56 results on '"Imaging Division"'
Search Results
2. Developmental Curves of the Paediatric Brain Using FLAIR MRI Texture Biomarkers.
- Author
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Chan K, Rabba D, Vidarsson L, Wagner MW, Ertl-Wagner BB, and Khademi A
- Abstract
Purpose: Analysis of FLAIR MRI sequences is gaining momentum in brain maturation studies, and this study aimed to establish normative developmental curves for FLAIR texture biomarkers in the paediatric brain. Methods: A retrospective, single-centre dataset of 465/512 healthy paediatric FLAIR volumes was used, with one pathological volume for proof-of-concept. Participants were included if the MRI was unremarkable as determined by a neuroradiologist. An automated intensity normalization algorithm was used to standardize FLAIR signal intensity across MRI scanners and individuals. FLAIR texture biomarkers were extracted from grey matter (GM), white matter (WM), deep GM, and cortical GM regions. Sex-specific percentile curves were reported and modelled for each tissue type. Correlations between texture and established biomarkers including intensity volume were examined. Biomarkers from the pathological volume were extracted to demonstrate clinical utility of normative curves. Results: This study analyzed 465 FLAIR sequences in children and adolescents (mean age 10.65 ± 4.22 years, range 2-19 years, 220 males, 245 females). In the WM, texture increased to a maximum at around 8 to 10 years, with different trends between females and males in adolescence. In the GM, texture increased over the age range while demonstrating a local maximum at 8 to 10 years. Texture had an inverse relationship with intensity in the WM across all ages. WM and edema in a pathological brain exhibited abnormal texture values outside of the normative growth curves. Conclusion: Normative curves for texture biomarkers in FLAIR sequences may be used to assess brain maturation and microstructural changes over the paediatric age range., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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3. Changes in cardiac-driven perivascular fluid movement around the MCA in a pharmacological model of acute hypertension detected with non-invasive MRI.
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Evans PG, Sajic M, Yu Y, Harrison IF, Hosford PS, Smith KJ, Lythgoe MF, Stuckey DJ, and Wells JA
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- Rats, Animals, Magnetic Resonance Imaging, Diffusion, Brain blood supply, Cerebrospinal Fluid metabolism, Middle Cerebral Artery, Hypertension metabolism
- Abstract
Perivascular spaces mediate a complex interaction between cerebrospinal fluid and brain tissue that may be an important pathway for solute waste clearance. Their structural or functional derangement may contribute to the development of age-related neurogenerative conditions. Here, we employed a non-invasive low b - value diffusion-weighted ECG-gated MRI method to capture perivascular fluid movement around the middle cerebral artery of the anaesthetised rat brain. Using this method, we show that such MRI estimates of perivascular fluid movement directionality are highly sensitive to the cardiac cycle. We then show that these measures of fluid movement directionality are decreased in the angiotensin-II pharmacological model of acute hypertension, with an associated dampening of vessel pulsatility. This translational MRI method may, therefore, be useful to monitor derangement of perivascular fluid movement associated with cardiovascular pathologies, such as hypertension, in order to further our understanding of perivascular function in neurology., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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4. Accuracy of Information and References Using ChatGPT-3 for Retrieval of Clinical Radiological Information.
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Wagner MW and Ertl-Wagner BB
- Subjects
- Humans, Pilot Projects, Radiography, Radiologists, Artificial Intelligence, Radiology
- Abstract
Purpose: To assess the accuracy of answers provided by ChatGPT-3 when prompted with questions from the daily routine of radiologists and to evaluate the text response when ChatGPT-3 was prompted to provide references for a given answer. Methods: ChatGPT-3 (San Francisco, OpenAI) is an artificial intelligence chatbot based on a large language model (LLM) that has been designed to generate human-like text. A total of 88 questions were submitted to ChatGPT-3 using textual prompt. These 88 questions were equally dispersed across 8 subspecialty areas of radiology. The responses provided by ChatGPT-3 were assessed for correctness by cross-checking them with peer-reviewed, PubMed-listed references. In addition, the references provided by ChatGPT-3 were evaluated for authenticity. Results: A total of 59 of 88 responses (67%) to radiological questions were correct, while 29 responses (33%) had errors. Out of 343 references provided, only 124 references (36.2%) were available through internet search, while 219 references (63.8%) appeared to be generated by ChatGPT-3. When examining the 124 identified references, only 47 references (37.9%) were considered to provide enough background to correctly answer 24 questions (37.5%). Conclusion: In this pilot study, ChatGPT-3 provided correct responses to questions from the daily clinical routine of radiologists in only about two thirds, while the remainder of responses contained errors. The majority of provided references were not found and only a minority of the provided references contained the correct information to answer the question. Caution is advised when using ChatGPT-3 to retrieve radiological information., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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5. Patient outcomes after treatment of brain aneurysm in small diameter vessels with the silk vista baby flow diverter: A systematic review.
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Hanel RA, Cortez GM, Benalia VHC, Sheffels E, Sutphin DJ, Pederson JM, and Pereira VM
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- Humans, Retrospective Studies, Stents, Treatment Outcome, Intracranial Aneurysm therapy, Intracranial Aneurysm surgery, Endovascular Procedures methods, Embolization, Therapeutic methods, Stroke therapy, Aneurysm, Ruptured therapy
- Abstract
Background: The Silk Vista Baby (SVB, BALT) is a first-in-class flow-diverter device delivered using a 0.017" microcatheter, designed for the treatment of intracranial aneurysms, including those in small diameter vessels. This study reports a systematic literature review (SLR) to evaluate the safety and efficacy of using SVB to treat intracranial aneurysms in vessels less than 3.5 mm in diameter., Methods: We performed a PRISMA-compliant SLR to evaluate the outcomes of SVB in the treatment of aneurysms in small intracranial vessels. Primary outcomes were occlusion status and major stroke, and secondary outcomes included all-cause mortality, procedure-related neurologic death, and post-operative aneurysm rupture. Data were expressed as descriptive statistics only., Results: A total of four studies, including 163 patients with 173 intracranial aneurysms, were included. The most common aneurysm locations were the anterior cerebral artery (24.9% [43/173]), the middle cerebral artery (24.3% [42/173]), and the anterior communicating artery (23.1% [40/173]). Parent artery diameter ranged from 0.9 mm to 3.6 mm, and 29% were acutely or previously ruptured aneurysms. Overall, complete or near-complete occlusion was 72.1% on early-term follow-up. Mortality rate among the studies was 2.5%, with 3 instances adjudicated as neurologic deaths (1.8%). Major stroke was noted in 1.2% of cases, and branch occlusion or stent thrombus formation in 5.5%., Conclusion: Our review suggests that SVB is a safe and effective treatment for intracranial aneurysms in small vessels. Further prospective and comparative studies with patient outcome data specific to aneurysm location are needed to confirm the safety and efficacy of SVB., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RAH is a consultant for Medtronic, Stryker, Cerenovous, Microvention, Balt, Phenox, Rapid Medical, and Q'Apel. He is on advisory board for MiVI, eLum, Three Rivers, Shape Medical and Corindus. Unrestricted research grant from NIH, Interline Endowment, Microvention, Stryker, CNX. Investor/stockholder for InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical Inc, Scientia, RisT, BlinkTBI, and Corindus. ES is employed by Superior Medical Experts. DS is employed by Nested Knowledge. JP is employed by and has ownership interest in Superior Medical Experts and Nested Knowledge, Inc. VMP is a consultant for Stryker, Medtronic, Penumbra, Neurovasc, and Balt. All other authors report no conflicts of interest.
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- 2024
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6. Increased rate of significant findings on brain MRI during the early stage of the COVID-19 pandemic.
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Wagner MW, Jadkarim D, Rajani NK, Biswas A, Olatunji R, Law W, Vidarsson L, Amirabadi A, and Ertl-Wagner BB
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- Female, Humans, Child, Pandemics, Magnetic Resonance Imaging methods, Neuroimaging, Brain diagnostic imaging, Brain abnormalities, Retrospective Studies, COVID-19
- Abstract
Objectives: To assess the effect of the COVID-19 pandemic on the proportion of abnormal paediatric neuroimaging findings as a surrogate marker for potential underutilisation., Methods: Consecutive paediatric brain MRIs performed between March 27th and June 19th 2019 (T
baseline ) and March 23rd and June 1st 2020 (Tpandemic ) were reviewed and classified according to presence or absence and type of imaging abnormality, and graded regarding severity on a 5-point Likert scale, where grade 4 was defined as abnormal finding requiring non-urgent intervention and grade 5 was defined as acute illness prompting urgent medical intervention. Non-parametric statistical testing was used to assess for significant differences between Tpandemic vs. Tbaseline ., Results: Fewer paediatric MRI brains were performed during Tpandemic compared to Tbaseline (12.2 vs 14.7 examinations/day). No significant difference was found between the two time periods regarding sex and age (Tbaseline : 557 females (44.63%), 7.95 ± 5.49 years, Tpandemic : 385 females (44.61%), 7.64 ± 6.11 years; p = 1 and p = .079, respectively). MRI brain examinations during Tpandemic had a higher likelihood of being abnormal, 41.25% vs. 25.32% ( p <.0001). Vascular abnormalities were more frequent during Tpandemic (11.01% vs 8.01%, p = .02), congenital malformations were less common (8.34% vs 12.34%, p = .004). Severity of MRI brain examinations was significantly different when comparing group 4 and group 5 individually and combined between Tbaseline and Tpandemic ( p = .0018, p < .0001, and p <.0001, respectively)., Conclusions: The rate of abnormality and severity found on paediatric brain MRI was significantly higher during the early phase of the pandemic, likely due to underutilisation., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.- Published
- 2023
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7. Retrospective Comparison of the Lateral-Arm and Vertical Needle Approaches for Prone Tomosynthesis-Guided Breast Biopsy.
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Cohen EO, Weaver O, Korhonen KE, Sun J, and Leung JWT
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- Humans, Female, Retrospective Studies, Biopsy, Mammography, Image-Guided Biopsy, Breast diagnostic imaging, Breast pathology, Breast Neoplasms diagnostic imaging, Breast Neoplasms pathology
- Abstract
Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2023
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8. Volumetric differences of thalamic nuclei in children with trisomy 21.
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Wagner MW, Bernhard N, Mndebele G, Vidarsson L, and Ertl-Wagner BB
- Abstract
Objectives: Histological studies have shown alterations of thalamic nuclei in patients with Down syndrome (DS). The correlation of these changes on MRI (magnetic resonance imaging) is unclear. Therefore, this study investigates volumetric differences of thalamic nuclei in children with DS compared to controls., Methods: Patients were retrospectively identified between 01/2000 and 10/2021. Patient inclusion criteria were: (1) 0-18 years of age, (2) diagnosis of DS, and (3) availability of a brain MRI without parenchymal injury and a non-motion-degraded volumetric T1-weighted sequence. Whole thalamus and thalamic nuclei ( n = 25) volumes were analyzed bilaterally relative to the total brain volume (TBV). Two-sided t-tests were used to evaluate differences between groups. Differences were considered significant if the adjusted p -value was <0.05 after correction for multiple hypothesis testing using the Holm-Bonferroni method., Results: 21 children with DS (11 females, 52.4%, mean age: 8.6 ± 4.3 years) and 63 age- and sex-matched controls (32 females, 50.8%, 8.6 ± 4.3 years) were studied using automated volumetric segmentation. Significantly smaller ratios were found for nine thalamic nuclei and the whole thalamus on the right and five thalamic nuclei on the left. TBV was significantly smaller in patients with DS ( p < 0.001). No significant differences were found between the groups for age and sex., Conclusions: In this exploratory volumetric analysis of the thalamus and thalamic nuclei, we observed statistically significant volumetric changes in children with DS. Our findings confirm prior neuroimaging and histological studies and extend the range of involved thalamic nuclei in pediatric DS., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2023
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9. Spontaneous intracranial hypotension due to CSF-venous fistula: Evaluation of renal accumulation of contrast following decubitus myelography and maintained decubitus CT to improve fistula localization.
- Author
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Farb RI, O'Reilly ST, Hendriks EJ, Peng PW, Massicotte EM, Hoydonckx Y, and Nicholson PJ
- Abstract
Purpose: Presented here is a strategy of sequential lateral decubitus digital subtraction myelography (LDDSM) followed closely by lateral decubitus CT (LDCT) to facilitate cerebrospinal fluid (CSF)-venous fistula (CVF) localization., Materials and Methods: This is a retrospective analysis of patients referred to our institution for evaluation of CSF leak. Patients with Type 1 and Type 2 leaks, and those not displaying MR brain stigmata of intracranial hypotension were excluded. All patients underwent consecutive LDDSM and LDCT. If the CVF was not localized on the first LDDSM-LDCT pair the patient returned for contralateral examinations. Images were reviewed for CVF and for accumulation of contrast within the renal pelvises expressed as a renal pelvis contrast score (RPCS) in Hounsfield units (HU)., Results: Twenty-two patients were included in this study. In 21 of 22 patients (95%) a CVF was identified yielding an RPCS for the LDDSM-LDCT pair ipsilateral to the CVF ranging from 71 to 423 with an average of 146 HU. An RPCS of the negative side LDDSM-LDCT pair contralateral to a CVF was available in 8 patients and averaged 51 HU. In 4 patients the initial bilateral LDDSM-LDCT pairs did not reveal the location of the CVF however in 3 of these 4 cases the CVF was revealed on a third LDDSM repeated ipsilateral to the higher RPCS., Conclusion: The strategy of sequential LDDSM-LDCT coupled with evaluation of renal accumulation of contrast agent appears to improve the rate of CVF localization and warrants further evaluation.
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- 2023
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10. Radiomic Features Based on MRI Predict Progression-Free Survival in Pediatric Diffuse Midline Glioma/Diffuse Intrinsic Pontine Glioma.
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Wagner MW, Namdar K, Napoleone M, Hainc N, Amirabadi A, Fonseca A, Laughlin S, Shroff MM, Bouffet E, Hawkins C, Khalvati F, Bartels U, and Ertl-Wagner BB
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- Female, Humans, Child, Progression-Free Survival, Retrospective Studies, Magnetic Resonance Imaging, Diffuse Intrinsic Pontine Glioma, Glioma diagnostic imaging, Glioma pathology, Brain Stem Neoplasms diagnostic imaging
- Abstract
Purpose: Biopsy-based assessment of H3 K27 M status helps in predicting survival, but biopsy is usually limited to unusual presentations and clinical trials. We aimed to evaluate whether radiomics can serve as prognostic marker to stratify diffuse intrinsic pontine glioma (DIPG) subsets. Methods: In this retrospective study, diagnostic brain MRIs of children with DIPG were analyzed. Radiomic features were extracted from tumor segmentations and data were split into training/testing sets (80:20). A conditional survival forest model was applied to predict progression-free survival (PFS) using training data. The trained model was validated on the test data, and concordances were calculated for PFS. Experiments were repeated 100 times using randomized versions of the respective percentage of the training/test data. Results: A total of 89 patients were identified (48 females, 53.9%). Median age at time of diagnosis was 6.64 years (range: 1-16.9 years) and median PFS was 8 months (range: 1-84 months). Molecular data were available for 26 patients (29.2%) (1 wild type, 3 K27M-H3.1, 22 K27M-H3.3). Radiomic features of FLAIR and nonenhanced T1-weighted sequences were predictive of PFS. The best FLAIR radiomics model yielded a concordance of .87 [95% CI: .86-.88] at 4 months PFS. The best T1-weighted radiomics model yielded a concordance of .82 [95% CI: .8-.84] at 4 months PFS. The best combined FLAIR + T1-weighted radiomics model yielded a concordance of .74 [95% CI: .71-.77] at 3 months PFS. The predominant predictive radiomic feature matrix was gray-level size-zone. Conclusion: MRI-based radiomics may predict progression-free survival in pediatric diffuse midline glioma/diffuse intrinsic pontine glioma.
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- 2023
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11. Mechanical aspiration thrombectomy for the treatment of pulmonary embolism: A systematic review and meta-analysis.
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Chandra VM, Khaja MS, Kryger MC, Sista AK, Wilkins LR, Angle JF, and Sharma AM
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- Adult, Aged, Humans, Middle Aged, Pulmonary Embolism therapy, Thrombectomy methods, Suction
- Abstract
Introduction: There are no randomized trials studying the outcomes of mechanical aspiration thrombectomy (MAT) for management of pulmonary embolism (PE)., Methods: We performed a systematic review and meta-analysis of existing literature to evaluate the safety and efficacy of MAT in the setting of PE. Inclusion criteria were as follows: studies reporting more than five patients, study involved MAT, and reported clinical outcomes and pulmonary artery pressures. Studies were excluded if they failed to separate thrombectomy data from catheter-directed thrombolysis data. Databases searched include PubMed, EMBASE, Web of Science until April, 2021., Results: Fourteen case series were identified, consisting of 516 total patients (mean age 58.4 ± 13.6 years). Three studies had only high-risk PE, two studies had only intermediate-risk PE, and the remaining nine studies had a combination of both high-risk and intermediate-risk PE. Six studies used the Inari FlowTriever device, five studies used the Indigo Aspiration system, and the remaining three studies used the Rotarex or Aspirex suction thrombectomy system. Four total studies employed thrombolytics in a patient-specific manner, with seven receiving local lysis and 17 receiving systemic lysis, and 40 receiving both. A random-effects meta-analyses of proportions of in-hospital mortality, major bleeding, technical success, and clinical success were calculated, which yielded estimate pooled percentages [95% CI] of 3.6% [0.7%, 7.9%], 0.5% [0.0%, 1.8%], 97.1% [94.8%, 98.4%], and 90.7% [85.5%, 94.3%]., Conclusion: There is significant heterogeneity in clinical, physiologic, and angiographic data in the currently available data on MAT. RCTs with consistent parameters and outcomes measures are still needed.
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- 2022
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12. Costs Associated With Timely and Delayed Surgical Treatment of Spinal Metastases.
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van Tol FR, Massier JRA, Frederix GWJ, Öner FC, Verkooijen HM, and Verlaan JJ
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Study Design: Retrospective cohort study., Objectives: Symptoms caused by spinal metastases are often difficult to distinguish from symptoms caused by non-malignant spinal disease, complicating timely diagnosis, referral and treatment. The ensuing delays may promote the risk of neurological deficits or severe mechanical instability and consequent emergency surgery, leading to poorer prognosis. Presumably, treatment delay may subsequently lead to more health-care consumption and therefore increased average costs of treatment., Methods: All patients surgically treated for spinal metastases were included in the current study. Based on the presence of alarming symptoms and urgency of the required intervention, patients were categorized as having received timely or delayed treatment. Pre-surgical, in-hospital, aftercare and total costs were analyzed and compared between the 2 groups., Results: In total, 299 patients were included, of which 205 underwent timely and 94 delayed treatment. There was no significant difference in pre-surigcal costs (€3.229,13 in the timely treated group vs. €2.528,70 in the delayed treatment group, p = 0.849). The in-hospital costs (€16.738,49 vs. €13.108,81, p < 0.001) and the aftercare costs (€13.950,37 vs . 3.981,93, p < 0.001) were significantly higher for delayed treatment vs. timely treatment, respectively. The total costs were €33.741,71 for delayed treatment and €20.318,52 for timely treatment (p < 0.001)., Conclusions: The total costs for timely treated patients with spinal metastases are significantly lower compared with patients receiving delayed treatment. Investing in the optimization of referral patterns may therefore reduce the overall pretreatment delay and subsequently increase patient outcome, leading to better clinical outcomes at lower costs.
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- 2022
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13. Digital Breast Tomosynthesis: One Step Forward.
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Scaranelo AM
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- Humans, Breast diagnostic imaging, Mammography
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- 2022
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14. What's Hot in Breast MRI.
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Scaranelo AM
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- Breast diagnostic imaging, Female, Humans, Breast Neoplasms diagnostic imaging, Magnetic Resonance Imaging methods
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Several articles in the literature have demonstrated a promising role for breast MRI techniques that are more economic in total exam time than others when used as supplement to mammography for detection and diagnosis of breast cancer. There are many technical factors that must be considered in the shortened breast MRI protocols to cut down time of standard ones, including using optimal fat suppression, gadolinium-chelates intravascular contrast administrations for dynamic imaging with post processing subtractions and maximum intensity projections (MIP) high spatial and temporal resolution among others. Multiparametric breast MRI that includes both gadolinium-dependent, i.e., dynamic contrast-enhanced (DCE-MRI) and gadolinium-free techniques, i.e., diffusion-weighted/diffusion-tensor magnetic resonance imaging (DWI/DTI) are shown by several investigators that can provide extremely high sensitivity and specificity for detection of breast cancer. This article provides an overview of the proven indications for breast MRI including breast cancer screening for higher than average risk, determining chemotherapy induced tumor response, detecting residual tumor after incomplete surgical excision, detecting occult cancer in patients presenting with axillary node metastasis, detecting residual tumor after incomplete breast cancer surgical excision, detecting cancer when results of conventional imaging are equivocal, as well patients suspicious of having breast implant rupture. Despite having the highest sensitivity for breast cancer detection, there are pitfalls, however, secondary to false positive and false negative contrast enhancement and contrast-free MRI techniques. Awareness of the strengths and limitations of different approaches to obtain state of the art MR images of the breast will facilitate the work-up of patients with suspicious breast lesions.
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- 2022
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15. Superior Vena Cava Syndrome due to pericardial hematoma: A case report and mini-review of literature.
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Saboe A, Pramanda AN, Hasan M, Kusumawardhani NY, Maryani E, Ruhimat U, and Cool CJ
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Superior vena cava syndrome is a life-threatening condition. Typically, the clinical presentations are gradual; hence, the diagnosis is often delayed until critical compression or obstruction has occurred. Pericardial hematoma is a rare condition that could occur after cardiac surgery. An asymptomatic, 25-year-old female, who underwent surgical atrial septal defect closure 5 days ago, was sent for routine echocardiography examination before discharge. An intrapericardiac hematoma was detected at the right atrium's free wall without any intracardiac hemodynamic consequences. The patient was discharged and planned for monthly evaluation. During follow-up, the intrapericardiac hematoma was expanding. In the third month's follow-up, the patient complained of shortness of breath, headaches, and coughs. Echocardiography evaluation revealed enlarged pericardial hematoma, which compressed the right atrium and superior vena cava orifice, without echo' sign of cardiac tamponade. Computed tomography scan revealed superior vena cava compression by the pericardial hematoma and appearance of the collateral vessel. The patient was diagnosed with superior vena cava syndrome and sent for surgical evacuation. Pericardial hematoma after cardiac surgery should be evaluated meticulously. Chronic expanding hematoma could cause superior vena cava syndrome, which is fatal. Early diagnosis and appropriate treatment are essential in managing this condition., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)
- Published
- 2021
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16. Controversies Surrounding the BMD Reporting Standard for the Determination of 10-Year Absolute Fracture Risk: A Canadian Perspective.
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Siminoski K, O'Keeffe M, Akincioglu C, Ganguli SN, Levesque J, Raaphorst P, Tarulli G, Thurston W, and Lyons D
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- Absorptiometry, Photon, Algorithms, Bone Density, Canada, Humans, Risk Assessment standards, Risk Factors, Validation Studies as Topic, World Health Organization, Fractures, Bone etiology, Osteoporosis complications, Osteoporosis diagnostic imaging, Practice Guidelines as Topic, Risk Assessment methods
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The Canadian Association of Radiologists and Osteoporosis Canada currently endorse a fracture risk prediction tool called CAROC. It has been used in Canada since 2005 with an update in 2010. It is an integral part of bone mineral densitometry reporting across the country. New osteoporosis guidelines from Osteoporosis Canada (OC) are expected in the near future. There has been pressure on radiologists to report fracture risk using an alternative fracture risk prediction platform called FRAX. In addition, OC collaborated in the development of the Canadian FRAX model and has been copromoting both FRAX and CAROC, raising the prospect that new guidelines may seek to replace CAROC with FRAX for fracture risk determination. A number of concerns have been raised about FRAX, including: (1) FRAX has not released its algorithms to the public domain with the consequence that it is impossible to verify results for an individual patient; (2) FRAX has incorrectly claimed that it was developed by the World Health Organization (WHO) and has used this affiliation to promote itself until recently ordered by the WHO to desist; (3) FRAX requires collection of additional clinical information beyond that needed for CAROC, and this patient-reported medical data is prone to substantial error; and (4) despite claims to the contrary, there are no valid studies comparing FRAX to CAROC. We believe it is important that radiologists be aware of these issues in order to provide input into future Technical Standards for Bone Mineral Densitometry Reporting of the Canadian Association of Radiologists.
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- 2021
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17. Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome.
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Portela de Oliveira E, Chakraborty S, Patel M, Finitsis S, and Iancu D
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- Adult, Aged, Aged, 80 and over, Angiography, Digital Subtraction, Cerebral Angiography, Contrast Media, Female, Humans, Iopamidol, Ischemic Stroke mortality, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Cerebral Hemorrhage diagnostic imaging, Computed Tomography Angiography methods, Ischemic Stroke diagnostic imaging, Ischemic Stroke surgery, Postoperative Complications diagnostic imaging, Thrombectomy methods
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Purpose: Cerebral hyperdensities can appear on head computed tomography (CT) images performed early after endovascular treatment (EVT) in patients with acute ischemic stroke and may be secondary to contrast staining or hemorrhagic transformation. The aim of this study was to determine how the high-density sign on CT affects mortality and clinical outcome and whether CT parameters predict hemorrhagic conversion or unfavorable outcome., Methods: We retrospectively reviewed a database of patients who underwent EVT with mechanical thrombectomy for acute ischemic stroke over 7 years. Included were acute stroke patients with a CT examination within 24 h post-EVT with mechanical thrombectomy, demonstrating areas of hyperdensity. We evaluated morphologic characteristics of these lesions, location, CT Hounsfield units and largest area, as well as patient demographics, EVT methods and patient outcome., Results: A total of 29 patients met the strict inclusion criteria. Complete recanalization was achieved in 58.6% (17/29). Seventeen (58.6%) cases of post-intervention cerebral hyperdensities were related to contrast staining and 12 (41.4%) cases to contrast staining and hemorrhage. Patient mortality was significantly higher in the hemorrhagic group (50.0% versus 5.9%, p = 0.003). The increased density on CT was associated with higher hemorrhagic risk (odds ratio 1.05, p = 0.036)., Conclusion: Patients with the high-density sign on CT images after mechanical thrombectomy for acute ischemic stroke demonstrated increased mortality and worse clinical outcome, primarily when these hyperdensities were related to hemorrhage. CT imaging parameters as higher density areas can help in the differentiation of hemorrhage from contrast staining.
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- 2021
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18. Monitoring and management of fibrosing interstitial lung diseases: a narrative review for practicing clinicians.
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Nambiar AM, Walker CM, and Sparks JA
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- Fibrosis, Humans, Lung Diseases, Interstitial pathology, Lung Diseases, Interstitial therapy, Monitoring, Physiologic
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Close monitoring of patients with fibrosing interstitial lung diseases (ILDs) is important to enable prompt identification and management of progressive disease. Monitoring should involve regular assessment of physiology (including pulmonary function tests), symptoms, and, when appropriate, high-resolution computed tomography. The management of patients with fibrosing ILDs requires a multidisciplinary approach and should be individualized based on factors such as disease severity, evidence of progression, risk factors for progression, comorbidities, and the preferences of the patient. In this narrative review, we discuss how patients with fibrosing ILDs can be effectively monitored and managed in clinical practice.
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- 2021
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19. Cost of hospitalization for stroke in a low-middle-income country: Findings from a public tertiary hospital in the Philippines.
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Diestro JDB, Omar AT, Sarmiento RJC, Enriquez CAG, Castillo LLC, Ho BL, Khu KJOL, and Pascual V JLR
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- Adult, Hospitalization, Hospitals, Public, Humans, Length of Stay, Male, Philippines epidemiology, Retrospective Studies, Tertiary Care Centers, Stroke epidemiology, Stroke therapy
- Abstract
Background: Determining the cost of hospitalization for acute stroke is important in the appropriate allocation of resources for public health facilities and in the cost effectiveness analysis of interventions. Despite being the second leading cause of mortality in the Philippines, there are no published data on the cost of stroke in the country., Aim: The study aims to determine the in-hospitalization cost for stroke (IHCS) in a tertiary public hospital in the Philippines and identify the factors influencing IHCS., Methods: The study was a retrospective review of the medical and billing records of the hospital. Adult patients admitted for acute stroke between 1 June 2017 and 31 May 2018 were included in the analysis. After the mean cost of stroke was determined, multivariate logistic regression analysis was done to determine demographic and clinical characteristics that were predictive of stroke cost., Results: A total of 863 patient records were analyzed. The median in-hospitalization cost for stroke was PHP 17,141.50 or US$329.52. Independent determinants of higher cost include male sex (p = 0.021), stroke type (hemorrhagic stroke, p = 0.001; subarachnoid hemorrhage, p < 0.001), lower GCS on admission (p = 0.023), surgical intervention (p < 0.001), intravenous thrombolysis (p < 0.001), infection (p < 0.001), length of hospital stay (p < 0.001), and mechanical ventilation (p = 0.008)., Conclusion: The study provided current data on the in-hospitalization cost of acute stroke in a public tertiary hospital in the Philippines. Male sex, stroke type, lower GCS on admission, surgical intervention, intravenous thrombolysis, infection, length of hospital stay, and mechanical ventilation were independent predictors of cost.
- Published
- 2021
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20. Imaging of Blunt Pancreatic Trauma: A Systematic Review.
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Odedra D, Mellnick VM, and Patlas MN
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- Contrast Media, Humans, Magnetic Resonance Imaging, Sensitivity and Specificity, Tomography, X-Ray Computed, Ultrasonography, Pancreas diagnostic imaging, Pancreas injuries, Wounds, Nonpenetrating diagnostic imaging
- Abstract
Purpose: Despite several published reports on the value of imaging in acute blunt pancreatic trauma, there remains a large variability in the reported performance of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The purpose of this study is to present a systematic review on the utility of these imaging modalities in the acute assessment of blunt pancreatic trauma. In addition, a brief overview of the various signs of pancreatic trauma will be presented., Methods: Keyword search was performed in MEDLINE, EMBASE, and Web of Science databases for relevant studies in the last 20 years (1999 onward). Titles and abstracts were screened, followed by full-text screening. Inclusion criteria were defined as studies reporting on the effectiveness of imaging modality (US, CT, or MRI) in detecting blunt pancreatic trauma., Results: After initial search of 743 studies, a total of 37 studies were included in the final summary. Thirty-six studies were retrospective in nature. Pancreatic injury was the primary study objective in 21 studies. Relevant study population varied from 5 to 299. Seventeen studies compared the imaging findings against intraoperative findings. Seven studies performed separate analysis for pancreatic ductal injuries and 9 studies only investigated ductal injuries. The reported sensitivities for the detection of pancreatic injuries at CT ranged from 33% to 100% and specificity ranged from 62% to 100%. Sensitivity at US ranged from 27% to 96%. The sensitivity at MRI was only reported in 1 study and was 92%., Conclusion: There remains a large heterogeneity among reported studies in the accuracy of initial imaging modalities for blunt pancreatic injury. Although technological advances in imaging equipment would be expected to improve accuracy, the current body of literature remains largely divided. There is a need for future studies utilizing the most advanced imaging equipment with appropriately defined gold standards and outcome measures.
- Published
- 2020
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21. Postmortem CT in Trauma: An Overview.
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Chandy PE, Murray N, Khasanova E, Nasir MU, Nicolaou S, and Macri F
- Subjects
- Humans, Autopsy methods, Forensic Pathology methods, Tomography, X-Ray Computed methods
- Abstract
As forensic radiology sees an exponential gain in popularity, postmortem computed tomography (PMCT) is increasingly being used in the appropriate setting, either as preautopsy guidance or as part of complementary virtual autopsy protocol. Many articles have expounded the value it adds to forensic pathology in the general setting and the appropriate technical parameters to be used for optimum benefit. We aim to put forth a concise review on the role of PMCT specifically in trauma and the pitfalls to be aware of. Reviews have shown that presumed cause of death in trauma have been proven by autopsy to be wrong in about 30% cases. Radiology applied to postmortem investigation in unnatural deaths and more specifically in trauma shares many semiotic features with emergency radiology. Therefore, in the near future, emergency radiologists might be required to integrate this type of imaging in their regular practice. Although the predominant drawbacks are time-dependent, PMCT also has some difficulty in differentiating antemortem and postmortem events. However, in many such scenarios, PMCT and autopsy play a complementary role in arriving at conclusions, and we believe understanding the benefits and role in trauma is imperative considering the expanding usage of PMCT.
- Published
- 2020
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22. Quantification of cerebral blood flow in adults by contrast-enhanced near-infrared spectroscopy: Validation against MRI.
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Milej D, He L, Abdalmalak A, Baker WB, Anazodo UC, Diop M, Dolui S, Kavuri VC, Pavlosky W, Wang L, Balu R, Detre JA, Amendolia O, Quattrone F, Kofke WA, Yodh AG, and St Lawrence K
- Subjects
- Adult, Contrast Media administration & dosage, Female, Humans, Indocyanine Green administration & dosage, Male, Middle Aged, Perfusion, Reproducibility of Results, Sensitivity and Specificity, Spin Labels, Young Adult, Blood Flow Velocity physiology, Brain blood supply, Brain diagnostic imaging, Cerebrovascular Circulation physiology, Magnetic Resonance Imaging methods, Spectroscopy, Near-Infrared methods
- Abstract
The purpose of this study was to assess the accuracy of absolute cerebral blood flow (CBF) measurements obtained by dynamic contrast-enhanced (DCE) near-infrared spectroscopy (NIRS) using indocyanine green as a perfusion contrast agent. For validation, CBF was measured independently using the MRI perfusion method arterial spin labeling (ASL). Data were acquired at two sites and under two flow conditions (normocapnia and hypercapnia). Depth sensitivity was enhanced using time-resolved detection, which was demonstrated in a separate set of experiments using a tourniquet to temporally impede scalp blood flow. A strong correlation between CBF measurements from ASL and DCE-NIRS was observed (slope = 0.99 ± 0.08, y-intercept = -1.7 ± 7.4 mL/100 g/min, and R
2 = 0.88). Mean difference between the two techniques was 1.9 mL/100 g/min (95% confidence interval ranged from -15 to 19 mL/100g/min and the mean ASL CBF was 75.4 mL/100 g/min). Error analysis showed that structural information and baseline absorption coefficient were needed for optimal CBF reconstruction with DCE-NIRS. This study demonstrated that DCE-NIRS is sensitive to blood flow in the adult brain and can provide accurate CBF measurements with the appropriate modeling techniques.- Published
- 2020
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23. Images in Vascular Medicine. Multivessel obstruction and treatment in a patient with retroperitoneal leiomyosarcoma.
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Clark MR, Khaja MS, Banathy AK, and Wilkins LR
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- Adult, Azygos Vein physiopathology, Collateral Circulation, Female, Humans, Leiomyosarcoma diagnostic imaging, Leiomyosarcoma pathology, Neoplasm Staging, Regional Blood Flow, Retroperitoneal Neoplasms diagnostic imaging, Retroperitoneal Neoplasms pathology, Stents, Treatment Outcome, Vascular Diseases diagnostic imaging, Vascular Diseases etiology, Vascular Diseases physiopathology, Vascular Patency, Endovascular Procedures instrumentation, Leiomyosarcoma complications, Retroperitoneal Neoplasms complications, Vascular Diseases therapy, Vena Cava, Inferior diagnostic imaging, Vena Cava, Inferior physiopathology
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- 2020
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24. Images in Vascular Medicine. Malignancy related superior vena cava (SVC) syndrome treated with kissing brachiocephalic vein and SVC stenting.
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Banathy AK, Wilkins LR, Marko X, Clark MR, Williams DM, and Khaja MS
- Subjects
- Aged, 80 and over, Carcinoma, Non-Small-Cell Lung diagnostic imaging, Carcinoma, Non-Small-Cell Lung secondary, Humans, Lung Neoplasms diagnostic imaging, Lung Neoplasms pathology, Male, Superior Vena Cava Syndrome diagnostic imaging, Superior Vena Cava Syndrome etiology, Superior Vena Cava Syndrome physiopathology, Treatment Outcome, Brachiocephalic Veins diagnostic imaging, Brachiocephalic Veins physiopathology, Carcinoma, Non-Small-Cell Lung complications, Endovascular Procedures instrumentation, Lung Neoplasms complications, Stents, Superior Vena Cava Syndrome therapy, Vena Cava, Superior diagnostic imaging, Vena Cava, Superior physiopathology
- Published
- 2020
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25. A critical role for the ATP-sensitive potassium channel subunit K IR 6.1 in the control of cerebral blood flow.
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Hosford PS, Christie IN, Niranjan A, Aziz Q, Anderson N, Ang R, Lythgoe MF, Wells JA, Tinker A, and Gourine AV
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- Adenosine Triphosphate metabolism, Animals, Brain blood supply, Male, Mice, Oxygen blood, Brain metabolism, Cerebrovascular Circulation, KATP Channels metabolism, Oxygen metabolism
- Abstract
K
IR 6.1 (KCNJ8) is a subunit of ATP sensitive potassium channel (KATP ) that plays an important role in the control of peripheral vascular tone and is highly expressed in brain contractile cells (vascular smooth muscle cells and pericytes). This study determined the effect of global deletion of the KIR 6.1 subunit on cerebral blood flow, neurovascular coupling and cerebral oxygenation in mice. In KIR 6.1 deficient mice resting cerebral blood flow and brain parenchymal partial pressure of oxygen ( P O2 ) were found to be markedly lower compared to that in their wildtype littermates. However, cortical blood oxygen level dependent responses triggered by visual stimuli were not affected in conditions of KIR 6.1 deficiency. These data suggest that KATP channels containing KIR 6.1 subunit are critically important for the maintenance of normal cerebral perfusion and parenchymal P O2 but play no significant role in the mechanisms underlying functional changes in brain blood flow.- Published
- 2019
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26. Back to the Basics: Resting State Functional Connectivity of the Reticular Activation System in PTSD and its Dissociative Subtype.
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Thome J, Densmore M, Koppe G, Terpou B, Théberge J, McKinnon MC, and Lanius RA
- Abstract
Background: Brainstem and midbrain neuronal circuits that control innate, reflexive responses and arousal are increasingly recognized as central to the neurobiological framework of post-traumatic stress disorder (PTSD). The reticular activation system represents a fundamental neuronal circuit that plays a critical role not only in generating arousal but also in coordinating innate, reflexive responding. Accordingly, the present investigation aims to characterize the resting state functional connectivity of the reticular activation system in PTSD and its dissociative subtype., Methods: We investigated patterns of resting state functional connectivity of a central node of the reticular activation system, namely, the pedunculopontine nuclei, among individuals with PTSD (n = 77), its dissociative subtype (PTSD+DS; n = 48), and healthy controls (n = 51)., Results: Participants with PTSD and PTSD+DS were characterized by within-group pedunculopontine nuclei resting state functional connectivity to brain regions involved in innate threat processing and arousal modulation (i.e., midbrain, amygdala, ventromedial prefrontal cortex). Critically, this pattern was most pronounced in individuals with PTSD+DS, as compared to both control and PTSD groups. As compared to participants with PTSD and controls, individuals with PTSD+DS showed enhanced pedunculopontine nuclei resting state functional connectivity to the amygdala and the parahippocampal gyrus as well as to the anterior cingulate and the ventromedial prefrontal cortex. No group differences emerged between PTSD and control groups. In individuals with PTSD+DS, state derealization/depersonalization was associated with reduced resting state functional connectivity between the left pedunculopontine nuclei and the anterior nucleus of the thalamus. Altered connectivity in these regions may restrict the thalamo-cortical transmission necessary to integrate internal and external signals at a cortical level and underlie, in part, experiences of depersonalization and derealization., Conclusions: The present findings extend the current neurobiological model of PTSD and provide emerging evidence for the need to incorporate brainstem structures, including the reticular activation system, into current conceptualizations of PTSD and its dissociative subtype., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)
- Published
- 2019
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27. The Threatful Self: Midbrain Functional Connectivity to Cortical Midline and Parietal Regions During Subliminal Trauma-Related Processing in PTSD.
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Terpou BA, Densmore M, Théberge J, Thome J, Frewen P, McKinnon MC, and Lanius RA
- Abstract
Background: The innate alarm system consists of a subcortical network of interconnected midbrain, lower brainstem, and thalamic nuclei, which together mediate the detection of evolutionarily-relevant stimuli. The periaqueductal gray is a midbrain structure innervated by the innate alarm system that coordinates the expression of defensive states following threat detection. In participants with post-traumatic stress disorder, the periaqueductal gray displays overactivation during the subliminal presentation of trauma-related stimuli as well as altered resting-state functional connectivity. Aberrant functional connectivity is also reported in post-traumatic stress disorder for the default-mode network, a large-scale brain network recruited during self-referential processing and autobiographical memory. Here, research lacks investigation on the extent to which functional interactions are displayed between the midbrain and the large-scale cortical networks in post-traumatic stress disorder., Methods: Using a subliminal threat presentation paradigm, we investigated psycho-physiological interactions during functional neuroimaging in participants with post-traumatic stress disorder (n = 26) and healthy control subjects (n = 20). Functional connectivity of the periaqueductal gray was investigated across the whole-brain of each participant during subliminal exposure to trauma-related and neutral word stimuli., Results: As compared to controls during subliminal threat presentation, the post-traumatic stress disorder group showed significantly greater periaqueductal gray functional connectivity with regions of the default-mode network (i.e., angular gyrus, precuneus, superior frontal gyrus). Moreover, multiple regression analyses revealed that the functional connectivity between the periaqueductal gray and the regions of the default-mode network correlated positively to symptoms of avoidance and state dissociation in post-traumatic stress disorder., Conclusion: Given that the periaqueductal gray engages the expression of defensive states, stronger midbrain functional coupling with the default-mode network may have clinical implications to self-referential and trauma-related processing in participants with post-traumatic stress disorder., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)
- Published
- 2019
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28. An Open-Label Feasibility Trial Examining the Effectiveness of a Cognitive Training Program, Goal Management Training, in Individuals With Posttraumatic Stress Disorder.
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Boyd JE, O'Connor C, Protopopescu A, Jetly R, Rhind SG, Lanius RA, and McKinnon MC
- Abstract
Background: Posttraumatic stress disorder (PTSD) is associated with dysfunction across multiple cognitive domains including executive functioning, attention, and verbal memory. This dysfunction is associated with negative impacts on functional outcomes (e.g., work or social functioning) and reduced response to psychotherapy for PTSD. Despite this knowledge, little work has investigated the efficacy of cognitive remediation strategies in improving cognition and functional outcomes among individuals with PTSD., Objective: The current study investigated the efficacy of an established cognitive remediation program, Goal Management Training (GMT), in improving cognitive functioning in a pilot sample of individuals with PTSD symptoms in an inpatient treatment setting., Method: Thirty-four inpatients with PTSD symptoms participated in either GMT in addition to treatment as usual (TAU; consisting of psychiatric management, group and individual psychotherapy) (TAU+GMT; n = 18) or TAU alone ( n = 16). The TAU+GMT group received neuropsychological assessment at baseline and posttreatment, while both the TAU+GMT and TAU groups received assessment with clinical self-report measures at baseline and posttreatment., Results: Paired-sample t-tests revealed significant improvements on measures of executive functioning (e.g., response inhibition, cognitive flexibility), processing speed, sustained attention, and verbal memory in the TAU+GMT group. Mixed-design analyses of variance (ANOVAs) revealed a trend toward an interaction effect indicating potentially greater improvements on a measure of the ability to engage in goal-directed behaviors while highly emotional in the TAU+GMT group as compared to the TAU group., Discussion: The results of this small feasibility investigation of GMT in PTSD point toward the potential efficacy of GMT in ameliorating cognitive difficulties in individuals with PTSD., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)
- Published
- 2019
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29. The Innate Alarm System and Subliminal Threat Presentation in Posttraumatic Stress Disorder: Neuroimaging of the Midbrain and Cerebellum.
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Terpou BA, Densmore M, Thome J, Frewen P, McKinnon MC, and Lanius RA
- Abstract
Background: The innate alarm system, a network of interconnected midbrain, other brainstem, and thalamic structures, serves to rapidly detect stimuli in the environment prior to the onset of conscious awareness. This system is sensitive to threatening stimuli and has evolved to process these stimuli subliminally for hastened responding. Despite the conscious unawareness, the presentation of subliminal threat stimuli generates increased activation of limbic structures, including the amygdala and insula, as well as emotionally evaluative structures, including the cerebellum and orbitofrontal cortex. Posttraumatic stress disorder (PTSD) is associated with an increased startle response and decreased extinction learning to conditioned threat. The role of the innate alarm system in the clinical presentation of PTSD, however, remains poorly understood., Methods: Here, we compare midbrain, brainstem, and cerebellar activation in persons with PTSD (n = 26) and matched controls (n = 20) during subliminal threat presentation. Subjects were presented with masked trauma-related and neutral stimuli below conscious threshold. Contrasts of subliminal brain activation for the presentation of neutral stimuli were subtracted from trauma-related brain activation. Group differences in activation, as well as correlations between clinical scores and PTSD activation, were examined. Imaging data were preprocessed utilizing the spatially unbiased infratentorial template toolbox within SPM12., Results: Analyses revealed increased midbrain activation in PTSD as compared to controls in the superior colliculus, periaqueductal gray, and midbrain reticular formation during subliminal threat as compared to neutral stimulus presentation. Controls showed increased activation in the right cerebellar lobule V during subliminal threat presentation as compared to PTSD. Finally, a negative correlation emerged between PTSD patient scores on the Multiscale Dissociation Inventory for the Depersonalization/Derealization subscale and activation in the right lobule V of the cerebellum during the presentation of subliminal threat as compared to neutral stimuli., Conclusion: We interpret these findings as evidence of innate alarm system overactivation in PTSD and of the prominent role of the cerebellum in the undermodulation of emotion observed in PTSD., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)
- Published
- 2019
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30. Temporoparietal Junction Functional Connectivity in Early Schizophrenia and Major Depressive Disorder.
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Penner J, Osuch EA, Schaefer B, Théberge J, Neufeld RWJ, Menon RS, Rajakumar N, and Williamson PC
- Abstract
Background: The temporoparietal junction (TPJ) has been linked to lower-level attentional and higher-level social processing, both of which are affected in schizophrenia (SZ) and major depressive disorder (MDD). We examined resting functional connectivity of bilateral anterior and posterior TPJ in SZ and MDD to evaluate potential anomalies in each disorder and differences between disorders., Methods: Resting-state functional magnetic resonance imaging data were acquired from 24 patients with SZ, 24 patients with MDD, and 24 age-matched healthy controls. We performed seed-based functional connectivity analyses with seed regions in bilateral anterior and posterior TPJ, covarying for gender and smoking., Results: SZ had reduced connectivity versus controls between left anterior TPJ and dorsolateral prefrontal cortex (dlPFC) and posterior cingulate cortex (PCC); between left posterior TPJ and middle cingulate cortex, left dorsal PFC, and right lateral PFC; between right anterior TPJ and bilateral PCC; and between right posterior TPJ and middle cingulate cortex, left posterior insula, and right insula. MDD had reduced connectivity versus controls between left posterior TPJ and right dlPFC and between right posterior TPJ and PCC and dlPFC. SZ had reduced connectivity versus MDD between right posterior TPJ and left fusiform gyrus and right superior-posterior temporal cortex., Conclusion: Functional connectivity to the TPJ was demonstrated to be disrupted in both SZ and MDD. However, TPJ connectivity may differ in these disorders with reduced connectivity in SZ versus MDD between TPJ and posterior brain regions., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2018.)
- Published
- 2018
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31. Diagnostic accuracy of whole-brain computed tomography perfusion for detection of ischemic stroke in patients with mild neurological symptoms.
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Frank RA, Chakraborty S, McGrath T, Mungham A, Ross J, Dowlatshahi D, Shamy M, and Stotts G
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Contrast Media, Diffusion Magnetic Resonance Imaging, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Sensitivity and Specificity, Young Adult, Brain diagnostic imaging, Brain Ischemia diagnostic imaging, Perfusion Imaging methods, Stroke diagnostic imaging, Tomography, X-Ray Computed methods
- Abstract
Mild and minor acute neurological symptoms may lead to diagnostic uncertainty, resulting in a heterogeneous group of patients with true ischemic events and stroke mimics with a potential for poor outcomes. More than half of ischemic stroke patients present as minor strokes (National Institutes of Health Stroke Scale score <6). Whole-brain computed tomography perfusion can be used as a diagnostic test for minor stroke, offering a potential method of reducing diagnostic uncertainty in these patients. We hypothesize that whole-brain computed tomography perfusion imaging features could accurately predict infarction in patients with minor neurological deficits. This retrospective chart review enrolled consecutive patients suspected of acute ischemic stroke with a National Institutes of Health Stroke Scale score <6, who underwent whole-brain computed tomography perfusion and follow-up diffusion-weighted magnetic resonance imaging at our institution. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for whole-brain computed tomography perfusion, using follow-up diffusion-weighted magnetic resonance imaging as a reference standard. A total of 524 patients (mean age: 67 years; range: 17-96 years; 56% men) met the inclusion criteria. Patients were excluded for non-diagnostic ( n = 25) or missing maps ( n = 8) scans, non-ischemic findings ( n = 7), and lack of follow-up magnetic resonance imaging ( n = 336). The final analysis included 148 patients who underwent diffusion-weighted magnetic resonance imaging. Whole-brain computed tomography perfusion has a sensitivity of 0.57 (95% CI: 0.45-0.69) and a specificity of 0.82 (95% CI: 0.71-0.90). The positive and negative predictive values and positive and negative likelihood ratios were 75%, 67%, 3.09, and 0.53, respectively. Our analysis suggests that although whole-brain computed tomography perfusion may offer some value as an adjunctive test for improving confidence in offering stroke treatment, it is not sufficiently sensitive or specific to accurately predict cerebral infarcts in patients with minor neurological symptoms.
- Published
- 2018
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32. Successful Reintroduction of Peritoneal Dialysis After Peritoneal-Pericardial Fistula in a Child: A Case Report.
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Derynck MR, Jones S, Rachinsky IV, McIntyre CW, Blake P, and Filler G
- Subjects
- Child, Conservative Treatment, Female, Fistula diagnostic imaging, Fistula therapy, Humans, Pericardial Effusion diagnostic imaging, Pericardial Effusion therapy, Fistula etiology, Pericardial Effusion etiology, Pericardium, Peritoneal Dialysis adverse effects, Peritoneum, Renal Insufficiency, Chronic therapy
- Published
- 2018
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33. Is Zika Virus an Emerging TORCH Agent? An Invited Commentary.
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Mehrjardi MZ
- Abstract
Zika virus (ZIKV) is a mosquito-borne arbovirus from the family Flaviviridae , which had caused some epidemics since its discovery in 1947 without any significant impacts on public health. In 2015, however, a 20-fold increase in congenital microcephaly cases in northeastern Brazil was attributed to prenatally acquired ZIKV infection. Traditionally, TORCH agents have 4 common characteristics including causing a mild illness in infected mother, vertical transmission to fetus, developing several anomalies in the affected fetus, and in some instances, maternal therapy may not ameliorate fetal prognosis. Prenatal ZIKV infection has shown the aforementioned characteristics during the recent epidemics in South America and the Caribbean region; therefore, it should be considered as an emerging TORCH agent that may seriously threaten public health. Fetal ultrasound can be used as a safe, inexpensive, and easy-to-access imaging modality for detecting suspicious cases of congenital Zika syndrome in utero and suggesting confirmatory diagnostic examinations to these patients., Competing Interests: DECLARATION OF CONFLICTING INTERESTS: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2017
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34. Gamma Knife radiosurgery for the treatment of intracranial dural arteriovenous fistulas.
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Dmytriw AA, Schwartz ML, Cusimano MD, Mendes Pereira V, Krings T, Tymianski M, Radovanovic I, and Agid R
- Subjects
- Adult, Aged, Central Nervous System Vascular Malformations diagnostic imaging, Cerebral Angiography, Female, Humans, Male, Middle Aged, Radiotherapy Dosage, Retrospective Studies, Treatment Outcome, Central Nervous System Vascular Malformations radiotherapy, Radiosurgery instrumentation
- Abstract
Background Intracranial dural arteriovenous fistulae (DAVF) may present a treatment challenge. Endovascular embolization is in most cases the first line of treatment but does not always achieve cure. Gamma Knife (GK) radiosurgery represents an alternative treatment option, and the purpose of this study was to further evaluate its utility. Methods We reviewed all cases of DAVF treated between 2009 and 2016 at our institution with GK radiosurgery independently, or following failed/refused endovascular or surgical management. Patients' clinical files, radiological images, catheter angiograms, and surgical DAVF disconnection reports were retrospectively reviewed. Results Sixteen DAVF (14 patients) treated by GK radiosurgery were identified. Eleven fistulae were aggressive and five were benign. Marginal doses ranged from 15 to 25 Gy. Target volumes ranged from 0.04 to 4.47 cm
3 . In all symptomatic patients, GK treatment resulted in symptom palliation. In 13/15 lesions, cure of symptoms (86.0%) was reported. One lesion was asymptomatic. Angiographic cure was achieved in eight cases (50%), small residual DAVF occurred in four, and four were unchanged. One patient developed headache that resolved at one year. No hemorrhage occurred during the follow-up period. There was no significant association between Borden type and cure rate. Prior failed endovascular treatment and small target volume were associated with lower rates of cure. Conclusions Stereotactic radiosurgery is viable treatment for DAVF. It is very effective in palliating symptoms as a de novo approach or adjunctive to endovascular therapy. In our experience it is only somewhat effective in achieving complete angiographic cure.- Published
- 2017
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35. Currarino Syndrome in a Fetus, Infant, Child, and Adolescent: Spectrum of Clinical Presentations and Imaging Findings.
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Caro-Domínguez P, Bass J, and Hurteau-Miller J
- Subjects
- Adolescent, Anal Canal diagnostic imaging, Child, Preschool, Female, Fetal Diseases diagnostic imaging, Humans, Infant, Infant, Newborn, Pregnancy, Rectum diagnostic imaging, Sacrum diagnostic imaging, Syndrome, Anal Canal abnormalities, Diagnostic Imaging methods, Digestive System Abnormalities diagnostic imaging, Prenatal Diagnosis methods, Rectum abnormalities, Sacrum abnormalities, Syringomyelia diagnostic imaging
- Abstract
In 1981, Currarino et al described a triad of findings that consist of partial sacral dysgenesis, presacral mass (anterior meningocele, enteric cyst, or presacral teratoma) and anorectal malformation. Currarino syndrome exhibits variable expressivity and the clinical presentation tends to vary with the age of the subject such as spinal anomaly detected in the fetus, imperforate anus in the newborn, and intractable constipation or neurologic symptoms in the infant and older child. At any age, meningitis can be the presenting symptom and imaging is required for proper investigation. Meningitis, sepsis, urinary tract infections, and, rarely, malignant transformation of a teratoma are serious potential complications. This pictorial review describes the imaging findings, clinical history, surgical interventions, and genetic background in 5 children with this syndrome who presented in our hospital in the interval of 1 year., (Copyright © 2016 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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36. Less can be more: Targeted embolization of aneurysms associated with arteriovenous malformations unsuitable for surgical resection.
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Alexander MD, Cooke DL, Hallam DK, Kim H, Hetts SW, and Ghodke BV
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Aneurysm, Ruptured etiology, Cerebral Angiography, Child, Child, Preschool, Dimethyl Sulfoxide, Female, Follow-Up Studies, Humans, Intracranial Aneurysm etiology, Intracranial Arteriovenous Malformations complications, Male, Middle Aged, Polyvinyls, Retrospective Studies, Treatment Outcome, Aneurysm, Ruptured therapy, Embolization, Therapeutic methods, Intracranial Aneurysm therapy, Intracranial Arteriovenous Malformations therapy
- Abstract
Introduction: To mitigate risks of hemorrhage, high-risk features of brain arteriovenous malformations (BAVMs) can be targeted to reduce the risk of rupture. Previous investigation has examined embolization of a pedicle supplying a high-risk feature; this study examines embolization targeted specifically at aneurysms associated with BAVMs., Materials and Methods: Patients with BAVMs treated at two high-volume neurointerventional services were retrospectively reviewed. Patients treated with intention to occlude only the associated aneurysm itself were analyzed. Demographic and lesion characteristics were identified, as were technical and clinical outcomes. Adverse events were defined as hemorrhage, new seizure, and death., Results: Thirty-two patients met inclusion criteria out of 1103 patients treated during the study period. Twenty-seven (84.4%) BAVMs were acutely ruptured, all with the aneurysm identified as the hemorrhage source. Twenty-four (75.0%) lesions involved eloquent territory. There were equal numbers of feeding artery and nidus aneurysms. Follow-up data were available for a total of 101.3 patient-years for a mean follow-up time of 2.9 years. One patient died; the remaining 31 patients had improved functional status at last contact. Annualized rate of hemorrhage after treatment was 1.0%; rate of adverse events after treatment was 3.0%. Excluding time after confirmed occlusion following radiosurgery, annualized rates were 1.4% and 4.8%, respectively., Conclusion: In inoperable BAVMs, targeted embolization of associated aneurysms can be performed safely and effectively. This should be considered in high-risk lesions prior to radiosurgery or in cases when no other treatment options are available. Such intervention warrants further investigation., (© The Author(s) 2016.)
- Published
- 2016
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37. Surgical resection margins after breast-conserving surgery: Senonetwork recommendations.
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Galimberti V, Taffurelli M, Leonardi MC, Aristei C, Trentin C, Cassano E, Pietribiasi F, Corso G, Munzone E, Tondini C, Frigerio A, Cataliotti L, and Santini D
- Subjects
- Adult, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Breast Neoplasms diagnostic imaging, Breast Neoplasms pathology, Chemotherapy, Adjuvant, Evidence-Based Medicine, Female, Humans, Italy, Magnetic Resonance Imaging, Mammography, Middle Aged, Neoadjuvant Therapy, Radiotherapy, Adjuvant, Reoperation, Time Factors, Breast Neoplasms surgery, Margins of Excision, Mastectomy, Segmental standards, Mastectomy, Segmental trends
- Abstract
This paper reports findings of the "Focus on Controversial Areas" Working Party of the Italian Senonetwork, which was set up to improve the care of breast cancer patients. After reviewing articles in English on the MEDLINE system on breast conserving surgery for invasive carcinoma, the Working Party presents their recommendations for identifying risk factors for positive margins, suggests how to manage them so as to achieve the highest possible percentage of negative margins, and proposes standards for investigating resection margins and therapeutic approaches according to margin status. When margins are positive, approaches include re-excision, mastectomy, or, as second-line treatment, radiotherapy with a high boost dose. When margins are negative, boost administration and its dose depend on the risk of local recurrence, which is linked to biopathological tumor features and surgical margin width. Although margin status does not affect the choice of systemic therapy, it may delay the start of chemotherapy when further surgery is required.
- Published
- 2016
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38. Onyx versus nBCA and coils in the treatment of intracranial dural arteriovenous fistulas.
- Author
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Choo DM and Shankar JJ
- Subjects
- Adult, Aged, Case-Control Studies, Embolization, Therapeutic adverse effects, Female, Humans, Infant, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Young Adult, Central Nervous System Vascular Malformations therapy, Dimethyl Sulfoxide, Embolization, Therapeutic methods, Enbucrilate, Polyvinyls, Stents
- Abstract
Background and Purpose: Intracranial dural arteriovenous fistulas (DAVFs) with cortical venous drainage have significant morbidity and mortality. Complete closure of these lesions is necessary to reduce these risks. The purpose of our study was to compare the outcome of DAVFs treated with Onyx versus those treated with n-Butyl Cyanoacrylate (nBCA) and coil embolization in a case-control study. Compared with nBCA and coil embolization, we hypothesized that Onyx embolization for DAVF is safer and has a higher chance of complete obliteration, with no need for post-embolization surgery for the DAVF., Materials and Methods: From 1998 to 2015, 29 patients who had DAVFs were treated with endovascular embolization. Of these, 24 patients had imaging available for analysis. Successful closure rates, complications, and procedure time were compared between the embolization techniques., Results: The chance of not requiring post-embolization surgery with Onyx (81.8%) was significantly higher (p = 0.005) than with nBCA (22.22%). The complication rate with Onyx (9.1%) tended to be lower compared with that of nBCA (22.22%; p = 0.37). Procedural time was not significantly different between Onyx (mean 267 minutes) and nBCA (mean 288 minutes) (p = 0.59). The odds ratio of a DAVF being treated with Onyx and then requiring no follow-up surgery was 17.5 (95% CI 1.97-155.4)., Conclusion: Our case-control study suggests that Onyx embolization is superior to nBCA and coil embolization in completely obliterating DAVFs, with higher odds of no post-embolization surgery. We also found that Onyx is safe for embolization of DAVFs, with no associated neurological mortality and morbidity., (© The Author(s) 2016.)
- Published
- 2016
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39. Use of a flow-diverting stent for ruptured dissecting aneurysm treatment in a patient with sickle cell disease.
- Author
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Dmytriw AA, Martinez JL, Marotta T, Montanera W, Cusimano M, and Bharatha A
- Subjects
- Aortic Dissection complications, Aneurysm, Ruptured complications, Aneurysm, Ruptured diagnostic imaging, Cerebral Angiography, Emergency Medical Services, Female, Humans, Magnetic Resonance Angiography, Middle Aged, Postoperative Complications therapy, Tomography, X-Ray Computed, Treatment Outcome, Anemia, Sickle Cell complications, Aortic Dissection surgery, Aneurysm, Ruptured surgery, Anterior Spinal Artery Syndrome surgery, Embolization, Therapeutic instrumentation, Embolization, Therapeutic methods, Endovascular Procedures methods, Stents
- Abstract
Introduction: Sickle cell disease (SCD) is a clinical phenotype that presents a unique challenge to the interventionalist, particularly when stent therapy is contemplated. Homozygous individuals are likely at increased risk for thromboembolic complications. There are no formal guidelines regarding antiplatelet therapy in the short or long term for intracranial stent use in SCD. The authors describe the novel use of a pipeline embolization device (PED) to treat a ruptured dissecting bilobed/fusiform vertebral artery V4 aneurysm in an SCD patient complicated by tortuous proximal anatomy and the anterior spinal artery arising from the diseased segment. Considerations regarding antiplatelet therapy in this scenario are discussed., Case Report: A 50-year-old woman with homozygous recessive SCD was transported to the emergency department and presented with diffuse subarachnoid hemorrhage. CT angiography demonstrated a left-sided 3 × 5 mm fusiform bi-lobulated presumed dissecting vertebral artery aneurysm, immediately distal to the origin of the posterior inferior cerebellar artery (PICA). A PED was deployed within the V4 segment across the aneurysm. Post-treatment angiography showed patency of the parent artery, and patency of the "jailed" anterior spinal artery and of the PICA., Discussion: Selecting a treatment method in SCD patients with a ruptured intracranial aneurysm is challenging and there are no clinical trials comparing treatment methods in this population. The authors demonstrate that flow diversion is feasible in SCD, which has not been described in the literature. Additionally, the case stresses the peri- and post-procedural management of SCD, as well as long-term considerations with a flow-diverting stent in place., (© The Author(s) 2015.)
- Published
- 2016
- Full Text
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40. Alternative technique for clot retrieval: The "tip of the iceberg" technique.
- Author
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Agid R and Power S
- Subjects
- Adult, Aged, Angiography, Digital Subtraction, Cerebral Angiography, Diagnosis, Differential, Female, Fibrinolytic Agents therapeutic use, Humans, Male, Stroke diagnostic imaging, Tissue Plasminogen Activator therapeutic use, Middle Cerebral Artery, Stents, Stroke therapy, Thrombectomy methods
- Abstract
We present a variation of the classical technique of stent retriever thrombectomy which we found helpful in two patients presenting with acute stroke. CT angiography in both patients demonstrated thrombus within a middle cerebral artery M2 branch. In both cases the occluded artery was not visualized on DSA and only the proximal tip of the clot could be seen as a filling defect "hanging" into the parent artery reminiscent of a "tip of an iceberg". Rather than selectively catheterizing the occluded branch we placed the stent retriever in the patent parent artery crossing only the tip of the clot. In both cases one pass of the stent retriever was sufficient to retrieve the whole clot by its tip and reopen the occluded branch. We suggest trying this technique whenever the clot is seated in the proximal part of a secondary branch such as an M2 segment of middle cerebral artery. This "tip of the iceberg" technique prevents the need to selectively catheterize the occluded branch which, if difficult, can prolong procedural and ischemic time., (© The Author(s) 2015.)
- Published
- 2015
- Full Text
- View/download PDF
41. Coronary Endothelial Dysfunction in Women With Type 2 Diabetes Measured by Coronary Phase Contrast Flow Velocity Magnetic Resonance Imaging.
- Author
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Maroules CD, Chang AY, Kotys-Traughber MS, and Peshock RM
- Subjects
- Adult, Blood Flow Velocity, Coronary Circulation, Female, Humans, Coronary Vessels physiopathology, Diabetes Mellitus, Type 2 physiopathology, Endothelium, Vascular physiopathology, Magnetic Resonance Imaging methods
- Abstract
Objective: The aim of this study was to determine if differences in coronary endothelial function are observed between asymptomatic women with type 2 diabetes mellitus (DM) and control subjects using coronary phase contrast flow velocity magnetic resonance imaging in response to cold pressor stress, an established endothelium-dependent vasodilatory stress., Methods: Phase contrast flow velocity imaging of the right coronary artery was performed in 7 asymptomatic premenopausal women with DM and 8 healthy female participants in response to the cold pressor test at 3 T., Results: There was no significant difference in percent increase in coronary flow velocity from rest to peak flow velocity between DM and control subjects (32% ± 22% vs 46% ± 17%; P = 0.11). However, percent increase in coronary flow velocity was lower in DM than in control subjects (-3% ± 14% vs 31% ± 30%; P = 0.01) during the second minute of cold pressor stress, when endothelial-mediated vasodilation should occur., Conclusions: Asymptomatic women with DM demonstrate reduced coronary flow velocity during the second minute of cold pressor stress, indicating coronary endothelial dysfunction.
- Published
- 2015
- Full Text
- View/download PDF
42. Increased cerebral vascular reactivity in the tau expressing rTg4510 mouse: evidence against the role of tau pathology to impair vascular health in Alzheimer's disease.
- Author
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Wells JA, Holmes HE, O'Callaghan JM, Colgan N, Ismail O, Fisher EM, Siow B, Murray TK, Schwarz AJ, O'Neill MJ, Collins EC, and Lythgoe MF
- Subjects
- Alzheimer Disease metabolism, Animals, Brain metabolism, Disease Models, Animal, Magnetic Resonance Imaging, Mice, Mice, Transgenic, Spin Labels, Alzheimer Disease pathology, Brain pathology, Cerebrovascular Circulation, tau Proteins metabolism
- Abstract
Vascular abnormalities are a key feature of Alzheimer's disease (AD). Imaging of cerebral vascular reactivity (CVR) is a powerful tool to investigate vascular health in clinical populations although the cause of reduced CVR in AD patients is not fully understood. We investigated the specific role of tau pathology in CVR derangement in AD using the rTg4510 mouse model. We observed an increase in CVR in cortical regions with tau pathology. These data suggest that tau pathology alone does not produce the clinically observed decreases in CVR and implicates amyloid pathology as the dominant etiology of impaired CVR in AD patients.
- Published
- 2015
- Full Text
- View/download PDF
43. Superior vena cava syndrome: role of the interventionalist.
- Author
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Rachapalli V and Boucher LM
- Subjects
- Angiography, Angioplasty, Balloon, Humans, Postoperative Complications, Stents, Superior Vena Cava Syndrome etiology, Superior Vena Cava Syndrome physiopathology, Thrombectomy, Endovascular Procedures, Radiography, Interventional, Superior Vena Cava Syndrome surgery, Ultrasonography, Interventional
- Abstract
Superior vena cava syndrome results from the obstruction of blood flow through the superior vena cava and is most often due to thoracic malignancy. However, benign etiologies are on the rise secondary to more frequent use of intravascular devices such as central venous catheters and pacemakers. Although rarely a medical emergency, the symptoms can be alarming, particularly to the patient. Traditionally, superior vena cava syndrome has been managed with radiotherapy and chemotherapy. But interventional endovascular techniques have made inroads that offer a safe, rapid, and durable response. In many cases, it may be the only reasonable treatment. Because of this, an approach to endovascular treatment of this condition must be in the armamentarium of the interventional radiologist. This review will provide the reader with an insight into the etiology, pathophysiology, and various management principles of superior vena cava syndrome. The focus will be on understanding the techniques used during various endovascular interventions, including angioplasty, stenting, and pharmacomechanical thrombolysis. Discussion will also be centred on possible complications and current evidence as well as controversies regarding these approaches., (Copyright © 2014 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
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44. Venous aneurysms in autogenous hemodialysis fistulas: is there an association with venous outflow stenosis.
- Author
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Rajput A, Rajan DK, Simons ME, Sniderman KW, Jaskolka JD, Beecroft JR, Kachura JR, and Tan KT
- Subjects
- Aneurysm physiopathology, Axillary Vein physiopathology, Axillary Vein surgery, Brachiocephalic Veins physiopathology, Brachiocephalic Veins surgery, Constriction, Pathologic, Female, Graft Occlusion, Vascular physiopathology, Humans, Male, Middle Aged, Regional Blood Flow, Retrospective Studies, Risk Factors, Subclavian Vein physiopathology, Subclavian Vein surgery, Vena Cava, Superior physiopathology, Vena Cava, Superior surgery, Aneurysm etiology, Arteriovenous Shunt, Surgical adverse effects, Graft Occlusion, Vascular etiology, Renal Dialysis, Upper Extremity blood supply
- Abstract
Purpose: To determine whether patients with venous aneurysms in their arteriovenous fistulas (AVFs) have associated venous outflow stenoses., Materials and Methods: A retrospective study was performed, which included all patients presenting with dysfunction and had venous aneurysms in their AVFs. Patient's medical records and imaging studies were examined and data collected including access characteristics, patient demographics and imaging findings. Data were analyzed using Fisher's exact test., Results: A total of 89 patients (58 men, 31 women; mean age 60) presented for intervention related to access dysfunction with incident venous aneurysms over the study period. Of the 89 patients with venous aneurysms (mean diameter 2.3 cm) of their AVF's, 69 (78%) patients had an associated venous outflow stenosis. The stenoses were present most commonly in the outflow cephalic vein (57%), followed by the cephalic arch (20%), brachiocephalic vein (10%) and subclavian vein (6%). Outflow stenoses in AVFs with venous aneurysms were observed in 87% of brachiocephalic AVFs, 60% of radiocephalic AVFs and 80% of brachiobasilic AVFs. Brachiocephalic AVFs with venous aneurysms were significantly more likely to have an associated outflow stenosis than radiocephalic AVFs with venous aneurysms (P=0.007). AVFs with outflow stenosis were on average 1502 days old while AVFs without outflow stenosis were on average 2351 days old, which was a statistically significant difference (P=0.031). No statistically significant differences were observed for sex and side of the fistula., Conclusions: Outflow stenosis was observed to be associated with venous aneurysms in AVFs with a more statistically significant association in brachiocephalic AVFs compared to other AVFs.
- Published
- 2013
- Full Text
- View/download PDF
45. Endovascular management of vascular complications in pancreatic transplants.
- Author
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Saad WE, Darwish WE, Turba UC, Angle JF, Wagner CE, Matsumoto AH, Brayman K, and Hagspiel KD
- Subjects
- Adolescent, Adult, Aneurysm, False diagnosis, Aneurysm, False etiology, Angiography, Digital Subtraction, Angioplasty, Balloon instrumentation, Arterial Occlusive Diseases diagnosis, Arterial Occlusive Diseases etiology, Arteriovenous Fistula diagnosis, Arteriovenous Fistula etiology, Embolization, Therapeutic instrumentation, Female, Graft Survival, Humans, Magnetic Resonance Angiography, Male, Mechanical Thrombolysis, Middle Aged, Retrospective Studies, Stents, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Ultrasonography, Doppler, Venous Thrombosis diagnosis, Venous Thrombosis etiology, Virginia, Young Adult, Aneurysm, False therapy, Arterial Occlusive Diseases therapy, Arteriovenous Fistula therapy, Endovascular Procedures instrumentation, Pancreas Transplantation adverse effects, Venous Thrombosis therapy
- Abstract
Vascular complications after pancreatic transplantation carry a high rate of graft loss. Endovascular management of these complications is confined to stent placement for iliac artery inflow disease and embolization for arteriovenous fistulae (AVFs), pseudoaneurysms, or active bleeding. The current study describes the endovascular management of pancreatic transplant venous thrombosis (N = 1), arterial stenosis (N = 5), thrombosis (N = 3), pseudoaneurysms (N = 1), and AVF (N = 2). In addition, embolization of nonfunctioning grafts is described as an endovascular alternative to pancreatectomy.
- Published
- 2012
- Full Text
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46. Amplatzer vascular plug for occlusion of parent artery in carotid blowout with active extravasation.
- Author
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Shankar JJ, Maloney WJ, and Vandorpe R
- Subjects
- Carotid Artery Diseases diagnostic imaging, Cerebral Angiography, Humans, Male, Middle Aged, Neoplasm Invasiveness, Rupture, Spontaneous, Carcinoma, Squamous Cell complications, Carotid Artery Diseases etiology, Carotid Artery Diseases therapy, Oropharyngeal Neoplasms complications, Septal Occluder Device
- Abstract
Carotid blowout is a devastating complication in patients with head and neck malignancy. Various treatments including high risk surgery, carotid stenting or carotid occlusion using either coils or detachable balloons have been described. The key for any treatment is the rapidity at which it can be performed. We describe treatment of common carotid blowout secondary to neoplastic infiltration using four Amplatzer vascular plugs deployed in less than ten minutes.
- Published
- 2011
- Full Text
- View/download PDF
47. N-butyl cyanoacrylate proved beneficial to avoid a nontarget embolization of the ophthalmic artery in endovascular management of epistaxis. A neurointerventional report and literature review.
- Author
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Shuster A, Gunnarsson T, Klurfan P, and Larrazabal R
- Subjects
- Aged, 80 and over, Epistaxis diagnostic imaging, Humans, Male, Ophthalmic Artery, Radiography, Tissue Adhesives therapeutic use, Blindness prevention & control, Embolization, Therapeutic methods, Enbucrilate therapeutic use, Epistaxis therapy
- Abstract
Epistaxis is a common disorder affecting equally both genders. Posterior origin of epistaxis in some instances requires endovascular treatment. Anastomoses between external carotid artery and internal carotid or ophthalmic arteries heighten the risk of stroke or blindness, if particles of polyvinyl alcohol are used for embolization. We report a case of 90-year-old man for whom successful embolization with N-Butyl Cyanoacrylate glue was performed as an alternative treatment for recurrent epistaxis.
- Published
- 2011
- Full Text
- View/download PDF
48. A new technique for functional imaging in songbirds and beyond.
- Author
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Voss HU
- Subjects
- Animals, Brain anatomy & histology, Magnetic Resonance Imaging, Neuronal Plasticity physiology, Cerebrovascular Circulation physiology, Songbirds anatomy & histology, Tomography, Optical methods
- Published
- 2011
- Full Text
- View/download PDF
49. Imaging approaches and findings in the reconstructed breast: a pictorial essay.
- Author
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Scaranelo AM, Lord B, Eiada R, and Hofer SO
- Subjects
- Breast Neoplasms diagnosis, Diagnostic Imaging, Female, Humans, Postoperative Complications diagnosis, Breast Neoplasms surgery, Mammaplasty methods, Mastectomy
- Abstract
Advances in breast imaging over the last 15 years have improved early breast cancer detection and management. After treatment for breast cancer, many women choose to have reconstructive surgery. In addition, with the availability of widespread genetic screening for breast cancer, an increasing number of women are choosing prophylactic mastectomies and subsequent breast reconstruction. The purpose of this pictorial essay is to present the spectrum of imaging findings in the reconstructed breast., (Copyright © 2011 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
50. Searching for perfect sleep: the continuing evolution of GABAA receptor modulators as hypnotics.
- Author
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Nutt DJ and Stahl SM
- Subjects
- Clinical Trials as Topic, Comorbidity, Drug Therapy, Combination, Humans, Randomized Controlled Trials as Topic, Receptors, GABA-A physiology, Sleep Initiation and Maintenance Disorders diagnosis, Treatment Outcome, Hypnotics and Sedatives adverse effects, Hypnotics and Sedatives pharmacokinetics, Hypnotics and Sedatives therapeutic use, Receptors, GABA-A drug effects, Sleep drug effects, Sleep Initiation and Maintenance Disorders drug therapy
- Abstract
The non-benzodiazepine GABA(A) receptor modulators ('Z-drugs') - zaleplon, zolpidem, zopiclone and eszopiclone - have become the accepted treatments for insomnia where they are available. However, recent randomized, placebo-controlled trials suggest that, for these drugs, there may be particular efficacy and tolerability profiles and distinct clinical outcomes in specific patient populations. This is particularly apparent when hypnotic/ selective serotonin reuptake inhibitor co-therapy is used to treat patients with co-morbid insomnia and psychiatric disorders, as patient recovery appears to be accelerated and enhanced by some drugs but not others. Emerging evidence of why this should be the case is that these hypnotic drugs may differ significantly from each other in their pharmacodynamic and pharmacokinetic profiles. Functional selectivity for specific GABA(A) receptor subtypes may determine each drug's clinical attributes, while the pharmacokinetic characteristics of Z-drugs also determine to a large extent how they perform in the clinic. For example, activity at GABA(A) alpha 1 receptor subtypes may be associated with sedative effects, whereas activity at alpha 2 and alpha 3 receptor subtypes may be associated with anxiolytic and antidepressant effects. In summary, the distinct clinical outcomes of zaleplon, zolpidem, zopiclone and eszopiclone may be explained by each drug's unique GABA(A) receptor subunit selectivity and pharmacokinetic profile. Further investigation of GABA( A) receptor subtype effects would help to increase understanding of current hypnotic drug effects, while knowledge of each drug's specific binding profile should enable clinicians to tailor treatment to individual patient's needs.
- Published
- 2010
- Full Text
- View/download PDF
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