Intra-arterial pulse wave analysis during thrombectomy for the assessment of collateral status - A feasibility study.

PURPOSE: Knowledge of the collateralization of an occluded vessel is important for the risk-benefit analysis of difficult revascularization maneuvers during mechanical thrombectomy. If the territory behind a clot is well perfused, one could desist from performing a risky thrombectomy maneuver. The arterial pulse pressure curve may serve as an indicator for the collateralization of an occluded target vessel. We investigated the feasibility of arterial pulse measurements with a standard microcatheter. METHODS: We measured the intra-arterial blood pressure proximal and distal to the clot in 40 thrombectomy maneuvers in a porcine stroke model. We used a microcatheter (Trevo Pro 18, Stryker, Kalamazoo, CA, USA), a pressure transducer (MEMSCAP SP844), an AdInstruments Powerlab 16/35 workstation, and LabChart 8 Software (AdInstruments, Dunedin, New Zealand). RESULTS: Median arterial blood pressure proximal and distal to the clot was 96.0 mmHg (IQR, 23.8 mmHg) and 47.5 mmHg (IQR, 43.5 mmHg), respectively (p < .001). The median difference between systolic maximum and diastolic minimum proximal and distal to the clot decreased significantly from 1.8 mmHg (IQR, 3.6 mmHg) to 0.0 mmHg (IQR, 0.5 mmHg) (p < .001). There was loss of the curve in 26 of 40 cases and loss of pressure in 23 of 40 cases (p = .008). There was no significant correlation between vessel diameter and either loss of the pulse pressure curve (p = .20) or overall pressure loss (p = .31). CONCLUSION: It is possible to measure the pulse pressure proximal and distal to the clot with a standard microcatheter used during mechanical thrombectomy.

Magnetic Resonance Imaging Assessment of Intra-Articular Structures in the Canine Stifle Joint after Implantation of a Titanium Tibial Plateau Levelling Osteotomy Plate.

OBJECTIVES: To determine the effectiveness of magnetic resonance imaging (MRI) in the evaluation of anatomical stifle structures with respect to implant positioning after tibial plateau levelling osteotomy (TPLO) using a titanium plate. METHODS: Selected sagittal and dorsal sequences of pre- and postoperative MRI (1.0 T scanner) of 13 paired (n = 26) sound cadaveric stifle joints were evaluated. The effect of susceptibility artifact on adjacent anatomical stifle structures was graded from 0 to 5. The impact of implant positioning regarding assessment score was calculated using Spearman's rank correlation coefficient. RESULTS: Sagittal turbo spin echo (TSE)-acquired images enabled interpretation of most soft tissue, osseous and cartilage structures without detrimental effect of susceptibility artifact distortions. In T2-weighted TSE images, the cranial cruciate ligament and caudal horn of the medial meniscus could be evaluated, independent of implant position, without any susceptibility artifact in all specimens. T2-weighted fast field echo, water selective, balanced fast field echo and short tau inversion recovery were most markedly affected by susceptibility artifact. CLINICAL SIGNIFICANCE: In selected TSE sequences, MRI allows evaluation of critical intra-articular structures after titanium TPLO plate implantation. Further investigations with confirmed stifle pathologies in dogs are required, to evaluate the accuracy of MRI after TPLO in clinical cases in this context.

Non-invasive assessment of patient-specific aortic haemodynamics from four-dimensional flow MRI data.

We introduce a parameter estimation framework for automatically and robustly personalizing aortic haemodynamic computations from four-dimensional magnetic resonance imaging data. The framework is based on a reduced-order multiscale fluid-structure interaction blood flow model, and on two calibration procedures. First, Windkessel parameters of the outlet boundary conditions are personalized by solving a system of nonlinear equations. Second, the regional mechanical wall properties of the aorta are personalized by employing a nonlinear least-squares minimization method. The two calibration procedures are run sequentially and iteratively until both procedures have converged. The parameter estimation framework was successfully evaluated on 15 datasets from patients with aortic valve disease. On average, only 1.27 ± 0.96 and 7.07 ± 1.44 iterations were required to personalize the outlet boundary conditions and the regional mechanical wall properties, respectively. Overall, the computational model was in close agreement with the clinical measurements used as objectives (pressures, flow rates, cross-sectional areas), with a maximum error of less than 1%. Given its level of automation, robustness and the short execution time (6.2 ± 1.2 min on a standard hardware configuration), the framework is potentially well suited for a clinical setting.

3D printing of MRI compatible components: why every MRI research group should have a low-budget 3D printer.

PURPOSE: To evaluate low budget 3D printing technology to create MRI compatible components. MATERIAL AND METHODS: A 3D printer is used to create customized MRI compatible components, a loop-coil platform and a multipart mouse fixation. The mouse fixation is custom fit for a dedicated coil and facilitates head fixation with bite bar, anesthetic gas supply and biomonitoring sensors. The mouse fixation was tested in a clinical 3T scanner. RESULTS: All parts were successfully printed and proved MR compatible. Both design and printing were accomplished within a few days and the final print results were functional with well defined details and accurate dimensions (Δ<0.4mm). MR images of the mouse head clearly showed reduced motion artifacts, ghosting and signal loss when using the fixation. CONCLUSIONS: We have demonstrated that a low budget 3D printer can be used to quickly progress from a concept to a functional device at very low production cost. While 3D printing technology does impose some restrictions on model geometry, additive printing technology can create objects with complex internal structures that can otherwise not be created by using lathe technology. Thus, we consider a 3D printer a valuable asset for MRI research groups.

A Low Cost Metal-Free Vascular Access Mini-Port for Artifact Free Imaging and Repeated Injections in Mice.

PURPOSE: Small injection ports for mice are increasingly used for drug testing or when administering contrast agents. Commercially available mini-ports are expensive single-use items that cause imaging-artifacts. We developed and tested an artifact-free, low-cost, vascular access mini-port (VAMP) for mice. PROCEDURES: Leakage testing of the VAMP was conducted with high speed bolus injections of different contrast agents. VAMP-induced artifacts were assessed using a micro-CT and a small animal MRI (9.4T) scanner ex vivo. Repeated contrast administration was performed in vivo. RESULTS: With the VAMP there was no evidence of leakage with repeated punctures, high speed bolus contrast injections, and drawing of blood samples. In contrast to the tested commercially available ports, the VAMP did not cause artifacts with MRI or CT imaging. CONCLUSIONS: The VAMP is an alternative to commercially available mini-ports and has useful applications in animal research involving imaging procedures and contrast agent testing.

Comparison of digital subtraction angiography, micro-computed tomography angiography and magnetic resonance angiography in the assessment of the cerebrovascular system in live mice.

PURPOSE: Mice are often used as small animal models of brain ischemia, venous thrombosis, or vasospasm. This article aimed at providing an overview of the currently available methodologies for in vivo imaging of the murine cerebrovasculature and comparing the capabilities and limitations of the different methods. METHODS: Micro-computed tomography angiography (CTA) was performed during intra-arterial and intravenous administration of a contrast agent bolus. Digital subtraction angiography (DSA) was performed during intra-arterial administration of contrast agent using the micro-CT scanner. Time-of-flight (ToF) magnetic resonance (MR) angiography was performed using a small animal scanner (9.4 T) equipped with a cryogenic transceive quadrature coil. Datasets were compared for scan time, contrast-to-noise ratio (CNR), temporal and spatial resolution, radiation dose, contrast agent dose and detailed recognition of cerebrovascular structures. RESULTS: Highest spatial resolution was achieved using micro-CTA (16 x 16 x 16 µm) and DSA (14 x 14 µm). Compared to micro-CTA (20-40 s) and ToF-MRA (57 min), DSA provided highest temporal resolutions (30 fps) allowing analyses of the cerebrovascular blood flow. Highest mean CNR was reached using ToF-MRA (50.7 ± 15.0), while CNR of micro-CTA depended on the intra-arterial (19.0 ± 1.0) and intravenous (1.3 ± 0.4) use of agents. The CNR of DSA was 10.0 ± 1.8. CONCLUSIONS: The use of dedicated small animal scanners allows cerebrovascular imaging in live animals as small as mice. As each of the methods analyzed has its advantages and limitations, choosing the best suited imaging modality for a defined question is of great importance. By this means the aforementioned methods offer a great potential for future projects in preclinical cerebrovascular research including ischemic stroke or vasospasm.

Power Doppler assessment of the neovascularization during uncomplicated fracture healing of long bones in dogs and cats.

The aims of this prospective study were to test the feasibility of assessing neovascularization with power Doppler ultrasonography and to investigate its usefulness to follow fracture healing of long bones in dogs and cats. A total of 51 patients (44 dogs and seven cats) were followed. Fracture types differed from simple to comminuted. Therapy ranged from external coaptation to plate osteosynthesis. Patients were followed with radiography, B-mode real time and power Doppler ultrasonography every 2-4 weeks until the fracture was healed. All fractures healed uneventfully. A semi-quantitative numerical score based on signal intensity, vessel area, and number of Doppler signals was assigned and the mean value was used to compare patients and examinations. Time postoperatively was divided into periods of 10 days. No Doppler signal was present during the first 10 days. The mean of the scores was highest between 11 and 20 days postoperatively and the median of the scores peaked between 21 and 30 days. A gradual decrease was seen thereafter. The mean of the scores was zero at 71-80 days and the median at 51-0 days postoperatively for the grouped results. In all positive power Doppler examinations, signals were present in and close to the callus. In seven patients (five dogs and two cats) signals were also present in the peripheral soft tissues in one of the follow up examinations. The normal healing process of fractured bones can be visualized using power Doppler ultrasonography and follows a distinctive time-dependent pattern.

Ultrasonographic and radiographic assessment of uncomplicated secondary fracture healing of long bones in dogs and cats.

OBJECTIVES: To evaluate the use of ultrasonography (US) to detect bone healing in uncomplicated diaphyseal fractures of dogs and cats, and to compare these observations with detection of healing by radiography (RG). STUDY DESIGN: Clinical study. ANIMALS: Dogs (33) and cats (11). METHODS: RG and brightness mode US were used to follow uncomplicated secondary fracture healing. Fractures were examined at admission and then every 2-4 weeks until healed or implant removal. Temporal differences in definitive detection of healed fracture by imaging technique were examined by species, patient age, bone, and fracture type. RESULTS: US images obtained during uncomplicated secondary fracture healing were consistent with images of fracture healing described in humans. Mean time to US diagnosis of a healed fracture (mean 46 days) was significantly shorter than by RG (mean 66 days). Mean time until diagnosis of a healed fracture (US and RG) did not differ significantly between open and closed treatment. Patients 36 months (n=11), but there was no significant difference between the latter 2 groups. Diagnosis of a healed simple fracture by US was significantly quicker than for a comminuted fracture (P<.05), but no difference was noted when using RG. CONCLUSIONS: US can be used to evaluate secondary fracture healing in biologically treated fractures in dogs and cats. US permits detection of a healed fracture earlier than RG. CLINICAL RELEVANCE: Earlier diagnosis of a healed fracture by US can prevent unnecessarily long limb immobilization and allow earlier dynamization.