MyT3 4 - Vascular

MyT3 4-1
Clinical applications of partial splenic artery embolisation
Purpose: Partial splenic embolisation is a safe and effective method in the management of certain clinical conditions related to splenic pathologies.
Methods: During the period from April 2016 to November 2016, the present study included 20 patients 11 males, 9 females, with different splenic pathologies candidate to splenic artery embolisation. Their ages ranged between 37- 72 years with a mean age of 55 years old. Patient inclusion criteria include adult males and females, patients candidate to the procedures, patients haemodynamically stable for procedure and patients with signs and symptoms of thrombocytopenia. Patients with hypersensitivity of contrast materials and haemodynamically unstable for procedure and pregnant females were excluded from the study.
Results: The technical success reflects in the success of all procedures in all cases. The technical complications occurred are puncture site haematoma, 4 cases developed haematoma at the puncture site and were resolved conservative. There is high significant increase in platelet count one month after PSE in all patients presented by hypersplenism. Before PSE platelet count means was 59.6±29.83 K/UL and increased to mean of 72.3±38.9 K/UL after one month of the procedure.
Conclusion: PSE is effective in improving thrombocytopenia due to hypersplenism with a statistically significant mean improvement of platelet counts. PSE is an alternative endovascular procedure for patients with portal hypertension complications. Splenic embolisation proved to be a lifesaving treatment in autoimmune haemolytic anaemia resistant to immunosuppressive and biological therapies, not eligible for surgical intervention because of critical condition.
Limitations: Patients presented with hypersensitivity of contrast materials, who were haemodynamically unstable for procedure and renal impairment.
Ethics: A written informed consent was done for all patients.
Funding: No funding was rcieved for this work.
MyT3 4-2
Endovascular management of cerebral arteriovenous malformations
Purpose: Endovascular management is effective and safe in management of cerebral AVMs to improve the outcome of patients with cerebral AVMs.
Methods: 25 patients with cerebral AVMs are subjected to CT, MRI, MRA, CT angiography and four-vessel angiography for detection of angioarchitexture of cerebral AVMs locations and grading.
Results: 25 patients with cerebral AVMs, one patient (4%) with a family history of cerebral AVMs. 10 patients (40%) were presented with intracranial haemorrhage, 7 patients (28%) with epilepsy, 6 patients (24%) with headache and 2 patients with weakness due to AVM itself (8%). The cerebral AVMs were present in the eloquent area in 11 patients (44%) and 14 patients (56%) in non-eloquent area. The Spetzler grading was grade II) in 3 patients (12%), grade III in 15 patients (60%), grade IV in 5 patients (20%) and G V in 2 patients (8%). 10 patients (40%) showed complete occlusion of the nidus and 15 patients (60%) had a partial reduction of the nidus and were candidates for radiosurgery (48%) and surgery (12%). The periprocedural problems were vaospasm in 2 patients (8%), one patient (4%) with microcatheter stuck in the 2 cm Onyx plug and broke during the removal attempt, temporary deficit in 2 patients (8%) due to Onyx reflux and extravasation of Onyx so we recommend uses of pressure cooker technique. Regarding outcome of epilepsy after 6 months we found that 5 of the 7 patients (71.4%) were well controlled while in other 2 patients (28.6%), the fits became infrequent.
Conclusion: Endovascular management of cerebral AVMs is a valid, effective and safe approach for AVM treatment with high rates of total and near-total occlusion with acceptable complications.
Limitations: There are no limitations to this study.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 4-3
Evaluating the vessel wall permeability of abdominal aortic aneurysm using 3D dynamic contrast-enhanced MRI (recorded)
Purpose: This study aims to 1) investigate the feasibility of 3D dynamic contrast-enhanced (DCE) MRI to evaluate the vessel wall permeability of abdominal aortic aneurysm(AAA), and 2) assess the relationship between Ktrans and AAA diameter/intraluminal thrombus (ILT).
Methods: 13 patients with AAAs were scanned on a 3T Siemens Skyra scanner. MRI was acquired using 1) a 3D T1-weighted black blood FSE sequence and 2) a 3D DCE sequence using fast gradient-echo. AAA diameter and ILT thickness were measured. Based on the volume distribution of ILT on the black blood MRI, patients were divided into two types: Type 1: Fresh ILT was present; Type 2: Without fresh ILT. 3D DCE MRI images were analysed. ROIs were carefully drawn on aneurysm wall and ILT (if available) and Ktrans was obtained for both aneurysm wall and ILT. Spearman?s r was used to evaluate the correlation of DCE Ktrans with AAA diameter and ILT thickness. Mann-Whitney test was used to compare DCE Ktrans between the aneurysm wall and ILT. DCE Ktrans differences were also investigated as a function of ILT types.
Results: 11/13 patients were found to have ILT and 3/13 patients? AAA diameter was ?5.5cm. There was a positive correlation between Ktrans and AAA diameter (r=-0.57; P=0.01). A relatively weak, non-significant negative correlation was found between Ktrans and ILT thickness (r=-0.32; P=0.34). DCE Ktrans of aneurysm wall was significantly higher than that of ILT(P=0.01). There was no significant difference in DCE Ktrans between different types of ILT.
Conclusion: 3D DCE MRI can be used to evaluate the vessel wall permeability of AAA with high temporal and spatial resolution.
Limitations: Small patients number, and further larger scale study is needed.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 4-4
Evaluation of different keV-settings in dual-energy CT angiography of the siphon of internal carotid artery using noise-optimised virtual monoenergetic imaging
Purpose: The aim of this study was to perform an objective image analysis of traditional and noise-optimised virtual monoenergetic imaging (VMI & VMI+) algorithms in third generation dual-source dual-energy computed tomography angiography (DE-CTA), for showing the siphon of internal carotid artery more clearly.
Methods: Twenty-eight patients who underwent DE-CTA of brain were evaluated in this retrospective study. On the VMI and VMI+, images were reconstructed from 40-keV to 190-keV. Then, attenuation and noise were measured in the siphon of bilateral internal carotid artery, and muscle and fat in the back of the neck. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated.
Results: Attenuation values were highest both on 40-keV VMI and VMI+ (745.55±184.87 vs 721.38±174.89, p=0.409). Although noise values were also greatest at 40-keV in the two reconstructions (117.40±39.97 vs 75.18±28.66, p<0.001), the values on 40-keV VMI+ were significantly lower compared to the VMI. SNR was the highest in 75-keV VMI and 84-keV VMI+, and there was no significant difference between the two datasets (11.39±2.72 vs 11.62±3.27, p=0.572). CNR was the greatest in 64-keV VMI and 40-keV VMI+ respectively (15.87±6.02 vs 29.95±10.94, p?0.001), and it was were higher in 40-keV VMI+.
Conclusion: The 40-keV VMI+ reconstruction was recommended for showing the siphon of internal carotid artery more clearly in third generation dual-source DE-CTA of brain.
Limitations: This study only involved objective evaluation and did not mention subjective evaluation.
Ethics: This retrospective study was approved by the institutional review board of our hospital.
Funding: This study was supported by the National Key Research and Development Program of China.
MyT3 4-5
The use of near-infrared spectroscopy (NIRS) to measure vascular haemodynamics within bone tissue in vivo
Purpose: Measuring vascular haemodynamics within bone tissue is difficult with existing imaging modalities due to bone's high density and mineral content. Near-infrared spectroscopy (NIRS) has the potential to safely measure markers of blood oxygenation and vascular responsiveness. The aim of this PhD project was to explore if NIRS could be an accurate, reliable and precise diagnostic tool for measuring markers of bone haemodynamics in vivo.
Methods: A systematic review was undertaken, establishing existing evidence around the use of NIRS for measuring in vivo haemodynamics in bone tissue. Arterial occlusion protocols were developed to measure haemodynamics at the tibia using NIRS. Thirty-six participants were recruited to assess if NIRS could obtain reproducible measurements which correlate with other markers of bone health, including dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), bone mineral densitometry, trabecular bone scoring, and blood markers of bone metabolism.
Results: Markers of NIRS at the tibia were identified with within-subject coefficients of variation ranging from 3.0% to 27.7%. These markers demonstrated statistically significant associations with bone density and relatable DCE-MRI haemodynamic markers at the tibia.
Conclusion: NIRS can produce reproducible markers of oxygen extraction and microvascular reactivity at the tibia. NIRS markers show promising associations with other markers of bone health which may facilitate future research into the vascular role of common bone pathologies such as osteoporosis.
Limitations: This PhD project explored a relatively small participant sample at one testing site. However, the study has demonstrated promise worthy of further investigations in wider populations using different commercially available NIRS systems.
Ethics: Reseach involving human participants was undertaken with ethical approval from the NHS Health Research Authority (16/SW/0254).
Funding: Funding for this PhD projet was gratefully received via the College of Radiographers Doctoral Fellowship Grant.
MyT3 4-6
How we see congenital portosystemic shunts through CT-angiography
Purpose: Portosystemic shunts(PSS) are rarely-observed anomalies. Depending on the shunt localisation, there are two types extrahepatic and intrahepatic. There are few studies related to paediatric age group in the literature. The aim of the study is to evaluate the computerised tomography angiography (CTA) findings according to PSS types.
Methods: The study included US and CTA exams of 8 patients (7 m-16 yr). US and CTA findings were recorded and classified by Blanc et al anatomical classification.
Results: 2 patients were female and the remaining 6 were male. 5 out of 8 patients had extrahepatic PSS - 3 children had type 1 and the remaining 2 had type 2 - 3 patients had type 3 intrahepatic PSS. One patient was tested with a pulmonary artery-vein shunt suspicion. Additionally, in that case, the pathologic signal was visualised in globus pallidus suggesting hepatic encephalopathy. Abdomen CT - Angiography imaging showed large shunt between the portal vein and the vena cava inferior (VCI). Another patient was tested due to primary pulmonary hypertension. In partially included abdominal sections, coincidentally detected a shunt between the portal vein and the VCI. No follow-up examination was performed in five patients. Two extrahepatic PSS patients were treated with coil occlusion by interventional radiologists. During the angiographic examination of one patient portal vein could not be visualised therefore could not be treated.
Conclusion: Small shunts may not be visualised via US. To demonstrate PSS, CTA might be necessary. In addition, CTA findings in the PSS could be a guide for tailoring clinical management and planning treatment by interventional radiologist or surgeons prior to the procedure.
Limitations: The study was limited by a few patient number and no follow-up with five patients.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 4-7
Resting-state functional connectivity in patients with asymptomatic stenoses of the internal carotid arteries
Purpose: To determine changes in the functional connectivity of the brain in patients with asymptomatic atherosclerotic stenoses of internal carotid arteries (ICA) arteries by performing resting-state functional magnetic resonance imaging (fMRI).
Methods: Resting-state fMRI was performed to 23 patients with asymptomatic atherosclerotic stenosis of one or several ICA to 60-75% (14 women, 9 men, 55 to 81 y.o., mean age 69 ± 5.4 y.o.) and healthy controls (13 women, 10 men) on 3.0T MR-scanner. All patients from the study group suffered from arterial hypertension. Carotids stenting was performed to 4 patients. We used CONN v.18 software package for statistical processing and result evaluation (rfMRI).
Results: Intergroup statistical analysis (ROI-ROI, Seed-to-Voxel) showed differences in functional connectivity in 19 patients (p <0.001). Right hemisphere: a significant increase in negative functional connections (FC) of the medial prefrontal cortex (MPFC) with the insula and the marginal gyrus was determined; decrease of positive FC of MPFC with the anterior and posterior part of the parahippocampal, middle and inferior temporal gyri. Left hemisphere: decrease of the positive functional connectivity of MPFC with the middle temporal gyrus and hippocampus (3.54 ? T ? 3.09). In 4 patients who underwent ICA stenting, there were no changes in the functional connections, compared to the control group.
Conclusion: Our findings confirm that brain connectome (and DMN in particular) alterations are most likely caused by contributions made by presence of asymptomatic atherosclerotic stenoses of the ICA.
Limitations: Our study had limitation as the sample size was relatively small. Limitations include evaluating only diseases mediated through BP and aCAS.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 4-8
Angiographic analysis on posterior fossa haemorrhages and vascular malformations using computed tomographic angiography and digital subtraction angiography
Purpose: The purpose of this study is to analyse the various causes of posterior fossa haemorrhages and to compare the diagnostic accuracy of computed tomography angiography (CTA) with digital subtraction angiography (DSA) in detecting various posterior fossa vascular pathologies.
Methods: From January 2017 ? October 2018, 80 patients (49 males, 31 females) were included who had symptoms of non-traumatic posterior fossa haemorrhage or vascular pathologies. The mean age of the patients was 43.59 ± 1.58 years. Among 80 patients, 31 patients underwent both CTA and DSA with a mean interval of 6.2 ± 1.1 days.
Results: Out of 80 patients, 47 (58.8%) had aneurysms, 29 (36.3%) had arteriovenous malformations (AVMs), one patient had developmental venous anomaly (DVA) and one patient had brainstem cavernoma. No cause could be detected in two patients. There was a statistically significant difference in the age groups of patients with aneurysms (46.96 ± 1.88 years) and AVMs (36.24 ± 2.56 years) (p<0.05). The correct diagnosis was made with CTA in 24 out of 25 aneurysms and 2 of the 4 AVMs. The cause of haemorrhage was found to be aneurysms in two missed cases of AVMs. The sensitivity and specificity of CTA in detecting aneurysms was 95.7 and 100% respectively, and in diagnosing AVM was 66.7 and 100% respectively. The overall sensitivity, specificity and diagnostic accuracy of CTA as compared to DSA were 96.6, 100 and 97% respectively.
Conclusion: CTA is a simple, fast and non-invasive imaging modality that can be used to detect and characterise the vascular pathologies in posterior fossa.
Limitations: The main limitations in our study was the unavoidable selection bias and smaller sample size.
Ethics: n/a
Funding: n/a
MyT3 4-9
A multidisciplinary approach to the diagnosis and treatment of kaposiform hemangioendothelioma in newborn children
Purpose: The aim of the study is the determination of the clinical course, the choice of the diagnostic and treatment methods and evaluating the effectiveness of treatment in newborn children with Kaposiform hemangioendothelioma (KHE) and Kasabach-Merritt phenomenon.
Methods: The study enrolled 6 newborn patients with Kaposiform hemangioendothelioma (KHE) and Kasabach-Merritt phenomenon within a period from 2013 - 2018. US, MRI (CT) performed for a primary diagnosis, and MRI follow-up investigations to evaluate treatment effectiveness.
Results: An infiltrative hypervascular lesion with the involvement of muscles, fat spaces and reticular lymphedema was observed. Possible involvement of bones, skin. Thrombocytopenia 8-20 ?
MyT3 4-10
Diagnostic yield of CT angiography in penetrating lower extremity trauma
Purpose: Injury is a major public health challenge, placing a significant demand on hospital resources, particularly in resource-limited settings. With the rise of interpersonal and gang violence, there has been an increase in penetrating injuries to the lower extremities, and the use of CT angiography (CTA) for suspected arterial injuries. Over-utilization of expensive imaging - with a relatively low yield - significantly increases healthcare costs. The implementation of value-based care is paramount in a resource-limited setting. The aim is to determine the value of CTA in penetrating lower extremity injuries in a resource-limited setting.
Methods: This retrospective descriptive study from 1 July 2013 ? 31 June 2018 included all Tygerberg Hospital patients undergoing penetrating trauma-related emergency lower extremity CTA for suspected arterial injury. The yield of clinically significant injuries and the positive predictive value of specific clinical signs were calculated.
Results: 982 patients (median age 27 years, 91% male) were included. 90% (885/982) had gunshots, 9% (89/982) stabs and 0.5% (5/982) other injuries. 33% (23/68) of patients with hard signs of vascular injury and 7.9% (73/914) with soft signs/no indication for imaging had clinically significant injuries. Significant (p<0.05) correlations were a rapidly expanding haematoma (PPV 40%), an absent pulse (PPV 39%), and a diminished pulse (PPV 18%). There was a year-on-year rise in the number of studies, but no significant difference in injury yield.
Conclusion: The current utilisation of CTA has a low yield in detecting clinically significant vascular injuries in penetrating lower extremity trauma. There is a poor correlation between the clinical indication provided and imaging findings.
Limitations: Retrospective study design.
Ethics: Stellenbosch University ethics approval (S18/10/219).
Funding: No funding was received for this work.
MyT3 4-11
Optimisation of window settings on traditional and noise-optimised virtual monoenergetic imaging for displaying intracranial arterial aneurysm in dual-energy CT angiography
Purpose: To determine the optimal window settings for displaying intracranial aneurysm more clearly on virtual monoenergetic imaging (VMI) reconstructions of third generation dual-source, dual-energy CT angiography (DE-CTA).
Methods: A total of 28 intracranial aneurysms were retrospectively evaluated in 26 patients who underwent cerebral angiography in third-generation dual-source dual-energy CT (DECT). Images were reconstructed with traditional VMI and noise-optimised VMI reconstructions at 1-keV intervals from 40-keV to 190-keV. Attenuation and noise were measured in the intracranial aneurysm, brain tissue around the aneurysm, fat in the posterior neck, and internal carotid arteries. A contrast-to-noise (CNR) was calculated. At the energy level where the dataset had highest CNR respectively on the traditional and noise-optimised VMI reconstructions, the subjectively best window setting (width and level, B-W/L) was independently determined by two observers and subsequently related with internal carotid arteries attenuation to calculate separate optimised values (O-W/L) using linear regression.
Results: The CNR was highest at 64-keV (M64) and 40-keV (M40+) respectively on the traditional and noise-optimised VMI reconstructions (21.29±8.51 vs 34.34±11.41, p<0.001). The B-W/L for M64 and M40+ was 690/190 and 1570/450, respectively. Results from regression analysis inferred an O-W/L of 650/180 for M64 and 1480/420 for M40+.
Conclusion: In order to display aneurysms more clearly on third-generation dual-source DE-CTA, we recommended 64-keV and 40-keV as the energy level on traditional and noise-optimised VMI reconstructions, respectively. And the W/L settings of 650/180 for M64 and 1480/420 for M40+ were suggested.
Limitations: There was no comparison between traditional and noise-optimised VMI in intracranial aneurysm visualisation.
Ethics: This study was approved by ethics committee of our hospital.
Funding: This study was supported by the National Key Research and Development Program of China.
MyT3 4-12
Comparison of moving bed contrast-enhanced MR angiography vs digital subtraction angiography in peripheral arterial disease
Purpose: Peripheral arterial disease is partial or total occlusion of one or more peripheral arteries due to atherosclerosis. The aim of this study is to evaluate the accuracy of contrast-enhanced moving bed MRA for significant stenosis and occlusions vs DSA serving as the gold standard.
Methods: We have evaluated retrospectively 1118 arterial segments of 43 patients with a known or suspicious PAD who underwent DSA after MRA within 30 days. DSA was accepted as the gold standard and the sensitivity, specificity and accuracy of MRA were determined. MRA and DSA images were examined by two different radiologists as a double-blind study. McNemar test was used to evaluate the significiant difference in diagnostic aspect between DSA and MRA. Specificity, sensitivity, positive and negative estimated values, diagnostic accuracy rate were calculated. Kappa coefficient (?) was calculated to determine the significance of diagnostic compliance between DSA and MRA. Results for p<0.05 were accepted statistically significant.
Results: The overall sensitivity and specificity values of contrast-enhanced moving bed MRA for significant (>70%) stenosis were 91% and 97.3%; for total occlusion, sensitivity and specificity values were 90% and 99.3% respectively. For both of them, the accuracy was 96%. No significant difference is found between contrast-enhanced moving bed MRA and DSA for the diagnosis of peripheral arterial disease (p>0.05).
Conclusion: Contrast-enhanced moving bed MRA is a reliable, fast, noninvasive imaging modality in the diagnosis of patients, in planning of interventional procedures and follow-up of the patients with peripheral arterial disease.
Limitations: 14 segments in 5 patients were excluded because of metallic artefact due to iliac stents. Lower sensitivity ratios were calculated from iliac arteries. It was due to a decrease in the number of iliac segments.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 4-14
Contrast-enhanced perfusion patterns and serum lipid signatures specific of vulnerable plaque in predicting stroke: a cohort study of carotid stenosis in Chinese patients (recorded)
Purpose: To investigate the correlation between contrast-enhanced ultrasound (CEUS) perfusion patterns and serum lipid signatures specific of carotid artery vulnerable plaque with the degree of carotid stenosis, which provide the basis for early diagnosis of cerebral ischaemic stroke.
Methods: From March 2018 to June 2018, 202 patients with carotid plaque who underwent CEUS were enrolled in this study. The patients who did not undergo CTA or DSA examination within 1 week after CEUS examination were excluded. 80 patients were analysed. All subjects underwent a contrast-enhanced ultrasound, CTA or DSA, and serum lipid testing. In face-to-face interviews with participants, trained investigators used questionnaires to get information about their routine cardiovascular and cerebrovascular risk factors, demographic characteristics, smoking history, lifestyle, atrial fibrillation history and other disease histories.
Results: Serum-free fatty acid was significantly associated with CVA events (P<0.05). Serum-free fatty acid was significantly associated with the different contrast agent enhancement level and difference contrast-enhanced perfusion patterns (P<0.05).
Conclusion: The enhancement levels and the CEUS perfusion patterns with microbubbles are infused from the surface to the interior of the plaque was increased with the degree of carotid stenosis, the CEUS perfusion pattern of moderate or higher carotid stenosis plaques is mainly infused from the surface to the interior of the plaque, serum-free fatty acid was increased with the enhancement levels of the plaques. These may evidence that the plaque begins to become vulnerable.
Limitations: This is an observational study. We did not analyse the morphology and properties of plaques in this study.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 4-15
Non-contrast MR venography in the diagnosis of post-thrombotic iliac vein obstruction and extravascular compression
Purpose: Evaluate value of non-contrast MRI in the diagnosis of post-thrombotic iliac vein obstruction and extravascular compression.
Methods: The study included 228 patients with CVD (clinical class C3-C6 according to the CEAP classification), including 110 males and 118 females. The average age of the patients was 43.6±11.6 years. All patients underwent ultrasound angioscanning veins of the lower extremities and MRI of the iliac veins and inferior vena cava. Studies were performed on MRI using a special protocol non-contrast sequences: 1. BH TRUFI/FIESTA 3D using Valsalva manoeuvre; 2. INHANCE 3D using the free-breathing technique, with subsequent 3D reconstruction.
Results: 107 patients have been diagnosed with stenosis of the left common iliac vein due to compression of the right common iliac artery (May-Thurner syndrome). 65 patients underwent stenting of left common iliac vein with the May-Turner syndrome. Two patients underwent stenting of the left external and common iliac veins with post-thrombotic obstruction. 50 post-thrombotic deep vein changes have been revealed.
Conclusion: MR-venography is the most optimal method in the diagnosis of the causes of extra and intravenous pathology of the IVC and its basin. There is no radiation exposure, no use of contrast agent and short time relation. 3D-reconstruction of the IVC and iliac veins can be used for planning corrective treatment and reconstructive operations. MR-venography is equal to contrast angiographic methods in detecting extravasal compression and is recommended in the initial evaluation of suspected May-Thurner syndrome and post-thrombotic iliac vein obstructions.
Limitations: n/a
Ethics: n/a
Funding: No funding was received for this work.
MyT3 4-16
Carotid stenosis evaluation by 128-slice CT: comparison of NASCET, ECST and CC grading methods, and comparison with colour-Doppler ultrasonography
Purpose: Purpose is to evaluate the intra- and interobserver variability of the North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trial (ECST), and Common Carotid (CC) methods, which are used to measure the degree of carotid stenosis, using 128-slice CT and to compare the measurements made by these three methods, and to compare those methods with the gold standard, ultrasound.
Methods: Of the initial 25 included patients, five patients were excluded during the study because the percentage of stenosis of these five patients could not be determined using the NASCET, ECST and/or CC method. CT-Angiography (CTA) examination was performed by a 128-slice scanner (Siemens SOMATOM Definition AS 128). Retrospective data from the CT scan and the ultrasound examination were used. In addition, prospective data has been collected. Two neuroradiologists measured the degree of carotid stenosis by using the NASCET-, ECST-, and CC-method. Intra-observeragreement and inter-observeragreement were determined by intraclass correlation coefficient (ICC).
Results: The similarity between neuroradiologists and ultrasound examination was highest in the ECST and CC method (85%). The similarity between neuroradiologists themselves was highest with the use of the ECST and CC method (95%). The inter-observer agreement is highest with the ECST method (0.672), followed by the NASCET method (0.667) and the CC method (0.532). The intra-observer agreement within the NASCET method is ?moderate" while within the ECST and CC methods it was "fair".
Conclusion: The ECST method is the most reliable way to determine the extent of carotid stenosis based on the high similarity with the golden method, the high similarity between neuroradiologists and the high inter-observer agreement compared to the NASCET and CC method.
Limitations: n/a
Ethics: n/a
Funding: No funding was received for this work.
MyT3 4-19
Factors resulting in the increase of the total dose received by the patient during endovascular procedures performed within the region of the central nervous system
Purpose: The aim of the study was to analyse factors influencing the total radiation dose during diagnostic and therapeutic procedures in the field of neuroradiology, obtained by a patient with suspicion of intracranial pathology.
Methods: The retrospective analysis involved 419 procedures. The following group can be divided into 321 panangiography and 98 embolisations preceded by panangiography procedures. For each of the procedures the total dose absorbed by the patient was calculated on the basis of the "cumulative air kerma" parameter. In the analysed group aneurysms were found in 318 patients, arteriovenous malformations in 46 patients, and in 54 cases no pathology was revealed. The collected data was subjected to statistical analysis. The relationship between the total dose received by the patient during procedures and the location of the pathology, the type of surgery, the type of embolisation material used, the presence of subarachnoid haemorrhage (SAH) and the type of embolisation were analysed.
Results: There was a statistically significant correlation between the total radiation dose absorbed by the patient and the type of procedure (p <0.000), the amount of embolisation material used (p <0.05) and the presence of SAH (p <0.000). There was no significant effect of the type of pathology and pathology location on the total dose received by the patient during the procedure.
Conclusion: The total dose received by the patient during neuroradiology procedures depends on the type of intervention, the type of material used during embolisation and the presence of SAH.
Limitations: n/a
Ethics: n/a
Funding: No funding was received for this work.
MyT3 4-20
Non-contrast magnetic resonance angiography in renal artery assessment
Purpose: To evaluate renal artery anatomy in cases of suspected renovascular hypertension using INHANCE non-contrast MR angiography and determine its significance in diagnosing renal artery stenosis.
Methods: Non-contrast MR angiography using INHANCE was performed on a 1.5T MRI system for assessing renal arteries in 114 patients referred with clinically suspected renovascular hypertension for a period of three years (June 2014 to May 2017). Out of this, 10 patients further underwent Contrast enhanced-MR Angiography, 7 underwent CT-angiography and one patient underwent both contrast-enhanced MR angiography and CT angiography.
Results: We evaluated the findings on non-contrast INHANCE MR angiography in suspected cases of renal artery hypertension in 114 subjects. Its validity was calculated in comparison with contrast-enhanced MR angiography and/or CT Angiography in 18 patients. In our study, renal artery stenosis was found in 21.2% arteries out of the 214 arteries examined. Also, there was noted a significant association between renal artery stenosis identified on non-contrast INHANCE MR angiography and that on contrast-enhanced MR angiography and CT angiography (p<0.001).
Conclusion: Non-contrast INHANCE MR angiography can be used as a significant and valuable screening investigation for renal artery assessment especially in patients with impaired renal functions where contrast-based investigations carry a high risk.
Limitations: No comparisons are available with the gold standard, digital subtraction angiography. INHANCE NC-MRA sequence was done in the axial plane and other planes could not be evaluated. Our study population may not be a true representation of all clinically suspicious cases of renovascular hypertension hence derived values may not be truly representative.
Ethics: Ethics committee approval was received.
Funding: No funding was received for this work.


Tiago Bilhim (Portugal)

Pascal Chabrot (France)

European Society of Radiology

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