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1.
Br J Radiol ; 93(1106): 20190017, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31899661

RESUMO

Paediatric aortic trauma is a rare injury which can be fatal if not identified and managed appropriately. Surgical repair remains the gold-standard in moderate to severe aortic injuries. In the last decade however, endovascular treatment has gained popularity in children who have suitable vascular anatomy for intervention and are either not fit for surgery or in whom, endovascular intervention is the only alternative that will make a difference in the clinical outcome. Children pose a unique set of challenges to endovascular therapy. In this article, we aim to illustrate the different endovascular options that are available for the treatment of acute traumatic aortic injury and visceral thromboembolisation through pictorial representation. We will also demonstrate the feasibility and the limitation of this technique.


Assuntos
Aorta Abdominal/lesões , Aorta Torácica/lesões , Procedimentos Endovasculares , Ferimentos não Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia , Acidentes de Trânsito , Adolescente , Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética , Masculino , Ferimentos não Penetrantes/diagnóstico , Ferimentos Perfurantes/diagnóstico
2.
Plast Reconstr Surg ; 145(2): 555-563, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985658

RESUMO

BACKGROUND: Fat accumulation is frequently observed in patients with lymphedema but is not accounted for in existing staging systems. In addition, the specific regional patterns of fat and fluid accumulation remain unknown and might affect outcomes following medical or surgical intervention. The purpose of this study was to evaluate fluid and fat distribution in patients with lower extremity lymphedema using magnetic resonance angiography. METHODS: Magnetic resonance angiographic examinations of patients with lower extremity lymphedema were reviewed. Fluid-fat grade and location were assessed by three observers. Three-point scales were developed to grade fluid (0 = no fluid, 1 = reticular pattern of fluid, and 2 = continuous stripe of subcutaneous fluid) and fat (0 = normal, 1 = subcutaneous thickness less than twice that of the unaffected side, and 2 = subcutaneous thickness greater than twice that of the unaffected side) accumulation. RESULTS: In total, 76 magnetic resonance angiographic examinations were evaluated. Using the proposed grading system, there was good interobserver agreement for fat and fluid accumulation location (91.5 percent; κ = 0.9), fluid accumulation grade (95.7 percent; κ = 0.95), and fat accumulation grade (87.2 percent; κ = 0.86). Patients with International Society of Lymphology stage 2 lymphedema had a wide range of fluid and fat grades (normal to severe). The most common location of fluid accumulation was the lateral lower leg, whereas the most common location of fat accumulation was the medial and lateral lower leg. CONCLUSION: The proposed magnetic resonance angiographic grading system may help stratify patients with International Society of Lymphology stage 2 lymphedema on the basis of tissue composition. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Líquidos Corporais , Perna (Membro)/patologia , Linfedema/patologia , Gordura Subcutânea/patologia , Adolescente , Adulto , Idoso , Distribuição da Gordura Corporal , Criança , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
3.
Artigo em Japonês | MEDLINE | ID: mdl-31956185

RESUMO

PURPOSE: In triggered acquisition noncontrast enhancement magnetic resonance angiography using ECG-gated with short-term inversion recovery (STIR-TRANCE), signal intensity and contrast fluctuate according to the value of refocus flip angle (RFA). We believe that we can visualize the pulmonary vascular excellently by optimized RFA which improves the signal intensity of pulmonary vascular and the contrast between pulmonary vascular and lung parenchyma. The purpose of this study is to optimize RFA in pulmonary vascular magnetic resonance angiography (MRA) imaging using STIR-TRANCE. METHOD: Pulmonary vascular MRA was performed in five normal volunteers. The department's ethics committee approved the study, and informed consent was obtained from all subjects. Before the STIR-TRANCE study, an ECG-gated single shot TSE (SS TSE) scan was performed to determine the timing of diastole. Later, the diastolic STIR-TRANCE imaging using both ECG and respiratory gating was performed with three different RFA (140 degree, 160 degree, and 180 degree). For physical evaluation, we used the signal to noise ratio (SNR) and contrast and for visual evaluation, so we used the Scheffe's method. RESULTS: SNR increases with increasing RFA. The contrast of 160 degree was significantly higher than the contrast of 180 degree. There was no significant difference in visual evaluation. CONCLUSION: From the perspective of specific absorption rate (SAR) reduction, we concluded that the optimal RFA for pulmonary vascular MRA in this study was 160 degree.


Assuntos
Eletrocardiografia , Imagem Tridimensional , Pulmão , Angiografia por Ressonância Magnética , Diástole , Humanos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Razão Sinal-Ruído
4.
Int J Oral Maxillofac Surg ; 49(2): 176-182, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31564478

RESUMO

The purpose of this study was to outline lower leg vessel anatomy and to investigate reliability and limitations of magnetic resonance angiography (MRA) in patients proposed for microvascular fibula transplantation (free fibula flap (FFF)). We retrospectively investigated MRAs of 99 patients considered for FFF. Frontal MRA planes and maximal intensity projections (MIPs) were evaluated for fibula lengths, anatomical branching pattern, arterial stenoses and fibular perforator positions in both legs (n=198). Normal branching patterns were observed in 168 (85.3%) legs. Twenty-nine (14.7%) legs presented abnormal branching patterns. Once (0.5%) the anterior, 19 times (9.6%) the posterior tibial artery were absent or hypoplastic. Nine (4.6%) lower legs presented an arteria peronea magna. Average length of the tibiofibular trunk (TFT) was 3.3±0.15cm. A total of 492 perforators were found with an average of 2.5 (±0.82±0.99) perforators per leg. A mapping of perforator run-offs was illustrated true to scale. Lower limb stenoses were distributed in the anterior tibial artery (14.1%), in the posterior tibial artery (11.1%) and in the fibular artery (8.1%). Smoking (P=0.828), diabetes (P=0.727) and peripheral arterial occlusive disease (P=0.172) did not correlate with presence of stenoses. Preoperative lower limb angiography avoids postoperative complications. MRA reliably and non-invasively identifies anatomical variants and arterial stenoses without radiation. Illustration of perforator run-offs enhances incision planning for fibula harvest.


Assuntos
Fíbula , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Perna (Membro) , Angiografia por Ressonância Magnética , Reprodutibilidade dos Testes , Estudos Retrospectivos
5.
World Neurosurg ; 133: 25-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550539

RESUMO

BACKGROUND: Spinal dural arteriovenous fistulas (DAVFs) in the sacral region are extremely rare. The location and complex angioarchitecture of these lesions make both identification and treatment challenging, even in experienced hands. We report on a sacral DAVF with a unique angioarchitecture and discuss its specific anatomy. CASE DESCRIPTION: A 76-year-old male presented with progressive distal paraparesis and spinal ataxia. Three lumbar decompression surgeries were performed between 2016 and 2018 elsewhere on the basis of suspected degenerative lumbar syndrome. On admission to our center, the patient was wheelchair dependent due to extensive spinal ataxia associated with bilateral foot paresis and hypoesthesia. Spinal contrast-enhanced time-resolved magnetic resonance angiography and digital subtraction angiography were performed after admission to our center. Contrast-enhanced magnetic resonance angiography examinations suggested a sacral DAVF. Subsequent digital subtraction angiography demonstrated a spinal DAVF on the left side at the S2 vertebral level supplied via an arterial epidural branch from the right L4 segmental artery. The fistula was treated via surgical interruption of the proximal part of the radicular drainage vein. CONCLUSIONS: Sacral DAVFs present serious diagnostic difficulties and require a profound understanding of possible fistula-supplying arteries of the sacral region. Microsurgical interruption of the often ventrally located drainage vein presents an efficient treatment modality and could provide an immediate confirmation of fistula occlusion using indocyanine green videoangiography.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Descompressão Cirúrgica , Sacro/diagnóstico por imagem , Idoso , Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Humanos , Angiografia por Ressonância Magnética , Masculino , Sacro/cirurgia
6.
Vasc Endovascular Surg ; 54(2): 97-101, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31746279

RESUMO

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.


Assuntos
Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Extremidade Inferior/irrigação sanguínea , Angiografia por Ressonância Magnética , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Padrões de Prática Médica/tendências , Idoso , Tomada de Decisão Clínica , Angiografia por Tomografia Computadorizada/tendências , Bases de Dados Factuais , Procedimentos Endovasculares/tendências , Feminino , Humanos , Angiografia por Ressonância Magnética/tendências , Masculino , Variações Dependentes do Observador , Seleção de Pacientes , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
8.
Br J Radiol ; 93(1105): 20190543, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31617743

RESUMO

OBJECTIVE: MR-perfusion post-processing still lacks standardization. This study evaluates the results of perfusion analysis with two established software solutions in a large series of patients with different diseases when a highly standardized processing workflow is ensured. METHODS: Multicenter data of 260 patients (80 with brain tumors, 124 with cerebrovascular disease and 56 with dementia examined with the same MR protocol) were analyzed. Raw data sets were processed with two software suites: Olea sphere and NordicICE. Group differences were analyzed with paired t-tests and one-way ANOVA. RESULTS: Perfusion metrics were significantly different for all examined diseases in the unaffected brain for both software suites [ratio cortex/white matter left hemisphere: mean transit time (MTT) 0.991 vs 0.847, p < 0.05; relative cerebral bloodflow (rBF) 3.23 vs 4.418, p < 0.001; relative cerebral bloodvolume (rBVc) 2.813 vs 3.884, p < 0.001; right hemisphere: MTT 1.079 vs 0.854, p < 0.05; rBF 3.262 vs 4.378, p < 0.001; rBVc 2.762 vs 3.935, p < 0.001)]. Perfusion results were also significantly different in patients with stroke (ratio cortex/white matter affected hemisphere: MTT 1.058 vs 0.784; p < 0.001), dementia (ratio cortex/white matter left hemisphere: rBVc 1.152 vs 1.795, p < 0.001; right hemisphere: rBVc 1.396 vs 1.662, p < 0.05) and brain tumors (ratio cortex/whole tumor rBVc: 0.778 vs 0.919, p < 0.001 and ratio cortex/tumor hotspot rBVc: 0.529 vs 0.512, p < 0.05). CONCLUSION: Despite a highly standardized workflow, parametric perfusion maps are depended on the chosen software. Radiologists should consider software related variances when using dynamic susceptibility contrast perfusion for clinical imaging and research. ADVANCES IN KNOWLEDGE: This multicenter study compared perfusion parameters calculated by two commercial dynamic susceptibility contrast perfusion post-processing software solutions in different central nervous system disorders with a large sample size and a highly standardized processing workflow. Despite, parametric perfusion maps are depended on the chosen software which impacts clinical imaging and research.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Demência/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética/métodos , Software , Circulação Cerebrovascular , Meios de Contraste , Feminino , Humanos , Masculino , Compostos Organometálicos , Perfusão
10.
Medicine (Baltimore) ; 98(52): e18427, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876719

RESUMO

RATIONALE: Contrast-enhanced computed tomographic venography (CTV) or magnetic resonance venography (MRV) are usually used to detect May-Thurner syndrome (MTS). However, both are associated with contrast-induced nephrotoxicity. For patients who cannot receive contrast media, non-contrast-enhanced MRV using three-dimensional (3D) turbo spin-echo (TSE) is considered an alternative. We report a case of MTS to describe its clinical utility and advantages. PATIENT CONCERNS: A 49-year-old male experienced isolated left leg swelling and pain for half a month. He had a history of chronic renal insufficiency that made contrast-enhanced imaging studies inadequate. DIAGNOSES: A lower extremity venous Duplex scan showed a thrombus extending from the left distal femoral vein to the popliteal vein with valvular reflux, consistent with infrainguinal deep vein thrombosis (DVT). The suprainguinal DVT was evaluated by non-contrast-enhanced MRV. The results showed sandwich external compression of the left common iliac vein between the right common iliac artery and lumbar vertebrae, consistent with DVT of the left common iliac vein caused by MTS. INTERVENTIONS: The patient received angioplasty with the implantation of a balloon-expandable stent over the left common iliac vein. OUTCOMES: Excellent recanalization of the left iliac vein was noted postoperatively. LESSONS: In the evaluation of suprainguinal venous lesions, non-contrast-enhanced MRV presents the venous structure alone at high resolution without the accompanying arterial structure, which makes it an excellent diagnostic imaging tool for MTS. These findings indicate that non-contrast-enhanced MRV could be useful for detecting systemic venous pathologies in patients with renal insufficiency.


Assuntos
Angiografia por Ressonância Magnética/métodos , Síndrome de May-Thurner/diagnóstico por imagem , Insuficiência Renal/diagnóstico por imagem , Veia Femoral/diagnóstico por imagem , Humanos , Masculino , Síndrome de May-Thurner/complicações , Pessoa de Meia-Idade , Veia Poplítea/diagnóstico por imagem , Insuficiência Renal/etiologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia
11.
Medicine (Baltimore) ; 98(52): e18526, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876747

RESUMO

A contrast agent can be pushed by a saline solution more effectively through a spiral flow tube than through a conventional T-shaped tube in contrast-enhanced magnetic resonance angiography (CEMRA). To compare the degree of contrast enhancement and signal stability in the carotid artery by using CEMRA between a spiral flow tube and a T-shaped tube.A total of 100 patients were analyzed in this retrospective study. The first 50 patients underwent CEMRA of the carotid artery with the T-shaped tube, while the last 50 patients used the spiral flow tube. Gadoterate meglumine was diluted with saline to make a total volume of 20 mL. Injection was performed with a bolus rate of 2.5 mL/s for 8 seconds. Five regions of interest (ROIs) were placed on the contrast-enhanced area in each carotid artery and the signal intensity (SI) in the ROI was used for the analysis. The ROIs on the brain stem were also placed and the average SI in this ROI was used as a reference signal. The enhancement of the artery (Eartery) was calculated as a normalized signal using the following equation: Eartery = SI in the ROI of the carotid bifurcation/SI in the ROI of the brain stem. Signal homogeneity in the contrast-enhanced area (SHenhance) was assessed by calculating the coefficient of variation from the SI in the 5 ROIs. The value of SHenhance and Eartery between the data obtained from the spiral flow tube and the T-shaped tube were compared. P-values <.05 were considered significant.We found a significant difference in SHenhance between the data obtained from the spiral flow tube (0.20 ±â€Š0.060) and the T-shaped tube (0.24 ±â€Š0.056) (P = .001). The Eartery values significantly increased by 15% (spiral flow tube, median 14.1 with interquartile range [IQR] 11.8-15.4 vs T-shaped tube, median 12.3 IQR 11.3-14.0, P = .02) using the spiral flow tube.These findings suggest that, by using the Spiral flow tube, the homogeneity of the contrast-enhanced signal intensity in the carotid artery was significantly improved without decreasing the signal intensity in CEMRA.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Angiografia por Ressonância Magnética/instrumentação , Pescoço/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Estudos Retrospectivos
12.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 75(12): 1437-1445, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31866642

RESUMO

The imaging parameters of non-contrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA) were optimized to improve the image quality for patients treated using stent-assisted coiling. A simulated blood flow phantom with three types of stents (Enterprise 2, Neuroform Atlas, and LVIS) was imaged by changing echo time (TE), band width (BW), flip angle (FA), and matrix (phase, frequency). The difference between the signal intensity in the simulated vessel and the background was measured at each imaging condition. The ratio of this difference with and without the stent was evaluated as the relative in-stent signal (RIS). In addition, the error ratio of the stent lumen diameter was assessed by comparing the full width at half maximum (FWHM) to that measured by 3D X-ray angiography. The RIS was higher in order of LVIS, Neuroform Atlas, and Enterprise 2 in all conditions. The RIS was higher in imaging conditions with short TE, narrow BW, high FA, and large phase matrix. The highest RIS was seen with a frequency matrix of 320 in the Enterprise 2 and 256 in the others. FWHM error ratio was smaller in the same order as the RIS. FWHM error ratio was smaller in imaging conditions with short TE, large frequency matrix (>384), large phase matrix (>224), and high FA (>20°). Imaging conditions of 3D TOF-MRA that were effective to improve the image quality for stent lumen evaluation were short TE and high spatial resolution.


Assuntos
Angiografia por Ressonância Magnética , Sistemas de Liberação de Medicamentos , Humanos , Imagem Tridimensional , Aneurisma Intracraniano , Imagens de Fantasmas , Stents
13.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 75(12): 1446-1451, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31866643

RESUMO

Generally, the imaging range of the brain magnetic resonance angiography (MRA) is determined in the subjectivity by the operator used by the plan image that a blood vessel is not depicted. However, a necessary blood vessel may not be often depicted by an error of the setting of the imaging area. Therefore, optimal slab angle, thickness, distance, and image contrast for depiction of the unruptured cerebral aneurysm were examined. The brain MRA of 14 subjects was imaged in a wide area parallel to an orbitomeatal line (OM) line. The line which linked the arteria vertebral (the first cervical vertebrae curved section) to anterior cerebral artery (A3) was determined with an optimal slab base line, and the angle with the OM line was evaluated. Moreover, slavic range including the unruptured aneurysm was calculated. In addition, the distance from the inferior margin of pons to the slavic bottom end was measured. Furthermore, the cerebrovascular contrast by the slave angle was compared. As a result, the slave setting of the range was recommended in brain-MRA as an angle was 34.3 degrees, and the thickness was 56.4 mm, and, as the distance from the inferior margin of pons was 27.6 mm. The cerebrovascular contrast of the optimal slab base line angle did not have a significant difference for an OM line.


Assuntos
Aneurisma Intracraniano , Angiografia por Ressonância Magnética , Algoritmos , Encéfalo , Humanos , Projetos de Pesquisa
15.
J Comput Assist Tomogr ; 43(6): 919-925, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738205

RESUMO

OBJECTIVES: The objective of this study was to compare gadobutrol-enhanced gradient-echo sequence (GRE) acquisition with T2-prepared non-contrast-enhanced steady-state free precession (SSFP) in coronary magnetic resonance angiography at 1.5 T. METHODS: Twenty-one subjects successfully completed GRE and SSFP acquisition. Signal-to-noise ratio (SNR), contrast-to-noise ratio, image quality, sharpness, visibility, length, and lumen diameter of vessels were analyzed by 2 experienced radiologists. RESULTS: The SNR at whole left circumflex artery, left main artery, and proximal left descending artery (LAD) was significantly higher in SSFP acquisition (P < 0.05). The SNR of distal LAD was slightly higher in GRE acquisition (P < 0.05). The contrast-to-noise ratio at distal LAD, proximal and distal RCA were significantly higher with GRE acquisition (P < 0.05). CONCLUSIONS: Double-dose gadobutrol-enhanced GRE and unenhanced SSFP coronary magnetic resonance angiography at 1.5 T have their own characteristics, and the combined use of the 2 methods may be taken into consideration.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Imagem Tridimensional/métodos , Adulto , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Respiração , Razão Sinal-Ruído
16.
J Comput Assist Tomogr ; 43(6): 943-947, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738210

RESUMO

OBJECTIVE: Silent magnetic resonance angiography (MRA) was compared with time-of-flight (TOF)-MRA in imaging of arteriovenous malformations (AVMs) of the brain. METHODS: Thirty-five consecutive patients with AVMs of the brain were included. Quantitative analyses were performed by measuring both signal-to-noise ratio and contrast-to-noise ratio of the nidus. Qualitative analysis (scores 1-4) was performed by evaluating depictions of feeding arteries and draining veins independently by 2 reviewers. RESULTS: Both signal-to-noise ratio and contrast-to-noise ratio in TOF-MRA were significantly higher than those in silent MRA. For both feeders and drainers, scores were significantly higher in silent MRA than in TOF-MRA for both reviewers. Interrater agreement was higher in silent MRA than in TOF-MRA. CONCLUSIONS: Silent MRA visualized feeders and drainers in AVMs significantly better than did TOF-MRA. Interrater agreement was also better in silent MRA.


Assuntos
Angiografia Digital/métodos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Adolescente , Adulto , Feminino , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica , Razão Sinal-Ruído , Adulto Jovem
17.
J Comput Assist Tomogr ; 43(6): 906-911, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738213

RESUMO

The aim of this article was to review computed tomography angiography and magnetic resonance angiography of pulmonary atresia with ventricular septal defect. This disorder is a rare complex congenital heart disease. Preoperative imaging of pulmonary atresia with ventricular septal defect with computed tomography angiography and magnetic resonance angiography is important for complete anatomical delineation and planning for treatment. Preoperative imaging used for assessment of the main pulmonary artery (its size, valve, and confluence), aortopulmonary collaterals (its origin, insertion, course, and size), presence of patent ductus arteriosus, other sources of collaterals as bronchial and coronary arteries, and pattern of pulmonary arborization. Imaging can detect associated aortic, pulmonary venous and coronary anomalies, and other congenital heart disease. Postoperative imaging after unifocalization and stent is for assessment of patency, stenosis, and occlusion of stent or perivascular lesions as seroma.


Assuntos
Defeitos dos Septos Cardíacos/diagnóstico por imagem , Defeitos dos Septos Cardíacos/cirurgia , Atresia Pulmonar/diagnóstico por imagem , Atresia Pulmonar/cirurgia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos , Angiografia por Tomografia Computadorizada , Humanos , Angiografia por Ressonância Magnética , Período Pós-Operatório , Período Pré-Operatório , Procedimentos Cirúrgicos Pulmonares
18.
Medicine (Baltimore) ; 98(48): e18147, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770254

RESUMO

INTRODUCTION: Neurosyphilis is a chronic infection of the central nervous system that is commonly found in adult with long latency periods. Neurosyphilis-attributed deaths in young patients have grown exponentially in the past decade, yet there have been few studies on the early stages of neurosyphilis. PATIENT CONCERNS: A young male patient with syphilitic cerebral arteritis was evaluated in our clinic for the clinical signs of progressive ischemic stroke. DIAGNOSIS: The progression of syphilitic cerebral arteritis was observed through computed tomography imaging, magnetic resonance imaging, magnetic resonance angiogram, and transcranial color Doppler. The pathological changes and clinical outcomes were reviewed. In this specific case, the development of syphilitic cerebral arteritis was dynamic, continuous, and rapid. The pathogenesis was related to Heubner arteritis, in which the formation of a mural thrombus (MT) causes the severe obstruction of blood flow without complete occlusion, leading to an increased risk of infarction. In this patient, formation of the MT resulted in the infarction of the smaller vessels and narrowing of the larger vessels. The partial dislodgment of the MT from the arterial wall of the larger vessels occluded the smaller vessels, leading to infarction. INTERVENTIONS: Standard pharmacotherapy for the treatment of the cerebral infarction and a single course of penicillin were applied. OUTCOMES: Muscle strength was recovered. The Glasgow Coma Scale score was 15, whereas the NIH Stroke Scale score was 0. The increase in blood flow of the right MCA was accompanied by severe stenosis with compensation of the anterior communicating artery. In addition, moderate to severe stenosis of the right vertebral artery and the basilar artery was suspected. There was a possibility that the right posterior communicating artery was recruited for compensation. CONCLUSION: Progressive stroke was the initial symptom of the neurosyphilis. Disease progression is rapid and difficult to control with a single course of penicillin.


Assuntos
Atorvastatina/administração & dosagem , Infarto Encefálico , Clopidogrel/administração & dosagem , Edaravone/administração & dosagem , Neurossífilis , Vasculite do Sistema Nervoso Central , Adulto , Anticolesterolemiantes/administração & dosagem , Infarto Encefálico/diagnóstico , Infarto Encefálico/tratamento farmacológico , Infarto Encefálico/etiologia , Infarto Encefálico/fisiopatologia , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Força Muscular , Exame Neurológico/métodos , Fármacos Neuroprotetores/administração & dosagem , Neurossífilis/complicações , Neurossífilis/tratamento farmacológico , Inibidores da Agregação de Plaquetas/administração & dosagem , Resultado do Tratamento , Ultrassonografia Doppler Transcraniana/métodos , Vasculite do Sistema Nervoso Central/diagnóstico , Vasculite do Sistema Nervoso Central/etiologia
19.
Radiol Clin North Am ; 57(6): 1083-1091, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582036

RESUMO

This article reviews the current state of imaging for acute ischemic stroke. Protocolized imaging acquisition using computed tomography in conjunction with coordinated stroke care allows for rapid diagnosis and prompt revascularization. Following the initial evidence to support endovascular therapy for large-vessel occlusion, published between 2014 and 2015, there are now guidelines supporting treatment up to 24 hours after time of onset of symptoms. Neuroimaging remains a central component in diagnosing acute stroke and potentially excluding patients from stroke treatment, as outlined in this article.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Humanos , Neuroimagem/métodos
20.
Radiol Clin North Am ; 57(6): 1093-1108, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582037

RESUMO

Acute stroke is a leading cause of morbidity and mortality in the United States. Acute ischemic strokes have been classified according to The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system, and this system aids in proper management. Nearly every patient who presents to a hospital with acute stroke symptoms has some form of emergent imaging. As such, imaging plays an important role in early diagnosis and management. This article reviews the imaging patterns of acute strokes, and how the infarct pattern and imaging characteristics can suggest an underlying cause.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Humanos , Fatores de Risco , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem
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