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Methodist DeBakey Cardiovascular Journal 2023The past decade has seen significant advances in dynamic imaging of the aorta. Today's vascular surgeons have the opportunity to choose from a wide array of imaging... (Review)
Review
The past decade has seen significant advances in dynamic imaging of the aorta. Today's vascular surgeons have the opportunity to choose from a wide array of imaging modalities to evaluate different aortic pathologies. While vascular ultrasound and aortography are considered to be the bread and butter imaging modalities, newer dynamic imaging techniques provide time-resolved information in various aortic pathologies. However, despite growing evidence of their advantages in the literature, they have not been routinely adopted. In order to understand the role of these emerging modalities, one must understand their principles, advantages, and limitations in the context of various clinical scenarios. In this review, we provide an overview of dynamic imaging techniques for aortic pathologies and describe various dynamic computed tomography and magnetic resonance imaging protocols, clinical applications, and potential future directions.
Topics: Humans; Magnetic Resonance Angiography; Aorta; Tomography, X-Ray Computed; Aortography; Magnetic Resonance Imaging
PubMed: 36910554
DOI: 10.14797/mdcvj.1172 -
Imaging the Choroid: From Indocyanine Green Angiography to Optical Coherence Tomography Angiography.Asia-Pacific Journal of Ophthalmology... 2020The choroid is the vascular structure nourishing the retinal pigment epithelium and the outer retina and it plays a key role in the homeostasis of the eye both under... (Review)
Review
The choroid is the vascular structure nourishing the retinal pigment epithelium and the outer retina and it plays a key role in the homeostasis of the eye both under physiological and pathological conditions. In the last 20 years we have moved from "guessing" what was happening beyond the retinal pigment epithelium to actually visualize structural and functional changes of the choroid in vivo noninvasively. In this review we describe the state of the art of choroidal imaging, focusing on the multiple techniques available in the clinical and research setting including indocyanine green angiography, labeled-cells angiographies, optical coherence tomography (OCT), enhanced depth imaging, swept source OCT, and OCT angiography. In the first section of the article, we describe their main applications and the basic principles to interpret the imaging results. Increasing evidence suggests that the choroid is much more involved than we used to think in many pathological conditions from uveitis to intraocular tumors, from vascular diseases to age-related macular degeneration. All clinicians should hence know which is the most appropriate imaging investigation to explore the choroid in the disease they are dealing with and how to interpret the results. For this reason the second section of this review summarizes the best imaging approach and the most common findings visible on choroidal imaging in different diseases of the eye.
Topics: Choroid; Coloring Agents; Fluorescein Angiography; Humans; Indocyanine Green; Tomography, Optical Coherence
PubMed: 32739938
DOI: 10.1097/APO.0000000000000307 -
Magma (New York, N.Y.) Apr 2023
Topics: Magnetic Resonance Imaging; Magnetic Resonance Angiography; Magnetic Resonance Spectroscopy
PubMed: 37072540
DOI: 10.1007/s10334-023-01087-x -
Cleveland Clinic Journal of Medicine Nov 2020Aneurysms of the renal artery and splenic artery are uncommon but clinically important, as they pose a risk of rupture with a high fatality rate. Indications for... (Review)
Review
Aneurysms of the renal artery and splenic artery are uncommon but clinically important, as they pose a risk of rupture with a high fatality rate. Indications for surgical or endovascular repair are based on aneurysm location and risk factors for rupture, such as aneurysm size, growth, and associated conditions, while medical management is also important. Regular surveillance with imaging is critical before and after intervention to guide treatment.
Topics: Aneurysm; Angiography; Humans; Renal Artery; Risk Assessment; Splenic Artery; Vascular Surgical Procedures; Watchful Waiting
PubMed: 33229392
DOI: 10.3949/ccjm.87a.19140-2 -
Journal of Interventional Cardiology 2020Percutaneous coronary intervention exposes patient and staff to ionizing radiation. Although staff only receive a small fraction of patient dose through scatter... (Review)
Review
BACKGROUND
Percutaneous coronary intervention exposes patient and staff to ionizing radiation. Although staff only receive a small fraction of patient dose through scatter radiation, there are concerns about the potential health effects of repeated exposure. Minimizing both patient and occupational exposure is needed.
OBJECTIVE
This article investigates patient and operator X-ray exposure over time in coronary intervention in relation to upgraded X-ray equipment, improved shielding, and enhanced operator awareness.
MATERIALS AND METHODS
Data regarding irradiation time, patient dose, and patient characteristics were extracted from the Norwegian Registry for Invasive Cardiology (NORIC) for procedures performed from 2013 to mid-2019. Personal operator dosimetry records were provided by the Norwegian Radiation and Nuclear Safety Authority. Improved operator shielding and awareness measures were introduced in 2018.
RESULTS
In the period 2013 through June 2019, 21499 procedures were recorded in our institution. Mean dose area product (DAP) for coronary angiography decreased 37% from 2981 Gy·m in 2013 to 1891 Gy·m in 2019 ( < 0.001). For coronary intervention, DAP decreased 39% from 8358 Gy·m to 5055 Gy·m. Personal dosimetry data indicate a 70% reduction in operator dose per procedure in 2019 compared to 2013. The most pronounced reduction occurred after improved radiation protection measures were implemented in 2018 (-48%).
CONCLUSIONS
This study shows a temporal trend towards considerable reduction in X-ray doses received by the patient and operator during cardiac catheterization. Upgraded X-ray equipment, improved shielding, and enhanced operator awareness are likely contributors to this development.
Topics: Coronary Angiography; Humans; Occupational Exposure; Percutaneous Coronary Intervention; Radiation Exposure; Radiologic Health
PubMed: 32934609
DOI: 10.1155/2020/9602942 -
RoFo : Fortschritte Auf Dem Gebiete Der... Feb 2020Peripheral vascular anomalies represent a rare disease with an underlying congenital mesenchymal and angiogenetic disorder. Vascular anomalies are subdivided into...
BACKGROUND
Peripheral vascular anomalies represent a rare disease with an underlying congenital mesenchymal and angiogenetic disorder. Vascular anomalies are subdivided into vascular tumors and vascular malformations. Both entities include characteristic features and flow dynamics. Symptoms can occur in infancy and adulthood. Vascular anomalies may be accompanied by characteristic clinical findings which facilitate disease classification. The role of periinterventional imaging is to confirm the clinically suspected diagnosis, taking into account the extent and location of the vascular anomaly for the purpose of treatment planning.
METHOD
In accordance with the International Society for the Study of Vascular Anomalies (ISSVA), vascular anomalies are mainly categorized as slow-flow and fast-flow lesions. Based on the diagnosis and flow dynamics of the vascular anomaly, the recommended periinterventional imaging is described, ranging from ultrasonography and plain radiography to dedicated ultrafast CT and MRI protocols, percutaneous phlebography and transcatheter angiography. Each vascular anomaly requires dedicated imaging. Differentiation between slow-flow and fast-flow vascular anomalies facilitates selection of the appropriate imaging modality or a combination of diagnostic tools.
RESULTS
Slow-flow congenital vascular anomalies mainly include venous and lymphatic or combined malformations. Ultrasound and MRI and especially MR-venography are essential for periinterventional imaging. Arteriovenous malformations are fast-flow vascular anomalies. They should be imaged with dedicated MR protocols, especially when extensive. CT with 4D perfusion imaging as well as time-resolved 3D MR-A allow multiplanar perfusion-based assessment of the multiple arterial inflow and venous drainage vessels of arterio-venous malformations. These imaging tools should be subject to intervention planning, as they can reduce procedure time significantly. Fast-flow vascular tumors like hemangiomas should be worked up with ultrasound, including color-coded duplex sonography, MRI and transcatheter angiography in case of a therapeutic approach. In combined malformation syndromes, radiological imaging has to be adapted according to the dominant underlying vessels and their flow dynamics.
CONCLUSION
Guide to evaluation of flow dynamics in peripheral vascular anomalies, involving vascular malformations and vascular tumors with the intention to facilitate selection of periinterventional imaging modalities and diagnostic and therapeutic approach to vascular anomalies.
KEY POINTS
· Peripheral vascular anomalies include vascular malformations and vascular tumors. Both entities represent a rare disease with an underlying congenital mesenchymal or angiogenetic disorder. · The role of periinterventional imaging is confirmation of the diagnosis by assessing the flow dynamics of the vascular anomaly. · Slow-flow congenital vascular anomalies include venous, lymphatic and venolymphatic malformations. Arteriovenous malformations are fast-flow vascular anomalies, whereas hemangiomas are fast-flow vascular tumors that are frequently associated with fast-flow arteriovenous shunts. The periinterventional imaging modalities of choice include dedicated MR protocols and CT with 4D perfusion imaging as well as invasive transcatheter angiography..
CITATION FORMAT
· Sadick M, Overhoff D, Baessler B et al. Peripheral Vascular Anomalies - Essentials in Periinterventional Imaging. Fortschr Röntgenstr 2020; 192: 150 - 162.
Topics: Angiography; Computed Tomography Angiography; Four-Dimensional Computed Tomography; Hemodynamics; Humans; Magnetic Resonance Angiography; Perfusion Imaging; Phlebography; Tomography, X-Ray Computed; Ultrasonography; Vascular Malformations
PubMed: 31622988
DOI: 10.1055/a-0998-4300 -
Medical Archives (Sarajevo, Bosnia and... Apr 2023The transfemoral (TF) arterial approach is still the most commonly used approach for performing diagnostic coronary angiography in most centers in the world as well as...
BACKGROUND
The transfemoral (TF) arterial approach is still the most commonly used approach for performing diagnostic coronary angiography in most centers in the world as well as in Bosnia and Herzegovina. Recently, the transradial (TR) arterial approach has gained more and more supporters among interventional cardiologists.
OBJECTIVE
The aim of the study was to compare the duration of the procedure, the amount of delivered ionizing radiation, the amount of applied contrast agent, the frequency of procedural complications and patient comfort during coronary angiography performed via TR and TF arterial approach.
METHODS
The total sample of 240 respondents was divided into two groups in such a way that the first group consisted of 121 respondents who underwent coronary angiography using TR arterial approach, and the second group consisted of 119 respondents who underwent coronary angiography using TF arterial approach. The Mann-Whitney U test was used to verify the research objective.
RESULTS
The obtained research results showed that the duration of coronary angiography and the amount of radiation was greater when using TR arterial approach compared to TF approach. There is no statistically significant difference in relation to the amount of applied contrast medium and the frequency of complications between the two approaches. Periprocedural and postprocedural comfort was better in patents who underwent TR approach.
CONCLUSION
The findings of this study show that diagnostic coronary angiography performed via the TR arterial approach is as safe for the patient as diagnostic coronary angiography performed via the TF arterial approach. With both approaches, there is no significant difference in the amount of contrast agent used nor in the frequency of complications. Procedure duration and radiation exposure are shorter when TF arterial approach i used, while patient comfort is better when the TR arterial approach is used.
Topics: Humans; Coronary Angiography; Contrast Media; Femoral Artery; Radial Artery; Treatment Outcome
PubMed: 37260800
DOI: 10.5455/medarh.2023.77.112-117 -
The Neuroradiology Journal Feb 2022After stent-assisted treatment for intracranial diseases, three-dimensional time-of-flight magnetic resonance angiography is a noninvasive follow-up method, but...
PURPOSE
After stent-assisted treatment for intracranial diseases, three-dimensional time-of-flight magnetic resonance angiography is a noninvasive follow-up method, but susceptibility artifacts prevent accurate evaluations of stented arteries. Sampling perfection with application-optimized contrast using different flip angle evolution (SPACE) sequence often used for vessel wall imaging is less susceptible to susceptibility artifacts, since it is a spin-echo sequence. Hence, we evaluated the feasibility of black-blood magnetic resonance angiography generated from vessel wall imaging data obtained using the SPACE sequence in the depiction of stented arteries by comparing with three-dimensional time-of-flight magnetic resonance angiography and digital subtraction angiography.
METHODS
Our study group comprised 11 consecutive patients. For both three-dimensional time-of-flight magnetic resonance angiography and black-blood magnetic resonance angiography, the contrast ratio obtained from the stented artery and the normal artery proximal to the stent were calculated. And the depiction of stented arteries was visually evaluated. Additionally, the relative diameter index obtained from the stented artery and the normal artery proximal to the stent were calculated for three-dimensional time-of-flight magnetic resonance angiography, black-blood magnetic resonance angiography and digital subtraction angiography.
RESULTS
The contrast ratio of the stented artery was significantly lower than that of the normal artery on three-dimensional time-of-flight magnetic resonance angiography, but no significant difference was seen using black-blood magnetic resonance angiography. Regarding both the diameter index and the visual assessment score, black-blood magnetic resonance angiography was significantly better than three-dimensional time-of-flight magnetic resonance angiography. On black-blood magnetic resonance angiography, the diameter index was equal to that of digital subtraction angiography, and the flow signal was homogeneous and continuous in most the cases.
Topics: Angiography, Digital Subtraction; Humans; Imaging, Three-Dimensional; Intracranial Aneurysm; Intracranial Arterial Diseases; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Stents
PubMed: 34096395
DOI: 10.1177/19714009211021775 -
Zeitschrift Fur Medizinische Physik May 2022
Topics: Angiography; Thorium Dioxide
PubMed: 35248451
DOI: 10.1016/j.zemedi.2022.01.004 -
Neuroradiology Jun 2021Time-of-flight (TOF)-MR angiography (MRA) is an important imaging sequence for the surveillance and analysis of cerebral arteriovenous shunt (AVS), including...
Evaluation of cerebral arteriovenous shunts: a comparison of parallel imaging time-of-flight magnetic resonance angiography (TOF-MRA) and compressed sensing TOF-MRA to digital subtraction angiography.
PURPOSE
Time-of-flight (TOF)-MR angiography (MRA) is an important imaging sequence for the surveillance and analysis of cerebral arteriovenous shunt (AVS), including arteriovenous malformation (AVM) and arteriovenous fistula (AVF). However, this technique has the disadvantage of a relatively long scan time. The aim of this study was to compare diagnostic accuracy between compressed sensing (CS)-TOF and conventional parallel imaging (PI)-TOF-MRA for detecting and characterizing AVS.
METHODS
This study was approved by the institutional review board for human studies. Participants comprised 56 patients who underwent both CS-TOF-MRA and PI-TOF-MRA on a 3-T MR unit with or without cerebral AVS between June 2016 and September 2018. Imaging parameters for both sequences were almost identical, except the acceleration factor of 3× for PI-TOF-MRA and 6.5× for CS-TOF-MRA, and the scan time of 5 min 19 s for PI-TOF-MRA and 2 min 26 s for CS-TOF-MRA. Two neuroradiologists assessed the accuracy of AVS detection on each sequence and analyzed AVS angioarchitecture. Concordance between CS-TOF, PI-TOF, and digital subtraction angiography was calculated using unweighted and weighted kappa statistics.
RESULTS
Both CS-TOF-MRA and PI-TOF-MRA yielded excellent sensitivity and specificity for detecting intracranial AVS (reviewer 1, 97.3%, 94.7%; reviewer 2, 100%, 100%, respectively). Interrater agreement on the angioarchitectural features of intracranial AVS on CS-MRA and PI-MRA was moderate to good.
CONCLUSION
The diagnostic performance of CS-TOF-MRA is comparable to that of PI-TOF-MRA in detecting and classifying AVS with a reduced scan time under 2.5 min.
Topics: Angiography, Digital Subtraction; Arteriovenous Fistula; Humans; Magnetic Resonance Angiography; Prostheses and Implants; Sensitivity and Specificity
PubMed: 33063222
DOI: 10.1007/s00234-020-02581-y