blood only. The threshold for transfusion was haemoglobin of 9 g dL(-1) in both the groups. The cell saver group required significantly less number of HBTs (1.6 +/- 1.2 vs. 2.4 +/- 1.3 units). The incidence of re-exploration was zero in both the groups. The mean mediastinal drainage in both the groups was not significantly different (355 +/- 196 vs. 316 +/- 119.8 mL). The number of patients requiring any blood transfusion however was very high. All the patients in the non-saver group and 20 (83%) of the patients in the saver group received homologous blood. During OPCAB surgery, the use of cell saver reduced the requirement for HBT. Its use is not associated with any clinically significant bleeding diathesis.
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http://dx.doi.org/10.1111/j.1365-3148.2007.00761.xDOI Listing
August 2007

MYH11 mutations result in a distinct vascular pathology driven by insulin-like growth factor 1 and angiotensin II.

Hum Mol Genet 2007 Oct 31;16(20):2453-62. Epub 2007 Jul 31.

Department of Internal Medicine and Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.

Non-syndromic thoracic aortic aneurysms and dissections (TAADs) are inherited in an autosomal dominant manner in approximately 20% of cases. Familial TAAD is genetically heterogeneous and four loci have been mapped for this disease to date, including a locus at 16p for TAAD associated with patent ductus arteriosus (PDA). The defective gene at the 16p locus has recently been identified as the smooth muscle cell (SMC)-specific myosin heavy chain gene (MYH11). On sequencing MYH11 in 93 families with TAAD alone and three families with TAAD/PDA, we identified novel mutations in two families with TAAD/PDA, but none in families with TAAD alone. Histopathological analysis of aortic sections from two individuals with MYH11 mutations revealed SMC disarray and focal hyperplasia of SMCs in the aortic media. SMC hyperplasia leading to significant lumen narrowing in some of the vessels of the adventitia was also observed. Insulin-like growth factor-1 (IGF-1) was upregulated in mutant aortas as well as explanted SMCs, but no increase in transforming growth factor-beta expression or downstream targets was observed. Enhanced expression of angiotensin-converting enzyme and markers of Angiotensin II (Ang II) vascular inflammation (macrophage inflammatory protein-1alpha and beta) were also found. These data suggest that MYH11 mutations are likely to be specific to the phenotype of TAAD/PDA and result in a distinct aortic and occlusive vascular pathology potentially driven by IGF-1 and Ang II.
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http://dx.doi.org/10.1093/hmg/ddm201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905218PMC
October 2007

Severe aortic and arterial aneurysms associated with a TGFBR2 mutation.

Nat Clin Pract Cardiovasc Med 2007 Mar;4(3):167-71

Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.

Background: A 24-year-old man presented with previously diagnosed Marfan's syndrome. Since the age of 9 years, he had undergone eight cardiovascular procedures to treat rapidly progressive aneurysms, dissection and tortuous vascular disease involving the aortic root and arch, the thoracoabdominal aorta, and brachiocephalic, vertebral, internal thoracic and superior mesenteric arteries. Throughout this extensive series of cardiovascular surgical repairs, he recovered without stroke, paraplegia or renal impairment.

Investigations: CT scans, arteriogram, genetic mutation screening of transforming growth factor beta receptors 1 and 2.

Diagnosis: Diffuse and rapidly progressing vascular disease in a patient who met the diagnostic criteria for Marfan's syndrome, but was later rediagnosed with Loeys-Dietz syndrome. Genetic testing also revealed a de novo mutation in transforming growth factor beta receptor 2.

Management: Regular cardiovascular surveillance for aneurysms and dissections, and aggressive surgical treatment of vascular disease.
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http://dx.doi.org/10.1038/ncpcardio0797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2561071PMC
March 2007

Genetic basis of thoracic aortic aneurysms and dissections: potential relevance to abdominal aortic aneurysms.

Ann N Y Acad Sci 2006 Nov;1085:242-55

Department of Internal Medicine and Institute of Molecular Medicine, The University of Texas Health Science Center, MSB 6.100, Houston, TX 77030, USA.

Ascending thoracic aortic aneurysms leading to type A dissections (TAAD) have long been known to occur in association with a genetic syndrome such as Marfan syndrome (MFS). More recently, TAAD has also been demonstrated to occur as an autosomal dominant disorder in the absence of syndromic features, termed familial TAAD. Familial TAAD demonstrates genetic heterogeneity, and linkage studies have identified TAAD loci at 5q13-14 (TAAD1), 11q23 (FAA1), 3p24-25 (TAAD2), and 16p12.2-13.13. The genetic heterogeneity of TAAD is reflected by variation in disease in terms of the age of onset, progression, penetrance, and association with additional cardiac and vascular features. The underlying genetic heterogeneity of TAAD is reflected in the phenotypic variation associated with familial TAAD with respect to age of onset, progression, penetrance, and association with additional cardiac and vascular features. Mutations in the TGFBR2 gene have been identified as the cause of disease linked to the 3p24-25 locus, implicating dysregulation of TGF-beta signaling in TAAD. Mutations in myosin heavy chain (MYH11), a smooth muscle cell-specific contractile protein, have been identified in familial TAAD associated with patent ductus arteriosus (PDA) linked to 16p12.2-12.13. The identification of these novel disease pathways has led to new directions for future research addressing the pathology and treatment of TAAD.
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http://dx.doi.org/10.1196/annals.1383.024DOI Listing
November 2006

Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 Intergroup Study.

J Clin Oncol 2006 Dec;24(36):5687-94

Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.

Purpose: To compare magnetic resonance imaging (MRI), computed tomography (CT), and clinical examination for delineating early cervical cancer and for measuring tumor size.

Patients And Methods: A 25-center study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT before attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist and retrospectively by four independent offsite radiologists, who were all blinded to surgical, histopathologic, and other imaging findings. Likelihood of cervical stromal and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in three axes. Surgical pathology was the standard of reference.

Results: Neither MRI nor CT was accurate for evaluating cervical stroma. For uterine body involvement, the area under the receiver operating characteristic curve was higher for MRI than for CT for both prospective (0.80 v 0.66, respectively; P = .01) and retrospective (0.68 v 0.57, respectively; P = .02) readings. Retrospective readers could measure diameter by CT in 35% to 73% of patients and by MRI in 79% to 94% of patients. Prospective readers had the highest Spearman correlation coefficient with pathologic measurement for MRI (r(s) = 0.54), followed by CT (r(s) = 0.45) and clinical examination (r(s) = 0.37; P < .0001 for all). Spearman correlation of multiobserver diameter measurements for MRI (r(s) = 0.58; P < .0001) was double that for CT (r(s) = 0.27; P = .03).

Conclusion: In patients with cervical cancer, MRI is superior to CT and clinical examination for evaluating uterine body involvement and measuring tumor size, but no method was accurate for evaluating cervical stroma.
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http://dx.doi.org/10.1200/JCO.2006.07.4799DOI Listing
December 2006

Cardiac valve assessment with MR imaging and 64-section multi-detector row CT.

Radiographics 2006 Nov-Dec;26(6):1769-84

Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, MRI, Room 143, 600 N Wolfe St, Baltimore, MD 21287, USA.

A variety of noninvasive techniques are available to assess cardiac valve morphologic features and function, with echocardiography currently being the most widely used modality for this purpose. Technical advances in electrocardiographically gated multi-detector row computed tomography (CT) and magnetic resonance (MR) imaging allow the noninvasive visualization of the cardiac valves. At present, 64-section multi-detector row CT and MR imaging are commonly being used for comprehensive examination of the heart. Information about the cardiac valves is routinely provided by MR imaging of cardiac function or coronary CT angiography. Thus, the interpreting physician may have additional information available that can aid in making the diagnosis. Supplemental movie clips are available at http://radiographics.rsnajnls.org/cgi/content/full/26/6/1769/DC1.
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http://dx.doi.org/10.1148/rg.266065035DOI Listing
December 2006

The role of MMP-2 and MMP-9 polymorphisms in sporadic intracranial aneurysms.

J Neurosurg 2006 Sep;105(3):418-23

Department of Internal Medicine and Neurosurgery, The University of Texas Medical School at Houston, USA.

Object: Matrix metalloproteinases (MMPs) are a family of endopeptidases that mediate vascular remodeling by degrading extracellular matrix components, such as collagen and elastin. On the basis of accumulating evidence that implicates increased MMP-2 (gelatinase A) and MMP-9 (gelatinase B) amounts and activity in the pathogenesis of aneurysms, the authors investigated the genetic association between polymorphisms in MMP-2 and MMP-9 and sporadic intracranial aneurysms.

Methods: Eight polymorphisms located in MMP-2 and MMP-9 were genotyped, and the association of these variations with disease was assessed in a Caucasian population consisting of 125 patients with intracranial aneurysms and 234 ethnically matched healthy volunteers. Polymorphisms in the MMP-2 gene and the haplotypes generated from these polymorphisms were not associated with the occurrence of intracranial aneurysms. However, a polymorphism located in the 3' untranslated region of MMP-9 showed a significant association with disease in the study population, with individuals carrying the TT genotype at increased risk for developing intracranial aneurysms (odds ratio 1.91, p = 0.005). Haplotypes containing the T allele of this polymorphism also showed a comparable association with disease. Similar results were obtained in an analysis of these polymorphisms in a subgroup of patients who presented with ruptured aneurysms.

Conclusions: The study findings support a role for MMP-9, but not MMP-2, in the pathogenesis of intracranial aneurysms.
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http://dx.doi.org/10.3171/jns.2006.105.3.418DOI Listing
September 2006

Aneurysm syndromes caused by mutations in the TGF-beta receptor.

N Engl J Med 2006 Aug;355(8):788-98

McKusick-Nathans Institute for Genetic Medicine, Johns Hopkins University School of Medicine, and the Kennedy Krieger Institute, Baltimore, USA.

Background: The Loeys-Dietz syndrome is a recently described autosomal dominant aortic-aneurysm syndrome with widespread systemic involvement. The disease is characterized by the triad of arterial tortuosity and aneurysms, hypertelorism, and bifid uvula or cleft palate and is caused by heterozygous mutations in the genes encoding transforming growth factor beta receptors 1 and 2 (TGFBR1 and TGFBR2, respectively).

Methods: We undertook the clinical and molecular characterization of 52 affected families. Forty probands presented with typical manifestations of the Loeys-Dietz syndrome. In view of the phenotypic overlap between this syndrome and vascular Ehlers-Danlos syndrome, we screened an additional cohort of 40 patients who had vascular Ehlers-Danlos syndrome without the characteristic type III collagen abnormalities or the craniofacial features of the Loeys-Dietz syndrome.

Results: We found a mutation in TGFBR1 or TGFBR2 in all probands with typical Loeys-Dietz syndrome (type I) and in 12 probands presenting with vascular Ehlers-Danlos syndrome (Loeys-Dietz syndrome type II). The natural history of both types was characterized by aggressive arterial aneurysms (mean age at death, 26.0 years) and a high incidence of pregnancy-related complications (in 6 of 12 women). Patients with Loeys-Dietz syndrome type I, as compared with those with type II, underwent cardiovascular surgery earlier (mean age, 16.9 years vs. 26.9 years) and died earlier (22.6 years vs. 31.8 years). There were 59 vascular surgeries in the cohort, with one death during the procedure. This low rate of intraoperative mortality distinguishes the Loeys-Dietz syndrome from vascular Ehlers-Danlos syndrome.

Conclusions: Mutations in either TGFBR1 or TGFBR2 predispose patients to aggressive and widespread vascular disease. The severity of the clinical presentation is predictive of the outcome. Genotyping of patients presenting with symptoms like those of vascular Ehlers-Danlos syndrome may be used to guide therapy, including the use and timing of prophylactic vascular surgery.
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http://dx.doi.org/10.1056/NEJMoa055695DOI Listing
August 2006

Clinically significant abnormal findings on the "nondiagnostic" CT portion of low-amperage-CT attenuation-corrected myocardial perfusion SPECT/CT studies.

J Nucl Med 2006 Aug;47(8):1312-8

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA.

Unlabelled: Attenuation correction is recommended to optimize the performance of cardiac SPECT. The 2.5-mA CT commonly used for this purpose in myocardial perfusion SPECT is generally considered "nondiagnostic" in quality. In other areas of cardiac and hybrid imaging, diagnostically relevant abnormal findings on higher-quality CT studies have been described. The purpose of this study was to establish the frequency and significance of abnormal findings on low-amperage-CT cardiac SPECT/CT scans and to assess whether a systematic review of the nondiagnostic CT findings should be recommended.

Methods: Two hundred consecutive patients who underwent clinical low-amperage-CT attenuation-corrected myocardial perfusion studies acquired on a SPECT/CT system were included in the study. The cardiac CT images were reviewed in consensus by both an experienced CT reader and a nuclear medicine resident less experienced in CT. Abnormal CT findings of varying significance were recorded.

Results: Eighty-one patients had no abnormal CT findings. In the remaining 119 patients, 234 abnormalities were detected. Twenty-five major findings (in 21 patients) were seen, and 16 of these had been previously unrecognized. Sixty-four minor and 131 minimal findings were noted. Fourteen findings were labeled as equivocal (i.e., the CT findings were not definite).

Conclusion: Potentially significant abnormal findings on the nondiagnostic-CT portion of the cardiac SPECT/CT examination were detected in 10.5% of our patients. These data suggest that, in addition to the review of the emission image dataset, low-amperage-CT findings should routinely be assessed for major diagnostic abnormalities.
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August 2006

Coronary CT angiography with 64-MDCT: assessment of vessel visibility.

AJR Am J Roentgenol 2006 Jul;187(1):119-26

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.

Objective: The objective of our study was to evaluate the image quality of 64-MDCT for coronary angiography.

Subjects And Methods: Fifty consecutive CT coronary angiograms obtained on a 64-MDCT scanner were independently reviewed by two reviewers. Segments were scored as showing no motion (score of 1), minimal motion (2), moderate motion (3), respiratory motion (4), or vessel blurring (5). Opacification was graded as good (score of 1) or limited (2). Segments < 2 mm were graded as well seen; or as poorly seen or not seen. The scores for motion artifact, opacification, and visibility were combined for overall vessel assessment. Segments with a motion score of 1 or 2 that had good opacification and were well seen were judged to be assessable.

Results: A total of 714 segments were analyzed in 50 patients. Seven hundred segments were assessed in all patients (segments 1-3, 11-20, 4, or 27), and a ramus intermedius segment was evaluated in 14 patients. Combining the scores for both reviewers, the average motion score was 1 for 619 segments (86.7%), the average motion score for all segments in an individual patient was 1.14 (range, 1-3.35), and the average opacification score for all segments in a patient was 1.02 (range, 1-1.38). A total of 374 segments were less than 2 mm in diameter. Combining the scores for both reviewers, an average of 36 segments (5.0% of 714) could not be identified by the reviewers, 319.5 segments (85.4%) were well seen, and 18.5 segments (4.9%) were poorly seen. Overall, an average of 637 segments (89.2%) were judged assessable by the reviewers. On a per-patient basis, 10 or more vessel segments were judged assessable in 47 patients (94%).

Conclusion: On 64-MDCT, 89% of coronary artery segments are assessable. Ten or more vessel segments are assessable in 94% of patients.
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http://dx.doi.org/10.2214/AJR.05.0908DOI Listing
July 2006

Gated cardiac imaging of the aortic valve on 64-slice multidetector row computed tomography: preliminary observations.

J Comput Assist Tomogr 2006 May-Jun;30(3):443-6

The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD21287, and Department of Radiology, New York University Medical Center, New York, NY, USA.

Purpose: To conduct a pilot study to determine the feasibility of evaluating aortic valve morphology and motion on electrocardiogram-gated 64-slice cardiac MDCT.

Methods: Four-dimensional images of the aortic valve were reviewed in 20 consecutive patients who underwent computed tomography (CT) coronary angiography. A consensus reading of 3 readers was performed of valve visibility, number of leaflets, valve motion, and calcification. Visibility of the valve leaflets and visualization of opening and closing of the valve leaflets were graded as well seen or suboptimally seen. The number of valve leaflets (3 or 2) and presence of valvular calcification were noted.

Results: The aortic valve was well seen in all 20 patients. Three leaflets were identified in all cases, and no calcifications were seen. Valve movement with opening and closure of the leaflets during the cardiac cycle was also well seen in all cases.

Conclusions: Visualization of the aortic valve and valvular motion during the cardiac cycle is feasible on CT studies performed for coronary angiography. CT has a potential role in the assessment of aortic valvular pathology.
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http://dx.doi.org/10.1097/00004728-200605000-00015DOI Listing
July 2006
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