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Background Elevated brain iron has been observed in Idiopathic Parkinson's disease (IPD) within the deep gray matter. Using quantitative susceptibility mapping (QSM) and a thresholded high-iron region, we quantified iron content in the midbrain of patients with Parkinson's disease as a function of age. Methods We used MRI to scan 24 IPD patients at 3-Tesla. Susceptibility-weighted images were collected with the following parameters, TE: 6 and 20 ms, TR: 30 ms, FA: 15°, and resolution: 0.5 × 0.5 × 2.0 mm3. QSM images were reconstructed from the source phase images. Whole-region and thresholded high-iron (RII) region boundaries for the Substantia Nigra (SN) and Red Nucleus (RN) were traced. Iron content was measured via mean susceptibilities and volumes, which were compared between the groups, as well as between right and left side of the structures within groups. Results Twenty patients with mild to moderate IPD were used in this study. For the SN, mean RII and whole-region iron and volumes were higher in the IPD group compared to HC, as well as mean RII for the RN, while no differences were seen between the groups when considering whole-region mean susceptibility bilaterally for the RN. Conclusion Using a two-region of interest analysis on QSM, we showed that abnormal iron occurs in IPD patients in the SN and with greater volumes compared to HC. This method may have application as a biomarker for disease diagnosis and early intervention.

Summary Background Chronic cerebrospinal venous insufficiency has been proposed as a unique combination of extracranial venous blockages and haemodynamic flow abnormalities that occurs only in patients with multiple sclerosis and not in healthy people. Initial reports indicated that all patients with multiple sclerosis had chronic cerebrospinal venous insufficiency. We aimed to establish the prevalence of venous narrowing in people with multiple sclerosis, unaffected full siblings, and unrelated healthy volunteers. Methods We did an assessor-blinded, case-control, multicentre study of people with multiple sclerosis, unaffected siblings, and unrelated healthy volunteers. We enrolled the study participants between January, 2011 and March, 2012, and they comprised 177 adults: 79 with multiple sclerosis, 55 siblings, and 43 unrelated controls, from three centres in Canada. We assessed narrowing of the internal jugular and azygous veins with catheter venography and ultrasound criteria for chronic cerebrospinal venous insufficiency proposed by Zamboni and colleagues. Catheter venography data were available for 149 participants and ultrasound data for 171 participants. Findings Catheter venography criteria for chronic cerebrospinal venous insufficiency were positive for one of 65 (2%) people with multiple sclerosis, one of 46 (2%) siblings, and one of 32 (3%) unrelated controls (p=1·0 for all comparisons). Greater than 50% narrowing of any major vein was present in 48 of 65 (74%) people with multiple sclerosis, 31 of 47 (66%) siblings (p=0·41 for comparison with patients with multiple sclerosis), and 26 of 37 (70%) unrelated controls (p=0·82). The ultrasound criteria for chronic cerebrospinal venous insufficiency were fulfilled in 35 of 79 (44%) participants with multiple sclerosis, 17 of 54 (31%) siblings (p=0·15 for comparison with patients with multiple sclerosis) and 17 of 38 (45%) unrelated controls (p=0·98). The sensitivity of the ultrasound criteria for detection of greater than 50% narrowing on catheter venography was 0·406 (95% CI 0·311–0·508), and specificity was 0·643 (0·480–0·780). Interpretation This study shows that chronic cerebrospinal venous insufficiency occurs rarely in both patients with multiple sclerosis and in healthy people. Extracranial venous narrowing of greater than 50% is a frequent finding in patients with multiple sclerosis, unaffected siblings, and unrelated controls. The ultrasound criteria are neither sensitive nor specific for narrowing on catheter venography. The significance of venous narrowing to multiple sclerosis symptomatology remains unknown. Funding MS Society of Canada, Saskatoon City Hospital Foundation, Lotte and John Hecht Memorial Foundation, Vancouver Coastal Health Foundation, and the Wolridge Foundation.

Purpose To evaluate the hypothesis that power-injectable totally implanted venous access devices (TIVADs) situated in the arm are associated with more frequent complications and complication-related removal than non–power-injectable arm TIVADs among adult cancer patients. Materials and Methods In this single-center trial, 211 adult chemotherapy patients were randomized to receive either a power-injectable or a non–power-injectable arm TIVAD. Follow-up involved a standardized telephone interview 1 week after insertion, followed by a chest X-ray, arm X-ray, and Doppler ultrasound at 3 months and 12 months. Online complication reporting was also provided by patients and care providers for a minimum of 1 year. The primary end point was removal for port-related complications; the secondary end point was the occurrence of any port-related complication. Results Forty-two complications occurred (19.9% of patients), precipitating the removal of 6 power-injectable ports and 7 standard ports. Time-to-removal did not differ between TIVAD types (hazard ratio 0.75, 95% confidence interval [CI] 0.25–2.24; P = .61). Complications were related to thrombosis, infection, or mechanical issues, with no statistical difference between groups for overall occurrence (23.1% vs 17.0%, odds ratio 1.47, 95% CI 0.74–2.92; P = .27); however, by type of complication, thrombosis occurred more frequently among power-injectable TIVAD patients (15.2% vs 6.1%, odds ratio 2.79, 95% CI 1.04–7.44; P = .03). Conclusions There was no difference in port-related complication occurrence or complication-related removal when using the arm power-injectable port compared with the non–power-injectable port among cancer patients.

Purpose The study sought to assess and compare the prevalence of narrowing of the major extracranial veins in subjects with multiple sclerosis and controls, and to assess the sensitivity and specificity of magnetic resonance venography (MRV) for describing extracranial venous narrowing as it applies to the chronic cerebrospinal venous insufficiency theory, using catheter venography (CV) as the gold standard. Methods The jugular and azygos veins were assessed with time-of-flight MRV in this assessor-blinded, case-control study of subjects with multiple sclerosis, their unaffected siblings, and unrelated controls. The veins were evaluated by diameter and area, and compared with CV. Collateral vessels were also analyzed for maximal diameter, as a potential indicator of compensatory flow. Results A high prevalence of extracranial venous narrowing was demonstrated in all study groups, collectively up to 84% by diameter criteria and 90% by area, with no significant difference between the groups when assessed independently ( P = .34 and .63, respectively). There was high interobserver variability in the reporting of vessel narrowing (kappa = 0.32), and poor vessel per vessel correlation between narrowing on MRV and CV (kappa = 0.064). Collateral neck veins demonstrated no convincing difference in maximum size or correlation with jugular narrowing. Conclusion There is a high prevalence of narrowing of the major extracranial veins on MRV in all 3 study groups, with no significant difference between them. These findings do not support the chronic cerebrospinal venous insufficiency theory. Although MRV has shown a high sensitivity for identifying venous narrowing, time-of-flight imaging demonstrates poor interobserver agreement and poor specificity when compared with the gold standard CV.

Background: The Cook Vital Port system was observed with fluoroscopy before elective removal. A previous publication noted that catheter fracture with this device occurred at the entry of the catheter into the vein used for catheter deployment. We hypothesized that catheter rupture at the vein entry site may be due to ballooning of the catheter during injection, or possibly due to angulation of the catheter during arm movements. Methods: Port system contrast injection and fluoroscopy was performed for 50 consecutive patients who attended for elective arm vein port removal. Assessment of the angle of entry of the catheter into the arm vein was performed with the arm in anatomic position and during arm movements. Results: There was no evidence of catheter ballooning or distortion during contrast injection. There was no evidence of fibrin sheath formation at the catheter tip. One catheter was observed to leak at the vein entry site with the injection of contrast. The only arm movement that affected the angle of the catheter at the vein entry site was flexion at the elbow. The average change in the angle of the catheter between anatomic position and full elbow flexion was 22.4°C. Conclusions: The hypothesis of ballooning of the catheter at the vein entry site during injection was not confirmed. We observed a wide variation in catheter angulation with elbow flexion. The exact cause for catheter fracture remains unknown.

Study objectives The management of life-threatening hemoptysis frequently poses a therapeutic dilemma because such patients are often poor surgical risks. Less often, patients refuse surgical intervention. The value of percutaneous embolotherapy, a useful alternative in these situations, was assessed. Design, setting, patients, interventions Sixteen consecutive patients who underwent percutaneous embolotherapy for life-threatening hemoptysis in a tertiary-care hospital were evaluated retrospectively. The bronchial arteries, as well as other intrathoracic arteries, were evaluated and selectively embolized if they were considered to supply the pathologic area from which the hemoptysis arose. Results The most common cause for hemoptysis was posttuberculous bronchiectasis (n = 12) with or without mycetomas. Ten patients required blood transfusions before embolotherapy. Pleural disease was noted on the chest radiograph in 13 patients and was generally associated with the presence of nonbronchial systemic collateral vessels. In three patients, arteries other than the bronchial arteries were the only source of hemoptysis. Percutaneous embolotherapy was successful in controlling the hemoptysis in all patients. The only complication documented was a transient paraparesis in one patient. Six patients did not return for follow-up. Of the remaining 10 patients, 3 patients had minor episodes of hemoptysis that were treated conservatively with success. One patient had significant recurrent hemoptysis that was managed with radiotherapy. One patient subsequently underwent a lobectomy. Conclusion Percutaneous embolotherapy is a useful therapeutic modality in the management of life-threatening hemoptysis. The contribution of nonbronchial systemic collateral vessels, particularly where there is evidence of coexistent pleural disease, should always be suspected. In experienced hands, this is a safe and potentially life-saving procedure.

We present a case of an infant with horizontal gaze palsy and a butterfly shaped medulla, which is seen in the setting of horizontal gaze palsy with progressive scoliosis (HGPPS). HGPPS presents with a striking brainstem malformation, with markedly diminished size and a bifid appearance of the medulla oblongata. To the best of our knowledge, magnetic resonance imaging (MRI) findings of this disease have only been reported in 6 similar cases, with or without progressive scoliosis. Ours is the youngest reported case with MRI findings. Early diagnosis of HGPPS could facilitate treatment and lifestyle planning for patients with the disease.

Introduction In the two cases described here, the subclavian artery was inadvertently cannulated during unsuccessful access to the internal jugular vein. The puncture was successfully closed using a closure device based on a collagen plug (Angio-Seal, St Jude Medical, St Paul, MN, USA). This technique is relatively simple and inexpensive. It can provide clinicians, such as intensive care physicians and anesthesiologists, with a safe and straightforward alternative to major surgery and can be a life-saving procedure. Case presentation In the first case, an anesthetist attempted ultrasound-guided access to the right internal jugular vein during the preoperative preparation of a 66-year-old Caucasian man. A 7-French (Fr) triple-lumen catheter was inadvertently placed into his arterial system. In the second case, an emergency physician inadvertently placed a 7-Fr catheter into the subclavian artery of a 77-year-old Caucasian woman whilst attempting access to her right internal jugular vein. Both arterial punctures were successfully closed by means of a percutaneous closure device (Angio-Seal). No complications were observed. Conclusions Inadvertent subclavian arterial puncture can be successfully managed with no adverse clinical sequelae by using a percutaneous vascular closure device. This minimally invasive technique may be an option for patients with non-compressible arterial punctures. This report demonstrates two practical points that may help clinicians in decision-making during daily practice. First, it provides a practical solution to a well-known vascular complication. Second, it emphasizes a role for proper vascular ultrasound training for the non-radiologist.

Purpose To determine the frequency of arm port catheter fracture and embolization related to the Cook Vital Port Mini Titanium. Materials and Methods A retrospective audit of our Cerner Radiology Information System was performed between June 1, 2006, and June 30, 2011, to determine the number of Cook arm venous ports implanted and the frequency of foreign body retrievals related to catheter fracture for these arm ports. Results A total of 691 arm implantations of the Cook Vital Port during the 5-year time frame were analysed. Eleven of these patients (1.6%) required intravenous foreign body retrieval in the interventional radiology suite related to catheter fracture and embolization. Three of these fractured catheters were retrieved from the peripheral venous system upstream of the pulmonary circulation, whereas 8 embolized to the pulmonary arteries. All were successfully extracted with an intravenous snare by interventional radiology. Conclusion We discovered a 1.6% frequency of catheter fracture and embolization associated with arm implantation of the Cook Vital Port. All the catheters fractured at the vein entry site and did not detach from the port housing. The cause for catheter fracture and embolization is uncertain. Pulmonary embolization of the fractured catheters puts the patients at risk for possible further complications. No patients had ancillary complications related to catheter embolization or to catheter extraction procedures. Further investigation is required in an attempt to determine the circumstances that may result in catheter fracture and embolization related to this venous access device.