scholarly journals The Role of Imaging in Patient Selection, Preoperative Planning, and Postoperative Monitoring in Human Upper Extremity Allotransplantation

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Eira S. Roth ◽  
David G. Buck ◽  
Vijay S. Gorantla ◽  
Joseph E. Losee ◽  
Daniel E. Foust ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Patient Selection ◽  
Muscular Atrophy ◽  
Multimodality Imaging ◽  
Vascular Complication ◽  
Exclusion Criterion ◽  
Native Bone ◽  
Postoperative Imaging ◽  
Vascular Exclusion

Objective. To describe the role of imaging in vascular composite allotransplantation based on one institution’s experience with upper extremity allotransplant patients.Methods. The institutional review board approved this review of HIPAA-compliant patient data without the need for individual consent. A retrospective review was performed of imaging from 2008 to 2011 on individuals undergoing upper extremity transplantation. This demonstrated that, of the 19 patients initially considered, 5 patients with a mean age of 37 underwent transplantation. Reports were correlated clinically to delineate which preoperative factors lead to patient selection versus disqualification and what concerns dictated postoperative imaging. Findings were subdivided into musculoskeletal and vascular imaging criterion.Results. Within the screening phase, musculoskeletal exclusion criterion included severe shoulder arthropathy, poor native bone integrity, and marked muscular atrophy. Vascular exclusion criterion included loss of sufficient arterial or venous supply and significant distortion of the native vascular architecture. Postoperative imaging was used to document healing and hardware integrity. Postsurgical angiography and ultrasound were used to monitor for endothelial proliferation or thrombosis as signs of rejection and vascular complication.Conclusion. Multimodality imaging is an integral component of vascular composite allotransplantation surgical planning and surveillance to maximize returning form and functionality while minimizing possible complications.

scholarly journals Through thick and thin: Diagnosis of transthyretin cardiac amyloidosis through non-invasive multimodality imaging

2021 ◽  
pp. 201010582110061
Author(s):  
Raja Ezman Raja Shariff ◽  
Hafisyatul Aiza Zainal Abidin ◽  
Sazzli Kasim
Keyword(s):  
Cardiac Amyloidosis ◽  
Troponin T ◽  
Multimodality Imaging ◽  
High Sensitivity ◽  
Dark Blood ◽  
Non Invasive ◽  
Doppler Study ◽  
Alternative Means ◽  
High Sensitivity Troponin T

Cardiac amyloidosis is a severely underdiagnosed cause of heart failure with preserved ejection fraction. We report a case of highly probable transthyretin (ATTR) cardiac amyloidosis (ATTR-CA) diagnosed through the assistance of non-invasive multimodality imaging. An 81-year-old man presented with worsening dyspnoea, reduced effort tolerance and limb swelling. Examination and bedside investigations demonstrated congestive cardiac failure. On arrival, N-terminal-pro B-type natriuretic peptide was 2400 ng/L, and high-sensitivity troponin T was 78 mmol/L. Echocardiography showed severe left and right ventricular hypertrophy, and a Doppler study revealed diastolic dysfunction. Cardiac magnetic resonance imaging revealed on non-conventional dark blood sequence an abnormal inversion time for nulling myocardium suggestive of infiltrative disease, including amyloidosis. The patient was referred for nuclear-based studies involving technetium-99m pyrophosphate which demonstrated changes highly diagnostic of ATTR-CA. Early diagnosis of ATTR-CA remains paramount due to the increasing availability of disease-modifying therapies. Current guidelines recognise the role of multimodality imaging in confidently recognising the disease without the need for histological evidence in the appropriate context, providing an alternative means of diagnosis.

scholarly journals Transcatheter Closure of PFO and ASD: Multimodality Imaging for Patient Selection and Perioperative Guidance

2021 ◽  
Vol 8 (7) ◽  
pp. 78
Author(s):  
Gabriele Egidy Assenza ◽  
Luca Spinardi ◽  
Elisabetta Mariucci ◽  
Anna Balducci ◽  
Luca Ragni ◽  
...  
Keyword(s):  
Patient Selection ◽  
Transcatheter Closure ◽  
Multimodality Imaging ◽  
Deep Understanding ◽  
Volume Overload ◽  
Arterial Embolization ◽  
Ventricular Volume ◽  
Intracardiac Echocardiography ◽  
Technical Details ◽  
Asd Closure

Transcatheter closure of patent foramen ovale (PFO) and secundum type atrial septal defect (ASD) are common transcatheter procedures. Although they share many technical details, these procedures are targeting two different clinical indications. PFO closure is usually considered to prevent recurrent embolic stroke/systemic arterial embolization, ASD closure is indicated in patients with large left-to-right shunt, right ventricular volume overload, and normal pulmonary vascular resistance. Multimodality imaging plays a key role for patient selection, periprocedural monitoring, and follow-up surveillance. In addition to routine cardiovascular examinations, advanced neuroimaging studies, transcranial-Doppler, and interventional transesophageal echocardiography/intracardiac echocardiography are now increasingly used to deliver safely and effectively such procedures. Long-standing collaboration between interventional cardiologist, neuroradiologist, and cardiac imager is essential and it requires a standardized approach to image acquisition and interpretation. Periprocedural monitoring should be performed by experienced operators with deep understanding of technical details of transcatheter intervention. This review summarizes the specific role of different imaging modalities for PFO and ASD transcatheter closure, describing important pre-procedural and intra-procedural details and providing examples of procedural pitfall and complications.

The role of endorectal coil MRI in patient selection and treatment planning for prostate seed implants

2002 ◽  
Vol 52 (4) ◽  
pp. 903-910 ◽  
Author(s):  
Daniel H Clarke ◽  
Stephen J Banks ◽  
A.Roger Wiederhorn ◽  
John W Klousia ◽  
Jeanne M Lissy ◽  
...  
Keyword(s):  
Treatment Planning ◽  
Patient Selection ◽  
Endorectal Coil

scholarly journals Adjuvant chemoradiotherapy after d2-lymphadenectomy for gastric cancer: the role of n-ratio in patient selection. results of a single cancer center

2012 ◽  
Vol 7 (1) ◽  
Author(s):  
Wilson L Costa ◽  
Felipe JF Coimbra ◽  
Ricardo C Fogaroli ◽  
Héber SC Ribeiro ◽  
Alessandro L Diniz ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Patient Selection ◽  
Adjuvant Chemoradiotherapy ◽  
Cancer Center ◽  
D2 Lymphadenectomy ◽  
Single Cancer

Role of Ultrasound Elastography in Patient Selection for Prostatic Artery Embolization

2021 ◽  
Author(s):  
André Moreira de Assis ◽  
Airton Mota Moreira ◽  
Francisco Cesar Carnevale ◽  
Antonio Sergio Zafred Marcelino ◽  
Alberto Azoubel Antunes ◽  
...  
Keyword(s):  
Patient Selection ◽  
Ultrasound Elastography ◽  
Artery Embolization ◽  
Prostatic Artery Embolization ◽  
Selection For ◽  
Prostatic Artery

Role of multimodality imaging in a case of heart failure with preserved ejection fraction

2021 ◽  
pp. postgradmedj-2021-139933
Author(s):  
Akash Batta ◽  
Ganesh Kasinadhuni ◽  
Manphool Singhal ◽  
Pankaj Malhotra ◽  
Rajesh Vijayvergiya
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Multimodality Imaging ◽  
Preserved Ejection Fraction

Abstract 94: Patient Selection using CT Perfusion (CTP) Imaging Improves Effectiveness of Stroke Thrombolysis in the 0-4.5 Hour Time Window

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Dulka Manawadu ◽  
Shankranand Bodla ◽  
Laszlo Sztriha ◽  
Josef Jarosz ◽  
Lalit Kalra
Keyword(s):  
Patient Selection ◽  
Functional Outcomes ◽  
Time Window ◽  
Ct Perfusion ◽  
Treatment Protocol ◽  
Early Improvement ◽  
Nihss Score ◽  
Ct Perfusion Imaging ◽  
Mean Blood Glucose

Background: The role of CT perfusion (CTP) in thrombolysis decisions remains controversial and there are no studies that compare outcomes of thrombolysis in patients with or without mismatch on CT perfusion imaging. Methods: We analysed registry data between Jan 2009 and December 2010 for patients thrombolysed within 0-4.5 hours of stroke onset in whom CTP studies were performed prior to thrombolysis. The centre followed thrombolysis guidelines but patients >80 years were included. CTP was not obligatory in the treatment protocol and failure to demonstrate a mismatch was not a contraindication to thrombolysis. We retrospectively analysed data for estimated CTP mismatch of ≥ 100% according to pre-defined criteria and compared outcomes of thrombolysed patients showing perfusion mismatch with those showing no mismatch. Findings: The sample included 160 patients aged between 32-95 years of whom 63 had no mismatch and 97 had a significant mismatch. The two groups were comparable for mean age (73 v 70 years, p=0.18), sex (49% v 54% male, p=0.75), premorbid Rankin Score (mRS) 0-2 (81% v 92%, p=0.77), vascular risk factors profile, mean baseline BP (148/87 v 148/79 mm Hg, p=0.92), mean blood glucose (6.6 v 6.6 mmols/L, p=0.98) and mean National Institute of Health Stroke Scale (NIHSS) score (14.0 v 12.6,p=0.12). Patients who had mismatch prior to thrombolysis showed lower mean 24 hour NIHSS score (7.6 v 11.8, p=0.002) and greater mean 24 hour improvement in NIHSS score (5.1 v 2.0, p=0.010). A higher proportion of patients with mismatch achieved mRS 0-1 and mRS 0-2 at 3 months (36% v 18%, p= 0.012 and 51% v 32%, p=0.015 respectively) but there were no differences in symptomatic sICH rates (1.1% v 0%). Mortality (29% v 18%) and any intracranial haemorrhages (19% v 13%) were lower in mismatch patients but did not achieve significance. Regression analyses showed that PCT mismatch prior to thrombolysis was an independent predictor of both early improvement and functional outcomes at 3 months. Conclusion: Stroke patients who have perfusion mismatch on CTP imaging prior to thrombolysis within the 4.5 hour time window show better early and 3 month outcomes compared with those in whom mismatch cannot be demonstrated. Patient selection using multimodal CT may improve the effectiveness of thrombolysis.

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