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Gryseleyn R, Schlund M, Pigache P, Wojcik T, Raoul G, Ferri J. Influence of preoperative imaging on fibula free flap harvesting. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:265-270. [PMID: 28529045 DOI: 10.1016/j.jormas.2017.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/22/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The fibula free flap (FFF) is the gold standard for the reconstruction of large maxillofacial defects. Magnetic resonance angiography (MRA) seems to supersede digital subtraction angiography (DSA) as the reference in preoperative evaluation, being non-invasive and having equivalent diagnostic results. The aim of this study was to assess the impact of preoperative MRA versus DSA on the viability of FFF and its success rate. MATERIAL AND METHODS A total of 216 patients, who underwent mandibular or maxillary FFF reconstruction from January 1995 to January 2011, were retrospectively included in the study. Of them, 101 patients underwent preoperative DSA and 115 underwent MRA. Recorded criteria were as follows: age, sex, tobacco consumption, defect etiology, preoperative vascular assessment, donor-site choice and flap failure. The DSA group was compared to the MRA group. RESULTS The harvested side was switched in 15.7% of cases with preoperative MRA versus 4% with DSA. Our success rate was higher (96.1%) with MRA than with DSA (88.1%) (P<0.05). More atherosclerotic patients (P=0.004) were diagnosed through MRA. MRA and DSA showed similar results in anatomical variation detection. CONCLUSION MRA is less invasive and more effective in atherosclerosis detection than DSA. Therefore, donor-site switching was more frequent in the MRA group, which led to a better success rate. MRA should replace DSA as the reference in preoperative assessment.
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Affiliation(s)
- R Gryseleyn
- Service de stomatologie et chirurgie maxillo-faciale, université Lille 2, hôpital Roger-Salengro, CHU Lille, 59000 Lille, France
| | - M Schlund
- Service de stomatologie et chirurgie maxillo-faciale, université Lille 2, hôpital Roger-Salengro, CHU Lille, 59000 Lille, France.
| | - P Pigache
- Service de stomatologie et chirurgie maxillo-faciale, université Lille 2, hôpital Roger-Salengro, CHU Lille, 59000 Lille, France
| | - T Wojcik
- Département de cancérologie cervico-faciale, centre Oscar-Lambret, université Lille 2, 59000 Lille, France
| | - G Raoul
- Service de stomatologie et chirurgie maxillo-faciale, université Lille 2, hôpital Roger-Salengro, CHU Lille, 59000 Lille, France; Inserm U 1008, controlled drug delivery systems and biomaterials, 59000 Lille, France
| | - J Ferri
- Service de stomatologie et chirurgie maxillo-faciale, université Lille 2, hôpital Roger-Salengro, CHU Lille, 59000 Lille, France; Inserm U 1008, controlled drug delivery systems and biomaterials, 59000 Lille, France
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Wurz C, Davari A, Ackermann H, Vogl TJ. Diagnostic performance of CE-MRA in grading stenosis and therapy planning with TASC II classification. Vascular 2014; 23:403-10. [PMID: 25298134 DOI: 10.1177/1708538114552094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To assess to what extent results of CE-MRA coincide with DSA in grading of stenosis and planning of therapy in patients with PAOD. Materials and methods Retrospectively, images of 71 PAOD-patients were studied by three observers. For evaluation, the lower limb was subdivided into 31 segments and categorized with TASCII-score. Results In grading stenosis, both modalities agreed in 93.26%. CE-MRA achieved sensitivity of 92.69% and specificity of 96.87% (κ = 0.88). The concordance of TASCII-classification was almost perfect. Conclusion CE-MRA is an excellent method for the evaluation of PAOD with some tendency to overrate the grade of stenosis.
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Affiliation(s)
- Clemens Wurz
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum der Goethe-Universität, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Amir Davari
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum der Goethe-Universität, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Hanns Ackermann
- Institut für Biostatistik und Mathematische Modellierung, Klinikum der Goethe-Universität, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum der Goethe-Universität, Theodor-Stern-Kai 7, Frankfurt am Main, Germany
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Dhaliwal G, Mukherjee D. Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment. Int J Angiol 2012; 16:36-44. [PMID: 22477268 DOI: 10.1055/s-0031-1278244] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Lower extremity peripheral arterial disease (PAD) affects approximately 10% of the American population, with 30% to 40% of these patients presenting with claudication symptoms. The prevalence of PAD increases with age and the number of vascular risk factors. More importantly, it is a marker of atherosclerotic disease burden, and is associated with increased mortality from cardiovascular and cerebrovascular causes. There have been recent advances in noninvasive imaging, endovascular approaches for revascularization, and aggressive risk factor management for prevention of cardiac and cerebrovascular complications in PAD. There is now a trend toward aggressive risk factor modification and endovascular revascularization for most patients, with surgical interventions reserved for certain situations only. In the present article, a systematic review is presented, focusing on the key aspects of the disease epidemiology, presentation, natural history, diagnosis and available management options.
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Affiliation(s)
- Gurbir Dhaliwal
- Gill Heart Institute, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA
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Hybrid contrast-enhanced MR angiography of pelvic and lower extremity vasculature at 3.0T: Initial experience. Eur J Radiol 2009; 70:170-6. [DOI: 10.1016/j.ejrad.2007.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 09/05/2007] [Accepted: 12/12/2007] [Indexed: 11/23/2022]
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Pedal Angiography in Peripheral Arterial Occlusive Disease: First-Pass IV Contrast-Enhanced MR Angiography with Blood Pool Contrast Medium Versus Intraarterial Digital Subtraction Angiography. AJR Am J Roentgenol 2009; 192:775-84. [DOI: 10.2214/ajr.08.1384] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
OBJECTIVE Current MRI technology and postprocessing tools have enabled 3D contrast-enhanced MR angiography (MRA) to evolve into a first-line noninvasive diagnostic tool to evaluate vascular disorders. CONCLUSION In this article, 3D MRA techniques, bolus timing issues, new IV contrast agents allowing a steady-state acquisition, principals of postprocessing, and unenhanced MRA techniques are reviewed and how to effectively use 3D gadolinium-enhanced MRA for peripheral arterial imaging is described.
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Contrast Enhanced Magnetic Resonance Angiography Versus Intra-arterial Digital Subtraction Angiography for Treatment Planning in Patients with Peripheral Arterial Disease: A Randomised Controlled Diagnostic Trial. Eur J Vasc Endovasc Surg 2008; 35:514-21; discussion 522-3. [DOI: 10.1016/j.ejvs.2007.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 12/04/2007] [Indexed: 11/22/2022]
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8
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Tizon X, Lin Q, Hansen T, Borgefors G, Johansson L, Ahlström H, Frimmel H. Identification of the main arterial branches by whole-body contrast-enhanced MRA in elderly subjects using limited user interaction and fast marching. J Magn Reson Imaging 2007; 25:806-14. [PMID: 17348000 DOI: 10.1002/jmri.20848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To extract a graph model corresponding to a predefined set of arterial branches from whole-body contrast-enhanced magnetic resonance angiography (CE-MRA) data sets in elderly asymptomatic subjects, a high-incidence group. MATERIALS AND METHODS Maximum intensity projections (MIPs) were used as an interface to place landmarks in the three-dimensional (3D) data sets. These landmarks were linked together using fast marching to form a graph model of the arterial tree. Only vessels of interest were identified. RESULTS We tested our method on 10 subjects. We were able to build a graph model of the main arterial branches that performed well in the presence of vascular pathologies, such as stenosis and aneurysm. The results were rated by an experienced radiologist, with an overall success rate of 80%. CONCLUSION We were able to extract chosen arterial branches in 3D whole-body CE-MRA images with a moderate amount of interaction using a single MIP projection.
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Affiliation(s)
- Xavier Tizon
- Centre for Image Analysis, SLU/Uppsala University, and Department of Oncology, Radiology and Clinical Immunology, Uppsala University Hospital, Sweden
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Deutschmann HA, Schoellnast H, Portugaller HR, Preidler KW, Reittner P, Tillich M, Pilger E, Szolar DHM. Routine Use of Three-Dimensional Contrast-Enhanced Moving-Table MR Angiography in Patients with Peripheral Arterial Occlusive Disease: Comparison with Selective Digital Subtraction Angiography. Cardiovasc Intervent Radiol 2006; 29:762-70. [PMID: 16625410 DOI: 10.1007/s00270-004-0309-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the diagnostic accuracy of contrast-enhanced (CE) three-dimensional (3D) moving-table magnetic resonance (MR) angiography with that of selective digital subtraction angiography (DSA) for routine clinical investigation in patients with peripheral arterial occlusive disease. METHODS Thirty-eight patients underwent CE 3D moving-table MR angiography of the pelvic and peripheral arteries. A commercially available large-field-of-view adapter and a dedicated peripheral vascular phased-array coil were used. MR angiograms were evaluated for grade of arterial stenosis, diagnostic quality, and presence of artifacts. MR imaging results for each patient were compared with those of selective DSA. RESULTS Two hundred and twenty-six arterial segments in 38 patients were evaluated by both selective DSA and MR angiography. No complications related to MR angiography were observed. There was agreement in stenosis classification in 204 (90.3%) segments; MR angiography overgraded 16 (7%) segments and undergraded 6 (2.7%) segments. Compared with selective DSA, MR angiography provided high sensitivity and specificity and excellent interobserver agreement for detection of severe stenosis (97% and 95%, kappa = 0.9 +/- 0.03) and moderate stenosis (96.5% and 94.3%, kappa = 0.9 +/- 0.03). CONCLUSION Compared with selective DSA, moving-table MR angiography proved to be an accurate, noninvasive method for evaluation of peripheral arterial occlusive disease and may thus serve as an alternative to DSA in clinical routine.
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Affiliation(s)
- Hannes A Deutschmann
- Medical University Graz, Department of Radiology, University Hospital Graz, Auenbruggerplatz 9, 8036 Graz, Austria
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Huegli RW, Aschwanden M, Bongartz G, Jaeger K, Heidecker HG, Thalhammer C, Schulte AC, Hashagen C, Jacob AL, Bilecen D. Intraarterial MR angiography and DSA in patients with peripheral arterial occlusive disease: prospective comparison. Radiology 2006; 239:901-8. [PMID: 16641335 DOI: 10.1148/radiol.2393041574] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate the accuracy of intraarterial magnetic resonance (MR) angiography in the depiction of significant stenoses and occlusions, with intraarterial digital subtraction angiography (DSA) serving as the reference standard. MATERIALS AND METHODS Approval of the local ethics committee and informed consent were obtained. Twenty patients (11 men; nine women; age range, 48-86 years; mean age, 69.5 years+/-11.2 [standard deviation]) with symptomatic peripheral arterial occlusive disease (PAOD) were prospectively enrolled. After percutaneous transluminal angioplasty (PTA), intraarterial MR angiography was performed in the thigh and the calf with a 1.5-T MR imager in two consecutive runs. Intraarterial MR angiography was performed with a low-dose injection protocol (ie, two 20-mL injections of a 50-mmol gadolinium-based contrast agent). Moderate stenoses (luminal narrowing<or=50%), significant stenoses (luminal narrowing 51%-99%), and occlusions (luminal narrowing of 100%) were identified on MR angiograms, which were compared with intraarterial DSA images. Intraarterial MR angiograms were analyzed for imaging artifacts. Sensitivity, specificity, accuracy, and positive and negative predictive values of intraarterial MR angiography with intraarterial DSA were determined for characterization of significant stenoses (>50%) or vessel occlusions; 95% confidence intervals (CIs) were calculated for sensitivity and specificity. RESULTS Intraarterial DSA revealed 78 moderate stenoses, 57 significant stenoses, and 28 occlusions. Sensitivity, specificity, and accuracy of intraarterial MR angiography in the characterization of significant stenoses or occlusions were 92% (95% CI: 72%, 99%), 94% (95% CI: 82%, 98%), and 93%, respectively, in femoropopliteal arteries and 93% (95% CI: 83%, 98%), 71% (95% CI: 51%, 86%), and 86%, respectively, in infrapopliteal arteries. The main artifact observed with intraarterial MR angiography was venous contamination (12%). CONCLUSION Intraarterial MR angiography is an accurate method used to depict significant stenoses and occlusions in lower extremity arteries with a low-dose injection protocol.
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Affiliation(s)
- Rolf W Huegli
- Department of Radiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland.
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Abstract
Magnetic resonance angiography (MRA) has evolved over the past years from an experimental imaging modality to a technique that is now widely applied in clinical practice. This article reviews the fundamentals of the different magnetic resonance angiographic techniques and how they can be applied for abdominal and peripheral arterial imaging. Currently, contrast-enhanced magnetic resonance angiography (CE-MRA), whereby a luminogram is obtained during initial arterial passage of contrast material, is the most widely used technique. With current hardware and software, high-spatial resolution images of the abdominal aorta and proximal visceral branches can be obtained that are equivalent to intra-arterial digital subtraction angiography (IA-DSA). High-quality imaging of the renal arteries demands isotropic voxels and reformations orthogonal to the vessel axis for evaluation. Contrast-enhanced magnetic resonance angiography of the peripheral vascular tree is now a highly accurate technique and has replaced diagnostic intra-arterial digital subtraction angiography and duplex ultrasonography in many hospitals.
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Affiliation(s)
- Tim Leiner
- Maastricht University Hospital, Department of Radiology, Maastricht, The Netherlands.
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12
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Beckman JA, Creager MA. Peripheral Arterial Disease: Clinical Evaluation. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sommerville RS, Jenkins J, Walker P, Olivotto R. 3-D MAGNETIC RESONANCE ANGIOGRAPHY VERSUS CONVENTIONAL ANGIOGRAPHY IN PERIPHERAL ARTERIAL DISEASE: PILOT STUDY. ANZ J Surg 2005; 75:373-7. [PMID: 15943719 DOI: 10.1111/j.1445-2197.2005.03395.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Angiography is usually performed as the preoperative road map for those requiring revascularization for lower extremity peripheral arterial disease (PAD). The alternative investigations are ultrasound, 3-D magnetic resonance angiography (3-D MRA) and computed tomography angiography. This pilot study aimed to assess whether 3-D MRA could replace the gold standard angiography in preoperative planning. METHODS Eight patients considered for aortoiliac or infrainguinal arterial bypass surgery were recruited. All underwent both imaging modalities within 7 days. A vascular surgeon and a radiologist each reported on the images from both the 3-D MRA and the angiography, with blinding to patient details and each others reports. Comparisons were made between the reports for the angiographic and the 3-D MRA images, and between the reports of the vascular surgeon and the radiologist. RESULTS Compared to the gold standard angiogram, 3-D MRA had a sensitivity of 77% and specificity of 94% in detecting occlusion, and a sensitivity of 72% and specificity of 90% in differentiating high grade (>50%) versus low grade (<50%) stenoses. There was an overall concordance of 78% between the two investigations with a range of 62% in the peroneal artery to 94% in the aorta. 3-D MRA showed flow in 23% of cases where conventional angiography showed no flow. CONCLUSIONS In the present pilot study, 3-D MRA had reasonable concordance with the gold standard angiography, depending on the level of the lesion. At times it showed vessel flow where occlusion was shown on conventional angiogram. 3-D MRA in peripheral vascular disease is challenging the gold standard, but is inconsistent at present.
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Affiliation(s)
- Ryan S Sommerville
- Department of Vascular Surgery, Royal Brisbane Hospital, Herston, Queensland, Australia.
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Romano M, Mainenti PP, Imbriaco M, Amato B, Markabaoui K, Tamburrini O, Salvatore M. Multidetector row CT angiography of the abdominal aorta and lower extremities in patients with peripheral arterial occlusive disease: diagnostic accuracy and interobserver agreement. Eur J Radiol 2004; 50:303-8. [PMID: 15145492 DOI: 10.1016/s0720-048x(03)00118-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2002] [Revised: 03/24/2003] [Accepted: 03/26/2003] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the accuracy of four channel multidetector row CT angiography (MDCTA) of the abdominal aorta and lower extremities arteries compared with digital subtraction angiography (DSA). MATERIALS AND METHODS In our prospective study 42 patients with peripheral vascular occlusive disease (27 M, 15 F, age range 40-79 years) underwent MDCTA and DSA within 5 days. Images were blindly interpreted by two radiologists. Maximum intensity projections (MIP), multiplanar (MPR) reformations, three-dimensional (3D) reconstructions as well as axial images were available for analysis of MDCTA. DSA were analyzed on hard copies. RESULTS Overall sensitivity and specificity of MDCTA were 93 and 95%, respectively, with positive and negative predictive values of 90 and 97%. Overall diagnostic accuracy was 94%. Normal arterial segments and 100% occlusions were correctly identified in all cases by MDCTA. Moderately stenotic segments interpretation in the calves appeared to be more controversial, but no statistical difference in accuracy of MDCTA in the infrapopliteal district arteries was noted with respect to accuracy in the more proximal arterial bed. Good to excellent interobserver and intraobserver agreement were observed, with k values greater than 0.80. CONCLUSIONS MDCTA of the abdominal aorta and lower extremities is an accurate imaging modality in clinical practice when compared with DSA.
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Affiliation(s)
- Maurizio Romano
- Department of Surgery, University Federico II, 5, Via Pansini, 80131 Naples, Italy.
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Vavrik J, Rohrmoser GM, Madani B, Ersek M, Tscholakoff D, Bucek RA. Comparison of MR Angiography Versus Digital Subtraction Angiography as a Basis for Planning Treatment of Lower Limb Occlusive Disease. J Endovasc Ther 2004; 11:294-301. [PMID: 15174919 DOI: 10.1583/03-1144.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare contrast-enhanced moving-bed magnetic resonance angiography (MRA) with digital subtraction angiography (DSA) for the ability to provide adequate information on which to construct a therapeutic strategy in patients suffering from peripheral arterial occlusive disease (PAOD). METHODS A prospective study was conducted involving 48 consecutive patients (25 men; mean age 65.7+/-10.2 years) with PAOD who underwent MRA and DSA of the peripheral arteries on 2 consecutive days. Every leg was divided into 3 anatomical regions (suprainguinal, femoropopliteal, calf), and the sensitivity and specificity for the detection of significant (>70%) lesions, as well as the interobserver variability, were calculated. The potential differences in the therapeutic strategy based on the results of both modalities were evaluated. RESULTS The MRA and DSA studies in the 48 study patients produced 864 arterial segments for interpretation. The sensitivity of MRA for the detection of significant lesions was 94.7% for the suprainguinal, 89.5% for the femoropopliteal, and 91.3% for the calf arteries. Corresponding specificity was 98.1%, 96.2% and 93.4%, respectively. The interobserver correlation for the detection of significant lesions by MRA and DSA was excellent (kappa>0.8) for all 3 segments, with slightly superior values for MRA. MRA and DSA agreed in the grading of 821 (95.0%) segments. In 8 (16.7%) patients, MRA suggested an additional intervention, and in 3 (6.3%) patients, additional DSA was necessary for the final diagnosis. CONCLUSIONS The accuracy of MRA for the detection of significant lesions is comparable to DSA. Basing the therapeutic strategy solely on the results of MRA can reduce the number of DSAs by three quarters, but at the risk of incurring lesion overestimation in approximately 17%.
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Affiliation(s)
- Joachim Vavrik
- Zentralröntgeninstiut der KA Rudolfstiftung, Vienna, Austria
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Zhu W, Feng D, Qi J, Xia L, Wang C. Evaluation of large intracranial aneurysms with cine MRA and 3D contrast-enhanced MRA. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2004; 24:95-8, 106. [PMID: 15165128 DOI: 10.1007/bf02830718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The value of combined application of both ECG-gated cine MRA and 3D-CEMRA in the detection of large intracranial aneurysms was evaluated and the findings were compared with those of conventional MRA and DSA. Twenty-four patients with 26 large intracranial aneurysms underwent MRI and DSA. All these aneurysms, diameter from 15 to 39 mm, were located at internal cerebral artery (n=12), vertebral artery (n=3), basilar artery (n=4), anterior cerebral artery (n=2), middle cerebral artery (n=2), anterior communicate artery (n=2) and posterior communicate artery (n=1). Thirteen cases of hematoma or cavernoma were studied as control group. All patients were examined on GE 1.5T MR system. ECG-gated cine MRA was performed with 2D multi-phase fast gradient-recalled echo sequence in a single section. All the images were analyzed with signal intensity VS time curve for differentiating intraaneurysmal blood flow from static tissue. The results were analyzed by statistic "t" test. 3D-CEMRA was performed with spoiled gradient-recalled echo and one dose of Gd-DTPA. All data was processed with multi-plannar reformat (MPR) and tomography for the demonstration of aneurysms in detail. All 26 aneurysms were demonstrated successfully by combined application of both cine MRA and 3D-CEMRA. Compared to DSA and conventional 3D-MOTSA, its sensitivity and specificity figures were both 100%. Cine MRA could differentiate the blood flow from the static tissue. The intensity VS time curves of intraaneurysmal blood flow offered fluctuating form and average signal change between systole and diastole period was about 89.8 +/- 37.4; However, under the control group, intraaneurysmal thrombus or cerebral hemorrhage or cavernomas had no significant signal change and the curves offered steady form with the average signal change being about 8.2 +/- 6.3. There was statistically significant difference between the intraaneurysmal blood flow and static tissue (P=0.025, <0.05). 3D-CEMRA was very useful in demonstrating the aneurysmal size, intraaneurysmal thrombus formation, neck and the detailed relationship of the aneurysm to the surrounding structures. It was concluded that the combined application of both cine MRA and 3D-CEMRA might be a valuable clinical tool for the detection of large intracranial aneurysms.
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Affiliation(s)
- Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030
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Nastri MV, Baptista LPS, Baroni RH, Blasbalg R, de Avila LF, Leite CC, de Castro CC, Cerri GG. Gadolinium-enhanced Three-dimensional MR Angiography of Takayasu Arteritis. Radiographics 2004; 24:773-86. [PMID: 15143227 DOI: 10.1148/rg.243035096] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Takayasu arteritis is a form of large vessel vasculitis with a possible autoimmune origin that may cause stenosis of the aorta and its major branches. Six types of Takayasu arteritis are recognized; the type depends on whether the ascending aorta, descending thoracic aorta, abdominal aorta, aortic cervicobrachial branches, or renal arteries are affected. The coronary and pulmonary arteries are also sometimes involved. Clinical features of the disease include diminished or absent pulses, claudication, hypertension, and mesenteric angina. Conventional angiography has been the standard imaging tool for diagnosis and evaluation of Takayasu arteritis, although it demonstrates only the lumen of the vessel. Less invasive cross-sectional methods such as computed tomographic angiography and, more recently, three-dimensional magnetic resonance (MR) angiography can effectively demonstrate thickening of the vessel wall, which may be the earliest manifestation of the disease, occurring before stenosis and dilatation. MR imaging in particular allows better soft-tissue differentiation and can show other signs of inflammation, including mural edema and increased mural vascularity. Other advantages of MR imaging are the lack of iodinated contrast material or ionizing radiation.
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Affiliation(s)
- Marcio V Nastri
- Institute of Radiology, University of São Paulo Medical School, São Paulo, Brazil.
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Zhang HL, Kent KC, Bush HL, Winchester PA, Watts R, Wang Y, Prince MR. Soft tissue enhancement on time-resolved peripheral magnetic resonance angiography. J Magn Reson Imaging 2004; 19:590-7. [PMID: 15112308 DOI: 10.1002/jmri.20037] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the incidence and locations of soft tissue enhancement on time-resolved two-dimensional projection magnetic resonance angiography (MRA) of the calf and foot. MATERIALS AND METHODS Time-resolved two-dimensional projection MRA of the knee, calf, and foot, performed at 1.5 Tesla using the head coil, was retrospectively reviewed in 326 patients. Soft tissue enhancement of the foot was identified and graded by blinded review. Subsequently, patient medical records were reviewed to determine the presence or absence of diabetes, cellulitis, gangrene, and ulceration of the foot and presence of neuropathic joints. RESULTS Enhancing spots were identified in 228 patients. For those feet without clinical abnormalities, diabetic patients had an average of 1.2 enhancing spots per foot, while nondiabetics had only 0.6 (P < 0.001). Higher-grade lesions were more prevalent in diabetics and in heavier patients. Of 64 patients with follow-up, 8 (13%) developed cellulitis (N = 4) or ulceration (N = 4) at the location of an enhancing spot, including 5 diabetic and 3 nondiabetic patients. CONCLUSION Pedal soft tissue enhancement frequently occurs on time-resolved gadolinium (Gd):MRA of the feet. The etiology is uncertain, but the high frequency in diabetic patients and observation of progression to cellulitis/ulceration suggest this soft tissue enhancement may identify sites of subclinical pedal soft tissue injury.
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Affiliation(s)
- Hong Lei Zhang
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
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Wu JM, Shi PF. A new algorithm of brain volume contours segmentation. JOURNAL OF ZHEJIANG UNIVERSITY. SCIENCE 2003; 4:294-299. [PMID: 12765282 DOI: 10.1631/jzus.2003.0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper explores brain CT slices segmentation technique and some related problems, including contours segmentation algorithms, edge detector, algorithm evaluation and experimental results. This article describes a method for contour-baed segmentation of anatomical structures in 3D medical data sets. With this method, the user manually traces one or more 2D contours of an anatomical structure of interest on parallel planes arbitrarily cutting the data set. The experimental results show the segmentation based on 3D brain volume and 2D CT slices. The main creative contributions in this paper are: (1) contours segmentation algorithm; (2) edge detector; (3) algorithm evaluation.
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Affiliation(s)
- Jian-Ming Wu
- Institute of Image Processing and Pattern Recognition, Shanghai Jiaotong University, Shanghai 200030, China.
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Cronberg CN, Sjoberg S, Albrechtsson U, Leander P, Lindh M, Norgren L, Danielsson P, Sonesson B, Larsson EM. Peripheral Arterial Disease. Contrast-Enhanced 3D Mr Angiography of the Lower Leg and Foot Compared with Conventional Angiography. Acta Radiol 2003. [DOI: 10.1034/j.1600-0455.2003.00007.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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