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ABSTRACT: Left ventricular (LV) trabeculation may be more pronounced in ethnic African than in Caucasian (European) athletes, leading to possible incorrect diagnosis of left ventricular non-compaction cardiomyopathy (LVNC). This study investigates ethnic differences in LV hypertrabeculation amongst elite athletes with cardiac magnetic resonance (CMR) and electrocardiography (ECG).
38 elite male football (soccer) players (mean age 23.0, range 19-34 years, 28/38 European, 10/38 African) underwent CMR and ECG. Hypertrabeculation was assessed using the ratio of non-compacted to compacted myocardium (NC/C ratio) on long-axis and short-axis segments. ECGs were systematically rated.
No significant differences were seen in ventricular volumes, wall mass or E/A ratio, whereas biventricular ejection fraction (EF) was significantly lower in African athletes (European/African athletes LVEF 55/50 %, p = 0.02; RVEF 51/48 %, p = 0.05). Average NC/C ratio was greater in African athletes but only significantly at mid-ventricular level (European/African athletes: apical 0.91/1.00, p = 0.65; mid-ventricular 0.89/1.45, p < 0.05; basal 0.40/0.46, p = 0.67). ECG readings demonstrated no significant group differences, and no correlation between ECG anomalies and hypertrabeculation.
A greater degree of LV hypertrabeculation is seen in healthy African athletes, combined with biventricular EF reduction at rest. Recognition of this phenomenon is necessary to avoid misdiagnosis of LVNC.
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 07/2012; 20(10):389-95. · 1.44 Impact Factor
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ABSTRACT: Left ventricular hypertrophy (LVH) is an independent risk factor for the development of heart failure, coronary heart disease
and stroke. LVH develops in response to haemodynamic overload, e.g. hypertension. LVH was originally thought to start as an
adaptive and beneficial response required to normalise wall stress. However, this concept has been challenged by recent animal
experiments suggesting that any degree of LVH is detrimental for the preservation of cardiac function and survival. If confirmed
in humans, these findings imply that an increase in LV mass should be prevented, e.g. by lifestyle or pharmacological interventions.
To facilitate and optimise interventions, the SMART Heart study was recently set up to develop a prediction model, also involving
single nucleotide polymorphism data, for the identification of subjects at high risk of developing LVH in hypertension. For
this purpose 1000 subjects with chronic hypertension will undergo cardiac MR imaging. In addition, this study allows the extrapolation
of animal experimental genetic research into the human situation. (Neth Heart J 2007;15:295-8).
hypertrophy-MRI-single nucleotide polymorphism (SNP)-risk prediction-delayed enhancement
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 04/2012; 15(9):295-298. · 1.44 Impact Factor
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ABSTRACT: The sudden demise of an athlete invariably leads to calls for prevention. Although few screening programmes live up to expectations, the 2005 European Society of Cardiology consensus statement contains a recommendation for routine pre-participation screening of asymptomatic young athletes. As the incidence of sudden cardiac death (SCD) in this group is very low (< 2 per 100,000 per year), and no test reliably identifies persons at an increased risk of SCD, the Health Council of the Netherlands advised against mandatory screening. It seems prudent, however, to consider other strategies for reducing the occurrence of exercise-related cardiac death, e.g. by stimulating prompt resuscitation efforts and, perhaps also focusing on the rapidly growing group of senior athletes at increased risk of acute cardiac (mainly coronary) events, as this group may benefit from the recent advances in CT imaging of the coronary arteries.
Nederlands tijdschrift voor geneeskunde 01/2012; 156(31):A5001.
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ABSTRACT: The pathogenesis of secondary infarctions (SI) after aneurysmal subarachnoid hemorrhage (SAH) is poorly understood. To assess whether SI in single (SSI) or multiple (MSI) vascular territories represent different disease entities, we compared clinical profiles of patients with these patterns of SI. CT/MRI-examinations of 448 patients were reviewed for new infarctions within 28 days after SAH, and categorized into SSI or MSI. Only patients with adequate follow-up imaging excluding any new infarctions were included for analysis (269 patients). Procedure-related infarctions were excluded. Odds ratios (ORs) with corresponding 95% confidence intervals (CI) were calculated for patients with SSI or MSI versus patients without SI to analyze differences in demographic characteristics, vascular risk factors, disease-related characteristics and treatment modalities. Thirty-six patients had SSI, 53 MSI and 180 no SI. ORs in MSI-patients were >1.5 times higher compared with ORs in SSI-patients for multiple vascular risk factors [MSI:5.4 (2.3-13) versus SSI:1.2 (0.5-2.8)], poor clinical condition on admission [MSI:4.6 (2.4-8.9) versus SSI:2.4 (1.1-5.2)], initial loss of consciousness [MSI:2.6 (1.3-5.3) versus SSI:1.1 (0.5-2.3)] and large amounts of intraventricular blood [MSI:2.9 (1.4-5.8) versus SSI:1.5 (0.7-3.2)]. In multivariate analysis ORs remained higher in MSI for presence of multiple vascular risk factors [MSI:1.9 (1.2-2.9) versus SSI:1.1 (0.8-1.7)] and initial loss of consciousness [MSI:3.0 (1.0-8.9) versus SSI:1.6 (0.6-4.0)]. Our findings suggest that SSI and MSI after SAH are not distinct disease entities. MSI was related to the same characteristics as SSI but to a larger extent, specifically to the presence of multiple vascular risk factors, initial loss of consciousness, larger amounts of intraventricular blood, and poor clinical status on admission.
Journal of Neurology 05/2011; 258(12):2133-9. · 3.47 Impact Factor
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ABSTRACT: Histopathologic findings in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) are replacement of the normal myocardium with fatty and fibrous elements with preferential involvement of the right ventricle. The right ventricular fibrosis can be visualised by post-gadolinium delayed enhancement inversion recovery imaging (DE imaging). We compared the image quality of three different gradient echo MRI sequences for short axis DE imaging of the right ventricle (RV). We retrospectively analysed MRI scans performed between February 2005 and December 2008 in 97 patients (mean age: 41.2 years, 67% men) suspected of ARVC/D. For DE imaging either a 2D Phase Sensitive (PSIR), a 2D (2D) or a 3D (3D) inversion recovery sequence was used in respectively 38, 32 and 27 MRI-examinations. The RV, divided in 10 segments, was assessed for image quality by two radiologists in random sequence. A consensus reading was performed if results differed between the two readings. Image quality was good in 24% of all segments in the 3D group, 66% in the 2D group and 79% in the PSIR group. Poor image quality was observed in 51% (3D), 10% (2D), and 2% (PSIR) of all segments. Exams were considered suitable for clinical use in 7% of exams in the 3D group, 75% of exams in the 2D group and 90% of exams of the PSIR group. Breathing-artifacts occurred in 22% (3D), 59% (2D) and 53% (PSIR). Motion-artifacts occurred in 56% (3D), 28% (2D) and 29% (PSIR). Post-gadolinium imaging using the PSIR sequence results in better and more consistent image quality of the RV compared to the 2D and 3D sequences.
The international journal of cardiovascular imaging 04/2011; 28(3):595-601. · 2.15 Impact Factor
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ABSTRACT: Because the pathogenesis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is unclear, we studied cerebral perfusion at different time points around the occurrence of DCI.
We prospectively enrolled 53 patients admitted to the University Medical Center Utrecht who underwent CT perfusion (CTP) scans on admission, and within 2 weeks after hemorrhage on 2 scheduled time points or during clinical deterioration. The occurrence of DCI was assessed according to predefined criteria by 2 neurological observers blinded to perfusion results. Clinically stable patients (no-DCI) served as reference, and patients with other causes of deterioration (n = 11) were excluded. In DCI patients, the day of DCI onset and in no-DCI patients the median day of DCI onset was taken as t = 0. Scans made before and after DCI were clustered into 5 additional time points. At each time point, cerebral blood volume (CBV) and flow (CBF), and mean transit time (MTT) were measured, and absolute and relative (interhemispheric asymmetry) values were compared between DCI and no-DCI patients.
Absolute CBF was lower and MTT was higher in the 18 DCI patients than in the 24 no-DCI patients before, during and after DCI. MTT asymmetry increased during DCI and partially recovered afterwards in DCI patients while it remained constant in no-DCI patients. Absolute and relative CBV remained constant in both groups.
Our findings suggest that DCI patients already have diffusely worse perfusion (absolute values) than no-DCI patients before focal worsening (increased asymmetry) occurs and becomes symptomatic. The partial recovery in the measured areas suggests that DCI can be partly reversible.
Cerebrovascular Diseases 01/2011; 32(2):133-40. · 2.72 Impact Factor
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ABSTRACT: Advanced cardiac imaging, using cardiac magnetic resonance imaging (MRI) and multidetector computed tomography (CT), is increasingly used in the work-up of athletes with suspected abnormalities on screening. Both imaging modalities produce highly accurate and reproducible structural and functional cardiac information. Cardiac MRI has the advantage of imaging without radiation exposure or the use of iodine-containing contrast agents, but is sometimes not possible due to claustrophobia or other contraindications. Although cardiac MRI can rule out coronary artery anomalies, multidetector CT is superior to cardiac MRI for visualising the full extent of the coronary arteries and atherosclerotic coronary artery disease. For patients less than 35 years of age, cardiac MRI is the first option after initial echocardiography for further assessment of cardiomyopathies, myocarditis and coronary anomalies, which are major causes of sudden cardiac death in young athletes. For athletes over 35 years of age the most common cause of sudden cardiac death is coronary artery disease, whereby cardiovascular screening requires further diagnostic modalities and may include multidetector CT.
British journal of sports medicine 10/2009; 43(9):677-84. · 2.55 Impact Factor
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ABSTRACT: Patients with intracranial aneurysms are at risk for future development of new aneurysms and growth of additional untreated aneurysms. Because in previous long-term studies duration of follow-up varied widely, the time interval after which screening could be effective remains largely unknown. The purpose of this study was to assess the incidence of de novo aneurysm formation and the growth of additional untreated aneurysms in patients with coiled aneurysms followed up with MR angiography (MRA) after a fixed period of 5 years.
In 65 patients with coiled intracranial aneurysms, high-resolution 3T MRA was performed 5.1 +/- 0.2 years after coiling. MRA follow-up imaging was compared with MRA or CT angiography at the time of coiling. Additional aneurysms detected at MRA follow-up were classified as unchanged, grown, de novo, or incomparable with previous imaging.
In 13 of 65 patients (20%), 24 additional aneurysms were found. Four aneurysms were incomparable with previous imaging and 2 of these were clipped. Of the remaining 20 additional aneurysms, 1 was de novo, 1 had grown slightly, and 18 were unchanged. The incidence of de novo aneurysm formation after 5 years was 1.54% (95% confidence interval, 0.01-9.0%). For additional aneurysms known at the time of initial coiling and for the 1 de novo aneurysm, no treatment was indicated.
MRA screening 5 years after coiling for detection of de novo aneurysms and growth of additional untreated aneurysms has a low yield in terms of finding aneurysms that need to be treated.
American Journal of Neuroradiology 11/2008; 30(2):303-7. · 2.93 Impact Factor
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ABSTRACT: The long-term fate of coiled intracranial aneurysms is largely unknown, and prolonged imaging follow-up has been advocated. The yield of follow-up imaging in coiled aneurysms adequately occluded at 6 months is unknown. In such patients, we performed time-of-flight MR angiography (MRA) to assess the incidence and therapeutic consequences of reopening 5-11 years after coiling.
Between 1995 and 2002, 661 aneurysms in 607 patients were coiled in 3 participating centers. Six-month follow-up angiograms were obtained in 497 (75%) aneurysms, of which 316 (64%) in 297 patients were adequately occluded. Of 297 patients, 84 were excluded for various reasons and 73 could not be traced. Of 140 eligible patients, 104 (74%) with 111 aneurysms were studied with 3T MR imaging and high-resolution MRA at a mean of 6.0 years after coiling (median, 5.6 years; range, 5.0-10.6 years).
The proportion of aneurysms with reopening was 3.6% (4/111; 95% confidence interval [CI], 1.1%-9.2%). One reopened aneurysm, which initially contained intraluminal thrombus, was additionally coiled (0.9%; 95% CI, 0.0%-5.4%).
In intracranial aneurysms with adequate occlusion at 6 months after coiling, the proportion of reopening needing retreatment after >5 years is low. The number of reopened aneurysms with therapeutic consequences was too small to assess risk factors, but probably the presence of intraluminal thrombus is one such risk factor. Most patients with coiled intracranial aneurysms that are adequately occluded at 6 months might not need prolonged imaging follow-up.
American Journal of Neuroradiology 06/2008; 29(9):1768-74. · 2.93 Impact Factor
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ABSTRACT: Left ventricular hypertrophy (LVH) is an independent risk factor for the development of heart failure, coronary heart disease and stroke. LVH develops in response to haemodynamic overload, e.g. hypertension. LVH was originally thought to start as an adaptive and beneficial response required to normalise wall stress. However, this concept has been challenged by recent animal experiments suggesting that any degree of LVH is detrimental for the preservation of cardiac function and survival. If confirmed in humans, these findings imply that an increase in LV mass should be prevented, e.g. by lifestyle or pharmacological interventions. To facilitate and optimise interventions, the SMART Heart study was recently set up to develop a prediction model, also involving single nucleotide polymorphism data, for the identification of subjects at high risk of developing LVH in hypertension. For this purpose 1000 subjects with chronic hypertension will undergo cardiac MR imaging. In addition, this study allows the extrapolation of animal experimental genetic research into the human situation. (Neth Heart J 2007;15:295-8.).
Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 10/2007; 15(9):295-8. · 1.44 Impact Factor
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ABSTRACT: To establish intraobserver and interobserver variability for regional measurement of CT brain perfusion (CTP) and to determine whether reproducibility can be improved by calculating perfusion ratios.
CTP images were acquired in 20 patients with unilateral symptomatic carotid artery stenosis (CAS). We manually drew regions of interest (ROIs) in the cortical flow territories of the anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries and the basal ganglia in each hemisphere; recorded cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT); and calculated ratios of perfusion values between symptomatic and asymptomatic hemisphere. We assessed intraobserver and interobserver variability by performing a Bland-Altman analysis of the relative differences between 2 observations and calculated SDs of relative differences (SDD(rel)) as a measure of reproducibility. We used an F test to assess significance of differences between SDD(rel) of absolute CTP values and CTP ratios, and the Levine test to compare the 4 perfusion territories.
MTT was the most reproducible parameter (SDD(rel) <or= 10%). Intraobserver and interobserver variability were higher for absolute CTP values compared with CTP ratios for CBV (16%-17% versus 11%-16%) and CBF (18% versus 10%-13%) but not for MTT (5%-9%). Reproducibility was best in the MCA territory: SDD(rel) was <or=11% for perfusion ratios of all 3 parameters.
MTT is the most reproducible CTP parameter in patients with unilateral symptomatic CAS. Measurement variability in CBV and CBF can be improved if CTP ratios instead of CTP values are used. The MCA territory shows the least measurement variability.
American Journal of Neuroradiology 05/2007; 28(5):927-32. · 2.93 Impact Factor
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ABSTRACT: To assess the presence of anterior and posterior collateral pathways in the circle of Willis in patients with symptomatic carotid artery stenosis (SCAS) and to compare this to patients without carotid artery stenosis.
Multislice CT angiography was performed in 91 patients and 91 control subjects. Using consensus reading, 2 observers evaluated the presence and diameter of the anterior communicating artery (AcomA), the A1 segments of the anterior cerebral arteries, the posterior communicating arteries (PcomA) and the P1 segments of the posterior cerebral arteries. Anterior or posterior pathways were assumed to be present if the diameter of continuous arterial segments was >1 mm; both A1 segments and AcomA anterior, and ipsilateral P1 segment and PcomA posterior. Comparison between patients and controls was performed using the chi(2) test.
In the patients we found significantly more hypoplastic (<1 mm) or invisible A1 segments (16 and 14 vs. 4 and 1, respectively, p < 0.01). The AcomA was invisible in 4 patients versus 1 control. An isolated compromised anterior pathway and a combined compromised anterior and posterior pathway occurred more frequently in the patients as compared to the controls; 9 versus 1% (p < 0.01) and 26 versus 4% (p < 0.01).
A compromised anterior collateral pathway, usually combined with a compromised posterior pathway, occurs more frequently in patients with SCAS as compared to controls, which suggests a relation between symptomatic carotid stenosis and an incomplete circle of Willis.
Cerebrovascular Diseases 02/2007; 23(4):267-74. · 2.72 Impact Factor
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ABSTRACT: Few risk factors have been identified for rebleeding in patients with subarachnoid haemorrhage. We studied whether size of aneurysm after rupture is a risk factor for rebleeding. Since intracranial aneurysms develop during life and may therefore be larger at an older age, we also assessed whether age confounds a relation between size and rebleeding.
We studied all patients with aneurysmal subarachnoid haemorrhage admitted between 1995 and 2000. Since 1995 CT-angiography is obtained in all patients on admission. Patients were followed until rebleeding, operation, discharge or death. For the relation between size and risk of rebleeding we used Cox proportional hazards modelling.
We included 354 patients. Rebleeding occurred in 22 (30%) of the 73 patients with a large (>10 mm) aneurysm, and in 68 (24%) of the 281 patients with a small (< or =10 mm) aneurysm (hazard ratio for large aneurysms 1.6 (95% confidence interval [CI] 1.0-2.6)). Within the first three days rebleeding occurred in 14 (19.2%) patients with a large aneurysm and in 25 (8.9%) patients with a small aneurysm (hazard ratio 2.4 (95% CI 1.2-4.5)). After adjustment for age, all hazard ratios remained essentially the same.
Patients with large aneurysms have a higher risk for rebleeding, in particular within the first three days after the initial haemorrhage. This increased risk is independent of age.
Acta Neurochirurgica 12/2006; 148(12):1277-9; discussion 1279-80. · 1.52 Impact Factor
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ABSTRACT: In patients with previous subarachnoid haemorrhage (SAH) undergoing follow up screening, the authors assessed the impact of finding but not treating very small aneurysms by comparing quality of life (QOL), anxiety, and depression between patients with a newly detected aneurysm that was left untreated (cases) and patients with a negative screening (controls) as this should be incorporated in the evaluation of effectiveness of screening.
In patients with previous SAH undergoing screening for new aneurysms the authors compared QOL (SF-36, EURO-QOL, and a screening related questionnaire), anxiety, and depression (Hospital Anxiety and Depression Scale (HADS)) between cases and controls. Differences in scores on the SF-36, EURO-QOL, and HADS were assessed with Student's t test and differences in proportions of patients with HADS scores in the pathological range and screening related changes with chi2 analysis. The authors powered the study to detect a moderate, clinically relevant difference.
Thirty five cases and 34 controls were included. Trends for health related QOL, anxiety, depression, and consequences in daily life pointed in the same direction of a less favourable situation for cases but all effects were small, and did not reach statistical significance. On the screenings specific questionnaire, cases more often (but not statistically significant) reported changes in daily life.
The authors found no major or moderate impact on QOL, anxiety, and depression of the awareness of having an untreated aneurysm, which was detected at screening, although most items showed a trend towards more negative effects for cases. Minor effects on individual level cannot be excluded by this study.
Journal of neurology, neurosurgery, and psychiatry 07/2006; 77(6):748-52. · 4.87 Impact Factor
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ABSTRACT: Delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is difficult to predict. The authors studied the relation between several parameters of brain perfusion at admission and development of DCI.
The authors analyzed the admission CT perfusion (CTP) scans of 46 patients scanned within 72 hours after SAH. They assessed cerebral blood volume (CBV) and flow (CBF), mean transit time (MTT), and time to peak (TTP) for eight predefined regions of interest. For patients with and without DCI, the authors compared perfusion quantitatively and semiquantitatively. With receiver-operator characteristic (ROC) curves, the authors assessed the relationship between DCI and perfusion parameters. To assess the potential prognostic value, they calculated sensitivity and specificity of optimal threshold values for the semiquantitative data.
DCI was not significantly related with quantitative perfusion values. For the semiquantitative data, patients with DCI had significantly more asymmetry in perfusion, and ROC curves indicated a good relation (0.75 to 0.81). Optimal threshold values distinguishing between patients with and without DCI were 0.77 for CBV and 0.72 for CBF ratios, and 0.87 seconds for MTT and 1.0 second for TTP differences. The corresponding sensitivity was 0.75 for all parameters; the specificity was 0.70 for CBV, 0.93 for CBF, 0.70 for MTT, and 0.90 for TTP.
Delayed cerebral ischemia (DCI) is related to perfusion asymmetry on admission CT perfusion (CTP). The cerebral blood flow ratio (comparing contralateral regions of interest) seems the best prognosticator for development of DCI. Further studies are needed to investigate the additional value of CTP to other prognosticators for DCI and to validate the chosen threshold values.
Neurology 06/2006; 66(10):1533-8. · 8.31 Impact Factor
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ABSTRACT: A level set based method is presented for cerebral vascular tree segmentation from computed tomography angiography (CTA) data. The method starts with bone masking by registering a contrast enhanced scan with a low-dose mask scan in which the bone has been segmented. Then an estimate of the background and vessel intensity distributions is made based on the intensity histogram which is used to steer the level set to capture the vessel boundaries. The relevant parameters of the level set evolution are optimized using a training set. The method is validated by a diameter quantification study which is carried out on phantom data, representing ground truth, and 10 patient data sets. The results are compared to manually obtained measurements by two expert observers. In the phantom study, the method achieves similar accuracy as the observers, but is unbiased whereas the observers are biased, i.e., the results are 0.00+/-0.23 vs. -0.32+/-0.23 mm. Also, the method's reproducibility is slightly better than the inter-and intra-observer variability. In the patient study, the method is in agreement with the observers and also, the method's reproducibility -0.04+/-0.17 mm is similar to the inter-observer variability 0.06+/-0.17 mm. Since the method achieves comparable accuracy and reproducibility as the observers, and since the method achieves better performance than the observers with respect to ground truth, we conclude that the level set based vessel segmentation is a promising method for automated and accurate CTA diameter quantification.
Medical Image Analysis 05/2006; 10(2):200-14. · 4.42 Impact Factor
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ABSTRACT: Lipomatous hypertrophy of the interatrial septum is a benign disorder that is characterized by the fat deposition in the interatrial septum. It typically occurs in elderly, obese patients and may cause arrhythmia. We report a case in which lipomatous hypertrophy of the interatrial septum was found incidentally.
The International Journal of Cardiovascular Imaging 01/2006; 21(6):659-61. · 2.29 Impact Factor
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ABSTRACT: Intracranial aneurysms have long been considered a once in a lifetime event. Nevertheless, patients who survive after subarachnoid haemorrhage (SAH) may be at risk for new aneurysms. In a cohort of patients with clipped aneurysms, we studied the yield of screening in the years after the SAH and we tried to identify risk factors for formation of new aneurysms as well as for enlargement of aneurysms that were already present at the time of the SAH. We screened 610 patients who had been admitted between 1985 and 2001 for SAH by means of CT-angiography. Risk factors were evaluated by Cox regression analyses. With screening we detected 129 aneurysms in 96 (16%) patients, after a mean interval of 8.9 years. Of these, 24 (19%) were located at the site of the previously ruptured and clipped aneurysm and 105 (81%) at a site remote from the clip site. Of the aneurysms at a remote site 59 could be compared with the initial (CT)-angiogram. Of these, 19 were truly de novo (32%) and 40 (68%) were already visible in retrospect. Of the 53 aneurysms that were followed over time 13 (25%) had enlarged. Risk factors for aneurysm formation and growth were presence of multiple aneurysms at time of SAH (HR 3.2, 95% CI 1.2-8.6), current smoking (HR 3.8, 95% CI 1.5-9.4) and hypertension (HR 2.3, 95% CI 1.1-4.9). These results suggest that intracranial aneurysms should not be considered as a single event in a lifetime but rather as a continuous process. Patients with a previous SAH have a substantial risk for new aneurysm formation and enlargement of untreated aneurysms. Screening these patients might be beneficial, especially in patients with multiple aneurysms, hypertension and a history of smoking. The risks and benefits of screening, however, should be carefully weighed, for example, in a decision model.
Brain 11/2005; 128(Pt 10):2421-9. · 9.46 Impact Factor
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ABSTRACT: Patients with a history of aneurysmal subarachnoid hemorrhage may have aneurysms on screening several years after the hemorrhage. For determining the benefits of follow-up screening, it is important to know whether these aneurysms have developed after the hemorrhage or are visible in retrospect, and if so, whether the size has increased.
Aneurysms were categorized into de novo aneurysms and aneurysms visible in retrospect (already present) with increased or stable size. We studied aneurysm characteristics for these 3 categories: the relation between aneurysm development or enlargement and duration of follow up and the relation between enlargement and initial size of the aneurysm.
In 87 of 495 patients (17.6%), aneurysms were detected; for 51 of these patients with 62 aneurysms, the original catheter or computed tomographic angiogram was available for comparison. Of the 62 aneurysms, 19 were de novo and 43 were visible in retrospect, 10 with increased size and 33 with stable size. De novo aneurysms were mainly < or =5 mm (95%) and located at the middle cerebral artery (63%). For aneurysms visible in retrospect, the most frequent location was the posterior communicating artery (21%). There was no relation between the development of de novo aneurysms or enlargement and the duration of follow-up or between enlargement and the initial size of the aneurysm.
Of aneurysms detected at screening, one third were de novo and two thirds were missed at the time of the initial hemorrhage. One quarter of initially small aneurysms had enlarged during follow-up.
Stroke 09/2005; 36(8):1753-8. · 5.73 Impact Factor
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ABSTRACT: In pulmonary vein isolation as a treatment for atrial fibrillation the proximal part of the pulmonary veins is catheterized. A protocol for preinterventional assessment of pulmonary vein anatomy was developed, based on contrast-enhanced magnetic resonance angiography (MRA) in combination with three-dimensional visualization to tailor periprocedural angiography. The results allow for assessment of the number, morphology, and location of the ostia of the pulmonary veins, as well as complicating anatomical variations, such as common trunks and aberrant courses.
Journal of Cardiovascular Magnetic Resonance 02/2003; 5(4):545-51. · 3.72 Impact Factor
