Multi-Slice Computed Tomographic Angiography for Stenosis Detection in Forearm Hemodialysis Arteriovenous Fistulas

2008 ◽  
Vol 9 (4) ◽  
pp. 278-284 ◽  
Author(s):  
P.P.G.M. Rooijens ◽  
G.P Serafino ◽  
D. Vroegindeweij ◽  
R. Dammers ◽  
T.I. Yo ◽  
...  
Keyword(s):  
High Specificity ◽  
Computed Tomographic Angiography ◽  
Observer Agreement ◽  
Predictive Values ◽  
Computed Tomographic ◽  
Arteriovenous Fistulas ◽  
Blinded Manner ◽  
Sensitivity Specificity ◽  
Tomographic Angiography ◽  
Diameter Reduction

Purpose A method of diagnosing the extent and severity of arteriovenous fistula (AVF) stenoses is multi-slice computed tomographic angiography (MS-CTA). The aim of this prospective study was to assess the accuracy of MS-CTA for the detection and grading of stenoses in AVF in comparison to digital subtraction angiography (DSA), which was used as the gold standard of reference. Methods Fifteen hemodialysis (HD) patients with dysfunctioning forearm AVF were included. These AVFs were evaluated by both DSA and MS-CTA and were read in a prospective, blinded manner by two radiologists experienced in vascular imaging. Results ROC analysis revealed areas under the curve of 0.90 ± 0.07 for observer I and 0.87 ± 0.08 for observer II at a stenosis cut-off level of ≥50% diameter reduction. The combined results for MS-CTA showed sensitivity, specificity and positive and negative predictive values of 82%, 98%, 82% and 98% for stenoses ≥50% and 71%, 99%, 77% and 98% for stenoses ≥75%. Inter-observer agreement for the detection of stenoses ≥50% diameter reduction was 0.70 and 1.0, for MS-CTA and DSA, respectively. Conclusion MS-CTA can provide good visualization of forearm HD access AVF and has moderate sensitivity, but high specificity for the detection of flow-limiting stenoses.

scholarly journals Comparison of CTA to DSA in Determining the Etiology of Spontaneous ICH

2009 ◽  
Vol 36 (2) ◽  
pp. 176-180 ◽  
Author(s):  
Robert Yeung ◽  
Tabassum Ahmad ◽  
Richard I. Aviv ◽  
Lyne Noel de Tilly ◽  
Allan J. Fox ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Predictive Value ◽  
Computed Tomographic Angiography ◽  
Lower Sensitivity ◽  
Study Cohort ◽  
Computed Tomographic ◽  
Arteriovenous Fistulas ◽  
Kappa Value ◽  
Sensitivity Specificity ◽  
Tomographic Angiography

Background and Purpose:To compare the efficacy of computed tomographic angiography (CTA) to that of digital subtraction angiography (DSA) in the detection of secondary causes of intracerebral hemorrhage (ICH).Methods:Between January 2001 and February 2007 there were 286 patients that had both CTA and DSA for intracranial hemorrhage of all types. Those with primarily subarachnoid hemorrhage or recent trauma were excluded. Fifty-five patients formed the study cohort. Three reviewers independently analyzed the CTAs in a blinded protocol and classified them based on presence or absence of a secondary etiology. Results were compared with the reference standard DSA and kappa values determined for interobserver variability.Results:The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA were 89%, 92%, 91%, 91% and 91%, respectively. Kappa value for interobserver agreement ranged from 0.78 to 0.89. Two of four dural arteriovenous fistulas (dAVF) were missed on CTA by all three reviewers.Conclusion:CTA is nearly as effective as DSA at determining the cause of secondary intracerebral hemorrhage, but with a lower sensitivity for dAVFs. This supports the use of CTA as the first screening test in patients presenting with spontaneous ICH.

Additional value of deep learning computed tomographic angiography-based fractional flow reserve in detecting coronary stenosis and predicting outcomes

2021 ◽  
pp. 028418512098397
Author(s):  
Yang Li ◽  
Hong Qiu ◽  
Zhihui Hou ◽  
Jianfeng Zheng ◽  
Jianan Li ◽  
...  
Keyword(s):  
Deep Learning ◽  
Unstable Angina ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Computed Tomographic Angiography ◽  
Fractional Flow ◽  
Computed Tomographic ◽  
Flow Reserve ◽  
Sensitivity Specificity ◽  
Tomographic Angiography

Background Deep learning (DL) has achieved great success in medical imaging and could be utilized for the non-invasive calculation of fractional flow reserve (FFR) from coronary computed tomographic angiography (CCTA) (CT-FFR). Purpose To examine the ability of a DL-based CT-FFR in detecting hemodynamic changes of stenosis. Material and Methods This study included 73 patients (85 vessels) who were suspected of coronary artery disease (CAD) and received CCTA followed by invasive FFR measurements within 90 days. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristics curve (AUC) were compared between CT-FFR and CCTA. Thirty-nine patients who received drug therapy instead of revascularization were followed for up to 31 months. Major adverse cardiac events (MACE), unstable angina, and rehospitalization were evaluated and compared between the study groups. Results At the patient level, CT-FFR achieved 90.4%, 93.6%, 88.1%, 85.3%, and 94.9% in accuracy, sensitivity, specificity, PPV, and NPV, respectively. At the vessel level, CT-FFR achieved 91.8%, 93.9%, 90.4%, 86.1%, and 95.9%, respectively. CT-FFR exceeded CCTA in these measurements at both levels. The vessel-level AUC for CT-FFR also outperformed that for CCTA (0.957 vs. 0.599, P < 0.0001). Patients with CT-FFR ≤0.8 had higher rates of rehospitalization (hazard ratio [HR] 4.51, 95% confidence interval [CI] 1.08–18.9) and MACE (HR 7.26, 95% CI 0.88–59.8), as well as a lower rate of unstable angina (HR 0.46, 95% CI 0.07–2.91). Conclusion CT-FFR is superior to conventional CCTA in differentiating functional myocardial ischemia. In addition, it has the potential to differentiate prognoses of patients with CAD.

Mirror-Image Spinal Dural Arteriovenous Fistulas at the Craniocervical Junction

Neurosurgery ◽  
2011 ◽  
Vol 69 (5) ◽  
pp. E1166-E1171 ◽  
Author(s):  
Jumpei Oshita ◽  
Satoshi Yamaguchi ◽  
Shinji Ohba ◽  
Kaoru Kurisu
Keyword(s):  
Spinal Cord ◽  
Urinary Incontinence ◽  
Computed Tomographic Angiography ◽  
Craniocervical Junction ◽  
Computed Tomographic ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Mirror Site ◽  
Tomographic Angiography ◽  
Spinal Dural Arteriovenous Fistulas

Abstract BACKGROUND AND IMPORTANCE We report an extremely rare case with mirror-site spinal dural arteriovenous fistulas (DAVFs) at the craniocervical junction. Although multiple spinal DAVFs have been reported in the literature, complete mirror-site lesions with fistulas and feeding arteries in the symmetric position have not been previously described. CLINICAL PRESENTATION A 74-year-old man presented with walking disturbance, urinary incontinence, and constipation progressing over a 14-month period. T2-weighted magnetic resonance imaging showed a high-intensity area in the spinal cord at the level from C4 to C6 and multiple flow voids at the surface of the spinal cord. Three-dimensional computed tomographic angiography revealed bilateral DAVFs located in the mirror site of the craniocervical junction. Direct surgery with suboccipital craniectomy and C1 laminectomy revealed dilated tortuous red veins on the dorsal surface of the spinal cord. We found bilateral symmetric red veins around the dural penetration of the vertebral artery. Both red veins were successfully interrupted with the aneurysmal clips. Postoperative 3-dimensional computed tomographic angiography revealed a disappearance of the bilateral fistulas. Magnetic resonance images obtained 6 months after the surgery confirmed the disappearance of the intramedullary high-intensity area and flow voids. The symptoms before the operation improved after surgery, especially urinary incontinence and constipation, with slight walking disturbance. CONCLUSION Because fistulas in the present case existed at the same spinal level, we found multiple fistulas on the first examination. This early notification resulted in a good outcome from the first operation. If patients with spinal DAVFs have rapidly progressing symptoms, one should suspect multiple fistulas.

Onyx Pulmonary Artery Embolization After Treatment of a Low-Flow Dural Arteriovenous Fistula: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (5) ◽  
pp. E1497-E1500 ◽  
Author(s):  
Bryan A. Pukenas ◽  
Sudhakar R. Satti ◽  
Robert Bailey ◽  
John B. Weigele ◽  
Robert W. Hurst ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Transarterial Embolization ◽  
Treatment Options ◽  
Computed Tomographic Angiography ◽  
Low Flow ◽  
Computed Tomographic ◽  
Arteriovenous Fistulas ◽  
Definitive Therapy ◽  
Tomographic Angiography

Abstract BACKGROUND AND IMPORTANCE: Endovascular management of dural arteriovenous fistulas (DAVFs) has become an accepted primary and often definitive therapy. We present the first documented case of Onyx pulmonary embolism after embolization of a low-flow DAVF. CLINICAL PRESENTATION: A 63-year-old man presented with subarachnoid hemorrhage secondary to a DAVF. Computed tomographic angiography, magnetic resonance imaging, and initial conventional angiogram were negative. A repeat angiogram demonstrated a DAVF, which was cured with Onyx embolization. A routine chest computed tomography after intervention revealed an asymptomatic Onyx embolization cast in a subsegmental pulmonary artery. CONCLUSION: Endovascular treatment options include transarterial embolization with microcoils, polyvinyl alcohol particles, n-butyl-2cyanoacrylate, and Onyx (ev3 Neurovascular, Irvine, California). Complications associated with the use of Onyx are low but include embolizate pulmonary embolism. Patients often remain asymptomatic, but for symptomatic patients, conservative treatment options usually result in resolution of symptoms.

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