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Background We report the first case series of spontaneous intracranial hypotension (SIH) patients who underwent CT-guided percutaneous cyanoacrylate injection targeting the cerebrospinal fluid (CSF) leak. Methods A retrospective analysis was performed for all consecutive cases of SIH patients with CSF leak confirmed on CT myelography, treated by CT-guided percutaneous cyanoacrylate injection at our institution from 2016 to 2022. On pretreatment brain and spine MRIs, we analyzed signs of SIH according to the Bern score, and dichotomized cases into positive/negative for spinal longitudinal extradural CSF collection (SLEC-P or SLEC-N). The leaks detected on CT myelography were classified into three types according to Schievink et al. We collected the Headache Impact Test 6 (HIT-6) scores throughout a 6-month follow-up, with a brain CT scan at each visit. Results 11 patients were included (mean age 48.4 years, six men). Five SLEC-P type 1, three SLEC-P type 2, and three SLEC-N type 3 leaks were identified. All patients had significant signs of SIH on pretreatment brain MRI (mean Bern score 7.8±1.1). Six patients underwent a foraminal puncture, and five patients had a cervical epidural approach. Two patients experienced mild and transient locoregional pain after cervical epidural injection. Mean HIT-6 score at baseline was 66.8±3.2 and at the 6-month follow-up was 38±3.6 (P<0.001). All patients achieved improvement in their symptoms, with 82% of them (9/11) having complete resolution of headaches and SIH findings on CT scans at 6 months. No clinical worsening or recurrence was observed. Conclusions CT-guided percutaneous cyanoacrylate injection may be a potential therapeutic option for the different types of CSF leak causing SIH. [ABSTRACT FROM AUTHOR]

Background Ruptured basilar artery perforator aneurysms (BAPAs), defined as microaneurysms which develop in basilar perforator arteries without direct involvement of the basilar trunk, represent a rare cause of subarachnoid hemorrhage (SAH). The diagnosis of BAPAs is difficult because of their small size, with high rates of negative angiography. The development of high- resolution MRI could increase the diagnostic performance. In this study we describe the usefulness of susceptibility weighted imaging (SWI) for the diagnosis of ruptured BAPAs. Methods In a case series, we retrospectively collected data of patients admitted to our institution from 2018 to 2021 for SAH with negative CT angiography who underwent MRI (including SWI) and DSA during hospitalization. Results Eight patients with a definitive diagnosis of ruptured BAPA and five patients with a definitive diagnosis of angiogram- negative SAH were included. In all of the patients with BAPAs MRI showed a focal, thick, semi- circumferential SWI hypointensity covering the vessel wall at the level of the BAPA subsequently revealed on DSA; this phenomen is known as 'SWI capping'. No SWI capping was observed in the five patients with a definitive diagnosis of angiogramnegative SAH. Conclusion SWI capping appears to be a reliable indirect sign for the diagnosis and localization of ruptured BAPAs, a rare form of microaneurysm easily misdiagnosed on DSA in initial angiogram- negative SAH. [ABSTRACT FROM AUTHOR]

Background: The gastro-omental artery (GOA) and the greater omentum are nowadays commonly used in many reconstructive surgeries, including cardiac, vascular, and plastic surgery. There are cases in which the GOA is found to be unsuitable only after partial harvesting following an upper laparotomy, and an improved method of pre-operative evaluation is required to eliminate the need for intraoperative small laparotomy. Methods: Multidetector computed tomography was performed for 30 consecutive patients admitted for lower limb ischemia in a routine pre-operative evaluation of lower limb peripheral arterial disease (PAD). The origin of the GOA was checked on coronal and sagittal slices, its pathway was identified on the three-dimensional rendering. We assessed length and mean diameter of the distal and proximal right GOA, and the mean distances between the origins of GOA and the omental branches. Finally, we report one case of omental flow-through flap. Results: 30 patients were included in our study. Routine pre-operative MDCT during lower limb PAD workup enabled identification of GOA in all cases. The mean internal diameter of the GOA at its origin was 3.3 mm (± 3.3). The mean internal diameter of the distal GOA was 1.26 mm (± 0.3). At least one omental descending branch was detected in every case and in 63% (19 patients) at least two branches were visualized. Conclusion: Routine pre-operative angio-MDCT imaging is an effective tool to assess precisely the different anatomical properties of the GOA. This exam could be useful for both diagnosis of lower limb PAD and evaluation of the GOA suitability for flow-through flap lower limb revascularisation. [ABSTRACT FROM AUTHOR]

Objective: Assess the use of a volumetric simulation tool for the evaluation of radiology resident MR and CT interpretation skills.Material and Methods: Forty-three participants were evaluated with a software allowing the visualisation of multiple volumetric image series. There were 7 medical students, 28 residents and 8 senior radiologists among the participants. Residents were divided into two sub-groups (novice and advanced). The test was composed of 15 exercises on general radiology and lasted 45 min. Participants answered a questionnaire on their experience with the test using a 5-point Likert scale. This study was approved by the dean of the medical school and did not require ethics committee approval.Results: The reliability of the test was good with a Cronbach alpha value of 0.9. Test scores were significantly different in all sub-groups studies (p < 0.0225). The relation between test scores and the year of residency was logarithmic (R2 = 0.974). Participants agreed that the test reflected their radiological practice (3.9 ± 0.9 on a 5-point scale) and was better than the conventional evaluation methods (4.6 ± 0.5 on a 5-point scale).Conclusion: This software provides a high quality evaluation tool for the assessment of the interpretation skills in radiology residents.Key Points: • This tool allows volumetric image analysis of MR and CT studies. • A high reliability test could be created with this tool. • Test scores were strongly associated with the examinee expertise level. • Examinees positively evaluated the authenticity and usability of this tool. [ABSTRACT FROM AUTHOR]

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