Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study

Background: Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed. This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH). Methods: In total, 42 patients with suspected PH who underwent unenhanced CT thorax and right heart catheterization (RHC) were included in the study. Three observers (a consultant radiologist, a specialist registrar in radiology, and a medical student) measured the parameters by using unenhanced CT. Diagnostic accuracy of the parameters was assessed by area under the receiver operating characteristic curve (AUC). Inter-observer variability between the consultant radiologist (primary observer) and the two secondary observers was determined by intra-class correlation analysis (ICC). Results: Overall, 35 patients were diagnosed with PH by RHC while 7 patients were not. Main pulmonary arterial (MPA) diameter was the strongest (AUC 0.79 to 0.87) and the most reproducible great vessel parameter. ICC comparing the MPA diameter measurement of the consultant radiologist to the specialist registrar’s and the medical student’s were 0.96 and 0.92, respectively. Right atrial area was the cardiac measurement with highest accuracy and reproducibility (AUC 0.76 to 0.79; ICC 0.980, 0.950) followed by tricuspid annulus diameter (AUC 0.76 to 0.79; ICC 0.790, 0.800). Conclusions: MPA diameter and right atrial areas showed high reproducibility. Diagnostic accuracies of these were within the range of acceptable to excellent, and might have clinical value. Tricuspid annular diameter was less reliable and less diagnostic and was therefore not a recommended diagnostic measurement.

Radial artery access anatomy: considerations for neuroendovascular procedures

Although enthusiasm for transradial access for neurointerventional procedures has grown, a unique set of considerations bear emphasis to preserve safety and minimize complications. In the first part of this review series, we will review important anatomical considerations for safe and easy neuroendovascular procedures from a transradial approach. These include normal and variant radial artery anatomy, the anatomic snuffbox, as well as axillary, brachial, and great vessel arterial anatomy that is imperative for the neuroendovascular surgeon to be intimately familiar prior to pursuing transradial access procedures. In the next part of the review series, we will focus on safety and complications specific to a transradial approach.

Diagnosis of Early Neurological Deterioration after Intravenous Thrombolysis for Patients with Cerebral Ischemic Stroke Using Compressed Sensing-Magnetic Resonance Imaging Algorithm

This study was to explore the risk factors and prognosis of early neurological deterioration (END) after intravenous thrombolysis in patients with cerebral ischemic stroke (CIS) with the guidance of magnetic resonance imaging (MRI) under the compressed sensing-MRI (CSMRI) algorithm. 187 patients with CIS in the hospital were selected and grouped into a deterioration group and a control group according to whether they had END. The CSMRI algorithm was constructed and compared with digital television (DTV) algorithm and Bayesian compressed sensing (BCS) algorithm. It was found that the reconstruction time of CSMRI algorithm in platform I (1134.9 s) and platform II (2615.8 s) was visibly lower than that of DTV algorithm (2634.6 s, 3963.4 s) and BCS algorithm (5631.5 s, 7412.3 s), showing statistically obvious differences ( P < 0.05 ). In addition, the reconstruction efficiency of the CSMRI algorithm was the best. After 4 hours of intravenous thrombolysis, the stroke scale score (12.3 scores) of the deterioration group was much higher than that of the control group (8.4 scores) ( P < 0.05 ). The occlusion of responsible great vessel in the deterioration group (30 cases, 83.33%) was obviously higher in contrast to that in the control group (74 cases, 49%) ( P < 0.05 ). Stroke scale score and occlusion of responsible great vessel were risk factors for EBD after intravenous thrombolysis.

Coiling of internal carotid through ‘eye of the needle’ internal jugular vein: a dual great vessel anomaly

A variation in the usual course of great vessels during neck dissection can predispose them to inadvertent iatrogenic injury, which can lead to massive bleeding. We present a case of a male patient with oral squamous cell carcinoma who underwent inferior maxillectomy and supra-omohyoid neck dissection. Lateral coiling of the extracranial internal carotid artery was seen through fenestration of the internal jugular vein. Anomalies of great vessels in the neck are rare. Variation in the course of any of these vessels can prove to be catastrophic if control is not achieved. Careful study of radiographic imaging with special consideration given to the course of great vessels in the neck should be undertaken prior to neck surgeries.