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1.
Vasc Endovascular Surg ; 54(2): 97-101, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31746279

RESUMEN

Preprocedural cross-sectional imaging (PCSI) for peripheral artery disease (PAD) may vary due to patient complexity, anatomical disease burden, and physician preference. The objective of this study was to determine the utility of PCSI prior to percutaneous vascular interventions (PVIs) for PAD. Patients receiving first time lower extremity angiograms from 2013 to 2015 at a single institution were evaluated for PCSI performed within 180 days, defined as computed tomography angiography (CTA) or magnetic resonance angiography (MRA) evaluating abdominal to pedal vasculature. The primary outcome was technical success defined as improving the target outflow vessels to <30% stenosis. Of the 346 patients who underwent lower extremity angiograms, 158 (45.7%) patients had PCSI, including 150 patients had CTA and 8 patients had MRA. Of these, 48% were ordered by the referring provider (84% at an outside institution). Preprocedural cross-sectional imaging was performed at a median of 26 days (interquartile range: 9-53) prior to the procedure. The analysis of the institution's 5 vascular surgeons identified PCSI rates ranging from 31% to 70%. On multivariate analysis, chronic kidney disease (odds ratio [OR] = 0.35; 95% confidence interval [CI]: 0.17-0.73) was associated with less PSCI usage, and inpatient/emergency department evaluation (OR = 3.20; 95% CI: 1.58-6.50) and aortoiliac disease (OR = 2.78; 95% CI: 1.46-5.29) were associated with higher usage. After excluding 31 diagnostic procedures, technical success was not statistically significant with PSCI (91.3%) compared to without PCSI (85.6%), P = .11. When analyzing 89 femoral-popliteal occlusions, technical success was higher with PCSI (88%) compared to procedures without (69%) P = .026. Our analysis demonstrates that routine ordering of PCSI may not be warranted when considering technical success of PVI; however, PCSI may be helpful in treatment planning. Further studies are needed to confirm these findings in another practice setting, with more prescriptive use of PCSI to improve procedural success, and thereby improve the value of PCSI.


Asunto(s)
Angiografía por Tomografía Computarizada , Procedimientos Endovasculares , Extremidad Inferior/irrigación sanguínea , Angiografía por Resonancia Magnética , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/terapia , Pautas de la Práctica en Medicina/tendencias , Anciano , Toma de Decisiones Clínicas , Angiografía por Tomografía Computarizada/tendencias , Bases de Datos Factuales , Procedimientos Endovasculares/tendencias , Femenino , Humanos , Angiografía por Resonancia Magnética/tendencias , Masculino , Variaciones Dependientes del Observador , Selección de Paciente , Enfermedad Arterial Periférica/fisiopatología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento
2.
Br J Radiol ; 92(1103): 20180309, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31502858

RESUMEN

Atherosclerosis is a chronic immunomodulated disease that affects multiple vascular beds and results in a significant worldwide disease burden. Conventional imaging modalities focus on the morphological features of atherosclerotic disease such as the degree of stenosis caused by a lesion. Modern CT, MR and positron emission tomography scanners have seen significant improvements in the rapidity of image acquisition and spatial resolution. This has increased the scope for the clinical application of these modalities. Multimodality imaging can improve cardiovascular risk prediction by informing on the constituency and metabolic processes within the vessel wall. Specific disease processes can be targeted using novel biological tracers and "smart" contrast agents. These approaches have the potential to inform clinicians of the metabolic state of atherosclerotic plaque. This review will provide an overview of current imaging techniques for the imaging of atherosclerosis and how various modalities can provide information that enhances the depiction of basic morphology.


Asunto(s)
Aterosclerosis/diagnóstico , Diagnóstico por Imagen/tendencias , Enfermedades de la Aorta/diagnóstico , Enfermedades de las Arterias Carótidas/diagnóstico , Medios de Contraste , Enfermedad Coronaria/diagnóstico , Humanos , Angiografía por Resonancia Magnética/tendencias , Espectroscopía de Resonancia Magnética , Nanopartículas de Magnetita , Imagen Molecular/tendencias , Espectrofotometría Infrarroja/tendencias , Tomografía de Coherencia Óptica/tendencias , Tomografía Computarizada por Rayos X/tendencias , Ultrasonografía Intervencional/tendencias , Calcificación Vascular/diagnóstico
4.
PET Clin ; 14(2): 271-279, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30826024

RESUMEN

Cardiac PET provides high sensitivity and high negative predictive value in the diagnosis of coronary artery disease and cardiomyopathies. Cardiac, respiratory as well as bulk patient motion have detrimental effects on thoracic PET imaging, in particular on cardiovascular PET imaging where the motion can affect the PET images quantitatively as well as qualitatively. Gating can ameliorate the unfavorable impact of motion additionally enabling evaluation of left ventricular systolic function. In this article, the authors review the recent advances in gating approaches and highlight the advances in data-driven approaches, which hold promise in motion detection without the need for complex hardware setup.


Asunto(s)
Técnicas de Imagen Sincronizada Cardíacas/métodos , Cardiomiopatías/diagnóstico , Tomografía de Emisión de Positrones/métodos , Técnicas de Imagen Sincronizada Respiratorias/métodos , Electrocardiografía/métodos , Humanos , Angiografía por Resonancia Magnética/métodos , Angiografía por Resonancia Magnética/tendencias , Imagen Multimodal/métodos , Imagen Multimodal/tendencias , Imagen de Perfusión Miocárdica/métodos , Imagen de Perfusión Miocárdica/tendencias , Tomografía de Emisión de Positrones/tendencias , Sensibilidad y Especificidad
5.
Expert Rev Gastroenterol Hepatol ; 13(5): 463-484, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30895833

RESUMEN

INTRODUCTION: Veno-occlusive-disease (VOD), known also as sinusoidal-obstruction-syndrome (SOS), is one of the main complications of haematopoietic stem cell transplantation and is related to the treatment with pyrrolizidine alkaloids or other toxic agents (chemotherapy for liver-metastasis). Clinical diagnosis using the recent criteria from the European Society for Blood and Marrow Transplantation, is the reference for VOD/SOS diagnosis. However, increasing evidence suggests the emerging role of several imaging methods that could help the clinician in VOD/SOS assessment. Areas covered: This review evaluates the current literature on the various imaging techniques used in VOD/SOS diagnosis in several clinical scenarios. Literature searches were performed using several keywords on MEDLINE/Ovid/In-Process/Cochrane Library/EMBASE and PubMed up to July 2018. Expert commentary: Hepatic-gradient-measurement (HVPG) and contextual transjugular-liver-biopsy are invasive and should always be considered in unclear cases. The main studies revolve around ultrasound with Doppler evaluation, identifying numerous findings suggestive of VOD/SOS. However, their accuracy and validation are still suboptimal and controversial. CT-Scan and MRI have shown encouraging data in other contexts in which VOD/SOS can develop, but studies on the post-HSCT patient are lacking. Elastography techniques measuring liver stiffness (LSM) represent the most recent and promising approach for an accurate and early diagnosis of VOD/SOS. In our view, a multidisciplinary approach to the VOD/SOS diagnosis should be highly encouraged.


Asunto(s)
Venas Hepáticas/diagnóstico por imagen , Enfermedad Veno-Oclusiva Hepática/diagnóstico por imagen , Ultrasonografía Doppler/tendencias , Animales , Antineoplásicos/efectos adversos , Angiografía por Tomografía Computarizada/tendencias , Difusión de Innovaciones , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedad Veno-Oclusiva Hepática/etiología , Humanos , Angiografía por Resonancia Magnética/tendencias , Flebografía/tendencias , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Factores de Riesgo
6.
J Neurointerv Surg ; 11(1): 84-89, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29794159

RESUMEN

BACKGROUND AND PURPOSE: It is classically thought that the internal cerebral veins (ICV) do not communicate with the venous pouch of vein of Galen malformations (VGM). We report on the anatomy of the deep venous system in VGM with special emphasis on the drainage of the ICV and possible changes after endovascular treatment. MATERIALS AND METHODS: We retrospectively analyzed DSA and 2D time-of-flight MR venograms of 55 children with VGM. We evaluated all pre- and post-operative images for the presence of the ICVs and determined their route of venous drainage. RESULTS: Of 55 children, pre-operative 2D MRV detected the ICVs in 19 cases (35%) compared with one case (2%) for pre-embolization DSA (2%) (P<0.0001). Of the cases in which the ICVs were seen preoperatively, in 15 cases (78.9%) the ICV drained directly into the VGM while in the other four cases, the ICV used alternative venous drainage routes. On post-operative MRV, the ICVs were seen in 17 cases (31%) on MRV and 10 cases (18.2%) on DSA with drainage into an adult-like vein of Galen in 13 cases (76%), respectively (P=0.08). In four cases normal ICV drainage into the vein of Galen was seen even when the venous sac was closed. In two cases there was a change in ICV drainage from the vein of Galen to the lateral mesencephalic vein. CONCLUSION: The communication of the ICV with the VGM is a common phenomenon. Different changes of venous drainage routes do occur after treatment and are best seen on MRV.


Asunto(s)
Venas Cerebrales/diagnóstico por imagen , Procedimientos Endovasculares/métodos , Angiografía por Resonancia Magnética/métodos , Malformaciones de la Vena de Galeno/diagnóstico por imagen , Malformaciones de la Vena de Galeno/terapia , Adolescente , Adulto , Venas Cerebrales/anatomía & histología , Niño , Preescolar , Embolización Terapéutica/métodos , Embolización Terapéutica/tendencias , Procedimientos Endovasculares/tendencias , Femenino , Humanos , Lactante , Angiografía por Resonancia Magnética/tendencias , Masculino , Flebografía/métodos , Flebografía/tendencias , Estudios Retrospectivos
7.
Stroke ; 48(8): 2274-2277, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28679853

RESUMEN

BACKGROUND AND PURPOSE: Childhood arterial ischemic stroke is frequently associated with an intracranial arteriopathy that often progresses in the first 3 to 6 months post stroke. We hypothesized that children with enhancing arteriopathies on vessel wall imaging (VWI) would have a higher risk of arteriopathy progression than those without enhancement. METHODS: Our institutional radiographic database was searched for cases of childhood stroke with VWI. Inclusion criteria consisted of age ranging from 1 month through 20 years, diagnosis of arterial ischemic stroke, available VWI, and follow-up magnetic resonance angiogram. Imaging was reviewed to systematically describe VWI findings, categorize arteriopathies, steroid therapy, and identify progressive arteriopathies using CACADE definitions. RESULTS: Sixteen cases of childhood stroke at Children's Hospital Colorado between January 1, 2010 and July 1, 2016 were reviewed. Strong vessel wall enhancement at presentation was associated with progressive arteriopathy in 83% of cases (10/12), when compared with 0% (0/4) without strong enhancement (P=0.008). CONCLUSIONS: Our case series demonstrates the potential benefit of VWI in children with stroke because it may identify patients who will have progressive arterial disease.


Asunto(s)
Arterias Cerebrales/diagnóstico por imagen , Progresión de la Enfermedad , Enfermedades Arteriales Intracraneales/diagnóstico por imagen , Angiografía por Resonancia Magnética/tendencias , Accidente Cerebrovascular/diagnóstico por imagen , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Arteriales Intracraneales/complicaciones , Angiografía por Resonancia Magnética/métodos , Masculino , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones
8.
J Vasc Surg ; 66(1): 112-121, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28359719

RESUMEN

OBJECTIVE: Previous studies involving large administrative data sets have revealed regional variation in the demographics of patients selected for carotid endarterectomy (CEA) and carotid artery stenting (CAS) but lacked clinical granularity. This study aimed to evaluate regional variation in patient selection and operative technique for carotid artery revascularization using a detailed clinical registry. METHODS: All patients who underwent CEA or CAS from 2009 to 2015 were identified in the Vascular Quality Initiative (VQI). Deidentified regional groups were used to evaluate variation in patient selection, operative technique, and perioperative management. χ2 analysis was used to identify significant variation across regions. RESULTS: A total of 57,555 carotid artery revascularization procedures were identified. Of these, 49,179 patients underwent CEA (asymptomatic: median, 56%; range, 46%-69%; P < .01) and 8376 patients underwent CAS (asymptomatic: median, 36%; range, 29%-51%; P < .01). There was significant regional variation in the proportion of asymptomatic patients being treated for carotid stenosis <70% in CEA (3%-9%; P < .01) vs CAS (3%-22%; P < .01). There was also significant variation in the rates of intervention for asymptomatic patients older than 80 years (CEA, 12%-27% [P < .01]; CAS, 8%-26% [P < .01]). Preoperative computed tomography angiography or magnetic resonance angiography in the CAS cohort also varied widely (31%-83%; P < .01), as did preoperative medical management with combined aspirin and statin (CEA, 53%-77% [P < .01]; CAS, 62%-80% [P < .01]). In the CEA group, the use of shunt (36%-83%; P < .01), protamine (32%-89%; P < .01), and patch (87%-99%; P < .01) varied widely. Similarly, there was regional variation in frequency of CAS done without a protection device (1%-8%; P < .01). CONCLUSIONS: Despite clinical benchmarks aimed at guiding management of carotid disease, wide variation in clinical practice exists, including the proportion of asymptomatic patients being treated by CAS and preoperative medical management. Additional intraoperative variables, including the use of a patch and protamine during CEA and use of a protection device during CAS, displayed similar variation in spite of clear guidelines. Quality improvement projects could be directed toward improved adherence to benchmarks in these areas.


Asunto(s)
Angioplastia/tendencias , Estenosis Carotídea/terapia , Endarterectomía Carotidea/tendencias , Disparidades en Atención de Salud/tendencias , Selección de Paciente , Pautas de la Práctica en Medicina/tendencias , /tendencias , Anciano , Anciano de 80 o más Años , Angioplastia/efectos adversos , Angioplastia/instrumentación , Benchmarking/tendencias , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/cirugía , Distribución de Chi-Cuadrado , Angiografía por Tomografía Computarizada/tendencias , Endarterectomía Carotidea/efectos adversos , Femenino , Adhesión a Directriz/tendencias , Humanos , Angiografía por Resonancia Magnética/tendencias , Masculino , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos
9.
J Neurointerv Surg ; 9(10): 929-932, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27634952

RESUMEN

BACKGROUND: The clot burden score (CBS) was developed as a tool to evaluate the extent of intracranial thrombus burden in patients with anterior circulation acute ischemic stroke. CBS is based on the presence or absence of contrast opacification on CT angiography (CTA). Its value in predicting radiographic and clinical outcomes in patients given endovascular stroke therapy remains unknown. OBJECTIVE: To evaluate the relationship between CBS and outcomes after stent retriever thrombectomy in the interventional arm of the SWIFT PRIME trial. METHODS: CBS was calculated for the endovascular arm (IV tissue plasminogen activator plus Solitaire stent retriever) of SWIFT PRIME using baseline CTA. The cohort of 69 patients was divided into three groups according to their CBS values: CBS 0-5 (n=14), CBS 6-7 (n=23), and CBS 8-9 (n=32). RESULTS: The mean age of the 69 patients who formed the study cohort was 63.2±13.1 years, mean National Institutes of Health Stroke Scale score was 16.8±4.5, and 55% of the patients were male. There was no difference in clinical characteristics among the three groups, except for the baseline Alberta Stroke Program Early CT Score (p=0.049). The site of proximal occlusion varied significantly among the three groups (p<0.001). Rates of successful recanalization (TICI 2b/3), complete recanalization (TICI 3 only) and of good clinical outcome at 3 months were similar among the three groups (p=0.24, p=0.35, and p=0.52, respectively). CONCLUSIONS: The combination of IV thrombolysis and stent retriever thrombectomy with the Solitaire device is highly effective in achieving successful recanalization and a good clinical outcome throughout the entire range of CBS values.


Asunto(s)
Isquemia Encefálica/terapia , Stents , Accidente Cerebrovascular/terapia , Trombectomía/tendencias , Trombosis/terapia , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Isquemia Encefálica/diagnóstico por imagen , Estudios de Cohortes , Costo de Enfermedad , Femenino , Humanos , Angiografía por Resonancia Magnética/métodos , Angiografía por Resonancia Magnética/tendencias , Masculino , Persona de Mediana Edad , Stents/efectos adversos , Accidente Cerebrovascular/diagnóstico por imagen , Trombectomía/instrumentación , Trombosis/diagnóstico por imagen , Resultado del Tratamiento
10.
Stroke ; 48(2): 348-352, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-28034965

RESUMEN

BACKGROUND AND PURPOSE: Early neurological deterioration (END) after anterior circulation stroke is strongly associated with poor outcome. Apart from straightforward causes, such as intracerebral hemorrhage and malignant edema, the mechanism of END occurring after intravenous thrombolysis remains unclear in most instances. We tested the hypothesis that unexplained END is associated with thrombus extension. METHODS: From our database of consecutively thrombolysed patients, we identified anterior circulation stroke patients who had both admission and 24-hour T2* magnetic resonance imaging, visible occlusion on admission magnetic resonance angiography and no recanalization on 24-hour magnetic resonance angiography. END was defined as ≥4 National Institutes of Health Stroke Scale-point deterioration on 24-hour clinical assessment and unexplained END as END without clear cause. The incidence of susceptibility vessel sign extension on T2* imaging, defined as any new occurrence or extension of susceptibility vessel sign from admission to 24-hour follow-up magnetic resonance, was compared between patients with unexplained END and those without END. RESULTS: Of 120 eligible patients for the present study, 22 experienced unexplained END. Susceptibility vessel sign extension was present in 41 (34%) patients and was significantly more frequent in the unexplained END than in the no-END group (59% versus 29%, respectively; adjusted odds ratio=3.96; 95% confidence interval, 1.25-12.53; P=0.02). CONCLUSIONS: In this study, unexplained END occurring after thrombolysis was independently associated with susceptibility vessel sign extension, suggesting in situ thrombus extension or re-embolization. These findings strengthen the need to further investigate early post-thrombolysis administration of antithrombotics to reduce the risk of this ominous clinical event.


Asunto(s)
Enfermedades del Sistema Nervioso/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/tendencias , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Fibrinolíticos/administración & dosificación , Fibrinolíticos/efectos adversos , Estudios de Seguimiento , Humanos , Angiografía por Resonancia Magnética/tendencias , Imagen por Resonancia Magnética/tendencias , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/inducido químicamente , Estudios Prospectivos , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
12.
Curr Cardiol Rep ; 18(9): 89, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27448403

RESUMEN

Non-invasive external magnetic resonance imaging (MRI) of large vessel atherosclerosis is a robust and promising imaging modality that can be applied for the evaluation of the atherosclerotic process in large vessels. However, it requires expertise for setup and time for data acquisition and analysis. Intravascular MRI is a promising tool, but its use remains at the pre-clinical stage within selected research groups. In this review, the current status and future role of intravascular MRI for atherosclerotic plaque characterization are summarized, along with important challenges which will be necessary to overcome prior to the wide adoption of this technique.


Asunto(s)
Procedimientos Endovasculares/métodos , Angiografía por Resonancia Magnética/métodos , Placa Aterosclerótica/diagnóstico por imagen , Procedimientos Endovasculares/tendencias , Humanos , Arteria Ilíaca/diagnóstico por imagen , Angiografía por Resonancia Magnética/tendencias
14.
Top Magn Reson Imaging ; 25(2): 41-7, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27049240

RESUMEN

Intracranial vessel wall magnetic resonance imaging (VW-MRI) can be a useful diagnostic technique in patients with ischemic stroke and subarachnoid hemorrhage. Unlike conventional vascular imaging that depicts only the vessel lumen, VW-MRI allows visualization of pathology in the arterial wall itself. The ability to image the arterial wall is useful, as many pathological processes reside within the wall and only secondarily affect the lumen. In this review, we will present 6 clinical uses for intracranial wall imaging to highlight the versatility of this technique.


Asunto(s)
Trastornos Cerebrovasculares/diagnóstico por imagen , Gadolinio , Angiografía por Resonancia Magnética , Medios de Contraste/metabolismo , Gadolinio/efectos adversos , Humanos , Angiografía por Resonancia Magnética/tendencias
15.
Curr Cardiol Rep ; 18(5): 47, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27038612

RESUMEN

In the Western world and developing countries, the number one causes of mortality and morbidity result from cardiovascular diseases. Cardiovascular diseases represent a wide range of pathologies, including myocardial infarction, peripheral vascular disease, and cerebrovascular disease, which are all linked by a common cause - atherosclerosis. Currently, the diagnosis of atherosclerosis is in most cases established at the end stage of the disease, when patients are administered to the emergency room due to a myocardial infarction or stroke. Even though cardiovascular diseases have an enormous impact on society, there are still limitations in the early diagnosis and the prevention of the disease. Current imaging methods mainly focus on morphological changes that occur at an advanced disease stage, e.g., degree of stenosis. Cardiovascular magnetic resonance imaging and specifically molecular cardiovascular magnetic resonance imaging are capable to reveal pathophysiological changes already occurring during early atherosclerotic plaque formation. This allows for the assessment of cardiovascular disease on a level, which goes beyond morphological or anatomical criteria. In this review, we will introduce promising MR-based molecular imaging strategies for the non-invasive assessment of cardiovascular disease.


Asunto(s)
Aterosclerosis/diagnóstico por imagen , Angiografía por Resonancia Magnética , Imagen Molecular , Infarto del Miocardio/prevención & control , Placa Aterosclerótica/diagnóstico por imagen , Accidente Cerebrovascular/prevención & control , Aterosclerosis/patología , Velocidad del Flujo Sanguíneo , Humanos , Angiografía por Resonancia Magnética/tendencias , Imagen Molecular/tendencias , Placa Aterosclerótica/patología , Guías de Práctica Clínica como Asunto
17.
Stroke ; 47(1): 99-105, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26585394

RESUMEN

BACKGROUND AND PURPOSE: We aimed to examine perfusion changes between 3 and 6 and 6 and 24 hours after stroke onset and their impact on tissue outcome. METHODS: Acute ischemic stroke patients underwent perfusion magnetic resonance imaging at 3, 6, and 24 hours after stroke onset and follow-up fluid-attenuated inversion recovery at 1 month to assess tissue fate. Mean transit time prolongation maps (MTTp=MTT-[median MTT of contralateral hemisphere]) were obtained at 3 (MTTp3 h), 6 (MTTp6 h), and 24 hours (MTTp24 h). Perfusion changes between 3 and 6 hours (ΔMTTp3_6) and 6 and 24 hours (ΔMTTp6_24) were calculated. A 2-step analysis was performed to evaluate the impact of ΔMTTp3_6 and ΔMTTp6_24 on tissue fate. First, a voxel-based multivariable logistic regression was performed for each individual patient with MTTp3 h, ΔMTTp3_6, and ΔMTT6_24 as independent variables and tissue fate as outcome. Second, Wilcoxon signed-rank tests on logistic regression coefficients were performed across patients to evaluate whether ΔMTTp3_6 and ΔMTT6_24 had significant impact on tissue fate for varying severities of baseline perfusion. RESULTS: Perfusion change was common during both time periods: 85% and 81% of patients had perfusion improvement during 3- to 6- and 6- and 24-hour time intervals, respectively. ΔMTT3_6 significantly influenced 1-month infarct probability across a wide range of baseline perfusion (MTTp 0-15 s). ΔMTT6_24 also impacted 1-month infarct probability, but its influence was restricted to tissue with milder baseline ischemia (MTTp 0-10 s). CONCLUSIONS: Brain tissue with mild to moderate ischemia can be salvaged by reperfusion even after 6 hours. Such tissue could be targeted for intervention beyond current treatment windows.


Asunto(s)
Isquemia Encefálica/diagnóstico , Isquemia Encefálica/cirugía , Reperfusión/tendencias , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/cirugía , Anciano , Infarto Cerebral/diagnóstico , Infarto Cerebral/cirugía , Humanos , Angiografía por Resonancia Magnética/tendencias , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo
19.
Magn Reson Imaging Clin N Am ; 24(1): 87-122, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26613877

RESUMEN

Functional MR imaging methods make possible the quantification of dynamic physiologic processes that occur in the brain. Moreover, the use of these advanced imaging techniques in the setting of oncologic treatment of the brain is widely accepted and has found worldwide routine clinical use.


Asunto(s)
Biomarcadores de Tumor/metabolismo , Neoplasias Encefálicas/diagnóstico , Imagen de Difusión por Resonancia Magnética/tendencias , Imagen de Difusión Tensora/tendencias , Angiografía por Resonancia Magnética/tendencias , Imagen Multimodal/tendencias , Neoplasias Encefálicas/metabolismo , Humanos , Imagen Molecular/tendencias
20.
Magn Reson Imaging Clin N Am ; 24(1): 123-133, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26613878

RESUMEN

Head and neck cancer is one of the most common cancers worldwide. MR imaging-based diffusion and perfusion techniques enable the noninvasive assessment of tumor biology and physiology, which supplement information obtained from standard structural scans. Diffusion and perfusion MR imaging techniques provide novel biomarkers that can aid monitoring in pretreatment, during treatment, and posttreatment stages to improve patient selection for therapeutic strategies; provide evidence for change of therapy regime; and evaluate treatment response. This review discusses pertinent aspects of the role of diffusion and perfusion MR imaging and computational analysis methods in studying head and neck cancer.


Asunto(s)
Imagen de Difusión por Resonancia Magnética/tendencias , Neoplasias de Cabeza y Cuello/diagnóstico , Angiografía por Resonancia Magnética/tendencias , Neovascularización Patológica/diagnóstico , Neoplasias de Cabeza y Cuello/complicaciones , Humanos , Imagen Multimodal/tendencias , Neovascularización Patológica/complicaciones
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