Gadofosveset-enhanced thoracic MR venography: a comparative study evaluating steady state imaging versus conventional first-pass time-resolved dynamic imaging.

Background Dedicated blood-pool contrast agents combined with optimal angiographic protocols could improve the diagnostic accuracy of thoracic magnetic resonance angiography (MRA). Purpose To assess the clinical utility of Gadofesveset-enhanced imaging and compare an optimized steady-state (SS) sequence against conventional first-pass dynamic multi-phase (DMP) imaging. Material and Methods Twenty-nine patients (17 men, 12 women; mean age = 42.7, age range = 18-72 years) referred for MR thoracic venography were recruited. Imaging was performed on a 1.5T MRI system. A blood-pool contrast agent (Gadofesveset) was administered intravenously. Thirty temporal phases were acquired using DMP. This was immediately followed by a high-resolution SS sequence. Three radiologists in consensus reviewed seven thoracic vascular segments after randomizing the acquisition order. Image quality, stenoses, thromboses, and artifacts were graded using a categorical scoring system. The image quality for both approaches was compared using Wilcoxon's signed-rank test. McNemar's test was used to compare the proportions of stenosis grades, thrombus and artifacts. Results SS had significantly better image quality than DMP (3.14 ± 0.73 and 2.92 ± 0.60, respectively; P < 0.001). SS identified fewer stenoses (>50%) than DMP; the differences in stenosis categorizations was statistically significant ( P = 0.013). There was no significant difference in the proportions of vessels with thromboses ( P = 0.617). DMP produced more artifacts than SS (101 versus 85); however, the difference was not statistically significant ( P = 0.073). Conclusion Gadofesveset-enhanced thoracic angiography is clinically feasible. SS imaging produces better image quality and fewer artifacts than conventional DMP imaging.

Radiological Evaluation of Abdominal Endovascular Aortic Aneurysm Repair.

Endovascular aortic aneurysm repair (EVAR) is an alternative to open surgical repair of aortic aneurysms offering lower perioperative mortality and morbidity. As experience increases, clinicians are undertaking complex repairs with hostile aortic anatomy using branched or fenestrated devices or extra components such as chimneys to ensure perfusion to visceral branch vessels whilst excluding the aneurysm. Defining the success of EVAR depends on both clinical and radiographic criteria, but ultimately depends on complete exclusion of the aneurysm from the circulation. Aortic stent grafts are monitored using a combination of imaging modalities including computed tomography angiography (CTA), ultrasonography, magnetic resonance imaging, plain films, and nuclear medicine studies. This article describes when and how to evaluate aortic stent grafts using each of these modalities along with the characteristic features of several of the main stent grafts currently used in clinical practice. The commonly encountered complications from EVAR are also discussed and how they can be detected using each imaging modality. As the radiation burden from serial follow up CTA imaging is now becoming a concern, different follow-up imaging strategies are proposed depending on the complexity of the repair and based on the relative merits and disadvantages of each imaging modality.

Profound acute limb ischemia affecting all four limbs following cocaine inhalation.

Recreational drug use is a recognized cause of a number of acute vascular events. Cocaine is associated with a number of cardiovascular diseases, including myocardial ischemia, arrhythmias, and aortic dissection. Cutting agents are commonly used to dilute the amount of cocaine required to enhance the profits of the seller. Such cutting agents themselves often provoke acute vascular disease. We present the case of a 34-year-old female presenting with profound ischemia affecting all four limbs secondary to cocaine inhalation.

How do patients perceive the benefits and risks of peripheral angioplasty? Implications for informed consent.

PURPOSE: To explore perceptions of benefits and risks of patients undergoing peripheral angioplasty and to investigate factors that modify them. MATERIALS AND METHODS: Two hundred patients undergoing peripheral angioplasty during a 12-month period (134 men and 66 women; mean age, 68.8 years; age range, 37-94 years) were interviewed by one interventional radiologist who asked 18 questions with regard to the risks and benefits of this procedure. The patients were randomly assigned into two groups of 100 patients. The first group answered questions with use of a recognized risk assessment chart. The other group answered without the aid. Depending on the referral pathway, patients received the institution's patient information sheet. RESULTS: Of the 200 patients, 178 (89%) thought that they would have at least a 75% (three in four) chance of benefiting from angioplasty. Eighty patients (40%) thought they would definitely benefit from angioplasty. One hundred one patients (50%) thought the test would be painful. Fifty-four patients (27%) thought there would be no radiation exposure. Forty-one patients (21%) realized there was a chance of needing emergency surgery. Sixty-seven patients (34%) thought the test was easier than anticipated. Previous peripheral angioplasty altered perceptions of benefit (P = .012), but not risk. The use of a risk assessment chart altered perceptions of benefit (P = .049). The use of a patient information sheet predicted (made more realistic) the patients' perceptions of risks (P = .012) and benefits (P = .001). CONCLUSIONS: Patients who undergo peripheral angiography tend to underestimate the risks and overestimate the benefits of peripheral angioplasty. The patient information sheet and risk assessment tool used in this study altered patient perceptions of risks and benefits of the procedure and, therefore, aid informed consent.