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An S, Hwang G, Kim R, Hwang TS, Lee HC. Comparison of bone subtraction CT angiography with standard CT angiography for evaluating circle of Willis in normal dogs. J Vet Sci 2023; 24:e65. [PMID: 38031644 PMCID: PMC10556283 DOI: 10.4142/jvs.23121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Bone subtraction computed tomography angiography (BSCTA) is a useful alternative technique for improving visualization of vessels surrounded by skull bone. However, no studies have compared computed tomography angiography (CTA) and BSCTA for improving the visibility of canine cerebral blood vessels. OBJECTIVES To evaluate the potential benefit of BSCTA for better delineation of brain arteries of the circle of Willis (CoW) in dogs by comparing BSCTA with non-subtraction computed tomography angiography (NSCTA). METHODS Brain CTA was performed for nine healthy beagle dogs using a bolus tracking method with saline flushing. A total dose of 600 mgI/kg of contrast agent with an iodine content of 370 mgI/mL was injected at a rate of 4 ml/s. Bone removal was achieved automatically by subtracting non-enhanced computed tomography (CT) data from contrast CT data. Five main intracranial arteries of the CoW were analyzed and graded on a scale of five for qualitative evaluation. RESULTS Scores of basilar artery, middle cerebral artery, and rostral cerebral artery in the BSCTA group were significantly higher than those in the NSCTA group (p = 0.001, p = 0.020, and p < 0.0001, respectively). Scores of rostral cerebellar artery (RcA) and caudal cerebral artery (CCA) did not differ significantly between the two groups. However, scores of RcA and CCA in the BSCTA group were higher than those in the NSCTA group. CONCLUSIONS BSCTA improved visualization of intracranial arteries of the CoW with close contact to bone. Thus, it should be recommended as a routine scan method in dogs suspected of having brain vessel disease.
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Affiliation(s)
- Soyon An
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Gunha Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Rakhoon Kim
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Tae Sung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea.
| | - Hee Chun Lee
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea.
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2
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Goh SP, Wilfred R, Husain S, Tang IP. Challenges in Managing Intractable Epistaxis in a Post-nasal Surgery and Radiated Cancer Patient: A Case Report and Literature Review. Indian J Otolaryngol Head Neck Surg 2023; 75:1096-1100. [PMID: 37206815 PMCID: PMC10188725 DOI: 10.1007/s12070-023-03625-4] [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: 01/09/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Recurrent epistaxis represents an alarming sign that may suggest a sinister aetiology, especially in patients with previous head and neck malignancy. The recognition of certain potentially life-threatening conditions, namely pseudoaneurysm or tumour recurrence, remains prudence to avoid disastrous repercussion. Nasal endoscopy has become an essential tool in otolaryngology. It can aid identify the underlying cause of epistasis and facilitate therapeutic management. On the other hand, radio imaging is highly sensitive in detecting vascular lesions, besides providing a pre-operative mapping if surgical intervention is planned. This paper reported a patient with sphenoidal sinus squamous cell carcinoma in remission presented with torrential epistaxis not relieved with nasal packing. Despite a repeated angiogram and magnetic resonance image, the identification of the source of bleeding remained futile, culminating in an examination under general anaesthesia. The diagnosis of carotid blowout syndrome was made intraoperatively, and the bleeding was temporarily secured with a muscular patch, preceded by the insertion of a vascular stent. The authors wish to highlight the importance of examination under general anaesthesia if radio imaging does not correlate to the clinical findings. Management options for carotid blowout should be tailored to the patients' medical conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03625-4.
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Affiliation(s)
- SP Goh
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
- Department of Otorhinolaryngology Head & Neck Surgery, Sarawak General Hospital, Kuching, Malaysia
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Rebecca Wilfred
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
- Department of Otorhinolaryngology Head & Neck Surgery, Sarawak General Hospital, Kuching, Malaysia
| | - Salina Husain
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - IP Tang
- Department of Otorhinolaryngology Head & Neck Surgery, Sarawak General Hospital, Kuching, Malaysia
- Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kota Samarahan, Malaysia
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He G, Wang J, Zhang Y, Li M, Lu H, Cheng Y, Zhu Y. Diagnostic Performance of MRA for UnrupturedAneurysms at the Distal ICA. Clin Neuroradiol 2022; 32:507-515. [DOI: 10.1007/s00062-021-01076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/21/2021] [Indexed: 11/03/2022]
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4
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The role of imaging in the management of non-traumatic subarachnoid hemorrhage: a practical review. Emerg Radiol 2021; 28:797-808. [PMID: 33580850 DOI: 10.1007/s10140-021-01900-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/12/2021] [Indexed: 01/01/2023]
Abstract
The purpose of this review is to understand the role of imaging in the diagnosis and management of non-traumatic subarachnoid hemorrhage (SAH). SAH is a life-threatening emergency and a relatively common entity, the most common etiology being ruptured aneurysms. Multiple conundrums exist in literature at various steps of its imaging workup: diagnosis, management, and follow-up. We target our review to highlight the most effective practice and suggest efficient workup plans based on literature search, and describe in detail the clinical diagnostic and prognostic scales, role of CT scan, lumbar puncture, and MR, including angiography in the diagnosis and workup of SAH and its complications, and try to simplify the conundrums. Practical knowledge of imaging workup of SAH can help guide correct management of these patients, so as to reduce morbidity and mortality without resource overutilization.
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5
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van Dam LF, van Walderveen MAA, Kroft LJM, Kruyt ND, Wermer MJH, van Osch MJP, Huisman MV, Klok FA. Current imaging modalities for diagnosing cerebral vein thrombosis - A critical review. Thromb Res 2020; 189:132-139. [PMID: 32220779 DOI: 10.1016/j.thromres.2020.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/17/2020] [Accepted: 03/17/2020] [Indexed: 12/19/2022]
Abstract
Cerebral vein thrombosis (CVT) is a rare presentation of venous thromboembolism. Prompt and accurate diagnosis is essential as delayed recognition and treatment may lead to permanent disability or even death. Since no validated diagnostic algorithms exist, the diagnosis of CVT mainly relies on neuroimaging. Digital subtraction angiography (DSA) is the historical diagnostic standard for CVT, but is rarely used nowadays and replaced by computed tomography (CT) and magnetic resonance imaging (MRI). High quality studies to evaluate the diagnostic test characteristics of state of the art imaging modalities are however unavailable to date. This review provides an overview of the best available evidence regarding the diagnostic performance of CT and MRI for the diagnosis of CVT. Notably, available studies are observational, mostly small, outdated, and with a high risk of bias. Therefore, direct comparison between studies is difficult due to large diversity in study design, imaging method, reference standard, patient selection and sample size. In general, contrast-enhanced techniques are more accurate for the diagnosis of CVT then non-contrast-enhanced techniques. CT venography and MRI have been both reported to be adequate for establishing a final diagnosis of CVT, but choice of modality as used in clinical practice depends on availability, local preference and experience, as well as patient characteristics. Our review underlines the need for high-quality diagnostic studies comparing CT venography and MRI in specific settings, to improve clinical care and standardize clinical trials.
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Affiliation(s)
- Lisette F van Dam
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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6
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Burkhardt JK, Chua MH, Winkler EA, Rutledge WC, Lawton MT. Incidence, classification, and treatment of angiographically occult intracranial aneurysms found during microsurgical aneurysm clipping of known aneurysms. J Neurosurg 2020; 132:434-441. [PMID: 30797191 DOI: 10.3171/2018.11.jns182416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE During the microsurgical clipping of known aneurysms, angiographically occult (AO) aneurysms are sometimes found and treated simultaneously to prevent their growth and protect the patient from future rupture or reoperation. The authors analyzed the incidence, treatment, and outcomes associated with AO aneurysms to determine whether limited surgical exploration around the known aneurysm was safe and justified given the known limitations of diagnostic angiography. METHODS An AO aneurysm was defined as a saccular aneurysm detected using the operative microscope during dissection of a known aneurysm, and not detected on preoperative catheter angiography. A prospective database was retrospectively reviewed to identify patients with AO aneurysms treated microsurgically over a 20-year period. RESULTS One hundred fifteen AO aneurysms (4.0%) were identified during 2867 distinct craniotomies for aneurysm clipping. The most common locations for AO aneurysms were the middle cerebral artery (60 aneurysms, 54.1%) and the anterior cerebral artery (20 aneurysms, 18.0%). Fifty-six AO aneurysms (50.5%) were located on the same artery as the known saccular aneurysm. Most AO aneurysms (95.5%) were clipped and there was no attributed morbidity. The most common causes of failed angiographic detection were superimposition of a large aneurysm (type 1, 30.6%), a small aneurysm (type 2, 18.9%), or an adjacent normal artery (type 3, 36.9%). Multivariate analysis identified multiple known aneurysms (odds ratio [OR] 3.45, 95% confidence interval [CI] 2.16-5.49, p < 0.0001) and young age (OR 0.981, 95% CI 0.965-0.997, p = 0.0226) as independent predictors of AO aneurysms. CONCLUSIONS Meticulous inspection of common aneurysm sites within the surgical field will identify AO aneurysms during microsurgical dissection of another known aneurysm. Simultaneous identification and treatment of these additional undiagnosed aneurysms can spare patients later rupture or reoperation, particularly in those with multiple known aneurysms and a history of subarachnoid hemorrhage. Limited microsurgical exploration around a known aneurysm can be performed safely without additional morbidity.
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Affiliation(s)
- Jan-Karl Burkhardt
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Michelle H Chua
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Ethan A Winkler
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - W Caleb Rutledge
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Michael T Lawton
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
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Subarachnoid Hemorrhage in the Neurocritical Care Unit. Neurocrit Care 2019. [DOI: 10.1017/9781107587908.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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8
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Sakakura K, Nakai Y, Ikeda G, Shiigai M, Watanabe N, Uemura K, Zaboronok A, Ishikawa E, Matsumura A. Transvenous Embolization of Dural Arteriovenous Fistula of the Anterior Condylar Confluence via the Intercavernous Sinus Assisted by Bone Subtraction Computed Tomography Angiography. World Neurosurg 2019; 126:151-155. [PMID: 30857996 DOI: 10.1016/j.wneu.2019.02.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dural arteriovenous fistulae (dAVFs) of the anatomically complex anterior condylar confluence (ACC) are often examined by computed tomography (CT) angiography and conventional angiography before treatment. Contrasted vessels often overlap with skull bones in enhanced CT scan and make it difficult to detect the shunt point of the dAVF. Bone subtraction CT angiography (BSCTA) can overcome this limitation and allow for superior imaging of dAVFs that may help to find an alternative access for catheterization. CASE DESCRIPTION An 80-year-old woman suffered from right ear tinnitus, headache, and an audible bruit. Preoperative imaging showed a dAVF of the ACC. It was fed by the bilateral ascending pharyngeal artery, drained to the internal jugular vein (IJV) via the inferior petrosal sinus, and had an intraosseous shunt pouch. We therefore performed transvenous embolization (TVE) via the intercavernous sinus because the angle between the anterior condylar vein and the IJV was too sharp to catheterize vessels through the ipsilateral IJV. CONCLUSIONS Understanding the inherently complex and individually unique venous anatomy of the ACC is crucial for treatment of dAVFs. BSCTA is an effective visualization technique for dAVFs of the ACC and allows for precise preoperative vascular structure evaluation. We suggest that in the case of the angle between the ACV and the IJV being too sharp to catheterize vessels through the ipsilateral IJV, TVE via the intercavernous sinus can be efficiently used.
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Affiliation(s)
- Kazuki Sakakura
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan; Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasunobu Nakai
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Go Ikeda
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Masanari Shiigai
- Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Noriyuki Watanabe
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan; Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazuya Uemura
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | | | - Eiichi Ishikawa
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Vaphiades MS, ten Hove MW, Matthews T, Roberson GH, Sinclair A. Imaging of Oculomotor (Third) Cranial Nerve Palsy. Neuroophthalmology 2019. [DOI: 10.1007/978-3-319-98455-1_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Yang X, Lu J, Wang J, Wang L, Qi P, Hu S, Chen K, Wang D. A clinical study and meta-analysis of carotid stenosis with coexistent intracranial aneurysms. J Clin Neurosci 2018; 52:41-49. [PMID: 29550249 DOI: 10.1016/j.jocn.2018.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/19/2017] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Abstract
Carotid stenosis (CS) and intracranial aneurysms (IAs) may concur in one person. We studied the prevalence of IAs in CS patients in our retrospectively collected database and systematically reviewed this issue. Five hundred and fifty-seven CS (≥50%) patients confirmed by DSA in our hospital from 2010-06 to 2015-06 were screened for coexistent IAs. After searching the related literatures from English and Chinese journal literature databases, a meta-analysis was performed to pool the prevalence of CS with coexistent IAs. Subgroup analyses were performed to explore the causes of heterogeneity among studies. IAs were detected in 98(17.0%) out of the 577 CS patients. 12 literatures and the present study including a total of 6965 CS patients and 446 cases with coexistent IAs. The pooled prevalence of CS with coexistent IAs was 6.3% (95%CI: 4.2-8.3%) in all the CS patients. The pooled RR for female to male CS patients to have coexistent IAs was 1.67 (95%CI: 1.34-2.08, P = 0.000). 3 studies and the present study were carried out in Asian countries with a pooled prevalence of 10.8% (95%CI: 5.3-16.3%); 6 studies in European countries with 3.0% (95%CI: 2.2-3.7%); and 3 studies in USA with 6.0% (95%CI: 2.2-9.7%). There was a statistically significant difference between the three subgroups (P < 0.001). The prevalence of IAs in CS patients seems higher in our clinical study and the meta-analysis than in the general population and previously reported. The eastern and the women CS patients have a higher risk for coexistent IAs.
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Affiliation(s)
- Ximeng Yang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Junjie Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Lijun Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Shen Hu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Kunpeng Chen
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Beijing, China.
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Current Perspectives in Imaging Modalities for the Assessment of Unruptured Intracranial Aneurysms: A Comparative Analysis and Review. World Neurosurg 2018; 113:280-292. [PMID: 29360591 DOI: 10.1016/j.wneu.2018.01.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) are pathologic dilatations of cerebral arteries. This systematic review summarizes and compares imaging techniques for assessing unruptured IAs (UIAs). This review also addresses their uses in different scopes of practice. Pathophysiologic mechanisms are reviewed to better understand the clinical usefulness of each imaging modality. METHODS A literature review was performed using PubMed with these search terms: "intracranial aneurysm," "cerebral aneurysm," "magnetic resonance angiography (MRA)," computed tomography angiography (CTA)," "catheter angiography," "digital subtraction angiography," "molecular imaging," "ferumoxytol," and "myeloperoxidase". Only studies in English were cited. RESULTS Since the development and improvement of noninvasive diagnostic imaging (computed tomography angiography and magnetic resonance angiography), many prospective studies and meta-analyses have compared these tests with gold standard digital subtraction angiography (DSA). Although computed tomography angiography and magnetic resonance angiography have lower detection rates for UIAs, they are vital in the treatment and follow-up of UIAs. The reduction in ionizing radiation and lack of endovascular instrumentation with these modalities provide benefits compared with DSA. Novel molecular imaging techniques to detect inflammation within the aneurysmal wall with the goal of stratifying risk based on level of inflammation are under investigation. CONCLUSIONS DSA remains the gold standard for preoperative planning and follow-up for patients with IA. Newer imaging modalities such as ferumoxytol-enhanced magnetic resonance imaging are emerging techniques that provide critical in vivo information about the inflammatory milieu within aneurysm walls. With further study, these techniques may provide aneurysm rupture risk and prediction models for individualized patient care.
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13
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Kamalian S, Lev MH, Pomerantz SR. Dual-Energy Computed Tomography Angiography of the Head and Neck and Related Applications. Neuroimaging Clin N Am 2017; 27:429-443. [DOI: 10.1016/j.nic.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Kiran Kumar Y, Mehta SB, Ramachandra M. Simulation study of Hemodynamic in Bifurcations for Cerebral Arteriovenous Malformation using Electrical Analogy. J Biomed Phys Eng 2017; 7:143-154. [PMID: 28580336 PMCID: PMC5447251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/28/2015] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Cerebral Arteriovenous Malformation (CAVM) hemodynamic is disease condition, results changes in the flow and pressure level in cerebral blood vessels. Measuring flow and pressure without catheter intervention along the vessel is big challenge due to vessel bifurcations/complex bifurcations in Arteriovenous Malformation patients. The vessel geometry in CAVM patients are complex, composed of varying diameters, lengths, and bifurcations of various angles. The variations in the vessel diameter and bifurcation angle complicate the measurement and analysis of blood flow features invasively or non-invasively. METHODS In this paper, we proposed a lumped model for the bifurcation for symmetrical and asymmetrical networks in CAVM patients. The models are created using MATLAB Simulation software for various bifurcation angles. Each bifurcation angle created using electrical network- RLC. The segmentation and pre-processing of bifurcation vessels are implemented using adaptive segmentation. The proposed network address clinicians problem by measuring hemodynamic non-invasively. The method is applicable for any types of bifurcation networks with different bifurcation angles in CAVM patients. RESULTS In this work, we constructed a mathematical model, measured hemodynamic for 23 patients (actual and simulated cases) with 60 vessel bifurcation angles variations. The results indicate that comparisons evidenced highly significant correlations between values computed by the lumped model and simulated mechanical model for both networks with p < 0.0001. A P value of less than 0.05 considered statistically significant. CONCLUSION In this paper, we have modelled different bifurcation types and automatically display pressure and flow non-invasively at different node and at different angles of bifurcation in the complex vessel with help of bifurcation parameters, using lumped parameter model. We have simulated for different bifurcation angles and diameters of vessel for various imaging modality and model extend for different organs. This will help clinicians to measure haemodynamic parameters noninvasively at various bifurcations, where even catheter cannot be reached.
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Affiliation(s)
- Y Kiran Kumar
- Philips Research, Research Scholar, Manipal University, India
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15
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Maldaner N, Stienen MN, Bijlenga P, Croci D, Zumofen DW, Dalonzo D, Marbacher S, Maduri R, Daniel RT, Serra C, Esposito G, Neidert MC, Bozinov O, Regli L, Burkhardt JK. Interrater Agreement in the Radiologic Characterization of Ruptured Intracranial Aneurysms Based on Computed Tomography Angiography. World Neurosurg 2017; 103:876-882.e1. [PMID: 28461281 DOI: 10.1016/j.wneu.2017.04.131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine interrater agreement in the initial radiologic characterization of ruptured intracranial aneurysms based on computed tomography angiography (CTA) with special emphasis on the rater's level of experience. METHODS One junior and one senior rater of 5 high-volume neurovascular tertiary centers evaluated anonymized CTA images of 30 consecutive patients with aneurysmal subarachnoid hemorrhage. Each rater described location, side, size, and morphology in a standardized manner. Interrater variability was analyzed using intraclass correlation and Fleiss' kappa analysis. RESULTS There was a high level of agreement for location (κ = 0.76, 95% confidence interval [CI] 0.74-0.79), side (κ = 0.95, CI 0.91-0.99), maximum diameter (intraclass correlation coefficient [ICC] 0.81, CI 0.70-0.90), and dome (ICC 0.78, CI 0.66-0.88) of intracranial aneurysms. In contrast, a lower level of agreement was observed for aneurysms' neck diameter (ICC 0.39, CI 0.28-0.58), the presence of multiple aneurysms (κ = 0.35, CI 0.30-0.40), and aneurysm morphology (blister κ = 0.11, CI -0.05 to 0.07; fusiform κ = 0.54, CI 0.48-0.60; multilobular, κ = 0.39 CI 0.33-0.45). The interrater agreement in the senior rater group was greater than in the junior rater group. CONCLUSIONS Interrater agreement confirms the benefit of CTA as initial diagnostic imaging in ruptured intracranial aneurysms but not for aneurysm morphology and presence of multiple aneurysms. A trend towards greater interrater agreement between more experienced raters was noticed.
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Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
| | - Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland
| | - Davide Croci
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, Basel University Hospital, Basel, Switzerland; Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, Basel, Switzerland
| | - Donato Dalonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Rodolfo Maduri
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
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Surgical Outcome of Patients with Very Small Intracranial Aneurysms: A Single-Center Experience from Southern Iran. World Neurosurg 2017; 98:470-478. [DOI: 10.1016/j.wneu.2016.11.086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 11/18/2022]
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Feng TY, Han XF, Lang R, Wang F, Wu Q. Subtraction CT angiography for the detection of intracranial aneurysms: A meta-analysis. Exp Ther Med 2016; 11:1930-1936. [PMID: 27168830 DOI: 10.3892/etm.2016.3166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 08/10/2015] [Indexed: 12/15/2022] Open
Abstract
The aim of this meta-analysis was to investigate the accuracy of subtraction computed tomography angiography (CTA) for diagnosing intracranial aneurysms. A systematic literature search up to January 1, 2013 was performed in PubMed. Two independent reviewers selected 8 studies that compared subtraction CTA with digital subtraction angiography. Data from the studies were used to construct a 2×2 contingency table on a per-patient basis in ≥5 diseased and 5 non-diseased patients, with additional data on a per-aneurysm basis. Overall, subtraction CTA had a pooled sensitivity of 99% [95% confidence interval (CI), 95-100%] and specificity of 94% (95% CI, 86-97%) for detecting and ruling out cerebral aneurysms, respectively, on a per-patient basis. On a per-aneurysm basis, the pooled sensitivity was 96% (95% CI, 90-99%), and the specificity was 91% (95% CI, 85-95%). In conclusion, subtraction CTA is a highly sensitive, specific and non-invasive method for the diagnosis and evaluation of intracranial aneurysms.
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Affiliation(s)
- Tian-Ying Feng
- Department of Ultrasound, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia Autonomous Region 010017, P.R. China
| | - Xue-Feng Han
- Department of Emergency, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia Autonomous Region 010017, P.R. China
| | - Rui Lang
- Department of Ultrasound, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia Autonomous Region 010017, P.R. China
| | - Fei Wang
- Department of Neurosurgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010050, P.R. China
| | - Qiong Wu
- Department of Magnetic Resonance Imaging, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010050, P.R. China
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Aulbach P, Mucha D, Engellandt K, Hädrich K, Kuhn M, von Kummer R. Diagnostic Impact of Bone-Subtraction CT Angiography for Patients with Acute Subarachnoid Hemorrhage. AJNR Am J Neuroradiol 2016; 37:236-43. [PMID: 26450538 DOI: 10.3174/ajnr.a4497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/22/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Detection and evaluation of ruptured aneurysms is critical for choosing an appropriate endovascular or neurosurgical intervention. Our aim was to assess whether bone-subtraction CTA is capable of guiding treatment for cerebral aneurysms in patients with acute SAH and could replace DSA. MATERIALS AND METHODS We prospectively studied 116 consecutive patients with SAH with 16-detector row bone-subtraction CTA and DSA before intracranial aneurysm treatment. Two independent neuroradiologists reviewed the bone-subtraction CTA blinded to DSA (reference standard). We determined the accuracy of bone-subtraction CTA for aneurysm detection and the measurement of aneurysm dimensions and compared the radiation doses of the 2 imaging modalities. RESULTS Seventy-one patients (61%) had 74 aneurysms on DSA. Bone-subtraction CTA detected 73 of these aneurysms, but it detected 1 additional aneurysm. On a per-aneurysm basis, sensitivity, specificity, and positive and negative predictive values for bone-subtraction CTA were 99%, 98%, and 99% and 98%, respectively. For aneurysms of ≤3 mm, sensitivity was 94% (95% CI, 73%-99%). Bone-subtraction CTA slightly overestimated neck and dome diameters by <0.2 mm and overestimated the dome-to-neck ratios by 2% on average. Dose-length product was 565 ± 201 mGy × cm for bone-subtraction CTA and 1609 ± 1300 mGy × cm for DSA. CONCLUSIONS Bone-subtraction CTA is as accurate as DSA in detecting cerebral aneurysms after SAH, provides similar information about aneurysm configuration and measures, and reduces the average effective radiation dose for vascular diagnostics by 65%. Diagnostic equivalence in association with dose reduction suggests replacing DSA with bone-subtraction CTA in the diagnostic work-up of spontaneous SAH.
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Affiliation(s)
- P Aulbach
- From the Department of Neuroradiology (P.A., K.E., K.H., R.v.K.), University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - D Mucha
- Department of Neuroradiology (D.M.), Heinrich Braun Hospital, Zwickau, Germany
| | - K Engellandt
- From the Department of Neuroradiology (P.A., K.E., K.H., R.v.K.), University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - K Hädrich
- From the Department of Neuroradiology (P.A., K.E., K.H., R.v.K.), University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - M Kuhn
- Institute for Medical Informatics and Biometry at the Medical Faculty (M.K.), Technische Universität, Dresden, Germany
| | - R von Kummer
- From the Department of Neuroradiology (P.A., K.E., K.H., R.v.K.), University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
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Wojak JC, Abruzzo TA, Bello JA, Blackham KA, Hirsch JA, Jayaraman MV, Dariushnia SR, Meyers PM, Midia M, Russell EJ, Walker TG, Nikolic B. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 2015; 26:1596-608. [DOI: 10.1016/j.jvir.2015.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/19/2022] Open
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Bechan RS, van Rooij SB, Sprengers ME, Peluso JP, Sluzewski M, Majoie CB, van Rooij WJ. CT angiography versus 3D rotational angiography in patients with subarachnoid hemorrhage. Neuroradiology 2015; 57:1239-46. [DOI: 10.1007/s00234-015-1590-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
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Yap L, Dyde RA, Hodgson TJ, Patel UJ, Coley SC. Spontaneous subarachnoid hemorrhage and negative initial vascular imaging--should further investigation depend upon the pattern of hemorrhage on the presenting CT? Acta Neurochir (Wien) 2015; 157:1477-84. [PMID: 26174752 DOI: 10.1007/s00701-015-2506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multiple investigations are usually performed in patients with spontaneous SAH who have negative initial angiography. This study aimed to evaluate the most appropriate use of additional imaging studies and how this may be influenced by the findings of the initial CT. METHODS A retrospective analysis was performed on a prospectively collected cohort of patients referred with spontaneous SAH and negative initial angiography. The patients were divided into four categories based upon the distribution of blood on the initial CT: perimesencephalic (pSAH), diffuse (dSAH), sulcal (sSAH) and CT negative (CSF positive for xanthochromia) (nCT-pLP). The number and nature of the subsequent imaging investigations were reviewed, and the results were correlated with the findings of the presenting CT. RESULTS One hundred fourteen patients were included in the study. Repeat imaging found five relevant abnormalities. Three cases of vasculitis were diagnosed on the first DSA following a negative CTA. A case of dissecting aneurysm was revealed on the third neurovascular study. A hemorrhagic spinal tumor presented with xanthochromia. No subsequent abnormality was found on the third DSA or MRI head. No case of pSAH had a subsequent positive finding if the initial CTA was negative. CONCLUSIONS Certain patterns of SAH are associated with a low yield of abnormalities on repeat imaging if the initial angiography is normal. The authors believe that the pattern of hemorrhage on the presenting CT should be used to guide the most appropriate use of further imaging modalities and present a diagnostic algorithm for this purpose.
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Affiliation(s)
- L Yap
- Department of Neuroradiology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK,
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Cheng B, Cai W, Sun C, Kang Y, Gong J. 3D bone subtraction CT angiography for the evaluation of intracranial aneurysms: a comparison study with 2D bone subtraction CT angiography and conventional non-subtracted CT angiography. Acta Radiol 2015; 56:1127-34. [PMID: 25258207 DOI: 10.1177/0284185114549495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 07/13/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bone subtraction computed tomography angiography (BSCTA) is better able to facilitate the detection of intracranial aneurysms adjacent to bone structures compared to conventional non-subtracted CTA (CNSCTA). However, the comparison of the diagnostic accuracy of three-dimensional (3D) and two-dimensional (2D) BSCTA and conventional CTA in evaluating intracranial aneurysms remains unclear. PURPOSE To evaluate whether 3D BSCTA has a superior diagnostic accuracy to those of 2D BSCTA and CNSCTA in a single center with the same instrument. MATERIAL AND METHODS Sixty-three patients received 3D BSCTA, 2D BSCTA, and NSCTA for the detection and treatment planning of suspected intracranial aneurysms. The angiography readouts were reviewed by two independent radiologists. The sensitivity of CTA in detecting aneurysm was analyzed on a per-aneurysm and per-patient basis, using 3D digital subtraction angiography (DSA) and surgical findings as the gold standard. The potential of endovascular treatment or surgical clipping was also assessed based on information provided by the CTA. RESULTS A total of 66 aneurysms were detected in 54 patients. The overall sensitivity, specificity, positive, and negative predictive values of 3D BSCTA were all 100%, and these values for 2D BSCTA were 98.1%, 100%, 100%, and 90%, respectively. The total sensitivity, specificity, positive, and negative predictive values of CNSCTA were 94.4%, 100%, 100%, and 75%, respectively. Finally, 100%, 98.1%, and 85.2% patients received appropriate treatment decisions after 3D BSCTA, 2D BSCTA, and CNSCTA imaging, respectively. CONCLUSION 3D BSCTA has a higher sensitivity for the detection of small aneurysms and aneurysms adjacent to bone compared to 2D BSCTA or CNSCTA, which were still able to obtain sufficient information for the detection of intracranial aneurysms and therapeutic decision-making.
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Affiliation(s)
- Bochao Cheng
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Wu Cai
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
| | - Chongran Sun
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, PR China
| | - Yan Kang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, PR China
| | - Jianping Gong
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China
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Natarajan SK, Mokin M, Sonig A, Levy EI. Neuroimaging of headaches associated with vascular disorders. Curr Pain Headache Rep 2015; 19:16. [PMID: 26017708 DOI: 10.1007/s11916-015-0489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Headaches from vascular causes need to be differentiated from primary headaches because a misdiagnosis may lead to dire consequences for the patient. Neuroimaging is critical in identifying patients with vascular headaches and identifying the nature of the pathologic disorder causing these headaches. In addition, the imaging findings guide the physician regarding the optimal treatment modality for these lesions. This review summarizes the nuances of differentiating patients with secondary headaches related to vascular disease and discusses pertinent neuroimaging studies.
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Affiliation(s)
- Sabareesh K Natarajan
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
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Abstract
Because of the different attenuations of tissues at different energy levels, dual-energy CT offers tissue differentiation and characterization, reduction of artifacts, and remodeling of contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR), hereby creating new opportunities and insights in CT imaging. The applications for dual-energy imaging in neuroradiology are various and still expanding. Automated bone removal is used in CT angiography and CT venography of the intracranial vessels. Monoenergetic reconstructions can be used in patients with or without metal implants in the brain and spine to reduce artifacts, improve CNR and SNR, or to improve iodine conspicuity. Differentiation of iodine and hemorrhage is used in high-density lesions, after intra-arterial recanalization in stroke patients or after administration of contrast media. Detection of underlying (vascular and non-vascular) pathology and spot sign can be used in patients presenting with (acute) intracranial hemorrhage.
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Affiliation(s)
- Alida A. Postma
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Annika A. R. Stadler
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Joachim E. Wildberger
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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Diagnostic accuracy of contrast enhancement MRI versus CTA in diagnosis of intracranial aneurysm in patients with non-traumatic subarachnoid hemorrhage. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Meta-analysis of diagnostic significance of sixty-four-row multi-section computed tomography angiography and three-dimensional digital subtraction angiography in patients with cerebral artery aneurysm. J Neurol Sci 2014; 346:197-203. [DOI: 10.1016/j.jns.2014.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 08/15/2014] [Accepted: 08/17/2014] [Indexed: 01/23/2023]
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Jeong HW, Seo JH, Kim ST, Jung CK, Suh SI. Clinical practice guideline for the management of intracranial aneurysms. Neurointervention 2014; 9:63-71. [PMID: 25426300 PMCID: PMC4239410 DOI: 10.5469/neuroint.2014.9.2.63] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/05/2014] [Indexed: 11/29/2022] Open
Abstract
Purpose An intracranial aneurysm, with or without subarachnoid hemorrhage (SAH), is a relevant health problem. The rupture of an intracranial aneurysm is a critical concern for individual health; even an unruptured intracranial aneurysm is an anxious condition for the individual. The aim of this guideline is to present current and comprehensive recommendations for the management of intracranial aneurysms, with or without rupture. Materials and Methods We performed an extensive literature search, using Medline. We met in person to discuss recommendations. This document is reviewed by the Task Force Team of the Korean Society of Interventional Neuroradiology (KSIN). Results We divided the current guideline for ruptured intracranial aneurysms (RIAs) and unruptured intracranial aneurysms (UIAs). The guideline for RIAs focuses on diagnosis and treatment. And the guideline for UIAs focuses on the definition of a high-risk patient, screening, principle for treatment and selection of treatment method. Conclusion This guideline provides practical, evidence-based advice for the management of patients with an intracranial aneurysm, with or without rupture.
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Affiliation(s)
- Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Jung Hwa Seo
- Department of Neurology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University, Busan, Korea
| | - Cheol Kyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
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Wewel J, Mangubat EZ, Muñoz L. Iatrogenic traumatic intracranial aneurysm after endoscopic sinus surgery. J Clin Neurosci 2014; 21:2072-6. [PMID: 25128281 DOI: 10.1016/j.jocn.2014.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 05/17/2014] [Indexed: 10/24/2022]
Abstract
Iatrogenic traumatic intracranial aneurysms are rare, but their clinical impact is significant secondary to their risk of intracranial hemorrhage and in their frequent complexity in management. We report an adult patient with a history of chronic sinusitis who, while undergoing elective endoscopic polypectomy, suffered an iatrogenic injury to an A2 segment branch of the left anterior cerebral artery, resulting in a pseudoaneurysm. Management included endovascular coiling and a bicoronal craniotomy approach, using a split-thickness cranial graft and abdominal fat graft to repair the associated left cribriform plate defect.
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Affiliation(s)
- Joshua Wewel
- Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA.
| | - Erwin Zeta Mangubat
- Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA
| | - Lorenzo Muñoz
- Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA
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Kayhan A, Koc O, Keskin S, Keskin F. The role of bone subtraction computed tomographic angiography in determining intracranial aneurysms in non-traumatic subarachnoid hemorrhage. IRANIAN JOURNAL OF RADIOLOGY 2014; 11:e12670. [PMID: 25035697 PMCID: PMC4090638 DOI: 10.5812/iranjradiol.12670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 10/11/2013] [Accepted: 11/11/2013] [Indexed: 11/16/2022]
Abstract
Background: The presence of blood in the subarachnoid space is an acute pathology with a serious risk of death and complications. The most common etiology (approximately 80%) is intracranial aneurysm. Objectives: The aim of this study was to assess the role of bone subtracted computed tomographic angiography (BSCTA), a novel and noninvasive method for determining and characterizing intracranial aneurysms. Patients and Methods: Sixty consecutive patients with clinically suspected non-traumatic subarachnoid hemorrhage (SAH) were considered to enter the study. The subtraction quality was inadequate in ten patients; thus, they were excluded, leaving 50 patients (84.4%) in the study. Bone subtracted and non-subtracted 3D images were obtained from the BSCTA raw data sets. All images obtained by digital subtraction angiography (DSA), BSCTA, and computed tomographic angiography (CTA) were evaluated for the presence or absence of an aneurysm and the location, minimal sac diameter, and neck size ratio of the aneurysm. DSA was considered as the gold standard during the evaluation of the data. Results: Of the 50 patients who participated in this study, 11 had no aneurysms as determined by both CTA and DSA. Examination of the remaining 39 patients revealed the presence of 51 aneurysms. While 3D-CTA could not detect six aneurysms that were located in the base of the skull, 3D-BSCTA easily detected them. Moreover, five aneurysms were only partially detected by 3D-CTA. According to this data, the sensitivity of 3D-BSCTA and 3D-CTA was calculated as 98% and 86.3%, respectively; the specificity was calculated as 100% and 90.9%, respectively, per aneurysm; and the sensitivity of 100% for 3D-BSCTA and 98% for 3D-CTA was achieved by using combined images with multi-planar reconstruction (MPR) and maximum intensity projection (MIP). BSCTA detected and characterized the aneurysms as well as DSA, and BSCTA and DSA gave concordant results in detecting aneurysms. Conclusions: BSCTA is easily accessible, less time consuming, and most importantly, a non-invasive technique for detecting intracranial aneurysms. It is also suitable for patients who have been referred to emergency services. Therefore, it can be used in emergency conditions and as a first-line diagnostic method in patients with non-traumatic SAH.
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Affiliation(s)
- Aysegul Kayhan
- Department of Radiology, Beysehir State Hospital, Konya, Turkey
| | - Osman Koc
- Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Suat Keskin
- Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
- Corresponding author: Suat Keskin, Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey. Tel: +90-5324887002, Fax: +90-3322236181, E-mail:
| | - Fatih Keskin
- Department of Neurosurgery, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Ikeda DS, Marlin ES, Shaw A, Sauvageau E, Powers CJ. Endovascular Management of Anterior Communicating Artery Aneurysms. Neurosurg Clin N Am 2014; 25:437-54. [DOI: 10.1016/j.nec.2014.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Inoue S, Hosoda K, Fujita A, Ohno Y, Fujii M, Sugimura K, Kohmura E. Utility of 320-detector row CT for diagnosis and therapeutic strategy for paraclinoid and intracavernous aneurysms. Acta Neurochir (Wien) 2014; 156:505-14. [PMID: 24445734 DOI: 10.1007/s00701-014-1996-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/09/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was (1) to assess the diagnostic accuracy of 320-detector row computed tomography (CT) for paraclinoid and intracavernous aneurysms, and (2) to investigate whether this method provides sufficient information for surgery. METHODS A total of 14 patients with 16 unruptured proximal ICA aneurysms underwent three-dimensional CT angiography (3D-CTA) fusion imaging, which was created by superimposing 3D-CT venography data and/or 3D-bone data onto 3D-CTA data using 320-detector row CT, magnetic resonance imaging (MRI), and 3D digital subtraction angiography (DSA). The images of each modality were assessed using intraoperative findings as the reference standard. RESULTS All aneurysms were clearly visualized on 320-detector row CT. Bone subtraction and arterio-venous discrimination were accurate. On 3D-CTA fusion images, 11 aneurysms were diagnosed as "extracavernous" and five as "intracavernous". No discordance in aneurysm location between the 3D-CTA fusion images and the intraoperative findings was found. In contrast, discordance between MRI and intraoperative findings were found in five of the 16 cases (31%), which was significantly more frequent than with 3D-CTA (p = 0.043). The findings DSA, which was performed in nine patients, were also in excellent agreement with the intraoperative findings. However, 3D-CTA fusion imaging provided more comprehensive information, including venous and osseous structures, than 3D-DSA. The 320-detector row CTA after surgery demonstrated a clear relationship between the clip and aneurysmal neck with notably few artifacts, which suggested the utility of this modality for postoperative assessment. CONCLUSIONS The 320-detector row CT provided high accuracy for the diagnosis of paraclinoid and intracavernous aneurysms. This technique also provided comprehensive depiction of the aneurysms and surrounding structures. Therefore, this modality might be useful for the diagnosis of the paraclinoid and intracavernous aneurysms and for developing a surgical treatment plan.
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Bentsen L, Nygård A, Ovesen C, Christensen A, Rosenbaum S, Havsteen I, Christensen H. Vascular pathology in the extracranial vertebral arteries in patients with acute ischemic stroke. Cerebrovasc Dis Extra 2014; 4:19-27. [PMID: 24575111 PMCID: PMC3934683 DOI: 10.1159/000357663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction Vascular pathology in the extracranial vertebral arteries remains among the possible causes in cryptogenic stroke. However, the diagnosis is challenged by the great variety in the anatomy of the vertebral arteries, clinical symptoms and difficulties in the radiological assessments. The aim of this study was to assess the prevalence of CT angiography (CTA)-detected pathological findings in the extracranial vertebral arteries in an acute stroke population and secondly to determine the frequency of posterior pathology as probable cause in patients with otherwise cryptogenic stroke. Method The analysis was based on 657 consecutive patients with symptoms of acute stroke and a final diagnosis of ischemic stroke or transient ischemic attack. On admission, a noncontrast CT cerebrum and CTA were performed. A senior consultant neuroradiologist, blinded to clinical data, reviewed all CTA scans systematically, assessing the four segments of the extracranial vertebral arteries. First, the frequency of pathological findings including stenosis, plaques, dissection, kinked artery and coiling was assessed. Subsequently, we explored the extent of the pathological findings that were the most plausible causes of stroke, namely either a possible dissection or a kinked artery. Results Findings in the extracranial vertebral arteries included significant stenosis (0.8%), atherosclerotic plaque types (3.8%), possible dissections (2.6%), kinked arteries (2.6%) and coiling (32.0%). Eighteen patients (2.8%) with pathological findings had an unknown cause of stroke, likely posterior symptoms and no clinical stroke symptoms from the anterior circuit. Of these, 3 cases were kinked arteries (0.5%) and 15 cases (2.3%) were possible dissections. Conclusion We found that in approximately 3% of the study population, the most plausible cause of the cryptogenic strokes was due to a pathological finding in the posterior extracranial vertebral arteries, being either a possible dissection or a kinked artery. In general, posterior vascular pathology is not uncommon, and CTA is a useful modality in the detection of changes based on characteristics and locations of findings in the extracranial vertebral arteries. Ultrasound examination can be a useful supplementary tool in deciding the consequence of vascular findings on CTA.
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Affiliation(s)
- L Bentsen
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - A Nygård
- Department of Radiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - C Ovesen
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - A Christensen
- Department of Radiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - S Rosenbaum
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - I Havsteen
- Department of Radiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - H Christensen
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
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Post-traumatic Amaurosis Secondary to Paraophthalmic Internal Carotid Artery Pseudoaneurysm Treated With Pipeline Embolization Device. J Neuroophthalmol 2013; 33:359-62. [DOI: 10.1097/wno.0b013e3182a30427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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O'Meara B, Rahal JP, Lauric A, Malek AM. Benefit of a Sharp Computed Tomography Angiography Reconstruction Kernel for Improved Characterization of Intracranial Aneurysms. Oper Neurosurg (Hagerstown) 2013; 10 Suppl 1:97-105; discussion 105. [DOI: 10.1227/neu.0000000000000167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Computed tomography angiography (CTA) is the first-line imaging modality used for cerebral aneurysms because of its speed and sensitivity for detection, although digital subtraction angiography is often required for more detailed aneurysm shape delineation.
OBJECTIVE:
To determine whether a sharper CTA reconstruction kernel can better characterize an aneurysm and improve decision-making before intervention.
METHODS:
Fifteen patients presenting with aneurysmal subarachnoid hemorrhage underwent 64-row CTA. CTA data were reconstructed using the default H20f smooth kernel and a H60f sharp kernel and compared with contemporaneous catheter 3-dimensional rotational angiography (3DRA). Aneurysm neck, width, and aspect ratio measurements were made using intensity line plots of identical projections on all imaging datasets and compared by matched-pair statistics.
RESULTS:
Aneurysm neck measurements from the H20f smooth kernel revealed overestimation compared with both the sharp kernel (greater by 0.64 ± 0.21 mm, P < .01) and 3DRA (greater by 0.68 ± 0.19 mm, P < .01). There was no statistically significant difference between 3DRA and the sharp kernel CTA measurements. Neck measurements correlated well between the H60f kernel and 3DRA but not between the H20f Kernel and 3DRA (R 0.97 vs 0.86).
CONCLUSION:
H60f sharp CTA kernel reconstruction provides more accurate anatomic characterization of cerebral aneurysms than the H20f smooth kernel at the expense of less visually pleasing reconstructions. Because it does not require additional contrast, radiation, or imaging hardware and is more similar to 3DRA, it may aid in selecting the appropriate treatment strategy before to evaluation by catheter-based angiography.
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Affiliation(s)
- Brian O'Meara
- >Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Jason P. Rahal
- >Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Alexandra Lauric
- >Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Adel M. Malek
- >Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
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Li Q, Lv F, Wei Y, Luo T, Xie P. Automated subtraction CT angiography for visualization of the whole brain vasculature: a feasibility study. Acad Radiol 2013; 20:1009-14. [PMID: 23746383 DOI: 10.1016/j.acra.2013.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES To develop an automated computed tomography angiography (CTA) imaging protocol that allows visualization of the whole brain vasculature and evaluate the clinical usefulness of the technique for delineation of intracranial vessels in patients with cerebrovascular disorders. MATERIALS AND METHODS We prospectively included 100 patients who underwent automated subtraction CTA for suspected cerebrovascular disorders. The nonenhanced and contrast enhanced scans were obtained with the same table feeding speed. The x-ray tube start angles of the two scans were matched to enable accurate registration and subtraction of the CTA datasets. Subtracted CTA datasets were reformatted as three-dimensional volume rendering and maximum intensity projection images for further review. Two independent readers assessed the quality of subtraction and delineation of intracranial vessels. The visibility of ophthalmic arteries was also assessed. RESULTS Subtraction was successful in all patients. The image quality of bone removal was rated excellent in 95 patients, with no or minimal bone remnants. Incomplete bone removal was observed in five patients because of severe motions between the scans. In 97 of 100 patients, arterial segments at the circle of Willis could be clearly visualized. Excellent delineation of bilateral ophthalmic arteries was possible in 81 of 100 patients. CONCLUSIONS The whole brain vasculature would be clearly visualized by using the optimized automated CTA protocol. Our automated, single-source, dual-energy subtraction CTA protocol is a fully automated subtraction method that is capable of delineating major intracranial vessels as well as very small arteries.
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Affiliation(s)
- Qi Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, 400016 Chongqing, China
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Wong GK, Leung JH, Yu JW, Woo PY, Tan HB, Siu DY, Poon WS. Reliability of computed tomographic angiography 3-D method of ruptured intracranial aneurysm measurements. SURGICAL PRACTICE 2013. [DOI: 10.1111/j.1744-1633.2012.00627.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- George K.C. Wong
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Joyce H.Y. Leung
- Department of Diagnostic Radiology and Organ Imaging; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Janice W.L. Yu
- Department of Diagnostic Radiology and Organ Imaging; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Peter Y.M. Woo
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Hai-Bin Tan
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Deyond Y.W. Siu
- Department of Diagnostic Radiology and Organ Imaging; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Wai-Sang Poon
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
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Kidoh M, Nakaura T, Ogata T, Takashima H, Yoshikawa M, Uemura S, Harada K, Yamashita Y. Subtracted 3D CT angiography for the evaluation of intracranial aneurysms in 256-slice multidetector CT: usefulness of the 80-kVp plus compact contrast medium bolus protocol. Eur Radiol 2013; 23:3012-9. [DOI: 10.1007/s00330-013-2928-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/02/2013] [Accepted: 05/20/2013] [Indexed: 02/02/2023]
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Portanova A, Hakakian N, Mikulis DJ, Virmani R, Abdalla WMA, Wasserman BA. Intracranial Vasa Vasorum: Insights and Implications for Imaging. Radiology 2013; 267:667-79. [DOI: 10.1148/radiol.13112310] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Abstract
Subarachnoid hemorrhage (SAH) is a devastating cerebrovascular disease. Outcome after SAH is mainly determined by the initial severity of the hemorrhage. Neuroimaging, in particular computed tomography, and aneurysm repair techniques, such as coiling and clipping, as well as neurocritical care management, have improved during the last few years. The management of a patient with SAH should have an interdisciplinary approach with case discussions between the neurointensivist, interventionalist and the neurosurgeon. The patient should be treated in a specialized neurointensive care unit of a center with sufficient SAH case volume. Poor-grade patients can be observed for complications and delayed cerebral ischemia through continuous monitoring techniques in addition to transcranial Doppler ultrasonography such as continuous electroencephalography, brain tissue oxygenation, cerebral metabolism, cerebral blood flow and serial vascular imaging. Neurocritical care should focus on neuromonitoring for delayed cerebral ischemia, management of hydrocephalus, seizures and intracranial hypertension, as well as of medical complications such as hyperglycemia, fever and anemia.
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Affiliation(s)
- Katja E Wartenberg
- Neurocritical Care Unit, Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
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Agarwal N, Gala NB, Choudhry OJ, Assina R, Prestigiacomo CJ, Duffis EJ, Gandhi CD. Prevalence of asymptomatic incidental aneurysms: a review of 2,685 computed tomographic angiograms. World Neurosurg 2013; 82:1086-90. [PMID: 23336985 DOI: 10.1016/j.wneu.2013.01.082] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 10/17/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Intracranial aneurysms are a public health issue with a potential for rupturing, causing significant morbidity/mortality. The prevalence of unruptured intracranial aneurysms, including those that are asymptomatic, varies widely, as it has been determined through autopsy studies as well as conventional angiography. However, computed tomography angiography, a less invasive procedure, has replaced the use of conventional angiography in the recent decades. The objective of the present study is to determine the prevalence of incidental aneurysms. METHODS The present study reviews all computed tomography angiography cases within the past decade at a single institution. RESULTS Of 2195 cases included in the study, 39 (1.8%) were found to have asymptomatic unruptured aneurysms. CONCLUSIONS The numbers of asymptomatic incidental aneurysms have increased.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Nihar B Gala
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Osamah J Choudhry
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Rachid Assina
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Charles J Prestigiacomo
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA; Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA; Department of Neurology and Neuroscience, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Ennis J Duffis
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Chirag D Gandhi
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA; Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
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Abstract
OBJECTIVE The purpose of this review is to summarize the principles and applications of dual-energy CT in evaluation of the brain and the intracranial blood vessels. CONCLUSION One major advantage of dual-energy CT is the capability of material differentiation. In general, this property can be applied to bone removal in CT angiography for easier and faster postprocessing. In neuroradiology, material decomposition allows detection of hemorrhage on contrast-enhanced CT scans and facilitates the search for the underlying pathologic mechanism of hematomas. The combination of low radiation dose and advantageous spectral information (blood vs contrast) from these datasets justifies broad clinical implementation of dual-energy CT in neuroradiology.
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43
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Ni W, Tian Y, Jiang H, Ning G, Xu F, Liao Y, Gu Y, Song D, Mao Y. Preliminary Experience of 256-Row Multidetector Computed Tomographic Angiography for Detecting Cerebral Aneurysms. J Comput Assist Tomogr 2013; 37:233-41. [DOI: 10.1097/rct.0b013e318281501d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Wei Ni
- Division of Cerebrovascular Surgery and Interventional Neuroradiology, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, PR China
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Mansour O, Megahed M, Schumacher M, Weber J, Khalil M. Coiling of ruptured tiny cerebral aneurysms, feasibility, safety, and durability at midterm follow-up, and individual experience. Clin Neuroradiol 2012. [PMID: 23197366 DOI: 10.1007/s00062-012-0182-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The tiny size of cerebral aneurysms represents one of the challenging facets for endovascular treatment, with a high risk for intraoperative rupture (IOR). We report on the treatment of tiny ruptured saccular cerebral aneurysms by coil embolization. All cases were that of £ 2-3 mm aneurysms with at least one of the dimensions < 2 mm. MATERIALS AND METHODS Between April 2008 and December 2010, we performed a retrospective analysis of nine consecutive cases of tiny aneurysms treated by coil embolization in our institution. RESULTS Coil embolization was successfully performed in nine cases, whereas in one case, intraoperative rupture (IOR) of the fundus was encountered before complete obliteration of the aneurysm expected to be achieved with two coils. Complete occlusion (in n = 7 aneurysms) or near-complete immediate occlusion (in n = 2 aneurysms) was achieved. A total of 18 coils was used for coiling of the nine aneurysms, wherein five aneurysms were coiled with two coils each, two aneurysms with three coils each, and two aneurysms with only one coil each to achieve accepted results. Balloon assistance was used in three cases. Although a minimal coil projection in the parent vessel was seen in three cases, no untoward clinical complications were seen. At mean follow-up (6.7 months, interquartile range (IQR) 3-12 months), digital subtraction angiography (DSA) and magnetic resonance angiography (MRA) in nine patients demonstrated persistent complete occlusion in six of the aneurysms; one aneurysm showed marked filling of the fundus, and two showed neck remnant but did not need retreatment. All patients with available follow-up were independent in day-to-day activities with a modified Rankin score (mRS) of 0 or 1. CONCLUSIONS Coil embolization of tiny ruptured cerebral aneurysms is feasible. Careful consideration of the technical issues in treatment of such aneurysms is essential to achieve technical success while avoiding complications.
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Affiliation(s)
- O Mansour
- Neurology Department, Alexandria University, Alexandria, Egypt.
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Wan-Yin S, Ming-Hua L, Bin-Xian G, Yong-Dong L, Hua-Qiao T. Azygous Anterior Cerebral Artery and Associated Aneurysms: Detection and Identification Using 3-Dimensional Time-of-Flight Magnetic Resonance Angiography. J Neuroimaging 2012; 24:18-22. [PMID: 23163794 DOI: 10.1111/j.1552-6569.2012.00769.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/13/2012] [Accepted: 04/15/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shi Wan-Yin
- Institute of Diagnostic and Interventional Radiology The Sixth Affiliated People's Hospital Shanghai Jiao Tong University No. 600; Yi Shan Road Shanghai China
| | - Li Ming-Hua
- Institute of Diagnostic and Interventional Radiology The Sixth Affiliated People's Hospital Shanghai Jiao Tong University No. 600; Yi Shan Road Shanghai China
| | - Gu Bin-Xian
- Institute of Diagnostic and Interventional Radiology The Sixth Affiliated People's Hospital Shanghai Jiao Tong University No. 600; Yi Shan Road Shanghai China
| | - Li Yong-Dong
- Institute of Diagnostic and Interventional Radiology The Sixth Affiliated People's Hospital Shanghai Jiao Tong University No. 600; Yi Shan Road Shanghai China
| | - Tan Hua-Qiao
- Institute of Diagnostic and Interventional Radiology The Sixth Affiliated People's Hospital Shanghai Jiao Tong University No. 600; Yi Shan Road Shanghai China
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Wang H, Li W, He H, Luo L, Chen C, Guo Y. 320-detector row CT angiography for detection and evaluation of intracranial aneurysms: comparison with conventional digital subtraction angiography. Clin Radiol 2012; 68:e15-20. [PMID: 23142024 DOI: 10.1016/j.crad.2012.09.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 09/06/2012] [Accepted: 09/10/2012] [Indexed: 11/16/2022]
Abstract
AIM To compare the diagnostic performance of 320-detector row computed tomographic angiography (CTA) with digital subtraction angiography (DSA) for the detection and characterization of intracranial aneurysms. MATERIALS AND METHODS Fifty-two consecutive patients with non-traumatic subarachnoid haemorrhage (SAH) and suspected intracranial aneurysms were evaluated from January 2009 to October 2011. All underwent both 320-detector row volume CTA examination and DSA. CTA volume data were transmitted to a VITREA workstation and two physicians with experience in diagnostic imaging of the nervous system independently carried out image post-processing and assessed the results. The three-dimensional (3D) CTA and DSA images were assessed using intraoperative findings as the reference standard. RESULTS In 52 patients, 54 aneurysms were detected; 48 patients underwent surgery for 50 aneurysms. The overall sensitivity, specificity, and accuracy of 3D CTA were 96.3, 100, and 94.6%, respectively. Meanwhile, the overall sensitivity, specificity, and accuracy of DSA were 98.1, 98.1, and 95.1%, respectively. For aneurysms less than 3 mm, the sensitivity, specificity, and accuracy of 3D CTA were 81.8, 100, and 93.3%, respectively. The sensitivity, specificity, and accuracy of DSA for small aneurysms were 90.9, 100, and 96.2%, respectively. 3D CTA was superior to DSA in demonstrating aneurysmal calcification, parent artery, and surrounding vascular anatomy. CONCLUSIONS 3D CTA is a highly sensitive, specific, and non-invasive imaging method for diagnosis and evaluation of intracranial aneurysms. It also allows for precise depiction of aneurysm morphology. Therefore, 320-detector row CTA may be used as an alternative to DSA as a first-line imaging technique in patients with SAH.
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Affiliation(s)
- H Wang
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
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Than KD, Sangala JR, Wang AC, Gandhi D, La Marca F, Park P. The current status and recent advances in high-resolution imaging of spinal vascular malformations. J Clin Neurosci 2012; 20:66-71. [PMID: 23117143 DOI: 10.1016/j.jocn.2012.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/12/2012] [Indexed: 10/27/2022]
Abstract
The management of spinal vascular malformations (SVM) has improved over the last four decades with the evolution of imaging, anesthesia, microsurgery, and endovascular techniques. Commonly used high-resolution imaging techniques include CT angiography, magnetic resonance angiography, and digital subtraction angiography. We review the advances that have been made in these imaging modalities and discuss their present role for imaging SVM, with the goal of assisting neurosurgeons in making judicious use of current imaging techniques to develop the most effective management strategies for these complex lesions.
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Affiliation(s)
- Khoi D Than
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI 48109-5338, USA
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Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 2012; 43:1711-37. [PMID: 22556195 DOI: 10.1161/str.0b013e3182587839] [Citation(s) in RCA: 2252] [Impact Index Per Article: 187.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). METHODS A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. RESULTS Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. CONCLUSIONS aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.
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Rai AT, Hogg JP, Cline B, Hobbs G. Cerebrovascular geometry in the anterior circulation: an analysis of diameter, length and the vessel taper. J Neurointerv Surg 2012; 5:371-5. [PMID: 22490430 DOI: 10.1136/neurintsurg-2012-010314] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND A study was undertaken to determine the typical length, diameter and taper of vessels in the anterior cerebral circulation. METHODS The sample size was calculated at 100 patients based on similar measurements in the literature and divided into cohorts based on gender and side. These patients were consecutively collected from a population that had undergone CT angiography and did not have any vascular abnormality. The arterial diameter was measured at the proximal cavernous internal carotid artery (ICA), the ICA terminus, the middle cerebral artery (MCA) origin and an M2 origin. The length between these endpoints was calculated along the center line. The vessel taper was calculated for the ICA as the change in caliber per unit length. RESULTS The mean length of the ICA from the proximal cavernous segment to the ICA terminus was 33.1 ± 6.1 mm. The mean diameter at the cavernous ICA and the ICA terminus was 5 ± 0.6 mm and 3.6 ± 0.4 mm, respectively. The mean ICA taper was 0.04 ± 0.02 mm/1 mm. For the MCA, the diameter at the MCA and M2 origins measured 3.1 ± 0.4 mm and 2.4 ± 0.4 mm, respectively. The mean MCA length was 22.5 ± 8.1 mm. There was no significant difference based on gender or between right and left sides. Patients aged >60 years had longer ICAs (p=0.02), larger cavernous ICA (p=0.003), ICA terminus (p<0.0001) and MCA origin (p=0.01) diameters than those aged 40-60 years. The ICA vessel taper did not change with age. CONCLUSION ICA and MCA vessel size did not change based on gender or side. Older patients had more redundant vessels based on diameter and length. The ICA has a gentle taper from its proximal cavernous segment to the ICA terminus. This information can be important in planning interventions or designing endovascular devices.
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Affiliation(s)
- Ansaar T Rai
- Department of Interventional Neuroradiology, West Virginia University Hospital, Morgantown, West Virginia, USA.
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50
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Gölitz P, Struffert T, Knossalla F, Saake M, Ott S, Ganslandt O, Doerfler A. Angiographic CT with intravenous contrast injection compared with conventional rotational angiography in the diagnostic work-up of cerebral aneurysms. AJNR Am J Neuroradiol 2012; 33:982-7. [PMID: 22268091 DOI: 10.3174/ajnr.a2883] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Noninvasive imaging of cerebral aneurysms is still considered inferior to conventional angiography. The purpose of this study was to evaluate the diagnostic accuracy of ivACT in the assessment of intracranial aneurysms compared with 3D-DSA. MATERIALS AND METHODS We included 13 patients with 15 incidental unruptured saccular aneurysms scheduled for diagnostic angiographic work-up in our study. In each patient, we performed an ivACT and a conventional angiography including a 3D rotational run. During postprocessing, MPR images were generated for each technique. Maximal aneurysm diameter, neck diameter, aneurysm height, maximum width, bulge height, parent artery diameter, and angle between the parent artery and aneurysm apex were measured for each aneurysm. RESULTS 3D-DSA and ivACT both provided images of high quality without artificial disturbances (ie, motion artifacts). Measurements of all parameters resulted in comparable values for both modalities with a strong correlation (P ≤ .001). CONCLUSIONS ivACT is feasible for the noninvasive visualization of saccular cerebral aneurysms and may provide reliable diagnostic information for the assessment of aneurysm size and geometry comparable with conventional intra-arterial 3D rotational angiography. These preliminary results might be a first promising step to replacing conventional angiography in preinterventional aneurysm imaging.
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Affiliation(s)
- P Gölitz
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91052 Erlangen, Germany.
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