Perfusion Patterns Research Articles

MP18-13 IS INDOCYANINE GREEN SUPERIOR TO SURGEON’S SUBJECTIVE ASSESSMENT WHEN CREATING A CATHETERIZABLE CHANNEL? DEVELOPMENT OF A STANDARDIZED PROTOCOL

You have accessJournal of UrologyCME1 Apr 2023MP18-13 IS INDOCYANINE GREEN SUPERIOR TO SURGEON’S SUBJECTIVE ASSESSMENT WHEN CREATING A CATHETERIZABLE CHANNEL? DEVELOPMENT OF A STANDARDIZED PROTOCOL Amanda Raines, Jennifer Ahn, Nicolas Fernandez, Mark Cain, Byron Joyner, Kathleen Kieran, Margarett Shnorhavorian, and Paul Merguerian Amanda RainesAmanda Raines More articles by this author , Jennifer AhnJennifer Ahn More articles by this author , Nicolas FernandezNicolas Fernandez More articles by this author , Mark CainMark Cain More articles by this author , Byron JoynerByron Joyner More articles by this author , Kathleen KieranKathleen Kieran More articles by this author , Margarett ShnorhavorianMargarett Shnorhavorian More articles by this author , and Paul MerguerianPaul Merguerian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While we know blood supply to catheterizable channels is important to their long term success, there is currently no objective means to assess perfusion. Indocyanine green has a well established use in the evaluation of bowel perfusion, however, use has not been reported in catheterizable channels. Our aims were to develop a standardized protocol for using ICG in the creation of catheterizable channels and establish perfusion patterns of the channels. METHODS: A standardized protocol for the use of ICG in catheterizable channel creation was developed in an adaptive process in this single institution pilot study. Stryker’s SPY PHI system and SPY-QP quantification system were used. SPY-QP allowed for quantification of ICG uptake in the channel relative to healthy bowel. The standardized protocol is described in figure 1. RESULTS: ICG was used in the creation of 3 new appendicovesicostomies and 1 channel revision. Overall, perfusion to the channel decreased with increasing mobilization, but degree of decrease varied between patients. The median ICG uptake went from 85.5% immediately after stapling the appendix to 63.5% when examining the subfascial channel after maturing and 27% at the stoma. In the one revision, ICG clearly delineated an area of poor perfusion in the distal channel after complete mobilization of the channel off the skin and fascial attachments. CONCLUSIONS: The standardized protocol for use in catheterizable channels was successfully implemented. In the channel revision, ICG clearly delineated the area of distal hypoperfusion after channel takedown. ICG can provide surgeons with an objective assessment of channel perfusion rather than relying on subjective assessment alone. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e228 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Raines More articles by this author Jennifer Ahn More articles by this author Nicolas Fernandez More articles by this author Mark Cain More articles by this author Byron Joyner More articles by this author Kathleen Kieran More articles by this author Margarett Shnorhavorian More articles by this author Paul Merguerian More articles by this author Expand All Advertisement PDF downloadLoading ...

Alteration of intracranial blood perfusion in temporal lobe epilepsy, an arterial spin labeling study

BackgroundA critical necessity before surgical resection in mesial temporal lobe epilepsy (mTLE) is lateralizing the seizure focus in the temporal lobe. This study aimed to investigate the differences in perfusion pattern changes in right and left mTLE. Methods42 mTLE patients (22 left and 20 right mTLE) and 14 controls were surveyed with pulsed arterial spin labeling at 3.0 T. The mean cerebral blood flow (CBF) and asymmetry index (AI) were calculated in the bilateral temporal lobe, amygdala, hippocampus, parahippocampus, and nine bilateral vascular territories ROIs. The alterations in whole-brain CBF were identified using statistical parametric mapping (SPM). ResultsCBF decreased in ipsilateral sides in both epilepsy subcohorts, with right mTLE showing a significant difference in most ROIs while left mTLE exhibiting no significant change. CBF comparison of left mTLE and controls showed a significant drop in ROI analysis in left middle temporal and left intermediate posterior cerebral artery and in AI analysis in parahippocampus, distal anterior cerebral artery, distal middle cerebral artery, and intermediate anterior cerebral artery. CBF hypoperfusion was seen in ROI analysis in the left intermediate anterior cerebral artery, left middle temporal, right middle temporal, left superior temporal in the right mTLE compared to controls. Left mTLE CBF differed significantly from right mTLE CBF in right distal middle cerebral artery ROI and AI of proximal middle cerebral artery. ConclusionOur result revealed that mTLE affects extratemporal regions and both mTLE subcohorts with different perfusion patterns, which may enhance the performance of preoperative MRI assessment in lateralization procedures.

Gadolinium-based MR cisternography with prepontine cisternal routine for evaluating distribution pattern of intrathecal targeted drug delivery in pain management

Gadolinium-based MR cisternography has been mainly applied in clinical evaluation of cerebrospinal fluid leaking, that is conducted by intrathecal administration of contrast media. Recently, we have reported one novel technique of intrathecal targeted drug delivery with prepontine cisternal routine to treat orofacial cancer pain. The aim of this study was to examine the distribution pattern of this intrathecal drug delivery strategy. Here, we introduce one case who suffered severe orofacial pain caused by sublingual gland tumor, and successfully attenuated by prepontine cisternal administration of analgesic agents. To assess the distribution of intrathecal drugs, postoperative MR images of brain, cervical, thoracic, and lumbar segments in axial, coronal, and sagittal planes were obtained after application of gadolinium. The perfusion rate of contrast medium was set at 0.01 mmol per hour for 24 hours prior to MR scanning. In the T1-weighted images, we can identify contrast spread not only locating around the site of the intrathecal catheter tip, but also concentrated to the lateral sides. None obvious side effect was found after intrathecal injection of contrast media. Thus, our finding demonstrated the local distribution phenomenon of intrathecal drugs through prepontine cisternal access, and the bilateral perfusion pattern may provide insights underlying the analgesic mechanism of trigeminal pain provided by this novel intrathecal therapy. Gadolinium-based MR cisternography may serve as a potential tool to confirm the therapeutic effect of intrathecal targeted drug delivery via prepontine cisternal routine in orofacial pain management.

Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation

BackgroundIntraoperative indocyanine green fluorescence angiography (ICG-FA) may be of added value during pouch surgery, in particular after vascular ligations as lengthening maneuver. The aim was to determine quantitative perfusion parameters within the efferent/afferent loop and explore the impact of vascular ligation. Perfusion parameters were also compared in patients with and without anastomotic leakage (AL).MethodsAll consenting patients that underwent FA-guided ileal pouch-anal anastomosis (IPAA) between July 2020 and December 2021 were included. After intravenous bolus injection of 0.1 mg/kg ICG, the near-infrared camera (Stryker Aim 1688) registered the fluorescence intensity over time. Quantitative analysis of ICG-FA from standardized regions of interests on the pouch was performed using software. Fluorescence parameters were extracted for inflow (T0, Tmax, Fmax, slope, Time-to-peak) and outflow (T90% and T80%). Change of management related to FA findings and AL rates were recorded.ResultsTwenty-one patients were included, three patients (14%) required vascular ligation to obtain additional length, by ligating terminal ileal branches in two and the ileocolic artery (ICA) in one patient. In nine patients the ICA was already ligated during subtotal colectomy. ICG-FA triggered a change of management in 19% of patients (n = 4/21), all of them had impaired vascular supply (ligated ileocolic/ terminal ileal branches). Overall, patients with intact vascular supply had similar perfusion patterns for the afferent and efferent loop. Pouches with ICA ligation had longer Tmax in both afferent as efferent loop than pouches with intact ICA (afferent 51 and efferent 53 versus 41 and 43 s respectively). Mean slope of the efferent loop diminished in ICA ligated patients 1.5(IQR 0.8–4.4) versus 2.2 (1.3–3.6) in ICA intact patients.ConclusionQuantitative analysis of ICG-FA perfusion during IPAA is feasible and reflects the ligation of the supplying vessels.

Dermal Nipple-Areola Complex Perfusion through Circumareolar Scars: A Delay Model in Two-Stage Nipple-Sparing Mastectomy.

Nipple-sparing mastectomy (NSM) has evolved as a standard surgical option. The NSM complication rate remains high in large breasts. To reduce the risk of necrosis, several authors have proposed delayed procedures to enhance blood supply to the nipple-areola complex (NAC). The purpose of this study in a porcine model was to show adequate redirection of NAC perfusion by neoangiogenesis through circumareolar scars. Delayed two-staged NSM was simulated in 52 nipples (six pigs) with a 60-day interval. The nipples underwent a full-thickness, circumareolar incision onto the muscular fascia, with preservation of underlying glandular perforators. After 60 days, NSM was performed through a radial incision. A silicone sheet was introduced in the mastectomy plane to prevent NAC revascularization by wound bed imbibition. Digital color imaging was used to assess necrosis. Near-infrared fluorescence with indocyanine green was used to assess perfusion patterns and perfusion in real time. No NAC necrosis was seen after 60 days' delay in any nipples. In all nipples, indocyanine green angiography showed complete alteration of the NAC vascular perfusion pattern from subjacent gland to a capillary fill following devascularization, exhibiting a predominant arteriolar capillary blush without distinct larger vessels. NAC delay reverses glandular perfusion to adequate dermal neovascularization. Neovascularization through full-thickness scars provides sufficient dermal perfusion after 60 days' delay. Identical staged delay in humans may be a surgically safe NSM option and could broaden therapeutic NSM indications in difficult breasts. Large clinical trials are necessary to provide identical results in human breasts. NAC delay reverses glandular perfusion to adequate dermal neovascularization. Neovascularization through full-thickness scars provides sufficient dermal perfusion after 60 days of delay. Identical staged delay in humans may be a surgically safe NSM option.

A quantitative assessment of perfusion of the gastric conduit after oesophagectomy using near-infrared fluorescence with indocyanine green

IntroductionAnastomotic leakage is a severe complication after oesophageal resection with gastric conduit reconstruction. Poor perfusion of the gastric conduit plays an important role in the development of anastomotic leakage. Quantitative near-infrared (NIR) fluorescence angiography with indocyanine green (ICG-FA) is an objective technique that can be used for perfusion assessment. This study aims to assess perfusion patterns of the gastric conduit with quantitative ICG-FA. MethodsIn this exploratory study, 20 patients undergoing oesophagectomy with gastric conduit reconstruction were included. A standardized NIR ICG-FA video of the gastric conduit was recorded. Postoperatively, the videos were quantified. Primary outcomes were the time-intensity curves and nine perfusion parameters from contiguous regions of interest on the gastric conduit. A secondary outcome was the inter-observer agreement of subjective interpretation of the ICG-FA videos between six surgeons. The inter-observer agreement was tested with an intraclass correlation coefficient (ICC). ResultsIn a total of 427 curves, three distinct perfusion patterns were recognized: pattern 1 (steep inflow, steep outflow); pattern 2 (steep inflow, minor outflow); and pattern 3 (slow inflow, no outflow). All perfusion parameters were significantly different between the perfusion patterns. The inter-observer agreement was poor – moderate (ICC:0.345,95%CI:0.164–0.584). DiscussionThis was the first study to describe perfusion patterns of the complete gastric conduit after oesophagectomy. Three distinct perfusion patterns were observed. The poor inter-observer agreement of the subjective assessment underlines the need for quantification of ICG-FA of the gastric conduit. Further studies should evaluate the predictive value of perfusion patterns and parameters on anastomotic leakage.

Abstract Number ‐ 46: Automated Magnetic Resonance Perfusion Imaging in the Management of Delayed Cerebral Ischemia: A Pilot Study

Introduction Inadequate perfusion secondary to changes in vascular narrowing and breakdown of cerebral autoregulation is thought to be a major contributor to delayed cerebral ischemia (DCI). Subjective evaluation of narrowing of large and medium intracranial vessels on angiography detects vasospasm in up to 70% of patients, though only 30% become clinically symptomatic. There are no available tools for the quantification of tissue level perfusion to detect critical levels of ischemia in this setting. We aimed to evaluate focal perfusion changes using MR‐perfusion weighted imaging with automated thresholding of flow and timing parameters in the setting of DCI. Methods This is a prospective observational pilot study that includes seven patients with SAH. All patients underwent multimodality MRI including diffusion and perfusion imaging when there was concern for DCI. RAPID software was used to process diffusion and perfusion images and obtain threshold maps for diffusion restriction, Tmax prolongation and drops in cerebral blood volume (CBV), and cerebral blood flow (CBF). Correspondence of neuroanatomic location of focal perfusion alteration and pattern of perfusion alteration was evaluated. Results Neuroanatomical location of perfusion alteration corresponded to neurological symptoms in 86% (6/7) of patients. The prominent patterns were: prolongation of Tmax greater than four seconds (7/7), greater than 20% drop in CBF (3/7), and greater than 20% drop in CBV (3/7). Significant radiographic vasospasm on concurrently catheter angiogram and/or MR angiogram which corresponded to the supplying vessels to the neuroanatomic area with altered perfusion was seen in 71% (5/7) of the patients. Conclusions MRI‐perfusion imaging using RAPID software can help detect and quantify the presence of inadequate focal perfusion for DCI in real‐time. This tool could guide the timing and extent of endovascular vasodilatory and medical hyperdynamic treatment and larger studies of MRI‐perfusion imaging for DCI are warranted.

Classifying Kidney Disease in a Vervet Model Using Spatially Encoded Contrast-Enhanced Ultrasound Perfusion Parameters.

Early stages of diabetic kidney disease (DKD) are difficult to diagnose in patients with type 2 diabetes. This work was aimed at identifying contrast-enhanced ultrasound (CEUS) perfusion parameters, a microcirculatory biomarker indicative of early DKD progression. CEUS kidney flash-replenishment data were acquired in control, insulin resistant and diabetic vervet monkeys (N=16). By use of a mono-exponential model, time-intensity curve parameters related to blood volume (A), velocity (β) and flow rate (perfusion index [PI]) were extracted from 10 concentric kidney layers to study spatial perfusion patterns that could serve as strong indicators of disease. Mean squared error (MSE) was used to assess model performance. Features calculated from the perfusion parameters were inputs for the linear regression models to determine which features could distinguish between cohorts. The mono-exponential model performed well, with average MSEs (±standard deviation) of 0.0254 (±0.0210), 0.0321 (±0.0242) and 0.0287 (±0.0130) for the control, insulin resistant and diabetic cohorts, respectively. Perfusion index features, with blood pressure, were the best classifiers between cohorts (p < 0.05). CEUS has the potential to detect early microvascular changes, providing insight into disease-related structural changes in the kidney. The sensitivity of this technique should be explored further by assessing various stages of DKD.

Real-time administration of indocyanine green in combination with computer vision and artificial intelligence for the identification and delineation of colorectal liver metastases

IntroductionFluorescence guided surgery for the identification of colorectal liver metastases (CRLM) can be better with low specificity and antecedent dosing impracticalities limiting indocyanine green (ICG) usefulness currently. We investigated the application of artificial intelligence methods (AIM) to demonstrate and characterise CLRMs based on dynamic signalling immediately following intraoperative ICG administration. MethodsTwenty-five patients with liver surface lesions (24 CRLM and 1 benign cyst) undergoing open/laparoscopic/robotic procedures were studied. ICG (0.05 mg/kg) was administered with near-infrared recording of fluorescence perfusion. User-selected region-of-interest (ROI) perfusion profiles were generated, milestones relating to ICG inflow/outflow extracted and used to train a machine learning (ML) classifier. 2D heatmaps were constructed in a subset using AIM to depict whole screen imaging based on dynamic tissue-ICG interaction. Fluorescence appearances were also assessed microscopically (using H&E and fresh-frozen preparations) to provide tissue-level explainability of such methods. ResultsThe ML algorithm correctly classified 97.2 % of CRLM ROIs (n = 132) and all benign lesion ROIs (n = 6) within 90-s of ICG administration following initial mathematical curve analysis identifying ICG inflow/outflow differentials between healthy liver and CRLMs. Time-fluorescence plots extracted for each pixel in 10 lesions enabled creation of 2D characterising heatmaps using flow parameters and through unsupervised ML. Microscopy confirmed statistically less CLRM fluorescence vs adjacent liver (mean ± std deviation signal/area 2.46 ± 9.56 vs 507.43 ± 160.82 respectively p < 0.001) with H&E diminishing ICG signal (n = 4). ConclusionML accurately identifies CRLMs from surrounding liver tissue enabling representative 2D mapping of such lesions from their fluorescence perfusion patterns using AIM. This may assist in reducing positive margin rates at metastatectomy and in identifying unexpected/occult malignancies.

Large-scale transient peri-ictal perfusion magnetic resonance imaging abnormalities detected by quantitative image analysis.

Epileptic seizures require a rapid and safe diagnosis to minimize the time from onset to adequate treatment. Some epileptic seizures can be diagnosed clinically with the respective expertise. For more subtle seizures, imaging is mandatory to rule out treatable structural lesions and potentially life-threatening conditions. MRI perfusion abnormalities associated with epileptic seizures have been reported in CT and MRI studies. However, the interpretation of transient peri-ictal MRI abnormalities is routinely based on qualitative visual analysis and therefore reader dependent. In this retrospective study, we investigated the diagnostic yield of visual analysis of perfusion MRI during ictal and postictal states based on comparative expert ratings in 51 patients. We further propose an automated semi-quantitative method for perfusion analysis to determine perfusion abnormalities observed during ictal and postictal MRI using dynamic susceptibility contrast MRI, which we validated on a subcohort of 27 patients. The semi-quantitative method provides a parcellation of 3D T1-weighted images into 32 standardized cortical regions of interests and subcortical grey matter structures based on a recently proposed method, direct cortical thickness estimation using deep learning-based anatomy segmentation and cortex parcellation for brain anatomy segmentation. Standard perfusion maps from a Food and Drug Administration-approved image analysis tool (Olea Sphere 3.0) were co-registered and investigated for region-wise differences between ictal and postictal states. These results were compared against the visual analysis of two readers experienced in functional image analysis in epilepsy. In the ictal group, cortical hyperperfusion was present in 17/18 patients (94% sensitivity), whereas in the postictal cohort, cortical hypoperfusion was present only in 9/33 (27%) patients while 24/33 (73%) showed normal perfusion. The (semi-)quantitative dynamic susceptibility contrast MRI perfusion analysis indicated increased thalamic perfusion in the ictal cohort and hypoperfusion in the postictal cohort. Visual ratings between expert readers performed well on the patient level, but visual rating agreement was low for analysis of subregions of the brain. The asymmetry of the automated image analysis correlated significantly with the visual consensus ratings of both readers. We conclude that expert analysis of dynamic susceptibility contrast MRI effectively discriminates ictal versus postictal perfusion patterns. Automated perfusion evaluation revealed favourable interpretability and correlated well with the classification of the visual ratings. It may therefore be employed for high-throughput, large-scale perfusion analysis in extended cohorts, especially for research questions with limited expert rater capacity.

Evaluation and Classification of Incidentally Detected Splenic Lesions Based on B-Mode and Contrast-Enhanced Ultrasound.

To evaluate B-mode ultrasound (B-US) and contrast-enhanced ultrasound (CEUS) patterns of focal splenic incidentalomas (FSIs), and to correlate ultrasound patterns with benignity and malignancy via histologic examination and/or the clinical course. Between 2004 and 2021, 139 consecutive patients with an FSI detected by B-US were investigated additionally with CEUS. On CEUS, the arterial enhancement (AE) of the FSI (hyperenhancement, isoenhancement, hypoenhancement, and absent enhancement) was analyzed. Subsequently, the malignancy rate according to different B-US echo patterns and CEUS perfusion patterns was determined. The final diagnosis of FSI was malignant in 9/139 (6.5%) and benign in 130/139 (93.5%) cases. The hypoechoic and hyperechoic lesions on B-US with arterial hyperenhancement on CEUS and the echogenic cystic or complex lesions on B-US with predominantly absent enhancement on CEUS were benign in 54/54 (100%) cases. 6/37 (16.2%) hypoechoic lesions on B-US with arterial hypo-/isoenhancement on CEUS and 3/48 (6.3%) of hyperechoic lesions on B-US with an arterial hypo-/isoenhancement on CEUS were malignant. Based on these results, FSIs reveal different malignancy rates depending on the B-US und CEUS patterns, and classification according to these B-US and CEUS patterns may be helpful in further evaluation of an FSI.

Association of ictal aphasia with hypoperfusion in language areas in temporal lobe epilepsy patients

Ictal clinical phenomenology, including aphasia, is usually associated with increased regional cerebral perfusion. We present an unusual pattern of ictal cerebral perfusion in three patients with pharmacoresistant, lesional temporal lobe epilepsy and ictal/postictal aphasia studied with prolonged video-EEG, ictal, and interictal SPECT and MRI for pre-surgical evaluation. Subtraction of ictal-interictal SPECT images co-registered with MRI (SISCOM) showed ictal hyperperfusion in the temporal epileptogenic area in all patients. In addition, hypoperfusion of Broca's area in one case, Wernicke's area in other patient, and both areas in the remaining one were observed. Ictal aphasia in these patients may be explained by functional inhibition of a primary language area, driven by the epileptogenic network. This pattern can contribute to understand the pathophysiology of some ictal signs, with an impact on the evaluation of individual surgical risks.

Quantitative ICG-fluorescence angiography of a gastric conduit after oesophagectomy – identifying objective and clinically relevant perfusion patterns

Quantitative ICG-fluorescence angiography of a gastric conduit after oesophagectomy – identifying objective and clinically relevant perfusion patterns

Comparison of dual-energy CT with positron emission tomography for lung perfusion imaging in patients with non-small cell lung cancer

Objective. Functional lung avoidance (FLA) radiotherapy treatment aims to spare lung regions identified as functional from imaging. Perfusion contributes to lung function and can be measured from the determination of pulmonary blood volume (PBV). An advantageous alternative to the current determination of PBV from positron emission tomography (PET) may be from dual energy CT (DECT), due to shorter examination time and widespread availability. This study aims to determine the correlation between PBV determined from DECT and PET in the context of FLA radiotherapy. Approach. DECT and PET acquisitions at baseline of patients enrolled in the HI-FIVE clinical trial (ID: NCT03569072) were reviewed. Determination of PBV from PET imaging (), from DECT imaging generated from a commercial software (Syngo.via, Siemens Healthineers, Forchheim, Germany) with its lowest () and highest () smoothing level parameter value (R), and from a two-material decomposition (TMD) method () with variable median filter kernel size (L) were compared. Deformable image registration between DECT images and the CT component of the PET/CT was applied to PBV maps before resampling to the PET resolution. The Spearman correlation coefficient (r s) between PBV determinations was calculated voxel-wise in lung subvolumes. Main results. Of this cohort of 19 patients, 17 had a DECT acquisition at baseline. PBV maps determined from the commercial software and the TMD method were very strongly correlated [r s( ) = 0.94 ± 0.01 and r s( ) = 0.94 ± 0.02]. was strongly correlated with [r s( ) = 0.67 ± 0.11]. Perfusion patterns differed along the posterior-anterior direction [r s( ) = 0.77 ± 0.13/0.57 ± 0.16 in the anterior/posterior region]. Significance. A strong correlation between DECT and PET determination of PBV was observed. Streak and smoothing effects in DECT and gravitational artefacts and misregistration in PET reduced the correlation posteriorly.

Neurodevelopmental and functional outcome in hypoplastic left heart syndrome after Hybrid procedure as stage I.

Patients with hypoplastic left heart syndrome (HLHS) undergoing staged palliation until Fontan procedure are at risk for impaired neurodevelopmental (ND) outcome. The Hybrid procedure with bilateral pulmonary artery banding, ductal stenting, and balloon atrioseptostomy may offer a less invasive stage I procedure compared to the Norwood stage I procedure avoiding early neonatal cardiopulmonary bypass (CPB) surgery. Despite altered fetal cerebral hemodynamics, the type of stage I procedure may be a covariate influencing ND outcome and functional outcome may also be altered due to postponing neonatal CPB surgery. Within this review, we analyzed ND outcome as well as functional outcome after Hybrid procedure as stage I procedure. The review analyzed original publications (OPs) published before March 15, 2022, identified by Cochrane, EMBASE, OVID, Scopus, and Web of science. An OP was included if short-to-long-term neurodevelopment outcome, brain development, somatic, and cardiac outcome in patients for HLHS and variants treated by Hybrid procedure were analyzed. In addition to database searches, we reviewed all references of the analyzed OP to obtain a comprehensive list of available studies. The author, year of publication, demographic characteristics of study population, study design (prospective or retrospective), study assessment, and main findings were summarized. Twenty-one OPs were included with data of patients with ND outcome and functional cardiac outcome. Overall, there is an impaired mid-term ND outcome in patients with Hybrid procedure as stage I for HLHS. Only slight differences between stage I procedures (Hybrid vs. Norwood) in two comparing studies have been determined affecting right ventricular remodeling, short- and mid-term ND outcome, reduced brain growth until two years of age, sufficient quality of life, and altered hemodynamics influencing brain volumes and cerebral perfusion pattern. Despite some minor differences regarding the mid-term follow-up in patients with HLHS comparing Hybrid vs. Norwood procedure, its impact on ND outcome seems rather low. This may be explained by the large number of covariates as well as the small study populations and the different selection criteria for patients undergoing Hybrid or Norwood procedure as stage I.

Contrast-Enhanced Ultrasound of Fibrolamellar Hepatocellular Carcinoma

We present the case of a 24-year-old male patient, who was admitted for endoscopy due to sustained pain in the upper abdomen with nausea and postprandial fullness without vomiting for more than 5 months. In the physical examination, an epigastric induration was found. Endoscopy revealed an external impression of the proximal duodenum. Beyond that, normal findings could be ascertained in gastroscopy and ileo-colonoscopy. Abdominal ultrasound identified a large hypoechoic lesion in the left liver lobe with a sharp delineation. Along the upper mesenteric vessels, enlarged lymphnodes were visible with contact to the proximal duodenum. Contrast-enhanced ultrasound (CE-US) was conducted and revealed the typical perfusion pattern of hepatocellular carcinoma. For further assessment, an ultrasound-guided core-biopsy of the lesion was performed. The histopathological evaluations resulted in the diagnosis of a hepatocellular carcinoma of fibrolamellar subtype.With the present case, we want to illustrate the perfusion pattern of a fibrolamellar hepatocellular carcinoma in contrast-enhanced ultrasound. Even though the tumor tissue is surrounded by lamellar bands of fibrosis with collagen-rich fibers, the perfusion pattern is consistent with the previously known appearance of HCC in CE-US.

Facial thermal and blood perfusion patterns of human emotions: Proof-of-Concept

In this work, a preliminary study of proof-of-concept was conducted to evaluate the performance of the thermographic and blood perfusion data when emotions of positive and negative valence are applied, where the blood perfusion data are obtained from the thermographic data. The images were obtained for baseline, positive, and negative valence according to the protocol of the Geneva Affective Picture Database. Absolute and percentage differences of average values of the data between the valences and the baseline were calculated for different regions of interest (forehead, periorbital eyes, cheeks, nose and upper lips). For negative valence, a decrease in temperature and blood perfusion was observed in the regions of interest, and the effect was greater on the left side than on the right side. In positive valence, the temperature and blood perfusion increased in some cases, showing a complex pattern. The temperature and perfusion of the nose was reduced for both valences, which is indicative of the arousal dimension. The blood perfusion images were found to be greater contrast; the percentage differences in the blood perfusion images are greater than those obtained in thermographic images. Moreover, the blood perfusion images, and vasomotor answer are consistent, therefore, they can be a better biomarker than thermographic analysis in identifying emotions.

Abnormal left ventricular subendocardial perfusion and diastolic function in women with obesity and heart failure and preserved ejection fraction

Purpose– Coronary microvascular dysfunction (CMD) is common in patients with heart failure with preserved ejection fraction (HFpEF) and obesity. Stress cardiovascular magnetic resonance (CMR) has been proposed as a non-invasive tool for detection of CMD. The aim of this study was to determine relationship between CMD and diastolic function in patients with HFpEF using a novel CMR technique.Methods– Patients with obesity and HFpEF without epicardial coronary artery disease (CAD) underwent Doppler echocardiography to measure diastolic function, followed by vasodilator stress CMR, using a single bolus, dual sequence, quantitative myocardial perfusion mapping to measure myocardial blood flow (MBF) at rest and at peak hyperemia. With this, myocardial perfusion reserve (MPR), global stress endocardial-to-epicardial (endo:epi) perfusion ratio, and total ischemic burden (IB, defined as myocardial segments with MBF < 1.94 mL/min/g) were calculated. Results are reported as median and interquartile range.Results– Nineteen subjects were enrolled (100% female, 42% Black). Median age was 64 [56–72] years. Global stress MBF was 2.43 ml/min/g [2.16–2.78] and global myocardial perfusion reserve (MPR) was 2.34 [2.07–2.88]. All had an abnormal subendocardial perfusion with an endo:epi of less than 1 (0.87 [0.81–0.90]). Regional myocardial hypoperfusion was detected in 14 (74%) patients with an IB of 6% [0-34.4]. Endo:epi ratio significantly correlated with IB (R=-0.510, p = 0.026) and measures of diastolic function (R = 0.531, p = 0.019 and R=-0.544, p = 0.014 for e’ and E/e’ respectively).Conclusion– Using a novel quantitative stress CMR myocardial perfusion mapping technique, women with obesity and HFpEF were found to have patterns of abnormal subendocardial perfusion which significantly correlated with measures of diastolic dysfunction.

Inflammatory Pseudotumor of the Omentum in Contrast-enhanced Ultrasound.

Inflammatory pseudotumor is a rare benign tumor that can occur at various body sites. Due to its rare occurrence and histological variety radiological data is heterogeneous and limited. We present a case of a 71-year-old man with inflammatory pseudotumor of the omentum. Contrast-enhanced ultrasound perfusion pattern showed homogeneous, isoechoic enhancement in the arterial phase with a washout phenomenon in the parenchymal phase, mimicking a peritoneal carcinomatosis. Inflammatory pseudotumor represents a rare, but important benign differential diagnostic option when considering a malignant disorder. Contrast-enhanced ultrasound is helpful in identifying vital tissue for a targeted biopsy for subsequent histological examination that is essential for the exclusion of malignancy.

Особливості мозкового кровотоку у пацієнтів з різними видами головного болю

Introduction. Currently, the most common types of neurological diseases presenting with headache are migraine (M), tension-type headache (TTH) and cervicogenic headache (CH). At the current level, the use of such a highly informative method as duplex scanning in the diagnosis of various types of headache is relevant. A large number of works are devoted to the study of cerebral hemodynamic disorders in patients with migraine with and without aura, in the period between attacks and during an attack. In patients with M, a change in the tone of the vessels of the arterial bed, an increase in interictal hypotension, a decrease in cerebral blood flow reserves, and the phenomenon of venous dysemia were determined. Paradoxical vascular reaction and disruption of autoregulation were noted in patients with TTH. Hemodynamic characteristics of TTH were signs of increased tone in extracranial arteries and decreased tone in intracranial vessels; decrease in cerebral blood flow reserves; signs of venous dyscirculation. In patients with CH the most pronounced changes in hemodynamics in the form of a decrease in speed and an increase in blood flow kinematic indices are observed in VA and BA. Also, in patients with CH, there is a correlation between the severity of vertebral dysfunction and cerebral dysgemia In the available works, hemodynamic patterns characteristic of certain types of headache were not determined. Nor was a comparison of hemodynamic characteristics in patients with M, TTH and CH. In connection with the above, the question of the role of vascular factors is relevant for the study of pathogenetic mechanisms of the development of various types of headache. The aim of the work was to study the features of blood circulation in extra- and intracerebral vessels in patients with migraine, tension type headache and cervicogenic headache. Materials and methods. 458 young patients (16-44 years old, men – 203, women – 255) with various types of headache were studied; including migraine – 124 patients, tension type headache – 186 patients, cervicogenic headache – 146 patients. The indicators of peak systolic blood flow velocity (Vs), time-averaged maximum blood flow velocity (TAMX), pulsatility (PI) and resistance (RI) indices in general (CCA), external (ECA), internal carotid (ICA), vertebral (VA) in segments V2 and V4, anterior (ACA), middle (MCA), posterior (PMA) cerebral, and basilar (BA) arteries were studied The results. In all clinical groups, there was a decrease in speed indicators and an increase in the values of the resistance index in VA. Changes in hemodynamics in the V2 segments are possibly due to extravasal compression and hypoplasia of the VA. In patients with M, the flow rate along the MCA was significantly increased. Patients with TTH showed excessive perfusion of BA. Pulsation index in MCA was increased in TTH and in M. PI values in patients with TTH were moderately increased in PMA and BA. In patients with M and TTH an increase in the PI index was observed in the MCA, the PI index was increased in the PMA in patients with CH and decreased in the groups with M and TTH. This index was increased in VA and BA in all clinical groups. In the group of patients with M, the peak-like variant of the spectrum in MCA prevailed. A characteristic feature of the group of patients with CH was the dominance of the peak-like spectrum in VA. Conclusions. Hemodynamic indicators in the extracranial segments of VA were reduced in all clinical groups, which is probably caused in most cases by vertebral impact and structural changes. Patterns of excessive perfusion in MCA were characteristic for patients with M and TTH, in PMA – for patients with M, in VA – for patients with CH, in BA – for patients with M and CH. In the group of patients with CH, the leading hemodynamic pattern was the presence of vasospastic reactions in the vertebral vessels. Pulsation indices increased in patients with TTH in MCA, as well as in patients with CH in PMA and BA. The predominance of the peak-like spectrum of the Doppler curve was noted in MCA in patients with M and in VA in patients with CH.