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Pakizer D, Kozel J, Taffé P, Elmers J, Feber J, Michel P, Školoudík D, Sirimarco G. Diagnostic accuracy of carotid plaque instability by noninvasive imaging: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2024; 25:1325-1335. [PMID: 38953552 DOI: 10.1093/ehjci/jeae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 07/04/2024] Open
Abstract
AIMS There is increasing evidence that plaque instability in the extracranial carotid artery may lead to an increased stroke risk independently of the degree of stenosis. We aimed to determine diagnostic accuracy of vulnerable and stable plaque using noninvasive imaging modalities when compared to histology in patients with symptomatic and asymptomatic carotid atherosclerosis. METHODS AND RESULTS Medline Ovid, Embase, Cochrane Library, and Web of Science were searched for diagnostic accuracy of noninvasive imaging modalities (CT, MRI, US) in the detection of 1) vulnerable/stable plaque, and 2) vulnerable/stable plaque characteristics, compared to histology. The quality of included studies was assessed by QUADAS-2 and univariate and bivariate random-effect meta-analyses were performed. We included 36 vulnerable and 5 stable plaque studies in the meta-analysis, and out of 211 plaque characteristics from remaining studies, we classified 169 as vulnerable and 42 as stable characteristics (28 CT, 120 MRI, 104 US characteristics). We found that MRI had high accuracy [90% (95% CI: 82-95%)] in the detection of vulnerable plaque, similar to CT [86% (95% CI: 76-92%); P > 0.05], whereas US showed less accuracy [80% (95% CI: 75-84%); P = 0.013]. CT showed high diagnostic accuracy in visualizing characteristics of vulnerable or stable plaques (89% and 90%) similar to MRI (86% and 89%; P > 0.05); however, US had lower accuracy (77%, P < 0.001 and 82%, P > 0.05). CONCLUSION CT and MRI have a similar, high performance in detecting vulnerable carotid plaques, whereas US showed significantly less diagnostic accuracy. Moreover, MRI visualized all vulnerable plaque characteristics allowing for a better stroke risk assessment. REGISTRATION PROSPERO ID CRD42022329690.
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Affiliation(s)
- David Pakizer
- Centre for Health Research, Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Jiří Kozel
- Centre for Health Research, Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Patrick Taffé
- Center for Primary Care and Public Health, Division of Biostatistics, University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Jolanda Elmers
- Medical Library, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Janusz Feber
- Centre for Health Research, Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, ON K1H8L1 Ottawa, Canada
| | - Patrik Michel
- Stroke Center, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - David Školoudík
- Centre for Health Research, Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Gaia Sirimarco
- Stroke Center, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Neurology Unit, Department of Internal Medicine, Riviera Chablais Hospital, Route du Vieux-Séquoia 20, 1847 Rennaz, Switzerland
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Kansagra AP, Balasetti V, Huang MC. Neurovascular trauma: Diagnosis and therapy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:325-344. [PMID: 33272402 DOI: 10.1016/b978-0-444-64034-5.00012-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Traumatic cerebrovascular injuries are common in both military and civilian populations. Whether such injuries occur in the aftermath of blunt or penetrating trauma has major implications for characteristics, classification, diagnosis, and optimal management of these lesions. Advances in screening methods, including particularly the dramatic rise of high-quality CT angiography, have facilitated early detection of these lesions. Fortunately, these diagnostic advances have occurred alongside improvements in pharmacological treatment and endovascular intervention, which now play an important role alongside surgical intervention in reducing the likelihood of adverse clinical outcomes. While the management of victims of trauma remains challenging, improved understanding of and ability to appropriately manage traumatic cerebrovascular lesions promises to yield better clinical outcomes for these vulnerable patients.
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Affiliation(s)
- Akash P Kansagra
- Departments of Radiology, Neurological Surgery, and Neurology, Washington University School of Medicine, St. Louis, MO, United States.
| | - Vamshi Balasetti
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael C Huang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States
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Ma G, YU Y, Duan H, Dou Y, Jia Y, Zhang X, Yang C, Chen X, Han D, Guo C, He T. Subtraction CT angiography in head and neck with low radiation and contrast dose dual-energy spectral CT using rapid kV-switching technique. Br J Radiol 2018; 91:20170631. [PMID: 29412008 PMCID: PMC6223275 DOI: 10.1259/bjr.20170631] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/15/2018] [Accepted: 02/01/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the application of low radiation and contrast dose spectral CT angiology using rapid kV-switching technique in the head and neck with subtraction method for bone removal. METHODS This prospective study was approved by the local ethics committee. 64 cases for head and neck CT angiology were randomly divided into Groups A (n = 32) and B (n = 32). Group A underwent unenhanced CT with 100 kVp, 200 mA and contrast-enhanced CT with spectral CT mode with body mass index-dependent low dose protocols. Group B used conventional helical scanning with 120 kVp, auto mA for noise index of 12 HU (Hounsfield unit) for both the unenhanced and contrast-enhanced CT. Subtraction images were formed by subtracting the unenhanced images from enhanced images (with the 65 keV-enhanced spectral CT image in Group A). CT numbers and their standard deviations in aortic arch, carotid arteries, middle cerebral artery and air were measured in the subtraction images. The signal-to-noise ratio and contrast-to-noise ratio for the common and internal carotid arteries and middle cerebral artery were calculated. Image quality in terms of bone removal effect was evaluated by two experienced radiologists independently and blindly using a 4-point system. Radiation dose and total iodine load were recorded. Measurements were statistically compared between the two groups. RESULTS The two groups had same demographic results. There was no difference in the CT number, signal-to-noise and contrast-to-noise ratio values for carotid arteries and middle cerebral artery in the subtraction images between the two groups (p > 0.05). However, the bone removal effect score [median (min-max)] in Group A [4 (3-4)] was rated better than in Group B [3 (2-4)] (p < 0.001), with excellent agreement between the two observers (κ > 0.80). The radiation dose in Group A (average of 2.64 mSv) was 57% lower than the 6.18 mSv in Group B (p < 0.001). The total iodine intake in Group A was 13.5g, 36% lower than the 21g in Group B. CONCLUSION Spectral CT imaging with rapid kV-switching in the subtraction angiography in head and neck provides better bone removal with significantly reduced radiation and contrast dose compared with conventional subtraction method. Advances in knowledge: This novel method provides better bone removal with significant radiation and contrast dose reduction compared with the conventional subtraction CT, and maybe used clinically to protect the thyroid gland and ocular lenses from unnecessary high radiation.
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Affiliation(s)
- Guangming Ma
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yong YU
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Haifeng Duan
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yuequn Dou
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yongjun Jia
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Xirong Zhang
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Chuangbo Yang
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Xiaoxia Chen
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Dong Han
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Changyi Guo
- Department of Diagnostic Radiology, The Second Affiliated Hospital of the Shannxi University of Traditional Chinese Medicine, Xianyang, China
| | - Taiping He
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
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Comparison of Measurement and Grading of Carotid Stenosis with Computed Tomography Angiography and Doppler Ultrasound. Ann Vasc Surg 2018. [PMID: 29522870 DOI: 10.1016/j.avsg.2018.01.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Doppler ultrasound (DUS) and computed tomography angiography (CTA) are the most commonly used imaging modalities for carotid disease. The aim of this study was to test the accuracy and reproducibility of CTA-derived measurements of carotid stenosis and compare them with those obtained by DUS. METHODS Images of 100 carotid arteries of patients who underwent carotid DUS at our unit and CTA of the carotids within a 28-day period were identified retrospectively from multidisciplinary team meeting records. CTAs were assessed by 2 investigators, each using a manual and a semi-automated method. With both methods, the degree of stenosis was calculated using the North American Symptomatic Carotid Endarterectomy Trial equation and graded as mild (0-49%), moderate (50-69%), or severe (70-99%). Cohen's kappa and specificity and sensitivity for ≥50% stenosis were calculated. RESULTS The interobserver agreement was moderate (κ 0.407, weighted-κ 0.517) for the manual method and good (κ 0.786, weighted-κ 0.842) for the semi-automated method. Using DUS as the gold standard, the semi-automated method had greater sensitivity (75%) and specificity (91%) in detecting clinically significant carotid artery stenosis (≥50%) than the manual one (63% and 86%, respectively). Agreement between DUS and the semi-automated method of CTA reporting was moderate (κ 0.453, 95% confidence interval [CI]: 0.320-0.586, weighted-κ 0.598, 95% CI: 0.486-0.710), whereas DUS and the manual method of CTA reporting had only fair agreement (κ 0.344, 95% CI: 0.209-0.478, weighted-κ 0.446, 95% CI: 0.315-0.577). CONCLUSIONS CTA tends to underestimate the degree of stenosis when compared with DUS. The semi-automated method of CTA reporting has greater reproducibility and greater agreement with DUS. These findings have practical implications when CTA is used to measure the degree of carotid stenosis in clinical practice.
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Bodanapally UK, Sliker CW. Imaging of Blunt and Penetrating Craniocervical Arterial Injuries. Semin Roentgenol 2016; 51:152-64. [DOI: 10.1053/j.ro.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bates ER, Babb JD, Casey DE, Cates CU, Duckwiler GR, Feldman TE, Gray WA, Ouriel K, Peterson ED, Rosenfield K, Rundback JH, Safian RD, Sloan MA, White CJ. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting. Vasc Med 2016; 12:35-83. [PMID: 17451093 DOI: 10.1177/1358863x06076103] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Osarumwense D, Pararajasingam R, Wilson P, Abraham J, Walker SR. Carotid Artery Imaging in the United Kingdom: A Postal Questionnaire of Current Practice. Vascular 2016; 13:173-7. [PMID: 15996375 DOI: 10.1258/rsmvasc.13.3.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There has been a steady rise in the use of carotid duplex imaging in the selection of patients for carotid endarterectomy (CEA). Some would suggest that CEA could be safely performed without preoperative contrast angiography. The purpose of this study was to focus on the role of duplex imaging among vascular surgeons in the United Kingdom and to highlight current practices in imaging prior to CEA. A postal questionnaire was sent to all consultant members of the Vascular Surgical Society of Great Britain and Ireland about the choice of imaging prior to selection of patients for CEA, preoperative imaging, and choice of imaging (if any) in the confirmation of carotid occlusion indicated by duplex scanning. Of 396 questionnaires sent, 323 (82%) were returned. Of these, 259 (80%) consultants performed carotid surgery, 118 (45%) in university hospitals (UHs) and 141 (53%) in district general hospitals (DGHs). One hundred eighteen (100%) and 137 (97%) respondents, respectively, chose duplex scanning as their first-line investigation. Sixty (51%) respondents in UHs and 49 (35%) respondents in DGHs repeated duplex scanning immediately preoperatively, with 57 (95%) and 46 (94%), respectively, using duplex scanning. Forty-seven (40%) respondents in UHs and 78 (55%) respondents in DGHs would reconfirm an occlusion, with 30 (64%) and 48 (62%), respectively, using computed tomography and magnetic resonance imaging as their preferred tool. Our study shows that duplex scanning is the first-line imaging technique for patient selection for CEA by vascular surgeons in the United Kingdom. Magnetic resonance imaging and computed tomography are replacing conventional angiography where duplex scanning is equivocal.
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Affiliation(s)
- Donald Osarumwense
- Lancaster and Lake District Vascular Unit, Royal Lancaster Infirmary, Lancaster, United Kingdom.
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8
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MA SHENGCHAO, ZHANG HUIPING, KONG FANQI, ZHANG HUI, YANG CHENG, HE YANGYANG, WANG YANHUA, YANG ANNING, TIAN JU, YANG XIAOLING, ZHANG MINGHAO, XU HUA, JIANG YIDENG, YU ZHENG. Integration of gene expression and DNA methylation profiles provides a molecular subtype for risk assessment in atherosclerosis. Mol Med Rep 2016; 13:4791-9. [DOI: 10.3892/mmr.2016.5120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 02/29/2016] [Indexed: 11/05/2022] Open
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9
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Buch K, Nguyen T, Mahoney E, Libby B, Calner P, Burke P, Norbash A, Mian A. Association between cervical spine and skull-base fractures and blunt cerebrovascular injury. Eur Radiol 2015; 26:524-31. [DOI: 10.1007/s00330-015-3858-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/07/2015] [Accepted: 05/20/2015] [Indexed: 11/29/2022]
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Abstract
Stroke is the third leading cause of death in developed nations. Up to 88% of strokes are ischemic in nature. Extracranial carotid artery atherosclerotic disease is the third leading cause of ischemic stroke in the general population and the second most common nontraumatic cause among adults younger than 45 years. This article provides comprehensive, evidence-based recommendations for the management of extracranial atherosclerotic disease, including imaging for screening and diagnosis, medical management, and interventional management.
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Affiliation(s)
- Yinn Cher Ooi
- Department of Neurosurgery, University of California, Los Angeles
| | - Nestor R. Gonzalez
- Department of Neurosurgery and Radiology, University of California, Los Angeles, 100 UCLA Med Plaza Suite# 219, Los Angeles, CA 90095, +1(310)825-5154
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11
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Doyle AJ, Stone JJ, Carnicelli AP, Chandra A, Gillespie DL. CT Angiography–derived Duplex Ultrasound Velocity Criteria in Patients with Carotid Artery Stenosis. Ann Vasc Surg 2014; 28:1219-26. [DOI: 10.1016/j.avsg.2013.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/20/2013] [Accepted: 12/02/2013] [Indexed: 11/25/2022]
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12
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Barros P, Felgueiras H, Pinheiro D, Guerra M, Gama V, Veloso M. Restenosis after Carotid Artery Stenting Using a Specific Designed Ultrasonographic Protocol. J Stroke Cerebrovasc Dis 2014; 23:1416-20. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 11/04/2013] [Accepted: 12/01/2013] [Indexed: 10/25/2022] Open
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Chaney KA, Rosenblum J. Commonly asked questions: imaging stroke and other types of neurovascular disorders. Expert Rev Neurother 2014; 14:277-86. [PMID: 24491109 DOI: 10.1586/14737175.2014.884929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The medical management of patients requiring imaging of the head is often complex. This is confounded by growth and development of neuroimaging technology. Summarizing established guidelines and provided answers to commonly asked questions about neurovascular imaging may aid in providing efficient medical care. Noncontrast head computed tomography (CT) is usually the first line in imaging because of its speed and wide-spread availability. More advanced techniques are reserved for more specific questions or when the CT head is non-diagnostic. MRI is the modality of choice for indications that include chronic headache, pulsatile tinnitus, and cerebrovascular diseases including stroke in the subacute or chronic setting. The imaging of stroke is evolving and many advanced techniques including CT and magnetic resonance perfusion are playing an increasing role in diagnosis. Digital subtraction angiography is widely accepted as the gold standard for evaluation of vascular pathology including aneurysm, vascular malformations, Moyamoya syndrome, carotid stenosis and dissection; and offers treatment options. Alternatives such as MR angiography, MR venography, and CT angiography offer similar sensitivity and specificity to conventional digital subtraction angiography. Safety considerations are an important concern. When using iodinated and gadolinium contrast agents, there are potential complications including allergic reactions, lactic acidosis, and nephrogenic systemic fibrosis. Impaired renal function requires modification in the use of contrast during neuroimaging. Neuroimaging during pregnancy is also discussed.
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Affiliation(s)
- Kimberly A Chaney
- Department of Radiology, Loyola University, Stritch School of Medicine, 2160 S. First Ave, Maywood, IL 60153, CA, USA
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Weber J, Veith P, Jung B, Ihorst G, Moske-Eick O, Meckel S, Urbach H, Taschner CA. MR Angiography at 3 Tesla to Assess Proximal Internal Carotid Artery Stenoses: Contrast-Enhanced or 3D Time-of-Flight MR Angiography? Clin Neuroradiol 2014; 25:41-8. [DOI: 10.1007/s00062-013-0279-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
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Dissection asymptomatique de l’artère carotide interne après un traumatisme grave : intérêt de l’angioscanner systématique des troncs supra-aortiques. ANNALES FRANCAISES DE MEDECINE D URGENCE 2013. [DOI: 10.1007/s13341-013-0286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Acharya UR, Sree SV, Mookiah MRK, Saba L, Gao H, Mallarini G, Suri JS. Computed tomography carotid wall plaque characterization using a combination of discrete wavelet transform and texture features: A pilot study. Proc Inst Mech Eng H 2013; 227:643-54. [PMID: 23636747 DOI: 10.1177/0954411913480622] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 30% of stroke victims, the cause of stroke has been found to be the stenosis caused by plaques in the carotid artery. Early detection of plaque and subsequent classification of the same into symptomatic and asymptomatic can help the clinicians to choose only those patients who are at a higher risk of stroke for risky surgeries and stenosis treatments. Therefore, in this work, we have proposed a non-invasive computer-aided diagnostic technique to classify the detected plaque into the two classes. Computed tomography (CT) images of the carotid artery images were used to extract Local Binary Pattern (LBP) features and wavelet energy features. Significant features were then used to train and test several supervised learning algorithm based classifiers. The Support Vector Machine (SVM) classifier with various kernel configurations was evaluated using LBP and wavelet features. The SVM classifier presented the highest accuracy of 88%, sensitivity of 90.2%, and specificity of 86.5% for radial basis function (RBF) kernel function. The CT images of the carotid artery provide unique 3D images of the artery and plaque that could be used for calculating percentage of stenosis. Our proposed technique enables automatic classification of plaque into asymptomatic and symptomatic with high accuracy, and hence, it can be used for deciding the course of treatment. We have also proposed a single-valued integrated index (Atheromatic Index) using the significant features which can provide a more objective and faster prediction of the class.
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Affiliation(s)
- U R Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore, Singapore.
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Biermann C, Tsiflikas I, Thomas C, Kasperek B, Heuschmid M, Claussen CD. Evaluation of computer-assisted quantification of carotid artery stenosis. J Digit Imaging 2012; 25:250-7. [PMID: 21786073 DOI: 10.1007/s10278-011-9413-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The purpose of this study was to evaluate the influence of advanced software assistance on the assessment of carotid artery stenosis; particularly, the inter-observer variability of readers with different level of experience is to be investigated. Forty patients with suspected carotid artery stenosis received head and neck dual-energy CT angiography as part of their pre-interventional workup. Four blinded readers with different levels of experience performed standard imaging interpretation. At least 1 day later, they performed quantification using an advanced vessel analysis software including automatic dual-energy bone and hard plaque removal, automatic and semiautomatic vessel segmentation, as well as creation of curved planar reformation. Results were evaluated for the reproducibility of stenosis quantification of different readers by calculating the kappa and correlation values. Consensus reading of the two most experienced readers was used as the standard of reference. For standard imaging interpretation, experienced readers reached very good (k = 0.85) and good (k = 0.78) inter-observer variability. Inexperienced readers achieved moderate (k = 0.6) and fair (k = 0.24) results. Sensitivity values 80%, 91%, 83%, 77% and specificity values 100%, 84%, 82%, 53% were achieved for significant area stenosis >70%. For grading using advanced vessel analysis software, all readers achieved good inter-observer variability (k = 0.77, 0.72, 0.71, and 0.77). Specificity values of 97%, 95%, 95%, 93% and sensitivity values of 84%, 78%, 86%, 92% were achieved. In conclusion, when supported by advanced vessel analysis software, experienced readers are able to achieve good reproducibility. Even inexperienced readers are able to achieve good results in the assessment of carotid artery stenosis when using advanced vessel analysis software.
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Affiliation(s)
- Christina Biermann
- Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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van Straten M, Schaap M, Dijkshoorn ML, Greuter MJ, van der Lugt A, Krestin GP, Niessen WJ. Automated bone removal in CT angiography: Comparison of methods based on single energy and dual energy scans. Med Phys 2011; 38:6128-37. [DOI: 10.1118/1.3651475] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Sun Z. Multislice computed tomography angiography in the diagnosis of cardiovascular disease: 3D visualizations. Front Med 2011; 5:254-70. [DOI: 10.1007/s11684-011-0153-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
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Tsiflikas I, Biermann C, Thomas C, Ketelsen D, Claussen CD, Heuschmid M. Carotid artery stenosis: performance of advanced vessel analysis software in evaluating CTA. Eur J Radiol 2011; 81:2255-9. [PMID: 21930358 DOI: 10.1016/j.ejrad.2011.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 08/24/2011] [Accepted: 08/28/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate time efficiency and diagnostic reproducibility of an advanced vessel analysis software for diagnosis of carotid artery stenosis. MATERIAL AND METHODS 40 patients with suspected carotid artery stenosis received head and neck DE-CTA as part of their pre-interventional workup. Acquired data were evaluated by 2 independent radiologists. Stenosis grading was performed by MPR eyeballing with freely adjustable MPRs and with a preliminary prototype of the meanwhile available client-server and advanced visualization software syngo.via CT Vascular (Siemens Healthcare, Erlangen, Germany). Stenoses were graded according to the following 5 categories: I: 0%, II: 1-50%, III: 51-69%, IV: 70-99% and V: total occlusion. Furthermore, time to diagnosis for each carotid artery was recorded. RESULTS Both readers achieved very good specificity values and good respectively very good sensitivity values without significant differences between both reading methods. Furthermore, there was a very good correlation between both readers for both reading methods without significant differences (kappa value: standard image interpretation k=0.809; advanced vessel analysis software k=0.863). Using advanced vessel analysis software resulted in a significant time saving (p<0.0001) for both readers. Time to diagnosis could be decreased by approximately 55%. CONCLUSIONS Advanced vessel analysis application CT Vascular of the new imaging software syngo.via (Siemens Healthcare, Forchheim, Germany) provides a high rate of reproducibility in assessment of carotid artery stenosis. Furthermore a significant time saving in comparison to standard image interpretation is achievable.
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Affiliation(s)
- Ilias Tsiflikas
- University Hospital of Tuebingen, Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
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Fusco MR, Harrigan MR. Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery 2011; 68:517-30; discussion 530. [PMID: 21135751 DOI: 10.1227/neu.0b013e3181fe2fda] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Traumatic cerebrovascular injury (TCVI) is present in approximately 1% of all blunt force trauma patients and is associated with injuries such as head and cervical spine injuries and thoracic trauma. Increased recognition of patients with TCVI in the past quarter century has been because of aggressive screening protocols and noninvasive imaging with computed tomography angiography. Extracranial carotid and vertebral artery injuries demonstrate a spectrum of severity, from intimal disruption to traumatic aneurysm formation or vessel occlusion. The most common intracranial arterial injuries are carotid-cavernous fistulae and traumatic aneurysms. Data on the long-term natural history of TCVI are limited, and management of patients with TCVI is controversial. Although antithrombotic medical therapy is associated with improved neurological outcomes, the optimal medication regimen is not yet established. Endovascular techniques have become more popular than surgery for the treatment of TCVI; endovascular options include stenting of dissections, intra-arterial thrombolysis for acute ischemic stroke caused by trauma, and embolization of traumatic aneurysms.
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Affiliation(s)
- Matthew R Fusco
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Yoshihara H, VanderHeiden TF, Harasaki Y, Beauchamp KM, Stahel PF. Fatal outcome after brain stem infarction related to bilateral vertebral artery occlusion - case report of a detrimental complication of cervical spine trauma. Patient Saf Surg 2011; 5:18. [PMID: 21756312 PMCID: PMC3161841 DOI: 10.1186/1754-9493-5-18] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 07/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vertebral artery injury (VAI) after blunt cervical trauma occurs more frequently than historically believed. The symptoms due to vertebral artery (VA) occlusion usually manifest within the first 24 hours after trauma. Misdiagnosed VAI or delay in diagnosis has been reported to cause acute deterioration of previously conscious and neurologically intact patients. CASE PRESENTATION A 67 year-old male was involved in a motor vehicle crash (MVC) sustaining multiple injuries. Initial evaluation by the emergency medical response team revealed that he was alert, oriented, and neurologically intact. He was transferred to the local hospital where cervical spine computed tomography (CT) revealed several abnormalities. Distraction and subluxation was present at C5-C6 and a comminuted fracture of the left lateral mass of C6 with violation of the transverse foramen was noted. Unavailability of a spine specialist prompted the patient's transfer to an area medical center equipped with spine care capabilities. After arrival, the patient became unresponsive and neurological deficits were noted. His continued deterioration prompted yet another transfer to our Level 1 regional trauma center. A repeat cervical spine CT at our institution revealed significantly worsened subluxation at C5-C6. CT angiogram also revealed complete occlusion of bilateral VA. The following day, a repeat CT of the head revealed brain stem infarction due to bilateral VA occlusion. Shortly following, the patient was diagnosed with brain death and care was withdrawn. CONCLUSION Brain stem infarction secondary to bilateral VA occlusion following cervical spine trauma resulted in fatal outcome. Prompt imaging evaluation is necessary to assess for VAI in cervical trauma cases with facet joint subluxation/dislocation or transverse foramen fracture so that treatment is not delayed. Additionally, multiple transportation events are risk factors for worsening when unstable cervical injuries are present. Close attention to proper immobilization and neck position depending on the mechanism of injury is mandatory.
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Affiliation(s)
- Hiroyuki Yoshihara
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - Todd F VanderHeiden
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - Yasuaki Harasaki
- Department of Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - Kathryn M Beauchamp
- Department of Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - Philip F Stahel
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
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Jochum S, Brockmann C, Diehl S, Baake D, Obertacke U, Schoenberg S, Dinter D. Diagnostik relevanter kraniozervikaler Gefäßverletzungen in der Schockraum-CT. Unfallchirurg 2011. [DOI: 10.1007/s00113-010-1780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kramer H, Runge VM, Morelli JN, Williams KD, Naul LG, Nikolaou K, Reiser MF, Wintersperger BJ. Magnetic resonance angiography of the carotid arteries: comparison of unenhanced and contrast enhanced techniques. Eur Radiol 2011; 21:1667-76. [DOI: 10.1007/s00330-011-2110-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 02/02/2011] [Accepted: 02/09/2011] [Indexed: 10/18/2022]
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Harrigan MR, Weinberg JA, Peaks YS, Taylor SM, Cava LP, Richman J, Walters BC. Management of blunt extracranial traumatic cerebrovascular injury: a multidisciplinary survey of current practice. World J Emerg Surg 2011; 6:11. [PMID: 21477304 PMCID: PMC3097147 DOI: 10.1186/1749-7922-6-11] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 04/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extracranial traumatic cerebrovascular injury (TCVI) is present in 1-3% of all blunt force trauma patients. Although options for the management of patients with these lesions include anticoagulation, antiplatelet agents, and endovascular treatment, the optimal management strategy for patients with these lesions is not yet established. OBJECTIVE Multidisciplinary survey of clinicians about current management of TCVI. METHODS A six-item multiple-choice survey was sent by electronic mail to a total of 11,784 neurosurgeons, trauma surgeons, stroke neurologists, and interventional radiologists. The survey included questions about their choice of imaging, medical management, and the use of endovascular techniques. Survey responses were analyzed according to stated specialty. RESULTS Seven hundred eighty-five (6.7%) responses were received. Overall, a total of 325 (42.8%) respondents favored anticoagulation (heparin and/or warfarin), 247 (32.5%) favored antiplatelet drugs, 130 (17.1%) preferred both anticoagulation and antiplatelet drugs, and 57 (7.5%) preferred stenting and/or embolization. Anticoagulation was the most commonly preferred treatment among vascular surgeons (56.9%), neurologists (50.2%) and neurosurgeons (40.7%), whereas antiplatelet agents were the most common preferred treatment among trauma surgeons (41.5%). Overall, 158 (20.7%) of respondents recommended treatment of asymptomatic dissections and traumatic aneurysms, 211 (27.7%) did not recommend it, and 39.4% recommended endovascular treatment only if there is worsening of the lesion on follow-up imaging. CONCLUSIONS These data demonstrate the wide variability of physicians' management of traumatic cerebrovascular injury, both on an individual basis, and between specialties. These findings underscore the need for multicenter, randomized trials in this field.
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Affiliation(s)
- Mark R Harrigan
- Division of Neurosurgery, University of Alabama, Birmingham, Birmingham, Alabama, USA.
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Abstract
Ocular ischemic syndrome (OIS) is a group of ocular diseases caused by chronic artery occlusion usually involving the internal carotid artery. Patients suffer from visual loss and pain. OIS is a rare disease which can be confounded with diabetic retinopathy or an older central retinal vein occlusion. The only therapy is to treat the neovascular complications. Due to the high mortality of OIS patients, medical and neurological examinations are mandatory. We discuss the clinical findings and diagnostic and therapeutic options of OIS patients in this paper.
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. J Am Coll Cardiol 2011; 57:e16-94. [PMID: 21288679 DOI: 10.1016/j.jacc.2010.11.006] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Stroke 2011; 42:e464-540. [PMID: 21282493 DOI: 10.1161/str.0b013e3182112cc2] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 2011; 124:e54-130. [PMID: 21282504 DOI: 10.1161/cir.0b013e31820d8c98] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hokari M, Kuroda S, Yasuda H, Nakayama N, Abe S, Iwasaki Y, Saito H. Lumen morphology in mild-to-moderate internal carotid artery stenosis correlates with neurological symptoms. J Neuroimaging 2010; 21:348-54. [PMID: 21122003 DOI: 10.1111/j.1552-6569.2010.00552.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Several prospective studies have shown that carotid endarterectomy can reduce the risk for subsequent ischemic stroke in patients with 70-99% stenosis of the internal carotid artery (ICA). However, its benefits are still controversial in less than 70% stenosis of the ICA. There is increasing evidence that carotid lumen irregularities may correlate with neurological symptoms. Recent development of computed tomography angiography (CTA) can provide adequate information on the carotid plaque morphology. In this study, therefore, we aimed to clarify whether carotid lumen morphology estimated by CTA correlates with neurological symptoms in patients with 30-69% ICA stenosis. METHODS This study included 67 carotid stenotic lesions with 30-69% ICA stenosis in 52 consecutive patients. These 67 lesions were examined by CTA from the viewpoints of the degree of stenosis, the prevalence of ulceration, and lumen morphology. Multivariate analysis was performed to detect significant predictors for the occurrence of ipsilateral ischemic events. RESULTS Multivariate analysis showed that the irregular shape of the carotid lumen was the most powerful variable to predict symptomatic lesion in 30-69% ICA stenosis. CONCLUSIONS These findings suggest that the morphology of carotid plaque may be associated with the occurrence of ipsilateral ischemic events in 30-69% ICA stenosis.
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Thomas C, Korn A, Krauss B, Ketelsen D, Tsiflikas I, Reimann A, Brodoefel H, Claussen C, Kopp A, Ernemann U, Heuschmid M. Automatic bone and plaque removal using dual energy CT for head and neck angiography: Feasibility and initial performance evaluation. Eur J Radiol 2010; 76:61-7. [DOI: 10.1016/j.ejrad.2009.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 04/01/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
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Mendrinos E, Machinis TG, Pournaras CJ. Ocular Ischemic Syndrome. Surv Ophthalmol 2010; 55:2-34. [PMID: 19833366 DOI: 10.1016/j.survophthal.2009.02.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 02/19/2009] [Accepted: 02/25/2009] [Indexed: 10/20/2022]
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Mitchell J. Doppler insonation of vertebral artery blood flow changes associated with cervical spine rotation: Implications for manual therapists. Physiother Theory Pract 2009; 23:303-13. [DOI: 10.1080/09593980701593771] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Puchner S, Popovic M, Wolf F, Reiter M, Lammer J, Bucek RA. Multidetector CTA in the Quantification of Internal Carotid Artery Stenosis: Value of Different Reformation Techniques and Axial Source Images Compared With Selective Carotid Arteriography. J Endovasc Ther 2009; 16:336-42. [DOI: 10.1583/08-2636.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Deng K, Liu C, Ma R, Sun C, Wang XM, Ma ZT, Sun XL. Clinical evaluation of dual-energy bone removal in CT angiography of the head and neck: comparison with conventional bone-subtraction CT angiography. Clin Radiol 2009; 64:534-41. [DOI: 10.1016/j.crad.2009.01.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 01/13/2009] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
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Computerized tomographic angiography for preoperative assessment of the superficial temporal artery for external carotid artery to internal carotid artery bypass: Case illustration. CASES JOURNAL 2008; 1:119. [PMID: 18718002 PMCID: PMC2553766 DOI: 10.1186/1757-1626-1-119] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Accepted: 08/21/2008] [Indexed: 11/10/2022]
Abstract
INTRODUCTION While catheter angiography has traditionally been used to assess the caliber and course of the superficial temporal artery prior to its use as a conduit for external carotid artery to internal carotid artery (EC-IC) bypass, computed tomographic angiography (CTA) has become increasingly used in the diagnostic assessment of cerebral vasculature. We demonstrate the application of CTA for evaluation of the superficial temporal artery as a vascular conduit for EC-IC bypass. CASE PRESENTATION A female in the fourth decade of life presented with the chief complaint of headache. CTA of the Circle of Willis revealed an unruptured fusiform aneurysm of the M1 segment of the right middle cerebral artery (MCA). We performed CTA for the preoperative assessment of the STA for a putative EC-IC bypass procedure, and correlated this to conventional external carotid angiography. Reformatted CTA provided excellent surface visualization of the STA and its course in relationship to the cranial and zygomatic surfaces, and correlated well with findings on the conventional angiogram. CONCLUSION CTA may eventually prove sufficient for use in assessing the STA in preparation for EC-IC bypass.
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Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient. ACTA ACUST UNITED AC 2008; 21:259-66. [PMID: 18525486 DOI: 10.1097/bsd.0b013e318141fce8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Injury to the carotid and vertebral arteries is an identified risk to patients after blunt high-energy cranio-cervical trauma with an associated risk of thromboembolic stroke. We sought to determine the incidence, features, and risk factors of arterial injury using selective cerebral angiography in a high-risk trauma patient subset. METHODS Blunt trauma patients with a high-energy mechanism were selected to undergo screening cerebral angiography if they met one of the following criteria: (1) cervical spine hyperextension/hyperflexion injury, (2) skull-base or facial fracture, (3) lateralizing neurologic deficit, ischemic deficit, or cerebral infarction, or (4) hemorrhage of arterial origin. RESULTS Of 69 screened patients 20 were found to have a vascular injury (28.9%), including 13 carotid and 15 vertebral; 9 of the 20 patients with vascular injury were symptomatic (45%). The most frequent injuries were intimal dissections (8/28), pseudoaneurysms (6/28), and vessel occlusions (5/28); 8 lesions were intracranial and 20 cervical. Displaced facial fractures (P<0.02) but not skull-base fracture were predictive of carotid injury; multilevel cervical spine fractures (P<0.001) and transverse foraminal fractures (P<0.02) were associated with vertebral injury. CONCLUSIONS Cerebral angiography in a selected group of trauma patients was found to yield a significant rate of carotid and vertebral arterial injury, a finding that had implications to subsequent clinical management.
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Monyé C, Dippel DWJ, Siepman TAM, Dijkshoorn ML, Tanghe HLJ, Lugt A. Is a fetal origin of the posterior cerebral artery a risk factor for TIA or ischemic stroke? J Neurol 2008; 255:239-45. [DOI: 10.1007/s00415-008-0699-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 06/14/2007] [Accepted: 07/10/2007] [Indexed: 11/29/2022]
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Kramer M, Vairaktaris E, Nkenke E, Schlegel KA, Neukam FW, Lell M. Vascular Mapping of Head and Neck: Computed Tomography Angiography Versus Digital Subtraction Angiography. J Oral Maxillofac Surg 2008; 66:302-7. [DOI: 10.1016/j.joms.2007.05.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 05/04/2007] [Indexed: 11/25/2022]
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Morhard D, Fink C, Becker C, Reiser MF, Nikolaou K. Value of automatic bone subtraction in cranial CT angiography: comparison of bone-subtracted vs. standard CT angiography in 100 patients. Eur Radiol 2008; 18:974-82. [PMID: 18224325 DOI: 10.1007/s00330-008-0855-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Revised: 11/16/2007] [Accepted: 01/04/2008] [Indexed: 11/28/2022]
Abstract
Non-contrast-enhanced cranial computed tomography (NECT) and CT angiography (CTA) are the most frequently used modalities in the triage of patients with acute ischemic and hemorrhagic stroke. CTA bone removal can improve the delineation of vasculature closely adjacent to bony structures, which is sometimes limited in standard CTA. The aim of this study was the evaluation of the clinical benefit of bone subtraction (BS) regarding delineation of cerebral vasculature, reading time and depiction of vascular pathologies compared to standard CTA without BS. A total of 100 patients who underwent NECT and supraaortic CTA on a 64-slice CT system were retrospectively included in the study. Bone removal was performed by subtraction of the NECT data from the CTA data using a dedicated workstation. Standard and BS CTA of each patient was reviewed for delineation of cerebral vasculature (grading scale from 1 = "excellent delineation" to 10 = "hardly any delineation"), reading time and depiction of vascular pathologies (standardized catalog) by two blinded readers. For BS data sets, the quality of BS was rated by a combination of the criteria complete bone removal, depiction of vascular structures and sufficient quality for diagnostic evaluation. The use of BS significantly reduced reading time from 4.60 min to 3.49 min (p<0.001). Performing BS, the quality of vascular delineation of the cerebral arteries, cerebral veins and cavernous segment of the ICA increased significantly as compared to standard CTA (1.70 vs. 2.70; 2.60 vs. 4.12; 2.35 vs. 4.40, all p<0.001). Consensus reading showed 41 pathologies in 35 patients. Diagnosis was missed or wrong overall in 15 cases, with 3 missed aneurysms (CTA: 2 vs. BS: 1), 8 wrong stenotic findings (CTA: 3 vs. BS: 5) and 4 missed partial thromboses (CTA: 2 vs. BS: 2). Performing BS in supraaortic CTA for the evaluation of cerebral vasculature reduces reading time and improves delineation of vessels. Diagnostic accuracy in general is not improved by BS, as the diagnostic accuracy of stenotic vessel alterations is reduced by potential truncation artifacts, but the detection rate of cerebral aneurysms slightly increases.
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Affiliation(s)
- Dominik Morhard
- Institute of Clinical Radiology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
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Lal BK, Hobson RW, Tofighi B, Kapadia I, Cuadra S, Jamil Z. Duplex ultrasound velocity criteria for the stented carotid artery. J Vasc Surg 2008; 47:63-73. [PMID: 18178455 DOI: 10.1016/j.jvs.2007.09.038] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 09/06/2007] [Accepted: 09/11/2007] [Indexed: 10/22/2022]
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Maldonado TS. What are Current Preprocedure Imaging Requirements for Carotid Artery Stenting and Carotid Endarterectomy: Have Magnetic Resonance Angiography and Computed Tomographic Angiography Made a Difference? Semin Vasc Surg 2007; 20:205-15. [DOI: 10.1053/j.semvascsurg.2007.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bucek RA, Puchner S, Haumer M, Reiter M, Minar E, Lammer J. CTA Quantification of Internal Carotid Artery Stenosis: Application of Luminal Area vs. Luminal Diameter Measurements and Assessment of Inter-observer Variability. J Neuroimaging 2007; 17:219-26. [PMID: 17608907 DOI: 10.1111/j.1552-6569.2007.00124.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE In contrast to digital subtraction angiography (DSAdia), computed tomography angiography (CTA) provides exact delineation of the perfused lumen in the axial plane, thus allowing luminal (CTAdia) as well as cross-sectional area (CTAarea) internal carotid artery stenosis (ICAS) assessment. The purposes of the present study were to correlate CTAdia and CTAarea with DSAdia and to assess the inter-observer variabilities of both CTA techniques. METHODS In a retrospective analysis, CTA images were reviewed by two observers and ICAS was assessed according to North American Symptomatic Carotid Endarterectomy Trial applying CTAdia and CTAarea. DSAdia was assessed by a third observer. RESULTS Based on 54 consecutive patients (40 males [74.1%] and 14 females [25.9%]; median age 73.3 years), ICAS percentages of CTAdia and CTAarea revealed significant correlations with DSAdia (r= 0.79-0.87, all P<.001) with median differences in the range of +8% to -6%. Inter-observer agreement was moderate for CTAdia (kappa= 0.60) and excellent for CTAarea (kappa= 0.86). Sensitivity of CTAarea for the detection of ICAS >70% was 100% for both observers, corresponding results for CTAdia were 97.1% and 71.4%, respectively, using DSAdia as the gold standard. CONCLUSION CTAarea assessment of ICAS correlates well with the results of DSAdia and provides an excellent sensitivity for the detection of ICAS >70% with superior inter-observer agreement compared to CTAdia.
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Affiliation(s)
- Robert A Bucek
- Department of Angiography and Interventional Radiology, Vienna Medical University, Vienna, Austria.
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Stengel D, Rademacher G, Hanson B, Ekkernkamp A, Mutze S. Screening for Blunt Cerebrovascular Injuries: The Essential Role of Computed Tomography Angiography. Semin Ultrasound CT MR 2007; 28:101-8. [PMID: 17432764 DOI: 10.1053/j.sult.2007.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The implementation of aggressive diagnostics refuted the thesis that blunt cerebrovascular injuries (BCVI) are rare events. Given the estimates from recent studies, the prevalence may be as high as 1 per 100 among blunt multiple trauma patients. The morbidity and mortality of unrecognized and untreated BCVI is exceptionally high and warrants distinct efforts to detect these injuries during the primary trauma survey. The primary goal is to detect BCVI before neurological symptoms occur, and to introduce anticoagulation or antiplatelet therapy as appropriate. Index injuries such as cervical spine fractures increase the prior probability of disease, but are not helpful in ruling BCVI out. Computed tomography angiography (CTA) may represent the screening tool of choice, although there is still limited evidence about its accuracy. Pooled data from six studies (1368 patients) published between 2002 and 2006 suggest a sensitivity of 79% and a specificity of 97% in the trauma setting. In the two largest investigations, no false negative results were observed. Further research is needed to determine the efficacy of CTA for disclosing BCVI, and to evaluate the potential benefits to patients.
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Affiliation(s)
- Dirk Stengel
- Center for Clinical Research, Unfallkrankenhaus Berlin Trauma Center, Berlin, Germany.
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Manniesing R, Viergever MA, Niessen WJ. Vessel axis tracking using topology constrained surface evolution. IEEE TRANSACTIONS ON MEDICAL IMAGING 2007; 26:309-16. [PMID: 17354637 DOI: 10.1109/tmi.2006.891503] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
An approach to 3-D vessel axis tracking based on surface evolution is presented. The main idea is to guide the evolution of the surface by analyzing its skeleton topology during evolution, and imposing shape constraints on the topology. For example, the intermediate topology can be processed such that it represents a single vessel segment, a bifurcation, or a more complex vascular topology. The evolving surface is then reinitialized with the newly found topology. Reinitialization is a crucial step since it creates probing behavior of the evolving front, encourages the segmentation process to extract the vascular structure of interest and reduces the risk on leaking of the curve into the background. The method was evaluated in two computed tomography angiography applications: 1) extracting the internal carotid arteries including the region in which they traverse through the skull base, which is challenging due to the proximity of bone structures and overlap in intensity values; 2) extracting the carotid bifurcations including many cases in which they are severely stenosed and contain calcifications. The vessel axis was found in 90% (18/20 internal carotids in ten patients) and 70% (14/20 carotid bifurcations in a different set of ten patients) of the cases.
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Bucek RA, Puchner S, Kanitsar A, Rand T, Lammer J. Automated CTA Quantification of Internal Carotid Artery Stenosis:A Pilot Trial. J Endovasc Ther 2007; 14:70-6. [PMID: 17291142 DOI: 10.1583/06-1905.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the feasibility and accuracy of automated analysis software for use with multidetector computed tomographic angiography (CTA) in the exact grading of internal carotid artery stenosis. METHODS A retrospective pilot trial was performed using CTA datasets from 87 stenotic carotid arteries in 46 consecutive patients (34 men; median age 73.5 years) with known cerebrovascular disease. Internal carotid artery (ICA) stenosis was graded according to NASCET criteria by 2 experienced vascular radiologists in consensus using axial source images as well as curved planar reformations and digital subtraction angiography (DSA). These results were then compared to those obtained from the automated CTA analysis software and the results of manually adapted automated CTA analysis. RESULTS Measurements from automated CTA analysis as well as manually adapted automated CTA analysis correlated significantly to those of axial/reformatted CTA and DSA (r=0.53 and r=0.82, r=0.58 and 0.70, respectively, all p<0.05). Compared to axial/reformatted CTA measurements, automated CTA analysis had a median difference of -16%, while manually adapted automated CTA had a difference of -10%. Corresponding differences in a comparison with DSA were +4% and -2%, respectively. Circumferential calcification or kinking of the ICA origin did not significantly interfere with these differences (all p>0.05). Sensitivities for the detection of ICA stenosis >70% by manually adapted automated CTA analysis and automated measurement were 44.2% and 34.9%, respectively, versus axial/reformatted CTA. Compared with DSA as the gold standard, the sensitivities were 54.2% and 62.5%, respectively. Specificities for both methods and gold standards all exceeded 90%. CONCLUSION Commercially available automated CTA analysis is a feasible tool, but sensitivities are still not sufficient for clinical application.
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Affiliation(s)
- Robert A Bucek
- Department of Angiography and Interventional Radiology, Medical University Vienna, Austria.
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Bates ER, Babb JD, Casey DE, Cates CU, Duckwiler GR, Feldman TE, Gray WA, Ouriel K, Peterson ED, Rosenfield K, Rundback JH, Safian RD, Sloan MA, White CJ. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting. J Am Coll Cardiol 2007; 49:126-70. [PMID: 17207736 DOI: 10.1016/j.jacc.2006.10.021] [Citation(s) in RCA: 199] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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