My Thesis in 3 Minutes

MyT3 4 - Vascular

Lectures

1
MyT3 4 - Clinical applications of partial splenic artery embolisation

MyT3 4 - Clinical applications of partial splenic artery embolisation

03:13A. Teama, kafrelsheikh / EG

Purpose:

Partial splenic embolisation is a safe and effective method in the management of certain clinical conditions related to splenic pathologies.

Methods and materials:

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 committee approval

A written informed consent was done for all patients.

Funding:

No funding was rcieved for this work.

2
MyT3 4 - Endovascular management of cerebral arteriovenous malformations

MyT3 4 - Endovascular management of cerebral arteriovenous malformations

03:00M. Mekhail, Zagazig / EG

Purpose:

Endovascular management is effective and safe in management of cerebral AVMs to improve the outcome of patients with cerebral AVMs.

Methods and materials:

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 committee approval

n/a

Funding:

No funding was received for this work.

3
MyT3 4 - The use of near-infrared spectroscopy (NIRS) to measure vascular haemodynamics within bone tissue in vivo

MyT3 4 - The use of near-infrared spectroscopy (NIRS) to measure vascular haemodynamics within bone tissue in vivo

03:12R. Meertens, Exeter / UK

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 and materials:

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 committee approval

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.

4
MyT3 4 - How we see congenital portosystemic shunts through CT-angiography

MyT3 4 - How we see congenital portosystemic shunts through CT-angiography

02:58M. Akyüz, Ankara / TR

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 and materials:

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 committee approval

n/a

Funding:

No funding was received for this work.

5
MyT3 4 - Resting-state functional connectivity in patients with asymptomatic stenoses of the internal carotid arteries

MyT3 4 - Resting-state functional connectivity in patients with asymptomatic stenoses of the internal carotid arteries

02:55A. Lepekhina, St. Petersburg / RU

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 and materials:

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 committee approval

n/a

Funding:

No funding was received for this work.

6
MyT3 4 - A multidisciplinary approach to the diagnosis and treatment of kaposiform hemangioendothelioma in newborn children

MyT3 4 - A multidisciplinary approach to the diagnosis and treatment of kaposiform hemangioendothelioma in newborn children

02:53S. Riebienkov, Kyiv / UA

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 and materials:

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 х 10 9 /l was diagnosed in all patients. Corticosteroids treatment lead to platelet count normalization in 7-15 days, but minimal decreasing of tumour size. A sustained clinical and laboratory remission was achieved in 2 patients after propranolol monotherapy in daily dose 2,5 mg/kg. In other 3 patients vincristine was prescribed in a dosage of 1,5 mg/m 2 once a week with following positive clinical outcome. Vincristine treatment duration was 6 - 12 months. An outcome was considered to be good in 5 patients and as satisfactory in 1. No excellent outcome was observed as in all patients MRI showed a residual tumor mass in 6 months after treatment termination.

Conclusion:

The diagnosis of kaposhiform hemangioendothelioma can be made without invasive procedures, based on data from radiological studies and laboratory parameters (Kasabach-Merritt phenomenon). Short courses of corticosteroids are effective for thrombocytopenia relief in KHE patients. The sustained remission was achieved with treatment by propranolol (n=2), vincristine (n=1), and propranolol+vincristine combination (n=3). The course of chemotherapy can be cancelled after stabilization of the size of the residual tumour.

Limitations:

n/a

Ethics committee approval

n/a

Funding:

No funding was received for this work.

7
MyT3 4 - Diagnostic yield of CT angiography in penetrating lower extremity trauma

MyT3 4 - Diagnostic yield of CT angiography in penetrating lower extremity trauma

03:04A. le Roux, Cape Town / ZA

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 and materials:

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 committee approval

Stellenbosch University ethics approval (S18/10/219).

Funding:

No funding was received for this work.

8
MyT3 4 - Contrast-enhanced perfusion patterns and serum lipid signatures specific of vulnerable plaque in predicting stroke: a cohort study of carotid stenosis in Chinese patients

MyT3 4 - Contrast-enhanced perfusion patterns and serum lipid signatures specific of vulnerable plaque in predicting stroke: a cohort study of carotid stenosis in Chinese patients

02:44H. Yunqian, Shanghai / CN

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 and materials:

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 committee approval

n/a

Funding:

No funding was received for this work.

9
MyT3 4 - Carotid stenosis evaluation by 128-slice CT: comparison of NASCET, ECST and CC grading methods, and comparison with colour-Doppler ultrasonography

MyT3 4 - Carotid stenosis evaluation by 128-slice CT: comparison of NASCET, ECST and CC grading methods, and comparison with colour-Doppler ultrasonography

03:01F. Rijnberg, Gieten / NL

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 and materials:

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 committee approval

n/a

Funding:

No funding was received for this work.

10
MyT3 4 - Non-contrast magnetic resonance angiography in renal artery assessment

MyT3 4 - Non-contrast magnetic resonance angiography in renal artery assessment

02:58S. Sethu Madhavan, Kannur / IN

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 and materials:

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 committee approval

Ethics committee approval was received.

Funding:

No funding was received for this work.

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