Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.609
Filtrar
1.
Medicine (Baltimore) ; 99(19): e20013, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384459

RESUMO

INTRODUCTION: Clinically, anterior communicating artery complex fenestration combined with fenestration-related aneurysms is rare, and combination of this condition with tandem aneurysms is even rarer. PATIENT CONCERNS: A case of a 43-year-old man with spontaneous subarachnoid hemorrhage. DIAGNOSIS: A computed tomography angiography examination revealed a fenestrated anterior communicating artery complex combined with 2 aneurysms. Then, a digital subtraction angiography examination was performed to further determine the diagnosis, which showed a complex anatomical structure of the local tissue. After the aneurysms ruptured, they were partially wrapped by a hematoma and compressed, which increased the difficulty of surgery. INTERVENTIONS: An endovascular interventional therapy method was chosen, and a simple coil was successfully inserted through the blood vessel into the tandem aneurysms to maintain the integrity of the anatomical structure. OUTCOMES: The patient recovered well postoperatively. An imaging review after the operation did not show the aneurysms, and the upper and lower branches were patent. CONCLUSION: Therefore, endovascular treatment is an appropriate choice for arterial fenestration combined with tandem aneurysms, once the aneurysms have ruptured.


Assuntos
Aneurisma Roto , Angiografia Cerebral/métodos , Artérias Cerebrais , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/métodos , Hemorragia Subaracnóidea , Adulto , Aneurisma Roto/diagnóstico , Aneurisma Roto/fisiopatologia , Aneurisma Roto/cirurgia , Angiografia Digital/métodos , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Artérias Cerebrais/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
2.
Cochrane Database Syst Rev ; 2: CD010722, 2020 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-32072609

RESUMO

BACKGROUND: An occlusion or stenosis of intracranial large arteries can be detected in the acute phase of ischaemic stroke in about 42% of patients. The approved therapies for acute ischaemic stroke are thrombolysis with intravenous recombinant tissue plasminogen activator (rt-PA), and mechanical thrombectomy; both aim to recanalise an occluded intracranial artery. The reference standard for the diagnosis of intracranial stenosis and occlusion is intra-arterial angiography (IA) and, recently, computed tomography angiography (CTA) and magnetic resonance angiography (MRA), or contrast-enhanced MRA. Transcranial Doppler (TCD) and transcranial colour Doppler (TCCD) are useful, rapid, noninvasive tools for the assessment of intracranial large arteries pathology. Due to the current lack of consensus regarding the use of TCD and TCCD in clinical practice, we systematically reviewed the literature for studies assessing the diagnostic accuracy of these techniques compared with intra-arterial IA, CTA, and MRA for the detection of intracranial stenosis and occlusion in people presenting with symptoms of ischaemic stroke. OBJECTIVES: To assess the diagnostic accuracy of TCD and TCCD for detecting stenosis and occlusion of intracranial large arteries in people with acute ischaemic stroke. SEARCH METHODS: We limited our searches from January 1982 onwards as the transcranial Doppler technique was only introduced into clinical practice in the 1980s. We searched MEDLINE (Ovid) (from 1982 to 2018); Embase (Ovid) (from 1982 to 2018); Database of Abstracts of Reviews of Effects (DARE); and Health Technology Assessment Database (HTA) (from 1982 to 2018). Moreover, we perused the reference lists of all retrieved articles and of previously published relevant review articles, handsearched relevant conference proceedings, searched relevant websites, and contacted experts in the field. SELECTION CRITERIA: We included all studies comparing TCD or TCCD (index tests) with IA, CTA, MRA, or contrast-enhanced MRA (reference standards) in people with acute ischaemic stroke, where all participants underwent both the index test and the reference standard within 24 hours of symptom onset. We included prospective cohort studies and randomised studies of test comparisons. We also considered retrospective studies eligible for inclusion where the original population sample was recruited prospectively but the results were analysed retrospectively. DATA COLLECTION AND ANALYSIS: At least two review authors independently screened the titles and abstracts identified by the search strategies, applied the inclusion criteria, extracted data, assessed methodological quality (using QUADAS-2), and investigated heterogeneity. We contacted study authors for missing data. MAIN RESULTS: A comprehensive search of major relevant electronic databases (MEDLINE and Embase) from 1982 to 13 March 2018 yielded 13,534 articles, of which nine were deemed eligible for inclusion. The studies included a total of 493 participants. The mean age of included participants was 64.2 years (range 55.8 to 69.9 years). The proportion of men and women was similar across studies. Six studies recruited participants in Europe, one in south America, one in China, and one in Egypt. Risk of bias was high for participant selection but low for flow, timing, index and reference standard. The summary sensitivity and specificity estimates for TCD and TCCD were 95% (95% CI = 0.83 to 0.99) and 95% (95% CI = 0.90 to 0.98), respectively. Considering a prevalence of stenosis or occlusion of 42% (as reported in the literature), for every 1000 people who receive a TCD or TCCD test, stenosis or occlusion will be missed in 21 people (95% CI = 4 to 71) and 29 (95% CI = 12 to 58) will be wrongly diagnosed as harbouring an intracranial occlusion. However, there was substantial heterogeneity between studies, which was no longer evident when only occlusion of the MCA was considered, or when the analysis was limited to participants investigated within six hours. The performance of either TCD or TCCD in ruling in and ruling out a MCA occlusion was good. Limitations of this review were the small number of identified studies and the lack of data on the use of ultrasound contrast medium. AUTHORS' CONCLUSIONS: This review provides evidence that TCD or TCCD, administered by professionals with adequate experience and skills, can provide useful diagnostic information for detecting stenosis or occlusion of intracranial vessels in people with acute ischaemic stroke, or guide the request for more invasive vascular neuroimaging, especially where CT or MR-based vascular imaging are not immediately available. More studies are needed to confirm or refute the results of this review in a larger sample of stroke patients, to verify the role of contrast medium and to evaluate the clinical advantage of the use of ultrasound.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Artérias Cerebrais/diagnóstico por imagem , Humanos , Infarto da Artéria Cerebral Média , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
World Neurosurg ; 136: e447-e459, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31953092

RESUMO

OBJECTIVE: To review the microsurgical anatomy of the donor arteries for extracranial-intracranial bypass, namely, the superficial temporal artery (STA), occipital artery (OA), and internal maxillary artery (IMA). METHODS: Seven cadaveric specimens were dissected to identify the relationships between each artery and its surrounding structures. Nineteen computed tomographic angiographic images of Japanese adult patients (38 sides) were analyzed to examine the course of each artery and to measure the diameters and distances from various anatomic landmarks to each artery. RESULTS: The courses of the STA, OA, and IMA, which must be exposed during revascularization procedures, were shown via cadaver dissection with special reference to the following relationships to surrounding structures: STA, soft tissue layers of the temporoparietal region and facial nerve; OA, suboccipital muscles; and IMA, mandibular nerve. In addition, we measured the diameter of the anastomotic site for each artery and its relationship with surrounding muscles. CONCLUSIONS: A precise understanding of the anatomic characteristics of the donor arteries and their relationships with surrounding structures provides safe access to these arteries.


Assuntos
Artérias Cerebrais/anatomia & histologia , Idoso , Anastomose Cirúrgica , Pontos de Referência Anatômicos , Prótese Vascular , Cadáver , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Revascularização Cerebral , Angiografia por Tomografia Computadorizada , Dissecação/métodos , Humanos , Masculino , Artéria Maxilar/anatomia & histologia , Artéria Maxilar/diagnóstico por imagem , Artéria Maxilar/cirurgia , Pessoa de Meia-Idade , Artérias Temporais/anatomia & histologia , Artérias Temporais/diagnóstico por imagem , Artérias Temporais/cirurgia , Doadores de Tecidos
4.
PLoS One ; 15(1): e0227747, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978097

RESUMO

We developed a visual ranking system by combining the parenchymal perfusion deficits (PPD) and hyperintense vessel signals (HVS) on arterial spin labeling (ASL) imaging. This study aimed to assess the performance of this ranking system by correlating with subtypes classified based on dynamic susceptibility contrast (DSC) imaging for evaluating the perfusion disturbance observed in patients with ischemic stroke. 32 patients with acute or subacute infarcts detected by DSC imaging were reviewed. Each patient's brain was divided into 12 areas. ASL ranks were defined by the presence (+) or absence (-) of PPD/HVS as follows; I:-/-, II:-/+, III: +/+, and IV: +/-. DSC imaging findings were categorized based on cerebral blood flow (CBF) and time to peak (TTP) as normal (normal CBF/TTP), mismatched (normal CBF/delayed TTP), and matched (decreased CBF/delayed TTP). Two reviewers rated perfusion abnormalities in the total of 384 areas. The four ASL ranks correlated well with the DSC subtypes (Spearman's r = 0.82). The performance of ASL ranking system was excellent as indicated by the area under the curve value of 0.94 using either matched or mismatched DSC subtype as the gold standard and 0.97 using only the matched DSC subtype as the gold standard. The two methods were in good-to-excellent agreement (maximum κ-values, 0.86). Inter-observer agreement was excellent (κ-value, 0.98). Although the number of patients was small and the number of dropouts was high, our proposed, ASL-based visual ranking system represented by PPD and HVS provides good, graded estimates of perfusion disturbance that agree well with those obtained by DSC perfusion imaging.


Assuntos
Infarto Encefálico/diagnóstico , Encéfalo/diagnóstico por imagem , Artérias Cerebrais/fisiopatologia , Angiografia por Ressonância Magnética/métodos , Imagem de Perfusão/métodos , Idoso , Idoso de 80 Anos ou mais , Encéfalo/irrigação sanguínea , Infarto Encefálico/fisiopatologia , Artérias Cerebrais/diagnóstico por imagem , Volume Sanguíneo Cerebral/fisiologia , Circulação Cerebrovascular/fisiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Marcadores de Spin
5.
World Neurosurg ; 133: e828-e834, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31622680

RESUMO

OBJECTIVE: It is generally accepted that larger saccular intracranial aneurysms are at greater risk to rupture. We investigated whether aneurysm location influences the effect of aneurysm size on the propensity of rupture. METHODS: We reviewed patient and aneurysm characteristics in a consecutive series of patients with unruptured and ruptured aneurysms presenting to our institution between 2006 and 2018. Differences between unruptured and ruptured aneurysms at different locations were subsequently investigated. RESULTS: A total of 766 aneurysms in 568 patients were included, with 355 and 411 unruptured and ruptured aneurysms, respectively. There were significant differences in the distribution of aneurysm location between unruptured and ruptured aneurysms (P < 0.001). The most common locations of unruptured aneurysms were the middle cerebral artery (MCA) (27.6%) and paraclinoid internal carotid artery (ICA) (25.4%), whereas the most common locations of ruptured aneurysms were the anterior communicating artery (ACOM) (34.8%) and posterior communicating artery (17.8%). Ruptured aneurysms were larger than unruptured aneurysms at all locations except at the ACOM, where there was no difference in size between unruptured and ruptured aneurysms (5.4 vs. 5.8 mm, respectively; P = 0.40). Ruptured ACOM aneurysms were also smaller than ruptured aneurysms of the paraclinoid ICA (5.8 vs. 10.3 mm; P < 0.001), MCA (5.8 vs. 8.0 mm; P = 0.021), and basilar apex (5.8 vs. 10.5 mm; P < 0.001), respectively. CONCLUSIONS: We observed no difference in size between unruptured and ruptured ACOM aneurysms, possibly suggesting a greater susceptibility for ACOM aneurysms to rupture at smaller sizes.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Adulto , Idoso , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
World Neurosurg ; 134: 284-291, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31678314

RESUMO

BACKGROUND: A considerable number of patients with subarachnoid hemorrhage (SAH) develop vasospasms of the infratentorial arteries. Transcranial Doppler sonography (TCD) is used to screen for vasospasm. In this study, we used a technical modification that combines TCD with an image guidance device that the operator can use to navigate to the ultrasonic window and to predefined intracranial vascular targets. Our aim was to analyze the feasibility, spatial precision, and spatial reproducibility of serial image-guided TCD of infratentorial and-for comparison-supratentorial arteries in the clinical setting of monitoring for vasospasm after SAH. METHODS: The study included 10 SAH patients, who each received 5 serial image-guided TCD examinations. Using computed tomography angiography data, trajectories to the infratentorial and supratentorial cerebral arteries were planned and loaded into an image guidance device tracking the Doppler probe. As a measure of spatial precision and spatial reproducibility, we analyzed the distances between the positions of preplanned vascular targets and optimal Doppler signals. RESULTS: The mean distance between preplanned and optimal target points was 4.8 ± 2.1 mm (first exam), indicating high spatial precision. The spatial precision decreased with increasing depth of the vascular target. In all patients, image-guided TCD detected all predefined supratentorial and infratentorial vascular segments. There were no significant changes in spatial precision in serial exams, indicating high reproducibility. CONCLUSIONS: Image-guided TCD is feasible for supratentorial and infratentorial arteries. It shows high spatial precision and reproducibility. This study provides a basis for future clinical studies on image-guided TCD for post-SAH vasospasm screening.


Assuntos
Artéria Basilar/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Vasoespasmo Intracraniano/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Isquemia Encefálica/etiologia , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Hemorragia Subaracnóidea/complicações , Vasoespasmo Intracraniano/etiologia
7.
World Neurosurg ; 134: e649-e656, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31689567

RESUMO

BACKGROUND: Aneurysm wall enhancement (AWE) may predict rupture-prone intracranial aneurysms (IAs). However, the clinical and morphologic risk factors related to AWE have not been well described. Furthermore, the risk factors related to enhancement patterns have never been studied, especially in patients with anterior circulation aneurysms. Therefore, we aimed to investigate the risk factors related to wall enhancement and the enhancement patterns in anterior circulation unruptured aneurysms. METHODS: One hundred patients (median age, 59 years; 68% female) with 113 anterior circulation unruptured aneurysms were included in this prospective study. Clinical and morphologic risk factors related to wall enhancement and circumferential enhancement were analyzed using univariate and multivariate analyses. RESULTS: There were 33 symptomatic unruptured IAs (29.2%) and 50 IAs with AWE (44.2%) (partial [n = 16] and circumferential [n = 34]). Univariate analysis showed that symptomatic IAs and morphologic factors (irregular shape, size, width, dome depth, size ratio, aspect ratio, and bottleneck) correlated with wall enhancement. Furthermore, female sex, blood parameters (cholesterol and low-density lipoprotein), and morphologic factors (size and dome depth) correlated with wall enhancement patterns (P <0.05). Multivariate analysis showed that size was the most important factor in wall enhancement (P = 0.06; odds ratio, 3.758) and a trend for symptomatic IAs (P = 0.033; odds ratio, 2.426). Female sex was the most important factor in circumferential enhancement (P = 0.017; odds ratio, 7.276). CONCLUSIONS: AWE was strongly associated with aneurysm size and was observed more frequently in symptomatic unruptured IAs. Sex hormones and atherosclerotic factors may be involved in circumferential enhancement. However, further studies should be performed to investigate the pathologic mechanisms for pattern of enhancement.


Assuntos
Aneurisma Intracraniano/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Imageamento Tridimensional , Inflamação/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
8.
Eur Radiol ; 30(2): 855-865, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31664504

RESUMO

OBJECTIVE: To systematically compare time-of-flight magnetic resonance angiography (TOF-MRA) acquired with Compressed SENSE (TOF-CS) to spiral imaging (TOF-Spiral) for imaging of brain-feeding arteries. METHODS: Seventy-one patients (60.2 ± 19.5 years, 43.7% females, 28.2% with pathology) who underwent TOF-MRA after implementation of a new scanner software program enabling spiral imaging were analyzed retrospectively. TOF-CS (standard sequence; duration ~ 4 min) and the new TOF-Spiral (duration ~ 3 min) were acquired. Image evaluation (vessel image quality and detectability, diagnostic confidence (1 (diagnosis very uncertain) to 5 (diagnosis very certain)), quantitative measurement of aneurysm diameter or degree of stenosis according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria) was performed by two readers. Quantitative assessments of pathology were compared to computed tomography angiography (CTA) or digital subtraction angiography (DSA). RESULTS: TOF-CS showed higher image quality for intraosseous and intradural segments of the internal carotid artery while TOF-Spiral better depicted small intracranial vessels like the anterior choroidal artery. All vessel pathologies were correctly identified by both readers for TOF-CS and TOF-Spiral with high confidence (TOF-CS (4.4 ± 0.6 and 4.3 ± 0.8), TOF-Spiral (4.3 ± 0.7 and 4.3 ± 0.8)) and good inter-reader agreement (Cohen's kappa > 0.8). Quantitative assessments of aneurysm size or stenosis did not significantly differ between TOF-CS or TOF-Spiral and CTA or DSA (p > 0.05). CONCLUSIONS: TOF-Spiral for imaging of brain-feeding arteries enables reductions in scan time without drawbacks in diagnostic confidence. A combination of spiral imaging and CS may help to overcome shortcomings of both sequences alone and could further reduce acquisition times in the future. KEY POINTS: • TOF-MRA with Compressed SENSE is superior in depicting arteries at the skull base while spiral TOF-MRA is able to better depict small intracranial vessels. • Both TOF-MRA with Compressed SENSE and TOF-MRA with spiral imaging provide high diagnostic confidence for detection of pathologies of brain-feeding arteries. • Spiral TOF-MRA is faster (by 25% for the sequence used in this study) than TOF-MRA with Compressed SENSE, thus enabling clear reductions in scan time for the clinical setting.


Assuntos
Transtornos Cerebrovasculares/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital/métodos , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia Cerebral/métodos , Artérias Cerebrais/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Software , Adulto Jovem
9.
World Neurosurg ; 134: e214-e223, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31627002

RESUMO

INTRODUCTION: Persistent trigeminal artery (PTA) is the most common remnant of primitive circulation communicating the developing carotid and vertebrobasilar junction. Although discovered incidentally, an altered hemodynamic may lead to an increased association of aneurysms, vascular malformations, and stroke. Neurosurgeons should be aware of the presence and significance of PTA when interpreting imaging and planning interventions. METHODS: We retrospectively reviewed all magnetic resonance angiography and cerebral digital subtraction angiography performed between 2012 and 2017 for the presence of PTA. The radiologic and anatomic details were noted and analyzed along with the clinical profiles. We categorized the radiologic findings with respect to the available classification systems. A review of the available literature was done comparing our results. RESULTS: We found 33 cases of incidentally detected PTA. The average age of the patients was 45.42 years. The lateral surface of the proximal cavernous internal carotid artery was the most common origin (n = 23). Only 3 cases had a medial/transsellar course. Most cases were Saltzman/Weon type I (19/33). Intracranial aneurysms were associated with 6 patients (18.18%). Trigeminal neuralgia (TN) was a presenting feature in 5 patients. None had a direct neurovascular conflict at the root entry zone. CONCLUSIONS: Our study is one of the largest to describe the incidence of PTA. We emphasized the importance of PTA to the neurosurgeons; increased association of aneurysms, as a route for intervention in occlusive disease of the posterior fossa; risk of injury and bleeding during transsphenoidal surgery; and the association with TN. However, we found that only PTA variants are likely to be associated with TN because of their cisternal course causing NV conflict.


Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Artérias Cerebrais/anormalidades , Artérias Cerebrais/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Neuralgia do Trigêmeo/diagnóstico por imagem , Adolescente , Adulto , Idoso , Angiografia Digital/métodos , Malformações Arteriovenosas/cirurgia , Artérias Cerebrais/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Aneurisma Intracraniano/cirurgia , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Gânglio Trigeminal/irrigação sanguínea , Gânglio Trigeminal/diagnóstico por imagem , Gânglio Trigeminal/cirurgia , Neuralgia do Trigêmeo/cirurgia , Adulto Jovem
11.
World Neurosurg ; 135: 214-216, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31881344

RESUMO

Pure pial arterial malformations (PAMs) are poorly understood owing to the limited number of reported cases. Because PAMs have been thought to have a benign natural history, they have generally been managed conservatively, unlike arteriovenous malformations or arteriovenous fistulas. In the present report, we have described a spontaneous subarachnoid hemorrhage from the rupture of a PAM at the cerebellomedullary junction. This hemorrhage was surgically treated using clip trapping.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/cirurgia , Artérias Cerebrais/anormalidades , Hemorragia Subaracnóidea/cirurgia , Idoso , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Humanos , Masculino , Bulbo/diagnóstico por imagem , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
12.
Am J Physiol Regul Integr Comp Physiol ; 318(2): R468-R479, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31868517

RESUMO

Cyclooxygenase (COX) is proposed to regulate cerebral blood flow (CBF); however, accurate regional contributions of COX are relatively unknown at baseline and particularly during hypoxia. We hypothesized that COX contributes to both basal and hypoxic cerebral vasodilation, but COX-mediated vasodilation is greater in the posterior versus anterior cerebral circulation. CBF was measured in 9 healthy adults (28 ± 4 yr) during normoxia and isocapnic hypoxia (fraction of inspired oxygen = 0.11), with COX inhibition (oral indomethacin, 100mg) or placebo. Four-dimensional flow magnetic resonance imaging measured cross-sectional area (CSA) and blood velocity to quantify CBF in 11 cerebral arteries. Cerebrovascular conductance (CVC) was calculated (CVC = CBF × 100/mean arterial blood pressure) and hypoxic reactivity was expressed as absolute and relative change in CVC [ΔCVC/Δ pulse oximetry oxygen saturation (SpO2)]. At normoxic baseline, indomethacin reduced CVC by 44 ± 5% (P < 0.001) and artery CSA (P < 0.001), which was similar across arteries. Hypoxia (SpO2 80%-83%) increased CVC (P < 0.01), reflected as a similar relative increase in reactivity (% ΔCVC/-ΔSpO2) across arteries (P < 0.05), in part because of increases in CSA (P < 0.05). Indomethacin did not alter ΔCVC or ΔCVC/ΔSpO2 to hypoxia. These findings indicate that 1) COX contributes, in a largely uniform fashion, to cerebrovascular tone during normoxia and 2) COX is not obligatory for hypoxic vasodilation in any regions supplied by large extracranial or intracranial arteries.


Assuntos
Artérias Cerebrais/enzimologia , Circulação Cerebrovascular , Hipóxia/enzimologia , Prostaglandina-Endoperóxido Sintases/metabolismo , Vasodilatação , Adulto , Biomarcadores/sangue , Velocidade do Fluxo Sanguíneo , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/efeitos dos fármacos , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular/efeitos dos fármacos , Inibidores de Ciclo-Oxigenase/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Hipóxia/sangue , Hipóxia/diagnóstico por imagem , Hipóxia/fisiopatologia , Indometacina/administração & dosagem , Masculino , Oxigênio/sangue , Distribuição Aleatória , Vasodilatação/efeitos dos fármacos , Adulto Jovem
13.
Eur Radiol ; 30(1): 119-127, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31372787

RESUMO

OBJECTIVES: To compare visualization of joint intracranial and carotid vessel walls between 5× compressed sensing accelerated three-dimensional DANTE-SPACE sequence (CS VWI) acquired in 5 min and the same sequence accelerated by 2.7× parallel imaging (PI VWI) which takes 9-10 min currently. METHODS: Following institutional review board approval and informed consent, 28 subjects including 20 stroke patients underwent PI and CS VWI examinations with an acquired spatial resolution of isotropic 0.55 mm and joint coverage of intracranial and carotid arteries. Quantitative wall thickness measurements of CS VWI and PI VWI were compared on healthy volunteers and patients with wall thickening respectively. Subjective wall visualizations of the two VWI methods on patients were scored by two radiologists blindly and independently using a 4-point scale followed by inter-rater reproducibility analysis. RESULTS: Linear regression analysis of wall thickness measurements showed excellent agreement between CS VWI and PI VWI in both healthy volunteers (r = 0.99) and stroke patients with wall thickening (r = 0.99). Subjective wall visualization score of CS VWI was slightly lower than PI VWI (3.13 ± 0.41 vs. 3.31 ± 0.79) but still had good diagnostic quality (> 3 based on a 4-point scale). The two radiologists' scores agreed excellently, evidenced by the intraclass correlation coefficient (ICC) values being higher than 0.75 (p < 0.001). CONCLUSIONS: Compressed sensing expedients joint intracranial and carotid VWI acquired at an isotropic resolution of 0.55 mm in 5 min without compromising quantitative vessel wall thickness measurement or diagnostic wall visualization. KEY POINTS: • CS VWI facilitates comprehensive visualization of intracranial and carotid vessel walls at an acquired isotropic resolution of 0.55 mm in a single 5-min scan. • CS VWI affords comparable vessel wall visualization and morphology measurement as PI VWI with a shortened acquisition time by 45%. • CS VWI alleviates the intensive trade-off between imaging resolution and scan time, and benefits the scan efficiency, motion robustness, and patient tolerance of high-resolution joint intracranial and carotid VWI.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Imageamento Tridimensional/métodos , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Reprodutibilidade dos Testes
14.
Cardiovasc Pathol ; 45: 107182, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31869771

RESUMO

A case is reported of a 40-year-old woman clinically diagnosed as moyamoya disease with associated fibromuscular dysplasia of intrapulmonary bronchial arteries incidentally revealed during autoptic examination. Moyamoya disease represents an idiopathic noninflammatory and nonatherosclerotic arterio-occlusive process of intracranial arteries. Prolonged brain ischemia leads to formation of tiny and fragile collaterals. Clinically, patients with moyamoya angiopathy commonly present with severe neurological symptoms caused by brain infarction or hemorrhage. Histologically, the steno-occlusive process is based on fibrocellular thickening of intima and intimal smooth muscle cell proliferation. In the literature, extracranial arterial involvement, i.e. fibromuscular dysplasia of renal or pulmonary arteries, has been described in several cases of moyamoya disease. Our aim is to show a unique case of moyamoya disease associated with fibromuscular dysplasia affecting an uncommon site.


Assuntos
Artérias Brônquicas/patologia , Artérias Carótidas/patologia , Artérias Cerebrais/patologia , Displasia Fibromuscular/patologia , Doença de Moyamoya/patologia , Adulto , Angiografia Digital , Autopsia , Biópsia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/cirurgia , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Evolução Fatal , Feminino , Displasia Fibromuscular/complicações , Humanos , Doença de Moyamoya/complicações , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/cirurgia
15.
PLoS One ; 14(10): e0223584, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31603919

RESUMO

Cerebral hemodynamics after arterial ischemic stroke (AIS) in children are largely unknown. This study aims to explore long-term cerebral perfusion balance of vital tissue and its relation to motor outcome after childhood AIS. Patients diagnosed with childhood AIS (≤16 years at diagnosis, time since stroke ≥2 years) and typically developing peers were examined. Hemiparesis was classified according to the Pediatric Stroke Outcome Measure. Manual ability was assessed using the ABILHAND-Kids questionnaire. Cerebral blood flow was measured by arterial spin labeling and analyzed in the following brain regions: the hemispheres, the territory of the anterior cerebral artery (ACA), the middle cerebral artery (MCA), and in subregions of the MCA territory (MCA anterior, middle, posterior). To assess cerebral perfusion balance, laterality indices were calculated using cerebral blood flow in the ipsi- and contralesional hemisphere. Laterality indices were compared between stroke patients with and without hemiparesis, and peers. Twenty participants diagnosed with AIS were included (12 boys, 8 girls; mean age 14.46±4.96 years; time since stroke 8.08±3.62 years); 9 (45%) were diagnosed with hemiparesis. Additionally, 47 typically developing peers (21 boys, 26 girls; mean age 14.24±5.42 years) were studied. Laterality indices were higher in stroke patients and oriented to the contralesional hemisphere in all brain regions except the ACA territory and MCA posterior subregion. This was significantly different from peers, who showed balanced laterality indices. There was a significant correlation between laterality indices and manual ability, except in the ACA territory. AIS is associated with long-term alterations of cerebral blood flow in vital tissue, even in patients without hemiparesis. The degree of imbalance of cerebral perfusion in children after AIS is associated with manual ability.


Assuntos
Isquemia Encefálica/fisiopatologia , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular/fisiologia , Atividade Motora , Acidente Vascular Cerebral/fisiopatologia , Adolescente , Isquemia Encefálica/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Criança , Feminino , Lateralidade Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Paresia/fisiopatologia , Grupo Associado , Perfusão , Acidente Vascular Cerebral/diagnóstico por imagem
16.
Biomed Mater Eng ; 30(4): 427-438, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31561321

RESUMO

BACKGROUND: The development of any disturbance in the Circle of Willis (COW) can change the hemodynamics of blood flow and result in damage to the vascular system. Clinical methods such as TCD for diagnosing an aneurysm or growth factors and rupture can measure blood velocity. Several factors influence the accuracy of TCD that can lead to wrong evaluations and affect the treatment planning. OBJECTIVE: In this study, the conformity between CFD and TCD was accomplished for investigating the accuracy of the clinical method (TCD) in different vessels of the Circle of Willis. METHODS: The realistic three-dimensional models have been produced from angiography images. Considering fluid-structure interaction, a domain of the blood flow and vessel wall has been simulated by the ANSYS.CFX software. The velocity in the cerebral arteries has been calculated and compared with the velocity acquired from TCD. RESULTS: According to the findings, there were significant differences between the results obtained from computational fluid dynamics and Doppler test in different vessels of the Circle of Willis. In some areas, differences close to 80 cm/s were also reported. CONCLUSION: According to the results, there are possibilities of errors in carrying out a Doppler test in some arteries and can lead to wrong estimates and ultimately incorrect decisions.


Assuntos
Aneurisma/diagnóstico por imagem , Círculo Arterial do Cérebro/diagnóstico por imagem , Idoso , Aneurisma/patologia , Aneurisma/fisiopatologia , Velocidade do Fluxo Sanguíneo , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Criança , Círculo Arterial do Cérebro/patologia , Círculo Arterial do Cérebro/fisiopatologia , Humanos , Masculino , Modelos Anatômicos , Software , Ultrassonografia Doppler Transcraniana
17.
J Comput Assist Tomogr ; 43(5): 697-707, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490889

RESUMO

OBJECTIVE: To explore the application value of postlabeling delay (PLD) in 3D pseudocontinuous arterial spin-labeled (3D-pcASL) perfusion imaging in normal children and to find the optimal PLD values for children at each age group. METHODS: Five groups of children, with 50 patients in each group, who underwent routine magnetic resonance imaging scans with normal results were included. The patients were stratified according to the following ages: younger than 1 month, more than 1 month to 6 months, more than 6 months to 12 months, more than 1 year to 3 years, more than 3 years to 6 years, and more than 6 years to 18 years. All patients received 3D-pcASL perfusion magnetic resonance scanning. The PLD values were set to 1025, 1525, or 2025 milliseconds. In subjective evaluations, the signal-to-noise ratio (SNR) and cerebral blood flow (CBF) of 3D-pcASL perfusion images under different PLD values were compared and analyzed. RESULTS: For patients in the <1-month group and >1-month to 6-month group, the images were mainly grade A when the PLD value was 1025 milliseconds, which equaled 43 and 46 cases, respectively. The brain CBF values and SNR values were higher than those of the images with PLD values of 1525 and 2025 milliseconds. For patients in the >6-month to 12-month group, >1-year to 3-year group, >3-year to 6-year group, and >6-year to 18-year group, the images were mainly grade A when the PLD value was 1525 milliseconds, which equaled 43, 45, 43, and 46 cases, respectively. The brain CBF values and SNR values were higher than those of the images with PLD values of 1025 and 2025 milliseconds. CONCLUSIONS: The optimal PLD values for 3D-pcASL perfusion imaging are different in children of different ages. The optimal PLD value for infants who are 6 months younger is 1025 milliseconds. The optimal PLD value for children older than 6 months to 18 years is 1525 milliseconds.


Assuntos
Encéfalo/irrigação sanguínea , Artérias Cerebrais/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Imagem por Ressonância Magnética/métodos , Imagem de Perfusão/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Imageamento Tridimensional , Lactente , Recém-Nascido , Masculino , Valores de Referência , Marcadores de Spin
18.
World Neurosurg ; 132: 154-160, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493610

RESUMO

BACKGROUND: Recurrent trigeminal neuralgia after successful microvascular decompression is not rare. CASE DESCRIPTION: A 72-year-old woman who presented with typical right trigeminal neuralgia had been successfully treated by microvascular decompression with transposition of the superior cerebellar artery. However, she complained of trigeminal neuralgia on the ipsilateral side 14 months after the microvascular decompression. Redo microvascular decompression showed that the anterior inferior cerebellar artery, which had not been detected at the initial surgery, compressed the right trigeminal nerve. CONCLUSIONS: This case is an unusual type of recurrent trigeminal neuralgia because of a subsequently developed offending vessel within a short period.


Assuntos
Artérias Cerebrais/cirurgia , Cirurgia de Descompressão Microvascular/métodos , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia , Idoso , Cerebelo/irrigação sanguínea , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Embolização Terapêutica , Feminino , Humanos , Imagem por Ressonância Magnética , Dor/etiologia , Dor/cirurgia , Reoperação , Neuralgia do Trigêmeo/diagnóstico por imagem
19.
Presse Med ; 48(9): 931-940, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31471096

RESUMO

Since 2000, imaging is frequently used for the diagnosis and follow-up of giant cell arteritis (GCA). At diagnosis, the demonstration on imaging of an involvement of the temporal arteries is useful to guide the temporal artery biopsy, or, sometimes, to replace it. Large-vessel imaging is nowadays currently performed as some studies indicate that 30 to 80% of patients might demonstrate involvement of the aorta and its branches, often silently. Aorta CT angiography, positron emission tomography or magnetic resonance angiography show a high sensibility to detect large-vessel inflammation, and have become in current practice and recent studies a supplementary criteria to classify or diagnose GCA. Many studies indicate a different prognosis in patients with large-vessel inflammation, highlighting the need to diagnose such involvement. Large-vessel imaging is important in the patients' follow-up to analyze how large-vessel inflammation evolves under treatment and to detect morphologic changes (dilations, dissections, or stenoses) that are more frequent in these patients. Recent European recommendations analyze the different imaging procedures available for diagnosis and follow-up of patients with GCA.


Assuntos
Aorta/diagnóstico por imagem , Aortite/diagnóstico por imagem , Arterite de Células Gigantes/diagnóstico por imagem , Artérias Temporais/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Europa (Continente) , Seguimentos , Humanos , Angiografia por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Guias de Prática Clínica como Assunto , Prognóstico , Sensibilidade e Especificidade
20.
J Stroke Cerebrovasc Dis ; 28(11): 104328, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31471213

RESUMO

OBJECTIVE: Present study was aimed to precisely evaluate the angio-architectures in patients with asymptomatic moyamoya disease (MMD) by comparing with those with hemorrhagic stroke. METHODS: This study used the data set of cerebral angiography in Asymptomatic Moyamoya Registry (AMORE) Study and Japan Adult Moyamoya (JAM) Trial at enrollment. The development of 3 subtypes of collateral vessels, including lenticulostriate, thalamic, and choroidal anastomosis, was evaluated on cerebral angiography. Suzuki's angiographical stage and posterior cerebral artery (PCA) involvement were also assessed. These findings were compared between asymptomatic (AMORE) and hemorrhagic (JAM) groups. RESULTS: This study included 55 hemispheres of 35 patients in asymptomatic group and 75 hemispheres of 75 patients in hemorrhagic group. In asymptomatic group, thalamic anastomosis was less developed than in hemorrhagic group (P = .011), but there were no significant differences in the development of lenticulostriate and choroidal anastomosis between the 2 groups (P = .077 and P = .26, respectively). Suzuki's stage was more progressed and the prevalence of PCA involvement was significantly higher in hemorrhagic group than in asymptomatic group (P = .0033 and P = .016, respectively). CONCLUSIONS: This study reveals no significant differences in the development of choroidal anastomoses between asymptomatic and hemorrhagic-onset MMD. On the other hand, disease stage and PCA involvement were less advanced in asymptomatic MMD than in hemorrhagic-onset MMD. These findings strongly suggest a certain subgroup of asymptomatic patients with MMD is at potential risk for hemorrhagic stroke.


Assuntos
Angiografia Cerebral/métodos , Artérias Cerebrais/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Doença de Moyamoya/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Doenças Assintomáticas , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Circulação Colateral , Estudos Transversais , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Japão , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/complicações , Doença de Moyamoya/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA