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Diagnostic and Interventional Imaging Nov 2014Thanks to a simultaneous acquisition at high and low kilovoltage, dual energy computed tomography (DECT) can achieve material-based decomposition (iodine, water,... (Review)
Review
Thanks to a simultaneous acquisition at high and low kilovoltage, dual energy computed tomography (DECT) can achieve material-based decomposition (iodine, water, calcium, etc.) and reconstruct images at different energy levels (40 to 140keV). Post-processing uses this potential to maximise iodine detection, which elicits demonstrated added value for chest imaging in acute and chronic embolic diseases (increases the quality of the examination and identifies perfusion defects), follow-up of aortic endografts and detection of contrast uptake in oncology. In CT angiography, these unique features are taken advantage of to reduce the iodine load by more than half. This review article aims to set out the physical basis for the technology, the acquisition and post-processing protocols used, its proven advantages in chest pathologies, and to present future developments.
Topics: Angiography; Forecasting; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Radiography, Dual-Energy Scanned Projection; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 24780370
DOI: 10.1016/j.diii.2014.01.001 -
Acta Neurologica Taiwanica Jun 2019ation. No significant past medical history except for pharmacologically controlled mild hypertension. During the neurological examination the patient appeared alert,...
ation. No significant past medical history except for pharmacologically controlled mild hypertension. During the neurological examination the patient appeared alert, oriented and showed no deficit of strength, sensitivity and coordination. An expressive temporary aphasia was confirmed and Transient Ischemic Attacks (TIA) was suspected. Cranial Computed Tomography Angiography (CTA) showed hypoplasia of left Internal Carotid Artery (ICA) with a focal duplication in the intracavernous segment (Figure 1, arrowhead). Circle of Willis appears to be regular, with the left middle cerebral artery supported by the vertebrobasilar system through the left posterior communicating artery of increased caliber, and by the contralateral ICA via anterior communicating artery. Consequently, patient underwent Digital Subtraction Angiography (DSA) lateral view that confirmed the segmental duplication of the left intracavernous ICA (Figure 2, arrowhead). Vessels had a lightly winding course within the cavernous sinus and the intracranial branches downstream of their confluence presented a slight delay in visualization. After few hours her symptoms completely regressed and, in agreement with clinical and imaging data, diagnosis of TIA was made. The transient ischemic event was, in fact, most likely caused by low flow to the left cerebral hemisphere due to hypoplasia of the ICA and aforementioned abnormalities of its intracavernous tract that caused alteration and reduction of intracranial flow distribution. Medical treatment with anti-platelet drugs was started and patient was discharged with a clinical, laboratory and imaging follow-up program. Duplications of ICA in the intracranial tract are very rare(1,2). Most of the cases are localized in the supraclinoid segment. To our knowledge this is the first case described in literature of true duplication of ICA in the intracavernous tract. Patients with congenital variants or acquired pathology of ICA are mostly asymptomatic, but when symptoms appear, patients must be investigated(1-3). CTA is considered the first line non-invasive diagnostic method for intracranial vascular anatomy. At present, medical treatment remains the choice in patients with no-complicated duplications of ICA in the intracranial tract.
Topics: Angiography, Digital Subtraction; Carotid Artery, Internal; Cerebral Angiography; Computed Tomography Angiography; Female; Humans
PubMed: 31867708
DOI: No ID Found -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... May 2022To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) in the treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB),...
OBJECTIVE
To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) in the treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB), and to guide clinical practice and continue to optimize diagnosis and treatment strategies.
METHODS
This retrospective study included 266 patients who underwent angiography due to ANVUGIB between March 2016 and March 2021. Data on the positive rate of angiography, the technical success rate and clinical success rate of TAE, and the rebleeding rate and the all-cause mortality within 30 days after TAE treatment were collected, and the influencing factors relevant to the above events were analyzed accordingly.
RESULTS
All 266 patients completed angiography--the positive rate of angiography was 54.1% (144/266), the total technical success rate was 97.3% (217/223), the clinical success rate was 73.1% (155/212), and the rebleeding rate and all-cause mortality within 30 days were 26.9% (57/212) and 16.1% (35/217), respectively. This study found that shock index>1 ( =5.950; 95% : 1.481-23.895; =0.012), computed tomography angiography (CTA) positive result ( =6.813; 95% : 1.643-28.252; =0.008) and interval<24 h ( =10.530; 95% : 2.845-38.976; <0.001) were independent predictors of positive angiography. Shock index>1 ( =2.544; 95% : 1.301-4.972; =0.006) and INR>1.5 ( =3.207; 95% : 1.381-7.451; =0.007) were independent risk factors for rebleeding. Patients with postoperative bleeding ( =3.174; 95% : 1.164-8.654; =0.024) and patients with rebleeding after embolization ( =34.665; 95% : 11.471-104.758; <0.001) had a higher risk of death within 30 days.
CONCLUSION
TAE is safe and effective in the treatment of ANVUGIB. Patients with shock index>1 and positive CTA are more likely to be angiographic positive, and should undergo angiography as early as possible after bleeding. In addition, rebleeding after embolization deserves high attention.
Topics: Acute Disease; Angiography; Embolization, Therapeutic; Gastrointestinal Hemorrhage; Humans; Retrospective Studies; Treatment Outcome
PubMed: 35642145
DOI: 10.12182/20220560203 -
Journal of Cardiovascular Magnetic... May 2021Coronary magnetic resonance angiography (CMRA) allows non-ionizing visualization of luminal narrowing in coronary artery disease (CAD). Although a prior study showed the...
BACKGROUND
Coronary magnetic resonance angiography (CMRA) allows non-ionizing visualization of luminal narrowing in coronary artery disease (CAD). Although a prior study showed the usefulness of CMRA for risk stratification in short-term follow-up, the long-term prognostic value of CMRA remains unclear. The purpose of this study was to evaluate the long-term prognostic value of CMRA.
METHODS
A total of 506 patients without history of myocardial infarction or prior coronary artery revascularization underwent free-breathing whole-heart CMRA between 2009 and 2015. Images were acquired using a 1.5 T or 3 T scanner and visually evaluated as the consensus decisions of two observers. Obstructive CAD on CMRA was defined as luminal narrowing of ≥ 50% in at least one coronary artery. Major adverse cardiac events (MACE) comprised cardiac death, nonfatal myocardial infarction, and unstable angina.
RESULTS
Obstructive CAD on CMRA was observed in 214 patients (42%). During follow-up (median, 5.6 years), 31 MACE occurred. Kaplan-Meier curve analysis revealed a significant difference in event-free survival between patients with and without obstructive CAD for MACE (log-rank, p = 0.003) and cardiac death (p = 0.012). Annualized event rates for MACE in patients with no obstructive CAD, 1-vessel disease, 2-vessel disease, and left-main or 3-vessel disease were 0.6%, 1.5%, 2.3%, and 3.6%, respectively (log-rank, p = 0.003). Cox proportional hazard regression analysis showed that, among obstructive CAD on CMRA and clinical risk factors (age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of CAD), obstructive CAD and diabetes were significant predictors of MACE (hazard ratios, 2.9 [p = 0.005] and 2.2 [p = 0.034], respectively). In multivariate analysis, obstructive CAD remained an independent predictor (adjusted hazard ratio, 2.6 [p = 0.010]) after adjusting for diabetes. Addition of obstructive CAD to clinical risk factors significantly increased the global chi-square result from 8.3 to 13.8 (p = 0.022).
CONCLUSIONS
In long-term follow-up, free breathing whole heart CMRA allows non-invasive risk stratification for MACE and cardiac death and provides incremental prognostic value over conventional risk factors in patients without a history of myocardial infarction or prior coronary artery revascularization. The presence and severity of obstructive CAD detected by CMRA were associated with worse prognosis. Importantly, patients without obstructive CAD on CMRA displayed favorable prognosis.
Topics: Coronary Angiography; Coronary Artery Disease; Humans; Magnetic Resonance Angiography; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors
PubMed: 33993891
DOI: 10.1186/s12968-021-00749-w -
Anatolian Journal of Cardiology 2020
Topics: Coronary Angiography; Coronary Vessels
PubMed: 32120371
DOI: 10.14744/AnatolJCardiol.2020.3 -
Computer Methods and Programs in... Mar 2023Automatic segmentation of the cerebral vasculature and aneurysms facilitates incidental detection of aneurysms. The assessment of aneurysm rupture risk assists with...
BACKGROUND AND OBJECTIVES
Automatic segmentation of the cerebral vasculature and aneurysms facilitates incidental detection of aneurysms. The assessment of aneurysm rupture risk assists with pre-operative treatment planning and enables in-silico investigation of cerebral hemodynamics within and in the vicinity of aneurysms. However, ensuring precise and robust segmentation of cerebral vessels and aneurysms in neuroimaging modalities such as three-dimensional rotational angiography (3DRA) is challenging. The vasculature constitutes a small proportion of the image volume, resulting in a large class imbalance (relative to surrounding brain tissue). Additionally, aneurysms and vessels have similar image/appearance characteristics, making it challenging to distinguish the aneurysm sac from the vessel lumen.
METHODS
We propose a novel multi-class convolutional neural network to tackle these challenges and facilitate the automatic segmentation of cerebral vessels and aneurysms in 3DRA images. The proposed model is trained and evaluated on an internal multi-center dataset and an external publicly available challenge dataset.
RESULTS
On the internal clinical dataset, our method consistently outperformed several state-of-the-art approaches for vessel and aneurysm segmentation, achieving an average Dice score of 0.81 (0.15 higher than nnUNet) and an average surface-to-surface error of 0.20 mm (less than the in-plane resolution (0.35 mm/pixel)) for aneurysm segmentation; and an average Dice score of 0.91 and average surface-to-surface error of 0.25 mm for vessel segmentation. In 223 cases of a clinical dataset, our method accurately segmented 190 aneurysm cases.
CONCLUSIONS
The proposed approach can help address class imbalance problems and inter-class interference problems in multi-class segmentation. Besides, this method performs consistently on clinical datasets from four different sources and the generated results are qualified for hemodynamic simulation. Code available at https://github.com/cistib/vessel-aneurysm-segmentation.
Topics: Humans; Deep Learning; Angiography; Neural Networks, Computer; Aneurysm; Brain; Image Processing, Computer-Assisted
PubMed: 36709557
DOI: 10.1016/j.cmpb.2023.107355 -
Radiology and Oncology Dec 2023Optical coherence tomography angiography (OCTA) is an emerging imaging modality that enables noninvasive visualization and analysis of tumor vasculature. OCTA has been... (Review)
Review
BACKGROUND
Optical coherence tomography angiography (OCTA) is an emerging imaging modality that enables noninvasive visualization and analysis of tumor vasculature. OCTA has been particularly useful in clinical ocular oncology, while in this article, we evaluated OCTA in assessing microvascular changes in clinical nonocular oncology through a systematic review of the literature.
METHOD
The inclusion criterion for the literature search in PubMed, Web of Science and Scopus electronic databases was the use of OCTA in nonocular clinical oncology, meaning that all ocular clinical studies and all ocular and nonocular animal, phantom, ex vivo, experimental, research and development, and purely methodological studies were excluded.
RESULTS
Eleven articles met the inclusion criteria. The anatomic locations of the neoplasms in the selected articles were the gastrointestinal tract (2 articles), head and neck (1 article) and skin (8 articles).
CONCLUSIONS
While OCTA has shown great advancements in ophthalmology, its translation to the nonocular clinical oncology setting presents several limitations, with a lack of standardized protocols and interpretation guidelines posing the most significant challenge.
Topics: Tomography, Optical Coherence; Angiography
PubMed: 38038417
DOI: 10.2478/raon-2023-0057 -
EuroIntervention : Journal of EuroPCR... Aug 2017Evaluation of non-invasive imaging modalities is shifting to an assessment of their effect on clinical outcomes rather than of their diagnostic accuracy. For this... (Review)
Review
Evaluation of non-invasive imaging modalities is shifting to an assessment of their effect on clinical outcomes rather than of their diagnostic accuracy. For this reason, we present the most useful and commonly used non-invasive tests in the clinical scenario of patients with suspected or already known coronary artery disease in terms of their diagnostic accuracy and prognostic stratification. Each of the four sections, dedicated to a single imaging method (echocardiography, coronary computed tomography angiography, nuclear imaging and cardiac magnetic resonance), describes its early clinical applications, the main current indications and the more promising future field of interest.
Topics: Coronary Angiography; Coronary Artery Disease; Echocardiography, Stress; Heart; Humans; Magnetic Resonance Angiography; Myocardial Ischemia
PubMed: 28844028
DOI: 10.4244/EIJ-D-17-00466 -
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