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Objective In this study, we sought to investigate the feasibility of fast carotid artery MR angiography (MRA) by combining three-dimensional time-of-flight (3D TOF) with compressed sensing method (CS-3D TOF). Materials and methods A pseudo-sequential phase encoding order was developed for CS-3D TOF to generate hyper-intense vessel and suppress background tissues in under-sampled 3D k-space. Seven healthy volunteers and one patient with carotid artery stenosis were recruited for this study. Five sequential CS-3D TOF scans were implemented at 1, 2, 3, 4 and 5-fold acceleration factors for carotid artery MRA. Blood signal-to-tissue ratio (BTR) values for fully-sampled and under-sampled acquisitions were calculated and compared in seven subjects. Blood area (BA) was measured and compared between fully sampled acquisition and each under-sampled one. Results There were no significant differences between the fully-sampled dataset and each under-sampled in BTR comparisons ( P > 0.05 for all comparisons). The carotid vessel BAs measured from the images of CS-3D TOF sequences with 2, 3, 4 and 5-fold acceleration scans were all highly correlated with that of the fully-sampled acquisition. The contrast between blood vessels and background tissues of the images at 2 to 5-fold acceleration is comparable to that of fully sampled images. The images at 2 × to 5 × exhibit the comparable lumen definition to the corresponding images at 1 ×. Conclusion By combining the pseudo-sequential phase encoding order, CS reconstruction, and 3D TOF sequence, this technique provides excellent visualizations for carotid vessel and calcifications in a short scan time. It has the potential to be integrated into current multiple blood contrast imaging protocol. [ABSTRACT FROM AUTHOR]

Background and purpose: Techniques to stratify subgroups of patients with asymptomatic carotid artery disease are urgently needed to guide decisions on optimal treatment. Reliance on estimates of % luminal stenosis has not been effective, perhaps because that approach entirely disregards potentially important information on the pathological process in the wall of the artery. Methods: Since plaque lipid is a key determinant of plaque behaviour we used a newly validated, high-sensitivity T2-mapping MR technique for a systematic survey of the quantity and distribution of plaque lipid in patients undergoing endarterectomy. Lipid percentage was quantified in 50 carotid endarterectomy patients. Lipid distribution was tested, using two imaging indices (contribution of the largest lipid deposit towards total lipid (LLD %) and a newly-developed LAI ‘lipid aggregation index’). Results: The bifurcation contained maximal lipid volume. Lipid percentage was higher in symptomatic vs. asymptomatic patients with degree of stenosis (DS ≥ 50%) and in the total cohort (P = 0.013 and P = 0.005, respectively). Both LLD % and LAI was higher in symptomatic patients (P = 0.028 and P = 0.018, respectively), suggesting that for a given plaque lipid volume, coalesced deposits were more likely to be associated with symptomatic events. There was no correlation between plaque volume or lipid content and degree of luminal stenosis measured on ultrasound duplex (r = -0.09, P = 0.53 and r = -0.05, P = 0.75), respectively. However, there was a strong correlation in lipid between left and right carotid arteries (r = 0.5, P <0.0001, respectively). Conclusions: Plaque lipid content and distribution is associated with symptomatic status of the carotid plaque. Importantly, plaque lipid content was not related to the degree of luminal stenosis assessed by ultrasound. Determination of plaque lipid content may prove useful for stratification of asymptomatic patients, including selection of optimal invasive treatments. [ABSTRACT FROM AUTHOR]

Background: Image-based computational models are widely used to determine atherosclerotic plaque stress/strain conditions and investigate their association with plaque progression and rupture. However, patient-specific vessel material properties are in general lacking in those models, limiting the accuracy of their stress/strain measurements. A noninvasive approach of combining in vivo 3D multi-contrast and Cine magnetic resonance imaging (MRI) and computational modeling was introduced to quantify patient-specific carotid plaque material properties for potential plaque model improvements. Vessel material property variation in patients, along vessel segment, and between baseline and follow up were investigated. Methods: In vivo 3D multi-contrast and Cine MRI carotid plaque data were acquired from 8 patients with follow-up (18 months) with written informed consent obtained. 3D thin-layer models and an established iterative procedure were used to determine parameter values of the Mooney-Rivlin models for the 81slices from 16 plaque samples. Effective Young’s Modulus (YM) values were calculated for comparison and analysis. Results: Average Effective Young’s Modulus (YM) and circumferential shrinkage rate (C-Shrink) value of the 81 slices was 411kPa and 5.62%, respectively. Slice YM value varied from 70 kPa (softest) to 1284 kPa (stiffest), a 1734% difference. Average slice YM values by vessel varied from 109 kPa (softest) to 922 kPa (stiffest), a 746% difference. Location-wise, the maximum slice YM variation rate within a vessel was 311% (149 kPa vs. 613 kPa). The average slice YM variation rate for the 16 vessels was 134%. The average variation of YM values for all patients from baseline to follow up was 61.0%. The range of the variation of YM values was [-28.4%, 215%]. For plaque progression study, YM at follow-up showed negative correlation with plaque progression measured by wall thickness increase (WTI) (r = -0.7764, p = 0.0235). Wall thickness at baseline correlated with WTI negatively, with r = -0.5253 (p = 0.1813). Plaque burden at baseline correlated with YM change between baseline and follow-up, with r = 0.5939 (p = 0.1205). Conclusion: In vivo carotid vessel material properties have large variations from patient to patient, along the diseased segment within a patient, and with time. The use of patient-specific, location specific and time-specific material properties in plaque models could potentially improve the accuracy of model stress/strain calculations. [ABSTRACT FROM AUTHOR]

Objective Although carotid artery stenting (CAS) has been gaining popularity as an alternative to carotid endarterectomy (CEA), perioperative stroke rate following contemporary CAS remains significantly higher than stroke rate after CEA. The purpose of this study was to assess perioperative (within 30 days) therapeutic results in patients with carotid stenosis (CS) after introduction of preoperative carotid magnetic resonance imaging plaque evaluation in a single center performing both CEA and CAS. Methods Based on prospectively collected data for patients with CS who were scheduled for carotid revascularization, retrospective analysis was conducted of 295 consecutive patients with CS. An intervention was selected after consideration of periprocedural risks for both CEA and CAS. Concerning risk factors for CAS, results of magnetic resonance imaging plaque evaluation were emphasized with a view toward reducing embolic complications. Results CAS was performed in 114 patients, and CEA was performed in 181 patients. Comparing baseline characteristics of the 295 patients, age, T1 signal intensity of plaque, symptomatic CS, urgent intervention, and diabetes mellitus differed significantly between CAS and CEA groups. Among patients who underwent CAS, new hyperintense lesions on diffusion-weighted imaging were confirmed in 47 patients. New hyperintense lesions on diffusion-weighted imaging were recognized in 21.4% of patients who underwent CEA ( n = 39), significantly less frequent than in patients who underwent CAS. Conclusions The overall short-term outcome of CEA and CAS is acceptable. Preoperative carotid magnetic resonance imaging evaluation of plaque might contribute to low rates of ischemic complications in CAS. [ABSTRACT FROM AUTHOR]

Purpose: We propose a magnetic resonance (MR) imaging protocol for the characterization of carotid web morphology, composition, and vessel wall dynamics. The purpose of this case series was to determine the feasibility of imaging carotid webs with MR imaging. Methods: Five patients diagnosed with carotid web on CT angiography were recruited to undergo a 30-min MR imaging session. MR angiography (MRA) images of the carotid artery bifurcation were acquired. Multi-contrast fast spin echo (FSE) images were acquired axially about the level of the carotid web. Two types of cardiac phase resolved sequences (cineFSE and cine phase contrast) were acquired to visualize the elasticity of the vessel wall affected by the web. Results: Carotid webs were identified on MRA in 5/5 (100%) patients. Multi-contrast FSE revealed vessel wall thickening and cineFSE demonstrated regional changes in distensibility surrounding the webs in these patients. Conclusion: Our MR imaging protocol enables an in-depth evaluation of patients with carotid webs: morphology (by MRA), composition (by multi-contrast FSE), and wall dynamics (by cineFSE). [ABSTRACT FROM AUTHOR]

Background: The multi-contrast assessment of the carotid artery wall has become an important diagnostic tool for the characterization of atherosclerotic plaque and vessel wall thickening. For providing the required T1-, T2-, and proton density weighted contrast, multi-slice turbo spin echo (TSE) techniques are normally applied. The straightforward extension of the TSE techniques to volumetric imaging of large sections of the carotid arteries is limited by the resulting long acquisition times. Where the acquisition of a T1-weighted contrast can be accelerated by applying a T1-weighted fast gradient echo technique, acceleration of the T2-weighted contrast is not as straightforward.Methods: In this work, the combination of a T2 preparation and a conventional fast gradient echo technique (T2P-3DGE) was evaluated for rapid acquisition of a T2-weighted image contrast. Acquisition parameters were optimized in an initial in vitro study in direct comparison to the conventional T2-weighted TSE (T2W-3DTSE) technique. Subsequently, the T2P-3DGE technique was evaluated in vivo.Results: In direct comparison, the T2P-3DGE sequence provided similar T2 contrast as the respective T2W-3DTSE sequence. After correction of an observed intensity offset, most likely caused by the additional T1-weighting of the T2P-3DGE sequence, no significant difference between the two T2-weighted sequences were observed in phantom data. The good correlation of the image contrast between the two sequences was confirmed in the initial in-vivo study, proving a potential reduction of the scan time for T2P-3DGE to 25% of the respective T2W-3DTSE technique.Conclusion: The in vitro as well as the in vivo results clearly indicate the potential of the T2P-3DGE technique for providing similar T2 image contrast as in the conventional techniques. Thereby, the acquisition times could be substantially reduced to about 25% of the respective 3D-TSE technique. [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine whether preoperative three-dimensional (3D) fast spin-echo (FSE) T1-weighted magnetic resonance (MR) plaque imaging for severely stenotic cervical carotid arteries could accurately predict the development of artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA). Seventy-five patients underwent preoperative MR plaque imaging and CEA under transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. On reformatted axialMRimage slices showing the maximum plaque occupation rate (POR) and maximum plaque intensity for each patient, the contrast ratio (CR) was calculated by dividing the internal carotid artery plaque signal intensity by the sternocleidomastoid muscle signal intensity. For all patients, the area under the receiver operating characteristic curve (AUC)--used to discriminate between the presence and absence of microembolic signals--was significantly greater for the CR on the axial image with maximum plaque intensity (CRmax intensity) (0.941) than for that with the maximum POR (0.885) (p < 0.05). For 32 patients in whom both the maximum POR and the maximum plaque density were identified, the AUCs for the CR were 1.000. Preoperative 3D FSE T1-weighted MR plaque imaging accurately predicts the development of artery-to-artery emboli during exposure of the carotid arteries in CEA. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to explore whether GSM based on 3D-ultrasound could predict rupture of carotid plaques and to quantitatively evaluate the vulnerability of carotid plaques. Materials and Methods: 22 Patients with carotid plaques enrolled received 3D-US and 3.0T MRI examinations with intervals less than 48h. Images from two modalities were compared plane by plane. Based on the MRI analysis of plaques tissue compositions, images were divided into 4 groups: fibrous group, lipid core group, calcification group and hybrid group. GSM differences among groups were analyzed and 95% CI was calculated. Based on CAS(carotid atherosclerosis score)system, MRI images were divided into low risk group, medium-low risk group, medium-high risk group and high risk group. GSM differences were compared among groups and 95% CI was calculated. The correlation between GSM and LRNC% (lipid-rich necrotic core%) was analyzed in medium-high risk group and high risk group. Coefficient of variation(CoV) was used to compare the reproducibility of GSM in calcification group and lipid core group. Results: A total of 164 images were matched between 3D-US and MRI. In the classification of plaque tissue composition, GSM was the highest in calcification group (n=29, 95%CI: 57.28-70.38) with a significant difference from other groups, whereas the lowest in lipid core group (n=78, 95% CI:41.79-49.36), but with no significance compared with the fibrous group and hybrid group. In CAS system, GSM was the lowest in high risk group (n=19, 95% CI: 26.44-36.56) and there were significant differences among each group (p<0.05). In high risk group and medium-high risk group, GSM was negatively correlated with lipid core ratio (r=-0.46, p=0.003). CoV of GSM in the calcification group(10.87%) was better than in lipid core group(13.02%), both of them were acceptable. Conclusion: GSM obtained by 3D-US VPQ could evaluate the plaque vulnerability and be served as a new promising method to predict plaque rupture. [ABSTRACT FROM AUTHOR]

Purpose: Carotid artery diseases due to plaque buildup at the carotid bifurcation are a leading cause of stroke. Accurate plaque quantification and characterization of plaque composition and morphology by magnetic resonance imaging(MRI) is essential to identifying high-risk patients. Difficulties in detecting plaque, which is physically small, and the unique physiological structure of the carotid artery make use of a radio frequency (RF) coil array with high resolution, large longitudinal coverage, and deep penetration ideal for clinical examinations. The goal of this project was to design and fabricate a sensitive RF coil array with sufficient imaging coverage and signal-to-noise ratio(SNR) for carotid arteryimaging at 3 T. Methods: Based on clinical requirements and the anatomical structure of the human carotid artery, an 8-channel carotid coil array was designed and fabricated for 3 T MRI of the carotid artery in humans. The performance of the proposed 8-channel carotid coil array was validated through bench tests and MR imaging experiments on a 3 T whole body MRI scanner. Its performance was also compared experimentally to the performance of a commercial 4-channel phased array carotid coil designed by Machnet BV (Machnet BV coil, Roden, Netherlands). Results: The 8-channel carotid coil array performed significantly better in imaging the carotid artery than the commercial 4-channel Machnet BV coil in terms of the SNR, coverage, and penetration depth. In parallel imaging, the proposed 8-channel carotid coil array demonstrated a much lower maximum value and average value of the geometry factor in the region of interest. Carotid arteryimages acquired in vivo using the proposed 8-channel carotid arterycoil and the commercial 4-channel Machnet BV coil were also compared, demonstrating the former's potential for clinical diagnosis. Conclusions: Based on the analyses of phantom and in vivoimaging studies, the proposed 8-channel carotid coil array has the potential for use in clinical diagnosis, performing better in terms of SNR,imaging coverage, and penetration depth than the commercial 4-channel carotid arterycoil array at 3 T. In future studies, the proposed 8-channel carotid coil array can also serve as an important part of a large-scale multichannel coil array for imaging the whole carotid artery system, including the extracranial and intracranial arteries. [ABSTRACT FROM AUTHOR]

Carotid artery atherosclerosis is an important source of mortality and morbidity in the Western world with significant socioeconomic implications. The quest for the early identification of the vulnerable carotid plaque is already in its third decade and traditional measures, such as the sonographic degree of stenosis, are not selective enough to distinguish those who would really benefit from a carotid endarterectomy. MRI of the carotid plaque enables the visualization of plaque composition and specific plaque components that have been linked to a higher risk of subsequent embolic events. Blood suppressed T1 and T2 weighted and proton density-weighted fast spin echo, gradient echo and time-of-flight sequences are typically used to quantify plaque components such as lipid-rich necrotic core, intraplaque haemorrhage, calcification and surface defects including erosion, disruption and ulceration. The purpose of this article is to review the most important recent advances in MRI technology to enable better diagnostic carotid imaging. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence of carotid artery (CA) and vertebral artery (VA) stenosis by contrast-enhanced MR angiography (CE-MRA) in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Methods: 72 patients with NPC after radiotherapy more than 3?years ago were recruited as irradiation group to investigate the incidence and degree of CA and VA stenosis by CE-MRA. The results were compared with those of the control group, which comprised 50 newly diagnosed patients with NPC who had not received radiotherapy. Results: There was a higher incidence of CA and VA stenosis in the irradiation group than in the control group in terms of patient number as well as vessel involvement. The incidence of significant (>50%) CA and VA stenosis, except for the basilar artery, was also higher in the irradiation group than in the control group. The most commonly detected stenosis in the irradiation group was found in the internal CA (ICA) and VA, followed by the external CA and common CA (CCA). CCA and/or ICA (CCA/ICA) stenosis was present in 67 (93.1%) of 72 patients, with 27 (37.5%) patients having significant CCA/ICA stenosis. The statistical analysis demonstrated that age at receiving CE-MRA scanning and time interval from radiotherapy were the independent predictors of significant CCA/ICA stenosis. Conclusion: The CE-MRA scanning results showed that the incidence of stenosis seems to exist in a wider range of CAs and VAs in the patients with NPC after radiotherapy than in the patients who had not received radiotherapy, and the incidence of significant CCA/ICA stenosis is higher in patients with older age and longer interval from radiotherapy. Advances in knowledge: Radiation-induced CA and VA stenosis exists widely in patients with NPC after radiotherapy, and its prevalence is more common in patients with older age and longer interval from radiotherapy. [ABSTRACT FROM AUTHOR]

Ehlers-Danlos syndrome (EDS) type IV is a collagen vascular disease with an autosomal dominant inheritance caused by COL3A1 mutation. Patients with EDS type IV can present with organ rupture, spontaneous arterial dissections and ruptured aneurysms. Because of their propensity to form arterial dissections, aneurysms and rupture, they can develop carotid- cavernous fistula (CCF) after minor trauma or spontaneously. In EDS, it has been reported that even conventional catheter diagnostic angiography may result in large artery dissections and vessel rupture. In addition, the treatment of CCF in EDS type IV can result in up to 59% mortality after initial treatment, of which 23% is attributed to direct complications of treatment. We present the case of a patient with EDS type IV who previously had spontaneous dissection and multiple pseudoaneurysms of both the iliac and femoral arteries and the distal abdominal aorta. Several years later the patient developed a direct type A CCF which was successfully treated with endovascular embolization using a transvenous approach with detachable coils. The literature pertaining to CCF in EDS type IV and its treatment is reviewed. [ABSTRACT FROM AUTHOR]

Idiopathic carotidynia is a syndrome characterized by pain and tenderness over the carotid artery without an associated structural luminal abnormality. Controversy exists over whether this is a distinct disease entity or merely a symptom attributable to other causes of neck pain, such as carotid dissection or vasculitis. A 50-year-old woman presented with sudden-onset right neck pain. Imaging studies demonstrated transmural inflammation of the proximal internal carotid artery, without evidence of intraluminal pathology. The patient was placed on low-dose aspirin and ibuprofen. Her symptoms resolved within a week. At 3-month follow-up, her carotid artery appeared normal on duplex ultrasonography. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Development of a fast 3D high-resolution magnetic resonance imaging (MRI) protocol for improved carotid artery plaque imaging. Methods: Two patients with carotid atherosclerosis disease underwent 3D high-resolution MRI which included time-of-flight and T1-weighted variable flip angle, fast-spin-echo (FSE) imaging, pre- and post-intravenous gadolinium-based contrast agent administration. Results: Good quality images with intrinsic blood suppression were obtained pre- and post-contrast administration using a 3D FSE sequence. The plaque burden, lipid core volume, hemorrhage volume and fibrous cap thickness were well determined. Conclusions: 3D high-resolution MR imaging of carotid plaque using TOF and 3D FSE can achieve high isotropic resolution, large coverage, and excellent image quality within a short acquisition time. [Copyright &y& Elsevier]

The common causes of pseudoaneurysms of internal carotid artery (ICA) in the neck are penetrating trauma, head and neck surgeries, carotid endarterectomies, infiltrating metastatic lymph nodes and neoplasms. We report a young male patient who presented with a swelling in left upper neck diagnosed as carotid body tumor with ultrasonography and magnetic resonance imaging. Subadventitial excision of the tumor was done. The patient developed dense right hemiplegia in the immediate postoperative period. Doppler study of neck revealed left ICA dissection with partial thrombosis of the lumen. Computed tomography of the brain revealed nonhemorrhagic left capsuloganglionic infarct and he was managed conservatively with heparin. Follow-up Doppler study done 2 weeks later revealed pseudoaneurysm of the ICA. Attempts to obliterate the pseudoaneurysm by interventional procedures failed due to the narrow neck of the pseudoaneurysm. Heparin was stopped and patient was maintained only on oral aspirin. Doppler study repeated 1 week later showed spontaneous thrombosis of the pseudoaneurysm with good flow in the distal ICA. To the best of our knowledge, only one case of pseudo-pseudoaneurysm complicating surgical resection of carotid body tumor has been reported so far The etiology, imaging features, and treatment options of pseudoaneurysms are discussed. [ABSTRACT FROM AUTHOR]

Abstract: In this study, we present a novel methodology that allows reliable segmentation of the magnetic resonance images (MRIs) for accurate fully automated three-dimensional (3D) reconstruction of the carotid arteries and semiautomated characterization of plaque type. Our approach uses active contours to detect the luminal borders in the time-of-flight images and the outer vessel wall borders in the T 1-weighted images. The methodology incorporates the connecting components theory for the automated identification of the bifurcation region and a knowledge-based algorithm for the accurate characterization of the plaque components. The proposed segmentation method was validated in randomly selected MRI frames analyzed offline by two expert observers. The interobserver variability of the method for the lumen and outer vessel wall was −1.60%±6.70% and 0.56%±6.28%, respectively, while the Williams Index for all metrics was close to unity. The methodology implemented to identify the composition of the plaque was also validated in 591 images acquired from 24 patients. The obtained Cohen''s k was 0.68 (0.60–0.76) for lipid plaques, while the time needed to process an MRI sequence for 3D reconstruction was only 30 s. The obtained results indicate that the proposed methodology allows reliable and automated detection of the luminal and vessel wall borders and fast and accurate characterization of plaque type in carotid MRI sequences. These features render the currently presented methodology a useful tool in the clinical and research arena. [Copyright &y& Elsevier]

Introduction: This study aimed to describe the lateralized petrous internal carotid artery (ICA), a rare variant of the intratemporal course of the ICA, and distinguish it from aberrant ICA. Methods: A retrospective multi-institutional review of all patients diagnosed over a 10-year period with lateralized ICA was completed. Medical records were reviewed for demographic data as well as clinical information in all patients. Computerized tomography (CT) studies were reviewed in all patients. Magnetic resonance studies in this patient group were reviewed when available. In order to obtain normative data for the ICA, the intratemporal course of the ICA was evaluated on 50 consecutive high-resolution sinus CT scans. Results: Sixteen cases of lateralized ICA were identified on CT scans in 12 patients. In each of these, the ICA entered the skull base in a position more lateral to the cochlea than normal and protruded into the anterior mesotympanum with dehiscent or thinned overlying bone. Magnetic resonance angiography was available in 5 of 12 patients and catheter angiography in 1 of 12. Conclusion: Lateralized petrous ICA can be identified on CT by its more posterolateral entrance to the skull base and protrusion into the anterior mesotympanum. It can be distinguished from the aberrant ICA which enters the posterior hypotympanum through an enlarged inferior tympanic canaliculus, then courses across the inferior cochlear promontory to connect with the normal horizontal petrous ICA. Lateralized ICA is best considered an incidental petrous ICA variant. Awareness of this entity is important in the presurgical evaluation of the temporal bone to avoid vascular injury and confusion with the congenital diagnosis of aberrant ICA. [ABSTRACT FROM AUTHOR]

We describe the case of a 37-year-old woman who presented with a complaint of recurrent headaches since childhood. Clinical examination revealed the presence of a reddish-bluish mass in the inferior half of the tympanic membrane in her right ear. Source and three-dimensional time-of-flight magnetic resonance angiography (MRA) detected a protruded right internal carotid artery (ICA) in the hypotympanum. The vertical segment of the ICA was absent, and the artery was narrowed and lateralized and had a "reverse 7" shape. Meanwhile, a persistent stapedial artery (PSA) was seen originating in the petrous portion of the ICA to form a middle meningeal artery. The A1 segment of the right anterior cerebral artery was hypoplastic. Based on these findings and on follow-up findings on computed tomography, the patient was diagnosed with a concomitant aberrant ICA and PSA. No intervention was undertaken. We review the management of this rare finding, and we discuss the role of MRA in its diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: The primitive persistent trigeminal artery (PTA) is the most common carotid-basilar anastomosis, but because of its extremely low incidence, it is poorly understood. The purpose of this study is to clarify the features of PTA and its variants (PTAV) based on a large magnetic resonance angiography (MRA) series. Methods: MRA was performed on continuous 16,415 patients (8,610 males and 7,805 females) between October 2005 and September 2008 using two 1.5-T systems and one 1.0-T system. These all MRAs were evaluated by neuroradiologists. Results: The incidence of both PTA and PTAV was 0.68% (48 cases of PTA, 50 cases of PTAV, and five unclassified). Among them, 65 cases originated from the left internal carotid artery and 38 from the right. There were 44 cases of lateral type PTA and four cases of medial type. Hypoplasia of the basilar artery proximal to the union of PTA was recognized as follows: no hypoplasia in 12 cases, moderate hypoplasia in 22 cases, and severe hypoplasia in 13 cases. Distance from SCA and the union was an average of 6.7 mm. Four cases of pre- and postoperative cerebral aneurysms were recognized in 103 cases (3.9%). Conclusion: We have identified details of both PTA/PTAV. The incidence of PTA was similar to previous studies, and the co-existence of cerebral aneurysm was also similar when compared to patients in the general population without PTA or PTAV. [ABSTRACT FROM AUTHOR]

Introduction: Direct carotid-cavernous fistula (CCF) is a direct communication between the internal carotid artery (ICA) and the cavernous sinus. Some patients treated with detachable balloons develop pseudoaneurysms or present with a true aneurysm recanalization in the cavernous ICA with poorly known long-term radiological and clinical progression. The objective of the present study was to evaluate the long-term clinical and radiological progression of patients treated with detachable balloons. Methods: The present study evaluated 13 patients previously treated for direct CCF by an endovascular approach. Results: The follow-up period ranged between 19 and 128 months. Ophthalmological evaluation demonstrated alterations in eight patients (61.5%). All of these alterations were already present from the moment of the treatment and displayed no signs of progression. Cranial magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) were performed in all patients, and 11 pseudoaneurysms were demonstrated in ten of the 11 patients in whom ICA patency had been preserved. Five patients were submitted for cerebral digital subtraction angiography (DSA) to characterize the pseudoaneurysms previously observed on MRA studies, with no significant differences in morphology, size, aneurismal neck, and number of lesions. Conclusion: Endovascular treatment of direct CCF with detachable balloons has been shown to be a long-term effective and stable therapeutic method. The authors found asymptomatic pseudoaneurysms in 91% of cases where the ICA patency was preserved. MRI and MRA demonstrated an accuracy similar to that of DSA in the diagnosis of pseudoaneurysms of cavernous ICA. [ABSTRACT FROM AUTHOR]

Abstract: Background: Specific foods and overall dietary patterns are associated with soluble biomarkers of systemic inflammation and endothelial activation. However, no large epidemiological studies have evaluated relationships between such dietary factors and cell-specific markers of activation and inflammation as measured by flow cytometry. Methods: Cell aggregates and multiple platelet and leukocyte markers were quantified by flow cytometry in fresh whole blood from 1101 white adults participating in the Carotid Artery MRI Study, a subset of the larger Atherosclerosis Risk in Communities (ARIC) Study. Two dietary patterns (“Healthy” and “Western”) were empirically derived via principal components analysis using data collected by food frequency questionnaire. Cross-sectional associations between dietary patterns and flow cytometry-measured biomarkers were evaluated, adjusting for demographics and lifestyle factors, including medications use. Results: After multivariable adjustment, monocyte lipopolysaccharide receptor (CD14), monocyte toll-like receptor-2, and platelet glycoprotein IIb (CD41) showed inverse associations with the Healthy dietary pattern (p =0.01, 0.04, and 0.01, respectively). In contrast, the Western dietary pattern was positively associated with CD41 and platelet–granulocyte aggregates (p =0.01 and 0.04, respectively). Independent of other dietary factors, alcohol consumption was inversely associated with levels of pan-leukocyte marker (CD45), P-selectin (CD62P) on PLA1 and on PLA2 platelets, and platelet–monocyte, platelet–granulocyte, and platelet–lymphocyte aggregates. Conclusion: Dietary patterns and alcohol intake were each cross-sectionally associated with select markers of cellular activation and inflammation measured by flow cytometry. These data are consistent with the hypothesis that holistic measures of dietary intake are associated with inflammation. [ABSTRACT FROM AUTHOR]

Atherosclerosis is now widely recognized as a multifactorial disease with outcomes that arise from complex factors such as plaque components, blood flow, and inflammation. Despite recent advances in understanding of plaque biology, diagnosis, and treatment, atherosclerosis remains a leading cause of morbidity and mortality. Further research into the development and validation of reliable indicators of the high-risk individual is greatly needed. Carotid MRI is a histologically validated, noninvasive imaging method that can track disease progression and regression, and quantitatively evaluate a spectrum of parameters associated with in vivo plaque morphology and composition. Intraplaque hemorrhage and the lipid-rich necrotic core are the best indicators of lesion severity currently visualized by carotid MRI. However, MRI methods capable of imaging other important aspects of carotid atherosclerotic disease in vivo-including inflammation, neovascularization, and mechanical forces-are emerging and may aid in advancing our understanding of the pathophysiology of this multifactorial disease. [ABSTRACT FROM AUTHOR]

Abstract: Background: The objective of this study is to evaluate the significance of reduced intercarotid artery distance in the C5 segment in acromegalic patients and the implications for transsphenoidal surgery. Methods: The skull base with the carotid canal was examined with a helical CT scan in 45 patients with acromegaly and 45 age group–matched controls. The distances between the inner walls (IWs) of the carotid sulcus (CS), the outer walls (OWs) of the CS, and the diameter of the ICA at the C5 segment were assessed. Preoperative IGF-1 and growth hormone levels and concomitant diseases were evaluated and correlated with the biometric findings. Statistical analysis was performed with JMP (JMP version 7.0.2, SAS, Cary, USA). Results: The mean distance between the IW was 1.64 ± 0.40 cm in the acromegalic patients and 1.90 ± 0.26 cm in the control group (P = .0005). The distance between the OW measured 3.01 ± 0.39 and 2.97 ± 0.33 cm in the acromegalics and in the control group, respectively (P = .6230). The difference in the diameter of the ICA was statistically significant (P < .0001) between patients and control group. Within the patient group, the distance between the IW of both ICA was significantly smaller in the subgroup with arterial hypertension (P = .0256). Conclusion: Narrowing of the inner borders of the CS between the right and left side is a statistically significant parameter in acromegaly. Attention should be given to an altered vascular course of the ICAs when planning and performing transsphenoidal microsurgery in acromegalic patients. A preoperative skull base CT may furnish important anatomical information and further reduce the risk of vascular injury. [Copyright &y& Elsevier]

BACKGROUND Thirty percent to 40% of strokes in the elderly are secondary to carotid bifurcation disease. The treatment of internal carotid artery (ICA) stenosis in this patient population is a clinical dilemma. Age more than 80 years is a risk factor for carotid endarterectomy (CEA). Carotid artery stenting (CAS) may be also associated with increased peri-procedural complications in this age group. DESIGN This study was a single-center, retrospective database analysis evaluating CAS in patients more than 80 years old. Primary outcome included death, myocardial infarction (MI), or ipsilateral stroke. Secondary outcome included re-stenosis at 30 days, 6 months, and 1-year post-procedure. RESULTS Between March 2001 and March 2004, CAS was performed in 178 patients. Twenty-four patients were more than 80 years old (range 80-91), and 16 men, 70.8%, were symptomatic. Success rate was 100% with residual stenosis of <20%. At the 30 days follow-up there was 1 non-Q wave MI (4.2%), 1 transitory ischemic attack (TIA), and 1 femoral occlusion in the symptomatic group. There were no deaths at 1-year follow-up evaluation as well as no ICA re-stenosis. CONCLUSIONS CAS can be performed in patients more than 80 years old. Complications may be higher than in younger patients. However, because of the high prevalence of stroke in octogenarians, randomized trials should include this patient population. [ABSTRACT FROM AUTHOR]

Intima-media thickness (IMT) is increasingly used as a surrogate end point of vascular outcomes in clinical trials aimed at determining the success of interventions that lower risk factors for atherosclerosis and associated diseases (stroke, myocardial infarction and peripheral artery diseases). The necessity to promote further criteria to distinguish early atherosclerotic plaque formation from thickening of IMT and to standardize IMT measurements is expressed through this updated consensus. Plaque is defined as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50% of the surrounding IMT value or demonstrates a thickness >1.5 mm as measured from the media-adventitia interface to the intima-lumen interface. Standard use of IMT measurements is based on physics, technical and disease-related principles as well as agreements on how to perform, interpret and document study results. Harmonization of carotid image acquisition and analysis is needed for the comparison of the IMT results obtained from epidemiological and interventional studies around the world. The consensus concludes that there is no need to ‘treat IMT values’ nor to monitor IMT values in individual patients apart from exceptions named, which emphasize that inside randomized clinical trials should be performed. Although IMT has been suggested to represent an important risk marker, according to the current evidence it does not fulfill the characteristics of an accepted risk factor. Standardized methods recommended in this consensus statement will foster homogenous data collection and analysis. This will help to improve the power of randomized clinical trials incorporating IMT measurements and to facilitate the merging of large databases for meta-analyses. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Pituitary insufficiency secondary to internal carotid artery (ICA) aneurysm is a very rare condition. Its prevalence is reported as 0.17% (Heshmati et al., 2001). We present a case of pituitary insufficiency and hyperprolactinemia secondary to suprasellar giant intracranial aneurysm. A 71-year-old man was admitted to our clinic with symptoms of hypopituitarism, hyperprolactinemia, and visual field defect. His pituitary MRI and cerebral angiography revealed a giant saccular aneurysm filling suprasellar cistern arising from the ophthalmic segment of the right ICA. Endovascular treatment was performed on the patient to decrease the mass effect of aneurysm and improve the hypophysis dysfunction. After treatment, his one-year follow-up showed the persistence of hypophysis insufficiency, decrease of prolactin (PRL) level, and normal visual field. An intracranial aneurysm can mimic the appearance and behavior of a pituitary adenoma. Intracranial aneurysms should be taken into consideration in the situation of hypopituitarism and hyperprolactinemia. It is important to distinguish them because their treatment approach is different from the others. [ABSTRACT FROM AUTHOR]

Objectives:We report a case of an internal carotid artery aneurysm presenting as orofacial pain.Method:Case report and discussion.Results:A 59-year-old patient presented with a four-year history of chronic oral pain accompanied by a right-sided occipital headache. No local organic pathology was detected, and a provisional diagnosis of persistent idiopathic facial pain was made. A neurosurgery referral was made to exclude neurovascular pathology, which resulted in the detection of an aneurysm originating from the right posterior communicating artery. This was successfully treated by coil embolisation, with subsequent resolution of symptoms.Conclusion:In this patient, an atypical history of pain with no other neurological signs or symptoms, other than accompanying occipital headache, led to the discovery of an intracranial aneurysm. This case highlights the need for appropriate referral and imaging in cases in which the clinical history and findings are not classical, and also emphasises the need for interdisciplinary management. [ABSTRACT FROM PUBLISHER]

Reports on the use of direct magnetic resonance imaging (MRI) of carotid artery thrombus in acute stroke. Description of the technique of MRI; Identification of complex atheroma, the precursor of intra-luminal thromboemboli; Suggestion the technique could be useful in following the behavior of carotid atherosclerosis and acute cerebral infarction.

Abstract: Purpose: To compare the diagnostic performance of three-dimensional variable-flip-angle turbo spin-echo and two-dimensional turbo spin-echo sequences in carotid plaque imaging, with histological analysis as the standard of reference. Materials and methods: Twenty-two patients scheduled for carotid endarterectomy underwent carotid plaque imaging including axial T1-weighted and T2-weighted two-dimensional turbo spin-echo, and coronal T1-weighted and T2-weighted three-dimensional variable-flip-angle turbo spin-echo sequences. The quality of images was visually graded using a three-point scale. The signal ratio of the arterial lumen to the plaque component, and that of the carotid plaque to the ipsilateral submandibular gland was calculated in each sequence. These ratios between two-dimensional and three-dimensional sequences were compared for each plaque component according to the histological category of the plaque. Results: No significant difference was observed among the overall imaging quality scores of the two-dimensional and three-dimensional sequences, although three-dimensional sequences allowed visualization in arbitrary orientations, as well as depiction of small plaque components such as ulcerations and calcifications. The signal ratio of the plaque to the submandibular gland on T1-weighted three-dimensional sequence was significantly higher than that on two-dimensional sequence (p <0.01), whereas no significant difference was found between two T2-weighted sequences. The signal ratios of the plaque to the submandibular gland of histology-defined soft plaque components were significantly higher on T1-weighted three-dimensional sequence than on two-dimensional sequence (p <0.01), whereas no significant differences were observed between two T1-weighted sequences for hard components. Conclusions: Three-dimensional variable-flip-angle turbo spin-echo is a promising tool for the diagnosis of carotid plaques. [Copyright &y& Elsevier]

The article presents a case study of a 19-year-old woman with a three-month history of numbness in her left limbs and an episode of intermittent stomach disorder. Magnetic resonance imaging (MRI) showed remote lacunar infarction at the anterior horn and bilateral common carotid arteries, while carotid angiography demonstrated complete occlusion of the bilateral common carotid arteries. The patient was diagnosed with Behçet's disease.