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MRI with MRA in abdominal aortic aneurysm

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81. Takayasu Arteritis (Diagnosis)

or aneurysm formation are found on angiography or magnetic resonance angiography (MRA). Vascular insufficiency related to stenosis and thrombosis of affected vessels may cause renovascular hypertension, neurologic symptoms, or lower extremity claudications. (See Workup.) Cardiac involvement may include aortic regurgitation and resulting from myocarditis or increased afterload. Aortic root dilatation contributes to the aortic regurgitation. Often, the diagnosis of Takayasu arteritis is made when a widened (...) of the disease. Although 5-year survival rates exceed 90%, the disease has a high incidence of residual morbidity. (See Prognosis, Presentation, and Workup.) Complications Complications of Takayasu arteritis include the following: Congestive heart failure due to aortic insufficiency, myocarditis, and/or hypertension Aortic aneurysms, thrombus formation, and rupture Ischemic stroke Myocardial infarction Hypertension Clinically silent progressive disease (despite normal acute phase reactants) Morbidity

2014 eMedicine Pediatrics

82. Takayasu Arteritis (Treatment)

-year-old adolescent girl with Takayasu arteritis. Note large aneurysms of descending aorta and dilatation of innominate artery. MRI of thorax of 15-year-old adolescent girl with Takayasu arteritis. Note aneurysms of descending aorta. Coronal MRI of abdomen of 15-year-old adolescent girl with Takayasu arteritis. Note thickening and tortuosity of abdominal aorta proximal to kidneys. of 3 Tables Contributor Information and Disclosures Author Christine Hom, MD Assistant Professor, Department (...) treatment at sites of inflammation. Previous Next: Monitoring Monitor medications and adverse effects in patients with Takayasu arteritis. In addition, monitor acute phase reactants as a limited measure of disease activity. Perform regular imaging of affected vasculature, as well as surveillance imaging for new lesions. Treatment may be monitored with MRI and/or MRA or CT scanning. Mural thickening is observed to decrease with corticosteroid treatment. Recognizing that Takayasu arteritis may progress

2014 eMedicine Pediatrics

83. Syncope (Diagnosis)

mass, effusion, or widened mediastinum Computed tomography (CT) of the head (noncontrast) - Has a low diagnostic yield in syncope but may be clinically indicated in patients with new neurologic deficits or in patients with head trauma secondary to syncope CT of the chest and abdomen - Indicated only in select cases (eg, suspected aortic dissection, ruptured abdominal aortic aneurysm, or pulmonary embolism [PE]) Magnetic resonance imaging (MRI) of the brain and magnetic resonance arteriography (MRA (...) a history of cardiac problems and are symptomatic. Chest pain, dyspnea, decreased exercise tolerance, and fatigue may all be present. Consider cardiac ischemia and medication side effects as additional causes. Cardiac outflow obstruction may also result in sudden-onset syncope with little or no prodrome. One critical clue is the exertional nature, and the other is the presence of a cardiac murmur. Young athletes may present with this etiology for syncope. Specific pathology includes aortic stenosis

2014 eMedicine Emergency Medicine

84. Lower-Extremity Atherosclerotic Arterial Disease

, CTA is the preferred imaging modality for planning endovascular interventions for abdominal and thoracic aortic aneurysms and lower-extremity arteries. [ , , ] Digital subtraction arteriography is the most accurate test used to define the anatomy and degree of pathology, but it is indicated only when intervention is considered. It is commonly performed using isosmolar, nonionic, iodinated contrast agent with ionizing radiation. Digital subtraction arteriography can be performed using CO 2 . CO 2 (...) overestimation of the degree of stenosis. Next: MRI Magnetic resonance angiography (MRA) has emerged as a safe and noninvasive alternative to conventional angiography in the diagnosis of lower-extremity vascular disease. Using MRA studies, a radiologist should be able to detect signs of narrowing (stenosis), dilatation (aneurysm) in the vessel, or a complete interruption of flow, and he or she should be able to compare the results in both legs. [ , , , , , , ] Magnetic resonance images of lower-extremity

2014 eMedicine Radiology

85. Liver, Metastases

than contrast-enhanced CT. MRI was found to be significantly superior to 18 F-FDG PET/CT in the detection and classification of liver metastases in patients with adenocarcinomas of the GI tract, especially regarding detection of small metastases. [ ] Limiting factors with MRI Two major factors limit the widespread use of MRI in liver imaging: technical factors and cost. The technical factors include motion artifacts; respiratory, cardiac, and bowel movements, as well as aortic pulsation, tend (...) fibrosing dermopathy (NFD). NSF/NFD has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans. NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip

2014 eMedicine Radiology

86. Colitis, Ischemic

introduced the term ischemic colitis in their article published in 1966. [ ] This report was preceded by the description of reversible colonic vascular occlusion by Boley and colleagues in 1963. [ ] Bowel ischemia is mainly a disease of old age caused by atheroma of mesenteric vessels. Other causes include embolic disease, vasculitis, fibromuscular hyperplasia, aortic aneurysm, blunt abdominal trauma, disseminated intravascular coagulation, irradiation, and hypovolemic or endotoxic shock. [ ] Occlusive (...) may have a common origin. Before Doppler studies of the SMA and celiac axis are performed, a Doppler velocity signal in the aorta is obtained at the level of the celiac axis and the SMA at a 60° angle. The aorta is scanned for atheroma, dissection, and aneurysm. Color flow and spectral analysis are used to detect flow disturbances. The peak systolic aortic velocity is recorded, after which velocity measurements are made at the origins of the celiac axis and the SMA. Care should be taken when

2014 eMedicine Radiology

87. Arteritis, Takayasu

of angiography are potentially greater than in adults. In cases of Takayasu arteritis, gadolinium-enhanced MRA may demonstrate concentric or crescent-like thickening of the arterial wall. [ ] Inversion recovery–prepared echo-gradient pulse sequences with fat suppression depict indistinct outlines. Delayed hyperenhancement is seen on delayed contrast-enhanced MRI in the inflamed aortic arterial walls. [ ] Mural thrombi can be more easily detected on MRI than on conventional angiography [ ] . Assessment (...) pattern of the aortic wall. [ ] Cardiac CTA has also detected silent coronary involvement characterized by nonostial stenosis, ostial stenosis, and coronary aneurysms. [ ] The CT differential diagnosis includes giant cell arteritis, polyarteritis nodosa, and atherosclerosis [ ] . The utility of this noninvasive technique is particularly high in pediatric patients, in whom the complications of angiography are potentially worse than they are in adults. [ , ] One disadvantage of CT, as compared

2014 eMedicine Radiology

88. Aorta, Dissection

A. Clinical application of single shot GRE-EPI as non-enhanced MRA (EPI- MRA) for aortic aneurysm and dissection. Radiat Med . 1999 Sep-Oct. 17(5):393-7. . Sakuma H, Bourne MW, O''Sullivan M. Evaluation of thoracic aortic dissection using breath-holding cine MRI. J Comput Assist Tomogr . 1996 Jan-Feb. 20(1):45-50. . Clough RE, Waltham M, Giese D, Taylor PR, Schaeffter T. A new imaging method for assessment of aortic dissection using four-dimensional phase contrast magnetic resonance imaging. J Vasc Surg (...) lumen is slower than in the true lumen, and the false lumen often becomes aneurysmal when subjected to systemic pressure. An acute aortic dissection is considered chronic at 2 weeks. The dissection usually stops at an aortic branch vessel or at the level of an atherosclerotic plaque. [ , , ] See the images of aortic dissection below. Image A represents a Stanford A or a DeBakey type 1 dissection. Image B represents a Stanford A or DeBakey type II dissection. Image C represents a Stanford type B

2014 eMedicine Radiology

89. Angioplasty, Peripheral

the combination of MRA and Doppler ultrasonography is used, however, nearly 100% specificity in defining the hemodynamic severity of carotid stenoses is achieved. Previous Next: Abdominal Aortic Aneurysm Although aneurysms may affect any arterial bed, infrarenal abdominal aortic aneurysms (AAAs) account for most arterial aneurysms. An AAA is defined as an aneurysm having a diameter of greater than 3 cm. Most AAAs are incidentally discovered during abdominal ultrasonography or angiographic examinations (...) . . Hope MD, Hope TA. Functional and molecular imaging techniques in aortic aneurysm disease. Curr Opin Cardiol . 2013 Nov. 28(6):609-618. . Nguyen VL, Kooi ME, Backes WH, van Hoof RH, Saris AE, Wishaupt MC, et al. Suitability of Pharmacokinetic Models for Dynamic Contrast-Enhanced MRI of Abdominal Aortic Aneurysm Vessel Wall: A Comparison. PLoS One . 2013 Oct 2. 8(10):e75173. . . Stacy MR, Zhou W, Sinusas AJ. Radiotracer Imaging of Peripheral Vascular Disease. J Nucl Med Technol . 2015 Sep. 43 (3):185

2014 eMedicine Radiology

90. Takayasu Arteritis (Diagnosis)

of descending aorta and dilatation of innominate artery. Image courtesy of Christine Hom, MD. MRI of thorax of 15-year-old girl with Takayasu arteritis. Note aneurysms of descending aorta. Image courtesy of Christine Hom, MD. Coronal MRI of abdomen of 15-year-old girl with Takayasu arteritis. Note thickening and tortuosity of abdominal aorta proximal to kidneys. Image courtesy of Christine Hom, MD. of 6 Tables Contributor Information and Disclosures Author Jefferson R Roberts, MD Chief of Rheumatology (...) with intimal proliferation. Lesions produced by the inflammatory process can be stenotic, occlusive, or aneurysmal. All aneurysmal lesions may have areas of arterial narrowing. Vascular changes lead to the main complications, including hypertension, most often due to renal artery stenosis or, more rarely, stenosis of the suprarenal aorta; aortic insufficiency due to aortic valve involvement; ; and aortic or arterial aneurysm. The renal arteries are involved in 24% to 68% of Takayasu arteritis cases. Renal

2014 eMedicine.com

91. Takayasu Arteritis (Diagnosis)

of descending aorta and dilatation of innominate artery. Image courtesy of Christine Hom, MD. MRI of thorax of 15-year-old girl with Takayasu arteritis. Note aneurysms of descending aorta. Image courtesy of Christine Hom, MD. Coronal MRI of abdomen of 15-year-old girl with Takayasu arteritis. Note thickening and tortuosity of abdominal aorta proximal to kidneys. Image courtesy of Christine Hom, MD. of 6 Tables Contributor Information and Disclosures Author Jefferson R Roberts, MD Chief of Rheumatology (...) with intimal proliferation. Lesions produced by the inflammatory process can be stenotic, occlusive, or aneurysmal. All aneurysmal lesions may have areas of arterial narrowing. Vascular changes lead to the main complications, including hypertension, most often due to renal artery stenosis or, more rarely, stenosis of the suprarenal aorta; aortic insufficiency due to aortic valve involvement; ; and aortic or arterial aneurysm. The renal arteries are involved in 24% to 68% of Takayasu arteritis cases. Renal

2014 eMedicine.com

92. Hypertensive Heart Disease (Diagnosis)

of pulmonary congestion, such as rales, decreased breath sounds, and dullness to percussion due to pleural effusion. Abdomen The abdominal examination may reveal a renal artery bruit in patients with hypertension secondary to renal artery stenosis, a pulsatile expansile mass of abdominal aortic aneurysm, and hepatomegaly and ascites due to CHF. Extremities Ankle edema may be present in patients with advanced heart failure. Central nervous system and ophthalmologic system Central nervous system (CNS (...) lines, and alveolar infiltrates in the presence of elevated LV end-diastolic pressure and pulmonary congestion; and blunting of the costophrenic angle in the presence of pleural effusion. Computed tomography (CT) scanning, and magnetic resonance imaging (MRI) of the heart, although not used routinely, have been shown in experimental studies to quantify LVH. CT scanning, MRI, and magnetic resonance angiography (MRA) of the abdomen and chest show the presence of adrenal masses, renal artery stenosis

2014 eMedicine.com

93. Renal Artery Stenosis (Diagnosis)

. Eventually,the decreased perfusion compromises renal function and structure. Patients with renal artery stenosis may present with one or more of the following (see ): Abdominal bruit Azotemia Sudden worsening of hypertension or renal function Acute kidney injury or decreased renal function after initiation of antihypertensive therapy, especially with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers Unexplained renal insufficiency, in elderly patients. Congestive heart (...) arterial luminal narrowing exceeds 50%. The degree of renal artery stenosis that would justify any attempt at either surgical intervention or radiologic intervention is not known. One study found that when the pressure distal to renal artery stenosis was less than 90% of aortic pressure, renin release from the affected kidney was significantly elevated (renin being measured in the ipsilateral renal vein). This might be useful as a functional measurement of significant renovascular stenosis leading

2014 eMedicine.com

94. Kidney Transplantation, Surgical Complications

offer important functional information, but the findings are often nonspecific, and the images have relatively poor spatial resolution. Abdominal and pelvic MRI is valuable. Some patients object to the MRI experience, and others have direct contraindications, such as cardiac pacemakers or cerebral aneurysm clips. Although Doppler ultrasound and scintigraphy with captopril, when the patient is hypertensive, are helpful, both tests have limitations. Differentials Intervention Interventional radiology (...) : Magnetic Resonance Imaging MRI is being increasingly used as a second-line imaging modality for the evaluation of kidney transplants. MRA has several advantages compared with conventional digital subtraction angiography (DSA). MRI and MRA are noninvasive and use no ionizing radiation. MRA provides true anatomic images and permits multiplanar reformatting. High-performance MR gradient systems allow the acquisition of 3D volumes in a single breath hold of shorter than 30 seconds. Imaging of the renal

2014 eMedicine Radiology

95. Fibromuscular Dysplasia (Visceral Arteries)

potential arterial donors with angiographic evidence of FMD, Cragg et al found that 26% developed hypertension, compared with 6% of age- and sex-matched control subjects. [ ] Hepatic and superior mesenteric involvement occurs infrequently, and sporadic cases of severe intestinal ischemia and HAA rupture have been reported. FMD is a rare cause of abdominal aortic aneurysm. [ ] Angiographic findings in systemic necrotizing vasculitis include 4 basic arterial anomalies: saccular microaneurysms (62 (...) , et al. Incidental fibromuscular dysplasia in potential renal donors: long-term clinical follow-up. Radiology . 1989 Jul. 172(1):145-7. . Matsushita M, Yano T, Ikezawa T, et al. Fibromuscular dysplasia as a cause of abdominal aortic aneurysm. Cardiovasc Surg . 1994 Oct. 2(5):615-8. . Vasbinder GB, Nelemans PJ, Kessels AG, et al. Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis. Ann Intern Med . 2001 Sep 18. 135(6):401-11

2014 eMedicine Radiology

96. Pancreatitis, Chronic

, metastasis, pseudocysts, and kwashiorkor. Calcification in a vascular atheroma, an aortic aneurysm, or branches of the aorta can occasionally be confused with pancreatic calcification on plain abdominal radiographs. Gastric displacement seen on barium examination is not specific for chronic pancreatitis and may be due to pancreatic carcinoma, a variety of peripancreatic masses (including adrenal gland or renal masses), aortic aneurysms, exophytic gastric or duodenal tumors, lymphoma and other (...) chronic pancreatitis (CP); it depicts most of the changes in pancreatic morphology. CT is also indicated to exclude other potential intra-abdominal pathologies that present with symptoms similar to those of chronic pancreatitis, but CT cannot exclude a diagnosis of CP and cannot exclusively diagnose early or mild CP. Magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) are superior and are indicated especially in patients in whom no specific pathologic changes are seen on CT

2014 eMedicine Radiology

97. Portal Hypertension

-recalled echo MRI, but these techniques cannot demonstrate the direction of portal flow. Time-of-flight MRI with bolus tracking has been found to be successful in imaging portal hypertension and its sequelae. Phase-contrast sequences may be used to evaluate the portal vein, and phase-contrast cine MRA may show the direction of portal venous flow and the presence of portal vein thrombus. MRI evaluation of the portal venous system is accurate in demonstrating thrombosis and collateral circulation (...) dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans. NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark

2014 eMedicine Radiology

98. Renal Artery Stenosis/Renovascular Hypertension

is fast becoming a clinical standard for the safe and noninvasive detection of RAS, aneurysms, and occlusions. [ ] A comprehensive examination includes 3D dynamic gadolinium-enhanced and 3D phase-contrast MRA techniques, which allow an evaluation of the renal arteries and other visceral arteries. The 3D phase-contrast technique is flow based and subject to dephasing in the presence of significant arterial stenosis. The 3D gadolinium-enhanced MRA method produces excellent contrast angiograms without (...) . [ , , ] Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have recently been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans. As of late December 2006, the FDA had

2014 eMedicine Radiology

99. Pulmonary Angiography

airway disease ( , , ), congenital pulmonary disease (absent lung), vasculitis, vascular compression (pulmonary fibrosis, benign and malignant neoplasms, aortic aneurysm/dissection), and altered pulmonary circulation (absence or hypoplasia of the pulmonary artery, bronchopulmonary sequestration, , mitral valvular disease). Previous Next: Digital Subtraction Pulmonary Angiography Digital subtraction pulmonary angiography (DSPA) is the criterion standard or definitive test in evaluating diseases (...) to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans. NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving

2014 eMedicine Radiology

100. Non-Hodgkin Lymphoma, Thoracic

and its multiplanar capability make MRI an excellent modality in the initial diagnosis of a mediastinal mass and in its follow-up after treatment. The vascular images provided are superior to CT scans and can better delineate the relationship of an identified mediastinal mass to adjacent intrathoracic vascular structures. MRI can be used to differentiate a suspected mediastinal mass and a vascular abnormality, such as an aortic aneurysm. MRI contrast agents can be used when iodinated contrast (...) and major blood vessels. However, angiography is being challenged by magnetic resonance angiography (MRA) and CTA. Lymphomatous deposits may be hypovascular. In rare cases, false-negative results may also occur in the differentiation of aneurysms associated with laminar intraluminal thrombus from other mediastinal masses. The sensitivity and specificity of angiography in the diagnosis of aortic aneurysms are 85% and 95%, respectively. Previous Next: Questions & Answers Overview Previous References Bligh

2014 eMedicine Radiology

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