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The Cochrane Database of Systematic... Jan 2017Pulmonary embolism is a leading cause of pregnancy-related death. An accurate diagnosis in pregnant patients is crucial to prevent untreated pulmonary embolism as well... (Review)
Review
BACKGROUND
Pulmonary embolism is a leading cause of pregnancy-related death. An accurate diagnosis in pregnant patients is crucial to prevent untreated pulmonary embolism as well as unnecessary anticoagulant treatment and future preventive measures. Applied imaging techniques might perform differently in these younger patients with less comorbidity and altered physiology, who largely have been excluded from diagnostic studies.
OBJECTIVES
To determine the diagnostic accuracy of computed tomography pulmonary angiography (CTPA), lung scintigraphy and magnetic resonance angiography (MRA) for the diagnosis of pulmonary embolism during pregnancy.
SEARCH METHODS
We searched MEDLINE and Embase until July 2015. We used included studies as seeds in citations searches and in 'find similar' functions and searched reference lists. We approached experts in the field to help us identify non-indexed studies.
SELECTION CRITERIA
We included consecutive series of pregnant patients suspected of pulmonary embolism who had undergone one of the index tests (computed tomography (CT) pulmonary angiography, lung scintigraphy or MRA) and clinical follow-up or pulmonary angiography as a reference test.
DATA COLLECTION AND ANALYSIS
Two review authors performed data extraction and quality assessment. We contacted investigators of potentially eligible studies to obtain missing information. In the primary analysis, we regarded inconclusive index test results as a negative reference test, and treatment for pulmonary embolism after an inconclusive index test as a positive reference test.
MAIN RESULTS
We included 11 studies (four CTPA, five lung scintigraphy, two both) with a total of 695 CTPA and 665 lung scintigraphy results. Lung scintigraphy was applied by different techniques. No MRA studies matched our inclusion criteria.Overall, risk of bias and concerns regarding applicability were high in all studies as judged in light of the review research question, as was heterogeneity in study methods. We did not undertake meta-analysis. All studies used clinical follow-up as a reference standard, none in a manner that enabled reliable identification of false positives. Sensitivity and negative predictive value were therefore the only valid test accuracy measures.The median negative predictive value for CTPA was 100% (range 96% to 100%). Median sensitivity was 83% (range 0% to 100%).The median negative predictive value for lung scintigraphy was 100% (range 99% to 100%). Median sensitivity was 100% (range 0% to 100%).The median frequency of inconclusive results was 5.9% (range 0.9% to 36%) for CTPA and 4.0% (range 0% to 23%) for lung scintigraphy. The overall median prevalence of pulmonary embolism was 3.3% (range 0.0% to 8.7%).
AUTHORS' CONCLUSIONS
Both CTPA and lung scintigraphy seem appropriate for exclusion of pulmonary embolism during pregnancy. However, the quality of the evidence mandates cautious adoption of this conclusion. Important limitations included poor reference standards, necessary assumptions in the analysis regarding inconclusive test results and the inherent inability of included studies to identify false positives. It is unclear which test has the highest accuracy. There is a need for direct comparisons between diagnostic methods, including MR, in prospective randomized diagnostic studies.
Topics: Angiography; Female; Humans; Magnetic Resonance Angiography; Positron-Emission Tomography; Pregnancy; Pregnancy Complications, Hematologic; Pulmonary Embolism; Radionuclide Imaging; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 28124411
DOI: 10.1002/14651858.CD011053.pub2 -
JACC. Cardiovascular Interventions Oct 2016
Topics: Coronary Angiography; Radial Artery
PubMed: 27712734
DOI: 10.1016/j.jcin.2016.07.036 -
Magnetic Resonance in Medicine May 2023To extend and optimize a non-contrast MRI technique to obtain whole head 4D (time-resolved 3D) qualitative angiographic and perfusion images from a single scan.
PURPOSE
To extend and optimize a non-contrast MRI technique to obtain whole head 4D (time-resolved 3D) qualitative angiographic and perfusion images from a single scan.
METHODS
4D combined angiography and perfusion using radial imaging and arterial spin labeling (CAPRIA) uses pseudocontinuous labeling with a 3D golden ratio ("koosh ball") readout to continuously image the blood water as it travels through the arterial system and exchanges into the tissue. High spatial/temporal resolution angiograms and low spatial/temporal resolution perfusion images can be flexibly reconstructed from the same raw k-space data. Constant and variable flip angle (CFA and VFA, respectively) excitation schedules were optimized through simulations and tested in healthy volunteers. A conventional sensitivity encoding (SENSE) reconstruction was compared against a locally low rank (LLR) reconstruction, which leverages spatiotemporal correlations. Comparison was also made with time-matched time-of-flight angiography and multi-delay EPI perfusion images. Differences in image quality were assessed through split-scan repeatability.
RESULTS
The optimized VFA schedule (2-9°) resulted in a significant (p < 0.001) improvement in image quality (up to 84% vs. CFA), particularly for the lower SNR perfusion images. The LLR reconstruction provided effective denoising without biasing the signal timecourses, significantly improving angiographic and perfusion image quality and repeatability (up to 143%, p < 0.001). 4D CAPRIA performed well compared with time-of-flight angiography and had better perfusion signal repeatability than the EPI-based approach (p < 0.001).
CONCLUSION
4D CAPRIA optimized using a VFA schedule and LLR reconstruction can yield high quality whole head 4D angiograms and perfusion images from a single scan.
Topics: Humans; Magnetic Resonance Angiography; Spin Labels; Imaging, Three-Dimensional; Cerebral Angiography; Perfusion
PubMed: 36533868
DOI: 10.1002/mrm.29558 -
Journal of Vascular Surgery Mar 2019
Topics: Angiography; Endarterectomy, Carotid
PubMed: 30798843
DOI: 10.1016/j.jvs.2018.07.025 -
International Journal of Molecular... Jun 2023Diabetic choroidopathy was first described on histopathological specimens of diabetic eyes. This alteration was characterized by the accumulation of PAS-positive... (Review)
Review
Diabetic choroidopathy was first described on histopathological specimens of diabetic eyes. This alteration was characterized by the accumulation of PAS-positive material within the intracapillary stroma. Inflammation and polymorphonuclear neutrophils (PMNs) activation are crucial elements in choriocapillaris impairment. The evidence of diabetic choroidopathy in vivo was confirmed with multimodal imaging, which provides key quantitative and qualitative features to characterize the choroidal involvement. The choroid can be virtually affected in each vascular layer, from Haller's layer to the choriocapillaris. However, the damage on the outer retina and photoreceptor cells is essentially driven by a choriocapillaris deficiency, which can be assessed through optical coherence tomography angiography (OCTA). The identification of characteristic features of diabetic choroidopathy can be significant for understanding the potential pathogenic and prognostic implications in diabetic retinopathy.
Topics: Humans; Diabetic Retinopathy; Retina; Choroid; Retinal Vessels; Angiography; Tomography, Optical Coherence; Fluorescein Angiography; Diabetes Mellitus
PubMed: 37373315
DOI: 10.3390/ijms241210167 -
Circulation Journal : Official Journal... Apr 2022
Topics: Angiography; Contrast Media; Coronary Angiography; Female; Humans; Male; Renal Insufficiency, Chronic
PubMed: 35354716
DOI: 10.1253/circj.CJ-22-0141 -
Diagnostic and Interventional Imaging Nov 2015Catheter ablation of arrhythmogenic triggers has been validated for the treatment of atrial fibrillation that is refractory to anti-arrhythmic medication. Imaging plays... (Review)
Review
Catheter ablation of arrhythmogenic triggers has been validated for the treatment of atrial fibrillation that is refractory to anti-arrhythmic medication. Imaging plays an important role in guiding the procedure as well as in planning and follow-up. The goal of pre-procedural imaging is to obtain a detailed anatomical description of the pulmonary veins, to eliminate a thrombus of the left atrium and to define the prognostic factors. MDCT angiography effectively and simply meets nearly all of these needs. Thus, a precise description of the left atrium anatomy before the procedure is a key factor to success and left atrium volume is a reliable prognostic factor of recurrence. Radiologists should be aware of early and late complications, sometimes severe such as pulmonary vein stenosis, cardiac tamponade or atrial-esophageal fistula, whose positive diagnosis is based on imaging.
Topics: Angiography; Atrial Fibrillation; Catheter Ablation; Humans; Imaging, Three-Dimensional; Multidetector Computed Tomography; Postoperative Care; Preoperative Care
PubMed: 26025160
DOI: 10.1016/j.diii.2014.12.011 -
JACC. Cardiovascular Imaging Dec 2020Coronary artery disease remains the leading cause of cardiovascular morbidity and mortality. Invasive X-ray angiography and coronary computed tomography angiography are... (Review)
Review
Coronary artery disease remains the leading cause of cardiovascular morbidity and mortality. Invasive X-ray angiography and coronary computed tomography angiography are established gold standards for coronary luminography. However, they expose patients to invasive complications, ionizing radiation, and iodinated contrast agents. Among a number of imaging modalities, coronary cardiovascular magnetic resonance (CMR) angiography may be used in some cases as an alternative for the detection and monitoring of coronary arterial stenosis, with advantages including its versatility, excellent soft tissue characterization, and avoidance of ionizing radiation and iodinated contrast agents. In this review, we explore the recent advances in motion correction, image acceleration, and reconstruction technologies that are bringing coronary CMR angiography closer to widespread clinical implementation.
Topics: Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Coronary Stenosis; Humans; Magnetic Resonance Angiography; Predictive Value of Tests
PubMed: 32199836
DOI: 10.1016/j.jcmg.2020.01.006 -
Diagnostic and Interventional Imaging Dec 2014Patients need to be examined for intracranial aneurysms if they have had a subarachnoid hemorrhage. The preferred technique in this situation is CT angiography.... (Review)
Review
Patients need to be examined for intracranial aneurysms if they have had a subarachnoid hemorrhage. The preferred technique in this situation is CT angiography. Screening can be done for familial forms or for elastic tissue disorders, for which the first line investigation is magnetic resonance angiography. These non-invasive methods have now taken over from conventional angiography that was reserved for the pretreatment phase. A good technical knowledge of these imaging methods, their artifacts and misleading images enables reliable detection of intracranial aneurysms and for an accurate report to be returned to clinicians.
Topics: Cerebral Angiography; Intracranial Aneurysm; Magnetic Resonance Angiography; Mass Screening; Risk Factors; Subarachnoid Hemorrhage; Tomography, X-Ray Computed
PubMed: 25465118
DOI: 10.1016/j.diii.2014.10.005 -
Diagnostic and Interventional Imaging Feb 2016Arterial spin labeling (ASL) perfusion-weighted magnetic resonance imaging is the only approach that enables direct and non-invasive quantitative measurement of cerebral... (Review)
Review
Arterial spin labeling (ASL) perfusion-weighted magnetic resonance imaging is the only approach that enables direct and non-invasive quantitative measurement of cerebral blood flow in the brain regions without administration of contrast material and without radiation. ASL is thus a promising perfusion imaging method for assessing cerebral blood flow in the pediatric population. Concerning newborns, there are current limitations because of their smaller brain size and lower brain perfusion. This article reviews and illustrates the use of ASL in pediatric clinical practice and discusses emerging cerebral perfusion imaging applications for children due to the highly convenient implementation of the ASL sequence.
Topics: Cerebral Angiography; Cerebrovascular Circulation; Child; Functional Neuroimaging; Humans; Magnetic Resonance Angiography; Spin Labels
PubMed: 26456912
DOI: 10.1016/j.diii.2015.09.001