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1.
Vasa ; 50(1): 38-44, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33153399

RESUMO

Background: Iliofemoral vein stenosis can cause debilitating chronic venous disease. Diagnostic tools include both computed tomography venography (CTV) and intravascular ultrasonography (IVUS). We aim to compare the diagnostic performance of CTV and IVUS. Patients and methods: We performed a retrospective study of patients with chronic venous disease presenting with iliac vein compression or post-thrombotic limb symptoms, excluding those with acute deep vein thrombosis, high anaesthesia risk, or who had contrast allergy. All patients received CTV before IVUS, as part of the diagnostic work-up and intervention. The cross-sectional area (CSA) of iliofemoral vein segments obtained from both studies were compared against reference CSAs to derive percentage stenosis. A 50% reduction in CSA was considered significant. Results: We studied 50 patients between May 2018 and April 2019. 58% of patients had severe disease CEAP C5-6. 48% of patients had at least one vein segment with significant stenosis. The left proximal common iliac vein was the most commonly stenosed vein segment (n = 12, 24% on IVUS). CSA measurements from CTV were greater than those of IVUS, with a correlation coefficient of 0.57 (p < 0.005). Conversely, percentage stenosis measured on CTV was lower than on IVUS, with approximately one-third of significant stenosis missed on CTV (58 veins from CTV vs. 78 from IVUS, p < 0.005). With IVUS as the gold standard, CTV has low sensitivity (37.2%, 95% CI 26.5-48.9) and high specificity (92.5%, 95% CI 89.3-94.9) in detecting significant stenosis. Conclusions: CTV has limited diagnostic performance in identifying iliofemoral vein stenosis. Patients with normal CTV findings should proceed with IVUS imaging if the clinical features are supportive of iliofemoral vein stenosis.


Assuntos
Constrição Patológica/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Flebografia/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
2.
3.
J Clin Neurosci ; 77: 134-141, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32418811

RESUMO

To develope a colored realistic AVM model using three-dimensional (3D) printing for surgical planning and research. Raw computed tomography angiography (CTA) and magnetic resonance venography (MRV) data were integrated and used for reconstruction. Each AVM model included the nidus, the feeding arteries, the draining veins, the sinuses, the adjacent principal arteries, and the skull. The models were employed to plan surgical and endovascular treatments. Surgical feedback was obtained using a survey. Five AVM cases were included. The AVMs and the models thereof did not differ significantly in terms of length, width, or height, as measured via magnetic resonance imaging (all p > 0.05). The 3D AVM models were thus accurate. The overall score on the questionnaire survey was >4 point; the model thus aided the planning of interventional surgery. All surgeons were confident that the 3D models reflected the true lesional boundaries. Our 3D-printed intracranial AVM models were accurate, and can be used for preoperative planning and training of residents. The models improved surgeons' understanding of AVM structure, reducing operative time.


Assuntos
Malformações Arteriovenosas Intracranianas/cirurgia , Modelagem Computacional Específica para o Paciente , Impressão Tridimensional , Adulto , Feminino , Humanos , Imageamento Tridimensional/métodos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Tomografia Computadorizada por Raios X/métodos
4.
Curr Med Sci ; 40(1): 192-198, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32166683

RESUMO

MR pulmonary angiography (MRPA) combined with indirect MR venography (MRV) was attempted by using 3D contrast-enhanced MR volume interpolated body examination (VIBE) sequence. Agreement rate for deep venous thrombosis (DVT) detection between MRV and duplex sonography (DUS) was evaluated; the potential of this method for venous thromoembolism (VTE) was also investigated. Thirty-four patients with DUS-identified DVT were enrolled in this study. MRI was performed after a single administration of Gadopentetate dimeglumine. Fat-suppressed 3D VIBE was applied for visualizing pulmonary arteries, abdominal veins, pelvic and leg veins, ranging from lung apex to ankle level. Two radiologists observed the MR images in consensus, recorded the location and number of emboli. MRV images were assessed based on per-vein segment. The agreement rate between MRV and DUS for venous segment-to-segment comparison was analyzed by Wilcoxon rank sum test. All the patients were diagnosed as having DVT by MRV. MRV detected 55 more venous segments with thrombi than DUS based on per-vein segment analysis. Twenty-three patients with pulmonary embolism (PE) were detected by MRPA. Twenty-one patients underwent both pulmonary CT angiography and MRPA, and consistency for PE detection was 100%. Total examination time of the combined MR protocol was 7 min for each patient. The contrast-enhanced VIBE sequence proves to be a feasible and reliable method for VTE diagnosis in one-stop MR scanning procedure, and contrast-enhanced VIBE performs better to depict DVT than DUS on per-vein segment basis.


Assuntos
Meios de Contraste/administração & dosagem , Gadolínio DTPA/administração & dosagem , Angiografia por Ressonância Magnética/métodos , Flebografia/métodos , Embolia Pulmonar/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Variações Dependentes do Observador , Exame Físico , Interpretação de Imagem Radiográfica Assistida por Computador , Sensibilidade e Especificidade , Ultrassonografia Doppler Dupla , Adulto Jovem
5.
J Neurointerv Surg ; 12(9): 906-910, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32161164

RESUMO

INTRODUCTION: Little is known about how changes in physiologic parameters affect venous sinus pressure measurements, waveforms, or gradients associated with sinus stenosis. OBJECTIVE: To evaluate the effect of changes in cardiovascular and respiratory physiologic parameters on venous sinus pressure and caliber measurements in patients with idiopathic intracranial hypertension (IIH) undergoing venous sinus stenting. METHODS: In a prospective, randomized pilot study, eight patients with IIH undergoing venous sinus stenting were randomized to one of two groups. Under general anesthesia, patients underwent venous manometry and waveform recordings twice in succession based on assigned physiologic groups immediately before stenting. The mean arterial pressure (MAP) group maintained normocapnia but modified MAPs in two arms to control for temporal confounding: group A1 (MAP 60-80 mm Hg then 100-110 mm Hg) and group A2 (MAP 100-110 mm Hg then 60-80 mm Hg). The end-tidal carbon dioxide (EtCO2) group maintained a high-normal MAP similar to standard neuroanesthesia goals and modified EtCO2: group B1 (EtCO2 24-26 mm Hg then 38-40 mm Hg) and B2 (EtCO2 28-40 mm Hg then 24-26 mm Hg). RESULTS: In group A, superior sagittal sinus (SSS) pressures (ranging from 8 to 76 mm Hg) and trans-stenotic pressure gradients (TSPGs) (ranging from 2 to 67 mm Hg) were seen at MAP of 100-110 mm Hg compared with SSS pressures (4-38 mm Hg) and TSPGs (3-31 mm Hg) at 60-80 mm Hg. In group B, SSS pressures and TSPGs were considerably higher at EtCO2 levels of 38-40 mm Hg (15-57 mm Hg and 3-44 mm Hg, respectively) than at 24-26 mm Hg (8-26 mm Hg and 1-8 mm Hg, respectively). CONCLUSIONS: Despite the small sample size, this pilot study demonstrates a dramatic effect of both MAP and EtCO2 on venous sinus pressures obtained during venography. These findings underscore the importance of maintaining normal physiologic cardiovascular and respiratory parameters during venous sinus manometry.


Assuntos
Pressão Arterial/fisiologia , Dióxido de Carbono/fisiologia , Cavidades Cranianas/fisiopatologia , Pseudotumor Cerebral/fisiopatologia , Pressão Venosa/fisiologia , Adulto , Cavidades Cranianas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Projetos Piloto , Estudos Prospectivos , Pseudotumor Cerebral/diagnóstico por imagem , Estudos Retrospectivos
6.
Br J Radiol ; 93(1108): 20190751, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32017608

RESUMO

OBJECTIVE: To determine the utility of low-dose gelatin sponge particles and 5% ethanolamine oleate iopamidol (EOI) mixture in retrograde transvenous obliteration (GERTO) for gastric varices (GV). METHODS: 57 consecutive patients who underwent balloon-occluded retrograde transvenous obliteration (B-RTO) for GV were divided into three groups with Hirota's grade by balloon-occluded retrograde transvenous venography. Hirota's Grade 1 patients were assigned to G1 group and underwent treatment with 5% EOI. Grade ≥ 2 patients prior to August 2015 were G ≥ 2 group treated with 5% EOI, and those treated thereafter were GERTO group. The amount of EOI used per unit GV volume (EOI/GV ratio), the times to embolization and recurrence rate of GV were evaluated. RESULTS: The EOI/GV ratio was 0.66 ± 0.19 in G1, 1.5 ± 0.8 in G ≥ 2, and 0.58 ± 0.23 in GERTO (G ≥ 2 vs GERTO, p < 0.0001). The times to embolization were 26.5 ± 10.5 min for G1, 39.2 ± 26.8 for G ≥ 2, and 21.4 ± 9.4 for GERTO (G ≥ 2 vs GERTO, p = 0.005). The recurrence rate was not significantly different in any of the groups. CONCLUSION: GERTO was performed in lower amount of sclerosants and in less time compared to conventional B-RTO in Hirota's grade ≥2. ADVANCES IN KNOWLEDGE: Feasibility of low-dose gelatin sponge particles and 5% EOI mixture as sclerosants for GV.


Assuntos
Oclusão com Balão/métodos , Varizes Esofágicas e Gástricas/terapia , Gelatina/administração & dosagem , Iopamidol/administração & dosagem , Ácidos Oleicos/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Idoso , Oclusão com Balão/efeitos adversos , Combinação de Medicamentos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Flebografia/métodos
7.
Eur. j. anat ; 24(1): 49-56, ene. 2020. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-186064

RESUMO

The anatomical variations of the intracranial venous dural sinuses must be put in consideration in diagnosing magnetic resonance venography (MRV) to avoid the diagnostic pitfalls resulting from over-diagnosis of cerebral venous dural sinus occlusion or thrombosis. The available data regarding the age and sex difference of the magnetic resonance venography (MRV) anatomical variations is still limited. A retrospective study is done for 500 patients ranging from 20 to 70 years. Only 363 patients (142 males and 221 females) were included in our final analysis: all have normal MRI brain & posterior fossa. Magnetic resonance venography (MRV) is done to detect the presence or absence of the transverse venous dural sinuses and to detect any age-or sex-related differences. Also 64 dry Egyptian skulls (41 males and 23 females) were employed to detect symmetry of transverse sulcus and to determine age and sex difference. Hypoplastic left transverse sinus was by far the commonest asymmetrical transverse sinus variants representing 22.0% of total: it was noted in 38 male and 38 female. Even if the asymmetrical transverse sinus is more common in females, there is no significant difference between both genders. In the dry skull, symmetrical transverse sulcus was observed in 67.2% of total, while asymmetrical transverse sulcus was recorded in 32.8% of total, which were more observed in female skull 17.2% of total with no significant difference


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Variação Anatômica , Flebografia/métodos , Cavidades Cranianas/anormalidades , Cavidades Cranianas/diagnóstico por imagem , Trombose dos Seios Intracranianos/diagnóstico por imagem , Crânio/anormalidades , Crânio/anatomia & histologia , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Cavidades Cranianas/anatomia & histologia , Estudos Retrospectivos , Diferenciação Sexual , Egito , Determinação da Idade pelo Esqueleto , Crânio/diagnóstico por imagem
8.
Cardiovasc Intervent Radiol ; 43(1): 46-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31650241

RESUMO

PURPOSE: To evaluate the safety and the efficacy of percutaneous pharmaco-mechanical thrombectomy (PPMT) of acute superior mesenteric vein (SMV) thrombosis. METHODS: A database of patients treated between 2011 and 2018 with acute venous mesenteric ischemia (VMI) was reviewed. VMI was diagnosed in the presence of SMV thrombosis and CT evidence of jejunal thickening. All patients presented with mild to moderate peritonism, which allowed surgery to be postponed. Initial treatment consisted of heparinization. PPMT was indicated in case of worsening abdominal pain despite anticoagulation and was performed via a transjugular or transhepatic approach, using a rotational aspiration thrombectomy catheter, followed by transcatheter thrombolysis. Clinical success was defined as symptoms resolution. Technical success was defined as patency of > 50% of SMV at venography and resolution of jejunal thickening. Patients were discharged on lifelong oral anticoagulation (INR 2.5-3.5). Follow-ups were performed using CT and color Doppler ultrasound. RESULTS: Population consisted of eight males, aged 37-81 (mean 56.5 years). Causes for thrombosis were investigated. Urokinase infusion time ranged from 48 to 72 h (3,840,000-5,760,000 IU). Clinical and technical success was obtained in all cases. One patient experienced bleeding from the superior epigastric artery and was treated with embolization. One patient died of multi-organ failure after 35 days, despite resolution of SMV thrombosis. In no case was surgery required after PPMT; mean hospitalization was 14.1 days (9-24). Mean follow-up of remaining seven patients was 37.7 months (12-84 months). CONCLUSION: PPMT of acute SMV thrombosis seems safe and effective, with an 87.5% long-term survival rate and a 12.5% major complication rate.


Assuntos
Isquemia Mesentérica/tratamento farmacológico , Isquemia Mesentérica/cirurgia , Trombectomia/métodos , Trombose Venosa/tratamento farmacológico , Trombose Venosa/cirurgia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Flebografia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Trombose Venosa/diagnóstico por imagem
9.
Int J Cardiovasc Imaging ; 36(1): 141-147, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31502067

RESUMO

To assess the diagnostic efficiency of CT angiography (CTA) to detect pulmonary vein stenosis in children. We retrospectively identify patients between 0 and 3 years old with confirmed pulmonary vein stenosis with conventional angiography or surgery and available CTA. Patients without confirmed stenosis of the pulmonary veins were included as controls. We excluded patients with previous surgery involving the pulmonary veins, exclusively right-heart conventional angiography or insufficient data in the operation note to confirm the status of the pulmonary veins. Two pediatric radiologists evaluated and determine the presence of stenosis and the pulmonary veins affected. Disagreement between the readers were solved by consensus with a third reader. A pediatric cardiologist reviewed the available angiographic images to determine the presence of stenosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Kappa statistics was performed. 26 patients (15 boys, 11 Girls) were included. Conventional angiography (n = 20) and cardiothoracic surgery (n = 6) confirmed the diagnosis of pulmonary vein stenosis in 13 children. The diagnostic performance at patient level showed the sensitivity, specificity, PPV, and NPV were 84.6%, 92.3%, 91.6%, 87.5%, and 88.4%, respectively. The interobserver was k = 0.76. The performance at pulmonary vein level showed the sensitivity, specificity, PPV, and NPV were 63.3%, 97.4%, 90.4%,85.7% and 87.9%, respectively. The interobserver agreement was k = 0.62. Computed Tomography Angiography is an excellent and reliable image technique for ruling in pulmonary vein stenosis in young children.


Assuntos
Angiografia por Tomografia Computadorizada , Tomografia Computadorizada Multidetectores , Flebografia/métodos , Veias Pulmonares/diagnóstico por imagem , Estenose de Veia Pulmonar/diagnóstico por imagem , Fatores Etários , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Veias Pulmonares/fisiopatologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estenose de Veia Pulmonar/fisiopatologia
10.
Neurosurgery ; 86(5): 631-636, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31384935

RESUMO

BACKGROUND: The resistivity index (RI) in cerebral venous sinus stenosis (VSS) has not been studied in patients with idiopathic intracranial hypertension (IIH). OBJECTIVE: To evaluate the role of RI measured by quantitative magnetic resonance venogram (QMRV) as a noninvasive tool in the diagnosis of venous hypertension associated with VSS in IIH. METHODS: Retrospective evaluation of 13 consecutive IIH patients who underwent venous sinus stenting at our institution between 2013 and 2018.Patients' demographics, clinical presentation, cerebral mean venous sinus pressure (MVP), and RI both pre- and poststenting were recorded. The baseline RI was also compared to a control group. RESULTS: Among 13 patients of IIH, 11 had unilateral VSS in dominant sinus, whereas 2 had bilateral VSS. RI was significantly higher in IIH patients compared to the control group in the superior sagittal (SSS) and transverse sinuses (TS) (0.21 vs 0.11, P = .01 and 0.22 vs 0.13, P = .03, respectively). The MVP (in mm Hg) decreased significantly after venous sinus stenting in the SSS (41.9 to 22.5, P < .001) and TS (39.4 to 19.5, P < .001), which was also associated with a significant reduction of the RI (0.22 vs 0.17, P < .01 in SSS and 0.23 vs 0.17, P = .03 in TS) poststenting. CONCLUSION: RI calculated using QMRV can serve as a noninvasive tool to aid in the diagnosis of hemodynamically significant VSS. The study had a small sample size, and larger multicenter studies would be required to validate the results further.


Assuntos
Cavidades Cranianas/patologia , Hemodinâmica/fisiologia , Pseudotumor Cerebral/etiologia , Adulto , Constrição Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Pseudotumor Cerebral/fisiopatologia , Estudos Retrospectivos
11.
J Neurointerv Surg ; 12(3): 320-325, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31473648

RESUMO

OBJECTIVE: To determine the relationship between normal physiologic and pathologic venous sinus pressures in patients with idiopathic intracranial hypertension (IIH), which is poorly understood. METHODS: Retrospective analysis was performed to identify patients with medically refractory IIH who were evaluated by angiography and retrograde venography with venous manometry. Patients were further subdivided into groups based on anatomic factors. RESULTS: 104 patients met inclusion criteria for the study. In the absence of non-invasive venographic screening, 58% of patients in this series were found to have pressure gradients of ≥8 mm Hg; 93% were located near the transverse-sigmoid sinus junction. Opening pressure (OP) is strongly predictive of superior sagittal sinus (SSS) pressures (p<0.001) and also of the presence of a pressure gradient ≥8 mm Hg (p<0.001). Twenty-three percent of patients with an OP <25 had a pressure gradient ≥8 mm Hg compared with 77% of patients with an OP ≥35. Analysis of patients with OP ≤20 suggests that SSS pressures in patients without IIH should be less than 16-18 mm Hg with total cranial gradients <5 mm Hg. Across all patients, a pressure decrement of approximately 1 mm Hg occurs with progressively more caudal transition across anatomic points of measurement. CONCLUSIONS: This study describes intracranial and extracranial venous pressure measurements and gradients in different subgroups of patients with IIH. OP is highly predictive of intracranial venous pressures and significant venous pressure gradients.


Assuntos
Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/fisiopatologia , Pseudotumor Cerebral/diagnóstico por imagem , Pseudotumor Cerebral/fisiopatologia , Adulto , Feminino , Humanos , Pressão Intracraniana/fisiologia , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Flebografia/métodos , Estudos Retrospectivos , Stents , Pressão Venosa/fisiologia
12.
Ann Vasc Surg ; 62: 497.e7-497.e12, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449937

RESUMO

BACKGROUND: The aneurysms of internal jugular vein (IJV) are very rare and hence scarcely described in the literature. Owing to the lack of guidelines on the treatment paradigm of this condition, management strategies vary. METHODS: Six patients presenting in our institution with internal jugular venous aneurysms from September 2007 to August 2017 were retrospectively analyzed. RESULTS: IJV aneurysms were confirmed in all 6 patients. For 3 of them, a surgical treatment was deemed necessary. These were 2 patients with intravenous thrombosis and 1 patient with progressive aneurysmal enlargement during the initial monitoring period. The choice of surgical technique was based on aneurysm morphology: 2 patients with saccular aneurysms underwent tangential aneurysmectomy with lateral venorrhaphy, and a patient presenting a fusiform aneurysm underwent its total excision followed by IJV ligation. Three remaining patients were managed conservatively, with one of them fully regressing and the other 2 remaining asymptomatic. CONCLUSIONS: IJV aneurysms are very rare and usually of benign natural history. For asymptomatic patients, conservative treatment with close follow-up is generally recommended. If any accompanying signs or symptoms are present, such as pain, swelling, evidence of thrombosis, progressive enlargement, or severe psychological stress, timely and appropriate surgical intervention should ensue.


Assuntos
Aneurisma/terapia , Tratamento Conservador , Veias Jugulares/cirurgia , Procedimentos Cirúrgicos Vasculares , Adulto , Aneurisma/diagnóstico por imagem , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Ligadura , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
13.
J Vasc Interv Radiol ; 30(10): 1549-1554, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31526576

RESUMO

PURPOSE: To identify factors independently associated with disease recurrence after venoplasty and stent placement for May-Thurner syndrome (MTS). MATERIALS AND METHODS: Fifty-nine consecutive patients (age, 47 y ± 15; 93% female) were identified who had undergone endovascular stent placement for MTS. Patient charts were reviewed for demographic data, risk factors for venous thrombosis, comorbidities, and venous inflow or outflow at first follow-up (3 wk to 6 mo after treatment). Logistic regression was used to identify independent predictors of symptom recurrence or repeat intervention, and multivariate analysis of variance and receiver operator characteristic curve analysis were used to assess relationships between degrees of in-stent stenosis and other variables in the 73% of patients with available cross-sectional imaging. Median follow up was 20.7 months (interquartile range, 4.7-49.5 mo). RESULTS: All procedures were technically successful. Disease recurrence, defined as symptom recurrence following initial postprocedural resolution, was observed in 38% of patients. No preprocedural variable was found to be independently predictive of disease recurrence; however, poor venous inflow or outflow were both strongly associated with recurrent disease, with adjusted odds ratios and 95% confidence intervals of 38.02 (3.76-384.20; P = .002) and 7.00 (1.15-42.71; P = .04), respectively. Higher degrees of in-stent stenosis were also associated with symptom recurrence, with an area under the curve of 0.93 (P = .000002) and 39%-41% stenosis being 78%-83% sensitive and 88%-92% specific for symptom recurrence. CONCLUSIONS: These results suggest that cross-sectional imaging can help differentiate patients in whom closer follow-up may be warranted after venoplasty and stent placement for MTS and also guide counseling regarding prognosis.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Ilíaca , Síndrome de May-Thurner/terapia , Stents , Adulto , Chicago , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/fisiopatologia , Pessoa de Meia-Idade , Flebografia/métodos , Recidiva , Retratamento , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
15.
Cardiovasc Intervent Radiol ; 42(11): 1619-1626, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31471721

RESUMO

PURPOSE: This study evaluates the image quality of lower extremity CT venography reconstructed with orthopedic metal artifact reduction (O-MAR) in patients with unilateral or bilateral metallic prostheses in the hip or knee. METHODS: This retrospective study was approved by our institutional review board, and informed consent was waived. Twenty-nine patients of lower extremity CT with 51 metallic hip or knee prostheses were reconstructed to both standard CT images and O-MAR images. The subjective image quality and vessel conspicuity for both images were evaluated by two readers using five-point scales (0-4). Vessel conspicuity scores of 3 or 4 were considered diagnostically acceptable. Image noise was measured in the air and subcutaneous fat. RESULTS: O-MAR images showed significantly higher scores of subjective image quality (p < .001) and vessel conspicuity (p = .002) than standard CT images. Diagnostic acceptance of vessel conspicuity was not significantly different between O-MAR images and standard CT images (p = 1.000). O-MAR images showed significantly less image noise than conventional CT images (p < .001 for both air and subcutaneous fat). CONCLUSION: O-MAR may be an effective solution for the metal artifacts in lower extremity CT venography; however, the distance between prostheses and vessels affects the diagnostic acceptance in patients with metallic hip or knee prostheses. LEVEL OF EVIDENCE: Level 4, Case Series.


Assuntos
Artefatos , Extremidade Inferior/diagnóstico por imagem , Flebografia/métodos , Próteses e Implantes , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Metais , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
J Med Vasc ; 44(5): 354-358, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474348

RESUMO

Bilateral absence of the superior vena cava (SVC) is an uncommon congenital vascular anomaly, mainly asymptomatic, usually undetected, and often associated with other cardiac anomalies. Though usually harmless and totally innocent, this vascular anomaly might complicate cardiovascular surgery, the insertion of a central venous catheter and the transvenous placement of a pacemaker. This SVC anomaly is still not well known, underdiagnosed and its incidence is much higher than described. A better understanding of this anomaly and its detection could play a key role in avoiding its potential complications. We are sharing a case of a female adult, with no medical history, who presented herself to the department of visceral surgery with a collateral venous circulation of the upper thorax, that was at first, mistaken for a portal hypertension syndrome, findings were pushed to finally conclude a bilateral absence of the SVC.


Assuntos
Malformações Vasculares , Veia Cava Superior/anormalidades , Adulto , Circulação Colateral , Angiografia por Tomografia Computadorizada , Erros de Diagnóstico , Feminino , Humanos , Flebografia/métodos , Valor Preditivo dos Testes , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/fisiopatologia
17.
Neuroradiol J ; 32(6): 452-457, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31478451

RESUMO

AIM: The most appropriate imaging protocol for three-dimensional rotational venography (3D RV) has not been established. The aim of this study was to optimise the protocol for 3D RV with low-dose contrast media using time-density curve analysis. METHODS: Twenty-five consecutive patients with brain tumours who received preoperative assessment with 3D RV were retrospectively collected and included in this study. To optimise the imaging delay time of 3D RV with low-dose contrast media, time-density curve analysis was performed on two-dimensional conventional angiography. The image quality for depicting cortical veins and venous sinuses was compared to that of magnetic resonance (MR) venography in five cases. RESULTS: A total of 27 3D RVs were performed in 25 patients. The time-density curves of cortical veins were different from those of cerebral arteries or sinuses. The mean time to peak of cortical veins was significantly longer than the time to peak of cerebral arteries (2.47 ± 0.35 seconds vs. 6.44 ± 1.14 seconds; p < 0.0001) and shorter than the time to peak of venous sinuses (6.44 ± 1.14 seconds vs. 8.18 ± 1.12 seconds; p < 0.0001). The optimal imaging delay time could be determined as the phases in which cortical arterial opacities disappeared and cortical veins started to appear. The mean dose of injected contrast media was 5.3 mL. The image quality of cortical veins in 3D RV was superior to that in MR venography in all cases. CONCLUSIONS: Three-dimensional RV with low-dose contrast media was useful for the preoperative assessment of cortical veins in patients with brain tumours.


Assuntos
Neoplasias Encefálicas/cirurgia , Angiografia Cerebral/métodos , Veias Cerebrais/diagnóstico por imagem , Cavidades Cranianas/diagnóstico por imagem , Imageamento Tridimensional/métodos , Flebografia/métodos , Adulto , Idoso , Meios de Contraste/administração & dosagem , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Adulto Jovem
18.
Eur J Radiol ; 120: 108644, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31539793

RESUMO

PURPOSE: Transverse sinus stenosis (TSS) is the most sensitive imaging characteristic of idiopathic intracranial hypertension (IIH). This study aimed to assess the diagnostic performance of contrast-enhanced magnetic resonance high-resolution variable flip angle turbo-spin-echo (T1 SPACE) technique in TSS patients and evaluate the diagnostic accuracy of enhanced T1 SPACE, and phase-contrast magnetic resonance venography (PC MRV) with digital subtraction angiography (DSA) as standard imaging. METHOD: This prospective study enrolled 62 patients with suspected IIH and PC MRV-confirmed transverse sinus stenosis. All patients underwent lumbar puncture, PC MRV, enhanced T1 SPACE sequences and DSA examination. The accuracy, sensitivity, and specificity of enhanced T1 SPACE in detecting venous sinus stenosis were calculated and compared with those of PC MRV. Intermodality agreement (Kendall's rank correlation coefficients and weighted kappa statistic) was assessed. RESULTS: Sixty-two patients were enrolled from November 2016 to October 2018. For the measured stenosis, better correlation was observed in enhanced T1 SPACE and DSA (AUC = 0.953) than PC MRV (AUC = 0.871). Intermodality agreement of enhanced T1 SPACE (rk = 0.895 and weighted ĸ = 0.868) was better than PC MRV (rk = 0.753 and weighted ĸ = 0.653) compared with DSA. Thirty-seven intrasinus filling defects were detected by contrast-enhanced T1 SPACE, while only twenty of them were detected on source imaging of PC MRV. CONCLUSIONS: The contrast-enhanced T1 SPACE sequence was more sensitive and specific compared with PC MRV in assessing stenosis and detecting lesions in TSS patients. Accurate determination of the presence and extent of TSS using this technique might be useful in patient selection and guiding the treatment.


Assuntos
Hipertensão Intracraniana/patologia , Seios Transversos/patologia , Adulto , Idoso , Angiografia Digital/métodos , Constrição Patológica/patologia , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Flebografia/métodos , Estudos Prospectivos , Sensibilidade e Especificidade
19.
J Stroke Cerebrovasc Dis ; 28(11): 104324, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31422004

RESUMO

BACKGROUND: It is plausible that extent of cerebral venous sinus thrombosis (CVST) may determine clinical severity, magnetic resonance imaging (MRI) lesion, and outcome, therefore this study was undertaken. METHODS: A total of 160 CVST patients were included and their clinical details, risk factors, Glasgow Coma Scale score, and parenchymal lesion on MRI were noted. The extent of venous sinus thrombosis on magnetic resonance venography was assessed by using CVST score which was computed giving 1 point for each thrombosed sinus and 3 points to superior sagittal sinus (SSS). Death and outcome at 6 months were assessed using modified Rankin Scale (mRS) as good (≤2) and poor (mRS 3-5). RESULTS: Their median age was 29.5 years, and 76 (47%) were females. The median CVST score was 3 (range 1-9). CVST score did not correlate with clinical severity and risk factors. Insignificantly higher proportion of patients had parenchymal lesion with a CVST score of more than 2 (76.5% versus 64.2%). Superficial venous system thrombosis, however, correlated with seizure, papilloedema, and frontal lobe lesion. Frontal, temporal lesion correlated with SSS thrombosis, frontal and temporal with transverse sinus, temporal and cerebellar involvement in sigmoid, and basal ganglia and thalamus in straight sinus thrombosis. Seventeen patients (11%) died, and at 6 months, 132 (82%) had good and 11 (7%) poor recovery. Death and 6 months outcomes were not related to CVST score. CONCLUSIONS: Extent of CVST does not determine clinical severity, MRI lesion, and outcome. The location of parenchymal lesion however is related to thrombosis of draining sinus.


Assuntos
Angiografia Cerebral/métodos , Imagem de Difusão por Ressonância Magnética/métodos , Angiografia por Ressonância Magnética/métodos , Flebografia/métodos , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Fatores de Risco , Trombose do Seio Sagital/diagnóstico por imagem , Índice de Gravidade de Doença , Trombose dos Seios Intracranianos/mortalidade , Trombose dos Seios Intracranianos/terapia , Fatores de Tempo , Trombose Venosa/mortalidade , Trombose Venosa/terapia , Adulto Jovem
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