Photoacoustic imaging of peripheral vessels in extremities by large-scale synthetic matrix array.

Significance: Various peripheral vascular diseases (PVD) in extremities, such as arterial atherosclerosis or venous occlusion in arm or legs, are a serious global health threat. Noninvasive vascular imaging is of great value for both diagnosis and assessment of PVD. Approach: By scanning a one-dimensional non-focusing linear array, an equivalent large two-dimensional (2D) matrix array with hundreds of thousands or more ultrasound elements is formed, thereby achieving a wide signal reception angle as well as large imaging area for three-dimensional (3D) imaging of peripheral extremities. Aim: To provide a feasible bedside and noninvasive imaging method for vascular imaging in extremities. Results: Our system can achieve high-quality photoacoustic (PA) peripheral vessel imaging. The 3D subcutaneous vascular imaging results of the palms and arms of healthy volunteers demonstrate the superior performance of the system. Conclusions: This work proposes a clinically oriented PA 3D subcutaneous vascular imaging system for human extremities. The system employs a synthetic matrix array via scanning a one-dimensional non-focusing linear probe, providing noninvasive, high-resolution, and high-contrast images of human extremities. It has potential application value in the diagnosis and monitoring of vascular diseases.

Design and development of the DE-SPECT system: a clinical SPECT system for broadband multi-isotope imaging of peripheral vascular disease.

Objective. Peripheral Vascular Disease (PVD) affects more than 230 million people worldwide and is one of the leading causes of disability among people over age 60. Nowadays, PVD remains largely underdiagnosed and undertreated, and requires the development of tailored diagnostic approaches. We present the full design of the Dynamic Extremity SPECT (DE-SPECT) system, the first organ-dedicated SPECT system for lower extremity imaging, based on 1 cm thick Cadmium Zinc Telluride (CZT) spectrometers and a dynamic dual field-of-view (FOV) synthetic compound-eye (SCE) collimator.Approach. The proposed DE-SPECT detection system consists of 48 1 cm thick 3D-position-sensitive CZT spectrometers arranged in a partial ring of 59 cm in diameter in a checkerboard pattern. The detection system is coupled with a compact dynamic SCE collimator that allows the user to select between two different FOVs at any time during an imaging study: a wide-FOV (28 cm diameter) configuration for dual-leg or scout imaging or a high-resolution and high-sensitivity (HR-HS) FOV (16 cm diameter) for single-leg or focused imaging.Main results.The preliminary experimental data show that the CZT spectrometer achieves a 3D intrinsic spatial resolution of <0.75 mm FWHM and an excellent energy resolution over a broad energy range (2.6 keV FWHM at 218, 3.3 keV at 440 keV). From simulations, the wide-FOV configuration offers a 0.034% averaged sensitivity at 140 keV and <8 mm spatial resolution, whereas the HR-HS configuration presents a peak central sensitivity of 0.07% at 140 keV and a ∼5 mm spatial resolution. The dynamic SCE collimator enables the capability to perform joint reconstructions that would ensure an overall improvement in imaging performance.Significance. The DE-SPECT system is a stationary and high-performance SPECT system that offers an excellent spectroscopic performance with a unique computer-controlled dual-FOV imaging capability, and a relatively high sensitivity for multi-tracer and multi-functional SPECT imaging of the extremities.

Stents in the femoropopliteal territory: prevalence of fractures and their consequences / Stents no território fêmoro-poplíteo: prevalência de fraturas e suas consequências

ABSTRACT Endovascular treatment for femoropopliteal arterial disease has made revascularization procedures less invasive, but the self-expanding stents used can suffer great wear in arteries with extreme mobility. Objective: to evaluate the prevalence of fractures in stents implanted in the femoropopliteal segment, to identify predisposing factors and consequences on arterial patency. Method: between March and June 2019, thirty patients previously operated for femoropopliteal obstruction underwent stent X-rays in anteroposterior and lateral views to detect fractures and Doppler to analyze arterial patency. Results: we observed 12 cases with fractures (33.3%): 1 type I (2.8%), 3 type II (8.3%), 5 type III (13.9%), 3 type IV (8.3%) and no type V. According to the TASC II we had 1 in group B (8.3%), 6 in group C (50%) and 5 in group D (41.6%) p <0.004. The number of stents per limb was 3.1 (± 1.3) in cases of fracture versus 2.3 (± 1.3) in cases without fracture (p = 0.08). The extension was 274.17mm (± 100.94) in cases of fracture and 230.83mm (± 135.44) in cases without fracture (p = 0.29). On Doppler we had: 17 patients (47.2%) without stenosis, 9 patients (25%) with stenosis> 50% and 10 patients (27.8%) with occlusion (p = 0.37). There was no correlation between fracture and arterial obstruction (p = 0.33). Conclusion: stent fractures are a frequent finding in the femoropopliteal area (33.3%), being more prevalent in cases of more advanced disease (C and D). There was no association between the finding of fracture and arterial obstruction.

RESUMO Os tratamentos endovasculares para a doença arterial obstrutiva fêmoro-poplítea tornaram os procedimentos de revascularização menos invasivos, porém os stents metálicos autoexpansíveis utilizados podem sofrer grande desgaste em artérias com extrema mobilidade. Objetivo: avaliar a prevalência de fraturas em stents implantados no segmento fêmoro-poplíteo, identificar fatores predisponentes e possíveis consequências sobre a patência arterial. Métodos: entre março a junho de 2019, trinta pacientes previamente operados por obstrução fêmoro-poplítea realizaram RX dos stents em incidências ântero-posterior e perfil para detectar fraturas e eco Doppler para analisar a patência arterial. Resultados: observamos 12 casos com fraturas (33,3%): 1 do tipo I (2,8%), 3 do tipo II (8,3%), 5 do tipo III (13,9%), 3 do tipo IV (8,3%) e nenhuma tipo V. Segundo a classificação TASC II, tivemos 1 no grupo B (8,3%), 6 no grupo C (50%) e 5 no grupo D (41,6%) p<0,004. O número de stents por membro foi de 3,1 (±1,3) nos casos de fratura contra 2,3 (±1,3) nos casos sem fratura (p = 0,08). A extensão tratada foi 274,17mm (±100,94) nos casos de fratura e 230,83mm (±135,44) nos casos sem fratura (p=0,29). No Doppler tivemos: 17 pacientes (47,2%) sem estenose, 9 pacientes (25%) com estenose>50% e 10 pacientes (27,8%) com oclusão (p=0,37). Não houve correlação entre fratura e obstrução arterial (p=0,33). Conclusão: as fraturas de stents são um achado frequente no setor fêmoro-poplíteo (33,3%) sendo mais prevalentes nos casos de doença mais avançada TASC II C e D. Não houve associação entre o achado de fratura e obstrução arterial.

Enfermedades vasculares periféricas y niveles de calidad de vida en el municipio Diez de Octubre / Peripheral vascular diseases and levels of quality of life in 10 of October municipality

Objetivo: Determinar la prevalencia de las enfermedades vasculares periféricas y los niveles de calidad de vida en el municipio "Diez de Octubre". Métodos: Estudio descriptivo en una muestra aleatorizada (n= 200) de los 201 586 habitantes del municipio. El diagnóstico de las enfermedades vasculares periféricas se realizó por examen físico-vascular confirmado por estudios hemodinámico, ultrasonográfico, y ecográfico. Se aplicó el cuestionario de "Calidad de vida" SF-36 a los mayores de 18 años sin discapacidad mental. Resultados: La tasa de enfermedades vasculares periféricas fue de 66 por 100 000 habitantes debida a las flebopatías (59,5 por ciento), la macroangiopatia diabética (13,9 por ciento), la enfermedad arterial periférica (8,4 por ciento) y la cerebrovascular (6,4 por ciento). Los factores de riesgo más frecuentes fueron: obesidad (48,5 por ciento), hipertensión arterial (37,5 por ciento) y tabaquismo (33,5 por ciento). Hubo un incremento de enfermedades vasculares periféricas a partir de los 50 años con la presencia de dos o más enfermedades en el 37,3 por ciento. De las personas. En aquellas con enfermedad vascular se encontró una disminución (p < 0,05) en todas las escalas de la calidad de vida con un deterioro en la medida sumaria "salud física", la que se encontró asociada a su presencia (χ2 = 27,11; p = 0,001). Conclusiones: En el municipio Diez de Octubre, hay una elevada tasa de enfermedades vasculares periféricas con un deterioro importante en los niveles de calidad de vida de las personas que la padecen(AU)

Objective: To determine the prevalence of peripheral vascular diseases and the levels of quality of life in 10 of October municipality. Methods: A descriptive study was conducted on a random sample (n=200) from 201 586 inhabitants of the municipality. The diagnosis of peripheral vascular diseases was performed by physical-vascular examination confirmed by hemodynamic, ultrasound, and echo-Doppler studies. The "Quality of life" questionnaire SF-36 was applied to people older than 18 years without mental disabilities. Results: The rate of peripheral vascular disease was 66 per 100 000 inhabitants due to phlebopathies (59.5 percent), diabetic macroangiopathy (13.9 percent), peripheral arterial disease (8.4 percent) and cerebrovascular disease (6.4percent). The most frequent risk factors were obesity (48.5 percent), hypertension (37.5 percent) and smoking (33.5 percent). There was an increase in peripheral vascular diseases after the age of 50 years with two or more types of diseases in 37.3 percent of the population. A decrease (p <0.05) in all the quality of life scales, with deterioration in the disease-related summary measure "physical health", was found in people with vascular disorders (χ2= 27.11; p= 0.001). Conclusions: In 10 of October municipality, there is a high rate of peripheral vascular diseases with a significant deterioration of the quality of life of people who suffer them(AU)

Vasculopatía coroidea oclusiva tras quimioterapia intraarterial: hallazgos en la RMN / Choroidal occlusive vasculopathy after intraarterial chemotherapy: MRI findings

Objetivo: Evaluar los hallazgos en las imágenes de resonancia magnética nuclear (RMN) en pacientes con vasculopatía coroidea oclusiva (VCO) tras quimioterapia intraarterial (QIA) por retinoblastoma. Métodos: Se realizó un estudio retrospectivo de 37 ojos de 34 pacientes que recibieron QIA entre 2016 y 2021 como tratamiento de primera o segunda línea del retinoblastoma intraocular. De estos pacientes, 22 recibieron quimioterapia sistémica y el resto QIA como primera línea, con melfalán (3-4mg), carboplatino (40mg) y topotecan (20mg). Los pacientes fueron examinados cada mes para observar la regresión tumoral y posibles complicaciones de los tratamientos. A los pacientes que presentaron VCO se les realizaron estudios con RMN para evaluar el grosor coroideo y la longitud del globo ocular. Resultados: Se observó VCO en cinco de los 37 ojos (13,51%), todos ellos con una coroidopatía sectorial completa con afectación foveal (grado 2). En cuatro de los cinco pacientes el grosor coroideo se vio disminuido, mientras que en tres casos el tamaño del globo afectado era claramente inferior. El control tumoral fue posible en todos los casos. Conclusiones:En esta muestra, la VCO se asocia con adelgazamiento coroideo y diminución del tamaño ocular en la RMN. Puede ser necesaria una nueva clasificación para correlacionar mejor la severidad de la coroidopatía que afecta a la fóvea. Los resultados iniciales son favorables respecto al uso de la QIA; aunque es necesaria la realización de estudios a largo plazo y una documentación exhaustiva para valorar tanto el papel de la QIA, como los efectos derivados de ella. (AU)

Purpose: To evaluate magnetic resonance imaging (MRI) findings in patients suffering choroidal occlusive vasculopathy (COV) after intra-arterial chemotherapy (IAC) for retinoblastoma. Methods: A retrospective study of 37 eyes of 34 patients receiving IAQ between 2016 to 2021 as primary or secondary treatment for retinoblastoma was conducted. Twenty-two patients received systemic chemotherapy with carboplatin, vincristine and etoposide. The rest received IAC as primary treatment. The drugs administered were melphalan (3-4mg), carboplatin (40mg) plus topotecan (20mg). The patients were examined under general anaesthesia every month to observe tumor regression and possible complications of the treatment. For the patients with COV an MRI was obtained to analyse the choroidal thickness and axial ocular length. Results: A COV was observed in 5 of the 37 eyes receiving IAC (13,51%), all of them with a complete sectorial choroidopathy not sparing the fovea (grade 2). In 4 of the 5 patients the choroidal thickness was decreased and in three cases the size of the eye which presented COV was clearly smaller than the contralateral eye. Tumor control was archived in all 5 patients. Conclusion: In our cases COV was associated with reduction of thinning of choroid and eye length in the MRI. A new classification maybe needed to correlate better with the severity of the complication affecting the fovea. Although early results generally are favorable to the use of IAC, longer follow up and scrupulous documentation of side effects will be necessary to know the true role of IAC for retinoblastoma. (AU)

Síndrome de Parkes-Weber / Parkes-Weber syndrome

No disponible

The application of spontaneous corpus cavernosum EMG to assess the status of cavernous smooth muscles, a preliminary study / La aplicación de cuerpo cavernoso EMG espontáneo para evaluar el estado de los músculos lisos cavernosos. Un estudio preliminar

Introduction: Diagnostic tests for vascular erectile dysfunction (ED) depend on cavernous smooth muscles (CSM) relaxation following an intracorporal injection (ICI). Enhanced sympathetic tone, which is not uncommon during performance of these tests, can bias its results. Also, CSM diseases can cause veno-occlusive diseases (VOD) ED. Corpus cavernosum electromyography (CC-EMG) potentials’ amplitudes represent the integrated sympathetic activity of healthy CSM. Stem-cells and gene-therapy are potential therapeutic options for impaired CSM. Objective: To utilize CC-EMG, as a new diagnostic technique that can confirm the integrity of CSM, and to identify patients with impaired CSM activity, among those diagnosed as vascular ED per Color Duplex Doppler Ultrasonography (CDDU). Patient and methods: Group 1 included 24 patients with ED and negative response to ICI. Group 2 included 10 men without ED. Patients included in group 1 had penile CDDU examination and all participants had spontaneous CC-EMG recordings. Results: According to CDDU parameters, group 1 was sub-grouped as nine arterial, ten VOD and five mixed type. CC-EMG potentials' amplitudes ranged 223-320, 179-237, 103-250 and 83-200μV for group 2 and arterial, mixed and VOD subgroups respectively. The widest ranges of potentials’ amplitudes were recorded in the subgroups of patients with an element of VOD. Four patients with ED, within these subgroups, had CC-EMG potentials’ amplitudes ranged 200-250μV that exceeded/approached the lowest value recorded from men in group 2. Conclusion: CC-EMG recordings elicited marked differences of CSM activity among patients diagnosed with an element of VOD ED per CDDU. This finding highlighted the need to utilize CC-EMG to assess the integrity of CSM. Identifying patients with impaired CSM activity may modify the chosen methods for therapeutic interventions

Introducción: Las pruebas diagnósticas para la disfunción eréctil (DE) vascular dependen de la relajación de los músculos cavernosos lisos (MCL) después de una inyección intracorporal (IIC). El tono simpático mejorado, que es frecuente durante la realización de estas pruebas, puede sesgar los resultados. Además, las enfermedades de los MCL pueden provocar DE con enfermedades venooclusivas (EVO). Las amplitudes de los potenciales de la electromiografía de los cuerpos cavernosos (CC-EMG) representan la actividad simpática integrada de los MCL sanos. Las células madre y la terapia génica son opciones terapéuticas potenciales para los MCL con discapacidad. Objetivo: Utilizar CC-EMG como una nueva técnica de diagnóstico que pueda confirmar la integridad de los MCL e identificar a los pacientes con actividad de MCL deteriorada entre los diagnosticados con DE vascular por ecografía Doppler color dúplex (CDDU, por sus siglas en inglés). Paciente y métodos: El grupo 1 incluyó a 24 pacientes con DE con una respuesta negativa a la IIC. El grupo 2 incluía a 10 varones sin DE. En los pacientes incluidos en el grupo 1 se realizó CDDU en el pene y todos los participantes presentaron grabaciones de la CC-EMG espontáneas. Resultados: De acuerdo con los parámetros CDDU, el grupo 1 se dividió en subgrupos, como 9 arteriales, 10 VOD y 5 tipos mixtos. Las amplitudes de los potenciales de la CC-EMG variaron entre 223-320, 179-237, 103-250 y 83-200μV para el grupo 2 y los subgrupos arteriales, mixtos y VOD, respectivamente. Los amplios rangos de amplitudes de los potenciales se registraron en los subgrupos de pacientes con un elemento de VOD. Cuatro pacientes dentro de estos subgrupos tenían amplitudes de potencial de la CC-EMG de 200-250μV que excedían/acercaban el valor más bajo para varones en el grupo 2. Conclusión: Las grabaciones de la CC-EMG provocaron marcadas diferencias de actividad de los MCL entre los pacientes diagnosticados con un elemento de VOD DE por CDDU. Este hallazgo destacó la necesidad de utilizar CC-EMG para evaluar la integridad de los MCL. La identificación de pacientes con actividad de CSM afectada puede modificar los métodos elegidos para las intervenciones terapéuticas

The Primary Patency and Fracture Rates of Self-Expandable Nitinol Stents Placed in the Popliteal Arteries, Especially in the P2 and P3 Segments, in Korean Patients

OBJECTIVE: We wanted to evaluate the status of self-expandable nitinol stents implanted in the P2 and P3 segments of the popliteal artery in Korean patients. MATERIALS AND METHODS: We retrospectively analyzed 189 consecutive patients who underwent endovascular treatment for stenoocclusive lesions in the femoropopliteal artery from July 2003 to March 2009, and 18 patients who underwent stent placement in popliteal arterial P2 and P3 segments were finally enrolled. Lesion patency was evaluated by ultrasound or CT angiography, and stent fracture was assessed by plain X-rays at 1, 3, 6 and 12 months and annually thereafter. RESULTS: At the 1-month follow-up, stent fracture (Type 2) was seen in one limb (up to P3, 1 of 18, 6%) and it was identified in seven limbs at the 3-month follow-up (Type 2, Type 3, Type 4) (n = 1: up to P2; n = 6: P3). At the 6-month follow-up, one more fracture (Type 1) (up to P3) was noted. At the 1-year follow-up, there were no additional stent fractures. Just four limbs (up to P2) at the 2-year follow-up did not have stent fracture. The primary patency was 94%, 61% and 44% at 1, 3 and 6 months, respectively, and the group with stent implantation up to P3 had a higher fracture rate than that of the group that underwent stenting up to P2 (p < 0.05). CONCLUSION: We suggest that stent placement up to the popliteal arterial P3 segment and over P2 in an Asian population can worsen the stent patency owing to stent fracture. It may be necessary to develop a stent design and structure for the Asian population that can resist the bending force in the knee joint.

Métodos diagnósticos de la enfermedad arterial periférica. Importancia del índice tobillo-brazo como técnica de criba / Diagnosis of peripheral vascular disease. Usefulness of the ankle-brachial index for screening

Debido a la elevada prevalencia de la enfermedad arterial periférica (EAP), que con frecuencia es asintomática, y sus graves repercusiones pronósticas, se recomienda la criba diagnóstica de los pacientes con alto riesgo de sufrirla: a) pacientes de edad > 70 años; b) pacientes de 50-69 años con historia de tabaquismo o diabetes mellitus; c) pacientes de 40-49 años con diabetes mellitus y al menos otro factor de riesgo de arteriosclerosis; d) síntomas compatibles con claudicación al esfuerzo o dolor isquémico en reposo; e) pulsos anormales en las extremidades inferiores; f) enfermedad arteriosclerosa en otros territorios, o g) pacientes con un score de Framingham entre el 10 y el 20%. Tanto la anamnesis como la exploración física tienen un valor para el diagnóstico de la enfermedad limitado porque, aunque son muy específicos, su sensibilidad es muy baja. Existen múltiples pruebas diagnósticas para valorar la presencia y la severidad de la enfermedad vascular periférica, entre las que cabe destacar el índice tobillo-brazo, las determinaciones de la presión segmentarias, los estudios de ecografía-Doppler y la angiografía mediante resonancia megnética, tomografía computarizada o de sustracción digital. En la actualidad se considera que el índice tobillo-brazo es el método no invasivo que presenta mejor rendimiento diagnóstico, ya que se trata de una prueba incruenta, fácil de realizar a la cabecera del paciente y con una elevada sensibilidad (superior al 90%) (AU)

Because peripheral arterial disease is highly prevalent, frequently silent, and has serious prognostic implications, it is recommended that diagnostic screening should be carried out in individuals at a high risk. This includes: a) those aged >70 years; b) those aged 50-69 years with a history of smoking or diabetes; c) those aged 40-49 years with diabetes mellitus and at least one other risk factor for atherosclerosis; d) those with symptoms indicating claudication on exercise or ischemic pain at rest; e) those with abnormal pulses in the lower extremities; f) those with atherosclerosis in other vascular territories; and g) those with a Framingham score of 10-20%. Neither anamnesis nor physical examination is of much value for disease diagnosis; although they are very specific, their sensitivity is very low. A large number of different diagnostic techniques are available for investigating the presence and severity of peripheral vascular disease, including ankle-brachial index measurement, segmental limb pressure measurement, Doppler ultrasonography, and various forms of angiography involving magnetic resonance imaging, computed tomography or digital subtraction imaging. At present, the ankle-brachial index is the non-invasive method that gives the best diagnostic performance. It is simple, inexpensive and has a high sensitivity (i.e. greater than 90%) (AU)

Enfermedad arterial periférica: índice tobillo/brazo: primera parte / Peripheral arterial disease: ankle-arm index: part 1

En esta primera parte se presenta la epidemiología de esta enfermedad, fisiopatología, factores de riesgo, manifestación clínica, diagnóstico, y obtención del índice tobillo-brazo, considerado el mejor método diagnóstico no invasivo para su estudio.

Enfermedad arterial periférica: índice tobillo/brazo: segunda parte / Peripheral arterial disease: ankle-arm index: part 2

En esta parte del artículo se describe la importancia del índice tobillo/brazo en el diagnóstico de ateromatosis arterial en territorios vasculares alejados de los miembros inferiores, y su utilidad en pacientes diabéticos.