RESUMEN
BACKGROUND: Familial cerebral cavernous malformation (CCM) syndrome is characterized by multiple, non-contiguous cavernous malformations. The lesion burden may affect morbidity. Our aim was to identify risk factors for high lesion burden in these patients. METHODS: Patients with radiologically confirmed CCM were screened between 2015 and 2023. Only familial or presumed familial CCM patients were included. Demographic information and medical history at the time of diagnosis were evaluated. The first diagnostic MRI was used to determine T2 total and T2 large lesion (≥5 mm) count. Chi-square was used to determine risk factors for total T2 large lesion count ≥5. RESULTS: Of 107 patients with familial or presumed familial CCM (55.1 % female, age 42.4 years), the median total T2 lesion count and large lesion count was 4 (range: 1-109) and 2 (range: 0-50) respectively. Current tobacco use was a risk factor for T2 large lesion count ≥5. CONCLUSION: Further studies combining familial cohorts and assessing length of exposure may be useful to confirm tobacco as a risk factor for T2 large lesion formation in familial CCM.
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Hemangioma Cavernoso del Sistema Nervioso Central , Imagen por Resonancia Magnética , Uso de Tabaco , Humanos , Femenino , Masculino , Hemangioma Cavernoso del Sistema Nervioso Central/diagnóstico por imagen , Hemangioma Cavernoso del Sistema Nervioso Central/complicaciones , Adulto , Persona de Mediana Edad , Adulto Joven , Factores de Riesgo , Uso de Tabaco/efectos adversos , Adolescente , Estudios Retrospectivos , AncianoRESUMEN
MR imaging is well-established as the criterion standard for carotid artery atherosclerosis imaging. The capability of MR imaging to differentiate numerous plaque components has been demonstrated, including those features that are associated with a high risk of sudden changes, thrombosis, or embolization. The field of carotid plaque MR imaging is constantly evolving, with continued insight into the imaging appearance and implications of various vulnerable plaque characteristics. This article will review the most up-to-date knowledge of these high-risk plaque features on MR imaging and will delve into 2 major emerging topics: the role of vulnerable plaques in cryptogenic strokes and the potential use of MR imaging to modify carotid endarterectomy treatment guidelines.
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Aterosclerosis , Enfermedades de las Arterias Carótidas , Estenosis Carotídea , Endarterectomía Carotidea , Placa Aterosclerótica , Humanos , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/complicaciones , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/complicaciones , Arterias Carótidas/diagnóstico por imagen , Aterosclerosis/complicaciones , Imagen por Resonancia Magnética/métodos , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/complicacionesRESUMEN
The management of acute ischemic stroke has undergone a paradigm shift in the past decade. This has been spearheaded by the emergence of endovascular thrombectomy, along with advances in medical therapy, imaging, and other facets of stroke care. Herein, we present an updated review of the various stroke trials that have impacted and continue to transform stroke management. It is critical for the radiologist to stay abreast of the ongoing developments to provide meaningful input and remain a useful part of the stroke team.
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Isquemia Encefálica , Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/terapia , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/terapia , Trombectomía/métodos , Procedimientos Endovasculares/métodos , Resultado del TratamientoRESUMEN
Symptomatic nonstenotic carotid artery disease has been increasingly recognized as a thromboembolic source in patients who would otherwise be classified as having embolic stroke of undetermined source. Evidence suggests that certain plaque features seen on sonography, CT, and MR imaging in nonstenotic carotid artery disease may predispose to recurrent stroke in patients with embolic stroke of undetermined source. We performed a focused literature review to further study plaque features in the context of embolic stroke of undetermined source and to determine which plaque features may be associated with ipsilateral ischemic events in such patients. Plaque thickness as seen on both ultrasound and CT appears to have a consistent association with ipsilateral stroke in patients with embolic stroke of undetermined source across multiple studies. Intraplaque hemorrhage as seen on MR imaging is now understood to have a strong association with ipsilateral stroke in patients with embolic stroke of undetermined source. Continued study of various plaque features as seen on different modalities is warranted to uncover other potential associations.
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Enfermedades de las Arterias Carótidas , Estenosis Carotídea , Accidente Cerebrovascular Embólico , Embolia Intracraneal , Placa Aterosclerótica , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular Embólico/complicaciones , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Arterias Carótidas , Placa Amiloide , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Embolia Intracraneal/diagnóstico por imagen , Embolia Intracraneal/etiologíaRESUMEN
BACKGROUND AND PURPOSE: Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS: A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS: A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS: This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.
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Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Procedimientos Endovasculares/métodos , Curva de Aprendizaje , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Resultado del Tratamiento , Estudios de Cohortes , Estudios Retrospectivos , Embolización Terapéutica/métodos , StentsRESUMEN
BACKGROUND AND PURPOSE: The CTA "rim sign" has been proposed as an imaging marker of intraplaque hemorrhage in carotid plaques. This study sought to investigate such findings using histopathologic confirmation. MATERIALS AND METHODS: Included patients had CTA neck imaging <1 year before carotid endarterectomy. On imaging, luminal stenosis and the presence of adventitial (<2-mm peripheral) and "bulky" (≥2-mm) calcifications, total plaque thickness, soft-tissue plaque thickness, calcification thickness, and the presence of ulcerations were assessed. The rim sign was defined as the presence of adventitial calcifications with internal soft-tissue plaque of ≥2 mm in maximum thickness. Carotid endarterectomy specimens were assessed for both the presence and the proportional makeup of lipid material, intraplaque hemorrhage, and calcification. RESULTS: Sixty-seven patients were included. Twenty-three (34.3%) were women; the average age was 70.4 years. Thirty-eight (57.7%) plaques had a rim sign on imaging, with strong interobserver agreement (κ = 0.85). A lipid core was present in 64 (95.5%) plaques (average, 22.2% proportion of plaque composition); intraplaque hemorrhage was present in 52 (77.6%), making up, on average, 13.7% of the plaque composition. The rim sign was not associated with the presence of intraplaque hemorrhage (P = .11); however, it was associated with a greater proportion of intraplaque hemorrhage in a plaque (P = .049). The sensitivity and specificity of the rim sign for intraplaque hemorrhage were 61.5% and 60.0%, respectively. CONCLUSIONS: The rim sign is not associated with the presence of intraplaque hemorrhage on histology. However, it is associated with a higher proportion of hemorrhage within a plaque and therefore may be a biomarker of more severe intraplaque hemorrhage, if present.
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Calcinosis , Estenosis Carotídea , Endarterectomía Carotidea , Placa Aterosclerótica , Anciano , Calcinosis/patología , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/patología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Femenino , Hemorragia/complicaciones , Hemorragia/etiología , Humanos , Lípidos , Masculino , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/diagnóstico por imagenRESUMEN
BACKGROUND AND PURPOSE: CT is considered the standard reference both for quantification and characterization of carotid artery calcifications. Our aim was to investigate the relationship among different types of calcium configurations detected with CT within the plaque with a novel classification and to investigate the prevalence of cerebrovascular events. MATERIALS AND METHODS: Seven hundred ninety patients (men = 332; mean age, 69.7 [SD, 13] years; 508 symptomatic for cerebrovascular symptoms and 282 asymptomatic) who underwent computed tomography of the carotid arteries were retrospectively included in this institutional review board-approved study. The plaque was classified into 6 types according to the different types of calcium configurations as the following: type 1, complete absence of calcification within the plaque; type 2, intimal or superficial calcifications; type 3, deep or bulky calcifications; type 4, adventitial calcifications with internal soft plaque of <2 mm thickness; type 5, mixed patterns with intimal and bulky calcifications; and type 6, positive rim sign. RESULTS: The highest prevalence of cerebrovascular events was observed for type 6, for which 89 of the 99 cases were symptomatic. Type 6 plaque had the highest degree of correlation with TIA, stroke, symptoms, and ipsilateral infarct for both sides with a higher prevalence in younger patients. The frequency of symptoms observed by configuration type significantly differed between right and left plaques, with symptoms observed more frequently in type 6 calcification on the right side (50/53; 94%) than on the left side (39/46; 85%, P < .001). CONCLUSIONS: We propose a novel carotid artery plaque configuration classification that is associated with the prevalence of cerebrovascular events. If confirmed in longitudinal analysis, this classification could be used to stratify the risk of occurrence of ischemic events.
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Enfermedades de las Arterias Carótidas , Estenosis Carotídea , Placa Aterosclerótica , Anciano , Arterias Carótidas , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/epidemiología , Humanos , Masculino , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
CSF-venous fistula is a relatively novel entity that is increasingly being recognized as a cause for spontaneous intracranial hypotension. Recently, our group published the first series of transvenous embolization of CSF-venous fistulas in this journal. Having now performed the procedure in 60 patients, we have garnered increasing familiarity with the anatomy and how to navigate our way through the venous system to any intervertebral foramen in the cervical, thoracic, and lumbar spine. The first part of this review summarizes the organization of spinal venous drainage as described in classic anatomy and interventional radiology texts, the same works that we studied when attempting our first cases. In the second part, we draw mostly on our own experience to provide a practical roadmap from the puncture site to the foramen. On the basis of these 2 parts, we hope this article will serve to collate the relevant anatomic knowledge and give confidence to colleagues who wish to embark on transvenous spinal procedures.
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Embolización Terapéutica , Hipotensión Intracraneal , Drenaje/efectos adversos , Embolización Terapéutica/efectos adversos , Humanos , Hipotensión Intracraneal/etiología , Punción Espinal/efectos adversos , Columna VertebralRESUMEN
Endovascular treatment of aneurysms with flow diverters or coiling is sometimes complicated by intraprocedural or postprocedural thrombosis along or within the devices. Thrombus composition and structure associated with such complications may provide insights into mechanisms of thrombus formation and clinical strategies to remove the thrombus. We present a retrospective histopathologic study of 4 patients who underwent mechanical thrombectomy due to acute occlusion of either implanted flow diverter devices or along coils during the treatment of intracranial aneurysm.
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Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Trombosis , Embolización Terapéutica/efectos adversos , Procedimientos Endovasculares/efectos adversos , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Estudios Retrospectivos , Stents/efectos adversos , Trombosis/diagnóstico por imagen , Trombosis/etiología , Resultado del TratamientoRESUMEN
Current guidelines for primary and secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis and symptom status. Recent publications have demonstrated that plaque morphology and composition, independent of the degree of stenosis, are important in the risk stratification of carotid atherosclerotic disease. This finding raises the question as to whether current guidelines are adequate or if they should be updated with new evidence, including imaging for plaque phenotyping, risk stratification, and clinical decision-making in addition to the degree of stenosis. To further this discussion, this roadmap consensus article defines the limits of luminal imaging and highlights the current evidence supporting the role of plaque imaging. Furthermore, we identify gaps in current knowledge and suggest steps to generate high-quality evidence, to add relevant information to guidelines currently based on the quantification of stenosis.
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Enfermedades de las Arterias Carótidas , Estenosis Carotídea , Placa Aterosclerótica , Accidente Cerebrovascular , Arterias Carótidas , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/terapia , Consenso , Humanos , Placa Aterosclerótica/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/prevención & controlRESUMEN
BACKGROUND: The Woven EndoBridge device has been increasingly used to treat wide-neck aneurysms, particularly ruptured ones. PURPOSE: Our aim was to investigate the safety and efficacy of the Woven EndoBridge device in the treatment of ruptured intracranial aneurysms. DATA SOURCES: All studies evaluating the outcomes of Woven EndoBridge device use in the treatment of ruptured intracranial aneurysms from inception through 2020 were searched on Ovid Evidence-Based Medicine Reviews, EMBASE, MEDLINE, Scopus, and the Web of Science Core Collection. STUDY SELECTION: Eighteen studies encompassing 487 patients with 496 ruptured aneurysms treated with the Woven EndoBridge device were included. DATA ANALYSIS: We studied rates of rerupture and retreatment, angiographic outcomes at the last follow-up point, complications, and mortality rates. Data were collected on anticoagulation and antiplatelet use. Meta-analysis was performed using the random effects model. DATA SYNTHESIS: The rate of late rebleeding was 1.1% (95% CI, 0.1%-2.1%). The treatment-related perioperative complication rate and the overall clinical complication rate were 13.2% (95% CI, 9.2%-17.2%) and 3.2% (95% CI, 1.6%-4.7%), respectively. Thirteen hemorrhagic (2%; 95% CI, 0.8%-3.3%) and 41 thromboembolic (6.8%; 95% CI, 4.6%-9%) complications occurred. Favorable clinical outcomes were achieved in 85% of patients. Procedure-related mortality and overall mortality rates were 2.1% (95% CI, 0.8%-3.3%) and 11.5% (95% CI, 7%-16%), respectively. At last follow-up, an adequate occlusion rate was 87.3% (95% CI, 82.1%-92.4%) and the retreatment rate was 5.1% (95% CI, 3%-7.3%). LIMITATIONS: Our meta-analysis is limited by selection bias and high heterogeneity. CONCLUSIONS: This meta-analysis demonstrated the safety and efficacy of the Woven EndoBridge device in the management of ruptured aneurysms, but further studies are needed.
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Aneurisma Roto , Embolización Terapéutica , Procedimientos Endovasculares , Aneurisma Intracraneal , Aneurisma Roto/terapia , Embolización Terapéutica/efectos adversos , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: The pseudophlebitic pattern is an increasingly recognized angiographic manifestation of chronic venous congestion in the setting of a cranial dural arteriovenous fistula. We sought to study the clinical and radiologic manifestations of patients with the pseudophlebitic pattern. MATERIALS AND METHODS: We retrospectively reviewed a cohort of patients with dural arteriovenous fistulas evaluated at our institution from 2008 to 2020. Angiograms were reviewed to classify dural arteriovenous fistulas and document the presence or absence of a pseudophlebitic pattern, defined as the presence of serpiginous and tortuous collateral, bridging, and cortical veins with an associated delay in circulation time of the normal brain. We then studied the association between the pseudophlebitic pattern and clinical presentation and MR imaging findings. RESULTS: Two hundred one patients were included. Patients with a pseudophlebitic pattern had more hemorrhage (22.8% versus 8.4%, P = .005), gait changes and ataxia (6.0% versus 0.0%, P = 0.002), cognitive changes (6.9% versus 1.4%, P = .04), and seizures (8.6% versus 2.1%, P = .03). On MR imaging, the pseudophlebitic pattern was associated with higher rates of cerebral edema (70.9% versus 2.9%, P < .0001), chronic hemosiderin deposition and microhemorrhage (17.3% versus 2.2%, P = .0002), and dilated transmedullary veins (47.1% versus 0.0%, P < .0001). When we considered only patients with malignant fistulas, there was no difference in hemorrhage at presentation between the 2 groups (22.6% versus 22.8%, P = .99). Patients with a pseudophlebitic pattern did have higher rates of nonhemorrhagic neurologic deficits (24.1% versus 9.4%, P = .03). CONCLUSIONS: The pseudophlebitic pattern was associated with high rates of brain parenchymal changes and neurologic symptoms in this cohort of patients with dural arteriovenous fistulas.
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Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/patología , Adulto , Anciano , Angiografía Cerebral/métodos , Femenino , Humanos , Angiografía por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: The role of the dural venous sinus system in cerebrovascular pathology and the understanding of normal developmental patterns and sizes of the dural venous sinus system continue to expand. The purpose of this study was to review MR venograms to elucidate developmental patterns and diameters of the major dural venous sinuses from 0 to 20 years of age. MATERIALS AND METHODS: All available MR venograms of patients 0-20 years of age who presented to our institution were retrospectively reviewed. Patient age at the time of image acquisition was noted, and measurements were taken of the diameters of the major dural venous sinuses. The presence of embryonic sinuses including the persistent falcine sinus and the occipital sinus was noted. Dominance patterns of the transverse sinus system were determined. Mean diameters of each sinus were plotted as a function of age. The prevalence of persistent prenatal sinuses and transverse sinus-dominance patterns was compared across ages. RESULTS: A total of 429 MR venograms from 429 patients were reviewed. All dural venous sinuses demonstrated a maximal growth rate from 0 to 7 years of age and reached maximal diameters around 5-10 years of age. The prevalence of falcine sinuses and occipital sinuses trended downward across increasing age categories (P = .09 and, <.0001, respectively). CONCLUSIONS: Dural venous sinuses demonstrate maximal growth between 0 and 7 years of age and reach adult size around 5-10 years of age. Involution of the prenatal sinuses continues to take place after birth into childhood but is largely absent in early adulthood.
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Senos Craneales/crecimiento & desarrollo , Adolescente , Niño , Preescolar , Senos Craneales/anatomía & histología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Flebografía/métodos , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: The utility of vessel wall MR imaging in identifying unstable intracranial aneurysms has been suggested but remains controversial. PURPOSE: Our aim was to provide further insight into the potential relationship between aneurysm wall enhancement on initial vessel wall imaging and aneurysm instability at follow-up. DATA SOURCES: Our sources were PubMed, Scopus, the Web of Science, and the Cochrane Central Register of Controlled Trials. STUDY SELECTION: We searched for English language studies that reported the presence of vessel wall enhancement of unruptured intracranial aneurysms on baseline vessel wall imaging studies with longitudinal follow-up of aneurysm status. DATA ANALYSIS: Aneurysms were grouped into "stable" and "unstable" groups at follow-up on the basis of growth, symptomatic manifestation, or rupture. The association of each group with aneurysm wall enhancement on initial vessel wall imaging was determined. DATA SYNTHESIS: Three studies constituting 407 aneurysms were included. Aneurysms with wall enhancement were at higher risk of being unstable at follow-up (risk ratio = 3.6; 95% confidence interval, 1.7-7.5). The sensitivity of aneurysm wall enhancement on vessel wall imaging was 74.3% (95% CI, 56.7%-87.5%), specificity was 58.3% (95% CI, 53.1%-63.4%), positive predictive value was 14.4% (95% CI, 11.8%-17.4%), negative predictive value was 96.0% (95% CI, 93.2%-97.7%), and the overall accuracy of the test was 59.7% (95% CI, 54.8%-64.5%). LIMITATIONS: Only 3 studies were identified for inclusion in this analysis. More longitudinal studies of vessel wall imaging and aneurysm progression are needed. CONCLUSIONS: The lack of wall enhancement may be a predictor of aneurysm stability. The utility of vessel wall imaging in detecting unstable aneurysms requires more data.
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Aneurisma Intracraneal/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Aneurisma Roto , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND AND PURPOSE: Inflammatory changes in the fat tissue surrounding the coronary arteries have been associated with coronary artery disease and high-risk vulnerable plaques. Our aim was to investigate possible correlations between the presence and degree of perivascular fat density and a marker of vulnerable carotid plaque, namely contrast plaque enhancement on CTA. MATERIALS AND METHODS: One-hundred patients (76 men, 24 women; mean age, 69 years) who underwent CT angiography for investigation of carotid artery stenosis were retrospectively analyzed. Contrast plaque enhancement and perivascular fat density were measured in 100 carotid arteries, and values were stratified according to symptomatic (ipsilateral-to-cerebrovascular symptoms)/asymptomatic status (carotid artery with the most severe degree of stenosis). Correlation coefficients (Pearson ρ product moment) were calculated between the contrast plaque enhancement and perivascular fat density. The differences among the correlation ρ values were calculated using the Fisher r-to-z transformation. Mann-Whitney analysis was also calculated to test differences between the groups. RESULTS: There was a statistically significant positive correlation between contrast plaque enhancement and perivascular fat density (ρ value = 0.6582, P value = .001). The correlation was stronger for symptomatic rather than asymptomatic patients (ρ value = 0.7052, P value = .001 versus ρ value = 0.4092, P value = .001). CONCLUSIONS: There was a positive association between perivascular fat density and contrast plaque enhancement on CTA. This correlation was stronger for symptomatic rather than asymptomatic patients. Our results suggest that perivascular fat density could be used as an indirect marker of plaque instability.
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Tejido Adiposo/patología , Estenosis Carotídea/patología , Placa Aterosclerótica/patología , Tejido Adiposo/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/patología , Angiografía por Tomografía Computarizada/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: Our aim was to assess the relationship between volume and percentage of intraplaque hemorrhage measured using CT and the occurrence of cerebrovascular events at the time of CT. MATERIALS AND METHODS: One-hundred-twenty-three consecutive subjects (246 carotid arteries) with a mean age of 69 years who underwent CTA were included in this retrospective study. Plaque volume of components and subcomponents (including intraplaque hemorrhage volume) was quantified with dedicated software. RESULTS: Forty-six arteries were excluded because no plaque was identified. In the remaining 200 carotid arteries, a statistically significant difference was found between presentation with cerebrovascular events and lipid volume (P = .002), intraplaque hemorrhage volume (P = .002), percentage of lipid (P = .002), percentage of calcium (P = .001), percentage of intraplaque hemorrhage (P = .001), percentage of lipid-intraplaque hemorrhage (P = .001), and intraplaque hemorrhage/lipid ratio (P = .001). The highest receiver operating characteristic area under the curve was obtained with the intraplaque hemorrhage volume with a value of 0.793 (P = .001), percentage of intraplaque hemorrhage with an area under the curve of 0.812 (P = .001), and the intraplaque hemorrhage/lipid ratio with an area under the curve value of 0.811 (P = .001). CONCLUSIONS: Results of our study suggest that Hounsfield unit values <25 have a statistically significant association with the presence of cerebrovascular events and that the ratio intraplaque hemorrhage/lipid volume represents a strong parameter for the association of cerebrovascular events.
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Estenosis Carotídea/patología , Hemorragia Cerebral/patología , Trastornos Cerebrovasculares/etiología , Placa Aterosclerótica/patología , Anciano , Estenosis Carotídea/complicaciones , Hemorragia Cerebral/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/complicaciones , Curva ROC , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: Selection of the correct flow-diverter size is critical for cerebral aneurysm treatment success, but it remains challenging due to the interplay of device size, anatomy, and deployment. Current convention does not address these challenges well. The goals of this pilot study were to determine whether computational modeling improves flow-diverter sizing over current convention and to validate simulated deployments. MATERIALS AND METHODS: Seven experienced neurosurgeons and interventional neuroradiologists used computational modeling to prospectively plan 19 clinical interventions. In each patient case, physicians simulated 2-4 flow-diverter sizes that were under consideration based on preprocedural imaging. In addition, physicians identified a preferred device size using the current convention. A questionnaire on the impact of computational modeling on the procedure was completed immediately after treatment. Rotational angiography image data were acquired after treatment and compared with flow-diverter simulations to validate the output of the software platform. RESULTS: According to questionnaire responses, physicians found the simulations useful for treatment planning, and they increased their confidence in device selection in 94.7% of cases. After viewing the simulations results, physicians selected a device size that was different from the original conventionally planned device size in 63.2% of cases. The average absolute difference between clinical and simulated flow-diverter lengths was 2.1 mm. In 57% of cases, average simulated flow-diverter diameters were within the measurement uncertainty of clinical flow-diverter diameters. CONCLUSIONS: Physicians found computational modeling to be an impactful and useful tool for flow-diverter treatment planning. Validation results showed good agreement between simulated and clinical flow-diverter diameters and lengths.
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Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Simulación por Computador , Aneurisma Intracraneal/cirugía , Femenino , Humanos , Masculino , Proyectos Piloto , Programas InformáticosRESUMEN
BACKGROUND AND PURPOSE: The presence of IPH is considered the most dangerous feature because it is significantly associated with clinical ipsilateral cerebrovascular events. Our aim was to explore the characterization of plaque with CT in symptomatic subjects with bilateral intraplaque hemorrhage. MATERIALS AND METHODS: Three-hundred-forty-three consecutive patients with recent anterior circulation ischemic events (<2 weeks) and CT of the carotid arteries (performed within 14 days of the cerebrovascular event) evaluated between June 2012 and September 2017 were analyzed for plaque volume composition to identify all subjects with bilateral intraplaque hemorrhage. Plaque volume was semiautomatically measured, and tissue components were classified according to the attenuation values such as the following: calcified (for values of ≥130 HU), mixed (for values of ≥60 and <130 HU), lipid (for values of ≥25 and <60 HU), and intraplaque hemorrhage (for values of <25 HU). Twenty-one subjects (15 men; mean age, 70 ± 11 years; range, 44-87 years) had bilateral intraplaque hemorrhage and were included in the analysis. RESULTS: Volume measurement revealed significantly larger plaques on the symptomatic side compared with the asymptomatic one (mean, 28 ± 9 versus 22 ± 8 mm, P = .007). Intraplaque hemorrhage volume and percentage were also significantly higher in the plaque ipsilateral to the cerebrovascular event (P < .001 and < .001, respectively). The volume of other plaque components did not show a statically significant association except for lipid and lipid + intraplaque hemorrhage percentages (23% versus 18% and 11% versus 15%), which were significantly different between the symptomatic and the asymptomatic sides (.016 and .011, respectively). The intraplaque hemorrhage/lipid ratio was higher on the symptomatic side (0.596 versus 0.171, P = .001). CONCLUSIONS: In patients with bilateral intraplaque hemorrhage and recent ischemic symptoms, the plaque ipsilateral to the symptomatic side has significantly larger volume and a higher percentage of intraplaque hemorrhage compared with the contralateral, asymptomatic side.
Asunto(s)
Isquemia Encefálica/etiología , Estenosis Carotídea/patología , Hemorragia/patología , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/patología , Adulto , Anciano , Anciano de 80 o más Años , Estenosis Carotídea/diagnóstico por imagen , Femenino , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/diagnóstico por imagen , Factores de RiesgoRESUMEN
BACKGROUND AND PURPOSE: Much has been written about the initial radiologic features of cavernous malformations, but less known are the radiologic natural history and evolution of the lesions, particularly when they initially present with hemorrhage. We aimed to describe the typical evolution of a sporadic, hemorrhagic brain cavernous malformation with time. MATERIALS AND METHODS: From our institutional review board-approved cavernous malformation registry, we assessed initial clinical and radiologic features and the subsequent MR imaging evolution of 51 patients with sporadic, hemorrhagic brain cavernous malformations (with follow-up brain MRIs available for review). RESULTS: The initial MR imaging demonstrated mostly Zabramski type I lesions (94.2%) with T1 hyperintensity (94.2%) and associated edema (76.5%). Eight patients (15.6%) rebled in the first year with lesions characterized by new T1 hyperintensity (100%), edema (61.5%), and growth (median, 4 mm). By 90 days, most lesions had changed from Zabramski type I to type II or III (65.2%). While 76.5% had edema associated with the acute hemorrhage, none had persistent edema beyond 90 days unless rebleeding occurred. Across time, the frequency of T1 hyperintensity decreased from 94.2% at baseline to 73.9%, 57.1%, and 50.0% at <90, 91-365, and >365 days. DWI intensity at baseline and <90, 91-365, and >365 days was hypointense at 53.1%, 56.5%, 70.1%, and 81.2%, respectively. CONCLUSIONS: Hemorrhagic cavernous malformation demonstrates a characteristic pattern of evolution on follow-up imaging. Knowing this evolution helps to analyze the timing of imaging in relation to the clinical presentation and may help distinguish true cavernous malformation hemorrhagic evolution from mimics and guide appropriate timing of interval-imaging follow-up after symptomatic bleeds in untreated patients.
Asunto(s)
Fístula Arteriovenosa/patología , Hemorragia Cerebral/patología , Malformaciones Arteriovenosas Intracraneales/patología , Adolescente , Adulto , Anciano , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/etiología , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/complicaciones , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: Conventional MR imaging can provide important clues regarding the location of a spinal vascular malformation. We hypothesized that a dilated vein of the filum terminale, identified as a curvilinear flow void on T2WI, could be an imaging marker for a lower lumbar (L3-L5) or sacral fistula. MATERIALS AND METHODS: We retrospectively identified all spinal dural and spinal epidural arteriovenous fistulas from 2 large tertiary referral centers from 2005 to 2018. All patients had a lumbar spinal MR imaging and a conventional spinal angiography. Images were reviewed by 2 neuroradiologists who categorized the level of the arterial feeder to the fistula and the presence or absence of a dilated vein of the filum terminale on T2WI and T1 postcontrast images. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula. RESULTS: One hundred sixty-two patients were included. An enlarged filum terminale vein was identified in 39 patients. Sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula were 86%, 98.3%, 94.9%, and 95.1%, respectively. CONCLUSIONS: The presence of a dilated vein of the filum terminale can accurately localize a spinal dural arteriovenous fistula/spinal epidural arteriovenous fistula to the lower lumbar or sacral spine in patients being evaluated for such lesions. This finding can be used to facilitate both noninvasive and conventional spinal angiography.