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Cystic artery pseudoaneurysm (CAP) is a rare entity, with just a few cases reported in the literature. The most common presentation of CAP is described by Quincke's triad of upper gastrointestinal bleeding, jaundice and right upper quadrant abdominal pain. We report the case of an 83-year-old male who presented to the adult emergency with a history of an acute cholecystitis 5 weeks prior for which responded to conservative management. Despite this patient not presenting with Quincke's triad, early suspicion of CAP was considered in light of his history of acute cholecystitis and a computed tomographic CT abdomen ordered promptly which showed a 6 mm cystic artery pseudoaneurysm and a thick-walled gallbladder with surrounding inflammatory changes. Management with an endovascular approach followed by an elective cholecystectomy was done.

Background: Stroke is a feared complication after TAVI. The objective was to assess whether left atrial appendage (LAA) filling-defect (FD) patterns from early and late-phase computed tomography (CT), predict stroke/TIA in patients with severe aortic stenosis. Methods: 124 patients with severe aortic stenosis (79.5y, 46.8% females) who underwent CT-Angiography for TAVI-planning were included (66.1% underwent TAVI, 18.6% surgical, 15.3% conservative treatment).CT-image-analysis included: CT-density (HU) from LAA tip-to-base and HU-gradients (I-III), the HU-ratio LAA/aorta, left-atrial-wall-thickness (LAWT) and the periatrial fat attenuation index (FAI). Results: Stroke/TIA rate was 9.6 %. LAA-HU-gradient was slightly higher in non-stroke patients (p = 0.087). Persisting FDs during the late-phase were associated with stroke (p = 0.047) but not early-phase FDs. Early-phase FDs with HU 10HU had 91 % sensitivity and 68 % specificity for prediction of stroke. LAA-HU gradient I had a moderate accuracy (c = 0.592; 95 %CI:0.472–0.711; p = 0.317) for discrimination of stroke during the early phase, which enhanced during the late phase (c = 0.686;95 %CI:0.503–0.868; p = 0.046). Patients with stroke had a higher rate of FDs with HU-progression from early to late phase (>10HU)(p = 0.013), while the ratios LAA/aorta, LAWT, and periatrial-FAI were not different. Among clinical parameters, only age predicted stroke but not CHA2DS2-VASc-score. In multivariate analysis, late-phase FDs (p = 0.059)(OR 5.66: 95 %CI:0.936–34.28) but not early-phase FD were associated with stroke, and none of the major conventional risk factors. Conclusion: Persisting LAA-filling defects on CT during the late-phase, and early-phase FD with 10HU from early-to-late phase. LAA-FD may improve stroke risk stratification.

The authors report a case of pathologically proven intracardiac bronchogenic cyst embedded within the interatrial septum of a 30-year-old woman presenting with chest pain and first-degree AV block. Multimodality imaging played an essential role in the discovery, investigation, and diagnosis of this extremely rare entity.

Carotid cavernous fistula (CCF) is a condition with abnormal flow from the carotid artery to the cavernous sinus. The characteristic clinical findings are ophthalmic monoplegia, ptosis, exophthalmos, chemosis, Horner's syndrome, facial pain, loss of sensation in the distribution of the trigeminal nerve, and headache. Digital subtraction angiography (DSA) is the gold standard modality for evaluating CCF. An 18-year-old patient came with decreased bilateral visual acuity after a traffic accident. CT angiography was performed on the patient and found a dilated right superior ophthalmic vein. CCF is present in the patient. The DSA procedure was performed on the patient, and embolization was performed on the right ophthalmic vein. On post-embolization angiography, the tubular structure is no longer visible, which is bilateral superior ophthalmic vein dilatation.

Background and objectives: The study sought to examine how symptomatic and asymptomatic carotid near-occlusion appeared on angiography. Methods: A blinded study evaluated 635 patients for consecutive CTAs at NRI Medical College/Hospital from June 2021 to May 2022 for estimation of symptomatic and asymptomatic carotid near occlusion. Results: 380 (60%) of the 635 patients (50% carotid stenosis) were symptomatic. Both symptomatic (112, 30%) and asymptomatic (50, 25%) cases of near-occlusion shared the same prevalence. Between symptomatic and asymptomatic cases with near-occlusion, the angiographic appearance was remarkably similar: the mean stenosis lumen diameter (0.7 mm), distal ICA diameter (2.1 mm), and ECA ratio (0.79) were the same in both groups. The average ICA ratio (0.46 and 0.48) and fraction of full collapse (46% and 40%) were fairly similar. Conclusion: The primary conclusion of this study was that there was no change in the angiographic appearance of near-occlusions between symptomatic patients and asymptomatic individuals. [ABSTRACT FROM AUTHOR]

Background: As guidelines endorse the use of computed tomography (CT) for examining coronary artery disease (CAD), it is important to compare the advantages and disadvantages of the novel photon counting detector CT (PCD-CT) technology with the established energy integrating detector CT (EID-CT). Purpose: To compare the image quality of coronary computed tomography angiography (CCTA) and the Agatston scores (AS) derived from EID-CT and PCD-CT. Material and Methods: In this prospective observational study, 28 patients underwent clinical calcium score and CCTA scans on an EID-CT and a PCD-CT scanner. CCTA images were qualitatively analyzed by five observers using visual grading characteristics. The correlation and agreement of the AS were assessed using Spearman's rank correlation and Bland–Altman plots. Results: This qualitative analyses demonstrated a high fraction of "good" or "excellent" ratings for the image criteria in both CT systems. The sharpness of the distal lumen and image quality regarding motion artifacts were rated significantly higher for EID-CT (P < 0.05). However, the sharpness of coronary calcification was rated significantly higher for PCD-CT (P < 0.05). Spearman's rank correlation and Bland–Altman plots showed good correlation (P = 0.95) and agreement regarding the AS between EID-CT and PCD-CT. Conclusion: Both CT systems exhibited high CCTA image quality. The sharpness of calcifications was rated significantly higher for PCD-CT. A good correlation was observed between the AS derived from the two systems. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the results of treatment of patients after undergoing surgical hemostasis in obstetric hypotonic bleeding. Materials and methods: the 31 patients were examined, whose delivery was complicated by hypotonic uterine bleeding, and as a result, surgical hemostasis was performed in the amount of ligation of the ovarian and internal iliac artery. Anthropometric data were analyzed, as well as the dynamics of the results of laboratory and instrumental research methods before and after surgery. In the late postoperative period, the results of helical computed tomography (CT) under angiography conditions were evaluated in the period from 6 months to 5 years. Statistical processing was carried out using the IBM SPSS Statistics 25 program. Results: the age, anamnestic data, anatomical and physiological parameters of patients, terms of delivery and their outcome did not become predictors of developed hypotonic bleeding. Early postpartum bleeding was determined in 93,5% of cases. Extirpation of the uterus was performed in 9,7% of cases. The median blood loss was 1200,0 ml, blood loss of 45-50% of the BCC was determined in 19,4%, 35–45% of the BCC was also in 19,4%. The reduced level of erythrocytes persisted until the moment of discharge, and the reduced hemoglobin after the operation tended to increase. In the course of CT, in 100% of cases, defects in the contrasting of the internal iliac artery on both sides were determined. Collateral circulation was also developed in 100,0% of cases, despite the type of defect in the internal iliac artery. Conclusions: ligation of the ovarian and internal iliac artery is a reliable method of surgical hemostasis, which allows saving the uterus in 90,3% of cases. In the late postoperative period, all patients developed various degrees of arterial patency in the ligation zone, and collateral circulation developed on both sides.

Purpose: The thrombus in the false lumen (FL) of aortic dissection (AD) patients is a meaningful indicator to determine aortic remodeling but difficult to measure in clinic. In this study, a novel segmentation strategy based on deep learning was proposed to automatically extract the thrombus in the FL in post‐operative computed tomography angiography (CTA) images of AD patients, which provided an efficient and convenient segmentation method with high accuracy. Methods: A two‐step segmentation strategy was proposed. Each step contained a convolutional neural network (CNN) to segment the aorta and the thrombus, respectively. In the first step, a CNN was used to obtain the binary segmentation mask of the whole aorta. In the second step, another CNN was introduced to segment the thrombus. The results of the first step were used as additional input to the second step to highlight the aorta in the complex background. Moreover, skip connection attention refinement (SAR) modules were designed and added in the second step to improve the segmentation accuracy of the thrombus details by efficiently using the low‐level features. Results: The proposed method provided accurate thrombus segmentation results (0.903 ± 0.062 in dice score, 0.828 ± 0.092 in Jaccard index, and 2.209 ± 2.945 in 95% Hausdorff distance), which showed improvement compared to the methods without prior information (0.846 ± 0.085 in dice score) and the method without SAR (0.899 ± 0.060 in dice score). Moreover, the proposed method achieved 0.967 ± 0.029 and 0.948 ± 0.041 in dice score of true lumen (TL) and patent FL (PFL) segmentation, respectively, indicating the excellence of the proposed method in the segmentation task of the overall aorta. Conclusions: A novel CNN‐based segmentation framework was proposed to automatically obtain thrombus segmentation for thrombosed AD in post‐operative CTA images, which provided a useful tool for further application of thrombus‐related indicators in clinical and research application. [ABSTRACT FROM AUTHOR]

Summary: Congenital vascular ring anomalies (VRA) have been occasionally described in horses. To the authors' knowledge, this is the first case report providing radiographic and computed tomography (CT) findings of a congenital type 3 persistent right aortic arch (PRAA) in a foal. A 1.5 months old Franches‐Montagnes colt was presented for growth retardation with a history of mild intermittent bilateral nasal discharge occasionally containing milk and coughing since birth. Thoracic radiographs and ultrasound, oesophagoscopy, positive contrast oesophagography and CT angiography were performed. A final diagnosis of persistent right fourth aortic arch, with left ligamentum arteriosum and aberrant left subclavian artery (type 3 VRA) and subsequent aspiration pneumonia was achieved. Due to the poor physical condition, the presence of severe aspiration pneumonia and most importantly the lack of a surgical option for a type 3 VRA, the colt was euthanised and the post‐mortem examination confirmed the oesophagography and CT angiography findings. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this retrospective study was to evaluate the added value of pre-procedural computed tomography angiography (CTA) prior to bronchial artery embolization for patients presenting with hemoptysis. Materials and Methods: In this retrospective study, we evaluated patients admitted for hemoptysis from 2010 to 2021 and treated by catheter-directed embolization. After establishing quality criteria for pre-procedural computed tomography (CT), patients were divided into two groups depending on their pre-procedural imaging assessment: Quality CT-angiography (QCTA group) and suboptimal pre-procedural imaging (suboptimal CTA, unenhanced or no CT evaluation; control group). Groups were compared based on radiological success, procedure-related complications, and clinical success, including cessation of hemoptysis, recurrence rates, and overall mortality. Results: We included 31 patients in the QCTA group, and 35 in the control group. Clinical success was n = 24/31 (77.4%) in the QCTA group and n = 27/35 (77.1%) in the control group (p = 0.979). Technical success was n = 37/42 (88.1%) in the QCTA group and n = 39/42 (92.86%) in the control group (p = 0.820). Overall recurrence was 10.6%. Minor complications occurred in 27.3%, and one major complication was reported. The concordance between the affected bleeding lung and the identification of pathological arteries during angiography was better in the QCTA group (p = 0.045). The average number of culprit arteries (bronchial, non-bronchial systemic arteries [NBSA] or pulmonary) in the QCTA group was not significantly higher than that in the control group. Conclusions: Preprocedural QCTA better identifies the affected bleeding lung and bleeding vessels compared to direct angiography. No difference in clinical success, complications, recurrence rates, or mortality was observed.

OBJECTIVE: Subarachnoid hemorrhage (SAH) due to an intracranial aneurysm is a life-threatening surgical emergency. After the diagnosis of SAH, physicians should find the reason for the bleeding. CT-Angiography (CTA) and Digital Subtraction Angiography (DSA) are techniques used to visualize the aneurysm. However, which one will surgeons prefer? In this study, we have compared these two radiological examinations. PATIENTS AND METHODS: This study includes 58 patients diagnosed with SAH and intracranial aneurysm diagnosis based on CTA (n=30) and DSA (n=28). We evaluated the patients according to demographic properties, CTA and DAS findings, aneurysm location, Fisher score, postoperative complications, and Glasgow outcome score. RESULTS: The most common location of aneurysms was the M1 level (48.3%). Patients in the DSA group had significantly more extended hospital stays (p= 0.021). There was no statistically significant difference between the two groups in complications. CONCLUSIONS: Enhanced CT Technologies provide higher fidelity images and shorten hospital stays. With CTA, surgeons may gain time for an emergency surgical procedure. Despite the fact that DSA remains a significant factor in aneurysm diagnosis, DSA is an invasive procedure and needs more time to diagnose. [ABSTRACT FROM AUTHOR]

Both computed tomography (CT) angiography and vascular ultrasound have a major role before and during a transfemoral approach to TAVR. CT angiography will determine whether the patient is eligible for a femoral approach. Peri-procedural arterial ultrasound will be helpful to improve safety and optimize results during the femoral approach. Being able to interpret both of these imaging modalities is of paramount importance for any interventional cardiologist who practices structural interventions. [ABSTRACT FROM AUTHOR]

Staikov et al. [[11]] obtained a linear regression between the three methods in which a stenosis gauged by one method can be converted into a stenosis measured by another method (e.g., 70% NASCET stenosis equals a 78% ECST stenosis). Assuming a 70% value of carotid stenosis as the cut-off for benefit of carotid endarterectomy, the sensibility, specificity, and accuracy of the NASCET method vary considerably at different levels of the carotid bulb. Keywords: carotid stenosis; CT-angiography; NASCET; ECST EN carotid stenosis CT-angiography NASCET ECST 1678 11 11/17/22 20221101 NES 221101 1. [Extracted from the article]

The aim of this study was to compare the angiographic appearance of symptomatic and asymptomatic carotid near-occlusion. We have found no such previous study. The study hypothesis was that among symptomatic patients with ≥ 50% carotid stenosis, near-occlusion is more common and near-occlusions are more severe than among asymptomatic persons with ≥ 50% carotid stenosis. We reassessed consecutive CTAs from 4042 persons, 645 had ≥ 50% carotid stenosis, and 385 (60%) symptomatic. Near-occlusion was similarly common in symptomatic (105, 27%) and asymptomatic (56, 24%) cases. Among near-occlusions, the angiographic appearance was very similar between symptomatic and asymptomatic cases: mean stenosis lumen diameter (0.7 mm), distal ICA diameter (2.1 mm), and ECA ratio (0.79) were the same in both groups. Mean ICA ratio (0.46 and 0.48) and share of full collapse was very similar (45% and 42%). These findings add to the pathophysiological understanding of carotid near-occlusion. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the effectiveness of a deep learning model (DLM) in improving the sensitivity of neurosurgery residents to detect intracranial aneurysms on CT angiography (CTA) in patients with aneurysmal subarachnoid hemorrhage (aSAH)., Methods: In this diagnostic accuracy study, a set of 104 CTA scans of aSAH patients containing a total of 126 aneurysms were presented to three blinded neurosurgery residents (a first-year, third-year, and fifth-year resident), who individually assessed them for aneurysms. After the initial reading, the residents were given the predictions of a dedicated DLM previously established for automated detection and segmentation of intracranial aneurysms. The detection sensitivities for aneurysms of the DLM and the residents with and without the assistance of the DLM were compared., Results: The DLM had a detection sensitivity of 85.7%, while the residents showed detection sensitivities of 77.8%, 86.5%, and 87.3% without DLM assistance. After being provided with the DLM's results, the residents' individual detection sensitivities increased to 97.6%, 95.2%, and 98.4%, respectively, yielding an average increase of 13.2%. The DLM was particularly useful in detecting small aneurysms. In addition, interrater agreement among residents increased from a Fleiss κ of 0.394 without DLM assistance to 0.703 with DLM assistance., Conclusions: The results of this pilot study suggest that deep learning models can help neurosurgeons detect aneurysms on CTA and make appropriate treatment decisions when immediate radiological consultation is not possible., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: CK serves as consultant for Acandis GmbH (Pforzheim, Germany) and as proctor for MicroVention Inc./Sequent Medical (Aliso Viejo, CA, USA). JPG was funded by the Interdisciplinary Center of Clinical Research Würzburg, Germany [grant number Z-2/CSP-06] and serves as a research consultant for Siemens Healthcare GmbH. RG was supported by the Cologne Clinician Scientist Program (CCSP) (Faculty of Medicine/University of Cologne, funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) (Project No. 413543196)), received research support from Philips Healthcare, and is on the speakers bureau of Philips Healthcare and Guerbet GmbH. The other authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for chronic coronary syndromes (CCS) improves outcomes compared with angiography-guided PCI, however cardiac events still occur during long-term follow-up of FFR-negative patients. In the PREVENT study preventive PCI reduced cardiac-events in lesions which were FFR-negative (FFR > 0.80) and had intracoronary imaging defined vulnerable plaque. Coronary computed tomography angiography (CTA)-defined high risk plaque (HRP) is known to predict future cardiac events. We hypothesized that CTA defined HRP would identify which FFR-negative patients were at greatest risk of future cardiac events., Methods and Results: We examined 373 consecutive CCS patients undergoing CTA followed not more than 90 days later by invasive FFR. Cardiac events were defined as cardiac death, non-fatal acute coronary syndromes, and ischemia-driven revascularization. Clinical follow-up was performed in all patients at a median of 32 months. Revascularization was performed in 131 of the 373 patients due to an FFR ≤ 0.80 (Treat group), with the remaining 242 having revascularization deferred (Defer group) due to an FFR > 0.80. In the Treat group the cardiac event rates between patients with and without HRP on CTA were similar (9.4 % versus 10.1 %, p = 0.90), whilst in the Defer group they were higher in patients with HRP (21.1 % versus 4.7 %, Log-rank-p < 0.0001). In multivariate Cox hazard analysis the presence of HRP (Hazard-ratio 12.79, 95 %confidence-intervals: 3.57-45.83, p < 0.0001) was an independent predictor for cardiac events in the Defer group., Conclusions: HRP on CTA was associated with future cardiac events in patients in whom revascularization was deferred due to a negative invasive-FFR (UMIN000054067; CAPTURE)., Competing Interests: Declaration of competing interest All authors did not have any conflict of interest (COI) for this study., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Syphilis is a sexually transmitted infection characterized by multiple stages. Cardiovascular involvement is a manifestation of tertiary syphilis, occurring between 10 and 40 years after the primary infection. The authors present a case of atypical presentation of tertiary syphilis in a 49-year-old male patient who was admitted to the hospital with bilateral transient loss of vision. Contrast-enhanced CT imaging revealed thoracic aortitis with carotid occlusion, coronary artery stenosis, ischemic stroke, myocardial infarction, and multiple intracardiac thrombi. A postmortem autopsy revealed positive laboratory results for syphilis, which was corroborated by medical autopsy findings of syphilitic aortitis. Keywords: CT-Angiography, Aorta, Cardiac, Vascular, Tertiary Syphilis © RSNA, 2024.

Objective: To assess long term outcomes of CT Angiography in low to intermediate risk patients of suspected ACS and to assess if CT-angiography is a safe modality to discharge patients with clinically non-significant coronary artery disease. Study Design: Descriptive cross-sectional study Place and Duration of Study: Tertiary Cardiac Center in Rawalpindi, from Dec 2021 to Apr, 2022. Methodology: A total of (n=600) patients who presented with ischemic sounding chest pain and suspicion of acute coronary syndrome (ACS) were selected via consecutive sampling technique and were followed up to 5-months. Patients' demographics, CT-Angiography findings and their outcomes were noted on data collection sheet. Data was analyzed by SPSS version-23. Descriptive statistics were run to present categorical data in frequencies and percentages. Chi-square and Fisher Exact Test was applied to find the association between study variables at 95% CI and 5% margin of error (α=5%). Results: Out of (n=600) suspected cases of acute coronary syndrome (ACS), n=352 (58.7%) were males and n=248 (42.3%) were females. As a result of follow-up of the ptaients, cases that represented in emergency department, readmission cases and revascularized cases were (n=10,4, 1;1.7%, 0.7%, & 0.2%) respectively. Frequency of ACS and STEMI patient was 0.0%. Mortality rate was 0.0%. There was significant association of comorbids with CT-angiography findings and the findings with outcome variables (p0.05). Conclusion: In low to intermediate risk patients of suspected ACS, discharge decision from emergency department based on CT-angiography findings is safe and shows excellent long-term outcomes with no major adverse cardiac event (MACE) on long-term follow-up.

Purpose: Acute basilar artery occlusion, a neurovascular emergency leading to high rates of morbidity and mortality, is usually diagnosed by CT imaging. The outcome is partly dependent on etiology, with a worse outcome in occlusions with underlying basilar artery stenosis. As this occlusion type requires a more complex angiographic therapy, this study aimed to develop new CT markers in emergency admission imaging to rapidly identify underlying stenosis. Methods: A total of 213 consecutive patients (female n = 91, age in years (mean/SD/range): 72/13/28–97), who received endovascular treatment at a single comprehensive stroke center for acute basilar artery occlusion, were included in this study. After applying strict inclusion criteria for imaging analyses, novel CT imaging markers, such as 'absolute density loss' (ADL) and relative thrombus attenuation (CTA-index), that measure perviousness, were assessed for n = 109 patients by use of CT-angiography and correlated to different occlusion patterns (thrombotic vs. embolic). Inter-observer agreement was assessed using an intraclass correlation coefficient for independent measures of a radiologist and a neuroradiologist. Associations between the imaging markers and clinical and interventional parameters were tested. Results: CT markers differ between the subgroups of basilar artery occlusions with and without underlying stenosis (for ADL: 169 vs. 227 HU (p = 0.03), for CTA-index: 0.55 vs. 0.70 (p < 0.001)), indicating a higher perviousness in the case of stenosis. A good inter-rater agreement was observed for ADL and CTA-index measures (ICC 0.92/0.88). For the case of embolic occlusions, a more pervious thrombus correlates to shorter time intervals, longer procedure times, and worse reperfusion success (p-values < 0.05, respectively). Conclusions: ADL and CTA-index are easy to assess in the emergency setting of acute basilar artery occlusion with the use of routinely acquired CT-angiography. They show a high potential to differentiate thrombotic from embolic occlusions, with an impact on therapeutic decisions and angiographic procedures. Measurements can be quickly performed with good reliability, facilitating implementation in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE distribution, and alveolar opacities (AO). Methods: This multicenter observational registry (clinicaltrials.gov identifier NCT04824313) included 268 patients diagnosed with SARS-CoV-2 infection and subjected to contrast-enhanced CT between March and June 2020. Acute PE was diagnosed in 61 (22.8%) patients, including 17 females (27.9%), at a mean age of 61.7 ± 14.2 years. Demographic, laboratory, and outcome data were retrieved. We analyzed CT images at the segmental level regarding VC (qualitatively and quantitatively [diameter]), AO (semi-quantitatively as absent, <50%, or >50% involvement), clot location, and distribution related to VC and AO. Segments with vs. without PE were compared. Results: Out of 411 emboli, 82 (20%) were lobar or more proximal and 329 (80%) were segmental or subsegmental. Venous diameters were significantly higher in segments with AO (p = 0.031), unlike arteries (p = 0.138). At the segmental level, 77% of emboli were associated with VC. Overall, PE occurred in 28.2% of segments with AO vs. 21.8% without (p = 0.047). In the absence of VC, however, AO did not affect PE rates (p = 0.94). Conclusions: Vascular changes predominantly affected veins, and most PEs were located in segments with VC. In the absence of VC, AOs were not associated with the PE rate. VC might result from increased flow supported by the hypothesis of pulmonary arteriovenous anastomosis dysregulation as a relevant contributing factor. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the correlation and agreement between AS derived from either an energy-integrating detector CT (EID-CT) or a photon-counting detector CT (PCD-CT). Reproducibility was also compared. In total, 26 calcified coronary lesions (from five cadaveric hearts) were identified for inclusion. The hearts were positioned in a chest phantom and scanned in both an EID-CT and a prototype PCD-CT. The EID-CT and PCD-CT acquisition and reconstruction parameters were matched. To evaluate the reproducibility, the phantom was manually repositioned, and an additional scan was performed using both methods. The EID-CT reconstructions were performed using the dedicated calcium score kernel Sa36. The PCD-CT reconstructions were performed with a vendor-recommended kernel (Qr36). Several monoenergetic energy levels (50–150 keV) were evaluated to find the closest match with the EID-CT scans. A semi-automatic evaluation of calcium score was performed on a post-processing multimodality workplace. The best match with Sa36 was PCD-CT Qr36 images, at a monoenergetic level of 72 keV. Statistical analyses showed excellent correlation and agreement. The correlation and agreement with regards to the Agatston score (AS) between the two methods, for each position as well as between the two positions for each method, were assessed with the Spearman´s rank correlation. The correlation coefficient, rho, was 0.98 and 0.97 respectively 0.99 and 0.98. The corresponding agreements were investigated by means of Bland–Altman plots. High correlation and agreement was observed between the AS derived from the EID-CT and a PCD-CT. Both methods also demonstrated excellent reproducibility. [ABSTRACT FROM AUTHOR]

Abstract Background Femoral cannulation for extracorporeal circulation (ECC) is a standard procedure for minimally invasive cardiac surgery (MICS) of the atrio-ventricular valves. Vascular pathologies may cause serious complications. Preoperative computed tomography-angiography (CT-A) of the aorta, axillary and iliac arteries was implemented at our department. Methods Between July 2017 and December 2018 all MICS were retrospectively reviewed (n = 143), and divided into 3 groups. Results In patients without CT (n = 45, 31.5%) ECC was applied via femoral arteries (91.1% right, 8.9% left). Vascular related complications (dissection, stroke, coronary and visceral ischemia, related in-hospital death) occurred in 3 patients (6.7%). In patients with non-contrast CT (n = 35, 24.5%) only femoral cannulation was applied (94.3% right) with complications in 4 patients (11.4%). CT-angiography (n = 63, 44.1%) identified 12 patients (19.0%) with vulnerable plaques, 7 patients (11.1%) with kinking of iliac vessels, 41 patients (65.1%) with multiple calcified plaques and 5 patients (7.9%) with small femoral artery diameter (d ≤ 6 mm). In 7 patients (11.1%) pathologic findings led to alternative cannulation via right axillary artery, additional 4 patients (6.3%) were cannulated via left femoral artery. Only 2 patients (3.2%) suffered from complications. Conclusions CT-A identifies vascular pathologies otherwise undetectable in routine preoperative preparation. A standardized imaging protocol may help to customize the operative strategy.

BackgroundWe aimed to investigate the anatomical relationship of the coronary sinus (CS) and the mitral valve annulus (MVA) in patients with or without functional mitral regurgitation (FMR) using a multislice CT (MSCT) software to determine (a) the distance and angle of both CS and MVA plane and (b) the mitral annulus geometry.MethodsA total of 215 patients with MSCT and CS to MVA topography evaluation were enrolled in this retrospective study.ResultsThis patient cohort included 145 patients without FMR (67.4%, FMR ≤ 1+) and 70 patients (32.6%) with clinically relevant FMR (FMR ≥ 2+). Distance and angulation of CS to MVA planes were highly variable. In all groups, no significant correlation was documented between the distance or angle of CS to MVA planes and left ventricular ejection fraction, left ventricular end-diastolic diameter, or left atrial volume. A significant increase in total CS length could be found in patients with FMR ≥ 2+ compared to the FMR ≤ 1+ group. MVA diameter, area, and perimeter were significantly increased in FMR ≥ 2+ compared to FMR ≤ 1+. In the FMR ≥ 2+ cohort 61% showed a distance of CS to MVA plane

Purpose: Create a new definition of near-occlusion with full collapse to predicting recurrent stroke. Methods: Pooled analysis of two studies. Patients with symptomatic ≥ 50% carotid stenoses were included. Outcome was preoperative recurrent ipsilateral ischemic stroke or retinal artery occlusion within 28 days of presenting event. We analyzed several artery diameters on computed tomography angiography and stenosis velocity on ultrasound. Results: A total of 430 patients with symptomatic ≥ 50% carotid stenosis were included, 27% had near-occlusion. By traditional definition, 27% with full collapse and 11% without full collapse reached the outcome (p = 0.047). Distal internal carotid artery (ICA) diameter, ICA ratio, and ICA-to-external carotid artery ratio were associated with the outcome. Best new definition of full collapse was distal ICA diameter ≤ 2.0 mm and/or ICA ratio ≤ 0.42. With this new definition, 36% with full collapse and 4% without full collapse reached the outcome (p < 0.001). Conclusions: Defining near-occlusion with full collapse as distal ICA diameter ≤ 2.0 mm and/or ICA ratio ≤ 0.42 seems to yield better prognostic discrimination than the traditional appearance-based definition. This novel definition can be used in prognostic and treatment studies of near-occlusion with full collapse. [ABSTRACT FROM AUTHOR]

We aimed to perform an anatomical evaluation of the carotid bulb using CT-angiography, implement a new reliable index for carotid stenosis quantification and to assess the accuracy of relationship between NASCET and ECST methods in a large adult population. The cross-sectional areas of the healthy carotid at five levels were measured by two experienced radiologists. A regression analysis was performed in order to quantify the relationship between the areas of the carotid bulb at different carotid bulbar level. A new index (Regression indeX, RegX) for carotid stenosis quantification was proposed. Five different stenoses with different grade in three bulbar locations were simulated for all patients for a total of 1365 stenoses and were used for a direct comparison of the RegX, NASCET, and ECST methods. The results of this study demonstrated that the RegX index provided a consistent and accurate measure of carotid stenosis through the application of the ECST method, avoiding the limitations of NASCET method. Furthermore, our results strongly depart from the consolidated relationships between NASCET and ECST values used in clinical practice and reported in extensive medical literature. In particular, we highlighted that a major misdiagnosis in patient selection for CEA could be introduced because of the large underestimation of real stenosis degree provided by the NASCET method. A reappraisal of carotid stenosis patients’ work-up is evoked by the effectiveness of state-of-the-art noninvasive contemporary carotid imaging.

Purpose: Thrombus features on admission CT are useful imaging markers for clot characterization, stroke pathogenesis and outcome prediction. In this context, thrombus perviousness is a promising parameter, but reliable assessment in daily clinical practice is demanding. The aim of the present study was to evaluate an easy to assess measuring method for thrombus permeability at the time of admission. Methods: The CTA-index, which measures relative thrombus attenuation on admission CTA, was compared to the known perviousness parameter in a cohort of 101 patients with large-vessel occlusions of the middle cerebral artery and correlated to clinical outcome parameters (mRS after 90 days, ≤2 rated as favorable). For validation, this correlation was tested in a second independent cohort (n = 87), and possible associations between the CTA-index and outcome measurements (NIHSS/mRS/mTICI) were assessed. Results: In the first cohort a coherence between conventional perviousness measurements and the CTA-index was shown. The CTA-index differed significantly between favorable (−0.55 ± 0.16) and non-favorable outcomes (−0.64 ± 0.14, p = 0.01). In the validation cohort this result could be independently reproduced (−0.52 ± 0.13/−0.70 ± 0.09, p < 0.01). The CTA-index showed an association with low NIHSS at discharge (p < 0.01), favorable outcome after 90 days (p < 0.001) and with better reperfusion (measured by mTICI score, p = 0.04). Conclusion: The CTA-index is an easy to assess imaging parameter on admission CTA in the acute stroke phase and is associated with angiographic and clinical outcome. It can be considered as a simplified measuring method for thrombus perviousness, which is known to provide useful information for further stroke progress and clinical course as well as therapeutic and rehabilitative decisions. [ABSTRACT FROM AUTHOR]

Background/Aim: Dilatation of the main pulmonary artery (mPA) is a common incidental finding in chest imaging and often leads to consultation. The aim of this study was to determine the prevalence of mPA dilatation in a coronary artery CT angiography (CCTA) population. Patients and Methods: The study investigated 985 consecutive patients scheduled for diagnostic CCTA. The transverse axial diameter of the mPA was measured. The prevalence of mPA dilatation was estimated using different reference values (Framingham Heart Study: 28.9 mm for males and 26.9 mm for females, Bozlar: 29.5 mm for both genders and Karazincir: 32.6 mm for males and 31.9 mm for females). Results: The patient mean age was 53.0±9.7 years (66.5% were women). Body surface area (BSA) correlated moderately with the mPA diameter (r=0.423, p<0.001). The prevalence of mPA dilatation varied from 5.9% (Karazincir) to 33.7% (Framingham Heart Study) in the overall study population. Conclusion: The prevalence of mPA dilatation is high in a CCTA patient population when using a cut-off value from the Framingham Heart Study. [ABSTRACT FROM AUTHOR]

• The winning deep learning algorithm of the RSNA 2020 pulmonary embolism detection on CTPA challenge was successfully retrained on the RSNA-STR Pulmonary Embolism CT (RSPECT) dataset and used to analyse CT data from two hospitals. • The deep learning algorithm achieved high diagnostic accuracy on external multidetector CTPA images with an AUC of 0.96. • On spectral detector CT, which included paired conventional images and virtual monochromatic images, a lower performance was observed (0.89 and 0.87, respectively). To evaluate the diagnostic performance and generalizability of the winning DL algorithm of the RSNA 2020 PE detection challenge to a local population using CTPA data from two hospitals. Consecutive CTPA images from patients referred for suspected PE were retrospectively analysed. The winning RSNA 2020 DL algorithm was retrained on the RSNA-STR Pulmonary Embolism CT (RSPECT) dataset. The algorithm was tested in hospital A on multidetector CT (MDCT) images of 238 patients and in hospital B on spectral detector CT (SDCT) and virtual monochromatic images (VMI) of 114 patients. The output of the DL algorithm was compared with a reference standard, which included a consensus reading by at least two experienced cardiothoracic radiologists for both hospitals. Areas under the receiver operating characteristic curve (AUCs) were calculated. Sensitivity and specificity were determined using the maximum Youden index. According to the reference standard, PE was present in 73 patients (30.7%) in hospital A and 33 patients (29.0%) in hospital B. For the DL algorithm the AUC was 0.96 (95% CI 0.92–0.98) in hospital A, 0.89 (95% CI 0.81–0.94) for conventional reconstruction in hospital B and 0.87 (95% CI 0.80–0.93) for VMI. The RSNA 2020 pulmonary embolism detection on CTPA challenge winning DL algorithm, retrained on the RSPECT dataset, showed high diagnostic accuracy on MDCT images. A somewhat lower performance was observed on SDCT images, which suggest additional training on novel CT technology may improve generalizability of this DL algorithm. [ABSTRACT FROM AUTHOR]

The OBJECTIVE was to demonstrate perioperative outcomes and angiographic graft patency rates in the mediumterm period in patients after multivessel minimally invasive coronary artery bypass grafting (MICS CABG) procedures.MATERIAL AND METHODS. In the period from 2014 to 2019, 270 patients with stable forms of coronary artery disease were operated on. All patients received left internal thoracic artery (LITA) and venous or arterial (radial artery) grafts. Off-pump surgery was performed in 264 cases (97.8 %). 127 patients underwent CT-bypass angiography (CT-BA) on a 128-slice computed tomography at least after 1 year after the operation. Mean follow-up duration was (30.3±7.9) months.RESULTS. All patients received full myocardial revascularization. Mean number of grafts was (2.6±0.5). Perioperative mortality rate was 0.4 % (1 patient). Perioperative myocardial infarctions or cerebrovascular accident occurred in 3 (1.1 %) and 1 (0.4 %) patients. Overall graft patency rate in examined patients was 89.8 % (290 of 323). At the time of LITA, the patency of mammary grafts was 98.4 % (124 of 126), venous graft –84.0 % (163 of 194) and radial artery grafts – 100 % (3 of 3).CONCLUSION. MICS CABG was safe and effective and was characterized by minimal rate of perioperative complications. This procedure allowed to achieve complete revascularization of the myocardium without sternotomy and could be performed off-pump (in most cases). MICS CABG provide excellent long-term graft patency rates.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

The results of the study of metabolic and clinical-radiological changes in patients of two groups with and without symptomatic epilepsy on the background of hemorrhages from ruptured arterial aneurysms are shown. The findings suggest that there is the development of hypoxic nature of violations with the activation of prooxidant reactions in both groups, however, in patients with symptomatic epilepsy was found a significant decrease in antioxidant activity of enzymatic and non-enzymatic cell protection systems with increasing the production of the proinflammatory cytokine TNF-alpha in contrast to the group of patients without epilepsy.

Arterio-venous malformations are rather rare findings but sometimes they result in neurologic complications and lethality. These diseases quite often manifest with hemorrhages, cerebral seizures (in cases with intracranial locations).Modern diagnostic methods allow to diagnose cases with AVM of the central nervous system at pre-clinical stage. Last years we tried to improve methods of surgical treatment in AVM patients, intravascular occlusion and possibility of radiosurgery.

Purpose: Acute basilar artery occlusion, a neurovascular emergency leading to high rates of morbidity and mortality, is usually diagnosed by CT imaging. The outcome is partly dependent on etiology, with a worse outcome in occlusions with underlying basilar artery stenosis. As this occlusion type requires a more complex angiographic therapy, this study aimed to develop new CT markers in emergency admission imaging to rapidly identify underlying stenosis. Methods: A total of 213 consecutive patients (female n = 91, age in years (mean/SD/range): 72/13/28–97), who received endovascular treatment at a single comprehensive stroke center for acute basilar artery occlusion, were included in this study. After applying strict inclusion criteria for imaging analyses, novel CT imaging markers, such as ‘absolute density loss’ (ADL) and relative thrombus attenuation (CTA-index), that measure perviousness, were assessed for n = 109 patients by use of CT-angiography and correlated to different occlusion patterns (thrombotic vs. embolic). Inter-observer agreement was assessed using an intraclass correlation coefficient for independent measures of a radiologist and a neuroradiologist. Associations between the imaging markers and clinical and interventional parameters were tested. Results: CT markers differ between the subgroups of basilar artery occlusions with and without underlying stenosis (for ADL: 169 vs. 227 HU (p = 0.03), for CTA-index: 0.55 vs. 0.70 (p < 0.001)), indicating a higher perviousness in the case of stenosis. A good inter-rater agreement was observed for ADL and CTA-index measures (ICC 0.92/0.88). For the case of embolic occlusions, a more pervious thrombus correlates to shorter time intervals, longer procedure times, and worse reperfusion success (p-values < 0.05, respectively). Conclusions: ADL and CTA-index are easy to assess in the emergency setting of acute basilar artery occlusion with the use of routinely acquired CT-angiography. They show a high potential to differentiate thrombotic from embolic occlusions, with an impact on therapeutic decisions and angiographic procedures. Measurements can be quickly performed with good reliability, facilitating implementation in clinical practice.

Purpose: To assess the sensitivity and specificity of common carotid ultrasound method for carotid near-occlusion diagnosis. Methods: Five hundred forty-eight patients examined with both ultrasound and CTA within 30 days of each other were analyzed. CTA graded by near-occlusion experts was used as reference standard. Low flow velocity, unusual findings, and commonly used flow velocity parameters were analyzed. Results: One hundred three near-occlusions, 272 conventional ≥50% stenosis, 162 <50% stenosis, and 11 occlusions were included. Carotid ultrasound was 22% (95%CI 14–30%; 23/103) sensitive and 99% (95%CI 99–100%; 442/445) specific for near-occlusion diagnosis. Near-occlusions overlooked on ultrasound were found misdiagnosed as occlusions (n = 13, 13%), conventional ≥50% stenosis (n = 65, 63%) and < 50% stenosis (n = 2, 2%). No velocity parameter or combination of parameters could identify the 65 near-occlusions mistaken for conventional ≥50% stenoses with >75% sensitivity and specificity. Conclusion: Near-occlusion is difficult to diagnose with commonly used carotid ultrasound methods. Improved carotid ultrasound methods are needed if ultrasound is to retain its position as sole preoperative modality. [ABSTRACT FROM AUTHOR]

Background: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE distribution, and alveolar opacities (AO). Methods: This multicenter observational registry (clinicaltrials.gov identifier NCT04824313) included 268 patients diagnosed with SARS-CoV-2 infection and subjected to contrast-enhanced CT between March and June 2020. Acute PE was diagnosed in 61 (22.8%) patients, including 17 females (27.9%), at a mean age of 61.7 ± 14.2 years. Demographic, laboratory, and outcome data were retrieved. We analyzed CT images at the segmental level regarding VC (qualitatively and quantitatively [diameter]), AO (semi-quantitatively as absent, 50% involvement), clot location, and distribution related to VC and AO. Segments with vs. without PE were compared. Results: Out of 411 emboli, 82 (20%) were lobar or more proximal and 329 (80%) were segmental or subsegmental. Venous diameters were significantly higher in segments with AO (p = 0.031), unlike arteries (p = 0.138). At the segmental level, 77% of emboli were associated with VC. Overall, PE occurred in 28.2% of segments with AO vs. 21.8% without (p = 0.047). In the absence of VC, however, AO did not affect PE rates (p = 0.94). Conclusions: Vascular changes predominantly affected veins, and most PEs were located in segments with VC. In the absence of VC, AOs were not associated with the PE rate. VC might result from increased flow supported by the hypothesis of pulmonary arteriovenous anastomosis dysregulation as a relevant contributing factor.

Background: Femoral cannulation for extracorporeal circulation (ECC) is a standard procedure for minimally invasive cardiac surgery (MICS) of the atrio-ventricular valves. Vascular pathologies may cause serious complications. Preoperative computed tomography-angiography (CT-A) of the aorta, axillary and iliac arteries was implemented at our department.Methods: Between July 2017 and December 2018 all MICS were retrospectively reviewed (n = 143), and divided into 3 groups.Results: In patients without CT (n = 45, 31.5%) ECC was applied via femoral arteries (91.1% right, 8.9% left). Vascular related complications (dissection, stroke, coronary and visceral ischemia, related in-hospital death) occurred in 3 patients (6.7%). In patients with non-contrast CT (n = 35, 24.5%) only femoral cannulation was applied (94.3% right) with complications in 4 patients (11.4%). CT-angiography (n = 63, 44.1%) identified 12 patients (19.0%) with vulnerable plaques, 7 patients (11.1%) with kinking of iliac vessels, 41 patients (65.1%) with multiple calcified plaques and 5 patients (7.9%) with small femoral artery diameter (d ≤ 6 mm). In 7 patients (11.1%) pathologic findings led to alternative cannulation via right axillary artery, additional 4 patients (6.3%) were cannulated via left femoral artery. Only 2 patients (3.2%) suffered from complications.Conclusions: CT-A identifies vascular pathologies otherwise undetectable in routine preoperative preparation. A standardized imaging protocol may help to customize the operative strategy. [ABSTRACT FROM AUTHOR]

Background/Objectives: Digital subtraction angiography (DSA) is the gold standard in the diagnosis of cerebral vasospasm, frequently observed after subarachnoid hemorrhage (SAH). However, less-invasive methods, such as computed tomography angiography (CTA), may be equally accurate. To further clarify comparability, this study evaluated the reliability of CTA in detecting cerebral vasospasm. Methods : This retrospective study included 51 patients with SAH who underwent both CTA and DSA within 24 h. The smallest diameter of the proximal cerebral arterial segments was measured in both modalities at admission and during the vasospasm period. The mean difference in diameter, the intraclass correlation coefficient (ICC) of CTA and DSA, the difference in grade of vasospasm and sensitivity, the specificity and the positive predictive value (PPV) for CTA were calculated. Results : A total of 872 arterial segments were investigated. At time of admission, arterial diameters were significantly smaller on CTA compared to DSA in all segments (-0.26 ± 0.12 mm; p < 0.05). At time of suspected vasospasm (day 9 ± 5), these differences remained significant only for the M1 segment (-0.18 ± 0.37 mm, p = 0.02), the P1 segment (-0.13 ± 0.24 mm, p = 0.04) and the basilar artery (-0.20 ± 0.37 mm, p = 0.0.04). The ICC between CTA and DSA was good (0.5-0.8). The sensitivity of CTA for predicting angiographic vasospasm was 99%, the specificity was 50% and the PPV was 92%. Conclusions : Arterial diameters measured on CTA may underestimate the arterial caliber observed in DSA; however, these absolute differences were minor. Importantly, vessel diameter alone does not fully reflect malperfusion, requiring additional imaging techniques such as CT perfusion.

Purpose This special report outlines a retrospective observational study of CT fractional flow reserve (CT-FFR) analysis using dual-source coronary CT angiography (CTA) scans performed without heart rate control and its impact on clinical outcomes. Materials and Methods All patients who underwent clinically indicated coronary CTA between August 2020 and August 2021 were included in this retrospective observational study. Scans were performed in the late systolic to early diastolic period without heart rate control and analyzed at the interpreting physician's discretion. Demographics, coronary CTA features, and rates of invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), myocardial infarction, and all-cause death at 3 months were assessed by chart review. Results During the study period, 3098 patients underwent coronary CTA, of whom 113 with coronary bypass grafting were excluded. Of the remaining 2985 patients, 292 (9.7%) were referred for CT-FFR analysis. Two studies (0.7%) were rejected from CT-FFR analysis, and six (2.1%) analyses did not evaluate the lesion of concern. A total of 160 patients (56.3%) had CT-FFR greater than 0.80. Among patients with significant stenosis at coronary CTA, patients who underwent CT-FFR analysis presented with lower rates of ICA (74.5% vs 25.5%, P = .04) and PCI (78.9% vs 21.1%, P = .05). Conclusion CT-FFR was implemented in patients not requiring heart rate control by using dual-source coronary CTA acquisition and showed the potential to decrease rates of ICA and PCI without compromising safety in patients with significant stenosis and an average heart rate of 65 beats per minute. Keywords: Angiography, CT, CT-Angiography, Fractional Flow Reserve, Cardiac, Heart, Arteriosclerosis Supplemental material is available for this article. © RSNA, 2024.

The review illuminated actual issues of the diagnostic efficiency of computed tomography (CT) of the coronary arteries in the planning of the procedure percutaneous coronary intervention (PCI) in patients with chronic occlusion of coronary arteries (CTO). The results of researches of detection of predictors of unsuccessful recanalization according to traditional coronary angiography (CAG) and CT angiography were presented. The major CT characteristics of the CTO, which can supplement the coronary angiography data to predict outcomes of the PCI were discussed.

Objective.To estimate the clinical significance of compression syndromes accidentally detected by multislice computed tomography (MSCT) of the abdominal cavity and retroperitoneal space.Material and methods. Intravenous bolus contrast-enhanced MSCT study was performed in 645 patients with different diseases of the abdominal cavity and retroperitoneal space. The information obtained after analysis of diagnostic images was compared with clinical symptoms and, in some cases, with intraoperative data.Results. MSCT study identified prerequisites for the occurrence of compression syndromes in 71 (11%) patients of the study group, of whom 11 (15%) patients were noted to have relevant clinical manifestations. Surgical treatment was performed in 3 cases; medical treatment proved to be effective in the remaining 8 cases.Conclusion. Compression syndromes were diagnosed in 11 (1.7%) of the 645 patients examined by MSCT for different diseases of the abdominal cavity and retroperitoneal space. Their timely and adequate diagnosis could rule out other diseases with similar clinical manifestations and define optimal tactics.

Background and Aim: The extent of penumbra tissue and outcome in stroke patients depend on the collateral cranial vasculature. To provide optimal individualized care for stroke patients in the emergency room setting we investigated the predictive capability of a stringent evaluation of the collateral vessels in ischemic stroke on clinical outcome and infarct size. Methods: We retrospectively studied uniform clinical and radiological data of 686 consecutive patients admitted to the emergency department with suspected acute ischemic stroke. Cranial collateral vasculature status was graded using the initial CT-angiography. Outcome was measured by mRS, NIHSS and final infarct size at hospital discharge. All data were used to build a linear regression model to predict the patients´ outcome. Results: Univariate and multivariate analyses showed significant effects of the whole brain collateral vessel score on all outcome variables. Atherosclerosis and piale collateral status were associated with the final infarct volume (FIV). Atherosclerosis and age were associated with the NIHSS at discharge. The presence of atherosclerosis, glucose level on admission and age were associated with the mRS at discharge. The multivariate models were able to predict 29% of the variance of the mRS at discharge, 24% of the variance in FIV and 17% of the variance of the NIHSS at discharge. The whole brain collateral status and the presence of atherosclerosis were the most relevant predictors for the clinical and radiological outcome. Conclusion: The whole brain collateral vasculature status is clearly associated with clinical and radiological outcome but in a multivariate model seems not sufficiently predictive for FIV, mRS and NIHSS outcome at discharge in non-preselected patients admitted to the emergency department with ischemic stroke. [ABSTRACT FROM AUTHOR]

To compare the diagnostic values of high-resolution magnetic resonance (HR-MRI) with computed tomographic angiography (CTA) in young adults with ischemic stroke due to cervical artery dissections. Totally 42 symptomatic patients were recruited in this study. All the 42 patients underwent both HR-MRI and CTA, including 28 patients with dissections confirmed by Digital Subtraction Angiography (DSA) and 4 patients with vertebral artery dissections diagnosed by follow-up. CTA and HR-MRI images were separately and blindly analyzed by two radiologists. The sensitivity, specificity, positive and negative predictive value of HR-MRI and CTA were calculated. The receiver operating characteristic (ROC) curves and AUC of each imaging modality were generated. A total of 20 carotid artery dissections, 12 vertebral artery dissections and 10 non-dissected cervical arteries were involved. The inter-observer concordance of HR-MRI and CTA was good (κ = 0.806 vs. 0.776). The sensitivity and specificity of HR-MRI and CTA on detecting the dissections were 87.5% vs. 62.5%, and 90.0% vs. 80.0%, respectively. Area under the ROC curve of HR-MRI [0.94 (95% CI 0.86-0.97)] was greater than that of CTA [0.87 (95% CI 0.71-1.0)]. Compared to CTA, HR-MRI is more sensitive and specific for the diagnosis of cervical artery dissections in high-risk symptomatic patients. This study supports the value of HR-MRI in non-invasive diagnosis of young adults with cervical artery dissections. [ABSTRACT FROM AUTHOR]

Computed tomography arterial portography (CTAP) is widely used with a fixed scan timing and contrast medium quantity; however, these parameters are not necessarily optimal. In this study, CTAP scan timing was analyzed by different bolus tracking methods to monitor the inflow of the contrast medium in real-time. A total of 249 patients who underwent CTAP were assessed. In 30 patients, the CTAP scanning began 33 s after contrast medium injection started (fixed method). In 74 patients, the regions of interest (ROIs) were established at two places in the inferior vena cava above the hepatic vein (inferior vena cava-ROI method). In 145 patients, the ROI was established at two places in the liver parenchyma (liver parenchyma-ROI method). Scan timing was considered appropriate when the difference in the CT value between the hepatic and portal veins approached 0; this was observed significantly more with the liver parenchyma-ROI method than with the other methods. CTAP scan timing with the liver parenchyma-ROI method was better than that with the fixed and inferior vena cava-ROI methods. [ABSTRACT FROM AUTHOR]

Introduction: Worldwide, near 200 million adults undergo major non cardiac surgery each year, and 10 million of them are estimated to suffer a myocardial injury after non-cardiac surgery (MINS), defined as an elevated high sensitive troponin T (hs-cTnT) in the first 3 days after surgery. Troponin levels need to be monitored in order to diagnose MINS, high sensitive cardiac Troponin T (hs-cTnT) assays being currently the most frequently used. Perioperative hs-cTnT screening could lead to care decisions that can potentially improve clinical outcomes. However, many of the clinical and economic implications of perioperative hs-cTnT monitoring remain unclear, and need to be elucidated. Methods and analysis: Prospective cohort that will include patients with high cardiovascular risk undergoing major non-cardiac surgery, expected to require at least an overnight hospital admission. Three determinations of hs-cTnT in each patient (before surgery, at 48, and 72 hours after surgery) will be obtained. We will determine the incidence and prognosis of MINS, and calculate prognostically relevant thresholds for pre- and post-operative hs-cTnT. We will also conduct a cost-effectiveness analysis of hs-cTnT screening, compared with usual care. Finally, using computed tomography angiography (CTA) and cardiac magnetic resonance imaging (MRI), we aim to elucidate further the pathophysiology of MINS. Ethics and dissemination: Our center had Ethics approval before including patients. Written informed consent is required for all patients before inclusion. The study will evaluate the feasibility and impact of implementing an hs-cTnT monitoring program at a tertiary hospital, as well as its cost-effectiveness, determine pre and postoperative thresholds of hs-cTnT and finally, evaluate potential mechanisms involved in perioperative ischemic events. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organizations, and taking published results to real practice.

Purpose: To evaluate contrast agent dose reduction using an algorithm based on heart rate and body surface area. Methods: A prospective study with 55 patients undergoing aortic CT was performed. Contrast agent dose, enhancement and image quality between three study groups were compared. Group 1: a fixed, standard dose of 120 ml, group 2: contrast agent dose calculated based on heart rate and body surface area, group 3: additional dilution of 50% of the calculated dose based on heart rate and body surface area. Results: The mean contrast agent dose in group 2 was reduced by 15% (P < 0.01) with unchanged high visual scoring in comparison to group 1. In group 3, contrast agent dose reduction was 60% (P < 0.01); average image quality dropped 19% (P < 0.01) compared to group 1, but was still sufficient, except for two patients. Conclusions: Contrast agent dose was significantly reduced without compromising diagnostic efficacy using the proposed algorithm.