Comprehensive comparison of carotid endarterectomy primary closure and patch angioplasty: A single-institution experience

Background: Carotid endarterectomy (CEA) is an effective intervention for the treatment of high-grade carotid stenosis. Technical preferences exist in the operative steps including the use patch for arteriotomy closure. The goals of this study are to compare the rate of postoperative complications and the rate of recurrent stenosis between patients undergoing primary versus patch closure during CEA. Methods: Retrospective chart review was conducted for patients who underwent CEA at single institution. Vascular surgeons mainly performed patch closure technique while neurosurgeons used primary closure. Patients’ baseline characteristics as well as intraprocedural data, periprocedural complications, and postprocedural follow-up outcomes were captured. Results: Seven hundred and thirteen charts were included for review with mean age of 70.5 years (SD = 10.4) and males representing 64.2% of the cohort. About 49% of patients underwent primary closure while 364 (51%) patients underwent patch closure. Severe stenosis was more prevalent in patients receiving patch closure (94.5% vs. 89.4%; P = 0.013). The incidence of overall complications did not differ between the two procedures (odds ratio = 1.23, 95% confidence intervals = 0.82–1.85; P = 0.353) with the most common complications being neck hematoma, strokes, and TIA. Doppler ultrasound imaging at 6 months postoperative follow-up showed evidence of recurrent stenosis in 15.7% of the primary closure patients compared to 16% in patch closure cohort. Conclusion: Both primary closure and patch closure techniques seem to have similar risk profiles and are equally robust techniques to utilize for CEA procedures.

Monitoring of Neuroendocrine Changes in Acute Stage of Severe Craniocerebral Injury by Transcranial Doppler Ultrasound Image Features Based on Artificial Intelligence Algorithm

This study was aimed at exploring the application value of transcranial Doppler (TCD) based on artificial intelligence algorithm in monitoring the neuroendocrine changes in patients with severe head injury in the acute phase; 80 patients with severe brain injury were included in this study as the study subjects, and they were randomly divided into the control group (conventional TCD) and the experimental group (algorithm-optimized TCD), 40 patients in each group. An artificial intelligence neighborhood segmentation algorithm for TCD images was designed to comprehensively evaluate the application value of this algorithm by measuring the TCD image area segmentation error and running time of this algorithm. In addition, the Glasgow coma scale (GCS) and each neuroendocrine hormone level were used to assess the neuroendocrine status of the patients. The results showed that the running time of the artificial intelligence neighborhood segmentation algorithm for TCD was 3.14 ± 1.02 s , which was significantly shorter than 32.23 ± 9.56 s of traditional convolutional neural network (CNN) algorithms ( P < 0.05 ). The false rejection rate (FRR) of TCD image area segmentation of this algorithm was significantly reduced, and the false acceptance rate (FAR) and true acceptance rate (TAR) were significantly increased ( P < 0.05 ). The consistent rate of the GCS score and Doppler ultrasound imaging diagnosis results in the experimental group was 93.8%, which was significantly higher than the 80.3% in the control group ( P < 0.05 ). The consistency rate of Doppler ultrasound imaging diagnosis results of patients in the experimental group with abnormal levels of follicle stimulating hormone (FSH), prolactin (PRL), growth hormone (GH), adrenocorticotropic hormone (ACTH), and thyroid stimulating hormone (TSH) was significantly higher than that of the control group ( P < 0.05 ). In summary, the artificial intelligence neighborhood segmentation algorithm can significantly shorten the processing time of the TCD image and reduce the segmentation error of the image area, which significantly improves the monitoring level of TCD for patients with severe craniocerebral injury and has good clinical application value.

Sonography of tendon pathology in the hand and wrist

Traumatic and non-traumatic tendon lesions are common at the wrist and hand. For the diagnosis, therapy management, and long-term prognosis of tendon lesions, a detailed understanding of the complex anatomy and knowledge of typical injury patterns is crucial for both radiologists and clinicians. Improvements in high-resolution ultrasound are producing high quality images of the superficial tendinous and peritendinous structures. Thus, ultrasound is a valuable first-choice tool for visualizing traumatic, inflammatory, and degenerative conditions of the extensor and flexor tendons, particularly with the advantage of possible dynamic examination. The additional use of duplex-Doppler and power Doppler ultrasound imaging is recommended for detection of tenosynovitis in overuse injury, inflammatory disease, infection, and after traumatic conditions. In traumatic tendon injuries, knowing the precise injury zone is important for treatment decision-making. In cases of tendon rupture, the radiologist should report the tear type (i.e., complete or partial-thickness) and assess the degree of tendon retraction and associated avulsion injury, including the degree of fragment displacement. The function of intact flexor tendons may be impaired by thickening, strain, or rupture of corresponding annular pulleys. This review describes in detail the typical ultrasound imaging features of common pathologies of hand and wrist tendons, including annular pulley lesions.

Differential diagnosis of peripheral exudative hemorrhagic chorioretinopathy and neoplasm of the choroid (clinical case)

Peripheral exudative hemorrhagic chorioretinopathy is a relatively rare and difficult to diagnose disease. This condition is clinically similar to choroidal melanoma, which is why it is called pseudomelanoma. An erroneous diagnosis of choroidal melanoma can lead to the wrong choice of aggressive treatment tactics. The aim of this work was to present a case of differential diagnosis of suspected neoplasm of the choroid with peripheral exudative hemorrhagic chorioretinopathy. The described clinical case demonstrates characteristic clinical picture and results of ultrasound with Doppler mapping, spectral optical coherence tomography, optical coherence tomographyangiography, scanning laser ophthalmoscopy for this condition, as well as important differential diagnostic signs of choroidal melanoma. Complaints, history, clinical picture and the results of instrumental examinations were characteristic of peripheral exudative hemorrhagic chorioretinopathy and allowed to exclude the diagnosis of choroidal neoplasm. Pathogenetic treatment (intravitreal injection of anti-VEGF agents) and observation were recommended to the patient, since this disease often affects both eyes. The main differential diagnostic criterion for suspected choroidal melanoma is Doppler ultrasound imaging. In difficult clinical cases, structural optical coherence tomography, optical coherence tomographyangiography, and scanning laser ophthalmoscopy provide valuable additional information for verifying the diagnosis.

Correlation between Ultra-Wide-Field Retinal Imaging Findings and Vascular Supra-Aortic Changes in Takayasu Arteritis

(1) Background: Takayasu arteritis (TA) is a chronic inflammatory large-vessel vasculitis. Ultra-wide-field imaging allows describing the retinal lesions in these patients and correlating them with vascular supra-aortic stenosis. (2) Methods: In total, 54 eyes of 27 patients diagnosed with TA were included, and a complete ophthalmological examination was performed, including UWF color fundus photography (UWF-CFP), fluorescein angiography (UWF-FA), and computed tomography angiography measuring supra-aortic stenosis. Eleven patients underwent Doppler ultrasound imaging assessing the blood flow velocity (BFV) in the central retinal artery (CRA). (3) Results: Microaneurysms were detected in 18.5% of eyes on fundus examination, in 24.4% of eyes on UWF-CFP, and in 94.4% of eyes on UWF-FA. The number of microaneurysms significantly correlated with the presence of an ipsilateral supra-aortic stenosis (p = 0.026), the presence of hypertension (p = 0.0011), and the duration of the disease (p = 0.007). The number of microaneurysms per eye negatively correlated with the BFV in the CRA (r = −0.61; p = 0.003). (4) Conclusions: UWF-FA improved the assessment of TA-associated retinal findings. The significant correlation between the number of microaneurysms and the BFV in the CRA gives new insight to our understanding of Takayasu retinopathy. The total number of microaneurysms could be used as an interesting prognostic factor for TA.

Doppler Ultrasound under Image Denoising Algorithm in the Diagnosis and Treatment of Fetal Growth Restriction Using Aspirin Combined with Low-Molecular-Weight Heparin

Objective. This study explored the clinical application value of image denoising algorithm combined with Doppler ultrasound imaging in evaluation of aspirin combined with low-molecular-weight heparin (LMWH) on fetal growth restriction (FGR). Method. A two-stage image denoising by principal component analysis (PCA) with local pixel grouping (LPG-PCA) denoising algorithm was constructed in this study. Eighty FGR pregnant women were included in the study, and they were rolled into an experimental group (aspirin enteric-coated tablets + LMWH calcium injection) and a control group (LMWH calcium injection) according to the different treatment plans, with 40 cases in each group. All patients were performed with Doppler ultrasound imaging. The blood flow parameters (BFPs) were recorded and compared before and after the treatment in two groups, including power index (PI), resistance index (RI), high systolic blood flow velocity (S), high diastolic blood flow velocity (D), S/D value, and peak systolic velocity (PSV). In addition, the middle cerebral artery (MCA) BFPs, cerebral placental rate (CPR), amniotic fluid index (AFI) and perinatal outcome (PO) of the two groups were compared. Results. The total effective rate of treatment in group A (87.5%) was greatly higher than that in group B (62.5%), showing statistical difference (P < 0.05). The PI (0.72 ± 0.19), RI (0.57 ± 0.17), and S/D values (2.26 ± 0.43) in group A were dramatically lower than those in group B, which were 0.92 ± 0.21, 0.75 ± 0.14, and 2.64 ± 0.45, respectively (P < 0.05), and the AFI was higher (13.71 ± 2.2 cm vs 11.38 ± 2.16 cm) (P < 0.05). The Apgar score (9.17 ± 0.26), weight (3.57 ± 1.08), and gestational age (38.85 ± 2.50) of group A were all higher in contrast to those of group B, which were 7.33 ± 0.25, 2.61 ± 1.13, and 36.18 ± 2.25, respectively (P < 0.05). In addition, the fetal double parietal diameter (2.4 ± 0.9 mm), femur diameter (2.2 ± 0.6 mm), head circumference (1.2 ± 0.4 mm), abdominal circumference (1.3 ± 0.7 mm), and uterine height (0.8 ± 0.3 mm) in group A were obviously superior to those in group B, which were 1.8 ± 0.4 mm, 1.7 ± 0.5 mm, 0.8 ± 0.2 mm, 0.9 ± 0.4 mm, and 0.4 ± 0.6 mm, respectively, showing statistically observable differences (P < 0.05). Conclusion. Doppler ultrasound based on image denoising algorithm can accurately evaluate the effect of aspirin combined with LMWH on the improvement of FGR and showed good application value.

Internal Perivenous Compression for venous insufficiency at the Saphenofemoral Junction: Early and Midterm Results and Operative Pain

Objectives To assess the postoperative pain and midterm results of patients undergoing internal perivenous compression with internal compression therapy (ICT) for venous insufficiency at the saphenofemoral junction (SFJ) Materials and Methods Patients managed with ICT between April and October 2019 for grade 4 venous reflux at the SFJ were retrospectively evaluated. The venous clinical severity score (VCSS) was calculated preoperatively and 1, 3, and 6 months postoperatively. Postoperative pain was assessed with the visual analog scale (VAS). Control Doppler ultrasound imaging was performed 6 months postoperatively. Results Forty-five patients [14 (31%) males and 31 (69%) females; mean age, 47 ± 13 years] were included. The median preoperative VCSS was 7 (5–8.5). The median VCSS at 1, 3, and 6 months postoperatively was 6 (4–7.5), 4 (3–5.5), and 3 (2–4), respectively, and these values were significantly lower than the preoperative score (p = 0,001, p < 0.001, and p < 0.001, respectively). The postoperative VAS score was 0 in 6 patients (13%), 1 in 17 patients (38%), 2 in 6 patients (13%), 3 in 15 patients (33%), and 4 in 1 patient (2%). At 6 months, reflux was absent in 9 (20%), grade 1 in 20 (44%), and grade 2 in 16 (36%) patients. A vena saphena magna diameter of >6.7 mm predicted grade >1 reflux at 6 months [87.5%, with an area under the curve of 0.78 (p < 0.001)]. No complications occurred. Conclusion ICT alleviated symptoms and reduced reflux grade in patients with venous insufficiency at the SFJ. This therapy can be applied with satisfactory patient comfort.

Hemorrhage due to attempted excision of a frontal exophytic lesion: A cautionary tale

Background: Despite mainly benign, exophytic subcutaneous cranial masses present with a myriad of differential diagnosis possibilities, ranging from simple, superficial lesions to complex lesions involving the central nervous system. Although the gold standard imaging modality for the diagnosis of these lesions is magnetic resonance imaging, Doppler Ultrasonography can be a useful, inexpensive, and available tool for evaluation of lesions that could potentially be safely treated in the primary care setting, and lesions that would demand advanced neurosurgical care. Case Description: This patient presented with a complex exophytic plasmocytoma that was first diagnosed and erroneously approached as a subcutaneous lipoma with surgical resection in an outpatient surgical setting. This interpretive approach resulted in the failure of the procedure due to significant hemorrhage. The patient was immediately referred to neurosurgical care and transferred to our center. Admission doppler ultrasound imaging revealed absence of the frontal bone, the enriched and profuse vascularization, allowing further and proper diagnostic approach and treatment. Conclusion: Ultrasound could be a reliable, fast, and simple imaging method aiding practitioners to perform a better workup for patients with exophytic subcutaneous cranial masses.

Morphological Study of Color Doppler Ultrasound Imaging to Observe the Effect of Ocular Fundus Surgery

High myopia continues to progress and the eye axis continues to grow, resulting in mechanical dilatation of the eyeball wall, and with the increase of age, resulting in a variety of myopic fundus pathological changes. Considering that in the late stage of fundus disease, patients can obviously feel the impact of the disease on vision, and ophthalmologists are needed for direct diagnosis, intervention and treatment. The impact of early lesions on vision is relatively weak, and patients can not detect the emergence of these lesions in time, which can only be found by fundus survey. Therefore, the automatic detection of early lesions of fundus disease (especially microaneurysms) is not only of great significance for early diagnosis and early treatment of fundus disease, but also a good reference for the detection of other fundus diseases. In this paper, color ultrasound can effectively analyze the origin of fundus diseases. The results showed that with the changes of age, eye axis and posterior sclera shape in high myopia, the area and range of myopic arc and choroidal atrophy arc expanded, the thickness of nerve fiber and choroid became thinner, and the fovea of macula mainly shifted vertically. In addition, it was also found that myopic arc, choroidal atrophic arc area, retinal thickness, nerve fiber thickness, choroidal thickness, vertical distance from macular fovea to optic disc center were correlated with age and eye axis.