Intracranial Magnetic Resonance and Vascular Imaging in Patients with Extracranial Carotid Stenosis

CONTEXT: Indications and results of carotid endarterectomy have been defined from clinical multicentric trials like the European Carotid Surgery Trialists, North-American Symptomatic Carotid Endarterectomy Trial and Asymptomatic Carotid Atherosclerosis Study. The patients included in these trials were highly selected, as were the surgeons performing the operations. Clinical practice is different but the same results should be achieved. OBJECTIVE: To study indications, technique, early and late results, and whether carotid endarterectomy has been performed in accordance with standards defined by multicentric trials. DESIGN: Retrospective case report study. SETTING: A tertiary care private hospital. PARTICIPANTS: 57 patients, on whom 70 carotid endarterectomies were performed over a 10-year period. The median age was 66.4 ± 7.8 years; 43 (75.4%) were male, 41 (71.9%) hypertensive, 36 (63.1%) current smokers and 24 (21.0%) had diabetes. Bilateral carotid stenosis was present in 31 (54.3%) patients, peripheral arterial occlusions in 32 (56.1%) and ischemic cardiopathy in 25 (43.1%). All patients had had angiography and 41 (71.9%) had also had a duplex-scan of neck arteries. Cerebral imaging via computerized tomography scan or magnetic resonance imaging was obtained for 36 patients. Patients were followed up over a period of one to 122 months. MAIN MEASUREMENTS: early and late post-operative death, early and late post-operative stroke, and recurrence of atheroma plaque and symptoms relative to carotid stenosis. RESULTS: There was one post-operative death (1.4%) caused by myocardial infarction and two early strokes (2.8%): a total complication rate of 4.2%. After 3 and 5 years, 95.4% and 81.3% of patients respectively were stroke-free and 72.8% and 67.3% were alive. There were four recurrences and two of them related to stroke. Forty-nine (70%) stenoses operated on were symptomatic. Brain infarction was detected in 59.2% of patients who underwent computerized tomography scan or magnetic resonance imaging. CONCLUSIONS: Carotid endarterectomy was done in accordance with international standards. The most frequent cause of late death was myocardial infarction, and recurrences were related to stroke. Patients should be followed up closely.

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Clinical Diagnosis and Treatment Value of CT Three-Dimensional Imaging of Gynecological Pelvic Blood Vessels

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3716 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1743-1752

Author(s):

Li Qiao ◽

Changxiao Li ◽

Qinde Yu ◽

Li Ma

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Clinical Diagnosis ◽

Young Women ◽

Three Dimensional ◽

Iliac Vein ◽

Vascular Imaging ◽

Diagnosis And Treatment ◽

3D Ct ◽

External Iliac Vein

For diseases of the abdominal and pelvic system, especially those of the blood duct system, the main examination methods of the transmission system are color Doppler ultrasound, enhanced CT angiography and digital subtraction angiography (DSA). Among them, DSA is the gold standard of angiography, but it is an invasive examination, which is complicated, time-consuming and laborious, and the skill of intubation is very high. Enhanced 3D-CT blood tube imaging has been gradually used in clinic because of its advantages such as fast imaging speed and wide imaging range. It has good vascular imaging conditions and satisfactory vascular imaging results in all parts of the human body, but this examination is radioactive and is not beneficial to young women of childbearing age, children and frail patients. The purpose of this paper is to further illustrate the value of magnetic resonance angiography (CTA) in displaying pelvic vessels by comparing the three-dimensional model of magnetic resonance angiography (CTA) and magnetic resonance angiography (MRA) in healthy young women. The results showed that for the venous system, CTA usually showed only the internal and external iliac vein, but not for the uterine vein and other branches of the internal and external iliac vein, and almost no imaging for the anterior sacral vein. CE-MRA can not only display 1-4 grade arteries to the same extent, but also show more branches of superior and inferior gluteal arteries, and show more abundant veins, especially presacral veins. For cases such as gynecological pelvic floor surgery, it is necessary to know the vascular network of presacral region before operation. In a word, for clinical diagnosis and treatment value, the 3D-CT imaging is the first choice.

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Vascular imaging of the spine in the US Medicare population: Catheter and MR angiography volumes from 2004 to 2016

The Neuroradiology Journal ◽

10.1177/1971400920932488 ◽

2020 ◽

Vol 33 (4) ◽

pp. 318-323

Author(s):

Kofi-Buaku Atsina ◽

Mougnyan Cox ◽

Neda I Sedora Roman ◽

Bryan Pukenas ◽

Laurence Parker ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Mr Angiography ◽

Vascular Imaging ◽

Fee For Service ◽

Current Procedural Terminology ◽

Catheter Angiography ◽

Physician Specialty ◽

The Us ◽

Spinal Catheter

Aims The purpose of our study was to analyze utilization trends and physician specialty distribution in spinal catheter angiography and magnetic resonance angiography in the Medicare fee-for-service population. Methods Data from the CMS Physician/Supplier Procedure Summary Master Files for 2004 to 2016 were used for this study. The Current Procedural Terminology version 4 codes for spinal magnetic resonance angiography (72159) and spinal catheter angiography (75705) were used to analyze the volumes of these procedures. Using Medicare’s 108 specialty code, we compared procedure volumes among physician specialties. Data analysis was performed using SAS version 9.3 for Windows. Results The volume of spinal catheter angiography performed was 4758 in 2004, peaked at 6869 in 2012, and dropped to 6656 in 2016. Overall, the volume of spinal catheter angiography increased by 40% from 2004 to 2016. Radiologists performed the majority of these procedures (3736 or 56.1%) in 2016, followed by neurosurgeons (2456 or 36.9%), and neurologists (346 or 5.2%). The spinal magnetic resonance angiography volume fluctuated between 0 and 1 from 2004 to 2009, then precipitously increased to 40 in 2010, peaked at 133 in 2011, and declined to 81 in 2016. The volume of spinal magnetic resonance angiography procedures increased by 8000% from 2004 to 2016, with radiologists performing the majority of them. Conclusion Our results show that spinal catheter angiography volumes continue to rise in the Medicare fee-for-service population, and are largely performed by radiologists, neurosurgeons, and neurologists. Although spinal magnetic resonance angiography volumes have started to increase, they comprise only a small fraction of studies performed for vascular evaluation of the spine.

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