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PURPOSE: To evaluate the effect of cone-beam computed tomography (CBCT) on radiation exposure, procedure time, and contrast media (CM) use in prostatic artery embolization (PAE). MATERIALS AND METHODS: Seventy-eight patients were enrolled in this retrospective, single-center study. All patients received PAE without (group A; n = 39) or with (group B; n = 39) CBCT. Total dose-area product (DAPtotal; Gycm2), total entrance skin dose (ESDtotal; mGy), and total effective dose (EDtotal; mSv) were primary outcomes. Number of digital subtraction angiography (DSA) series, CM use, fluoroscopy time, and procedure time were secondary outcomes. PAE in group A was performed by a single radiologist with 15 years experience, PAE in group B was conducted by four radiologists with 4 to 6 years experience. RESULTS: For groups A vs. B, respectively, median (IQR): DAPtotal 236.94 (186.7) vs. 281.20 (214.47) Gycm2(p = 0.345); EDtotal 25.82 (20.35) vs. 39.84 (23.75) mSv (p = < 0.001); ESDtotal 2833 (2278) vs. 2563 (3040) mGy(p = 0.818); number of DSA series 25 (15) vs. 23 (10)(p = 0.164); CM use 65 (30) vs. 114 (40) mL(p = < 0.001); fluoroscopy time 23 (20) vs. 28 (25) min(p = 0.265), and procedure time 70 (40) vs.120 (40) min(p = < 0.001). Bilateral PAE was achieved in 33/39 (84.6%) group A and 32/39 (82.05%) group B(p = 0.761), all other patients received unilateral PAE. There were no significant differences between clinical parameters and origins of the prostatic arteries (PA) (p = 0.206-1.00). CONCLUSION: Operators with extensive expertise on PAE may not benefit from addition of CBCT to DSA runs, whereas for operators with less expertise, CBCT when used alongside with DSA runs increased the overall radiation exposure.
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Angiografía de Substracción Digital/métodos , Tomografía Computarizada de Haz Cónico/métodos , Medios de Contraste/farmacología , Embolización Terapéutica/métodos , Hiperplasia Prostática/terapia , Anciano , Fluoroscopía , Humanos , Masculino , Hiperplasia Prostática/diagnóstico , Exposición a la Radiación , Estudios RetrospectivosRESUMEN
PURPOSE: To evaluate the image quality and the safety of automated carbon dioxide (CO2) digital subtraction angiography (DSA). MATERIALS AND METHODS: Fifty patients receiving DSA for femoropopliteal peripheral arterial disease (PAD) were enrolled in this single-center prospective study. All patients received iodinated contrast media (ICM) and CO2 as a contrast agent in the same target lesion. As a primary endpoint, four raters independently evaluated the angiography images based on overall image quality, visibility of collaterals, and assessment of stenoses/occlusions. Inter-rater agreement was assessed using the intraclass correlation coefficient (ICC) and differences between the raters were evaluated using Friedmann's test. Secondary endpoints were procedure safety and patient pain assessment. RESULTS: Inter-rater agreement between CO2-DSA and ICM-DSA images was fair to excellent for overall image quality (ICC: 0.399-0.748), fair to excellent for the visibility of collaterals (ICC: 0.513-0.691), and poor to excellent for the assessment of stenoses/occlusions (ICC: -0.065-0.762). There were no significant differences between the raters. Two patients had a hematoma, one reported pain related to puncture, one became nauseous, and one vomited. No other adverse events were observed. Reported pain scores were significantly higher for CO2-DSA vs. ICM-DSA (1.25 vs. 0625; pâ¯<â¯0.028). CONCLUSION: CO2-DSA using automated injection system in combination with proprietary post-processing software is safe and comparable diagnostic test compared to ICM-DSA.
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Dióxido de Carbono , Enfermedad Arterial Periférica , Angiografía de Substracción Digital , Medios de Contraste/efectos adversos , Arteria Femoral , Humanos , Enfermedad Arterial Periférica/diagnóstico por imagen , Estudios ProspectivosRESUMEN
PURPOSE: To determine whether the use of a magnetic tracking and electrocardiography-guided catheter tip confirmation system (TCS) is safe and noninferior to fluoroscopy concerning positioning accuracy of a peripheral inserted central catheter (PICC). METHODS: In this prospective, randomized, single-center study, adult patients scheduled for PICC insertion were assigned 1:1 either to TCS or fluoroscopy. The primary objective was a noninferiority comparison of correct PICC tip position confirmed by X-ray obtained immediately after catheter insertion. Time needed for PICC insertion and insertion-related complications up to 14 days after the procedure were secondary outcomes to be assessed for superiority. RESULTS: A total of 210 patients (62.3 ± 14.4 years, 63.8% male) were included at a single German center between June 2016 and October 2017. Correct PICC tip position was achieved in 84 of 103 TCS (82.4%) and 103 of 104 fluoroscopy patients (99.0%). One-sided 95% lower confidence limit on the difference between proportions was -23.1%. Thus, noninferiority of TCS was not established (p > 0.99). Insertion of PICC took longer with TCS compared to fluoroscopy (8.4 ± 3.7 min vs. 5.0 ± 2.7 min, p < 0.001). Incidence of complications within a mean follow-up of 5.0 ± 2.3 days did not differ significantly between groups. CONCLUSION: Noninferiority of TCS to fluoroscopy in the incidence of correct PICC tip position was not reached. Ancillary benefit of TCS over fluoroscopy including less radiation exposure and lower resource requirements may nonetheless justify the use of TCS. The study is registered with Clinical.Trials.gov (Identifier: NCT02929368).
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Cateterismo Periférico/métodos , Catéteres Venosos Centrales , Fenómenos Electromagnéticos , Fluoroscopía , Radiografía , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios ProspectivosRESUMEN
BACKGROUND: The aim of this investigator-initiated trial is to evaluate the safety and efficacy of the novel Luminor® paclitaxel-coated drug-eluting balloon (DEB) catheter (iVascular, S.L.U., Barcelona, Spain) in inhibiting restenosis and in ensuring long-term vascular patency. METHODS/DESIGN: This is a multicenter randomized controlled trial to evaluate the Luminor® paclitaxel-coated DEB catheter for stenotic or occlusive lesions (length ≤15 cm) in the superficial femoral artery (SFA) and the popliteal artery (PA) up to the P1 segment compared to the noncoated, plain old balloon angioplasty (POBA) catheter. In total 172 subjects will be treated with either the DEB catheter or the POBA catheter in 11 German study centers in a 1:1 randomization study design. The primary endpoint is late lumen loss (LLL) at 6 months. Secondary endpoints are patency rate, target lesion/vessel revascularization, quality of life (assessed with the Walking Impairment Questionnaire (WIQ) and the EQ-5D), change of Rutherford stage and ankle-brachial index, major and minor amputation rate at the index limb, number of dropouts and all-cause mortality. DISCUSSION: EffPac represents a randomized controlled trial that will provide evidence on the effectiveness of the Luminor® paclitaxel-coated DEB catheter for the reduction of restenosis compared to the POBA catheter for the SFA and the PA. The results of EffPac will allow direct comparison to other already-completed RCTs applying paclitaxel-coated DEBs from different manufacturers with different coating technologies in the same target vessel. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02540018 , registered on 17 August 2015. Protocol version: CIP Version Final04, 11 February 2016. EUDAMED No: CIV-15-03-013204.
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Angioplastia de Balón/instrumentación , Fármacos Cardiovasculares/administración & dosificación , Materiales Biocompatibles Revestidos , Arteria Femoral , Paclitaxel/administración & dosificación , Enfermedad Arterial Periférica/terapia , Arteria Poplítea , Dispositivos de Acceso Vascular , Angiografía de Substracción Digital , Angioplastia de Balón/efectos adversos , Índice Tobillo Braquial , Fármacos Cardiovasculares/efectos adversos , Protocolos Clínicos , Angiografía por Tomografía Computarizada , Constricción Patológica , Tolerancia al Ejercicio , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/fisiopatología , Alemania , Humanos , Masculino , Paclitaxel/efectos adversos , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/fisiopatología , Calidad de Vida , Recuperación de la Función , Recurrencia , Proyectos de Investigación , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex , Grado de Desobstrucción Vascular , CaminataRESUMEN
OBJECTIVES: To evaluate the impact of endovascular embolisation therapy in men with erectile impotence due to veno-occlusive dysfunction. METHODS: We retrospectively evaluated 29 patients with a history of erectile impotence due to veno-oclusive dysfunction confirmed by pharmacocavernosometry and cavernosography. All underwent endovascular embolisation therapy over transfemoral approach. After positioning the catheter system at the target level heights, embolisation with N-butyl-2-cyanoacrylate (Histoacryl(®)) was performed. Technical and clinical success as well as major and minor complications were evaluated. RESULTS: All procedures were performed without any major or minor events. Complication rate was 0%. Technical success was achieved in 27/29 (93.1%). Two patients failed for anatomical reasons. Overall clinical success was achieved in 24/27 (88.8%) patients with recovering from E1 (poor tumescense/no rigidity) to E4 (good tumescence/intermediate rigidity) in 11/27 (40.7%), E1 to E5 in 8/27 (tumescence/normal rigidity) (29.6%) and E1 to E3 (good tumescence/poor rigidity) in 5/27 (18.5%) respectively. 3/27 (11.1%) received no change in ED severity score. CONCLUSION: Endovascular embolisation therapy for veno-occlusive dysfunction in erectile impotence is a safe and effective therapeutic option with low complication rate and highly technical and clinical success rates.
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Embolización Terapéutica/métodos , Enbucrilato/uso terapéutico , Hemostáticos/uso terapéutico , Impotencia Vasculogénica/diagnóstico , Impotencia Vasculogénica/terapia , Insuficiencia Venosa/diagnóstico , Insuficiencia Venosa/terapia , Adulto , Humanos , Impotencia Vasculogénica/etiología , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Insuficiencia Venosa/etiología , Adulto JovenRESUMEN
BACKGROUND: We report the results of our single center series of patients with chronic mesenteric ischemia (CMI) to determine the role of stenting in the management of patients. PATIENTS AND METHODS: We retrospectively reviewed all patients with CMI treated endovascularly with stent revascularisation from January 2008 to January 2011.CMI diagnosis was made according to clinical symptoms, including postprandial abdominal pain, food fear, and weight loss. Additionally, the diagnosis was confirmed by duplex ultrasonography and/or computed tomography angiography and/or contrast-enhanced magnetic resonance angiography. RESULTS: All 45 patients presented with typical CMI symptoms: 45/45 (100 %) had postprandial pain, 31/45 (68.8 %) had a weight loss of more than 10 kilograms, and 11/45 (24.4 %) suffered from ischemic colitis combined with lower gastrointestinal bleeding. In three patients occlusion could not be crossed, therefore considered as technical failure. A total of 55 arteries were stented in the remaining 42 patients. Nineteen patients underwent SMA stenting alone, eight underwent celiac stenting, alone and three patients underwent stenting of inferior mesenteric artery (IMA) alone. We performed combined stenting of the celiac artery and superior mesenteric artery in ten patients, and one patient underwent a combined stenting of the celiac artery and the IMA. All three mesenteric arteries were stented in only one patient. Primary technical success was achieved in 42/45 (94.8 %) patients. Clinical symptom relief was achieved in 39/45 (86.6 %) patients with abdominal pain. Increased body weight was observed in 28/31 (90.3 %) patients with an average weight gain of 8.8 kilograms (5 - 12 kilograms), and 10/11 (90.9 %) patients recovered from ischaemic colitis/lower gastrointestinal bleeding. CONCLUSIONS: Stent revascularisation can be considered as the first-line therapy for patients with chronic mesenteric ischemia.
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Angioplastia de Balón/instrumentación , Isquemia/terapia , Oclusión Vascular Mesentérica/terapia , Stents , Enfermedades Vasculares/terapia , Dolor Abdominal/etiología , Anciano , Angioplastia de Balón/efectos adversos , Arteria Celíaca , Constricción Patológica , Femenino , Hemorragia Gastrointestinal/etiología , Alemania , Humanos , Isquemia/complicaciones , Isquemia/diagnóstico , Estimación de Kaplan-Meier , Angiografía por Resonancia Magnética , Masculino , Arterias Mesentéricas , Isquemia Mesentérica , Oclusión Vascular Mesentérica/complicaciones , Oclusión Vascular Mesentérica/diagnóstico , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnóstico , Pérdida de PesoRESUMEN
OBJECTIVES: To evaluate the use of dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck. METHODS: We retrospectively evaluated the head-neck MRIs of 30 patients with a history of hyperparathyroidism, prior head-neck surgery, and intraoperative proven adenomas. The protocol included conventional imaging with T2-weighted STIR sequences, T1w axial and coronal prior to and after contrast media administration, and dynamic magnetic resonance angiography. We compared the results from MRI, dynamic magnetic resonance angiography with 99m-Tc-Sestamibi with intraoperative findings as the gold standard. RESULTS: In conventional MRI 19/30 true positives were detected with a sensitivity and specificity of 63.3% and 100%, respectively. However, by adding dynamic magnetic resonance angiography the detection rate increased to 28/30 true positives. Based on intraoperative findings, the sensitivity and specificity of dynamic magnetic resonance angiography were 93.3% and 100%, respectively. 99m-Tc-Sestamibi detected 24/30 true positives, sensitivity was 80%. CONCLUSION: The diagnostic value of MRI including dynamic magnetic resonance angiography is superior to MRI alone and superior to that of 99m-Tc-Sestamibi in the diagnostic workup of hyperfunctioning parathyroid glands when compared against intraoperative findings.
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Hiperparatiroidismo/patología , Hiperparatiroidismo/cirugía , Angiografía por Resonancia Magnética/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Post-therapeutic imaging is crucial for treatment planning and control in patients with malignant lesions in the head and neck. Focussed on CT, PET-CT and MRI, imaging strategies for post-therapeutic follow-up have been developed and investigated during the last few years. This review should help to interpret the results of these studies and make the reader familiar with the latest developments.
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Aumento de la Imagen , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias de Oído, Nariz y Garganta/diagnóstico , Neoplasias de Oído, Nariz y Garganta/terapia , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Terapia Combinada , Medios de Contraste/administración & dosificación , Diagnóstico Diferencial , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Metástasis Linfática/patología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neoplasias Primarias Desconocidas/diagnóstico , Neoplasias Primarias Desconocidas/patología , Neoplasias Primarias Desconocidas/terapia , Neoplasias de Oído, Nariz y Garganta/patología , Neoplasias de Oído, Nariz y Garganta/secundario , Pronóstico , Sensibilidad y EspecificidadAsunto(s)
Absceso/diagnóstico por imagen , Artritis Infecciosa/diagnóstico por imagen , Clavícula/diagnóstico por imagen , Mediastinitis/diagnóstico por imagen , Osteomielitis/diagnóstico por imagen , Articulación Esternoclavicular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Absceso/patología , Absceso/cirugía , Artritis Infecciosa/patología , Artritis Infecciosa/cirugía , Clavícula/patología , Clavícula/cirugía , Diagnóstico Diferencial , Drenaje , Humanos , Masculino , Mediastinitis/patología , Mediastinitis/cirugía , Persona de Mediana Edad , Osteomielitis/patología , Osteomielitis/cirugía , Músculos Pectorales/diagnóstico por imagen , Músculos Pectorales/patología , Músculos Pectorales/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación , Articulación Esternoclavicular/patología , Articulación Esternoclavicular/cirugíaAsunto(s)
Angiografía de Substracción Digital , Arteria Carótida Interna , Estenosis Carotídea/diagnóstico , Angiografía Cerebral , Hemorragia Cerebral/diagnóstico , Infarto Cerebral/diagnóstico , Imagen de Difusión por Resonancia Magnética , Síndrome de Down/complicaciones , Hemiplejía/etiología , Procesamiento de Imagen Asistido por Computador , Angiografía por Resonancia Magnética , Enfermedad de Moyamoya/complicaciones , Enfermedad de Moyamoya/diagnóstico , Ultrasonografía Doppler Transcraneal , Preescolar , Síndrome de Down/diagnóstico , Humanos , Masculino , Cuidados PaliativosRESUMEN
PURPOSE: To evaluate the frequency of ischemia after transbrachial digital subtraction angiography under ambulant conditions using diffusion-weighted imaging. MATERIALS AND METHODS: 200 patients were included in a prospective study design and received transbrachial digital subtraction angiography under ambulant conditions. Before and after digital subtraction angiography, diffusion-weighted imaging of the brain was performed. RESULTS: In our study population no new lesions were found in diffusion-weighted imaging after digital subtraction angiography during the 3-hour window after angiography. One new lesion was found 3 days after angiography as a late onset complication. Therefore, the frequency of neurological complications is at the level of the confidence interval of 0 - 1.5 %. CONCLUSION: The transbrachial approach under ambulant conditions is a safe method for digital subtraction angiography resulting in a low rate of ischemic lesions in diffusion-weighted imaging.
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Angiografía de Substracción Digital/efectos adversos , Arteria Braquial , Isquemia Encefálica/diagnóstico , Imagen de Difusión por Resonancia Magnética , Embolia Intracraneal/diagnóstico , Adulto , Anciano , Atención Ambulatoria , Isquemia Encefálica/epidemiología , Estudios Transversales , Femenino , Alemania , Humanos , Embolia Intracraneal/epidemiología , Masculino , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Aracnoiditis/diagnóstico , Quistes/etiología , Aumento de la Imagen , Imagen por Resonancia Magnética , Compresión de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/etiología , Hemorragia Subaracnoidea/complicaciones , Vértebras Torácicas , Aracnoiditis/cirugía , Quistes/diagnóstico , Quistes/cirugía , Femenino , Humanos , Laminectomía , Persona de Mediana Edad , Compresión de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/cirugía , Vértebras Torácicas/patología , Vértebras Torácicas/cirugía , Adherencias TisularesRESUMEN
BACKGROUND: Description of the technique of the transbrachial catheter diagnostics, retrospective evaluation of the technical success rate and the complications. PATIENTS AND METHODS: In a period of 8 years the transbrachial approach was used in 2555 patients, 1734 men and 821 women with an average age of 62.9 years. The investigation was done with outpatients in approximately 90% of the cases. Usually, the preferred arm was not punctured. For the diagnostics F4 and F5-catheter sheaths and selective catheter and/or plain catheters were used. RESULTS: 12 times (0.47%) the investigation did not succeed technically. The image quality of the vascular representations was diagnostically sufficient. The total complication rate amounted to 0.47%. The following complications appeared: four dissections in the site of puncture, one embolism into arteries at the forearm, three transitory ischemic attacks, four haematoma at the site of puncture. CONCLUSIONS: The transbrachial catheter diagnostics is a little invasive, efficient and low-risk method, which is practicable in out-patients.
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Angiografía/métodos , Angiografía/estadística & datos numéricos , Arteria Braquial/diagnóstico por imagen , Medios de Contraste/administración & dosificación , Medición de Riesgo/métodos , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Causalidad , Femenino , Alemania/epidemiología , Humanos , Inyecciones Intraarteriales/métodos , Inyecciones Intraarteriales/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Punciones/métodos , Punciones/estadística & datos numéricos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Evaluation of the technical practicability of the acute results and complications with transbrachial catheter interventions. PATIENTS AND METHODS: Retrospective investigation of 156 catheter interventions with 147 patients within the period of 4/2000 to 12/2003. Target vessel, technical success, complications and in- or out-patient' practicability received special consideration. RESULTS: The intervention was technically successful in 94%, 10 times segment obliterations of the distal femoral artery could not be recanalised. Renal arteries and mesenteric arteries going off steeply, processes of the femoral bifurcation, bypass stenosis, bilateral distal vascular processes as well as difficult puncturable or not puncturable inguinal arteries are particularly suitable for transbrachial procedure. Three complications arose, two haematoma, conservatively treated, and one cerebrovascular insult. CONCLUSIONS: Many vascular processes can be treated without any problem by transbrachial approach. The technical success rates are very high. The interventions can be realized without hospitalisation of the patient, except for some special cases (renal arteries and mesenteric arteries). The complication rate is low, condition is a large experience of the examiner.
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Arteria Braquial/cirugía , Cateterismo Periférico/métodos , Cateterismo Periférico/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Medición de Riesgo/métodos , Enfermedades Vasculares/epidemiología , Enfermedades Vasculares/cirugía , Adulto , Anciano , Causalidad , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del TratamientoRESUMEN
Magnetic resonance angiography is a noninvasive method in vascular imaging using non-contrast-enhanced and contrast-enhanced techniques. The contrast media used in contrast-enhanced magnetic resonance angiography are different from the X-ray contrast me-dia and do not affect the thyroid gland or renal function. In detecting hypervascularized lesions in the head and neck, contrast-enhanced magnetic resonance angiography is the method of choice, which provides an acceptable quality in comparison to digital subtraction angiography. Future developments in magnetic resonance imaging techniques will cause a wider use of magnetic resonance angiography, especially in head and neck imaging. Digital subtraction angiography should therefore only be used in problem cases and for preoperative embolization.
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Neoplasias de Cabeza y Cuello/diagnóstico , Angiografía por Resonancia Magnética , Enfermedades Vasculares/diagnóstico , Angiografía de Substracción Digital , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/diagnóstico por imagen , Circulación Colateral , Contraindicaciones , Medios de Contraste , Cabeza , Neoplasias de Cabeza y Cuello/irrigación sanguínea , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Angiografía por Resonancia Magnética/métodos , Cuello , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Ultrasonografía , Enfermedades Vasculares/diagnóstico por imagenRESUMEN
Magnetic resonance angiography is a noninvasive method in vascular imaging using non-contrast-enhanced and contrast-enhanced techniques. The contrast media used in contrast-enhanced magnetic resonance angiography are different from the X-ray contrast media and do not affect the thyroid gland or renal function. In detecting hyper-vascularized lesions in the head and neck, contrast-enhanced magnetic resonance angiography is the method of choice, which provides an acceptable quality in comparison to digital subtraction angiography. Future developments in magnetic resonance imaging techniques will cause a wider use of magnetic resonance angiography, especially in head and neck imaging. Digital subtraction angiography should therefore only be used in problem cases and for preoperative embolization.
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Aumento de la Imagen , Procesamiento de Imagen Asistido por Computador , Angiografía por Resonancia Magnética , Enfermedades Otorrinolaringológicas/diagnóstico , Neoplasias de Oído, Nariz y Garganta/diagnóstico , Angiografía de Substracción Digital , Malformaciones Arteriovenosas/diagnóstico , Estenosis Carotídea/diagnóstico , Contraindicaciones , Diagnóstico Diferencial , Humanos , Neovascularización Patológica/diagnóstico , Neoplasias de Oído, Nariz y Garganta/irrigación sanguínea , Paraganglioma/irrigación sanguínea , Paraganglioma/diagnóstico , Sensibilidad y EspecificidadRESUMEN
PURPOSES: Evaluation of high resolution dynamic magnetic resonance angiography (ceMRA) in detection and graduation of carotid artery stenosis in comparison to intraarterial digital subtraction angiography. MATERIALS AND METHODS: Magnetic resonance angiography and intraarterial digital subtraction angiography was performed in 65 patients with suspected carotid artery stenosis by ultrasound examination. Detection and graduation of carotid artery stenosis by magnetic resonance angiography were compared to those of intraarterial digital subtraction angiography after stenosis grading according to NASCET criteria. RESULTS: All magnetic resonance angiographies were of excellent quality, with 46 stenoses type I and II and 12 stenoses type III NASCET correctly identified and classified by magnetic resonance angiography. Overestimation was found in 4 cases and underestimation in 2 cases. Both modalities detected 13 occlusions. Sensitivity and specificity of ceMRA were 92%. The positive predictive value was 86% and the negative predictive value 96%. CONCLUSION: High resolution dynamic magnetic resonance angiography is suitable in detecting and classifying carotid artery stenoses over 70% with high sensitivity and specificity in comparison to intraarterial digital subtraction angiography. Intraarterial digital subtraction angiography should only be performed in critical cases.