Identify Feeding Arteries Research Articles

High diagnostic performance of time-resolved MR angiography in spinal arteriovenous shunts

Background and purposeIn comparison with the limited efficacy of conventional MR imaging and the invasiveness of catheter-based digital subtraction angiography (DSA), time-resolved MR angiography (TR-MRA) has been proposed as a promising examination for early diagnosis of spinal arteriovenous shunts (SAVSs). This paper aims to investigate the diagnostic performance of TR-MRA with scan parameters optimized for SAVSs evaluation in a large number of patients. MethodsOne hundred patients with suspected SAVSs were enrolled. Each patient underwent preoperative TR-MRA with optimized scan parameters followed by DSA. The presence or absence of SAVS, the types and the angioarchitecture of SAVSs in the TR-MRA images were diagnostically analyzed. ResultsAmong the final 97 patients, 80 cases (82.5 %) were diagnosed and classified by TR-MRA as spinal cord arteriovenous shunts (SCAVSs; n = 22), spinal dural arteriovenous shunts (SDAVSs; n = 48), and spinal extradural arteriovenous shunts (SEDAVSs; n = 10). The agreement for classifying SAVSs between TR-MRA and DSA was excellent (κ = 0.91). The sensitivity, specificity, PPV, NPV, and accuracy of TR-MRA for the diagnosis of SAVSs were 100 % (95 % CI, 94.3–100.0 %), 76.5 % (95 % CI, 49.8–92.2 %), 95.2 % (95 % CI, 87.6–98.5 %), 100 % (95 % CI, 71.7–100.0 %), and 95.9 % (95 % CI, 89.9–98.4 %). The accuracy rates of TR-MRA for the detection of feeding arteries were 75.9 %, 91.7 %, and 80.0 % for SCAVSs, SDAVSs, and SEDAVSs respectively. ConclusionTime-resolved MR angiography showed excellent diagnostic performance for SAVSs screening. Additionally, this method can classify SAVSs and identify feeding arteries in SDAVSs with high diagnostic accuracy.

A novel method for predicting hepatocellular carcinoma response to chemoembolization using an intraprocedural CT hepatic arteriography-based enhancement mapping: a proof-of-concept analysis

BackgroundTo evaluate the feasibility of a novel approach for predicting hepatocellular carcinoma (HCC) response to drug-eluting beads transarterial chemoembolization (DEB-TACE) using computed tomography hepatic arteriography enhancement mapping (CTHA-EM) method.MethodsThis three-institution retrospective study included 29 patients with 46 HCCs treated with DEB-TACE between 2017 and 2020. Pre- and posttreatment CTHA-EM images were generated using a prototype deformable registration and subtraction software. Relative tumor enhancement (TPost/pre-RE) defined as the ratio of tumor enhancement to normal liver tissue was calculated to categorize tumor response as residual (TPost-RE > 1) versus non-residual (TPost-RE ≤ 1) enhancement, which was blinded compared to the response assessment on first follow-up imaging using modified RECIST criteria. Additionally, for tumors with residual enhancement, CTHA-EM was evaluated to identify its potential feeding arteries.ResultsCTHA-EM showed residual enhancement in 18/46 (39.1%) and non-residual enhancement in 28/46 (60.9%) HCCs, with significant differences on TPost-RE (3.05 ± 2.4 versus 0.48 ± 0.23, respectively; p < 0.001). The first follow-up imaging showed non-complete response (partial response or stable disease) in 19/46 (41.3%) and complete response in 27/46 (58.7%) HCCs. CTHA-EM had a response prediction sensitivity of 94.7% (95% CI, 74.0–99.9) and specificity of 100% (95% CI, 87.2–100). Feeding arteries to the residual enhancement areas were demonstrated in all 18 HCCs (20 arteries where DEB-TACE was delivered, 2 newly developed collaterals following DEB-TACE).ConclusionCTHA-EM method was highly accurate in predicting initial HCC response to DEB-TACE and identifying feeding arteries to the areas of residual arterial enhancement.

Changes in vascular supply pattern associated with growth of nonfunctioning pituitary adenomas.

The vascular supply to nonfunctioning pituitary adenomas (NFPAs) differs compared with that of the anterior lobe of the normal pituitary gland. In this study, we aimed to identify feeding arteries and flow dynamics using 3.0 T magnetic resonance imaging (MRI) in NFPAs. We divided 77 cases of NFPA into three groups according to the time-intensity curve (TIC) pattern by dynamic MRI. We also investigated the presence of feeder arteries as a flow void signal on T2-weighted imaging (T2WI). According to the TIC, 39 cases demonstrated an ascending pattern, 10 cases demonstrated a descending pattern, and 28 cases demonstrated a monophasic pattern. Tumor size in the ascending group was larger compared with the descending group (P = 0.0036). Flow void signals were identified in 51 of 77 cases (66.2%) on T2WI. Tumor size was larger in tumors with a flow void signal compared with those without (P < 0.0001). Flow void signals were more frequently observed in the group of ascending pattern compared with the group of monophasic and descending pattern (P = 0.032 and P = 0.003, respectively). Particularly on the caudal side, the difference between the ascending group and the monophasic and descending groups was remarkable (P = 0.0035 and P < 0.0001, respectively). We successfully evaluated the blood supply pattern by the TIC analysis and identified flow voids using 3.0 T MRI. Blood supply pattern was significantly associated with NFPA size. These results suggested that NFPA hemodynamics changes during tumor growth.

Presurgical Planning with Open-Source Horos Software for Superficial Brain Arteriovenous Malformations

Surgical planning for treating brain arteriovenous malformations (bAVMs) is challenging because it entails visualizing 3-dimensional (3D) relationships between the nidus, its feeding and en passage arteries, and draining veins. Surgical experience in developing the capacity to mentally visualize pathological bAVM angioarchitecture could be complemented by this software, and thus potentially lower the steep learning curve for understanding complex bAVM angioarchitecture. We evaluated the clinical application of freely available online 3D reconstruction software in facilitating visualization of AVM angioarchitecture for presurgical planning. Preoperative Digital Imaging and Communications in Medicine magnetic resonance imaging/magnetic resonance angiography images of 56 superficial bAVMs from 2013 to 2018 were processed using open-source software Horos. 3D rendered images were compared with the surgical view to evaluate software accuracy and determine its value as a preoperative tool. 3D reconstructed images were compared with intraoperative recordings. A useful image identifying both the main feeding artery and draining vein was achieved in 35 of 56 cases (62.5%). Reconstructions of small AVMs (nidus ≤2 cm) and those located within the temporal or cerebellar cortex were less useful due to soft tissue artifacts. Frontal and parietal lobe lesions had significantly higher rates of identifying feeding arteries and draining veins (P < 0.05). Presurgical planning for resection of superficial bAVMs using Horos software allows for a comprehensive 3D analysis of the bAVM angioarchitecture. This technique is most useful for frontal and parietal lobe lesions, and aids the surgeon in formulating an optimal surgical strategy. The 3D reconstruction of the brain surface offers a surgical map not influenced by brain shift.

Hemodynamic changes in superficial arteriovenous malformation surgery measured by intraoperative ICG fluorescence videoangiography with FLOW 800 software

BackgroundArteriovenous malformation(AVM) have long-term “blood stealing” characteristics, which result in complicated hemodynamic features. To analyze the application of intraoperative indocyanine green angiography with FLOW 800 software in AVM surgeries.MethodsData on 17 patients undergoing surgery with ICG fluorescence were collected in Beijing Tiantan Hospital. To analyze the hemodynamic features of AVM and the influence on the peripheral cortex of AVM resection, we assessed the following hemodynamic parameters: maximum intensity, slope of rise, time to half-maximal fluorescence, and transit time from arteries to veins.ResultsIn the 17 superficial AVMs studied, the time-delay color mode of the FLOW 800 software was superior to the traditional playback mode for identifying feeding arteries, draining veins, and their relation to normal cortical vessels. The maximum fluorescence intensity and slope of the ICG fluorescence curve of feeder arteries and draining veins were higher than those of normal peripheral vessels (P < 0.05). The transit times in AVMs were significantly shorter than those in normal peripheral vessels (P < 0.05). After AVM resection, cerebral flow increased in the cortex, and local cycle time becomes longer, although the differences were not significant (P > 0.05).ConclusionsHemodynamic parameter analysis provided quality guidance for the resection of AVMs and could also be used in estimating changes in blood flow in the local cortex to identify abnormal hyperperfusion and residual nidus.

Cone beam computed tomography improves the detection of injured vessels and involved vascular territories in patients with bleeding of uncertain origin

The purpose ofthis preliminary retrospective study was to analyse if cone beam CT (CBCT) is able to identify more bleeding sites and correspondingfeeding arteriesin patients with haemorrhage of uncertain origin. In 18vascular territories (16 patients), pre-interventional CTangiography (CTA) and selective angiograms resulted in discordant informationregarding the suspected bleeding site and hence received CBCT. Image data ofCTA and selective angiograms in comparison to CBCT were independently reviewedby two interventional radiologists.Image quality, diagnostic confidence, numberof bleeding sites and involved vascular territories were investigated.Additionally,thecorrelation between number of bleeding sites and involved vascular territories witha clinical gold-standard(super-selective angiographic findings and definitive clinicaloutcomes) was analysed. Overall, subjective image quality did not significantly differ between investigatedimaging modalities. However, CBCT significantly improved diagnostic confidence inboth readers in detecting bleeding vessel(s) (p=0.0024/0.0005; Reader 1/Reader2).High correlation coefficients regarding the number of bleeding sites(r=0.9163/0.7692) in contrast to the number of involved vascular territories(r=0.2888/0.0105) were observed for CTA in comparison to clinical gold-standard.In this context, CBCT demonstrated a very strong correlation for bothparameters,the number of bleeding vessels (r=0.9720/0.9721) and the number involvedvascular territories (r=0.9441/0.9441). In complexcases of suspected haemorrhage, CBCT images can aid the interventionalist in detectingbleeding sites as well as narrowing down the number of involved vascularterritories and thereby identifying feeding arteries of the bleeding source. Advances in knowledge: (1)CBCT showed no improvement in image quality. However, in complex bleeding cases CBCT information might aid in treatment planning.(2)CBCT improves visualization of bleeding vessels and involved feeding arteries.(3)Particularly, less experienced interventionalists might benefit from the three-dimensional information gathered by CBCT.

Detecting hepatic nodules and identifying feeding arteries of hepatocellular carcinoma: efficacy of cone-beam computed tomography in transcatheter arterial chemoembolization

Hepatoma Research is an open access journal and focuses on all topics related to hepatoma. The following articles are especially welcome: pathogenesis, clinical examination and early diagnosis of hepatoma, complications of hepatoma, and their preventions and treatments, etc.

Utility of noncontrast-enhanced time-resolved four-dimensional MR angiography with a vessel-selective technique for intracranial arteriovenous malformations.

To evaluate the utility of a vessel-selective four-dimensional (4D) magnetic resonance angiography (MRA) technique for the evaluation of intracranial arteriovenous malformations (AVMs). Twelve AVM patients were evaluated retrospectively. Time-of-flight (TOF) MRA, nonvessel-selective 4D-MRA (NS-4D-MRA), and vessel-selective 4D-MRA (VS-4D-MRA) were performed using a 3T MR unit in all patients, and used to identify feeding arteries and draining veins and measure nidus size. The diagnostic accuracy of the three techniques was compared using digital subtraction angiography (DSA). If a multifeeder was observed, the percentage of blood flow of each feeding artery to the entire nidus was evaluated and compared to the DSA findings using the "error value," defined as the degree of overestimation of the blood flow. All imaging findings were assessed by two neuroradiologists. In both raters, the detectability of feeding arteries by VS-4D-MRA (12 and 11 patients) was significantly higher than those of TOF-MRA (7 and 6 patients) and NS-4D-MRA (8 and 7 patients) (P &lt; 0.016). The detectability of drainer veins by TOF-MRA (10 and 10 patients) was significantly higher than that of VS-4D-MRA (7 and 6 patients). In the percentage of the blood flow of each feed artery to the entire nidus, the DSA findings (error value; 27.1 ± 5.7) indicated overestimations of the blood flow compared to the VS-4D-MRA (error value; 7.1 ± 3.9) (P &lt; 0.001). VS-4D-MRA was shown to be a useful technique for the evaluation of intracranial AVMs, especially for detecting feed arteries and estimating details of the nidus structure. J. MAGN. RESON. IMAGING 2016;44:834-845.

Accuracy of Vessel-Encoded Pseudocontinuous Arterial Spin-Labeling in Identification of Feeding Arteries in Patients with Intracranial Arteriovenous Malformations

Identifying feeding arteries of intracranial AVMs is very important for preoperative evaluation. DSA remains the reference standard for diagnosis but is invasive. Our aim was to evaluate the diagnostic accuracy of vessel-encoded pseudocontinuous arterial spin-labeling in identifying feeding arteries of intracranial AVMs by using DSA as the criterion standard. Eighteen patients with AVMs were examined with vessel-encoded pseudocontinuous arterial spin-labeling and DSA. Three postlabeling delays (postlabeling delay = 1, 1.3, and 1.6 seconds) were applied in 6 patients, and a single postlabeling delay (1 second) was applied in the remainder. Perfusion-weighted images were decoded into individual vascular territories with standard and relative tagging efficiencies, respectively. The supply fraction of each feeding artery to the AVM was calculated. The within-subject ANOVA was applied to compare supply fractions acquired across 3 postlabeling delays. Receiver operating characteristic analysis curves were calculated to evaluate the diagnostic accuracy of vessel-encoded pseudocontinuous arterial spin-labeling for identifying the feeding arteries of AVMs. There were no significant differences in supply fractions of the 3 major arteries to AVMs acquired with 3 postlabeling delays (P > .05). For vessel-encoded pseudocontinuous arterial spin-labeling with standard labeling efficiencies, the area under the receiver operating characteristic analysis curve was 0.942. The optimal cutoff of the supply fraction for identifying feeding arteries was 15.17%, and the resulting sensitivity and specificity were 84.62% and 93.33%, respectively. For vessel-encoded pseudocontinuous arterial spin-labeling with relative labeling efficiencies, the area under the receiver operating characteristic analysis curve was 0.957. The optimal cutoff of the supply fraction was 11.73%, which yielded an 89.74% sensitivity and 93.33% specificity. The contribution fraction of each feeding artery of the AVM can be reliably estimated by using vessel-encoded pseudocontinuous arterial spin-labeling. Vessel-encoded pseudocontinuous arterial spin-labeling with either standard or relative labeling efficiencies offers a high level of diagnostic accuracy compared with DSA for identifying feeding arteries.

FLOW 800-assisted surgery for arteriovenous malformation

FLOW 800 is software for analytical colour visualisation and objective evaluation of fluorescence video obtained by microscope-integrated intraoperative indocyanine green fluorescence angiography. A 56-year-old male underwent surgical excision of a large complex arteriovenous malformation (AVM) of the right parietal region. FLOW 800 software was used to identify feeding arteries, arterialised veins and passing vessels. Complete excision of the AVM was achieved, confirmed by FLOW 800 and postoperative digital subtraction angiography. The role of FLOW 800, its applications and limitations in AVM surgery are discussed.

Identifying Feeding Arteries During TACE of Hepatic Tumors: Comparison of C-Arm CT and Digital Subtraction Angiography

This study compares the diagnostic accuracy of C-arm CT with digital subtraction angiography (DSA) in identifying tumor-feeding arteries during superselective transarterial chemoembolization (TACE). Thirty-three consecutive patients with hepatocellular carcinoma (HCC) underwent superselective TACE using a flat-detector angiographic system. Angiographic operators determined which feeding arteries were potentially supplying the target tumor. When two or more feeding arteries were possible, all were included. Superselective DSA and C-arm CT were sequentially performed for each studied artery. Four independent observers separately viewed the DSA and C-arm CT images and used a 5-point grading scale to determine whether a studied artery supplied the target tumor. Diagnostic performance was compared using receiver operating characteristic (ROC) analysis. Sensitivity, specificity, and accuracy were calculated for arteries rated as definite or probable tumor feeders. Iodized oil accumulation on follow-up CT was the reference standard. We examined 58 possible feeding arteries in 33 patients. Among the studied arteries, follow-up CT confirmed that 33 were verified tumor-feeding arteries, and the remaining 25 were not. C-arm CT resulted in a significantly larger area under the ROC curve (A(z) = 0.995) compared with DSA (A(z) = 0.841). The sensitivity, specificity, and accuracy of C-arm CT (96.9%, 97.0%, and 96.9%, respectively) were significantly higher than those for DSA (77.2%, 73.0%, and 75.4%). C-arm CT is superior to DSA for identifying tumor-feeding arteries during superselective TACE for HCC.

Use of Color and Power Doppler Sonography to Identify Feeding Arteries Associated with Parathyroid Adenomas

Use of Color and Power Doppler Sonography to Identify Feeding Arteries Associated with Parathyroid Adenomas

Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas.

The objective of our study was to determine the value of using color and power Doppler sonography to reveal extrathyroidal feeding arteries in the detection of abnormal parathyroid glands. Forty-four patients with primary hyperparathyroidism were imaged prospectively with high-resolution gray-scale, color flow, and power Doppler sonography. The presence of extrathyroidal arteries supplying the adenomas was noted. All patients underwent subsequent neck exploration. The locations of the abnormal glands were recorded. At surgery, 51 abnormal parathyroid glands were removed in the 44 patients. Sonography correctly revealed an adenoma in 40 of the 44 patients. Likewise, sonography revealed 42 of the 51 adenomas. Nine false-negative and two false-positive interpretations of the sonograms were made. Thus, overall sensitivity was 83%, specificity was 98%, and accuracy was 94%. Three of the false-negative interpretations were ectopic glands within the superior mediastinum. Excluding these three glands from analysis, the sensitivity for detection of adenomas within the neck was 88%, specificity was 98%, and accuracy was 95%. An extrathyroidal artery leading to a parathyroid adenoma was seen in 35 of the 42 adenomas revealed by sonography. The presence of an extrathyroidal artery leading to an adenoma was found to aid in the detection of an otherwise inconspicuous parathyroid gland in five patients, which improved sensitivity from 73% to 83%. Prominent vessels supplying parathyroid adenomas are frequently revealed by color flow and power Doppler sonography. These vessels can serve as "road maps" to abnormal parathyroid glands.

Portable Digital Subtraction Angiography in the Operating Room and Intensive Care Unit

A simple, inexpensive method of portable digital subtraction angiography (DSA) using an image processor (Sigma X), still-videorecorder and control panel combined with a surgical x-ray television unit can provide real time subtraction images on the monitor. This portable DSA unit was used in 161 cases (130 in the operating room and 31 in the intensive care unit). In the operating room it is useful: 1) to confirm patency of the parent artery and its branches after aneurysm clipping, 2) to identify feeding arteries of arteriovenous malformation and to confirm total extirpation, 3) to confirm the patency of extracranial-intracranial bypass, 4) to confirm patency of the internal carotid artery and absence of flap formation after carotid endarterectomy. In the intensive care unit, it is particularly useful for visualizing cerebral vasospasm after subarachnoid hemorrhage and recanalization of an occluded major intracranial artery. Absence of intracranial circulation can be demonstrated in patients with suspected brain death.