MRI Angiography of Physiological and Pathological Pregnancy Placentas Ex-Vivo (MAPLE): protocol for a prospective pilot study. (Preprint)

BACKGROUND Preeclampsia (PE) and intra-uterine growth restriction (IUGR) are two major pregnancy complications due to abnormal placental vasculogenesis. Data on whole fetoplacental vasculature are still missing to better understand these pathologies. Ex-vivo magnetic resonance imaging (MRI) angiography has been developed to characterize the human placental vasculature by injecting contrast within the umbilical cord. OBJECTIVE The primary objective is to compare the vascular architecture of placenta between physiological and pathological pregnancies. Secondary objectives are (i) to analyse vascularization indices and texture features according to the group and within comparable gestational age (ii) to compare de vascularization indices to histological analysis. METHODS This is a prospective controlled study. We expect to include 100 placentas: 40 from normal pregnancies and 60 from pathological pregnancies with 30 for IUGR and 30 for PE. Ex-vivo MRI acquisition will be performed shortly after delivery and with preparation by injection within the umbilical cord. The vascular architecture will be quantitatively described by vascularization indices measured from ex-vivo MRI angiography data. Comparisons of vascularization indices and texture features according to the group and within comparable gestational age will be also performed. After MR acquisition, placental histopathological analysis will be performed. RESULTS The enrolment of women began in November 2019. In view of the recruitment capacity of our institution and the availability of the MRI, the recruitment should be completed by March 2022. As of November 2021, we enrolled 70% of the population. CONCLUSIONS This study protocol aims to provide information about the fetal side of placental vascular architecture in normal and pathological placenta with MRI. CLINICALTRIAL NCT 04389099 (Clinical Trial)

Theory about traumatic brain injury effects. Part II. Clinical and morphological forms of traumatic brain injury effects

Clinical and morphological forms of traumatic brain injury effects are reported, distinguished based on the results, obtained during years of research in the National Medical Research Center for Neurosurgery. Basic criteria are proposed for the diagnosis of those based on the neurological and instrumental examination data, mostly on the neuroimaging data (CT, MRI, angiography).

Spleen

The spleen develops from mesoderm during the fifth week of gestation. Eighty-five percent of humans have 1 spleen, and 15% have accessory spleens. The spleen cleans the blood by trapping and breaking down dysfunctional or old red blood cells. Splenic problems most commonly arise with trauma, lymphoma, benign cysts, and hematologic disorders. Surgeons evaluate the spleen using plain radiography (CXR; kidney, ureter, bladder), CT, MRI, angiography, and nuclear studies. Open splenectomy for trauma or splenomegaly is at times dangerous and difficult with the need for speed, blood transfusion, and hemodynamic support. Potential early postoperative complications include abscess, pancreatic injury, pneumonia, and wound infection.

Thoracic aortic imaging

The type of imaging performed on the thoracic aorta is usually dependent on the clinical presentation, local clinical practice, and availability of imaging techniques. Cardiovascular CT remains the gold standard for aortic assessment, but increasingly cardiac MRI angiography is used, particularly in patients who are young and require serial follow-up. Other standard cardiac imaging procedures are also used in the assessment of aortic pathology, including the PA chest radiograph, TTE, and TOE. Invasive aortography is occasionally also used.

Avoiding Pitfalls in Insulinomas by Preoperative Localization with a Dual Imaging Approach

Insulinomas are rare endocrine malignancies of the pancreas that require surgical resection but can be difficult to localize preoperatively. We sought to review and improve the accuracy of preoperative localization techniques at our institution. We retrospectively reviewed all insulinomas that underwent resection at our institution between 1998 and 2016. Localization techniques include selective arterial calcium stimulation (CaStim), CT, MRI, angiography, and somatostatin receptor scintigraphy. Thirty-eight patients had pathologically proven insulinomas on surgical resection. Localization accuracies of CaStim, CT, and MRI were 89 per cent (31/35), 67 per cent (22/33), and 46 per cent (11/24), respectively. When compared with CTalone and CaStim alone, the combination of these two modalities resulted in 100 per cent preoperative localization (30/30), whereas the use of CaStim alone resulted in 80 per cent (4/5) localization and the use of CT alone resulted in 66 per cent (2/3) localization. Four of our patients had both negative CT and MRI. Among these patients, CaStim was 100 per cent localizing and the only positive modality for these patients. These data confirm that CaStim is accurate in preoperatively identifying single and multiple insulinomas; and when combined with CT, this accuracy is increased to 100 per cent. Based on these data, we propose that a dual imaging approach is a superior means of preoperative localization.

Cerebral Artery Aneurysm Masquerading as Ptosis in a Child

An 8-year-old female presented to Eye OPD of Dhulikhel Hospital, Kathmandu University Hospital, with drooping of the right upper lid and inability to move right eye ball since 3 days. She had no history of trauma or fall injury. On ocular examination, visual acuity was 6/6 on both eyes and there was severe ptosis on the right eye in which eyeball remained abducted with restriction of ocular motility on all gazes. The pupil was dilated and 6mm on the right eye in room light. Posterior segment examination was normal. MRI angiography was done which revealed a right Posterior cerebral artery aneurysm.

Glaucoma Management in Carotid Cavernous Fistula

Carotid cavernous fistulas (CCF) are vascular communications between the carotid artery and the cavernous sinus. Ophthalmologists are called to diagnose and manage the condition in cases that present with ocular features. A 73-year-old female was referred to our glaucoma center clinic. Eight years before, she had started receiving medication for glaucoma and had undergone laser iridotomy, but a satisfactory management of intraocular pressure (IOP) had not been achieved. The patient was complaining of intermittent diplopia, bilateral proptosis, and conjunctival chemosis over the past 6 months. Best-corrected visual acuity in the right (OD) and left eye (OS) was 9/10 and 10/10, respectively. Visual field testing showed slight paracentral field defects mostly in OS. IOP was 20 mm Hg in OD and 34 mm Hg in OS. We referred the patient to neuroradiology, and MRI angiography revealed a CCF with angiographic classification of Cognard grade 2. Closure of the CCF by transarterial embolization was performed in the neuroradiology department. One week following the procedure, the clinical signs of diplopia, proptosis, and conjunctival chemosis had greatly improved, and IOP was reduced to 12 mm Hg OD and 19 mm Hg in OS. Glaucoma treatment was maintained with topical brimatoprost, brinzolamide, and timolol. Owing to the risk of vision loss associated with vascular stasis, retinal ischemia, and high IOP, ophthalmologists must be aware of the clinical features of CCF and should request appropriate imaging studies such as MRI angiography in order to confirm the diagnosis and plan multidisciplinary treatment.

Pathophysiologic features of Takotsubo Cardiomyopathy: A review of the literature

Takotsubo cardiomyopathy is a newly recognized cause of chest pain mimicking a myocardial infarction in post-menopausal women. It is diagnosed based on clinical criteria established at the Mayo Clinic and imaging studies, including echocardiography, cardiac MRI, angiography, and left ventriculography. Several hypotheses have been postulated towards its etiology, with the dominant theory being cathecholamine toxicity to the myocardium in response to a stressful trigger. Pathologic investigations are limited, based mostly on autopsy findings, and represent inflammatory and fibrotic replacement of the myocardium. Here, we will address the current understanding of the disease entity of Takotsubo cardiomyopathy, its clinical mimics, and its pathophysiology. Ibrahim Cardiac Med J 2013; 3(1&2): 39-48