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Sample records for angiography nimiscad-non invasive

  1. Utilization of cardiac computed tomography angiography and outpatient invasive coronary angiography in Ontario, Canada.

    PubMed

    Roifman, Idan; Rezai, Mohammad R; Wijeysundera, Harindra C; Chow, Benjamin J W; Wright, Graham A; Tu, Jack V

    2015-01-01

    Cardiac computed tomography angiography (coronary CTA) has emerged as a non-invasive method of diagnosing coronary artery disease. The extent of utilization and uptake of this technology since initiation of its funding by the government of Ontario is unknown. The aim of our study was to examine coronary CTA utilization and the rates of elective invasive coronary angiography and revascularization before and after funding initiation. We studied all coronary CTAs performed on adults in Ontario after initiation of funding. We also used an interrupted time series analysis to compare the average monthly rates of invasive angiography and revascularization before and after initiation of funding. There was an initial steep increase in age-and sex-standardized rates of coronary CTA from 5.0 to 11.4/100,000 over the first two quarters after funding initiation. Afterwards, there was a gradual increase in utilization from 11.4 to 17.1/100,000 over two subsequent calendar years. There was a significant reduction in both the mean monthly outpatient invasive coronary angiography (from 20.7 to 19.9 per 100,000 (p = 0.0004)) and revascularization (from 4.9 to 4.4 per 100,000 (p < 0.0001)) rates in the three years following introduction of the coronary CTA billing code as compared to the three prior to its introduction. Since the introduction of coronary CTA funding in Ontario, there has been a steady and controlled increase in its utilization. The increasing use of coronary CTA was associated with a reduction in both the rates of invasive angiography and revascularization. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  2. Coronary CT angiography with prospective ECG-triggering: an effective alternative to invasive coronary angiography

    PubMed Central

    2012-01-01

    Despite the tremendous contributions of coronary CT angiography to coronary artery disease, radiation dose associated with coronary CT angiography has raised serious concerns in the literature, as the risk of developing radiation-induced malignancy is not negligible. Various dose-saving strategies have been implemented, with some of the strategies resulting in significant dose reduction. Of these strategies, prospective ECG-triggering is one of the most effective techniques with resultant effective radiation dose similar to or even lower than that of invasive coronary angiography. Prospective ECG-triggered coronary CT angiography has been reported to have high diagnostic accuracy in the diagnosis of coronary artery disease with image quality comparable to that of retrospective ECG-gating, but with significantly reduced radiation dose. Successful performance of prospective ECG-triggering is determined by strict exclusion criteria and careful patient preparation. The aim of this article is to provide an overview of the diagnostic applications of coronary CT angiography with prospective ECG-triggering with focus on radiation dose reduction. Radiation dose measurements are discussed with aim of allowing accurate dose estimation. Diagnostic value of prospective ECG-triggered coronary CT angiography in patients with different heart rate is discussed. Finally, current status and future directions are highlighted. PMID:24282694

  3. Ultrahigh-speed non-invasive widefield angiography

    NASA Astrophysics Data System (ADS)

    Blatter, Cedric; Klein, Thomas; Grajciar, Branislav; Schmoll, Tilman; Wieser, Wolfgang; Andre, Raphael; Huber, Robert; Leitgeb, Rainer A.

    2012-07-01

    Retinal and choroidal vascular imaging is an important diagnostic benefit for ocular diseases such as age-related macular degeneration. The current gold standard for vessel visualization is fluorescence angiography. We present a potential non-invasive alternative to image blood vessels based on functional Fourier domain optical coherence tomography (OCT). For OCT to compete with the field of view and resolution of angiography while maintaining motion artifacts to a minimum, ultrahigh-speed imaging has to be introduced. We employ Fourier domain mode locking swept source technology that offers high quality imaging at an A-scan rate of up to 1.68 MHz. We present retinal angiogram over ˜48 deg acquired in a few seconds in a single recording without the need of image stitching. OCT at 1060 nm allows for high penetration in the choroid and efficient separate characterization of the retinal and choroidal vascularization.

  4. Latest-generation catheterization systems enable invasive submillisievert coronary angiography.

    PubMed

    Kuon, E; Weitmann, K; Hummel, A; Dörr, M; Reffelmann, T; Riad, A; Busch, M C; Felix, S B; Hoffmann, W; Empen, K

    2015-05-01

    The radiation risk of patients undergoing invasive cardiology remains considerable and includes skin injuries and cancer. To date, submillisievert coronary angiography has not been considered feasible. In 2011, we compared results from 100 consecutive patients undergoing elective coronary angiography using the latest-generation flat-panel angiography system (FPS) with results from examinations by the same operator using 106 historic controls with a conventional image-intensifier system (IIS) that was new in 2002. The median patient exposure parameters were measured as follows: dose-area product (DAP) associated with radiographic cine acquisitions (DAP(R)) and fluoroscopy (DAP(F)) scenes, radiographic frames and runs, and cumulative exposure times for radiography and fluoroscopy. On the FPS as compared to the traditional IIS, radiographic detector entrance dose levels were reduced from 164 to 80 nGy/frame and pulse rates were lowered from 12.5/s to 7.5/s during radiography and from 25/s to 4/s during fluoroscopy. The cardiologist's performance patterns remained comparable over the years: fluoroscopy time was constant and radiography time even slightly increased. Overall patient DAP decreased from 7.0 to 2.4 Gy × cm(2); DAP(R), from 4.2 to 1.7 Gy × cm(2); and DAP(F), from 2.8 to 0.6 Gy × cm(2). Time-adjusted DAP(R)/s decreased from 436 to 130 mGy × cm(2) and DAP(F)/s, from 21.6 to 4.4 mGy × cm(2). Cumulative patient skin dose with the FPS amounted to 67 mGy, and the median (interquartile range) of effective dose was 0.5 (0.3 … 0.7) mSv. Consistent application of radiation-reducing techniques with the latest-generation flat-panel systems enables submillisievert coronary angiography in invasive cardiology.

  5. Cost-effectiveness of computed tomography coronary angiography versus conventional invasive coronary angiography.

    PubMed

    Darlington, Meryl; Gueret, Pascal; Laissy, Jean-Pierre; Pierucci, Antoine Filipovic; Maoulida, Hassani; Quelen, Céline; Niarra, Ralph; Chatellier, Gilles; Durand-Zaleski, Isabelle

    2015-07-01

    To determine the costs and cost-effectiveness of a diagnostic strategy including computed tomography coronary angiography (CTCA) in comparison with invasive conventional coronary angiography (CA) for the detection of significant coronary artery disease from the point of view of the healthcare provider. The average cost per CTCA was determined via a micro-costing method in four French hospitals, and the cost of CA was taken from the 2011 French National Cost Study that collects data at the patient level from a sample of 51 public or not-for-profit hospitals. The average cost of CTCA was estimated to be 180 (95 % CI 162-206) based on the use of a 64-slice CT scanner active for 10 h per day. The average cost of CA was estimated to be 1,378 (95 % CI 1,126-1,670). The incremental cost-effectiveness ratio of CA for all patients over a strategy including CTCA triage in the intermediate risk group, no imaging test in the low risk group, and CA in the high risk group, was estimated to be 6,380 (95 % CI 4,714-8,965) for each additional correctly classified patient. This strategy correctly classifies 95.3 % (95 % CI 94.4-96.2) of all patients in the population studied. A strategy of CTCA triage in the intermediate-risk group, no imaging test in the low-risk group, and CA in the high-risk group, has good diagnostic accuracy and could significantly cut costs. Medium-term and long-term outcomes need to be evaluated in patients with coronary stenosis potentially misclassified by CTCA due to false negative examinations.

  6. Coronary competitive reverse flow: Imaging findings at CT angiography and correlation with invasive coronary angiography.

    PubMed

    Li, Minghua; Liu, Shuyong; Zhang, Jiayin; Lu, Zhigang; Wei, Meng; Chun, Eun-Ju; Lu, Bin

    2015-01-01

    To study the imaging features of coronary competitive reverse flow and incidence of a "reverse attenuation gradient" in coronary CT angiography (CTA) with correlation to invasive coronary angiography (ICA). Patients who had undergone coronary CTA and ICA within 2 weeks were retrospectively identified in our database and reviewed. All cases with ICA-confirmed competitive reverse flow or chronic total occlusions (CTOs) were included for further analysis. The "reverse attenuation gradient sign" was defined as a reverse intraluminal opacification gradient of vessels which showed higher opacification in more distal compared with proximal segments. ICA findings were recorded and served as the reference to identify the clinical implications of this sign. In total, 134 patients (mean age, 68.1 ± 11.3 years; range, 38-90 years; 104 men) were included in our study. ICA revealed 11 cases of coronary competitive reverse flow and 123 cases of CTO. A reverse attenuation gradient sign was present in 9 of 11 patients (82%) with coronary competitive reverse flow and 72 of 123 (59%) chronically occluded coronary arteries. Myocardial bridges, distal collateral filling, as well as direct visualization of collateral connection were all more frequent in cases with coronary competitive reverse flow group compared with cases with a CTO. The reverse attenuation gradient sign distal to an upstream coronary severe stenosis indicates the presence of competitive collateral flow. Coronary CTA is able to correctly detect coronary competitive collateral flow and differentiate it from CTOs. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  7. Patient Acceptance of Noninvasive and Invasive Coronary Angiography

    PubMed Central

    Schönenberger, Eva; Schnapauff, Dirk; Teige, Florian; Laule, Michael; Hamm, Bernd; Dewey, Marc

    2007-01-01

    Background Noninvasive angiography using multislice computed tomography (MSCT) is superior to magnetic resonance imaging (MRI) for detection of coronary stenoses. We compared patient acceptance of these two noninvasive diagnostic tests and invasive conventional coronary angiography (Angio). Methods and Findings A total of 111 consecutive patients with suspected coronary artery disease underwent MSCT, MRI, and Angio. Subsequently, patient acceptance of the three tests was evaluated with questionnaires in all patients. The main acceptance variables were preparation and information prior to the test, degree of concern, comfort, degree of helplessness, pain (on visual analog scales), willingness to undergo the test again, and overall satisfaction. Preparation for each test was not rated significantly differently, whereas patients were significantly more concerned about Angio than the two noninvasive tests (p<0.001). No pain during MSCT, MRI, and Angio as assessed on visual analog scales (0 to 100) was reported by 99, 93, and 31 patients, respectively. Among the 82 patients who felt pain during at least one procedure, both CT (0.9±4.5) and MRI (5.2±16.6) were significantly less painful than Angio (24.6±23.4, both p<0.001). MSCT was considered significantly more comfortable (1.49±0.64) than MRI (1.75±0.81, p<0.001). In both the no-revascularization (55 patients) and the revascularization group (56 patients), the majority of the patients (73 and 71%) would prefer MSCT to MRI and Angio for future imaging of the coronary arteries. None of the patients indicated to be unwilling to undergo MSCT again. The major advantages patients attributed to MSCT were its fast, uncomplicated, noninvasive, and painless nature. Conclusions Noninvasive coronary angiography with MSCT is considered more comfortable than MRI and both MSCT and MRI are less painful than Angio. Patient preference for MSCT might tip the scales in favor of this test provided that the diagnostic accuracy of MSCT

  8. Multidetector CT coronary angiography for patient triage to invasive coronary angiography: Performance and cost in ambulatory patients with equivocal or suspected inaccurate noninvasive stress tests.

    PubMed

    Menon, Madhav; Lesser, John R; Hara, Hidehiko; Birkett, Richard; Knickelbine, Thomas; Longe, Terry; Flygenring, Bjorn; Henry, Jason; Schwartz, Robert

    2009-03-01

    Multidetector-CT angiography (MDCTA) differs from noninvasive stress tests by directly imaging coronary anatomy. The utility of MDCTA for invasive triage is undefined however. We evaluated MDCTA triage to invasive coronary angiography in outpatients with indeterminate or suspected inaccurate stress tests, and estimated cost savings by MDCTA in this role. Consecutive MDCTA patients were retrospectively compared with noninvasive stress tests if performed within 6 months of MDCTA. Twelve-month clinical follow up was obtained for patients not undergoing invasive angiography, and cost using MDCTA for triage to invasive coronary angiography was calculated. MDCTA was performed in 385 patients who had noninvasive stress testing. Stress tests include included treadmill (n = 37), stress echo (n = 178), and nuclear perfusion imaging (n = 170). Invasive angiography was performed in 57 (14.8%). MDCTA compared to CA showed positive and negative predictive values of 94%/100% respectively for lesions found by invasive QCA. Stress testing compared to MDCTA showed positive/negative predictive values of 100%/67% for treadmill exercise, 60%/54% for stress echo, and 59%/55% of nuclear perfusion examinations respectively. One year clinical follow up in 314 patients showed no coronary events in 98% (309) of patients. Triage to invasive angiography by MDCTA showed a 4-fold cost reduction. MDCTA shows excellent performance as a triage for invasive angiography in patients with stress tests that are equivocal or thought inaccurate. A negative CTA confers good 12-month prognosis. Substantial cost savings may accrue using MDCTA in this triage role.

  9. Procedural success of CTO recanalization: Comparison of the J-CTO score determined by coronary CT angiography to invasive angiography.

    PubMed

    Li, Yuehua; Xu, Nan; Zhang, Jiayin; Li, Minghua; Lu, Zhigang; Wei, Meng; Lu, Bin; Zhang, Yang

    2015-01-01

    The J-CTO score is based on invasive angiography, combines several parameters of chronic total coronary occlusions (CTO), and is well established to predict the likelihood of success of percutaneous recanalization. The purpose of this study was to evaluate and validate a J-CTOCT score derived from coronary computed tomography angiography (coronary CTA). Between April 2011 and December 2014, 159 consecutive patients were retrospectively included. All had at least one CTO in invasive angiography, had coronary CTA performed at an interval of no more than one week from invasive angiography, and had an attempt at percutaneous coronary intervention (PCI) following coronary CTA In parallel to the angiographic J-CTO score, the J-CTOCT score was determined by awarding one point each for a blunt vessel stump, bending > 45°, occlusion length ≥ 20 mm, presence of calcium covering > 50% of any vessel cross-section within the occlusion, or a previously failed attempt at PCI. a. Both scores were compared regarding their ability to predict successful recanalization. A total of 171 CTO lesions were analyzed. Intraobserver (k = 0.814, p < 0.001) and interobserver agreement (k = 0.771, p < 0.001) for calculation of the J-CTOCT score were close. The mean occlusion length measured by coronary CTA was significantly shorter than in invasive angiography (27.6 ± 14.8 mm vs. 37.2 ± 18.8 mm, p < 0.001). The J-CTOCT score (mean: 1.9 ± 1.4) correlated closely to the angiographic J-CTO score (mean: 1.8 ± 1.3, r = 0.856, p < 0.001), and in 122/171 lesions (71%), the scores were identical. Both J-CTOCT score (area under curve: 0.882, p < 0.001) and angiographic J-CTO score (area under curve: 0.868, p < 0.001) yielded similarly high predictive value for successful guidewire crossing within 30 min (p = 0.496). While the length of coronary occlusions in coronary CTA is significantly shorter than in invasive angiography, a J-CTOCT score determined by coronary CTA closely correlates to the

  10. Intravenous flat detector CT angiography for non-invasive visualisation of intracranial flow diverter: technical feasibility.

    PubMed

    Struffert, Tobias; Saake, Marc; Ott, Sabine; Engelhorn, Tobias; Gölitz, Philipp; Kloska, Stephan; Doelken, Marc; Doerfler, Arnd

    2011-08-01

    To demonstrate the feasibility of intravenous Flat Detector CT Angiography (FD-CTA) for visualisation of intracranial Flow Diverting Devices. Flow Diverting Devices are used increasingly for treatment of intracranial aneurysms. A close follow up is necessary because it becomes obvious that a significant proportion of aneurysms treated with these devices remain patent. A minimally invasive method is highly desirable. In two patients treated with flow diverters a Flat Detector CT (FD-CT) with intravenous contrast medium application was performed. Post-processing was performed using commercially available software. In both patients the lumen of the device and the lumen of the aneurysm could be clearly evaluated. Some beam hardening artefacts due to the marker wires of the device were obvious. Flat Detector CT with intravenous contrast material application to evaluate flow-diverting devices seems to be feasible. Further studies are necessary to perform comparative evaluation of FD-CTA with angiography and other techniques like MRA or conventional CT angiography.

  11. Non-invasive coronary angiography with multi-detector computed tomography: comparison to conventional X-ray angiography.

    PubMed

    Schoenhagen, Paul; Stillman, Arthur E; Halliburton, Sandy S; Kuzmiak, Stacie A; Painter, Tracy; White, Richard D

    2005-02-01

    Selective coronary angiography introduced clinical coronary imaging in the late 1950s. The angiographic identification of high-grade coronary lesions in patients with acute and chronic symptomatic coronary artery disease (CAD) led to the development of surgical and percutaneous coronary revascularization. However, the fact that CAD remains the major cause of death in North America and Europe demonstrates the need for novel, complementary diagnostic strategies. These are driven by the need to characterize both increasingly advanced disease stages but also early, asymptomatic disease development. Complex revascularization techniques for patients with advanced disease stages will initiate a growing demand for 3-dimensional coronary imaging and integration of imaging modalities with new mechanical therapeutic devices. An emerging focus is atherosclerosis imaging with the goal to identify subclinical disease stages as the basis for pharmacological intervention aimed at disease stabilization or reversal. Non-invasive coronary imaging with coronary multidetector computed tomographic angiography (MDCTA) allows both assessment of luminal stenosis and subclinical disease of the arterial wall. Its complementary role in the assessment of early and advanced stages of CAD is increasingly recognized.

  12. Non-diagnostic coronary artery calcification and stenosis: a correlation of coronary computed tomography angiography and invasive coronary angiography.

    PubMed

    Engel, Leif-Christopher; Thai, Wai-Ee; Medina-Zuluaga, Hector; Karolyi, Mihaly; Sidhu, Manavjot S; Maurovich-Horvat, Pal; Margey, Ronan; Pomerantsev, Eugene; Abbara, Suhny; Ghoshhajra, Brian B; Hoffmann, Udo; Liew, Gary Y

    2017-05-01

    Background Heavy coronary artery calcification (CAC) impairs diagnostic accuracy of coronary computed tomography angiography (cCTA) and is considered to be a major limitation. Purpose To investigate the effect of non-evaluable CAC seen on cCTA on clinical decision-making by determining the degree of subsequent invasive testing and to assess the relationship between non-evaluable segments containing CAC and significant stenosis as seen in invasive coronary angiography (ICA). Material and Methods The study comprised of 356 patients who underwent cCTA and subsequent ICA within 2 months between 2005 and 2009. Clinical reports were reviewed to identify the indications for referral to ICA. In a subset of 68 patients where non-diagnostic CAC on cCTA and significant stenosis on ICA were present in the same segment, we correlated and analyzed the underlying stenosis severity of the lesion on ICA to the cCTA. Lesions with CAC were analyzed in a standardized fashion by application of reading rules. Results Non-diagnostic CAC on cCTA prompted ICA in 5.6% of patients. CAC occurred at the site of maximum stenosis in segments with stenosis <50% (95.9% [47/49]), 50-69% (82.4% [28/34]), 70-99% (64.5% [31/48]), and 100% (33.3% [1/3]). At the point of maximum calcium deposit, non-obstructive disease was present in 61.2%. Application of reading rules resulted in a 44% reduction in non-diagnostic cCTA reads. Conclusion Severe CAC may prompt further investigation with ICA. There is less CAC with increasing lesion severity at the point of maximum stenosis. Additional application of reading rules improved non-diagnostic cCTA reads.

  13. Ethical issues for invasive cardiologists: Society for cardiovascular angiography and interventions.

    PubMed

    Cameron, Airlie A C; Laskey, Warren K; Sheldon, William C

    2004-02-01

    In view of the major impact of medical economic forces, rapidly changing technology, and other pressures on invasive cardiologists, the Society for Cardiovascular Angiography and Interventions determined that a statement of the ethical issues confronting the modern invasive cardiologist was needed. The various conflicts presented to the cardiologist in his or her roles as practicing clinician, administrator of the catheterization laboratory, educator, or clinical researcher were reviewed. In all instances, the major concern was determined to be the welfare of the patient no matter how forceful the pressures from various outside force or concerns for personal advancement might be.

  14. Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial.

    PubMed

    Napp, Adriane E; Haase, Robert; Laule, Michael; Schuetz, Georg M; Rief, Matthias; Dreger, Henryk; Feuchtner, Gudrun; Friedrich, Guy; Špaček, Miloslav; Suchánek, Vojtěch; Fuglsang Kofoed, Klaus; Engstroem, Thomas; Schroeder, Stephen; Drosch, Tanja; Gutberlet, Matthias; Woinke, Michael; Maurovich-Horvat, Pál; Merkely, Béla; Donnelly, Patrick; Ball, Peter; Dodd, Jonathan D; Quinn, Martin; Saba, Luca; Porcu, Maurizio; Francone, Marco; Mancone, Massimo; Erglis, Andrejs; Zvaigzne, Ligita; Jankauskas, Antanas; Sakalyte, Gintare; Harań, Tomasz; Ilnicka-Suckiel, Malgorzata; Bettencourt, Nuno; Gama-Ribeiro, Vasco; Condrea, Sebastian; Benedek, Imre; Čemerlić Adjić, Nada; Adjić, Oto; Rodriguez-Palomares, José; Garcia Del Blanco, Bruno; Roditi, Giles; Berry, Colin; Davis, Gershan; Thwaite, Erica; Knuuti, Juhani; Pietilä, Mikko; Kępka, Cezary; Kruk, Mariusz; Vidakovic, Radosav; Neskovic, Aleksandar N; Díez, Ignacio; Lecumberri, Iñigo; Geleijns, Jacob; Kubiak, Christine; Strenge-Hesse, Anke; Do, The-Hoang; Frömel, Felix; Gutiérrez-Ibarluzea, Iñaki; Benguria-Arrate, Gaizka; Keiding, Hans; Katzer, Christoph; Müller-Nordhorn, Jacqueline; Rieckmann, Nina; Walther, Mario; Schlattmann, Peter; Dewey, Marc

    2017-07-01

    More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266). In this trial, patients with a low-to-intermediate pretest probability (10-60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines. Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences. The DISCHARGE trial will assess the comparative effectiveness of CT and ICA. • Coronary artery disease (CAD) is a major cause of morbidity and mortality. • Invasive coronary angiography (ICA) is the reference standard for detection of CAD. • Noninvasive computed tomography angiography excludes CAD with high sensitivity. • CT may effectively reduce the approximately 2 million negative ICAs in Europe. • DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest probability for CAD.

  15. [Comparative assessment of ct-bypass angiography and invasive coronary angiography in patients after coronary bypass surgery in the late postoperative period].

    PubMed

    Men'kov, I A; Trufanov, G E; Zhelezniak, I S; Rud', S D; Kniazev, E A

    2013-10-01

    The aim of the study was to evaluate the diagnostic accuracy of ct-bypass angiography in the evaluation of significant stenosis and occlusion of grafts, recipient and nongrafted vessels in patients after coronary bypass surgery in the late postoperative period. Ct-bypass angiography was performed on 64-slice ct scanner with a slice thickness of 0.5 mm and a gantry rotation time of 0.4 s. All results were compared with quantitative invasive coronary angiography. 43 patients with 113 grafts were included in the study. Sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy for the evaluation of significant stenosis were 94%, 95%, 88%, 98%, 95%, respectively. Diagnostic accuracy for the evaluation of significant stenosis in the recipient and nongrafted vessels were 91% and 90%, respectively. The diagnostic accuracy for the evaluation graft occlusion, recipient and nongrafted vessels was 100%, 100% and 98%, respectively. Ct-bypass angiography allows accurate non-invasive assessment of significant stenosis and occlusion of coronary bypass grafts and native coronary arteries in patients after coronary bypass surgery in the late postoperative period.

  16. A comparison of radiation doses between state-of-the-art multislice CT coronary angiography with iterative reconstruction, multislice CT coronary angiography with standard filtered back-projection and invasive diagnostic coronary angiography.

    PubMed

    Gosling, O; Loader, R; Venables, P; Roobottom, C; Rowles, N; Bellenger, N; Morgan-Hughes, G

    2010-06-01

    To accurately compare the radiation dose between prospectively gated cardiac multidetector CT (with and without iterative reconstruction) and diagnostic invasive coronary angiography using the latest International Commission on Radiological Protection 103 (ICRP) tissue weightings. A retrospective analysis of consecutive patients presenting to a university teaching hospital for investigation of coronary artery disease. Radiation doses for each technique were calculated using computational Monte Carlo modelling of a standard Cristy phantom rather than the application of previously published conversion factors. While these have frequently been used in other studies, they are based on out-dated ICRP tissue weightings (ICRP 60) and are for the whole chest rather than for structures irradiated in cardiac imaging. In order to allow a comparison, doses were calculated and expressed in terms of effective dose in millisieverts (mSv). From a population presenting for angiography within a clinical service, the median radiation dose from cardiac CT with standard filtered back-projection (84 patients, 5.4 mSv) was comparable with the dose from invasive diagnostic coronary angiography (94 patients, 6.3 mSv). The dose for cardiac CT using iterative reconstruction was significantly lower (39 patients, 2.5 mSv). The median effective dose from cardiac CT with standard filtered back-projection was comparable with the effective dose from invasive coronary angiography, even with application of the most contemporary ICRP tissue weightings and use of cardiac specific volumes. Cardiac CT scanning incorporating iterative reconstruction resulted in a significant reduction in the effective dose.

  17. Stress testing and non-invasive coronary angiography in patients with suspected coronary artery disease: time for a new paradigm

    PubMed Central

    Arbab-Zadeh, Armin

    2012-01-01

    Diagnosis and management of coronary artery disease represents major challenges to our health care system, affecting millions of patients each year. Until recently, the diagnosis of coronary artery disease was possible only through cardiac catheterization and invasive coronary angiography. To avoid the risks of an invasive procedure, stress testing is often employed for an initial assessment of patients with suspected coronary artery disease, serving as a gatekeeper for cardiac catheterization. With the emergence of non-invasive coronary angiography, the question arises if such a strategy is still sensible, particularly, in view of only a modest agreement between stress testing results and the presence of coronary artery disease established by cardiac catheterization. Much data in support of the diagnostic accuracy and prognostic value of non-invasive coronary angiography by computed tomography have emerged within the last few years. These data challenge the role of stress testing as the initial imaging modality in patients with suspected coronary artery disease. This article reviews the clinical utility, limitations, as well as the hazards of stress testing compared with non-invasive coronary artery imaging by computed tomography. Finally, the implications of this review are discussed in relation to clinical practice. PMID:22690295

  18. Non-invasive evaluation of the cardiac function in golden retriever dogs by radionuclide angiography.

    PubMed

    Devaux, J Y; Cabane, L; Esler, M; Flaouters, H; Duboc, D

    1993-01-01

    Golden Retriever dogs manifest an X-linked, Duchenne-like, muscular dystrophy with a characteristic lack of dystrophin. Histologic findings have demonstrated the cardiac involvement in these dogs to be a model for the cardiac insufficiency in human Duchenne muscular dystrophy (DMD). The goal of this study was to assess the capability of radionuclide angiography (RNA) as an assessment tool to measure the ventricular dysfunction in these dogs. Three dogs, one normal and two with muscular dystrophy (MD), were studied by equilibrium gated blood pool. Red blood cells were labelled with 420 MBq of 99mTc. The three dogs lying on their left sides on the table, received no drugs and were not restrained in any manner. RNA left ejection fraction (EF) and echographic measurements of left ventricular fractional shortening (FS) were performed during the same session. EF values were 61%, 48%, 36% and FS values were 47%, 32%, 26%, respectively, for the control dog, the 6 month old MD dog and the 12 month old MD dog. This preliminary study demonstrates the potential usefulness of RNA for the non-invasive follow-up exams of specific therapy in a canine model of muscular dystrophy.

  19. Impact of Calcium Score on Agreement Between Multidetector Computed Tomography and Invasive Coronary Angiography.

    PubMed

    de Agustín, José Alberto; Gómez de Diego, José Juan; Marcos-Alberca, Pedro; Mahía, Patricia; Rodrigo, José Luis; Luaces, María; Núñez-Gil, Iván Javier; Ferreiros, Joaquín; Bustos, Ana; Cabeza, Beatriz; García-Fernández, Miguel Ángel; Macaya, Carlos; Pérez de Isla, Leopoldo

    2017-05-18

    Multidetector computed tomography (MDCT) has been demonstrated as a feasible alternative to invasive coronary angiography (ICA). However, contradictory results have been reported regarding the effect of coronary artery calcium score (CS) on the diagnostic accuracy of MDCT. Our aim was to assess the agreement of MDCT and ICA and to evaluate the influence of CS on this agreement. We enrolled 266 consecutive patients who underwent evaluation with 64-slice MDCT and ICA. Standard CS software tools were used to calculate the Agatston score. Stenosis was qualitatively classified as mild, moderate, or severe by 1 blinded observer and the results were compared with those of ICA, which was used as the gold standard. The mean age of the patients was 65.4 ± 11.2 years, and 188 patients (70.3%) were men. A total of 484 segments with coronary stenosis ≥ mild were qualitatively evaluated and quantified with MDCT. Noninvasive measurements were concordant with ICA in 402 stenoses (83.05%; Kappa, 0.684), with no significant differences between vessels and with no statistically significant influence of CS on this agreement (OR, 0.93; 95%CI, 0.76-1.09; P = .21). Multidetector computed tomography had high sensitivity, specificity, positive predictive value, and negative predictive value on a per-segment, per-vessel, and per-patient basis. Non-ICA using MDCT showed good agreement with ICA in the qualitative quantification coronary stenosis and CS had no significant impact on this agreement. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  20. Impact of computed tomography myocardial perfusion following computed tomography coronary angiography on downstream referral for invasive coronary angiography, revascularization and, outcome at 12 months.

    PubMed

    van Rosendael, Alexander R; Dimitriu-Leen, Aukelien C; de Graaf, Michiel A; van Zwet, Erik W; Jukema, J Wouter; Bax, Jeroen J; Kroft, Lucia J; Scholte, Arthur J

    2017-05-29

    The aim of this study was to assess the impact of adding stress computed tomography (CT) myocardial perfusion (CTP) to coronary CT angiography (CTA) on downstream referral for invasive coronary angiography (ICA), revascularization, and outcome in patients presenting with new-onset chest pain. Three hundred and eighty-four patients were referred for cardiac CT. Patients with lesions ≥50% stenosis underwent subsequently stress CTP. Perfusion scans were considered abnormal if a defect was observed in ≥ 1 segment. Downstream performance of ICA, revascularization, and the occurrence of major cardiovascular events (death, non-fatal myocardial infarction, and unstable angina requiring urgent revascularization) were assessed within 12 months. In total, 119 patients showed ≥50% stenosis on coronary CTA; stress CTP was normal in 61 patients, abnormal in 38 patients and was not performed in 20 patients. After normal stress CTP, 19 (31%) patients underwent ICA and 9 (15%) underwent revascularization. After abnormal stress CTP, 36 (95%) patients underwent ICA and 29 (76%) revascularizations were performed. Multivariable analyses showed a five-fold reduction in likelihood of proceeding to ICA when a normal stress CTP was added to a coronary CTA showing obstructive CAD. Major cardiovascular event rates at 12 months for patients with obstructive CAD and normal stress CTP (N = 61) were low: 1 myocardial infarction, 1 urgent revascularization, and 1 non-cardiac death. The performance of stress CTP in patients with obstructive CAD at coronary CTA in the same setting is feasible and reduces the referral rate for ICA and revascularization. Secondly, the occurrence of major cardiovascular events at 12 months follow-up in patients with normal stress CTP is low.

  1. Pre-operative CT coronary angiography in patients with mitral valve prolapse referred for surgical repair: comparison of accuracy, radiation dose and cost versus invasive coronary angiography.

    PubMed

    Pontone, Gianluca; Andreini, Daniele; Bertella, Erika; Cortinovis, Sarah; Mushtaq, Saima; Foti, Claudia; Annoni, Andrea; Formenti, Alberto; Baggiano, Andrea; Conte, Edoardo; Ballerini, Giovanni; Fiorentini, Cesare; Bartorelli, Antonio L; Pepi, Mauro

    2013-09-10

    The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT. Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost. The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99% and 93%, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B. The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  2. Minimally invasive autopsy employing post-mortem CT and targeted coronary angiography: evaluation of its application to a routine Coronial service.

    PubMed

    Roberts, Ian S D; Traill, Zoe C

    2014-01-01

    Post-mortem imaging is a potential alternative to traditional medicolegal autopsy. We investigate the reduction in number of invasive autopsies required by use of post-mortem CT ± coronary angiography. A total of 120 adult deaths referred to the Coroner were investigated by CT, with coronary angiography employed only for the second series of 60 cases, in order to determine the added value of angiography. The confidence of imaging cause of death was classified as definite (no autopsy), probable, possible or unascertained. Invasive autopsy was not required in 38% of cases without coronary angiography and 70% of cases with angiography. Full autopsy, including brain dissection, was required in only 9% of cases. There was complete agreement between autopsy and radiological causes of death in the cases with a 'probable' imaging cause of death, indicating that cases for which imaging provides an accurate cause of death without autopsy were identified correctly. In two patients, CT demonstrated unsuspected fractures, not detected at subsequent autopsy. A two-thirds reduction in the number of invasive coronial autopsies can be achieved by use of post-mortem CT plus coronary angiography. At the same time, use of post-mortem CT may improve accuracy of diagnosis, particularly for traumatic deaths. © 2013 John Wiley & Sons Ltd.

  3. High-resolution magnetic resonance coronary angiography of the entire heart using a new blood-pool agent, NC100150 injection: comparison with invasive x-ray angiography in pigs.

    PubMed

    Johansson, L O; Nolan, M M; Taniuchi, M; Fischer, S E; Wickline, S A; Lorenz, C H

    1999-01-01

    Recent developments of novel magnetic resonance intravascular contrast agents with low T1 in blood and a long intravascular half-life will rapidly position magnetic resonance coronary angiography (MRCA) at the threshold of clinical application. This article describes the use of one such intravascular contrast agent for noninvasive coronary angiography and comparison with routine invasive x-ray angiography. Six domestic farm pigs with an artificial stenoses at the left circumflex were studied. NC100150 Injection, a new ultra-small superparmagnetic iron oxide (Nycomed Amersham Imaging, Oslo, Norway), was injected using a dose of 5.0 mg Fe/kg body weight. Scanning was done using a 1.5-T Gyroscan ACS-NT. A high-resolution electrocardiogram-triggered scan covering the entire heart was applied. Navigator echoes were used for respiratory triggering. In all animals the location of the stenoses detected with MRCA correlated well with x-ray angiography. The correlation factor between the grade of stenoses determined by MRCA and x-ray angiography was 0.993. MRCA using NC100150 Injection can depict the major coronary arteries and branches well. Decreases in vessel caliber detected by MRCA correlate well with x-ray angiography. The use of such intravascular contrast agents show great promise for clinical applications for noninvasive detection of coronary artery disease in humans.

  4. Cost analysis of non-invasive fractional flow reserve derived from coronary computed tomographic angiography in Japan.

    PubMed

    Kimura, Takeshi; Shiomi, Hiroki; Kuribayashi, Sachio; Isshiki, Takaaki; Kanazawa, Susumu; Ito, Hiroshi; Ikeda, Shunya; Forrest, Ben; Zarins, Christopher K; Hlatky, Mark A; Norgaard, Bjarne L

    2015-01-01

    Percutaneous coronary intervention (PCI) based on fractional flow reserve (FFRcath) measurement during invasive coronary angiography (CAG) results in improved patient outcome and reduced healthcare costs. FFR can now be computed non-invasively from standard coronary CT angiography (cCTA) scans (FFRCT). The purpose of this study is to determine the potential impact of non-invasive FFRCT on costs and clinical outcomes of patients with suspected coronary artery disease in Japan. Clinical data from 254 patients in the HeartFlowNXT trial, costs of goods and services in Japan, and clinical outcome data from the literature were used to estimate the costs and outcomes of 4 clinical pathways: (1) CAG-visual guided PCI, (2) CAG-FFRcath guided PCI, (3) cCTA followed by CAG-visual guided PCI, (4) cCTA-FFRCT guided PCI. The CAG-visual strategy demonstrated the highest projected cost ($10,360) and highest projected 1-year death/myocardial infarction rate (2.4 %). An assumed price for FFRCT of US $2,000 produced equivalent clinical outcomes (death/MI rate: 1.9 %) and healthcare costs ($7,222) for the cCTA-FFRCT strategy and the CAG-FFRcath guided PCI strategy. Use of the cCTA-FFRCT strategy to select patients for PCI would result in 32 % lower costs and 19 % fewer cardiac events at 1 year compared to the most commonly used CAG-visual strategy. Use of cCTA-FFRCT to select patients for CAG and PCI may reduce costs and improve clinical outcome in patients with suspected coronary artery disease in Japan.

  5. Invasive coronary angiography in patients with acute exacerbated COPD and elevated plasma troponin

    PubMed Central

    Pizarro, Carmen; Herweg-Steffens, Neele; Buchenroth, Martin; Schulte, Wolfgang; Schaefer, Christian; Hammerstingl, Christoph; Werner, Nikos; Nickenig, Georg; Skowasch, Dirk

    2016-01-01

    Background In acute exacerbation of COPD, increased plasma levels of cardiac troponin are frequent and associated with increased mortality. Thus, we aimed at prospectively determining the diagnostic value of coronary angiography in patients with exacerbated COPD and concomitantly elevated cardiac troponin. Patients and methods A total of 88 patients (mean age 72.9±9.2 years, 56.8% male) hospitalized for acute exacerbation of COPD with elevated plasma troponin were included. All patients underwent coronary angiography within 72 hours after hospitalization. Complementary 12-lead electrocardiogram, transthoracic echocardiography, pulmonary function, and angiological testing were performed. Results Coronary angiography objectified the presence of ischemic heart disease (IHD) in 59 patients (67.0%), of whom 34 patients (38.6% of total study population) underwent percutaneous coronary intervention. Among these 34 intervened patients, the vast majority (n=26, 76.5%) had no previously known IHD, whereas only eight out of 34 patients (23.5%) presented an IHD history. Patients requiring coronary intervention showed significantly reduced left ventricular ejection fraction (45.8%±13.1% vs 55.1%±13.3%, P=0.01) and a significantly more frequent electrocardiographic ST-segment depression (20.6% vs 7.4%, P=0.01). Neither additional laboratory parameters for inflammation and myocardial injury nor lung functional measurements differed significantly between the groups. Conclusion Angiographically confirmed IHD that required revascularization occurred in 38.6% of exacerbated COPD patients with elevated cardiac troponin. In this considerable portion of patients, coronary angiography emerged to be of diagnostic and therapeutic value. PMID:27695304

  6. Performance of dual-source CT with high pitch spiral mode for coronary stent patency compared with invasive coronary angiography.

    PubMed

    Yang, Xia; Yu, Qiang; Dong, Wei; Fu, Zhen-Hong; Yang, Jun-Jue; Guo, Jun; Chen, Yun-Dai

    2016-10-01

    To investigate the performance of dual-source computed tomography (DSCT) using high-pitch spiral (HPS) mode for coronary stents patency. We conducted a prospective study on 120 patients with 260 previous stents implanted due to recurred suspicious symptoms of angina scheduled for invasive coronary angiography (ICA), while DSCT were conducted using HPS mode. There was no significant impact of age, body mass index or heat rate (HR) on image quality (P > 0.05), while HR variability had a slight impact on that (P < 0.05). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of DSCT in detection of in-stent restenosis (ISR) based per-patient were 92.3%, 96.7%, 88.9%, and 97.8%, respectively. And those based per-stent were 87%, 96.8%, 83.3%, and 97.7% with un-assessment stents, 97.4%, 99.5%, 97.4%, and 99.5% without un-assessment stents. There was significant difference on sensitivity, specificity, PPV and NPV between diameter ≥ 3.0 mm group (93.3%, 97.9%, 87.5%, and 98.9%) and diameter < 3.0 mm group (80%, 93.3%, 80.0%, and 93.3%) (P < 0.05), and that between stent number ≥ 3 group (82.3%, 77.8%, 66.7%, and 60%) with < 3 group (97.3%, 80%, 96.5%, and 75%). The effective dose of DSCT (1.4 ± 0.5 mSv) is significantly less than that by invasive coronary angiography [4.0 ± 0.8 mSv (P < 0.01)]. DSCT using HPS mode provides good diagnostic performance on stent patency with lower effective dose in patients with HR < 65 beats/min.

  7. Performance of dual-source CT with high pitch spiral mode for coronary stent patency compared with invasive coronary angiography

    PubMed Central

    Yang, Xia; Yu, Qiang; Dong, Wei; Fu, Zhen-Hong; Yang, Jun-Jue; Guo, Jun; Chen, Yun-Dai

    2016-01-01

    Objective To investigate the performance of dual-source computed tomography (DSCT) using high-pitch spiral (HPS) mode for coronary stents patency. Methods We conducted a prospective study on 120 patients with 260 previous stents implanted due to recurred suspicious symptoms of angina scheduled for invasive coronary angiography (ICA), while DSCT were conducted using HPS mode. Results There was no significant impact of age, body mass index or heat rate (HR) on image quality (P > 0.05), while HR variability had a slight impact on that (P < 0.05). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of DSCT in detection of in-stent restenosis (ISR) based per-patient were 92.3%, 96.7%, 88.9%, and 97.8%, respectively. And those based per-stent were 87%, 96.8%, 83.3%, and 97.7% with un-assessment stents, 97.4%, 99.5%, 97.4%, and 99.5% without un-assessment stents. There was significant difference on sensitivity, specificity, PPV and NPV between diameter ≥ 3.0 mm group (93.3%, 97.9%, 87.5%, and 98.9%) and diameter < 3.0 mm group (80%, 93.3%, 80.0%, and 93.3%) (P < 0.05), and that between stent number ≥ 3 group (82.3%, 77.8%, 66.7%, and 60%) with < 3 group (97.3%, 80%, 96.5%, and 75%). The effective dose of DSCT (1.4 ± 0.5 mSv) is significantly less than that by invasive coronary angiography [4.0 ± 0.8 mSv (P < 0.01)]. Conclusion DSCT using HPS mode provides good diagnostic performance on stent patency with lower effective dose in patients with HR < 65 beats/min. PMID:27928222

  8. Non-invasive prediction of hemodynamically significant coronary artery stenoses by contrast density difference in coronary CT angiography.

    PubMed

    Hell, Michaela M; Dey, Damini; Marwan, Mohamed; Achenbach, Stephan; Schmid, Jasmin; Schuhbaeck, Annika

    2015-08-01

    Coronary computed tomography angiography (CTA) allows the detection of obstructive coronary artery disease. However, its ability to predict the hemodynamic significance of stenoses is limited. We assessed differences in plaque characteristics and contrast density difference between hemodynamically significant and non-significant stenoses, as defined by invasive fractional flow reserve (FFR). Lesion characteristics of 59 consecutive patients (72 lesions) in whom invasive FFR was performed in at least one coronary artery with moderate to high-grade stenoses in coronary CTA were evaluated by two experienced readers. Coronary CTA data sets were acquired on a second-generation dual-source CT scanner using retrospectively ECG-gated spiral acquisition or prospectively ECG-triggered axial acquisition mode. Plaque volume and composition (non-calcified, calcified), remodeling index as well as contrast density difference (defined as the percentage decline in luminal CT attenuation/cross-sectional area over the lesion) were assessed using a semi-automatic software tool (Autoplaq). Additionally, the transluminal attenuation gradient (defined as the linear regression coefficient between intraluminal CT attenuation and length from the ostium) was determined. Differences in lesion characteristics between hemodynamically significant (invasively measured FFR ≤0.80) and non-significant lesions (FFR >0.80) were determined. Mean patient age was 64±11 years with 44 males (75%). 21 out of 72 coronary artery lesions (29%) were hemodynamically significant according to invasive FFR. Mean invasive FFR was 0.66±0.12 vs. 0.91±0.05 for hemodynamically significant versus non-significant lesions. Hemodynamically significant lesions showed a significantly greater percentage of non-calcified plaque compared to non-hemodynamically relevant lesions (51.3±15.3% vs. 43.6±16.5%, p=0.021). Contrast density difference was significantly increased in hemodynamically relevant lesions (26.0±20.2% vs

  9. High resolution computed tomography angiography improves the radiographic diagnosis of invasive mold disease in patients with hematological malignancies.

    PubMed

    Stanzani, Marta; Sassi, Claudia; Lewis, Russell E; Tolomelli, Giulia; Bazzocchi, Alberto; Cavo, Michele; Vianelli, Nicola; Battista, Giuseppe

    2015-06-01

    Computed tomography pulmonary angiography (CTPA) may improve the diagnostic capabilities of CT imaging for invasive mold disease, but its performance relative to other signs (ie, halo sign, hypodense sign, pleural effusion, reversed halo sign) is unknown. We prospectively compared the diagnostic performance of CTPA vs other CT imaging findings in 100 patients with hematological malignancies and possible invasive mold disease defined by EORTC/MSG criteria. After undergoing extensive diagnostic work-up, patients were upgraded to probable or proven mold disease based on galactomannan antigen, culture or histology; or remained as possible mold disease if an alternative diagnosis could not be established. In total, 46 /100 patients who underwent CTPA were upgraded to probable or proven mold disease. Excluding 8 CTPA cases that were nonevaluable by the radiologist, a positive occlusion sign identified by CTPA was 100% sensitive for the diagnosis of probable or proven mold disease (41/41). Among patients who could not be upgraded from the possible mold disease category (n = 51), 25 (49%) had evidence of vessel occlusion by CTPA with only one positive patient eventually reaching an alternative diagnosis (Staphylococcus aureus septic thrombosis). Intravenous and/or oral antifungal therapy was stopped earlier in patients with a negative vs positive CTPA results (P ≤ .001). Vessel occlusion detected by CTPA is a more sensitive and possibly more specific radiographic sign vs other common CT findings of invasive mold disease in patients with hematological malignancies. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  10. Novel Non-invasive Estimation of Coronary Blood Flow using Contrast Advection in Computed Tomography Angiography

    NASA Astrophysics Data System (ADS)

    Eslami, Parastou; Seo, Jung-Hee; Rahsepar, Amirali; George, Richard; Lardo, Albert; Mittal, Rajat

    2014-11-01

    Coronary computed tomography angiography (CTA) is a promising tool for assessment of coronary stenosis and plaque burden. Recent studies have shown the presence of axial contrast concentration gradients in obstructed arteries, but the mechanism responsible for this phenomenon is not well understood. We use computational fluid dynamics to study intracoronary contrast dispersion and the correlation of concentration gradients with intracoronary blood flow and stenotic severity. Data from our CFD patient-specific simulations reveals that contrast dispersions are generated by intracoronary advection effects, and therefore, encode the coronary flow velocity. This novel method- Transluminal Attenuation Flow Encoding (TAFE) - is used to estimate the flowrate in phantom studies as well as preclinical experiments. Our results indicate a strong correlation between the values estimated from TAFE and the values measured in these experiments. The flow physics of contrast dispersion associated with TAFE will be discussed. This work is funded by grants from Coulter Foundation and Maryland Innovation Initiative. The authors have pending patents in this technology and RM and ACL have other financial interests associated with TAFE.

  11. Aortic valve stenosis: non-invasive preoperative evaluation using 64-slice CT angiography.

    PubMed

    Ciolina, F; Sedati, P; Zaccagna, F; Galea, N; Noce, V; Miraldi, F; Cavarretta, E; Francone, M; Carbone, I

    2015-10-01

    In patients affected by aortic valve stenosis (AS) it is mandatory to rule out coronary artery disease (CAD). The role of retrospectively ECG-gated 64-slice CT angiography (64-SCTA) was assessed in patients with AS referred for surgical valve replacement. Forty-two patients with AS underwent ECG-gated 64-SCTA of thoracic aorta, including the heart and coronary arteries, before surgical valve replacement. Images were evaluated by two independent readers and compared with surgical findings in terms of aortic valve calcification grading, valvular morphology, aortic valve annulus and sino-tubular junction diameters, and valvular area planimetry. Quantitative evaluation of cusps opening was also performed. Finally, the presence of CAD, thoracic aortic aneurysm and left ventricle hypertrophy were assessed. Visualization of the aortic valve without motion artefacts was possible in 38 patients (90.5%). Valvular morphology was correctly assessed in all cases (100%). 64-SCTA correctly determined aortic valve calcification grading and the aortic valve annulus and sinotubular junction diameters in 100% of cases. The aortic valve planimetric area was assessed in 38 cases (90.5%). Ascending aortic aneurysms requiring surgical replacement were detected in 12 patients (28.6%). Significant left ventricle hypertrophy was found in 30 patients (71%). Preoperative evaluation of patients undergoing surgical replacement for AS with 64-SCTA is feasible. 64-SCTA can rule out CAD and evaluate the status of the aortic valve and thoracic aorta in the same examination, obtaining relevant information for surgical planning.

  12. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial.

    PubMed

    Dewey, Marc; Rief, Matthias; Martus, Peter; Kendziora, Benjamin; Feger, Sarah; Dreger, Henryk; Priem, Sascha; Knebel, Fabian; Böhm, Marko; Schlattmann, Peter; Hamm, Bernd; Schönenberger, Eva; Laule, Michael; Zimmermann, Elke

    2016-10-24

     To evaluate whether invasive coronary angiography or computed tomography (CT) should be performed in patients clinically referred for coronary angiography with an intermediate probability of coronary artery disease.  Prospective randomised single centre trial.  University hospital in Germany.  340 patients with suspected coronary artery disease and a clinical indication for coronary angiography on the basis of atypical angina or chest pain.  168 patients were randomised to CT and 172 to coronary angiography. After randomisation one patient declined CT and 10 patients declined coronary angiography, leaving 167 patients (88 women) and 162 patients (78 women) for analysis. Allocation could not be blinded, but blinded independent investigators assessed outcomes.  The primary outcome measure was major procedural complications within 48 hours of the last procedure related to CT or angiography.  Cardiac CT reduced the need for coronary angiography from 100% to 14% (95% confidence interval 9% to 20%, P<0.001) and was associated with a significantly greater diagnostic yield from coronary angiography: 75% (53% to 90%) v 15% (10% to 22%), P<0.001. Major procedural complications were uncommon (0.3%) and similar across groups. Minor procedural complications were less common in the CT group than in the coronary angiography group: 3.6% (1% to 8%) v 10.5% (6% to 16%), P=0.014. CT shortened the median length of stay in the angiography group from 52.9 hours (interquartile range 49.5-76.4 hours) to 30.0 hours (3.5-77.3 hours, P<0.001). Overall median exposure to radiation was similar between the CT and angiography groups: 5.0 mSv (interquartile range 4.2-8.7 mSv) v 6.4 mSv (3.4-10.7 mSv), P=0.45. After a median follow-up of 3.3 years, major adverse cardiovascular events had occurred in seven of 167 patients in the CT group (4.2%) and six of 162 (3.7%) in the coronary angiography group (adjusted hazard ratio 0.90, 95% confidence interval 0.30 to 2.69, P=0.86). 79% of patients

  13. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial

    PubMed Central

    Rief, Matthias; Martus, Peter; Kendziora, Benjamin; Feger, Sarah; Dreger, Henryk; Priem, Sascha; Knebel, Fabian; Böhm, Marko; Schlattmann, Peter; Hamm, Bernd; Schönenberger, Eva; Laule, Michael; Zimmermann, Elke

    2016-01-01

    Objective To evaluate whether invasive coronary angiography or computed tomography (CT) should be performed in patients clinically referred for coronary angiography with an intermediate probability of coronary artery disease. Design Prospective randomised single centre trial. Setting University hospital in Germany. Participants 340 patients with suspected coronary artery disease and a clinical indication for coronary angiography on the basis of atypical angina or chest pain. Interventions 168 patients were randomised to CT and 172 to coronary angiography. After randomisation one patient declined CT and 10 patients declined coronary angiography, leaving 167 patients (88 women) and 162 patients (78 women) for analysis. Allocation could not be blinded, but blinded independent investigators assessed outcomes. Main outcome measure The primary outcome measure was major procedural complications within 48 hours of the last procedure related to CT or angiography. Results Cardiac CT reduced the need for coronary angiography from 100% to 14% (95% confidence interval 9% to 20%, P<0.001) and was associated with a significantly greater diagnostic yield from coronary angiography: 75% (53% to 90%) v 15% (10% to 22%), P<0.001. Major procedural complications were uncommon (0.3%) and similar across groups. Minor procedural complications were less common in the CT group than in the coronary angiography group: 3.6% (1% to 8%) v 10.5% (6% to 16%), P=0.014. CT shortened the median length of stay in the angiography group from 52.9 hours (interquartile range 49.5-76.4 hours) to 30.0 hours (3.5-77.3 hours, P<0.001). Overall median exposure to radiation was similar between the CT and angiography groups: 5.0 mSv (interquartile range 4.2-8.7 mSv) v 6.4 mSv (3.4-10.7 mSv), P=0.45. After a median follow-up of 3.3 years, major adverse cardiovascular events had occurred in seven of 167 patients in the CT group (4.2%) and six of 162 (3.7%) in the coronary angiography group (adjusted hazard

  14. Congenital coronary artery anomalies silent until geriatric age: non-invasive assessment, angiography tips, and treatment

    PubMed Central

    Rigatelli, Gianluca; Dell'Avvocata, Fabio; Van Tan, Nguyen; Daggubati, Rames; Nanijundappa, Aravinda

    2015-01-01

    Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischemia. The cardiovascular professional may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment. A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional significance is mandatory for deciding how to manage CAAs: non-invasive stress tests and in particular the invasive pharmacological stress tests with or without intravascular ultrasound monitoring can assess correctly the functional significance of the most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels. A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities. PMID:25678906

  15. Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter Study.

    PubMed

    Chen, Marcus Y; Rochitte, Carlos E; Arbab-Zadeh, Armin; Dewey, Marc; George, Richard T; Miller, Julie M; Niinuma, Hiroyuki; Yoshioka, Kunihiro; Kitagawa, Kakuya; Sakuma, Hajime; Laham, Roger; Vavere, Andrea L; Cerci, Rodrigo J; Mehra, Vishal C; Nomura, Cesar; Kofoed, Klaus F; Jinzaki, Masahiro; Kuribayashi, Sachio; Scholte, Arthur J; Laule, Michael; Tan, Swee Yaw; Hoe, John; Paul, Narinder; Rybicki, Frank J; Brinker, Jeffrey A; Arai, Andrew E; Matheson, Matthew B; Cox, Christopher; Clouse, Melvin E; Di Carli, Marcelo F; Lima, João A C

    2017-07-01

    Purpose To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. Materials and Methods This study was approved by all institutional review boards, and written informed consent was obtained. Between November 2009 and July 2011, 381 participants clinically referred for ICA and aged 45-85 years were enrolled in the Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) prospective multicenter diagnostic study. All images were analyzed in blinded independent core laboratories, and a panel of physicians adjudicated all adverse events. MACE was defined as revascularization (>30 days after index ICA), myocardial infarction, or cardiac death; hospitalization for chest pain or congestive heart failure; or arrhythmia. Late MACE was defined similarly, except for patients who underwent revascularization within the first 182 days after ICA, who were excluded. Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier curves and restricted mean survival times bootstrapped with 2000 replicates. Results An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P < .001 for both). Event-free rates for CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not

  16. Automated quantitative Rb-82 3D PET/CT myocardial perfusion imaging: normal limits and correlation with invasive coronary angiography.

    PubMed

    Nakazato, Ryo; Berman, Daniel S; Dey, Damini; Le Meunier, Ludovic; Hayes, Sean W; Fermin, Jimmy S; Cheng, Victor Y; Thomson, Louise E J; Friedman, John D; Germano, Guido; Slomka, Piotr J

    2012-04-01

    We aimed to characterize normal limits and to determine the diagnostic accuracy for an automated quantification of 3D 82-Rubidium (Rb-82) PET/CT myocardial perfusion imaging (MPI). We studied 125 consecutive patients undergoing Rb-82 PET/CT MPI, including patients with suspected coronary artery disease (CAD) and invasive coronary angiography, and 42 patients with a low likelihood (LLk) of CAD. Normal limits for perfusion and function were derived from LLk patients. QPET software was used to quantify perfusion abnormality at rest and stress expressed as total perfusion deficit (TPD). Relative perfusion databases did not differ in any of the 17 segments between males and females. The areas under the receiver operating characteristic curve for detection of CAD were 0.86 for identification of ≥50% and ≥70% stenosis. The sensitivity/specificity was 86%/86% for detecting ≥50% stenosis and 93%/77% for ≥70% stenosis, respectively. In regard to normal limits, mean rest and stress left ventricular ejection fraction (LVEF) were 67% ± 10% and 75% ± 9%, respectively. Mean transient ischemic dilation ratio was 1.06 ± 0.14 and mean increase in LVEF with stress was 7.4% ± 6.1% (95th percentile of 0%). Normal limits have been established for 3D Rb-82 PET/CT analysis with QPET software. Fully automated quantification of myocardial perfusion PET data shows high diagnostic accuracy for detecting obstructive CAD.

  17. Minimally Invasive Coronary Angiography with Monochromatic X-Rays Developmental Studies Utilizing Synchrotron Radiation.

    NASA Astrophysics Data System (ADS)

    Otis, John Noel

    Iodine-containing compounds are used as contrast agents in obtaining X-ray images of blood vessels for medical diagnosis. If the X-ray contrast produced by iodine can be enhanced sufficiently relative to that produced by the intervening body tissues, it becomes possible to obtain images of arteries by introducing the contrast agent into the venous circulation rather than through an arterial catheter directly into the vessel under examination. This prospect is attractive because invasion of the arterial system is the chief cause of the medical complications that are encountered in the application of current angiographic procedures. An imaging system that shows promise of accomplishing this goal for examination of the coronary arteries has been developed for operation in an X-ray beam at the Stanford Synchrotron Radiation Laboratory. Iodine-selective contrast enhancement is achieved by logarithmic subtraction of two images of the same field. One of these images is formed by monochromatic X-rays of energy just above the characteristic iodine K-absorption edge at 33.17 keV, the other by X-rays of energy just below the edge. The computer-controlled imaging system acquires digitized images line by line while scanning the subject through a stationary X-ray beam of linear profile. At present, only synchrotron radiation can provide monochromatic X-ray beams of intensity sufficient to image the small and rapidly moving coronary arteries. Preliminary studies of static phantoms and in vivo studies of dogs establish the feasibility of using synchrotron radiation as the X-ray source for iodine-selective imaging with sensitivity and speed adequate for providing sharp images of coronary arteries after intravenous introduction of contrast agent. Application of the method to human subjects began with imaging studies of three patients in May, 1986.

  18. Cerebral angiography

    MedlinePlus

    ... Carotid angiogram; Cervicocerebral catheter-based angiography; Intra-arterial digital subtraction angiography; IADSA ... with the dye are seen. This is called digital subtraction angiography (DSA). After the x-rays are ...

  19. Image quality, radiation dose, and diagnostic accuracy of prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp in a clinical setting: comparison with invasive coronary angiography.

    PubMed

    Zhang, Long Jiang; Wang, Yining; Schoepf, U Joseph; Meinel, Felix G; Bayer, Richard R; Qi, Li; Cao, Jian; Zhou, Chang Sheng; Zhao, Yan E; Li, Xie; Gong, Jian Bin; Jin, Zhengyu; Lu, Guang Ming

    2016-03-01

    To investigate image quality, radiation dose, and diagnostic performance of prospectively ECG-triggered high-pitch coronary CT angiography (CCTA) at 70 kVp compared to invasive coronary angiography (ICA) as reference standard. Forty-three patients underwent prospectively ECG-triggered high-pitch CCTA at 70 kVp using 30 cc (11 g iodine) contrast medium and ICA. Subjective and objective image quality was evaluated for each CCTA study. CCTA performance for diagnosing ≥50% stenosis was assessed. Results were stratified according to heart rate (HR), body mass index (BMI), Agatston score, and image quality. At CCTA, 94.3% (500/530) of coronary segments were of diagnostic quality. Using ICA as reference standard, sensitivity and accuracy were 100% and 93.0% on a per-patient basis. Per-vessel and per-segment performances were 92.2% and 89.5%; 79.5% and 88.3%, respectively. No differences were found in diagnostic accuracy between different HR, BMI, and calcification subgroups (all P > 0.05) on a per-patient basis. However, low image quality reduced diagnostic accuracy on a per-patient, per-vessel and per-segment basis (all P < 0.05). The mean effective radiation dose was 0.2 ± 0.0 mSv. Our presented protocol results in an effective radiation dose of 0.2 mSv and high diagnostic accuracy for stenosis detection in a selected, non-obese population. Prospectively ECG-triggered high-pitch CCTA at 70 kVp is feasible. This protocol has a high diagnostic accuracy for stenosis detection. The mean effective radiation dose was 0.2 ± 0.0 mSv. Only 30 cc of contrast material is used in this protocol. Low image quality reduced diagnostic accuracy of CCTA.

  20. Diagnostic Performance of Coronary CT Angiography, Stress Dual-Energy CT Perfusion, and Stress Perfusion Single-Photon Emission Computed Tomography for Coronary Artery Disease: Comparison with Combined Invasive Coronary Angiography and Stress Perfusion Cardiac MRI

    PubMed Central

    Chung, Hyun Woo; Hwang, Hweung Kon; So, Young; Yi, Jeong Geun; Lee, Eun Jeong

    2017-01-01

    Objective To investigate the diagnostic performance of coronary computed tomography angiography (CCTA), stress dual-energy computed tomography perfusion (DE-CTP), stress perfusion single-photon emission computed tomography (SPECT), and the combinations of CCTA with myocardial perfusion imaging (CCTA + DE-CTP and CCTA + SPECT) for identifying coronary artery stenosis that causes myocardial hypoperfusion. Combined invasive coronary angiography (ICA) and stress perfusion cardiac magnetic resonance (SP-CMR) imaging are used as the reference standard. Materials and Methods We retrospectively reviewed the records of 25 patients with suspected coronary artery disease, who underwent CCTA, DE-CTP, SPECT, SP-CMR, and ICA. The reference standard was defined as ≥ 50% stenosis by ICA, with a corresponding myocardial hypoperfusion on SP-CMR. Results For per-vascular territory analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 96, 96, 68, 93, and 68%, respectively, and specificities were 72, 75, 89, 85, and 94%, respectively. The areas under the receiver operating characteristic curve (AUCs) were 0.84 ± 0.05, 0.85 ± 0.05, 0.79 ± 0.06, 0.89 ± 0.04, and 0.81 ± 0.06, respectively. For per-patient analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 100, 100, 89, 100, and 83%, respectively; the specificities were 14, 43, 57, 43, and 57%, respectively; and the AUCs were 0.57 ± 0.13, 0.71 ± 0.11, 0.73 ± 0.11, 0.71 ± 0.11, and 0.70 ± 0.11, respectively. Conclusion The combination of CCTA and DE-CTP enhances specificity without a loss of sensitivity for detecting hemodynamically significant coronary artery stenosis, as defined by combined ICA and SP-CMR. PMID:28458600

  1. Diagnostic Performance of Coronary CT Angiography, Stress Dual-Energy CT Perfusion, and Stress Perfusion Single-Photon Emission Computed Tomography for Coronary Artery Disease: Comparison with Combined Invasive Coronary Angiography and Stress Perfusion Cardiac MRI.

    PubMed

    Chung, Hyun Woo; Ko, Sung Min; Hwang, Hweung Kon; So, Young; Yi, Jeong Geun; Lee, Eun Jeong

    2017-01-01

    To investigate the diagnostic performance of coronary computed tomography angiography (CCTA), stress dual-energy computed tomography perfusion (DE-CTP), stress perfusion single-photon emission computed tomography (SPECT), and the combinations of CCTA with myocardial perfusion imaging (CCTA + DE-CTP and CCTA + SPECT) for identifying coronary artery stenosis that causes myocardial hypoperfusion. Combined invasive coronary angiography (ICA) and stress perfusion cardiac magnetic resonance (SP-CMR) imaging are used as the reference standard. We retrospectively reviewed the records of 25 patients with suspected coronary artery disease, who underwent CCTA, DE-CTP, SPECT, SP-CMR, and ICA. The reference standard was defined as ≥ 50% stenosis by ICA, with a corresponding myocardial hypoperfusion on SP-CMR. For per-vascular territory analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 96, 96, 68, 93, and 68%, respectively, and specificities were 72, 75, 89, 85, and 94%, respectively. The areas under the receiver operating characteristic curve (AUCs) were 0.84 ± 0.05, 0.85 ± 0.05, 0.79 ± 0.06, 0.89 ± 0.04, and 0.81 ± 0.06, respectively. For per-patient analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 100, 100, 89, 100, and 83%, respectively; the specificities were 14, 43, 57, 43, and 57%, respectively; and the AUCs were 0.57 ± 0.13, 0.71 ± 0.11, 0.73 ± 0.11, 0.71 ± 0.11, and 0.70 ± 0.11, respectively. The combination of CCTA and DE-CTP enhances specificity without a loss of sensitivity for detecting hemodynamically significant coronary artery stenosis, as defined by combined ICA and SP-CMR.

  2. Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?

    PubMed

    Tanis, Wilco; Suchá, Dominika; Laufer, Ward; Habets, Jesse; van Herwerden, Lex A; Symersky, Petr; Chamuleau, Steven; Budde, Ricardo P J

    2015-06-01

    Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG). PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test. Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two. MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD. • Retrospective MDCT is increasingly used for prosthetic heart valve dysfunction assessment • In case of PHV reoperation, invasive coronary angiography is also required • MDCT can replace CAG in 50 % of patients without coronary artery disease • When conclusive for coronary assessment, MDCT stenosis rule out is highly accurate • Replacing CAG saves associated risks of distant embolization of thrombi or vegetations.

  3. A myocardial perfusion imaging system using a multifocal collimator for detecting coronary artery disease: validation with invasive coronary angiography.

    PubMed

    Ogino, Yutaka; Horiguchi, Yoriko; Ueda, Tomohiro; Shiomori, Tomofumi; Kanna, Masahiko; Kawaminami, Tomoko; Iinuma, Naoki; Sudo, Yuta; Morita, Yukiko

    2015-05-01

    Myocardial perfusion imaging (MPI) systems using a multifocal collimator can reduce scan time substantially compared with conventional MPI systems. In this study, we evaluated the diagnostic accuracy of multifocal collimator SPECT/CT in coronary artery disease (CAD) detection by comparing it with coronary artery angiography (CAG). We retrospectively analyzed 50 consecutive patients who had undergone CAG and stress (201)Tl MPI multifocal collimator SPECT/CT within a 3-month period. A summed difference score (SDS) was calculated for each vascular territory from the MPI images. On CAG, a stenotic coronary artery was defined as one with luminal narrowing of ≥75 % with quantitative coronary angiography software. We analyzed the diagnostic accuracy of coronary artery stenosis detection using the definition that a coronary artery territory was ischemic when the SDS per vessel was ≥2. We generated receiver operating characteristic (ROC) curves to evaluate the usefulness of SDS per vascular territory to find coronary artery stenoses. The area under the ROC curve was 0.86 and cut-off value was 2. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy to detect stenoses were 85, 83, 66, 94 and 84 %, respectively. We confirmed the high accuracy of imaging with multifocal collimator SPECT/CT for detection of angiographically significant CAD.

  4. Duret hemorrhage: demonstration of ruptured paramedian pontine branches of the basilar artery on minimally invasive, whole body postmortem CT angiography.

    PubMed

    Chew, Ka Lip; Baber, Yeliena; Iles, Linda; O'Donnell, Christopher

    2012-12-01

    A 25 year old male died suddenly and unexpectedly. Postmortem CT scanning revealed marked raised intracranial pressure with brainstem compression due to subarachnoid, subdural and parenchymal hemorrhage. A hyperdense mass at the termination of the right internal carotid artery was thought to represent an aneurysm. Postmortem, whole body CT angiography failed to fill the aneurysm but did demonstrate multiple central pontine linear enhancing structures in continuity with the mid basilar artery and small foci of contrast leak into the adjacent mid pontine parenchyma. Autopsy confirmed subarachnoid hemorrhage, a thrombosed and ruptured proximal right middle cerebral artery aneurysm and Duret hemorrhages in the mid pons. This finding supports the theory that Duret hemorrhages occur as a result of perforating pontine branch of the basilar arterial rupture but does not exclude the contribution of venous congestion.

  5. A non-invasive cardiac output measurement as an alternative to the test bolus technique during CT angiography.

    PubMed

    Nijhof, W H; Hilbink, M; Jager, G J; Slump, C H; Rutten, M J C M

    2016-09-01

    To investigate the association between a non-invasive cardiac output (CO) measurement and the scan delay, as derived from a test bolus injection protocol. The secondary objective was to determine which factors affect the relationship between the CO and scan delay. Fifty-five patients referred for a contrast-enhanced (thorax-)abdomen CT examination were included in this feasibility study. A test bolus examination was performed prior to the abdominal CT. During the test bolus injection, the CO of the patient was measured using a non-invasive finger-cuff measurement. Associations were analysed using linear regression analyses. Age, gender, height, weight, and blood pressure were included as potential confounders. Linear regression analysis showed a negative and significant association between CO and delay. The regression formula was as follows: scan delay (seconds) = 26.8-1.6 CO (l/min), with a 95% CI between -2.3 and -1.0 (p<0.001). Weight appeared to be a confounder in this relation, and gender and blood pressure were effect modifiers. There was no interaction between scan delay and age, height and weight. There is a negative and significant association between the non-invasive CO measurement and the CT scan delay; however, to validate these findings a larger cohort study is needed to investigate whether the non-invasively determined scan delay is as accurate as the use of a test bolus. Copyright © 2016. Published by Elsevier Ltd.

  6. Reducing radiation exposure during invasive coronary angiography and percutaneous coronary interventions implementing a simple four-step protocol.

    PubMed

    Seiffert, Moritz; Ojeda, Francisco; Müllerleile, Kai; Zengin, Elvin; Sinning, Christoph; Waldeyer, Christoph; Lubos, Edith; Schäfer, Ulrich; Sydow, Karsten; Blankenberg, Stefan; Westermann, Dirk

    2015-06-01

    With an increasing number of complex and repeated percutaneous coronary interventions (PCI), radiation-induced hazards for patients and operators remain an important issue in fluoroscopy-guided procedures. Our objective was to evaluate radiation exposure during coronary angiographic procedures and assess the efficacy of a four-step program to reduce radiation exposure during coronary angiography (CAG) and PCI. A retrospective single-center analysis was performed in patients undergoing CAG or PCI in the first 6 months of 2012 vs. the first 6 months of 2014 (n = 3,107 procedures). During 2013, a four-step protocol was established in our hospital. It contained measures to reduce radiation exposure, including a frame rate reduction from 15 to 7.5 frames per second, the use of fluoroscopy storage, strict use of beam collimation, and repeat training on radiation safety. After adjustment for confounding variables, a dose-area product (DAP) reduction of 54.2% was observed subsequent to implementation of the four-step protocol. Independent predictors of DAP were age [odds ratio (OR) 1.01], body surface area (OR 5.47), prior coronary artery bypass grafting (OR 1.44), radial access (OR 1.16), PCI (OR 2.36), female gender (OR 0.91), and the implementation of the four-step program (OR 0.46). A simple four-step protocol led to a significant reduction in radiation exposure in diagnostic and interventional coronary procedures without significant drawbacks in image quality. Hence, radiation safety programs are of paramount importance and should be established to improve patient and operator safety with regard to radiation-induced hazards.

  7. Non-invasive diagnostic workup of patients with suspected stable angina by combined computed tomography coronary angiography and magnetic resonance perfusion imaging.

    PubMed

    Kirschbaum, Sharon W; Nieman, Koen; Springeling, Tirza; Weustink, Annick C; Ramcharitar, Steve; Mieghem, Carlos van; Rossi, Alexia; Duckers, Eric; Serruys, Patrick W; Boersma, Eric; de Feyter, Pim J; van Geuns, Robert-Jan M

    2011-01-01

    To evaluate additional adenosine magnetic resonance perfusion (MRP) imaging in the diagnostic workup of patients with suspected stable angina with computed tomography coronary angiography (CTCA) as first-line diagnostic modality. Two hundred and thirty symptomatic patients (male, 52%; age, 56 year) with suspected stable angina underwent CTCA. In patients with a stenosis of >50% as visually assessed, MRP was performed and the quantitative myocardial perfusion reserve index (MPRI) was calculated. Coronary flow reserve (CFR) using invasive coronary flow measurements served as the standard of reference. CTCA showed non-significant CAD in 151/230 (66%) patients and significant CAD in 79/230 patients (34%), of whom 50 subsequently underwent MRP and CFR. MRP showed reduced perfusion in 32 patients (64%), which was confirmed by CFR in 27 (84%). All 18 cases of normal MRP (36%) were confirmed by CFR. The positive likelihood ratio of MRP for the presence of functional significant disease in patients with a lesion on CTCA was 4.49 (95% confidence interval [CI] 2.12-9.99). The negative likelihood ratio was 0.05 (95%CI 0.01-0.34). CTCA as first-line diagnostic modality excluded coronary artery disease in a high percentage of patients referred for diagnostic workup of suspected stable angina. MRP made a significant contribution to the detection of functional significant lesions in patients with a positive CTCA.

  8. Catheter Angiography

    MedlinePlus

    ... medical conditions. Angiography uses one of three imaging technologies and, in most cases, a contrast material injection ... the extent and severity of the effects of coronary artery disease and plan for a surgical operation, such as ...

  9. Pulmonary angiography

    MedlinePlus

    ... Pulmonary arteriography; Pulmonary angiogram; Angiogram of the lungs Images Pulmonary arteries References Jackson JE, Meaney JFM. Angiography. ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

  10. Stress thallium-201/rest technetium-99m sequential dual-isotope high-speed myocardial perfusion imaging validation versus invasive coronary angiography.

    PubMed

    Barone-Rochette, Gilles; Leclere, Mélanie; Calizzano, Alex; Vautrin, Estelle; Céline, Gallazzini-Crepin; Broisat, Alexis; Ghezzi, Catherine; Baguet, Jean Philippe; Machecourt, Jacques; Vanzetto, Gérald; Fagret, Daniel

    2015-06-01

    Recent advances in nuclear myocardial perfusion imaging (MPI) have made it possible to develop a dual-isotope protocol for high-speed acquisition with image quality and radiation delivery comparable to that obtained with conventional single isotope protocols. So far, no study has compared dual-isotope high-speed MPI to invasive coronary angiography (ICA) in a large cohort using a Cadmium-zinc-telluride SPECT system. Over a 1-year period (May 2011 to April 2012), 1366 patients underwent dual-isotope high-speed MPI. Patients with ICA within 3 months after dual-isotope high-speed MPI were included together with patients with a low likelihood of coronary artery disease (CAD) in order to assess normalcy rate. Global summed stress score (SSS) and summed rest score (SRS) were calculated, and ICA results were analyzed independently. The main end point was a patient-based assessment of the diagnostic performance of dual-isotope high-speed MPI in detecting or ruling out significant CAD (>70% reduction in lumen diameter). Inclusion criteria were fulfilled for 214 patients (143 men; age 60 ± 14 years; ICA, n = 104; low likelihood for CAD, n = 110). An exercise stress test was performed in 62% of patients and a pharmacological stress test was performed with either dipyridamole (32%) or dobutamine (6%). Average examination duration was 22.4 ± 4.5 minutes. Mean SSS, SRS, and SDS were 8.0 ± 4.9, 3.1 ± 4.3, and 5.0 ± 3.2, respectively. Prevalence of angiographic CAD was 75%. ICA detected stenosis in the left main trunk, left anterior descending artery, left circumflex artery, and right coronary artery in 4, 33, 31, and 42 patients, respectively. Sensitivity of dual-isotope high-speed MPI was 94%, normalcy rate was 92%, and accuracy was 83% for detecting CAD. Dual-isotope high-speed MPI is reliable at detecting or ruling out CAD. NCT01785589.

  11. Quantitative Upright–Supine High-Speed SPECT Myocardial Perfusion Imaging for Detection of Coronary Artery Disease: Correlation with Invasive Coronary Angiography

    PubMed Central

    Nakazato, Ryo; Tamarappoo, Balaji K.; Kang, Xingping; Wolak, Arik; Kite, Faith; Hayes, Sean W.; Thomson, Louise E.J.; Friedman, John D.; Berman, Daniel S.; Slomka, Piotr J.

    2011-01-01

    A recently developed camera system for high-speed SPECT (HS-SPECT) myocardial perfusion imaging shows excellent correlation with conventional SPECT. Our goal was to test the diagnostic accuracy of an automated quantification of combined upright and supine myocardial SPECT for detection of coronary artery disease (CAD) (≥70% luminal diameter stenosis or, in left main coronary artery, ≥50% luminal diameter stenosis) in comparison to invasive coronary angiography (ICA). Methods We studied 142 patients undergoing upright and supine HS-SPECT, including 56 consecutive patients (63% men; mean age 6 ± SD, 64 ± 13 y; 45% exercise stress) without known CAD who underwent diagnostic ICA within 6 mo of HS-SPECT and 86 consecutive patients with a low likelihood of CAD. Reference limits for upright and supine HS-SPECT were created from studies of patients with a low likelihood of CAD. Automated software adopted from supine–prone analysis was used to quantify the severity and extent of perfusion abnormality and was expressed as total perfusion deficit (TPD). TPD was obtained for upright (U-TPD), supine (S-TPD), and combined upright–supine acquisitions (C-TPD). Stress U-TPD ≥ 5%, S-TPD ≥ 5%, and C-TPD ≥ 3% myocardium were considered abnormal for per-patient analysis, and U-TPD, S-TPD, and C-TPD ≥ 2% in each coronary artery territory were considered abnormal for per-vessel analysis. Results On a per-patient basis, the sensitivity was 91%, 88%, and 94% for U-TPD, S-TPD, and C-TPD, respectively, and specificity was 59%, 73%, and 86% for U-TPD, S-TPD, and C-TPD, respectively. C-TPD had a larger area under the receiver-operating-characteristic curve than U-TPD or S-TPD for identification of stenosis ≥ 70% (0.94 vs. 0.88 and 0.89, P < 0.05 and not significant, respectively). On a per-vessel basis, the sensitivity was 67%, 66%, and 69% for U-TPD, S-TPD, and C-TPD, respectively, and specificity was 91%, 94%, and 97% for U-TPD, S-TPD, and C-TPD, respectively (P = 0

  12. Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials.

    PubMed

    Damman, Peter; van Geloven, Nan; Wallentin, Lars; Lagerqvist, Bo; Fox, Keith A A; Clayton, Tim; Pocock, Stuart J; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; de Winter, Robbert J

    2012-02-01

    This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management. The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate. Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk score, study, and the propensity of receiving early angiography using inverse probability weighting. Of 2,721 patients originally randomized to the routine invasive arm, consisting of routine angiography and subsequent revascularization if suitable, 975 underwent early angiography and 1,141 delayed angiography. No difference was observed in 5-year cardiovascular death or myocardial infarction in unadjusted (HR: 1.06, 95% confidence interval [CI]: 0.79 to 1.42, p=0.61) and adjusted (HR: 0.93, 95% CI: 0.75 to 1.16, p=0.54) Cox regression models. In the FIR database of patients presenting with nSTE-ACS, the timing of angiography was not related to long-term cardiovascular mortality or myocardial infarction. (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes [ICTUS]; ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction [the Third Randomised Intervention Treatment of Angina Trials (RITA-3)]; ISRCTN

  13. Pediatric body MR angiography.

    PubMed

    Krishnamurthy, Rajesh; Muthupillai, Raja; Chung, Taylor

    2009-02-01

    Vascular pathology in children is commonplace and involves every organ system; however, the powerful, noninvasive, and rapid three-dimensional imaging capability offered by MR angiography is underutilized in children. The success of pediatric MR angiography depends on modifying the MR angiography on the basis of patient size, hemodynamic status, and clinical indications in children, and requires an adequate understanding of pediatric-specific hardware, software, and equipment requirements. This article provides an overview of general pediatric MR angiography techniques, common indications for body MR angiography in children, and the complementary role of MR angiography to other vascular imaging modalities in children, including CT angiography, Doppler ultrasound, and catheter angiography.

  14. Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores.

    PubMed

    Cordeiro, M A S; Miller, J M; Schmidt, A; Lardo, A C; Rosen, B D; Bush, D E; Brinker, J A; Bluemke, D A; Shapiro, E P; Lima, J A C

    2006-05-01

    To show an overall diagnostic accuracy > or = 90% for detection of > or = 50% stenoses by coronary half millimetre 32 detector row computed tomography angiography (32 x 0.5-MDCTA) in patients with advanced coronary artery disease (CAD) and a high likelihood of raised calcium scores. ECG gated 32 x 0.5-MDCTA (32 x 0.5 mm cross sections, 0.35 x 0.35 x 0.35 mm3 isotropic voxels, 400 ms rotation) was performed after injection of iodixanol (120 ml, 320 mg/ml) in 30 consecutive patients (25 men, mean (SD) age 59 (13) years, body mass index 26.2 (4.9) kg/m2). Native arteries, including > or = 1.5 mm branches, and bypass grafts were screened for > or = 50% stenoses. Stents were excluded. Conventional coronary angiography (performed 18 (12) days before 32 x 0.5-MDCTA) was analysed by quantitative coronary angiography. Median Agatston calcium score was 510 (range 3-5066). Sensitivity, specificity, and positive and negative predictive values for detection of > or = 50% stenoses in native arteries were 76% (29 of 38), 94% (190 of 202), 71% (29 of 41), and 96% (190 of 199), respectively. Overall diagnostic accuracy was 91% (219 of 240). Due to the following artefacts 20% (69 of 352) of the vessels were excluded: motion, noise, and low contrast enhancement isolated or in combination (45 of 69 (65%)); image distortion by implantable cardioverter-defibrillator or pacemaker leads (18 of 69 (26%)); and blooming secondary to severe calcification (6 of 69 (9%)). Coronary 32 x 0.5-MDCTA accurately excludes > or = 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%.

  15. Non‐invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores

    PubMed Central

    Cordeiro, M A S; Miller, J M; Schmidt, A; Lardo, A C; Rosen, B D; Bush, D E; Brinker, J A; Bluemke, D A; Shapiro, E P

    2006-01-01

    Objective To show an overall diagnostic accuracy ⩾ 90% for detection of ⩾ 50% stenoses by coronary half millimetre 32 detector row computed tomography angiography (32 × 0.5‐MDCTA) in patients with advanced coronary artery disease (CAD) and a high likelihood of raised calcium scores. Methods ECG gated 32 × 0.5‐MDCTA (32 × 0.5 mm cross sections, 0.35 × 0.35 × 0.35 mm3 isotropic voxels, 400 ms rotation) was performed after injection of iodixanol (120 ml, 320 mg/ml) in 30 consecutive patients (25 men, mean (SD) age 59 (13) years, body mass index 26.2 (4.9) kg/m2). Native arteries, including ⩾ 1.5 mm branches, and bypass grafts were screened for ⩾ 50% stenoses. Stents were excluded. Conventional coronary angiography (performed 18 (12) days before 32 × 0.5‐MDCTA) was analysed by quantitative coronary angiography. Results Median Agatston calcium score was 510 (range 3–5066). Sensitivity, specificity, and positive and negative predictive values for detection of ⩾ 50% stenoses in native arteries were 76% (29 of 38), 94% (190 of 202), 71% (29 of 41), and 96% (190 of 199), respectively. Overall diagnostic accuracy was 91% (219 of 240). Due to the following artefacts 20% (69 of 352) of the vessels were excluded: motion, noise, and low contrast enhancement isolated or in combination (45 of 69 (65%)); image distortion by implantable cardioverter‐defibrillator or pacemaker leads (18 of 69 (26%)); and blooming secondary to severe calcification (6 of 69 (9%)). Conclusions Coronary 32 × 0.5‐MDCTA accurately excludes ⩾ 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%. PMID:16251224

  16. Low-cost portable fluorescein angiography.

    PubMed

    Maude, Richard J; Plewes, Katherine; Dimock, Joss; Dondorp, Arjen M

    2011-09-01

    Fundus fluorescein angiography has great potential as a unique non-invasive tool to investigate in vivo the microvascular pathogenesis of a wide variety of diseases affecting the central nervous system. However, because it requires a bulky and expensive tabletop retinal camera, it is normally limited to cooperative and alert seated patients in well-resourced settings. Recently completed and ongoing studies of the pathogenesis of severe malaria are using fluorescein angiography to examine in detail the postulated central role of microvascular obstruction. We describe a novel method of fluorescein angiography with a portable retinal camera that can be adapted at very low cost for use in sick patients at the bedside. This method greatly expands the scope of potential studies utilising fluorescein angiography.

  17. [Position paper of the Italian Society of Invasive Cardiology (SICI-GISE) on indications for coronary angiography in patients with stable angina].

    PubMed

    Marchese, Alfredo; Rossini, Roberta; Basile, Marco; Bedogni, Francesco; Danzi, Gian Battista; Musumeci, Giuseppe; Paradies, Valeria; Piccaluga, Emanuela; Sardella, Gennaro; Varbella, Ferdinando; Giordano, Arturo; Berti, Sergio

    2015-10-01

    Available data suggest a steep increase in stable coronary artery disease with age. Its prevalence reaches a peak of almost 12-14% in men aged 65-84 years with an annual mortality ranging from 1.2% to 2.4%. The diagnosis of stable angina is primarily based on history and therefore relies on clinical judgment. In addition, its diagnosis can be extremely challenging because of the frequent transition from unstable to stable angina. Current European guidelines on the management of stable coronary artery disease give increased importance to the pre-test probability, which strongly affects the diagnostic algorithms. Imaging techniques play a greater role in the diagnosis of stable angina than in the past. Conversely, despite recent advances in technology and in the physiological assessment of coronary stenosis, an ever decreasing relevance is conferred to coronary angiography. Another difficult and controversial issue relates to the prognostic benefit of myocardial revascularization. The aim of this position paper is to review the most relevant clinical aspects of the European guidelines on the management of stable coronary artery disease.

  18. Comparison of CT angiography and digital subtraction angiography in the diagnosis of aortic coarctation.

    PubMed

    Miabi, Zinat; Pourfathi, Hojjat; Midia, Mehran; Midia, Ramin; Parvizi, Rezayat

    2011-01-01

    There are several methods for the diagnosis and evaluation of coarctation of the aorta. Digital Subtraction Angiography (DSA) is the standard detection method, though it entails complications and side-effects. The aim of the present study was to compare Computed Tomography (CT) angiography with DSA for diagnosing aortic coarctation. We performed a cross-sectional study of 15 patients (11 males and four females aged between two and 30 years) referred to Tabriz Shahid Madani Hospital and Imaging Center between August 2005 and February 2006 with suspected aortic coarctation. All patients were subjected to DSA and CT angiography for diagnosis of aortic coarctation. The mean age of the patients was 14.6 years; 11 were male (74.4%) and four (26.6%) were female. The DSA and CT angiography results were comparable in all patients in terms of diagnosis and the detection of complications, particularly cardiovascular complications. However, CT angiography was less time-consuming to perform than DSA (p < 0.0001). In conclusion, CT angiography, comparableto DSA, diagnosed coarctation of aorta in all the patients. However, CT angiography is a non-invasive, cost effective procedure that takes significantly less time to carry out than DSA. Therefore, CT angiography is recommended as an appropriate method for diagnosing the coarctation of aorta.

  19. CT angiography - chest

    MedlinePlus

    Computed tomography angiography - thorax; CTA - lungs; Pulmonary embolism - CTA chest; Thoracic aortic aneurysm - CTA chest; Venous thromboembolism - CTA lung; Blood clot - CTA lung; Embolus - CTA lung; CT ...

  20. Indocyanine green video angiography

    NASA Astrophysics Data System (ADS)

    Frambach, Donald A.

    1994-06-01

    Over the last two years, ophthalmologists have begun to use indocyanine green angiography as a supplement to fluorescein angiography. Unlike fluorescein, indocyanine green absorbs near infrared and emits slightly longer infrared light. Therefore, indocyanine green angiography images structures deeper in the retina and through blood, pigment, and turbid serous fluid that accumulates in a number of diseases. In addition, indocyanine green shows very different properties of dye leakage than does fluorescein and this can be used to identify certain abnormal blood vessels that grow beneath the retinas of patients with macular degeneration. Finally, indocyanine green fluoresces only 4% as efficiently as fluorescein which has presented a major technical problem until highly amplified video systems have become available to ophthalmologists. We have used a scanning laser ophthalmoscope to perform video indocyanine green angiography at the Doheny Eye Institute since November, 1991. In this paper, I will present several clinical cases that demonstrate the clinical usefulness of indocyanine green angiography.

  1. Rationale and Design of the Dual Energy Computed Tomography for Ischemia Determination Compared to “Gold Standard” Non-invasive and Invasive Techniques (DECIDE-Gold): A Multicenter International Efficacy Diagnostic Study of Rest-Stress Dual-Energy Computed Tomography Angiography with Perfusion

    PubMed Central

    Truong, Quynh A.; Knaapen, Paul; Pontone, Gianluca; Andreini, Daniele; Leipsic, Jonathon; Carrascosa, Patricia; Lu, Bin; Branch, Kelley; Raman, Subha; Bloom, Stephen; Min, James K.

    2014-01-01

    BACKGROUND Dual-energy CT (DECT) has potential to improve myocardial perfusion for physiologic assessment of coronary artery disease (CAD). Diagnostic performance of rest-stress DECT perfusion (DECTP) is unknown. OBJECTIVE DECIDE-Gold is a prospective multicenter study to evaluate the accuracy of DECT to detect hemodynamic (HD) significant CAD, as compared to fractional flow reserve (FFR) as a reference standard. METHODS Eligible participants are subjects with symptoms of CAD referred for invasive coronary angiography (ICA). Participants will undergo DECTP, which will be performed by pharmacological stress, and participants will subsequently proceed to ICA and FFR. HD-significant CAD will be defined as FFR ≥ 0.80. In those undergoing myocardial stress imaging (MPI) by positron emission tomography (PET), single photon emission computed tomography (SPECT) or cardiac magnetic resonance (CMR) imaging, ischemia will be graded by % ischemic myocardium. Blinded core laboratory interpretation will be performed for CCTA, DECTP, MPI, ICA and FFR. RESULTS Primary endpoint is accuracy of DECTP to detect ≥ 1 HD-significant stenosis at the subject-level when compared to FFR. Secondary and tertiary endpoints are accuracies of combinations of DECTP at the subject and vessel levels compared to FFR and MPI. CONCLUSION DECIDE-Gold will determine the performance of DECTP for diagnosing ischemia. PMID:25549826

  2. Relaxation response in femoral angiography.

    PubMed

    Mandle, C L; Domar, A D; Harrington, D P; Leserman, J; Bozadjian, E M; Friedman, R; Benson, H

    1990-03-01

    Immediately before they underwent femoral angiography, 45 patients were given one of three types of audiotapes: a relaxation response tape recorded for this study, a tape of contemporary instrumental music, or a blank tape. All patients were instructed to listen to their audiotape during the entire angiographic procedure. Each audiotape was played through earphones. Radiologists were not told the group assignment or tape contents. The patients given the audiotape with instructions to elicit the relaxation response (n = 15) experienced significantly less anxiety (P less than .05) and pain (P less than .001) during the procedure, were observed by radiology nurses to exhibit significantly less pain (P less than .001) and anxiety (P less than .001), and requested significantly less fentanyl citrate (P less than .01) and diazepam (P less than .01) than patients given either the music (n = 14) or the blank (n = 16) control audiotapes. Elicitation of the relaxation response is a simple, inexpensive, efficacious, and practical method to reduce pain, anxiety, and medication during femoral angiography and may be useful in other invasive procedures.

  3. CT Angiography (CTA)

    MedlinePlus

    ... medical conditions. Angiography uses one of three imaging technologies and, in most cases, a contrast material injection ... the extent and severity of the effects of coronary artery disease and plan for a surgical operation, such as ...

  4. Coronary CT angiography: current status and continuing challenges

    PubMed Central

    Sun, Z; Choo, G H; Ng, K H

    2012-01-01

    Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease owing to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with multislice CT scanners (64 slice and higher), and in selected patients coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. With high-quality coronary CT imaging increasingly being performed, patients can benefit from an imaging modality that provides a rapid and accurate diagnosis while avoiding an invasive procedure. Despite the tremendous contributions of coronary CT angiography to cardiac imaging, study results reported in the literature should be interpreted with caution as there are some limitations existing within the study design or related to patient risk factors. In addition, some attention must be given to the potential health risks associated with the ionising radiation received during cardiac CT examinations. Radiation dose associated with coronary CT angiography has raised serious concerns in the literature, as the risk of developing malignancy is not negligible. Various dose-saving strategies have been implemented, with some of the strategies resulting in significant dose reduction. The aim of this review is to present an overview of the role of coronary CT angiography on cardiac imaging, with focus on coronary artery disease in terms of the diagnostic and prognostic value of coronary CT angiography. Various approaches for dose reduction commonly recommended in the literature are discussed. Limitations of coronary CT angiography are identified. Finally, future directions and challenges with the use of coronary CT angiography are highlighted. PMID:22253353

  5. Optical Coherence Tomography Angiography in Retinal Diseases

    PubMed Central

    Chalam, K. V.; Sambhav, Kumar

    2016-01-01

    Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging system that generates volumetric data of retinal and choroidal layers. It has the ability to show both structural and blood flow information. Split-spectrum amplitude-decorrelation angiography (SSADA) algorithm (a vital component of OCTA software) helps to decrease the signal to noise ratio of flow detection thus enhancing visualization of retinal vasculature using motion contrast. Published studies describe potential efficacy for OCTA in the evaluation of common ophthalmologic diseases such as diabetic retinopathy, age related macular degeneration (AMD), retinal vascular occlusions and sickle cell disease. OCTA provides a detailed view of the retinal vasculature, which allows accurate delineation of microvascular abnormalities in diabetic eyes and vascular occlusions. It helps quantify vascular compromise depending upon the severity of diabetic retinopathy. OCTA can also elucidate the presence of choroidal neovascularization (CNV) in wet AMD. In this paper, we review the knowledge, available in English language publications regarding OCTA, and compare it with the conventional angiographic standard, fluorescein angiography (FA). Finally, we summarize its potential applications to retinal vascular diseases. Its current limitations include a relatively small field of view, inability to show leakage, and tendency for image artifacts. Further larger studies will define OCTA's utility in clinical settings and establish if the technology may offer a non-invasive option of visualizing the retinal vasculature, enabling us to decrease morbidity through early detection and intervention in retinal diseases. PMID:27195091

  6. Prognostic utility of coronary computed tomographic angiography

    PubMed Central

    Otaki, Yuka; Berman, Daniel S.; Min, James K.

    2013-01-01

    Coronary computed tomographic angiography (CCTA) employing CT scanners of 64-detector rows or greater represents a noninvasive method that enables accurate detection and exclusion of anatomically obstructive coronary artery disease (CAD), providing excellent diagnostic information when compared to invasive angiography. There are numerous potential advantages of CCTA beyond simply luminal stenosis assessment including quantification of atherosclerotic plaque volume as well as assessment of plaque composition, extent, location and distribution. In recent years, an array of studies has evaluated the prognostic utility of CCTA findings of CAD for the prediction of major adverse cardiac events, all-cause death and plaque instability. This prognostic information enhances risk stratification and, if properly acted upon, may improve medical therapy and/or behavioral changes that may enhance event-free survival. The goal of the present article is to summarize the current status of the prognostic utility of CCTA findings of CAD. PMID:23809386

  7. CT angiography in the diagnosis of cardiovascular disease: a transformation in cardiovascular CT practice

    PubMed Central

    Al Moudi, Mansour; Cao, Yan

    2014-01-01

    Computed tomography (CT) angiography represents the most important technical development in CT imaging and it has challenged invasive angiography in the diagnostic evaluation of cardiovascular abnormalities. Over the last decades, technological evolution in CT imaging has enabled CT angiography to become a first-line imaging modality in the diagnosis of cardiovascular disease. This review provides an overview of the diagnostic applications of CT angiography (CTA) in cardiovascular disease, with a focus on selected clinical challenges in some common cardiovascular abnormalities, which include abdominal aortic aneurysm (AAA), aortic dissection, pulmonary embolism (PE) and coronary artery disease. An evidence-based review is conducted to demonstrate how CT angiography has changed our approach in the diagnosis and management of cardiovascular disease. Radiation dose reduction strategies are also discussed to show how CT angiography can be performed in a low-dose protocol in the current clinical practice. PMID:25392823

  8. Multidetector computed tomography angiography of the abdomen.

    PubMed

    Güven, Koray; Acunaş, Bülent

    2004-10-01

    Multidetector computed tomography (MDCT) angiography has provided excellent opportunities for advancement of computed tomography (CT) technology and clinical applications. It has a wide range of applications in the abdomen including vascular pathologies either occlusive or aneurysmal; enables the radiologist to produce vascular mapping that clearly show tumor invasion of vasculature and the relationship of vessels to mass lesions. MDCTA can be used in preoperative planning for hepatic resection, preoperative evaluation and planning for liver transplantation. MDCTA can also provide extremely valuable information in the evaluation of ischemic bowel disease, active Crohn disease, the extent and location of collateral vessels in cirrhosis.

  9. Safety and efficacy of dual-axis rotational coronary angiography vs. standard coronary angiography.

    PubMed

    Klein, Andrew J; Garcia, Joel A; Hudson, Paul A; Kim, Michael S; Messenger, John C; Casserly, Ivan P; Wink, Onno; Hattler, Brack; Tsai, Thomas T; Chen, S Y James; Hansgen, Adam; Carroll, John D

    2011-05-01

    To determine the safety and efficacy of dual-axis rotational coronary angiography (DARCA) by directly comparing it to standard coronary angiography (SA). Standard coronary angiography (SA) requires numerous fixed static images of the coronary tree and has multiple well-documented limitations. Dual-axis rotational coronary angiography (DARCA) is a new rotational acquisition technique that entails simultaneous LAO/RAO and cranial/caudal gantry movement. This technological advancement obtains numerous unique images of the left or right coronary tree with a single coronary injection. We sought to assess the safety and efficacy of DARCA as well as determine DARCA's adequacy for CAD screening and assessment. Thirty patients underwent SA following by DARCA. Contrast volume, radiation dose (DAP) and procedural time were recorded for each method to assess safety. For DARCA acquisitions, blood pressure (BP), heart rate (HR), symptoms and any arrhythmias were recorded. All angiograms were reviewed for CAD screening adequacy by two independent invasive cardiologists. Compared to SA, use of DARCA was associated with a 51% reduction in contrast, 35% less radiation exposure, and 18% shorter procedural time. Both independent reviewers noted DARCA to be at least equivalent to SA with respect to the ability to screen for CAD. DARCA represents a new angiographic technique which is equivalent in terms of image quality and is associated with less contrast use, radiation exposure, and procedural time than SA. Copyright © 2011 Wiley-Liss, Inc.

  10. Aqueous Angiography with Fluorescein and Indocyanine Green in Bovine Eyes.

    PubMed

    Huang, Alex S; Saraswathy, Sindhu; Dastiridou, Anna; Begian, Alan; Legaspi, Hanz; Mohindroo, Chirayu; Tan, James C H; Francis, Brian A; Caprioli, Joseph; Hinton, David R; Weinreb, Robert N

    2016-11-01

    We characterize aqueous angiography as a real-time aqueous humor outflow imaging (AHO) modality in cow eyes with two tracers of different molecular characteristics. Cow enucleated eyes (n = 31) were obtained and perfused with balanced salt solution via a Lewicky AC maintainer through a 1-mm side-port. Fluorescein (2.5%) or indocyanine green (ICG; 0.4%) were introduced intracamerally at 10 mm Hg individually or sequentially. With an angiographer, infrared and fluorescent images were acquired. Concurrent anterior segment optical coherence tomography (OCT) was performed, and fixable fluorescent dextrans were introduced into the eye for histologic analysis of angiographically positive and negative areas. Aqueous angiography in cow eyes with fluorescein and ICG yielded high-quality images with segmental patterns. Over time, ICG maintained a better intraluminal presence. Angiographically positive, but not negative, areas demonstrated intrascleral lumens with anterior segment OCT. Aqueous angiography with fluorescent dextrans led to their trapping in AHO pathways. Sequential aqueous angiography with ICG followed by fluorescein in cow eyes demonstrated similar patterns. Aqueous angiography in model cow eyes demonstrated segmental angiographic outflow patterns with either fluorescein or ICG as a tracer. Further characterization of segmental AHO with aqueous angiography may allow for intelligent placement of trabecular bypass minimally invasive glaucoma surgeries for improved surgical results.

  11. Aqueous Angiography with Fluorescein and Indocyanine Green in Bovine Eyes

    PubMed Central

    Huang, Alex S.; Saraswathy, Sindhu; Dastiridou, Anna; Begian, Alan; Legaspi, Hanz; Mohindroo, Chirayu; Tan, James C. H.; Francis, Brian A.; Caprioli, Joseph; Hinton, David R.; Weinreb, Robert N.

    2016-01-01

    Purpose We characterize aqueous angiography as a real-time aqueous humor outflow imaging (AHO) modality in cow eyes with two tracers of different molecular characteristics. Methods Cow enucleated eyes (n = 31) were obtained and perfused with balanced salt solution via a Lewicky AC maintainer through a 1-mm side-port. Fluorescein (2.5%) or indocyanine green (ICG; 0.4%) were introduced intracamerally at 10 mm Hg individually or sequentially. With an angiographer, infrared and fluorescent images were acquired. Concurrent anterior segment optical coherence tomography (OCT) was performed, and fixable fluorescent dextrans were introduced into the eye for histologic analysis of angiographically positive and negative areas. Results Aqueous angiography in cow eyes with fluorescein and ICG yielded high-quality images with segmental patterns. Over time, ICG maintained a better intraluminal presence. Angiographically positive, but not negative, areas demonstrated intrascleral lumens with anterior segment OCT. Aqueous angiography with fluorescent dextrans led to their trapping in AHO pathways. Sequential aqueous angiography with ICG followed by fluorescein in cow eyes demonstrated similar patterns. Conclusions Aqueous angiography in model cow eyes demonstrated segmental angiographic outflow patterns with either fluorescein or ICG as a tracer. Translational Relevance Further characterization of segmental AHO with aqueous angiography may allow for intelligent placement of trabecular bypass minimally invasive glaucoma surgeries for improved surgical results. PMID:27847692

  12. Cost-effectiveness of initial stress cardiovascular MR, stress SPECT or stress echocardiography as a gate-keeper test, compared with upfront invasive coronary angiography in the investigation and management of patients with stable chest pain: mid-term outcomes from the CECaT randomised controlled trial

    PubMed Central

    Thom, Howard; West, Nicholas E J; Hughes, Vikki; Dyer, Matthew; Buxton, Martin; Sharples, Linda D; Jackson, Christopher H; Crean, Andrew M

    2014-01-01

    Objectives To compare outcomes and cost-effectiveness of various initial imaging strategies in the management of stable chest pain in a long-term prospective randomised trial. Setting Regional cardiothoracic referral centre in the east of England. Participants 898 patients (69% man) entered the study with 869 alive at 2 years of follow-up. Patients were included if they presented for assessment of stable chest pain with a positive exercise test and no prior history of ischaemic heart disease. Exclusion criteria were recent infarction, unstable symptoms or any contraindication to stress MRI. Primary outcome measures The primary outcomes of this follow-up study were survival up to a minimum of 2 years post-treatment, quality-adjusted survival and cost-utility of each strategy. Results 898 patients were randomised. Compared with angiography, mortality was marginally higher in the groups randomised to cardiac MR (HR 2.6, 95% CI 1.1 to 6.2), but similar in the single photon emission CT-methoxyisobutylisonitrile (SPECT-MIBI; HR 1.0, 95% CI 0.4 to 2.9) and ECHO groups (HR 1.6, 95% CI 0.6 to 4.0). Although SPECT-MIBI was marginally superior to other non-invasive tests there were no other significant differences between the groups in mortality, quality-adjusted survival or costs. Conclusions Non-invasive cardiac imaging can be used safely as the initial diagnostic test to diagnose coronary artery disease without adverse effects on patient outcomes or increased costs, relative to angiography. These results should be interpreted in the context of recent advances in imaging technology. Trial registration ISRCTN 47108462, UKCRN 3696. PMID:24508847

  13. [Angiography and interventional radiology of the kidney].

    PubMed

    Hansmann, J; Richter, G M; Hallscheidt, P; Düx, M; Nöldge, G; Kauffmann, G W

    1999-05-01

    For imaging of renal pathology a broad spectrum of radiologic diagnostic procedures are available which are, sometimes and particularly more recently, competing among each other in their diagnostic yield and relevance. For tumorous lesions ultrasound, computed tomography and magnetic resonance imaging are performed predominantly. Angiography is no longer required with the exception of highly selected cases and in some specific preoperative workup requirements. Until recently, catheter based digital subtraction angiography has been considered as gold standard. However, non-invasive techniques such as CT-angiography and MR-angiography are evolving parallel to their quantum leap of resolutions and readiness to use. Nevertheless, well accepted criteria for quality assessement of these new modalities are still lacking. More comparison studies are urgently warranted. Despite the availability of ultrashort pulse sequences applying the T1 relaxation reduction effect of gadolinium enhanced MR techniques overestimation of renal artery stenosis still poses a substantial problem. Renal intervention implies a variety of procedures such as plain angioplasty, stent placement, embolization of traumatic and both benign and malignant tumors. These methods have emerged over the last two decades from a more experimental nature to a fully accepted treatment option. When renal artery angioplasty is embedded in an aggressive approach including stenting as an adjunct for more complex cases, renal ostial lesions and a well organized follow-up regimen its therapeutic potential for treatment of renal insufficiency, malignant hypertension, for organ preservation bears a very high potential. Provided adequat periinterventional drug regimen restenosis rates may be as low as 10%. In highly selected cases capillary embolization might be used as an alternative to nephrectomy with a similar clinical outcome. Particularly the development of superselective small caliber embolization catheters

  14. Pulmonary arterial hypertension: an imaging review comparing MR pulmonary angiography and perfusion with multidetector CT angiography

    PubMed Central

    Junqueira, F P; Lima, C M A O; Coutinho, A C; Parente, D B; Bittencourt, L K; Bessa, L G P; Domingues, R C; Marchiori, E

    2012-01-01

    Pulmonary hypertension (PH) is a progressive disease that leads to substantial morbidity and eventual death. Pulmonary multidetector CT angiography (MDCTA), pulmonary MR angiography (MRA) and MR-derived pulmonary perfusion (MRPP) imaging are non-invasive imaging techniques for the differential diagnosis of PH. MDCTA is considered the gold standard for the diagnosis of pulmonary embolism, one of the most common causes of PH. MRA and MRPP are promising techniques that do not require the use of ionising radiation or iodinated contrast material, and can be useful for patients for whom such material cannot be used. This review compares the imaging aspects of pulmonary MRA and 64-row MDCTA in patients with chronic thromboembolic or idiopathic PH. PMID:22932061

  15. Pulmonary arterial hypertension: an imaging review comparing MR pulmonary angiography and perfusion with multidetector CT angiography.

    PubMed

    Junqueira, F P; Lima, C M A O; Coutinho, A C; Parente, D B; Bittencourt, L K; Bessa, L G P; Domingues, R C; Marchiori, E

    2012-11-01

    Pulmonary hypertension (PH) is a progressive disease that leads to substantial morbidity and eventual death. Pulmonary multidetector CT angiography (MDCTA), pulmonary MR angiography (MRA) and MR-derived pulmonary perfusion (MRPP) imaging are non-invasive imaging techniques for the differential diagnosis of PH. MDCTA is considered the gold standard for the diagnosis of pulmonary embolism, one of the most common causes of PH. MRA and MRPP are promising techniques that do not require the use of ionising radiation or iodinated contrast material, and can be useful for patients for whom such material cannot be used. This review compares the imaging aspects of pulmonary MRA and 64-row MDCTA in patients with chronic thromboembolic or idiopathic PH.

  16. Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds.

    PubMed

    Adibi, Ali; Krishnam, Mayil S; Dissanayake, Sumudu; Plotnik, Adam N; Mohajer, Kiyarash; Arellano, Cesar; Ruehm, Stefan G

    2014-07-01

    To assess the role of CT angiography in the evaluation of patients with lower extremity gunshot wounds in the emergency room. Eighty patients (73 male, 7 female, mean age 26 years) underwent CT angiography for the evaluation of lower extremity gunshot injuries. Imaging was conducted on the basis of standardized protocols utilizing 16-slice and 64-slice multidetector systems and images were qualitatively graded and assessed for various forms of arterial injury. CT angiography findings indicative of arterial injury were observed in 24 patients (30%) and a total of 43 arterial injuries were noted; the most common form was focal narrowing/spasm (n = 16, 37.2%); the most common artery involved was the superficial femoral artery (n = 12, 50%). In qualitative assessment of images based on a 4-point grading system, both readers considered CT angiography diagnostically excellent (grade 4) in most cases. Surgical findings were consistent with CT angiography and follow-up of patients' medical records showed no arterial injuries in patients with normal findings on initial imaging. Our findings demonstrate that CT angiography is an effective imaging modality for evaluation of lower extremity gunshot wounds and could help limit more invasive procedures such as catheter angiography to a select group of patients. • CT angiography efficiently evaluates lower extremity gunshot wounds. • CT angiography provides image quality sufficiently reliable for assessment of gunshot injuries. • CT angiography could help limit invasive procedures to select patients.

  17. Angiography and the gastrointestinal bleeder

    SciTech Connect

    Baum, S.

    1982-05-01

    The role of angiography in the diagnosis and treatment of gastrointestinal hemorrhage is discussed. Three categories of gastrointestinal bleeding are considered: upper gastrointestinal bleeding due to gastroesophageal varices, upper gastrointestinal bleeding of arterial or capillary origin, and lower gastrointestinal bleeding. The advantages and disadvantages of angiography are compared with those of radionuclide scanning and endoscopy or colonoscopy. It is anticipated that, as radionuclide scans are more widely employed, angiography will eventually be performed only in those patients with positive scans.

  18. Coronary plaque imaging by coronary computed tomography angiography

    PubMed Central

    Sato, Akira

    2014-01-01

    Coronary computed tomography angiography (CTA) has become the useful noninvasive imaging modality alternative to the invasive coronary angiography for detecting coronary artery stenoses in patients with suspected coronary artery disease (CAD). With the development of technical aspects of coronary CTA, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology and patients outcomes by coronary CTA. In this review we discuss the coronary plaque morphology estimated by CTA beyond coronary angiography including the comparison to the currently available other imaging modalities used to examine morphological characteristics of the atherosclerotic plaque. Furthermore, this review underlies the value of a combined assessment of coronary anatomy and myocardial perfusion in patients with CAD, and adds to an increasing body of evidence suggesting an added diagnostic value when combining both modalities. We hope that an integrated, multi-modality imaging approach will become the gold standard for noninvasive evaluation of coronary plaque morphology and outcome data in clinical practice. PMID:24876919

  19. Pediatric digital subtraction angiography

    SciTech Connect

    Amundson, G.M.; Wesenberg, R.L.; Mueller, D.L.; Reid, R.H.

    1984-12-01

    Experience with intravenous digital subtraction angiography (DSA) in infants and children is limited, although its relative rate of performance, low complication rate, and diagnostic accuracy indicate great potential. The authors performed 87 DSA examinations (74 patients) and obtained sufficient detail to facilitate diagnosis in most cases. The major problems of patient movement and overlapping vessels can be minimized by judicious use of sedation and strict attention to technique. Exposure of patients to radiation has not been a limiting factor since our system uses low exposure factors. Our results demonstrate that DSA has wide applicability to many organ systems and is especially useful in intracranial disease and for preoperative evaluation of neoplasms.

  20. Optical Coherence Tomography Angiography

    PubMed Central

    Gao, Simon S.; Jia, Yali; Zhang, Miao; Su, Johnny P.; Liu, Gangjun; Hwang, Thomas S.; Bailey, Steven T.; Huang, David

    2016-01-01

    Optical coherence tomography angiography (OCTA) is a noninvasive approach that can visualize blood vessels down to the capillary level. With the advent of high-speed OCT and efficient algorithms, practical OCTA of ocular circulation is now available to ophthalmologists. Clinical investigations that used OCTA have increased exponentially in the past few years. This review will cover the history of OCTA and survey its most important clinical applications. The salient problems in the interpretation and analysis of OCTA are described, and recent advances are highlighted. PMID:27409483

  1. Hepatic Artery Angiography and Embolization for Hemobilia Following Laparoscopic Cholecystectomy

    SciTech Connect

    Nicholson, Tony; Travis, Simon; Ettles, Duncan; Dyet, John; Sedman, Peter; Wedgewood, Kevin; Royston, Christopher

    1999-01-15

    Purpose: The effectiveness of angiography and embolization in diagnosis and treatment were assessed in a cohort of patients presenting with upper gastrointestinal hemorrhage secondary to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Methods: Over a 6-year period 1513 laparoscopic cholecystectomies were carried out in our region. Nine of these patients (0.6%) developed significant upper gastrointestinal bleeding, 5-43 days after surgery. All underwent emergency celiac and selective right hepatic artery angiography. All were treated by coil embolization of the right hepatic artery proximal and distal to the bleeding point. Results: Pseudoaneurysms of the hepatic artery adjacent to cholecystectomy clips were demonstrated in all nine patients at selective right hepatic angiography. In three patients celiac axis angiography alone failed to demonstrate the pseudoaneurysm. Embolization controlled hemorrhage in all patients with no further bleeding and no further intervention. One patient developed a candidal liver abscess in the post-procedure period. All patients are alive and well at follow-up. Conclusion: Selective right hepatic angiography is vital in the diagnosis of upper gastrointestinal hemorrhage following laparoscopic cholecystectomy. Embolization offers the advantage of minimally invasive treatment in unstable patients, does not disrupt recent biliary reconstruction, allows distal as well as proximal control of the hepatic artery, and is an effective treatment for this potentially life-threatening complication.

  2. Fluorescent blood cell angiography

    NASA Astrophysics Data System (ADS)

    Ben-nun, Joshua; Constable, Ian J.

    1994-06-01

    Fluorescein angiography is currently the main method for evaluation of the retinal vascular patency. Ashton noted that capillary patency to the small fluorescein molecule may differ from that of the larger red blood cells. He concluded that fluorescein angiography is not able to demonstrate a developing stenosis, that might be the precipitating cause of a later capillary closure in various microvasculopathies. Sarelius et al have shown, in hamster cheek pouch and cremaster muscle, that fluorescently labeled erythrocytes in known concentrations can be used for the direct measurement of capillary flow parameters. The only assumption that this method relies on, is that the labeled cells are rheologically normal and therefore reflect the behavior of the total cell population. We have developed a new method for an in-vivo, real-time demonstration of the blood cell flow in the retinal capillary net. Based on the assumption presented by Sarelius et al, measurement and analysis of the retinal capillary blood cell flow is also possible from the results achieved by the new method.

  3. Coronary CT Angiography-derived Fractional Flow Reserve.

    PubMed

    Tesche, Christian; De Cecco, Carlo N; Albrecht, Moritz H; Duguay, Taylor M; Bayer, Richard R; Litwin, Sheldon E; Steinberg, Daniel H; Schoepf, U Joseph

    2017-10-01

    Invasive coronary angiography (ICA) with measurement of fractional flow reserve (FFR) by means of a pressure wire technique is the established reference standard for the functional assessment of coronary artery disease (CAD) ( 1 , 2 ). Coronary computed tomographic (CT) angiography has emerged as a noninvasive method for direct assessment of CAD and plaque characterization with high diagnostic accuracy compared with ICA ( 3 , 4 ). However, the solely anatomic assessment provided with both coronary CT angiography and ICA has poor discriminatory power for ischemia-inducing lesions. FFR derived from standard coronary CT angiography (FFRCT) data sets by using any of several advanced computational analytic approaches enables combined anatomic and hemodynamic assessment of a coronary lesion by a single noninvasive test. Current technical approaches to the calculation of FFRCT include algorithms based on full- and reduced-order computational fluid dynamic modeling, as well as artificial intelligence deep machine learning ( 5 , 6 ). A growing body of evidence has validated the diagnostic accuracy of FFRCT techniques compared with invasive FFR. Improved therapeutic guidance has been demonstrated, showing the potential of FFRCT to streamline and rationalize the care of patients suspected of having CAD and improve outcomes while reducing overall health care costs ( 7 , 8 ). The purpose of this review is to describe the scientific principles, clinical validation, and implementation of various FFRCT approaches, their precursors, and related imaging tests. (©) RSNA, 2017.

  4. Multislice CT angiography in coronary artery disease: Technical developments, radiation dose and diagnostic value

    PubMed Central

    Sun, Zhonghua

    2010-01-01

    Multislice computed tomography (CT) angiography has been increasingly used in the detection and diagnosis of coronary artery disease because of its rapid technical evolution from the early generation of 4-slice CT scanners to the latest models such as 64-slice, 256-slice and 320-slice CT scanners. Technical developments of multislice CT imaging enable improved diagnostic value in the detection of coronary artery disease, and this indicates that multislice CT can be used as a reliable less-invasive alternative to invasive coronary angiography in selected patients. In addition, multislice CT angiography has played a significant role in the prediction of disease progression and cardiac events. Despite promising results reported in the literature, multislice CT has the disadvantage of having a high radiation dose which could contribute to the radiation-induced malignancy. A variety of strategies have been currently undertaken to reduce the radiation dose associated with multislice CT coronary angiography while in the meantime acquiring diagnostic images. In this article, the author will review the technical developments, radiation dose associated with multislice CT coronary angiography, and strategies to reduce radiation dose. The diagnostic and prognostic value of multislice CT angiography in coronary artery disease is briefly discussed, and future directions of multislice CT angiography in the diagnosis of coronary artery disease will also be highlighted. PMID:21160611

  5. High resolution 3 Tesla contrast-enhanced MR angiography of the hands in Raynaud's disease.

    PubMed

    Walcher, J; Strecker, R; Goldacker, S; Winterer, J; Langer, M; Bley, T A

    2007-04-01

    Raynaud's disease is associated with disorders in blood circulation of the hands. The gold standard to visualise pathology of digital arteries is catheter angiography. Contrast-enhanced MR angiography (CE MRA) has developed even more as an alternative non-invasive method to digital subtraction angiography, mostly for pelvic or lower limb vessels. We report a case of primary Raynaud's disease with high-grade stenosis and an occlusion of the digital arteries. This case illustrates the benefit and efficiency of CE MRA at high fields in depicting location and extension of peripheral arterial alterations.

  6. Role of routine early angiography post-fibrinolysis for ST elevation myocardial infarction--a meta-regression analysis using angiography rate in the non-routine arm.

    PubMed

    Wong, Cheuk-Kit; Leon de la Barra, Sophia; Herbison, Peter

    2013-09-01

    The current European and American Guidelines differ with regard to the recommended level for the use of routine early angiography after fibrinolysis for STEMI. Previous meta-analyses on randomized controlled trials have supported the routine early approach, but its advantage may be because of an excessively low angiography rate among patients in the non-routine strategy arm of the trials. We update the meta-analysis and apply meta-regression to evaluate whether the difference in outcome between the 2 randomized arms could be explained by the angiography rates in the non-routine strategy arm. Because reinfarction and recurrent ischemia are often the reported indication for angiography, we only use mortality endpoint in our meta-regression analysis. Among the eight trials included with 3195 patients, the angiography rate in the non-routine strategy arms ranges from 15% to 100%. The overall odds ratio for 30-day mortality comparing the routine early angiography arm vs the non-routine arm is 0.86 (95% confidence interval 0.60-1.24). On the plot listing the eight trials according to angiography rates, there is no visual trend in the odds ratio estimates for mortality when comparing the 2 treatment strategies as angiography rate decreases. In meta-regression analysis, angiography rate does not predict 30-day mortality (p=0.461). For STEMI, mortality endpoint trumps the softer endpoints of recurrent infarction and ischemia. The current study shows that the equipoise between the routine early invasive versus the non-routine strategy on 30-day mortality cannot be explained by the variable performance of angiography in the non-routine strategy arm. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  7. Risks and Complications of Coronary Angiography: A Comprehensive Review

    PubMed Central

    Tavakol, Morteza; Ashraf, Salman; Brener, Sorin J.

    2012-01-01

    Coronary angiography and heart catheterization are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of hemodynamic parameters. The risks and complications associated with these procedures relate to the patient’s concomitant conditions and to the skill and judgment of the operator. In this review, we examine in detail the major complications associated with invasive cardiac procedures and provide the reader with a comprehensive bibliography for advanced reading. PMID:22980117

  8. Optical projection angiography

    NASA Astrophysics Data System (ADS)

    Liao, Riwei; Wang, Mingyi; Zhang, Fuli; Han, Dingan; Wang, Ruikang K.; Yang, Guojian; Zeng, Yaguang

    2016-11-01

    We propose the optical projection angiography (OPA) based on lateral dynamic scattering light for visualizing a three-dimensional (3D) blood-flow network. In OPA, a pulsed laser source illuminates a live biological sample for eliminating digital camera integration effects. The 2D flow image can be obtained by separating the dynamic and static scattering light signal of each camera pixel in the frequency domain. Flow images at a different angle are combined to reconstruct the 3D volume of the sample to realize OPA. Moreover, as our experiment retains the bright-field optical projection tomography (OPT) setup, the OPA image for the circulatory system and the OPT image for the skeletal structure can simultaneously be reconstructed. The experimental results can potentially be applied in physiological development studies.

  9. Optical coherence angiography

    PubMed Central

    Wylęgała, Adam; Teper, Sławomir; Dobrowolski, Dariusz; Wylęgała, Edward

    2016-01-01

    Abstract Background: Retinal vascular diseases are one of the most common causes of blindness in the developed world. Optical Coherence Tomography Angiography (OCT-A) is a new noninvasive method that uses several algorithms to detect blood movement. This enables the creation of high-resolution vascular images with contrast depicting motionless tissue. Methods: This review presents the results of articles relevant to age-related macular degeneration (AMD), diabetic retinopathy (DR), and OCT-A. The OCT-A technique can successfully be used in the diagnosis of neovascularization, retinal vein occlusion (RVO) and retinal artery occlusion (RAO), vessel abnormalities and even anterior segment neovascularization. OCT-A can also be applied to compute data such as vessel density, and flow index in both superficial and deep plexuses. Results: Many studies have compared fluorescein angiography with OCT-A. Other studies have reported differences in vascular density in AMD patients and have compared them with people having healthy eyes. Although OCT-A offers rapid picture acquisition, high repeatability and resolution, it also has many drawbacks. The most common are: motion artifacts, projections from overlying vessels and limited field of view. An interesting new application is the possibility to assess changes during antivascular endothelial growth factor (anti-VEGF) therapy. Another function of OCT-A is the possible application in the study of choriocapillaries in many fields of ocular pathology. Conclusion: OCT-A is a new promising method that allows the visualization of the retinal vascular network and the counting of blood flow parameters. This technique provides reliable images useful in clinical routines. PMID:27741104

  10. The potential for neurovascular intravenous angiography using K-edge digital subtraction angiography

    NASA Astrophysics Data System (ADS)

    Schültke, E.; Fiedler, S.; Kelly, M.; Griebel, R.; Juurlink, B.; LeDuc, G.; Estève, F.; Le Bas, J.-F.; Renier, M.; Nemoz, C.; Meguro, K.

    2005-08-01

    Background: Catheterization of small-caliber blood vessels in the central nervous system can be extremely challenging. Alternatively, intravenous (i.v.) administration of contrast agent is minimally invasive and therefore carries a much lower risk for the patient. With conventional X-ray equipment, volumes of contrast agent that could be safely administered to the patient do not allow acquisition of high-quality images after i.v. injection, because the contrast bolus is extremely diluted by passage through the heart. However, synchrotron-based digital K-edge subtraction angiography does allow acquisition of high-quality images after i.v. administration of relatively small doses of contrast agent. Materials and methods: Eight adult male New Zealand rabbits were used for our experiments. Animals were submitted to both angiography with conventional X-ray equipment and synchrotron-based digital subtraction angiography. Results: With conventional X-ray equipment, no contrast was seen in either cerebral or spinal blood vessels after i.v. injection of iodinated contrast agent. However, using K-edge digital subtraction angiography, as little as 1 ml iodinated contrast agent, when administered as i.v. bolus, yielded images of small-caliber blood vessels in the central nervous system (both brain and spinal cord). Conclusions: If it would be possible to image blood vessels of the same diameter in the central nervous system of human patients, the synchrotron-based technique could yield high-quality images at a significantly lower risk for the patient than conventional X-ray imaging. Images could be acquired where catheterization of feeding blood vessels has proven impossible.

  11. Optical coherence tomography based angiography [Invited

    PubMed Central

    Chen, Chieh-Li; Wang, Ruikang K.

    2017-01-01

    Optical coherence tomography (OCT)-based angiography (OCTA) provides in vivo, three-dimensional vascular information by the use of flowing red blood cells as intrinsic contrast agents, enabling the visualization of functional vessel networks within microcirculatory tissue beds non-invasively, without a need of dye injection. Because of these attributes, OCTA has been rapidly translated to clinical ophthalmology within a short period of time in the development. Various OCTA algorithms have been developed to detect the functional micro-vasculatures in vivo by utilizing different components of OCT signals, including phase-signal-based OCTA, intensity-signal-based OCTA and complex-signal-based OCTA. All these algorithms have shown, in one way or another, their clinical values in revealing micro-vasculatures in biological tissues in vivo, identifying abnormal vascular networks or vessel impairment zones in retinal and skin pathologies, detecting vessel patterns and angiogenesis in eyes with age-related macular degeneration and in skin and brain with tumors, and monitoring responses to hypoxia in the brain tissue. The purpose of this paper is to provide a technical oriented overview of the OCTA developments and their potential pre-clinical and clinical applications, and to shed some lights on its future perspectives. Because of its clinical translation to ophthalmology, this review intentionally places a slightly more weight on ophthalmic OCT angiography. PMID:28271003

  12. Computed tomography imaging and angiography - principles.

    PubMed

    Kamalian, Shervin; Lev, Michael H; Gupta, Rajiv

    2016-01-01

    The evaluation of patients with diverse neurologic disorders was forever changed in the summer of 1973, when the first commercial computed tomography (CT) scanners were introduced. Until then, the detection and characterization of intracranial or spinal lesions could only be inferred by limited spatial resolution radioisotope scans, or by the patterns of tissue and vascular displacement on invasive pneumoencaphalography and direct carotid puncture catheter arteriography. Even the earliest-generation CT scanners - which required tens of minutes for the acquisition and reconstruction of low-resolution images (128×128 matrix) - could, based on density, noninvasively distinguish infarct, hemorrhage, and other mass lesions with unprecedented accuracy. Iodinated, intravenous contrast added further sensitivity and specificity in regions of blood-brain barrier breakdown. The advent of rapid multidetector row CT scanning in the early 1990s created renewed enthusiasm for CT, with CT angiography largely replacing direct catheter angiography. More recently, iterative reconstruction postprocessing techniques have made possible high spatial resolution, reduced noise, very low radiation dose CT scanning. The speed, spatial resolution, contrast resolution, and low radiation dose capability of present-day scanners have also facilitated dual-energy imaging which, like magnetic resonance imaging, for the first time, has allowed tissue-specific CT imaging characterization of intracranial pathology.

  13. Magnetic Resonance Angiography of the Aorta

    PubMed Central

    Takehara, Yasuo; Yamashita, Shuhei; Sakahara, Harumi; Masui, Takayuki; Isoda, Haruo

    2011-01-01

    Magnetic resonance angiography (MRA) is capable of imaging arteries in the half to whole body by a single acquisition without a nephrotoxic contrast medium, and acquired images can be reconstructed into a specific cross-sectional view in an arbitrary directions. MRA is applicable for vessels non-reachable by a catheter approach, and collateral vessels can be fully visualized. Since MRA is minimally-invasive with no exposure to ionized radiation, it can be repeatedly applied for follow-up. However, there are also disadvantages: the temporal and spatial resolutions are inferior to those of X-ray angiography, and, at present, it cannot be used as a guide for intervention. Moreover, gadolinium administrations may cause NSF in patients who have lost renal function, as a new risk. Accordingly, strict consideration is required for an indication of its application. Development of non-contrast MRA and evaluation of the wall itself may draw more attention in the future. Plaque imaging is being routinely performed nowadays, and the measurement of vascular wall shear stress, which has a close association with arteriosclerosis, may become possible by utilizing the time-resolved phase-contrast method capable of measuring the time-resolved velocity vectors of blood flow throughout the body. (*English Translation of J Jpn Coll Angiol, 2009, 49: 503-516.) PMID:23555465

  14. CT angiography - head and neck

    MedlinePlus

    ... medlineplus.gov/ency/article/007677.htm CT angiography - head and neck To use the sharing features on this page, ... create pictures of the blood vessels in the head and neck. How the Test is Performed You will be ...

  15. CT angiography - abdomen and pelvis

    MedlinePlus

    Computed tomography angiography - abdomen and pelvis; CTA - abdomen and pelvis; Renal artery - CTA; Aortic - CTA; Mesenteric CTA ... belly or pelvis Masses and tumors in the abdomen or pelvis, including cancer, when needed to help ...

  16. Technical aspects of CT angiography.

    PubMed

    Kuszyk, B S; Fishman, E K

    1998-10-01

    The basic tasks of spiral CT acquisition, image processing, and image display are the foundations underlying CT angiography regardless of the anatomic region of interest. Volume rendering is a rapidly emerging image processing technique for creating three-dimensional (3D) images from CT datasets, which has important advantages over other 3D rendering techniques including maximum intensity projection and surface rendering. This articles reviews the techniques that are commonly used in CT angiography and key considerations for optimization.

  17. CT Angiography after 20 Years

    PubMed Central

    Rubin, Geoffrey D.; Leipsic, Jonathon; Schoepf, U. Joseph; Fleischmann, Dominik; Napel, Sandy

    2015-01-01

    Through a marriage of spiral computed tomography (CT) and graphical volumetric image processing, CT angiography was born 20 years ago. Fueled by a series of technical innovations in CT and image processing, over the next 5–15 years, CT angiography toppled conventional angiography, the undisputed diagnostic reference standard for vascular disease for the prior 70 years, as the preferred modality for the diagnosis and characterization of most cardiovascular abnormalities. This review recounts the evolution of CT angiography from its development and early challenges to a maturing modality that has provided unique insights into cardiovascular disease characterization and management. Selected clinical challenges, which include acute aortic syndromes, peripheral vascular disease, aortic stent-graft and transcatheter aortic valve assessment, and coronary artery disease, are presented as contrasting examples of how CT angiography is changing our approach to cardiovascular disease diagnosis and management. Finally, the recently introduced capabilities for multispectral imaging, tissue perfusion imaging, and radiation dose reduction through iterative reconstruction are explored with consideration toward the continued refinement and advancement of CT angiography. PMID:24848958

  18. Non-invasive evaluation of hemodynamics in pulmonary hypertension by a Septal angle measured by computed tomography pulmonary angiography: Comparison with right-heart catheterization and association with N-terminal pro-B-type natriuretic peptide

    PubMed Central

    TANG, QIANG; LIU, MIN; MA, ZHANHONG; GUO, XIAOJUAN; KUANG, TUGUANG; YANG, YUANHUA

    2013-01-01

    The septal angle, an angle between the interventricular septum and the line connecting the sternum midpoint and thoracic vertebral spinous process, as measured by computed tomographic pulmonary angiography (CTPA), has been observed to be increased in patients with pulmonary hypertension (PH), but its meaning remains unclear. The aim of this study was to investigate the potential role of the septal angle in evaluating hemodynamics and its association with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with PH. Patients with PH (n=106), including 76 with chronic thromboembolic pulmonary hypertension (CTEPH) and 30 with pulmonary artery hypertension (PAH), were retrospectively reviewed. The patients underwent CTPA prior to right-heart catheterization. The septal angle was measured on transversal CTPA images. Hemodynamic parameters were evaluated by right-heart catheterization. The level of plasma NT-proBNP was measured by enzyme-linked sandwich immunoassay. The septal angle had a moderate correlation with cardiac output (CO; r=−0.535, P=0.000) and a high correlation with pulmonary vascular resistance (PVR; r=0.642, P=0.000). The mean level of NT-proBNP in PH was 1,716.09±1,498.30 pg/ml, which correlated with the septal angle (r=0.693, P=0.000). In a stepwise forward regression analysis, the Septal angle was entered into the final equation for predicting PVR, leading to the following equation: PVR = 28.256 × Septal angle - 728.72. In CTEPH, the Septal angle strongly correlated with NT-proBNP (r=0.668, P=0.000) and PVR (r=0.676, P=0.000). In PAH, the Septal angle strongly correlated with NT-proBNP (r=0.616, P=0.003) and PVR (r=0.623, P=0.000). The CTPA-derived Septal angle is a superior predictor for evaluating and monitoring the level of NT-proBNP and PVR in patients with PH. PMID:24255661

  19. Magnetic resonance angiography vs. angiography in tetralogy of Fallot.

    PubMed

    Rao, Uppalapati Venkateswara; Vanajakshamma, Velam; Rajasekhar, Durgaprasad; Lakshmi, Amancharla Yadagiri; Reddy, Reddivari Niranjan

    2013-08-01

    : To determine whether gadolinium-enhanced three-dimensional magnetic resonance angiography can provide a noninvasive alternative to diagnostic catheterization for evaluation of pulmonary artery anatomy in tetralogy of Fallot. Thirty-five consecutive patients with tetralogy of Fallot, who attended the cardiology outpatient department between January 2008 and December 2009, were included in the study. There were 21 males and 14 females, with a mean age of 9 ± 4.15 years (range, 3-21 years). Thirty-two patients had tetralogy of Fallot with varying severities of valvular and infundibular stenosis. Three patients had tetralogy of Fallot with pulmonary atresia. All patients underwent both cardiac catheterization with X-ray angiography and 3-dimensional magnetic resonance angiography within one month. Measurements of right and left pulmonary arteries and aortopulmonary collaterals were equal by both methods. There was a good correlation between magnetic resonance angiography and catheterization measurements of branch pulmonary arteries. Gadolinium-enhanced three-dimensional magnetic resonance angiography can be used as a reliable noninvasive alternative to X-ray cineangiography for delineation of pulmonary arterial anatomy in sick infants and young children, obviating the need for catheterization.

  20. Optical coherence tomography angiography and indocyanine green angiography for corneal vascularisation.

    PubMed

    Ang, Marcus; Cai, Yijun; MacPhee, Becky; Sim, Dawn A; Keane, Pearse A; Sng, Chelvin C A; Egan, Catherine A; Tufail, Adnan; Larkin, Daniel F; Wilkins, Mark R

    2016-11-01

    To describe an optical coherence tomography angiography (OCTA) system adapted for anterior segment imaging, compared with indocyanine green angiography (ICGA) in eyes with corneal vascularisation. Retrospective study of subjects with corneal vascularisation secondary to microbial keratitis who had OCTA scans performed using a commercially available split-spectrum amplitude-decorrelation algorithm angiography system (AngioVue; Optovue Inc., Fremont, California, USA) and ICGA images (Spectralis; Heidelberg Engineering, Heidelberg, Germany). The agreement between OCTA and ICGA techniques in terms of area of vascularisation measured, using Bland-Altman 95% limits of agreement (LOA). We compared the area of corneal vascularisation in 64 scan images (eight eyes, four scans for each angiography technique). In our series, the overall mean area of vascularisation from the ICGA scans was 0.49±0.34 mm(2) and OCTA scans was 0.51±0.36 mm(2). We obtained substantial repeatability in terms of image quality score (κ=0.80) for all OCTA scans. The agreement between OCTA and ICGA scans was good, although ICGA measured a smaller area compared with the OCTA with a mean difference of -0.03 mm(2) (95% CI -0.07 to 0.01). The LOA ranged from a lower limit of -0.27 (95% CI -0.34 to -0.19) to an upper limit of 0.20 (95% CI 0.13 to 0.28, p=0.127). We found that rapid, non-contact OCTA adapted for the cornea was comparable with ICGA for measurement of the area of corneal vascularisation in this pilot clinical study. Further prospective studies are required to confirm if this relatively new imaging technique may be further developed to replace invasive angiography techniques for the anterior segment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    PubMed Central

    dos Prazeres, Carlos Eduardo Elias; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro; Rochitte, Carlos Eduardo

    2013-01-01

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies. PMID:24145392

  2. Advances in non-invasive imaging of intracranial vascular disease.

    PubMed Central

    Jäger, H. R.; Grieve, J. P.

    2000-01-01

    Intra-arterial catheter angiography has, in the past, been the mainstay for the investigation of intracranial vascular disease. It is, however, invasive, usually requires in-patients admission, and is associated with a rate of neurological complications between 1% and 3%. In recent years, magnetic resonance angiography (MRA) and CT angiography (CTA) have emerged as non-invasive alternatives for imaging blood vessels and have made a significant impact on neuroradiological investigations. It is the purpose of this article to explain the basic technical principles of these two methods and to give an overview of their current clinical applications. PMID:10700757

  3. Noninvasive coronary artery angiography using electron beam computed tomography

    NASA Astrophysics Data System (ADS)

    Rumberger, John A.; Rensing, Benno J.; Reed, Judd E.; Ritman, Erik L.; Sheedy, Patrick F., II

    1996-04-01

    Electron beam computed tomography (EBCT), also known as ultrafast-CT or cine-CT, uses a unique scanning architecture which allows for multiple high spatial resolution electrocardiographic triggered images of the beating heart. A recent study has demonstrated the feasibility of qualitative comparisons between EBCT derived 3D coronary angiograms and invasive angiography. Stenoses of the proximal portions of the left anterior descending and right coronary arteries were readily identified, but description of atherosclerotic narrowing in the left circumflex artery (and distal epicardial disease) was not possible with any degree of confidence. Although these preliminary studies support the notion that this approach has potential, the images overall were suboptimal for clinical application as an adjunct to invasive angiography. Furthermore, these studies did not examine different methods of EBCT scan acquisition, tomographic slice thicknesses, extent of scan overlap, or other segmentation, thresholding, and interpolation algorithms. Our laboratory has initiated investigation of these aspects and limitations of EBCT coronary angiography. Specific areas of research include defining effects of cardiac orientation; defining the effects of tomographic slice thickness and intensity (gradient) versus positional (shaped based) interpolation; and defining applicability of imaging each of the major epicardial coronary arteries for quantitative definition of vessel size, cross-sectional area, taper, and discrete vessel narrowing.

  4. Computed tomography angiography in patients with active gastrointestinal bleeding*

    PubMed Central

    Reis, Fatima Regina Silva; Cardia, Patricia Prando; D'Ippolito, Giuseppe

    2015-01-01

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding. PMID:26811556

  5. Computed tomography angiography in patients with active gastrointestinal bleeding.

    PubMed

    Reis, Fatima Regina Silva; Cardia, Patricia Prando; D'Ippolito, Giuseppe

    2015-01-01

    Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding.

  6. OCT angiography in the mouse: A novel evaluation method for vascular pathologies of the mouse retina.

    PubMed

    Alnawaiseh, Maged; Rosentreter, André; Hillmann, Anja; Alex, Anne F; Niekämper, Daniel; Heiduschka, Peter; Pap, Thomas; Eter, Nicole

    2016-04-01

    To investigate the application of optical coherence tomography (OCT) angiography in the retinas of healthy mice and to evaluate choroidal neovascularization (CNV) in a mouse model of laser-induced CNV. C57BL/6J mice aged 18-25 weeks were examined using the spectral-domain optical coherence tomography device RTVue XR Avanti (Optovue, Inc, Fremont, California, USA). Blood flow in different retinal layers was detected using the split-spectrum amplitude-decorrelation angiography algorithm. Fluorescein angiography (FA) images were obtained using the Heidelberg Spectralis device (Heidelberg, Germany). Using the RTVue XR Avanti, we were able to obtain high-quality OCT angiography images of normal vasculature in the superficial, deep capillary and choriocapillary layers in laser-treated mice and untreated controls. Whereas no blood flow was detectable in the outer retina of untreated mice, blood flow and hence neovascular vessels were found in laser-treated mice. OCT angiography can clearly visualize the normal vascular plexus in the different retinal layers in the mouse retina and choroid. With OCT angiography, it is possible to verify the choroidal neovascularization induced by laser treatment. Thus, OCT angiography is a helpful imaging tool for non-invasive, in vivo evaluation of laser-induced CNV in the mouse. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Evolution of digital angiography systems.

    PubMed

    Brigida, Raffaela; Misciasci, Teresa; Martarelli, Fabiola; Gangitano, Guido; Ottaviani, Pierfrancesco; Rollo, Massimo; Marano, Pasquale

    2003-01-01

    The innovations introduced by digital subtraction angiography in digital radiography are briefly illustrated with the description of its components and functioning. The pros and cons of digital subtraction angiography are analyzed in light of present and future imaging technologies. In particular, among advantages there are: automatic exposure, digital image subtraction, digital post-processing, high number of images per second, possible changes in density and contrast. Among disadvantages there are: small round field of view, geometric distortion at the image periphery, high sensitivity to patient movements, not very high spatial resolution. At present, flat panel detectors represent the most suitable substitutes for digital subtraction angiography, with the introduction of novel solutions for those artifacts which for years have hindered its diagnostic validity. The concept of temporal artifact, reset light and possible future evolutions of this technology that may afford both diagnostic and protectionist advantages, are analyzed.

  8. Your Radiologist Explains Magnetic Resonance Angiography (MRA)

    MedlinePlus

    ... Sponsored by Image/Video Gallery Your Radiologist Explains Magnetic Resonance Angiography (MRA) Transcript Welcome to Radiology Info ... I’d like to talk with you about magnetic resonance angiography, or as it’s commonly known, MRA. ...

  9. Duplex ultrasound assessment of femorodistal grafts: correlation with angiography.

    PubMed

    McShane, M D; Gazzard, V M; Clifford, P C; Hacking, C N; Fairhurst, J J; Humphries, K N; Birch, S J; Webster, J H; Chant, A D

    1987-12-01

    Fifty-eight grafts have been assessed using duplex scanning and ankle brachial pressure indices. This assessment is compared with the findings by angiography. Eighteen grafts were occluded and 40 patent. Duplex scanning defined graft status with a greater accuracy than pressure indices. Pressure indices alone would not differentiate "satisfactory" grafts from those with localised, haemodynamically significant disease. Only 55% of those grafts with localised stenoses demonstrated a fall of greater than 0.2 in ankle brachial pressure index after exercise. When the information obtained using pressure indices and duplex scanning was combined non-invasive assessment had a sensitivity of 86% and specificity of 94% for detection of localised, haemodynamically significant disease in patent grafts. Haemodynamically significant disease, as defined by angiography, can be detected and localised with duplex scanning complementing the use of pressure indices in graft assessment.

  10. Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease

    PubMed Central

    Costa Filho, Francisco Flávio; Chaves, Áurea Jacob; Ligabó, Lourenço Teixeira; dos Santos, Eduardo Moreira; da Silva, Danillo Taiguara; Puzzi, Marcelo Aguiar; Braga, Sérgio Luiz; Abizaid, Alexandre; Sousa, Amanda GMR

    2015-01-01

    Background Guidelines recommend that in suspected stable coronary artery disease (CAD), a clinical (non-invasive) evaluation should be performed before coronary angiography. Objective We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD. Methods We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests. Results A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77), age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26), diabetes (OR, 2.01; CI 95%, 1.40 - 2.90), dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07), typical angina (OR, 2.92; CI 95%, 1.77 - 4.83) and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27). Conclusions In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography. PMID:26312552

  11. Accuracy of distance measurements in biplane angiography

    NASA Astrophysics Data System (ADS)

    Toennies, Klaus D.; Oishi, Satoru; Koster, David; Schroth, Gerhard

    1997-05-01

    Distance measurements of the vascular system of the brain can be derived from biplanar digital subtraction angiography (2p-DSA). The measurements are used for planning of minimal invasive surgical procedures. Our 90 degree-fixed-angle G- ring angiography system has the potential of acquiring pairs of such images with high geometric accuracy. The sizes of vessels and aneurysms are estimated applying a fast and accurate extraction method in order to select an appropriate surgical strategy. Distance computation from 2p-DSA is carried out in three steps. First, the boundary of the structure to be measured is detected based on zero-crossings and closeness to user-specified end points. Subsequently, the 3D location of the center of the structure is computed from the centers of gravity of its two projections. This location is used to reverse the magnification factor caused by the cone-shaped projection of the x-rays. Since exact measurements of possibly very small structures are crucial to the usefulness in surgical planning, we identified mechanical and computational influences on the geometry which may have an impact on the measurement accuracy. A study with phantoms is presented distinguishing between the different effects and enabling the computation of an optimal overall exactness. Comparing this optimum with results of distance measurements on phantoms whose exact size and shape is known, we found, that the measurement error for structures of size of 20 mm was less than 0.05 mm on average and 0.50 mm at maximum. The maximum achievable accuracy of 0.15 mm was in most cases exceeded by less than 0.15 mm. This accuracy surpasses by far the requirements for the above mentioned surgery application. The mechanic accuracy of the fixed-angle biplanar system meets the requirements for computing a 3D reconstruction of the small vessels of the brain. It also indicates, that simple measurements will be possible on systems being less accurate.

  12. Mechanical aspects of CO₂ angiography.

    PubMed

    Corazza, Ivan; Rossi, Pier Luca; Feliciani, Giacomo; Pisani, Luca; Zannoli, Sebastiano; Zannoli, Romano

    2013-01-01

    The aim of this paper is to clarify some physical-mechanical aspects involved in the carbon dioxide angiography procedure (CO₂ angiography), with a particular attention to a possible damage of the vascular wall. CO₂ angiography is widely used on patients with iodine intolerance. The injection of a gaseous element, in most cases manually performed, requires a long training period. Automatic systems allow better control of the injection and the study of the mechanical behaviour of the gas. CO₂ injections have been studied by using manual and automatic systems. Pressures, flows and jet shapes have been monitored by using a cardiovascular mock. Photographic images of liquid and gaseous jet have been recorded in different conditions, and the vascular pressure rises during injection have been monitored. The shape of the liquid jet during the catheter washing phase is straight in the catheter direction and there is no jet during gas injection. Gas bubbles are suddenly formed at the catheter's hole and move upwards: buoyancy is the only governing phenomenon and no bubbles fragmentation is detected. The pressure rise in the vessel depends on the injection pressure and volume and in some cases of manual injection it may double the basal vascular pressure values. CO₂ angiography is a powerful and safe procedure which diffusion will certainly increase, although some aspects related to gas injection and chamber filling are not jet well known. The use of an automatic system permits better results, shorter training period and limitation of vascular wall damage risk.

  13. Angiography by Synchrotron Radiation

    NASA Astrophysics Data System (ADS)

    Rubenstein, E.; Brown, G. S.; Giacomini, J. C.; Gordon, H. J.; Hofstadter, R.; Kernoff, R. S.; Otis, J. N.; Thomlinson, W.; Thompson, A. C.; Zeman, H. D.

    1987-01-01

    Because coronary disease represents the principal health problem in the Western, industrialized world, and because of the risks and costs associated with conventional methods of visualizing the coronary arteries, an effort has been underway at the Stanford Synchrotron Radiation Laboratory to develop a less invasive coronary imaging procedure based on iodine K-edge dichromography. A pair of line images, recorded within a few milliseconds of each other, is taken with two monochromatic X-ray beams whose energy closely brackets the K-edge of iodine, 33.17 keV. The logarithmic subtraction of the images produced by these beams results in an image which greatly enhances signals arising from attenuation by iodine and almost totally suppresses signals arising from attenuation by soft tissue and bone. The high sensitivity to iodine allows the visualization of arterial structures after an intravenous injection of contrast agent and its subsequent 20-30 fold dilution. The experiments began in 1979, with initial studies done on phantoms and excised pig hearts. The first images of anesthetized dogs were taken in 1982. The results of experiments on dogs will be reviewed, showing the stepwise evolution of the imaging system, leading to the use of the system on human subjects in 1986. The images recorded on human subjects will be described and the remaining problems discussed.

  14. Coronary computed tomographic angiography: current and future uses

    PubMed Central

    Kantor, Birgit; Kuzo, Ronald S.; Gerber, Thomas C.

    2009-01-01

    Coronary computed tomographic angiography (CCTA) is a direct but minimally invasive method of visualizing coronary arteries. Acceptable indications for this technique include the assessment of suspected or known coronary artery anomalies, the evaluation of chest pain syndromes in patients with non diagnostic stress tests or who are unable to exercise, and exclusion of an ischemic etiology in patients with unexplained left ventricular dysfunction. Assessment of coronary stents with a diameter of <3.0 mm and imaging of asymptomatic patients with a goal of establishing prognosis are currently not accepted indications for CCTA. PMID:20011235

  15. Ruling out coronary artery disease with noninvasive coronary multidetector CT angiography before noncoronary cardiovascular surgery.

    PubMed

    Catalán, Paz; Leta, Rubén; Hidalgo, Alberto; Montiel, José; Alomar, Xavier; Viladés, David; Barros, Antonio; Pujadas, Sandra; Carreras, Francesc; Padró, Josep M; Cinca, Juan; Pons-Lladó, Guillem

    2011-02-01

    To assess the usefulness of preoperative coronary computed tomographic (CT) angiography in the detection of coronary artery disease (CAD) in nonselected patients scheduled to undergo noncoronary cardiovascular surgery to avoid unnecessary invasive coronary angiography (ICA). The institutional review board approved the study protocol; informed consent was given. This prospective study involved 161 consecutive patients who underwent coronary calcium scoring and coronary CT angiography before undergoing noncoronary cardiovascular surgery. Seven patients were excluded because of contraindications to CT angiography. The major indication of noncoronary cardiovascular surgery was valvular heart disease (121 patients). Follow-up was performed at a median of 20 months to define ischemic events described as acute coronary syndrome or death secondary to acute coronary syndrome, arrhythmias, or cardiac failure. Multivariate analysis was performed to determine predictors of nondiagnostic coronary CT angiography. Kaplan-Meier analysis was performed to evaluate outcome at follow-up. Twenty-one patients did not undergo surgery, which left 133 patients as the study group. Atrial fibrillation was present in 45 of 133 patients. The interquartile range of the Agatston coronary calcium score was 0-471. Coronary CT angiography was diagnostic in 108 of 133 patients. Of these, 93 of 108 had no significant CAD (≤ 50% stenosis), and noncoronary cardiovascular surgery was performed in them without preoperative ICA. No patients in this group had postoperative ischemic events at follow-up. Coronary CT angiography was nondiagnostic in 25 of 133 patients who were referred for preoperative ICA. Multivariate analysis showed Agatston score to be the only independent predictor of nondiagnostic coronary CT angiography (odds ratio = 1.002; 95% confidence interval: 1.001, 1.003; P = .001). The best Agatston score cutoff for diagnostic coronary CT angiography was 579. In nonselected patients scheduled

  16. From the RSNA refresher courses: CT angiography: clinical applications in the abdomen.

    PubMed

    Fishman, E K

    2001-10-01

    The development of spiral computed tomography (CT) and subsequently multidetector CT has provided unparalleled opportunities for advancement of CT technology and clinical applications. One of the most influential developments has been CT angiography, which is the use of thin-section CT combined with postprocessing of imaging data by using a variety of three-dimensional reconstruction techniques to produce vascular maps that equal or exceed those provided by classic angiography in many applications. In the evaluation of pancreatic disease, the use of multidetector CT angiography enables the radiologist to produce vascular maps that clearly show tumor invasion of vasculature and the relationship of vessels to pancreatic masses. Anatomic areas for which the three-dimensional display is especially helpful include the confluence of the portal vein and the superior mesenteric vein and the more distal portions of the portal vein. Preliminary studies indicate that CT angiography may prove beneficial in the evaluation of ischemic bowel and active Crohn disease. CT angiography has proved extremely valuable for applications such as preoperative planning for hepatic resection, preoperative evaluation and planning for liver transplantation, pretreatment planning for patients considered for hepatic arterial infusion chemotherapy, and pretreatment evaluation of portal vein patency for a variety of reasons. CT angiography can also provide supplemental information in patients with cirrhosis, upper gastrointestinal tract bleeding due to varices, or primary extrahepatic neoplasms.

  17. Angiography of nonneoplastic retroperitoneal masses

    SciTech Connect

    Lois, J.F.; Levin, D.C.; Hooshmand, I.

    1982-01-01

    Although noninvasive imaging modalities can be used to initially detect retroperitoneal masses, angiography is still desirable for several reasons in those cases in which surgery is contemplated. The latter can forewarn the surgeon as to possible hemorrhagic complications in highly vascular lesions. In some cases it can predict the malignant potential of the lesion. Finally, since these masses may derive blood supply from multiple sources, a vascular ''road map'' is provided to the surgeon. The angiographic findings of malignant retroperitoneal tumors are well known, but very little has been published dealing with benign nonneoplastic retroperitoneal masses. We have performed angiography in 11 surgically proven nonneoplastic retroperitoneal masses (9 inflammatory lesions, 2 hematomas). Major arterial or renal displacement occurred in 10. The 2 hematomas and 3 inflammatory lesions were totally avascular; 6 of the 9 inflammatory lesions revealed fine neovascularity and 5 of these 6 had an associated capillary blush. Sources of vascular supply included the lumbar, renal capsular, superior mesenteric, and gastroduodenal arteries. Although angiography is helpful in preoperative evaluation of retroperitoneal masses for the aforementioned reasons, it may be difficult or impossible to differentiate benign from malignant lesions based on the angiographic findings alone.

  18. Technical principles of MR angiography methods.

    PubMed

    Ivancevic, Marko K; Geerts, Liesbeth; Weadock, William J; Chenevert, Thomas L

    2009-02-01

    Magnetic resonance provides a wide variety of possibilities for arterial and venous blood vessel imaging in all vascular territories. This article provides a brief review of the technical principles of MR angiography. The first section is dedicated to non-contrast-enhanced angiography techniques and includes several distinct approaches: time-of-flight, phase contrast, triggered angiography non-contrast-enhanced, and balanced steady-state free precession. The second section relates to the contrast-enhanced and time-resolved contrast-enhanced MR angiography methods. The latest technical developments in MR imaging hardware, sequences and software, coil technology, and reconstruction capability allow dynamic MR angiography performance similar to CT angiography, without risks of iodine contrast agent and ionizing radiation exposure.

  19. Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease

    PubMed Central

    Williams, Michelle C.; Hunter, Amanda; Shah, Anoop S.V.; Assi, Valentina; Lewis, Stephanie; Smith, Joel; Berry, Colin; Boon, Nicholas A.; Clark, Elizabeth; Flather, Marcus; Forbes, John; McLean, Scott; Roditi, Giles; van Beek, Edwin J.R.; Timmis, Adam D.; Newby, David E.

    2016-01-01

    Background In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). Objectives The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. Methods In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. Results Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95% CI: $303 to $621). Conclusions In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590) PMID:27081014

  20. Radiation dose measurements in coronary CT angiography

    PubMed Central

    Sabarudin, Akmal; Sun, Zhonghua

    2013-01-01

    Coronary computed tomography (CT) angiography is associated with high radiation dose and this has raised serious concerns in the literature. Awareness of various parameters for dose estimates and measurements of coronary CT angiography plays an important role in increasing our understanding of the radiation exposure to patients, thus, contributing to the implementation of dose-saving strategies. This article provides an overview of the radiation dose quantity and its measurement during coronary CT angiography procedures. PMID:24392190

  1. Quality of life after acute myocardial infarction among patients treated at sites with and without on-site availability of angiography.

    PubMed

    Pilote, Louise; Lauzon, Claude; Huynh, Thao; Dion, Danielle; Roux, René; Racine, Normand; Carignan, Suzanne; Diodati, Jean G; Lévesque, Claude; Charbonneau, François; Pouliot, Joël; Joseph, Lawrence; Eisenberg, Mark J

    2002-03-11

    Previous studies have compared the treatment and outcome of patients with acute myocardial infarction (AMI) admitted at sites with and without availability of angiography. Although mortality rates do not differ, it is unknown if quality of life (QOL) and functional status differ. We measured QOL and functional status in patients with AMI treated within Québec at 5 sites with (n = 253) and 5 sites without (n = 334) angiography. At admission, clinical characteristics, complication rates, and baseline measures of QOL and functional status were similar at sites with and without angiography. During hospitalization, patients treated at sites with angiography were more likely to undergo an invasive cardiac procedure than patients admitted at sites without angiography (angiography, 63% vs 26%; percutaneous transluminal coronary angioplasty, 33% vs 13%; and coronary artery bypass graft, 12% vs 5%). At 30 days and 6 months after AMI, QOL was slightly superior at sites with angiography, but by 1 year, most measures of QOL were back to baseline at both types of sites and were similar between the 2 groups. At 6 months, most standard health-related QOL components were similar; only physical and emotional role limitations were higher at sites with angiography. Return to work occurred earlier (at 30 days, 23% vs 12%), and a lower proportion of patients was readmitted for angina (within 1 year after AMI, 12% vs 18%) at sites with angiography. In the early post-AMI period, the QOL of patients admitted at sites with angiography was higher than that of patients admitted at sites without angiography. However, by 1 year, the QOL and functional status of patients was similar in both groups. Differences in QOL were greatest when differences in treatment were greatest, lending support to a positive albeit small association between an early invasive approach to post-AMI care and improved QOL.

  2. Radionuclide angiography: as diagnostic method for Wilms' tumor with direct extension into the heart.

    PubMed

    Avila Ramírez, E; Martínez Guerra, G

    1982-01-01

    Radioisotope angiography may be used as an initial study in Wilms' tumor. We report a patient who had a total nephrectomy but then had severe cardiovascular complications. These led to open heart surgery and removal of a tumor lodged in the right atrium. Radioisotope angiography, performed two weeks earlier, showed a "cold" image on the anterior wall of the right ventricle. This finding was later confirmed by other studies and finally at the time of a second operation. The purpose of this paper is to discuss the different methods employed in this case, to emphasize the risks attributed to each, and finally to suggest the use of non-invasive studies such as radioisotope angiography as a practical method of study in infancy.

  3. Digital subtraction angiography in children

    SciTech Connect

    Wagner, M.L.; Singleton, E.B.; Egan, M.E.

    1983-01-01

    Preliminary results with digital subtraction angiography in infants and children have shown this to be an excellent screening procedure and often diagnostic. The examination can be performed satisfactorily on outpatients. Sixty patients have undergone this examination for evaluation of suspected abnormalities of the aortic arch and its branches, intracranial arteries, pulmonary arteries, abdominal aorta and its branches, and peripheral vessels. Adequate sedation is mandatory to prevent motion artifacts. While the literature reports increasing use of central venous catheters for delivery of contrast material, the use of short catheters placed in an antecubital vein is satisfactory for the pediatric patient. Techniques of the procedures are described along with seven appropriate case examples.

  4. OCT Angiography Compared to Fluorescein and Indocyanine Green Angiography in Chronic Central Serous Chorioretinopathy.

    PubMed

    Teussink, Michel M; Breukink, Myrte B; van Grinsven, Mark J J P; Hoyng, Carel B; Klevering, B Jeroen; Boon, Camiel J F; de Jong, Eiko K; Theelen, Thomas

    2015-08-01

    Abnormal choroidal blood flow is considered important in the pathogenesis of chronic central serous chorioretinopathy (CSC). Optical coherence tomography (OCT) angiography can image ocular blood cell flow and could thus provide novel insights in disease mechanisms of CSC. We evaluated depth-resolved flow in chronic CSC by OCT angiography compared to fluorescein angiography (FA) and indocyanine green angiography (ICGA). Eighteen eyes with chronic CSC, and six healthy controls, were included. Two human observers annotated areas of staining, hypofluorescence, and hotspots on FA and ICGA, and areas of abnormal flow on OCT angiography. Interobserver agreement in annotating OCT angiography and FA/ICGA was measured by Jaccard indices (JIs). We assessed colocation of flow abnormalities and subretinal fluid visible on OCT, and the distance between hotspots on ICGA from flow abnormalities. Abnormal areas were most frequently annotated in late-phase ICGA and choriocapillary OCT angiography, with moderately high (median JI, 0.74) and moderate (median JI, 0.52) interobserver agreement, respectively. Abnormalities on late-phase ICGA and FA colocated with those on OCT angiography. Aberrant choriocapillary OCT angiography presented as foci of reduced flow surrounded by hyperperfused areas. Hotspots on ICGA were located near hypoperfused spots on OCT angiography (mean distance, 168 μm). Areas with current or former subretinal fluid were colocated with flow abnormalities. On OCT angiography, chronic CSC showed irregular choriocapillary flow patterns, corresponding to ICGA abnormalities. These results suggest focal choriocapillary ischemia with surrounding hyperperfusion that may lead to subretinal fluid leakage.

  5. Indocyanine green fluorescence angiography of the choroid.

    PubMed Central

    Craandijk, A; Van Beek, C A

    1976-01-01

    Indocyanine green fluorescence (ICG) angiography of the choroid gives better visualization of the choroidal vessels than does fluorescein angiography. We found that the detachment of the pigment epithelium seems bigger on ICG than on fluorescein angiograms, and pigmented lesions are more clearly delineated. Images PMID:952809

  6. Doppler Fourier Domain Optical Coherence Tomography for Label-Free Tissue Angiography

    NASA Astrophysics Data System (ADS)

    Leitgeb, Rainer A.; Szkulmowski, Maciej; Blatter, Cedric; Wojtkowski, Maciej

    Information about tissue perfusion and the vascular structure is certainly most important for assessment of tissue state or personal health and the diagnosis of any pathological conditions. It is therefore of key medical interest to have tools available for both quantitative blood flow assessment as well as qualitative vascular imaging. The strength of optical techniques is the unprecedented level of detail even for small capillary structures or microaneurysms and the possibility to combine different techniques for additional tissue spectroscopy giving insight into tissue metabolism. There is an immediate diagnostic and pharmacological demand for high-resolution, label-free, tissue angiography and flow assessment that in addition allow for precise depth gating of flow information. The most promising candidate is Doppler optical coherence tomography (DOCT) being noncontact, label free, and without employing hazardous radiation. DOCT provides fully quantitative volumetric information about blood flow together with the vascular and structural anatomy. Besides flow quantification, analysis of OCT signal fluctuations allows to contrast moving scatterers in tissue such as red blood cells from static tissue. This allows for non-invasive optical angiography and yields high resolution even for smallest capillaries. Because of the huge potential of DOCT and lable-free optical angiography for diagnosis, the last years saw a rapid increase of publications in this field with many different approaches. The present chapter gives an overview over existing Doppler OCT approaches and angiography techniques. It furthermore discusses limitations and noise issues, and gives examples for angiography in the eye and the skin.

  7. Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death.

    PubMed

    Ross, Steffen G; Bolliger, Stephan A; Ampanozi, Garyfalia; Oesterhelweg, Lars; Thali, Michael J; Flach, Patricia M

    2014-01-01

    Whole-body postmortem computed tomographic (CT) angiography is a promising new development in forensic radiology that has the potential to improve vascular and soft-tissue imaging beyond levels currently achievable with unenhanced postmortem CT. Postmortem access to the vascular system and injection of contrast medium are different from those steps in clinical (antemortem) radiology. Because there is no circulation in a corpse that could transport or dilute a contrast medium, the injection must be performed by using a roller pump to fill the vasculature (arterial and venous) with a mixture of a water-soluble iodized contrast medium and polyethylene glycol. In contrast to a classic autopsy, postmortem CT angiography is a minimally invasive procedure. It allows the diagnosis of vascular lesions without the disruption or destruction of anatomic structures, which could result in a loss of evidence in a criminal investigation. Furthermore, postmortem CT angiography facilitates the display of vascular pathologic conditions in areas that are not typically covered with autopsy alone, such as the craniocervical junction and the small pelvis. Therefore, postmortem CT angiography adds substantial value to the classic forensic autopsy; cross-sectional data can be reevaluated objectively at any time and are fully reproducible as counterexpertise, which is as useful in the fields of forensic medicine and pathology as in clinical research. Familiarity with the capabilities of postmortem CT angiography may help radiologists working with forensic cases improve their diagnostic performance. RSNA, 2014

  8. Benefit of second catheter angiography in patients with nontraumatic subarachnoidal hemorrhage.

    PubMed

    Ringelstein, A; Mueller, O; Goericke, S L; Moenninghoff, C; Sure, U; Wanke, I; Forsting, M; Schlamann, M

    2015-03-01

    This study aimed to determine the yield of repetitive catheter angiography (digital subtraction angiography (DSA)) for the detection of causative vascular lesions in patients with nontraumatic subarachnoidal hemorrhage (SAH) and negative initial DSA. We hypothesize that a second DSA might be helpful to detect an initially occult bleeding source. We retrospectively evaluated 649 patients with acute SAH and invasive catheter angiographies between 2004 and 2012. In 90 SAH patients initial imaging was negative concerning a causative bleeding source. A total of 113 repetitive DSA were performed. Two neuroradiologists reanalyzed the initial imaging and the result of the reangiography independently. In 4/90 patients (4.5 %) bleeding source was first detected in the second or third DSA. In all other patients, no causative vascular lesion was found. Reasons for the initially false negative diagnostics were one dissecting aneurysm and thrombosis of three aneurysms within the acute phase of SAH. Repetitive DSA revealed the cause of SAH in 4.5 % of the cases. These findings have a therapeutic and prognostic impact. We think that at least a second DSA should be part of diagnostic work-up in patients with SAH and missing bleeding source, even considering the risk of an additional invasive angiography itself.

  9. Comparison of coronary artery lesion length by NIRS-IVUS versus angiography alone.

    PubMed

    Hanson, Ivan D; Goldstein, James A; Dixon, Simon R; Stone, Gregg W

    2015-09-01

    Intravascular ultrasound (IVUS) studies analyzing target lesion plaque burden (PB) have established that invasive coronary angiography commonly underestimates lesion length, predisposing to 'geographic miss' during a percutaneous coronary intervention, which has been associated with adverse outcomes. Plaque composition may also influence stent outcome. The present study used near-infrared spectroscopy and IVUS (NIRS-IVUS) to assess the prevalence of PB and lipid-core plaque (LCP) extending beyond angiographic borders of target lesions. Fifty-eight patients (58 lesions) undergoing NIRS-IVUS were identified. By invasive coronary angiography, target lesion length and minimum lumen diameter were measured. Plaque, defined as NIRS-IVUS atheroma (either PB>40% or LCP), was identified adjacent to the angiographic-defined lesion margins. By NIRS-IVUS, atheroma (either PB>40% or LCP) was identified beyond angiographic lesion margins in 52/58 (90%) lesions. The mean lesion length was 13.4±5.9 mm by angiography and 19.8±7.0 mm (P<0.0001) by NIRS-IVUS. LCP extending beyond the angiographic border was observed in 30/58 (52%) lesions. NIRS-IVUS imaging shows that target lesion length is commonly underestimated by angiography alone. This finding may have implications for stent length selection and avoidance of geographic miss.

  10. Diagnostic Performance of Self-navigated Whole-Heart Contrast-enhanced Coronary 3-T MR Angiography.

    PubMed

    He, Yi; Pang, Jianing; Dai, Qinyi; Fan, Zhanming; An, Jing; Li, Debiao

    2016-11-01

    Purpose To evaluate the diagnostic performance of self-navigated whole-heart coronary 3-T magnetic resonance (MR) angiography by using conventional invasive coronary angiography (ICA) as the reference gold standard. Materials and Methods This study was approved by the local ethics committee. Written informed consent was obtained from each patient before the study. Thirty-nine consecutive patients underwent coronary MR angiography and later underwent ICA. Coronary MR angiography was performed with a 3-T imager with contrast agent enhancement during free breathing with self-navigated affine motion correction reconstruction. Coronary segments with reference diameters larger than 1.5 mm were included in the comparison between coronary MR angiography and ICA. The coronary MR angiography images were evaluated by two experienced readers blinded to the ICA results to identify significant luminal narrowing (>50% diameter reduction in reference ICA). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were performed to detect significant coronary artery stenosis. Results Coronary MR angiography examinations were successfully performed in all 39 patients. A total of 327 coronary segments had reference luminal diameter larger than 1.5 mm. Of these 327 coronary segments, 303 (92.7%) segments had a quality score greater than 1 at coronary MR angiography and were included in the analysis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 78.2%, 75.0%, 81.8%, 70.6%, and 76.9%, respectively, on a per-patient basis. Conclusion Contrast-enhanced self-navigated coronary 3-T MR angiography is a promising technique for the noninvasive detection of clinically significant coronary stenosis. (©) RSNA, 2016.

  11. Investigating Invasives

    ERIC Educational Resources Information Center

    Lightbody, Mary

    2008-01-01

    Invasive species, commonly known as "invasives," are nonnative plants, animals, and microbes that completely take over and change an established ecosystem. The consequences of invasives' spread are significant. In fact, many of the species that appear on the Endangered Species list are threatened by invasives. Therefore, the topic of invasive…

  12. Investigating Invasives

    ERIC Educational Resources Information Center

    Lightbody, Mary

    2008-01-01

    Invasive species, commonly known as "invasives," are nonnative plants, animals, and microbes that completely take over and change an established ecosystem. The consequences of invasives' spread are significant. In fact, many of the species that appear on the Endangered Species list are threatened by invasives. Therefore, the topic of invasive…

  13. Diagnostic accuracy of noninvasive coronary angiography with 320-detector row computed tomography.

    PubMed

    Nasis, Arthur; Leung, Michael C; Antonis, Paul R; Cameron, James D; Lehman, Sam J; Hope, Sarah A; Crossett, Marcus P; Troupis, John M; Meredith, Ian T; Seneviratne, Sujith K

    2010-11-15

    We sought to evaluate the diagnostic accuracy of noninvasive coronary angiography using 320-detector row computed tomography, which provides 16-cm craniocaudal coverage in 350 ms and can image the entire coronary tree in a single heartbeat, representing a significant advance from previous-generation scanners. We evaluated 63 consecutive patients who underwent 320-detector row computed tomography and invasive coronary angiography for the investigation of suspected coronary artery disease. Patients with known coronary artery disease were excluded. Computed tomographic (CT) studies were assessed by 2 independent observers blinded to results of invasive coronary angiography. A single observer unaware of CT results assessed invasive coronary angiographic images quantitatively. All available coronary segments were included in the analysis, regardless of size or image quality. Lesions with >50% diameter stenoses were considered significant. Mean heart rate was 63 ± 7 beats/min, with 6 patients (10%) in atrial fibrillation during image acquisition. Thirty-three patients (52%) and 70 of 973 segments (7%) had significant coronary stenoses on invasive coronary angiogram. Seventeen segments (2%) were nondiagnostic on computed tomogram and were assumed to contain significant stenoses on an "intention-to-diagnose" analysis. Sensitivity, specificity, and positive and negative predictive values of computed tomography for detecting significant stenoses were 94%, 87%, 88%, and 93%, respectively, by patient (n = 63), 89%, 95%, 82%, and 97%, respectively, by artery (n = 260), and 87%, 97%, 73%, and 99%, respectively, by segment (n = 973). In conclusion, noninvasive 320-detector row CT coronary angiography provides high diagnostic accuracy across all coronary segments, regardless of size, cardiac rhythm, or image quality.

  14. "Geyser" leakage on fluorescein angiography.

    PubMed

    Levy, Jaime; Fagan, Xavier J; Lifshitz, Tova; Schneck, Marina

    2013-11-22

    An 82-year-old patient with diabetes was followed up due to moderate nonproliferative diabetic retinopathy with macular edema in the right eye. Visual acuity was 6/36. Focal macular laser was conducted (A). Three years later, the patient presented with blurry vision in the right eye. Visual acuity was 3/60. Vitreous hemorrhage was observed (B), and neovascularization of the disc was suspected (C). Fluorescein angiography (D, mid venous phase; E-F, recirculation phase) confirmed neovascularization of the disc and depicted a striking vertical leakage. Panretinal photocoagulation was started. Possible explanations for the "geyser" leakage may be either a partial posterior vitreous detachment allowing the fluorescein to track upwards but not elsewhere or a pocket of syneretic vitreous allowing the fluorescein passage in which to diffuse, much like the passage the blood would have taken.

  15. Digital subtraction angiography of the heart and lungs

    SciTech Connect

    Moodie, D.S.; Yiannikas, J.

    1986-01-01

    This book contains 12 chapters. Some of the chapter titles are: Physical Principles of Cardiac Digital Subtraction Angiography, The Use of Intravenous Digital Subtraction Angiography in Evaluating Patients with Complex Congenital Heart Disease, Exercise Intravenous Digital Subtraction Angiograpny, Cardiomyopathic and Cardiac Neoplastic Disease, Digital Subtraction Angiography in the Catheterization Laboratory, and Cardiac Digital Subtraction Angiography - Future Directions.

  16. Renal angiography with iohexol and metrizoate

    SciTech Connect

    Toernquist, C.; Holtaes, S.

    1984-02-01

    The nephrotoxicity of the ionic contrast medium metrizoate was compared with that of nonionic iohexol when used for renal angiography. Fifteen patients who underwent renal angiography with metrizoate and 15 with iohexol were studied. Serum creatinine level, Cr-51-EDTA clearance, and urine albumin level were recorded before and after angiography. Metrizoate affected renal function, as indicated both by a transient decrease in glomerular filtration rate and by a transient albuminuria. Renal function was unaffected by iohexol. Furthermore, iohexol produced less subjective discomfort than metrizoate. There appeared to be no difference in the quality of the angiograms obtained with the two media.

  17. Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings.

    PubMed

    Artigas, José M; Martí, Milagros; Soto, Jorge A; Esteban, Helena; Pinilla, Inmaculada; Guillén, Eugenia

    2013-01-01

    Acute gastrointestinal bleeding is a common reason for emergency department admissions and an important cause of morbidity and mortality. Factors that complicate its clinical management include patient debility due to comorbidities; intermittence of hemorrhage; and multiple sites of simultaneous bleeding. Its management, therefore, must be multidisciplinary and include emergency physicians, gastroenterologists, and surgeons, as well as radiologists for diagnostic imaging and interventional therapy. Upper gastrointestinal tract bleeding is usually managed endoscopically, with radiologic intervention reserved as an alternative to be used if endoscopic therapy fails. Endoscopy is often less successful in the management of acute lower gastrointestinal tract bleeding, where colonoscopy may be more effective. The merits of performing bowel cleansing before colonoscopy in such cases might be offset by the resultant increase in response time and should be weighed carefully against the deficits in visualization and diagnostic accuracy that would result from performing colonoscopy without bowel preparation. In recent years, multidetector computed tomographic (CT) angiography has gained acceptance as a first-line option for the diagnosis and management of lower gastrointestinal tract bleeding. In selected cases of upper gastrointestinal tract bleeding, CT angiography also provides accurate information about the presence or absence of active bleeding, its source, and its cause. This information helps shorten the total diagnostic time and minimizes or eliminates the need for more expensive and more invasive procedures. © RSNA, 2013.

  18. Optical Coherence Tomography Angiography of Iris Nevus: A Case Report

    PubMed Central

    Allegrini, Davide; Montesano, Giovanni; Pece, Alfredo

    2016-01-01

    Iris nevus is common: 6% of patients with suspected iris melanoma have lesions other than melanoma, and 36% of them are nevi. Iris nevus turns into melanoma in approximately 8% of cases at a mean of 15 years. This case report provides the first description of an iris tumor examined with iris optical coherence tomography angiography (OCTA) compared to iris fluorescein angiography (IFA). A 60-year-old man with a diagnosis of iris nevus in the left eye was referred to our department for IFA and iris OCTA. The iris vasculature in IFA was visible only in the early phases, but not clearly. OCTA, however, gave visualization of the vascular network and very precisely defined the vessels of the whole lesion, except for the pupillary portion, which was masked by superficial pigment accumulations. IFA and iris OCTA can add information about the vascular architecture compared to slit-lamp biomicroscopy, ultrasound biomicroscopy, and anterior-segment OCT. However, IFA is time-consuming and invasive and can – very occasionally – cause serious adverse reactions. In contrast, OCTA defines the texture of the iris vasculature better. In conclusion, OCTA is a new method, easy to execute, needing no dye injection, and provides useful information on the vascular network of iris lesions. It could therefore be helpful in the diagnosis and follow-up of these lesions. PMID:27790134

  19. [Placental 3D Doppler angiography: current and upcoming applications].

    PubMed

    Duan, J; Perdriolle-Galet, E; Chabot-Lecoanet, A-C; Callec, R; Beaumont, M; Chavatte-Palmer, P; Tsatsaris, V; Morel, O

    2015-02-01

    The placental dysfunction, which seems to be caused by a defect of trophoblastic invasion and impaired uterine vascular remodeling since the first trimester, is responsible in a non-exclusive way for the chronic placental hypoxia, resulting secondarily in the intra-uterine growth restriction (IUGR) and/or pre-eclampsia (PE). The quality of utero-placental vasculature is essential for a proper fetal development and a successful progress of pregnancy. However, the in vivo assessment of placental vascularization with non-invasive methods is complicated by the small size of placental terminal vessel and its complex architecture. Moreover, imaging with contrast agent is not recommended to pregnant women. Until recently, the fetal and maternal vascularization could only be evaluated through pulse Doppler of uterine arteries during pregnancy, which has little clinical value for utero-placental vascularization defects assessment. Recently, a non-invasive study, without use of contrast agent for vasculature evaluation of an organ of interest has become possible by the development of 3D Doppler angiography technique. The objective of this review was to make an inventory of its current and future applications for utero-placental vasculature quantification. The main findings of the literature on the assessment of utero-placental vascularization in physiological situation and major placental vascular dysfunction pathologies such as PE and IUGR were widely discussed.

  20. Whole body postmortem magnetic resonance angiography.

    PubMed

    Ruder, Thomas D; Hatch, Gary M; Ebert, Lars C; Flach, Patricia M; Ross, Steffen; Ampanozi, Garyfalia; Thali, Michael J

    2012-05-01

      Computed tomography (CT) and magnetic resonance (MR) imaging have become important elements of forensic radiology. Whereas the feasibility and potential of CT angiography have long been explored, postmortem MR angiography (PMMRA) has so far been neglected. We tested the feasibility of PMMRA on four adult human cadavers. Technical quality of PMMRA was assessed relative to postmortem CT angiography (PMCTA), separately for each body region. Intra-aortic contrast volumes were calculated on PMCTA and PMMRA with segmentation software. The results showed that technical quality of PMMRA images was equal to PMCTA in 4/4 cases for the head, the heart, and the chest, and in 3/4 cases for the abdomen, and the pelvis. There was a mean decrease in intra-aortic contrast volume from PMCTA to PMMRA of 46%. PMMRA is technically feasible and allows combining the soft tissue detail provided by MR and the information afforded by angiography. © 2011 American Academy of Forensic Sciences.

  1. Digital Subtraction Angiography In Peripheral Vascular Disease

    NASA Astrophysics Data System (ADS)

    Stieghorst, Michael F.; Crummy, Andrew B.; Lieberman, Robert P.; Turnipseed, William D.; Detmer, Donald E.; Berkoff, Herbert A.

    1981-11-01

    Digital subtraction angiography (DSA) has considerable utility in the evaluation of peripheral vascular disease. It is useful in screening selected patients for vascular disease and its relative ease of performance and good patient tolerance make it ideal for serial examinations of post operative patients. When used in conjunction with intra arterial injections, the technique may show "run-off" vessels which were not demonstrated by standard angiography. This paper presents our experience using DSA to image peripheral vascular problems.

  2. Invasive Candidiasis

    MedlinePlus

    ... Invasive candidiasis is an infection caused by a yeast (a type of fungus) called Candida . Unlike Candida ... mouth and throat (also called “thrush”) or vaginal “yeast infections,” invasive candidiasis is a serious infection that ...

  3. Invasive Species

    EPA Pesticide Factsheets

    Invasive species have significantly changed the Great Lakes ecosystem. An invasive species is a plant or animal that is not native to an ecosystem, and whose introduction is likely to cause economic, human health, or environmental damage.

  4. Incremental Value of Adenosine-induced Stress Myocardial Perfusion Imaging with Dual-Source CT at Cardiac CT Angiography1

    PubMed Central

    Rocha-Filho, Jose A.; Blankstein, Ron; Shturman, Leonid D.; Bezerra, Hiram G.; Okada, David R.; Rogers, Ian S.; Ghoshhajra, Brian; Hoffmann, Udo; Feuchtner, Gudrun; Mamuya, Wilfred S.; Brady, Thomas J.

    2010-01-01

    Purpose: First, to assess the feasibility of a protocol involving stress-induced perfusion evaluated at computed tomography (CT) combined with cardiac CT angiography in a single examination and second, to assess the incremental value of perfusion imaging over cardiac CT angiography in a dual-source technique for the detection of obstructive coronary artery disease (CAD) in a high-risk population. Materials and Methods: Institutional review board approval and informed patient consent were obtained before patient enrollment in the study. The study was HIPAA compliant. Thirty-five patients at high risk for CAD were prospectively enrolled for evaluation of the feasibility of CT perfusion imaging. All patients underwent retrospectively electrocardiographically gated (helical) adenosine stress CT perfusion imaging followed by prospectively electrocardiographically gated (axial) rest myocardial CT perfusion imaging. Analysis was performed in three steps: (a)Coronary arterial stenoses were scored for severity and reader confidence at cardiac CT angiography, (b)myocardial perfusion defects were identified and scored for severity and reversibility at CT perfusion imaging, and (c)coronary stenosis severity was reclassified according to perfusion findings at combined cardiac CT angiography and CT perfusion imaging. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of cardiac CT angiography before and after CT perfusion analysis were calculated. Results: With use of a reference standard of greater than 50% stenosis at invasive angiography, all parameters of diagnostic accuracy increased after CT perfusion analysis: Sensitivity increased from 83% to 91%; specificity, from 71% to 91%; PPV, from 66% to 86%; and NPV, from 87% to 93%. The area under the receiver operating characteristic curve increased significantly, from 0.77 to 0.90 (P < .005). Conclusion: A combination protocol involving adenosine perfusion CT imaging and cardiac

  5. CT angiography ofthe carotid arteries.

    PubMed

    Prokop, M; Waaijer, A; Kreuzer, S

    2004-01-01

    The introduction of multislice scanning has made CT angiography (CTA) a serious competitor to MR angiography (MRA) as a second line method for the evaluation of the carotid arteries. For optimum display of the morphology of stenoses, it is necessary to apply the thinnest possible section collimation (ideally [symbol: see text] 1.25mm). While the scan range is limited for single slice CTA, it is possible to cover the whole supraaortic circulation from the aortic arch to the intracranial vessels using multislice scanning. Timing of contrast injection is important, however, the injection technique for carotid CTA is more forgiving than for other body regions. Image evaluation is mainly based on axial sections and curved planar reformations (CPR). Other techniques only serve as an adjunct to better be able to demonstrate the findings. Most potential pitfalls can be avoided by using the appropriate technique. CTA has been shown to have a pooled sensitivity of 95% and specificity of 98% for the detection of >70% stenoses, even if only older single-slice techniques are used. Differentiation between lipid, fibrous and calcified plaques may be possible, especially with multislice scanning. Multislice CTA can in addition detect tandem stenoses in the region of the carotid origin from the aorta, the carotid siphon, and the intracranial portion of the carotids. CT is able to provide a comprehensive evaluation of patients with acute stroke by using a combined approach of pre-contrast CT to detect hemorrhage and manifest infarction, CT brain perfusion measurements to differentiate between penumbra and infarct and CTA to detect the occluded vessel as well as potential concomitant carotid abnormalities. In summary, carotid CTA has come of age and can be used to quantify stenoses more precisely than ultrasound, to detect tandem stenoses and for the workup of acute stroke patients. The learning objectives include learning how to chose acquisition parameters for carotid CTA, how to

  6. Postmortem whole-body computed tomography angiography visualizing vascular rupture in a case of fatal car crash.

    PubMed

    Flach, Patricia M; Ross, Steffen G; Bolliger, Stephan A; Preiss, Ulrich S; Thali, Michael J; Spendlove, Danny

    2010-01-01

    In addition to the increasingly significant role of multislice computed tomography in forensic pathology, the performance of whole-body computed tomography angiography provides outstanding results. In this case, we were able to detect multiple injuries of the parenchymal organs in the upper abdomen as well as lesions of the brain parenchyma and vasculature of the neck. The radiologic findings showed complete concordance with the autopsy and even supplemented the autopsy findings in areas that are difficult to access via a manual dissection (such as the vasculature of the neck). This case shows how minimally invasive computed tomography angiography can serve as an invaluable adjunct to the classic autopsy procedure.

  7. Good visibility of TITAN-2 coronary stents demonstrable on cardiac computer tomographic angiography: a report of 2 cases.

    PubMed

    Ong, Paul Jau; Jau, Ong Paul; Ho, Hee Hwa; Hwa, Ho Hee; Jafary, Fahim Haider; Haider, Jafary Fahim; Loh, Kwok Kong; Kong, Loh Kwok; Ooi, Yau Wei; Wei, Ooi Yau; Wong, Chun Pong; Pong, Wong Chun; Foo, David; David, Foo

    2011-09-01

    Numerous studies have sought to assess stent patency by cardiac computer tomographic angiography (CCTA) in comparison with invasive coronary angiography in patients who had undergone percutaneous coronary stenting. Even with newer generation scanners, CCTA has been of limited value in the assessment of the revascularized patient. The main reason being blooming artifact from metallic stents often obscures stent luminal dimension, making the stented segment unassessable. We report on a novel finding of good visibility of TITAN-2 coronary stents demonstrable on CCTA for 2 patients and discuss the possible mechanism and potential implications of this observation.

  8. Software-based on-site estimation of fractional flow reserve using standard coronary CT angiography data.

    PubMed

    De Geer, Jakob; Sandstedt, Mårten; Björkholm, Anders; Alfredsson, Joakim; Janzon, Magnus; Engvall, Jan; Persson, Anders

    2016-10-01

    The significance of a coronary stenosis can be determined by measuring the fractional flow reserve (FFR) during invasive coronary angiography. Recently, methods have been developed which claim to be able to estimate FFR using image data from standard coronary computed tomography angiography (CCTA) exams. To evaluate the accuracy of non-invasively computed fractional flow reserve (cFFR) from CCTA. A total of 23 vessels in 21 patients who had undergone both CCTA and invasive angiography with FFR measurement were evaluated using a cFFR software prototype. The cFFR results were compared to the invasively obtained FFR values. Correlation was calculated using Spearman's rank correlation, and agreement using intraclass correlation coefficient (ICC). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for significant stenosis (defined as both FFR ≤0.80 and FFR ≤0.75) were calculated. The mean cFFR value for the whole group was 0.81 and the corresponding mean invFFR value was 0.84. The cFFR sensitivity for significant stenosis (FFR ≤0.80/0.75) on a per-lesion basis was 0.83/0.80, specificity was 0.76/0.89, and accuracy 0.78/0.87. The positive predictive value was 0.56/0.67 and the negative predictive value was 0.93/0.94. The Spearman rank correlation coefficient was ρ = 0.77 (P < 0.001) and ICC = 0.73 (P < 0.001). This particular CCTA-based cFFR software prototype allows for a rapid, non-invasive on-site evaluation of cFFR. The results are encouraging and cFFR may in the future be of help in the triage to invasive coronary angiography. © The Foundation Acta Radiologica 2015.

  9. Arrhythmogenic right ventricular disease: MR imaging vs angiography.

    PubMed

    Auffermann, W; Wichter, T; Breithardt, G; Joachimsen, K; Peters, P E

    1993-09-01

    Arrhythmogenic right ventricular disease (ARVD) is increasingly found in young adults with ventricular arrhythmias and is characterized by ventricular tachycardia originating within the right ventricle and regional or diffuse abnormalities in the contraction of the right ventricle. Until now, the gold standard for the detection of global and regional abnormalities of the right ventricular wall has been angiography combined with biopsy. The purpose of the current study was to compare MR imaging with angiography for assessing the location and extent of morphologic and functional abnormalities in patients with ARVD. Electrocardiographically gated spin-echo and cine gradient-echo MR imaging of the heart was performed in 36 consecutive patients with biopsy-proved ARVD. Patients were prospectively separated into two groups according to the results of invasive electrophysiologic tests (18 with inducible ventricular tachycardia during invasive electrophysiologic studies [ARVD 1] and 18 without inducible ventricular tachycardia [ARVD 2]) and compared with 11 control subjects. Global and regional morphology and function of the right ventricle were assessed with MR imaging, and those findings were compared with angiographic findings. Right ventricular ejection fraction was significantly lower in patients with ARVD 1 than in patients with ARVD 2 or in control subjects. Regional abnormalities of the right ventricular wall also were more pronounced in patients with ARVD 1 than in patients with ARVD 2. Signal-intensity increases corresponding to fatty replacement shown by biopsy were seen in 33% of patients with ARVD 1 and in 11% of patients with ARVD 2. Abnormal regions of the right ventricular wall seen on MR images corresponded to angiographic findings in 86% of patients. Comparison with control subjects showed that patients with ARVD 1 had a significant delay in diastolic relaxation of the right ventricle. Our results show that MR imaging can be used to assess morphologic

  10. MD CT Angiography and MR Angiography of Nonatherosclerotic Renal Artery Disease

    SciTech Connect

    Flors, Lucia; Leiva-Salinas, Carlos; Ahmad, Ehab Ali; Norton, Patrick T.; Turba, Ulku C.; Bozlar, Ugur; Hagspiel, Klaus D.

    2011-12-15

    We reviewed the computed tomographic and magnetic resonance angiographic appearances of the various nonatherosclerotic renal artery pathologies. Rapid progress in cross-sectional techniques has allowed computed tomography and magnetic resonance angiography to replace digital subtraction angiography in most circumstances. When state-of-the-art equipment and optimized protocols are used, diagnosing a wide range of nonatherosclerotic pathologies is possible.

  11. Effective radiation doses associated with non-invasive versus invasive assessment of coronary anatomy and physiology.

    PubMed

    Toth, G G; Ntalianis, A; Ntarladimas, Y; de Booij, M; De Winter, O; Barbato, E; Pilet, B; Van Mieghem, C; Wijns, W; De Bruyne, B

    2015-06-01

    To compare the effective radiation dose (ERD) needed to obtain information on coronary anatomy and physiology by a non-invasive versus an invasive diagnostic strategy. Knowledge of anatomy and physiology is needed for management of patients with coronary artery disease (CAD). There is, however, a growing concern about detrimental long-term effects of radiation associated with diagnostic procedures. In a total of 671 patients with suspected CAD, we compared the ERD needed to obtain anatomical and physiological information through a non-invasive strategy or an invasive strategy. The non-invasive strategy consisted of coronary computed tomography angiography (CCTA) and single photon emission computed tomography (SPECT). The invasive strategy included coronary angiography (CA) and fractional flow reserve (FFR) measurement. In 464 patients, the data were acquired in Period 2009 and in 207 the data were acquired in Period 2011 (after each period, the CCTA- and the CA-equipment had been upgraded). For the Period 2009 total ERD of the non-invasive approach was significantly larger compared to the invasive approach (28.45 ± 5.37 mSv versus 15.79 ± 7.95 mSv, respectively; P < 0.0001). For Period 2011, despite the significant decrease in ERD for both groups (P<0.0001 for both), the ERD remained higher for the non-invasive approach compared to the invasive approach (16.67 ± 10.45 mSv vs. 10.36 ± 5.87 mSv, respectively; P < 0.0001). Simulation of various diagnostic scenarios showed cumulative radiation dose is the lowest when a first positive test is followed by an invasive strategy. To obtain anatomic and physiologic information in patients with suspected CAD, the combination of CA and FFR is associated with lower ERD than the combination of CCTA and SPECT. © 2014 Wiley Periodicals, Inc.

  12. Postmortem whole-body CT angiography: evaluation of two contrast media solutions.

    PubMed

    Ross, Steffen; Spendlove, Danny; Bolliger, Stephan; Christe, Andreas; Oesterhelweg, Lars; Grabherr, Silke; Thali, Michael J; Gygax, Erich

    2008-05-01

    The objective of our study was to establish a standardized procedure for postmortem whole-body CT-based angiography with lipophilic and hydrophilic contrast media solutions and to compare the results of these two methods. Minimally invasive postmortem CT angiography was performed on 10 human cadavers via access to the femoral blood vessels. Separate perfusion of the arterial and venous systems was established with a modified heart-lung machine using a mixture of an oily contrast medium and paraffin (five cases) and a mixture of a water-soluble contrast medium with polyethylene glycol (PEG) 200 in the other five cases. Imaging was executed with an MDCT scanner. The minimally invasive femoral approach to the vascular system provided a good depiction of lesions of the complete vascular system down to the level of the small supplying vessels. Because of the enhancement of well-vascularized tissues, angiography with the PEG-mixed contrast medium allowed the detection of tissue lesions and the depiction of vascular abnormalities such as pulmonary embolisms or ruptures of the vessel wall. The angiographic method with a water-soluble contrast medium and PEG as a contrast-agent dissolver showed a clearly superior quality due to the lack of extravasation through the gastrointestinal vascular bed and the enhancement of soft tissues (cerebral cortex, myocardium, and parenchymal abdominal organs). The diagnostic possibilities of these findings in cases of antemortem ischemia of these tissues are not yet fully understood.

  13. Learning-based automatic detection of severe coronary stenoses in CT angiographies

    NASA Astrophysics Data System (ADS)

    Melki, Imen; Cardon, Cyril; Gogin, Nicolas; Talbot, Hugues; Najman, Laurent

    2014-03-01

    3D cardiac computed tomography angiography (CCTA) is becoming a standard routine for non-invasive heart diseases diagnosis. Thanks to its high negative predictive value, CCTA is increasingly used to decide whether or not the patient should be considered for invasive angiography. However, an accurate assessment of cardiac lesions using this modality is still a time consuming task and needs a high degree of clinical expertise. Thus, providing automatic tool to assist clinicians during the diagnosis task is highly desirable. In this work, we propose a fully automatic approach for accurate severe cardiac stenoses detection. Our algorithm uses the Random Forest classi cation to detect stenotic areas. First, the classi er is trained on 18 CT cardiac exams with CTA reference standard. Then, then classi cation result is used to detect severe stenoses (with a narrowing degree higher than 50%) in a 30 cardiac CT exam database. Features that best captures the di erent stenoses con guration are extracted along the vessel centerlines at di erent scales. To ensure the accuracy against the vessel direction and scale changes, we extract features inside cylindrical patterns with variable directions and radii. Thus, we make sure that the ROIs contains only the vessel walls. The algorithm is evaluated using the Rotterdam Coronary Artery Stenoses Detection and Quantication Evaluation Framework. The evaluation is performed using reference standard quanti cations obtained from quantitative coronary angiography (QCA) and consensus reading of CTA. The obtained results show that we can reliably detect severe stenosis with a sensitivity of 64%.

  14. Complications with Outpatient Angiography and Interventional Procedures

    SciTech Connect

    Young, Noel; Chi, Ka-Kit; Ajaka, Joe; McKay, Lesa; O'Neill, Diane; Wong, Kai Ping

    2002-03-15

    Purpose: To prospectively identify the complications, and rates of complication, in outpatient angiography and interventional procedures. Methods: There were 1050 consecutive patients, 646 men and 404 women, aged 17-89 years, with a total of 1239 procedures studied in a 2-year period, 1997 to 1999. Results: There were 560 cases of aorto-femoral angiography,resulting in 124 complications (22%), with pain or hematoma in 110.There were 206 cases of neck and cerebral angiography, resulting in 51 complications (25%), with pain and hematoma in 34, transient ischemic attack in 2 and cerebrovascular accident in 1. There were 197 interfentional procedures, with 177 being balloon dilatations, resulting in 68 complications (35%), with 2 having hematomas and 1 having hematoma/abscess requiring active treatment. There were 276 cases having various 'other' procedures (e.g., renal angiography),resulting in 65 complications (24%), with pain and hematoma in 61. No procedure-related death occurred. Eighteen cases (1.5%) had significant complications, with contrast allergy in eight. Conclusion: Outpatient angiography and intervention are relatively safe, with low significant complication rates.

  15. Innovations in imaging for chronic total occlusions: a glimpse into the future of angiography's blind-spot.

    PubMed

    Courtney, Brian K; Munce, Nigel R; Anderson, Kevan J; Thind, Amandeep S; Leung, General; Radau, Perry E; Foster, F Stuart; Vitkin, I Alex; Schwartz, Robert S; Dick, Alexander J; Wright, Graham A; Strauss, Bradley H

    2008-03-01

    Chronic total occlusions (CTOs) are a subset of lesions that present a considerable burden to cardiovascular patients. There exists a strong clinical desire to improve non-surgical options for CTO revascularization. While several techniques, devices, and guide wires have been developed and refined for use in CTOs, the inability of angiography to adequately visualize occluded arterial segments makes interventions in this setting technically challenging. This review describes the current status of several invasive and non-invasive imaging techniques that may facilitate improved image guidance during CTO revascularization, with the goals of improving procedure safety and efficacy while reducing the time required to complete these interventions. Cardiac imaging also has important potential roles in selecting patients most likely to benefit from revascularization as well as pre-procedural planning, post-procedural assessment of revascularized segments and long-term outcomes studies. Modalities discussed include non-invasive techniques, such as CT(computed tomography) angiography and cardiac magnetic resonance imaging (MRI), as well as invasive techniques, such as intravascular ultrasound, optical coherence tomography, intravascular MRI, and conventional angiography. While some of these techniques have some evidence to support their use at present, others are at earlier stages of development. Strategies that combine imaging techniques with the use of interventional therapies may provide significant opportunities to improve results in CTO interventions and represent an active area of investigation.

  16. Indirect coronary angiography: a feasibility study.

    PubMed

    Wolffgram, T; Krieter, A; Berger, H; Detter, C; Schurr, M O; Braun, M; Schneider, U

    2002-01-01

    The diagnostic method of choice to proof coronary artery disease and to localize stenoses and to judge the stage of the disease is coronary angiography. A new angiographic technique invented by. Wolffgram and Krieter that works without cannulation of the coronary arteries could simplify the interventional procedure. In addition, a technique like this could be used for angiography after CABG surgery directly on the table for quality assurance reasons. This angiography could be performed by the cardiac surgeon without necessarily involving a cardiologist. A feasibility study was successfully done in a cooperation of the Departments. for Cardiology and Cardiac Surgery, Munich University, Steinbeis Transfer Centre for rHealthcare Technologies, Tuebingen and Fraunhofer Technology Development Group (TEG), Stuttgart.

  17. Full-field optical micro-angiography

    NASA Astrophysics Data System (ADS)

    Wang, Mingyi; Zeng, Yaguang; Liang, Xianjun; Lu, Xuanlong; Feng, Guanping; Han, Dingan; Yang, Guojian

    2014-02-01

    We present a detailed description of full-field optical micro-angiography on the basis of frequency-domain laser speckle imaging with intensity fluctuation modulation (LSI-IFM). The imaging approach works based on the instantaneous local intensity fluctuation realized via the combination of short exposure and low sampling rate of a camera and appropriate magnification of a microscope. In vivo experiments on mouse ear verify the theoretical description we made for the imaging mechanism and demonstrate the ability of LSI-IFM as optical micro-angiography. By introducing a fundus camera into LSI-IFM system, our approach has a potential application in label-free retina optical micro-angiography.

  18. Diagnostic Accuracy of Fractional Flow Reserve From Anatomic CT Angiography

    PubMed Central

    Min, James K.; Leipsic, Jonathon; Pencina, Michael J.; Berman, Daniel S.; Koo, Bon-Kwon; van Mieghem, Carlos; Erglis, Andrejs; Lin, Fay Y.; Dunning, Allison M.; Apruzzese, Patricia; Budoff, Matthew J.; Cole, Jason H.; Jaffer, Farouc A.; Leon, Martin B.; Malpeso, Jennifer; John Mancini, G. B.; Park, Seung-Jung; Schwartz, Robert S.; Shaw, Leslee J.; Mauri, Laura

    2014-01-01

    Context Coronary computed tomographic (CT) angiography is a noninvasive anatomic test for diagnosis of coronary stenosis that does not determine whether a stenosis causes ischemia. In contrast, fractional flow reserve (FFR) is a physiologic measure of coronary stenosis expressing the amount of coronary flow still attainable despite the presence of a stenosis, but it requires an invasive procedure. Noninvasive FFR computed from CT (FFRCT) is a novel method for determining the physiologic significance of coronary artery disease (CAD), but its ability to identify ischemia has not been adequately examined to date. Objective To assess the diagnostic performance of FFRCT plus CT for diagnosis of hemodynamically significant coronary stenosis. Design, Setting, and Patients Multicenter diagnostic performance study involving 252 stable patients with suspected or known CAD from 17 centers in 5 countries who underwent CT, invasive coronary angiography (ICA), FFR, and FFRCT between October 2010 and October 2011. Computed tomography, ICA, FFR, and FFRCT were interpreted in blinded fashion by independent core laboratories. Accuracy of FFRCT plus CT for diagnosis of ischemia was compared with an invasive FFR reference standard. Ischemia was defined by an FFR or FFRCT of 0.80 or less, while anatomically obstructive CAD was defined by a stenosis of 50% or larger on CT and ICA. Main Outcome Measures The primary study outcome assessed whether FFRCT plus CT could improve the per-patient diagnostic accuracy such that the lower boundary of the 1-sided 95% confidence interval of this estimate exceeded 70%. Results Among study participants, 137 (54.4%) had an abnormal FFR determined by ICA. On a per-patient basis, diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of FFRCT plus CT were 73% (95% CI, 67%–78%), 90% (95% CI, 84%–95%), 54% (95% CI, 46%–83%), 67% (95% CI, 60%–74%), and 84% (95% CI, 74%–90%), respectively. Compared

  19. Analysis of coronary angiography related psychophysiological responses

    PubMed Central

    2011-01-01

    Background Coronary angiography is an important tool in diagnosis of cardiovascular diseases. However, it is the administration is relatively stressful and emotionally traumatic for the subjects. The aim of this study is to evaluate psychophysiological responses induced by the coronary angiography instead of subjective methods such as a questionnaire. We have also evaluated the influence of the tranquilizer on the psychophysiological responses. Methods Electrocardiography (ECG), Blood Volume Pulse (BVP), and Galvanic Skin Response (GSR) of 34 patients who underwent coronary angiography operation were recorded. Recordings were done at three phases: "1 hour before," "during," and "1 hour after" the coronary angiography test. Total of 5 features obtained from the physiological signals were compared across these three phases. Sixteen of the patients were administered 5 mg of a tranquilizer (Diazepam) before the operation and remaining 18 were not. Results Our results indicate that there is a strong correlation between features (LF/HF, Bk, DN1/DN2, skin conductance level and seg_mean) in terms of reflecting psychophysiological responses. However only DN1/DN2 feature has statistically significant differences between angiography phases (for diazepam: p = 0.0201, for non_diazepam p = 0.0224). We also note that there are statistically significant differences between the diazepam and non-diazepam groups for seg_mean features in "before", "during" and "after" phases (p = 0.0156, 0.0282, and 0.0443, respectively). Conclusions The most intense sympathetic activity is observed in the "during" angiography phase for both of the groups. The obtained features can be used in some clinical studies where generation of the customized/individual diagnoses styles and quantitative evaluation of psychophysiological responses is necessary. PMID:21834993

  20. Noninvasive Imaging of Atherosclerotic Plaque Progression: Status of Coronary CT Angiography

    PubMed Central

    Sandfort, Veit; Lima, Joao A.C.; Bluemke, David A.

    2015-01-01

    The process of coronary artery disease progression is infrequently visualized. Intravascular ultrasound has been used to gain important insights but is invasive and therefore limited to high risk patients. For low to moderate risk patients, noninvasive methods may be useful to quantitatively monitor plaque progression or regression, and to understand and personalize atherosclerosis therapy. This review discusses the potential for coronary CT angiography (CCTA) to evaluate the extent and subtypes of coronary plaque. CT technology is evolving and image quality of the method approaches the level required for plaque progression monitoring. Methods to quantify plaque on CT angiography are reviewed as well as a discussion of their use in clinical trials. Limitations of CCTA compared to competing modalities include limited evaluation of plaque subcomponents and incomplete knowledge of the value of the method especially in patients with low to moderate cardiovascular risk. PMID:26156016

  1. Contrast enhanced ultrasonography versus MR angiography in aortocaval fistula: case report.

    PubMed

    Bhatia, Mona; Platon, Alexandra; Khabiri, Ebrahim; Becker, Christoph; Poletti, Pierre-Alexandre

    2010-06-01

    Aortocaval fistula (ACF) is a rare, life threatening complication of abdominal aortic aneurysms. Time to diagnosis is crucial as preoperative diagnosis and early surgical intervention significantly improve the outcome. The clinical spectrum being varied, the challenge of prompt and reliable diagnosis rests on emergency radiology. While the gold standard for detecting ACF today is CT angiography (CTA), frequently complicating renal insufficiency discourages the use of iodinated contrast making MR angiography (MRA) a useful alternative. Contrast enhanced ultrasound (CEUS) provides a promising new diagnostic option allowing rapid, non invasive and bedside diagnosis, especially in hemodynamically unstable patients. We present a case of prompt diagnosis of ACF by CEUS in comparison to modern MRA, thus establishing the new potential role of CEUS.

  2. Follow-up of true visceral artery aneurysm after coil embolization by three-dimensional contrast-enhanced MR angiography

    PubMed Central

    Koganemaru, Masamichi; Abe, Toshi; Nonoshita, Masaaki; Iwamoto, Ryoji; Kusumoto, Masashi; Kuhara, Asako; Kugiyama, Tomoko

    2014-01-01

    PURPOSE We aimed to evaluate the outcomes of coil embolization of true visceral artery aneurysms by three-dimensional contrast-enhanced magnetic resonance (MR) angiography. MATERIALS AND METHODS We used three-dimensional contrast-enhanced MR angiography, which included source images, to evaluate 23 patients (mean age, 60 years; range, 28–83 years) with true visceral artery aneurysms (splenic, n=15; hepatic, n=2; gastroduodenal, n=2; celiac, n=2; pancreaticoduodenal, n=1; gastroepiploic, n=1) who underwent coil embolization. Angiographic aneurysmal occlusion was revealed in all cases. Follow-up MR angiography was conducted with either a 1.5 or 3 Tesla system 3–25 months (mean, 18 months) after embolization. MR angiography was evaluated for aneurysmal occlusion, hemodynamic status, and complications. RESULTS Complete aneurysmal occlusion was determined in 22 patients (96%) on follow-up MR angiography (mean follow-up period, 18 months). Neck recanalization, which was observed at nine and 20 months after embolization, was confirmed in one of eight patients (13%) using a neck preservation technique. In this patient, a small neck recanalization covered by a coil mass was demonstrated. The complete hemodynamic status after embolization was determined in 21 patients (91%); the visualization of several collateral vessels, such as short gastric arteries, after parent artery occlusion was poor compared with that seen on digital subtraction angiography in the remaining two patients (9%). An asymptomatic localized splenic infarction was confirmed in one patient (4%). CONCLUSION Our study presents the follow-up results from three-dimensional contrast-enhanced MR angiography, which confirmed neck recanalization, the approximate hemodynamic status, and complications. This effective and less invasive method may be suitable for serial follow-up after coil embolization of true visceral aneurysms. PMID:24356294

  3. Follow-up of true visceral artery aneurysm after coil embolization by three-dimensional contrast-enhanced MR angiography.

    PubMed

    Koganemaru, Masamichi; Abe, Toshi; Nonoshita, Masaaki; Iwamoto, Ryoji; Kusumoto, Masashi; Kuhara, Asako; Kugiyama, Tomoko

    2014-01-01

    We aimed to evaluate the outcomes of coil embolization of true visceral artery aneurysms by three-dimensional contrast-enhanced magnetic resonance (MR) angiography. We used three-dimensional contrast-enhanced MR angiography, which included source images, to evaluate 23 patients (mean age, 60 years; range, 28-83 years) with true visceral artery aneurysms (splenic, n=15; hepatic, n=2; gastroduodenal, n=2; celiac, n=2; pancreaticoduodenal, n=1; gastroepiploic, n=1) who underwent coil embolization. Angiographic aneurysmal occlusion was revealed in all cases. Follow-up MR angiography was conducted with either a 1.5 or 3 Tesla system 3-25 months (mean, 18 months) after embolization. MR angiography was evaluated for aneurysmal occlusion, hemodynamic status, and complications. Complete aneurysmal occlusion was determined in 22 patients (96%) on follow-up MR angiography (mean follow-up period, 18 months). Neck recanalization, which was observed at nine and 20 months after embolization, was confirmed in one of eight patients (13%) using a neck preservation technique. In this patient, a small neck recanalization covered by a coil mass was demonstrated. The complete hemodynamic status after embolization was determined in 21 patients (91%); the visualization of several collateral vessels, such as short gastric arteries, after parent artery occlusion was poor compared with that seen on digital subtraction angiography in the remaining two patients (9%). An asymptomatic localized splenic infarction was confirmed in one patient (4%). Our study presents the follow-up results from three-dimensional contrast-enhanced MR angiography, which confirmed neck recanalization, the approximate hemodynamic status, and complications. This effective and less invasive method may be suitable for serial follow-up after coil embolization of true visceral aneurysms.

  4. Acute Ischemic Stroke: Infarct Core Estimation on CT Angiography Source Images Depends on CT Angiography Protocol

    PubMed Central

    Pulli, Benjamin; Schaefer, Pamela W.; Hakimelahi, Reza; Chaudhry, Zeshan A.; Lev, Michael H.; Hirsch, Joshua A.; González, R. Gilberto

    2012-01-01

    Purpose: To test whether the relationship between acute ischemic infarct size on concurrent computed tomographic (CT) angiography source images and diffusion-weighted (DW) magnetic resonance images is dependent on the parameters of CT angiography acquisition protocols. Materials and Methods: This retrospective study had institutional review board approval, and all records were HIPAA compliant. Data in 100 patients with anterior-circulation acute ischemic stroke and large vessel occlusion who underwent concurrent CT angiography and DW imaging within 9 hours of symptom onset were analyzed. Measured areas of hyperintensity at acute DW imaging were used as the standard of reference for infarct size. Information regarding lesion volumes and CT angiography protocol parameters was collected for each patient. For analysis, patients were divided into two groups on the basis of CT angiography protocol differences (patients in group 1 were imaged with the older, slower protocol). Intermethod agreement for infarct size was evaluated by using the Wilcoxon signed rank test, as well as by using Spearman correlation and Bland-Altman analysis. Multivariate analysis was performed to identify predictors of marked (≥20%) overestimation of infarct size on CT angiography source images. Results: In group 1 (n = 35), median hypoattenuation volumes on CT angiography source images were slightly underestimated compared with DW imaging hyperintensity volumes (33.0 vs 41.6 mL, P = .01; ratio = 0.83), with high correlation (ρ = 0.91). In group 2 (n = 65), median volume on CT angiography source images was much larger than that on DW images (94.8 vs 17.8 mL, P < .0001; ratio = 3.5), with poor correlation (ρ = 0.49). This overestimation on CT angiography source images would have inappropriately excluded from reperfusion therapy 44.4% or 90.3% of patients eligible according to DW imaging criteria on the basis of a 100-mL absolute threshold or a 20% or greater mismatch threshold, respectively

  5. Digital subtraction angiography of the kidney.

    PubMed

    Gattoni, F; Avogadro, A; Baldini, U; Pozzato, C; Bonfanti, M T; Gandini, D; Franch, L; Uslenghi, C

    1988-09-01

    Intravenous and intra-arterial digital subtraction angiography (DSA) was performed in 88 patients: 34 with tumours, 10 with renal trauma, 26 with suspected renovascular hypertension, 6 with vascular impression on the renal pelvis, 8 with nephrolithiasis and 4 with sonographically abnormal kidneys. Venous and arterial DSA always gave diagnostically useful images. Intravenous DSA is valuable in patients with suspected renovascular hypertension or after vascular surgery, percutaneous transluminal angioplasty and transcatheter embolisation. Arterial DSA is preferable to venous DSA in other clinical situations, particularly in the evaluation of renal tumours, and may be recommended in preference to conventional angiography.

  6. Digital subtraction angiography of the thoracic aorta

    SciTech Connect

    Grossman, L.B.; Buonocore, E.; Modic, M.T.; Meaney, T.F.

    1984-02-01

    Forty-three patients with acquired and congenital abnormalities of the thoracic aorta were studied using digital subtraction angiography (DSA) after an intravenous bolus injection of 40 ml of contrast material. Abnormalities studied included coarctation, pseudocoarctation, Marfan syndrome, cervical aorta, double aortic arch, aneurysm, dissection, and tumor. Twenty-four patients also had conventional angiography. DSA was accurate in 95% of cases; in the other 5%, involving patients with acute type I dissection, the coronary arteries could not be seen. The authors concluded that in 92% of their patients, DSA could have replaced the standard aortogram.

  7. Fluorescein and Indocyanine Green Angiography for Uveitis

    PubMed Central

    Herbort, Carl P

    2009-01-01

    In recent years enormous progress has been achieved in investigational procedures for uveitis. Imaging is one such example with the advent of new methods such as indocyanine green angiography, ultrasound biomicroscopy and optical coherence tomography to cite only the most important. This tremendous increase in precision and accuracy in the assessment of the level and degree of inflammation and its monitoring comes in parallel with the development of extremely potent and efficacious therapies. In view of these developments, our whole attitude in the appraisal and investigation of the uveitis patient has to be adapted and correctly reoriented integrating the recent developments and this is no different for ocular angiography. PMID:20404985

  8. Iodide Mumps Complicating Coronary and Carotid Angiography.

    PubMed

    Elder, Alexander M M; Ng, Martin K C

    2017-02-01

    We report a case of asceptic sialadenitis that occurred in a patient with end-stage renal failure following administration of iodinated contrast for coronary and carotid angiography. This is a rare but important complication of iodinated contrast. Early diagnosis of iodide mumps following angiography avoids unnecessary investigations and treatment. In this case the patient underwent haemodialysis with subsequent complete resolution of the sialadenitis, a treatment that has previously not been reported for this condition. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  9. Utility of 64 detector coronary computed tomographic angiography in patients with and without prior equivocal stress tests.

    PubMed

    Chan, Raymond H; Javali, Shruti; Ellins, Mary Lou; Montgomery, Alison; Sheth, Tej

    2011-01-01

    This study sought to compare and the utility of cardiac computed tomographic angiography (CCTA) in patients with and without prior equivocal stress testing, and the subsequent need for invasive angiography and revascularization after CCTA. Evidence for the clinical utility of CCTA in the assessment of low to intermediate risk patients with equivocal stress testing is limited. Consecutive patients referred for outpatient CCTA for evaluation of suspected CAD with and without prior equivocal stress testing were included. CCTA studies were performed on a 64 detector scanner (Toshiba Aquilion). The diagnostic yield of CCTA for coronary stenoses and the subsequent need of the patients for invasive angiography and revascularization was evaluated. Of 228 patients evaluated, 43.9% were male, average age 59.3 ± 10.3. 66.2% (n = 151) had an equivocal stress test prior to CCTA. The prevelance of significant lesions (>50% stenosis) was high at 31% (n = 71), and was similar for those with and without a prior equivocal stress test (29.1 vs. 35.0%, P = NS). During a mean follow up of 1.4 ± 0.4 years, all patients with normal or stenosis by CCTA of <50% remained free from revascularization. Among those with a >50% stenosis by CCTA, the revascularization rate was 33.8%. The rates of angiography and revascularization were similar in those with or without prior stress tests (19 vs. 27%, P = 0.13 and 12 vs. 7.8%, P = 0.34 respectively). Regardless of whether or not patients had prior equivocal stress tests, CCTA detected a substantial number of obstructive CAD lesions and effectively identified the need for subsequent invasive angiography and revascularization. It appears to be a very promising triage test in this population.

  10. ICG angiography predicts burn scarring within 48 h of injury in a porcine vertical progression burn model.

    PubMed

    Fourman, Mitchell S; McKenna, Peter; Phillips, Brett T; Crawford, Laurie; Romanelli, Filippo; Lin, Fubao; McClain, Steve A; Khan, Sami U; Dagum, Alexander B; Singer, Adam J; Clark, Richard A F

    2015-08-01

    The current standard of care in determining the need to excise and graft a burn remains with the burn surgeon, whose clinical judgment is often variable. Prior work suggests that minimally invasive perfusion technologies are useful in burn prognostication. Here we test the predictive capabilities of Laser Doppler Imaging (LDI) and indocyanine green dye (ICG) angiography in the prediction of burn scarring 28 days after injury using a previously validated porcine burn model that shows vertical progression injury. Twelve female Yorkshire swine were burned using a 2.5 × 2.5 cm metal bar at variable temperature and application times to create distinct burn depths. Six animals (48 injuries total) each were analyzed with LDI or ICG angiography at 1, 24, 48, and 72 h following injury. A linear regression was then performed correlating perfusion measurements against wound contraction at 28 days after injury. ICG angiography showed a peak linear correlate (r(2)) of .63 (95% CI .34 to .92) at 48 h after burn. This was significantly different from the LDI linear regression (p < .05), which was measured at r(2) of .20 (95% CI .02 to .39). ICG angiography linear regression was superior to LDI at all timepoints. Findings suggest that ICG angiography may have significant potential in the prediction of long-term burn outcomes.

  11. Likelihood of aneurysmal subarachnoid haemorrhage in patients with normal unenhanced CT, CSF xanthochromia on spectrophotometry and negative CT angiography.

    PubMed

    Rana, A K; Turner, H E; Deans, K A

    2013-01-01

    Patients with suspected subarachnoid haemorrhage, a normal noncontrast computed tomography (CT) and cerebrospinal fluid (CSF) evidence of haemoglobin breakdown products often undergo CT angiography (CTA). If this is normal, then invasive catheter angiography may be offered. In current clinical practice, haemoglobin breakdown products are detected by spectrophotometry rather than visible xanthochromia, and CTA is performed on multidetector scanners. The aim of this study was to determine if such patients should still have a catheter angiography, given the associated risks. Patients positive for CSF spectrophotometry (n=26) were retrospectively identified from the clinical biochemistry information system and imaging data from the electronic radiology records were reviewed. Discharge letters were consulted to relate the biochemistry and radiology results to the final diagnosis. 15 patients with CT angiography were found. Nine patients had normal CT angiography. No causative aneurysms had been missed. One patient had small, coincidental aneurysms missed on initial reading of the CTA. The likelihood of a clinically significant aneurysm in a patient who is CT negative, lumbar puncture positive and CTA negative is low. Double reporting of negative CT angiograms may be advisable.

  12. Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64.

    PubMed

    Miller, Julie M; Dewey, Marc; Vavere, Andrea L; Rochitte, Carlos E; Niinuma, Hiroyuki; Arbab-Zadeh, Armin; Paul, Narinder; Hoe, John; de Roos, Albert; Yoshioka, Kunihiro; Lemos, Pedro A; Bush, David E; Lardo, Albert C; Texter, John; Brinker, Jeffery; Cox, Christopher; Clouse, Melvin E; Lima, João A C

    2009-04-01

    Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective "CORE-64" trial ("Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors"). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows.

  13. Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography.

    PubMed

    Naya, Masanao; Murthy, Venkatesh L; Taqueti, Viviany R; Foster, Courtney R; Klein, Josh; Garber, Mariya; Dorbala, Sharmila; Hainer, Jon; Blankstein, Ron; Resnic, Frederick; Di Carli, Marcelo F

    2014-02-01

    Myocardial perfusion imaging has limited sensitivity for the detection of high-risk coronary artery disease (CAD). We tested the hypothesis that a normal coronary flow reserve (CFR) would be helpful for excluding the presence of high-risk CAD on angiography. We studied 290 consecutive patients undergoing (82)Rb PET within 180 d of invasive coronary angiography. High-risk CAD on angiography was defined as 2-vessel disease (≥ 70% stenosis), including the proximal left anterior descending artery; 3-vessel disease; or left main CAD (≥ 50% stenosis). Patients with prior Q wave myocardial infarction, elevated troponin levels between studies, prior coronary artery bypass grafting, a left ventricular ejection fraction of less than 40%, or severe valvular heart disease were excluded. Fifty-five patients (19%) had high-risk CAD on angiography. As expected, the trade-off between the sensitivity and the specificity of the CFR for identifying high-risk CAD varied substantially depending on the cutoff selected. In multivariable analysis, a binary CFR of less than or equal to 1.93 provided incremental diagnostic information for the identification of high-risk CAD beyond the model with the Duke clinical risk score (>25%), percentage of left ventricular ischemia (>10%), transient ischemic dilation index (>1.07), and change in the left ventricular ejection fraction during stress (<2) (P = 0.0009). In patients with normal or slightly to moderately abnormal results on perfusion scans (<10% of left ventricular mass) during stress (n = 136), a preserved CFR (>1.93) excluded high-risk CAD with a high sensitivity (86%) and a high negative predictive value (97%). A normal CFR has a high negative predictive value for excluding high-risk CAD on angiography. Although an abnormal CFR increases the probability of significant obstructive CAD, it cannot reliably distinguish significant epicardial stenosis from nonobstructive, diffuse atherosclerosis or microvascular dysfunction.

  14. Preserved Coronary Flow Reserve Effectively Excludes High-Risk Coronary Artery Disease on Angiography

    PubMed Central

    Naya, Masanao; Murthy, Venkatesh L.; Taqueti, Viviany R.; Foster, Courtney R.; Klein, Josh; Garber, Mariya; Dorbala, Sharmila; Hainer, Jon; Blankstein, Ron; Resnic, Frederick; Di Carli, Marcelo F.

    2014-01-01

    Myocardial perfusion imaging has limited sensitivity for the detection of high-risk coronary artery disease (CAD). We tested the hypothesis that a normal coronary flow reserve (CFR) would be helpful for excluding the presence of high-risk CAD on angiography. Methods We studied 290 consecutive patients undergoing 82Rb PET within 180 d of invasive coronary angiography. High-risk CAD on angiography was defined as 2-vessel disease (≥70% stenosis), including the proximal left anterior descending artery; 3-vessel disease; or left main CAD (≥50% stenosis). Patients with prior Q wave myocardial infarction, elevated troponin levels between studies, prior coronary artery bypass grafting, a left ventricular ejection fraction of less than 40%, or severe valvular heart disease were excluded. Results Fifty-five patients (19%) had high-risk CAD on angiography. As expected, the trade-off between the sensitivity and the specificity of the CFR for identifying high-risk CAD varied substantially depending on the cutoff selected. In multivariable analysis, a binary CFR of less than or equal to 1.93 provided incremental diagnostic information for the identification of high-risk CAD beyond the model with the Duke clinical risk score (>25%), percentage of left ventricular ischemia (>10%), transient ischemic dilation index (>1.07), and change in the left ventricular ejection fraction during stress (<2) (P = 0.0009). In patients with normal or slightly to moderately abnormal results on perfusion scans (<10% of left ventricular mass) during stress (n = 136), a preserved CFR (>1.93) excluded high-risk CAD with a high sensitivity (86%) and a high negative predictive value (97%). Conclusion A normal CFR has a high negative predictive value for excluding high-risk CAD on angiography. Although an abnormal CFR increases the probability of significant obstructive CAD, it cannot reliably distinguish significant epicardial stenosis from nonobstructive, diffuse atherosclerosis or microvascular

  15. [MRI angiography of the thoracic vessels including coronary arteries: techniques and indications].

    PubMed

    Didier, D

    1999-09-01

    Because it is a non-invasive method, Magnetic Resonance Angiography has more and more indications in the thorax, particularly with the help of use of contrast media. Different types of sequences used (Cine-MR, Gradient-echo 2D and Gadolinium enhanced breath-hold and non breath-hold 3D) are described as well as acquisition parameters and reconstructions from natives images. Post-processing techniques (MIP, MPR, 3D Surface Rendering) and their limitations depending upon the region explored are explained. Major indications (congenital anomalies of the great vessels, aneurysms, dissections, post-operative studies, evaluation of coronary arteries) are illustrated and the role of MRA compared to the other invasive and non invasive modalities is discussed.

  16. Clinical applications of computed tomography angiography in neuroimaging.

    PubMed

    Dross, Peter; Fisher, Brandon

    2005-06-01

    Recent technical advances in multidetector computed tomography angiography (CTA) now allow for the noninvasive evaluation of the neurovascular tree. In the evaluation of intracranial aneurysms, stroke imaging, and other vascular abnormalities, CTA compares favorably with conventional angiography. Several illustrative case reports are presented and the advantages of CTA over conventional angiography are discussed.

  17. Performance of magnetic resonance angiography in suspected acute pulmonary embolism.

    PubMed

    Blum, Alain; Bellou, Abdelouahab; Guillemin, Francis; Douek, Philippe; Laprévote-Heully, Marie-Claude; Wahl, Denis

    2005-03-01

    Pulmonary embolism (PE) is a common and potentially fatal disorder. Non-specific findings make the clinical diagnosis of PE difficult. To assess the diagnostic value and inter-observer agreement of magnetic resonance angiography (MRA) in a cohort of patients with suspected PE, we conducted a prospective clinical study. MRA was compared for sensitivity and specificity to a diagnostic strategy including clinical probability, D-dimer testing, spiral CT, ultrasound leg compression and pulmonary angiography. A total of 89 patients with clinically suspected PE were included: the clinical probability of PE was intermediate or high in 78, and low in the remaining 11. All patients underwent monoor multi-slice spiral CT and MRA with gadolinium injection (both within 24 hours of entry to the study). Anticoagulation was withheld in patients concerned about the strategy. All subjects were followed up for 3 months. MRA was read independently by two experienced teams of radiologists: one local and one from another university centre. Spiral CT was positive in 62 of 63 cases of confirmed PE. No patient with negative CT findings was positive ultrasonographically. Only one patient with a negative CT (and negative ultrasound) had a recurrent thromboembolic event. The first team diagnosed PE with MRA in 47 cases, with a sensitivity of 71% and a specificity of 92%; the second team obtained the diagnosis in 23 cases, with a sensitivity of 31% and a specificity of 85%. Inter-observer agreement between MRA reading was low: Kappa = 0.16 (-0.01 to 0.33); p = 0.07. In conclusion, compared with a non-invasive strategy based on spiral CT, the diagnostic value of MRA is limited by poor inter-observer agreement.

  18. Comparative analysis of fluorescent angiography, computed tomographic angiography and magnetic resonance angiography for planning autologous breast reconstruction

    PubMed Central

    Chae, Michael P.; Hunter-Smith, David J.

    2015-01-01

    Background The high incidence of breast cancer and growing number of breast cancer patients undergoing mastectomy has led to breast reconstruction becoming an important part of holistic treatment for these patients. In planning autologous reconstructions, preoperative assessment of donor site microvascular anatomy with advanced imaging modalities has assisted in the appropriate selection of flap donor site, individual perforators, and lead to an overall improvement in flap outcomes. In this review, we compare the accuracy of fluorescent angiography, computed tomographic angiography (CTA), and magnetic resonance angiography (MRA) and their impact on clinical outcomes. Methods A review of the published English literature dating from 1950 to 2015 using databases, such as PubMed, Medline, Web of Science, and EMBASE was undertaken. Results Fluorescent angiography is technically limited by its inability to evaluate deep-lying perforators and hence, it has a minimal role in the preoperative setting. However, it may be useful intraoperatively in evaluating microvascular anastomotic patency and the mastectomy skin perfusion. CTA is currently widely considered the standard, due to its high accuracy and reliability. Multiple studies have demonstrated its ability to improve clinical outcomes, such as operative length and flap complications. However, concerns surrounding exposure to radiation and nephrotoxic contrast agents exist. MRA has been explored, however despite recent advances, the image quality of MRA is considered inferior to CTA. Conclusions Preoperative imaging is an essential component in planning autologous breast reconstruction. Fluorescent angiography presents minimal role as a preoperative imaging modality, but may be a useful intraoperative adjunct to assess the anastomosis and the mastectomy skin perfusion. Currently, CTA is the gold standard preoperatively. MRA has a role, particularly for women of younger age, iodine allergy, and renal impairment. PMID

  19. [Effects of video information in patients undergoing coronary angiography].

    PubMed

    Philippe, F; Meney, M; Larrazet, F; Ben Abderrazak, F; Dibie, A; Meziane, T; Folliguet, T; Delahousse, P; Lemoine, J F; Laborde, F

    2006-02-01

    informed consent is a fundamental and legal obligation for each interventional cardiologist. The effect of consent form describing risks of invasive procedure on anxiety is controversial. This trial was aimed to assess the added value of video information to the standard informed consent process. 200 consecutive patients undergoing coronary angiography were enrolled. The first one hundred were assigned to conventional education conducted by the physician (no video group) and the second one hundred had consent obtained in the conventional manner assisted by video information (video group). The outcome variables for this comparison consisted of a standard anxiety score (Spielberger Statement Anxiety Inventory questionnary) plus hemodynamics measurements of heart rate, systolic and diastolic blood pressure obtained at baseline and immediately after written informed consent In addition, before discharge, patients graded the tolerability and satisfaction on a 4-point scale. The groups were similar with regard to their baseline characteristics and anxity score (37+23 vs 37+23). Patients who had not had prior experience of catheterization had higher baseline anxiety than those who had prior angiography (45 + 22 vs 31 + 20; p = 0.027). Patients who watched the video were significantly less anxious after informed consent (28 + 21 vs 34 + 22; p = 0.048) and had a significantly lower heart rate (65 + 10 vs 71 + 12; p = 0.03). The benefits of video information were especially prominent in those with higher anxiety scores at baseline (score after 45 + 24 vs 57 + 26; p = 0.046). Tolerability were higher in the video group compared with no video group (98% vs 86%; p = 0.003). Finally, satisfaction of information for informed consent process was higher in video group than in no video group (99% vs 76%; p = 0.001). a video information decreased anxiety level after written informed consent and improved tolerability and satisfaction scales in patients undergoing coronary angiography

  20. Magnetic Resonance Angiography: Principles and Applications.

    PubMed

    Dyke, Lara M

    2013-12-01

    Magnetic Resonance Angiography: Principles and Applications. Carr J. C., Carroll T. J., Springer-Verlag, Heidelberg/New York, 2012. 412 pp. Price $179.00. ISBN 978-1-4419-1685-3 (hardcover). © 2013 American Association of Physicists in Medicine.

  1. Clinical applications of magnetic resonance angiography.

    PubMed

    Glazer, M; McCormack, J; Dross, P

    1992-08-01

    Recent technical advances in magnetic resonance imaging (MRI) now allow for the noninvasive study of blood flow in vessels, or magnetic resonance angiography (MRA). We describe several case reports involving the use of MRA and discuss its advantages in evaluating patients for carotid artery stenosis, intracerebral aneurysms, and arteriovenous malformations (AVMs).

  2. Unexpected Angiography Findings and Effects on Management

    PubMed Central

    Neill, Matthew; Charles, Hearns W; Gross, Jonathan S; Farquharson, Sean; Deipolyi, Amy R

    2016-01-01

    Despite progress in noninvasive imaging with computed tomography and magnetic resonance imaging, conventional angiography still contributes to the diagnostic workup of oncologic and other diseases. Arteriography can reveal tumors not evident on cross-sectional imaging, in addition to defining aberrant or unexpected arterial supply to targeted lesions. This additional and potentially unanticipated information can alter management decisions during interventional procedures. PMID:27688932

  3. Diagnostic performance of image navigated coronary CMR angiography in patients with coronary artery disease.

    PubMed

    Henningsson, Markus; Shome, Joy; Bratis, Konstantinos; Vieira, Miguel Silva; Nagel, Eike; Botnar, Rene M

    2017-09-11

    The use of coronary MR angiography (CMRA) in patients with coronary artery disease (CAD) remains limited due to the long scan times, unpredictable and often non-diagnostic image quality secondary to respiratory motion artifacts. The purpose of this study was to evaluate CMRA with image-based respiratory navigation (iNAV CMRA) and compare it to gold standard invasive x-ray coronary angiography in patients with CAD. Consecutive patients referred for CMR assessment were included to undergo iNAV CMRA on a 1.5 T scanner. Coronary vessel sharpness and a visual score were assigned to the coronary arteries. A diagnostic reading was performed on the iNAV CMRA data, where a lumen narrowing >50% was considered diseased. This was compared to invasive x-ray findings. Image-navigated CMRA was performed in 31 patients (77% male, 56 ± 14 years). The iNAV CMRA scan time was 7 min:21 s ± 0 min:28 s. Out of a possible 279 coronary segments, 26 segments were excluded from analysis due to stents or diameter less than 1.5 mm, resulting in a total of 253 coronary segments. Diagnostic image quality was obtained for 98% of proximal coronary segments, 94% of middle segments, and 91% of distal coronary segments. The sensitivity and specificity was 86% and 83% per patient, 80% and 92% per vessel and 73% and 95% per segment. In this study, iNAV CMRA offered a very good diagnostic performance when compared against invasive x-ray angiography. Due to the short and predictable scan time it can add clinical value as a part of a comprehensive CAD assessment protocol.

  4. Whole body postmortem angiography with a high viscosity contrast agent solution using poly ethylene glycol as contrast agent dissolver.

    PubMed

    Jackowski, Christian; Persson, Anders; Thali, Michael J

    2008-03-01

    Postmortem minimal invasive angiography has already been implemented to support virtual autopsy examinations. An experimental approach in a porcine model to overcome an initially described artificial tissue edema artifact by using a poly ethylene glycol (PEG) containing contrast agent solution showed promising results. The present publication describes the first application of PEG in a whole corpse angiographic CT examination. A minimal invasive postmortem CT angiography was performed in a human corpse utilizing the high viscosity contrast agent solution containing 65% of PEG. Injection was carried out via the femoral artery into the aortic root in simulated cardiac output conditions. Subsequent CT scanning delivered the 3D volume data of the whole corpse. Visualization of the human arterial anatomy was excellent and the contrast agent distribution was generally limited to the arterial system as intended. As exceptions an enhancement of the brain, the left ventricular myocardium and the renal cortex became obvious. This most likely represented the stage of centralization of the blood circulation at the time of death with dilatation of the precapillary arterioles within these tissues. Especially for the brain this resulted in a distinctively improved visualization of the intracerebral structures by CT. However, the general tissue edema artifact of postmortem minimal invasive angiography examinations could be distinctively reduced.

  5. Assessment of coronary artery disease using coronary computed tomography angiography and biochemical markers.

    PubMed

    Gitsioudis, Gitsios; Katus, Hugo A; Korosoglou, Grigorios

    2014-07-26

    Chronic inflammatory mechanisms in the arterial wall lead to atherosclerosis, and include endothelial cell damage, inflammation, apoptosis, lipoprotein deposition, calcification and fibrosis. Cardiac computed tomography angiography (CCTA) has been shown to be a promising tool for non-invasive assessment of theses specific compositional and structural changes in coronary arteries. This review focuses on the technical background of CCTA-based quantitative plaque characterization. Furthermore, we discuss the available evidence for CCTA-based plaque characterization and the potential role of CCTA for risk stratification of patients with coronary artery disease.

  6. Patients with Life-Threatening Arterial Renal Hemorrhage: CT Angiography and Catheter Angiography with Subsequent Superselective Embolization

    SciTech Connect

    Sommer, C. M. Stampfl, U.; Bellemann, N.; Ramsauer, S.; Loenard, B. M.; Haferkamp, A.; Hallscheidt, P.; Richter, G. M.; Kauczor, H. U.; Radeleff, B. A.

    2010-06-15

    The purpose of this study was to evaluate the technical and clinical success of superselective embolization in patients with life-threatening arterial renal hemorrhage undergoing preinterventional CT angiography. Forty-three patients with clinical signs of life-threatening arterial renal hemorrhage underwent CT angiography and catheter angiography. Superselective embolization was indicated in the case of a positive catheter angiography. Primary study goals were technical and clinical success of superselective embolization. Secondary study goals were CT angiographic and catheter angiographic image findings and clinical follow-up. The mean time interval between CT angiography and catheter angiography was 8.3 {+-} 10.3 h (range, 0.2-34.1 h). Arterial renal hemorrhage was identified with CT angiography in 42 of 43 patients (98%) and catheter angiography in 39 of 43 patients (91%) (overview angiography in 4 of 43 patients [9%], selective angiography in 16 of 43 patients [37%], and superselective angiography in 39 of 43 patients [91%]). Superselective embolization was performed in 39 of 43 patients (91%) and technically successful in 37 of 39 patients (95%). Therefore, coil embolization was performed in 13 of 37 patients (35%), liquid embolization in 9 of 37 patients (24%), particulate embolization in 1 of 37 patients (3%), and a combination in 14 of 37 patients (38%). Clinical failure occurred in 8 of 39 patients (21%) and procedure-related complications in 2 of 39 patients (5%). The 30-day mortality rate was 3%. Hemoglobin decreased significantly prior to intervention (P < 0.001) and increased significantly after intervention (P < 0.005). In conclusion, superselective embolization is effective, reliable, and safe in patients with life-threatening arterial renal hemorrhage. In contrast to overview and selective angiography, only superselective angiography allows reliable detection of arterial renal hemorrhage. Preinterventional CT angiography is excellent for detection

  7. Non-invasive or minimally invasive autopsy compared to conventional autopsy of suspected natural deaths in adults: a systematic review.

    PubMed

    Blokker, Britt M; Wagensveld, Ivo M; Weustink, Annick C; Oosterhuis, J Wolter; Hunink, M G Myriam

    2016-04-01

    Autopsies are used for healthcare quality control and improving medical knowledge. Because autopsy rates are declining worldwide, various non-invasive or minimally invasive autopsy methods are now being developed. To investigate whether these might replace the invasive autopsies conventionally performed in naturally deceased adults, we systematically reviewed original prospective validation studies. We searched six databases. Two reviewers independently selected articles and extracted data. Methods and patient groups were too heterogeneous for meaningful meta-analysis of outcomes. Sixteen of 1538 articles met our inclusion criteria. Eight studies used a blinded comparison; ten included less than 30 appropriate cases. Thirteen studies used radiological imaging (seven dealt solely with non-invasive procedures), two thoracoscopy and laparoscopy, and one sampling without imaging. Combining CT and MR was the best non-invasive method (agreement for cause of death: 70 %, 95%CI: 62.6; 76.4), but minimally invasive methods surpassed non-invasive methods. The highest sensitivity for cause of death (90.9 %, 95%CI: 74.5; 97.6, suspected duplicates excluded) was achieved in recent studies combining CT, CT-angiography and biopsies. Minimally invasive autopsies including biopsies performed best. To establish a feasible alternative to conventional autopsy and to increase consent to post-mortem investigations, further research in larger study groups is needed. • Health care quality control benefits from clinical feedback provided by (alternative) autopsies. • So far, sixteen studies investigated alternative autopsy methods for naturally deceased adults. • Thirteen studies used radiological imaging modalities, eight tissue biopsies, and three CT-angiography. • Combined CT, CT-angiography and biopsies were most sensitive diagnosing cause of death.

  8. Comparison and co-relation of invasive and noninvasive methods of ejection fraction measurement.

    PubMed Central

    Godkar, Darshan; Bachu, Kalyan; Dave, Bijal; Megna, Robert; Niranjan, Selva; Khanna, Ashok

    2007-01-01

    BACKGROUND: Accurate estimation of left ventricular ejection fraction (LVEF) has assumed great significance in the era of automatic implantable cardioverter defibrillators (AICDs), and a low EF may be one of the sole deciding factor in determining AICD implantation in certain patient populations. AIM: There are various methods, invasive and noninvasive, which can help calculate EF. We sought to conduct a retrospective study comparing EF estimation by invasive (angiography) and noninvasive methods [MUGA (multiple-gated acquisition), echocardiography (echo), single-photon emission computed tomography (SPECT)] in 5,558 patients in our hospital from 1995-2004. METHODS AND RESULTS: EF was estimated by > or = 1 method (angiography, MUGA, echo, SPECT) within a one-month period. Values for the four tests in 5,558 patients were as follows: angiography mean 46.2, range 20-75, standard deviation (SD) 13.1; MUGA mean 45.7, range 20-70, SD 11.6; echo mean 45.7, range 22-70, SD 11.2; and SPECT mean 54.4, range 30-75, SD 11.9. Excellent positive correlations were found among all four tests as follows: angiography and MUGA, correlation coefficient (r) = 0.97, angiography and echo r = 0.96, angiography and SPECT r = 0.94, MUGA and echo r = 0.97, MUGA and SPECT r = 0.94, and echo and SPECT r = 0.94. Values for SPECT were significantly higher than for angiography, echo and MUGA (p < 0.001). The arithmetic difference between angiography and MUGA (mean 0.50, range -5.0-5.0) and the arithmetic difference between angiography and echo (mean 0.52, range -5.0-15.0) were similar (p = 0.59). The arithmetic difference between SPECT and angiography (mean 8.2, range -15.0-20.0) was significantly larger than the arithmetic difference between angiography and echo (p < 0.001). CONCLUSIONS: All the four methods used to estimate EF corelate well with each other. However, values estimated during stress testing by SPECT overestimate EF and are significantly higher as compared to MUGA, echo and

  9. [Non-contrast-Enhanced MR angiography for selective evaluation of the hepatic portal vein].

    PubMed

    Wu, Bing; Sun, JiayU; Wang, Chenglong; Xia, Chuncao; Li, Changxian

    2011-08-01

    This study was aimed to compare and evaluate the diagnostic performance of non-contrast-enhanced MR angiography (NCE-MRA) with contrast-enhanced MR angiography (CE-MRA) in the anatomic assessment of hepatic portal vein. Thirty people, ten patients with hepatic cirrhosis without ascites and twenty normal physical examination donors as control group were included in the NCE-MRA and CE-MRA with the same 1.5T MR scanner. Anatomic angiographic images were reconstructed and their datasets available for analysis independently performed by two radiologists. Assessment of data quality of hepatic portal vein vessels was rated with a four-point scale. After consensus reading, a total 27 images (90%) scored more than 3 point were observed in NCE-MRA and 28 (93.3%) in CE-MRA, respectively. Segmental branch vessels were visualized on MR angiography in the majority of cases. Both NCE-MRA and CE-MRA correctly characterized the hepatic portal veins with grade 5 and without false positive cases. Only 4 false negatives with grade 6 were missed in NCE-MRA group. There were no statistically significant differences between NCE-MRA and CE-MRA for characterization of hepatic vasculature (P < 0.05). Kappa value was larger than 0.75 for both reviewers. A conclusion could be drawn that NCE-MRA is a non-invasive and effective method that provides a comprehensive assessment of the hepatic portal vein.

  10. [Non-contrast-enhanced MR angiography for selective visualization of the hepatic vein].

    PubMed

    Wu, Bing; Sun, Jia-Yu; Xia, Chun-Cao; Li, Chang-Xian

    2011-05-01

    To evaluate the diagnostic performance of non-contrast-enhanced MR angiography (NCE-MRA) in the preoperative assessment of hepatic vein. Contrast-enhanced MR angiography (CE-MRA)and NCE-MRA were performed on ten patients with hepatic cirrhosis and twelve potential living liver donors with the same 1. 5T MR scanner. The anatomic angiographic images were reconstructed and reviewed by two radiologists independently. The quality of the images of hepatic vein vessels was rated with a four point scale. After consensus reading, 19 NCE-MRA images (86.4%) and 20 CE-MRA images (90.9%) scored more than 3 point, respectively. The segmental branch vessels were visualized on MR angiography in the majority of cases. Both NCE-MRA and CE-MRA correctly characterized 20 out of 22 hepatic veins without false positive reporting. The NCE-MRA reported two false negative cases. There were no statistically significant differences between NCE-MRA and CE-MRA for the characterization of hepatic vasculature (P > 0.05). High consistency was achieved between the two reviewers, with Kappa values over 0.75. NCE-MRA is a non-invasive and effective method for the comprehensive assessment of hepatic vein.

  11. Management of acute chest pain: A major role for coronary CT angiography.

    PubMed

    Pernès, J-M; Dupouy, P; Labbé, R; Sotirov, Y; Pongas, D; Mansour, H; Gaux, J-C

    2015-11-01

    Most patients presenting with acute chest pain (ACP) at the emergency unit do not have any marked electrocardiogram abnormalities or known history of heart disease. Identifying the few patients who have, or will actually develop acute coronary syndrome in this group that is considered to be at low risk, is an actual clinical challenge for emergency department physicians. In these patients, the goal of complementary non-invasive morphological or functional imaging tests is to exclude heart disease. The diagnostic values of coronary CT angiography include a sensitivity of 96% and a negative likelihood ratio of 0.09, which are highly contributory to the diagnosis, and the integration of this imaging test into a decision tree algorithm appears to be the least expensive strategy with the best cost/effective ratio. Coronary CT angiography is indicated in the presence of ACP associated with an inconclusive electrocardiogram, in the absence of any other obvious diagnoses, when the ultrasensitive troponin assay is negative or the dynamic changes are modest, slow and/or inconclusive. Ideally, coronary CT angiography should be performed within 3 to 48hours after the initial consultation. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  12. Acute chest pain: the role of MR imaging and MR angiography.

    PubMed

    Hunold, Peter; Bischoff, Peter; Barkhausen, Jörg; Vogt, Florian M

    2012-12-01

    MR imaging (MRI) and MR angiography (MRA) have gained a high level of diagnostic accuracy in cardiovascular disease. MRI in cardiac disease has been established as the non-invasive standard of reference in many pathologies. However, in acute chest pain the situation is somewhat special since many of the patients presenting in the emergency department suffer from potentially life-threatening disease including acute coronary syndrome, pulmonary embolism, and acute aortic syndrome. Those patients need a fast and definitive evaluation under continuous monitoring of vital parameters. Due to those requirements MRI seems to be less suitable compared to X-ray coronary angiography and multislice computed tomography angiography (CTA). However, MRI allows for a comprehensive assessment of all clinically stable patients providing unique information on the cardiovascular system including ischemia, inflammation and function. Furthermore, MRI and MRA are considered the method of choice in patients with contraindications to CTA and for regular follow-up in known aortic disease. This review addresses specific features of MRI and MRA for different cardiovascular conditions presenting with acute chest pain.

  13. Evaluation of coronary bypass graft occlusion and stenosis with 64-detector-row computed tomography angiography.

    PubMed

    Oncel, D; Oncel, G; Tastan, A; Tamci, B

    2007-11-01

    A noninvasive imaging modality is desirable for the evaluation of coronary bypass graft stenosis and occlusion. To prospectively evaluate the effectiveness of 64-detector-row computed tomography (DCT) for the assessment of coronary bypass grafts. Forty-two patients (35 male, seven female, mean age 66.3 years) with 103 bypass grafts (32 arterial, 71 venous) were examined with 64-DCT. The evaluations were done by two radiologists blinded to the results of quantitative coronary angiography (QCA), used as the reference standard. All of the 26 occluded grafts, nine of the 10 stenosed grafts, and 66 of the 67 patent grafts were correctly diagnosed with 64-DCT angiography. The sensitivity, specificity, and positive and negative predictive values for 64-DCT in detecting graft stenosis were 90%, 99%, 90%, and 99%, respectively. For graft occlusion, all were 100%. No statistically significant difference was found between 64-DCT and QCA for the evaluation of bypass grafts. Intermodality and interobserver agreement were excellent. 64-DCT angiography is a reliable, noninvasive diagnostic method for the assessment of coronary bypass grafts. It can be considered as a useful tool for follow-up purposes and may function as a gatekeeper before invasive procedures.

  14. A Randomized-Controlled Trial Examining the Effects of Reflexology on Anxiety of Patients Undergoing Coronary Angiography

    PubMed Central

    Molavi Vardanjani, Mehdi; Masoudi Alavi, Negin; Razavi, Narges Sadat; Aghajani, Mohammad; Azizi-Fini, Esmail; Vaghefi, Seied Morteza

    2013-01-01

    Background: The anxiety reduction before coronary angiography has clinical advantages and is one of the objectives of nursing. Reflexology is a non-invasive method that has been used in several clinical situations. Applying reflexology might have effect on the reduction of anxiety before coronary angiography. Objectives: The aim of this randomized clinical trial was to investigate the effect of reflexology on anxiety among patients undergoing coronary angiography. Patients and Methods: This trial was conducted in Shahid Beheshti Hospital, in Kashan, Iran. One hundred male patients who were undergoing coronary angiography were randomly enrolled into intervention and placebo groups. The intervention protocol was included 30 minutes of general foot massage and the stimulation of three reflex points including solar plexus, pituitary gland, and heart. The placebo group only received the general foot massage. Spielbergers state trait anxiety inventory was used to assess the anxiety experienced by patients. Data was analyzed using Man-Witney, Wilcoxon and Chi-square tests. The stepwise multiple regressions used to analyze the variables that are involved in anxiety reduction. Results: The mean range of anxiety decreased from 53.24 to 45.24 in reflexology group which represented 8 score reduction (P = 0.0001). The reduction in anxiety was 5.9 score in placebo group which was also significant (P = 0.0001). The anxiety reduction was significantly higher in reflexology group (P = 0.014). The stepwise multiple regression analysis showed that doing reflexology can explain the 7.5% of anxiety reduction which made a significant model. Conclusions: Reflexology can decrease the anxiety level before coronary angiography. Therefore, reflexology before coronary angiography is recommended. PMID:25414869

  15. Angiography of Liver Transplantation Patients 1

    PubMed Central

    Zajko, Albert B.; Bron, Klaus M.; Starzl, Thomas E.; Van Thiel, David H.; Gartner, J. Carlton; Iwatsuki, Shunzaburo; Shaw, Byers W.; Zitelli, Basil J.; Malatack, J. Jeffrey; Urbach, Andrew H.

    2010-01-01

    Over 45 months, 119 angiographic examinations were performed in 95 patients prior to liver transplantation, and 53 examinations in 44 patients after transplantation. Transplantation feasibility was influenced by patency of the portal vein and inferior vena cava. Selective arterial portography, wedged hepatic venography, and transhepatic portography were used to assess the portal vein if sonography or computed tomography was inconclusive. Major indications for angiography after transplantation included early liver failure, sepsis, unexplained elevation of liver enzyme levels, and delayed bile leakage, all of which may be due to hepatic artery thrombosis. Other indications included gastrointestinal tract bleeding, hemobilia, and evaluation of portal vein patency in patients with chronic rejection who were being considered for retransplantation. Normal radiographic features of hepatic artery and portal vein reconstruction are demonstrated. Complications diagnosed using results of angiography included hepatic artery or portal vein stenoses and thromboses and pancreaticoduodenal aneurysms. Intrahepatic arterial narrowing, attenuation, slow flow, and poor filling were seen in five patients with rejection PMID:3901102

  16. Gadofosveset-enhanced magnetic resonance angiography

    PubMed Central

    Goyen, Mathias

    2008-01-01

    Gadofosveset (Vasovist®, Bayer Schering Pharma AG, Berlin/Germany) is the first intravascular contrast agent approved for use with magnetic resonance angiography in the European Union, Switzerland, Turkey, Canada, and Australia. Gadofosveset reversibly binds to albumin providing extended intravascular enhancement compared wth existing extracellular magnetic resonance contrast agents. Prior to approval, gadofosveset underwent extensive testing to evaluate the safety and efficacy of the drug; the clinical trials show that gadofosveset-enhanced magnetic resonance angiography (MRA) is safe and well tolerated in patients with vascular disease and effective for the detection of vascular stenosis and aneurysms gadofosveset has the potential to open new horizons in diagnostic MRA by increasing the spatial resolution and the robustness of MRA examinations and facilitating the examination of multiple vascular beds. PMID:18629367

  17. Types of diaphragmatic motion during hepatic angiography.

    PubMed

    Katsuda, T; Kuroda, C; Fujita, M

    1997-01-01

    To determine the types and causes of diaphragmatic motion during hepatic angiography, the authors used transarterial cut-film portography (TAP) to study movement of the diaphragm during breath-holding. Thirty-three TAP sequences were studied, and the patients' diaphragmatic motions were classified into four categories according to the distance their diaphragms moved. Results showed that the diaphragm was stationary in 33% of the TAP studies, while perpetual motion occurred in 15% of the studies, early-phase motion occurred in 12% and late-phase motion occurred in 40%. Ten sequences showed diaphragmatic motion of more than 10 mm, with eight sequences showing caudal motion and two showing cranial motion. This article discusses the cause of diaphragmatic motion during breath-holding for hepatic angiography and presents suggestions to reduce motion artifacts during the exam.

  18. Value of first day angiography/angioplasty in evolving Non-ST segment elevation myocardial infarction: an open multicenter randomized trial. The VINO Study.

    PubMed

    Spacek, R; Widimský, P; Straka, Z; Jiresová, E; Dvorák, J; Polásek, R; Karel, I; Jirmár, R; Lisa, L; Budesínský, T; Málek, F; Stanka, P

    2002-02-01

    Direct angioplasty is an effective treatment for ST-elevation myocardial infarction. The role of very early angioplasty in non-ST-elevation infarction is not known. Thus, a randomized study of first day angiography/angioplasty vs early conservative therapy of evolving myocardial infarction without persistent ST-elevation was conducted. One hundred and thirty-one patients with confirmed acute myocardial infarction without ST-segment elevations were randomized within 24 h of last rest chest pain: 64 in the first day angiography/angioplasty group and 67 in the early conservative group (coronary angiography only after recurrent or stress induced myocardial ischaemia). All patients in the invasive group underwent coronary angiography on the day of admission (mean randomization-angiography time 6.2 h). First day angioplasty of the infarct related artery was performed in 47% of the patients and bypass surgery in 35%. In the conservative group, 55% underwent coronary angiography, 10% angioplasty and 30% bypass surgery within 6 months. The primary end-point (death/reinfarction) at 6 months occurred in 6.2% vs 22.3% (P<0.001). Six month mortality in the first day angiography/angioplasty group was 3.1% vs 13.4% in the conservative group (P<0.03). Non-fatal reinfarction occurred in 3.1% vs. 14.9% (P<0.02). First day coronary angiography followed by angioplasty whenever possible reduces mortality and reinfarction in evolving myocardial infarction without persistent ST-elevation, in comparison with an early conservative treatment strategy. Copyright 2001 The European Society of Cardiology.

  19. 5-F catheter in cerebral angiography

    SciTech Connect

    O'Reilly, G.V.; Naheedy, M.H.; Colucci, V.M.; Hammerschlag, S.B.

    1981-11-01

    Although the 5-F catheter is reputed to cause less vascular trauma than larger catheters, subintimal injections of contrast material have occurred following intimal damage by the catheter tip. Microscopic studies of the tips of two widely used 5-F polyethylene catheters have revealed a difference in configuration resulting in one of the catheters becoming markedly damaged during angiography. The authors make recommendations for finishing and protecting the catheter tip.

  20. [Clinical applications of computed tomography coronary angiography].

    PubMed

    Bastarrika, G; Schoepf, U J

    2009-01-01

    The clinical applications of computed tomography coronary angiography (CTCA) are constantly evolving. Initially employed to quantify coronary artery calcification, multidetector CT also makes it possible to evaluate the anatomy and anatomical variations of coronary circulation, rule out coronary disease, and follow up surgical and percutaneous revascularization procedures. Moreover, CTCA may potentially be useful to quantify ventricular function, characterize non-calcified atherosclerotic plaques, and analyze myocardial perfusion and viability, providing anatomical, morphological, and functional information in patients with suspected ischemic heart disease.

  1. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN GEOGRAPHIC ATROPHY.

    PubMed

    Sacconi, Riccardo; Corbelli, Eleonora; Carnevali, Adriano; Querques, Lea; Bandello, Francesco; Querques, Giuseppe

    2017-10-06

    To analyze choriocapillaris (CC) vessel density (VD) around geographic atrophy (GA) secondary to non-neovascular dry age-related macular degeneration using optical coherence tomography angiography. We compared CC VD surrounding GA margin (500 μm radius) with control CC (outside GA margin) in a consecutive series of GA patients presenting between August 2016 and February 2017 at the Medical Retina and Imaging Unit of University Vita-Salute, IRCCS Ospedale San Raffaele in Milan. Images were obtained through thresholding and binarization. We also compared the CC VD in a sample area of 500 μm × 500 μm surrounding GA margin rated as hyperautofluorescent on fundus autofluorescence to a similar area rated as isoautofluorescent. Fifty eyes of 29 patients (19 women and 10 men; mean age 77 ± 6 years) with mean GA area of 9.43 ± 5.08 mm and mean subfoveal choroidal thickness of 164 ± 73 μm were included. Choriocapillaris VD surrounding GA margin as detected by optical coherence tomography angiography revealed a significant impairment compared with control CC outside GA margin (0.317 ± 0.083 vs. 0.461 ± 0.054, P < 0.001), which was even greater in patients with foveal involvement (P = 0.013). Furthermore, mean VD in hyperautofluorescent areas was significantly lower compared with isoautofluorescent areas (0.242 ± 0.112 vs. 0.327 ± 0.130, P = 0.001). A positive correlation was disclosed between VD surrounding GA margin and subfoveal choroidal thickness (r = 0.332, P = 0.019). Optical coherence tomography angiography discloses CC impairment surrounding GA margin. Such CC impairment at GA margin seems to precede retinal pigment epithelium alterations at fundus autofluorescence. Optical coherence tomography angiography could be a new valuable tool for detecting CC alterations and to evaluate potential therapeutic responses in clinical studies.

  2. Cardiac CT Angiography in Congestive Heart Failure.

    PubMed

    Levine, Avi; Hecht, Harvey S

    2015-06-01

    Cardiac CT angiography has become an important tool for the diagnosis and treatment of congestive heart failure. Differentiation of ischemic from nonischemic cardiomyopathy; evaluation of myocardial perfusion; characterization of hypertrophic cardiomyopathy, left ventricular noncompaction, and arrhythmogenic right ventricular dysplasia; and delineation of congenital heart defects and valvular abnormalities are the primary diagnostic applications. Therapeutic use includes visualization of the coronary venous anatomy for optimal implementation of cardiac resynchronization therapy and evaluation of left ventricular assist devices and transplant vasculopathy.

  3. Sudden death after chest pain: feasibility of virtual autopsy with postmortem CT angiography and biopsy.

    PubMed

    Ross, Steffen G; Thali, Michael J; Bolliger, Stephan; Germerott, Tanja; Ruder, Thomas D; Flach, Patricia M

    2012-07-01

    To determine the potential of minimally invasive postmortem computed tomographic (CT) angiography combined with image-guided tissue biopsy of the myocardium and lungs in decedents who were thought to have died of acute chest disease and to compare this method with conventional autopsy as the reference standard. The responsible justice department and ethics committee approved this study. Twenty corpses (four female corpses and 16 male corpses; age range, 15-80 years), all of whom were reported to have had antemortem acute chest pain, were imaged with postmortem whole-body CT angiography and underwent standardized image-guided biopsy. The standard included three biopsies of the myocardium and a single biopsy of bilateral central lung tissue. Additional biopsies of pulmonary clots for differentiation of pulmonary embolism and postmortem organized thrombus were performed after initial analysis of the cross-sectional images. Subsequent traditional autopsy with sampling of histologic specimens was performed in all cases. Thereafter, conventional histologic and autopsy reports were compared with postmortem CT angiography and CT-guided biopsy findings. A Cohen κ coefficient analysis was performed to explore the effect of the clustered nature of the data. In 19 of the 20 cadavers, findings at postmortem CT angiography in combination with CT-guided biopsy validated the cause of death found at traditional autopsy. In one cadaver, early myocardial infarction of the papillary muscles had been missed. The Cohen κ coefficient was 0.94. There were four instances of pulmonary embolism, three aortic dissections (Stanford type A), three myocardial infarctions, three instances of fresh coronary thrombosis, three cases of obstructive coronary artery disease, one ruptured ulcer of the ascending aorta, one ruptured aneurysm of the right subclavian artery, one case of myocarditis, and one pulmonary malignancy with pulmonary artery erosion. In seven of 20 cadavers, CT-guided biopsy

  4. Indocyanine green angiography features of malattia leventinese

    PubMed Central

    Souied, E H; Leveziel, N; Querques, G; Darmon, J; Coscas, G; Soubrane, G

    2006-01-01

    Background/aim Malattia leventinese (ML) is an inherited macular degeneration characterised by the presence of small radial drusen. Despite extensive descriptions of this study of the fundus, angiographic features of ML have been inadequately described. The aim is to describe the indocyanine green angiography (ICG) features observed in ML. Methods 10 eyes from five consecutive ML patients (aged 27–44 years) were prospectively included. A complete ophthalmological examination including colour fundus photographs, autofluorescence, fluorescein angiography (FA), and ICG was performed. Results ICG differentiated two types of drusen. Large round aggregated drusen were consistently hypofluorescent in the early phases and presented as hyperfluorescent spots surrounded by halos of hypofluorescence in the late phases. Conversely, small radial drusen were mostly hyperfluorescent in the early phases with decreased fluorescence in the late phases of the ICG sequence. FA also showed differences in staining between the two types of drusen. Conclusions ICG angiography revealed marked differences between the large round and small radial drusen observed in ML. The large central drusen presented with an unusual pustuliform feature on the late phases of the ICG sequence. This distinct feature may be useful in the diagnosis of late stage disease when drusen consolidation could obscure the radial drusen. PMID:16488948

  5. Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography.

    PubMed

    Múnera, F; Soto, J A; Palacio, D; Velez, S M; Medina, E

    2000-08-01

    To determine the sensitivity and specificity of helical computed tomographic (CT) angiography in the diagnosis of carotid and vertebral arterial injuries caused by penetrating neck trauma. A prospective study was conducted during 24 months in 60 patients with penetrating neck trauma who were referred for conventional angiography owing to clinical suspicion of arterial injury. In the patient population, 146 arteries (77 carotid, 69 vertebral) were studied by means of conventional angiography. In all patients, conventional angiography and helical CT angiography were completed within 6 hours. Two radiologists interpreted helical CT angiographic studies by means of consensus. Conventional angiography was the standard of reference for determining the sensitivity and specificity of helical CT angiography. Conventional angiograms showed arterial injuries in 10 (17%) of 60 patients. Conventional angiographic findings were arterial occlusion (n = 4), arteriovenous fistula (n = 2), pseudoaneurysm (n = 3), pseudoaneurysm with arteriovenous fistula (n = 1), and normal arteries (n = 136). Nine of 10 arterial injuries and all normal arteries were depicted adequately at helical CT angiography. Sensitivity of helical CT angiography was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 98%. The sensitivity and specificity of helical CT angiography are high for detection of major carotid and vertebral arterial injuries resulting from penetrating trauma.

  6. Changes in Medical Management after Coronary CT Angiography.

    PubMed

    Naue, Vânia Mairi; Camargo, Gabriel; Sabioni, Letícia Roberto; Lima, Ronaldo de Souza Leão; Derenne, Maria Eduarda; Lorenzo, Andréa Rocha de; Freire, Monica Di Calafiori; Azevedo Filho, Clério Francisco; Resende, Elmiro Santos; Gottlieb, Ilan

    2015-08-07

    Coronary computed tomography angiography (CCTA) allows for non-invasive coronary artery disease (CAD) phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients. To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC) levels. We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after. A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had non-obstructive (< 50%) lesions and 41 (42%) had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32). We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001). We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD. Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.

  7. Perceptual enhancement of arteriovenous malformation in MRI angiography displays

    NASA Astrophysics Data System (ADS)

    Abhari, Kamyar; Baxter, John S. H.; Eagleson, Roy; Peters, Terry; de Ribaupierre, Sandrine

    2012-02-01

    The importance of presenting medical images in an intuitive and usable manner during a procedure is essential. However, most medical visualization interfaces, particularly those designed for minimally-invasive surgery, suffer from a number of issues as a consequence of disregarding the human perceptual, cognitive, and motor system's limitations. This matter is even more prominent when human visual system is overlooked during the design cycle. One example is the visualization of the neuro-vascular structures in MR angiography (MRA) images. This study investigates perceptual performance in the usability of a display to visualize blood vessels in MRA volumes using a contour enhancement technique. Our results show that when contours are enhanced, our participants, in general, can perform faster with higher level of accuracy when judging the connectivity of different vessels. One clinical outcome of such perceptual enhancement is improvement of spatial reasoning needed for planning complex neuro-vascular operations such as treating Arteriovenous Malformations (AVMs). The success of an AVM intervention greatly depends on fully understanding the anatomy of vascular structures. However, poor visualization of pre-operative MRA images makes the planning of such a treatment quite challenging.

  8. Assessment of the Circle of Willis with Cranial Tomography Angiography.

    PubMed

    Karatas, Ayse; Coban, Gokmen; Cinar, Celal; Oran, Ismail; Uz, Aysun

    2015-09-06

    The circle of Willis is a major collateral pathway important in ischemic conditions. The aim of our study was to assess the structural characteristics of the circle of Willis within the Turkish adult population, along with variations and arteries involved in the measurement of diameters and lengths on cranial computed tomography angiography (CTA). One hundred adult patients who underwent CTA images were evaluated retrospectively. Results of the study revealed 82% adult, 17% fetal, and 1% transitional configurations. A complete polygonal structure was observed in 28% of cases. Variations of the circle of Willis were more common in the posterior portion. Hypoplasia was found to be the most common variation and was observed as a maximum in the posterior communicating artery (AComP). The patency and size of arteries in the circle of Willis are important in occlusive cerebrovascular diseases and cerebrovascular surgery. Although CTA is an easily accessible non-invasive clinical method for demonstrating the vascular structure, CTA should be evaluated taking into account image resolution quality and difficulties in the identification of small vessels.

  9. Changes in Medical Management after Coronary CT Angiography.

    PubMed

    Naue, Vânia Mairi; Camargo, Gabriel; Sabioni, Letícia Roberto; Lima, Ronaldo de Souza Leão; Derenne, Maria Eduarda; Lorenzo, Andréa Rocha de; Freire, Monica Di Calafiori; Azevedo Filho, Clério Francisco; Resende, Elmiro Santos; Gottlieb, Ilan

    2015-10-01

    Coronary computed tomography angiography (CCTA) allows for non-invasive coronary artery disease (CAD) phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients. To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC) levels. We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after. A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had non-obstructive (< 50%) lesions and 41 (42%) had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32). We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001). We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD. Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.

  10. Changes in Medical Management after Coronary CT Angiography

    PubMed Central

    Naue, Vânia Mairi; Camargo, Gabriel; Sabioni, Letícia Roberto; Lima, Ronaldo de Souza Leão; Derenne, Maria Eduarda; de Lorenzo, Andréa Rocha; Freire, Monica Di Calafiori; Azevedo Filho, Clério Francisco; Resende, Elmiro Santos; Gottlieb, Ilan

    2015-01-01

    Introduction Coronary computed tomography angiography (CCTA) allows for non-invasive coronary artery disease (CAD) phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients. Objective To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC) levels. Methods We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after. Results A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had non-obstructive (< 50%) lesions and 41 (42%) had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32). We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001). We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD. Conclusion Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD. PMID:26559988

  11. Multislice computerized tomography angiography in the evaluation of intracranial aneurysms: a comparison with intraarterial digital subtraction angiography.

    PubMed

    Wintermark, Max; Uske, Antoine; Chalaron, Marc; Regli, Luca; Maeder, Philippe; Meuli, Reto; Schnyder, Pierre; Binaghi, Stefano

    2003-04-01

    The goal of this study was to assess the diagnostic accuracy of computerized tomography (CT) angiography performed with the aid of multislice technology (MSCT angiography) in the investigation of intracranial aneurysms, by comparing this method with intraarterial digital subtraction (IADS) angiography. Fifty consecutive adult patients, who successively underwent MSCT angiography (four rows) and IADS angiography of intracranial vessels, were prospectively identified. The MSCT angiography studies consisted of 1.25-mm slices, with 0.8-mm reconstruction intervals, a pitch of 0.75, and timing determined by a test bolus. Two neuroradiologists, who were blinded to the initial interpretation of the MSCT angiograms as well as to those of the IADS angiograms, independently reviewed the MSCT angiograms for the detection and characterization of intracranial aneurysms. Forty-nine intracranial aneurysms were identified in 40 patients; 33 of these lesions were responsible for subarachnoid hemorrhage. The sensitivity, specificity, and accuracy of MSCT angiography in the detection of intracranial aneurysms were 94.8, 95.2, and 94.9%, respectively, on a per-aneurysm basis and 99, 95.2, and 98.3%, respectively, on a per-patient basis. Interobserver agreement was 98%. There was an excellent correlation between aneurysm size assessed using MSCT angiography and that determined by IADS angiography (slope = 0.916, r = 0.877, p < 0.001); however, 2 mm stood as the cutoff size below which the sensitivity of MSCT angiography was statistically lower. That method displayed great accuracy in characterizing the morphological characteristics of the aneurysm. Multislice CT angiography is an accurate and robust noninvasive screening test for intracranial aneurysms. It performs better than that reported for single-slice CT angiography. Introduction of eight- and especially 16-row MSCT angiography will provide further progression through thinner slices, a lower pitch, and a purely arterial phase.

  12. Diagnostic yield and accuracy of CT angiography, MR angiography, and digital subtraction angiography for detection of macrovascular causes of intracerebral haemorrhage: prospective, multicentre cohort study

    PubMed Central

    Velthuis, Birgitta K; Rinkel, Gabriël J E; Algra, Ale; de Kort, Gérard A P; Witkamp, Theo D; de Ridder, Johanna C M; van Nieuwenhuizen, Koen M; de Leeuw, Frank-Erik; Schonewille, Wouter J; de Kort, Paul L M; Dippel, Diederik W; Raaymakers, Theodora W M; Hofmeijer, Jeannette; Wermer, Marieke J H; Kerkhoff, Henk; Jellema, Korné; Bronner, Irene M; Remmers, Michel J M; Bienfait, Henri Paul; Witjes, Ron J G M; Greving, Jacoba P; Klijn, Catharina J M

    2015-01-01

    Study question What are the diagnostic yield and accuracy of early computed tomography (CT) angiography followed by magnetic resonance imaging/angiography (MRI/MRA) and digital subtraction angiography (DSA) in patients with non-traumatic intracerebral haemorrhage? Methods This prospective diagnostic study enrolled 298 adults (18-70 years) treated in 22 hospitals in the Netherlands over six years. CT angiography was performed within seven days of haemorrhage. If the result was negative, MRI/MRA was performed four to eight weeks later. DSA was performed when the CT angiography or MRI/MRA results were inconclusive or negative. The main outcome was a macrovascular cause, including arteriovenous malformation, aneurysm, dural arteriovenous fistula, and cavernoma. Three blinded neuroradiologists independently evaluated the images for macrovascular causes of haemorrhage. The reference standard was the best available evidence from all findings during one year’s follow-up. Study answer and limitations A macrovascular cause was identified in 69 patients (23%). 291 patients (98%) underwent CT angiography; 214 with a negative result underwent additional MRI/MRA and 97 with a negative result for both CT angiography and MRI/MRA underwent DSA. Early CT angiography detected 51 macrovascular causes (yield 17%, 95% confidence interval 13% to 22%). CT angiography with MRI/MRA identified two additional macrovascular causes (18%, 14% to 23%) and these modalities combined with DSA another 15 (23%, 18% to 28%). This last extensive strategy failed to detect a cavernoma, which was identified on MRI during follow-up (reference strategy). The positive predictive value of CT angiography was 72% (60% to 82%), of additional MRI/MRA was 35% (14% to 62%), and of additional DSA was 100% (75% to 100%). None of the patients experienced complications with CT angiography or MRI/MRA; 0.6% of patients who underwent DSA experienced permanent sequelae. Not all patients with negative CT angiography and

  13. Invasive Candidiasis.

    PubMed

    McCarty, Todd P; Pappas, Peter G

    2016-03-01

    Invasive candidiasis is a collective term that refers to a group of infectious syndromes caused by a variety of species of Candida, 5 of which cause most cases. Candidemia is the most commonly recognized syndrome associated with invasive candidiasis. Certain conditions may influence the likelihood for one species versus another in a specific clinical scenario, and this can have important implications for selection of antifungal therapy and the duration of treatment. Molecular diagnostic technology plays an ever-increasing role as an adjunct to traditional culture-based diagnostics, offering significant potential toward improvement in patient care.

  14. Diagnostic accuracy of 64-slice computed tomography coronary angiography for the detection of in-stent restenosis: a meta-analysis.

    PubMed

    Carrabba, Nazario; Schuijf, Joanne D; de Graaf, Fleur R; Parodi, Guido; Maffei, Erica; Valenti, Renato; Palumbo, Alessandro; Weustink, Annick C; Mollet, Nico R; Accetta, Gabriele; Cademartiri, Filippo; Antoniucci, David; Bax, Jeroen J

    2010-06-01

    We sought to evaluate the diagnostic accuracy of 64-slice multi-detector row computed tomography (MDCT) compared with invasive coronary angiography for in-stent restenosis (ISR) detection. MEDLINE, Cochrane library, and BioMed Central database searches were performed until April 2009 for original articles. Inclusion criteria were (1) 64-MDCT was used as a diagnostic test for ISR, with >50% diameter stenosis selected as the cut-off criterion for significant ISR, using invasive coronary angiography and quantitative coronary angiography as the standard of reference; (2) absolute numbers of true positive, false positive, true negative, and false negative results could be derived. Standard meta-analytic methods were applied. Nine studies with a total of 598 patients with 978 stents included were considered eligible. On average, 9% of stents were unassessable (range 0-42%). Accuracy tests with 95% confidence intervals (CIs) comparing 64-MDCT vs invasive coronary angiography showed that pooled sensitivity, specificity, positive and negative likelihood ratio (random effect model) values were: 86% (95% CI 80-91%), 93% (95% CI 91-95%), 12.32 (95% CI 7.26-20.92), 0.18 (95% CI 0.12-0.28) for binary ISR detection. The symmetric area under the curve value was 0.94, indicating good agreement between 64-MDCT and invasive coronary angiography. 64-MDCT has a good diagnostic accuracy for ISR detection with a particularly high negative predictive value. However, still a relatively large proportion of stents remains uninterpretable. Accordingly, only in selected patients, 64-MDCT may serve as a potential alternative noninvasive method to rule out ISR.

  15. Comparison between indocyanine green angiography and fluorescein angiography in normal cats.

    PubMed

    Hayashi, Miri; Maehara, Seiya; Ito, Yosuke; Yamashita, Kazuto; Kubo, Akira; Nakade, Tetsuya

    2017-07-01

    To study a new approach to indocyanine green (ICG) angiography for contrasting the ocular fundus in cats. Six healthy laboratory cats. Fluorescein (FLUO) and ICG angiography were performed using an infrared-sensitive charged coupled device-equipped fundus camera on sedated cats. At 12.3 ± 3.4 s after ICG administration, the choroidal arteries could be seen extending radially from the optic disk. The choroidal veins became apparent at 16.2 ± 4.1 s alongside the choroidal arteries. Gradual fading of the choroidal vessels began 5.8 ± 1.5 min postdye administration and diffuse fluorescence of the fundus appeared. Diffuse fluorescence of the optic disk faded at about 18.8 ± 2.9 min. Mean arterial blood pressure at 1 and 3 min after ICG administration showed no significant change when compared to pre-administration (P > 0.05). However, 5 min (P = 0.054) and 10 min (P < 0.05) postadministration, a significant drop in blood pressure occurred. The time lapse between FLUO administration and its appearance in the ocular fundus was 15.7 ± 3.8 s. Retinal veins became apparent at 22.0 ± 3.6 s alongside retinal arteries. At 31.2 ± 4.1 s, full venous fluorescence was visualized throughout the entire fundus. While FLUO angiography shows only the retinal vessels, ICG angiography enabled visualization of the choroidal vasculature. ICG angiography provides clear resolution while remaining reliable and simple; thus, a combination of ICG and FLUO angiography shows promise as a diagnostic aid for clinical evaluation of various chorioretinal diseases in cats. © 2016 American College of Veterinary Ophthalmologists.

  16. A feasibility study of epicardial coronary angiography from microbubble-contrasted tridimensional echocardiography: segmentation approaches

    NASA Astrophysics Data System (ADS)

    Lage, Danilo Meneses; Tsutsui, Jeane Mike; Furuie, Sérgio Shiguemi

    2010-03-01

    Conventional coronary angiography has been the current gold standard for evaluation of coronary stenosis severity. However, this is an invasive procedure, based on ionizing radiation (X-Ray) and dependent of nephrotoxic contrast agents. In the past three decades, echocardiography has emerged as an important medical image modality in Cardiology. With the advent of microbubble-based contrast agents and array transducers, 3D-echocardiography now presents itself as a relative low-cost, non invasive and non ionizing alternative method to visibilize arteries and their dynamics. This paper investigates some segmentation techniques to emphasize and isolate epicardial coronaries in tridimensional microbubblecontrasted echocardiographic images, since available computational tools do not provide adequate processing.

  17. Pedal angiography in peripheral arterial occlusive disease: first-pass i.v. contrast-enhanced MR angiography with blood pool contrast medium versus intraarterial digital subtraction angiography.

    PubMed

    Kos, Sebastian; Reisinger, Clemens; Aschwanden, Markus; Bongartz, Georg M; Jacob, Augustinus L; Bilecen, Deniz

    2009-03-01

    The purpose of this study was to prospectively evaluate first-pass i.v. gadofosveset-enhanced MR angiography in patients with peripheral arterial occlusive disease for visualization of the pedal arteries and stenosis or occlusion of those arteries with intraarterial digital subtraction angiography as the reference standard. Twenty patients with peripheral arterial occlusive disease (nine women, 11 men; age-range 58-83 years) were prospectively enrolled. Gadofosveset first-pass contrast-enhanced MR angiography was performed with a 1.5-T system, a dedicated foot coil, and cuff compression to the calf. Arterial segments were assessed for degree of arterial stenosis, arterial visibility, diagnostic utility, and venous contamination. Detection of vessel stenosis or occlusion was evaluated in comparison with findings at digital subtraction angiography. The unpaired Student's t test was used to test arterial visibility with the two techniques. First-pass MR angiography with gadofosveset had good diagnostic utility in 83.9% of all segments and no venous contamination in 96.8% of all segments. There was no difference between the performance of intraarterial digital subtraction angiography and that of i.v. contrast-enhanced MR angiography in arterial visibility overall (p = 0.245) or in subgroup analysis of surgical arterial bypass targets (p = 0.202). The overall sensitivity, specificity, and accuracy of i.v. gadofosveset-enhanced MR angiography for characterization of clinically significant stenosis and occlusion were 91.4%, 96.1%, and 93.9%. In the subgroup analysis, the sensitivity, specificity, and accuracy were 85.5%, 96.5%, and 92.1%. Gadofosveset-enhanced MR angiography of the pedal arteries in patients with peripheral arterial occlusive disease has arterial visibility equal to that of digital subtraction angiography and facilitates depiction of clinically significant stenosis and occlusion.

  18. The Use of Fluorescein Angiography to Study Oxygen Toxicity

    DTIC Science & Technology

    1976-02-28

    NAVAL RESEA DICAL ÄTORY SUBMARINE BASE, GROTON, CONN. REPORT NUMBER 833 THE USE OF FLUORESCEIN ANGIOGRAPHY TO STUDY OXYGEN TOXICITY by...distribution unlimited PROBLEM To test whether fluorescein angiography can be used as a technique for monitoring an individual’s response to... Angiography to Study Oxygen Toxicity* Reprinted from Annals of Ophthalmology, Volume 9, Number 8, August 1977. Copyright 1977 by Annals of

  19. Evaluation of image quality in carotid and cerebrovascular disease: a comparative study between subtraction and routine computed tomography angiography.

    PubMed

    Zhao, De-Li; Wan, Yong; Wang, Guo-Kun; Wang, Hai-Bo; Liang, Hong-Wei; Zhou, Hai-Ting; Gao, Li; Zhang, Jin-Ling

    2016-11-01

    Few data exist comparing the image quality and diagnostic accuracy of subtraction computed tomography (CT) angiography (SCTA) in carotid and cerebrovascular arteries with routine CT angiography (RCTA). In this study, 56 patients underwent 128-row CT angiography of these vessels with review by two radiologists using routine, nonsubtracted, and SCTA protocols. Comparisons were made using a 4-point subjective rating scale in all patients. Eighteen patients were examined with both SCTA and invasive digital subtraction angiography (DSA). The accuracy of SCTA and routine CTA reformations was assessed and compared by both patient-based and vessel-based analyses of intracranial aneurysms and intracranial and extracranial arterial stenotic lesions using DSA results as the reference standard. Diagnostic accuracy in the adjacent skull base portion of the internal carotid artery (ICA) and reading time for cerebral aneurysms and vessel stenoses were obviously improved with SCTA protocol, but the accuracy in vertebro-basilar arteries was no different. The diagnostic accuracy in general was slightly increased compared with routine CTA. Review of SCTA images is an effective means to remove bone close to vessels as seen on routine CTA and has good image quality and diagnostic accuracy. SCTA is superior to routine CTA in the visualization and diagnostic accuracy of adjacent skull base part of the ICA and decreases reading time for carotid and cerebrovascular arterial imaging. © 2016, Wiley Periodicals, Inc.

  20. Fractional Flow Reserve and Coronary Computed Tomographic Angiography: A Review and Critical Analysis.

    PubMed

    Hecht, Harvey S; Narula, Jagat; Fearon, William F

    2016-07-08

    Invasive fractional flow reserve (FFR) is now the gold standard for intervention. Noninvasive functional imaging analyses derived from coronary computed tomographic angiography (CTA) offer alternatives for evaluating lesion-specific ischemia. CT-FFR, CT myocardial perfusion imaging, and transluminal attenuation gradient/corrected contrast opacification have been studied using invasive FFR as the gold standard. CT-FFR has demonstrated significant improvement in specificity and positive predictive value compared with CTA alone for predicting FFR of ≤0.80, as well as decreasing the frequency of nonobstructive invasive coronary angiography. High-risk plaque characteristics have also been strongly implicated in abnormal FFR. Myocardial computed tomographic perfusion is an alternative method with promising results; it involves more radiation and contrast. Transluminal attenuation gradient/corrected contrast opacification is more controversial and may be more related to vessel diameter than stenosis. Important considerations remain: (1) improvement of CTA quality to decrease unevaluable studies, (2) is the diagnostic accuracy of CT-FFR sufficient? (3) can CT-FFR guide intervention without invasive FFR confirmation? (4) what are the long-term outcomes of CT-FFR-guided treatment and how do they compare with other functional imaging-guided paradigms? (5) what degree of stenosis on CTA warrants CT-FFR? (6) how should high-risk plaque be incorporated into treatment decisions? (7) how will CT-FFR influence other functional imaging test utilization, and what will be the effect on the practice of cardiology? (8) will a workstation-based CT-FFR be mandatory? Rapid progress to date suggests that CTA-based lesion-specific ischemia will be the gatekeeper to the cardiac catheterization laboratory and will transform the world of intervention. © 2016 American Heart Association, Inc.

  1. Non-contrast-enhanced magnetic resonance angiography: techniques and applications.

    PubMed

    Blankholm, Anne Dorte; Ringgaard, Steffen

    2012-01-01

    Non-contrast-enhanced magnetic resonance angiography has gained renewed interest since the discovery of the association between gadolinium-based contrast agents and nephrogenic systemic fibrosis. The following article is an overview of the different magnetic resonance angiography sequences, the technical possibilities and new developments. Clinical options and recent advancements will be highlighted, and recommendations for non-contrast-enhanced magnetic resonance angiography techniques in different anatomical regions will be given. Furthermore, the authors seek to predict the future of non-contrast-enhanced magnetic resonance angiography, with special focus on patients at risk.

  2. Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspectives from the SCOT-HEART Trial.

    PubMed

    Doris, Mhairi; Newby, David E

    2016-02-01

    Coronary artery disease is the leading cause of death worldwide. Many trials to date have investigated the diagnostic accuracy of coronary computed tomography angiography (CCTA) when compared to the gold standard diagnostic test, invasive coronary angiography. However, whether the use of a non-invasive anatomical test, such as CCTA, can translate into improved patient risk stratification, management and outcome has yet to be established. The Scottish COmputed Tomography of the HEART (SCOT-HEART) trial sought to address these questions and determined whether CCTA, when used in addition to standard care, could aid the diagnosis, further investigation and treatment of patients referred to the cardiology clinic with suspected angina due to coronary heart disease. In this trial, CCTA clarified the diagnosis of angina due to coronary heart disease in a quarter of patients and this led to major alterations in treatment and management that appeared to reduce the risk of subsequent coronary heart disease death or non-fatal myocardial infarction. The SCOT-Heart trial has established that CCTA is a valuable diagnostic test in patients with suspected angina pectoris due to coronary heart disease and leads to greater clarity, more focused appropriate treatments and better coronary heart disease outcomes.

  3. Adolescent Kawasaki disease: usefulness of 64-slice CT coronary angiography for follow-up investigation.

    PubMed

    Carbone, Iacopo; Cannata, David; Algeri, Emanuela; Galea, Nicola; Napoli, Alessandro; De Zorzi, Andrea; Bosco, Giovanna; D'Agostino, Rita; Menezes, Leon; Catalano, Carlo; Passariello, Roberto; Francone, Marco

    2011-09-01

    Kawasaki disease (KD) is a systemic vasculitis that mainly affects coronary arteries in children, and requires regular follow-up from the time of diagnosis. To evaluate the feasibility of 64-slice CT angiography (CTA) for follow-up of patients with KD using previously performed invasive catheter coronary angiography (CCA) as reference standard. The study group comprised 12 patients (age 17.6 ± 2.9 years, mean ± SD) with a diagnosis of KD and a previously performed CCA (interval, 32.6 ± 13.5 months) who underwent 64-slice cardiac CTA. The quality of the images for establishing the presence of coronary abnormalities was determined by two observers. The CTA findings were compared with those from the prior CCA. Adequate image quality was obtained in all patients. Mean effective dose for CTA was 6.56 ± 0.95 mSv. CTA allowed accurate identification, characterization and measurement of all coronary aneurysms (n = 32), stenoses (n = 3) and occlusions (n = 9) previously demonstrated by CCA. One patient with disease progression went on to have percutaneous coronary intervention. Coronary lesions were reliably evaluated by 64-slice CTA in the follow-up of compliant patients with KD, reducing the need for repeated diagnostic invasive CCA. Hence, in an adequately selected patient population, the role of CCA could be limited almost only to therapeutic procedures.

  4. Noninvasive detection of vertebral artery stenosis: a comparison of contrast-enhanced MR angiography, CT angiography, and ultrasound.

    PubMed

    Khan, Sofia; Rich, Philip; Clifton, Andrew; Markus, Hugh S

    2009-11-01

    Vertebral stenosis is associated with a high risk of recurrent stroke, but noninvasive imaging techniques to identify it have lacked sensitivity. Contrast-enhanced MR angiography and CT angiography have been recently developed and appear to have better sensitivity. However, no prospective studies have compared both of these techniques with ultrasound against the gold standard of intra-arterial angiography in the same group of patients. Forty-six patients were prospectively recruited in whom intra-arterial angiography was being performed. Contrast-enhanced MR angiography, CT angiography, and duplex ultrasound were also performed. Angiographic images were analyzed blinded to patient identity by 2 experienced neuroradiologists. Contrast-enhanced MR angiography had the highest sensitivity and specificity (Radiologist 1, 0.83 and 0.91, respectively; Radiologist 2, 0.89 and 0.87) for detecting >or=50% stenosis. CT angiography had good sensitivity (Radiologist 1, 0.68; Radiologist 2, 0.58) and excellent specificity (Radiologist 1, 0.92; Radiologist 2, 0.93), whereas duplex had low sensitivity (0.44) but excellent specificity (0.95). For vertebral origin stenosis >or=50%, sensitivities were similar for contrast-enhanced MR angiography (Radiologist 1, 0.91; Radiologist 2, 0.82) but relatively higher for CT angiography (Radiologist 1, 0.82; Radiologist 2, 0.82) and duplex (0.67). Contrast-enhanced MR angiography is the most sensitive noninvasive technique to detect vertebral artery stenosis and also has high specificity. CT angiography has good sensitivity and high specificity. In contrast, ultrasound has low sensitivity and will miss many vertebral stenoses.

  5. Kinematics of Compton backscattering x-ray source for angiography

    SciTech Connect

    Blumberg, L.N.

    1992-05-01

    Calculations of X-Ray production rates, energy spread, and spectrum of Compton-backscattered photons from a Free Electron Laser on an electron beam in a low energy (136-MeV) compact (8.5-m circumference) storage ring indicate that an X-Ray intensity of 34.6 10{sup 7} X-Ray photons per 0.5-mm {times} 0.5-mm pixel for Coronary Angiography near the 33.169-keV iodine K-absorption edge can be achieved in a 4-msec pulse within a scattering cone of 1-mrad half angle. This intensity, at 10-m from the photon-electron interaction point to the patient is about a factor of 10 larger than presently achieved from a 4.5-T superconducting wiggler source in the NSLS 2.5-GeV storage ring and over an area about 5 times larger. The 2.2-keV energy spread of the Compton-backscattered beam is, however, much larger than the 70-eV spread presently attained form the wiggler source and use of a monochromator. The beam spot at the 10-m interaction point-to-patient distance is 20-mm diameter; larger spots are attainable at larger distances but with a corresponding reduction in X-Ray flux. Such a facility could be an inexpensive clinical alternative to present methods of non-invasive Digital Subtraction Angiography (DSA), small enough to be deployed in an urban medical center, and could have other medical, industrial and aerospace applications. Problems with the Compton backscattering source include laser beam heating of the mirror in the FEL oscillator optical cavity, achieving a large enough X-Ray beam spot at the patient, and obtaining radiation damping of the transverse oscillations and longitudinal emittance dilution of the storage ring electron beam resulting from photon-electron collisions without going to higher electron energy where the X-Ray energy spread becomes excessive for DSA. 38 refs.

  6. Detection of significant coronary artery stenosis with cardiac dual-source computed tomography angiography in heart transplant recipients.

    PubMed

    von Ziegler, Franz; Rümmler, Janine; Kaczmarek, Ingo; Greif, Martin; Schenzle, Jan; Helbig, Susanne; Becker, Christoph; Meiser, Bruno; Becker, Alexander

    2012-10-01

    Present study evaluates clinical feasibility of cardiac dual-source computed tomography angiography (DSCTA) to detect significant coronary stenosis because of chronic allograft vasculopathy (CAV) after heart transplantation (HTX). An overall of 51 consecutive heart transplant recipients (43 men, 8 women, mean age: 52.3 ± 13.6 years) underwent DSCTA 1 ± 2 days before annual routine invasive coronary angiography (ICA). Three patients were excluded from further analysis. Total 714/717 (99.6%) segments in remaining 48 patients were depicted in diagnostic image quality by DSCTA with three vessel segments in two patients being additionally excluded because of motion artefacts. On a segment-based analysis, sensitivity, specificity, and diagnostic accuracy (DA) for detection of significant stenosis were calculated as 100%, 98.9% and 98.9% respectively. On a patient-based evaluation, sensitivity, specificity and DA were 100%, 86.0% and 93.0% respectively for remaining 46 patients. Negative predictive value (NPV) was 100%. DSCTA enables diagnosis and especially the exclusion of significant coronary artery stenosis in patients after HTX with a high NPV. The low rate of excluded vessel segments compared with former studies indicates improvement in image acquisition and robustness of latest scanner technology and thus may make subsequent annual invasive coronary angiography unnecessary. © 2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation.

  7. Analysis of enlarged images using time-of-flight magnetic resonance angiography, computed tomography, and conventional angiography.

    PubMed

    Heo, Yeong-Cheol; Lee, Hae-Kag; Yang, Han-Jun; Cho, Jae-Hwan

    2014-12-01

    This study aimed to assess the accuracy of time-of-flight magnetic resonance angiography, computed tomography, and conventional angiography in depicting the actual length of the blood vessels. Three-dimensional time-of-flight magnetic resonance angiography and computed tomography angiography were performed using a flow phantom model that was 2.11 mm in diameter and had a total area of 0.26 cm(2). After this, volume rendering technique and the maximum intensity projection method as well as two-dimensional digital subtraction angiography and three-dimensional rotational angiography based on conventional angiography were conducted. For three-dimensional time-of-flight magnetic resonance angiography, 8 channel sensitivity encoding (SENSE) head coil for the 3.0 Tesla equipment was used. Fluid was added to the normal saline solution at various rates, such as 11.4, 20.0, 31.4, 40.0, 51.5, 60.0, 71.5, 80.1, 91.5, and 100.1 cm/s using an automatic contrast media injector. Each image was thoroughly examined. After reconstructing the image using the maximum intensity projection method, the length of the conduit in the center of the coronal plane was measured 30 times. After performing computed tomography angiography with the 64-channel CT scanner and 16-channel CT scanner, the images were sent to TeraRecon. Then, the length of the conduit in the center of the coronal plane of each image was measured 30 times after reconstructing the images using volume rendering and maximum intensity projection techniques. For conventional angiography, three-dimensional rotational angiography and two-dimensional digital subtraction angiography were used. Images obtained by three-dimensional rotational angiography were reconstructed and enhanced by 33, 50, and 100 % in the 128 Matrix and the 256 Matrix, respectively on the Xtra Vision workstation. The maximum intensity projection was used for the reconstruction, and the length of the conduit was measured 30 times in the center of the coronal

  8. Radionuclide Ventriculography or Radionuclide Angiography (MUGA Scan)

    MedlinePlus

    ... a Heart Attack Treatment of a Heart Attack Life After a Heart Attack Heart Failure About Heart Failure ... Non-invasive - Invasive • Treatment of a Heart Attack • Life After a Heart Attack • Heart Attack Tools & Resources • Support ...

  9. Does CT Angiography Matter for Patients with Cervical Spine Injuries?

    PubMed

    Hagedorn, John C; Emery, Sanford E; France, John C; Daffner, Scott D

    2014-06-04

    Cervical injury can be associated with vertebral artery injury. This study was performed to determine the impact of computed tomography (CT) angiography of the head and neck on planning treatment of cervical spine fracture, if these tests were ordered appropriately, and to estimate cost and associated exposure to radiation and contrast medium. This retrospective review included all patients who underwent CT of the cervical spine and CT angiography of the head and neck from January 2010 to August 2011 at one institution. Patients were divided into those with and those without cervical spine fracture seen on CT of the cervical spine. We determined if the CT angiography of the head and neck was positive for vascular injury in the patients with a cervical fracture. Vascular injury treatment and alterations in surgical fracture treatment due to positive CT angiography of the head and neck were recorded. A scan was deemed appropriate if it had been ordered per established institutional protocol. Of the 381 patients who underwent CT angiography of the head and neck, 126 had a cervical injury. Sixteen of the CT angiography studies were appropriately ordered for non-spinal indications, and twenty-three were inappropriately ordered. The CT angiography was positive for one patient for whom the imaging was off protocol and one for whom the indication was non-spinal. Nineteen patients had positive CT angiography of the head and neck; no patient underwent surgical intervention for a vascular lesion. Eleven patients underwent surgical intervention for a cervical fracture; the operative plan was changed because of vascular injury in one case. The CT angiography was positive for eleven of forty-eight patients who had sustained a C2 fracture; this group accounted for eleven of the nineteen positive CT angiography studies. Noncontiguous injuries occurred in nineteen patients; three had positive CT angiography of the head and neck. The approximate charge for the CT angiography was

  10. Discordance between CT and angiography in the PIOPED II study.

    PubMed

    Wittram, Conrad; Waltman, Arthur C; Shepard, Jo-Anne O; Halpern, Elkan; Goodman, Lawrence R

    2007-09-01

    To retrospectively evaluate the causes of discordant computed tomographic (CT)-angiographic readings from the Prospective Investigation of Pulmonary Embolism Diagnosis, or PIOPED, II study. Institutional review board approval was obtained for this HIPAA-compliant study. Of 1036 patients suspected of having pulmonary embolism who were examined with CT, 226 underwent angiography; 206 patients had concordant results and 20 had discordant results according to two independent readers. Of these 20 patients, 10 were men and 10 were women (mean age, 49 years). Among the 20 studies with discordant results, central readers identified seven cases as negative and 13 as positive for pulmonary embolism at CT; these findings were reversed at angiography. Side-by-side comparisons of discordant studies were performed in consensus. The time between CT and angiography and all locations of pulmonary embolism vascular territory were recorded. The McNemar binomial test was used. One patient had false-positive findings at angiography, 13 patients had false-negative findings at angiography, and two patients had false-negative findings at CT. Four patients had true-negative findings at CT; however, findings were positive for thrombus at angiography. The sensitivity for the detection of pulmonary embolism was 87% for CT and 32% for angiography (P=.007). The largest missed thrombus at angiography was subsegmental in eight patients, segmental in two patients, and lobar in three patients; at CT it was subsegmental in two patients. The mean time between CT and angiography was 40 hours+/-21 (standard deviation) (range, 10-97 hours). In the interval between CT and angiography, thrombi can remain the same, resolve, develop, or result from angiography. Copyright (c) RSNA, 2007.

  11. Computed Tomographic Angiography of the Abdominal Aorta.

    PubMed

    Hansen, Neil J

    2016-01-01

    Computed tomographic (CT) angiography (CTA) has become the preferred imaging test of choice for various aortic conditions because of its excellent spatial resolution, rapid image acquisition, and its wide availability. CTA provides a robust tool for planning aortic interventions and diagnosing acute and chronic vascular diseases in the abdomen. CTA is the standard for imaging aneurysms before intervention and evaluating the aorta in the acute setting to assess traumatic injury, dissection, and aneurysm rupture. Knowledge of the imaging features of these disease processes, inflammatory vasculitides, and occlusive atherosclerotic disease is essential for guiding surgical and medical management of patients.

  12. Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

    PubMed Central

    Korosoglou, Grigorios; Giusca, Sorin; Gitsioudis, Gitsios; Erbel, Christian; Katus, Hugo A.

    2014-01-01

    Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein. PMID:25147526

  13. Feasibility and diagnostic performance of fractional flow reserve measurement derived from coronary computed tomography angiography in real clinical practice.

    PubMed

    Kawaji, Tetsuma; Shiomi, Hiroki; Morishita, Hiroshi; Morimoto, Takeshi; Taylor, Charles A; Kanao, Shotaro; Koizumi, Koji; Kozawa, Satoshi; Morihiro, Kazuhisa; Watanabe, Hirotoshi; Tazaki, Junichi; Imai, Masao; Saito, Naritatsu; Shizuta, Satoshi; Ono, Koh; Togashi, Kaori; Kimura, Takeshi

    2017-02-01

    Non-invasive fractional flow reserve measured by coronary computed tomography angiography (FFRCT) has demonstrated a high diagnostic accuracy for detecting coronary artery disease (CAD) in selected patients in prior clinical trials. However, feasibility of FFRCT in unselected population have not been fully evaluated. Among 60 consecutive patients who had suspected significant CAD by coronary computed tomography angiography (CCTA) and were planned to undergo invasive coronary angiography, 48 patients were enrolled in this study comparing FFRCT with invasive fractional flow reserve (FFR) without any exclusion criteria for the quality of CCTA image. FFRCT was measured in a blinded fashion by an independent core laboratory. FFRCT value was evaluable in 43 out of 48 (89.6 %) patients with high prevalence of severe calcification in CCTA images [calcium score (CS) >400: 40 %, and CS > 1000: 19 %). Per-vessel FFRCT value showed good correlation with invasive FFR value (Spearman's rank correlation = 0.69, P < 0.001). The area under the receiver operator characteristics curve (AUC) of FFRCT was 0.87. Per-vessel accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 68.6, 92.9, 52.4, 56.5, and 91.7 %, respectively. Even in eight patients (13 vessels) with extremely severely calcified lesions (CS > 1000), per-vessel FFRCT value showed a diagnostic performance similar to that in patients with CS ≤ 1000 (Spearman's rank correlation = 0.81, P < 0.001). FFRCT could be measured in the majority of consecutive patients who had suspected significant CAD by CCTA in real clinical practice and demonstrated good diagnostic performance for detecting hemodynamically significant CAD even in patients with extremely severe calcified vessels.

  14. Hemodialysis fistula occlusion: demonstration with 64-slice CT angiography.

    PubMed

    Neyman, Edward G; Johnson, Pamela T; Fishman, Elliot K

    2006-01-01

    The speed and resolution of 64-slice CT have resulted in new applications for CT angiography (CTA) owing to rapid data acquisition during the arterial phase, improved visualization of small vessels, and lengthened anatomic coverage. Extremity CT angiography is one such region. This case report shows the utility of multislice CTA for the evaluation of hemodialysis graft dysfunction.

  15. Optical coherence tomography (OCT) angiography findings in retinal arterial macroaneurysms.

    PubMed

    Alnawaiseh, Maged; Schubert, Friederike; Nelis, Pieter; Wirths, Gabriele; Rosentreter, André; Eter, Nicole

    2016-07-22

    Optical coherence tomography angiography is a novel imaging technique that allows dyeless in vivo visualization of the retinal and choroidal vasculature. The purpose of this study was to describe optical coherence tomography (OCT) angiography findings in patients with retinal arterial macroaneurysms (RAMs). Three eyes of three patients with RAMs were retrospectively included. Fundus photography, OCT, fluorescein angiography (FA), and OCT angiography were performed. The entire imaging data was analyzed in detail. OCT angiography could detect the RAMs noninvasively without dye injection. By simultaneously observing the OCT scans, it was possible to determine the depth of the RAMs in the retina, to detect the exact localization in relation to the main vessel, and to determine the level of blood flow in the RAMs. OCT angiography can clearly visualize RAMs without use of a dye. It also allows layer-specific observation of blood flow in each layer of the RAM. OCT angiography provides additional dynamic information on RAMs, which is not obtained with FA and facilitates a better understanding of its morphology and activity. This information in combination with ICG and fluorescein angiography can help to optimize direct laser treatment.

  16. The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals

    PubMed Central

    Chien, Ning; Wang, Tzung-Dau; Chang, Yeun-Chung; Lin, Po-Chih; Tseng, Yao-Hui; Lee, Yee-Fan; Ko, Wei-Chun; Lee, Bai-Chin; Lee, Wen-Jeng

    2016-01-01

    Coronary computed tomographic angiography (CCTA) has been widely available since 2004. After that, the diagnostic accuracy of CCTA has been extensively validated with invasive coronary angiography for detection of coronary arterial stenosis. In this paper, we reviewed the updated evidence of the role of CCTA in both scenarios including acute chest pain and screening in asymptomatic adults. Several large-scale studies have been conducted to evaluate the diagnostic value of CCTA in the context of acute chest pain patients. CCTA could play a role in delivering more efficient care. For risk stratification of asymptomatic patients using CCTA, latest studies have revealed incremental benefits. Future studies evaluating the totality of plaque characteristics may be useful for determining the role of noncalcified plaque for risk stratification in asymptomatic individuals. PMID:27122947

  17. Invasive forest species

    Treesearch

    Barbara L. Illman

    2006-01-01

    Nonnative organisms that cause a major change to native ecosystems-once called foreign species, biological invasions, alien invasives, exotics, or biohazards–are now generally referred to as invasive species or invasives. invasive species of insects, fungi, plants, fish, and other organisms present a rising threat to natural forest ecosystems worldwide. Invasive...

  18. The Contemporary Use of Angiography and Revascularization Among Patients With Non-ST-Segment Elevation Myocardial Infarction in the United States Compared With South Korea.

    PubMed

    Kang, Hyun-Jae; Simon, Dajuanicia; Wang, Tracy Y; Alexander, Karen P; Jeong, Myung Ho; Kim, Hyo-Soo; Bates, Eric R; Henry, Timothy D; Peterson, Eric D; Roe, Matthew T

    2015-12-01

    Practice guidelines recommend an early invasive strategy for high-risk non-ST-segment elevation myocardial infarction (NSTEMI) patients, but international differences in the use of invasive strategies are unknown. Profiling NSTEMI patient management in the United States (U.S.) and South Korea could provide insight into how patients are triaged for an early invasive strategy in different health care environments and geographical regions. We evaluated the use of angiography and revascularization for NSTEMI patients treated at revascularization-capable hospitals (2007-2010) in both the ACTION Registry-GWTG (U.S.: n = 133,835; 433 hospitals) and KAMIR/KorMI Registry (South Korea: n = 7,901; 72 hospitals). Compared with South Korean patients, U.S. NSTEMI patients more commonly had established cardiovascular risk factors, disease, and prior cardiovascular events and procedures. From 2007-2010, the use of angiography for NSTEMI patients rose steadily in both countries, but the use of revascularization only rose in South Korea. Patients from South Korea more commonly underwent angiography and revascularization. Percutaneous coronary intervention was the most common type of revascularization in both countries, but coronary artery bypass grafting was less common in South Korea. The use of both angiography and revascularization was incrementally lower with a higher predicted mortality risk for patients from both countries, but greater differences between low- and high-risk patients occurred in the U.S. The profile, characteristics, and use of angiography and revascularization for NSTEMI patients in the U.S. vs South Korea differed substantially from 2007-2010, underscoring the heterogeneity of NSTEMI patients and treatment selection among different countries. © 2015 Wiley Periodicals, Inc.

  19. Image Artifacts in Optical Coherence Angiography

    PubMed Central

    Spaide, Richard F.; Fujimoto, James G.; Waheed, Nadia K.

    2016-01-01

    To describe image artifacts of optical coherence tomography angiography (OCTA) and their underlying causative mechanisms. To establish a common vocabulary for the artifacts observed. Methods The methods by which OCTA images are acquired, generated and displayed are reviewed as are the mechanisms by which each or all of these methods can produce extraneous image information. A common set of terminology is proposed and used. Results OCTA uses motion contrast to image blood flow and thereby images the vasculature without the need for a contrast agent. Artifacts are very common and can arise from the OCT image acquisition, intrinsic characteristics of the eye, eye motion, or image processing and display strategies. OCT image acquisition for angiography takes more time than simple structural scans and necessitates trade-offs in flow resolution, scan quality, and speed. An important set of artifacts are projection artifacts in which images of blood vessels appear at erroneous locations. Image processing used for OCTA can alter vascular appearance through segmentation defects and because of image display strategies can give false impressions of the density and location of vessels. Eye motion leads to discontinuities in displayed data. OCTA artifacts can be detected by interactive evaluation of the images. Conclusions Image artifacts are common, and can lead to incorrect interpretations of OCTA images. Because of the quantity of data available and the potential for artifacts, physician interaction in viewing the image data will be required, much like what happens in modern radiology practice. PMID:26428607

  20. Perfusion Angiography in Acute Ischemic Stroke

    PubMed Central

    Liebeskind, David S.

    2016-01-01

    Visualization and quantification of blood flow are essential for the diagnosis and treatment evaluation of cerebrovascular diseases. For rapid imaging of the cerebrovasculature, digital subtraction angiography (DSA) remains the gold standard as it offers high spatial resolution. This paper lays out a methodological framework, named perfusion angiography, for the quantitative analysis and visualization of blood flow parameters from DSA images. The parameters, including cerebral blood flow (CBF) and cerebral blood volume (CBV), mean transit time (MTT), time-to-peak (TTP), and Tmax, are computed using a bolus tracking method based on the deconvolution of the time-density curve on a pixel-by-pixel basis. The method is tested on 66 acute ischemic stroke patients treated with thrombectomy and/or tissue plasminogen activator (tPA) and also evaluated on an estimation task with known ground truth. This novel imaging tool provides unique insights into flow mechanisms that cannot be observed directly in DSA sequences and might be used to evaluate the impact of endovascular interventions more precisely. PMID:27446232

  1. Angiography with a multifunctional line scanning ophthalmoscope

    NASA Astrophysics Data System (ADS)

    Hammer, Daniel X.; Ferguson, R. Daniel; Patel, Ankit H.; Vazquez, Vanessa; Husain, Deeba

    2012-02-01

    A multifunctional line scanning ophthalmoscope (mLSO) was designed, constructed, and tested on human subjects. The mLSO could sequentially acquire wide-field, confocal, near-infrared reflectance, fluorescein angiography (FA), and indocyanine green angiography (ICGA) retinal images. The system also included a retinal tracker (RT) and a photodynamic therapy laser treatment port. The mLSO was tested in a pilot clinical study on human subjects with and without retinal disease. The instrument exhibited robust retinal tracking and high-contrast line scanning imaging. The FA and ICGA angiograms showed a similar appearance of hyper- and hypo-pigmented disease features and a nearly equivalent resolution of fine capillaries compared to a commercial flood-illumination fundus imager. An mLSO-based platform will enable researchers and clinicians to image human and animal eyes with a variety of modalities and deliver therapeutic beams from a single automated interface. This approach has the potential to improve patient comfort and reduce imaging session times, allowing clinicians to better diagnose, plan, and conduct patient procedures with improved outcomes.

  2. Coronary CT angiography: Beyond morphological stenosis analysis.

    PubMed

    Sun, Zhonghua

    2013-12-26

    Rapid technological developments in computed tomography (CT) imaging technique have made coronary CT angiography an attractive imaging tool in the detection of coronary artery disease. Despite visualization of excellent anatomical details of the coronary lumen changes, coronary CT angiography does not provide hemodynamic changes caused by presence of plaques. Computational fluid dynamics (CFD) is a widely used method in the mechanical engineering field to solve complex problems through analysing fluid flow, heat transfer and associated phenomena by using computer simulations. In recent years, CFD is increasingly used in biomedical research due to high performance hardware and software. CFD techniques have been used to study cardiovascular hemodynamics through simulation tools to assist in predicting the behaviour of circulatory blood flow inside the human body. Blood flow plays a key role in the localization and progression of coronary artery disease. CFD simulation based on 3D luminal reconstructions can be used to analyse the local flow fields and flow profiling due to changes of vascular geometry, thus, identifying risk factors for development of coronary artery disease. The purpose of this article is to provide an overview of the coronary CT-derived CFD applications in coronary artery disease.

  3. INDOCYANINE GREEN ANGIOGRAPHY OF PACHYCHOROID PIGMENT EPITHELIOPATHY.

    PubMed

    Ersoz, M Giray; Arf, Serra; Hocaoglu, Mumin; Sayman Muslubas, Isil; Karacorlu, Murat

    2017-07-18

    To compare choroidal hyperpermeability and vessel density between eyes with central serous chorioretinopathy (CSC), those with pachychoroid pigment epitheliopathy (PPE) and those with uncomplicated pachychoroid (UCP). We retrospectively reviewed indocyanine green angiography images of 60 patients with unilateral active CSC who had PPE (36 eyes) or UCP (24 eyes) in their fellow eyes. We used color thresholding of indocyanine green angiography images to determine choroidal vessel density. The mean choroidal thickness of eyes with CSC was greater than that of eyes with PPE or UCP, but this difference was not statistically significant (P = 0.46). There was no significant difference between the PPE (92%) and CSC (93%) groups regarding choroidal hyperpermeability (P = 0.76), but both of these groups had higher choroidal permeability than the UCP group (50%) (both P < 0.001). In 30 (90%) of 33 eyes with PPE who had choroidal hyperpermeability, retinal pigment epithelium alterations were in the region of hyperpermeability. Choroidal vessel density did not differ between the PPE and UCP groups (P = 0.57). Pachychoroid pigment epitheliopathy is forme fruste of CSC. There is no difference between complicated and UCP regarding subfoveal choroidal thickness and choroidal vessel density. The main difference between these groups is choroidal hyperpermeability.

  4. Indocyanine green angiography in posterior uveitis.

    PubMed

    Agrawal, Rupesh V; Biswas, Jyotirmay; Gunasekaran, Dinesh

    2013-04-01

    Literature review for indocyanine green angiography and evaluate the role of indocyanine green angiogram (ICGA) in patients with posterior uveitis seen at a tertiary referral eye care centre. Detailed review of the literature on ICGA was performed. Retrospective review of medical records of patients with posterior uveitis and dual fundus and ICGA was done after institutional board approval. Eighteen patients (26 eyes) had serpiginous choroiditis out of which 12 patients had active choroiditis and six patients had healed choroiditis, six patients (12 eyes) had ampiginous choroiditis, six patients (12 eyes) had acute multifocal posterior placoid pigment epitheliopathy, eight patients (10 eyes) had multifocal choroiditis, four patients (eight eyes) had presumed ocular histoplasmosis syndrome, four patients (eight eyes) had presumed tuberculous choroiditis, two patients (four eyes) had multiple evanescent white dot syndrome and two patients (four eyes) had Vogt Koyanagi Harada (VKH) syndrome. The most characteristic feature noted on ICGA was the presence of different patterns of hypofluorescent dark spots, which were present at different stages of the angiogram. ICGA provides the clinician with a powerful adjunctive tool in choroidal inflammatory disorders. It is not meant to replace already proven modalities such as the fluorescein angiography, but it can provide additional information that is useful in establishing a more definitive diagnosis in inflammatory chorioretinal diseases associated with multiple spots. It still needs to be determined if ICGA can prove to be a follow up parameter to evaluate disease progression.

  5. Indocyanine green angiography in posterior uveitis

    PubMed Central

    Agrawal, Rupesh V; Biswas, Jyotirmay; Gunasekaran, Dinesh

    2013-01-01

    Literature review for indocyanine green angiography and evaluate the role of indocyanine green angiogram (ICGA) in patients with posterior uveitis seen at a tertiary referral eye care centre. Detailed review of the literature on ICGA was performed. Retrospective review of medical records of patients with posterior uveitis and dual fundus and ICGA was done after institutional board approval. Eighteen patients (26 eyes) had serpiginous choroiditis out of which 12 patients had active choroiditis and six patients had healed choroiditis, six patients (12 eyes) had ampiginous choroiditis, six patients (12 eyes) had acute multifocal posterior placoid pigment epitheliopathy, eight patients (10 eyes) had multifocal choroiditis, four patients (eight eyes) had presumed ocular histoplasmosis syndrome, four patients (eight eyes) had presumed tuberculous choroiditis, two patients (four eyes) had multiple evanescent white dot syndrome and two patients (four eyes) had Vogt Koyanagi Harada (VKH) syndrome. The most characteristic feature noted on ICGA was the presence of different patterns of hypofluorescent dark spots, which were present at different stages of the angiogram. ICGA provides the clinician with a powerful adjunctive tool in choroidal inflammatory disorders. It is not meant to replace already proven modalities such as the fluorescein angiography, but it can provide additional information that is useful in establishing a more definitive diagnosis in inflammatory chorioretinal diseases associated with multiple spots. It still needs to be determined if ICGA can prove to be a follow up parameter to evaluate disease progression. PMID:23685486

  6. Intraoperative Fluorescence Vascular Angiography: During Tibial Bypass

    PubMed Central

    Perry, Diana; Bharara, Manish; Armstrong, David G; Mills, Joseph

    2012-01-01

    Preventing amputations in persons with lower extremity complications of diabetes is a complex endeavor, particularly in those with concomitant ischemia and tissue loss. Fluorescence angiography (Novadaq SPY system) may provide a tool for objective evaluations of tissue viability in the diabetic foot, which is an important indicator of the ability of the diabetic ulcer to heal adequately. The SPY system uses a low-power laser coupled with a charge-coupled device camera and indocyanine green (ICG) to sequence perfusion at the surface of the skin. We present an illustrated example of the potential utility of ICG fluorescence angiography (ICGFA) before and after vascular intervention in a high-risk limb. ICGFA appeared to reveal demarcation between viable and nonviable tissue and real-time perfusion, specifically capillary fill. ICGFA clarified the extent of necessary debridement and provided an immediate indication of improvement in regional perfusion status following revascularization. Future studies involving ICGFA may include pre- and postdebridement and closure perfusion, comparison of tissue perfusion pre- and post-endovascular therapy, and lower extremity flap viability. Future works will also address the consistency of results with ICGFA by analyzing a larger cohort of patients being treated by our unit. PMID:22401340

  7. Gadolinium-Enhanced Magnetic Resonance Angiography for Pulmonary Embolism

    PubMed Central

    Stein, Paul D.; Chenevert, Thomas L.; Fowler, Sarah E.; Goodman, Lawrence R.; Gottschalk, Alexander; Hales, Charles A.; Hull, Russell D.; Jablonski, Kathleen A.; Leeper, Kenneth V.; Naidich, David P.; Sak, Daniel J.; Sostman, H. Dirk; Tapson, Victor F.; Weg, John G.; Woodard, Pamela K.

    2011-01-01

    Background The accuracy of gadolinium-enhanced magnetic resonance pulmonary angiography and magnetic resonance venography for diagnosing pulmonary embolism has not been determined conclusively. Objective To investigate performance characteristics of magnetic resonance angiography, with or without magnetic resonance venography, for diagnosing pulmonary embolism. Design Prospective, multicenter study from 10 April 2006 to 30 September 2008. (ClinicalTrials.gov registration number: NCT00241826) Setting 7 hospitals and their emergency services. Patients 371 adults with diagnosed or excluded pulmonary embolism. Measurements Sensitivity, specificity, and likelihood ratios were measured by comparing independently read magnetic resonance imaging with the reference standard for diagnosing pulmonary embolism. Reference standard diagnosis or exclusion was made by using various tests, including computed tomographic angiography and venography, ventilation–perfusion lung scan, venous ultra-sonography, D-dimer assay, and clinical assessment. Results Magnetic resonance angiography, averaged across centers, was technically inadequate in 25% of patients (92 of 371). The proportion of technically inadequate images ranged from 11% to 52% at various centers. Including patients with technically inadequate images, magnetic resonance angiography identified 57% (59 of 104) with pulmonary embolism. Technically adequate magnetic resonance angiography had a sensitivity of 78% and a specificity of 99%. Technically adequate magnetic resonance angiography and venography had a sensitivity of 92% and a specificity of 96%, but 52% of patients (194 of 370) had technically inadequate results. Limitation A high proportion of patients with suspected embolism was not eligible or declined to participate. Conclusion Magnetic resonance pulmonary angiography should be considered only at centers that routinely perform it well and only for patients for whom standard tests are contraindicated. Magnetic

  8. Invasive coronary imaging: any role in primary and secondary prevention?

    PubMed

    Di Mario, Carlo; Moreno, Pedro R

    2016-06-21

    This review discusses the possibilities offered by new modalities of non-invasive and invasive coronary imaging in an effort to optimize risk stratification for coronary artery disease, and identify subgroups at high risk that may benefit from an aggressive, personalized approach, with access to a growing number of novel drugs and interventions. Special emphasis is placed on the progress of novel invasive imaging techniques such as near infrared spectroscopy and optical coherence tomography that can reliably identify thin-capped fibroatheromas. Multiple trials are exploring the feasibility of these techniques to guide modulation of risk factor control and treatment of non-flow limiting lesions at high risk of destabilization and progression in patients undergoing clinically mandated angioplasty of angiographically critical lesions. Asymptomatic patients at high risk of cardiovascular ischaemic events may also benefit, with the intermediate step of a wider application of calcium score and angiography with multi-slice computed tomography, by a selective use of invasive imaging.

  9. Prospective evaluation of the development of contrast-induced nephropathy in patients with acute coronary syndrome undergoing rotational coronary angiography vs. conventional coronary angiography: CINERAMA study.

    PubMed

    Fernández-Rodríguez, Diego; Grillo-Pérez, José J; Pérez-Hernández, Horacio; Rodríguez-Esteban, Marcos; Pimienta, Raquel; Acosta-Materán, Carlos; Rodríguez, Sara; Yanes-Bowden, Geoffrey; Vargas-Torres, Manuel J; Sánchez-Grande Flecha, Alejandro; Hernández-Afonso, Julio; Bosa-Ojeda, Francisco

    2017-07-19

    Rotational coronary angiography (RCA) requires less contrast to be administered and can prevent the onset of contrast-induced nephropathy (CIN) during invasive coronary procedures. The aim of the study is to evaluate the impact of RCA on CIN (increase in serum creatinine ≥0.5mg/dl or ≥25%) after an acute coronary syndrome. From April to September 2016, patients suffering acute coronary syndromes who underwent diagnostic coronary angiography, with the possibility of ad hoc coronary angioplasty, were prospectively enrolled. At the operator's discretion, patients underwent RCA or conventional coronary angiography (CCA). CIN (primary endpoint), as well as analytical, angiographic and clinical endpoints, were compared between groups. Of the 235 patients enrolled, 116 patients received RCA and 119 patients received CCA. The RCA group was composed of older patients (64.0±11.8 years vs. 59.7±12.1 years; p=0.006), a higher proportion of women (44.8 vs. 17.6%; p<0.001), patients with a lower estimated glomerular filtration rate (76±25 vs. 86±27ml/min/1.73 m(2); p=0.001), and patients who underwent fewer coronary angioplasties (p<0.001) compared with the CCA group. Furthermore, the RCA group, received less contrast (113±92 vs. 169±103ml; p<0.001), including in diagnostic procedures (54±24 vs. 85±56ml; p<0.001) and diagnostic-therapeutic procedures (174±64 vs. 205±98ml; p=0.049) compared with the CCA group. The RCA group presented less CIN (4.3 vs. 22.7%; p<0.001) compared to the CCA group, and this finding was maintained in the regression analysis (Adjusted relative risk: 0.868; 95% CI: 0.794-0.949; p=0.002). There were no differences in clinical endpoints between the groups. RCA was associated with lower administration of contrast during invasive coronary procedures in acute coronary syndrome patients, resulting in lower incidence of CIN, in comparison with CCA. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All

  10. Vascular hand-arm vibration syndrome--magnetic resonance angiography.

    PubMed

    Poole, C J M; Cleveland, T J

    2016-01-01

    The diagnosis of vascular hand-arm vibration syndrome (HAVS) requires consistent symptoms, photographic evidence of digital blanching and sufficient exposure to hand-transmitted vibration (HTV; A(8) > 2.5 m/s2). There is no reliable quantitative investigation for distinguishing HAVS from other causes of Raynaud's phenomenon and from normal individuals. Hypothenar and thenar hammer syndromes produce similar symptoms to HAVS but are difficult to diagnose clinically and may be confused with HAVS. Magnetic resonance angiography (MRA) is a safe and minimally invasive method of visualizing blood vessels. Three cases of vascular HAVS are described in which MRA revealed occlusions of the ulnar, radial and superficial palmar arteries. It is proposed that HTV was the cause of these occlusions, rather than blows to the hand unrelated to vibration, the assumed mechanism for the hammer syndromes. All three cases were advised not to expose their hands to HTV despite one of them being at Stockholm vascular stage 2 (early). MRA should be the investigation of choice for stage 2 vascular HAVS or vascular HAVS with unusual features or for a suspected hammer syndrome. The technique is however technically challenging and best done in specialist centres in collaboration with an occupational physician familiar with the examination of HAVS cases. Staging for HAVS should be developed to include anatomical arterial abnormalities as well as symptoms and signs of blanching. Workers with only one artery supplying a hand, or with only one palmar arch, may be at increased risk of progression and therefore should not be exposed to HTV irrespective of their Stockholm stage.

  11. Intra-arterial CT angiography visualization of arterial supply to inferior vena cava tumor thrombus prior to radioembolization of hepatocellular carcinoma.

    PubMed

    Roche, Glen; Teo, Terence K B; Tan, Andrew E H; Irani, Farah G

    2012-01-01

    Unresectable hepatocellular carcinoma has a high frequency of vascular invasion and arterial parasitization. Trans-arterial radioembolization using yttrium-90 (Y90) microspheres is a possible treatment option. Paramount to its success is the meticulous angiographic interrogation of tumor feeding arteries and extra-hepatic supply. We describe a patient with tumor invasion of the inferior vena cava with arterial supply from the right inferior phrenic artery, which was exquisitely visualized using intra-arterial computed tomographic angiography (IACTA) during the planning technetium-99m macro aggregated albumin phase. This technique was useful in planning which artery to administer Y90 microspheres into for maximal brachytherapy. Although patient outcome was poor due to significant arterio-portal shunting, we believe that IACTA is a useful adjunct to conventional digital subtraction angiography in planning radioembolization therapy.

  12. Fluorescein Angiography Versus Optical Coherence Tomography Angiography in Macular Telangiectasia Type I Treated With Bevacizumab Therapy.

    PubMed

    Yannuzzi, Nicolas A; Gregori, Ninel Z; Roisman, Luiz; Gupta, Nisha; Goldhagen, Brian E; Goldhardt, Raquel

    2017-03-01

    This is a report of microvascular changes seen on fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) in a 47-year-old man with macular telangiectasia Type 1 (MacTel1) after a 7-year bevacizumab (Avastin; Genentech, South San Francisco, CA) treatment course. OCTA allowed for clear visualization of most telangiectasias and aneurysms in the deep capillary plexus, with only few microvascular dilatations in the superficial plexus. In addition, areas of capillary dropout in the superficial and deep vascular plexa located near telangiectasias were documented on OCTA. Serial FA demonstrated reduced number of aneurysms and telangiectasias at the 7-year mark compared to baseline. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:263-266.]. Copyright 2017, SLACK Incorporated.

  13. Type 1 Choroidal Neovascularization Lesion Size: Indocyanine Green Angiography Versus Optical Coherence Tomography Angiography.

    PubMed

    Costanzo, Eliana; Miere, Alexandra; Querques, Giuseppe; Capuano, Vittorio; Jung, Camille; Souied, Eric H

    2016-07-01

    To evaluate the size of type 1 choroidal neovascularization (CNV) in neovascular AMD by optical coherence tomography angiography (OCTA) and to compare with indocyanine green angiography (ICGA). Patients diagnosed type 1 CNV underwent multimodal imaging by fluorescein angiography (FA), ICGA, spectral-domain (SD)-OCT, and OCTA. Lesion size was measured both on OCTA at the choriocapillaris level with "select area" and "vessel area" functions, incorporated in AngioVue software and on ICGA at intermediate and late phases, by two masked independent readers. Nineteen eyes of 17 patients (mean age 80.6 ± 8.36) were included in the analysis. Mean visual acuity was 0.2 logMAR. All OCTA revealed a high flow neovascular network in the choriocapillaris segmentation. On OCTA, interclass correlation between readers 1 and 2 was 0.96 (95% confidence interval [CI] 0.94-0.99) for select area and 0.97 (95% CI 0.96-0.99) for vessel area. The difference between lesion size in OCTA versus ICGA was detected in all eyes and it was statistically significant for both readers (P < 0.05). Optical coherence tomography angiography provides both quantitative and qualitative information on type 1 CNV and appears as a new reproducible way to evaluate CNV area and vessels area. Type 1 CNV lesion size in the choriocapillaris segmentation of OCTA and ICGA intermediate and late phases revealed that the OCTA size is significantly smaller than the ICGA size. This supports the idea that OCTA could be considered for evaluation of the neovascular lesion and for evaluation of therapeutic responses.

  14. Rationale and design of the HeartFlowNXT (HeartFlow analysis of coronary blood flow using CT angiography: NeXt sTeps) study.

    PubMed

    Gaur, Sara; Achenbach, Stephan; Leipsic, Jonathon; Mauri, Laura; Bezerra, Hiram G; Jensen, Jesper Møller; Bøtker, Hans Erik; Lassen, Jens Flensted; Nørgaard, Bjarne Linde

    2013-01-01

    Coronary CT angiography (CTA) is an established noninvasive method for visualization of coronary artery disease. However, coronary CTA lacks physiological information; thus, it does not permit differentiation of ischemia-causing lesions. Recent advances in computational fluid dynamic techniques applied to standard coronary CTA images allow for computation of fractional flow reserve (FFR), a measure of lesion-specific ischemia. The diagnostic performance of computed FFR (FFRCT) compared with invasively measured FFR is not yet fully established. HeartFlowNXT (HeartFlow analysis of coronary blood flow using coronary CT angiography: NeXt sTeps) is a prospective, international, multicenter study designed to evaluate the diagnostic performance of FFRCT for the detection and exclusion of flow-limiting obstructive coronary stenoses, as defined by invasively measured FFR as the reference standard. FFR values ≤ 0.80 will be considered to be ischemia causing. All subjects (N = 270; 10 investigative sites) will undergo coronary CTA (single- or dual-source CT scanners with a minimum of 64 slices) and invasive coronary angiography with FFR. Patients with insufficient quality of coronary CTA will be excluded. Blinded core laboratory interpretation will be performed for FFRCT, invasive coronary angiography, and FFR. Stenosis severity by coronary CTA will be evaluated by the investigative site in addition to a blinded core laboratory interpretation. The primary objective of the study is to determine the diagnostic performance of FFRCT compared with coronary CTA alone to noninvasively determine the presence of hemodynamically significant coronary lesions. The secondary end point comprises assessment of diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of FFRCT. Copyright © 2013 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  15. Pre-procedural combined coronary angiography and stress myocardial perfusion imaging using 320-detector CT in unprotected left main and ostial left anterior descending artery intervention.

    PubMed

    Ko, Brian S; Crossett, Marcus; Seneviratne, Sujith K

    2015-07-01

    Pre-procedural anatomic and functional coronary assessment plays a crucial role in selection of patients suitable for unprotected left main percutaneous coronary intervention. Combined coronary computed tomography angiography and adenosine stress computed tomography myocardial perfusion imaging is a non-invasive technique which may provide this information. This is the first report describing its use to assist patient selection and procedural planning prior to elective left main and ostial left anterior descending artery coronary intervention.

  16. Visual-Functional Mismatch Between Coronary Angiography, Fractional Flow Reserve, and Quantitative Coronary Angiography.

    PubMed

    Safi, Morteza; Eslami, Vahid; Namazi, Mohammad Hasan; Vakili, Hossain; Saadat, Habib; Alipourparsa, Saeid; Adibi, Ali; Movahed, Mohammad Reza

    2016-12-01

    Anatomical and functional mismatches are not uncommon in the assessment of coronary lesions. The aim of this study was to identify clinical and lesion-specific factors affecting angiographic, anatomical, and functional mismatch in intermediate coronary lesions. In patients who underwent coronary angiography for clinical reasons, fractional flow reserve (FFR), and quantitative coronary angiography (QCA) analyses for intermediate stenotic lesions were performed simultaneously. Mismatches between the measured values were analyzed. A total of 95 intermediate lesions were assessed simultaneously by visual angiography, FFR, and QCA. The visual-FFR mismatch was found in 40% of the lesions while reverse visual-FFR mismatch was determined in nearly 14% of the lesions. Mismatch and reverse mismatch between FFR and QCA parameters were observed in 10 and 23% of the lesions. FFR value was significant in 32% of the lesions while visually significant stenosis was shown in 61% of the lesions. Among the visual-FFR reverse mismatch group, the prevalence of culprit lesions within the left anterior descending (LAD) was significantly higher than other vessels (p value < 0.02). There were high frequencies of angiographic, QCA, and functional mismatches in analyses of intermediate coronary lesions. LAD lesions showed the highest mismatch. Angiographic or QCA estimation of lesion severity has consistently resulted in inappropriate stenting of functionally nonsignificant lesions or undertreatment of significant lesions based on FFR.

  17. Patient radiation dose from computed tomography angiography and digital subtraction angiography of the brain

    NASA Astrophysics Data System (ADS)

    Netwong, Y.; Krisanachinda, A.

    2016-03-01

    The 64-row multidetector computed tomography angiography (64-MDCTA) provides vascular image quality of the brain similar to digital subtraction angiography (DSA), but the effective dose of CTA is lower than DSA studied in phantom. The purpose of this study is to evaluate the effective dose from 64-MDCTA and DSA. Effective dose (according to ICRP 103) from 64-MDCTA and DSA flat panel detector for cerebral vessels examination of the brain using standard protocols as recommended by the manufacturer was calculated for 30 cases of MDCTA (15 male and 15 female).The mean patient age was 49.5 (23-89) yrs. 30 cases of DSA (14 male and 16 female), the mean patient age was 46.8 (21-81) yrs. For CTA, the mean effective dose was 3.7 (2.82- 5.19) mSv. For DSA, the mean effective dose was 5.78 (3.3-10.06) mSv. The effective dose of CTA depends on the scanning protocol and scan length. Low tube current can reduce patient dose whereas the number of exposures and number of series in 3D rotational angiography (3D RA) resulted in increasing effective dose in DSA patients.

  18. Inpatient Coronary Angiography and Revascularisation following Non-ST-Elevation Acute Coronary Syndrome in Patients with Renal Impairment: A Cohort Study Using the Myocardial Ischaemia National Audit Project

    PubMed Central

    Shaw, Catriona; Nitsch, Dorothea; Steenkamp, Retha; Junghans, Cornelia; Shah, Sapna; O’Donoghue, Donal; Fogarty, Damian; Weston, Clive; Sharpe, Claire C.

    2014-01-01

    Background International guidelines support an early invasive management strategy (including early coronary angiography and revascularisation) for non-ST-elevation acute coronary syndrome (NSTE-ACS) in patients with renal impairment. However, evidence from outside the UK suggests that this approach is underutilised. We aimed to describe practice within the NHS, and to determine whether the severity of renal dysfunction influenced the provision of angiography and modified the association between early revascularisation and survival. Methods We performed a cohort study, using multivariable logistic regression and propensity score analyses, of data from the Myocardial Ischaemia National Audit Project for patients presenting with NSTE-ACS to English or Welsh hospitals between 2008 and 2010. Findings Of 35 881 patients diagnosed with NSTE-ACS, eGFR of <60 ml/minute/1.73 m2 was present in 15 680 (43.7%). There was a stepwise decline in the odds of undergoing inpatient angiography with worsening renal dysfunction. Compared with an eGFR>90 ml/minute/1.73 m2, patients with an eGFR between 45–59 ml/minute/1.73 m2 were 33% less likely to undergo angiography (adjusted OR 0.67, 95% CI 0.55–0.81); those with an eGFR<30/minute/1.73 m2 had a 64% reduction in odds of undergoing angiography (adjusted OR 0.36, 95%CI 0.29–0.43). Of 16 646 patients who had inpatient coronary angiography, 58.5% underwent inpatient revascularisation. After adjusting for co-variables, inpatient revascularisation was associated with approximately a 30% reduction in death within 1 year compared with those managed medically after coronary angiography (adjusted OR 0.66, 95%CI 0.57–0.77), with no evidence of modification by renal function (p interaction = 0.744). Interpretation Early revascularisation may offer a similar survival benefit in patients with and without renal dysfunction, yet renal impairment is an important determinant of the provision of coronary angiography following NSTE-ACS. A

  19. Fluorescein angiography basic science and engineering.

    PubMed

    Wolfe, D R

    1986-12-01

    Fluorescein angiography is an application of the physical phenomenon of fluorescence, which is phosphorescence in which the quantum mechanical decay curve is so rapid that it appears instantaneous, and it consequently has no afterglow. Sodium fluorescein is excited by light energy between 465 and 490 nm, and it decays into a lower state emitting light energy between 520 and 530 nm as fluorescent radiation. The free electrons available for excitation are reduced by chemical bonding between the fluorescein dye and plasma proteins to which up to 80% of the dye is bound in the bloodstream, thus reducing overall fluorescence. Optimalization of the observed and recorded fluorescence is afforded by providing exciter and barrier filters with as little overlap as possible to reduce or eliminate contrast reducing pseudofluorescence.

  20. Indications for angiography in blunt thoracic trauma

    SciTech Connect

    Barcia, T.C.; Livoni, J.P.

    1983-04-01

    The clinical charts and radiographs of 113 patients who underwent aortography for suspected blunt injury to the aorta and brachiocephalic vessels were reviewed to identify the most useful indications for angiography. Eight previously described clinical criteria and 14 previously described radiographic criteria were evaluated in each of these patients, 27 of whom had either an aortic or brachiocephalic injury. Contrary to previous reports, our data indicate that no single clinical or radiographic sign is highly specific for vascular injury. An abnormal aortic outline and mediastinal widening remain the most sensitive criteria, although these were also present in a large number of patients without vascular injury. Displaced paraspinous lines and nasogastric tubes are also useful signs.

  1. Digital subtraction angiography in extremity trauma

    SciTech Connect

    Goodman, P.C.; Jeffrey, R.B. Jr.; Brant-Zawadzki, M.

    1984-10-01

    Digital subtraction angiography (DSA) may have considerable impact on the work-up of patients who have suffered trauma. The angiographic evaluation of vascular injuries can be accomplished rapidly and with minimal catheter use and manipulation, which is particularly important for those critically ill patients who have significant immobility because of multiple fractures. The authors retrospectively reviewed the digital subtraction angiograms in 50 consecutive cases of extremity trauma. The quality of the images in 44 of these permitted a confident diagnosis, the accuracy of which was confirmed by surgical or clinical follow-up. DSA reduces the time required to perform the procedure, the amount of contrast material injected, patient discomfort, and film cost. Its major disadvantage is the limited field size of the image intensifier.

  2. Coronary CT angiography with low radiation dose.

    PubMed

    Xu, Lei; Zhang, Zhaoqi

    2010-02-01

    With the introduction of 64-slice CT and dual-source CT technology, coronary CT angiography(CCTA) has emerged as a useful diagnostic imaging modality for the noninvasive assessment of coronary heart disease. Recently, the risks associated with ionizing radiation on CT have raised serious concerns.The main concern of exposure to ionizing radiation is the potential risk of cancer. CCTA involves much higher radiation dose with the advances in the spatial and temporal resolution of cardiac CT. Currently,various dose-saving algorithms, such as ECG (electrocardiography)-based dose modulation, reduced tube voltage, and prospective ECG gating, high-pitch helical scanning are available to lower radiation exposure during cardiac CT. Therefore, careful selection of CT scanning protocols is needed to keep the radiation exposure 'as low as reasonably achievable (ALARA)'. In this review we will discuss the radiation dose safety issues, the measurement of radiation dose and current use of dose-saving techniques in CCTA.

  3. [Myocardial perfusion imaging by digital subtraction angiography].

    PubMed

    Kadowaki, H; Ishikawa, K; Ogai, T; Katori, R

    1986-03-01

    Several methods of digital subtraction angiography (DSA) were compared to determine which could better visualize regional myocardial perfusion using coronary angiography in seven patients with myocardial infarction, two with angina pectoris and five with normal coronary arteries. Satisfactory DSA was judged to be achieved if the shape of the heart on the mask film was identical to that on the live film and if both films were exactly superimposed. To obtain an identical mask film in the shape of each live film, both films were selected from the following three phases of the cardiac cycle; at the R wave of the electrocardiogram, 100 msec before the R wave, and 200 msec before the R wave. The last two were superior for obtaining mask and live films which were similar in shape, because the cardiac motion in these phases was relatively small. Using these mask and live films, DSA was performed either with the continuous image mode (CI mode) or the time interval difference mode (TID mode). The overall perfusion of contrast medium through the artery to the vein was adequately visualized using the CI mode. Passage of contrast medium through the artery, capillary and vein was visualized at each phase using TID mode. Subtracted images were displayed and photographed, and the density of the contrast medium was adequate to display contour lines as in a relief map. Using this DSA, it was found that regional perfusion of the contrast medium was not always uniform in normal subjects, depending on the typography of the coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Diagnosing an atypical site of giant cell arteritis with magnetic resonance angiography: a case report.

    PubMed

    Tan, Boon L; Liu, Jonathan J; Yong, Tuck Y; Tan, Chrismin C; Li, Jordan Y

    2016-06-23

    Giant cell arteritis typically involves the temporal arteries, but can involve other cranial arteries. Temporal artery biopsy is the mainstay for the diagnosis of giant cell arteritis; however, biopsy may be problematic if giant cell arteritis involves other cranial arteries that are inaccessible for sampling. In these situations, magnetic resonance angiography is a useful, non-invasive adjunctive method in the diagnosis of giant cell arteritis. In this case report, we describe a case of giant cell arteritis involving only the occipital artery which was revealed by magnetic resonance angiography. A 67-year-old Caucasian man was admitted to our hospital with a 4-week history of malaise, fever, and mild occipital headaches. There were no other positive findings on physical examination. Laboratory studies were remarkable for normocytic anemia, raised inflammatory markers, and mildly deranged liver function tests. To exclude intracranial pathology, he underwent a cranial magnetic resonance imaging with gadolinium, which demonstrated a thickened wall and mural enhancement of his right occipital artery, consistent with giant cell arteritis. His temporal arteries were normal. His occipital arteries were not accessible for biopsy and he was commenced on high-dose prednisolone (60 mg daily). His symptoms resolved completely after a week of glucocorticoid steroid treatment and he was well on 5 mg of prednisolone once a day on follow-up. While magnetic resonance angiography may not replace the need for biopsy, it may have a diagnostic role in suspected giant cell arteritis, such as when the involved arteries are inaccessible for biopsy.

  5. Accurate, fully-automated registration of coronary arteries for volumetric CT digital subtraction angiography

    NASA Astrophysics Data System (ADS)

    Razeto, Marco; Mohr, Brian; Arakita, Kazumasa; Schuijf, Joanne D.; Fuchs, Andreas; Kühl, J. Tobias; Chen, Marcus Y.; Kofoed, Klaus F.

    2014-03-01

    Diagnosis of coronary artery disease with Coronary Computed Tomography Angiography (CCTA) is complicated by the presence of signi cant calci cation or stents. Volumetric CT Digital Subtraction Angiography (CTDSA) has recently been shown to be e ective at overcoming these limitations. Precise registration of structures is essential as any misalignment can produce artifacts potentially inhibiting clinical interpretation of the data. The fully-automated registration method described in this paper addresses the problem by combining a dense deformation eld with rigid-body transformations where calci cations/stents are present. The method contains non-rigid and rigid components. Non-rigid registration recovers the majority of motion artifacts and produces a dense deformation eld valid over the entire scan domain. Discrete domains are identi ed in which rigid registrations very accurately align each calci cation/stent. These rigid-body transformations are combined within the immediate area of the deformation eld using a distance transform to minimize distortion of the surrounding tissue. A recent interim analysis of a clinical feasibility study evaluated reader con dence and diagnostic accuracy in conventional CCTA and CTDSA registered using this method. Conventional invasive coronary angiography was used as the reference. The study included 27 patients scanned with a second-generation 320-row CT detector in which 41 lesions were identi ed. Compared to conventional CCTA, CTDSA improved reader con dence in 13/36 (36%) of segments with severe calci cation and 3/5 (60%) of segments with coronary stents. Also, the false positive rate of CTDSA was reduced compared to conventional CCTA from 18% (24/130) to 14% (19/130).

  6. OCT-Angiography for monitoring and managing neovascular age-related macular degeneration.

    PubMed

    Malamos, P; Tsolkas, G; Kanakis, M; Mylonas, G; Karatzenis, D; Oikonomopoulos, N; Lakoumentas, J; Georgalas, Ilias

    2017-09-22

    To evaluate the combined use of optical coherence tomography and angiography (OCT-A) for imaging choroidal neovascularization (CNV) secondary to neovascular age-related macular degeneration (nAMD). This prospective observational study was conducted from May 2015 to April 2017. Included in the study were 54 patients (n = 63 eyes), all of whom had CNV secondary to nAMD and all of whom had been examined by OCT-A. Angioscans (3x3 and 6 × 6) and conventional B-scan OCT scans were obtained for all patients at baseline and at various times during the 24-month follow-up period. For diagnostic confirmation, conventional imaging methods fluorescein angiography (FA) and indocyanine green angiography (ICGA) were performed at baseline. A total of 13 patients (n = 15 eyes) underwent serial imaging during 34 follow-up visits. The main outcomes included (i) determination of OCT-A sensitivity for the detection of CNV (classic and occult) and (ii) the correlation between B-scan OCT and OCT-A vis-à-vis consecutive follow-up changes. At baseline, the detection rate (i.e., overall sensitivity) of OCT-A for detecting CNV was 64.4% (75.7 and 48.0% for classic and occult CNV, respectively), independent of prior treatment status. In terms of quality, 6 × 6 angioscans were superior to 3 × 3. Moreover, specific CNV morphologic patterns by B-scan OCT did not correlate with lesion composition. Correspondence between OCT-A and B-scan OCT was observed in only 53% of the cases. OCT-A may prove to be a valuable adjunctive diagnostic tool for the interpretation of CNV, as it not only reduces the need for invasive angiographic procedures but also facilitates the follow-up process.

  7. Acceptance of noninvasive computed tomography coronary angiography: for a patient-friendly medicine.

    PubMed

    La Grutta, Ludovico; La Grutta, Sabina; Galia, Massimo; Lo Piccolo, Giuseppe; Gentile, Giovanni; La Tona, Giuseppe; Epifanio, Maria Stella; Maffei, Erica; Cademartiri, Filippo; Lo Baido, Rosa; Lagalla, Roberto; Midiri, Massimo

    2014-02-01

    This study was done to evaluate the psychological state and anxiety of patients undergoing computed tomography coronary angiography (CTCA), and assess their acceptance and satisfaction compared to invasive conventional coronary angiography (CCA). A total of 442 consecutive patients (282 male; mean age 57.7 ± 9.5 years) who underwent CTCA for suspected or known coronary artery disease were evaluated with the Endler Multimodality Anxiety Scales (EMAS) before and after the scan, and a questionnaire administered after the scan. Among the 442 patients, 181 had a history of CCA. Two radiologists assessed the image quality of CTCA. Anxiety was more intense prior to the scan (EMAS score 51.7 vs. 46.7, p < 0.01) and in patients with a history of CCA (EMAS score 55.5 vs. 49.1, p < 0.01). Women presented more intense anxiety (EMAS score 59.5 vs. 47.3, p < 0.01), higher mean heart rate (63.5 ± 7.6 vs. 60.7 ± 7.3 beats per minute, p < 0.01) and a lower image quality than men (p < 0.0001). CTCA proved to be more acceptable than CCA because of accurate preparation, lower concern prior to the examination, negligible pain, higher comfort, and greater overall satisfaction (p < 0.0001). Computed tomography coronary angiography is a patient-friendly imaging method because of the minimal perceived discomfort. Anxiety may affect CTCA image quality in women.

  8. Symptoms and angiographic findings of patients undergoing elective coronary angiography without prior stress testing.

    PubMed

    Abdallah, Mouin S; Spertus, John A; Nallamothu, Brahmajee K; Kennedy, Kevin F; Arnold, Suzanne V; Chan, Paul S

    2014-08-01

    Many patients undergo elective coronary angiography without preprocedural stress testing that may be suitable if performed in patients with more angina pectoris or more frequently identified obstructive coronary artery disease (CAD). Patients in the National Cardiovascular Data Registry CathPCI Registry undergoing elective coronary angiography from July 2009 to April 2013 were assessed for differences in angina (Canadian Cardiovascular Society [CCS] class) and severity of obstructive CAD in those with and without preprocedural stress testing, stratified by CAD history. Given the large sample size, differences were considered clinically meaningful if the standardized difference (SD) was >10%. Of 790,601 patients without CAD history, 36.9% did not undergo preprocedural stress testing. Compared with patients with preprocedural stress testing, patients without preprocedural stress testing were more frequently angina free (CCS class 0; 28.2% with stress test vs 38.5% without, SD = 14.8%) and had similar rates of obstructive CAD (40.1% with stress test vs 35.7% without, SD = 9.0). Of 449,579 patients with CAD history, 44.2% did not undergo preprocedural stress testing. Patients without preprocedural stress testing reported more angina (CCS class III/IV angina: 17.8% vs 13.4%; SD = 11.3%) but were not more likely to have obstructive CAD (78.7% vs 81.1%; SD = 5.8%) than patients with preprocedural stress testing. In conclusion, approximately 40% of patients undergoing elective coronary angiography did not have preprocedural risk stratification with stress testing. For these patients, the clinical decision to proceed directly to invasive evaluation was not driven primarily by severe angina and did not result in higher detection rates for obstructive CAD. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. CT angiography in the abdomen: a pictorial review and update.

    PubMed

    Liu, Peter S; Platt, Joel F

    2014-02-01

    The development of multidetector CT technology and helical scanning techniques has revolutionized the use of CT for primary diagnostic evaluation of the abdominal vasculature, particularly the arterial system. CT angiography has numerous benefits relative to conventional catheter angiography, and has largely replaced catheter-based techniques in many clinical algorithms. This pictorial review and update will cover important technical principles related to modern CT angiography (including contrast delivery and dose considerations), discuss relevant anatomy and variants, and illustrate numerous arterial conditions related to the abdominal aorta and branch vessels.

  10. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFRCT: outcome and resource impacts study

    PubMed Central

    Douglas, Pamela S.; Pontone, Gianluca; Hlatky, Mark A.; Patel, Manesh R.; Norgaard, Bjarne L.; Byrne, Robert A.; Curzen, Nick; Purcell, Ian; Gutberlet, Matthias; Rioufol, Gilles; Hink, Ulrich; Schuchlenz, Herwig Walter; Feuchtner, Gudrun; Gilard, Martine; Andreini, Daniele; Jensen, Jesper M.; Hadamitzky, Martin; Chiswell, Karen; Cyr, Derek; Wilk, Alan; Wang, Furong; Rogers, Campbell; De Bruyne, Bernard

    2015-01-01

    Aims In symptomatic patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) improves patient selection for invasive coronary angiography (ICA) compared with functional testing. The impact of measuring fractional flow reserve by CTA (FFRCT) is unknown. Methods and results At 11 sites, 584 patients with new onset chest pain were prospectively assigned to receive either usual testing (n = 287) or CTA/FFRCT (n = 297). Test interpretation and care decisions were made by the clinical care team. The primary endpoint was the percentage of those with planned ICA in whom no significant obstructive CAD (no stenosis ≥50% by core laboratory quantitative analysis or invasive FFR < 0.80) was found at ICA within 90 days. Secondary endpoints including death, myocardial infarction, and unplanned revascularization were independently and blindly adjudicated. Subjects averaged 61 ± 11 years of age, 40% were female, and the mean pre-test probability of obstructive CAD was 49 ± 17%. Among those with intended ICA (FFRCT-guided = 193; usual care = 187), no obstructive CAD was found at ICA in 24 (12%) in the CTA/FFRCT arm and 137 (73%) in the usual care arm (risk difference 61%, 95% confidence interval 53–69, P< 0.0001), with similar mean cumulative radiation exposure (9.9 vs. 9.4 mSv, P = 0.20). Invasive coronary angiography was cancelled in 61% after receiving CTA/FFRCT results. Among those with intended non-invasive testing, the rates of finding no obstructive CAD at ICA were 13% (CTA/FFRCT) and 6% (usual care; P = 0.95). Clinical event rates within 90 days were low in usual care and CTA/FFRCT arms. Conclusions Computed tomographic angiography/fractional flow reserve by CTA was a feasible and safe alternative to ICA and was associated with a significantly lower rate of invasive angiography showing no obstructive CAD. PMID:26330417

  11. Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants *

    PubMed Central

    Araujo Neto, Severino Aires; de Mello Júnior, Carlos Fernando; Franca, Henrique Almeida; Duarte, Cláudia Martina Araújo; Borges, Rafael Farias; de Magalhães, Ana Guardiana Ximenes

    2016-01-01

    Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications. PMID:26929461

  12. Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants.

    PubMed

    Araujo Neto, Severino Aires; de Mello Júnior, Carlos Fernando; Franca, Henrique Almeida; Duarte, Cláudia Martina Araújo; Borges, Rafael Farias; de Magalhães, Ana Guardiana Ximenes

    2016-01-01

    Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications.

  13. Spiral CT angiography in diagnosis of cerebral aneurysms of cases with acute subarachnoid hemorrhage.

    PubMed

    Uysal, Ender; Yanbuloğlu, Bariş; Ertürk, Mehmet; Kilinç, Bekir M; Başak, Muzaffer

    2005-06-01

    To investigate the diagnostic accuracy of spiral CT angiography (CTA) in detection of cerebral aneurysms in cases with acute subarachnoid hemorrhage (SAH). Spiral CT angiography and DSA examinations were performed in 32 cases due to non-traumatic SAH. CTA data were obtained by maximum intensity projection (MIP) method. CTA and DSA findings were evaluated and compared in terms of existence of aneurysm, size and location. In 32 patients, DSA detected 34 aneurysms with diameters ranging from 3 to 13 mm while four cases were free of aneurysms. With CTA, an aneurysm at anterior communicating artery location could not be demonstrated. In all other cases CTA correlated well with DSA in detecting the site, size and orientation of the aneurysms. It was found that CTA sensitivity was 97% and specificity was 100% in diagnosis of intracranial aneurysms. Spiral CTA is a highly accurate, cheap and non-invasive imaging method in diagnosis of intracranial aneurysms in cases with SAH and can be used as a safe alternative method to DSA when emergency surgery is needed.

  14. Multidetector computed tomography angiography of the renal arteries: normal anatomy and its variations*

    PubMed Central

    de Mello Júnior, Carlos Fernando; Araujo Neto, Severino Aires; de Carvalho Junior, Arlindo Monteiro; Rebouças, Rafael Batista; Negromonte, Gustavo Ramalho Pessoa; de Oliveira, Carollyne Dantas

    2016-01-01

    Conventional angiography is still considered the gold standard for the study of the anatomy and of vascular diseases of the abdomen. However, the advent of multidetector computed tomography and techniques of digital image reconstruction has provided an alternative means of performing angiography, without the risks inherent to invasive angiographic examinations. Therefore, within the field of radiology, there is an ever-increasing demand for deeper knowledge of the anatomy of the regional vasculature and its variations. Variations in the renal vascular system are relatively prevalent in the venous and arterial vessels. For various conditions in which surgical planning is crucial to the success of the procedure, knowledge of this topic is important. The aim of this study was to familiarize the general radiologist with variations in the renal vascular system. To that end, we prepared a pictorial essay comprising multidetector computed tomography images obtained in a series of cases. We show patterns representative of the most common anatomical variations in the arterial blood supply to the kidneys, calling attention to the nomenclature, as well as to the clinical and surgical implications of such variations. PMID:27403020

  15. Subtraction CT angiography for the detection of intracranial aneurysms: A meta-analysis

    PubMed Central

    FENG, TIAN-YING; HAN, XUE-FENG; LANG, RUI; WANG, FEI; WU, QIONG

    2016-01-01

    The aim of this meta-analysis was to investigate the accuracy of subtraction computed tomography angiography (CTA) for diagnosing intracranial aneurysms. A systematic literature search up to January 1, 2013 was performed in PubMed. Two independent reviewers selected 8 studies that compared subtraction CTA with digital subtraction angiography. Data from the studies were used to construct a 2×2 contingency table on a per-patient basis in ≥5 diseased and 5 non-diseased patients, with additional data on a per-aneurysm basis. Overall, subtraction CTA had a pooled sensitivity of 99% [95% confidence interval (CI), 95–100%] and specificity of 94% (95% CI, 86–97%) for detecting and ruling out cerebral aneurysms, respectively, on a per-patient basis. On a per-aneurysm basis, the pooled sensitivity was 96% (95% CI, 90–99%), and the specificity was 91% (95% CI, 85–95%). In conclusion, subtraction CTA is a highly sensitive, specific and non-invasive method for the diagnosis and evaluation of intracranial aneurysms. PMID:27168830

  16. [Important of magnetic resonance angiography with gadolinium injection in pulmonary vein diseases].

    PubMed

    Godart, F; Cocheteux, B; Willoteaux, S; Francart, Ch; Brevière, G M; Jaillard, S; Beregi, J P; Rey, Ch

    2002-05-01

    The study of the pulmonary veins by echocardiography is sometimes difficult especially when the ultrasonic window is restricted. Conventional angiography is the classic reference examination but it exposes the patient to ionising radiation and requires the injection of an iodine contrast product. Another technique that can provide the essential information is magnetic resonance angiography (MRA) with injection of gadolinium. It was performed in 9 patients for suspected congenital or acquired anomalies of the pulmonary veins between June 1999 and December 2001. The patient's ages varied from 1 month to 10 years. The examinations were carried out on a 1.5 T Vision machine (Siemens, Erlangen, Germany) without "cardiac gating" or apnoea after parental consent. MRA with gadolinium injection showed 5 drainage anomalies (3 partial pulmonary venous refluxes in the superior vena cava, 2 scimitar syndromes) and 3 stenoses (one due to compression by an aneurysm of the left pulmonary artery, a second secondary to pericardial agenesis, and a third secondary to hypoplasia of an isolated vein). MRA allowed three dimensional visualisation of these anomalies. This is a rapid, non-invasive and certain imaging technique which does not expose the patient to ionising radiation. It is therefore of significance in the investigation of anomalies of the pulmonary veins complementing echocardiography, and could in future replace cardiac catheterisation.

  17. Registration of ultrasound to CT angiography of kidneys: a porcine phantom study

    NASA Astrophysics Data System (ADS)

    Xiang, Jing; Gill, Sean; Nguan, Christopher; Abolmaesumi, Purang; Rohling, Robert N.

    2010-02-01

    3D ultrasound (US) to computed tomography (CT) registration is a topic of significant interest because it can potentially improve many minimally invasive procedures such as laparoscopic partial nephrectomy. Partial nephrectomy patients often receive preoperative CT angiography, which helps define the important structures of the kidney such as the vasculature. Intraoperatively, dynamic real-time imaging information can be captured using ultrasound and compared with the preoperative data. Providing accurate registration between the two modalities would enhance navigation and guidance for the surgeon. However, one of the major problems of developing and evaluating registration techniques is obtaining sufficiently accurate and realistic phantom data especially for soft tissue. We present a detailed procedure for constructing tissue phantoms using porcine kidneys, which incorporates contrast agent into the tissue such that the kidneys appear representative of in vivo human CT angiography. These phantoms are also imaged with US and resemble US images from human patients. We then perform registration on corresponding CT and US datasets using a simulation-based algorithm. The method simulates an US image from the CT, generating an intermediate modality that resembles ultrasound. This simulated US is then registered to the original US dataset. Embedded fiducial markers provide a gold standard for registration. Being able to test our registration method on realistic datasets facilitates the development of novel CT to US registration techniques such that we can generate an effective method for human studies.

  18. Marked reduction of effective radiation dose in patients undergoing CT coronary angiography using prospective ECG gating.

    PubMed

    Freeman, Anthony; Learner, Ruth; Eggleton, Simon; Lambros, John; Friedman, Daniel

    2011-08-01

    Coronary CT angiography (CCTA) is a rapidly evolving technology which can characterise and image sub clinical atherosclerotic plaque and visualise anatomy and quantitate stenosis. Concern about radiation exposure has limited the uptake of this technology. The aim of this study was to review the radiation dose data in 2298 consecutive patients referred to a single centre in an Australian outpatient setting over 27 months using all available radiation dose reduction strategies. Prospective ECG gating ("step and shoot") was used preferentially in 2025 patients with a mean effective dose of 3.39 ± 1.84 mSv (range 0.86-12.6 mSv). For clinical reasons only 273 patients required retrospective ECG gating, mean dose 19.21 ± 5.58 mSv (range 2.4-34.9 mSv) resulting in an 85.7% reduction in dose for the majority of patients with the low dose technique. In conclusion, most patients referred for routine CCTA can be studied with a radiation dose comparable to invasive X-ray angiography and less than radionuclide myocardial perfusion imaging. Copyright © 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier B.V. All rights reserved.

  19. Multidetector computed tomography angiography of the renal arteries: normal anatomy and its variations.

    PubMed

    de Mello Júnior, Carlos Fernando; Araujo Neto, Severino Aires; de Carvalho Junior, Arlindo Monteiro; Rebouças, Rafael Batista; Negromonte, Gustavo Ramalho Pessoa; de Oliveira, Carollyne Dantas

    2016-01-01

    Conventional angiography is still considered the gold standard for the study of the anatomy and of vascular diseases of the abdomen. However, the advent of multidetector computed tomography and techniques of digital image reconstruction has provided an alternative means of performing angiography, without the risks inherent to invasive angiographic examinations. Therefore, within the field of radiology, there is an ever-increasing demand for deeper knowledge of the anatomy of the regional vasculature and its variations. Variations in the renal vascular system are relatively prevalent in the venous and arterial vessels. For various conditions in which surgical planning is crucial to the success of the procedure, knowledge of this topic is important. The aim of this study was to familiarize the general radiologist with variations in the renal vascular system. To that end, we prepared a pictorial essay comprising multidetector computed tomography images obtained in a series of cases. We show patterns representative of the most common anatomical variations in the arterial blood supply to the kidneys, calling attention to the nomenclature, as well as to the clinical and surgical implications of such variations.

  20. "Role of CT Coronary Angiography in Recanalization of Chronic Total Occlusion"

    PubMed Central

    Roy, Sanjeeb; Sharma, Jugal

    2015-01-01

    Chronic total occlusion (CTO) is considered as the most challenging frontier in interventional cardiology and the last one to be conquered. With availability of state of the art hardware, wires and catheters in particular and increased skills of the operators, the success rate for recanalization of CTO by percutaneous catheter intervention (PCI) has improved. Yet the complications rate and longterm adverse events are high, mostly due to failure in tracking or navigation of hardware through the occluded CTO segment, prolonged exposure to radiation and high doses of contrast used. Therefore, proper selection of patient is of utmost importance. One of the major challenges for successful CTO recanalization is satisfactory visualization of the occluded CTO segment. Conventional invasive catheterization fails to fill the gap and the shortcomings and handicaps of such invasive imaging can be resolved with the use of non-invasive CT coronary angiography (CTCA). CTCA helps to better define the morphological features of the occluded CTO segment, which are established predictors of success, like the actual length of the occluded segment and any calcification or tortuosity in its course. Integration of reconstructed three-dimensional CT coronary images with twodimensional fluoroscopic images, offers directional guide to select the best angiographic plane for visualization of angiographically “missing segment”. With advances in CT technology, CTCA has now become an established technology for pre-procedure evaluation of CTO segment, thereby help in planning and execution of successful PCI.

  1. Coronary MR angiography revealed: how to optimize image quality.

    PubMed

    Ishida, Masaki; Sakuma, Hajime

    2015-02-01

    Magnetic resonance (MR) imaging of the coronary arteries has been challenging, owing to the small size of the vessels and the complex motion caused by cardiac contraction and respiration. Free-breathing, whole-heart coronary MR angiography has emerged as a method that can provide visualization of the entire coronary arterial tree within a single 3-dimensional acquisition. Although coronary MR angiography is noninvasive and without radiation exposure, acquisition of high-quality coronary images is operator dependent and is generally more difficult than computed tomographic angiography. This article explains how to optimize acquisition of coronary MR angiography for reliable assessment of coronary artery disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Aortic valve laceration following coronary angiography and percutaneous coronary intervention.

    PubMed

    Roy, James; Manganas, Con; Youssef, George; Rees, David

    2016-11-01

    Valve complications following coronary angiography and percutaneous coronary interventions are rare. We report a case of an aortic valve laceration following cardiac catheterization and percutaneous coronary intervention, which required surgical valve replacement. © 2016 Wiley Periodicals, Inc.

  3. Digital subtraction angiography for preoperative evaluation of extremity tumors

    SciTech Connect

    Paushter, D.M.; Borkowski, G.R.; Buonocore, E.; Belhobek, G.H.; Marks, K.E.

    1983-07-01

    A retrospective study was undertaken to evaluate the role of digital subtraction angiography (DSA) in the surgical planning of musculoskeletal neoplasms. Thirteen patients with primary bone and soft-tissue tumors were examined by CT and DSA. Three patients also had conventional angiography. DSA yielded surgically useful information in 10 patients, comparable to that expected from conventional angiography. DSA was most helpful in demonstrating the presence or absence of major vessel involvement by tumor when this could not be ascertained definitely on CT. Demonstration of mass extent by CT was accurate in 11 patients. Results of this study suggest that the combination of CT and DSA is useful in the preoperative evaluation of selected extremity tumors and should diminish the need for conventional angiography.

  4. Intra-Operative Indocyanine Green Angiography of the Parathyroid Gland.

    PubMed

    Vidal Fortuny, Jordi; Karenovics, Wolfram; Triponez, Frederic; Sadowski, Samira M

    2016-10-01

    Major complications of thyroid and parathyroid surgery are recurrent laryngeal nerve injuries and definitive hypoparathyroidism. The use of intra-operative Indocyanine Green Angiography for confirmation of vascular status of the parathyroid gland is reported here.

  5. Indocyanine green angiography findings in acute retinal necrosis syndrome.

    PubMed

    Bissig, A; Balaskas, K; Vaudaux, J D; Guex-Crosier, Y

    2011-04-01

    Acute retinal necrosis syndrome is clinically defined by the presence of peripheral necrotizing retinitis associated with severe occlusive vasculitis caused primarily by herpes simplex virus and varicella zoster virus. Previously considered as an exclusively retinal pathology, choroidal involvement, as demonstrated by indocyanine green angiography, has not been extensively studied. Indocyanine green angiography was performed in 4 patients with ARN. Observed angiographic patterns included: 1. a characteristic triangular area of hypo-perfusion, 2. hypofluorescent lobular patches and areas of fuzzy choroidal vascular hyperfluorescence, and 3. isolated hypofluorescent lobular patches of the contralateral eye. Marked choroidal hypo-perfusion on indocyanine green angiography was associated with extensive retinal ischemia. Treatment included a combination of antiviral agents and corticosteroids complemented by prophylactic acetylsalicylate. Indocyanine green angiography may provide important information regarding choroidal vascular involvement in ARN. It may also permit the timely identification of sub-clinical contralateral eye involvement. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Cine photography and video recording of anterior segment fluorescein angiography.

    PubMed Central

    Marsh, R J; Ford, S M

    1978-01-01

    A description is given of apparatus and technique for carrying out cine photography and video recording of anterior segment fluorescein angiography. We found cine best for single-frame analysis and video tape recording less expensive. Images PMID:708682

  7. Three-dimensional visualization of choroidal vessels by using standard and ultra-high resolution scattering optical coherence angiography

    NASA Astrophysics Data System (ADS)

    Hong, Youngjoo; Makita, Shuich; Yamanari, Masahiro; Miura, Masahiro; Kim, Soohyun; Yatagai, Toyohiko; Yasuno, Yoshiaki

    2007-06-01

    Scattering optical coherence angiography (S-OCA) is a noninvasive imaging method that is based on the high-speed standard 800nm band spectral-domain optical coherence tomography (SD-OCT) and the ultra-high-resolution SD-OCT which has the axial resolution of 6.1 μm and 2.9 μm in tissue, respectively. In this paper, we have demonstrated the use of this method for in vivo human retinal imaging. A three-dimensional view of the choroidal vasculature was obtained by segmenting the choroidal vessels; this was done using intensity threshold based binarization at each depth plane relative to the retinal pigment epithelium. A vascular projection image was obtained by integrating the segmented choroidal vasculature. In order to assess the feasibility of the proposed method, we compared these images with those obtained using existing invasive methods such as fluorescein angiography and indocyanine green angiography. Clinically worthful images are obtained from the application of S-OCA to the agerelated macular degeneration and polypoidal choroidal vasculopathy.

  8. Gadolinium-free MR in coarctation-can contrast-enhanced MR angiography be replaced?

    PubMed

    Kalmar, Peter I; Koestenberger, Martin; Marterer, Robert; Tschauner, Sebastian; Sorantin, Erich

    2016-01-01

    To determine the difference in vessel measurements, signal-to-noise ratio (SNR), and voxel size between contrast-enhanced and noncontrast magnetic resonance techniques in patients with coarctation of the aorta (CoA). In 39 patients, vessel size, SNR, and voxel size were compared in cine magnetic resonance imaging (MRI), gadolinium-free magnetic resonance angiography (Gd-free MRA), and contrast-enhanced MRA (ce-MRA). There was no significant difference in measurement and SNR, but there was a significant difference in voxel size (P<.001). Our results show that, in CoA patients, monitoring of vessel size using cine MRI and Gd-free MRA is equivalent to ce-MRA while being less invasive. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Three-dimensional contrast-enhanced magnetic resonance angiography of the thoracic vasculature.

    PubMed

    Leung, D A; Debatin, J F

    1997-01-01

    Magnetic resonance angiography (MRA) has become a useful non-invasive imaging technique for the assessment of vascular disease. Due to limitations such as respiratory motion artefacts, saturations problems, and long acquisition times, applications of MRA in the thorax have largely been restricted to imaging of the aorta. The recent introduction of breath-hold three-dimensional (3D) contrast-enhanced MRA promises not only to enhance conventional MR protocols for aortic imaging, but to extend the clinical indications of MRI to diseases affecting other vascular structures of the thorax, most notably the pulmonary arteries. This article describes the technical aspects of contrast-enhanced 3D MRA and reviews existing and potential future clinical applications.

  10. Comparison of echocardiography and angiography in determining the cause of severe aortic regurgitation.

    PubMed

    DePace, N L; Nestico, P F; Kotler, M N; Mintz, G S; Kimbiris, D; Goel, I P; Glazier-Laskey, E E; Ross, J

    1984-01-01

    To assess the accuracy of echocardiography in determining the cause of aortic regurgitation M mode and cross sectional echocardiography were compared with angiography in 43 patients with predominant aortic regurgitation. Each patient had all three investigations performed during the same admission to hospital. In each instance, the cause of aortic regurgitation was confirmed at surgery or necropsy. Seventeen patients had rheumatic aortic valve disease, 13 bacterial endocarditis with a perforated or partially destroyed cusp, five a bicuspid aortic valve (four with a history of endocarditis), and eight aortic regurgitation secondary to aortic root dilatation or aneurysm. Overall sensitivity of echocardiography and aortography was 84% in determining the cause of aortic regurgitation. Thus, rheumatic valve disease and endocarditis appear to be the most common causes of severe aortic regurgitation in this hospital based population. Furthermore, echocardiography is a sensitive non-invasive technique for determining the cause of aortic regurgitation and allows differentiation of valvular from root causes of aortic regurgitation.

  11. Comparison of echocardiography and angiography in determining the cause of severe aortic regurgitation.

    PubMed Central

    DePace, N L; Nestico, P F; Kotler, M N; Mintz, G S; Kimbiris, D; Goel, I P; Glazier-Laskey, E E; Ross, J

    1984-01-01

    To assess the accuracy of echocardiography in determining the cause of aortic regurgitation M mode and cross sectional echocardiography were compared with angiography in 43 patients with predominant aortic regurgitation. Each patient had all three investigations performed during the same admission to hospital. In each instance, the cause of aortic regurgitation was confirmed at surgery or necropsy. Seventeen patients had rheumatic aortic valve disease, 13 bacterial endocarditis with a perforated or partially destroyed cusp, five a bicuspid aortic valve (four with a history of endocarditis), and eight aortic regurgitation secondary to aortic root dilatation or aneurysm. Overall sensitivity of echocardiography and aortography was 84% in determining the cause of aortic regurgitation. Thus, rheumatic valve disease and endocarditis appear to be the most common causes of severe aortic regurgitation in this hospital based population. Furthermore, echocardiography is a sensitive non-invasive technique for determining the cause of aortic regurgitation and allows differentiation of valvular from root causes of aortic regurgitation. Images PMID:6689919

  12. Digital subtraction angiography in pediatric cerebrovascular occlusive disease

    SciTech Connect

    Faerber, E.N.; Griska, L.A.B.; Swartz, J.D.; Capitanio, M.A.; Popky, G.L.

    1984-08-01

    While conventional angiography has been used to demonstrate cerebrovascular occlusive disease in the past, digital subtraction angiography (DSA) is capable of showing progressive vascular involvement with ease, simplicity, and extremely low morbidity, making it particularly well suited for children and outpatients either alone or coordinated with computed tomography. The authors discuss the usefulness and advantages of DSA as demonstrated in 7 infants and children with hemiplegia, 4 of whom had sickle-cell disease.

  13. Esophagectomy - minimally invasive

    MedlinePlus

    Minimally invasive esophagectomy; Robotic esophagectomy; Removal of the esophagus - minimally invasive; Achalasia - esophagectomy; Barrett esophagus - esophagectomy; Esophageal cancer - esophagectomy - laparoscopic; Cancer of the ...

  14. Relationships between coronary angiography, mood, anxiety and insomnia.

    PubMed

    Ozdemir, Pınar Guzel; Selvi, Yavuz; Boysan, Murat; Ozdemir, Mahmut; Akdağ, Serkan; Ozturk, Fatih

    2015-08-30

    The purpose of this study was to investigate and compare the anxiety, depression and insomnia levels in the pre- and post-coronary angiography in patients undergoing elective coronary angiography due to suspected coronary artery disease. This prospective cross-sectional study consisted of 120 patients consecutively underwent coronary angiogram (CAG) between January and August 2014 in Departments of Cardiology. The mean age was 57.49 (SD±9.73), and 58.3% of the sample were women. The Hospital Anxiety and Depression Scale, Profile of Mood States Scale, Spielberger's State-Trait Anxiety Inventory, and Insomnia Severity Index were used. Patients were subsumed under 2 groups as normal and critical according to the presence or the absence of visually severe stenosis in at least one coronary artery. Subjects with significant stenosis had greater mean scores on depression-dejection and anger-hostility sub-scales of the POMS in the post-angiography than pre-angiography scores. We found that older age and having a physical illness significantly contributed to the risk of having significant stenosis in coronary vasculature. Subjects with severe coronary artery stenosis scored higher on depression-dejection and anger-hostility sub-scales at the post-angiography time period relative to pre-angiography scores. Trait and state anxiety levels were found to be moderate higher in both groups. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. CT angiography of intracranial aneurysms: a focus on postprocessing.

    PubMed

    Tomandl, Bernd F; Köstner, Niels C; Schempershofe, Miriam; Huk, Walter J; Strauss, Christian; Anker, Lars; Hastreiter, Peter

    2004-01-01

    Computed tomographic (CT) angiography is a well-known tool for detection of intracranial aneurysms and the planning of therapeutic intervention. Despite a wealth of existing studies and an increase in image quality due to use of multisection CT and increasingly sophisticated postprocessing tools such as direct volume rendering, CT angiography has still not replaced digital subtraction angiography as the standard of reference for detection of intracranial aneurysms. One reason may be that CT angiography is still not a uniformly standardized method, particularly with regard to image postprocessing. Several methods for two- and three-dimensional visualization can be used: multiplanar reformation, maximum intensity projection, shaded surface display, and direct volume rendering. Pitfalls of CT angiography include lack of visibility of small arteries, difficulty differentiating the infundibular dilatation at the origin of an artery from an aneurysm, the kissing vessel artifact, demonstration of venous structures that can simulate aneurysms, inability to identify thrombosis and calcification on three-dimensional images, and beam hardening artifacts produced by aneurysm clips. Finally, an algorithm for the safe and useful application of CT angiography in patients with subarachnoid hemorrhage has been developed, which takes into account the varying quality of equipment and software at different imaging centers. Copyright RSNA, 2004

  16. Usefulness of rotational spin for coronary angiography in patients with advanced renal insufficiency.

    PubMed

    Kuon, Eberhard; Niederst, Pierre N; Dahm, Johannes B

    2002-08-15

    Coronary angiography in patients with advanced renal insufficiency is typically restricted to cases of life-threatening circumstances such as acute myocardial infarction and unstable angina. To gather a large amount of visual information with a minimum number of cine runs, and consequently, with a minimum volume of contrast medium, we rotated the gantry at 40 degrees /s throughout an angle of 120 degrees, from the right toward the left anterior oblique positions. This technique of rotational spin during cinegraphic runs has not yet become established in invasive cardiology. Three experienced cardiologists independently evaluated all coronary segments in rotational versus standard coronary angiography modes for 15 patients, on the basis of an 11-point scale (0 = cardiac spin far better to 10 = standard mode far better). A score of 5 signified that there was no difference in quality between the 2 modes. The arithmetic mean of the assessment values was 4.9 +/- 0.3 for coronary segments, 5.4 +/- 1.3 for coronary lesions, 5.1 +/- 1.4 for bifurcations, and 5.0 +/- 0.1 for coronary flow. The arithmetic means for the volume of contrast medium (25 +/- 4 ml), for the overall dose area product (8.6 +/- 4.5 Gy x cm(2)), and for the number of cine graphic frames (203 +/- 65) for a diagnostic cardiac spin were significantly below published typical values in standard mode. Cardiac spin enables 3-dimensional coronary impression under conditions of adequate image quality and represents a new, useful, and beneficial method in invasive cardiology for applications involving the special indication of advanced renal insufficiency.

  17. Contrast agent choice for intravenous coronary angiography

    NASA Astrophysics Data System (ADS)

    Zeman, H. D.; Siddons, D. P.

    1990-05-01

    The screening of the general population for coronary artery disease would be practical if a method existed for visualizing the extent of occlusion after an intravenous injection of contrast agent. Measurements performed with monochromatic synchrotron radiation X-rays and an iodine-containing contrast agent at the Stanford Synchrotron Radiation Laboratory have shown that such an intravenous angiography procedure would be possible with an adequately intense monochromatic X-ray source. Because of the size and cost of synchrotron radiation facilities it would be desirable to make the most efficient use of the intensity available, while reducing as much as possible the radiation dose experienced by the patient. By choosing contrast agents containing elements with a higher atomic number than iodine, it is possible to both improve the image quality and reduce the patient radiation dose, while using the same synchrotron radiation source. By using Si monochromator crystals with a small mosaic spread, it is possible to increase the X-ray flux available for imaging by over an order of magnitude, without any changes in the storage ring or wiggler magnet. The most critical imaging task for intravenous coronary angiography utilizing synchrotron radiation X-rays is visualizing a coronary artery through the left ventricle or aorta which also contain contrast agent. Calculations have been made of the signal to noise ratio expected for this imaging task for various contrast agents with atomic numbers between that of iodine and bismuth. The X-ray energy spectrum of the X-17 superconduction wiggler beam line at the National Synchrotron Light Source at Brookhaven National Laboratory has been used for these calculations. Both perfect Si crystals and Si crystals with a small mosaic spread are considered as monochromators. Contrast agents containing Gd or Yb seem to have about the optimal calculated signal to noise ratio. Gd-DTPA is already approved for use as a contrast agent for

  18. 4D CT angiography more closely defines intracranial thrombus burden than single-phase CT angiography.

    PubMed

    Frölich, A M J; Schrader, D; Klotz, E; Schramm, R; Wasser, K; Knauth, M; Schramm, P

    2013-10-01

    In patients with acute stroke, the location and extent of intravascular thrombi correlate with clinical and imaging outcomes and have been used to predict the success of intravenous thrombolysis. We hypothesized that 4D-CTA reconstructed from whole-brain CTP more closely outlines intracranial thrombi than conventional single-phase CTA. Sixty-seven patients with anterior circulation occlusion were retrospectively analyzed. For 4D-CTA, temporal maximum intensity projections were calculated that combine all 30 spiral scans of the CTP examination through temporal fusion. Thrombus extent was assessed by a semi-quantitative clot burden score (0-10; in which 0 = complete unilateral anterior circulation occlusion and 10 = patent vasculature). In patients with sufficient collateral flow, the length of the filling defect and corresponding hyperdense middle cerebral artery sign on NCCT were measured. Clot burden on temporal maximum intensity projection (median clot burden score, 7.0; interquartile range, 5.1-8.0) was significantly lower than on single-phase CT angiography (median, 6.0; interquartile range, 4.5-7.0; P < .0001). The length of the hyperdense middle cerebral artery sign (14.30 ± 5.93 mm) showed excellent correlation with the filling defect in the middle cerebral artery on temporal maximum intensity projection (13.40 ± 6.40 mm); this filling defect was larger on single-phase CT angiography (18.08 ± 6.54 mm; P = .043). As the result of an increased sensitivity for collateral flow, 4D-CTA temporal maximum intensity projection more closely outlines intracranial thrombi than conventional single-phase CT angiography. Our findings can be helpful when planning acute neurointervention. Further research is necessary to validate our data and assess the use of 4D-CTA in predicting response to different recanalization strategies.

  19. Imaging Foveal Microvasculature: Optical Coherence Tomography Angiography Versus Adaptive Optics Scanning Light Ophthalmoscope Fluorescein Angiography

    PubMed Central

    Mo, Shelley; Krawitz, Brian; Efstathiadis, Eleni; Geyman, Lawrence; Weitz, Rishard; Chui, Toco Y. P.; Carroll, Joseph; Dubra, Alfredo; Rosen, Richard B.

    2016-01-01

    Purpose To compare the use of optical coherence tomography angiography (OCTA) and adaptive optics scanning light ophthalmoscope fluorescein angiography (AOSLO FA) for characterizing the foveal microvasculature in healthy and vasculopathic eyes. Methods Four healthy controls and 11 vasculopathic patients (4 diabetic retinopathy, 4 retinal vein occlusion, and 3 sickle cell retinopathy) were imaged with OCTA and AOSLO FA. Foveal perfusion maps were semiautomatically skeletonized for quantitative analysis, which included foveal avascular zone (FAZ) metrics (area, perimeter, acircularity index) and vessel density in three concentric annular regions of interest. On each set of OCTA and AOSLO FA images, matching vessel segments were used for lumen diameter measurement. Qualitative image comparisons were performed by visual identification of microaneurysms, vessel loops, leakage, and vessel segments. Results Adaptive optics scanning light ophthalmoscope FA and OCTA showed no statistically significant differences in FAZ perimeter, acircularity index, and vessel densities. Foveal avascular zone area, however, showed a small but statistically significant difference of 1.8% (P = 0.004). Lumen diameter was significantly larger on OCTA (mean difference 5.7 μm, P < 0.001). Microaneurysms, fine structure of vessel loops, leakage, and some vessel segments were visible on AOSLO FA but not OCTA, while blood vessels obscured by leakage were visible only on OCTA. Conclusions Optical coherence tomography angiography is comparable to AOSLO FA at imaging the foveal microvasculature except for differences in FAZ area, lumen diameter, and some qualitative features. These results, together with its ease of use, short acquisition time, and avoidance of potentially phototoxic blue light, support OCTA as a tool for monitoring ocular pathology and detecting early disease. PMID:27409463

  20. Correlation between magnetic resonance angiography (MRA) and quantitative coronary angiography (QCA) in ectatic coronary vessels.

    PubMed

    Mavrogeni, Sophie I; Manginas, Athanassios; Papadakis, Emmanouil; Foussas, Stefanos; Douskou, Marouso; Baras, Panagiotis; Seimenis, Ioannis; Cokkinos, Dennis V

    2004-01-01

    Coronary artery ectasia (CAE) is defined as a dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal artery. The correct follow-up of ectatic vessels is hampered by the need for repeat angiograms. In this work we compared quantitative coronary angiography (QCA) measurements of the diameter of the proximal most ectatic part of coronary vessels, with corresponding measurements obtained by magnetic resonance angiography (MRA) using both gradient echo and turbo spin echo imaging sequences. Fifteen patients (14 male), aged 45-65 years, with known CAE were prospectively studied. Two electrocardiogram (ECG)-triggered pulse sequences were implemented for coronary magnetic resonance angiography. The first was a three-dimensional (3D), segmented, k-space gradient-echo sequence, employing a T2-weighted preparation prepulse and a frequency-selective, fat-saturation prepulse to enhance "white blood" (WB) contrast of the coronary arteries. The second sequence was an M2D dual Inversion Recovery (IR) Turbo Spin-Echo with a linear k-space acquisition scheme, providing "black-blood" (BB) contrast of the coronaries. All scans were carried out with the patient free breathing using a 2D, real-time Navigator beam, for respiratory motion tracking and gating. All patients underwent QCA, and the diameter of the proximal most ectatic part of each vessel was measured and compared with "white-blood" and "black-blood" MRA measurements. The average length of continuously visualized LM, LAD, LCx, and RCA by MRA was 2.5 +/- 0.3, 5.8 +/- 0.8, 3.9 +/- 1.0, and 7.2 +/- 1.2 cm, respectively. There were no statistically significant differences between diameter measurements of the proximal most ectatic part of each vessel, obtained with WB and BB sequences. There was a close correlation between MRA and QCA measurements (r = 0.87, p < 0.001). Bland-Altman analysis showed no systematic differences between the examined methods, over the whole range of vessel

  1. Unusual Congenital Aortic Anomaly with Rare Common Celiamesenteric Trunk Variation: MR Angiography and Digital Substraction Angiography Findings

    SciTech Connect

    Tosun, Ozgur Sanlidilek, Umman; Cetin, Huseyin; Ozdemir, Ozcan; Kurt, Aydin; Sakarya, Mehmet Emin; Tas, Ismet

    2007-09-15

    Magnetic resonance angiography and digital substraction angiography (DSA) findings in a case with a rare congenital thoracoabdominal aortic hypoplasia and common celiamesenteric trunk variation with occlusion of infrarenal abdominal aorta are described here. To our knowledge, this aortic anomaly has not been previously described in the English literature. DSA is the optimum imaging modality for determination of aortic hypoplasia, associated vascular malformations, collateral vessels, and direction of flow within vessels.

  2. Acceptance of Combined Coronary CT Angiography and Myocardial CT Perfusion versus Conventional Coronary Angiography in Patients with Coronary Stents—Intraindividual Comparison

    PubMed Central

    Martus, Peter; Laule, Michael; Dewey, Marc; Schönenberger, Eva

    2015-01-01

    Objectives To evaluate how well patients with coronary stents accept combined coronary computed tomography angiography (CTA) and myocardial CT perfusion (CTP) compared with conventional coronary angiography (CCA). Background While combined CTA and CTP may improve diagnostic accuracy compared with CTA alone, patient acceptance of CTA/CTP remains to be defined. Methods A total of 90 patients with coronary stents prospectively underwent CTA/CTP (both with contrast agent, CTP with adenosine) and CCA as part of the CARS-320 study. In this group, an intraindividual comparison of patient acceptance of CTA, CTP, and CCA was performed. Results CTP was experienced to be significantly more painful than CTA (p<0.001) and was associated with a higher frequency of dyspnea (p<0.001). Comparison of CTA/CTP with CCA revealed no significant differences in terms of pain (p = 0.141) and comfort (p = 0.377). Concern before CTA/CTP and CCA and overall satisfaction were likewise not significantly different (p = 0.097 and p = 0.123, respectively). Nevertheless, about two thirds (n = 60, 68%) preferred CTA/CTP to CCA (p<0.001). Moreover, patients felt less helpless during CTA/CTP than during CCA (p = 0.026). Lack of invasiveness and absence of pain were the most frequently mentioned advantages of CTA/CTP over CCA in our patient population. Conclusions CCA and combined CTA/CTP are equally well accepted by patients; however, more patients prefer CTA/CTP. CTP was associated with more intense pain than CTA and more frequently caused dyspnea than CTA alone. Trial Registration ClinicalTrials.gov NCT00967876 PMID:26327127

  3. Image quality metrics for optical coherence angiography

    PubMed Central

    Lozzi, Andrea; Agrawal, Anant; Boretsky, Adam; Welle, Cristin G.; Hammer, Daniel X.

    2015-01-01

    We characterized image quality in optical coherence angiography (OCA) en face planes of mouse cortical capillary network in terms of signal-to-noise ratio (SNR) and Weber contrast (Wc) through a novel mask-based segmentation method. The method was used to compare two adjacent B-scan processing algorithms, (1) average absolute difference (AAD) and (2) standard deviation (SD), while varying the number of lateral cross-sections acquired (also known as the gate length, N). AAD and SD are identical at N = 2 and exhibited similar image quality for N<10. However, AAD is relatively less susceptible to bulk tissue motion artifact than SD. SNR and Wc were 15% and 35% higher for AAD from N = 25 to 100. In addition data sets were acquired with two objective lenses with different magnifications to quantify the effect of lateral resolution on fine capillary detection. The lower power objective yielded a significant mean broadening of 17% in Full Width Half Maximum (FWHM) diameter. These results may guide study and device designs for OCA capillary and blood flow quantification. PMID:26203372

  4. Photodynamic therapy monitoring with optical coherence angiography

    PubMed Central

    Sirotkina, M. A.; Matveev, L. A.; Shirmanova, M. V.; Zaitsev, V. Y.; Buyanova, N. L.; Elagin, V. V.; Gelikonov, G. V.; Kuznetsov, S. S.; Kiseleva, E. B.; Moiseev, A. A.; Gamayunov, S. V.; Zagaynova, E. V.; Feldchtein, F. I.; Vitkin, A.; Gladkova, N. D.

    2017-01-01

    Photodynamic therapy (PDT) is a promising modern approach for cancer therapy with low normal tissue toxicity. This study was focused on a vascular-targeting Chlorine E6 mediated PDT. A new angiographic imaging approach known as M-mode-like optical coherence angiography (MML-OCA) was able to sensitively detect PDT-induced microvascular alterations in the mouse ear tumour model CT26. Histological analysis showed that the main mechanisms of vascular PDT was thrombosis of blood vessels and hemorrhage, which agrees with angiographic imaging by MML-OCA. Relationship between MML-OCA-detected early microvascular damage post PDT (within 24 hours) and tumour regression/regrowth was confirmed by histology. The advantages of MML-OCA such as direct image acquisition, fast processing, robust and affordable system opto-electronics, and label-free high contrast 3D visualization of the microvasculature suggest attractive possibilities of this method in practical clinical monitoring of cancer therapies with microvascular involvement. PMID:28148963

  5. Quantitative fluorescence angiography for neurosurgical interventions.

    PubMed

    Weichelt, Claudia; Duscha, Philipp; Steinmeier, Ralf; Meyer, Tobias; Kuß, Julia; Cimalla, Peter; Kirsch, Matthias; Sobottka, Stephan B; Koch, Edmund; Schackert, Gabriele; Morgenstern, Ute

    2013-06-01

    Present methods for quantitative measurement of cerebral perfusion during neurosurgical operations require additional technology for measurement, data acquisition, and processing. This study used conventional fluorescence video angiography--as an established method to visualize blood flow in brain vessels--enhanced by a quantifying perfusion software tool. For these purposes, the fluorescence dye indocyanine green is given intravenously, and after activation by a near-infrared light source the fluorescence signal is recorded. Video data are analyzed by software algorithms to allow quantification of the blood flow. Additionally, perfusion is measured intraoperatively by a reference system. Furthermore, comparing reference measurements using a flow phantom were performed to verify the quantitative blood flow results of the software and to validate the software algorithm. Analysis of intraoperative video data provides characteristic biological parameters. These parameters were implemented in the special flow phantom for experimental validation of the developed software algorithms. Furthermore, various factors that influence the determination of perfusion parameters were analyzed by means of mathematical simulation. Comparing patient measurement, phantom experiment, and computer simulation under certain conditions (variable frame rate, vessel diameter, etc.), the results of the software algorithms are within the range of parameter accuracy of the reference methods. Therefore, the software algorithm for calculating cortical perfusion parameters from video data presents a helpful intraoperative tool without complex additional measurement technology.

  6. Photodynamic therapy monitoring with optical coherence angiography

    NASA Astrophysics Data System (ADS)

    Sirotkina, M. A.; Matveev, L. A.; Shirmanova, M. V.; Zaitsev, V. Y.; Buyanova, N. L.; Elagin, V. V.; Gelikonov, G. V.; Kuznetsov, S. S.; Kiseleva, E. B.; Moiseev, A. A.; Gamayunov, S. V.; Zagaynova, E. V.; Feldchtein, F. I.; Vitkin, A.; Gladkova, N. D.

    2017-02-01

    Photodynamic therapy (PDT) is a promising modern approach for cancer therapy with low normal tissue toxicity. This study was focused on a vascular-targeting Chlorine E6 mediated PDT. A new angiographic imaging approach known as M-mode-like optical coherence angiography (MML-OCA) was able to sensitively detect PDT-induced microvascular alterations in the mouse ear tumour model CT26. Histological analysis showed that the main mechanisms of vascular PDT was thrombosis of blood vessels and hemorrhage, which agrees with angiographic imaging by MML-OCA. Relationship between MML-OCA-detected early microvascular damage post PDT (within 24 hours) and tumour regression/regrowth was confirmed by histology. The advantages of MML-OCA such as direct image acquisition, fast processing, robust and affordable system opto-electronics, and label-free high contrast 3D visualization of the microvasculature suggest attractive possibilities of this method in practical clinical monitoring of cancer therapies with microvascular involvement.

  7. Diagnostic accuracy of coronary computed tomography angiography as interpreted on a mobile handheld phone device.

    PubMed

    LaBounty, Troy M; Kim, Robert J; Lin, Fay Y; Budoff, Matthew J; Weinsaft, Jonathan W; Min, James K

    2010-05-01

    This study assessed the diagnostic performance of coronary computed tomography angiography (CTA) for the detection and exclusion of significant coronary artery stenosis as remotely interpreted on a mobile handheld device with dedicated medical imaging software. Recent advances in technology now permit remote interpretation of medical imaging studies on mobile handheld devices, although the diagnostic performance of this approach is unknown. We evaluated 102 patients with stable chest pain and both 64-detector row coronary CTA and quantitative invasive coronary angiography. The diagnostic performance of remote coronary CTA interpretation was assessed using a mobile handheld device and employing dedicated software. The coronary CTA studies were examined in an intent-to-diagnose manner for the presence or absence of coronary artery stenosis > or =50% on a per-artery and per-patient level; results were compared with quantitative invasive coronary angiography. Two blinded imagers independently interpreted coronary CTA studies, with a third imager achieving consensus for discordance. Coronary CTAs were re-interpreted in random order to determine interobserver agreement. Finally, coronary CTAs were evaluated on a dedicated 3-dimensional imaging workstation; results were compared to mobile handheld device findings for intertechnology agreement. The prevalence of significant coronary artery stenosis was 25% (26 of 102) at the per-patient level and 10% (40 of 405) at the per-artery level. Per-patient and per-artery sensitivity, specificity, and positive and negative predictive values were: 100% (26 of 26), 78% (59 of 76), 60% (26 of 43), and 100% (59 of 59), respectively; and 95% (38 of 40), 85% (310 of 365), 41% (38 of 93), and 99% (310 of 312), respectively. At the per-artery level, interobserver, intraobserver, and intertechnology agreement was 0.74, 0.89, and 0.75, respectively (p < 0.01 for all). The interpretation of coronary CTA using a mobile handheld device with

  8. Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography: design and implementation of the CORE320 multicenter, multinational diagnostic study.

    PubMed

    Vavere, Andrea L; Simon, Gregory G; George, Richard T; Rochitte, Carlos E; Arai, Andrew E; Miller, Julie M; Di Carli, Marcello; Arbab-Zadeh, Armin; Zadeh, Armin A; Dewey, Marc; Niinuma, Hiroyuki; Laham, Roger; Rybicki, Frank J; Schuijf, Joanne D; Paul, Narinder; Hoe, John; Kuribyashi, Sachio; Sakuma, Hajime; Nomura, Cesar; Yaw, Tan Swee; Kofoed, Klaus F; Yoshioka, Kunihiro; Clouse, Melvin E; Brinker, Jeffrey; Cox, Christopher; Lima, Joao A C

    2011-01-01

    Multidetector coronary computed tomography angiography (CTA) is a promising modality for widespread clinical application because of its noninvasive nature and high diagnostic accuracy as found in previous studies using 64 to 320 simultaneous detector rows. It is, however, limited in its ability to detect myocardial ischemia. In this article, we describe the design of the CORE320 study ("Combined coronary atherosclerosis and myocardial perfusion evaluation using 320 detector row computed tomography"). This prospective, multicenter, multinational study is unique in that it is designed to assess the diagnostic performance of combined 320-row CTA and myocardial CT perfusion imaging (CTP) in comparison with the combination of invasive coronary angiography and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). The trial is being performed at 16 medical centers located in 8 countries worldwide. CT has the potential to assess both anatomy and physiology in a single imaging session. The co-primary aim of the CORE320 study is to define the per-patient diagnostic accuracy of the combination of coronary CTA and myocardial CTP to detect physiologically significant coronary artery disease compared with (1) the combination of conventional coronary angiography and SPECT-MPI and (2) conventional coronary angiography alone. If successful, the technology could revolutionize the management of patients with symptomatic CAD.

  9. Routine invasive versus selective invasive strategies for Non-ST-elevation acute coronary syndromes: An Updated meta-analysis of randomized trials.

    PubMed

    Elgendy, Islam Y; Kumbhani, Dharam J; Mahmoud, Ahmed N; Wen, Xuerong; Bhatt, Deepak L; Bavry, Anthony A

    2016-11-01

    To perform an updated systematic review comparing a routine invasive strategy with a selective invasive strategy for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) in the era of stents and antiplatelet therapy. Recent meta-analyses comparing both strategies have shown conflicting results. Electronic databases were searched for randomized trials that compared a routine invasive strategy (i.e., routine coronary angiography +/- revascularization) versus a selective invasive strategy (i.e., medical stabilization and coronary angiography +/- revascularization if objective evidence of ischemia or refractory ischemia) in patients with NSTE-ACS. Summary odds ratios (OR) were primarily constructed using Peto's model. Twelve trials with 9,650 patients were included. Compared with a selective invasive strategy, a routine invasive strategy was associated with a reduction in the composite of all-cause mortality or myocardial infarction (MI) [OR: 0.86, 95% confidence interval (CI) 0.77-0.96] at a mean follow-up of 39 months, primarily due to a reduction in the risk of MI (OR: 0.78, 95% CI: 0.68-0.88). The risk of all-cause mortality was non-significantly reduced with a routine invasive strategy (OR: 0.88, 95% CI: 0.77-1.01). The risk of recurrent angina was reduced with a routine invasive strategy (OR: 0.55, 95% CI: 0.49-0.62), as well as the risk of future revascularization procedures (OR: 0.35, 95% CI: 0.30-0.39). In patients with NSTE-ACS, a routine invasive strategy reduced the risk of ischemic events, including the risk of mortality or MI. Routine invasive therapy reduced the risk of recurrent angina and future revascularization procedures. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  10. Diabetic Macular Ischemia Diagnosis: Comparison between Optical Coherence Tomography Angiography and Fluorescein Angiography

    PubMed Central

    Lima, Talita Toledo; Louzada, Ricardo Noguera; Rassi, Alessandra Thome; Isaac, David Leonardo Cruvinel; Avila, Marcos

    2016-01-01

    Purpose. To compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) images of foveal avascular zone (FAZ) in patients with diabetic retinopathy (DR) with and without diabetic macular ischemia (DMI). Methods. The Wilcoxon signed-rank test was used to compare area measurements and p values of <0.05 were considered statistically significant. FA and OCTA images were independently graded by 2 observers that reached agreement regarding quantitative DMI according established protocols. The ischemic area was divided into “large” macular ischemia (superior to 0.32 mm2) and “small” (inferior to 0.32 mm2) groups. Quantitative analyses of the FAZ were performed using custom software. Results. Thirty-four eyes from 34 diabetic patients were enrolled. Subjects with DMI presented a mean area on FA and OCTA of 0.68 ± 0.53 mm2 and 0.58 ± 0.35 mm2, respectively (p = 0.1374). Patients without DMI presented a mean area on FA and OCTA of 0.19 ± 0.67 mm2 and 0.20 ± 0.79 mm2, respectively (p = 0.9594). The ICC for the FAZ measurements between the 2 observers on FA and OCTA was 0.96 and 0.92, respectively. Conclusion. OCTA represents a novel technique for the diagnosis of DMI and it may become an alternative to FA for this purpose. PMID:27891250

  11. Dexmedetomidine compared with propofol for pediatric sedation during cerebral angiography.

    PubMed

    Peng, Ke; Li, Jian; Ji, Fu-Hai; Li, Zhi

    2014-06-01

    Sedation of pediatric patients undergoing cerebral angiography is challenging. Although dexmedetomidine is used for sedation in various procedures, it has not been reported for pediatric patients undergoing cerebral angiography. This study compared the safety and efficacy of dexmedetomidine with that of propofol for cerebral angiography in pediatric patients. Sixty-two patients (6-15 years) scheduled for elective cerebral angiography were apportioned randomly and equally to receive either propofol or dexmedetomidine sedation. Patients in the propofol group received an initial bolus of intravenous propofol (1 mg/kg) and a maintenance infusion of 100 μg/kg/min. Patients in the dexmedetomidine group received an initial bolus of intravenous dexmedetomidine (1 μg/kg over 10 min) and a maintenance infusion of 1 μg/kg/h. An additional bolus of propofol 0.5 mg/kg or dexmedetomidine 0.25 μg/kg was repeated if needed. Procedure time, time to recovery and adverse events associated with sedation were recorded. All cerebral angiographies were completed successfully under sedation with dexmedetomidine or propofol. Mean cerebral angiography time was 36 ± 10 min in the propofol group and 31 ± 7 min in the dexmedetomidine group (P = 0.047). The percentage of airway events and total adverse events were significantly higher in the propofol group (P < 0.05). Heart rate decreased in the dexmedetomidine group and mean arterial pressure decreased in the propofol group (P < 0.05, each). Although cerebral angiography can be performed successfully under sedation with either propofol or dexmedetomidine, dexmedetomidine may be a better alternative because of fewer respiratory adverse events.

  12. Early surgery after angiography in patients scheduled for valve replacement.

    PubMed

    Dayan, Victor; Stanham, Roberto; Soca, Gerardo; Genta, Fernando; Mariño, Jorge; Lorenzo, Alvaro

    2017-01-01

    Background There are limited data regarding the risks of cardiac surgery early after coronary angiography in patients scheduled for isolated aortic and/or mitral valve replacement. Our aim was to evaluate the risk of early surgery after coronary angiography in these patients. Methods We retrospectively analyzed data of 1044 patients who underwent isolated aortic and/or mitral valve replacement from 2006 to 2014. Baseline, operative, and postoperative variables were collected. The patients were divided into 3 groups based on the interval between coronary angiography and surgery: ≤3 days ( n = 216), 4-7 days ( n = 109), and ≥8 days ( n = 719). We evaluated hospital mortality and postoperative acute kidney injury. Subgroup analysis was performed according to preoperative creatinine clearance. Results Postoperative creatinine clearance was lower in patients who underwent surgery ≤3 days after coronary angiography (63.57 ± 38.52 mL min(-1)) compared to ≥8 days after coronary angiography (74.56 ± 54.25 mL min(-1), p = 0.015). Patients who underwent surgery ≤3 days after coronary angiography had higher hospital mortality when preoperative creatinine clearance was ≤60 mL min(-1) (12% vs. 4% for creatinine clearance ≤and >60 mL min(-1), respectively; p = 0.039). Predictors of hospital mortality were New York Heart Association class and postoperative creatinine clearance. Conclusion Hospital mortality was higher in patients with decreased preoperative renal function who underwent surgery within the first 3 days after coronary angiography. Delaying surgery in this subgroup of patients could be a good strategy.

  13. Impact of clinical urgency, physician supply and procedural capacity on regional variations in wait times for coronary angiography

    PubMed Central

    2010-01-01

    Background Despite universal health care, there continues to be regional access disparities to coronary angiography in Canada. Our objective was to evaluate the extent to which demand-side factors such as clinical urgency/need, and supply-side factors, as reflected by differences in physician and procedural supply account for these inequalities. Methods Our cohort consisted of 74,254 consecutive patients referred for coronary angiography in Ontario, Canada between April 1st 2005 and March 31st 2006, divided into three urgency strata based on a clinical urgency scale. Cox-proportional hazard models were developed, adjusting for age, gender, socioeconomic status (SES), region, and urgency score, with greater hazard ratios (HR) indicating shorter wait times. To evaluate mediators of any residual wait-time differences, we examined the influence of the regional supply of cath lab facilities, invasive cardiologists and general practitioners (GP). Results We found that the urgency score was a significant predictor of wait time in all three strata (urgent patients: HR 1.61 for each unit increase in patient urgency (95% Confidence interval (CI) 1.55-1.67); semi-urgent patients: HR 1.55 (95% CI 1.44-1.68); elective patients: HR 1.13 (95% CI 1.08-1.18)). After accounting for clinical need/urgency, regional wait time differences persisted; these were most consistently associated with variation in cath lab supply. The impact of invasive cardiologist supply was restricted to urgent patients while that of GP supply was confined to semi-urgent and elective patients. Conclusion We found that there remained significant regional disparities in access to coronary angiography after accounting for clinical need. These disparities are partially explained by variations in supply of both procedural capacity and physician services, most notably in elective and semi-urgent patients. PMID:20051136

  14. Costs and clinical outcomes for non-invasive versus invasive diagnostic approaches to patients with suspected in-stent restenosis.

    PubMed

    Min, James K; Hasegawa, James T; Machacz, Susanne F; O'Day, Ken

    2016-02-01

    This study compared costs and clinical outcomes of invasive versus non-invasive diagnostic evaluations for patients with suspected in-stent restenosis (ISR) after percutaneous coronary intervention. We developed a decision model to compare 2 year diagnosis-related costs for patients who presented with suspected ISR and were evaluated by: (1) invasive coronary angiography (ICA); (2) non-invasive stress testing strategy of myocardial perfusion imaging (MPI) with referral to ICA based on MPI; (3) coronary CT angiography-based testing strategy with referral to ICA based on CCTA. Costs were modeled from the payer's perspective using 2014 Medicare rates. 56 % of patients underwent follow-up diagnostic testing over 2 years. Compared to ICA, MPI (98.6 %) and CCTA (98.1 %) exhibited lower rates of correct diagnoses. Non-invasive strategies were associated with reduced referrals to ICA and costs compared to an ICA-based strategy, with diagnostic costs lower for CCTA than MPI. Overall 2-year costs were highest for ICA for both metallic as well as BVS stents ($1656 and $1656, respectively) when compared to MPI ($1444 and $1411) and CCTA. CCTA costs differed based upon stent size and type, and were highest for metallic stents >3.0 mm followed by metallic stents <3.0 mm, BVS < 3.0 mm and BVS > 3.0 mm ($1466 vs. $1242 vs. $855 vs. $490, respectively). MPI for suspected ISR results in lower costs and rates of complications than invasive strategies using ICA while maintaining high diagnostic performance. Depending upon stent size and type, CCTA results in lower costs than MPI.

  15. Costs and clinical outcomes for non-invasive versus invasive diagnostic approaches to patients with suspected in-stent restenosis

    PubMed Central

    Hasegawa, James T.; Machacz, Susanne F.; O’Day, Ken

    2015-01-01

    This study compared costs and clinical outcomes of invasive versus non-invasive diagnostic evaluations for patients with suspected in-stent restenosis (ISR) after percutaneous coronary intervention. We developed a decision model to compare 2 year diagnosis-related costs for patients who presented with suspected ISR and were evaluated by: (1) invasive coronary angiography (ICA); (2) non-invasive stress testing strategy of myocardial perfusion imaging (MPI) with referral to ICA based on MPI; (3) coronary CT angiography-based testing strategy with referral to ICA based on CCTA. Costs were modeled from the payer’s perspective using 2014 Medicare rates. 56 % of patients underwent follow-up diagnostic testing over 2 years. Compared to ICA, MPI (98.6 %) and CCTA (98.1 %) exhibited lower rates of correct diagnoses. Non-invasive strategies were associated with reduced referrals to ICA and costs compared to an ICA-based strategy, with diagnostic costs lower for CCTA than MPI. Overall 2-year costs were highest for ICA for both metallic as well as BVS stents ($1656 and $1656, respectively) when compared to MPI ($1444 and $1411) and CCTA. CCTA costs differed based upon stent size and type, and were highest for metallic stents >3.0 mm followed by metallic stents <3.0 mm, BVS < 3.0 mm and BVS > 3.0 mm ($1466 vs. $1242 vs. $855 vs. $490, respectively). MPI for suspected ISR results in lower costs and rates of complications than invasive strategies using ICA while maintaining high diagnostic performance. Depending upon stent size and type, CCTA results in lower costs than MPI. PMID:26335370

  16. 3-T contrast-enhanced MR angiography in evaluation of suspected intracranial aneurysm: comparison with MDCT angiography.

    PubMed

    Nael, Kambiz; Villablanca, J Pablo; Mossaz, Léonard; Pope, Whitney; Juncosa, Alex; Laub, Gerhard; Finn, J Paul

    2008-02-01

    The purpose of this study was to prospectively evaluate a high-spatial-resolution contrast-enhanced 3-T MR angiography protocol for detection and characterization of intracranial aneurysms and to compare the results with those of MDCT angiography. Forty-one patients with suspected intracranial aneurysm underwent high-spatial-resolution 3D contrast-enhanced MR angiography and CT angiography (CTA). With a generalized autocalibrating partially parallel acquisition algorithm with an acceleration factor of 4 at 3 T, contrast-enhanced MR angiographic images were acquired over 20 seconds with a spatial-resolution of 0.7 x 0.7 x 0.8 mm. CTA images were acquired with a spatial resolution of 0.35 x 0.35 x 0.8 mm on a 16-MDCT scanner in 17 seconds. The images from the two studies were evaluated independently by two neuroradiologists for image quality, presence of aneurysm, and characterization of aneurysm. The dimensions of the aneurysm were measured independently with both techniques. A total of 25 aneurysms were identified with both contrast-enhanced MR angiography and CTA. A comparative analysis of detection and depiction of aneurysms showed excellent interobserver agreement for both contrast-enhanced MR angiography (kappa = 0.81) and CTA (kappa = 0.91) images. There was significant correlation between the techniques for both qualitative assessment of aneurysm depiction (rho = 0.92; 95% CI, 0.88-0.95) and quantitative dimensional measurement of aneurysm size (r = 0.94; 95% CI, 0.92-0.97). Contrast-enhanced MR angiography at 3 T is reliable for evaluation and characterization of intracranial aneurysms. The results are comparable with those of MDCTA.

  17. [Vascular complications of percutaneous transradial coronary angiography and coronary intervention].

    PubMed

    Prull, Magnus W; Brandts, Bodo; Rust, Henning; Trappe, Hans-Joachim

    2005-07-15

    Vascular complications following transradial coronary angiography and coronary intervention could severely compromise perfusion of the hand. Drastic complications after cannulation of the radial artery (ischemia of the hand with occlusion of the digital arteries) are published only in brief reports. This study investigates whether percutaneous transradial artery coronary angiography/intervention results in vascular complications. 93 patients were consecutively studied over a 4-month period. The following data were recorded before and after coronary angiography and/or intervention: diameter of the radial artery, blood volume, flow velocity, and occlusion pressure. Graduation of the stenosis after intervention was done according to the principle of the peak velocity ratio. A transradial coronary angiography/intervention was performed in 93 patients (75 men, mean age 62.5 years) in case of an unremarkable Allen test. Procedural success rate was 97.2%. The intervention could not be completed successfully in three patients (2.8%). Mean vessel diameter increased from 2.46 +/- 1.7 mm (standard deviation [SD]) before intervention to 2.78 +/- 0.69 mm (SD) after intervention; this increase was statistically significant (p = 0.002). Changes in blood flow, flow velocity and occlusion pressure did not reach significance. Vascular complications were seen in nine of 93 patients (10%) after the procedure. No patient mentioned discomfort. No perfusion deficit of the digital arteries was seen. The transradial coronary angiography and intervention is a safe method with a high procedural success rate.

  18. Acute management and outcomes of iatrogenic dissections during cerebral angiography.

    PubMed

    Groves, Andrew P; Kansagra, Akash P; Cross, DeWitte T; Moran, Christopher J; Derdeyn, Colin P

    2017-05-01

    Iatrogenic dissection is a known complication of cerebral angiography, but the clinical outcomes and optimal treatment of these patients is not well established. We sought to review our experience with cerebral angiography to determine the incidence of iatrogenic dissections along with clinical outcomes associated with a generally conservative treatment strategy. We retrospectively reviewed clinical records for all patients that underwent cerebral angiography between March 2002 and May 2015. Demographic information, angiography reports, follow-up CT and MRI reports, and follow-up clinical notes were reviewed. 17 418 cerebral angiograms were performed during the review period, including 13 485 diagnostic angiograms and 3933 endovascular interventional procedures. 68 iatrogenic dissections were identified, for a per procedure incidence of 0.39%. The vertebral artery was the most commonly dissected vessel (49/68, 72%). 67 of 68 cases (98.5%) were managed conservatively with either no treatment or medical therapy alone. There were two adverse events potentially attributable to the dissections, only one of which was symptomatic. Iatrogenic dissections occur infrequently during cerebral angiography. When dissections do occur, most cases can be safely managed without further intervention in the acute setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  19. Coronary artery angiography and myocardial viability imaging: a 3.0-T contrast-enhanced magnetic resonance coronary artery angiography with Gd-BOPTA.

    PubMed

    Yun, Hong; Jin, Hang; Yang, Shan; Huang, Dong; Chen, Zhang-wei; Zeng, Meng-su

    2014-01-01

    With improving MR sequence, phase-array coil and image quality, cardiac magnetic resonance imaging is becoming a promising method for a comprehensive non-invasive evaluation of coronary artery and myocardial viability. The study aimed to evaluate contrast-enhanced whole-heart coronary MR angiography (CE WH-CMRA) at 3.0-Tesla for the diagnosis of significant stenosis (≥50%) and detection of myocardial infarction (MI) in patients with suspected coronary artery disease (CAD). CE WH-CMRA was performed in consecutive 70 patients with suspected CAD by using a 3.0-T MR system. A respiratory-gated, electrocardiography-triggered, inversion-recovery, segmented fast low angle shot sequence (TI = 200 ms) was used. Data acquisition began 60 s after the slow injection of Gd-BOPTA (0.2 mmol/kg body weight, at an injection rate 0.3 ml/s). At last, breath-hold 2D-PSIR-SSFP sequence was performed. Diagnostic accuracy of CE WH-CMRA in detecting significant stenosis (≥50%) was evaluated using invasive coronary angiography as the referenced standard. The MI region appearing as high signal intensity visualized on CEWH-CMRA and 2D-PSIR-SSFP images were compared and analyzed. CE WH-CMRA correctly identified 42 of 44 patients with significant CAD. The overall sensitivity, specificity, negative predictive value, positive predictive value and accuracy for diagnosing significant CAD was 83.6, 95.8, 96.0, 82.8 and 93.4% respectively. The MI region detected by WH-CMRA and 2D-PSIR-SSFP were consistent in 10 patients and these segments manifested with transmural or subendocardial enhancement patterns. Only one MI patient was judged inconsistent between WH-CMRA and 2D-PSIR-SSFP, who was confirmed by clinical and electrocardiogram results. The enhancement pattern in this patient was spotted and focal in 2D-PSIR-SSFP, but was dismissed by WH-CMRA. It is feasible to obtain information about coronary artery stenosis and myocardial viability in a single CE WH-CMRA with administration of Gd-BOPTA.

  20. Transient Global Amnesia following Neural and Cardiac Angiography May Be Related to Ischemia

    PubMed Central

    Zhang, Yang; Chen, Ming; Bao, Shengde

    2016-01-01

    Introduction. Transient global amnesia (TGA) following angiography is rare, and the pathogenesis has not been illustrated clearly till now. The aim of this research is to explore the pathogenesis of TGA following angiography by analyzing our data and reviewing the literature. Methods. We retrospectively studied 20836 cases with angiography in our hospital between 2007 and 2015 and found 9 cases with TGA following angiography. The data of these 9 cases were analyzed. Results. We found all 9 cases with TGA following neural angiography (5 in 4360) or cardiac angiography (4 in 8817) and no case with TGA following peripheral angiography (0 in 7659). Statistical difference was found when comparing the neural and cardiac angiography group with peripheral group (p = 0.022). Two cases with TGA were confirmed with small acute infarctions in hippocampus after angiography. This might be related to the microemboli which were rushed into vertebral artery following blood flow during neural angiography or cardiac angiography. There was no statistical difference when comparing the different approaches for angiography (p = 0.82) and different contrast agents (p = 0.619). Conclusion. Based on the positive findings of imaging study and our analysis, we speculate that ischemia in the medial temporal lobe with the involvement of the hippocampus might be an important reason of TGA following angiography. PMID:27419129

  1. Cryptic invasions: A review.

    PubMed

    Morais, Pedro; Reichard, Martin

    2017-06-22

    Cryptic invasions are defined as the introduction and spread of non-native lineages within the species' native range (intra-specific cryptic invasion) or the invasion of non-native species that goes unnoticed due to misidentification as a native or another invasive species (inter-specific cryptic invasion). While population-specific attributes are acknowledged to play a critical role in the success and impact of biological invasions in general, our knowledge of the causes and consequences of cryptic invasions is largely neglected. Cryptic invasions are inherently difficult to recognize and, despite being likely widespread, often go undetected. In this review, we analyse the sources, mechanisms, and consequences of cryptic invasions. Using a bibliometric survey, we first quantify the relative proportion of study questions, taxa, and geographic regions. We then highlight the value of comparative information from archived specimens in uncovering the occurrence and timing of cryptic invasions. We examine the mechanisms of cryptic invasions and emphasise the role of anthropogenic environmental changes on the arrival of cryptic invaders. We then discuss the role of interspecific biological interactions in the success of cryptic invasions and the role of hybridization between native and non-native lineages in cryptic invasions. We examine the competitive advantage of some invasive lineages in key physiological, ecological or sexually-selected traits. We argue that cryptic invasions, often undetected, may trigger subsequent rapid range expansions. We suggest that cryptic invasions are much more common than currently acknowledged. We highlight the role of coevolved associations (host-parasite, mutualism, herbivory), inherently population-specific, in the impacts of cryptic invasions on local communities. Finally, we outline a framework to manage intraspecific cryptic invasions. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Visualization of intrarenal vessels by 3.0-T MR angiography in comparison with digital subtraction angiography using renal specimens.

    PubMed

    Schenk, Jens-Peter; Friebe, Björn; Ley, Sebastian; Baudendistel, Klaus; Schoebinger, Max; Hähnel, Stefan; Mehrabi, Arianeb; Tröger, Jochen; Hallscheidt, Peter

    2006-10-01

    MRI at 3.0 T enables high-spatial resolution for renal MR angiography. Evaluation of an arterial tree model in animal kidney specimens with comparison of digital subtraction angiography (DSA) and high-field MRI to find out the maximum spatial resolution of intrarenal vessels. It was considered that objective quantitation of angiogram quality could be achieved. A total of 27 pig kidney specimens were examined by MR angiography (flash 3D) using a 3.0-T scanner (TRIO; Siemens, Erlangen, Germany) with an eight-channel head coil and a voxel size of 0.9x0.9x1.1 mm in the early arterial phase after implantation of a 4F catheter in the renal artery. DSA (Integris, Philips, Best, The Netherlands) was performed immediately after the MRI. With the help of semiautomated segmentation, all vessels were marked for comparison of the vessel trees. The Wilcoxon rank test was used for statistical evaluation of vessel numbers and branching depths. Objective comparison between DSA and MR angiography was achieved. High-field MR angiography had the ability to depict vessels up to the seventh branching on average. Significant differences in vessel delineation and counts were found from the fifth level of intrarenal branching onwards with DSA showing an advantage. High-field MRI has great potential in the detection of intrarenal arteries and is comparable to DSA in visualization of the central intrarenal vessel tree.

  3. [Vascular assessment in stroke codes: role of computed tomography angiography].

    PubMed

    Mendigaña Ramos, M; Cabada Giadas, T

    2015-01-01

    Advances in imaging studies for acute ischemic stroke are largely due to the development of new efficacious treatments carried out in the acute phase. Together with computed tomography (CT) perfusion studies, CT angiography facilitates the selection of patients who are likely to benefit from appropriate early treatment. CT angiography plays an important role in the workup for acute ischemic stroke because it makes it possible to confirm vascular occlusion, assess the collateral circulation, and obtain an arterial map that is very useful for planning endovascular treatment. In this review about CT angiography, we discuss the main technical characteristics, emphasizing the usefulness of the technique in making the right diagnosis and improving treatment strategies. Copyright © 2012 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  4. Split-spectrum phase-gradient optical coherence tomography angiography

    PubMed Central

    Liu, Gangjun; Jia, Yali; Pechauer, Alex D.; Chandwani, Rahul; Huang, David

    2016-01-01

    A phase gradient angiography (PGA) method is proposed for optical coherence tomography (OCT). This method allows the use of phase information to map the microvasculature in tissue without the correction of bulk motion and laser trigger jitter induced phase artifacts. PGA can also be combined with the amplitude/intensity to improve the performance. Split-spectrum technique can further increase the signal to noise ratio by more than two times. In-vivo imaging of human retinal circulation is shown with a 70 kHz, 840 nm spectral domain OCT system and a 200 kHz, 1050 nm swept source OCT system. Four different OCT angiography methods are compared. The best performance was achieved with split-spectrum amplitude and phase-gradient angiography. PMID:27570689

  5. Computed tomography angiography to evaluate thoracic outlet neurovascular compression.

    PubMed

    Hasanadka, Ravishankar; Towne, Jonathan B; Seabrook, Gary R; Brown, Kellie R; Lewis, Brian D; Foley, W Dennis

    2007-01-01

    The objective was to evaluate the efficacy of computed tomography angiography with upper extremity hyperabduction to diagnose thoracic outlet syndrome. Over 5 years, 21 patients were treated surgically for neurogenic symptoms of thoracic outlet syndrome. For patients whose diagnosis was unclear after history and physical examination, adjunctive tests (duplex, magnetic resonance angiography, or computed tomography angiography) were performed to help establish the diagnosis. Five of the 6 computed tomography angiograms were positive. The sixth computed tomography was deemed to be an incomplete study. With mean follow-up of 9.4 months, 95% (n = 19) of patients with a positive hyperabduction test on physical examination were free of symptoms postoperatively. All patients with a positive computed tomography angiogram, with their neurovascular compression localized to the thoracic outlet, had successful operative decompression. Computed tomography angiogram with abduction of the arm can be used as an adjunct to confirm the diagnosis of neurovascular compression and then predict successful operative decompression.

  6. Diagnostic Sensitivity of Indocyanine Green Angiography for Birdshot Chorioretinopathy.

    PubMed

    Reddy, Ashvini K; Gonzalez, Marco A; Henry, Christopher R; Yeh, Steven; Sobrin, Lucia; Albini, Thomas A

    2015-07-01

    To describe a cohort of patients with birdshot chorioretinopathy who did not manifest birdshot lesions on clinical examination but had retinal vasculitis, low-grade to moderate vitritis, and hypocyanescent lesions on indocyanine green angiography (ICGA). Case series of 3 patients with mild to moderate vitritis and retinal vasculitis without definite birdshot lesions on clinical examination evaluated from January 2007 to December 2014 at 4 academic ophthalmology centers. All patients' results were positive for human leukocyte antigen-A29. All cases had hypocyanescent lesions visible on ICGA but not detectable on fluorescein angiography. Patients with retinal vasculitis and low-grade vitritis with or without macular edema may have birdshot chorioretinopathy evident on ICGA before lesions are visible on clinical examination or fluorescein angiography. Expanding birdshot chorioretinopathy diagnostic criteria to include the presence of hypocyanescent lesions on ICGA could improve the sensitivity of diagnosis.

  7. Optical Coherence Tomography Angiography to Estimate Retinal Blood Flow in Eyes with Retinitis Pigmentosa.

    PubMed

    Sugahara, Masako; Miyata, Manabu; Ishihara, Kenji; Gotoh, Norimoto; Morooka, Satoshi; Ogino, Ken; Hasegawa, Tomoko; Hirashima, Takako; Yoshikawa, Munemitsu; Hata, Masayuki; Muraoka, Yuki; Ooto, Sotaro; Yamashiro, Kenji; Yoshimura, Nagahisa

    2017-04-13

    Ophthalmologists sometimes face difficulties in identifying the origin of visual acuity (VA) loss in a retinitis pigmentosa (RP) patient, particularly before cataract surgery: cataract or the retinal disease state. Therefore, it is important to identify the significant factors correlating with VA. Nowadays, retinal blood flow in superficial and deep layers can be estimated non-invasively using optical coherence tomography angiography (OCTA). We estimated blood flow per retinal layer by using OCTA; investigated the correlation between VA and other parameters including blood flow and retinal thickness; and identified the most associated factor with VA in patients with RP. OCTA images in 68 of consecutive 110 Japanese RP patients were analysable (analysable RP group). Thirty-two age- and axial length-matched healthy eyes (control group) were studied. In the analysable RP group, the parafoveal flow density in superficial and deep layers was 47.0 ± 4.9% and 52.4 ± 5.5%, respectively, which was significantly lower than that in controls. Using multivariate analysis, we found that the parafoveal flow density in the deep layer and superficial foveal avascular area were the factors associated with VA. Non-invasive estimation of retinal blood flow per retinal layer using OCTA is useful for predicting VA in RP patients.

  8. Three-dimensional MDCT angiography of splanchnic arteries: pearls and pitfalls.

    PubMed

    Dohan, A; Dautry, R; Guerrache, Y; Fargeaudou, Y; Boudiaf, M; Le Dref, O; Sirol, M; Soyer, P

    2015-02-01

    Fast scanning along with high resolution of multidetector computed tomography (MDCT) have expanded the role of non-invasive imaging of splanchnic arteries. Advancements in both MDCT scanner technology and three-dimensional (3D) imaging software provide a unique opportunity for non-invasive investigation of splanchnic arteries. Although standard axial computed tomography (CT) images allow identification of splanchnic arteries, visualization of small or distal branches is often limited. Similarly, a comprehensive assessment of the complex anatomy of splanchnic arteries is often beyond the reach of axial images. However, the submillimeter collimation that can be achieved with MDCT scanners now allows the acquisition of true isotropic data so that a high spatial resolution is now maintained in any imaging plane and in 3D mode. This ability to visualize the complex network of splanchnic arteries using 3D rendering and multiplanar reconstruction is of major importance for an optimal analysis in many situations. The purpose of this review is to discuss and illustrate the role of 3D MDCT angiography in the detection and assessment of abnormalities of splanchnic arteries as well as the limitations of the different reconstruction techniques.

  9. Upper Extremity Runoff: Pearls and Pitfalls in Computed Tomography Angiography and Magnetic Resonance Angiography.

    PubMed

    Nagpal, Prashant; Maller, Vinod; Garg, Gunjan; Hedgire, Sandeep; Khandelwal, Ashish; Kalva, Sanjeeva; Steigner, Michael L; Saboo, Sachin S

    Upper extremity vasculature can be affected by various traumatic and nontraumatic pathologies; however, the evaluation of these arteries can be challenging for the radiologists as well as for the clinicians. After an accurate history and clinical examination, imaging plays a vital role in the diagnosis and treatment planning of these patients. Depending on the urgency and the indication, upper extremity arteries may be evaluated by ultrasonography with color Doppler, computed tomography (CT), magnetic resonance imaging (MRI), or digital subtraction angiography. This review article discusses relevant imaging anatomy of the upper extremity arteries, presents CT and MRI protocols, briefly describes the state-of-the-art CT and MRI of various pathologies affecting the upper extremity arteries, and summarizes the important pearls needed for busy practicing radiologist. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Glucagon-Induced Vasospasm of Hepatic Artery Branches During Visceral Angiography

    SciTech Connect

    Dziedzic, T. Scott; Smith, Tony P.

    2008-07-15

    Glucagon is often used in radiology to decrease bowel motility for enhanced imaging, including visceral digital subtraction angiography. We present a case in which branch hepatic artery vasospasm followed the intravenous administration of glucagon during visceral angiography.

  11. Optical Coherence Tomography Angiography in Mice: Comparison with Confocal Scanning Laser Microscopy and Fluorescein Angiography

    PubMed Central

    Giannakaki-Zimmermann, Helena; Kokona, Despina; Wolf, Sebastian; Ebneter, Andreas; Zinkernagel, Martin S.

    2016-01-01

    Purpose Optical coherence tomography angiography (OCT-A) allows noninvasive visualization of retinal vessels in vivo. OCT-A was used to characterize the vascular network of the mouse retina and was compared with fluorescein angiography (FA) and histology. Methods In the present study, OCT-A based on a Heidelberg Engineering Spectralis system was used to investigate the vascular network in mice. Data was compared with FA and confocal microscopy of flat-mount histology stained with isolectin IB4. For quantitative analysis the National Cancer Institute's AngioTool software was used. Vessel density, the number of vessel junctions, and endpoints were measured and compared between the imaging modalities. Results The configuration of the superficial capillary network was comparable with OCT-A and flat-mount histology in BALBc mice. However, vessel density and the number of vessel junctions per region of interest (P = 0.0161 and P = 0.0015, respectively) in the deep vascular network of BALBc mice measured by OCT-A was significantly higher than with flat-mount histology. In C3A.Cg-Pde6b+Prph2Rd2/J mice, where the deep capillary plexus is absent, analysis of the superficial network provided similar results for all three imaging modalities. Conclusion OCT-A is a helpful imaging tool for noninvasive, in vivo imaging of the vascular plexus in mice. It may offer advantages over FA and confocal microscopy especially for imaging the deep vascular plexus. Translational Relevance The present study shows that OCT-A can be employed for small animal imaging to assess the vascular network and offers advantages over flat-mount histology and FA. PMID:27570710

  12. Stent sizing by coronary computed tomographic angiography: comparison with conventional coronary angiography in an experienced setting.

    PubMed

    de Silva, Ramesh; Mussap, Christian J; Hecht, Harvey S; van Mieghem, Nicolas M; Matarazzo, Thomas J; Roubin, Gary S; Panagopoulos, Georgia

    2011-11-01

    The goal was to compare stent sizing by coronary computed tomographic angiography (CCTA) with that deployed in an experienced setting based upon conventional coronary angiography (CA). Stent sizing is currently performed by visual estimation, with infrequent guidance by intravascular ultrasound. CCTA permits quantitative determination of stent length (Stent L) and diameter (Stent D). Projected L (CTA-Stent L) and D (CTA-Stent D) were determined from CCTA obtained in 248 patients with 352 lesions undergoing percutaneous coronary intervention within 4 months of the CCTA, and were compared to the Stent-L and Stent-D of the actually deployed stents. The effects of lesion modification and calcified plaque were also evaluated. There were significant correlations between CTA-Stent L and Stent L (r = 0.656, P < 0.0001) and between CTA-Stent D and Stent D (r = 0.40, P < 0.001). Median predicted CTA-Stent L was slightly longer (20 mm vs. 18 mm, P < 0.0001) and predicted CTA-Stent D was slightly smaller (3.0 mm vs. 3.2 mm, P < 0.0001) than Stent-L and Stent-D, respectively. The differences were unchanged in stents with lesion modification by pre-dilation or intracoronary nitroglycerin. CTA Stent-L and CTA Stent-D increased significantly with increasing calcium (P < 0.0001 and P = 0.019, respectively). (1) There are significant correlations between CCTA and CA based stent sizing in an experienced setting. (2) CCTA projects slightly longer and slightly smaller diameter stents than those deployed during PCI irrespective of lesion modification; the small differences are unlikely to have clinical significance. (3) CCTA may offer a noninvasive alternative to intravascular ultrasound for stent planning. Copyright © 2011 Wiley-Liss, Inc.

  13. Comparative evaluation of 64-slice CT angiography and digital subtraction angiography in assessing the cervicocranial vasculature.

    PubMed

    Klingebiel, Randolf; Kentenich, Max; Bauknecht, Hans-Christian; Masuhr, Florian; Siebert, Eberhard; Busch, Markus; Bohner, Georg

    2008-01-01

    Noninvasive 64-slice computed tomography angiography (64-MSCTA) closely approximates conventional catheter angiography (DSA) in terms of detail resolution. Retrospective evaluation of cervicocranial (cc) 64-MSCTA in comparison with DSA in patients with presumptive cc vascular disorders. Twenty-four 64-MSCTA studies (32 mm detector width, slice thickness 0.5 mm, 120 kv, 150 mAs, pitch 0.75) of patients with presumptive cc vascular pathology (13 men, 11 women, mean age 38.3 +/- 11.3 yrs, range 19-54 yrs) were assessed in comparison with DSA studies without abnormal findings in age-matched patients (11 men, 13 women, mean age 39.7 +/- 11.9 yrs, range 18-54 yrs). Study readings were performed in a blinded manner by two neuroradiologists with respect to image quality and assessibility of various cc vascular segments by using a five-point scale. Radiation exposure was calculated for 64-MSCTA. Each reader assessed 384/528 different vessel segments (64-MSCTA/DSA). Superior image quality was attributed to DSA with respect to the C1 ICA-C6 ICA, A3 ACA, and P3 PCA segments as well the AICA and SCA. 64-MSCTA was scored superior for C7 ICA and V4 VA segments. A significantly increased number ofnonassessable V2- and V3 VA segments in DSA studies was noted. The effective dose for 64-MSCTA amounted to 2.2 mSv. 64-MSCTA provides near-equivalent diagnostic information of the cc vasculature as compared with DSA. According to our results, DSA should be considered primarily when peripheral vessels (A3/P3) or ICA segments close to the skull base (C2-5) are of interest, such as in primary angiitis or stenoocclusive ICA disease, respectively.

  14. Comparison of indocyanine green angiography and optical coherence tomographic angiography in polypoidal choroidal vasculopathy.

    PubMed

    Takayama, K; Ito, Y; Kaneko, H; Kataoka, K; Sugita, T; Maruko, R; Hattori, K; Ra, E; Haga, F; Terasaki, H

    2017-01-01

    PurposeTo compare optical coherence tomographic angiography (OCTA) and indocyanine green angiography (ICGA) images for detecting polypoidal lesions (PLs) and branching vascular networks (BVNs), and to measure the polypoidal areas (PAs) in patients with polypoidal choroidal vasculopathy (PCV).MethodsAll patients underwent ICGA, optical coherence tomography (OCT), and OCTA. We compared the detection sensitivity for PL and BVN, as evaluated by the ICGA and OCTA images. Furthermore, PA measured by ICGA was divided into two groups: one in which the area could be measured by OCTA (ICGA(+)OCTA(+)) and the other in which the area could not be measured by OCTA (ICGA(+)OCTA(-)).ResultsTwenty-one consecutive eyes of 21 patients (mean age, 73.8±9.8 years) were included. ICGA detected PL in all eyes (100%), whereas OCTA detected PL in 16 eyes (75.2%); ICGA detected BVN in 15 eyes (71.4%), whereas OCTA detected BVN in 20 eyes (95.2%). The mean PA in ICGA(+)OCTA(+) and ICGA(+)OCTA(-) was 0.24±0.04 and 0.14±0.01 mm(2), respectively; a significant difference was observed between ICGA(+)OCTA(+) PA and ICGA(+)OCTA(-) PA (P<0.0001). In addition, the mean PA in the ICGA(+)OCTA(+) group measured by ICGA and OCTA was 0.24±0.04 was 0.19±0.04 mm(2), respectively; these values were significantly different (P=0.0046).ConclusionsOCTA might detect more BVNs and fewer PLs compared with ICGA, and PL detected by OCTA might be smaller than those detected by ICGA.

  15. When is rotational angiography superior to conventional single‐plane angiography for planning coronary angioplasty?

    PubMed Central

    Taylor, Jane; Boutong, Sara; Brett, Sarah; Louis, Amal; Heppenstall, James; Morton, Allison C.; Gunn, Julian P.

    2015-01-01

    Objectives To investigate the value of rotational coronary angiography (RoCA) in the context of percutaneous coronary intervention (PCI) planning. Background As a diagnostic tool, RoCA is associated with decreased patient irradiation and contrast use compared with conventional coronary angiography (CA) and provides superior appreciation of three‐dimensional anatomy. However, its value in PCI remains unknown. Methods We studied stable coronary artery disease assessment and PCI planning by interventional cardiologists. Patients underwent either RoCA or conventional CA pre‐PCI for planning. These were compared with the referral CA (all conventional) in terms of quantitative lesion assessment and operator confidence. An independent panel reanalyzed all parameters. Results Six operators performed 127 procedures (60 RoCA, 60 conventional CA, and 7 crossed‐over) and assessed 212 lesions. RoCA was associated with a reduction in the number of lesions judged to involve a bifurcation (23 vs. 30 lesions, P < 0.05) and a reduction in the assessment of vessel caliber (2.8 vs. 3.0 mm, P < 0.05). RoCA improved confidence assessing lesion length (P = 0.01), percentage stenosis (P = 0.02), tortuosity (P < 0.04), and proximity to a bifurcation (P = 0.03), particularly in left coronary artery cases. X‐ray dose, contrast agent volume, and procedure duration were not significantly different. Conclusions Compared with conventional CA, RoCA augments quantitative lesion assessment, enhances confidence in the assessment of coronary artery disease and the precise details of the proposed procedure, but does not affect X‐ray dose, contrast agent volume, or procedure duration. © 2015 Wiley Periodicals, Inc. PMID:26012725

  16. Computed tomographic versus catheterization angiography in tetralogy of Fallot.

    PubMed

    Garg, Naveen; Walia, Rohit; Neyaz, Zafar; Kumar, Sunil

    2015-02-01

    To compare multidetector computed tomographic angiography with the gold standard cardiac catheterization and angiography in tetralogy of Fallot. In 40 consecutive patients over 5 years of age with tetralogy of Fallot, multidetector computed tomographic angiography and catheterization angiography studies were compared for intracardiac anatomy, pulmonary anatomy and indices, coronaries and collaterals. Safety parameters, relative advantages and limitations were also analyzed. All catheterization studies required hospitalization whereas all tomographic studies were performed as outpatient procedures. The need for sedation and amount of contrast used were significantly greater in catheterization than in tomographic studies. Complications noted during catheterization were access site complications in 4 patients, cyanotic spells in 2, transient complete heart block requiring temporary pacing in 2, and air embolism in one. No complication was observed during tomographic studies. All tomographic studies were adequate, but 2 catheterization studies were inadequate. Ventricular septal defects, aortic override, level of right ventricular outflow tract obstruction, and pulmonary artery anatomy were equally assessed by both imaging modalities. However, tomographic studies missed additional small muscular ventricular septal defects. There was a linear correlation between tomographic and catheterization studies for pulmonary annulus size, artery sizes, Z-score, and Nakata index. There was complete concordance with respect to side of aortic arch and detection of collaterals. Coronary anatomy was better delineated in tomographic studies. For preoperative evaluation of tetralogy of Fallot patients, multidetector computed tomographic angiography can be used as a reliable noninvasive alternative to cardiac catheterization angiography. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. Coronary computed tomography angiography in coronary artery disease

    PubMed Central

    Sun, Zhonghua; Ng, Kwan-Hoong

    2011-01-01

    AIM: To investigate the research directions of coronary computed tomography (CT) angiography in the diagnosis of coronary artery disease (CAD) based on a systematic review of the literature. METHODS: A search of articles on coronary CT angiography in the diagnosis of CAD was performed during a 6-year-period between 2005 and 2010 from five main radiology journals namely, Radiology, American Journal of Roentgenology, European Radiology, European Journal of Radiology and British Journal of Radiology. Analysis of the references was focused on the research directions of coronary CT angiography with regard to the type of studies in terms of diagnostic value, application of dose-reduction strategies and resultant effective radiation doses with use of these techniques. RESULTS: One hundred and forty two studies were identified which met the selection criteria and were included in the analysis. 64-slice CT (single source and dual-source CT) dominated 78% of the coronary CT angiography studies. Prior to 2007, research was focused on the diagnostic value of coronary CT angiography, but since 2008 more attention has been paid to radiation dose reduction. Radiation dose was reported in 64 studies, representing 45% of total studies published in the five radiology journals. Various dose-saving strategies have been implemented and prospective electrocardiography-triggering and high pitch techniques were found to be the most effective approaches for radiation dose reduction, with the corresponding mean effective dose being 3.5 ± 1.9 mSv and 1.7 ± 0.6 mSv, respectively. CONCLUSION: This review shows that the current research in coronary CT angiography has shifted from the previous focus on diagnostic accuracy in CAD to more emphasis on radiation dose reduction. PMID:21949572

  18. Combined multi-modal photoacoustic tomography, optical coherence tomography (OCT) and OCT angiography system with an articulated probe for in vivo human skin structure and vasculature imaging

    PubMed Central

    Liu, Mengyang; Chen, Zhe; Zabihian, Behrooz; Sinz, Christoph; Zhang, Edward; Beard, Paul C.; Ginner, Laurin; Hoover, Erich; Minneman, Micheal P.; Leitgeb, Rainer A.; Kittler, Harald; Drexler, Wolfgang

    2016-01-01

    Cutaneous blood flow accounts for approximately 5% of cardiac output in human and plays a key role in a number of a physiological and pathological processes. We show for the first time a multi-modal photoacoustic tomography (PAT), optical coherence tomography (OCT) and OCT angiography system with an articulated probe to extract human cutaneous vasculature in vivo in various skin regions. OCT angiography supplements the microvasculature which PAT alone is unable to provide. Co-registered volumes for vessel network is further embedded in the morphologic image provided by OCT. This multi-modal system is therefore demonstrated as a valuable tool for comprehensive non-invasive human skin vasculature and morphology imaging in vivo. PMID:27699106

  19. Combined multi-modal photoacoustic tomography, optical coherence tomography (OCT) and OCT angiography system with an articulated probe for in vivo human skin structure and vasculature imaging.

    PubMed

    Liu, Mengyang; Chen, Zhe; Zabihian, Behrooz; Sinz, Christoph; Zhang, Edward; Beard, Paul C; Ginner, Laurin; Hoover, Erich; Minneman, Micheal P; Leitgeb, Rainer A; Kittler, Harald; Drexler, Wolfgang

    2016-09-01

    Cutaneous blood flow accounts for approximately 5% of cardiac output in human and plays a key role in a number of a physiological and pathological processes. We show for the first time a multi-modal photoacoustic tomography (PAT), optical coherence tomography (OCT) and OCT angiography system with an articulated probe to extract human cutaneous vasculature in vivo in various skin regions. OCT angiography supplements the microvasculature which PAT alone is unable to provide. Co-registered volumes for vessel network is further embedded in the morphologic image provided by OCT. This multi-modal system is therefore demonstrated as a valuable tool for comprehensive non-invasive human skin vasculature and morphology imaging in vivo.

  20. Ultra-Wide-Field Fluorescein Angiography in Microscopic Polyangiitis

    PubMed Central

    Philander, Shannon A.; Ter-Zakarian, Anna; Rao, Narsing A.; Rodger, Damien C.

    2016-01-01

    A 25-year-old Hispanic female presented with 5 months of dry eyes and 2 months of bilateral photophobia and decreased vision. On examination, she had bilateral anterior uveitis and mild disc edema of the left eye. A complete infectious and inflammatory work-up was positive for elevated antinuclear antibodies and p-ANCA, leading to a diagnosis of microscopic polyangiitis. One year after initial treatment and steroid taper, an ultra-wide-field fluorescein angiography revealed peripheral vasculitis, outside of the standard traditional field of view, leading to an increase in immunomodulatory therapy and illustrating the utility of wide-field angiography for managing patients with uveitis. PMID:27872779

  1. Technical innovation: Multidimensional computerized software enabled subtraction computed tomographic angiography.

    PubMed

    Bhatia, Mona; Rosset, Antoine; Platon, Alexandra; Didier, Dominique; Becker, Christoph D; Poletti, Pierre-Alexandre

    2010-01-01

    Computed tomographic angiography (CTA) is a frequent noninvasive alternative to digital subtraction angiography. We previously reported the development of a new subtraction software to overcome limitations of adjacent bone and calcification in CT angiographic subtraction. Our aim was to further develop and improve this fast and automated computerized software, universally available for free use and compatible with most CT scanners, thus enabling better delineation of vascular structures, artifact reduction, and shorter reading times with potential clinical benefits. This computer-based free software will be available as an open source in the next release of OsiriX at the Web site http://www.osirix-viewer.com.

  2. MR pulmonary angiography and perfusion imaging: recent advances.

    PubMed

    Hatabu, H

    1997-10-01

    Recent advances in MR pulmonary angiography and MR perfusion imaging are reviewed, focusing on two principal areas of technical development: (1) the availability of MR scanners equipped with enhanced gradient systems; and (2) new trends in MR angiography using gadolinium contrast agents or labeling of blood with an inversion recovery radiofrequency pulse in place of the more traditional methods using naturally flowing spins as the source of intravascular signal. These recent developments in MR have significant potential for clinical imaging of the pulmonary vasculature, particularly for the diagnosis of pulmonary embolism, and are now opening windows to functional MR imaging of the lung.

  3. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction.

    PubMed

    Duggal, Claire S; Madni, Tarik; Losken, Albert

    2014-01-01

    Intraoperative angiography is a useful tool for predicting both tissue perfusion during postmastectomy breast reconstruction and mastectomy flap and free flap survival. The authors determine whether the routine use of laser-assisted indocyanine green (ICG) fluorescence angiography (SPY Imaging; LifeCell Corp, Branchburg, New Jersey) in breast reconstruction decreases the incidence of complications and whether this new technology is cost-effective. A retrospective review was conducted for 184 consecutive patients who underwent breast reconstruction using intraoperative ICG angiography from April 2009 to December 2011 at Emory University (Atlanta, Georgia). The incidence of complications (including mastectomy skin necrosis, flap necrosis, fat necrosis, unexpected reoperations, infections, and dehiscence) among these patients was compared with data for 184 consecutive patients who underwent breast reconstruction at Emory University from October 2007 to April 2009, prior to the introduction of ICG angiography. Patient data recorded included age, body mass index, smoking status, and history of preoperative radiation as well as the timing and type of reconstruction, along with complications. The cost of unexpected reoperations for perfusion-related complications and associated hospital stays was calculated. The 184 patients who underwent procedures using ICG angiography imaging had a lower incidence of mastectomy skin necrosis (13% vs 23.4%; P = .010) and unexpected reoperations for perfusion-related complications (5.9% vs 14.1%, P = .009). The 184 patients who underwent procedures without ICG angiography had a higher mean degree of severity of mastectomy skin necrosis (2.22 vs 1.83 on a scale of 1-3; P = .065). There were no significant differences in the degree of flap necrosis, nipple necrosis, fat necrosis, dehiscence, infection, implant exposure, flap loss, seroma, hematoma, or the number of overall complications between the 2 groups. The use of ICG angiography

  4. Anomalous left main coronary artery detected by CT angiography.

    PubMed

    Forte, Ernesto; Inglese, Marianna; Infante, Teresa; Schiano, Concetta; Napoli, Claudio; Soricelli, Andrea; Salvatore, Marco; Tedeschi, Carlo

    2016-10-01

    The growing improvements of computed tomography have made this technique more and more available for cardiac evaluation. Coronary artery anomalies (CAAs) are often incidental findings in subjects with suspected coronary artery disease (CAD) undergoing coronary angiography or computed tomography coronary angiography (CTCA). In some cases, CAAs can be clinically relevant so their identification could change radically patient management and treatment. We report the case of a 68-year-old male patient with known CAD and associated anomalous origination of the left coronary artery from the opposite sinus.

  5. Pearls and pitfalls of optical coherence tomography angiography in the multimodal evaluation of uveitis.

    PubMed

    Pichi, Francesco; Sarraf, David; Morara, Mariachiara; Mazumdar, Shahana; Neri, Piergiorgio; Gupta, Vishali

    2017-10-05

    Optical coherence tomography angiography (OCTA) employs a novel imaging algorithm that detects the amplitude or phase decorrelation of blood cell movement. It thus provides a flow map with depth-resolved visualization of the various vascular layers in the posterior pole of the eye including the retina capillary plexus and the choroid. In the past 3 years, the number of research papers on the subject of OCTA in retinal diseases has grown exponentially including important applications in the field of uveitis. While the study of OCTA in uveitic diseases has gained remarkable relevance worldwide, interpretation can be challenging, and many limitations exist in optimally using this advanced system in uveitic eyes. The aim of this review is to describe the many significant applications of OCTA in uveitis disorders and to outline the various limitations that can confound interpretation and support uveitis specialists in the integration of OCTA in the multimodal imaging approach to inflammatory diseases. Unlike conventional angiography that can dynamically detect inflammation and leakage of dye from retinal vessels, OCTA provides other important biomarkers of inflammation. Detailed microvascular reconstruction of normal and abnormal blood vessels and quantitative evaluation are advantages of OCTA analysis. OCTA can therefore non-invasively detect choroidal neovascularization that may complicate inflammatory disorders, and with remarkable depth-resolved capability, OCTA can identify and quantitate flow loss as a manifestation of ischemia and/or inflammation. The areas of flow deficit on OCTA at the level of the inner choroid often co-localize with hypofluorescent lesions with indocyanine green angiography. These regions of presumed choriocapillaris ischemia may occur in placoid disorders. Space-occupying granulomas may occur in disorders such as sarcoid and may or may not co-localize with choriocapillaris ischemia on ICG angiography. Blocking or shadowing artifacts should

  6. National invasive species program

    Treesearch

    Anna Rinick; Hilda Diaz-Soltero

    2007-01-01

    The structure and function of the National Invasive Species Council was presented below. The names and contact information for the USDA Invasive Species coordinators as of February 2006 were presented on the next page.

  7. Treatment of arteriovenous malformations with stereotactic radiosurgery employing both magnetic resonance angiography and standard angiography as a database

    SciTech Connect

    Petereit, D.; Mehta, M.; Turski, P.; Levin, A.; Strother, C.; Mistretta, C.; Mackie, R.; Gehring, M.; Kubsad, S.; Kinsella, T. )

    1993-01-15

    Twenty-one arteriovenous malformations were prospectively evaluated using magnetic resonance angiography, compare it to stereotactic angiography, employ magnetic resonance angiography in follow-up, and semiquanitfy flow. A correlative evaluation between flow and response to stereotactic radiosurgery was carried out. Phase contrast angiograms were obtained at flow velocities of 400, 200, 100, 60 and 20 cm/sec. The fractionated velocities provided images that selectively demonstrated the arterial and venous components of the arteriovenous malformations. Qualitative assessment of the velocity within the arteriovenous malformations and the presence of fistulae were also determined by multiple velocity images. In addition, 3-dimensional time-of-flight magnetic resonance angiograms were obtained to define the exact size and shape of the nidus. This technique also permitted evaluation of the nidus and feeding arteries for the the presence of low flow aneurysms. Correlation between the two imaging modalities was carried out by subjective and semiquantitative estimation of flow velocity and estimation of nidus size. The following velocity parameters were employed: fast, intermediate, slow, and none. Early analysis suggests that slower flowing arteriovenous malformations may obliterate faster after stereotactic radiosurgery an flow parameters should be employed to predict response. In conclusion, magnetic resonance angiography permits semiquantitative flow velocity assessment and may therefore be superior to stereotactic angiography. An additional advantage of magnetic resonance angiography is the generation of serial transverse images which can replace the conventional CT scan employed for stereotactic radiosurgery treatment planning. A single diagnostic test may therefore be used for diagnosis, radiosurgical treatment planning, follow-up, and treatment selection by identifying patients likely to respond early to radiosurgical management.

  8. Should computed tomography coronary angiography be aborted when the calcium score exceeds a certain threshold in patients with chest pain?

    PubMed

    de Agustin, Jose Alberto; Marcos-Alberca, Pedro; Fernández-Golfin, Covadonga; Feltes, Gisela; Nuñez-Gil, Ivan Javier; Almeria, Carlos; Rodrigo, Jose Luis; Arrazola, Juan; Pérez de Isla, Leopoldo; Macaya, Carlos; Zamorano, Jose

    2013-09-01

    There is ongoing debate about whether a computed tomography coronary angiography (CTCA) should be aborted when the calcium score (CS) exceeds a certain threshold in patients with chest pain. The aim of this study was to discover whether specific "cutpoints" regarding coronary artery CS could be determined to predict severe coronary stenoses assessed by CTCA, thus identifying patients amenable to an invasive diagnostic approach. 294 consecutive patients with chest pain of uncertain cause who were referred for non-invasive diagnostic CTCA were included. Subjects underwent Agatston CS and CTCA using current 64-slice technology. Severe coronary stenoses were noted in 75 of 294 (25.1%) patients on CTCA. A very high prevalence of severe coronary stenoses was found in patients with CS ≥ 400 (87.0%). The CS had area under the ROC curve 0.86 to predict severe coronary stenoses on CTCA. The best discriminant cut-off point was CS ≥ 400 (sensitivity of 55.3%, specificity of 93.5, positive predictive value of 85.8%, negative predictive value of 84.0%). Multivariable logistic regression analysis controlling for traditional risk factors showed CS ≥ 400 remained an independent predictor of severe coronary stenoses on CTCA (OR 14.553, 95% confidence interval 4.043 to 52.384, p<0.001). CS can be used as a "gatekeeper" to CTCA in patients with chest pain. Due to the very high prevalence of severe coronary stenoses in patients with CS ≥ 400, further evaluation with CTCA is not warranted as these patients should be referred to invasive coronary angiography, avoiding the repeated exposure to ionizing radiation and iodinated contrast. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. Attacking invasive grasses

    USGS Publications Warehouse

    Keeley, Jon E.

    2015-01-01

    In grasslands fire may play a role in the plant invasion process, both by creating disturbances that potentially favour non-native invasions and as a possible tool for controlling alien invasions. Havill et al. (Applied Vegetation Science, 18, 2015, this issue) determine how native and non-native species respond to different fire regimes as a first step in understanding the potential control of invasive grasses.

  10. Multimodality evaluation of dural arteriovenous fistula with CT angiography, MR with arterial spin labeling, and digital subtraction angiography: case report.

    PubMed

    Alexander, Matthew; McTaggart, Ryan; Santarelli, Justin; Fischbein, Nancy; Marks, Michael; Zaharchuk, Greg; Do, Huy

    2014-01-01

    Dural arteriovenous fistulae (DAVF) are cerebrovascular lesions with pathologic shunting into the venous system from arterial feeders. Digital subtraction angiography (DSA) has long been considered the gold standard for diagnosis, but advances in noninvasive imaging techniques now play a role in the diagnosis of these complex lesions. Herein, we describe the case of a patient with right-side pulsatile tinnitus and DAVF diagnosed using computed tomography angiography, magnetic resonance with arterial spin labeling, and DSA. Implications for imaging analysis of DAVFs and further research are discussed.

  11. Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography

    PubMed Central

    Santana, Cesar A.; Garcia, Ernest V.; Faber, Tracy L.; Sirineni, Gopi K. R.; Esteves, Fabio P.; Sanyal, Rupan; Halkar, Raghuveer; Ornelas, Mario; Verdes, Liudmila; Lerakis, Stamatios; Ramos, Julie J.; Aguadé-Bruix, Santiago; Cuéllar, Hugo; Candell-Riera, Jaume; Raggi, Paolo

    2011-01-01

    Background We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard. Methods 50 subjects (36 men; 56 ± 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (<5%) pre-test likelihood (LLK) of disease. Three blinded readers scored the images in sequential sessions using (1) MPI alone (2) MPI and CTA side-by-side, (3) fused CTA/MPI images. Results One or more critical stenoses during ICA were found in 28 patients and non-critical stenoses were found in 9 patients. MPI, side-by-side MPI-CTA, and fused CTA/MPI showed the same normalcy rate (NR:13/13) in LLK subjects. The fusion technique performed better than MPI and MPI and CTA side-by-side for the presence of CAD in any vessel (overall area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion. Conclusions Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery. PMID:19156478

  12. Correlation Between Quantitative Angiography-Derived Translesional Pressure and Fractional Flow Reserve.

    PubMed

    Seike, Fumiyasu; Uetani, Teruyoshi; Nishimura, Kazuhisa; Iio, Chiharuko; Kawakami, Hiroshi; Fujimoto, Kaori; Higashi, Haruhiko; Kono, Tamami; Aono, Jun; Nagai, Takayuki; Inoue, Katsuji; Suzuki, Jun; Ogimoto, Akiyoshi; Okura, Takafumi; Yasuda, Kazunori; Higaki, Jitsuo; Ikeda, Shuntaro

    2016-10-15

    Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. However, it has the disadvantage of cost and invasive complication risks. We investigated the usefulness of quantitative coronary angiography-derived translesional pressure (QCA-TP) for predicting functional myocardial ischemia, using FFR as the gold standard. We retrospectively analyzed 152 coronary narrowings (98 left anterior descending arteries, 28 left circumflex arteries, and 26 right) in 132 patients with mild-severe coronary stenosis who underwent coronary angiography and FFR measurements simultaneously. QCA-TP was calculated using software implemented in the QCA software. Coronary morphology was calculated using both densitometry and lumen edges. Functional myocardial ischemia was defined as an FFR of 0.8 or less. The mean values of diameter stenosis by QCA and FFR were 48.9% ± 14.9 and 0.76 ± 0.14, respectively. QCA-TP was significantly correlated with FFR (r = 0.76, p <0.01). The cut-off values of QCA-TP for predicting functional myocardial ischemia based on FFR were 72.8 mm Hg for the left anterior descending arteries (accuracy, 86.7%; area under the curve [AUC], 0.93), 60.5 mm Hg for the left circumflex arteries (accuracy, 89.3%; AUC, 0.88), and 64.4 mm Hg for the right (accuracy, 88.5%; AUC, 0.94). Therefore, our data suggest that QCA-TP can predict myocardial ischemia with high diagnostic accuracy. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Computed Tomography Angiography Allows the Classification of the First Dorsal Metatarsal Arteries.

    PubMed

    Xu, Lin; Yang, Keqin; Wei, Pingou; Luo, Xiang; Mo, Yongjun; Liang, Xuquan; Lin, Han; Tan, Haitao; Mudgal, Chaitanya S

    2016-11-01

    Background Conventional angiography is an invasive technique. Submillimeter computed tomography angiography (CTA) has been shown to be an effective alternative for peripheral artery branches. This study aimed to assess the use of CTA to guide the choice and design of foot donor area for finger or thumb reconstruction. Methods This was a retrospective study of 79 patients who underwent finger or thumb reconstruction between January, 2011 and March, 2014. All these patients underwent preoperative CTA to determine the exact blood supply at the donor site. Preoperative imaging and intraoperative findings at the donor site were compared. Results Among the 79 patients (158 feet), 474 artery segments (dorsalis pedis artery [DPA], first dorsal metatarsal artery [FDMA], and toe web artery [TWA]) were evaluated using CTA. Image satisfaction rates of the vessels were 100.0 ± 0.0%, 89.2 ± 3.2%, and 60.1 ± 5.0% for DPA, FDMA, and TWA, respectively. Among the 158 feet, 90 were Gilbert type I (57.0%), 52 were Gilbert type II (32.9%), 13 were Gilbert type III (8.2%), and 3 were with poor visibility and could not be classified (1.9%). In all 79 patients, the CTA image of the FDMA was consistent with the intraoperative observations. All reconstructed fingers survived. Follow-up was available for 69 patients. After a 6- to 18-month follow-up, the reconstructed fingers and donor area recovered well, and the reconstructed fingers had strong holding power, without pain. Conclusion CTA can produce three-dimensional images for extremity arteries, allowing the preoperative assessment of blood supply and planning of donor site.

  14. Computed tomography as an alternative to catheter angiography prior to robotic mitral valve repair.

    PubMed

    Morris, Michael F; Suri, Rakesh M; Akhtar, Nila J; Young, Phillip M; Gruden, James F; Burkhart, Harold M; Williamson, Eric E

    2013-04-01

    Computed tomography angiography (CTA) of the coronary arteries has been proposed as an alternative screening modality to catheter coronary angiography (CCA) prior to noncoronary cardiac surgery. The safety and utility of preoperative coronary CTA in patients undergoing robotic mitral valve repair is unknown. One hundred and ninety consecutive patients undergoing robotic repair of degenerative mitral leaflet prolapse were eligible for preoperative CT evaluation; retrospective electrocardiogram-gated CTA of the chest to assess the coronary arteries, followed by contrast-enhanced CT of the abdomen and pelvis to assess the systemic arterial and vascular anatomy. If coronary CTA identified coronary artery stenosis 50% or greater, CCA was performed for further assessment. Computed tomography evaluation was performed in 178 patients (94%). Six patients (3%) had coronary artery stenosis 50% or greater identified on coronary CTA and underwent CCA. In each of these cases, CCA revealed no significant obstructive lesion. On a per patient basis, coronary CTA had an accuracy of 91% (95% confidence interval 0.81 to 0.96) for excluding obstructive coronary disease. The CT also demonstrated significant noncoronary vascular findings in 6 patients (3%). These findings included iliac artery dissection and aneurysm (n=4), and pulmonary embolism (n=2). Mitral repair rate was 100% and no patients underwent conversion to sternotomy. Median hospital stay was 3 days and there were no deaths. In patients at low-to-intermediate risk of coronary artery disease, CT is useful as a single screening modality of the coronary arteries and peripheral vasculature to determine candidacy for minimally invasive robotic mitral valve repair. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Coronary computed tomographic angiography: current role in the diagnosis and management of coronary artery disease.

    PubMed

    Bowman, Andrew W; Kantor, Birgit; Gerber, Thomas C

    2009-06-01

    Advances in computed tomography (CT) technology allow images to be obtained with high spatial and temporal resolution. These features now permit noninvasive coronary CT angiography (CCTA). Many studies addressing proof of concept, feasibility, and clinical robustness have been published since CCTA was first described. More recently, the scientific evaluation of CCTA has rightly focused less on technical aspects and more on multicenter trials of the diagnostic value of CCTA and on head-to-head comparisons with other noninvasive modalities for the detection of coronary artery disease (CAD), such as stress myocardial perfusion imaging (MPI) with radionuclides. Recent peer-reviewed publications that compare CCTA to invasive, selective coronary angiography (SCA) or MPI, or that address radiation protection issues related to CCTA, were reviewed and summarized. Overall, there is high agreement between CCTA and both SCA and MPI for the presence of CAD. However, CCTA can over- or underestimate the severity of CAD compared to SCA as a reference standard. Initial studies that compared CCTA to MPI found their accuracies for determining the presence of high-grade luminal obstructions comparable. Limitations of CCTA include inability to reliably assess the coronary artery lumen dimensions in patients with large amounts of coronary artery calcium, artifacts caused by coronary and respiratory motion, and the need for ionizing radiation and intravenous administration of iodinated contrast material. Various dose reduction methods for CCTA now exist that may substantially lower patient dose to levels less than those of SCA or MPI. Although current expert consensus does not call for CCTA to be a first-line test for CAD, particularly for screening in asymptomatic individuals, current data suggest a promising role in the evaluation of symptomatic patients for possible CAD.

  16. SYNTAX Score Derived From Coronary CT Angiography for Prediction of Complex Percutaneous Coronary Interventions.

    PubMed

    Shalev, Aryeh; Nakazato, Ryo; Arsanjani, Reza; Nakanishi, Rine; Park, Hyung-Bok; Otaki, Yuka; Cheng, Victor Y; Gransar, Heidi; LaBounty, Troy M; Hayes, Sean W; Berman, Daniel S; Min, James K

    2016-11-01

    SYNTAX score is a useful metric determined at the time of invasive coronary angiography (ICA) to assess the complexity of coronary artery disease, and improves prediction of complications at the time of percutaneous complex intervention (PCI). We aimed to determine whether SYNTAX score can be reliably determined from coronary computed tomography angiography (CCTA) and whether a CCTA-derived SYNTAX score can predict complex PCI. SYNTAX scores were calculated on per-patient, per-vessel, and per-segment basis in 154 consecutive patients who underwent CCTA and ICA. PCI complexity in 113 patients who underwent intervention was defined by total fluoroscopy time and contrast volume. Compared to ICA, CCTA detected 285 of 302 (94%) obstructive lesions in 230 vessels, for which PCI was performed for 154 lesions in 131 vessels. Overall, on a per-patient basis, ICA-derived SYNTAX score was lower in comparison to CCTA-derived score (10.2 ± 8.0 vs 10.9 ± 8.3, P = 0.001). As compared to lesions in the lowest CCTA-derived segmental SYNTAX tertile, lesions in the highest tertile required longer fluoroscopy time (17.5 ± 12 min vs 11.5 ± 7.9 min, P = 0.01) and greater contrast volume (215.4 ± 125.5 mL vs 144.3 ± 49 mL, P = 0.02). SYNTAX scores derived from CCTA are concordant with those derived from ICA and correspond with complex PCI. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  17. Impact of heart rate on diagnostic accuracy of second generation 320-detector computed tomography coronary angiography.

    PubMed

    Nerlekar, Nitesh; Ko, Brian S; Nasis, Arthur; Cameron, James D; Leung, Michael; Brown, Adam J; Wong, Dennis T L; Ngu, Philip J; Troupis, John M; Seneviratne, Sujith K

    2017-06-01

    To assess the impact of elevated heart rate (HR) on the diagnostic accuracy and image quality of second-generation 320-detector computed tomography coronary angiography (320-CTCA). Consecutive patients with suspected coronary disease referred for invasive coronary angiography (ICA) were prospectively recruited and underwent 320-CTCA. Pre-scan beta-blockers were administered if native HR>80 bpm and post-scan cohorts stratified by traditional (HR ≤60 bpm) and elevated HR (61-80 bpm). A wider phase window was used for the elevated HR group (30-80%). 320-CTCA and ICA were analyzed by independent readers blinded to other data. Significant disease was defined as ≥50% visual stenosis on ICA. Uninterpretable segments by 320-CTCA were considered to be significant on an intention-to-diagnose principle. Image quality was assessed by 5-point Likert score. Of 107 patients studied (1,662 segments), there was no significant difference in sensitivity, specificity, positive and negative predictive value between patients with HR ≤60 bpm (n=55) vs. HR 61-80 bpm (n=52): 97%, 88%, 95%, 94% vs. 100%, 88%, 95%, 100%; Receiver operator characteristic-area under the curve 0.93 vs. 0.94, P=0.82). Overall per-patient diagnostic accuracy was 96% in both groups with no significant difference in interpretable segments (Likert ≥2) or median radiation dose (2.4 mSv vs. 2.7 mSv, P=0.35). Only 4/1,662 (0.2%) segments were uninterpretable by motion artefact in the whole cohort. In patients with HR >60 and up to 80bpm, second generation 320-CTCA provides comparably adequate diagnostic accuracy to HR ≤60 without significantly impacting upon overall segmental evaluability.

  18. Coronary CT angiography in patients with high calcium score: evaluation of plaque characteristics and diagnostic accuracy.

    PubMed

    Park, Mi Jung; Jung, Jung Im; Choi, Yun-Seok; Ann, Soe Hee; Youn, Ho-Joong; Jeon, Gyeong Nyeo; Choi, Ho Cheol

    2011-12-01

    Our aim was to evaluate the plaque characteristics of coronary arteries related to significant stenosis with coronary CT angiography (CCTA) and to discuss the diagnostic accuracy of CCTA in patients with high calcium scores. After institutional review board approval, 110 patients (63 men; mean age: 67.1 ± 7.9 years) with Agatston scores >400 were retrospectively reviewed. Patients underwent Agatston calcium scoring and 64-slice CCTA, in addition to invasive coronary angiography (CAG). The composition (calcified, mixed, and non-calcified) and configuration (concentric, eccentric) of coronary artery plaques were analyzed on a per-segment basis by CCTA. We analyzed the differences in plaque composition and configuration between significant (≥ 50%) and non-significant (<50%) stenosis. Additionally, the diagnostic accuracy of stenosis according to plaque composition was evaluated by CCTA, using CAG as a reference method. Significant differences in plaque composition and configurations were observed between the two groups. In cases of significant stenosis, the proportions of concentric, mixed, and non-calcified plaques were significantly higher than those of eccentric and calcified plaques (P < 0.001). The sensitivity and positive predictive value of mixed (97.4, 87.6%) and non-calcified plaques (97.8, 95.7%) were significantly higher than those of calcified plaques (87.6, 67.2%). Although CCTA has limited value due to low diagnostic accuracy of calcified plaques, knowledge about the high frequencies of mixed and non-calcified plaques in significant stenosis help to make an accurate assessment of CAD with CCTA in patients with high calcium scores.

  19. Invasive species in agriculture

    USDA-ARS?s Scientific Manuscript database

    Agricultural production of food, feed, fiber or fuel is a local human activity with global ecological impacts, including the potential to foster invasions. Agriculture plays an unusual role in biological invasions, in that it is both a source of non-indigenous invasive species (NIS) and especially s...

  20. Vascular ultrasound studies for the non-invasive assessment of vascular flow and patency in experimental surgery in the pig.

    PubMed

    Osorio-da Cruz, S M; Aggoun, Y; Cikirikcioglu, M; Khabiri, E; Djebaili, K; Kalangos, A; Walpoth, B

    2009-10-01

    Vascular ultrasound is a reliable non-invasive tool used for the routine assessment of vascular flow and patency in human recipients. We describe the use at three different time points (immediately, 1 week and 4 weeks postsurgery) of ultrasound studies and its validation by angiographic studies in 37 swine undergoing carotid graft replacement. We calculated predictive values (>92%), sensitivity (>85%) and specificity (>92%) with high results at all time points. Ultrasound appeared as an accessible non-invasive technique, providing rapid, safe, repeatable and reliable results. It is an excellent alternative to angiography, avoiding risks inherent to invasive methods and therefore contributing to animal welfare.

  1. Mono-energy coronary angiography with a compact light source

    NASA Astrophysics Data System (ADS)

    Eggl, Elena; Mechlem, Korbinian; Braig, Eva; Kulpe, Stephanie; Dierolf, Martin; Günther, Benedikt; Achterhold, Klaus; Herzen, Julia; Gleich, Bernhard; Rummeny, Ernst; Noël, Peter B.; Pfeiffer, Franz; Muenzel, Daniela

    2017-03-01

    While conventional x-ray tube sources reliably provide high-power x-ray beams for everyday clinical practice, the broad spectra that are inherent to these sources compromise the diagnostic image quality. For a monochromatic x-ray source on the other hand, the x-ray energy can be adjusted to optimal conditions with respect to contrast and dose. However, large-scale synchrotron sources impose high spatial and financial demands, making them unsuitable for clinical practice. During the last decades, research has brought up compact synchrotron sources based on inverse Compton scattering, which deliver a highly brilliant, quasi-monochromatic, tunable x-ray beam, yet fitting into a standard laboratory. One application that could benefit from the invention of these sources in clinical practice is coronary angiography. Being an important and frequently applied diagnostic tool, a high number of complications in angiography, such as renal failure, allergic reaction, or hyperthyroidism, are caused by the large amount of iodine-based contrast agent that is required for achieving sufficient image contrast. Here we demonstrate monochromatic angiography of a porcine heart acquired at the MuCLS, the first compact synchrotron source. By means of a simulation, the CNR in a coronary angiography image achieved with the quasi-mono-energetic MuCLS spectrum is analyzed and compared to a conventional x-ray-tube spectrum. The results imply that the improved CNR achieved with a quasi-monochromatic spectrum can allow for a significant reduction of iodine contrast material.

  2. Penetrating neck injuries: helical CT angiography for initial evaluation.

    PubMed

    Múnera, Felipe; Soto, Jorge A; Palacio, Diana M; Castañeda, Jorge; Morales, Carlos; Sanabria, Alvaro; Gutiérrez, Juan E; García, Giovanni

    2002-08-01

    To report an experience with helical computed tomographic (CT) angiography as the initial procedure to rule out arterial lesions caused by penetrating neck injuries. During 27 months, 175 patients were referred for helical CT angiography of the neck because of clinical suspicion of arterial injuries. The protocol included a 100-mL bolus of nonionic contrast material injected at 4.5 mL/sec, with 11-second scanning delay, 3-mm collimation, and pitch of 1.3-2.0. CT images were interpreted prospectively by the emergency radiologist, and two radiologists retrospectively interpreted studies with consensus. Outcome was determined with examination of patients and their charts. The sensitivity, specificity, and positive and negative predictive values were calculated. Studies in two patients were considered inadequate for diagnosis; these patients were referred for conventional arteriography and had normal findings. In 27 patients (15.6%), arterial lesions were detected. One patient had two arterial injuries. Lesions demonstrated with helical CT angiography were arterial occlusion (n = 14), pseudoaneurysm (n = 8), pseudoaneurysm and arteriovenous fistulae (n = 4), and partial thrombosis (n = 2). The remaining 146 patients had normal arteries. On the basis of these findings, patients were treated with surgery (n = 21), endovascular intervention (n = 7), and observation alone (n = 146). Results indicate that helical CT angiography can be used as the initial method for evaluation in patients with possible arterial injuries of the neck. Copyright RSNA, 2002

  3. Radiation exposure risk to the surgeon during operative angiography

    SciTech Connect

    Ramalanjaona, G.R.; Pearce, W.H.; Ritenour, E.R.

    1986-09-01

    Intraoperative angiography has become an essential adjunct to reconstructive vascular surgery. Therefore, radiation exposure and its potential risks to the performing surgeon need to be known. To study this, we designed experimental and clinical tests quantifying the radiation exposure to the surgeon during different intraoperative angiograms. Radiation exposure to various parts of the surgeon's body was quantified by thermoluminescence dosimetry. During each exposure a surgeon standing one foot from the x-ray tube received an absorbed dose equivalent to 0.24 to 1.4 millirems, which is about half that of an intraoperative cholangiogram. With 5000 millirems considered the maximum permissible dose, this would imply that an upper limit of about 3500 intraoperative angiograms each year (68 each week) could be performed safely. Comparatively, abdominal angiography carried the most significant risk (p = 0.01) and peripheral angiography was the least hazardous. Fluoroscopy increased radiation exposure more than four times that of nonfluoroscopic procedures (p = 0.05). The surgeon's extremities received the greatest dose, followed by the eyes and neck, suggesting the need for individual monitoring devices for those parts to be worn by surgeons who perform operative angiograms more frequently than average. Our study indicates that the radiation dose received by the surgeon during operative angiography, especially that of peripheral vessels, is minimal. Operative arteriography is not only a simple and readily available diagnostic tool, but it is quite a safe procedure if applied correctly.

  4. Nuclear angiography in a dog with congestive cardiomyopathy

    SciTech Connect

    Lippert, A.C.; Twardock, A.R.; Gelberg, H.B.

    1986-03-01

    Nuclear angiography was used as a diagnostic aid and in monitoring the clinical course of a case of congestive cardiomyopathy in a dog. Serial examinations revealed progressively deteriorating values for left ventricular ejection fraction before the dog's death. This noninvasive technique can be an alternative to echocardiography for the evaluation of cardiac performance.

  5. Preduodenal portal vein in an adult--angiography and CT.

    PubMed

    Sasai, K; Sano, A; Nishizawa, S; Imanaka, K; Kuroda, Y

    1985-01-01

    We report on an adult case of preduodenal portal vein illustrated by computed tomography (CT) and angiography. These diagnostic modalities were initially performed to evaluate a coexisting pancreatic cancer. Contrast-enhanced CT demonstrated unusual positioning of the portal vein ventral to the duodenum. The superior mesenteric-portal vein, which was L-shaped and convexly caudad, strongly suggested this anomalous condition.

  6. Advances in post-mortem CT-angiography

    PubMed Central

    Grimm, J; Dominguez, A; Vanhaebost, J; Mangin, P

    2014-01-01

    Performing a post-mortem multidetector CT (MDCT) scan has already become routine in some institutes of forensic medicine. To better visualize the vascular system, different techniques of post-mortem CT-angiography have been explored, which can essentially be divided into partial- and whole-body angiography techniques. Probably the most frequently applied technique today is the so-called multiphase post-mortem CT-angiography (MPMCTA) a standardized method for investigating the vessels of the head, thorax and abdomen. Different studies exist, describing its use for medicolegal investigations, and its advantages as well as its artefacts and pitfalls. With the aim to investigate the performance of PMCTA and to develop and validate techniques, an international working group was created in 2012 called the “Technical Working Group Post-mortem Angiography Methods” (TWGPAM). Beyond its primary perspective, the goals of this group include creating recommendations for the indication of the investigation and for the interpretation of the images and to distribute knowledge about PMCTA. This article provides an overview about the different approaches that have been developed and tested in recent years and an update about ongoing research in this field. It will explain the technique of MPMCTA in detail and give an outline of its indications, application, advantages and limitations. PMID:24234582

  7. Advances in post-mortem CT-angiography.

    PubMed

    Grabherr, S; Grimm, J; Dominguez, A; Vanhaebost, J; Mangin, P

    2014-04-01

    Performing a post-mortem multidetector CT (MDCT) scan has already become routine in some institutes of forensic medicine. To better visualize the vascular system, different techniques of post-mortem CT-angiography have been explored, which can essentially be divided into partial- and whole-body angiography techniques. Probably the most frequently applied technique today is the so-called multiphase post-mortem CT-angiography (MPMCTA) a standardized method for investigating the vessels of the head, thorax and abdomen. Different studies exist, describing its use for medicolegal investigations, and its advantages as well as its artefacts and pitfalls. With the aim to investigate the performance of PMCTA and to develop and validate techniques, an international working group was created in 2012 called the "Technical Working Group Post-mortem Angiography Methods" (TWGPAM). Beyond its primary perspective, the goals of this group include creating recommendations for the indication of the investigation and for the interpretation of the images and to distribute knowledge about PMCTA. This article provides an overview about the different approaches that have been developed and tested in recent years and an update about ongoing research in this field. It will explain the technique of MPMCTA in detail and give an outline of its indications, application, advantages and limitations.

  8. The role of CT angiography in military trauma.

    PubMed

    Watchorn, J; Miles, R; Moore, N

    2013-01-01

    To review whole-body computed tomography (CT) angiography as an unmatched way of fully assessing battle-injured patients, and the prevalence of vascular, predominantly arterial, injuries identified. A retrospective analysis of 144 patients who underwent whole-body CT angiography in March 2011 was made. A vascular radiologist reviewed all images and imaging reports. Data gathered included positive findings from CT, anatomical region injured, mechanism of injury, time to CT, and the number of casualties per incident. One hundred and forty-four patients underwent whole-body CT of which 17% had an occult vascular injury on CT. Twenty of these injuries (56%) were in the lower limbs, excluding extravasation at the site of amputation. Improvised explosive devices (IEDs) accounted for 71% (180 of 253) of battle injuries. The median time from admission to CT was 28 min. An additional 12% longer per patient is taken on average in a multiple casualty incident. Including contrast medium administration, whole-body angiography is completed in less than 2 min (mean 116 s). A significant proportion of occult vascular injuries occur in penetrating fragmentation and blast injuries in military trauma. A low threshold for single-pass whole-body CT angiography is therefore justified. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  9. High-speed lossless compression for angiography image sequences

    NASA Astrophysics Data System (ADS)

    Kennedy, Jonathon M.; Simms, Michael; Kearney, Emma; Dowling, Anita; Fagan, Andrew; O'Hare, Neil J.

    2001-05-01

    High speed processing of large amounts of data is a requirement for many diagnostic quality medical imaging applications. A demanding example is the acquisition, storage and display of image sequences in angiography. The functional performance requirements for handling angiography data were identified. A new lossless image compression algorithm was developed, implemented in C++ for the Intel Pentium/MS-Windows environment and optimized for speed of operation. Speeds of up to 6M pixels per second for compression and 12M pixels per second for decompression were measured. This represents an improvement of up to 400% over the next best high-performance algorithm (LOCO-I) without significant reduction in compression ratio. Performance tests were carried out at St. James's Hospital using actual angiography data. Results were compared with the lossless JPEG standard and other leading methods such as JPEG-LS (LOCO-I) and the lossless wavelet approach proposed for JPEG 2000. Our new algorithm represents a significant improvement in the performance of lossless image compression technology without using specialized hardware. It has been applied successfully to image sequence decompression at video rate for angiography, one of the most challenging application areas in medical imaging.

  10. [Myelomalacia following vertebral angiography with a femoral catheter (author's transl)].

    PubMed

    Seitz, D; Hintze, A

    1976-07-01

    Cerebral angiography with femoral catheters in two patients was followed by an incomplete cervical transverse myelitis. The complications were thought to be due to high contrast concentration in the cervical spinal vessels because of hypoplasia of one vertebral artery, and to contrast injection into the thyro-cervical trunk.

  11. Fluorescein and indocyanine green angiographies in Susac syndrome.

    PubMed

    Martinet, Nadege; Fardeau, Christine; Adam, Raphael; Bodaghi, Bahram; Papo, Thomas; Piette, Jean-Charles; Lehoang, Phuc

    2007-01-01

    Susac syndrome is a rare microangiopathy of the brain, retina, and cochlea that mainly affects young women. We studied the management of this disease using retinal fluorescein and indocyanine green angiographies. Retrospective, observational case series of seven patients with Susac syndrome identified in ophthalmology and internal medicine departments. We reviewed medical, ophthalmologic, and angiographic records at study enrollment and during long-term treatment. Mean follow-up was 37 months. Best-corrected visual acuity, intraocular inflammation score, ophthalmoscopy data, automated perimetry score, and fluorescein and indocyanine green angiographic features were analyzed with the results of cerebral magnetic resonance imaging and spinal fluid analysis and ENT signs. Retinal fluorescein angiography showed focal nonperfused retinal arterioles with hyperfluorescent walls in all cases. Indocyanine green angiography showed normal choroidal circulation. Retinal vasculitis was uncontrolled in a patient treated with steroids. Improvement of retinal arteriole perfusion occurred during immunosuppressive treatment with cyclophosphamide. Absence of intraocular inflammation and focal, labile nonperfused retinal arterioles with integrity of choroidal circulation are monomorphic ophthalmologic features that could immediately suggest the diagnosis of Susac syndrome. Early ophthalmologic examination aided by retinal fluorescein angiography could be useful for managing cases of unexplained neurologic symptoms in women.

  12. Myocardial Scar Detection by Standard CT Coronary Angiography

    PubMed Central

    Jeevarethinam, Anand; Venuraju, Shreenidhi; Mehta, Vishal Shahil; Atwal, Satvir; Raval, Usha; Rakhit, Roby; Davar, Joseph; Lahiri, Avijit

    2014-01-01

    We have described a myocardial infarct scar identified by a standard dual source CT coronary angiography (CTCA). We were able to detect the scar during the routine coronary assessment without contrast late enhancement and without additional radiation exposure. It is therefore feasible to assess chronic scar using a standard CTCA technique.

  13. Extended axial range, widefield OCT and OCT angiography (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Liu, Gangjun; Yang, Jianlong; Li, Yan; Zhang, Pengxiao; Jia, Yali; Huang, David

    2017-02-01

    Using a commercial available 200K swept source laser, we demonstrated high resolution wide field angiographic imaging of human retinal. 8mm by 8mm and 10mm by 6mm retina areas were imaged in a single scan within 4 seconds. By montaging four 10 x 6mm scan, 10 x 20mm wide field OCT angiography images were demonstrated.

  14. Non-enhanced MR angiography of renal arteries: comparison with contrast-enhanced MR angiography.

    PubMed

    Angeretti, M G; Lumia, D; Canì, A; Barresi, M; Nocchi Cardim, L; Piacentino, F; Maresca, A M; Novario, R; Genovese, E A; Fugazzola, C

    2013-09-01

    The main causes of renal artery stenosis (RAS) are atherosclerosis and fibromuscular dysplasia. Despite contrast-enhanced magnetic resonance angiography (CE-MRA) being a safe and reliable method for diagnosis of RAS especially in young individuals, recently it has been possible to adopt innovative technologies that do not require paramagnetic contrast agents. To assess the accuracy of steady-state free-precession (SSFP) non-contrast-enhanced magnetic resonance angiography (NC-MRA) by using a 1.5 T MR scanner for the detection of renal artery stenosis, in comparison with breath-hold CE-MRA as the reference standard. Sixty-three patients (33 men, 30 women) with suspected renovascular hypertension (RVHT) were examined by a 1.5T MR scanner; NC-MRA with an electrocardiography (ECG)-gated SSFP sequence was performed in 58.7% (37/63) of patients; in 41.3% (26/63) of patients a respiratory trigger was used in addition to cardiac gating. CE-MRA, with a three-dimensional gradient echo (3D-GRE) T1-weighted sequence, was performed in all patients within the same session. Maximum intensity projection (MIP) image quality, number of renal arteries, and the presence of stenosis were assessed by two observers (independently for NC-MRA and together for CE-MRA). The agreement between NC-MRA and CE-MRA as well as the inter-observer reproducibility were calculated with Bland-Altman plots. MIP image quality was considered better for NC-MRA. NC-MRA identified 143 of 144 (99.3%) arteries detected by CE-MRA (an accessory artery was not identified). Fourteen stenoses were detected by CE-MRA (11 atherosclerotic, 3 dysplastic) with four of 14 (28.5%) significant stenosis. Bland-Altman plot demonstrated an excellent concordance between NC-MRA and CE-MRA; particularly, the reader A evaluated correctly all investigated arteries, while over-estimation of two stenoses occurred for reader B. Regarding NC-MRA, inter-observer agreement was excellent. NC-MRA is a valid alternative to CE-MRA for the

  15. [Analysis of fundus fluorescein angiography, indocyanine green angiography and choroidal thickness in central serous chorioretinopathy].

    PubMed

    Li, Lüe; Li, Dong-hui; Yang, Zhi-kun; Bian, Ai-ling; Chen, You-xin; Dong, Fang-tian

    2012-10-01

    To evaluate the characteristics of choroidal thickness changes and abnormalities in choroidal circulation in cases of central serous chorioretinopathy (CSC). This was a case control study, we measured the bilateral choroidal thickness in 21 patients with unilateral CSC and 24 eyes of 24 age- and sex-matched normal subjects using enhanced depth imaging optical coherence tomography (EDI-OCT). The choroid was measured from the posterior edge of the retinal pigment epithelium (RPE) to the choroid-scleral junction at 500 µm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Paired-samples t-test was conducted to compare mean choroidal thicknesses between symptomatic eyes and fellow eyes of patients. The datum between patients and normal subjects were analyzed by independent-samples t-test. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed and the digital images were analyzed in CSC patients. The 21 CSC patients had a mean age of 45.6 years, and 12 patients (57.1%) were male. The choroid in symptomatic eyes was thickest beneath the fovea (519.0 ± 102.5) µm. It was significantly thicker than that in the fellow eyes (439.3 ± 94.1) µm (t = 4.171, P < 0.05). Choroidal thickness in both groups was significantly greater than that in the eyes of age- and sex-matched normal subjects (332.0 ± 67.3) µm (t = 7.125, 4.441; P < 0.05). Choroidal thickness at each of the other 12 points showed a similar tendency (t = 2.544 to 3.819, 4.799 to 7.816, 2.487 to 5.236; P < 0.05). ICGA showed a choroidal filling delay (100%), vessels dilation (90.5%), and focal choroidal hyperfluorescence (100%) surrounding leakage from the RPE in symptomatic eyes. Pigment epithelium detachment with abnormal choroidal circulation was observed in 6 fellow eyes. In 4 symptomatic eyes and 11 fellow eyes, ICGA revealed choroidal hyperfluorescence but FFA showed normal appearance. CSC seems to be a bilateral eye disease

  16. Evaluating Polypoidal Choroidal Vasculopathy With Optical Coherence Tomography Angiography

    PubMed Central

    Wang, Min; Zhou, Yao; Gao, Simon S.; Liu, Wei; Huang, Yongheng; Huang, David; Jia, Yali

    2016-01-01

    Purpose We observed and analyzed the morphologic characteristics of polypoidal lesions and abnormal branching vascular network (BVN) in patients with polypoidal choroidal vasculopathy (PCV) by optical coherence tomography angiography (OCTA). Methods A retrospective observational case series was done of patients with PCV. All patients were scanned with a 70-kHz spectral-domain OCT system using the split-spectrum amplitude-decorrelation angiography (SSADA) algorithm to distinguish blood flow from static tissue. The OCTA images of these patients were compared to those from indocyanine green angiography (ICGA). Semiautomated segmentation was used to further analyze the polypoidal lesion and the BVN. Results We studied 13 eyes of 13 patients 51 to 69 years old. A total of 11 patients were treatment-naive. Two patients had multiple anti-VEGF injections and one underwent photodynamic therapy (PDT). Optical coherence tomography angiography was able to detect the BVN in all cases. Using cross-sectional OCTA, BVN locations were shown to be in the space between the RPE and Bruch's membrane. Using en face OCTA, the BVN vascular pattern could be shown more clearly than by ICGA. Polypoidal lesions showed high flow signals in different patterns in 12 cases in the outer retina slab. Using cross-sectional OCTA, the polyps were shown to be just below the top of the pigment epithelial detachment (PED). In one case, the polypoidal lesion was not detectable at the outer retina slab. Conclusions Optical coherence tomography angiography is a noninvasive imaging tool for detecting vascular changes in PCV. Branching vascular networks showed more clearly on OCTA than on ICGA. Polypoidal lesions had variable patterns on OCTA and were not always detected. The OCTA patterns of the polypoidal lesions and the BVN are helpful in understanding the pathology of PCV. PMID:27472276

  17. [Digital thermo-coronary angiography--development and validation of the method in comparison with conventional cine-coronary angiography].

    PubMed

    Mohr, F W; Grundfest, W; Litvack, F; Forrester, J; Matloff, J; Kirchhoff, P G

    1989-07-01

    We describe the technique-thermal coronary angiography (TCA)-for real-time assessment of coronary anatomy and flow. The goal of this study was to compare thermal coronary angiography to cine coronary angiography and to validate its value for detecting stenoses. We studied the exposed LAD both in beating and arrested hearts in 11 open-chest pigs by TCA and cine angiography. We used an AGA 782 Thermovision system combined with a TIC 8000 digital image processor providing coronary images with 0.1-0.2 mm spatial and 0.1 degrees C thermal resolution, and a CFR x-ray system. The coronary arteries were catheterized via the right carotid artery, using standard 5F catheters. The thermal camera was focused at a 1m-distance to the heart surface and the x-ray was angled to LAO position. We performed simultaneous thermal and cine angiography using Angiovist 370 at different temperatures (10-40 degrees C) and injection rates (1-2.5 ml/s). Different grades of stenoses were created by snares. Thermistor probe readings of the epimyocardium and the left atrial blood were performed to reference the thermal camera measurements. We obtained high resolution TCA images of both the coronaries and of the myocardial perfusion beds whenever there was greater than 4 degrees C difference between injectate and epicardial temperature. The TCA detection of stenoses as compared to cine angiography was 29/30 (96.6%) in arrested and 36/42 (85.7%) in beating hearts. Coronary occlusion produced immediate and dramatic perfusion defects as detected by TCA. TCAs were highly reproducible. Injection rate of 2 ml/s provided optimal thermal coronary images. Thermal angiograms of the LAD were sometimes affected by large crossing coronary veins, myocardial bridges, and excess of fat pretending nonexistent coronary stenosis. TCA is a highly sensitive and reproducible method as compared to standard coronary angiography and allows for detection of coronary stenoses. The image quality was best in arrested hearts.

  18. MR-Guided PTA in Experimental Bilateral Rabbit Renal Artery Stenosis and MR Angiography Follow-Up Versus Histomorphometry

    SciTech Connect

    Le Blanche, Alain-Ferdinand; Rossert, Jerome; Wassef, Michel; Levy, Bernard; Bigot, Jean-Michel; Boudghene, Frank

    2000-09-15

    Purpose: To assess in vivo 1) MR-guided percutaneous transluminal renal angioplasty (PTRA) in experimental bilateral rabbit renal artery stenosis (RAS); 2) postprocedural follow-up by gadolinium-enhanced MR angiography versus histomorphometry.Methods: Fifteen male NZW rabbits of mean weight 4.0 kg (range 3.5-4.2 kg) underwent bilateral RAS induction by combined overdilation-deendothelialization with a gadolinium-filled balloon, passively MR-guided by the artifact of a 0.014-inch guidewire. After 4 weeks the rabbits were randomized into two groups: group A (n = 8) underwent right-sided PTRA for treatment of RAS, group B (n = 7) underwent left-sided PTRA. After another 4 weeks the rabbits were killed to assess by histomorphometry recurrent stenosis and contralateral induction injury stenosis lesions. Each step was preceded by gadolinium-enhanced three-dimensional MR angiography, and the cortex-to-aorta (C/A) signal intensity ratio was calculated.Results: RAS induction was successful in all cases. Fourteen arteries developed restenosis and 13 only initial stenosis. MR-guided PTRAs were feasible in 22 arteries (73%). For a successful catheterization of the ostium (20 arteries, 66% success rate), 10-25 steps were required. Five to eight steps were required for balloon localization and inflation for each PTRA. The restenosis effect was reflected by a 16% (12%-27%) decrease in C/A values on MR angiograms (p < 0.05).Conclusion: MR guidance and MR angiography represent a feasible, less invasive alternative for performing and assessing experimental PTRA in RAS.

  19. Advances in MR angiography with 7T MRI: From microvascular imaging to functional angiography.

    PubMed

    Park, Chan-A; Kang, Chang-Ki; Kim, Young-Bo; Cho, Zang-Hee

    2017-01-13

    Over the past few decades, vascular flow-dependent imaging techniques have proven to be effective for the visualization of large vessel diseases. However, these approaches are unlikely to be efficacious for small vessels because the affected small vessels cannot always be visualized directly, owing to a lack of detection sensitivity. Recently, many researchers have introduced state-of-the-art imaging techniques to visualize cerebral microvessels using ultra-high-field (UHF) magnetic resonance angiography (MRA). They have demonstrated the superiority of UHF MRA, especially for visualization of the microvasculature compared with clinical MRA images using 1.5T or 3T magnetic resonance imaging (MRI). Thus, UHF MRA may become an important investigative tool for research, facilitating examinations of vascular mechanisms for small vessel diseases and contributing to the early detection of cerebrovascular diseases in clinics. Furthermore, new imaging methods for visualizing vascular dynamics or flow effects may help investigate brain functions, especially in conjunction with blood oxygenation level-dependent contrast functional MRI modalities, as well as situations in which small vessel abnormalities are clinically important. The present article reviews recent technological advances in UHF MRA, especially 7T MRA, and discusses the potential benefits and future directions of UHF MRA. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Three-dimensional spiral CT angiography in pancreatic surgical planning using non-tailored protocols: comparison with conventional angiography.

    PubMed

    Blomley, M J; Albrecht, T; Williamson, R C; Allison, D J

    1998-03-01

    The aim of this study was to investigate three-dimensional spiral computed tomography (3DCT) as an adjunct to routine pancreatic CT scanning, with particular regard to the identification of surgically important hepatic arterial anomalies, correlated with conventional visceral angiography. 32 patients underwent spiral CT scans prior to pancreatic surgery using established protocols. Oral contrast medium was used throughout. 150 ml of intravenous contrast medium was given at 3 ml s-1 with a 24 s spiral CT sequence starting 35 s after the start of infusion. Two protocols were employed, both with a pitch of 1:3 mm table feed/collimation (n = 17) and 5 mm table feed/collimation (n = 15). Overlapping (1 mm minimum) axial reformats were reconstructed. 3DCT shaded-surface displays of the visceral arteries were assessed for visceral arterial anomalies. Visceral angiography (n = 23) was independently correlated. Satisfactory 3D angiograms were performed in all but one patient, in whom the coeliac axis was missed. (i) 3 mm protocol: 3DCT (n = 17) showed three anomalous right hepatic arteries (ARHA), one trifurcation anomaly and one splenic artery with an aortic origin. Angiography (n = 11) confirmed these findings, although one patient with an ARHA did not have angiography. A left gastric arterial supply to the left liver was not detected. (ii) 5 mm protocol: 3DCT (n = 15) showed two cases of ARHA. While confirming these findings, angiography (n = 12) showed a third case of ARHA, in which the coeliac and superior mesenteric artery had very close origins. A left gastric supply to the left liver was also missed. It is concluded that satisfactory 3DCT is possible without changing existing scanning protocols, although narrow sections are required for the confident assessment of right hepatic arterial anomalies, and any left hepatic supply via the left gastric artery was poorly assessed in this series.

  1. Individual patient data meta-analysis for the clinical assessment of coronary computed tomography angiography: protocol of the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT)

    PubMed Central

    2013-01-01

    Background Coronary computed tomography angiography has become the foremost noninvasive imaging modality of the coronary arteries and is used as an alternative to the reference standard, conventional coronary angiography, for direct visualization and detection of coronary artery stenoses in patients with suspected coronary artery disease. Nevertheless, there is considerable debate regarding the optimal target population to maximize clinical performance and patient benefit. The most obvious indication for noninvasive coronary computed tomography angiography in patients with suspected coronary artery disease would be to reliably exclude significant stenosis and, thus, avoid unnecessary invasive conventional coronary angiography. To do this, a test should have, at clinically appropriate pretest likelihoods, minimal false-negative outcomes resulting in a high negative predictive value. However, little is known about the influence of patient characteristics on the clinical predictive values of coronary computed tomography angiography. Previous regular systematic reviews and meta-analyses had to rely on limited summary patient cohort data offered by primary studies. Performing an individual patient data meta-analysis will enable a much more detailed and powerful analysis and thus increase representativeness and generalizability of the results. The individual patient data meta-analysis is registered with the PROSPERO database (CoMe-CCT, CRD42012002780). Methods/Design The analysis will include individual patient data from published and unpublished prospective diagnostic accuracy studies comparing coronary computed tomography angiography with conventional coronary angiography. These studies will be identified performing a systematic search in several electronic databases. Corresponding authors will be contacted and asked to provide obligatory and additional data. Risk factors, previous test results and symptoms of individual patients will be used to estimate the pretest

  2. High Resolution Ultrasound Superharmonic Perfusion Imaging: In Vivo Feasibility and Quantification of Dynamic Contrast-Enhanced Acoustic Angiography.

    PubMed

    Lindsey, Brooks D; Shelton, Sarah E; Martin, K Heath; Ozgun, Kathryn A; Rojas, Juan D; Foster, F Stuart; Dayton, Paul A

    2017-04-01

    Mapping blood perfusion quantitatively allows localization of abnormal physiology and can improve understanding of disease progression. Dynamic contrast-enhanced ultrasound is a low-cost, real-time technique for imaging perfusion dynamics with microbubble contrast agents. Previously, we have demonstrated another contrast agent-specific ultrasound imaging technique, acoustic angiography, which forms static anatomical images of the superharmonic signal produced by microbubbles. In this work, we seek to determine whether acoustic angiography can be utilized for high resolution perfusion imaging in vivo by examining the effect of acquisition rate on superharmonic imaging at low flow rates and demonstrating the feasibility of dynamic contrast-enhanced superharmonic perfusion imaging for the first time. Results in the chorioallantoic membrane model indicate that frame rate and frame averaging do not affect the measured diameter of individual vessels observed, but that frame rate does influence the detection of vessels near and below the resolution limit. The highest number of resolvable vessels was observed at an intermediate frame rate of 3 Hz using a mechanically-steered prototype transducer. We also demonstrate the feasibility of quantitatively mapping perfusion rate in 2D in a mouse model with spatial resolution of ~100 μm. This type of imaging could provide non-invasive, high resolution quantification of microvascular function at penetration depths of several centimeters.

  3. Noninvasive evaluation of collateral blood flow through circle of Willis in cervical carotid stenosis using selective magnetic resonance angiography.

    PubMed

    Ito, Kenji; Sasaki, Makoto; Kobayashi, Masakazu; Ogasawara, Kuniaki; Nishihara, Takashi; Takahashi, Tetsuhiko; Natori, Tatsunori; Uwano, Ikuko; Yamashita, Fumio; Kudo, Kohsuke

    2014-01-01

    Preoperative assessment of intracranial collateral circulation is helpful in predicting cerebral ischemia during surgical procedures for cervical internal carotid artery (ICA) stenosis. However, magnetic resonance angiography (MRA) and other less-invasive techniques cannot evaluate collateral blood flow because these techniques are nonselective. Hence, by using a newly developed selective MRA technique, we attempted to visualize collaterals via the circle of Willis in patients with ICA stenosis. Twelve patients who underwent carotid endarterectomy were prospectively examined with a 1.5-T MR scanner. Both selective and nonselective MRA were obtained using a 3-dimensional time-of-flight technique, with or without a cylindrical saturation pulse that suppresses the flow signal from the region of the target ICA. Maximum intensity projection MRA images were generated and compared with digital subtraction angiography (DSA) images. In all patients, the distal flow signal of the ipsilateral ICA was completely suppressed on selective MRA compared with nonselective MRA. In addition, collateral blood flow through the anterior and posterior communicating arteries was visualized in 5 and 2 patients, respectively. These findings corresponded well with the DSA imaging. Selective MRA techniques can readily suppress signals from the distal blood flow of the target artery and visualize the presence of collateral flows through the circle of Willis in patients with cervical ICA stenosis. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. Generation and visualization of four-dimensional MR angiography data using an undersampled 3-D projection trajectory.

    PubMed

    Liu, Jing; Redmond, Michael J; Brodsky, Ethan K; Alexander, Andrew L; Lu, Aiming; Thornton, Francis J; Schulte, Michael J; Grist, Thomas M; Pipe, James G; Block, Walter F

    2006-02-01

    Time-resolved contrast-enhanced magnetic resonance (MR) angiography (CE-MRA) has gained in popularity relative to X-ray Digital Subtraction Angiography because it provides three-dimensional (3-D) spatial resolution and it is less invasive. We have previously presented methods that improve temporal resolution in CE-MRA while providing high spatial resolution by employing an undersampled 3-D projection (3D PR) trajectory. The increased coverage and isotropic resolution of the 3D PR acquisition simplify visualization of the vasculature from any perspective. We present a new algorithm to develop a set of time-resolved 3-D image volumes by preferentially weighting the 3D PR data according to its acquisition time. An iterative algorithm computes a series of density compensation functions for a regridding reconstruction, one for each time frame, that exploit the variable sampling density in 3D PR. The iterative weighting procedure simplifies the calculation of appropriate density compensation for arbitrary sampling patterns, which improve sampling efficiency and, thus, signal-to-noise ratio and contrast-to-noise ratio, since it is does not require a closed-form calculation based on geometry. Current medical workstations can display these large four-dimensional studies, however, interactive cine animation of the data is only possible at significantly degraded resolution. Therefore, we also present a method for interactive visualization using powerful graphics cards and distributed processing. Results from volunteer and patient studies demonstrate the advantages of dynamic imaging with high spatial resolution.

  5. Current role of hybrid CT/angiography system compared with C-arm cone beam CT for interventional oncology

    PubMed Central

    Arai, Y; Inaba, Y; Inoue, M; Nishiofuku, H; Anai, H; Hori, S; Sakaguchi, H; Kichikawa, K

    2014-01-01

    Hybrid CT/angiography (angiography) system and C-arm cone beam CT provide cross-sectional imaging as an adjunct to angiography. Current interventional oncological procedures can be conducted precisely using these two technologies. In this article, several cases using a hybrid CT/angiography system are shown first, and then the advantages and disadvantages of the hybrid CT/angiography and C-arm cone beam CT are discussed with literature reviews. PMID:24968749

  6. Current role of hybrid CT/angiography system compared with C-arm cone beam CT for interventional oncology.

    PubMed

    Tanaka, T; Arai, Y; Inaba, Y; Inoue, M; Nishiofuku, H; Anai, H; Hori, S; Sakaguchi, H; Kichikawa, K

    2014-09-01

    Hybrid CT/angiography (angiography) system and C-arm cone beam CT provide cross-sectional imaging as an adjunct to angiography. Current interventional oncological procedures can be conducted precisely using these two technologies. In this article, several cases using a hybrid CT/angiography system are shown first, and then the advantages and disadvantages of the hybrid CT/angiography and C-arm cone beam CT are discussed with literature reviews.

  7. Comparison of Rates of Coronary Angiography and Combined Testing Procedures in Patients Seen in the Emergency Room With Chest Pain (But No Objective Acute Coronary Syndrome Findings) Having Coronary Computed Tomography Versus Exercise Stress Testing.

    PubMed

    Grunau, Brian; Leipsic, Jonathon; Purssell, Elizabeth; Kasteel, Naomi; Nguyen, Kimchi; Kazem, Mikameh; Naoum, Christopher; Raju, Rekha; Blanke, Philipp; Heilbron, Brett; Taylor, Carolyn; Scheuermeyer, Frank X

    2016-07-15

    Coronary computed tomography angiography (CCTA) appears comparable to standard care, including exercise stress testing (EST), in diagnosing acute coronary syndrome in emergency department (ED) patients with chest pain but may increase downstream testing. The objective of this study was to investigate rates of post-CCTA versus post-EST testing for (1) invasive angiography and (2) all combined cardiac testing. This was a retrospective cohort study performed at 2 urban Canadian EDs involving patients aged up to 65 years with chest pain but no objective ACS findings that were evaluated with CCTA or EST at the physician's discretion. The primary outcome was the proportion of patients who had 30-day invasive angiography in each group; secondary outcomes included all subsequent 30-day cardiac testing, including nuclear medicine scanning. From July 1, 2012, to June 30, 2014, we collected 1,700 patients: 521 CCTA and 1,179 EST. Demographics and risk factors were similar in both cohorts. In the following 30 days, 30 CCTA (5.8%) and 297 EST (25.2%) patients underwent any type of additional cardiac testing (difference 19.4%, 95% CI 16.0 to 22.6), whereas 12 CCTA (2.3%) and 20 EST patients (1.7%) underwent angiography (difference 0.6%, 95% CI -0.8% to 2.6%). No patients in either group died or had a myocardial infarction within 30 days. For ED patients with chest pain who underwent brief observation, CCTA and EST had similar 30-day angiography rates, but CCTA patients underwent significantly less overall cardiac investigations. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. What Have We Learned from CONFIRM? Prognostic Implications from a Prospective Multicenter International Observational Cohort Study of Consecutive Patients Undergoing Coronary Computed Tomographic Angiography

    PubMed Central

    Otaki, Yuka; Arsanjani, Reza; Gransar, Heidi; Cheng, Victor Y.; Dey, Damini; Labounty, Troy; Lin, Fay Y.; Achenbach, Stephan; Al-Mallah, Mouaz; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin J. W.; Delago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Kaufmann, Philipp; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J.; Villines, Todd C.; Dunning, Allison; Cury, Ricardo C.; Feuchtner, Gudrun; Kim, Yong-Jin; Leipsic, Jonathon; Berman, Daniel S.; Min, James K.

    2014-01-01

    Coronary computed tomographic angiography (CCTA) employing CT scanners of 64-detector rows or greater represents a novel noninvasive method for detection of coronary artery disease (CAD), providing excellent diagnostic information when compared to invasive angiography. In addition to its high diagnostic performance, prior studies have shown that CCTA can provide important prognostic information, although these prior studies have been generally limited to small cohorts at single centers. The Coronary CT Angiography EvaluatioN For clinical Outcomes: An InterRnational Multicenter Registry, or CONFIRM, is a large, prospective, multinational, dynamic observational cohort study of patients undergoing CCTA. This registry currently represents more than 32,000 consecutive adults suspected of having CAD who underwent ≥ 64–detector row CCTA at 12 centers in 6 countries between 2005 and 2009. Based on its large sample size and adequate statistical power, the data derived from CONFIRM registry has and will continue to provide key answers to many important topics regarding CCTA. Based on its multisite international national design, the results derived from CONFIRM should be considered as more generalizable than prior smaller single-center studies. This article summarizes the current status of several studies from CONFIRM registry. PMID:22689072

  9. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals

    SciTech Connect

    Crowhurst, James A; Whitby, Mark; Thiele, David; Halligan, Toni; Westerink, Adam; Crown, Suzanne; Milne, Jillian

    2014-09-15

    Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (P{sub KA}), skin surface entrance dose (K{sub AR}), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the P{sub KA.} 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median K{sub AR} = 581 mGy (374–876). Median P{sub KA} = 3908 uGym{sup 2} (2489–5865) DRL = 5865 uGym{sup 2}. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median K{sub AR} = 1501 mGy (928–2224). Median P{sub KA} = 8736 uGym{sup 2} (5449–12,900) DRL = 12,900 uGym{sup 2}. This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.

  10. Flat-detector computed tomography in the assessment of intracranial stents: comparison with multi detector CT and conventional angiography in a new animal model.

    PubMed

    Struffert, Tobias; Ott, Sabine; Adamek, Edyta; Schwarz, Marc; Engelhorn, Tobias; Kloska, Stephan; Deuerling-Zheng, Yu; Doerfler, Arnd

    2011-08-01

    Careful follow up is necessary after intracranial stenting because in-stent restenosis (ISR) or residual stenosis (RS) is not rare. A minimally invasive follow-up imaging technique is desirable. The objective was to compare the visualisation of stents in Flat Detector-CT Angiography (FD-CTA) after intravenous contrast medium injection (i.v.) with Multi Detector Computed Tomography Angiography (MD-CTA) and Digital Subtracted Angiography (DSA) in an animal model. Stents were implanted in the carotid artery of 12 rabbits. In 6 a residual stenosis (RS) was surgically created. Imaging was performed using FD-CTA, MD-CTA and DSA. Measurements of the inner and outer diameter and cross-section area of the stents were performed. Stenosis grade was calculated. In subjective evaluation FD-CTA was superior to MD-CTA. FD-CTA was more accurate compared with DSA than MD-CTA. Cross-sectional area of the stent lumen was significantly larger (p < 0.05) in FD-CTA in comparison to MD-CTA. Accurate evaluation of stenosis was impossible in MD-CTA. There was no statistically significant difference in the stenosis grade of DSA and FD-CTA. Our results show that visualisation of stent and stenosis using intravenous FD-CTA compares favourably with DSA and may replace DSA in the follow-up of patients treated with intracranial stents.

  11. Registration of 3D+t coronary CTA and monoplane 2D+t X-ray angiography.

    PubMed

    Metz, Coert T; Schaap, Michiel; Klein, Stefan; Baka, Nora; Neefjes, Lisan A; Schultz, Carl J; Niessen, Wiro J; van Walsum, Theo

    2013-05-01

    A method for registering preoperative 3D+t coronary CTA with intraoperative monoplane 2D+t X-ray angiography images is proposed to improve image guidance during minimally invasive coronary interventions. The method uses a patient-specific dynamic coronary model, which is derived from the CTA scan by centerline extraction and motion estimation. The dynamic coronary model is registered with the 2D+t X-ray sequence, considering multiple X-ray time points concurrently, while taking breathing induced motion into account. Evaluation was performed on 26 datasets of 17 patients by comparing projected model centerlines with manually annotated centerlines in the X-ray images. The proposed 3D+t/2D+t registration method performed better than a 3D/2D registration method with respect to the accuracy and especially the robustness of the registration. Registration with a median error of 1.47 mm was achieved.

  12. Comparison of Efficacy of Intraoperative Indocyanine Green Videoangiography in Clipping of Anterior Circulation Aneurysms with Postoperative Digital Subtraction Angiography.

    PubMed

    Kumar, Vikas; Jagetia, Anita; Singh, Daljit; Srivastava, Arvind Kumar; Tandon, Monica Sehgal

    2017-01-01

    The aim of this study is to assess the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) using postoperative digital subtraction angiography (DSA) in clipped anterior circulation aneurysms. A prospective study was conducted for 1 year which included thirty patients of anterior circulation aneurysm treated by clipping of aneurysm. Intraoperative ICG-VA was performed on all the patients. Postoperative DSA was performed to assess the efficacy of ICG-VA. Intraoperative ICG-VA revealed the occlusion of aneurysm in all the thirty patients. Postoperative DSA revealed aneurysm neck remnant in two patients and demonstrated no branch occlusion. Intraoperative ICG-VA is useful in assessing the completeness of clipping of cerebral aneurysms and ensures patency of branch vessels, thus providing a better postoperative outcome. It replaces the need for invasive postoperative angiographic imaging in a selected group of patients and is also cost effective.

  13. Routine Use of Three-Dimensional Contrast-Enhanced Moving-Table MR Angiography in Patients with Peripheral Arterial Occlusive Disease: Comparison with Selective Digital Subtraction Angiography

    SciTech Connect

    Deutschmann, Hannes A.; Schoellnast, Helmut; Portugaller, Horst R.; Preidler, Klaus W.; Reittner, Pia; Tillich, Manfred; Pilger, Ernst; Szolar, Dieter H. M.

    2006-10-15

    Purpose. To compare the diagnostic accuracy of contrast-enhanced (CE) three-dimensional (3D) moving-table magnetic resonance (MR) angiography with that of selective digital subtraction angiography (DSA) for routine clinical investigation in patients with peripheral arterial occlusive disease. Methods. Thirty-eight patients underwent CE 3D moving-table MR angiography of the pelvic and peripheral arteries. A commercially available large-field-of-view adapter and a dedicated peripheral vascular phased-array coil were used. MR angiograms were evaluated for grade of arterial stenosis, diagnostic quality, and presence of artifacts. MR imaging results for each patient were compared with those of selective DSA. Results. Two hundred and twenty-six arterial segments in 38 patients were evaluated by both selective DSA and MR angiography. No complications related to MR angiography were observed. There was agreement in stenosis classification in 204 (90.3%) segments; MR angiography overgraded 16 (7%) segments and undergraded 6 (2.7%) segments. Compared with selective DSA, MR angiography provided high sensitivity and specificity and excellent interobserver agreement for detection of severe stenosis (97% and 95%, {kappa} = 0.9 {+-} 0.03) and moderate stenosis (96.5% and 94.3%, {kappa} = 0.9 {+-} 0.03). Conclusion. Compared with selective DSA, moving-table MR angiography proved to be an accurate, noninvasive method for evaluation of peripheral arterial occlusive disease and may thus serve as an alternative to DSA in clinical routine.

  14. Determination of Stent Stenosis: An In Vivo Experimental Comparison of Intravascular Ultrasound and Angiography with Histology

    SciTech Connect

    Schuermann, Karl; Vorwerk, Dierk; Uppenkamp, Robert; Klosterhalfen, Bernd; Buecker, Arno; Guenther, Rolf W.

    1998-05-15

    Purpose: To compare intravascular ultrasound (IVUS) and angiography with histology in determining the degree of stent stenosis in an in vivo experiment. Methods: In 16 sheep, a total of 64 stents were implanted into the external iliac arteries. Two stents were inserted on either side. Patency was followed by angiography and IVUS. Four types of stent were used: two Dacron-covered (Cragg Endopro and heparinized Cragg Endopro) and two non-covered (Cragg and Memotherm stents). Eight animals were killed after 1 month, eight others after 6 months. Histological sections were prepared from the stented vessels. Measurements of the patent and total stent diameters determined by IVUS, angiography, and histology were compared. Results: Correlation between IVUS and angiography was 0.75, between IVUS and histology 0.77, and between angiography and histology 0.85. A mean stent stenosis of 17 {+-} 11% (range 0-51%) was found on angiography, of 10 {+-} 11% (0-46%) on IVUS, and of 20 {+-} 11% (4%-49%) on histology. In comparison with histology, IVUS underestimated the degree of stenosis by 10 {+-} 8%, and angiography underestimated it by 3 {+-} 6%. Resolution of IVUS was calculated to be about 0.35 mm and that of angiography to be about 0.15 mm. Conclusion: Under experimental conditions, IVUS was not superior to angiography in determining the degree of stent stenosis in long-segment stenoses of iliac artery stents, when measurements were correlated with histology. Angiography is sufficient for following the patency of iliac artery stents.

  15. Neuroradiologic applications of dynamic MR angiography at 3 T.

    PubMed

    Parmar, Hemant; Ivancevic, Marko K; Dudek, Nancy; Gandhi, Dheeraj; Geerts, Liesbeth; Hoogeveen, R; Mukherji, S K; Chenevert, Thomas L

    2009-02-01

    Four-dimensional time-resolved MR angiography (4D-MRA) using keyhole imaging techniques is a new method of performing contrastenhanced vascular imaging. Combining parallel imaging and keyhole imaging techniques, it is possible to obtain dynamic MRA scans up to 60 times faster, thereby achieving subsecond sampling of the contrast hemodynamics. Furthermore, imaging at 3 T gives higher signal, thus affording higher spatial resolution and allowing dynamic 3D MRA to approach the diagnostic performance of conventional digital subtraction angiography. This article presents the authors' clinical experience using 4D-MRA to evaluate various vascular abnormalities in the brain, spine, orbits, and neck at 3 T, demonstrates the imaging findings of this novel technique, and discusses its advantages and use in current neuroradiology practice.

  16. Towards the use of OCT angiography in clinical dermatology

    NASA Astrophysics Data System (ADS)

    Baran, Utku; Choi, Woo June; Wang, Ruikang K.

    2016-02-01

    Optical coherence tomography (OCT) is a popular imaging technique used in ophthalmology, and on the way to become clinically viable alternative in dermatology due to its capability of acquiring histopathology level images of in vivo tissue, noninvasively. In this study, we demonstrate the capabilities of OCT-based angiography (OMAG) in detecting high-resolution, volumetric structural and microvascular features of in vivo human skin with various conditions using a swept source OCT system that operates on a central wavelength of 1310 nm with an A-line rate of 100 kHz. OMAG images provide detailed in vivo visualization of microvasculature of abnormal human skin conditions from face, chest and belly. Moreover, the progress of wound healing on human skin from arm is monitored during longitudinal wound healing process. The presented results promise the clinical use of OCT angiography in treatment of prevalent cutaneous diseases within human skin, in vivo.

  17. Fluorescent angiography of chicken embryo and photobleaching velocimetry

    NASA Astrophysics Data System (ADS)

    Namykin, Anton A.; Stiukhina, Elena S.; Fedosov, Ivan V.; Postnov, Dmitry E.; Tuchin, Valery V.

    2017-03-01

    Fluorescent angiography approach in application to a living chicken embryo is discussed. It provides precise vessel wall detection and demonstrates usefulness for real time monitoring of vasoconstriction and vasodilatation related to self regulation of vascular network as well as to response to external factors. On the other hand, high stability of fluorescence and long period of dye elimination makes variations of fluorescent intensity practically independent from fast variations of blood flow rate. Therefore, we proposed the improvement of fluorescent angiography technique by introduction of photobleaching fluorescent velocimetry approach. We have developed the imaging system for intravital microscopic photobleaching velocimetry and tested it by using a glass capillary tube as a model of blood vessel. We demonstrated high potential of the technique for instant flow velocity distribution profile measurement with high spatial and temporal resolution up to 2 μm and 60 ms, respectively.

  18. Peripheral vascular disease: correlation of MR imaging and angiography

    SciTech Connect

    Wesbey, G.E.; Higgins, C.B.; Amparo, E.G.; Hale, J.D.; Kaufman, L.; Pogany, A.C.

    1985-09-01

    The capability of magnetic resonance (MR) imaging for detecting aortic, iliac, and femoral stenoses and occlusions was evaluated. Multisection spin-echo studies at 0.35 tesla were obtained of the infrarenal aorta to the femoral bifurcation in 24 patients, all of whom had undergone intraarterial angiography within 14 days of imaging. Transaxial MR images were compared with the angiograms. Arterial stenoses and occlusions in these vessels detected by MR imaging correlated with angiographic findings in 91% of the instances. Due to the limited spatial resolution, MR images failed to demonstrate some femoral stenoses. MR imaging may be used for evaluation of aortoiliac vascular disease and for follow-up study after surgical revascularization. However, the limited spatial resolution, noncomposite display of the aortoiliofemoral circulation, and lack of evaluation of peripheral runoff provided by current MR imaging techniques militate against its replacing angiography prior to vascular intervention.

  19. Automatic extraction of coronary vessels from digital subtraction angiography

    NASA Astrophysics Data System (ADS)

    Tang, Songyuan; Wen, Junhai; Wang, Yongtian; Chen, Yan-wei

    2007-03-01

    In the X-ray coronary digital subtraction angiography, there are serious motion artifacts and noises, and backgrounds such as ribs, spine, cathers and etc, which are tube structures and like vessels. It's difficult to separate vessels from the background automatically if they are close each other. In this paper, an automatic extraction of coronary vessels from X-ray digital subtraction angiography is proposed. We used edge preserving smooth filter to reduce the noises in the images and keep the vessel edge firstly. Then affine and B-spline based FFD nonrigid registration is applied to the images. Compared with the segmentation method, the proposed method can remove background greatly and extract the coronary vessel very well.

  20. Detection of radiation cardiomyopathy by gated radionuclide angiography

    SciTech Connect

    Burns, R.J.; Bar-Shlomo, B.Z.; Druck, M.N.; Herman, J.G.; Gilbert, B.W.; Perrault, D.J.; McLaughlin, P.R.

    1983-02-01

    Twenty-one asymptomatic adults underwent rest and exercise gated radionuclide angiography seven to 20 years after having received mediastinal radiation (2,000 to 7,600 rads) for Hodgkin's disease. None of these patients received cytotoxic chemotherapy. Twelve patients (57 percent) had abnormal left (less than 53 percent at rest and/or greater than 5 percent decrease at peak exercise) and/or right (less than 27 percent at rest and/or greater than 5 percent decrease at peak exercise) ventricular ejection fractions. Previous reports have described myocardial fibrosis occurring late after therapeutic mediastinal radiation; however, the incidence of this occurrence based on clinical follow-up has been low. Rest and exercise radionuclide angiography is a sensitive method for assessing systolic ventricular function and reveals a high prevalence of cardiomyopathy that can be linked to previous radiotherapy.

  1. Subarachnoid hemorrhage mimicking leakage of contrast media after coronary angiography.

    PubMed

    Oh, Min Seok; Kwon, Jee Eun; Kim, Kyung Jun; Jo, Joon Hwan; Min, Yun Ju; Byun, Jun Soo; Kim, Kyung Tae; Kim, Sang Wook; Kim, Tae Ho

    2012-03-01

    We report a patient who developed subarachnoid hemorrhage (SAH) just after coronary angiography (CAG) with non-ionic contrast media (CM) and minimal dose of heparin. The 55-year-old man had a history of acute ST elevation myocardial infarction that had been treated with primary percutaneous coronary intervention and was admitted for a follow-up CAG. The CAG was performed by the transradial approach, using 1000 U of unfractionated heparin for the luminal coating and 70 mL of iodixanol. At the end of CAG, he complained of nausea and rapidly became stuporous. Brain CT showed a diffusely increased Hounsfield unit (HU) in the cisternal space, similar to leakage of CM. The maximal HU was 65 in the cisternal space. No vascular malformations were detected on cerebral angiography. The patient partially recovered his mental status and motor weakness after 2 days. Two weeks later, subacute SAH was evident on magnetic resonance imaging. The patient was discharged after 28 days.

  2. Fluorescein angiography in retrolental fibroplasia: experience from 1969-1977.

    PubMed

    Flynn, J T; Cassady, J; Essner, D; Zeskind, J; Merritt, J; Flynn, R; Williams, M J

    1979-10-01

    Acute proliferative retrolental fibroplasia (RLF) has been studied in premature infants employing a Zeiss fundus camera and fluorescein angiography. A total of 164 angiograms have been performed on 122 infants. At the present time, angiography is reserved for studying infants with peculiar or puzzling fundus pictures. A dose of 0.1-0.4 cc of 10% sodium fluoresceinate is employed, depending on the age and the weight of the baby. Fluorescein clearly outlines the major arteriovenous shunt in the retina, which is the hallmark of acute RLF. The shunt fills with fluorescein and leaks it profusely. On regression, a fine brush border of capillaries is seen in the region where the shunt previously had been located. Study of the population susceptible to RLF reveals it to be the smallest sickest babies in the premature nursery.

  3. Select Features of Diabetic Retinopathy on Swept-Source Optical Coherence Tomographic Angiography Compared With Fluorescein Angiography and Normal Eyes

    PubMed Central

    Salz, David A.; de Carlo, Talisa E.; Adhi, Mehreen; Moult, Eric; Choi, WhooJhon; Baumal, Caroline R.; Witkin, Andre J.; Duker, Jay S.; Fujimoto, James G.; Waheed, Nadia K.

    2017-01-01

    IMPORTANCE Optical coherence tomographic angiography (OCTA) is a recently developed noninvasive imaging technique that can visualize the retinal and choroidal microvasculature without the injection of exogenous dyes. OBJECTIVE To evaluate the potential clinical utility of OCTA using a prototype swept-source OCT (SS-OCT) device and compare it with fluorescein angiography (FA) for analysis of the retinal microvasculature in diabetic retinopathy. DESIGN, SETTING, AND PARTICIPANTS Prospective, observational cross-sectional study conducted at a tertiary care academic retina practice from November 2013 through November 2014. A cohort of diabetic and normal control eyes were imaged with a prototype SS-OCT system. The stage of diabetic retinopathy was determined by clinical examination. Imaging was performed using angiographic 3 × 3-mm and 6 × 6-mm SS-OCT scans to generate 3-dimensional en-face OCT angiograms for each eye. Two trained Boston Image Reading Center readers reviewed and graded FA and OCTA images independently. MAIN OUTCOMES AND MEASURES The size of the foveal nonflowzone and the perifoveal intercapillary area on OCTA were measured in both normal and diabetic eyes using Boston Image Reading Center image analysis software. RESULTS The study included 30 patients with diabetes (mean [SD] age, 55.7 [10] years) and 6 control individuals (mean [SD] age, 55.1 [6.4] years). A total of 43 diabetic and 11 normal control eyes were evaluated with OCTA. Fluorescein angiography was performed in 17 of 43 diabetic eyes within 8 weeks of the OCTA. Optical coherence tomographic angiography was able to identify a mean (SD) of 6.4 (4.0) microaneurysms (95% CI, 4.4–8.5), while FA identified a mean (SD) of 10 (6.9) microaneurysms (95% CI, 6.4–13.5). The exact intraretinal depth of microaneurysms on OCTA was localized in all cases (100%). The sensitivity of OCTA in detecting microaneuryms when compared with FA was 85% (95% CI, 53–97), while the specificity was 75% (95% CI, 21

  4. [Invasive and minimally invasive hemodynamic monitoring].

    PubMed

    Hansen, Matthias

    2016-10-01

    Advanced hemodynamic monitoring is necessary for adequate management of high-risk patients or patients with derangement of circulation. Studies demonstrate a benefit of early goal directed therapy in unstable cardiopulmonary situations. In these days we have different possibilities of minimally invasive or invasive hemodynamic monitoring. Minimally invasive measurements like pulse conture analysis or pulse wave analysis being less accurate under some circumstances, however only an artery catheter is needed for cardiac output monitoring. Pulmonary artery, transpulmonary thermodilution and lithium dilution technology have acceptable accuracy in cardiac output measurement. For therapy of unstable circulation there are additionally parameters to obtain. The pulmonary artery catheter is the device with the largest rate of complications, used by a trained crew and with a correct indication, his use is unchained justified.

  5. National Synchrotron Light Source angiography personnel protection interlock

    SciTech Connect

    Gmuer, N.; Larson, R.; Thomlinson, W.

    1992-06-01

    This document has been written to describe the safety system operation at the NSLS X17B2 beamline Synchrotron Medical Research Facility (SMERF). The angiography exposure process involves scanning a patient up and down through dual fixed-position x-ray beams; exposure is controlled by opening and closing a fast-acting Safety Shutter mechanism at precise times in relation to the up and down motion of the scan chair. The fast-acting Safety Shutter mechanism is the primary radiation-stopping element protecting the patient while the chair is at rest and while it is reversing directions during the scan. Its fail-safe and fast operation is essential for the safety of the patient. Operation of X17B2 as a human subject angiography station necessitates the implementation of a personnel protection interlock system that, in conjunction with the Safety Shutters: permits safe access to the patient exposure area while the synchrotron radiation beam is illuminating the upstream dual energy monochromator; allows a patient to be imaged by the monochromatized beam under the supervision of a Responsible Physician, with scan chair motion and precision shutter actuation regulated by an angiography control computer, while providing a suitable number of safeguards against accidental radiation exposure; has different modes of operation to accommodate equipment set-up, test, and calibration; and patient exposure; and ensures the quick extinction of the beam if a potentially unsafe condition is detected. The interlock system which performs these safety functions is called the Angiography Personnel Protection Interlock (APPI). The APPI Document is organized such that the level of detail changes from a general overview to detailed engineering drawings of the hardware system.

  6. Optical Coherence Tomography Angiography of the Optic Disc; an Overview

    PubMed Central

    Akil, Handan; Falavarjani, Khalil Ghasemi; Sadda, Srinivas R.; Sadun, Alfredo A.

    2017-01-01

    Different diseases of the optic disc may be caused by or lead to abnormal vasculature at the optic nerve head. Optical coherence tomography angiography (OCTA) is a novel technology that provides high resolution mapping of the retinal and optic disc vessels. Recent studies have shown the ability of OCTA to visualize vascular abnormalities in different optic neuropathies. In addition, quantified OCTA measurements were found promising for differentiating optic neuropathies from healthy eyes. PMID:28299012

  7. National Synchrotron Light Source angiography personnel protection interlock

    SciTech Connect

    Gmuer, N.; Larson, R.; Thomlinson, W.

    1992-06-01

    This document has been written to describe the safety system operation at the NSLS X17B2 beamline Synchrotron Medical Research Facility (SMERF). The angiography exposure process involves scanning a patient up and down through dual fixed-position x-ray beams; exposure is controlled by opening and closing a fast-acting Safety Shutter mechanism at precise times in relation to the up and down motion of the scan chair. The fast-acting Safety Shutter mechanism is the primary radiation-stopping element protecting the patient while the chair is at rest and while it is reversing directions during the scan. Its fail-safe and fast operation is essential for the safety of the patient. Operation of X17B2 as a human subject angiography station necessitates the implementation of a personnel protection interlock system that, in conjunction with the Safety Shutters: permits safe access to the patient exposure area while the synchrotron radiation beam is illuminating the upstream dual energy monochromator; allows a patient to be imaged by the monochromatized beam under the supervision of a Responsible Physician, with scan chair motion and precision shutter actuation regulated by an angiography control computer, while providing a suitable number of safeguards against accidental radiation exposure; has different modes of operation to accommodate equipment set-up, test, and calibration; and patient exposure; and ensures the quick extinction of the beam if a potentially unsafe condition is detected. The interlock system which performs these safety functions is called the Angiography Personnel Protection Interlock (APPI). The APPI Document is organized such that the level of detail changes from a general overview to detailed engineering drawings of the hardware system.

  8. Indocyanine Green Angiography-assisted Laparoendoscopic Single-site Varicocelectomy.

    PubMed

    Tomita, Keiji; Kageyama, Susumu; Hanada, Eiki; Yoshida, Tetsuya; Okinaka, Yuki; Kubota, Shigehisa; Nagasawa, Masayuki; Johnin, Kazuyoshi; Narita, Mitsuhiro; Kawauchi, Akihiro

    2017-08-01

    To study the efficacy of a new laparoscopic varicocelectomy technique using indocyanine green (ICG) angiography. Laparoendoscopic single-site (LESS) varicocelectomy using ICG angiography was performed in a single institution on 11 patients with a grade 2 or 3 varicocele. Adult men (N = 9, 82%) who were apparently infertile and had a varicocele, as well as prepubertal boys (N = 2, 18%) with testicular growth retardation, underwent a LESS varicocelectomy using ICG angiography. After the separation of testicular veins, arteries, and lymphatics, ICG was injected intravenously, and arterial and venous blood flows were observed by ICG fluorescence. Spermatic veins were cauterized by bipolar forceps and cut. The spermatic artery and lymphatics were preserved. The mean time to the arterial phase (AP) from the ICG injection was 34.9 seconds and the mean time to the venous phase was 58.3 seconds. The mean interval from the arterial phase to the venous phase was 23.3 seconds, and in all cases, this time interval facilitated the identification of arteries and veins. The rates of residual varicocele 3 and 6 months after surgery were 9.1% and 0%, respectively. Serious postoperative complications were not observed nor were adverse events induced by ICG. ICG angiography appears to be safe and appears to facilitate the detection of artery and veins during LESS varicocelectomy. Continuing investigations of efficacy are required of this new and promising procedure in a larger number of patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Computed Tomography Angiography in Microsurgery: Indications, Clinical Utility, and Pitfalls

    PubMed Central

    Lee, Gordon K.; Fox, Paige M.; Riboh, Jonathan; Hsu, Charles; Saber, Sepideh; Rubin, Geoffrey D.; Chang, James

    2013-01-01

    Objective: Computed tomographic angiography (CTA) can be used to obtain 3-dimensional vascular images and soft-tissue definition. The goal of this study was to evaluate the reliability, usefulness, and pitfalls of CTA in preoperative planning of microvascular reconstructive surgery. Methods: A retrospective review of patients who obtained preoperative CTA in preparation for planned microvascular reconstruction was performed over a 5-year period (2001–2005). The influence of CTA on the original operative plan was assessed for each patient, and CTA results were correlated to the operative findings. Results: Computed tomographic angiography was performed on 94 patients in preparation for microvascular reconstruction. In 48 patients (51%), vascular abnormalities were noted on CTA. Intraoperative findings correlated with CTA results in 97% of cases. In 42 patients (45%), abnormal CTA findings influenced the original operative plan, such as the choice of vessels, side of harvest, or nature of the reconstruction (local flap instead of free tissue transfer). Technical difficulties in performing CTA were encountered in 5 patients (5%) in whom interference from external fixation devices was the main cause. Conclusions: This large study of CTA obtained for preoperative planning of reconstructive microsurgery at both donor and recipient sites study demonstrates that CTA is safe and highly accurate. Computed tomographic angiography can alter the surgeon's reconstructive plan when abnormalities are noted preoperatively and consequently improve results by decreasing vascular complication rates. The use of CTA should be considered for cases of microsurgical reconstruction where the vascular anatomy may be questionable. PMID:24023972

  10. Compton-backscattering x-ray source for coronary angiography

    SciTech Connect

    Blumberg, L.N.

    1992-12-01

    An X-ray source utilizing Compton-backscattered (CB) photons in a 75-MeV electron storage ring containing an infrared FEL is proposed for producing 33.17-keV X-rays (Iodine K-edge) for coronary angiography. The X-ray intensity into a 4-mrad cone is computed as 7.21 {times} 10{sup 14}/sec for a 500-mA electron beam colliding with 0.2-J/bunch, 3.22-{mu}m photons from an in-ring IR-FEL at the 353.21-MHz rate of a SLAC-PEP 500-kW RF system. The resultant average flux at the patient is 6.4 {times} 10{sup 7} photons/pixel/4-msec aver a 12-cm diameter circle at 3-m from the interaction point for the 0.5 {times}0.5-mm{sup 2} pixel size of the present Si(Li) array of the BNL-SMERF Angiography Facility. This flux is 2.1 times larger than obtains at SMERF at a comparable source-to-patient distance and over an area sufficient to encompass the entire coronary region. However, the X-Ray energy spread due to kinematics alone is 2.63-keV, a factor of 35 larger then SMERF, and presents the major difficulty for the digital subtraction angiography method (DSA) envisioned.

  11. Understanding the basic concepts of CO2 angiography

    NASA Astrophysics Data System (ADS)

    Zannoli, Romano; Bianchini, David; Rossi, Pier Luca; Caridi, James G.; Corazza, Ivan

    2016-11-01

    The diagnostic quality of carbon dioxide angiography depends both on optimal setting of radiological aspects (X-ray emission and image post-processing) and on the mechanical behavior of the injected gas bubbles. The gas behavior differs in large cavities (d > 12 mm), medium sized vessels (d > 6 mm), and small diameter vessels (d < 6 mm): to optimize the result the operator has to adapt his action to the physical rules governing the phenomenon in the particular situation. In most cases, it is impossible to fill a vessel completely with gas, and to obtain an adequate angiogram, the gas volume and injection pressure must be properly selected, patient's position must be adjusted and radiological image optimization algorithms, like Digital Subtraction Angiography (DSA) and stacking, must be applied. In this optimization process, the cultural and practical intervention of a medical physicist is fundamental. Obtaining a good quality CO2 angiogram is not only a matter of medical operator experience or radiological system performance, but involves matching a wide knowledge of medical physics to particular pathophysiological conditions and to unusual measurement tests. Most medical physicists are used to dealing mainly with radiological problems, and other physical aspects are considered beyond their interest. In CO2 angiography, non-radiological aspects strongly interfere with radiological issues and an optimal result can only be obtained by tackling the two simultaneously.

  12. Mono-Energy Coronary Angiography with a Compact Synchrotron Source

    NASA Astrophysics Data System (ADS)

    Eggl, Elena; Mechlem, Korbinian; Braig, Eva; Kulpe, Stephanie; Dierolf, Martin; Günther, Benedikt; Achterhold, Klaus; Herzen, Julia; Gleich, Bernhard; Rummeny, Ernst; Noёl, Peter B.; Pfeiffer, Franz; Muenzel, Daniela

    2017-02-01

    X-ray coronary angiography is an invaluable tool for the diagnosis of coronary artery disease. However, the use of iodine-based contrast media can be contraindicated for patients who present with chronic renal insufficiency or with severe iodine allergy. These patients could benefit from a reduced contrast agent concentration, possibly achieved through application of a mono-energetic x-ray beam. While large-scale synchrotrons are impractical for daily clinical use, the technology of compact synchrotron sources strongly advanced during the last decade. Here we present a quantitative analysis of the benefits a compact synchrotron source can offer in coronary angiography. Simulated projection data from quasi-mono-energetic and conventional x-ray tube spectra is used for a CNR comparison. Results show that compact synchrotron spectra would allow for a significant reduction of contrast media. Experimentally, we demonstrate the feasibility of coronary angiography at the Munich Compact Light Source, the first commercial installation of a compact synchrotron source.

  13. Mono-Energy Coronary Angiography with a Compact Synchrotron Source

    PubMed Central

    Eggl, Elena; Mechlem, Korbinian; Braig, Eva; Kulpe, Stephanie; Dierolf, Martin; Günther, Benedikt; Achterhold, Klaus; Herzen, Julia; Gleich, Bernhard; Rummeny, Ernst; Noёl, Peter B.; Pfeiffer, Franz; Muenzel, Daniela

    2017-01-01

    X-ray coronary angiography is an invaluable tool for the diagnosis of coronary artery disease. However, the use of iodine-based contrast media can be contraindicated for patients who present with chronic renal insufficiency or with severe iodine allergy. These patients could benefit from a reduced contrast agent concentration, possibly achieved through application of a mono-energetic x-ray beam. While large-scale synchrotrons are impractical for daily clinical use, the technology of compact synchrotron sources strongly advanced during the last decade. Here we present a quantitative analysis of the benefits a compact synchrotron source can offer in coronary angiography. Simulated projection data from quasi-mono-energetic and conventional x-ray tube spectra is used for a CNR comparison. Results show that compact synchrotron spectra would allow for a significant reduction of contrast media. Experimentally, we demonstrate the feasibility of coronary angiography at the Munich Compact Light Source, the first commercial installation of a compact synchrotron source. PMID:28181544

  14. Calibration of optical coherence tomography angiography with a microfluidic chip

    NASA Astrophysics Data System (ADS)

    Su, Johnny P.; Chandwani, Rahul; Gao, Simon S.; Pechauer, Alex D.; Zhang, Miao; Wang, Jie; Jia, Yali; Huang, David; Liu, Gangjun

    2016-08-01

    A microfluidic chip with microchannels ranging from 8 to 96 μm was used to mimic blood vessels down to the capillary level. Blood flow within the microfluidic channels was analyzed with split-spectrum amplitude-decorrelation angiography (SSADA)-based optical coherence tomography (OCT) angiography. It was found that the SSADA decorrelation value was related to both blood flow speed and channel width. SSADA could differentiate nonflowing blood inside the microfluidic channels from static paper. The SSADA decorrelation value was approximately linear with blood flow velocity up to a threshold Vsat of 5.83±1.33 mm/s (mean±standard deviation over the range of channel widths). Beyond this threshold, it approached a saturation value Dsat. Dsat was higher for wider channels, and approached a maximum value Dsm as the channel width became much larger than the beam focal spot diameter. These results indicate that decorrelation values (flow signal) in capillary networks would be proportional to both flow velocity and vessel caliber but would be capped at a saturation value in larger blood vessels. These findings are useful for interpretation and quantification of clinical OCT angiography results.

  15. Fluorescein and indocyanine green angiography in ocular toxoplasmosis.

    PubMed

    Atmaca, Leyla S; Simsek, Tulay; Atmaca Sonmez, Pelin; Sonmez, Kenan

    2006-12-01

    To document fluorescein and indocyanine green angiographic findings in patients with ocular toxoplasmosis. Charts of patients with ocular toxoplasmosis who were evaluated with fluorescein and indocyanine green angiograpy were reviewed. In this study, eight (38%) females and 13 (62%) males with a mean age of 20.3 years were included. Of the 21 patients, five (24%) had bilateral involvement with active or inactive toxoplasmic lesion. There were active lesions in 12 (46%) eyes and inactive lesions in 14 (54%) eyes. Indocyanine green angiograpy showed hypofluorescence of the active and inactive retinochoroiditis lesions at all phases. Hypofluorescent multiple satellite dark dots were observed in 11 (92%) eyes with active retinochoroiditis and in two (14%) eyes with inactive lesions. In two patients with unilateral active toxoplasmic retinochoroiditis, hyperfluorescent plaques were observed in the fellow eyes on indocyanine green angiograpy. The fundus examination and fluorescein angiography of the fellow eyes were normal and had a visual acuity of 10/10. Choroidal neovascularization was observed in two (8%) eyes. In eyes with active inflammation, fluorescein angiography revealed early hypo-fluorescence and late intense hyper-fluorescence with fuzzy margins of the retinochoroiditis lesion (12 eyes), hyperfluorescence of the optic nerve head (four eyes) and leakage from the vessels and/or vascular sheathing (four eyes) and neuroretinitis (one eye). Toxoplasmic retinochoroiditis is a more widespread inflammation than visible fundus lesions. Indocyanine green angiography is a useful method for evaluating the amount of inflammatory activity and late complications in patients with ocular toxoplasmosis.

  16. Optical coherence tomography angiography in pediatric choroidal neovascularization

    PubMed Central

    Veronese, Chiara; Maiolo, Chiara; Huang, David; Jia, Yali; Armstrong, Grayson W.; Morara, Mariachiara; Ciardella, Antonio P.

    2016-01-01

    Purpose To report two cases of pediatric choroidal neovascularization (CNV) and the associated neo-vascular and retinal findings identified on Optical Coherence Tomography Angiography (OCTA) imaging. Methods A 14-year-old boy with handheld laser-induced maculopathy-related CNV and a 13-year-old boy with idiopathic CNV were evaluated with visual acuity testing, slit-lamp exam, fundus photography, fluorescein angiography, indocyanine green angiography, spectral domain optical coherence tomography, and OCTA. Results Macular CNV were identified in both pediatric patients using OCTA imaging. The first case demonstrated a classic pediatric type II CNV with a “tree-like” pattern and a single vessel in-growth site, while the second case demonstrated a type I CNV with a “glomerular” pattern. Conclusion Distinct choroidal neovascular patterns were visualized in these two cases of pediatric CNV when compared to adult subtypes. OCTA is a noninvasive imaging modality capable of evaluating and characterizing pediatric CNV and their associated vascular patterns. PMID:27990495

  17. Compton-backscattering x-ray source for coronary angiography

    SciTech Connect

    Blumberg, L.N.

    1992-01-01

    An X-ray source utilizing Compton-backscattered (CB) photons in a 75-MeV electron storage ring containing an infrared FEL is proposed for producing 33.17-keV X-rays (Iodine K-edge) for coronary angiography. The X-ray intensity into a 4-mrad cone is computed as 7.21 [times] 10[sup 14]/sec for a 500-mA electron beam colliding with 0.2-J/bunch, 3.22-[mu]m photons from an in-ring IR-FEL at the 353.21-MHz rate of a SLAC-PEP 500-kW RF system. The resultant average flux at the patient is 6.4 [times] 10[sup 7] photons/pixel/4-msec aver a 12-cm diameter circle at 3-m from the interaction point for the 0.5 [times]0.5-mm[sup 2] pixel size of the present Si(Li) array of the BNL-SMERF Angiography Facility. This flux is 2.1 times larger than obtains at SMERF at a comparable source-to-patient distance and over an area sufficient to encompass the entire coronary region. However, the X-Ray energy spread due to kinematics alone is 2.63-keV, a factor of 35 larger then SMERF, and presents the major difficulty for the digital subtraction angiography method (DSA) envisioned.

  18. Coronary artery plaque formation at coronary CT angiography: morphological analysis and relationship to hemodynamics.

    PubMed

    Enrico, Benedetta; Suranyi, Pal; Thilo, Christian; Bonomo, Lorenzo; Costello, Philip; Schoepf, U Joseph

    2009-04-01

    We aimed to demonstrate that coronary CT angiography (cCTA) can be used to non-invasively study the effect of hemodynamic factors in the pathophysiology of plaque formation. cCTA data of 73 patients were analyzed. All detected plaques were classified according to location (bifurcation, non-branching segment), configuration (eccentric, concentric), orientation (myocardial, lateral, epicardial side of the vessel wall), and composition (calcified, mixed, non-calcified). Bifurcation lesions were further characterized using the Medina classification. Of 382 plaques, 8.1% were in the LM, 46.3% in the LAD, 18.3% in the LCx, and 25.9% in the RCA. Also, 25.1% were completely calcified, 72.3% were mixed, and 2.6% were purely non-calcified. Of the plaques, 51.3% were bifurcation lesions. The most frequent (40%) Medina pattern was 1.1.0 (lesion starts before, extends beyond bifurcation, sparing the side branch). Eighty percent of plaques were eccentric. A significant (p < 0.01) majority (55%) were on the myocardial side, while 17.3% were lateral, and 27.7% epicardial. Of all non-calcified and mixed plaques, 45.1% (p < 0.01) were myocardial, whereas only 14.3% were lateral, 20.6% epicardial, and 19.9% concentric. We conclude that cCTA can non-invasively study the effect of vascular hemodynamics, such as turbulent flow (bifurcations) and low shear stress (myocardial vessel wall), on the distribution and composition of atherosclerotic plaque deposition.

  19. Visualization of micro-capillaries using optical coherence tomography angiography with and without adaptive optics

    PubMed Central

    Salas, Matthias; Augustin, Marco; Ginner, Laurin; Kumar, Abhishek; Baumann, Bernhard; Leitgeb, Rainer; Drexler, Wolfgang; Prager, Sonja; Hafner, Julia; Schmidt-Erfurth, Ursula; Pircher, Michael

    2016-01-01

    The purpose of this work is to investigate the benefits of adaptive optics (AO) technology for optical coherence tomography angiography (OCTA). OCTA has shown great potential in non-invasively enhancing the contrast of vessels and small capillaries. Especially the capability of the technique to visualize capillaries with a lateral extension that is below the transverse resolution of the system opens unique opportunities in diagnosing retinal vascular diseases. However, there are some limitations of this technology such as shadowing and projection artifacts caused by overlying vasculature or the inability to determine the true extension of a vessel. Thus, the evaluation of the vascular structure and density based on OCTA alone can be misleading. In this paper we compare the performance of AO-OCT, AO-OCTA and OCTA for imaging retinal vasculature. The improved transverse resolution and the reduced depth of focus of AO-OCT and AO-OCTA greatly reduce shadowing artifacts allowing for a better differentiation and segmentation of different vasculature layers of the inner retina. The comparison is done on images recorded in healthy volunteers and in diabetic patients with distinct pathologies of the retinal microvasculature. PMID:28101412

  20. Coronary angiography after cardiac arrest: Rationale and design of the COACT trial.

    PubMed

    Lemkes, Jorrit S; Janssens, Gladys N; Straaten, Heleen M Oudemans-van; Elbers, Paul W; van der Hoeven, Nina W; Tijssen, Jan G P; Otterspoor, Luuk C; Voskuil, Michiel; van der Heijden, Joris J; Meuwissen, Martijn; Rijpstra, Tom A; Vlachojannis, Georgios J; van der Vleugel, Raoul M; Nieman, Koen; Jewbali, Lucia S D; Bleeker, Gabe B; Baak, Rémon; Beishuizen, Bert; Stoel, Martin G; van der Harst, Pim; Camaro, Cyril; Henriques, José P S; Vink, Maarten A; Gosselink, Marcel T M; Bosker, Hans A; Crijns, Harry J G M; van Royen, Niels

    2016-10-01

    Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI) after restoration of spontaneous circulation following cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains debated. We hypothesize that immediate CAG and PCI, if indicated, will improve 90-day survival in post-cardiac arrest patients without signs of STEMI. In a prospective, multicenter, randomized controlled clinical trial, 552 post-cardiac arrest patients with restoration of spontaneous circulation and without signs of STEMI will be randomized in a 1:1 fashion to immediate CAG and PCI (within 2 hours) versus initial deferral with CAG and PCI after neurological recovery. The primary end point of the study is 90-day survival. The secondary end points will include 90-day survival with good cerebral performance or minor/moderate disability, myocardial injury, duration of inotropic support, occurrence of acute kidney injury, need for renal replacement therapy, time to targeted temperature control, neurological status at intensive care unit discharge, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, and reasons for discontinuation of treatment. The COACT trial is a multicenter, randomized, controlled clinical study that will evaluate the effect of an immediate invasive coronary strategy in post-cardiac arrest patients without STEMI on 90-day survival. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Visualization of micro-capillaries using optical coherence tomography angiography with and without adaptive optics.

    PubMed

    Salas, Matthias; Augustin, Marco; Ginner, Laurin; Kumar, Abhishek; Baumann, Bernhard; Leitgeb, Rainer; Drexler, Wolfgang; Prager, Sonja; Hafner, Julia; Schmidt-Erfurth, Ursula; Pircher, Michael

    2017-01-01

    The purpose of this work is to investigate the benefits of adaptive optics (AO) technology for optical coherence tomography angiography (OCTA). OCTA has shown great potential in non-invasively enhancing the contrast of vessels and small capillaries. Especially the capability of the technique to visualize capillaries with a lateral extension that is below the transverse resolution of the system opens unique opportunities in diagnosing retinal vascular diseases. However, there are some limitations of this technology such as shadowing and projection artifacts caused by overlying vasculature or the inability to determine the true extension of a vessel. Thus, the evaluation of the vascular structure and density based on OCTA alone can be misleading. In this paper we compare the performance of AO-OCT, AO-OCTA and OCTA for imaging retinal vasculature. The improved transverse resolution and the reduced depth of focus of AO-OCT and AO-OCTA greatly reduce shadowing artifacts allowing for a better differentiation and segmentation of different vasculature layers of the inner retina. The comparison is done on images recorded in healthy volunteers and in diabetic patients with distinct pathologies of the retinal microvasculature.

  2. Comparison of adaptive optics scanning light ophthalmoscopic fluorescein angiography and offset pinhole imaging.

    PubMed

    Chui, Toco Y P; Dubow, Michael; Pinhas, Alexander; Shah, Nishit; Gan, Alexander; Weitz, Rishard; Sulai, Yusufu N; Dubra, Alfredo; Rosen, Richard B

    2014-04-01

    Recent advances to the adaptive optics scanning light ophthalmoscope (AOSLO) have enabled finer in vivo assessment of the human retinal microvasculature. AOSLO confocal reflectance imaging has been coupled with oral fluorescein angiography (FA), enabling simultaneous acquisition of structural and perfusion images. AOSLO offset pinhole (OP) imaging combined with motion contrast post-processing techniques, are able to create a similar set of structural and perfusion images without the use of exogenous contrast agent. In this study, we evaluate the similarities and differences of the structural and perfusion images obtained by either method, in healthy control subjects and in patients with retinal vasculopathy including hypertensive retinopathy, diabetic retinopathy, and retinal vein occlusion. Our results show that AOSLO OP motion contrast provides perfusion maps comparable to those obtained with AOSLO FA, while AOSLO OP reflectance images provide additional information such as vessel wall fine structure not as readily visible in AOSLO confocal reflectance images. AOSLO OP offers a non-invasive alternative to AOSLO FA without the need for any exogenous contrast agent.

  3. [Early invasive strategy no better than a selective invasive strategy for patients with non-ST-segment elevation acute coronary syndromes and elevated cardiac troponin T levels: long-term follow-up results of the ICTUS trial].

    PubMed

    Windhausen, F; Hirsch, A; Tijssen, J G P; Verheugt, F W A; Cornel, J H; de Winter, R J

    2008-02-23

    To determine whether routine coronary angiography followed by revascularisation where appropriate is better than initial drug treatment in patients with non-ST-segment elevation acute coronary syndromes (nSTE-ACS) and elevated troponin T concentrations. Multicentre randomised clinical trial (www.controlled-trials. com, number: SRCTN82153174). Patients with nSTE-ACS and elevated cardiac troponin were randomly assigned to an early invasive strategy or a selective invasive strategy. The early invasive strategy consisted of coronary angiography and revascularisation as indicated within 48 hours. The selective invasive strategy consisted of initial drug therapy; catheterisation was performed if the patient developed refractory angina or recurrent ischaemia. The main endpoints were a composite of death, recurrent myocardial infarction and rehospitalisation for anginal symptoms within 3 years, and all-cause mortality within 4 years. A total of 1200 patients were enrolled from 42 hospitals in the Netherlands. The in-hospital revascularisation rate was 76% in the early invasive group and 40% in the selective invasive group. After 3 years, the cumulative rate for the composite endpoint was 30.0% in the early invasive group and 26.0% in the selective invasive group (hazard ratio 1.21; 95% CI: 0.97-1.50; p = 0.09). The 4-year all-cause mortality rate was similar in both treatment groups (7.9% vs 7.7%; p = 0.62). Long-term follow-up of this trial suggests that an early invasive strategy is not better than a selective invasive strategy in patients with nSTE-ACS and elevated cardiac troponin. Therefore, implementation of either strategy is acceptable in these patients.

  4. Safety, efficacy, and cost of intraoperative indocyanine green angiography compared to intraoperative catheter angiography in cerebral aneurysm surgery.

    PubMed

    Hardesty, Douglas A; Thind, Harjot; Zabramski, Joseph M; Spetzler, Robert F; Nakaji, Peter

    2014-08-01

    Intraoperative angiography in cerebrovascular neurosurgery can drive the repositioning or addition of aneurysm clips. Our institution has switched from a strategy of intraoperative digital subtraction angiography (DSA) universally, to a strategy of indocyanine green (ICG) videoangiography with DSA on an as-needed basis. We retrospectively evaluated whether the rates of perioperative stroke, unexpected postoperative aneurysm residual, or parent vessel stenosis differed in 100 patients from each era (2002, "DSA era"; 2007, "ICG era"). The clip repositioning rate for neck residual or parent vessel stenosis did not differ significantly between the two eras. There were no differences in the rate of perioperative stroke or rate of false-negative studies. The per-patient cost of intraoperative imaging within the DSA era was significantly higher than in the ICG era. The replacement of routine intraoperative DSA with ICG videoangiography and selective intraoperative DSA in cerebrovascular aneurysm surgery is safe and effective.

  5. Matching of projection imaging and tomographic imaging: application to digital subtracted angiography (DSA) and magnetic resonance angiography (MRA)

    NASA Astrophysics Data System (ADS)

    Vermandel, Maximilien; Kulik, Carine; Leclerc, Xavier; Rousseau, Jean; Vasseur, Christian

    2002-05-01

    This study proposes a new method for matching vascular imaging modalities without the use of external frame or external landmarks. We first perform a 3D reconstruction of a piece of the cerebral vascular tree using Magnetic Resonance Angiography (MRA). Then, this structure is projected on the Digital Subtracted Angiography (DSA) images until its best position and orientation are found. As the 3D structure is known in the MRA referential, this method enables us to match information from DSA and MRA. The complete matching of all the DSA images in many incidences and the MRA set have been obtained. For the DSA images, the epipolar constraint has been verified between all the incidences. This new approach in medical imaging brings a very original method, making easier and more efficient visualization and quantification of vascular information.

  6. Factors influencing plant invasiveness

    Treesearch

    Yvette Ortega; Dean Pearson

    2009-01-01

    Invasiveness of spotted knapweed and biological control agents. Dean and Yvette are examining the influence of drought on the invasiveness of spotted knapweed (Centaurea maculosa) and its susceptibility to herbivory by biological control agents. In collaboration with the University of Montana and Forest Health Protection, researchers have constructed 150...

  7. Use of pulmonary angiography for suspected pulmonary embolism: influence of scintigraphic diagnosis

    SciTech Connect

    Sostman, H.D.; Ravin, C.E.; Sullivan, D.C.; Mills, S.R.; Glickman, M.G.; Dorfman, G.S.

    1982-10-01

    The use of pulmonary angiography as related to ventilation-perfusion scintigraphy was studied at two teaching hospitals in 600 patients clinically suspected of having pulmonary embolism, using a combined prospective-retrospective approach. Sixty patients underwent angiography, 30 in each institution. A minority of patients in each scintigraphic diagnostic category underwent angiography, but the scintigraphic diagnosis had a major impact on the frequency of requests for angiography. Inconclusive scintigraphy was the principal reason for requesting angiography, although nearly half of patients in whom scintigraphic assessment was indecisive were managed without further diagnostic measures. Few patients in the low-probability and high-probability scintigraphic categories received angiography. This study also indicates that a substantial patient selection bias may exist in series that correlate scintigraphic and angiographic results.

  8. Multislice CT Angiography in Renal Artery Stent Evaluation: Prospective Comparison with Intra-Arterial Digital Subtraction Angiography

    SciTech Connect

    Raza, Syed A.; Chughtai, Aamer R.; Wahba, Mona; Cowling, Mark G.; Taube, David; Wright, Andrew R.

    2004-01-15

    Purpose: To assess the role of multislice computed tomography angiography (MCTA) in the evaluation of renal artery stents, using intra-arterial digital subtraction angiography (DSA) as the gold standard. Methods: Twenty consecutive patients (15 men, 5 women) with 23 renal artery stents prospectively underwent both MCTA and DSA. Axial images, multiplanar reconstructions and maximum intensity projection images were used for diagnosis. The MCTA and DSA images were each interpreted without reference to the result of the other investigation. Results:The three cases of restenosis on DSA were detected correctly by MCTA; in 19 cases where MCTA showed a fully patent stent, the DSA was also negative. Sensitivity and negative predictive value (NPV) of MCTA were therefore 100%. In four cases, MCTA showed apparently minimal disease which was not shown on DSA. These cases are taken as false positive giving a specificity of 80% and a positive predictive value of 43%. Conclusion: The high sensitivity and NPV suggest MCTA may be useful as a noninvasive screen for renal artery stentrestenosis. MCTA detected mild disease in a few patients which was not confirmed on angiography.

  9. Analysis of target lesion length before coronary artery stenting using angiography and near-infrared spectroscopy versus angiography alone.

    PubMed

    Dixon, Simon R; Grines, Cindy L; Munir, Ahmad; Madder, Ryan D; Safian, Robert D; Hanzel, George S; Pica, Mark C; Goldstein, James A

    2012-01-01

    Lipid core plaque (LCP) can extend beyond the angiographic margins of a target lesion, potentially resulting in incomplete lesion coverage. We sought to compare the target lesion length using near-infrared spectroscopy (NIRS) combined with conventional coronary angiography versus angiography alone. NIRS was performed in 69 patients (75 lesions) undergoing native vessel percutaneous coronary intervention (LipiScan Coronary Imaging System). Chemograms were analyzed for the presence and location of LCP, either within or extending beyond, the angiographic margins of the target lesion. The target lesion length was measured by quantitative coronary angiography (QCA) and compared to the lesion length measured using QCA and NIRS. LCP was present in 50 target lesions (67%). In 42 lesions (84%), LCP was present only within the target lesion. In 8 lesions (16%) LCP extended beyond the angiographic margins of the lesion. Of these 8 lesions, 4 (8%) had LCP ≤5 mm from the margins, and 4 lesions (8%) had LCP >5 mm from the angiographic margins. The mean distance that the LCP extended beyond the angiographic lesion margin was 7 ± 4 mm (range 2 to 14). For these 8 lesions, the target lesion length with NIRS plus QCA was 28 ± 10 mm versus 21 ± 8 mm with QCA alone. In conclusion, patients undergoing coronary artery stenting could have LCP extending beyond the intended treatment margins as defined using QCA alone. This could have implications for stent length selection and optimal lesion coverage. Copyright © 2012. Published by Elsevier Inc.

  10. Persistent Primitive Trigeminal Artery That Mimics Persistent Primitive Otic Artery on Cerebral Angiography

    PubMed Central

    Lee, Kwangho; Park, Insung; Han, Jongwoo

    2016-01-01

    Persistent primitive trigeminal artery (PPTA) is the most common carotid-basilar anastomosis; on the other hand, persistent primitive otic artery (PPOA) is extremely rare. PPTA is often misdiagnosed as PPOA on cerebral angiography. We present a case of PPTA that mimicked PPOA on cerebral angiography. We further describe the utility of brain computed tomography angiography for differential diagnosis of PPTA from PPOA, together with a review of previous literature. PMID:27790403

  11. Impact of Early Invasive Approach on Outcomes of Patients With Acute Coronary Syndrome and Baseline Anemia: Analysis From the ACSIS Registry.

    PubMed

    Sudarsky, Doron; Sudarsky, Merav; Matezky, Shlomi; Goldenberg, Ilan; Farcas, Ateret; Nikolsky, Eugenia

    2015-08-01

    Anemia in patients with acute coronary syndromes (ACS) is strongly related to the increased risk of bleeding and mortality. Whether benefit of early invasive strategy exceeds the risk of bleeding in these patients is unknown. To assess impact of early coronary angiography on outcomes of patients with ACS and baseline anemia. Biennial Israeli ACS registry (ACSIS) prospectively collects data from all 26 public hospitals. The endpoints included rates of in-hospital major bleeding, as well as 30-day and 1-year mortality. Anemia at baseline was present in 1,464 of 5,600 patients with ACS (26.1%). Coronary angiography within index hospitalization was performed less frequently in patients with anemia (76.6% vs. 90.8%, P < 0.001). Non-performance of coronary angiography was associated with older age and higher prevalence of comorbidities. Among patients with anemia who underwent coronary angiography, the majority (95.5%) had obstructive coronary disease, of whom 77.8% were triaged to revascularization. Performance of coronary angiography was associated with significantly lower (P < 0.0001) rates of mortality at 30 days (5.7% vs. 15.6%) and at 1 year (11.9% vs. 34.1%). Major bleeding occurred with similar incidence in groups with and without coronary angiography (3.1% vs. 3.8%, respectively; P = 0.54). By multivariable analysis, performance of coronary angiography was an independent predictor of lower 1-year mortality (hazard ratio [95%CI] = 0.30 [0.21, 0.44]. In the setting of ACS, despite the presence of baseline anemia, early coronary angiography with subsequent revascularization, when indicated, was associated with improved clinical outcomes including 1-year mortality without significant increase in rates of major bleeding. © 2015, Wiley Periodicals, Inc.

  12. A Case Report of Thunderclap Headache with Sub-arachnoid Hemorrhage and Negative Angiography: A Review of Call-Fleming Syndrome and the use of Transcranial Dopplers in Predicting Morbidity

    PubMed Central

    Bittel, Brennen; Husmann, Kathrin

    2011-01-01

    Introduction: We present a case report in a patient with severe, recurrent, thunderclap with computed tomography (CT) evidence of subarachnoid blood and negative work-up for aneurysm. This case is an example of Call-Fleming syndrome with subarachnoid hemorrhage in which transcranial Doppler (TCD) was used for monitoring of cerebral vasoconstriction when angiography did not evidence vasoconstriction. We will review Call-Fleming syndrome and the utility of transcranial doppler imaging to assess cerebral vasoconstriction. Methods: A review of the current literature regarding diagnostics, treatment, and morbidity in Call-Fleming (reversible cerebral vasoconstriction syndrome) as well as a review of the data using transcranial color-coded sonography and transcranial doppler imaging to assess vasospasm in these cases. Results: The patient underwent computed tomography angiography (CTA) and venography (CTV), catheter angiography, lumbar puncture, and vasculitis work-up which were all negative. His magnetic resonance imaging (MRI) showed T2 weighted and fluid attenuation inversion recovery (FLAIR) hyper-intensities in the posterior frontal lobes as well as subarachnoid blood along bilateral occipital convexities. TCDs were obtained which showed elevated mean velocities. Conclusion: The use of bedside transcranial doppler imaging is a non-invasive means of assessing vasospasm in Call-Fleming syndrome; even in cases where angiography is negative. Determining the degree of vasospasm based on the data in subarachnoid hemorrhage, we are able to predict a patient’s risk of complications related to vasospasm including reversible posterior leukoencephalopathy and ischemic events. PMID:22518264

  13. 3.0 T versus 1.5 T MR angiography of the head and neck.

    PubMed

    DeLano, Mark C; DeMarco, J Kevin

    2006-05-01

    This article presents the advantages and challenges of MR angiography of the intracranial and extracranial cerebral vasculature at 3.0 T with comparative assessment to 1.5 T approaches. The physical basis for the superiority of 3.0 T MR angiography is discussed in the context of evolving technological capabilities afforded by the synergistic advent of higher field scanners, improved coil design, and parallel imaging. This review emphasizes 3.0 T issues related to noncontrast three-dimensional time of flight MR angiography of the intracranial circulation, contrast enhanced three-dimensional time of flight MR angiography of the extracranial cerebral vasculature, and carotid plaque characterization.

  14. Aqueous Angiography-Mediated Guidance of Trabecular Bypass Improves Angiographic Outflow in Human Enucleated Eyes.

    PubMed

    Huang, Alex S; Saraswathy, Sindhu; Dastiridou, Anna; Begian, Alan; Mohindroo, Chirayu; Tan, James C H; Francis, Brian A; Hinton, David R; Weinreb, Robert N

    2016-09-01

    To assess the ability of trabecular micro-bypass stents to improve aqueous humor outflow (AHO) in regions initially devoid of AHO as assessed by aqueous angiography. Enucleated human eyes (14 total from 7 males and 3 females [ages 52-84]) were obtained from an eye bank within 48 hours of death. Eyes were oriented by inferior oblique insertion, and aqueous angiography was performed with indocyanine green (ICG; 0.4%) or fluorescein (2.5%) at 10 mm Hg. With an angiographer, infrared and fluorescent images were acquired. Concurrent anterior segment optical coherence tomography (OCT) was performed, and fixable fluorescent dextrans were introduced into the eye for histologic analysis of angiographically positive and negative areas. Experimentally, some eyes (n = 11) first received ICG aqueous angiography to determine angiographic patterns. These eyes then underwent trabecular micro-bypass sham or stent placement in regions initially devoid of angiographic signal. This was followed by fluorescein aqueous angiography to query the effects. Aqueous angiography in human eyes yielded high-quality images with segmental patterns. Distally, angiographically positive but not negative areas demonstrated intrascleral lumens on OCT images. Aqueous angiography with fluorescent dextrans led to their trapping in AHO pathways. Trabecular bypass but not sham in regions initially devoid of ICG aqueous angiography led to increased aqueous angiography as assessed by fluorescein (P = 0.043). Using sequential aqueous angiography in an enucleated human eye model system, regions initially without angiographic flow or signal could be recruited for AHO using a trabecular bypass stent.

  15. Does pelvic hematoma on admission computed tomography predict active bleeding at angiography for pelvic fracture?

    PubMed

    Brown, Carlos V R; Kasotakis, George; Wilcox, Alison; Rhee, Peter; Salim, Ali; Demetriades, Demetrios

    2005-09-01

    Pelvic angiography plays an increasing role in the management of pelvic fractures (PFs). Little has been written regarding the size of pelvic hematoma on admission computed tomography (CT) and how it relates to angiography results after PF. This is a retrospective review of trauma patients with PF who underwent an admission abdominal/pelvic CT scan and pelvic angiography from 2001 to 2003. CT pelvic hematoma was measured and classified as minimal or significant based on hematoma dimensions. Presence of a contrast blush on CT scan was also documented. Thirty-seven patients underwent an admission CT scan and went on to pelvic angiography. Of the 22 patients with significant pelvic hematoma, 73 per cent (n = 16) had bleeding at angiography. Fifteen patients had minimal pelvic hematoma, with 67 per cent (n = 10) showing active bleeding at angiography. In addition, five of six patients (83%) with no pelvic hematoma had active bleeding at angiography. Six patients had a blush on CT scan, with five of these (83%) having a positive angiogram. But, 22 of 31 (71%) patients with no blush on CT scan had bleeding at angiography. The absence of a pelvic hematoma or contrast blush should not alter indications for pelvic angiography, as they do not reliably exclude active pelvic bleeding.

  16. Detection of carotid artery stenosis using histological specimens: a comparison of CT angiography, magnetic resonance angiography, digital subtraction angiography and Doppler ultrasonography.

    PubMed

    Netuka, David; Belšán, Tomáš; Broulíková, Karolina; Mandys, Václav; Charvát, František; Malík, Josef; Coufalová, Lucie; Bradáč, Ondřej; Ostrý, Svatopluk; Beneš, Vladimír

    2016-08-01

    Carotid endarterectomy (CEA) is accepted as a primary modality to treat carotid stenosis. The accuracy of measuring carotid stenosis is important for indication of the CEA procedure. Different diagnostic tools have been developed and used in the past 2 decades for the diagnosis of carotid stenosis. Only a few studies, however, have focused on the comparison of different diagnostic tools to histological findings of carotid plaque. Patients with internal carotid artery (ICA) stenosis were investigated primarily by computed tomography angiography (CTA). Digital subtraction angiography (DSA), Doppler ultrasonography (DUS) and magnetic resonance angiography (MRA) were performed as well. Atherosclerotic plaque specimens were transversally cut into smaller segments and histologically processed. The slides were scanned and specimens showing maximal stenosis were determined; the minimal diameter and the diameter of the whole plaque were measured. High quality histological specimen and histological measurement was considered to be the prerequisite for inclusion into the analysis. The preoperative findings were compared with histological measurement. CTA and histological measurements were obtained from 152 patients. DSA measurements were available in 138 of these cases, MRA in 107 and DUS in 88. A comparison between preoperative and histological findings was performed. In addition, correlation coefficients were computed and tested. A significant correlation was found for each of the diagnostic procedures. The strongest correlation coefficient and the best allocation of stenosis into clinical significant groups (<50 %, 50-69 %, ≥70 %) was observed for CTA. Mean differences in the whole cohort between preoperative and histological measurements were as follows: CTA underestimated histological measurement by 2.4 % (based on European Carotid Surgery Trial [ECST] methodology) and 11.9 % (based on North American Symptomatic Carotid Endarterectomy Trial [NASCET] methodology

  17. Indocyanine Green Angiography-Guided Focal Laser Photocoagulation for Diabetic Macular Edema.

    PubMed

    Ogura, Shuntaro; Yasukawa, Tsutomu; Kato, Aki; Kuwayama, Soichiro; Hamada, Satoshi; Hirano, Yoshio; Uemura, Akiyoshi; Yoshida, Munenori; Ogura, Yuichiro

    2015-01-01

    To evaluate the usefulness of indocyanine green angiography (ICGA) to detect leaking spots and the effectiveness of ICGA-guided focal laser photocoagulation in eyes with diabetic macular edema (DME). Ten eyes (8 patients) with diffuse DME diagnosed using fluorescein angiography (FA) and refractory to a sub-Tenon injection of triamcinolone acetonide (STTA), grid laser photocoagulation, or both were enrolled. FA and ICGA were performed using the Heidelberg Retina Angiograph 2. Hyperfluorescent spots on early-phase FA and on early- and late-phase ICGA were superimposed onto the macular thickness map measured by optical coherence tomography (OCT) and counted to calculate the spot density in the area with or without macular edema (ME). ICGA-guided focal laser photocoagulation was carried out. In 7 eyes, STTA was simultaneously performed. The central macular thickness (CRT) and macular volume (MV) were measured by OCT. On early-phase FA, 4.8 ± 2.3 and 2.3 ± 1.5 hyperfluorescent spots/disk area were observed inside and outside the ME, respectively. In contrast, the spot density was significantly decreased to 1.8 ± 0.9 inside the ME and was only 0.3 ± 0.4 outside the ME on late-phase ICGA (p < 0.01). The mean follow-up period after ICGA-guided photocoagulation was 19.0 months. The mean best-corrected visual acuity improved significantly from 0.77 ± 0.34 logarithm of the minimum angle of resolution at baseline to 0.52 ± 0.37 at the last visit (p < 0.01). Both CRT and MV significantly decreased (p < 0.01). Recurrence of DME was observed in 4 eyes: 3 eyes were treatable only with STTA and 1 required additional ICGA-guided laser photocoagulation. ICGA may be useful to detect leaking spots responsible for DME, enabling less invasive focal laser photocoagulation even in some of the eyes with diffuse DME. © 2015 S. Karger AG, Basel.

  18. A study of noninvasive fractional flow reserve derived from a simplified method based on coronary computed tomography angiography in suspected coronary artery disease.

    PubMed

    Shi, Changzheng; Zhang, Dong; Cao, Kunlin; Zhang, Tao; Luo, Liangping; Liu, Xin; Zhang, Heye

    2017-04-14

    The invasive fractional flow reserve has been considered the gold standard for identifying ischaemia-related stenosis in patients with suspected coronary artery disease. Determining non-invasive FFR based on coronary computed tomographic angiography datasets using computational fluid dynamics tends to be a demanding process. Therefore, the diagnostic performance of a simplified method for the calculation of FFRCTA requires further evaluation. The aim of this study was to investigate the diagnostic performance of FFRCTA calculated based on a simplified method by referring to the invasive FFR in patient-specific coronary arteries and clinical decision-making. Twenty-nine subjects included in this study underwent CCTA before undergoing clinically indicated invasive coronary angiography for suspected coronary artery disease. Pulsatile flow simulation and a novel boundary condition were used to obtain FFRCTA based on the CCTA datasets. The Pearson correlation, Bland-Altman plots and the diagnostic performance of FFRCTA and CCTA stenosis were analyzed by comparison to the invasive FFR reference standard. Ischaemia was defined as an FFR or FFRCTA ≤0.80, and anatomically obstructive CAD was defined as a CCTA stenosis >50%. FFRCTA and invasive FFR were well correlated (r = 0.742, P = 0.001). Slight systematic underestimation was found in FFRCTA (mean difference 0.03, standard deviation 0.05, P = 0.001). The area under the receiver-operating characteristic curve was 0.93 for FFRCTA and 0.75 for CCTA on a per-vessel basis. Per-patient accuracy, sensitivity and specificity were 79.3, 93.7 and 61.5%, respectively, for FFRCTA and 62.1, 87.5 and 30.7%, respectively, for CCTA. Per-vessel accuracy, sensitivity and specificity were 80.6, 94.1 and 68.4%, respectively, for FFRCTA and 61.6, 88.2 and 36.8%, respectively, for CCTA. FFRCTA derived from pulsatile simulation with a simplified novel boundary condition was in good agreement with invasive FFR and showed better

  19. Quantification of fluorescence angiography in a porcine model.

    PubMed

    Nerup, Nikolaj; Andersen, Helene Schou; Ambrus, Rikard; Strandby, Rune Broni; Svendsen, Morten Bo Søndergaard; Madsen, Mads Holst; Svendsen, Lars Bo; Achiam, Michael Patrick

    2017-06-01

    There is no consensus on how to quantify indocyanine green (ICG) fluorescence angiography. The aim of the present study was to establish and gather validity evidence for a method of quantifying fluorescence angiography, to assess organ perfusion. Laparotomy was performed on seven pigs, with two regions of interest (ROIs) marked. ICG and neutron-activated microspheres were administered and the stomach was illuminated in the near-infrared range, parallel to continuous recording of fluorescence signal. Tissue samples from the ROIs were sent for quantification of microspheres to calculate the regional blood flow. A software system was developed to assess the fluorescent recordings quantitatively, and each quantitative parameter was compared with the regional blood flow. The parameter with the strongest correlation was then compared with results from an independently developed algorithm, to evaluate reproducibility. A strong correlation was found between regional blood flow and the slope of the fluorescence curves (ROI I: Pearson r = 0.97, p < 0.001; ROI II: 0.96, p < 0.001) as the normalized slope (ROI I: Pearson r = 0.92, p = 0.004; ROI II: r = 0.96, p = 0.001). There was acceptable correlation of the slope of the curve between two independently developed algorithms (ROI I+II: Pearson r = 0.83, p < 0.001), and good resemblance was found with the Bland-Altman method, with no proportional bias. Perfusion assessment with quantitative indocyanine green fluorescence angiography is not only feasible but easy to perform with commercially available equipment and readily accessible software.

  20. Dual-Energy CT Angiography in Peripheral Arterial Occlusive Disease

    SciTech Connect

    Brockmann, Carolin Jochum, Susanne; Sadick, Maliha; Huck, Kurt; Ziegler, Peter; Fink, Christian; Schoenberg, Stefan O.; Diehl, Steffen J.

    2009-07-15

    We sought to study the accuracy of dual-energy computed tomographic angiography (DE-CTA) for the assessment of symptomatic peripheral arterial occlusive disease of the lower extremity by using the dual-energy bone removal technique compared with a commercially available conventional bone removal tool. Twenty patients underwent selective digital subtraction angiography and DE-CTA of the pelvis and lower extremities. CTA data were postprocessed with two different applications: conventional bone removal and dual-energy bone removal. All data were reconstructed and evaluated as 3D maximum-intensity projections. Time requirements for reconstruction were documented. Sensitivity, specificity, accuracy, and concordance of DE-CTA regarding degree of stenosis and vessel wall calcification were calculated. A total of 359 vascular segments were analyzed. Compared with digital subtraction angiography, sensitivity, specificity, and accuracy, respectively, of CTA was 97.2%, 94.1%, and 94.7% by the dual-energy bone removal technique. The conventional bone removal tool delivered a sensitivity of 77.1%, a specificity of 70.7%, and an accuracy of 72.0%. Best results for both postprocessing methods were achieved in the vascular segments of the upper leg. In severely calcified segments, sensitivity, specificity, and accuracy stayed above 90% by the dual-energy bone removal technique, whereas the conventional bone removal technique showed a substantial decrease of sensitivity, specificity, and accuracy. DE-CTA is a feasible and accurate diagnostic method in the assessment of symptomatic peripheral arterial occlusive disease. Results obtained by DE-CTA are superior to the conventional bone removal technique and less dependent on vessel wall calcifications.

  1. Predictors of Technical Failure in Transradial Coronary Angiography and Intervention.

    PubMed

    Tröbs, Monique; Achenbach, Stephan; Plank, Pia Maria; Marwan, Mohamed; Röther, Jens; Klinghammer, Lutz; Blachutzik, Florian; Schlundt, Christian

    2017-07-31

    Transradial access for coronary angiography and intervention is preferred over the femoral approach but can be technically challenging. Identification of predictors of transradial access failure is important, especially in the context of acute coronary syndromes. We therefore retrospectively analyzed 13,095 consecutive patients (66 ± 12 years, 64% male) in whom transradial access was attempted for coronary angiography or intervention to identify predictors of transradial access failure. Angiograms and patient files were systematically reviewed to analyze patient characteristics associated with failure. Transradial access failure rate was 6.8% (909 of 13,095). Patients with transradial access failure were more frequently female (9.5% vs 5.5%; p <0.001), significantly older (68 ± 12 vs 66 ± 12 years, p <0.001), and had a smaller body surface area (1.89 ± 0.21 vs 1.94 ± 0.2 m(2); p <0.001). Transradial failure was not significantly more frequent in ST-elevation myocardial infarction versus other patients (8.1% vs 6.9%, p = 0.195). After multivariable adjustment, only female sex (odds ratio [OR] 1.44, p <0.001), higher patient age (OR 1.01/year, p = 0.002), and lower height (OR 0.98/cm, p = 0.004) independently predicted transradial access failure. In conclusion, female sex, higher age, and smaller height independently predict transradial access failure in coronary angiography and intervention. Failure rate in ST-elevation myocardial infarction is not significantly increased. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Prostate resection - minimally invasive

    MedlinePlus

    ... invasive - discharge Transurethral resection of the prostate - discharge Review Date 6/29/2015 Updated by: Jennifer Sobol, ... the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by ...

  3. Invasive Prenatal Testing

    PubMed Central

    Hunter, A.

    1988-01-01

    Invasive prenatal diagnosis is a major diagnostic tool which is used in modern obstetrical care. A synopsis of these techniques is provided to assist the family practitioner in providing this information to his patients. PMID:21253097

  4. Non-enhanced, ECG-gated MR angiography of the pedal vasculature: comparison with contrast-enhanced MR angiography and digital subtraction angiography in peripheral arterial occlusive disease.

    PubMed

    Schubert, Tilman; Takes, Martin; Aschwanden, Markus; Klarhoefer, Markus; Haas, Tanja; Jacob, Augustinus L; Liu, David; Gutzeit, Andreas; Kos, Sebastian

    2016-08-01

    This study was conducted in order to compare a high resolution, non-contrast-enhanced MRA (NATIVE SPACE, NE-MRA) of the pedal vasculature with contrast-enhanced MRA (CE-MRA) and digital subtraction angiography (DSA) in patients with peripheral arterial occlusive disease (PAOD). The prospective study consists of 20 PAOD patients. All patients underwent percutaneous transluminal angioplasty or stenting and received MR angiographies the following day. With CE-MRA, 75.7 % of vessel segments showed good, 16.4 % suboptimal and 7.9 % not usable image quality. With NE-MRA, 64.6 % showed good, 18.6 % suboptimal and 16.8 % not usable image quality. CE-MRA showed a sensitivity and negative predictive value of 90 %/95 % regarding significant stenosis (greater than 50 %), and specificity and positive predictive value were 88 %/77 %. Accordingly, sensitivity and negative predictive value for the NE-MRA were 96 %/97 % and specificity and positive predictive value were 80 %/69 % for stenoses greater than 50 %. The applied NE-MRA technique achieves high diagnostic accuracy even in very small distal arteries of the foot. However, the rate of non-diagnostic vessel segments is considerably higher for NE-MRA than for CE-MRA. NE-MRA is a valuable alternative to CE-MRA in selected patients. • Comparison of non-enhanced MRA with contrast-enhanced MRA and DSA as gold standard. • High resolution MRA at 3 T for the depiction of small pedal vessels. • Evaluation of high resolution non-enhanced MRA in PAOD patients.

  5. 64-Slice Computed Tomographic Angiography for the Diagnosis of Intermediate Risk Coronary Artery Disease

    PubMed Central

    2010-01-01

    Executive Summary In July 2009, the Medical Advisory Secretariat (MAS) began work on Non-Invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease (CAD), an evidence-based review of the literature surrounding different cardiac imaging modalities to ensure that appropriate technologies are accessed by patients suspected of having CAD. This project came about when the Health Services Branch at the Ministry of Health and Long-Term Care asked MAS to provide an evidentiary platform on effectiveness and cost-effectiveness of non-invasive cardiac imaging modalities. After an initial review of the strategy and consultation with experts, MAS identified five key non-invasive cardiac imaging technologies for the diagnosis of CAD. Evidence-based analyses have been prepared for each of these five imaging modalities: cardiac magnetic resonance imaging, single photon emission computed tomography, 64-slice computed tomographic angiography, stress echocardiography, and stress echocardiography with contrast. For each technology, an economic analysis was also completed (where appropriate). A summary decision analytic model was then developed to encapsulate the data from each of these reports (available on the OHTAC and MAS website). The Non-Invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease series is made up of the following reports, which can be publicly accessed at the MAS website at: www.health.gov.on.ca/mas or at www.health.gov.on.ca/english/providers/program/mas/mas_about.html Single Photon Emission Computed Tomography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Stress Echocardiography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Stress Echocardiography with Contrast for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis 64-Slice Computed Tomographic Angiography for the Diagnosis of Coronary Artery Disease: An Evidence-Based Analysis Cardiac

  6. Multidetector Computed Tomographic Angiography (MDCTA) for Penetrating Neck Injuries.

    PubMed

    Pasley, Jason; Berg, Regan J; Inaba, Kenji

    2012-07-01

    Evaluation of patients after penetrating neck injury has evolved over time. Previously, location of injury and symptoms were used to determine management. The contemporary management of penetrating neck injuries relies on physical examination. Patients with hard signs of vascular or aerodigestive tract injury require immediate operation, regardless of location of injury. Those with no signs can be observed. For the remainder with soft signs, multidetector computed tomographic angiography (MDCTA) is a highly sensitive and specific screening modality for evaluating the vasculature and aerodigestive structures in the neck. Utilizing MDCTA, the patient can be safely directed towards operative intervention, observation, or further investigation.

  7. Multidetector Computed Tomographic Angiography (MDCTA) for Penetrating Neck Injuries

    PubMed Central

    Pasley, Jason; Berg, Regan J.; Inaba, Kenji

    2012-01-01

    Evaluation of patients after penetrating neck injury has evolved over time. Previously, location of injury and symptoms were used to determine management. The contemporary management of penetrating neck injuries relies on physical examination. Patients with hard signs of vascular or aerodigestive tract injury require immediate operation, regardless of location of injury. Those with no signs can be observed. For the remainder with soft signs, multidetector computed tomographic angiography (MDCTA) is a highly sensitive and specific screening modality for evaluating the vasculature and aerodigestive structures in the neck. Utilizing MDCTA, the patient can be safely directed towards operative intervention, observation, or further investigation. PMID:23908840

  8. Microscope integrated indocyanine green video-angiography in cerebrovascular surgery.

    PubMed

    Dashti, Reza; Laakso, Aki; Niemelä, Mika; Porras, Matti; Hernesniemi, Juha

    2011-01-01

    Microscope integrated indocyanine green video-angiography (ICG-VA) is a new technique for intraoperative assessment of blood flow that has been recently applied to the field of Neurosurgery. ICG-VA is known as a simple and practical method of blood flow assessment with acceptable reliability. Real time information obtained under magnification of operating microscope has many potential applications in the microneurosurgical management of vascular lesions. This review is based on institutional experience with use of ICG-VA during surgery of intracranial aneurysms, AVMs and other vascular lesions at the Department of Neurosurgery at Helsinki University Central Hospital.

  9. Fluorescein angiography: insight and serendipity a half century ago.

    PubMed

    Marmor, Michael F; Ravin, James G

    2011-07-01

    It has been 50 years since fluorescein angiography was developed as a clinical procedure by 2 medical students at Indiana University. The story of its discovery and the recognition of its value to ophthalmology involve a combination of insight and serendipity. Fluorescein had been in use clinically for more than half a century, but it took a pulmonary medicine laboratory to provide the stimulus for the development of flash and barrier filters that would make vascular photography practical. The first article was rejected by the ophthalmology literature, but several clinics heard about it and soon documented the enormous diagnostic value of the procedure.

  10. Congenital left ventricular aneurysm diagnosed by spiral CT angiography

    SciTech Connect

    Beregi, J.P.; Coulette, J.M.; Ducloux, G.

    1996-05-01

    We report a rare case of congenital left ventricular aneurysm, diagnosed by spiral CT angiography. Despite 1 s time acquisition, spiral CT, with adequate acquisition parameters and bolus injection of contrast medium, produced sufficiently good images to permit visualization of the aneurysm. Subsequently, reconstructions (shaded surface display and multiplanar reformation) were performed to demonstrate the relationship of the aneurysm with the remainder of the left ventricle, the wide neck of the aneurysm, and the absence of contractility, therein permitting differentiation from a congenital diverticulum. 6 refs., 3 figs.

  11. Quantitative Digital Subtraction Angiography in Pediatric Moyamoya Disease

    PubMed Central

    2015-01-01

    Moyamoya disease is a unique cerebrovascular disorder characterized by idiopathic progressive stenosis at the terminal portion of the internal carotid artery (ICA) and fine vascular network. The aim of this review is to present the clinical application of quantitative digital subtraction angiography (QDSA) in pediatric moyamoya disease. Using conventional angiographic data and postprocessing software, QDSA provides time-contrast intensity curves and then displays the peak time (Tmax) and area under the curve (AUC). These parameters of QDSA can be used as surrogate markers for the hemodynamic evaluation of disease severity and quantification of postoperative neovascularization in moyamoya disease. PMID:26180611

  12. Transient Global Amnesia After Cerebral Angiography With Iomeprol

    PubMed Central

    Tiu, Cristina; Terecoasă, Elena Oana; Grecu, Nicolae; Dorobăţ, Bogdan; Marinescu, Andreea Nicoleta; Băjenaru, Ovidiu Alexandru

    2016-01-01

    Abstract Transient global amnesia is now considered a very rare complication of cerebral angiography. Various etiological mechanisms have been suggested to account for this complication, but no consensus has been reached yet. This case report documents one of the few reported cases of cerebral angiography-related transient global amnesia associated with magnetic resonance imaging (MRI) evidence of unilateral hippocampal ischemia, most probably as a consequence of a transient reduction in regional hippocampal blood flow. However, the possibility of a direct neurotoxic effect of the nonionic contrast media Iomeprol on the Cornu ammonis – field 1 neurons cannot be firmly ruled out. We describe the case of a 54-year-old woman admitted to our department for left upper limb weakness with acute onset 8 days before. The brain computed tomography (CT) scan performed at admission revealed subacute ischemic lesions in the right watershed superficial territories and a right thalamic lacunar infarct. Diagnostic digital subtraction cerebral angiography was performed 4 days after admission with the nonionic contrast media Iomeprol. A few minutes after completion of the procedure, the patient developed symptoms suggestive for transient global amnesia. The brain MRI performed 22 hours after the onset of symptoms demonstrated increased signal within the lateral part of the right hippocampus on the diffusion-weighted imaging (DWI) sequences, associated with a corresponding reduction in the apparent diffusion coefficient (ADC) and increased signal on the fluid-attenuated inversion recovery (FLAIR) sequences, consistent with acute hippocampal ischemia and several T2/FLAIR hyperintensities in the right watershed superficial territories and in the right thalamus, corresponding to the lesions already identified on the CT scan performed at admission. A follow-up MRI, performed 2 months later, demonstrated the disappearance of the increased signal within the right hippocampus on the DWI

  13. Peripheral MR Angiography of Klippel-Trenaunay Syndrome

    SciTech Connect

    Fontana, Alessandro; Olivetti, Lucio

    2004-09-15

    Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disease of unknown etiology that affects one or more limbs. It is characterized clinically by three physical findings (the so-called triad): port-wine stain hemangioma, hypertrophy of the bony and/or soft tissue, and varicose veins. A review of the medical literature in 1999 revealed about 1,000 case studies. We present here the case of a patient with clinical diagnosis of KTS studied using peripheral magnetic resonance angiography.

  14. Diagnostic accuracy of cerebral angiography and computerized transaxial tomography.

    PubMed Central

    Strasberg, Z.; Molot, M. J.; Kapur, P.; Tuttle, R. J.

    1977-01-01

    Computer tomography (CT) of the brain has become widely accepted as an accurate method of studying a variety of intracranial diseases. In a prospective controlled study one group of radiologists interpreted cerebral angiograms and another interpreted CT studies undertaken in the same patients. The overall rates of diagnostic accuracy were similar (81 and 84% for angiography and CT, respectively), albeit less than reported in the literature, and thus support the contention that CT scanning should be available as the initial neuroradiologic examination whenever possible. Images FIG. 1A FIG. 1B FIG. 2A FIG. 2B FIG. 3 PMID:861866

  15. Conventional Coronary Angiography Induced Takotsubo Cardiomyopathy Complicated with Cardiac Tamponade

    PubMed Central

    Kang, Min Gyu; Kim, Kye-Hwan; Koh, Jin-Sin; Jeong, Young-Hoon; Hwang, Jin-Yong

    2017-01-01

    Takotsubo cardiomyopathy (TCM) is a transient left ventricular dysfunction that typically occurs after emotional or physical stress. TCM has a benign prognosis and serious complications are uncommon. However, though very rarely reported, cardiac tamponade has occurred on some occasions. We hereby report the case of a 70-year-old woman who underwent coronary angiography with an ergonovine provocation test to evaluate recurrent chest pain and was readmitted 7 days later presenting with TCM, followed by left ventricular outflow tract obstruction and cardiac tamponade.

  16. Stress reduction through music in patients undergoing cerebral angiography.

    PubMed

    Schneider, N; Schedlowski, M; Schürmeyer, T H; Becker, H

    2001-06-01

    We studied the influence of music on stress reaction of patients during cerebral angiography. We randomised 30 patients to a music or a control group. We measured stress hormones, blood pressure, heart rate and psychological parameters. Patients examined without music showed rising levels of cortisol in plasma, indicating high stress levels, while cortisol in patients examined with music remained stable. Systolic blood pressure was significantly lower listening to music. Patients with a high level of fear did appear to benefit particularly from the music.

  17. Digital subtraction angiography: principles and pitfalls of image improvement techniques.

    PubMed

    Levin, D C; Schapiro, R M; Boxt, L M; Dunham, L; Harrington, D P; Ergun, D L

    1984-09-01

    The technology of imaging methods in digital subtraction angiography (DSA) is discussed in detail. Areas covered include function of the video camera in both interlaced and sequential scan modes, digitization by the analog-to-digital converter, logarithmic signal processing, dose rates, and acquisition of images using frame integration and pulsed-sequential techniques. Also discussed are various methods of improving image content and quality by both hardware and software modifications. These include the development of larger image intensifiers, larger matrices, video camera improvements, reregistration, hybrid subtraction, matched filtering, recursive filtering, DSA tomography, and edge enhancement.

  18. Automated detection of dilated capillaries on optical coherence tomography angiography

    PubMed Central

    Dongye, Changlei; Zhang, Miao; Hwang, Thomas S.; Wang, Jie; Gao, Simon S.; Liu, Liang; Huang, David; Wilson, David J.; Jia, Yali

    2017-01-01

    Automated detection and grading of angiographic high-risk features in diabetic retinopathy can potentially enhance screening and clinical care. We have previously identified capillary dilation in angiograms of the deep plexus in optical coherence tomography angiography as a feature associated with severe diabetic retinopathy. In this study, we present an automated algorithm that uses hybrid contrast to distinguish angiograms with dilated capillaries from healthy controls and then applies saliency measurement to map the extent of the dilated capillary networks. The proposed algorithm agreed well with human grading. PMID:28271005

  19. Choriocapillaris evaluation in choroideremia using optical coherence tomography angiography

    PubMed Central

    Gao, Simon S.; Patel, Rachel C.; Jain, Nieraj; Zhang, Miao; Weleber, Richard G.; Huang, David; Pennesi, Mark E.; Jia, Yali

    2016-01-01

    The choriocapillaris plays an important role in supporting the metabolic demands of the retina. Studies of the choriocapillaris in disease states with optical coherence tomography angiography (OCTA) have proven insightful. However, image artifacts complicate the identification and quantification of the choriocapillaris in degenerative diseases such as choroideremia. Here, we demonstrate a supervised machine learning approach to detect intact choriocapillaris based on training with results from an expert grader. We trained a random forest classifier to evaluate en face structural OCT and OCTA information along with spatial image features. Evaluation of the trained classifier using previously unseen data showed good agreement with manual grading. PMID:28101400

  20. Application of image processing techniques to gamma-angiography.

    PubMed

    Romary, D; Lerallut, J F; Fontenier, G

    1985-10-01

    Different image processing techniques have been tested and compared on data derived from gamma-angiography images to detect the boundary of the left ventricle. The method involves a preprocessing step, followed by the edge detection itself. The best preprocessing is a nonlinear "variant" filtering, where each pixel is replaced by the average of the 3 X 3 neighborhood having the smallest variance. The edge detector giving the best contour is a Sobel operator. A second-order high-pass Butterworth filter also provides a good segmentation.

  1. Minimally invasive stomas.

    PubMed

    Hellinger, Michael D; Al Haddad, Abdullah

    2008-02-01

    Traditionally, stoma creation and end stoma reversal have been performed via a laparotomy incision. However, in many situations, stoma construction may be safely performed in a minimally invasive nature. This may include a trephine, laparoscopic, or combined approach. Furthermore, Hartmann's colostomy reversal, a procedure traditionally associated with substantial morbidity, may also be performed laparoscopically. The authors briefly review patient selection, preparation, and indications, and focus primarily on surgical techniques and results of minimally invasive stoma creation and Hartmann's reversal.

  2. Minimally invasive lumbar foraminotomy.

    PubMed

    Deutsch, Harel

    2013-07-01

    Lumbar radiculopathy is a common problem. Nerve root compression can occur at different places along a nerve root's course including in the foramina. Minimal invasive approaches allow easier exposure of the lateral foramina and decompression of the nerve root in the foramina. This video demonstrates a minimally invasive approach to decompress the lumbar nerve root in the foramina with a lateral to medial decompression. The video can be found here: http://youtu.be/jqa61HSpzIA.

  3. Parasites and marine invasions

    USGS Publications Warehouse

    Torchin, M.E.; Lafferty, K.D.; Kuris, A.M.

    2002-01-01

    Introduced marine species are a major environmental and economic problem. The rate of these biological invasions has substantially increased in recent years due to the globalization of the world's economies. The damage caused by invasive species is often a result of the higher densities and larger sizes they attain compared to where they are native. A prominent hypothesis explaining the success of introduced species is that they are relatively free of the effects of natural enemies. Most notably, they may encounter fewer parasites in their introduced range compared to their native range. Parasites are ubiquitous and pervasive in marine systems, yet their role in marine invasions is relatively unexplored. Although data on parasites of marine organisms exist, the extent to which parasites can mediate marine invasions, or the extent to which invasive parasites and pathogens are responsible for infecting or potentially decimating native marine species have not been examined. In this review, we present a theoretical framework to model invasion success and examine the evidence for a relationship between parasite presence and the success of introduced marine species. For this, we compare the prevalence and species richness of parasites in several introduced populations of marine species with populations where they are native. We also discuss the potential impacts of introduced marine parasites on native ecosystems.

  4. Evaluation of Coronary Artery Disease Using Myocardial Elastography with Diverging Wave Imaging: Validation against Myocardial Perfusion Imaging and Coronary Angiography.

    PubMed

    Grondin, Julien; Waase, Marc; Gambhir, Alok; Bunting, Ethan; Sayseng, Vincent; Konofagou, Elisa E

    2017-02-28

    Myocardial elastography (ME) is an ultrasound-based technique that can image 2-D myocardial strains. The objectives of this study were to illustrate that 2-D myocardial strains can be imaged with diverging wave imaging and differ, on average, between normal and coronary artery disease (CAD) patients. In this study, 66 patients with symptoms of CAD were imaged with myocardial elastography before a nuclear stress test or an invasive coronary angiography. Radial cumulative strains were estimated in all patients. The end-systolic radial strain in the total cross section of the myocardium was significantly higher in normal patients (17.9 ± 8.7%) than in patients with reversible perfusion defect (6.2 ± 9.3%, p < 0.001) and patients with significant (-0.9 ± 7.4%, p < 0.001) and non-significant (3.7 ± 5.7%, p < 0.01) lesions. End-systolic radial strain in the left anterior descending, left circumflex and right coronary artery territory was found to be significantly higher in normal patients than in CAD patients. These preliminary findings indicate that end-systolic radial strain measured with ME is higher on average in healthy persons than in CAD patients and that ME has the potential to be used for non-invasive, radiation-free early detection of CAD.

  5. Animal experiments by K-edge subtraction angiography by using SR (abstract)

    NASA Astrophysics Data System (ADS)

    Anno, I.; Akisada, M.; Takeda, T.; Sugishita, Y.; Kakihana, M.; Ohtsuka, S.; Nishimura, K.; Hasegawa, S.; Takenaka, E.; Hyodo, K.; Ando, M.

    1989-07-01

    Ischemic heart disease is one of the most popular and lethal diseases for aged peoples in the world, and is usually diagnosed by transarterial selective coronary arteriography. However, it is rather invasive and somewhat dangerous, so that the selective coronary arteriography is not feasible for prospective screening of coronary occlusive heart disease. Conventional digital subtraction angiography (DSA) is widely known as a relatively noninvasive and useful technique is making a diagnosis of arterial occlusive disease, especially in making the diagnosis of ischemic heart disease. Conventional intravenous subtraction angiography by temporal subtraction, however, has several problems when applying to the moving objects. Digital subtraction method using high-speed switching above and below the K edge could be the ideal approach to this solution. We intend to make a synchrotron radiation digital K-edge subtraction angiography in the above policy, and to apply it to the human coronary ischemic disease on an outpatient basis. The principles and experimental systems have already been described in detail by our coworkers. Our prototype experimental system is situated at the AR (accumulation ring) for TRISTAN project of high energy physics. The available beam size is 70 mm by 120 mm. The electron energy of AR is 6.5 GeV and average beam current is approximately 10 mA. This paper will show the animal experiments of our K-edge subtraction system, and discuss some problems and technical difficulties. Three dogs, weighing approximately 15 kg, were examined to evaluate the ability of our prototype synchrotron radiation DSA unit, that we are now constructing. The dogs were anaesthetized with pentobarbital sodium, intravenously (30 mg/kg). Six french-sized (1.52 mm i.d.) pigtail catheter with multiple side holes were introduced via the right femoral vein into the right atrium by the cutdown technique under conventional x-ray fluoroscopic control. Respiration of the dogs was

  6. A unified approach for quantifying invasibility and degree of invasion

    Treesearch

    Qinfeng Guo; Songlin Fei; Jeffrey S. Dukes; Christopher M. Oswalt; Basil V. Iannone III; Kevin M. Potter

    2015-01-01

    Habitat invasibility is a central focus of invasion biology, with implications for basic ecological patterns and processes and for effective invasion management. ‘‘Invasibility’’ is, however, one of the most elusive metrics and misused terms in ecology. Empirical studies and meta-analyses of invasibility have produced inconsistent and even conflicting results. This ...

  7. Computed Tomographic Angiography as an Adjunct to Digital Subtraction Angiography for the Pre-Operative Assessment of Cerebral Aneurysms

    PubMed Central

    Farsad, Khashayar; Mamourian, Alexander C; Eskey, Clifford J; Friedman, Jonathan A

    2009-01-01

    Objectives: Computerized tomographic angiography (CTA) has emerged as a valuable diagnostic tool for the management of patients with cerebrovascular disease. The use of CTA in lieu of, or as an adjunct to, conventional cerebral angiography in the management of cerebral aneurysms awaits further experience. In this study, we evaluated the role of CTA specifically for the pre-operative assessment and planning of cerebral aneurysm surgery. Patients and Methods: We reviewed the relevant neuroimaging of all patients treated at Dartmouth Hitchcock Medical Center between January, 2001 and December, 2004 with a diagnosis of cerebral aneurysm and diagnostic evaluation with both CTA and conventional digital subtraction angiography (DSA) using standard imaging protocols. 32 patients underwent both CTA and DSA during the study period for a total of 36 aneurysms. Images were independently re-assesed by two neurosurgeons for information valuable for pre-operative surgical planning. Results: In 26 of 36 aneurysms (72%), the CTA was felt to provide the best image quality in defining the morphology of the aneurysm. In 14 aneurysms (39%), CTA provided clinically valuable anatomic detail not demonstrated on DSA, largely due to better visualization of parent and perforating vessel relationships at the aneurysm neck. There were no instances where a lesion was seen on DSA but missed on CTA. The DSA was of most clinical value in determining flow dynamics, such as the arterial supply of an anterior communicating artery aneurysm and distal anterior cerebral branches via the two A1 segments. Conclusion: CTA with three-dimensional reconstructions is a valuable adjunct to the preoperative evaluation of cerebral aneurysms. We advocate routine use of CTA in all patients in whom surgical aneurysm repair is planned, even when DSA has already been performed. PMID:19452029

  8. Simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) imaging: Comparison with contrast-enhanced MR angiography for measuring carotid stenosis.

    PubMed

    Shu, Hongge; Sun, Jie; Hatsukami, Thomas S; Balu, Niranjan; Hippe, Daniel S; Liu, Haining; Kohler, Ted R; Zhu, Wenzhen; Yuan, Chun

    2017-02-06

    To evaluate in a proof-of-concept study the feasibility of Simultaneous Noncontrast Angiography and intraPlaque hemorrhage (SNAP) imaging as a clinical magnetic resonance angiography (MRA) technique for measuring carotid stenosis. There is a growing interest in detecting intraplaque hemorrhage (IPH) during the clinical management of carotid disease, yet luminal stenosis has remained indispensable during clinical decision-making. SNAP imaging has been proposed as a novel IPH imaging technique that provides carotid MRA with no added scan time. Flowing blood shows negative signal on SNAP because of phase-sensitive inversion recovery. In all, 58 asymptomatic subjects with 16-79% stenosis on ultrasound were scanned at 3T by SNAP with 0.8 mm isotropic resolution and 16 cm longitudinal coverage. Two readers measured luminal stenosis of bilateral carotid arteries (n = 116) on minimum intensity projections of SNAP using the NASCET criteria. In the subset (48 arteries) with contrast-enhanced (CE) MRA available for comparison, luminal stenosis was also measured on maximum intensity projections of CE-MRA. Intraclass correlation coefficients (ICCs) with 95% confidence intervals were 0.94 (0.90-0.96) and 0.93 (0.88-0.96) for intra- and interreader agreement on stenosis measurements, respectively. Corresponding kappas for grading stenosis (0-29%, 30-69%, 70-99%, and 100%) were 0.79 (0.67-0.89) and 0.80 (0.68-0.90). Agreement between SNAP and CE-MRA was high (ICC: 0.95 [0.90-0.98]; kappa: 0.82 [0.71-0.93]). As a dedicated IPH-imaging sequence, SNAP also provided carotid stenosis measurement that showed high intra- and interreader consistency and excellent agreement with CE-MRA. Further comparisons with digital subtraction angiography and other noninvasive techniques are warranted. 4 J. Magn. Reson. Imaging 2016. © 2017 International Society for Magnetic Resonance in Medicine.

  9. Indocyanine Green Angiography and Optical Coherence Tomography Angiography of Choroidal Neovascularization in Age-Related Macular Degeneration.

    PubMed

    Eandi, Chiara M; Ciardella, Antonio; Parravano, Mariacristina; Missiroli, Filippo; Alovisi, Camilla; Veronese, Chiara; Morara, Maria C; Grossi, Massimo; Virgili, Gianni; Ricci, Federico

    2017-07-01

    To compare the capability of indocyanine green angiography (ICGA) and optical coherence tomography angiography (OCTA) in detecting choroidal neovascularization (CNV). In this prospective study, patients with CNV detected with fluorescein angiography (FA) underwent ICGA and OCTA, spectral domain OCT (SD-OCT), and infrared or fundus color photographs. CNV lesions were outlined on ICGA and OCTA images, and the composition and size of the CNV was documented. One hundred eighty-two eyes were included. With ICGA, well-defined lesions were observed in 37.9%, partly defined in 44.5%, and undefined in 17% of eyes. On OCTA, well-defined, partly defined, and undefined vessels were observed in 53.8%, 27.5%, and 18.7% of eyes, respectively. There was a good correlation between CNV size measured with the two instruments (r = 0.84). However, OCTA underestimated CNV area by about 4.5% (slope coefficient with linear regression: 0.55, 95% confidence interval [CI]: 0.46 to 0.65; intercept: 0.27, 95% CI: -0.2 to 0.56). On ICGA, CNV composition was capillary in 28%, mature in 14.3%, and mixed (capillary and major neovascular complex) in 57.7% of eyes. Similarly, OCTA revealed capillary, mature, and mixed CNV in 28.9%, 15.9%, and 55.5% of eyes, respectively. OCTA provides the clinician the ability to perform precise structural and vascular assessment of CNV noninvasively. Our study is, to our knowledge, the largest OCTA analysis to date of CNV secondary to neovascular AMD analyzed simultaneously by ICGA and OCTA.

  10. Unenhanced respiratory-navigated NATIVE(®) TrueFISP magnetic resonance angiography in the evaluation of renal arteries: Comparison with contrast-enhanced magnetic resonance angiography.

    PubMed

    Değirmenci, B; Kara, M; Kıdır, V; İnal, S; Sezer, T; Umul, A; Orhan, H; Çelik, A O; Demirtaş, H; Yilmaz, Ö

    2017-02-01

    To compare unenhanced three-dimensional (3D) NATIVE(®) true fast imaging with steady-state precession (TrueFISP) magnetic resonance (MR) angiography with the more conventional MR angiography technique obtained after intravenous administration of a gadolinium chelate in the evaluation of renal arteries and their branches in patients with suspected renal artery stenosis. A total of 39 patients (25 men, 14 women) with a mean age of 51.4±17.5years (SD) (range: 10-82years) were included in the study. All patients with suspected renal artery stenosis underwent unenhanced 3D NATIVE(®) TrueFISP MR angiography and contrast-enhanced MR angiography. The two MR angiography methods were compared by two independent readers for image quality using a four-point scale, diagnostic performance and grading of renal artery stenosis on a total of 78 renal arteries. For both readers image quality of unenhanced 3D NATIVE(®) TrueFISP MR angiography (3.12 to 3.63) was greater than that of contrast-enhanced MR angiography (1.94 to 2.71) for renal artery ostium-trunk and the left renal artery segmental branches. The sensitivity of 3D NATIVE(®) TrueFISP MR angiography for the diagnosis of renal artery stenosis was 100% for both readers for the right renal artery and 66% and 80% for the left renal artery for reader 1 and reader 2, respectively. Agreement between 3D NATIVE(®) TrueFISP MR angiography and CE-MR angiography was 95% (74/78) for reader 1 and 92% (72/78) for reader 2. Unenhanced NATIVE(®) TrueFISP magnetic resonance angiography can play an additional role in the evaluation of renal arteries in patients with hypertension, especially in subjects at risk of nephrogenic systemic fibrosis. Copyright © 2016 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  11. Simultaneous technetium-99m MIBI angiography and myocardial perfusion imaging

    SciTech Connect

    Baillet, G.Y.; Mena, I.G.; Kuperus, J.H.; Robertson, J.M.; French, W.J.

    1989-01-01

    Resting first-pass radionuclide angiography (FPRNA) was performed with the myocardial perfusion agent technetium-99m MIBI. In 27 patients, it was compared with technetium-99m diethylenetriamine pentaacetic acid FPRNA. A significant correlation was present in left (r = 0.93, p less than 0.001) as well as right (r = 0.92, p less than 0.001) ventricular ejection fraction measured with both radiopharmaceuticals. In 13 patients, MIBI derived segmental wall motion was compared with contrast ventriculography. A high correlation was present (p less than 0.001), and qualitative agreement was found in 38/52 segments. In 19 patients with myocardial infarction a significant correlation was present between MIBI segmental wall motion and perfusion scores (p less than 0.001). In ten patients with a history of myocardial infarction, 18 myocardial segments demonstrated diseased coronary vessels and impaired wall motion at contrast angiography. These segments were all identified by the MIBI wall motion and perfusion study. We conclude that MIBI is a promising agent for simultaneous evaluation of cardiac function and myocardial perfusion at rest.

  12. Predictors of prolonged fluoroscopy time in diagnostic coronary angiography.

    PubMed

    Adachi, Yusuke; Sakakura, Kenichi; Wada, Hiroshi; Funayama, Hiroshi; Umemoto, Tomio; Momomura, Shin-Ichi; Fujita, Hideo

    2016-07-01

    Prolonged fluoroscopy time during coronary angiography is a major concern for interventional cardiologists as well as for patients. It is unknown which factors affect the prolonged fluoroscopy time. A total of 458 patients who underwent diagnostic coronary angiography were included. The patients who had the highest decile of fluoroscopy time were assigned to the prolonged fluoroscopy group (fluoroscopy time ≥15.7min), while the other patients were assigned to the non-prolonged fluoroscopy group (fluoroscopy time <15.7min). We performed univariate and multivariate logistic regression analysis to identify the predictors of prolonged fluoroscopy time. Mean fluoroscopy time in 458 patients was 8.5±5.8min. Median and ranges of fluoroscopy time were 19.0 [15.7-47.0]min in the prolonged fluoroscopy group and 6.0 [2.0-15.3]min in the non-prolonged fluoroscopy group, respectively. The multivariate logistic regression analysis showed that significant predictors of prolonged fluoroscopy time were prior surgery of ascending aorta replacement [odds ratios (OR) 11.46, 95% confidence intervals (CI) 1.53-85.74, p=0.02] and the prevalence of moderate to severe aortic regurgitation (OR 2.83, 95% CI 1.20-6.66, p=0.02). The prior surgery of ascending aorta replacement and moderate to severe aortic regurgitation were significant predictors of the prolonged fluoroscopy time. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  13. Optical Coherence Tomography Angiography in Central Serous Chorioretinopathy

    PubMed Central

    Costanzo, Eliana; Cohen, Salomon Yves; Miere, Alexandra; Querques, Giuseppe; Capuano, Vittorio; Semoun, Oudy; El Ameen, Ala'a; Oubraham, Hassiba; Souied, Eric H.

    2015-01-01

    Purpose. To analyze optical coherence tomography angiography (OCTA) findings in eyes with central serous chorioretinopathy (CSC) and to compare them with those obtained with multimodal imaging. Methods. A series of consecutive patients diagnosed with CSC, underwent OCTA and multimodal imaging, including spectral domain OCT, fluorescein, and indocyanine green angiography. OCTA images were performed at three main depth intervals: automatically segmented outer retina, manually adjusted outer retina, and automatically segmented choriocapillaris. Results. Thirty-three eyes of 32 consecutive patients were analyzed. OCTA showed 3 main anomalies at the choriocapillaris: the presence of dark areas (19/33 eyes) which were frequently associated with serous retinal detachment, presence of dark spots (7/33 eyes) which were frequently associated with retinal pigment epithelium detachment, and presence of abnormal vessels (12/33 eyes) which were frequently, but not systematically, associated with choroidal neovascularization, as confirmed by multimodal imaging. Conclusions. OCTA revealed dark areas and dark spots, which were commonly observed. An abnormal choroidal pattern was also observed in one-third of cases, even