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Objectives Preoperative identification of the artery of Adamkiewicz can help prevent postoperative spinal cord injury in patients undergoing thoracic and thoraco-abdominal aortic aneurysm repair. Although several studies have shown the feasibility of evaluating the artery of Adamkiewicz using multidetector row computed tomography (MDCT), no detailed investigations regarding the collateral circulation to the artery of Adamkiewicz have been performed. The purpose of this study was to investigate the collateral circulation to the artery of Adamkiewicz using MDCT in patients with thoracic and thoraco-abdominal aortic aneurysms. Methods Our institutional review board approved this study. Sixty-four patients with descending thoracic and thoraco-abdominal aortic aneurysms associated with the occlusion of the segmental artery from which the artery of Adamkiewicz originated were scanned using 64- or 320-detector row computed tomography. Two independent observers evaluated the MDCT images based on the degree of visualization of the artery of Adamkiewicz and its collateral circulation using a 4-point scale. Results The average visualization score was 2.8 ± 0.6. In 53 of the 64 (83%) patients, image quality was judged to be diagnostic. MDCT demonstrated 75 collateral pathways to the artery of Adamkiewicz in these 53 patients. Sixty-four of the 75 (85%) pathways were collaterals around the spinal column, and the remaining 11 (15%) pathways were collateral arteries in the thoracic wall. Conclusions MDCT revealed the collateral pathways to the artery of Adamkiewicz around the spinal column and in the thoracic wall in 83% of our patients with thoracic and thoraco-abdominal aortic aneurysms.

Preoperative identification of the artery of Adamkiewicz can help prevent postoperative spinal cord injury following thoracic and thoracoabdominal aortic repair. Several studies have demonstrated the feasibility of evaluating the artery of Adamkiewicz using multi-detector row computed tomography (CT), but precise visualization remains a challenge. The present study was conducted to evaluate the usefulness of ultra-high-resolution CT for visualizing the artery of Adamkiewicz with a slice thickness of 0.25 versus 0.5 mm in patients with aortic aneurysms. Our institutional review board approved this study. Twenty-four patients with thoracic and thoracoabdominal aneurysms were scanned with beam collimation of 0.25 mm × 128. Images were reconstructed with slice thicknesses of 0.25 and 0.5 mm. The signal-to-noise ratio (SNR) of the aorta and contrast-to-noise ratio (CNR) between the anterior spinal artery and spinal cord were measured. Two independent observers evaluated visualization of the artery of Adamkiewicz and its continuity between the anterior spinal artery and the aorta using a four-point scale. No significant differences in the SNR of the aorta or CNR of the anterior spinal artery were observed between 0.25- and 0.5-mm slices. The average visualization score was significantly higher for 0.25-mm slices (3.58 ± 0.78) than for 0.5-mm slices (3.13 ± 0.99) (p = 0.01). The percentage of patients with nondiagnostic image quality was significantly lower for 0.25-mm slices (8.3%) than for 0.5-mm slices (33.3%) (p = 0.03). In patients with aortic aneurysms, ultra-high-resolution CT with 0.25-mm slices significantly improves visualization of the artery of Adamkiewicz compared to 0.5-mm slices.

Rationale and Objectives Severe calcifications of the coronary arteries are still a major challenge in coronary computed tomography (CT) angiography (CCTA). Subtraction CCTA using a 320-detector row CT scanner has recently been introduced for patients with severe calcifications. However, the conventional subtraction CCTA method requires a long breath-holding time of approximately 20–40 seconds. This is a major problem in clinical practice because many patients may not be able to perform such a long breath-hold. We explored a modified subtraction CCTA method with a short breath-holding time to overcome this problem. Materials and Methods This study was approved by our institutional review board, and all patients gave written informed consent. A total of 12 patients with a coronary calcium score of >400 were enrolled in this study. All patients were unable to hold their breath for more than 20 seconds. Modified subtraction CCTA was performed using the bolus-tracking method. The acquisition protocol was adjusted so that the mask scan was acquired 10 seconds after the postcontrast scan during a single breath-hold. The subtraction image was obtained by subtracting the mask image data from the postcontrast image data. The breath-holding times were recorded. Enhancement of the coronary arteries in the subtraction images was assessed. Subjective image quality was evaluated in a total of 32 segments using a 4-point scale. Results The mean breath-holding time was 12.8 ± 0.8 seconds (range, 12–14 seconds). The average CT number in the coronary arteries was 288.6 ± 80.5 Hounsfield units (HU) in the subtraction images. Average image quality was significantly increased from 2.1 ± 0.9 with conventional CCTA to 3.1 ± 0.7 with subtraction CCTA ( P P = 0.001). Conclusions This preliminary study has shown that our modified subtraction CCTA method allows the breath-holding time to be shortened to

To explore the feasibility and diagnostic accuracy of modified subtraction coronary CT angiography (CCTA) with short breath-holding time in patients who have limited breath-hold capability and severe coronary artery calcification.11 patients with a coronary calcium score400 underwent CCTA using a modified subtraction protocol. All patients were unable to hold their breath for more than 20 s. Subjective image quality using a four-point scale and the presence of significant (50%) luminal stenosis were assessed for each calcified or stented segment on both conventional CCTA and modified subtraction CCTA images and compared with invasive coronary angiography (ICA) as the gold standard.The mean breath-holding time was 13.0 ± 0.9 s. A total of 35 calcified or stented coronary segments were evaluated. The average image quality was increased from 2.1 ± 0.9 with conventional CCTA to 3.1 ± 0.7 with subtraction CCTA (p 0.001). The segment-based diagnostic accuracy for detecting significant stenosis according to ICA revealed an area under the receiver-operating characteristic curve of 0.722 for conventional CCTA and 0.892 for subtraction CCTA (p = 0.036).Modified subtraction CCTA allows the breath-holding time to be shortened to15 s. As compared with conventional CCTA, modified subtraction CCTA showed improvement in image quality and diagnostic accuracy in patients with limited breath-hold capability and severe calcification.Modified subtraction CCTA can improve the diagnostic accuracy in patients with a high calcium score and patients who are unable to perform long breath-holds.

Modulation characteristics of a novel InGaAs/InAlAs multiple quantum well (MQW) microring-enhanced Mach-Zehnder modulator (MRE-MZM) is investigated in detail and its low-voltage operation with high extinction ratio is demonstrated. The MZM has a single microring resonator in one arm and is driven by the change in electrorefractive index induced by the quantum-confined Stark effect in the MQW core layer. As the MQW, a multiple five-layer asymmetric coupled quantum well (FACQW) is used to obtain a large electrorefractive index change. The driving voltage of the proposed MZM is significantly reduced owing to the enhanced phase shift in the microring resonator. High-mesa waveguide structures are grown by solid-source molecular beam epitaxy and fabricated by inductively coupled plasma etching. A directional coupler with an asymmetric branching ratio is used as an input coupler to prevent the degradation of the extinction ratio of the MZM. The extinction ratio of the fabricated MRE-MZM is approximately 27 dB. The product of the half-wave voltage and phase shifter length, V(π) · L, is 1.7 Vmm in static modulation. This value is one-quarter that of a conventional MZM with the same waveguide structure.

The effect of coherent coupling on the performance of a directional coupler is investigated for the first time. Coherent coupling is the interference between a guided mode in a core layer and an unguided mode in a cladding layer (cladding mode) in a waveguide. It was experimentally confirmed that the cladding mode exists in an actual high-mesa semiconductor waveguide and it can be represented by a single propagation constant. The effect of coherent coupling on coupling loss and coupling efficiency in a directional coupler is analyzed using a new technique based on a matrix method. The analyzed results reveal that a small periodic oscillation of coupling loss of the transmitted light that depends on coupler length occurs owing to the coherent coupling in a strong-coupled directional coupler, and its effect should be considered when we minimize propagation loss in high-mesa semiconductor directional couplers. It is also shown that it is possible to design a directional coupler with both the desired coupling efficiency and low loss on the basis of the periodic oscillation of coupling loss.

We propose and a novel InGaAs/InAlAs multiple quantum well (MQW) Mach–Zehnder (MZ) modulator with a single microring resonator, and a significant reduction of driving voltage is demonstrated for the first time. The modulator is driven by the quantum-confined Stark effect (QCSE) in the MQW and the driving voltage of the proposed modulator is expected to be significantly reduced by the phase-shift-enhancement effect in the microring. A waveguide structure was grown by solid-source molecular beam epitaxy and fabricated by inductively coupled plasma etching. A directional coupler with a shallow gap is employed to control the coupling parameters between a busline and the microring waveguide. An asymmetrical splitter was used as an input coupler to prevent the degradation of the extinction ratio of the MZ modulator. The extinction ratio of the fabricated microring MZ modulator was approximately 17.5 dB. The product of half-wave voltage and phase shifter length V π L was 2.0 Vmm in static modulation. This value was one-third that of a conventional MZ modulator with the same waveguide structure.