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Surgical and Radiologic Anatomy : SRA Jun 2024The present case report aims to describe the rare coexistence of three variants of the cerebral arterial system diagnosed by computed tomography angiography (CTA).
PURPOSE
The present case report aims to describe the rare coexistence of three variants of the cerebral arterial system diagnosed by computed tomography angiography (CTA).
METHODS
A retrospective study on head and neck CTAs was performed on a Greek adult population from the Department of Radiology, University Hospital of Larissa. An interesting case of an 80-year-old male was further investigated.
RESULTS
The cerebral arterial circle presented with a combination of three variations. The left anterior cerebral artery (ACA) was fenestrated 1.4 mm proximally to the anterior communicating artery formation. The left posterior cerebral artery (PCA) was also fenestrated, 5.5 mm distally to its origin from the basilar artery. Lastly, the right PCA originated from the ICA supraclinoid segment.
CONCLUSIONS
This case report highlights an unusual coexistence of A1 and P1 segments fenestration with a fetal PCA, resulting in a unique cerebral circle. A1 segment fenestration has been previously reported as rare, while the PCA fenestration as extremely rare variant. Awareness of these rare variations could aid interventionists in their preoperative assessments.
PubMed: 38942933
DOI: 10.1007/s00276-024-03428-4 -
Injury Jun 2024Nonoperative management (NOM) of blunt splenic injury (BSI) is well accepted in appropriate patients. Splenic artery embolization (SAE) in higher-grade injuries likely...
OBJECTIVES
Nonoperative management (NOM) of blunt splenic injury (BSI) is well accepted in appropriate patients. Splenic artery embolization (SAE) in higher-grade injuries likely plays an important role in increasing the success of NOM. We previously implemented a protocol requiring referral of all BSI grades III-V undergoing NOM for SAE. It is unknown the risk of complications as well as longitudinal outcomes. We aimed to examine the splenic salvage rate and safety profile of the protocol. We hypothesized the splenic salvage rate would be high and complications would be low.
METHODS
A retrospective study was performed at our Level 1 trauma center over a 9-year period. Injury characteristics and outcomes in patients sustaining BSI grades III-V were collected. Outcomes were compared for NOM on protocol (SAE) and off protocol (no angiography or angiography but no embolization). Complications for angiographies were examined.
RESULTS
Between January 2010 and February 2019, 570 patients had grade III-V BSI. NOM was attempted in 359 (63 %) with overall salvage rate of 91 % (328). Of these, 305 were on protocol while 54 were off protocol (41 no angiography and 13 angiography but no SAE). During the study period, for every grade of injury a pattern was seen of a higher salvage rate in the on-protocol group when compared to the off-protocol group (Grade III, 97 %(181/187) vs. 89 %(32/36), Grade IV, 91 %(98/108) vs. 69 %(9/13) and Grade V, 80 %(8/10 vs. 0 %(0/5). The overall salvage rate was 94 %(287) on protocol vs. 76 %(41) off protocol (p < 0.001, Cochran-Mantel-Haenszel test). Complications occurred in only 8 of the 318 who underwent angiography (2 %). These included 5 access complications and 3 abscesses.
CONCLUSION
The use of a protocol requiring routine splenic artery embolization for all high-grade spleen injuries slated for non-operative management is safe with a very low complication rate. NOM with splenic angioembolization failure rate is improved as compared to non-SAE patients' at all higher grades of injury. Thus, SAE for all hemodynamically stable patients of all high-grade types should be considered as a primary form of therapy for such injuries.
PubMed: 38942724
DOI: 10.1016/j.injury.2024.111707 -
Annals of Vascular Surgery Jun 2024Endovascular aortic repair requires extensive preoperative, intraoperative, and postoperative imaging for planning, surveillance, and detection of endo-leaks. There have... (Review)
Review
OBJECTIVES
Endovascular aortic repair requires extensive preoperative, intraoperative, and postoperative imaging for planning, surveillance, and detection of endo-leaks. There have been many advancements in imaging modalities to achieve this purpose. This review discussed different imaging modalities used at different stages of treatment of complex endovascular aortic repair.
METHODS
We conducted a literature review of all the imaging modalities utilized in endovascular aortic repair by searching various databases.
RESULTS
Pre-operative techniques include analysis of images obtained via modified central line using analysis software and intravascular ultrasound. Fusion imaging, CO2 angiography, intravascular ultrasound, and Fiber Optic RealShape technology have been crucial in obtaining real-time imaging for the detection of endo-leaks during operative procedures. Conventional imaging modalities like CT Angiography and MR Angiography are still employed for post-operative surveillance along with computational fluid dynamics and contrast-enhanced ultrasound. The advancements in artificial intelligence have been the breakthrough in developing robust imaging applications.
CONCLUSIONS
This review explains the advantages, disadvantages, and side-effect profile of the abovementioned imaging modalities.
PubMed: 38942370
DOI: 10.1016/j.avsg.2024.06.003 -
Survey of Ophthalmology Jun 2024Diabetic macular edema (DME), defined as retinal thickening near, or involving the fovea caused by fluid accumulation in the retina, can lead to vision impairment and... (Review)
Review
Diabetic macular edema (DME), defined as retinal thickening near, or involving the fovea caused by fluid accumulation in the retina, can lead to vision impairment and blindness in patients with diabetes. Current knowledge of retina anatomy and function and DME pathophysiology has taken great advantage of the availability of several techniques for visualizing the retina. Combining these techniques in a multimodal imaging approach to DME is recommended to improve diagnosis and to guide treatment decisions. We review the recent literature about the following retinal imaging technologies: optical coherence tomography (OCT), OCT angiography (OCTA), wide-field and ultrawide-field techniques applied to fundus photography, fluorescein angiography, and OCTA. The emphasis will be on characteristic DME features identified by these imaging technologies and their potential or established role as diagnostic, prognostic, or predictive biomarkers. The role of artificial intelligence in the assessment and interpretation of retina images is also discussed.
PubMed: 38942124
DOI: 10.1016/j.survophthal.2024.06.006 -
Journal of Lipid Research Jun 2024The roles of lipoprotein(a) [Lp(a)] and related oxidized phospholipids (OxPL) in the development and progression of coronary disease is known, but their influence on...
The roles of lipoprotein(a) [Lp(a)] and related oxidized phospholipids (OxPL) in the development and progression of coronary disease is known, but their influence on extra-coronary vascular disease is not well-established. We sought to evaluate associations between Lp(a), OxPL apolipoprotein B (OxPL-apoB), and apolipoprotein(a) (OxPL-apo(a)) with angiographic extra-coronary vascular disease and incident major adverse limb events (MALE). 446 participants who underwent coronary and/or peripheral angiography were followed up for a median of 3.7 years. Lp(a) and OxPLs were measured before angiography. Elevated Lp(a) was defined as ≥150 nmol/L. Elevated OxPL-apoB and OxPL-apo(a) were defined as greater than or equal to the 75th percentile (OxPL-apoB ≥8.2 nmol/L and OxPL-apo(a) ≥35.8 nmol/L, respectively). Elevated Lp(a) had a stronger association with the presence of extra-coronary vascular disease compared to OxPLs and was minimally improved with the addition of OxPLs in multivariable models. Compared to participants with normal Lp(a) and OxPL concentrations, participants with elevated Lp(a) levels were twice as likely to experience a MALE (OR 2.14 95% CI: 1.03, 4.44) and the strength of the association as well as the C statistic of 0.82 was largely unchanged with the addition of OxPL-apoB and OxPL-apo(a). Elevated Lp(a) and OxPLs are risk factors for progression and complications of extra-coronary vascular disease. However, the addition of OxPLs to Lp(a) does not provide additional information about risk of extra-coronary vascular disease. Therefore, Lp(a) alone captures the risk profile of Lp(a), OxPL-apoB, and OxPL-apo(a) in the development and progression of atherosclerotic plaque in peripheral arteries. These results lay a foundation in support of studying Lp(a) lowering medications and their effect on limb-related complications.
PubMed: 38942114
DOI: 10.1016/j.jlr.2024.100585 -
Physics in Medicine and Biology Jun 2024The use of uniform phantoms to assess the influence of X-ray scatter and antiscatter grids on X-ray angiography and fluoroscopy image quality disregards the influence of...
OBJECTIVE
The use of uniform phantoms to assess the influence of X-ray scatter and antiscatter grids on X-ray angiography and fluoroscopy image quality disregards the influence of spatially variable X-ray attenuation of patients. The purpose of this work was to measure scatter to primary ratio (SPR) and antiscatter grid SNR improvement factor (KSNR) using experimental conditions which better mimic patient imaging conditions.
APPROACH
Three adult-sized anthropomorphic phantoms were used. AP and lateral projection images of the thorax and abdomen were acquired with and without an antiscatter grid. Grids with ratio 15:1 and 29:1 (r15, r29) and X-ray fields of view 20, 25 (thorax) and 32, 42 cm (abdomen) were tested. Combined with a-priori measurements of grid scatter and primary transmission fractions, these images were used to calculate 2D SPR and KSNR maps.
MAIN RESULTS
Results demonstrated that measurements by uniform phantom do not describe the complex 2D SPR and KSNR distributions associated with anthropomorphic phantoms. The regions of the images with the lowest primary X-ray intensity (greatest attenuation) had the highest SPR and the highest KSNR attributable to the grids. Considering all conditions, the 95th percentile of the SPR maps was in the range 42-185% greater than the median values and that of the KSNR maps was 4-20% higher than the median values. The combined influences of SID 120 vs. 107 cm and r29 vs. r15 grid resulted in KSNR in the range 1.05-1.49.
SIGNIFICANCE
Performance of anti-scatter grids using anatomically complex phantoms highlights the substantial variation of SPR and KSNR within 2D images. Also, this work demonstrates the benefit of the prototype r29 grid for thoracic and abdominal angiography imaging conditions is substantial, especially for large patients and radiodense image regions.
PubMed: 38942002
DOI: 10.1088/1361-6560/ad5d4d -
British Journal of Hospital Medicine... Jun 2024Coronary heart disease is a common disease in the elderly and has a complex pathogenesis, which complicates the clinical diagnostic process. Thus, enhancing the...
Coronary heart disease is a common disease in the elderly and has a complex pathogenesis, which complicates the clinical diagnostic process. Thus, enhancing the diagnostic efficiency for coronary heart disease is imperative to improve the life expectancy of the elderly. This study aimed to explore the diagnostic value of multimodal cardiovascular imaging technology coupled with biomarker detection in elderly patients with coronary heart disease. The medical records of 421 patients with suspected coronary heart disease obtained from the geriatric department of the First Affiliated Hospital of Hebei North University from February 2020 to February 2023 were retrospectively analysed. After excluding 10 patients who did not meet the inclusion criteria, the remaining 411 patients were included in this study. The included subjects had undergone coronary computed tomography angiography and were divided into coronary heart disease group (n=208) and non-coronary heart disease group (n=203) according to the diagnostic results. Multimodal cardiovascular imaging (coronary computed tomography angiography and echocardiography) and detection of serum biomarkers such as small dense low-density lipoprotein, lipoprotein a, and gamma-glutamyl transferase were performed in both groups. The clinical indicators of the two groups were compared, and the combined diagnostic efficacy of multimodal cardiovascular imaging and biomarker detection was evaluated. Compared to the non-coronary heart disease group, the coronary heart disease group had significantly higher levels of maximum area stenosis, total plaque volume, total plaque burden and fibrotic plaque volume ( < ..001), and lower left ventricular ejection fraction level ( < ..001). Additionally, the coronary heart disease group exhibited higher levels of left ventricular end-diastolic volume, left ventricular end-systolic volume and stroke volume than the non-coronary heart disease group ( < ..001), and had higher levels of small dense low-density lipoprotein, lipoprotein a and gamma-glutamyl transferase ( < ..001). Our results demonstrated that combined diagnosis had better diagnostic efficacy than individual approaches, marked by higher area under the curve and sensitivity of the former ( < ..001). Multimodal cardiovascular imaging technology combined with biomarker detection can distinctly improve the accuracy of coronary heart disease diagnosis in elderly patients.
Topics: Humans; Male; Aged; Female; Biomarkers; Retrospective Studies; Multimodal Imaging; Computed Tomography Angiography; Echocardiography; Coronary Disease; Coronary Angiography; Aged, 80 and over; gamma-Glutamyltransferase
PubMed: 38941970
DOI: 10.12968/hmed.2024.0123 -
Medical Image Analysis Jun 2024The automated segmentation of Intracranial Arteries (IA) in Digital Subtraction Angiography (DSA) plays a crucial role in the quantification of vascular morphology,...
The automated segmentation of Intracranial Arteries (IA) in Digital Subtraction Angiography (DSA) plays a crucial role in the quantification of vascular morphology, significantly contributing to computer-assisted stroke research and clinical practice. Current research primarily focuses on the segmentation of single-frame DSA using proprietary datasets. However, these methods face challenges due to the inherent limitation of single-frame DSA, which only partially displays vascular contrast, thereby hindering accurate vascular structure representation. In this work, we introduce DIAS, a dataset specifically developed for IA segmentation in DSA sequences. We establish a comprehensive benchmark for evaluating DIAS, covering full, weak, and semi-supervised segmentation methods. Specifically, we propose the vessel sequence segmentation network, in which the sequence feature extraction module effectively captures spatiotemporal representations of intravascular contrast, achieving intracranial artery segmentation in 2D+Time DSA sequences. For weakly-supervised IA segmentation, we propose a novel scribble learning-based image segmentation framework, which, under the guidance of scribble labels, employs cross pseudo-supervision and consistency regularization to improve the performance of the segmentation network. Furthermore, we introduce the random patch-based self-training framework, aimed at alleviating the performance constraints encountered in IA segmentation due to the limited availability of annotated DSA data. Our extensive experiments on the DIAS dataset demonstrate the effectiveness of these methods as potential baselines for future research and clinical applications. The dataset and code are publicly available at https://doi.org/10.5281/zenodo.11401368 and https://github.com/lseventeen/DIAS.
PubMed: 38941857
DOI: 10.1016/j.media.2024.103247 -
European Journal of Radiology Jun 2024To propose a convolutional neural network (EmbNet) for automatic pulmonary embolism detection on computed tomography pulmonary angiogram (CTPA) scans and to assess its...
OBJECTIVE
To propose a convolutional neural network (EmbNet) for automatic pulmonary embolism detection on computed tomography pulmonary angiogram (CTPA) scans and to assess its diagnostic performance.
METHODS
305 consecutive CTPA scans between January 2019 and December 2021 were enrolled in this study (142 for training, 163 for internal validation), and 250 CTPA scans from a public dataset were used for external validation. The framework comprised a preprocessing step to segment the pulmonary vessels and the EmbNet to detect emboli. Emboli were divided into three location-based subgroups for detailed evaluation: central arteries, lobar branches, and peripheral regions. Ground truth was established by three radiologists.
RESULTS
The EmbNet's per-scan level sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 90.9%, 75.4%, 48.4%, and 97.0% (internal validation) and 88.0%, 70.5%, 42.7%, and 95.9% (external validation). At the per-embolus level, the overall sensitivity and PPV of the EmbNet were 86.0% and 61.3% (internal validation), and 83.5% and 57.5% (external validation). The sensitivity and PPV of central emboli were 89.7% and 52.0% (internal validation), and 94.4% and 43.0% (external validation); of lobar emboli were 95.2% and 76.9% (internal validation), and 93.5% and 72.5% (external validation); and of peripheral emboli were 82.6% and 61.7% (internal validation), and 80.2% and 59.4% (external validation). The average false positive rate was 0.45 false emboli per scan (internal validation) and 0.69 false emboli per scan (external validation).
CONCLUSION
The EmbNet provides high sensitivity across embolus locations, suggesting its potential utility for initial screening in clinical practice.
PubMed: 38941822
DOI: 10.1016/j.ejrad.2024.111586 -
Heart, Lung & Circulation Jun 2024While there has been an increase in the use of the transradial approach when performing percutaneous coronary angiography and intervention, there is evidence of...
BACKGROUND
While there has been an increase in the use of the transradial approach when performing percutaneous coronary angiography and intervention, there is evidence of variations in international practice. Ensuring that operators' practices are supported by evidence is important to ensure optimal outcomes.
METHOD
Interventional cardiologists and advanced trainees completed a cross-sectional survey followed by semi-structured interviews to map current practices for transradial coronary artery procedures in Australia and New Zealand and explore factors that influence clinical decision-making around procedural practice.
RESULTS
The right radial artery was the preferred access site (88%). Over a third (37%) of the participants indicated that they tested the hand circulation pre-procedure. Over a quarter of respondents (28.6%) reported that they would carry out transradial procedures regardless of the patient's coagulation status. Most participants (77.8%) described radial artery spasm in around 10% of transradial procedures performed. Only 62% of participants assessed for radial artery occlusion post-catheterisation. Interview data revealed four themes that guided clinical decision-making, namely (1) Decision-making based on research, (2) Using clinical experience, (3) Being led by their training, and (4) Individual patient factors.
CONCLUSIONS
This study has demonstrated that despite clinical guidelines, substantial practice variation exists in transradial coronary artery catheterisation across Australia and New Zealand. The variation in practice and factors impacting clinical decision-making highlight a need for future strategies to optimise evidence translation and implementation across clinical settings.
PubMed: 38942624
DOI: 10.1016/j.hlc.2024.03.009