Magnetic Resonance Imaging Angiography Research Articles

A scoping review of magnetic resonance angiography and perfusion image synthesis

IntroductionDeregulation of the cerebrovascular system has been linked to neurodegeneration, part of a putative causal pathway into etiologies such as Alzheimer's disease (AD). In medical imaging, time-of-flight magnetic resonance angiography (TOF-MRA) and perfusion MRI are the most common modalities used to study this system. However, due to lack of resources, many large-scale studies of AD are not acquiring these images; this creates a conundrum, as the lack of evidence limits our knowledge of the interaction between the cerebrovascular system and AD. Deep learning approaches have been used in recent developments to generate synthetic medical images from existing contrasts. In this review, we study the use of artificial intelligence in the generation of synthetic TOF-MRA and perfusion-related images from existing neuroanatomical and neurovascular acquisitions for the study of the cerebrovascular system.MethodFollowing the PRISMA reporting guidelines we conducted a scoping review of 729 studies relating to image synthesis of TOF-MRA or perfusion imaging, from which 13 met our criteria.ResultsStudies showed that T1-w, T2-w, and FLAIR can be used to synthesize perfusion map and TOF-MRA. Other studies demonstrated that synthetic images could have a greater signal-to-noise ratio compared to real images and that some models trained on healthy subjects could generalize their outputs to an unseen population, such as stroke patients.DiscussionThese findings suggest that generating TOF-MRA and perfusion MRI images holds significant potential for enhancing neurovascular studies, particularly in cases where direct acquisition is not feasible. This approach could provide valuable insights for retrospective studies of several cerebrovascular related diseases such as stroke and AD. While promising, further research is needed to assess their sensitivity and specificity, and ensure their applicability across diverse populations. The use of models to generate TOF-MRA and perfusion MRI using commonly acquired data could be the key for the retrospective study of the cerebrovascular system and elucidate its role in the development of dementia.

Study of the effectiveness factors of microsurgical treatment of cerebral arterial aneurysms

BACKGROUND: Despite improvements in diagnostic methods and microsurgical techniques for treating arterial aneurysms of the cerebral vessels, there remains a high probability of mortality and persistent disability among the working population. AIM: To determine the factors influencing the effectiveness of surgical interventions in patients with cerebral arterial aneurysms. MATERIALS AND METHODS: This scientific work presents the results of examination and surgical treatment of 86 patients operated on from 2017 to 2023 y. at the Neurosurgery Clinic of the National Hospital. The age of the patients ranged from 23 to 78 years (average age - 47±1.7 years), among them there were 48 (55.8%) men, 38 (44.2%) women. All patients underwent MRI or CT angiography of cerebral vessels; in 47 (54.6%) patients, cerebral aneurysm was confirmed by selective cerebral angiography. The size of the aneurysms ranged from miliary (3.0 mm to giant sizes 25.0-30.0 mm). RESULTS: The clinical picture of patients with ruptured arterial aneurysms was associated with the prevalence of subarachnoid hemorrhage, the location and volume of formed intracerebral hematomas in patients in the pre-hemorrhagic period with unruptured aneurysms - with the location and size of arterial aneurysms. One of the serious complications that arose during operations was intraoperative rupture (15.1%) of the aneurysmal sac at different stages of operations. The worst results with mortality up to 4.17% were observed in patients with ruptured arterial aneurysms, on the HH scale III, IV and 7-8, 9-10 points on the Glasgow scale. In cases where direct access to the aneurysm is difficult, it is advisable to perform subpial microresection of the altered medulla around the aneurysm. This allows you to avoid traumatic damage to the walls of the aneurysm and the development of spasm of arterial vessels. In order to avoid aneurysm rupture when isolating the aneurysm neck, it is advisable to temporarily apply special removable (temporary) clips to the proximal and distal segments of the supporting vessel of the aneurysm. After it was possible to isolate the neck of the aneurysm, a special clip was applied and, if possible, the patency and integrity of the vessel carrying the aneurysm and its branches were preserved. To determine the absence of blood flow in the aneurysm and assess the patency of arterial vessels, it is recommended to use intraoperative microvascular doplefography. CONCLUSION: The results of surgical treatment for ruptured aneurysms depended on the preoperative condition of the patients. Microsurgical clipping of arterial aneurysms effectively prevents the risk of recurrent subarachnoid hemorrhage. The absence of complications in patients during surgery and the early postoperative period does not guarantee the possibility of developing delayed complications that may require repeated operations.

The use of dynamic magnetic resonance angiography in the diagnosis of rotational vertebral artery syndrome

AbstractBackgroundRotational vertebral artery (VA) syndrome represents a rare mechanical vasculopathy that can lead to vertebrobasilar insufficiency and ischemic stroke.ObjectiveWe describe a 10‐year‐old boy with a history of chronic morning emesis who presented with acute onset dizziness, gait instability, and vomiting and was diagnosed with acute ischemic posterior circulation stroke.InterpretationContrast‐enhanced magnetic resonance angiography (MRA) of the head and neck with dynamic positioning demonstrated loss of flow‐related enhancement with head tilted to the left, conferring a diagnosis of rotational VA syndrome. He started aspirin monotherapy and subsequently underwent C1 laminectomy, with both radiographic and clinical improvement on follow‐up.ConclusionDynamic contrasted‐enhanced MRA imaging can serve as a noninvasive alternative to digital subtraction angiography in the diagnosis of rotational VA syndrome and should be considered in suspected cases of pediatric rotational arteriopathy.

Are Exercise-Induced Premature Ventricular Contractions Associated with Significant Coronary Artery Disease?

Objectives: Exercise-induced premature ventricular contractions (EIPVC) have been associated with higher mortality, but the association with coronary artery disease (CAD) has not been precisely established. Our objective was to assess in a group of subjects with EIPVC and cardiovascular risk factors the association with underlying significant coronary artery disease (CAD), in comparison with a control group of patients with cardiovascular risk factors and exercise test (ET) showing ischaemia. Methods: All the patients (above 35 years old) referred for ET at our institution were prospectively included. Patients with at least one cardiovascular risk factor and without known CAD were divided into 2 groups: group A if EIPVC were present (either during exercise or during recovery), at least more than 10% over 30 s of recording; group B if ET was showing ischaemia. The presence of CAD was then confirmed in both groups by coronary arteriography, and/or thallium scintigraphy, and/or cardiac MRI and/or coronary CT angiography performed within 2 months after ET realization. Results: From November 2020 to December 2022, 4098 ETs were performed. After exclusion (normal ETs = 2194; known CAD = 1109; age < 35 years old = 487; congenital heart disease = 59; mitral valve prolapse = 4), 46 patients with EIPVC were finally identified (male 65%, mean age 61.5 ± 11 years), and 71 in group B. CAD was confirmed using additional tests in 5/46 (11%) patients in group A versus 38/71 (54%) in group B (p < 0.0001). Conclusions: Amongst patients without known CAD, the presence of EIPVC was less frequently associated with an underlying CAD, compared to the presence of exercise-induced “electrical” ischaemia.

Principal component analysis identified neo-aortic diameter variations post Norwood surgery associated with the single ventricle performance and flow quality.

The purpose of this study was to investigate neo-aortic curvature and diameter variation using the principal component analysis in patients who underwent a Norwood procedure for hypoplastic left heart syndrome. We further assessed whether neo-aortic curvature and diameter features are associated with clinical outcomes, single right ventricle function and flow hemodynamic patterns derived by 4D-Flow MRI. 55 patients with Fontan circulation who underwent a Norwood procedure in infancy underwent cardiac MRI as part of surveillance of their Fontan circulation. Neo-aortic models segmented from the MRI angiography were subjected to principal component analysis. Principal component (PC) score values representing curvature and diameter variability were compared between patients with and without composite clinical event and correlated with standard cardiac hemodynamics. Fourteen patients experienced composite adverse clinical events. The PCs describing the variations in aortic curvature were not associated with cardiac MRI hemodynamics or clinical events. The diameter-based 2nd PC describing the degree of aortic tapering was significantly associated with the end-systolic volume index (R = 0.34, P = 0.011), ejection fraction (R = -0.44, P = 0.001), and viscous energy loss measured in the ascending aorta (R = 0.45, P = 0.009). High 2nd PC score values describing abrupt diameter changes were also associated with worse freedom from clinical events (P = 0.042). Neo-aortic shape variation described by gradual diameter tapering is strongly linked to better clinical and hemodynamic outcomes. Neo-aortic curvature and luminal trajectory seems to have less impact on the overall hemodynamics and long-term outcomes.

A resident’s sharp learning curve: Post-needle stick injury arteriovenous fistula of the finger

Iatrogenic vascular injuries can be encountered during diagnostic or therapeutic interventions. Traumatic arteriovenous fistulas (AVFs) occur due to penetrating injury involving contiguous arteries and veins. We report a case of a 27-year-old postgraduate trainee who presented with swelling over her left middle finger for 5 months following a needle prick injury at the same site 1 year back, which was diagnosed with ultrasound and dynamic magnetic resonance imaging angiography. Endovascular embolization is avoided in AVFs of the hand due to the risk of distal ischemia, and surgical excision with reconstruction is the preferred treatment.

The Correlation of Vessel Wall Macrophage Infiltration with Hemosiderin in Arteriovenous Malformations

Endothelial dysfunction, induced by high shear stress from increased nidal blood flow, may promote a cycle of inflammation, possibly leading to instability and cerebral arteriovenous malformations (AVMs) rupture. Macrophages, identified with CD68, are key inflammatory components in AVM pathology. We aim to evaluate the relationship of inflammation with AVM flow and hemosiderin. This is a retrospective study of archived tissue. Adult patients (2002-2022) with baseline quantitative magnetic resonance angiography (QMRA) imaging, no embolization, and history of microsurgical resection (n=17), with both ruptured (n=9) and unruptured cases (n=8). Brain AVM sections were stained with CD68 to quantify vessel wall macrophage infiltration and hematoxylin and eosin stain as a control and to quantify hemosiderin. QMRA with noninvasive optimal vessel analysis (NOVA) was reviewed, and AVM flow was calculated. Statistical analyses were performed. There were no significant differences between macrophage infiltration and patient demographics, Spetzler-Martin grade, eloquence, venous stenosis, nidus compactness, volume, and AVM flow. Vessel wall macrophage infiltration positively correlated with patients who presented with confirmed AVM rupture (163.8 +/- 46.7 vs. 101.3 +/- 49.4, p=0.017). Increases in vessel wall macrophage infiltration were found to positively correlate with higher grades of hemosiderin (p=0.023), except for grade 4 hemosiderin. Venous anomaly showed a negative association with macrophage infiltration (p=0.035). These findings suggest a relationship between AVM vessel wall inflammation, hemosiderin, and hemorrhage presentation. Further investigations with larger sample sizes are warranted to understand the role of altered hemodynamics, hemosiderin deposition and inflammation in AVM vessel walls.

Cerebrovascular reactivity and response times describe recent ischemic symptomatology in patients with moyamoya

Abstract Moyamoya is a non-atherosclerotic intracranial steno-occlusive condition that places patients at high risk for ischemic stroke. Randomized trials of surgical revascularization demonstrating efficacy in ischemic moyamoya have not been performed, and as such, biomarkers of parenchymal hemodynamic impairment are needed to assist with triage and evaluate post-surgical response. In this prospective study, we test the hypothesis that parenchymal cerebrovascular reactivity (CVR) metrics in response to a fixed-inspired 5% carbon dioxide challenge correlate with recent focal ischemic symptoms. Hypercapnic reactivity blood oxygenation level-dependent (BOLD) MRI (echo time=35ms; spatial resolution=3.5x3.5x3.5mm) and catheter angiography assessments of cortical reserve capacity and vascular patency, respectively, in moyamoya disease and syndromic participants (n=73) were performed in sequence. Cerebrovascular reactivity uncorrected for response time (CVRRAW) was quantified, and time regression analyses were applied to quantify maximum cerebrovascular reactivity (CVRMAX) and cerebrovascular reactivity response time (CVRDELAY). Symptomatology was categorized by a stroke neurologist by hemisphere: symptomatic (lateralizing ischemic symptoms < 6 months) or asymptomatic (no ischemic symptom history). Values are presented as median [interquartile range]; logistic regression assessed the association of cerebrovascular reactivity metrics with symptoms, controlling for age and sex. A total of 109 hemispheres, including 39 symptomatic and 70 asymptomatic hemispheres, met inclusion criteria. Symptomatic hemispheres displayed reduced CVRRAW (p<0.01) (symptomatic=0.45 [0.28-0.70] z-statistic/ΔEtCO2 vs. asymptomatic=0.67 [0.44-0.98] z-statistic/ΔEtCO2), lengthened CVRDELAY (p<0.001) (symptomatic=47.6 [37.7-57.0] seconds vs. asymptomatic=37.7 [30.4-46.4] seconds), and reduced CVRMAX (p=0.037) (symptomatic=1.31 [0.99-1.94] z-statistic/ΔEtCO2 vs. asymptomatic=1.64 [1.29-2.12] z-statistic/ΔEtCO2). CVRDELAY (p<0.001) was found to be significantly related to age in asymptomatic hemispheres (0.33-unit increase/year). Of assessed measures, the receiver operating characteristic curves suggest that CVRDELAY is associated most closely with recent ischemic symptoms (p<0.001). Findings support that cerebrovascular reactivity metrics are uniquely altered in hemispheres with recent ischemic symptoms, further motivating their utilization as biomarkers of ischemic symptomatology and potential treatment efficacy in moyamoya disease and syndrome.

Foix-Alajouanine syndrome: a comprehensive overview of rare but relevant diagnosis.

Foix-Alajouanine syndrome (FAS) is an uncommon neurological disorder marked by the gradual development of spinal cord congestion. First documented by Foix and Alajouanine in 1926. Although it is infrequent, delayed or misdiagnosis is nonetheless prevalent, resulting in inadequate therapy and unfavorable results. Using the PubMed database, MEDLINE, and EMBASE, we collected data on FAS patients and conducted a pooled analysis. The term 'FAS' was used to search for related articles. Our search was restricted to previous clinical case reports or series that were published in English. Non-English articles were excluded. We included the articles in the period from 1974 to 2024. Articles were eligible if the radiographic and clinical findings were indicative of FAS. A thorough research analysis was performed, examining case reports that specifically addressed this issue. This study examines the clinical symptoms, difficulties in diagnosis, methods of treatment, and outcomes related to FAS. FAS predominantly impacts the elderly population. A total of 26 patients were diagnosed with FAS. The median age of affected individuals was 53 (SD ±15.96). The ratio of males to females is roughly 5:1. The clinical manifestations encompass gradual muscle weakness and sensory impairments. The diagnosis is dependent on radiological evaluations, specifically MRI and digital subtraction angiography. Possible treatments include endovascular therapy, surgical closure of arteriovenous fistula, or a combination of the two. Significant improvements in neurological impairments can be achieved by early intervention. The diagnosis of FAS continues to be difficult due to its infrequency and varied clinical manifestations. Prompt and precise diagnosis is essential for proper intervention, typically utilizing endovascular or surgical methods. Additional research is required to determine prognostic markers and enhance long-term care techniques for this rare neurological condition.

Imaging signs of carotid plaque vulnerability predict subclinical neurological events in asymptomatic patients: the carotid artery multi-modality imaging prognostic study

Abstract Background Carotid artery plaques should be considered for invasive treatment if diameter stenoses is ≥60%, in the presence of clinical and/or imaging characteristics associated with an increased risk of ipsilateral stroke, such as intraplaque haemorrhage (IPH) or lipid-rich necrotic core (LRNC). However, little is known about plaque’s characteristics in patients with <60% stenoses. Purpose To evaluate the prevalence and significance of imaging signs of plaque vulnerability in patients with asymptomatic <60% carotid artery stenoses. Methods In the Carotid Artery Multi-modality imaging Prognostic (CAMP) study (granted by Bando Ricerca Salute 2018 - Regione Toscana) we prospectively enrolled 200 patients with asymptomatic, mild/moderate (40-60%) carotid artery stenoses, as assessed at Doppler ultrasound (DUS). All patients were evaluated with multimodality imaging, including computed tomography angiography (CTA), magnetic resonance angiography (MRA) and brain magnetic resonance imaging (MRI), whenever not contraindicated. A subgroup of 75 patients underwent also a 18[F]-fluorodeoxyglucose (FDG) positron emission tomography (PET). A thorough clinical, biochemical, cardiological and neurological evaluation was performed in all patients. Results Imaging signs of plaque vulnerability were frequent (IPH and/or LRNC at MRA were found in 26.3% patients, plaque ulceration at CTA was found in 36.7% of patients). No difference in the prevalence of cardiovascular risk factors was noted in those with and without signs of vulnerability. Subclinical embolic brain infarctions at brain MRI were found in 8.8% of patients at enrollment. These patients had more frequently a LRNC at MRA than patients without subclinical embolic brain infarctions (50% vs 17%, p<0.05), lower estimated glomerular filtration rate (55±8 vs 73±23 mL/min/1.73mq, p<0.001), higher troponin HS values (16±4 vs 12±8 ng/ml, p<0.05). Presence of LRNC at MRA was the only predictor of embolic lesions at MRI (odds ratio 4.86, 95% confidence interval 1.08-21.8, p<0.05). Conclusions Imaging signs of vulnerability are highly prevalent in patients with asymptomatic intermediate carotid artery stenosis. Presence of a LRNC at MRA is associated with subclinical embolic brain infarcts. The use of non-invasive multi-imaging can better characterize carotid plaques, independent of the degree of stenosis, and help identifying a subgroup of patients at higher risk of events.

Evolution and Adaptations of Robotic DIEP Flap Surgery: A Systematic Review.

The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery. A systematic literature search was conducted after PRISMA 2020 guidelines across databases including PubMed, Embase, Google Scholar, and Web of Science from 2000 to 2023. Articles exploring robotic DIEP flap harvest for breast reconstruction were assessed to compare operative techniques, clinical outcomes, and complications. The risk of bias was evaluated using ROBINS-I and the Newcastle-Ottawa scale. Fourteen studies involving 108 patients were included. Three studies used a totally extraperitoneal (TEP) technique, whereas 11 studies used a transabdominal preperitoneal (TAPP) approach. Preoperative planning utilized computed tomography angiography and magnetic resonance angiography imaging. The mean robotic operative time was 64 minutes, with total operative times averaging 574 minutes for TAPP and 497 minutes for TEP. The mean length of stay was 5 days, and the mean fascial incision length was 3cm. Overall complication rate was 14.9%, with no significant difference compared with conventional DIEP flap procedures. Robotic DIEP flap harvest is a promising technique that may reduce postoperative pain and limiting abdominal donor site morbidity. Potential limitations include longer operative times, variable hospital stays, and increased costs.

Structure preservation constraints for unsupervised domain adaptation intracranial vessel segmentation.

Unsupervised domain adaptation (UDA) has received interest as a means to alleviate the burden of data annotation. Nevertheless, existing UDA segmentation methods exhibit performance degradation in fine intracranial vessel segmentation tasks due to the problem of structure mismatch in the image synthesis procedure. To improve the image synthesis quality and the segmentation performance, a novel UDA segmentation method with structure preservation approaches, named StruP-Net, is proposed. The StruP-Net employs adversarial learning for image synthesis and utilizes two domain-specific segmentation networks to enhance the semantic consistency between real images and synthesized images. Additionally, two distinct structure preservation approaches, feature-level structure preservation (F-SP) and image-level structure preservation (I-SP), are proposed to alleviate the problem of structure mismatch in the image synthesis procedure. The F-SP, composed of two domain-specific graph convolutional networks (GCN), focuses on providing feature-level constraints to enhance the structural similarity between real images and synthesized images. Meanwhile, the I-SP imposes constraints on structure similarity based on perceptual loss. The cross-modality experimental results from magnetic resonance angiography (MRA) images to computed tomography angiography (CTA) images indicate that StruP-Net achieves better segmentation performance compared with other state-of-the-art methods. Furthermore, high inference efficiency demonstrates the clinical application potential of StruP-Net. The code is available at https://github.com/Mayoiuta/StruP-Net .

Cerebral infarcts, edema, hypoperfusion and vasospasm in preeclampsia and eclampsia

Eclampsia, a serious pregnancy complication, is associated with cerebral edema and infarctions but the underlying pathophysiology remains largely unexplored. To assess the pathophysiology of eclampsia using specialized magnetic resonance imaging that measures diffusion, perfusion, and vasospasm. This was a cross-sectional study recruiting consecutive pregnant women between April 2018 to November 2021 at Tygerberg Hospital, Cape Town, South Africa. We recruited women with eclampsia, preeclampsia, and normotensive pregnancies who underwent magnetic resonance imaging after birth. Main outcome measures were cerebral infarcts, edema, and perfusion using intravoxel incoherent motion imaging and vasospasm using magnetic resonance imaging angiography. The imaging protocol was established before inclusion. Forty-nine women with eclampsia, 20 with preeclampsia and 10 normotensive women were included. Cerebral infarcts were identified in 34% of eclamptic, 5% of preeclamptic (risk difference (RD) 0.29; 95% confidence interval (CI) 0.06 to 0.52, p=0.012) and in no normotensive controls. Eclamptic women were more likely to have vasogenic cerebral edema compared to preeclamptic (80% vs 20%, RD 0.60; CI 0.34 to 0.85, p<.001) and normotensive women (RD 0.80; CI 0.47 to 1.00, p<.001). Diffusion was increased in eclampsia in the parietooccipital white matter (mean difference (MD) 0.02 x10-3 mm2/s, CI 0.00 to 0.05, p=0.045) and the caudate nucleus (MD 0.02 x10-3 mm2/s, CI 0.00 to 0.04, p=0.033) when compared to preeclamptic women. Diffusion was also increased in eclamptic women in the frontal (MD 0.07 x10-3 mm2/s, CI 0.02 to 0.12, p=0.012) and parietooccipital white matter (MD 0.05 x10-3 mm2/s, CI 0.02 to 0.07, p=0.03) and the caudate nucleus (MD 0.04 x10-3 mm2/s, CI 0.00 to 0.07, p=0.028) when compared to normotensive women. Perfusion was decreased in edematous regions. Hypoperfusion was present in the caudate nucleus in eclampsia (MD -0.17 x10-3 mm2/s, CI -0.27 to -0.06, p=0.003) when compared to preeclampsia. There were no signs of hyperperfusion. Vasospasm was present in 18% of eclamptic, 6% of preeclamptic and none of the controls. Eclampsia is associated with cerebral infarcts, vasogenic cerebral edema, vasospasm and decreased perfusion, all not usually evident on standard clinical imaging. This may explain why some have cerebral symptoms and signs despite having normal conventional imaging.

Basilar Artery Tortuosity Increases the Risk of Persistent Dizziness and Unsteadiness After Posterior Circulation Infarction.

Basilar artery (BA) tortuosity is closely associated with posterior circulation infarction (PCI) and dizziness/unsteadiness. This study aims to determine the relationship between BA tortuosity and the outcome of dizziness and unsteadiness in PCI patients. This study prospectively recruited PCI patients presenting with dizziness and unsteadiness. BA tortuosity was diagnosed based on Smoker's criteria. The BA tortuosity index (BATI) was measured from magnetic resonance angiography (MRA) images. Posterior circulation was divided into proximal (medulla oblongata and posterior inferior cerebellar), middle, and distal territories. Symptoms, risk of falls, and quality of life were followed up in 3 months after stroke. Logistic regression was used to identify possible factors associated with the persistence of dizziness and unsteadiness. Among 182 PCI patients presenting with dizziness and unsteadiness, 97 (53.3%) had BA tortuosity, including 19 (10.4%) with moderate-to-severe BA tortuosity. At the 3-month follow-up, 58 (31.9%) patients continued to experience dizziness and unsteadiness, with significantly decreased quality of life and a high risk of falls. Binary logistic regression analysis identified moderate-to-severe BA tortuosity (OR, 4.474; 95% CI, 1.591-12.579; p = 0.004) and lesions involving the proximal posterior circulation territory (OR, 2.146; 95% CI, 1.097-4.199; p = 0.026) as risk factors for persistent dizziness and unsteadiness after PCI, while thrombolysis (OR, 0.280; 95% CI, 0.079-0.992; p = 0.049) as a protective factor. BATI (OR, 1.072; 95% CI, 1.028-1.119; p = 0.001) was also independently associated with dizziness and unsteadiness after PCI. Prominent BA tortuosity increases the risk of persistent dizziness and unsteadiness after PCI, leading to a high risk of falls and decreased quality of life. This warrants more attention in clinical practice.

Impact of superficial middle cerebral vein compression on peritumoral brain edema of the sphenoid wing meningioma

ObjectiveSphenoid wing meningiomas (SWMs) often cause occlusion or stenosis of the superficial middle cerebral vein (SMCV) by tumor compression. This study aimed to analyze the correlation between SMCV compression and peritumoral brain edema (PTBE) in SWM patients and to clarify the importance of surgical preservation of the SMCV in SWM surgery. MethodsThis retrospective study included 31 patients who underwent surgery for SWM at our institution from April 2011 to March 2022. Patient demographics, tumor characteristics, PTBE size, and SMCV patency before and after surgery were evaluated using preoperative and postoperative MRI or digital subtraction angiography. ResultsOf the 31 patients, 24 (77.4 %) exhibited PTBE, with varying degrees of severity: mild (32.3 %), moderate (25.8 %), and severe (41.9 %). Preoperative MRI showed SMCV patency in 14 patients (45.2 %) and SMCV compression in 17 patients (54.8 %). There was a significant association between PTBE severity and SMCV compression (p = 0.002). Postoperatively, SMCV recanalization was observed in 4 out of 16 patients (25.0 %) with preoperative SMCV compression. These patients had significantly smaller tumors (p = 0.013) and larger preoperative PTBE volumes (p = 0.042) compared to those without recanalization. ConclusionsOur study demonstrates a significant correlation between SMCV compression and severe PTBE in SWM patients. A subset of patients showed postoperative SMCV recanalization, particularly those with smaller tumors and more pronounced PTBE. These findings highlight the importance of SMCV preservation during SWM surgery to potentially improve postoperative outcomes.

Aspects of renal function and renal artery anatomy as indications for renal denervation.

Renal denervation (RDN) is a minimally invasive, endovascular catheter-based procedure using radiofrequency, ultrasound, or alcohol-mediated ablation to treat resistant hypertension. As more attention is focused on the renal sympathetic nerve as a cause and treatment target of hypertension, understanding the anatomy of the renal artery may have important implications for determining endovascular treatment strategies as well as for future selection of devices and appropriate candidates for RDN treatment. However, the anatomical structure of the renal artery (RA) is complex, and standardized morphological evaluations of the RA structure are lacking. Computed tomography angiography or magnetic resonance angiography imaging is useful for assessing RA anatomy before conducting RDN. RA echocardiography is an established noninvasive screening method for significant stenosis. Major randomized controlled trials have limited enrollment to patients with preserved renal function, usually defined as an estimated glomerular filtration rate (eGFR) ≥ 45 mL/min/1.73 m2. Therefore, the level of renal function at which RDN is indicated has not yet been determined. This mini-review summarizes the characteristics of renal artery anatomy and renal function that constitute indications for renal denervation. (Role of Clinical Trials: K. Kario is an Executive Committee Principal Investigator for the Spyral OFF MED, the Spyral ON MED, the DUO and the REQUIRE; a Coordinating investigator for the TCD-16164 study; a Site Principal Investigator for the HTN-J, the Spyral OFF MED, the Spyral ON MED, the DUO, the REQUIRE and the TCD-16164 study). Evaluation of renal arteries for radiofrequency renal denervation. A Simultaneous quadrantal ablations at four sites in the main renal artery or the equivalent renal artery to the main renal artery. B If there is a renal artery branch with a diameter >3 mm in the middle of the main renal artery, this branch is the distal end of the main renal artery. In this case, four simultaneous and quadrantal ablations can be performed on the equivalent renal arteries. C Four simultaneous and quadrantal ablations can be performed in the branch renal artery. D Sonication should be spaced at least 5 mm (one transducer*) apart. Perform 2 to 3 mm proximal to the arterial bifurcation. Perform 2 to 3 mm distal to the abdominal aortic inlet.

Cardiothoracic Imaging for Outcome Prediction in Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Endarterectomy or Balloon Pulmonary Angioplasty: A Scoping Review.

There has been a rapid expansion in centers performing balloon pulmonary angioplasty (BPA) and pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH). The purpose of this scoping review was to identify cardiothoracic imaging predictors of outcomes and to identify gaps to address in future work. A scoping review was conducted using the framework outlined by Arksey and O'Malley and Levac et al. in MEDLINE and EMBASE. The study protocol was preregistered in OSF Registries and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. There were 1117 identified studies, including 48 involving pulmonary thromboendarterectomy (n = 25) and balloon pulmonary angioplasty (n = 23). CT was the most common preoperative imaging modality used (n = 21) and CT level of disease was the most reported imaging predictor of outcomes for pulmonary thromboendarterectomy. Although must studies evaluated hemodynamic improvements, imaging was of additional use in predicting clinically significant procedural complications after balloon pulmonary angioplasty, as well as mortality and long-term outcome after pulmonary endarterectomy. Predictors reported in MRI and digital subtraction angiography were less commonly reported and warrant multicenter validation. Cardiothoracic imaging may predict clinically significant outcomes after balloon pulmonary angioplasty and pulmonary thromboendarterectomy. Radiologists involved in the assessment of CTEPH patients should be aware of key predictors and future investigations could focus on multicenter validation and new technologies.

Cigar-shaped Left Ventricular Thrombus in Cocaine-related Cardiomyopathy: Echocardiography, Cardiac MRI and Coronary CT Angiography Correlations.

Cigar-shaped Left Ventricular Thrombus in Cocaine-related Cardiomyopathy: Echocardiography, Cardiac MRI and Coronary CT Angiography Correlations.

Thoracic aortic pseudoaneurysm: Inside its pathophysiology.

Our aim was to investigate pathophysiology of pseudoaneurysm of the thoracic aorta, an acute or chronic pathology, respectively, secondary to blunt thoracic trauma and aortitis, or complicating a deep penetrating aortic ulcer, intraparietal hematoma, aortic aneurysm, and even aortic graft, often with atherosclerosis as a common background. Given the relative rarity of this disease, an "inductive" retrospective method made it possible to retrieve clinical, radiological, and histopathological elements, which were mutually compared and validated through a "deductive" process of reinterpretation. We have identified three main structural constituents of this disease: a cavity, a single blood entry port, communicating with the aortic lumen, and a pseudocapsule. It is often caused by a chronic degenerative pathology of the intima and medial layers of the aorta, typically involving elastic fibers and smooth muscle cells, with possible intermediate stages of deep aortic ulcer or intraparietal hematoma. Otherwise, the acute onset may be secondary to acute aortitis or aortic injury. Today, thanks to the current angiographic tools represented by 3-D high resolution multidetector CT and MRI angiography, the diagnosis of thoracic aortic pseudoaneurysm is easier, as well as its surgical indications.

Advances in the diagnosis of multiorgan involvement in systemic sclerosis: a focus on MRI.

Systemic sclerosis (SSc) is a rare chronic multisystem autoimmune disease characterized by endothelial dysfunction, tissue hypoxia, and diffuse organ fibrosis. MRI provides a radiation free approach to noninvasively assess the key manifestations of SSc in multiple organs. The purpose of this review is to summarize recent advances in MRI techniques to provide diagnostic and prognostic information in patients with SSc. MRI can probe processes that play a key role in the development of SSc-related complications, including neointima proliferation, fibrosis, and hypoxia. Feature tracking and parametric mapping MRI can detect cardiac involvement at the subclinical level. Contrast-free MRI angiography with Digital Artery Volume Index (DAVIX) assessment allow comprehensive assessment of hand involvement. T1 mapping and BOLD imaging can assess SSc effects on skeletal muscle, and lung MRI is becoming a key method for imaging of interstitial lung disease. As a new exciting application, the sodium content of the skin can be quantified by 23Na MRI reflective of glycosaminoglycan content. Recent advances in MRI provide a unique opportunity to study the key pathophysiologic processes and clinical manifestations of SSc in multiple organs noninvasively, which can pave the way for the development of effective therapies.