CT Calcium Score In The Elderly With Aortic Stenosis (2020)

Type of publication:
Conference abstract

Author(s):
*Pastfield E.; *Botley S.; *Pakala V.; *Ingram T.; *Lee E.

Citation:
Journal of Cardiovascular Computed Tomography; 2020; vol. 14 (no. 1)

Abstract:
Introduction: Degenerative aortic stenosis is a common condition. Many elderly frail patients with multiple comorbidities now have an alternative to conventional surgery since the availability of transcutaneous aortic valve implantation (TAVI). Echocardiography (echo) remains the key tool for the diagnosis of aortic stenosis. CT calcium scoring, has proven a useful adjunct to diagnosis, when there are discordant echo measurements. The current societies’ consensus propose a cut-off score (>2000 for men and >1200 for women) above which ‘severe aortic stenosis is likely’. However, many elderly patients have discordant echo measurements, low calcium score despite having severe aortic stenosis. We propose that the adverse event rates in elderly patients, regardless of calcium score category, are not significantly different. Method(s): We retrospectively examined the records of consecutive patients undergoing CT calcium score between Jan 2017 and Sep 2019. These investigations were done, either for TAVI procedure planning or as an adjunct to assessing the severity of aortic stenosis (in the case of discordant echo measurements). All these patients were followed up for adverse events, defined as a composite of heart failure, chest pain or death. Statistical analysis was performed using SPSS 25 (IBM). Result(s): 88 patients, age 82+/-6 years, 55% men, underwent CT aortic valve calcium scoring and echo. Peak aortic velocity 3.9 +/- 0.8 m/s, mean gradient 35 +/- 13 mmHg, aortic valve area 0.8 +/- 0.2cm2, stroke volume index (SVI) 38 +/- 11 ml/m2. 52.4% of the study population had discordant echo measurements and 43.6% had SVI<35ml/m2. The calcium score for women and men were 2230 +/- 1250 and 3866 +/- 1997 respectively. 24% of these patients had calcium score below the cut-off value for ‘likely severe aortic stenosis’. Median follow up was 382 days (range 66-1381 days) from the initial echo. Adverse events occurred in 20+/-4% and 29+/-5% in the ‘high’ and ‘low’ calcium score groups, independent t-test, p=0.40. Using Kaplan-Meier survival curve, there is no difference in the event free survival days between the two groups, 888 days for the ‘low’ and 702 days for the ‘high’ calcium score groups, Log rank Chi-square=0.26, p=0.61. Conclusion(s): In an elderly population with aortic stenosis, there is no difference in short term adverse event rates (composite of heart failure/death/chest pain) as categorised by their calcium scores. Therefore, the current diagnostic approach may under estimate the severity of aortic stenosis in some patients. [Formula presented]

Correlating chest CT radiological reporting of tree-in-bud with clinical diagnosis (2018)

Type of publication:
Conference abstract

Author(s):
*Muthusami R.; *Makan A.; *Ahmad N.; *Srinivasan K.S.; *Moudgil H.

Citation:
American Journal of Respiratory and Critical Care Medicine; May 2018; vol. 197

Abstract:
RATIONALE Although initially describing Endobronchial Tuberculosis, the Tree-in-Bud (TIB) pattern is increasingly recognised in a wider number of conditions. Objective here was to establish how frequently this was reported and the spectrum of subsequent diagnosis. METHODS Reports relating to all Chest CT scans undertaken at our District General Hospital during 2015 were identified and those with reference to TIB further explored from electronic medical records. RESULTS 27 patients had the TIB (2.7% of total CTs) pattern reported. Average age was 72 years with 59% female. The right lung was affected (78%) more than the left (52%) along with one of the lower lobes (55%). The most common lobe affected was the RLL (41%) followed by the RML (37%) and then RUL & LLL (both 33%). 21 (78%) were seen by a Respiratory Physician. For the group as a whole, two had died from advanced cancer (1 lung cancer) and one with advanced dementia. An Infectious Aetiology was proposed in 16 (59%) with half confirmed with a positive microbiological result. 2 patients had Non-Tuberculous Mycobacteria, alongside Chronic Cavitatory Pulmonary Aspergillosis (1), ABPA (Allergic BronchoPulmonary Aspergillosis) in 3 (11%), Emphysema (3), Asbestos Disease (2) and one each had Pulmonary Sarcoid and BOOP (Bronchiolitis Obliterans Organizing Pneumonia). CONCLUSION The Tree-in-Bud pattern occurs as a result of a number of processes, although often they co-exist in the same condition and though we identified some mycobacterial disease, cases identified had a wider spectrum including other infectious, allergic, and vasculitic pathways alongside malignancy. The radiological distribution of disease within the lungs further proposes a role for silent aspiration into the airways. (Figure Presented) .

Anatomical siting of the splenic flexure using computed tomography (2017)

Type of publication:
Journal article

Author(s):
*Meecham, L; *Brookes, A; *Macano, Caw; *Stone, T; *Cheetham, M

Citation:
Annals of the Royal College of Surgeons of England; Mar 2017; vol. 99 (no. 3); p. 207-209

Abstract:
INTRODUCTION Often, left-sided colorectal surgery requires splenic flexure mobilisation (SFM) to allow a tension-free anastomosis to be carried out. This step is difficult and not without risk. We investigated a system of anatomical siting of the splenic flexure using computed tomography (CT). METHODS The Shrewsbury Splenic Flexure Siting (SSFS) system involves siting of the splenic flexure using the vertebral level (VL) as a reference point. We asked three surgical registrars (SRs) to analyse 20 CT scans of patients undergoing colonic resection to ascertain the anatomical site of the splenic flexure using the SSFS system. The distance from the centre of the vertebral body to the lateral edge (CVBL) of the splenic flexure was measured, as was the distance from the centre of the vertebral body to the inner abdominal wall (CVBI) along the same line, on axial images. RESULTS VL assessment demonstrated substantial inter-observer agreement with a kappa (κ) value of 0.742 (95% confidence interval (CI), 0.463-0.890). CVBL and CVBI demonstrated very strong inter-observer agreement (CVBL: κ = 0.905 (95% CI, 0.785-0.961); CVBI: 0.951 (0.890-0.979) (p<0.001). Overall, there was strong correlation between assessments by all three SRs across the three variables measured. CONCLUSIONS The SSFS system is an accurate method to site the splenic flexure anatomically using CT. We can use the SSFS system to develop a validated scoring system to help colorectal surgeons assess the difficulty of SFM.