Download Clinical Diagnosis of Atherosclerosis: Quantitative Methods by D. Eugene Strandness (auth.), M. Gene Bond Ph.D., William PDF

By D. Eugene Strandness (auth.), M. Gene Bond Ph.D., William Insull Jr. M.D., Seymour Glagov M.D., A. Bleakley Chandler M.D., J. Fredrick Cornhill D. Phil. (eds.)

This quantity is the made of a February 1982 convention, cosponsored via the yank center organization, the nationwide Institutes of wellbeing and fitness, and the Bowman grey tuition of medication, which tested concepts for delineating quantitatively the usual heritage of atherosclerosis. opposed to the historical past of present pathologic and medical wisdom of atherosclerosis, invasive and noninvasive evaluative tools now in use and lower than improvement are surveyed extensive. Correlative clinicopathologic reviews of atherosclerosis pose precise questions with admire to either luminal and plaque features which are addressed during this quantity. An outdated observa­ tion, in line with the exam of arterial casts, steered that the so-called nodose lesion of atherosclerosis could be in the beginning flattened into the wall of a weakened, dilated artery, instead of raised into the lumen. this can be now totally proven in vivo through ultrasonic and different imaging ideas. The morbid anatomist is challenged anew to explain lesions as they're prone to take place in vivo. to accomplish nearer correlation with average stipulations, perfu­ sion fixation of arteries lower than arterial strain is turning into extra customary and has already proven extra legitimate quantita­ tion of the composition and configuration of lesions. whereas the noninvasive tools of B-mode and Doppler ultrasound are appropriate just for the scientific learn of superficial arteries, corresponding to the carotid or femoral, the hot and comparatively noninvasive approach of intravenous electronic subtraction angio­ graphy should be successfully used for the exam of deep structures, corresponding to cerebral vessels.

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These features may help to explain why correlations between angiograms and postmortem findings in undistended specimens are best for the most severely advanced lesions (see Chap. 12). The reported angiographic underestimations of narrowings by less advanced lesions may in many instances actually reflect postmortem overestimations due to measurements on collapsed or partially distended vessels. In addition, pressure fixation preserves vessel geometry at branch ostia, bifurcations, and curves, revealing lesion localizations that are more accurate than those noted in freshly opened or immersion-fixed arteries (5).

Intravenous digital radiography, for example, can be used to visualize most of the major arteries except the coronaries, and ultrasound systems are available for routine carotid artery imaging. ' Imaging systems using nuclear magnetic resonance have successfully visualized arteries in small animals and phantoms that simulate arteries in the millimeter range (1). While these noninvasive methods appear very likely to be used for quantitative lesion assessment in the near future, relatively The portion of the work described in this paper that was performed at the Jet Propulsion Laboratory of the California Institute of Technology and at the University of Southern California School of Medicine was supported in part by grants HL-14l38, HL-236l9, HL-23807, and contract HV-7-2930 from the National Heart, Lung, and Blood Institute and by funding from the NASA Office of Life Sciences.

Completely encircling, with or without axisymmetric lumens (11,12). Inferences have been drawn that these configurations have pathogenetic and/or prognostic significance. The extent to which coronary artery plaques are indeed "eccentric" as opposed to "concentric" or encircl ing, or tend to bulge into the lumen on transverse cross section under conditions of normal distending pressure are therefore problems worthy of careful quantitative study. The relative incidence of such manifestations elsewhere in the arterial tree and the relation of such differences in configuration to extent of disease and to lesion location, composition, and complication in the course of lesion, will also require clarification.

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