Multislice Computed Tomography Angiography Research Articles

Body mass index and long-term survival following acute pulmonary embolism: insights from machine learning models

Abstract Funding Acknowledgements None. Introduction Body mass index (BMI) has been associated with long-term survival in the setting of acute pulmonary embolism (PE) [1,2]. The non-linear pattern of this association proves to be challenging for frequentist statistical analyses. Contemporary machine learning models offer superior handling capabilities of datasets with non-linear data distributions. Purpose To examine the predictive power of BMI expressed as a continuous variable in a dataset of patients with pulmonary embolism (PE) using the extreme gradient boosting (XGBoost) machine learning framework. Methods All consecutive patients with confirmed PE admitted to the two tertiary teaching Clinical Hospitals in the metropolitan area from November 2013 until November 2018 were included in the study. The diagnosis was established by multislice computed tomography angiography. Machine learning models were investigated using the LightGBM variant of XGBoost. We allocated 80% of the dataset for model training and the remaining 20% for testing. Two models were tested: (1) a model with 20 variables tailored according to the Cox proportional hazards model in the initial publication; (2) a model with 11 independent predictors of outcome. Results The study population is described in detail in previous publications [1,2]. In brief, a total of 761 patients were included in the study. The population was predominantly female (57.4%), aged 73 (61-81). The median overall follow-up was 675 days (114-1331). There were 335 (44.0%) cases of death recorded at follow-up. A Cox proportional hazards model with 19 covariates significantly predicted death during follow-up (χ2 = 595.5, p<0.001). The first BMI quartile was an independent predictor of death (hazard ratio 1.66, 95% confidence interval 1.31-2.10). However, when expressed as a continuous variable, BMI failed to enter the model. In both XGBoost models, BMI expressed as a continuous variable proved to be a feature with high predictive power, second only to pulmonary embolism severity index score (Figure 1 and 2). The models showed high accuracy, with an area under curve of 0.840 and 0.864 respectively. Conclusion In the XGBoost analysis, a machine learning framework with superior handling of non-linear data, BMI expressed as a continuous variable emerged as the second strongest predictor of outcome among 761 PE patients.Figure 1Figure 2

Off-label use of muscular VSD device for closure of a rare congenital portosystemic shunt

BackgroundCongenital portosystemic shunt (CPSS) is a vascular malformation in which portal blood drains toward the systemic circulation, leading to pulmonary hypertension.Case presentationA 10-year-old patient was brought for evaluation because of dyspnea on exertion. Echocardiography revealed a pulmonary hypertension of 75 mmHg, and multi-slice CT angiography revealed the presence of a CPSS. Closure was finally implemented using a muscular ventricular septal defect device. Follow-up of the patient revealed a gradual decline in pulmonary hypertension.ConclusionsCPSS is an overlooked cause of reversible pulmonary hypertension (PH). Closure of such lesions and reversal pulmonary hypertension are possible via catheterization. The preferred device type depends largely on the intervening team. Plugs are the first choice for interventional radiologists, while ventricular and atrial septal occluder devices and duct occluders are preferred by pediatric cardiologists.

NONINVASIVE DIAGNOSTICS OF EXTRACRANIAL ARTERIES TORTUOSITY

Deformations of carotid artery – deviation, tortuosity, coiling, hold the 2nd placeamong other carotid pathologies. They are the cause of 10-17% of cerebrovasculardisorders. It should also be noted that this pathology is common for a relatively youngage. It is considered that in the elderly carotid deformation is an acquired lesion mostcommonly seen in patients suffering from arteriosclerosis and hypertension, while inchildren and younger patients, the kinks and coils are congenital. For diagnostics ofdeformations of magistral arteries, highly efficient non-invasive methods are applied:ultrasound duplex-scanning, MR angiography, and multi-slice CT angiography. We havestudied deformations of magistral carotid and vertebral arteries in cases of isolatedatherosclerosis, isolated arterial hypertension, and a combination of atherosclerosisand hypertension. Out of 205 patients we diagnosed deformations of carotid arteriesin 93 (30%) cases, and deformations of vertebral arteries in 64 (21%) cases. Bilateraldeformation of carotid arteries was diagnosed in 43 (17%) cases. C- or S-shaped deformationsin 55 (81%) cases were located in proximal or medial parts of CCA or ICA. 76%of patients with this pathology had arterial hypertension. In the case of C- or S-typedeformation rate amounted to 30%, in the case of coiling increase of flow it reached50%, and in the case of kinking – exceeded 60%. In the case of C- or S-type elongation,flow volume (Q) is practically within the normal range - 488±38 ml/min. In the case ofspiral shape elongation, it showed the tendency of decrease -402±22 ml/min, which ismore obvious in the case of kinking - 332±22 ml/min. The frequency of elongations ispractically the same in the case of isolated atherosclerosis or hypertension, however,in the case of their combination the frequency increases. In order to study the impactof the deformation of magistral arteries on intracranial hemodynamics, we examined84 patients without any hemodynamically significant atherosclerotic pathology of carotids.We found a total of 91 elongations: In the case of C- or S-shaped deformation,flow parameters remain within the normal range, as in the case of spiral elongation orcoiling. In the case of kinking, there is an obvious tendency for a decrease in flow rate – the average flow rate is 20% below the normal value. Our data correspond to similar data of other authors, who revealed the tendency of a 20-35% decrease of flow rate in the ipsilateral middle cerebral artery, in case of significant tortuosity or kinking of the carotid artery.

Assessment of Plaque Vulnerability in Diabetic and Non-Diabetic Patients with Coronary Artery Disease Using Multi-slice CT Angiography

Assessment of Plaque Vulnerability in Diabetic and Non-Diabetic Patients with Coronary Artery Disease Using Multi-slice CT Angiography

A young woman with acute coronary syndrome and antiphospholipid syndrome. Is it the antiphospholipid syndrome or COVID-19 vaccination or classical risk as the risk factor? a case report

BackgroundAcute coronary syndrome (ACS) in young women is poorly understood due to underdiagnosis and undertreatment. One of the possible risk factors for ACS in young women is antiphospholipid syndrome (APS). Coronavirus disease 2019 (COVID-19) vaccination also emerged as one of the possible risk factors for ACS during the COVID-19 pandemic.Case presentationOur patient, a 39-year-old Batak woman with dyslipidemia and family history of cardiovascular disease, experienced chest pain slightly improved at rest accompanied by autonomic symptoms. She was diagnosed with non-ST-elevation myocardial infarction (NSTEMI) based on her clinical features, dynamic electrocardiogram changes, troponin elevation, and multislice computed tomography angiography confirmed with diagnostic catheterization. The patient was managed by percutaneous coronary intervention with implantation of drug-eluting stents. On follow-up, the patient was diagnosed with APS based on history of preeclampsia with severe features in the first and third pregnancy, spontaneous abortion in the second pregnancy, history of transient ischemic attack, moderately positive lupus anticoagulant on two occasions with an interval of 12 weeks, and ACS. Further investigation revealed a history of COVID-19 vaccination with Sinovac four and six weeks before presentation. The patient was recommended for lifelong warfarin and short-term dual antiplatelet (aspirin and ticagrelor).ConclusionsYoung women are not completely immune to ACS as evident in this case of ACS in a young woman with classical risk factors (dyslipidemia and family history of cardiovascular disease) and APS. Further studies are required to fill the knowledge gap on whether COVID-19 vaccination had any contribution to the ACS in the young woman.

Retracted: Multislice Computed Tomography Angiography Imaging Diagnosis of Lower Extremity Arteriosclerosis in Patients with Hypertension and Its Correlation with the Level of High-Sensitivity C-Reactive Protein

Retracted: Multislice Computed Tomography Angiography Imaging Diagnosis of Lower Extremity Arteriosclerosis in Patients with Hypertension and Its Correlation with the Level of High-Sensitivity C-Reactive Protein

Clinical case of 9-month observation of orbital venous varicose with intraluminal thrombus using radiologic methods

A rare clinical case of thrombosis of varicose superior ophthalmic vein in combination with a unilateral venous anomaly of the subcortical region of the brain with successful antithrombotic therapy is presented. Varicose veins of the superior ophthalmic vein are rare (2% of all orbital formations) and are a risk factor for thrombosis.Material and methods. A 41-year-old patient with verified thrombosis of unilateral orbital venous varicose veins was observed for 9 months. Initially, MSCT of the brain and MSCT angiography were performed, then dynamic monitoring was carried out by performing MRI of the brain and MR venography, and finally an ultrasound examination of the orbit was performed.Description of a clinical case. The clinical presentation consisted of a slight non-pulsatile unilateral exophthalmos, mild ptosis, periorbital soft tissue edema, subconjunctival hemorrhage, paraorbital hematoma, and venous dysfunction in the fundus. MSCT and MSCT angiography revealed a thrombus inside the sac of orbital venous varicose veins. The disease was probably secondary in nature, given that it was combined with venous angioma of the subcortical region on the same side. During 9 months of observation, to monitor the effectiveness of therapy, MRI was performed three times before and after contrast enhancement, which showed a gradual decrease in exophthalmos, the size of the thrombus and the varicocele sac, which was accompanied by a gradual improvement in the clinical picture until subjective recovery.Conclusion. MRI was as good an imaging modality as MSCT, and, in our opinion, more preferable due to the absence of radiation exposure and the need for iodine contrast agent.

True aneurysms of the inferior phrenic arteries in celiac trunk compression syndrome and surgical treatment of three patients

The Objective was to pay attention to the rare combination of a true aneurysm of the inferior phrenic artery and the syndrome of compression of the celiac trunk, its open decompression and elimination of aneurysms in three patients.Methods and Materials. From September 2018 to December 2022, in 5 patients with celiac trunk compression syndrome (three men; mean age 49.4 years, from 18 to 72 years) out of 182, according to MSCT angiography and during surgery, an aneurysm of the right inferior phrenic artery was detected in two and left for three. These arteries originated from the post-stenotic moderately dilated part of the celiac trunk.Results. On average, its diameter at the site of stenosis was 1.9 mm and the degree was 58 %, the trunk was 8.6 mm and the aneurysm was 6.8 mm, and its length was 8 mm. In 4 cases, the aneurysm originated from the ostium of this artery and in one case, 5 mm from it, without involvement of the celiac trunk. All 5 aneurysms were concentric sac-shaped, including a funnel-shaped variant in two of them. Three out of 5 patients successfully underwent open decompression of the celiac trunk and immediately resection of the aneurysm in two with the imposition of a lateral suture and ligatures on the artery, respectively, and exclusion in one with a purse-string suture.Conclusion. An aneurysm of the inferior phrenic artery originating from the celiac trunk may be one of the specific manifestations of its long-term significant diaphragmatic compression. With such a combination of lesions, the expediency of decompressing the celiac trunk and removing the aneurysm from the bloodstream, regardless of its size, should be considered.

Case Report: Pulmonary Sequestration in an Adult Not A Metastasis

Introduction: Pulmonary sequestrum is a rare congenital lung anomaly defined as an area of dysplasia and nonfunctional lung tissue with abnormal systemic blood supply and various forms of venous drainage. We report the case of a 43-year-old man who was followed up for prostate adenocarcinoma with bone and lung metastases. The diagnosis of bronchopulmonary sequestration was made. Case report: The patient was 62 years old and was being followed for metastatic prostate adenocarcinoma to the bone. The frontal chest radiograph showed a poorly limited right basal opacity. Bronchial endoscopy noted an inflammatory appearance of the right lower lobar bronchus. A thoraco-abdomino-pelvic CT scan was requested as part of the extension work-up to identify a focus of intra-parenchymal condensation on the right posterior basal side vascularized by an abnormal systemic vessel emanating from the descending thoracic aorta in favor of an intra-lobar sequestration. Discussion and Conclusion: Pulmonary sequestration is a rare malformation whose diagnosis must be evoked in front of repeated infections in the same pulmonary territory, in particular the posterobasal territory. Multislice CT or MRI angiography are the examinations of choice for diagnosis and assessment. Surgical treatment remains the most important option.

Application effect of multi-slice spiral CT angiography combined with MRI in the diagnosis of cerebral aneurysm

ABSTRACT To investigate the clinical value of multi-slice spiral computed tomography (CT) angiography (MSCTA) combined with MRI in the diagnosis of cerebral aneurysm. A total of 90 patients with cerebral aneurysms diagnosed by DSA were selected as the subjects of this study. Another 30 patients with cerebral infarction were selected as negative controls (NC). Before diagnosis, all patients underwent comprehensive examination using MSCTA and MRI. The results of the comparison and the clinical data of all patients were retrospectively analyzed. MSCTA and MRI examinations can clearly show the specific location, shape, size and anatomical relationship with surrounding tissues of cerebral aneurysms. MSCTA diagnosed 82 patients and missed or misdiagnosed 8 patients in the 90 patients with cerebral aneurysm. The diagnostic sensitivity and accuracy of MSCTA were 91.1 (82/90) and 89.2 (107/120), respectively. MRI examination diagnosed 87 patients and missed or misdiagnosed 3 patients in the 90 patients with cerebral aneurysm. The diagnostic sensitivity and accuracy of MRI were 96.7 (87/90) and 96.7 (116/120), respectively. The sensitivity and accuracy of MSCTA combined with MRI were 100.0 (90/90) and 99.2 (119/120), respectively. MSCTA combined with MRI can not only display the whole picture of brain tissue, but also display the size, shape and relationship with the parent vessel of the aneurysm. The combination of MSCTA and MRI has high sensitivity and accuracy in diagnosing intracranial aneurysms, which provides a promising diagnostic protocol for patients with aneurysms.

The effectiveness of MRI and CT with intravenous contrast in the assessment of carotid chemodectoma at the preoperative stage and in dynamics after surgery

Background. Carotid chemodectoma is rare, slow growing, richly vascularized lesion. It is a single unilateral or bilateral tumor, localized mainly in the area of the carotid triangle. Different forms and bilateral cases are also known. A complex of radiological studies, including MRI and CT with intravenous contrast, can help in determining the surgical treatment strategy, as well as treatment monitoring. Objective. To determine the role of MRI and CT with intravenous contrast in the assessment of carotid chemodectoma at the preoperative stage and at post-surgery monitoring. Materials and Methods. We analyzed the results of a comprehensive radiological examination of 12 patients with suspected carotid chemodectoma, including MRI and MSCT with intravenous contrast, and X-ray angiography. All patients got operated, the results were confirmed by histological and immunohistochemical study. Results. Multislice computed tomography, supplemented by CT angiography, allows visualizing chemodectoma, determining its size, shape, structure, and relations with the nearby vessels. In addition to size, shape, structure of chemodectoma MRI can provide a detailed picture of the internal vascular network, the walls of adjacent vascular structures, as well as the soft tissue structures of the peripharyngeal area, which is helpful for vascular surgeons in surgical intervention. It was not possible to determine the histogenesis of the tumor according to the methods of radiation diagnostics. Conclusions. In order to determine the option of surgical treatment of carotid chemodectomas and reduce the risk of intraoperative complications at the preoperative stage, it is necessary to carry out the entire spectrum of radiation diagnostic methods (including ultrasound, MSCT, MRI and X-ray angiography).

Acute mesenterial ischaemia: a contemporary view

During the COVID-19 pandemic, the incidence of acute mesenteric ischemia (AMI) increased to 10.9 per 100 000 population. Here we discuss causes, symptoms, current diagnosis and treatment of AMI.Frequently, such patients suffer from stenosis or occlusion of superior mesenteric artery accompanied by coronary artery disease, chronic heart failure, or chronic brain ischaemia. The main clinical symptom is constant abdominal pain which is sharp in case of mesenteric artery thrombosis or dull if thrombosis is restricted to the branch of superior or inferior mesenteric veins. Conventionally, the diagnosis of AMI is verified by multislice computed tomography angiography and contrast-enhanced multislice computed tomography. Timely diagnosis with emergency surgery reduces mortality from 90% to 30-50%. The best treatment outcomes are observed after early revascularizations and minimally invasive endovascular interventions.

Headache as a Symptom of Carotid Web

Headache is a frequent symptom in emergency department, especially in patients with hypertension. Carotid web, also known as the variant of fibromuscular dysplasia (FMD), is a rare disorder, found in only 1- 1.2 % of patients undergoing angiography, and it should be searched for in patients with cryptogenic stroke. We present a female hyper- tensive patient presented to emergency department with headache and visual symptoms, in whom further work-up revealed carotid web. A 46 years old female patient presented to the ED with headache occurring few days before the examination. It was a constant left temporal headache accompanied with flashes in the right half of the visual field. History taking revealed well-controlled hypertension with calcium channel antagonists. The first manifestation of hypertension was eclampsia during pregnancy. In emergency department normal neurologic status was obtained, brain CT scan was normal. Neurosonological examination revealed right carotid web, confirmed by MSCT angiography.

Angiographic patterns of portal venous system in children with extrahepatic portal hypertension and its etiological and clinical relevance.

To study the relationship between the angiographic pattern of extrahepatic portal vein obstruction (EHPVO) and its etiology and clinical manifestations. Clinical, etiological, and angiographic findings in 155 children with EHPVO were reviewed. Anatomy of extrahepatic portal venous system (EPVS) was categorized into five imaging patterns. Assessment of the severity of esophageal and gastric varices (EV and GV) was performed by upper gastrointestinal endoscopy. Based on multislice CT angiography, most commonly observed pattern of EHPVO was type I (48.4%) and type II (29%). According to anamnesis, 68 (43.8%) children had pathological conditions in neonatal period. Of these, 35 (22.6%) had an umbilical vein catheterization, 11 (7.1%) had a history of omphalitis, and 9 (5.8%) had prolonged jaundice. Thirteen (8.4%) patients had various septic conditions in neonatal period and it was more common associated with widespread thrombosis throughout the EPVS (type 5)-28% of observations. Significantly lower risk of bleeding from EV (p = 0.01) was noted in children with type IV pattern, whereas children with type III and V patterns had higher grades of EV. Angiographic pattern of portomesenteric occlusion may provide a clue to its etiology, and clinical manifestation, especially in children with widespread thrombosis throughout the EPVS.

Arterial Thrombosis of Vermiform Appendix Resulting in Gangrenous Appendicitis

Acute appendicitis is still the most common surgical disease in the experience of surgeon and it requires operative treatment in hospital. There are several suggestions on the causes of acute appendicitis: infectious or neurovascular conditions, obturation of the orifice of vermiform appendix with a fecal bolus, and other versions. One of the rare causes of acute appendicitis is ischemia of vermiform appendix, which results in the development of primary gangrenous appendicitis. The clinical manifestation of this pathology may be atypical. We present a case report of a 65-year-old patient with acute gangrenous appendicitis complicated by localized purulent peritonitis. When admitted to the hospital, the patient was suspected of mesenteric thrombosis. MSCT angiography was performed about that, which diagnosed thrombosis of a. appendicularis and acute appendicitis. Treatment included laparotomy, appendectomy, sanitation, and abdominal drainage. In the paper, we discuss the incidence and results of treatment of acute appendicitis.

Comparative Study between Role of Multi Slice Computed Tomography Angiography and Doppler Ultrasonography in Evaluation of Patients with Lower Limb Arterial Diseases

Comparative Study between Role of Multi Slice Computed Tomography Angiography and Doppler Ultrasonography in Evaluation of Patients with Lower Limb Arterial Diseases

The relation between pericoronary fat thickness and density quantified by coronary computed tomography angiography with coronary artery disease severity

ObjectiveTo study the correlation between epicardial fat thickness (EFT), pericoronary fat thickness (PCFT), and pericoronary fat density (PCFD) with the existence and severity of coronary artery disease (CAD). MethodsThis cross-sectional study included 210 patients referred for multislice CT angiography. Group I normal CTCA, Group II patients had non-obstructive atherosclerosis, and Group III patients had obstructive atherosclerosis. All patients underwent a clinical examination, history taking, and multislice CT angiography. ResultsThe mean EFT was significantly greater in group III (10.43 ± 2.31 mm) compared to groups II (6.30 ± 1.61 mm) and I (5.06 ± 1.14 mm). The mean PCFT was significantly greater in group III (17.96 ± 2.89 mm) compared to group II (11.47 ± 2.51 mm) and group I (9.67 ± 1.99 mm). PCFD was significantly higher adjacent to the lesion (−80.47 ± 29.14) compared to the normal segment (−109.03 ± 35.24), higher in the obstructive group (−59.44 ± 20.10) compared to the non-obstructive group (−101.51 ± 20.23), but lower in calcified lesions (−89.58 ± 28.94) compared to non-calcified (−75.01 ± 29.20), and mixed lesions (−74.83 ± 26.90). EFT and PCFT cut-off values for predicting obstructive CAD were 8.3 and 12.4 mm, respectively, with 87.1% and 92.9% sensitivity and 92.9% and 86.4% specificity, respectively. ConclusionThere is a significant association between epicardial fat thickness, pericoronary fat thickness and density with the severity of coronary artery disease.

Effect of low density carotid plaque on the development of cerebral small vessel disease in patients with carotid stenosis

Objective: To investigate the correlation between cerebral small vessel disease (CSVD) and carotid low-density plaque on multi-slice spiral CT angiography (MSCTA) in patient with carotid stenosis. Methods: The clinical data of 221 patients with carotid stenosis who admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, from January 2016 to January 2021 were retrospectively analyzed. There were 195 males and 26 females, with the age of (70.0±8.4) years (range: 48 to 88 years). According to MRI, the patients were divided into carotid stenosis combined with CSVD group (the CSVD group) and carotid stenosis without CSVD group (the non-CSVD group). Lowest density in the carotid atherosclerotic plaque area (CAPALD) was analyzed by MSCTA. The t-test, Mann-Whitney U test and Chi-square test were used for comparison between the two groups. Univariate and multivariate Logistic regression analysis were performed on CAPALD and other clinical indicators with CSVD. Receiver operating characteristic (ROC) curves of CAPALD and CAPALD combined with the demographics (sex, age and body mass index) were plotted for predicting CSVD, and the area under the curve (AUC), sensitivity and specificity were calculated. Results: There were 169 patients in the CSVD group and 52 patients in the non-CSVD group. In the CSVD group, 88.8% (150/169) were males and 11.2% (19/169) were females, with the age of (70.5±8.2) years (range: 48 to 88 years). In the non-CSVD group, 86.5% (45/52) were males and 13.5% (7/52) were females, with the age of (68.4±9.1) years (range: 51 to 85 years). CAPALD and the score of Montreal cognitive assessment were lower in the CSVD group than those in the non-CSVD group (21.0 HU vs. 35.0 HU, Z=-3.760, P<0.01; 22.6±3.9 vs. 24.8±3.3, t=-2.064, P<0.05). Multivariate Logistic regression analysis showed that CAPALD was an independent factor for CSVD (OR=1.044, 95%CI:1.020 to 1.070, P<0.01). The AUC of the ROC curve for CAPALD predicting carotid stenosis with CSVD was 0.672 (P<0.01), with cut-off value of 34.5 HU, sensitivity of 82.8%, and specificity of 50.0%. The AUC of ROC curve for CAPALD combined with the demographics predicting CSVD was 0.733 (P<0.01), with sensitivity of 82.9% and specificity of 64.0%. Conclusions: The decreased CAPALD is a risk factor for CSVD in patients with carotid stenosis. The analysis of carotid plaque density by MSCTA may help to identify the patients at high risk of CSVD.

Successful throb endarterectomy in a patient with occlusion of the internal carotid artery

Strokes account for 15–25 % of confirmed cases internal carotid artery (ICA) occlusion. The frequency of ICA occlusion in asymptomatic patients is unknown. The strategy of treatment patients with symptomatic ICA occlusion has not been determined. A clinical observation is presented with the stage of surgical treatment of a 67‑year-old patient with a developed stroke in the basin of the left middle cerebral artery. The examination according to MSCT angiography revealed occlusion of the left ICA. To assess the brain perfusion, a single-photon emission computed tomography (SPECT) with 99mTc was performed. Throb endarterectomy of the left internal carotid artery was performed, with a control ultrasound examination on the 6th day after the operation and after 6 months the blood flow through the internal carotid artery was preserved. Control SPECT with 99mTc was performed, in comparison with the previous study, a significant improvement perfusion on both hemispheres is determined. Improvements in the neurological status were noted in the form of a complete regression of neurological symptoms. On the sixth day after surgical treatment, the patient was discharged in a satisfactory condition. During the hospital stay, the patient was “examined” using a questionnaire for assessing the quality of life – The Short Form‑36 (SF‑36) and MoCA (Montreal Cognitive Impairment Assessment Scale). The survey was conducted on the 15th day of inpatient treatment, before surgery, and on the 6th day after surgery. After 6 months, the patient was re-interviewed. The results obtained indicate a correlation between the improvement of brain perfusion and cognitive impairment, as well as a positive effect of revascularization of the internal carotid artery on the patient’s quality of life. The presented results indicate not only the possibility, but also the high efficiency of surgical treatment of occlusive lesions of the internal carotid artery. Surgical treatment in the early stages after occlusion against the background of the collapse of atherosclerotic plaque and thrombosis of the lumen is a determining factor in the successful restoration of blood flow, improvement of brain perfusion.

Multislice CT angiography as a roadmap for pedicle selection prior to breast reduction surgery

BackgroundAccurate knowledge of breast arterial supply on individual basis is crucial prior to breast reduction surgery to minimize the risk of post-operative necrosis of nipple-areola complex which is a well reported complication. The purpose of this cross-sectional study was to test the ability of multislice CT angiography to delineate the dominant arterial supply of nipple-areola complex to facilitate accurate breast pedicle selection to improve patient outcome.ResultsTwelve patients underwent multislice CTA of both breasts to delineate dominant arterial supply to NAC, internal mammary artery was the dominant arterial supply in most of breasts (87.5%) based on CTA findings and hence superomedial pedicle was the commonest pedicel chosen. None of patients experienced NAC necrosis postoperatively while minority of patients (16.6%) exhibited decreased NAC sensation bilaterally.ConclusionsMultislice CT angiography is a useful pre-operative tool to minimize the risk of post-operative necrosis of nipple-areola complex in patients undergoing breast reduction surgery.