RESUMO
BACKGROUND: To perform a systematic literature review to assess the usefulness of performing magnetic resonance angiography (MRA) with vessel wall imaging (VWI) sequences for the assessment of symptomatic carotid artery plaques and the identification of risky plaque features predisposing for stroke. METHODS: We performed a systematic review of the literature pertaining to MRA with VWI techniques in patients with carotid artery disease, focusing on symptomatic patients' plaque features and morphology. Independent reviewers screened and analyzed data extracted from eligible studies, and a modified Newcastle-Ottawa Scale was used to appraise the quality of the design and content of the selected manuscripts to achieve an accurate interpretation. RESULTS: This review included nineteen peer-reviewed manuscripts, all of them including MRA and VWI assessments of the symptomatic carotid artery plaque. We focused on patients' comorbidities and reviewed plaque features, including intraplaque hemorrhage, a lipid-rich necrotic core, a ruptured fibrous cap, and plaque ulceration. CONCLUSIONS: MRA with VWI is a useful tool in the evaluation of carotid artery plaques. This imaging technique allows clinicians to identify plaques at risk of causing a neurovascular event. The presence of intraplaque hemorrhage, plaque ulceration, a ruptured fibrous cap, and a lipid-rich necrotic core are associated with neurovascular symptoms. The timely identification of these features could have a positive impact on neurovascular event prevention.
Assuntos
Estenose das Carótidas , Placa Aterosclerótica , Humanos , Estenose das Carótidas/complicações , Angiografia por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética , Resultado do Tratamento , Placa Aterosclerótica/complicações , Hemorragia , Lipídeos , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologiaRESUMO
We aim to provide a comprehensive summary of the current body of literature concerning the Imaging 3.0 initiative and its implications for patient care within the field of radiology. We offer a thorough analysis of the literature pertaining to the Imaging 3.0 initiative, emphasizing the practical application of the five pillars of the program, their cost-effectiveness, and their benefits in patient management. By doing so, we hope to illustrate the impact the Imaging 3.0 Initiative can have on the future of radiology and patient care.
Assuntos
Diagnóstico por Imagem , Radiologia , Humanos , Radiografia , Radiologia/métodos , Assistência Centrada no PacienteRESUMO
BACKGROUND: Direct common carotid artery puncture (DCP) is conventionally used as a bailout technique in stroke patients. However, little is known about the relevant anatomy. OBJECTIVE: Examine the relationship of the common carotid artery (CCA) to surrounding structures based on different DCP trajectories passing through the artery's center. METHODS: Fifty randomly selected head/neck CTAs were analyzed. The trajectory of DCP and relationship to the internal jugular vein (IJV) and thyroid were analyzed at 1 cm intervals above the clavicle on 7 axial sections. Using the trans-carotid sagittal plane (TCSP) as the 0° trajectory, we plotted 3 additional trajectories at 30° intervals and the relationship with the IJV and thyroid proximity was graded as following: 0 = absent, 1 = adjacent, and 2 = crossing. The CCA tortuosity index (TI) was also analyzed for each vessel. RESULTS: Analysis of 2800 trajectories across 100 CCAs showed that the IJV and thyroid were least encountered on the axial sections 2 cm above the clavicle, at 0° on the right (9 thyroids and 6 IJV), and at 90° on the left (0 Thyroids and 14 IJVs). The TI of the CCA was significantly lower above the clavicle than its entire length (p<0.001). CONCLUSION: DCP performed 2 cm above the clavicle at 0° on the right, and 90° on the left appears to minimize encounters with the IJV and thyroid gland, reducing potential complications. However, despite these findings, ultrasound guidance remains vital for DCP safety. Further focus on endovascular device safety in DCP is needed.
RESUMO
This overview of the current state of skin wound healing includes in vitro and in vivo approaches along with some recent clinical trials. From an introduction to wound healing, to tissue engineering as applied to the skin, we cover the basis for the current wound care techniques as well as novel and promising approaches. Special emphasis is given to refractory wounds which include wounds in diabetic patients. Natural compounds have been ever present in wound healing, and so we devote a section to highlighting current attempts to understand their mechanisms and to use them in novel ways.