RESUMO
PURPOSE: Indicators for comparing and understanding differences in antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) for benchmarking are essential to identify priorities for hospitals. METHODS: This study measured the incidence of hospital-acquired or resistant Gram-negative bacilli bloodstream infections (GNB-BSIs) in a large public healthcare consortium in the Parisian region of France. RESULTS: Within each hospital, there was a strong positive correlation between the incidence of GNB-BSIs due to resistant GNB and the incidence of hospital-acquired GNB-BSIs. Two scores measuring AMR and HAI rates by combining different GNB-BSI incidence rates were developed as indicators. These scores were highly variable within the hospital consortium. On multi-variate analysis, AMR and HAI scores were significantly associated with the proportion of surgical beds, staff absenteeism and the consumption of alcohol-based hand rub, with the latter two characteristics being amenable to interventions. Carbapenem use was also linked to AMR, but this may be because carbapenems are the preferred drug for treating resistant infections. CONCLUSION: These results shed light on the incidence of HAIs and AMR in the study hospitals, and suggest possibilities for targeted interventions at healthcare facility level.
Assuntos
Antibacterianos , Infecção Hospitalar , Humanos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Farmacorresistência Bacteriana , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Bactérias Gram-Negativas , Hospitais , Carbapenêmicos/uso terapêuticoRESUMO
The management of patients with unruptured intracranial aneurysms (UIAs) is a complex clinical challenge and constitutes an immense field of research. While a preponderant proportion of these aneurysms never rupture, the consequences of such an event are severe and represent an important healthcare problem. To date, however, the natural history of UIAs is not completely understood and there is no accurate means to discriminate the UIAs that will rupture from those that will not. Yet, a good understanding of the recent evidence and future perspectives is needed when advising a patient with IA to tailor any information to the given patient's level of risk and psychoaffective status. Thus, this review addresses the current concepts of epidemiology, risk factors, detection and management of UIAs.
Assuntos
Aneurisma Intracraniano/terapia , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Fatores de RiscoRESUMO
BACKGROUND: Cerebral dural arteriovenous fistulas (DAVFs) are rare intracranial vascular lesions but can cause significant morbidity and mortality. OBJECTIVES: To analyze the effect of the center's experience on DAVF embolization efficacy and safety. METHODS: From May 2008 to October 2014, 57 embolization procedures were attempted on 48 patients (37 men and 11 women; median age: 63.9 years) for DAVF in a single center. DAVF presented with cortical venous reflux in 44/48 cases (91.7%) and hemorrhagic manifestation in 21/48 cases (43.75%). Angiographic occlusion quality, whether complete or incomplete (efficacy), and neurological complications (safety) were recorded. The patient population was divided into four consecutive quartiles during the inclusion period to assess the progress profile. Efficacy and safety outcomes were compared with Fisher's test. RESULTS: A logistic regression was performed to explore a learning curve phenomenon, showing a significant association between the chronological rank in the cohort and embolization efficacy (P=0.007). Significant differences were found between first and last quarter (P=0.036). The endovascular technique involved an arterial injection of Onyx® in 36/48 cases (75%), administered via the middle meningeal artery in 25/36 cases (69.5%). The complete occlusion rate improved significantly from 33.3% for the first quartile of the population, to 75.0% for the 2nd and 3rd quartiles and 83.3% for the last quartile. Neurological complications were found in 7/48 patients (14.6%), the rate decreased by 41.7% to 16.7%, without statistically difference. CONCLUSION: The efficacy and safety of DAVF embolization improved with the experience gained at the center, suggesting the existence of a learning curve.
Assuntos
Malformações Vasculares do Sistema Nervoso Central/terapia , Doenças Arteriais Cerebrais/terapia , Embolização Terapêutica/métodos , Curva de Aprendizado , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Cerebral , Doenças Arteriais Cerebrais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Traumatic subarachnoid hemorrhage (SAH) has an annual incidence of 9 per 100 000 people. It is a rare but serious event, with an estimated mortality rate of 40% within the first 48hours. In 85% of cases, it is due to rupture of an intracranial aneurysm. In the early phase, during the first 24hours, cerebral CT, combined with intracranial CT angiography is recommended to make a positive diagnosis of SAH, to identify the cause and to investigate for an intracranial aneurysm. Cerebral MRI may be proposed if the patient's clinical condition allows it. FLAIR imaging is more sensitive than CT to demonstrate a subarachnoid hemorrhage and offers greater degrees of sensitivity for the diagnosis of restricted subarachnoid hemorrhage in cortical sulcus. A lumbar puncture should be performed if these investigations are normal while clinical suspicion is high.
Assuntos
Aneurisma Roto/diagnóstico , Emergências , Hemorragia Subaracnoídea Traumática/diagnóstico , Hemorragia Subaracnóidea/diagnóstico , Aneurisma Roto/mortalidade , Artefatos , Angiografia Cerebral , Meios de Contraste , Diagnóstico Diferencial , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/mortalidade , Aumento da Imagem , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Sensibilidade e Especificidade , Punção Espinal , Hemorragia Subaracnóidea/mortalidade , Hemorragia Subaracnoídea Traumática/mortalidade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Fibromuscular dysplasia (FMD) is a noninflammatory nonatherosclerotic disease of small- to medium-sized arteries. The frequency of multisite involvement and its influence on prognosis has not been systematically assessed in patients with cervicocephalic FMD, and little is known about their mid-term clinical and arterial prognosis. The aim of our study was to assess the prevalence of renal involvement and clinical and arterial prognosis in patients with cervicocephalic FMD. METHODS: We reviewed clinical and radiological data of consecutive patients with a diagnosis of cervicocephalic FMD, admitted to our hospital between January 2000 and March 2010. Patients were identified retrospectively until December 2008, and prospectively from January 2009. For each cervical and intracranial artery, we recorded the presence and type (unifocal or multifocal) of FMD. We classified each FMD-related stenosis into four categories:<50%, 50-80%,>80% and occlusion. During the first six months of 2012, patients were scheduled for follow-up visit, including cervicocephalic follow-up imaging, and renal artery imaging, if not already available. On follow-up imaging, FMD-related stenosis was classified according to the same method used at baseline. Renal artery FMD was defined as the presence of the typical string of beads appearance, or as the presence of a unique stenosis of renal artery. Primary endpoints were stroke (ischemic or hemorrhagic), death, and progression of FMD lesions, defined by any increase in category of stenosis on follow-up imaging. RESULTS: Out of the 36 patients included (32 women), all with carotid artery involvement and 17 with associated vertebral artery involvement, 28 (78%) had ischemic symptoms and/or cervical artery dissection at the time of the diagnosis of FMD. Among the 30 patients who had renal artery imaging, 13 (43%) had renal FMD. Patients with renal artery disease did not differ from those without renal artery disease. After a median follow-up of 3.5 years, three patients had four strokes, one recurrent cervical dissection, one brain hemorrhage, and one fatal cardiac arrhythmia. Among the 31 patients who had follow-up imaging, two showed progression of cervicocephalic FMD (occlusion of carotid artery). Patients with renal involvement showed a non-significant trend toward a higher rate of stroke (P=0.17). CONCLUSIONS: In patients with cervicocephalic FMD, renal involvement is common. The risk of stroke, death or FMD progression was high in our cohort, suggesting that prognosis may not be as good as expected. This underlines the need for larger prospective studies to define the best treatment options.
Assuntos
Displasia Fibromuscular/epidemiologia , Adulto , Idoso , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/epidemiologia , Dissecção Aórtica/etiologia , Angiografia , Artérias Carótidas/patologia , Artérias Cerebrais/patologia , Comorbidade , Constrição Patológica , Feminino , Displasia Fibromuscular/complicações , Displasia Fibromuscular/diagnóstico por imagem , Displasia Fibromuscular/patologia , Seguimentos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/etiologia , Masculino , Pessoa de Meia-Idade , Pescoço/irrigação sanguínea , Prevalência , Prognóstico , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/patologia , Estudos Retrospectivos , Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/etiologia , Análise de SobrevidaRESUMO
BACKGROUND AND PURPOSE: The susceptibility vessel sign (SVS) on T2*-weighted magnetic resonance imaging has been reported in several studies as a negative predictor of early recanalization after intravenous thrombolysis. The meaning of SVS regarding the results of mechanical thrombectomy with stent retrievers was investigated. METHODS: Susceptibility vessel sign presence and length were studied in 153 acute ischaemic stroke patients (82 men; mean ± SD age 59 ± 17 years, baseline National Institutes of Health Stroke Scale score 17.2 ± 6.5) from three stroke centres, treated with either mechanical thrombectomy alone (n = 84) or bridging therapy (n = 69). Variables were compared between recanalizers, defined as thrombolysis in cerebral infarction (TICI) scores ≥2b, and non-recanalizers (TICI<2b). RESULTS: The SVS was present in 113 (73.8%) patients. There was no association between the presence of SVS and recanalization, obtained in 86 (56.2%) patients, in the whole population [odds ratio (OR) 1.24, 95% confidence interval (CI) 0.53-2.92, P = 0.84) and in treatment subgroups (bridging: OR = 0.91, 95% CI 0.29-2.87, P = 1.0; thrombectomy alone: OR = 1.85, 95% CI 0.48-7.16, P = 0.54). However, in SVS+ patients, recanalization decreased with SVS length (OR 0.94 for each additional mm, 95% CI 0.89-0.99; P = 0.02). CONCLUSIONS: The success of recanalization in acute stroke patients treated with stent retrievers was related to thrombus length but not to the presence of SVS.
Assuntos
Isquemia Encefálica/terapia , Imageamento por Ressonância Magnética , Trombólise Mecânica/métodos , Avaliação de Resultados em Cuidados de Saúde , Acidente Vascular Cerebral/terapia , Trombose/patologia , Adulto , Idoso , Isquemia Encefálica/patologia , Estudos de Coortes , Feminino , Humanos , Masculino , Trombólise Mecânica/instrumentação , Pessoa de Meia-Idade , Stents , Acidente Vascular Cerebral/patologia , Estados UnidosRESUMO
Moya-Moya disease is a rare arterial occlusive disease affecting the internal carotid artery and its branches. It is found in both pediatric and adult populations, and it may lead to severe clinical presentations such as stroke and intracranial hemorrhage. Several surgical procedures have been developed to improve its clinical outcome. Imaging techniques have a key role in management of Moya-Moya disease, as they are necessary for diagnosis, choice of treatment and follow-up. Although catheter angiography remains the diagnostic gold standard, and nuclear-medicine techniques best perform hemodynamic studies, less invasive imaging techniques have become efficient in serving these purposes. Conventional MRI and MR angiography, as well as MR functional and metabolic studies, are now widely used in each stage of disease management, from diagnosis to follow-up. CT scan and Doppler sonography may also help assess severity of disease and effects of treatment. The aim of this review is to clarify the utility, efficiency and latest developments of each imaging modality in management of Moya-Moya disease.
Assuntos
Diagnóstico por Imagem/métodos , Doença de Moyamoya/diagnóstico , Adulto , Angiografia Cerebral/métodos , Ecoencefalografia/métodos , Humanos , Angiografia por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Doppler , Dispositivos de Acesso VascularRESUMO
Patients need to be examined for intracranial aneurysms if they have had a subarachnoid hemorrhage. The preferred technique in this situation is CT angiography. Screening can be done for familial forms or for elastic tissue disorders, for which the first line investigation is magnetic resonance angiography. These non-invasive methods have now taken over from conventional angiography that was reserved for the pretreatment phase. A good technical knowledge of these imaging methods, their artifacts and misleading images enables reliable detection of intracranial aneurysms and for an accurate report to be returned to clinicians.
Assuntos
Angiografia Cerebral , Aneurisma Intracraniano/diagnóstico , Angiografia por Ressonância Magnética , Tomografia Computadorizada por Raios X , Programas de Rastreamento , Fatores de Risco , Hemorragia Subaracnóidea/etiologiaRESUMO
Because of its excellent sensitivity and specificity to diagnose arterial ischemic stroke (AIS) in the acute phase, MRI answers the main questions to guide treatment in "candidates" for thrombolysis. It lasts less than ten minutes, can confirm the diagnosis of AIS and distinguish it from hematomas and other "stroke mimics". It can identify the ischemic penumbra (perfusion-diffusion mismatch), determine the site of occlusion and provide prognostic information to adapt treatment in some cases in which the indications are poorly defined. In light of the most recent scientific findings, MRI can guide the treatment turning it into the investigation of choice in "candidates" for thrombolysis.
Assuntos
Isquemia Encefálica/diagnóstico , Imagem de Difusão por Ressonância Magnética , Aumento da Imagem , Interpretação de Imagem Assistida por Computador , Seleção de Pacientes , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Artefatos , Infarto Cerebral/diagnóstico , Infarto Cerebral/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Sensibilidade e EspecificidadeRESUMO
While depiction and definition of morphological and architectural characteristics of CNS vascular disorders remains the first step of an MR analysis, emerging imaging techniques offer new functional information that might help to characterize rupture risk of CNS vascular disorders. Two main orientations are suggested by recent studies: inflammation of the vessel wall and analysis of physical constraints of blood flow using 4D flow imaging (shear parietal). This paper will focus on radiological application of 4D flow imaging and inflammation imaging, in the characterization of potential prognostic markers of CNS vascular disorders. We will review the basic technical considerations of 4D flow MRA, inflammation imaging and discuss their applications in CNS vascular disorders: aneurysms, arteriovenous malformation, dural arteriovenous fistulas. We will illustrate their potential in the development of individual rupture risk criteria in brain vascular disorders.
Assuntos
Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Hemodinâmica/fisiologia , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Aneurisma Intracraniano/fisiopatologia , Angiografia por Ressonância Magnética/métodos , Músculo Liso Vascular/fisiopatologia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Humanos , Imageamento Tridimensional/métodos , Aneurisma Intracraniano/diagnóstico , Prognóstico , Ruptura Espontânea , Resistência ao CisalhamentoRESUMO
The European Antimicrobial Resistance Surveillance Network (EARS-Net) reported an increase in the rates of resistance of Pseudomonas aeruginosa to antimicrobials between 2008 and 2011 in France. This alarming report was based on data collected during the harmonisation of breakpoints by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) committee. However, these data were not supported by the findings of other national surveillance networks. In this study, we assessed the trends in P. aeruginosa antimicrobial drug resistance at six French hospitals over a longer period of time (2001-2011) and with a constant definition of resistance. After the exclusion of incomplete data and duplicates, we sorted 34,065 isolates into the antimicrobial resistance patterns defined by the European Centre for Disease Prevention and Control (ECDC). The proportion of isolates with a resistant pattern (non-susceptible to one or two antimicrobial categories), a multidrug-resistant pattern (non-susceptible to three or four antimicrobial categories) or an extensively drug-resistant pattern (non-susceptible to five or six antimicrobial categories) decreased significantly over time. Logically, the proportion of isolates with a wild-type resistance pattern has increased significantly over the same period. No significant changes in the rates of resistance to cephalosporins and penicillins were observed, whereas carbapenem resistance rates increased. By contrast, the proportion of isolates resistant to fluoroquinolones, aminoglycosides and monobactams decreased significantly over time. In conclusion, our data do not confirm the EARS-net data, suggesting instead that antimicrobial drug resistance in P. aeruginosa might not have increased in French hospitals over the last decade.
Assuntos
Antibacterianos/farmacologia , Infecção Hospitalar/microbiologia , Microbiologia Ambiental , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Infecção Hospitalar/epidemiologia , França/epidemiologia , Hospitais , Humanos , Testes de Sensibilidade Microbiana , PrevalênciaRESUMO
Cervical artery dissection (CAD) may affect the internal carotid and/or the vertebral arteries. CAD is the leading cause of ischemic stroke in patients younger than 45 years. Specific treatment (aspirin or anticoagulants) can be implemented once the diagnosis of CAD has been confirmed. This diagnosis is based on detection of a mural haematoma on ultrasound or on MRI. The diagnosis can be suspected on contrast-enhanced MRA (magnetic resonance angiography) or CT angiography, in case of long stenosis, sparing the internal carotid bulb, or suspended, at the junction of V2 and V3 segments of the vertebral artery, in patients with no signs of atheroma of the cervical arteries. MRI is recommended as the first line imaging screening tool, including a fat suppressed T1 weighted sequence, acquired in the axial or oblique plane at 1.5T, or 3D at 3T. Complete resolution of the lumen abnormality occurred in 80% of cases, and CAD recurrence is rare, encountered in less than 5% of cases. Interventional neuroradiology (angioplasty and/or stenting of the dissected vessel) may be envisaged in rare cases of haemodynamic effects with recurring clinical infarctions in the short-term.
Assuntos
Dissecação da Artéria Carótida Interna/diagnóstico , Angiografia Cerebral , Angiografia por Ressonância Magnética , Tomografia Computadorizada por Raios X , Dissecação da Artéria Vertebral/diagnóstico , Dissecação da Artéria Carótida Interna/etiologia , Progressão da Doença , Seguimentos , Humanos , Aumento da Imagem , Interpretação de Imagem Assistida por Computador , Prognóstico , Dissecação da Artéria Vertebral/etiologiaRESUMO
The French Society of Radiology's guide to good use of medical imaging examinations recommends MRI as the first-line examination for exploring cerebrovascular events or disorders. This paper will discuss the main traps in the images when stroke is suspected and provide the technical tips or knowledge necessary for an optimal radiological report.
Assuntos
Artefatos , Transtornos Cerebrovasculares/diagnóstico , Imageamento por Ressonância Magnética , Humanos , Imageamento por Ressonância Magnética/métodosRESUMO
PURPOSE: To report clinical and imaging features of diffuse cerebral vasoconstriction and to discuss the role of non-invasive imaging modalities for the diagnosis and the follow-up. PATIENTS AND METHODS: Retrospective study including 13 consecutive patients with a diffuse cerebral vasoconstriction. Evaluation of the sensitivity of Doppler US and magnetic resonance angiography for the diagnosis. RESULTS: The diagnosis is based on the association of a thunderclap headache, declenching factors found in 50% of cases and of stenosis involving middle and small cerebra arteries. In some cases cerebral hemorrhage may be present. DISCUSSION: Diffuse cerebral vasoconstriction is a rare cause of thunder clap headhache, which needs to exclude other causes such as subarchnoid hemorrhage from aneurysm rupture. Non contrast CT of the head, frequently normal, may be falsely reassuring. It is therefore necessary to further assess the cerebral arteries to exclude an aneurysm but also to detect the presence of stenoses that would suggest the diagnosis. Non-invasive imaging modalities (MRA and Doppler US) are favored for detection and follow-up of proximal lesions.
Assuntos
Transtornos Cerebrovasculares/diagnóstico , Doença Aguda , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
After endovascular coiling, several authors have reported refilling of the aneurysm, appearance of a mass effect, coils protruding into the parent artery, migration of coils into parent artery or through aneurysm wall, and compression of the parent artery by coil impaction. This is the first report of an endovascular coil transfixing a cranial nerve. We present a 59 year old man who presented with a symptomatic bilobulated aneurysm of the right internal carotid artery. The aneurysm was embolised by endovascular coiling. Angiographic follow up showed occlusion of the aneurysm. Five years later, the patient complained of progressive diplopia with ptosis. Follow-up angiography showed renewed filling of the aneurysm at its neck. The aneurysm was clipped surgically. At operation, a coil mass effect was noted and one coil penetrated the fibres of the right oculomotor nerve.
Assuntos
Doenças das Artérias Carótidas/terapia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Doenças do Nervo Oculomotor/etiologia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Doenças do Nervo Oculomotor/complicações , Doenças do Nervo Oculomotor/fisiopatologia , Recidiva , Hemorragia Subaracnóidea/etiologia , Fatores de TempoRESUMO
Patients with stroke on awakening are denied the potential benefit of thrombolysis on the grounds that the onset time is unknown. Relying on clinical and MR imaging to indicate the most appropriate treatment could be more rational. We report 2 cases of stroke with unknown onset time. In both cases, anamnesis and MR imaging indicated that we might still be within 6 hours from stroke onset, with salvageable tissue. Arterial recanalization was successfully performed in both cases.
Assuntos
Ritmo Circadiano/fisiologia , Imagem de Difusão por Ressonância Magnética , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Infarto da Artéria Cerebral Média/tratamento farmacológico , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Sono/fisiologia , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Vigília/fisiologia , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Dominância Cerebral/fisiologia , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Prognóstico , Fatores de Tempo , Resultado do TratamentoRESUMO
Recent technical progress of MRI and CT made it possible to widen the field of exploration of the noninvasive vascular imaging in the study of supra-aortic, encephalic and medullary vessels. MRI of the carotid plaques, CT angiography in the detection of the intracranial aneurysms, intracranial time-resolved MRA and MRA of the spinal cord took their place in the field of the noninvasive vascular imaging.
Assuntos
Angiografia Digital/métodos , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/diagnóstico , Encefalopatias/diagnóstico por imagem , Encefalopatias/diagnóstico , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico , Angiografia Cerebral , Dura-Máter/irrigação sanguínea , Angiografia por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/métodos , Medula Espinal/irrigação sanguínea , Tomografia Computadorizada por Raios X/métodos , Adulto , Aneurisma/diagnóstico , Aneurisma/diagnóstico por imagem , Artéria Carótida Interna , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral/métodos , Diagnóstico Diferencial , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
PURPOSE: To estimate the value of duplex color-coded ultrasonography in the initial diagnosis of acute cervical artery dissection. MATERIAL AND METHOD: Retrospective study of 31 patients, mean age 45, sex ratio=1, referred for clinical suspicion of cervical artery dissection, confirmed by MRI. 46 dissected arteries were imaged. Ten patients presented multiple dissections. The evaluated sonographic diagnostic criteria were the direct signs of intra-mural hematoma: localized increased diameter of the artery, narrowed lumen, hypo and/or isoechoic intra-mural hematoma, intimal flap. The associated criteria studied were: the location of intra-mural hematoma and in case of an occlusion, the dissection of an other artery. RESULTS: We analyzed separately the arterial segments visualized in B-mode ultrasound (supra-bulbar internal carotid artery, vertebral artery from V0 to V3) and the arterial segments evaluated only by pulsed Doppler (intrapetrosal carotid artery, V3-V4 of the vertebral artery). With the above criteria, on arterial segments visualized in B-mode ultrasound, the diagnosis of dissection was done in 83% of cases during the initial examination but in only 30% of the arterial segments non visualized on ultrasonography. CONCLUSION: The direct signs of intra-mural hematoma on internal carotid and vertebral segments imaged by B-mode ultrasonography have a good sensitivity. Because results were compared to MRI, the specificity could not be assessed. In case of occlusion of an artery, multiple dissections are a strong argument for the diagnosis.
Assuntos
Dissecção Aórtica/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Dissecação da Artéria Vertebral/diagnóstico por imagem , Doença Aguda , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Estudos RetrospectivosRESUMO
Imaging evaluation of cerebral arteriovenous malformations (AVM) requires selective visualization of the different compartments of the malformation in order to select the therapeutic management. Conventional angiography remains the reference to analyze intracranial vessel conspicuity but non-invasive methods constitute an excellent alternative. Among these techniques, CT angiography is rarely used because of the need to inject iodinated contrast material and because of irradiation. MR angiography provides useful information and can be performed using several techniques: time of flight with or without contrast material injection, phase contrast, three-dimensional (3D) gradient echo acquisition after contrast material injection and, more recently, MR digital subtraction angiography. The purpose of this review article is to summarize the different non-invasive techniques for vascular imaging and to analyze the usefulness of these techniques for the assessment of brain AVMs.