Non-paraganglioma tumors of the jugular foramen - Growth patterns, radiological presentation, differential diagnosis.

OBJECTIVE: Most common tumors of the jugular foramen are paragangliomas. However, other lesions, also malignant, may involve the jugular foramen and mimic radiographic presentation of paragangliomas. Therefore, a correct preoperative diagnosis is crucial for best treatment planning. This study analyzes imaging characteristics of non-paraganglioma neoplasms involving the jugular foramen, with attention given to features helpful in differential diagnosis. STUDY DESIGN: A retrospective chart search. SETTING: Teritary referral university centre. SUBJECTS AND METHODS: During the years 1997-2010, 11 cases of jugular foramen tumors other than paragangliomas, with available imaging studies, were identified. Histopathology revealed: 3 schwannomas, 1 malignant schwannoma, 2 meningiomas, 1 hemangiopericytoma, 1 ependymoma, 1 endolymphatic sac carcinoma (ELST) and 2 nasopharyngeal carcinoma metastases. CT, MRI and angiography were assessed to determine tumor growth directions, bone involvement, tumor morphology and vascular composition. RESULTS: Schwannomas were characterized by parapharyngeal space involvement, jugular foramen expansion, preservation of cortical margins, irregular contrast enhancement. Meningiomas presented diffuse bone infiltration, sclerotic changes, erosion of the cortical bone. Ependymoma showed diffuse skull base infiltration, permeative erosion, heterogeneity, abundant vascularization. Hemangiopericytoma radiologically imitated paraganglioma. ELST showed permeative/geographic bony destruction, heterogeneity, intratumoral bony fragments. Metastases were lytic, solid lesions characterized by circumferential growth, internal carotid artery encasement and stenosis. CONCLUSIONS: A combination of certain radiological features including tumor epicenter, growth vectors, skull base infiltration, bony changes and tumor morphology help establish correct preoperative diagnosis and differentiate less common jugular foramen tumors, from most common paragangliomas. Hemangiopericytoma may radiologically mimic paraganglioma.

Changes in cerebral hemodynamics after carotid stenting: evaluation with CT perfusion studies.

PURPOSE: To determine changes in cerebral perfusion parameters, based on CT perfusion imaging, in patients after unilateral transluminal angioplasty and stent placement. MATERIAL AND METHODS: 74 patients with symptomatic high - grade internal carotid artery stenosis (>70%) were studied with CT perfusion imaging before and - on average - 70 hours and 172 days after carotid stent placement. There were 50 patients with unilateral carotid artery stenosis and 24 with stenosis and accompanying contralateral internal carotid artery occlusion. CT examination was performed using a multidetector helical CT scanner (Light Speed Ultra Advantage, GE Healthcare, USA). Maps showing the absolute values of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were generated. RESULTS: In a group with unilateral carotid artery stenosis perfusion deficits were present in 84% of patients, ipsilaterally to stenosis. MTT elongation was noted (6.2-6.8s) together with decreased values of CBF (40-46ml/100g/min) and slightly increased CBV (3.2ml/100g). In this group, 3 days after stenting, 30% of patients had perfusion deficits, and after 6 months only 6%. In a group with carotid artery stenosis and contralateral artery occlusion severe perfusion deficits were noted in both hemispheres and they were present in 100% of patients. 6 months after stenting hypoperfusion was observed only in 17% of patients. CONCLUSIONS: Brain perfusion deficits, observed in a majority of patients with carotid artery stenosis tend to improve considerably after carotid artery stenting, in long - term follow up.

Renal artery stenosis: value of contrast-enhanced ultrasonography.

Renal artery stenosis is the most common cause of potentially curable secondary hypertension. For a long time, angiography has been considered the "gold standard" in screening for renal arterial occlusive disease, but it is expensive and invasive. Magnetic resonance angiography and spiral computed tomography are safer alternatives to angiography but are expensive and not widely available. Due to the fact that duplex scanning is noninvasive, it has been advocated since the early 1980s as a screening test for renal vascular disorders. Factors that make duplex ultrasound an attractive screening measure for renovascular disease are its safety, suitability for outpatient use, and low cost. However, the frequency of artery variants, lengthy examination time, and technically inadequate test conditions limit the use of the direct duplex ultrasound detection of renal artery stenosis. Advances in Doppler technology may alleviate some of the current problems related to examination of renal arteries. One such technique is the use of echo-enhancing agents, which increase Doppler signal strength and can improve the sensitivity and specificity in Doppler ultrasound detection of renal artery stenosis.

Two Distally Located Right SCA Aneurysms: Endovascular Treatment by Parent Artery Occlusion with GDC Coils and N-BCA Injection. Case Report and Review of the Literature.

SUMMARY: Peripheral aneurysms of the superior cerebellar artery are considered difficult to treat surgically and endovascularly because of their inaccessibility. Parent artery occlusion is therefore frequently the preferred method. Embolic materials previously reported in this situation are either GDC coils or a polymerizing agent (n- BCA). We report a patient with two distally located, wide-neck aneurysms of the right superior cerebellar artery who presented with hemorrhage and was treated by endovascular embolization of the parent artery using a combination of GDC coils and n-BCA.

Endovascular treatment of giant p1/p2 aneurysm by direct puncture of the vertebral artery. Case report.

SUMMARY: Vascular access is usually achieved through a femoral arterial puncture using a modified Seldinger technique. However, selective catheterization of the great cerebral vessels by femoral approach fails completely when the vessel is tortuous or atheromatous. In case of posterior vascular circulation aneurysms, transbrachial approach or direct puncture of the vertebral artery (VA) is an alternative. The aneurysms of the posterior cerebral artery (PCA) are reported to be rare. Due to unfavorable anatomic location, the PCA aneurysms are difficult to reach during surgical procedure. Endovascular embolization is at present considered to be more effective and safer treatment of the PCA aneurysms arising from different segments, offering a viable alternative to the surgical approach. We report the case of the giant left PCA aneurysm, located at the junction of P1/P2 segments, successfully treated by parent artery occlusion achieved after the direct puncture of the right VA which was used because both VAs were tortuous, irregular and their ostia were not accessible by femoral approach. According to different authors, parent artery occlusion appears to be safe in the treatment of P2 segment aneurysms, whatever the location of the occlusion. In our case we decided to perform this kind of treatment believing it was the only possible one.

Spontaneous Thrombosis of the Pseudoaneurysm of Right SCA after an Attempt at Embolisation. A Case Report.

SUMMARY: Spontaneous thrombosis of intracranial aneurysms rare, mostly affecting giant aneurysms with narrow necks. We present the case of 34 y/o man with pseudoaneurysm that developed in the course of SAH. The initial CT scan showed an isolated, well-defined hematoma within the right cerebellar hemisphere, digital subtraction angiogram (DSA) performed in a regional hospital showed an irregular shaped aneurysm of the distal segment of the right SCA. The patient was sent to our department, where diagnostic DSA, performed before embolisation revealed an entirely different morphology of the aneurysm. It became larger, round and no other functional branches distal to it were found (picture of "a balloon on a string"). During supraselective catheterization, when microcatheter and microguidewire were already in the right SCA a technical problem of our angio-machine occurred, so the intervention had to be postponed. A week later, a second attempt at embolisation was made. This time an initial DSA showed a lack of filling of the aneurysm sac and thrombosis of the main trunk of the right SCA. The patient remained clinically stable. He was discharged from our hospital five days later.

[Endovascular treatment of thoracic aortic aneurysm--case report]. / Zastosowanie protezy wewnatrznaczyniowej w leczeniu tetniaka aorty piersiowej--opis przypadku.

Thoracic aortic aneurysm (TAA) is life threatening disease. 76 to 50% of untreated patients die during 5 years. Mortality rate increases to 93% in patients with cardiopulmonary disease. Perioperative mortality rate is 15% and in patients with cardiopulmonary disease or urgent surgery, it amounts even 50%. Endovascular treatment of TAA was first reported in 1994. The introduction of stent-grafts has been a big progress in the treatment. A patient, 59 year-old man with TAA was described. He was admitted to our hospital for endovascular treatment of TAA. Both spiral CT and angiography were performed. The placement of the stent-graft was technically successful, but angiography showed the small leakage. Second stent was added. Angiogram confirmed the proper position of stent-grafts and complete exclusion of aneurysm. There was no incidence of neurological deficits. Spiral CT and angiography obtained at 3 month after procedure confirmed exclusion of aneurysm and satisfactory stent-graft position. The placement of endoluminal stent-grafts for repair of thoracic aortic aneurysms is technically feasible and safe procedure. Long-term studies are needed to compare its results with surgical treatment.

[Chronic venous occlusion in hemodialysis-related fistula: diagnosis and endovascular treatment]. / Przewlekla zakrzepica przetoki dializacyjnej--diagnostyka i leczenie metoda wewnatrznaczyniowej rekanalizacji.

The main reasons of fistula dysfunction are stenosis and thrombosis. There are two kinds of thrombosis: acute and chronic. Acute thrombosis is total fistula occlusion while chronic occlusion is partial venous occlusion with collateral veins, which lead to impair fistula's function. 450 dialysis fistulas were referred to US (ultrasound) examination. Among 392 patients with fistula dysfunction, 71 presented chronic venous occlusion in hemodialysis shunt. 35 patients were qualified to endovascular recanalization. The mean length of the occluded segment was 3-35 cm (subclavian vein 2-4 cm). 38 patients underwent angiography (35 before endovascular treatment). Technique of recanalization included antegrade venous puncture, insertion guidewire (0.021'), catheter (5 Fr), balloon catheter (5-8 mm) and in 2 cases stent placement. Colour Doppler allowed to diagnose 34 (97%) cases of chronic venous occlusion in hemodialysis shunt. Decrease of mean flow volume in brachial artery--709 +/- 395 ml/min. (50-1500 ml/min) was statistically significant (p = 0.0015). Normal mean flow volume was 1242 +/- 641 ml/min. 20 of 35 recanalization procedures were performed successfully. The main reason of failure was perforation or false channel. Mean primary patency was 75% after 3 months. Mean cumulative was 85% (10/12) after 6 months. Chronic venous occlusion is often present in hemodialysis shunt and reduces flow volume. Percutaneous recanalization results aren't magnificent but there is only kind treatment for many patients with fistula failure.

[Endovascular treatment of internal carotid artery giant aneurysm by embolization of the parent artery using a detachable balloon]. / Przeznaczyniowe leczenie gigantyccznego tetniaka tetnicy szyjnej wewnetrznej na drodze calkowitej embolizacji tetnicy macierzystej przy uzyciu balonu odczepialnego.

A giant, unclippable right ICA aneurysm located partially intracavernously is reported with neck deriving at C3 level. The aneurysm caused optic chiasm compression, progressive left eye vision loss and exophthalmus as well as persistent headache. The presence of the aneurysm was first found in CT and confirmed by angiography. After having performed the temporary occlusion test of right ICA the ICA was permanently occluded with a detachable balloon. Control angiography showed complete occlusion of right ICA and no opacification of the aneurysm sac from vertebral and left carotid arteries.

[Basic terminology for describing hemodialysis fistula]. / Podstawowe mianownictwo dotyczace przetoki dializacyjnej.

Many specialists: nephrologists, surgeons, radiologists and nurses pay much attention to dialyzed patient using different terminology. The presented work establishes the principal rules of describing hemodialysis fistula to find convergence in terminology.

Pulsating mass after accidental artery trauma: diagnosis with duplex ultrasound and the role of angiography.

BACKGROUND: Pulsating mass located close to peripheral arteries is usually considered as a result of arterial wall injury. Clinically important is to distinct pseudoaneurysm from haematoma and also to evaluate proximal and distal arterial bed for the assessment of the injury extent. A few previous reports claim good results of duplex Doppler US diagnosis of iatrogenic (post-catheterization) femoral artery injuries. This paper presents diagnostic findings of arterial injuries caused by accidental trauma. PATIENTS AND METHODS: A retrospective analysis of 49 patients with post-traumatic pulsating mass close to peripheral artery was performed. The diagnostic results of both sonography and angiography were reviewed. All the patients underwent B-mode and duplex Doppler US examination using PW-, color- and power Doppler imaging techniques. RESULTS: 34 pseudoaneurysms were diagnosed correctly with typical B-mode, color/power Doppler images and PW-Doppler spectral waveforms. The lack of flow signal and distinctive B-mode images enabled proper diagnosis of 13 haematomas. In 2 patients duplex Doppler US misdiagnosis occurred, because of secondary pseudoaneurysm formation, primary diagnosed as haematoma. The 47 correct US findings gave 96% efficacy in distinguishing pseudoaneurysm from haematoma, which compares well with the other studies. In 20 patients suffering from peripheral ischemia, US examination, in spite of proper distinction between pseudoaneurysm and haematoma was unable for precise estimation of proximal and distal arterial damage. Thus, it was successfully supported with angiography before surgical decision making. Angiography was also necessary in 8 patients with severe injuries of carotid, subclavian and palmar arch arteries, hardly accessible for ultrasound penetration. CONCLUSIONS: We conclude that duplex Doppler US is essential for noninvasive, unequivocal distinction between pseudoaneurysm and haematoma but it could not completely replace contrast angiography in the evaluation of post-traumatic pulsating mass caused by severe, extensive trauma, frequently complicated with peripheral ischemia or located in regions with poor access for ultrasound penetration.

Power Doppler imaging in the evaluation of extracranial vertebral artery compression in patients with vertebrobasilar insufficiency.

OBJECTIVE: The recent introduction of Power Doppler Imaging (PDI) made a promise for better visualization of blood vessels lying in regions anatomically difficult for ultrasound imaging, i.e. vertebral arteries. The purpose of our study was to assess usefulness of PDI technique in visualization of vertebral artery course and to assess its utility in the detecting spondylotic vertebral artery compression in patients with vertebrobasilar insufficiency (VBI). METHODS: A total of 428 patients with VBI symptoms was evaluated. A total of 282 (66%) patients related their symptoms to a specific head position. Thus, all Doppler examinations were performed in four head positions: hyperextension, flexion and right/left rotation and also in a position reported by a patient to produce symptoms. PDI technique was employed as vertebral artery mapping for precise PW-Doppler range gate placing. RESULTS: Vertebral artery compression was found in 73 (17%) patients: 65 unilateral and eight bilateral. The diagnosis was based on flow decrease or its absence shown on PW-Doppler scans, after a specific head turning. CONCLUSION: Vertebral artery compression, related to a specific head position is relatively frequent in patients with VBI symptoms, especially in an older population commonly suffering from cervical spondylosis. PDI facilitates noninvasive Doppler US diagnosis by showing the real course of vertebral artery, particularly its intertransverse portion.

[Use of arterial embolization in treatment of pulmonary hemorrhage]. / Zastosowanie embolizacji tetnic w leczeniu krwotoków plucnych.

Embolization of bronchial and systemic arteries is a method of choice in treatment of pulmonary hemorrhages in patients with existing contraindications to surgical therapy. Embolization was carried out in 57 patients with pulmonary hemorrhages in the course of pulmonary tuberculosis, mycetomas, bronchiectases, malignancy, vessel malformations and post-traumatic changes. In all patients it terminated hemorrhages. During the 5 year follow-up period recurrencies were seen in 14% of the patients warranting additional embolization.

[Experimental femoral neck fractures in rats after prolonged steroid therapy]. / Doswiadczalne zlamania szyjki kosci udowej szczurów poddanych przewleklemu podawaniu hydrokortyzonu.

The method of the experiment has been presented. It was found, that after 8 weeks of hydrocortisonum hemisuccinatum administration, 20 mg per day in two doses the braking force decreased by 15 per cent. The calculation of the measurements at 150 g of animal body weight proved to be useful.

[Evaluation of the consequences of hepatic artery embolization under experimental conditions]. / Ocena nastepstw embolizacji tetnicy watrobowej w warunkach doswiadczalnych.

The experiments were performed in the healthy mongrel dogs aged 5 to 8 years whose body weight ranged from 10-20 kg. Just after the coeliac arteriography the hepatic artery was embolized. The dogs were divided into 2 groups because of the application of two different embolizing materials. Spongostan was used as the embolizing material in group I consisting of 7 dogs. In group II consisting of 5 dogs the embolizing material was absolute ethyl alcohol with urogranic acid. The symptoms of the postembolization syndrome were observed in all dogs after the embolization for 1-5 days. In most dogs the transient increase of the aminotransferase activity was observed while the results of thymol turbidity test and bilirubin levels in serum were not significantly changed. In dogs of group II the clinical picture after the embolization was clearly more severe. The anatomo- and histopathological examinations in dogs after the hepatic artery embolization were carried out. In group I no hepatic changes were found macroscopically. In the histopathological studies of liver the numerous, tiny foci of coagulative necrosis with the resorptive reactions were noticed. In group II multifocal deliquescent necrosis in the liver, numerous, small perivascular and extravascular foci of coagulative-deliquescent necrosis with the inflammatory and the resorptive reactions were noted.