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Summary This study aims to examine and compare the effectiveness of dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) and Digital Subtraction Angiography (DSA) in evaluating hypervascular spinal metastases. A comprehensive literature review was conducted, utilizing top‐tier databases such as PubMed, Scopus and Google Scholar, to compile an authoritative and up‐to‐date overview of the current advancements in the field. We synthesized key studies focusing on the advantages, limitations and efficacy of both imaging techniques. DCE‐MRI provides a non‐invasive method for evaluating tissue morphology, perfusion and vascularity, offering valuable information for cancer diagnosis and treatment monitoring. In contrast, DSA is an invasive procedure primarily used for embolization and diagnosing cerebrovascular events. Both modalities have distinct features regarding image acquisition, contrast agents, resolution and accessibility. DCE‐MRI shows promise for cancer‐related applications, offering advantages over conventional MRI by incorporating anatomical and hemodynamic parameters. While DSA remains important for cases requiring critical vascular information, further research is necessary to explore its potential therapeutic benefits in assessing vessel patency. Continued investigations are crucial to uncover additional insights and therapeutic applications for both DCE‐MRI and DSA in medical imaging. [ABSTRACT FROM AUTHOR]

Background and objectives: This study aimed to employ machine learning techniques to predict the clinical efficacy of acupuncture as an intervention for patients with upper limb motor dysfunction following ischemic stroke, as well as to assess its potential utility in clinical practice. Methods: Medical records and digital subtraction angiography (DSA) imaging data were collected from 735 ischemic stroke patients with upper limb motor dysfunction who were treated with standardized acupuncture at two hospitals. Following the initial screening, 314 patient datasets that met the inclusion criteria were selected. We applied three deep-learning algorithms (YOLOX, FasterRCNN, and TOOD) to develop the object detection model. Object detection results pertaining to the cerebral vessels were integrated into a clinical efficacy prediction model (random forest). This model aimed to classify patient responses to acupuncture treatment. Finally, the accuracies and discriminative capabilities of the prediction models were assessed. Results: The object detection model achieved an optimal recognition rate, The mean average precisions of YOLOX, TOOD, and FasterRCNN were 0.61, 0.7, and 0.68, respectively. The prediction accuracy of the clinical efficacy model reached 93.6%, with all three-treatment response classification area under the curves (AUCs) exceeding 0.95. Feature extraction using the prediction model highlighted the significant influence of various cerebral vascular stenosis sites within the internal carotid artery (ICA) on prediction outcomes. Specifically, the initial and C1 segments of the ICA had the highest predictive weights among all stenosis sites. Additionally, stenosis of the middle cerebral, anterior cerebral, and posterior cerebral arteries exerted a notable influence on the predictions. In contrast, the stenosis sites within the vertebral artery exhibited minimal impact on the model's predictive abilities. Conclusions: Results underscore the substantial predictive influence of each cerebral vascular stenosis site within the ICA, with the initial and C1 segments being pivotal predictors. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodResultsConclusionAngiogenesis and nascent blood vessel formation is thought to be important in cerebral arteriovenous malformation (cAVM) development and maintenance, of which little is known. Digital subtraction angiogram (DSA) features of angiogenesis in cAVMs are poorly described and the aim of this study was to describe the frequency of angiogenesis in patients who had a DSA showing a cAVM. We also sought to evaluate the intra- and inter-observer agreement of a diagnosis of angiogenesis and explore which angioarchitectural features were associated with angiogenesis.Patients that underwent a DSA were identified from the database of referred cAVM patients at the Manchester Centre for Clinical Neurosciences. Data were collected from 100 patients (102 cAVMs). cAVM angioarchitecture, including the presence of angiogenesis, was described after reviewing cAVM patient angiograms. The association of angioarchitectural features with angiogenesis was determined using univariate analysis. Ten cases were distributed amongst two other observers for reporting (inter-observer agreement). Twenty cases (including the previous 10) were reported twice by the first author, after a six-month interval (intra-observer agreement).Angiogenesis was observed in 39 cAVMs (38.2%), with 12 having a complete border (11.8%). Most intra-observer agreement was strong (ranging from κ = 1 to 0.2), but inter-observer agreement was moderate (κ = 1 to −0.316). There was a significant association between angiogenesis and venous reflux (OR 2.52 [95% CI = 1.08–5.88]), venous congestion (OR 4.47 [95% CI = .671–2.52]), arterial ectasia (OR 16.6 [95% CI = 4.65–59.6]), and artery: vein ratio (4.28 [95% CI = .956–19.15]).We have demonstrated perinidal angiogenesis can be visualised on angiograms with moderate reliability, and that it may be related to angioarchitectural characteristics associated with venous hypertension. [ABSTRACT FROM AUTHOR]

Background and Purpose: Carotid artery stenosis is a major risk factor for ischemic stroke. Despite carotid artery stenting, in‐stent restenosis (ISR) remains challenging. Pigs serve as an ideal ISR model. This study aims to establish a novel porcine model of carotid ISR using open‐loop and closed‐loop stents and to assess ISR with optical coherence tomography (OCT) and histopathology, comparing incidence and vascular response between stent types. Methods: Twelve adult male Bama miniature pigs underwent carotid stenting with either open‐loop or closed‐loop stents. The animals received antiplatelet therapy pre‐ and postimplantation. Postimplantation evaluations at 90 days included carotid digital subtraction angiography (DSA), OCT, histopathological examination, and electron microscopy. Results: Both stent types showed ISR as detected by OCT and DSA. OCT revealed comparable neointimal proliferation within stent struts for both types, with no significant differences in stent, lumen, and neointimal dimensions. Histopathological analysis and electron microscopy provided insights into tissue responses and healing processes following stent implantation. No significant difference in ISR incidence was found between the stent types based on a χ2 test (p =.110). OCT and hematoxylin‐eosin staining exhibit the highest consistency in evaluating neointimal area. Conclusions: The novel porcine ISR model demonstrated similar ISR outcomes for open‐loop and closed‐loop stents. OCT proved to be a highly consistent and valuable tool for evaluating stent and arterial conditions, comparable to histopathological findings. However, due to a small sample size, the validity of these preliminary findings requires further investigation to be confirmed. [ABSTRACT FROM AUTHOR]

Purpose: To provide detailed reports on radiation doses during transarterial chemoembolization (TACE) in the cone-beam computed tomography (CBCT) era and to identify the associated factors. Methods: This retrospective study included 385 consecutive patients who underwent initial conventional TACE for hepatocellular carcinoma (HCC) between January 2016 and December 2017. In most cases, CBCT was performed at the common hepatic artery or celiac axis to confirm the location of the tumor and the three-dimensional hepatic artery anatomy. Superselective TACE was performed for all technically feasible cases. Information on total dose area product (DAP), total cumulative air kerma (CAK), fluoroscopy time, and DAP and CAK of each digital subtraction angiography (DSA) and CBCT scan was recorded. Multiple linear regression analysis was performed to identify the factors associated with increased DAP during TACE. Results: The mean values of total DAP and CAK were 165.2 ± 81.2 (Gy·cm²) and 837.1 ± 571.0 (mGy), respectively. The mean fluoroscopy time was 19.1 ± 10.3 min. The mean DAP caused by fluoroscopy, DSA, and CBCT was 51.8 ± 43.9, 28.0 ± 24.1, and 83.9 ± 42.1 Gy·cm², respectively. Male sex, a high body mass index, largest tumor size > 3 cm, presence of aberrant right and left hepatic arteries, and superselective TACE were identified as independent predictors of increased total DAP during TACE. Conclusion: We were able to provide detailed reports on radiation doses during TACE and associated factors. [ABSTRACT FROM AUTHOR]

Purpose: The main purpose of this study was to investigate the dimensions of cerebral arteries in the Thai population using digital subtraction angiography (DSA), with a focus on the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA). The research aimed to explore anatomical variations in diameters and lengths of these arteries across different sexes and age groups, which are crucial for cerebrovascular interventions. Methods: This retrospective study measured the diameters and lengths of the ACA, MCA, and PCA in 177 Thai patients with an average age of 47.6 years (range: 11–82 years) with normal cerebral angiograms. Digital subtraction angiography (DSA) was used for the measurements. Results: The study found significant sex-based differences in the mean diameters of the left ACA (males: 2.12 ± 0.28 mm, females: 1.92 ± 0.20 mm; p < 0.01), right MCA (males: 2.50 ± 0.25 mm, females: 2.31 ± 0.17 mm; p < 0.01), and left MCA (males: 2.44 ± 0.19 mm, females: 2.30 ± 0.17 mm; p < 0.01) with males exhibiting larger diameters. The right ACA length was significantly longer in males (15.46 ± 1.74 mm) compared to females (13.98 ± 1.92 mm; p < 0.01). While no significant age-related differences were observed in diameters, a significant increase in length with age was noted for the left ACA in the ≥ 60 years group (13.61 ± 1.64 mm) compared to the < 60 years group (12.63 ± 1.36 mm; p < 0.01). Among others, significant correlations were found between the diameters of the left ACA and right MCA (r = 0.699; p < 0.01), and a strong correlation between left ACA length and left PCA diameter (r = 0.975; p < 0.01). Conclusion: The findings provide invaluable data for tailoring neurosurgical approaches and designing angiographic equipment for the Thai population, emphasizing the importance of considering anatomical variations in clinical practice. These results highlight the necessity for personalized medical care based on anatomical differences to improve cerebrovascular intervention outcomes. [ABSTRACT FROM AUTHOR]

Purpose. Arterial supply of thalamus is complex and highly variable. In particular, the distribution pattern of thalamoperforating arteries received more attention some decades ago than in recent years. Methods. We are presenting the case of a 46-year-old patient with wake-up drowsiness, complex oculomotor disorder and dysarthria. He was investigated in the acute phase using non-contrast brain Computed Tomography (NCCT), CT Angiography (CTA), and in the following days Digital Subtraction Angiography (DSA) was performed Results. The NCCT showed a subacute ischemic stroke in the right anterior thalamus and rostral midbrain with normal findings on CTA. DSA imaged a variant of thalamic supply (Percheron type III), constituted by perforating branches arising from an artery bridging the P1 segments of both Posterior Cerebral Arteries (PCAs). Results. The thalamus has a complex and variable arterial supply, mainly in the pattern of paramedian thalamic-mesencephalic perforating arteries. The most reported variant is Percheron type IIb and supplies the paramedian thalami and the rostral midbrain. Type IIb occlusion usually causes a bilateral paramedian thalamic stroke, but rostral midbrain and anterior thalamus are involved in 57% and 19% cases. The rarer Type III variant probably prevented the bilateral extension of infarction and involved the territory of tuberothalamic and paramedian perforating arteries. Conclusions. Currently, DSA allows directly imaging variants in thalamic vascularization and better understanding the stroke mechanisms. In particular, in the presented case, a medium-sized vessel occlusion rather than a small vessel occlusion mechanism might be raised, leading to a different diagnostic pathway. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our study is to report a case of a large fenestrated vertebral artery (FVA) and bilateral duplication of the superior cerebellar artery (SCA) incidentally diagnosed using Computed Tomography Angiography (CTA) and Digital Subtraction Angiography (DSA). Case presentation: A 63-year-old female patient presenting to the neurology clinic with complaints of dizziness and balance disorder. CTA and DSA revealed a large FVA involving the V3 and V4 segments. Additionally, we observed bilateral duplicated SCAs originating from the distal basilar artery. Discussion: FVA is a rare anomaly resulting from fusion failure during the embryological period, with a reported incidence of 0.1%. FVA is often (70%) detected in the extracranial region, but it can also occur intracranially at a frequency of approximately 30%. Although various nomenclatures are used in the literature, we identified only two reports of a single fenestration encompassing the V3 and V4 segments, i.e., involving both the extracranial and intracranial regions. While duplication of the SCA is relatively common, bilateral duplication of SCA occurs at a rate of 0.9–5%. Conclusion: This case report describes an unusual case of VA fenestration involving both extracranial and intracranial segments, along with bilateral duplication of the SCAs. While rare, these findings highlight the importance of recognizing such vascular anomalies, which could be relevant for planning surgical or endovascular procedures in the posterior circulation. [ABSTRACT FROM AUTHOR]

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Purpose: Peripheral arterial calcification is an important predictor of outcomes after both conservative and endovascular treatment. Digital subtraction angiography (DSA)-based calcification scores are limited by low sensitivity and inter-observer agreement. The Peripheral Arterial Calcium Scoring System (PACSS) assesses the severity of target lesion calcification. The newly introduced modified PACSS (mPACSS) also evaluates target vessel calcification. This study aimed to assess the inter- and intra-observer reliability of PACSS and mPACSS on computed tomography angiography (CTA) in (infra)popliteal endovascular interventions. Methods: A random sample of 50 limbs from the prospective multicenter Dutch Chronic Lower Limb-Threatening Ischemia Registry (THRILLER) were included. Three experienced independent raters scored PACSS on CTA. Three months later, one blinded rater assessed the same 50 CTA scans, keeping track of assessment time. The reliability of the original 5-step PACSS, a simplified binary PACSS (0–2 vs 3–4) and the 7-step mPACSS were tested using Cohen's and Fleiss' kappa statistics. Results: In total, 50 limbs (mean age 70.1 ± 11.0, 29 men) with 41 popliteal and 40 infrapopliteal lesions were scored. Inter-observer agreement of PACSS and binary PACSS were moderate (κ = 0.60) and substantial (κ = 0.72), respectively, while intra-observer agreement was almost perfect in both scores (κ = 0.86). Inter- and intra-observer agreement of mPACSS were moderate (κ = 0.48) and substantial (κ = 0.77), respectively. Mean assessment time for an experienced rater was 3.43 ± 0.93 min per CTA scan. Conclusion: Both the semi-quantitative PACSS and mPACSS scores for (infra)popliteal arteries can be performed reliably on pre-operative CTA. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the effect and clinical implications of IL-1β on the development of aneurysmal subarachnoid hemorrhage. Methods: This retrospective study included a total of 80 participants, and these participants were divided into the following two groups: control group (healthy participants) and experimental group (aneurysmal subarachnoid hemorrhage patients). Then, all of the participants received digital subtraction angiography or computed tomography angiography. Participants' general data were collected and analyzed. IL-1β expression in blood samples were determined by ELISA, and then IL-1β protein were determined by western blotting. Results: A total of 80 participants was included in this study, and the participants' general data, including gender, age, and previous medical history, showed no significant differences between the experimental group and control group. The IL-1β value in the experimental group was significantly increased, and the difference was statistically significant (p < 0.05). Conclusions: Upregulated IL-1β can promote the development of aneurysmal subarachnoid hemorrhage, indicating that IL-1β is a key factor in evaluating the prognosis of patients with aneurysmal subarachnoid hemorrhage. [ABSTRACT FROM AUTHOR]

Background: Patients with essential thrombocythemia (ET) can develop systemic thrombotic and hemorrhagic vascular complications due to increased and dysfunctional platelets. Case presentation: We encountered a 49-year-old Japanese woman with a history of essential ET, cerebral infarction, hypertension, and hyperlipidemia. She had been taking anagrelide (2.5 mg/day) and aspirin (100 mg/day) and had vomited at home. At the time of admission to our hospital, she was in a deep stupor. We thought these symptoms were caused by intracranial hypertension. Head computed tomography showed severe subarachnoid hemorrhage (SAH) at the interhemispheric fissure, hematoma at the corpus callosum, and intraventricular hemorrhages. Digital subtraction angiography demonstrated multiple dilated, stenotic, tortuous intracranial arteries, and a dissecting aneurysm at the right anterior cerebral artery (ACA). The dissecting aneurysm measured 7.7 × 15.5 mm, and a bleb was observed. Our diagnosis was ruptured ACA dissecting aneurysm and diffuse intracranial arterial dolichoectasia (DIADE). We performed stent-assisted coil embolization of the aneurysm. She remained apathetic and manifested unilateral apraxia and alien limb syndrome due to a partial callosal disconnection. Two months thereafter her symptoms gradually improved, her consciousness level and limb function improved, and her modified Rankin scale (mRS) score was 2. However, when we tapered her antiplatelet therapy, she again developed an acute cerebral infarct. Conclusions: This is the first presentation of a patient with ET complicated by DIADE, both of which can result in ischemic and hemorrhagic vascular complications including SAH. As antithrombotic therapy in patients with DIADE and ET may be associated with higher hemorrhage rates, its effects must be monitored carefully. [ABSTRACT FROM AUTHOR]

Background and purpose: Posterior circulation strokes, accounting for 20% of acute ischemic strokes, significantly contribute to morbidity and mortality. Fibrinolysis by rtPA improves outcomes in stroke but the risk of intracranial hemorrhage limits benefit. Arterial recanalization of basilar artery occlusion by thrombolysis or endovascular thrombectomy improves outcomes in posterior circulation strokes. This study investigates a VWF-targeting RNA aptamer as a safer and more effective alternative to rtPA in a canine model. Materials and methods: Autologous clots were placed into the basilar artery to induce stroke in 24 beagles. To compare reperfusion, 0.9 mg/kg rtPA, 0.5 mg/kg BB-031, or vehicle were administered 60 min after the initiation of occlusion. Digital subtraction angiography, laser speckle imaging and magnetic resonance imaging were used to assess recanalization, reperfusion and infarct volume, respectively. Results: Treatment with BB-031 resulted in recanalization of the posterior circulation on digital subtraction angiography with no evidence of microembolism assessed at sacrifice. 66.5% of animals treated with BB-031 resulted in reperfusion with a TICI score of =1 whereas vehicle remained at TICI score 0 as did all but one rtPA animal at sacrifice. Improved perfusion was seen in the basilar artery and surrounding blood vessels visualized through the cranial window with laser speckle imaging to ~47% of its original baseline in BB-031 group compared to rtPA at 37% and vehicle at 22%. Finally, BB-031-treatment resulted in an approximate 32% mean infarct volume, significantly smaller on magnetic resonance imaging compared to 56% in vehicle treated and 48% with rtPA treatment. Conclusion: Targeted inhibition of VWF by BB-031 increased recanalization and reperfusion, and reduced infarct volume in a canine model of BAO stroke. It represents a promising target based on preliminary results for treating acute ischemic stroke. [ABSTRACT FROM AUTHOR]

Background: Congenital agenesis of internal carotid artery (ICA) is a rare cerebrovascular variation entity. Most cases of congenital ICA agenesis are asymptomatic and discovered incidentally. Congenital ICA agenesis presenting as ischemic stroke is even rare. Case presentation: An 80-year-old male patient was admitted to our hospital due to sudden dysarthria and left limb weakness for 3.5 h. Based on emergency physical examination and head computed tomography (CT) scan results, acute ischemic stroke (AIS) of right cerebral hemisphere was suspected. Following intravenous thrombolysis with recombinant tissue plasminogen activator, right congenital agenesis of ICA was confirmed by CT and digital subtraction angiography. Additionally, there was a severe right vertebral artery ostial (VAO) stenosis. After ruling out common causes of AIS such as haematological diseases, arterial dissection, organic heart disease, immunological abnormality and underlying possible malignancies, we hypothesize that the severe stenosis of the right VAO may have contributed to the development of AIS in this case. Conclusions: We present a case of right congenital ICA agenesis in which severe stenosis of the right VAO may have played a role in the development of AIS. This case underscores a rare scenario where a lesion in the posterior circulation leads to an infarction in the anterior circulation in the setting of congenital ICA agenesis. [ABSTRACT FROM AUTHOR]

Background: Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening subtype of stroke. Prompt and appropriate anticoagulation is crucial for improving the prognosis of CVST and preventing its recurrence. Identifying the underlying cause of CVST is decisive for guiding anticoagulant selection and determining treatment duration. Case Presentation: A 50-year-old man presented with a 35-day history of headache, nausea, vomiting, and blurred vision. Digital subtraction angiography performed at another facility revealed CVST. A contrast-enhanced black-blood MRI at our center confirmed the diagnosis, which was supported by a high intracranial pressure of 330mmH2O. Laboratory tests showed elevated leukocytes and platelet counts, raising suspicion of an underlying myeloproliferative neoplasms (MPNs). A bone marrow biopsy demonstrated increased megakaryocytes and granulocytes, and genetic testing identified the presence of the Janus kinase 2 V617F (JAK2 V617F) mutation, leading to a diagnosis of pre-primary myelofibrosis (pre-PMF). During hospitalization, anticoagulation with nadroparin calcium and fibrinolytic therapy were initiated. Upon discharge, rivaroxaban and aspirin were prescribed to prevent CVST recurrence and arterial thrombosis. Conclusion: This case highlights the importance of recognizing dynamic changes in routine blood tests that may link CVST to underlying hematological disorders. The JAK2 mutation is not only associated with MPNs but also increases the risk of thrombosis, including CVST. Further investigation is warranted to better understand the mechanisms by which JAK2 mutations contribute to thrombosis and to explore the potential benefits of JAK2 inhibitors in reducing this risk. [ABSTRACT FROM AUTHOR]

Background: Central venous catheterization, crucial for device insertion, monitoring, medication, and fluid resuscitation, commonly uses the subclavian, internal jugular, and femoral veins. Despite its general safety, complications like arterial puncture can be life-threatening, requiring rapid diagnosis and treatment. Case presentation: A 74-year-old woman in the recovery phase of cerebral infarction underwent right subclavian vein catheterization. The catheter was mistakenly placed in the brachiocephalic trunk, with its tip in the ascending aorta, as confirmed by computed tomography (CT) and digital subtraction angiography (DSA). With the high surgical risk and the complexity of endovascular treatment, catheter replacement was chosen. One month after the initial placement, the catheter was replaced with a smaller one, and another month later, it was retracted without complications. Follow-up CT and DSA revealed no leakage, with the patient's vitals remaining stable. A three-month post-discharge phone follow-up confirmed the patient's continued stability. Conclusion: This case demonstrates the effective use of a catheter replacement technique as a minimally invasive repair method when other options are impractical. Ultrasound guidance is also recommended to improve the procedure's accuracy and safety. [ABSTRACT FROM AUTHOR]

Background: Digital subtraction angiography (DSA) is most commonly used in vessel disease examinations and treatments. We aimed to develop a novel deep learning-based method to deblur the large focal spot DSA images, so as to obtain a clearer and sharper cerebrovascular DSA image. Methods: The proposed network cascaded several residual dense blocks (RDBs), which contain dense connected layers and local residual learning. Several loss functions for image restoration were investigated. Our training set consisted of 52 paired images of angiography with more than 350,000 cropped patches. The testing set included 10 body phantoms and 80 clinical images of different types of diseases for subjective evaluation. All test images were acquired using a large focal spot, and phantom images were simultaneously acquired using a micro focal spot as ground-truth. Peak-to-noise ratio (PSNR) and structural similarity (SSIM) were determined for quantitative analysis. The deblurring results were compared with the original data, and the image quality was subjectively evaluated and graded by two clinicians. Results: For quantitative analysis of phantom images, the average PSNR/SSIM based on the deep-learning approach (35.34/0.9566) was better than that of large focal spot images (30.64/0.9163). For subjective evaluation of 80 clinical patient images, image quality in all types of cerebrovascular diseases was also improved based on a deep-learning approach (p < 0.001). Conclusions: Deep learning-based focal spot deblur algorithm can efficiently improve DSA image quality for better visualization of blood vessels and lesions in the image. [ABSTRACT FROM AUTHOR]

Background/Objectives: Detailed morphometric analysis of an aneurysm and the related vascular bifurcation are critical factors when determining rupture risk and planning treatment for unruptured intracranial aneurysms (UIAs). The standard visualization of digital subtraction angiography (DSA) and its 3D reconstruction on a 2D monitor provide precise measurements but are subject to variability based on the rater. Visualization using virtual (VR) and augmented reality platforms can overcome those limitations. It is, however, unclear whether accurate measurements of the aneurysm and adjacent arterial branches can be obtained on VR models. This study aimed to assess interrater reliability and compare measurements between 3D VR, standard 2D DSA, and 3D DSA reconstructions, evaluating the reliability and accuracy of 3D VR as a measurement tool. Methods: A pool of five neurosurgeons performed three individual analyses on each of the ten UIA cases, measuring them in completely immersed 3D VR and the standard on-screen format (2D DSA and 3D reconstruction). This resulted in three independent measurements per modality for each case. Interrater reliability of measurements and morphology characterization, comparative differences, measurement duration, and VR user experience were assessed. Results: Interrater reliability for 3D VR measurements was significantly higher than for 3D DSA measurements (3D VR mean intraclass correlation coefficient [ICC]: 0.69 ± 0.22 vs. 3D DSA mean ICC: 0.36 ± 0.37, p = 0.042). No significant difference was observed between 3D VR and 2D DSA (3D VR mean ICC: 0.69 ± 0.22 vs. 2D DSA mean ICC: 0.43 ± 0.31, p = 0.12). A linear mixed-effects model showed no effect of 3D VR and 3D DSA (95% CI = −0.26–0.28, p = 0.96) or 3D VR and 2D DSA (95% CI = −0.02–0.53, p = 0.066) on absolute measurements of the aneurysm in the anteroposterior, mediolateral, and craniocaudal dimensions. Conclusions: 3D VR technology allows for reproducible, accurate, and reliable measurements comparable to measurements performed on a 2D screen. It may also potentially improve precision for measurements of non-planar aneurysm dimensions. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the relationship between systemic immune‐inflammation index (SII) and short‐term mortality in acute ischemic stroke (AIS) with internal carotid artery (ICA) severe stenosis and stroke associated pneumonia (SAP) patients. Methods: Information on general demographic, laboratory data, CT angiography, magnetic resonance angiography, or digital subtraction angiography were obtained. The predictive power was evaluated by assessing the area under the receiver operating characteristic (ROC) curve. The logistic regression was performed to assess the association of SII and short‐term mortality in severe stenosis ICA‐AIS and SAP patients. Result: Among 342 patients with severe stenosis ICA‐AIS and SAP, death occurred in 66 patients during 120 days follow‐up. Multivariate regression analyses indicated that increased SII predicts higher mortality in 120 days follow‐up, and the risk of short‐term mortality in SII > 666.31 × 109/L group is increased 4.671‐fold. Patients with SII > 666.31 × 109/L had higher proportion of male, hypertension, smoking, higher admission NIHSS score, higher systolic blood pressure, and higher proportion of 120 days mortality. Higher SII predicted a worse 120 days mortality was worked out by Kaplan–Meier methods. Conclusion: An elevated SII was remarkably associated with 120 days mortality in severe stenosis ICA‐AIS and SAP patients. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to describe our experience in the embolization of hypervascular giant thoracic tumors before surgical excision. Methods: A single-center retrospective review of five trans-arterial preoperative embolization procedures executed between October 2020 and July 2024. Patients' demographics, anatomical aspects, feasibility, technique, and outcomes were reviewed. Results: In all cases, accurate targeting and safe embolization was achieved, with satisfactory devascularization evaluated with post-procedural angiography and with minimal blood loss during subsequent surgical operation. Conclusions: In our experience, preoperative embolization of giant thoracic masses has been technically feasible, safe, and effective in reducing tumor vascularization, thus facilitating surgical treatment. This approach should be evaluated as an option, especially in patients with hypervascular thoracic tumors. [ABSTRACT FROM AUTHOR]

Objective: To compare and analyze the efficacy and safety of different methods for injecting polidocanol in the treatment of venous malformations. Methods: The medical records of patients with venous malformations in our hospital from April 2021 to April 2023 were analyzed retrospectively, and they were divided into control group (n = 38) and observation group (n = 20) according to different treatment methods. Control group was injected with polidocanol under ultrasound guidance, while observation group was injected with polidocanol under digital subtraction angiography (DSA) monitoring. Therapeutic effects of observation group and control group after 3-6 months of treatment were compared and analyzed, and complications that can be used to reflect the safety of treatment in two groups were collected and recorded. Results: After treatment, the total effective rates of observation group and control group were 97.37% (37/38) and 75.00% (15/20) respectively, with significant differences (both p <.05). After 3-6 months of treatment, 13 complications occurred in observation group, while 16 occurred in control group. The number of complications in observation group was 6, with an incidence rate of 15.78%; while that in control group was 9, with an incidence rate of 45.00%, with a significant difference (p <.05). There were no significant differences among other baseline data, age and complications between two groups (all p >.05). Conclusion: Injection of polidocanol in patients with venous malformations under DSA monitoring was more effective and safer. [ABSTRACT FROM AUTHOR]

Some patients with intracranial aneurysms (IAs) cannot undergo three-dimensional computed tomography angiography (3D-CTA) or digital subtraction angiography due to contraindications to contrast agents or radiation. Time-of-flight magnetic resonance angiography (TOF-MRA) offers a contrast-free alternative but lacks cranial bone detail critical for surgical planning. This study evaluates the feasibility of using 3D Slicer to fuse TOF-MRA with thin-section CT images to generate synthetic images resembling CTA for surgical clipping planning. This prospective study included 22 patients with unruptured IAs and 8 with ruptured IAs undergoing aneurysm clipping surgery (≥3 mm). TOF-MRA and CT/3D-CTA scans were fused using 3D Slicer. Neuroradiologists and neurosurgeons independently assessed 3D-CTA and synthetic TOF-MRA-CT images for aneurysm detection rates, morphology, and dimensions. Evaluation metrics included dice similarity coefficient and 95% Hausdorff distance. Evaluation of aneurysm detection rates, morphology, and dimensions showed no significant differences between synthetic TOF-MRA-CT fusion images and 3D-CTA (all P > 0.05). Neuroradiologist assessments revealed strong concordance in aneurysm morphology between synthetic TOF-MRA-CT fusion images and 3D-CTA (κ = 0.867, P < 0.001). The dice similarity coefficient (0.937 ± 0.012) and Hausdorff distance (4.54 ± 0.26) indicated a high degree of image overlap between synthetic TOF-MRA-CT fusion images and 3D-CTA. Surgeons rated the consistency of aneurysm morphology between synthetic TOF-MRA-CT fusion images and intraoperative findings as strongly concordant (κ = 0.873, P < 0.001). Synthetic TOF-MRA-CT fusion images closely match 3D-CTA for ≥3 mm aneurysms, demonstrating comparable diagnostic and surgical clipping planning effectiveness. They represent a promising alternative for personalized preoperative planning, particularly when contrast agents are contraindicated. [ABSTRACT FROM AUTHOR]

In this preliminary study, we investigated the value of fusion techniques by flat detector computed tomography based dual volume rotational angiography (DVRA) for the evaluation of the anatomical relationship of cavernous sinus dural arteriovenous fistula (CSDAVF) and assessed the possibility of transvenous target segment embolization. Twenty-six patients with CSDAVF supplied by multiple feeders underwent DVRA for each feeding large vessel separately. We assessed the anatomical relationship of feeders, fistula points, and venous drainage with 3 dual volume image fusion techniques. Transvenous embolization was targeted to the segment of fistulous point for preserving those not involved and reducing coil mass effect. Dual vessel multi-planar reconstruction fusion technique could show which segment of the cavernous sinus supplied by feeding arteries. In the dual vessel volume rendering fusion technique, the association between feeding arteries, fistula points, and draining veins of 2 different vessels could be accurately identified in 3 dimensions. In addition, we could visualize the exact anatomical relationship between the components of CSDAVF and skull anatomy with the single vessel fusion technique. Based on various fusion images, target segment embolization was successfully performed in 8 patients. In this group, we achieved complete or near complete occlusion without complications, including cranial nerve palsy. Detailed anatomical information including accurate fistula point, specific feeding arteries, and draining veins could be obtained with various dual volume image fusion techniques. In addition, the target segment embolization of CSDAVF could be possible with understanding of the precise CSDAVF architectures. [ABSTRACT FROM AUTHOR]

Background: a relatively little amount of studies that discuss the optimal imaging method for subarachnoid haemorrhage caused by aneurysmal bleeding. In these individuals, a variety of imaging modalities are used despite the fact that they are seen as invasive, not always accessible, and possibly hazardous to the patient. Consequently, there has been a significant need for non-invasive alternatives. We aim To achieve an accurate diagnosis of aneurysmal subarachnoid hemorrhage. Methods: This comparative cross-sectional study was conducted at the Radiology Department, Zagazig University Hospital on 18 male and female patients with aneurysmal subarachnoid hemorrhage, their ages ranged from 30 to 60 years. Digital subtraction angiography and three-dimensional computed tomography were performed for all cases. Results: The sensitivity and specificity of digital subtraction angiography in comparison to 3D CT angiography were 98% and 87.5% respectively with statistically significant value (p= 0.035). The true positive was 16 and the true negative was 1.Conclusion: Recent advances in CT angiography technique, being non-invasive with no procedural neurological complications, add to the advantages of CTA. [ABSTRACT FROM AUTHOR]

This document contains summaries of various research studies in the field of neurosurgery and endovascular treatment. The studies cover a range of topics, including stroke treatment, aneurysm treatment, and other neurovascular conditions. The summaries provide insights into different treatment approaches, outcomes, and potential advancements in the field. They offer an overview of current research in neurosurgery and neurointerventional procedures. [Extracted from the article]

A study published in the British Journal of Surgery found that there is widespread non-adherence to guidelines for the surgical management of diabetes-related foot complications. The study examined the practices and outcomes of diabetic foot surgery and found that overall compliance with recommended practices was moderate. The study suggests that the complexity of the guidelines and the low certainty of evidence may contribute to the deviation from recommended practices. The authors emphasize the need to improve guideline adherence and conduct further research to strengthen the evidence supporting international guidelines for diabetic foot management. [Extracted from the article]

Background: Severe large vessel disease may lead to cerebral hemodynamic failure that critically impairs cerebral blood flow (CBF) regulation elevating the risk of ischemic events. Assessment of the condition is often based on changes in CBF during vasodilatation; however, pharmacologically induced vasodilation does not reflect the physiological condition during an ischemic event caused by hemodynamic failure. We compared a [15O]H2O PET brain scan during vasodilation to a [99mTc]HMPAO SPECT brain scan during an ongoing transient ischemic attack (TIA). Case presentation: A single patient presenting with limb-shaking TIA underwent CT, Digital Subtraction Angiography, and two different modalities of cerebral perfusion scans: [15O]H2O PET and [99mTc]HMPAO SPECT. Acetazolamide was used in the PET scan to induce vasodilatation, and during the SPECT scan physiological stress, standing up rapidly, was used to induce limb-shaking TIA. CT-angiography and Digital Subtraction Angiography revealed an occlusion in the distal part of the right A2 segment of the anterior cerebral artery, with a corresponding infarction in the watershed area. Collaterals supplied the main vascular territory of the anterior cerebral artery. During rest, neither perfusion modalities demonstrated reduced perfusion outside of the ischemic core. However, we found a pronounced difference between the PET utilizing acetazolamide and the SPECT during the TIA. The PET scan demonstrated relative hypoperfusion in vascular territory supplied by collaterals, while the area around the ischemic core was not affected. Contrary, the SPECT had only minor relative hypoperfusion in the collateral-supplied area, whereas the watershed area proximal to the infarct core had pronounced relative hypoperfusion. Conclusions: The observed discrepancy in compromised areas during physiological provocation compared to pharmacological induced vasodilation questions the use of an unphysiological stressor for assessment of cerebrovascular hemodynamics. A physiological provocation test may achieve more clinically relevant evaluation. [ABSTRACT FROM AUTHOR]

Background: We report a case of 39-year-old male patient with an unruptured middle cerebral artery aneurysm associated with moyamoya disease (MMD) treated by surgical clipping combined with encephalo-duro-myo-synangiosis surgery. Case description: A 39-year-old male patient with a history of intraventricular hemorrhage was admitted to our hospital. Preoperative digital subtraction angiography (DSA) showed the aneurysm, arising from a collateral branch of the right middle cerebral artery (RMCA), had an extremely thin neck. Also present were an occlusion of the RMCA main trunk, and moyamoya vessels. Microsurgical aneurysm clipping was performed for the aneurysm, while encephalo-duro-myo-synangiosis was performed for ipsilateral MMD. At the 4-month follow-up, the patient had recovered well and DSA indicated improved cerebral perfusion with no de novo aneurysms. Conclusions: For ipsilateral moyamoya disease accompanied with intracranial aneurysm (IA), simultaneous surgery combining microsurgical clipping and encephalo-duro-myo-synangiosis can be a good treatment option. [ABSTRACT FROM AUTHOR]

Purpose: To highlight the clinical and diagnostic importance of correctly identifying cervical internal carotid artery fenestration (fcICA), an extremely rare vascular anomaly, and to present a case where fcICA was initially misdiagnosed as a dissection in a patient with fibromuscular dysplasia (FMD). Methods: A 47-year-old woman with pulsatile tinnitus underwent computed tomography angiography (CTA) and digital subtraction angiography (DSA) to differentiate between fenestration and dissection of the internal carotid artery. Results: CTA revealed a fusiform dilatation of the distal C1 segment of the right internal carotid artery (ICA) with a linear filling defect, suggesting either fenestration or dissection. DSA confirmed the presence of a fenestrated right ICA segment composed of two symmetrical, smooth-walled limbs without a dissection flap, along with signs of FMD in the proximal vessel. The patient's symptoms were attributed to local flow perturbations induced by fcICA and FMD. Conclusion: This case illustrates that fcICA can be a true anatomical variant rather than a result of dissection, emphasizing the need for accurate imaging and diagnosis to avoid unnecessary treatments. The coexistence of fcICA with FMD increases the risk of dissection, necessitating careful monitoring. The distinction between fenestration and pseudofenestration remains challenging, requiring comprehensive imaging and close collaboration between radiologists and vascular neurologists. [ABSTRACT FROM AUTHOR]

Vascular compression syndromes are a group of conditions resulting from mechanical compression of blood vessels by adjacent structures leading to compromised blood flow and various associated symptoms. They frequently affect young, otherwise healthy individuals and are often underdiagnosed due to their rarity and vague clinical manifestations. Achieving an accurate diagnosis depends on the integration of clinical presentation and imaging findings. Imaging modalities including color doppler ultrasound, computed tomography angiography, magnetic resonance angiography, and catheter-directed digital subtraction angiography are essential for diagnosis and management. Dynamic imaging is crucial in eliciting findings due to the positional nature of many of these syndromes. In this paper, we will present a "head-to-toe" overview of vascular compression syndromes including Vascular Eagle Syndrome, Vascular Thoracic Outlet Syndrome, Quadrilateral Space Syndrome, Hypothenar Hammer Syndrome, Median Arcuate Ligament Syndrome, Renal Artery Entrapment Syndrome, Left Renal Vein Compression/Nutcracker Syndrome, May-Thurner Syndrome, Adductor Canal Syndrome, and Popliteal Artery Entrapment Syndrome. Treatment is variable but typically involves a combination of conservative and surgical management. Surgical approaches focus on decompression of affected neurovascular structures. Endovascular treatment alone is rarely recommended. We aim to equip general radiologists with the knowledge needed to accurately diagnose patients with vascular compression syndromes, allowing for timely treatment. • Vascular compression syndromes are rare and require a combination of clinical signs and imaging findings for diagnosis. • Dynamic imaging techniques are pivotal in enhancing the diagnostic sensitivity of vascular compression syndromes. • CTA and MRA yield comparable assessments of vascular compression syndromes, contingent upon the institutional protocols. [ABSTRACT FROM AUTHOR]

Background: In this study, we aimed to investigate the risk factors and impact of poststroke pneumonia (PSP) on mortality and functional outcome in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT). Methods: This was a post hoc analysis of a prospective randomized trial (Direct intraarterial thrombectomy in order to revascularize AIS patients with large-vessel occlusion efficiently in Chinese tertiary hospitals: a multicenter randomized clinical trial). Patients with AIS who completed EVT were evaluated for the occurrence of PSP during the hospitalization period and their modified Rankin Scale (mRS) scores at 90 days after AIS. Logistic regression analysis was conducted to investigate the independent predictors of PSP. Propensity score matching was conducted for the PSP and non-PSP groups by using the covariates resulting from the logistic regression analysis. The associations between PSP and outcomes were analyzed. The outcomes included 90-day poor functional outcome (mRS scores > 2), 90-day mortality, and early 2-week mortality. Results: A total of 639 patients were enrolled, of whom 29.58% (189) developed PSP. Logistic regression analysis revealed that history of chronic heart failure (unadjusted odds ratio [OR] 2.011, 95% confidence interval [CI] 1.026–3.941; P = 0.042), prethrombectomy reperfusion on initial digital subtraction angiography (OR 0.394, 95% CI 0.161–0.964; P = 0.041), creatinine levels at admission (OR 1.008, 95% CI 1.000–1.016; P = 0.049), and National Institutes of Health Stroke Scale at 24 h (OR 1.023, 95% CI 1.007–1.039; P = 0.004) were independent risk factors for PSP. With propensity scoring matching, poor functional outcome (mRS > 2) was more common in patients with PSP than in patients without PSP (81.03% vs. 71.83%, P = 0.043) at 90 days after EVT. The early 2-week mortality of patients with PSP was lower (5.74% vs. 12.07%, P = 0.038). But there was no statistically significant difference in 90-day mortality between the PSP group and non-PSP group (22.41% vs. 14.94%, P = 0.074). The survivorship curve also shows no statistical significance (P = 0.088) between the two groups. Conclusions: Nearly one third of patients with AIS and EVT developed PSP. Heart failure, higher creatinine levels, prethrombectomy reperfusion, and National Institutes of Health Stroke Scale at 24 h were associated with PSP in these patients. PSP was associated with poor 90-day functional outcomes in patients with AIS treated with EVT. [ABSTRACT FROM AUTHOR]

Objectives This study reported a single-center clinical trial of endovascular treatment for symptomatic nonacute occlusion of the intracranial large artery (NA-ILAO). The aim of this study was to evaluate the safety, feasibility, and clinical effect of simple balloon dilatation and stent implantation. Methods The patients diagnosed with symptomatic NA-ILAO were enrolled. A total of 40 cases were included in this study. While recanalization failed in 4 patients, it was successful in 36 patients, who were then divided into two groups for further analysis: balloon dilatation group (n = 24) and stent implantation group (n = 12). The perioperative complications, clinical outcome, and follow-up results were analyzed. Results Perioperative complications in the stent implantation group were significantly higher than those in the simple balloon dilatation group (p < 0.05). There were 21 and 10 cases of 90-day good clinical outcome (modified Rankin scale [mRS] ≤ 2) in the balloon and stent groups, respectively (p = 0.518). All patients with successful recanalization underwent digital subtraction angiography (DSA) or CT angiography (CTA) during an average follow-up of 14 months. There were two cases of restenosis in the balloon dilatation group and one in the stent implantation group (p = 1.000). There were two cases of re-occlusion in the stent group and none in the balloon dilatation group (p < 0.001). Stroke recurred in two cases in the stent group and in one case in the simple balloon dilatation group (p = 0.013). Conclusion Endovascular recanalization is safe and feasible for patients with symptomatic NA-ILAO. Compared with stent implantation, simple balloon dilation may be a better recanalization method, but larger randomized controlled trials are needed to confirm it. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of a semi-automated artificial intelligence (AI) software program (CerebralDoc® system) in aneurysm detection and morphological measurement. Methods: In this study, 354 cases of computed tomographic angiography (CTA) were retrospectively collected in our hospital. Among them, 280 cases were diagnosed with aneurysms by either digital subtraction angiography (DSA) and CTA (DSA group, n = 102), or CTA-only (non-DSA group, n = 178). The presence or absence of aneurysms, as well as their location and related morphological features determined by AI were evaluated using DSA and radiologist findings. Besides, post-processing image quality from AI and radiologists were also rated and compared. Results: In the DSA group, AI achieved a sensitivity of 88.24% and an accuracy of 81.97%, whereas radiologists achieved a sensitivity of 95.10% and an accuracy of 84.43%, using DSA results as the gold standard. The AI in the non-DSA group achieved 81.46% sensitivity and 76.29% accuracy, as per the radiologists' findings. The comparison of position consistency results showed better performance under loose criteria than strict criteria. In terms of morphological characteristics, both the DSA and the non-DSA groups agreed well with the diagnostic results for neck width and maximum diameter, demonstrating excellent ICC reliability exceeding 0.80. The AI-generated images exhibited superior quality compared to the standard software for post-processing, while also demonstrating a significantly reduced processing time. Conclusions: The AI-based aneurysm detection rate demonstrates a commendable performance, while the extracted morphological parameters exhibit a remarkable consistency with those assessed by radiologists, thereby showcasing significant potential for clinical application. [ABSTRACT FROM AUTHOR]

The evaluation of hemodynamic conditions in critical limb-threatening ischemia (CLTI) patients is inevitable in endovascular interventions. In this study, the performance of color-coded digital subtraction angiography (ccDSA) and the recently developed color-coded digital variance angiography (ccDVA) was compared in the assessment of key time parameters in lower extremity interventions. The observational study included 19 CLTI patients who underwent peripheral vascular intervention at our institution in 2020. Pre- and post-dilatational images were retrospectively processed and analyzed by a commercially available ccDSA software (Kinepict Medical Imaging Tool 6.0.3; Kinepict Health Ltd., Budapest, Hungary) and by the recently developed ccDVA technology. Two protocols were applied using both a 4 and 7.5 frames per second acquisition rate. Time-to-peak (TTP) parameters were determined in four pre- and poststenotic regions of interest (ROI), and ccDVA values were compared to ccDSA read-outs. The ccDVA technology provided practically the same TTP values as ccDSA (r = 0.99, R2 = 0.98, p < 0.0001). The correlation was extremely high independently of the applied protocol or the position of ROI; the r value was 0.99 (R2 = 0.98, p < 0.0001) in all groups. A similar correlation was observed in the change in passage time (r = 0.98, R2 = 0.96, p < 0.0001). The color-coded DVA technology can reproduce the same hemodynamic data as a commercially available DSA-based software; therefore, it has the potential to be an alternative decision-supporting tool in catheter labs. [ABSTRACT FROM AUTHOR]

Objective: To compare the detection rates of hepatic artery digital subtraction angiography (HA‐DSA) and magnetic resonance imaging (MRI) gadolinium diethylenetriaminepentaacetic acid (MRI‐Gd‐DTPA) and MRI gadolinium diethylenetriaminepentaacetic acid (MRI‐Gd‐EOB‐DTPA) for small (diameter ≤2 cm) hepatocellular carcinoma (HCC) lesions. Methods: A prospective analysis of patients admitted to the Tumor Hospital of Guangxi Medical University between January 1, 2015, and December 30, 2016, was conducted. The detection rates of the three methods were analyzed. The diameter of small HCC lesions detected using HA‐DSA and MRI‐Gd‐EOB‐DTPA were evaluated. The diagnostic value of HCC Barcelona staging for HA‐DSA was analyzed. Results: For 107 small lesions detected in 57 patients, the detection rates of HA‐DSA and MRI‐Gd‐DTPA were 86.0% (92/107) and 71.0% (76/107), respectively (p <.05). Of 77 small lesions detected in 42 patients using MRI‐Gd‐EOB‐DTPA and HA‐DSA, 67 were detected using HA‐DSA, all of which had a rich blood supply, and 72 were detected using MRI‐Gd‐EOB‐DTPA. The minimum diameter of lesions detected using MRI‐Gd‐EOB‐DTPA was approximately 0.4 cm, whereas that of lesions detected using HA‐DSA was approximately 0.5 cm. After HA‐DSA, a change in the Barcelona staging occurred in 33.3% (62/186) of cases but not after MRI‐Gd‐DTPA; HA‐DSA was significantly better than MRI‐Gd‐DTPA for staging (p =.03). Conclusion: HA‐DSA and MRI‐Gd‐EOB‐DTPA have high diagnostic values for the detection of small HCC lesions, which is helpful for accurate staging of HCC and provides the most valuable information for patient treatment and prognosis. [ABSTRACT FROM AUTHOR]

With the continuous development of robot-assisted technology, Robot-assisted Laparoscopic Partial Nephrectomy (RALPN) has gradually become an optional method for the treatment of Hemorrhage secondary to angiomyolipoma (HSA). However, there are rare clinical reports of the primary RALPN for HSA. Therefore, this research aims to evaluate the efficacy and safety of primary RALPN for HSA. Fourteen patients(six males and eight females), aged 14–56 years, underwent primary RALPN for HSA and were retrospectively analyzed from 2015 to 2023. The initial blood routine examination revealed decreased hemoglobin in all patients, and Contrast-enhanced computed tomography (CT) indicated retroperitoneal hematoma. After correcting shock and electrolyte imbalance through fluid therapy and medical treatment, all primary RALPN procedures were performed with transabdominal access on the side of the Hemorrhage. After tumor resection and hematoma removal with a monopolar Curved Scissor, the absorbable barbed suture was performed for inner and outer running stitches, respectively. Patient demographic information, perioperative characteristics, and functional outcomes were collected and analyzed. The initial tumor size of fourteen patients ranged from 57 to 145 mm, and the RENAL ranged from 7 to 11. All of the HSA was controlled, and primary RALPN was successful. The operating time it was ranged from 105 to 265 min. Postoperatively, one patient exhibited chylous drainage (Clavien-Dindo II), and another patient developed pleural effusion (Clavien-Dindo III). No postoperative transfusion and Digital Subtraction Angiography (DSA) highly selective embolization of the bleeding vessel was needed. No patients developed urinoma or urinary fistula. Within the follow-up period, the overall complications were manageable. Primary RALPN is a safe and effective procedure for HSA, which may be considered an alternative to selective renal artery embolization. [ABSTRACT FROM AUTHOR]

Background: Accurate detection of Hepatocellular carcinoma (HCC) feeding vessels during transcatheter arterial chemoembolization (TACE) is important for an effective treatment, while limiting non-target embolization. This study aimed to investigate the feasibility and accuracy of pre-TACE three dimensional (3D) CT angiography for tumor-feeding vessels detection compared to DSA. Methods: Sixty-nine consecutive patients referred for TACE from May 2022 to May 2023 were included. (3D) CT images were reconstructed from the pre-TACE diagnostic multiphasic contrast enhanced CT images and compared with non-selective digital subtraction angiography (DSA) images obtained during TACE for detection of HCC feeding vessels. A "Ground truth" made by consensus between observers after reviewing all available pre-TACE CT images, and DSA and CBCT images during TACE to detect the true feeding vessels was the gold standard. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy and ROC curve with AUC were calculated for each modality and compared. Results: A total of 136 active HCCs were detected in the 69 consecutive patients included in the study. 185 feeding arteries were detected by 3D CT and DSA and included in the analysis. 3D CT detection of feeding arteries revealed mean sensitivity, specificity, PPV, NPV and accuracy of 91%, 71%, 98%, 36%, and 90%, respectively, with mean AUC = 0.81. DSA detection of feeding arteries revealed mean sensitivity, specificity, PPV, NPV, and accuracy of 80%, 58%, 96.5%, 16.5% and 78%, respectively, with mean AUC = 0.69. Conclusions: Pre-TACE 3D CT angiography has shown promise in improving the detection of HCC feeding vessels compared to DSA. However, further studies are required to confirm these findings across different clinical settings and patient populations. Trial registration: This study was prospectively registered at Clinicaltrials.gov with ID NCT05304572; Date of registration: 2-4-2022. [ABSTRACT FROM AUTHOR]

Moyamoya disease (MMD) is a chronic, rare cerebrovascular disorder of unknown cause featured by extensive narrowing of the terminal internal carotid artery (ICA) and its main branches. As a compensatory mechanism, perforators dilate forming fragile collateral vessels that appear as an abnormal vascular network resembling 'puff of smoke drifting in the air' observed via angiography around stenotic area in the brain. Patients and methods: The database of the current hospital was retrospectively studied. All patients with ischemic strokes owing to MMD treated with surgical revascularization between January 2015 and December 2022 were included. MMD was identified on catheter-based digital subtraction angiography (DSA) by the presence of stenosis at the terminal portions of both internal carotid arteries and the development of abnormal collateral "moyamoya vessels" around the base of the brain. Clinical, radiological and follow-up data were retrospectively analyzed. Results: During the mentioned time window, nine patients were diagnosed with moyamoya disease among all pediatric patients with established diagnosis of ischemic stroke in our institute; six of them underwent surgery. Unilateral EDMS was performed in 5 cases (83.3%), while one patient (16.67%) underwent staged bilateral surgeries with no added neurological deficit. Conclusion: Indirect revascularization surgery for pediatric moyamoya-related stroke patients has high rates of reperfusion and promising outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study explored the utility of NLR (neutrophil-to-lymphocyte ratio) as a marker to predict Lower Extremity Peripheral Artery Disease (PAD) in the Chinese population, as well as to assess its consistency and diagnostic value with digital subtraction angiography. Methods: Patients were distributed into three groups according to the angiography in lower limb arterial: group L1, plaque with no stenosis; group L2, plaque with luminal stenosis and group L3, total vascular occlusion. Changes in the neutrophil-to-lymphocyte ratio were documented and compared among groups. Results: Compared to group L1, NLR was significantly increased in L2 (1.76 vs 2.35, p=0.037) and L3 (1.76 vs 3.60, p<0.001), with a gradual decrease in ABI (Ankle-Brachial Index, 1.11 vs 1.02 vs 0.94, p<0.001). Those older patients with higher prevalence of hypertension (p=0.002), obesity (p=0.032), or reduced high-density lipoprotein cholesterol (p=0.020) were more likely to develop PAD; higher glycosylated hemoglobin (p=0.045), low-density lipoprotein cholesterol (p=0.006), and systolic blood pressure (p<0.001) levels led to a greater tendency to suffer stenosis or even occlusion; the probability of severe stenosis (>70%) increased to 2.075 times for every 1 increase in NLR, while it was 46.8% for every 0.1 increase in ABI. The optimal NLR cut-off value to predict severe stenosis in PAD was 2.73. Receiver operating characteristic curve analysis of the inflammatory biomarkers and severe stenosis prediction displayed an area under the curve of 0.81. Conclusion: NLR could serve as a new noninvasive and accurate marker in predicting PAD. [ABSTRACT FROM AUTHOR]

Objective: Symptomatic carotid artery disease is indicative of an elevated likelihood of experiencing a subsequent stroke, with the morphology of plaque and its specific features being closely linked to the risk of stroke occurrence. Our study based on the characteristics of carotid plaque assessed by optical coherence tomography (OCT), the plaque morphology evaluated by digital subtraction angiography (DSA) and clinical laboratory indicators were combined, develop a combined predictive model to identify symptomatic carotid plaque. Methods: Patients diagnosed with carotid atherosclerotic stenosis who underwent whole-brain DSA and OCT examination at the Affiliated Hospital of Jining Medical University from January 2021 to November 2023 were evaluated. Clinical features, as well as DSA and OCT plaque characteristics, were analyzed for differences between symptomatic and asymptomatic cohorts. An analysis of logistic regression was carried out to identify factors associated with the presence of symptomatic carotid plaque. A multivariate binary logistic regression equation was established with the odds ratio (OR) serving as the risk assessment parameter. The receiver operating characteristic curve was utilized to assess the combined predictive model and independent influencing factors. Results: A total of 52 patients were included in the study (symptomatic: 44.2%, asymptomatic: 55.8%). Symptomatic carotid stenosis was significantly linked to four main factors: low-density lipoprotein-cholesterol >3.36 mmol/L [OR, 6.400; 95% confidence interval (CI), 1.067-38.402; p = 0.042], irregular plaque (OR, 6.054; 95% CI, 1.016-36.083; p = 0.048), ruptured plaque (OR, 6.077; 95% CI, 1.046-35.298; p = 0.048), and thrombus (OR, 6.773; 95% CI, 1.194-38.433; p = 0.044). The combined predictive model generated using four indicators showed good discrimination (Area Under Curve, 0.924; 95% CI, 0.815-0. 979). The p value was <0.05 with 78.26% sensitivity and 93.10% specificity. Conclusion: OCT is valuable in evaluating the plaque characteristics of carotid atherosclerotic stenosis. The combined predictive model comprising lowdensity lipoprotein-cholesterol >3.36 mmol/L, irregular plaque, ruptured plaque, and thrombus could help in the detection of symptomatic carotid plaque. Further research conducted on additional independent cohorts is necessary to confirm the clinical significance of the predictive model for symptomatic carotid plaque. [ABSTRACT FROM AUTHOR]

Moyamoya disease, characterized by basal cerebral artery obstruction, was studied for differential protein expression to elucidate its pathogenesis. Proteomic analysis of cerebrospinal fluid from 10 patients, categorized by postoperative angiography into good and poor prognosis groups, revealed 46 differentially expressed proteins. Notably, cadherin 18 (CDH18) was the most significantly upregulated in the good prognosis group. In addition, the expression of cadherin 18 (CDH18) and phenotypic transformation-related proteins were measured by qRT-PCR and western blot. The effects of CDH18 in vascular smooth muscle cells were detected by CCK-8, EdU, transwell and wound healing assays. The overexpression of CDH18 in vascular smooth muscle cells (VSMCs) was found to inhibit proliferation, migration, and phenotypic transformation. These findings suggest CDH18 as a potential therapeutic target in moyamoya disease. [ABSTRACT FROM AUTHOR]

Purpose: Recent innovations in radiological imaging have enabled the detection of micro-remnant niduses of arteriovenous malformations (AVMs) after gamma knife radiosurgery (GKS), which have not been previously perceptible. Herein, we focus on the difficulty of evaluating micro-remnant AVMs after GKS that are hardly perceptible on conventional examinations and propose integrating follow-up three-dimensional rotational angiography (3D-RA) in the previous gamma plan as a solution. Methods: We retrospectively searched NTT Medical Center Tokyo hospital database for patients with AVMs who underwent both two-dimensional digital subtraction angiography (2D-DSA) and 3D-RA as follow-up for GKS from February 2021 to January 2024. Patients with suspected nidus occlusion on the latest non-contrast-enhanced magnetic resonance angiography (NC-MRA) were included, and contrast-enhanced magnetic resonance angiography (CE-MRA), 2D-DSA, and 3D-RA were evaluated. Results: Twelve patients with 13 AVM sites were defined as having complete nidus occlusion on upfront NC-MRA. On 2D-DSA, seven AVM sites showed the presence of slight remaining AVMs based on the detection of remnant drainage veins, however the nidus was not detected in three cases. Nevertheless, 3D-RA detected micro-remnant niduses in all seven AVM sites, and four patients underwent re-GKS. Nine patients with ten AVM sites also underwent CE-MRA, and six AVM sites were diagnosed with radiation-induced parenchymal injury. Conclusion: Importing the 3D-RA image into the treatment planning has the potential to be more helpful than NC-MRA or CE-MRA to detect micro-remnant AVMs and evaluate the true remnant volume, and may contribute to a more detailed treatment planning, thereby improving the results of GKS retreatment. [ABSTRACT FROM AUTHOR]

Objective: Expanding on previous investigations, this study aims to elucidate the role of lipid metabolism disorders in the development of intracranial atherosclerotic stenosis (ICAS) and the determination of stroke risk. The primary objective is to explore the connections between lipid parameters and acute ischemic stroke (AIS), while also examining the potential mediating influence of fasting glucose levels. Methods: Retrospectively, we collected data from symptomatic ICAS patients at the First Affiliated Hospital of Soochow University, including their baseline information such as medical histories and admission blood biochemical parameters. Stenotic conditions were evaluated using magnetic resonance imaging, computed tomography angiography, or digital subtraction angiography. The associations between lipid parameters and AIS risks were investigated via multivariate logistic regression analysis. Results: A total of 1103 patients with symptomatic ICAS were recruited, among whom 441 (40.0%) suffered new ischemic events during hospitalization. After adjusting for confounding factors, the RCS curves exhibited a dose-response relationship between the atherogenic index of plasma (AIP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and AIS. Further multivariate analysis revealed significant associations between these parameters and AIS. Furthermore, mediation analysis indicated that fasting blood glucose (FBG) acted as a mediator in the association between lipid parameters (AIP, TC, and TG) and AIS. Conclusion: Higher lipid parameters in ICAS patients, particularly AIP, TC, and TG, were associated with an increased AIS risk. Additionally, FBG may mediate stroke risk in ICAS patients, highlighting the need for further exploration of underlying mechanisms. [ABSTRACT FROM AUTHOR]

Objective: Internal carotid artery (ICA) agenesis has been classified into six types: A-F. Type F demonstrates distal reconstitution of the ICA via anastomosis with distal branches of the external carotid artery. Herein, we report the ICA agenesis of type F without rete-like collaterals, which has not been previously reported. Case Presentation: An 80-year-old woman presented with segmental agenesis of the right ICA accompanied by an unruptured intracranial aneurysm. Stent-assisted coil embolization was successfully performed. Digital subtraction angiography showed segmental agenesis of the right ICA from the cervical to the ascending foramen lacerum segment, which was preoperatively supplied with collateral blood flow by a dilated right accessory meningeal artery (AMA) anastomosed with the inferolateral trunk (ILT)-posteromedial branch. Based on the segmental concept, the case was diagnosed with segment 7 (horizontal intracavernous portion until ICA branches off the ILT) agenesis, which may have resulted in secondary regression of the ICA proximal to segment 7. According to the ICA agenesis classification, this was of type F because the case showed collateral flow to the distal ICA via transcranial anastomoses from the AMA without carotid rete-like collaterals. Conclusion: These findings suggest that the carotid rete-like collaterals did not form because the AMA was first developed during embryonic development. [ABSTRACT FROM AUTHOR]

We determined the value of computed tomography perfusion (CTP) for assessing the response of hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE). 20 post-TACE HCC patients were re-evaluated with contrast-enhanced computed tomography and CTP. Patients with persistent arterial vascularization [non-response (NR)] or those with no arterial vascularization in the mass, but with signs of new nodules, underwent digital subtraction angiography (DSA), which was used to analyze image characteristics and CTP parameters of TACE-treated HCC. 27 post-TACE HCC masses (mean size 4.21 cm, range 2-6.5 cm) were observed in the 20 patients. The values yielded by CTP were 78.30±40.41 mL/min/100g and 33.67±38.74 mL/min/100g for hepatic arterial blood flow (HABF) and 51.40±17.80% and 25.60±26.53% for hepatic arterial fraction (HAF) in the NR group and complete response group, respectively. The NR group's cutoff value of HABF was =55.95 mL/min/100g, with a sensitivity of 91.7% and specificity of 71.42%, and that of HAF was =32.55%, with a sensitivity of 92.3% and specificity of 83.33%. The CTP and DSA techniques showed high agreement in assessing the post-TACE responses of liver tumors (κ=0.872). The perfusion parameters HABF and HAF have high value for assessing post-TACE responses of HCC. [ABSTRACT FROM AUTHOR]

BACKGROUND: The current 3D-iFlow application can only measure the arrival time of contrast media through intensity values. If the flow rate could be estimated by 3D-iFlow, patient-specific hemodynamics could be determined within the scope of normal diagnostic management, eliminating the need for additional resources for blood flow rate estimation. OBJECTIVE: The aim of this study is to develop and validate a method for measuring the flow rate by data obtained from 3D-iFlow images – a prototype application in Four-dimensional digital subtraction angiography (4D-DSA). METHODS: Using phantom model and experimental circuit with circulating glycerin solution, an equation for the relationship between contrast media intensity and flow rate was developed. Applying the equation to the aneurysm phantom models, the derived flow rate was evaluated. RESULTS: The average errors between the derived flow rate and setting flow rate became larger when the glycerin flow and the X-rays from the X-ray tube of the angiography system were parallel to each other or when the measurement point included overlaps with other contrast enhanced areas. CONCLUSION: Although the error increases dependent on the imaging direction and overlap of contrast enhanced area, the developed equation can estimate the flow rate using the image intensity value measured on 3D-iFlow based on 4D-DSA. [ABSTRACT FROM AUTHOR]

Objective: To investigate the diagnostic value of balloon-assisted small enteroscopy and other examination methods for Meckel's diverticulum of the small intestine. Methods: A retrospective analysis was conducted on 87 patients diagnosed with Meckel's diverticulum at the First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2023. Data regarding demographics, clinical presentations, diagnostic methods, treatments, and pathological findings were collected. Clinical characteristics were summerized, and the diagnostic efficacy of balloon-assisted small enteroscopy was compared with other examination methods for detecting Meckel's diverticulum. Results: A total of 87 patients with Meckel's diverticulum were included, with 55 patients had complications such as gastrointestinal bleeding, intestinal obstruction, diverticulitis, and intestinal perforation. Compared to patients without complications, those with complications had a younger median age(P=0.003), longer diverticulum diameter [(5.2 ± 2.6) cm vs. (3.3 ± 1.4) cm, P=0.001], wider opening [(2.4 ± 1.1) cm vs (.1.6 ± 0.7) cm, P=0.002], and higher surgery rate [(89.1% vs. 56.3%, P < 0.001]. The diagnostic sensitivity of different examination methods for Meckel's diverticulum were as follows: balloon-assisted small enteroscopy 94.4%, nuclide imaging(ectopic gastric mucosal imaging) 58.3%, capsule endoscopy 30.0%, small intestine CT 9.4%, abdominal CT 8.2%, and digital subtraction angiography 0%. Conclusion: Young patients with longer diverticulum diameter and wider opening of small intestine Meckel's diverticulumin are more prone to complications such as diverticulitis, perforation, bleeding, and obstruction. Balloon-assisted small enteroscopy has the highest preoperative diagnostic value for Meckel's diverticulum and should be the preferred examination method for patients suspected of having small intestine Meckel's diverticulum. [ABSTRACT FROM AUTHOR]

There has been a rapid expansion in centers performing balloon pulmonary angioplasty (BPA) and pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH). The purpose of this scoping review was to identify cardiothoracic imaging predictors of outcomes and to identify gaps to address in future work. A scoping review was conducted using the framework outlined by Arksey and O'Malley and Levac et al. in MEDLINE and EMBASE. The study protocol was preregistered in OSF Registries and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. There were 1117 identified studies, including 48 involving pulmonary thromboendarterectomy (n = 25) and balloon pulmonary angioplasty (n = 23). CT was the most common preoperative imaging modality used (n = 21) and CT level of disease was the most reported imaging predictor of outcomes for pulmonary thromboendarterectomy. Although must studies evaluated hemodynamic improvements, imaging was of additional use in predicting clinically significant procedural complications after balloon pulmonary angioplasty, as well as mortality and long-term outcome after pulmonary endarterectomy. Predictors reported in MRI and digital subtraction angiography were less commonly reported and warrant multicenter validation. Cardiothoracic imaging may predict clinically significant outcomes after balloon pulmonary angioplasty and pulmonary thromboendarterectomy. Radiologists involved in the assessment of CTEPH patients should be aware of key predictors and future investigations could focus on multicenter validation and new technologies. [ABSTRACT FROM AUTHOR]