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Deen R, Austin C, Bullen A. Review article: Non-penetrating neck artery dissection in young adults: Not to be missed! Emerg Med Australas 2023; 35:384-389. [PMID: 36948224 DOI: 10.1111/1742-6723.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/10/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023]
Abstract
Young adults who present to the ED with neck pain following non-penetrating, seemingly trivial trauma to the neck, are at risk of neck artery dissection and subsequent stroke. Sport-related neck injury is the chief cause. Physical examination may often be unremarkable, and although there may be reluctance to expose young patients to radiation, radiological imaging is central to making a diagnosis of arterial wall disruption. A comprehensive literature search was performed in relation to neck artery dissection, and the evidence was scrutinised. We discuss the typical mechanism of injury, symptoms, anatomical considerations and clinical aids in diagnosis of neck artery dissection. Although the incidence is low, neck artery dissection has a mortality of 7%. As such, it is important for front-line physicians to have a high suspicion of the diagnosis and a low threshold to organise radiological examinations, specifically computerised tomography. Early detection of neck artery dissection will trigger clinical protocols that call for multi-disciplinary team management of this condition. In general, guideline-based recommendation for the management of neck artery dissection involving an intimal flap is by anti-platelet therapy while treatment of neck artery dissection that results in a pseudo-aneurysm or thrombosis is managed by surgical intervention or endovascular techniques. Close follow up combined with antithrombotic treatment is recommended in these individuals, the goal being prevention of stroke.
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Affiliation(s)
- Raeed Deen
- Department of Vascular Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Calyb Austin
- Department of Vascular Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew Bullen
- Department of Vascular Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
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Wang Q, Liu M, Zhao K, Xu X, Zhang J, Xu B. Hyperhomocysteinemia increases the risk of vertebrobasilar dissecting aneurysm among the male Han Chinese population: a retrospective case-control study. Int J Neurosci 2023:1-7. [PMID: 36714920 DOI: 10.1080/00207454.2023.2174024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/31/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
OBJECT Vertebrobasilar dissecting aneurysms (VBDAs) are known to have a poor natural history with high rates of re-bleeding and mortality. There is a strong relation between hyperhomocysteinemia (HHcy) and cerebrovascular disease; we perform a retrospective study within the male of Chinese Han population to explore the association between HHcy and VBDAs. METHODS Eighty-eight male patients with VBDA and Eighty-one male control subjects were evaluated for their serum total homocysteine levels. With multiple logistic regression analysis, the association between HHcy and the risk of VBDAs was estimated. Interaction and stratified analyses were conducted according to age, BMI, smoking status, drinking status, and chronic disease histories. The two-piecewise linear regression model examined the threshold effect. RESULTS The multivariate logistic regression analyses revealed a significant association between HHcy and VBDAs (odds ratio (OR) = 2.62; 95% confidence interval (CI), 1.02-6.71) after adjusting for classical vascular risk factors. The relationship was stable in all subgroup analysis. The interactive role was not found in the association between HHcy and VBDAs for the potential risk factor. CONCLUSIONS In summary, our study provides evidence that HHcy can increases the risk of VBDAs in the male Han Chinese population. Further researches with appropriate study designs including sex differences and aneurysm types are needed to verify this association.
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Affiliation(s)
- Qun Wang
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Minghang Liu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Kai Zhao
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Xinghua Xu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - JiaShu Zhang
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - BaiNan Xu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
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Three-Dimensional Constructive Interference in Steady State (3D CISS) Imaging and Clinical Applications in Brain Pathology. Biomedicines 2022; 10:biomedicines10112997. [PMID: 36428564 PMCID: PMC9687637 DOI: 10.3390/biomedicines10112997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Three-dimensional constructive interference in steady state (3D CISS) is a steady-state gradient-echo sequence in magnetic resonance imaging (MRI) that has been used in an increasing number of applications in the study of brain disease in recent years. Owing to the very high spatial resolution, the strong hyperintensity of the cerebrospinal fluid signal and the high contrast-to-noise ratio, 3D CISS can be employed in a wide range of scenarios, ranging from the traditional study of cranial nerves, the ventricular system, the subarachnoid cisterns and related pathology to more recently discussed applications, such as the fundamental role it can assume in the setting of acute ischemic stroke, vascular malformations, infections and several brain tumors. In this review, after briefly summarizing its fundamental physical principles, we examine in detail the various applications of 3D CISS in brain imaging, providing numerous representative cases, so as to help radiologists improve its use in imaging protocols in daily clinical practice.
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Differentiation of Cerebral Dissecting Aneurysm from Hemorrhagic Saccular Aneurysm by Machine-Learning Based on Vessel Wall MRI: A Multicenter Study. J Clin Med 2022; 11:jcm11133623. [PMID: 35806913 PMCID: PMC9267569 DOI: 10.3390/jcm11133623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
Abstract
The differential diagnosis of a cerebral dissecting aneurysm (DA) and a hemorrhagic saccular aneurysm (SA) often depends on the intraoperative findings; thus, improved non-invasive imaging diagnosis before surgery is essential to distinguish between these two aneurysms, in order to provide the correct formulation of surgical procedure. We aimed to build a radiomic model based on high-resolution vessel wall magnetic resonance imaging (VW-MRI) and a machine-learning algorithm. In total, 851 radiomic features from 146 cases were analyzed retrospectively, and the ElasticNet algorithm was used to establish the radiomic model in a training set of 77 cases. A clinico-radiological model using clinical features and MRI features was also built. Then an integrated model was built by combining the radiomic model and clinico-radiological model. The area under the ROC curve (AUC) was used to quantify the performance of models. The models were evaluated using leave-one-out cross-validation in a training set, and further validated in an external test set of 69 cases. The diagnostic performance of experienced radiologists was also assessed for comparison. Eight features were used to establish the radiomic model, and the radiomic model performs better (AUC = 0.831) than the clinico-radiological model (AUC = 0.717), integrated model (AUC = 0.813), and even experienced radiologists (AUC = 0.801). Therefore, a radiomic model based on VW-MRI can reliably be used to distinguish DA and hemorrhagic SA, and, thus, be widely applied in clinical practice.
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Shi H, Li Y, Wang Y, Guo W, Zhang K, Du Y, Shi H, Qian T. The preoperative evaluation value of 3D-slicer program before microsurgical vascular decompression in patients with hemifacial spasm. Clin Neurol Neurosurg 2022; 217:107241. [DOI: 10.1016/j.clineuro.2022.107241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
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Cao X, Xia W, Tang Y, Zhang B, Yang J, Zeng Y, Geng D, Zhang J. Radiomic Model for Distinguishing Dissecting Aneurysms from Complicated Saccular Aneurysms on high-Resolution Magnetic Resonance Imaging. J Stroke Cerebrovasc Dis 2020; 29:105268. [PMID: 32992167 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/07/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To build radiomic model in differentiating dissecting aneurysm (DA) from complicated saccular aneurysm (SA) based on high-resolution magnetic resonance imaging (HR-MRI) through machine-learning algorithm. METHODS Overall, 851 radiomic features from 77 cases were retrospectively analyzed, and the ElasticNet algorithm was used to build the radiomic model. A clinico-radiological model using clinical features and conventional MRI findings was also built. An integrated model was then built by incorporating the radiomic model and clinico-radiological model. The diagnostic abilities of these models were evaluated using leave one out cross validation and quantified using the receiver operating characteristic (ROC) analysis. The diagnostic performance of radiologists was also evaluated for comparison. RESULTS Five features were used to form the radiomic model, which yielded an area under the ROC curve (AUC) of 0.912 (95 % CI 0.846-0.976), sensitivity of 0.852, and specificity of 0.861. The radiomic model achieved a better diagnostic performance than the clinico-radiological model (AUC=0.743, 95 % CI 0.623-0.862), integrated model (AUC=0.888, 95 % CI 0.811-0.965), and even many radiologists. CONCLUSION Radiomic features derived from HR-MRI can reliably be used to build a radiomic model for effectively differentiating between DA and complicated SA, and it can provide an objective basis for the selection of clinical treatment plan.
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Affiliation(s)
- Xin Cao
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China; Institute of Functional and Molecular Medical Imaging, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Wei Xia
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China; Academy for Engineering and Technology, Fudan University, 20 Handan Road, Yangpu District, Shanghai 200433, China; Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, 88 Keling Road, Suzhou New District, Suzhou 215163, Jiangsu, China
| | - Ye Tang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Bo Zhang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Jinming Yang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Yanwei Zeng
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China; Institute of Functional and Molecular Medical Imaging, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China; Institute of Functional and Molecular Medical Imaging, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China.
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China; Institute of Functional and Molecular Medical Imaging, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China.
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Yang X, Bai Y, Guo H, Shi M, Zhang W, Pei Y, Song J, Drokow EK, Huang G, Liu X, Xu J, Kai Sun. Evaluating and monitoring bone marrow hypoplasia in adults with aplastic anemia via high-resolution iliac magnetic resonance imaging in the current era. Medicine (Baltimore) 2019; 98:e18214. [PMID: 31804346 PMCID: PMC6919526 DOI: 10.1097/md.0000000000018214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The diagnosis and monitoring of aplastic anemia (AA) rely heavily on a complete blood count (CBC), and multiple-site bone marrow (BM) aspirations and biopsies. However, these approaches have certain limitations. We aimed to assess high-resolution magnetic resonance imaging (MRI) as a complementary approach for evaluating BM hypoplasia and monitoring treatment response in adults with AA in the current era.Twelve newly diagnosed AA patients and 12 sex- and age-matched healthy controls were enrolled in this study from January 2017 to August 2018. A bilateral iliac 3.0T MRI was used to collect data for each subject, and the signal intensity on the T1-weighted images (T1WIs) were expressed as a contrast-to-noise ratio (CNR). The MRI, CBC, and BM biopsy data were analyzed and compared.A qualitative analysis identified a significant difference in MRI signal characteristics between the AA group and the healthy control group. The clinical classifications of very severe aplastic anemia (VSAA) and severe aplastic anemia (SAA) corresponded to pattern I and pattern II on the MR images, respectively. However, this imaging classification did not correlate with the biopsy-based BM cellularity measure. A quantitative analysis showed a significantly higher signal intensity in AA patients than in controls. A within-group comparison revealed that more severe types of AA, based on the clinical classification, corresponded to stronger signals. Notably, MRI could detect treatment response earlier than CBC, regardless of whether there were improvements in hematopoiesis.MRI can be used to predict the therapeutic effects in patients with AA and is an important complementary tool for evaluating and monitoring BM hypoplasia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Junling Xu
- Department of Nuclear Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan, PR China
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