A comprehensive review of finerenone-a third-generation non-steroidal mineralocorticoid receptor antagonist.

Multiple studies have shown that finerenone (BAY 94-8862), a third-generation non-steroidal mineralocorticoid receptor antagonist (MRA), possesses different or superior mechanisms of action to traditional MRAs. Specifically, animal and cell-based experiments have demonstrated that this compound exerts multiple effects including fibrosis inhibition, reduced pulmonary artery pressure, improved diabetic retinopathy, enhanced endothelial functions, metabolic optimization as well as reduced oxidative stress, thereby exerting overall positive effects on renal and cardiovascular diseases. Consequently, clinical research, such as the FIGARO-DKD and FIDELIO-DKD trials, has demonstrated dual benefits for patients with type 2 diabetes mellitus and chronic kidney disease (T2DM-CKD), especially by validating MRAs' potential in reducing risks of renal and cardiovascular composite endpoints. Currently, cardiovascular indications for finerenone are limited to patients with T2DM-CKD, while its use in non-T2DM CKD patients remains at clinical trial stages. Despite showing good safety and efficacy in T2DM-CKD patients, there are insufficient corresponding data for those presenting chronic kidney disease without diabetes (ndCKD). Furthermore, the application of this compound in diseases such as primary aldosteronism and its association with cancer risk need to be further validated through larger-scale and longer-term clinical studies. Nevertheless, the development of finerenone provides an additional option for treating cardiovascular and renal diseases. With further research, it is expected that finerenone will be relevant to a broader range of CKD patient populations by addressing current knowledge gaps to comprehensively evaluate its clinical value and potentially alter existing treatment strategies. The current review aims to comprehensively analyze the basic research and clinical advancements involving finerenone in order to explore its prospects for treating cardiovascular and renal diseases, while addressing unmet needs in current treatment strategies. Additionally, through a comprehensive analysis of relevant research findings, a deeper understanding of finerenone's drug characteristics will be provided alongside scientific guidance for future treatment strategies and their clinical significance.

Highly efficient image navigator based 3D whole-heart cardiac MRA at 0.55T.

PURPOSE: To develop and evaluate a highly efficient free-breathing and contrast-agent-free three-dimensional (3D) whole-heart Cardiac Magnetic Resonance Angiography (CMRA) sequence at 0.55T. METHODS: Free-breathing whole-heart CMRA has been previously proposed at 1.5 and 3T. Direct application of this sequence to 0.55T is not possible due to changes in the magnetic properties of the tissues. To enable free-breathing CMRA at 0.55T, pulse sequence design and acquisition parameters of a previously proposed whole-heart CMRA framework are optimized via Bloch simulations. Image navigators (iNAVs) are used to enable nonrigid respiratory motion-correction and 100% respiratory scan efficiency. Patch-based low-rank denoising is employed to accelerate the scan and account for the reduced signal-to-noise ratio at 0.55T. The proposed approach was evaluated on 11 healthy subjects. Image quality was assessed by a clinical expert (1: poor to 5: excellent) for all intrapericardiac structures. Quantitative evaluation was performed by assessing the vessel sharpness of the proximal right coronary artery (RCA). RESULTS: Optimization resulted in an imaging flip angle of 11 0 ∘ $$ 11{0}^{\circ } $$ , fat saturation flip angle of 18 0 ∘ $$ 18{0}^{\circ } $$ , and six k-space lines for iNAV encoding. The relevant cardiac structures and main coronary arteries were visible in all subjects, with excellent image quality (mean 4 . 9 / 5 . 0 $$ 4.9/5.0 $$ ) and minimal artifacts (mean 4 . 9 / 5 . 0 $$ 4.9/5.0 $$ ), with RCA vessel sharpness ( 50 . 3 % ± 9 . 8 % $$ 50.3\%\pm 9.8\% $$ ) comparable to previous studies at 1.5T. CONCLUSION: The proposed approach enables 3D whole-heart CMRA at 0.55T in a 6-min scan ( 5 . 9 ± 0 . 7 min $$ 5.9\pm 0.7\;\min $$ ), providing excellent image quality, minimal artifacts, and comparable vessel sharpness to previous 1.5T studies. Future work will include the evaluation of the proposed approach in patients with cardiovascular disease.

Dynamic contrast-enhanced MRA of the aorta using a Golden-angle RAdial Sparse Parallel (GRASP) sequence: comparison with conventional time-resolved cartesian MRA (TWIST).

PURPOSE: To compare the application of two contrast-enhanced time-resolved magnetic resonance angiography sequences on an aortic disease patient cohort: the conventional Cartesian-sampling-based, Time-resolved angiography With Interleaved Stochastic Trajectories (TWIST) sequence, and the radial-sampling-based Golden-angle RAdial Sparse Parallel (GRASP) sequence. TWIST is highly sensitive to patient movement, which can lead to blurring and reduced sharpness of vascular structures, particularly in dynamic regions like the aorta. Such motion artifacts can compromise diagnostic accuracy. Radial-sampling-based techniques are less sensitive to motion than cartesian sampling and are expected to improve the image quality in body parts subjected to motion. METHODS: 30 patients (60.9 ± 16.1y.o.) with various aortic diseases underwent a 1.5T magnetic resonance angiography examination. Assessment of image quality in the ascending aorta (AA), descending aorta (DA), and abdominal aorta (AbA) on a 4-point Likert scale (1 = excellent, 4 = non-diagnostic) as well as max. aortic diameters (Dmax) were performed. T-test and multilevel mixed-effect proportional-odds models were used for the image analysis. RESULTS: GRASP offered superior depiction of vascular structures in terms of vascular contrast for qualitative analysis (TWIST, reader 1: 1.6 ± 0.5; reader 2: 1.9 ± 0.4; reader 3: 1.1 ± 0.4; GRASP, reader 1: 1.5 ± 0.5; reader 2: 1.4 ± 0.5; reader 3: 1.0 ± 0.2) and vessel sharpness for qualitative (TWIST, reader 1: 1.9 ± 0.6; reader 2: 1.6 ± 0.6; reader 3: 2.0 ± 0.3; GRASP, reader 1: 1.4 ± 0.6; reader 2: 1.2 ± 0.4; reader 3: 1.3 ± 0.6) and quantitative analysis (TWIST, AA = 0.12 ± 0.04, DA = 0.12 ± 0.03, AbA = 0.11 ± 0.03; GRASP, AA = 0.20 ± 0.05, DA = 0.22 ± 0.06, AbA=0.20 ± 0.05). Streaking artefacts of GRASP were more visible compared to TWIST (TWIST, reader 1: 2.2 ± 0.6; reader 2: 1.9 ± 0.3; reader 3: 2.0 ± 0.5; GRASP, reader 1: 2.6 ± 0.6; reader 2: 2.3 ± 0.5; reader 3: 2.8 ± 0.6). Aortic Dmax comparison among the sequence showed no clinical relevance. CONCLUSION: GRASP outperformed TWIST in SNR, vessel sharpness, and reduction in image blurring; streaking artefacts were stronger with GRASP, but did not affect diagnostic image quality.

Comparative effectiveness and safety of eplerenone and spironolactone in patients with heart failure: a systematic review and meta-analysis.

BACKGROUND: Eplerenone and spironolactone, recognized as mineralocorticoid receptor antagonists (MRAs), have been reported to improve clinical prognosis among individuals diagnosed with heart failure (HF). However, the difference in the clinical effects between eplerenone and spironolactone in individuals with HF remains uncertain. We aimed to assess the impact of eplerenone compared to spironolactone on clinical outcomes within the HF population. METHODS: An extensive search was executed in several databases (PubMed, Web of Science, Scopus, Cochrane Library). All relevant studies evaluating eplerenone compared to spironolactone in patients with HF were included. Dichotomous data were pooled as Hazard ratio (HR) or Risk ratio (RR) with a 95% confidence interval (CI). Our main outcome was all-cause mortality. Secondary outcomes included death from cardiovascular causes, treatment withdrawal, and gynecomastia. RESULTS: Ten studies, comprising 21,930 HF individuals, were included in our investigation. Eplerenone showed a lower risk of all-cause mortality (HR = 0.78, 95%CI [0.64 to 0.94], P = 0.009) and cardiovascular mortality (HR = 0.54, 95%CI [0.39, 0.74], P = 0.0001) compared to spironolactone. Furthermore, eplerenone exhibited a reduced risk of treatment withdrawal (RR = 0.69, 95% CI [0.62, 0.78], P = 0.0001) and gynecomastia (RR = 0.07, 95% CI [0.02 to 0.31], P = 0.0001) than spironolactone. CONCLUSION: Eplerenone revealed lower all-cause and cardiovascular mortality events in comparison to spironolactone. Moreover, eplerenone was associated with lower gynecomastia and treatment withdrawal events compared to spironolactone. Further well-designed randomized controlled trials are still warranted better to identify the clinical differences between eplerenone and spironolactone. TRIAL REGISTRATION: Protocol registration: https://doi.org/10.17605/OSF.IO/VNMGK.

Significant systematic bias of alpha angles measured on MRI compared to various radiographic views in patients with femoroacetabular impingement syndrome.

PURPOSE: The aim of this study was to assess the inter-rater reproducibility and inter-method comparability of hip alpha angle measurements on magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA) and plain radiographs in patients with femoroacetabular impingement syndrome (FAIS). METHODS: A cross-sectional study of patients who were diagnosed with symptomatic FAIS underwent preoperative MRI/MRA with axial oblique and/or radial plane imaging and had preoperative radiographs with anterior-posterior (AP), 45° Dunn and 90° Dunn views. Alpha angle measurements were performed independently by two musculoskeletal radiologists. Inter-rater reproducibility and inter-method comparability between MRI/MRA images and radiographic views were assessed using the intraclass correlation coefficient (ICC) with 95% confidence interval (CI). RESULTS: Ninety-seven patients were included of whom 93 (95.8%) received axial oblique plane images and 54 (55.6%) had radial plane MRI/MRA images. Inter-rater reproducibility was excellent (ICC > 0.9) for all planes on MRI/MRA and radiographs. MRI/MRA axial oblique images had poor (ICC 0.39, 95% CI [0.09, 0.59]), moderate (ICC 0.57, 95% CI [0.18, 0.75]) and moderate (ICC 0.64, 95% CI [0.20, 0.81]) comparability with AP, 45° Dunn and 90° Dunn, respectively. MRI/MRA radial plane images had equivocal (0 included in all CIs) comparability with AP (ICC 0.66), 45° Dunn (ICC 0.35) and 90° Dunn (ICC 0.14) radiographs. On average, alpha angle measurements were significantly higher with radial images and lower with axial oblique images, when compared to all radiographic views (p < 0.05), except axial oblique versus 45° Dunn views, where angles measured on axial oblique were significantly larger. CONCLUSION: Alpha angle measurements taken on axial oblique MRI/MRA images show moderate comparability to radiographic 45° Dunn and 90° Dunn views despite negative bias to measurements taken on radiographic AP and 45° Dunn view. Larger alpha angles were appreciated on MRI/MRA radial and axial oblique views compared to radiographic views supporting the inclusion of MRI/MRA alpha angle measurements to properly identify deformity. LEVEL OF EVIDENCE: Level II.

Characterization of cyclotides Mra30 and cycloviolacin O17 derived from Viola dalatensis Gadnep.

Bacteria threaten human and animal health, and standard antibiotics no longer effective. Antibiotic-resistant microorganisms can make infection treatment challenging and perhaps fail. Investigating the attributes of cyclotide, a peptide with promising antibacterial properties that holds great potential in the field of antibiotic research. The structure of these cyclic peptides involves six conserved cysteine residues that form three disulfide bonds, resulting in a cyclic cystine knot (CCK). This feature guarantees their durability when exposed to changes in temperature, chemicals, and enzymatic degradation. The two cyclotides, cycloviolacin O17 and mra30, were obtained from Viola dalatensis Gadnep through a series of techniques including the use of a 50% acetonitrile/49% miliQ water/1% formic acid solution for extraction, ammonium salt precipitation, RP-HPLC purification and sequence identification by LC-MS/MS. These cyclotides exhibit antibacterial effects on specific strains of bacteria like Staphylococcus aureus, Bacillus subtilis, and Pseudomonas aeruginosa at a concentration of 0.2 mg/mL, leading to inhibition zones ranging from 10 to 14 mm. In addition, the disulfide bonds play a crucial role in the antibacterial function of cyclotides. Disrupting the disulfide bonds through ankylation reaction results in the loss of antibacterial properties in the cyclotides (cyO17 and mra30). The minimum inhibitory concentration (MIC) values of mra30 and cyO17 are significantly low, ranging from 0.1 to 0.6 µM. These values are approximately three times lower than the MIC values observed in salt precipitation samples.

High-resolution magnetic resonance imaging features of time-of-flight magnetic resonance angiography signal loss and its relevance to ischemic stroke.

Background: Focal signal loss of intracranial artery stenosis is commonly observed on three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA). We aimed to investigate the underlying pathophysiology of vessel signal loss observed on 3D-TOF-MRA and its relevance to recent ischemic stroke. Methods: High-resolution magnetic resonance imaging (HR-MRI) was performed in 401 patients with unilateral or bilateral moderate-to-severe stenosis (50-99%) of the middle cerebral artery (MCA) on TOF-MRA. The patients were classified according to the presence or absence of focal signal loss in the M1 segment of the MCA. The wall features between the vessels with and without signal loss were compared, and their relationship with recent ischemic stroke was analyzed. Results: A total of 414 stenotic lesions caused by atherosclerotic plaque were detected, including 231 with signal loss on TOF-MRA and 183 without. The signal loss group, compared to the group without signal loss, showed a higher degree of stenosis (P<0.001), grade 2 enhanced plaques (82.3% vs. 28.4%; P<0.001), and concentric pattern (63.2% vs. 34.4%; P<0.001). Multivariate analysis suggested grade 2 enhanced plaques and concentric pattern were independently associated with signal loss. Patients in the signal loss group were more likely to have had a recent ischemic stroke (62.4% vs. 40.4%; P<0.001). Conclusions: In addition to the degree of stenosis, the vulnerability and morphology of plaques on HR-MRI may influence signals on 3D-TOF-MRA. The presence of signal loss on 3D-TOF-MRA is associated with recent ischemic stroke.

Highly accelerated non-contrast-enhanced time-resolved 4D MRA using stack-of-stars golden-angle radial acquisition with a self-calibrated low-rank subspace reconstruction.

PURPOSE: To develop a highly accelerated non-contrast-enhanced 4D-MRA technique by combining stack-of-stars golden-angle radial acquisition with a modified self-calibrated low-rank subspace reconstruction. METHODS: A low-rank subspace reconstruction framework was introduced in radial 4D MRA (SUPER 4D MRA) by combining stack-of-stars golden-angle radial acquisition with control-label k-space subtraction-based low-rank subspace modeling. Radial 4D MRA data were acquired and reconstructed using the proposed technique on 12 healthy volunteers and 1 patient with steno-occlusive disease. The performance of SUPER 4D MRA was compared with two temporally constrained reconstruction methods (golden-angle radial sparse parallel [GRASP] and GRASP-Pro) at different acceleration rates in terms of image quality and delineation of blood dynamics. RESULTS: SUPER 4D MRA outperformed the other two reconstruction methods, offering superior image quality with a clear background and detailed delineation of cerebrovascular structures as well as great temporal fidelity in blood flow dynamics. SUPER 4D MRA maintained excellent performance even at higher acceleration rates. CONCLUSIONS: SUPER 4D MRA is a promising technique for highly accelerating 4D MRA acquisition without comprising both temporal fidelity and image quality.

Predicting the O'Kelly-Marotta scale score after flow-diverter stent placement using silent MRA.

PURPOSE: Flow-diverter (FD) stents were developed to treat aneurysms that are difficult to treat with conventional coiling or surgery. This study aimed to compare usefulness of Silent MRA and TOF (time of flight) -MRA in patients with aneurysms after FD placement. MATERIALS AND METHODS: We retrospectively collected images from 22 patients with 23 internal carotid artery aneurysms treated with FD. Two radiologists conducted MRA and DSA experiments. In the first reading experiment, the radiologists evaluated the aneurysm filling by employing Silent MRA and TOF-MRA and utilizing the modified O'Kelly-Marotta (OKM) scale, a four-class classification system for aneurysms after FD placement. We then calculated the agreement between the modified OKM scale on MRA and the original OKM scale on DSA. In the second reading experiment, the radiologists rated blood flow within the FD using a five-point scale. RESULTS: The weighted kappa value of the OKM scale between DSA and TOF-MRA was 0.436 (moderate agreement), and that between DSA and Silent MRA was 0.943 (almost perfect agreement). The accuracies for the four-class classification were 0.435 and 0.870 for TOF-MRA and Silent MRA, respectively. The mean score of blood flow within FD for TOF-MRA was 2.43 ± 0.90 and that for Silent MRA was 3.04 ± 1.02 (P < 0.001). CONCLUSION: Silent MRA showed a higher degree of agreement than TOF-MRA in aneurysm filling with DSA. In addition, Silent MRA was significantly superior to TOF-MRA in depicting blood flow within the FD. Therefore, Silent MRA is clinically useful for the follow-up of patients after FD placement.

Cardio-reno-vascular protection in type 2 diabetes mellitus: new insights into pharmacotherapeutic management.

INTRODUCTION: From 2008 and following the withdrawal of rosiglitazone, obligatory cardiovascular outcomes trials are performed for glucose lowering drugs introduced to the market to ensure their cardiovascular (CV) safety. Paradoxically, these studies have demonstrated CV safety but also shown additional cardio-reno-vascular protection of some therapeutic agents. Additionally, nonsteroidal mineralocorticoid receptor antagonists (ns-MRA) have emerged as novel drugs for cardio - and renoprotection in type 2 diabetes (T2D) and chronic kidney disease (CKD). In addition to atherosclerotic CV disease, heart failure (HF) and CKD are important clinical problems in T2D leading to poor quality of life and premature death as such cardio-reno-vascular protection is an important clinical issue. AREAS COVERED: We provide new insights into pharmacotherapeutic cardio-reno-vascular protection in T2D based on the new glucose lowering drugs and ns-MRA. PUB MED/CINAHL/Web of Science/Scopus were searched (May 2024). EXPERT OPINION: The conventional glucose lowering approach alone which was implemented for decades is now replaced by the use of disease modifying drugs which lower the rates of CV events, HF decompensation, hospitalization due to HF, slow progression of CKD and all-cause mortality. Indeed, the choice of medications in T2D should be focused on underlying co-morbidities with cardio-reno-vascular protection rather than a gluco-centric approach.

Magnetic Resonance Angiography Alone Is Insufficient for Diagnosis and Surgical Planning in Children With Moyamoya.

BACKGROUND: The gold standard for evaluation of the severity of moyamoya vasculopathy is the Suzuki grade determined with cerebral catheter angiography (CA). With greater use of magnetic resonance angiography (MRA) it is important to understand if MRA is truly comparable to CA. METHODS: Children with moyamoya were evaluated using the Suzuki score for CA and the modified MRA six-stage Suzuki score to describe the angiographic findings in moyamoya from initial narrowing of the distal internal carotid artery to the "puff of smoke" appearance of the lenticulostriate collaterals and finally to the disappearance of this network of collaterals. Using Cohen kappa we compared Suzuki grade based on CA with MRA in the same patients. RESULTS: A total of 27 children with moyamoya were reviewed. We calculated a weighted Cohen kappa of 0.49 (P < 0.0001), which is a moderate correlation. CONCLUSIONS: We suggest caution in the reliance on MRA for the diagnosis and evaluation of severity of moyamoya in children.

Improved visualization of intracranial distal arteries with multiple 2D slice dynamic ASL-MRA and super-resolution convolutional neural network.

PURPOSE: To develop a novel framework to improve the visualization of distal arteries in arterial spin labeling (ASL) dynamic MRA. METHODS: The attenuation of ASL blood signal due to the repetitive application of excitation RF pulses was minimized by splitting the acquisition volume into multiple thin 2D (M2D) slices, thereby reducing the exposure of the arterial blood magnetization to RF pulses while it flows within the brain. To improve the degraded vessel visualization in the slice direction due to the limited minimum achievable 2D slice thickness, a super-resolution (SR) convolutional neural network (CNN) was trained by using 3D time-of-flight (TOF)-MRA images from a large public dataset. And then, we applied domain transfer from 3D TOF-MRA to M2D ASL-MRA, while avoiding acquiring a large number of ASL-MRA data required for CNN training. RESULTS: Compared to the conventional 3D ASL-MRA, far more distal arteries were visualized with higher signal intensity by using M2D ASL-MRA. In general, however, the vessel visualization with a conventional interpolation was prone to be blurry and unclear due to the limited spatial resolution in the slice direction, particularly in small vessels. Application of CNN-based SR transferred from 3D TOF-MRA to M2D ASL-MRA successfully addressed such a limitation and achieved clearer visualization of small vessels than conventional interpolation. CONCLUSION: This study demonstrated that the proposed framework provides improved visualization of distal arteries in later dynamic phases, which will particularly benefit the application of this approach in patients with cerebrovascular disease who have slow blood flow.

Flow capacity of a superficial temporal artery as a donor in a consecutive series of 100 patients with superficial temporal artery-middle cerebral artery bypass.

OBJECTIVE: A superficial temporal artery-middle cerebral artery (STA-MCA) bypass is classically considered a low-flow bypass. It is known that the flow in the flow augmentation STA-MCA bypass is influenced by flow demand of the revascularized territory and can reach significantly higher values. The authors report their intraoperative flow measurement data in a consecutive series of 100 STA-MCA bypasses performed at their institution. Moreover, in a subanalysis, they show the postoperative bypass flow measured with quantitative MR angiography (qMRA) noninvasive optimal vessel analysis (NOVA). METHODS: Between January 2013 and October 2023, 100 patients with acute, subacute, or chronic large-vessel occlusion (LVO) or moyamoya disease underwent a flow augmentation STA-MCA bypass revascularization at the authors' department with intraoperative bypass flow measurement. Patients with atherosclerotic LVO who underwent bypass surgery within a 6-week period following the onset of ischemic stroke symptoms were categorized into the acute bypass group, encompassing both acute and subacute LVO cases. Conversely, those who underwent bypass surgery > 6 weeks after the last occurrence of ischemic stroke were classified as the chronic group. Since May 2019, a consecutive subgroup of 37 patients received a postoperative (before discharge) bypass flow measurement with the qMRA-NOVA imaging tool. RESULTS: The mean ± SD intraoperative bypass flow in this consecutive series of 100 STA-MCA bypasses was 53.5 ± 28.8 ml/min (range 14-145 ml/min). In the subanalysis, there was no difference in the intraoperative flow capacity between the acute and chronic groups and between the moyamoya and acute groups. Patients in the moyamoya group showed a significantly higher flow rate in the STA-MCA bypass compared with the chronic group (63.0 ± 30.2 ml/min vs 48.4 ± 26.5 ml/min, p = 0.03). In a consecutive subanalysis of 37 STA-MCA bypass cases, postoperative flow measurements were also performed using qMRA-NOVA, showing a significant increase in the flow of STA-MCA bypasses after surgery compared with intraoperative flow measurements (mean intraoperative bypass flow rate vs qMRA-NOVA postoperative bypass flow rate: 73.4 ± 29.9 ml/min vs 111.3 ± 51.4 ml/min, p = 0.005). CONCLUSIONS: Using intraoperative and postoperative quantitative flow measurements of the STA, the data confirm that the flow in the flow augmentation STA-MCA bypass is influenced by the flow demand of the revascularized territory and can reach high values if needed. Moreover, the significant flow increase in the postoperative flow measurement using qMRA-NOVA demonstrates that the bypass can increase its flow over time.

Evaluating the Prevalence and Clinical Significance of Fetal Posterior Cerebral Artery Variants via Magnetic Resonance Imaging: Insights From a Tertiary Healthcare Facility in Tamil Nadu.

Introduction The prevalence and clinical significance of fetal posterior cerebral artery (FPCA) variants are studied using magnetic resonance imaging (MRI) at Saveetha Medical College. This research focuses on the fetal origin of the posterior cerebral artery (PCA), a condition where the posterior communicating artery (PComA) is larger than the P1 segment of the PCA, affecting cerebral hemodynamics and associated with various cerebrovascular pathologies. Materials and methods This retrospective analysis employed MRI records from the Department of Radio Diagnosis at Saveetha Medical College, conducted between January 2013 and December 2023. The study included patients undergoing MRI for various neurological indications, with specific imaging protocols including T1- and T2-weighted sequences, diffusion-weighted imaging, and magnetic resonance angiography (MRA). Results The study confirmed a prevalence rate of FPCA variants within the expected range of 20%-30%. MRI findings were systematically analyzed by experienced radiologists to assess the presence and characteristics of FPCA variants. The relationship between these variants and clinical symptoms was explored, revealing significant correlations that emphasize the variants' impact on patient outcomes, particularly in the context of cerebrovascular events. Conclusion The study underlines the importance of recognizing FPCA variants due to their significant implications in neurovascular health and cerebrovascular accident (CVA) outcomes. These variants alter cerebral hemodynamics and can complicate neurosurgical and diagnostic procedures. Therefore, personalized treatment and management strategies are crucial for optimizing patient care.

Left Main Snorkel Stent Thrombosis in Association With Takayasu Arteritis.

Takayasu arteritis (TA) is a rare form of large vessel arteritis that predominantly affects the aorta and its major branches. This inflammation leads to thickening, fibrosis, and stenosis of the arterial walls, which may lead to thrombus formation. The resulting symptoms are typically due to ischemia of the end organs. Coronary artery involvement is uncommon and primarily affects the ostia of the arteries. Ostial involvement of the coronary arteries can have a dramatic course, including fatal outcomes. We present the case of a 16-year-old female with TA involving the ostium of the left main coronary artery, causing severe stenosis. A successful percutaneous coronary intervention was performed on the left main artery with snorkel stent placement, which was complicated by cardiac arrest seven months later due to complete thrombosis of the proximal opening of the protruding stent.

Distinct Profiles and New Pharmacological Targets for Heart Failure with Preserved Ejection Fraction.

Background: Heart failure with preserved ejection fraction (HFpEF) is a multifactorial condition with a variety of pathophysiological causes and morphological manifestations. The inclusion criteria and patient classification have become overly simplistic due to the customary differentiation regarding the ejection fraction (EF) cutoff. EF is considered a measure of systolic function; nevertheless, it only represents a portion of the true contractile state and has been shown to have certain limits due to methodological and hemodynamic irregularities. Methods: As a result, broader randomized clinical trials have yet to incorporate the most recent criteria for HFpEF diagnosis, leading to a lack of data consistency and confusion in interpreting the results. The primary variations between the bigger clinical trials published in this context concerning patient selection and echocardiographic characteristics were analyzed. For all these reasons, we aim to clarify the main features and clinical impact of HFpEF in a study combining imaging, bio-humoral analysis, and clinical history to identify the specific subgroups that respond better to tailored treatment. Results: Disparate clinical characteristics and a lack of uniform diagnostic standards may cause suboptimal therapeutic feedback. To optimize treatment, we suggest shifting the paradigm from the straightforward EF measurement to a more comprehensive model that considers additional information, such as structural traits, related disorders, and biological and environmental data. Therefore, by evaluating certain echocardiographic and clinical factors, a stepwise diagnostic procedure may be useful in identifying patients at high risk, subjects with early HFpEF, and those with evident HFpEF. Conclusions: The present assessment underscores the significance of the precision medicine approach in guaranteeing optimal patient outcomes by providing the best care according to each distinct profile.

Using Adaptive Imaging Parameters to Improve PEGylated Ultrasmall Iron Oxide Nanoparticles-Enhanced Magnetic Resonance Angiography.

The PEGylated ultrasmall iron oxide nanoparticles (PUSIONPs) exhibit longer blood residence time and better biodegradability than conventional gadolinium-based contrast agents (GBCAs), enabling prolonged acquisitions in contrast-enhanced magnetic resonance angiography (CE-MRA) applications. The image quality of CE-MRA is dependent on the contrast agent concentration and the parameters of the pulse sequences. Here, a closed-form mathematical model is demonstrated and validated to automatically optimize the concentration, echo time (TE), repetition time (TR) and flip angle (FA). The pharmacokinetic studies are performed to estimate the dynamic intravascular concentrations within 12 h postinjection, and the adaptive concentration-dependent sequence parameters are determined to achieve optimal signal enhancement during a prolonged measurement window. The presented model is tested on phantom and in vivo rat images acquired from a 3T scanner. Imaging results demonstrate excellent agreement between experimental measurements and theoretical predictions, and the adaptive sequence parameters obtain better signal enhancement than the fixed ones. The low-dose PUSIONPs (0.03 mmol kg-1 and 0.05 mmol kg-1) give a comparable signal intensity to the high-dose one (0.10 mmol kg-1) within 2 h postinjection. The presented mathematical model provides guidance for the optimization of the concentration and sequence parameters in PUSIONPs-enhanced MRA, and has great potential for further clinical translation.

Imaging arterial and venous vessels using Iron Dextran enhanced multi-echo 3D gradient echo MRI at 7T.

Iron Dextran is a widely used iron oxide compound to treat iron-deficiency anemia patients in the clinic. Similar to other iron oxide compounds such as Ferumoxytol, it can also be used off-label as an intravascular magnetic resonance imaging (MRI) contrast agent due to its strong iron-induced T2 and T2* shortening effects. In this study, we seek to evaluate the feasibility of using Iron Dextran enhanced multi-echo susceptibility weighted imaging (SWI) MRI at 7T to image arterial and venous blood vessels in the human brain. Phantom experiments were performed to measure the r2* relaxivity for Iron Dextran in blood, based on which the SWI sequence was optimized. Pre- and post-infusion MR images were acquired in human subjects from which maps of arteries and veins were extracted. The post-contrast SWI images showed enhanced susceptibility difference between blood and the surrounding tissue in both arteries and veins. Our results showed that the proposed Iron Dextran enhanced multi-echo SWI approach allowed the visualization of blood vessels with diameters down to ~100 µm, including small blood vessels supplying and draining small brain structures such as the hippocampus. We conclude that Iron Dextran can be an alternative iron-based MRI contrast agent for blood vessel imaging in the human brain.

Additional Relevant Intracranial Findings in Persons Screened with MR for Intracranial Aneurysms.

BACKGROUND: Radiological screening for intracranial aneurysms (IAs) may identify other relevant intracranial findings. We investigated their prevalence on MR in persons screened for IAs. METHODS: We included all persons who were screened for the presence of IAs with brain MRI/MRA between 1996 and 2022 because of a family history of aneurysmal subarachnoid haemorrhage (aSAH) or autosomal dominant polycystic kidney disease (ADPKD). We reviewed radiology reports of initial and repeated brain MR to identify additional intracranial findings that needed follow-up or treatment, or carried a risk of becoming symptomatic. RESULTS: We included 766 persons (positive family history of aSAH: n = 681; ADPKD: n = 85) who had 1446 MRI/MRAs. At initial screening, 49 additional relevant intracranial findings were reported in 47 persons (6.1%, 95% CI 4.7-8.1%). Of all included persons, 338 (44%) underwent one (n = 154) or more (n = 184) follow-up screenings (total MRI/MRAs at follow-up: n = 680). In 15/338 persons (4.4%, 95% CI 2.7-7.2%), 16 new additional relevant findings were reported at a median follow-up duration of 10 years (IQR 5-12). CONCLUSIONS: Persons who are counselled for screening for IAs should be informed that there is a six percent chance of identifying an additional finding that requires follow-up or treatment, or may become symptomatic. Additionally, after 10-year follow-up screening there is a four percent chance of identifying a new additional relevant finding. The impact of such findings on quality of life needs further study.