Aortic Intramural Hematoma due to Intercostal Artery Aneurysms

Background Intercostal artery aneurysms (ICA) are rare vascular disease. A rupture of ICA is a possible mechanism of intramural aortic hematoma (IH). We report a case with IH and ICAs without clear etiology. Case presentation: A 64-year-old man was admitted to our emergency room with a sudden onset of acute diffused abdominal and chest pain, radiating to the back. Without previous traumatic insult, a computed tomographic angiography scan (CTA) revealed an IH beginning inferior to the left subclavian artery extending to the level of the celiac trunk. Follow-up CTA demonstrated a stable maximal IH thickness diameter of 11 mm, maximal aortic diameter of 40 mm, a new left hemorrhagic pleural effusion, and a focal contrast enhancement at T9 level. Due to these findings, thoracic endovascular aortic repair (TEVAR) was performed. During follow up, T9 focal enhancement continues to grow and an additional one developed. Selective angiography was performed demonstrating a connection to the costal artery and the aortic lumen, confirming ICA. Successful embolization with micro coils was performed. During follow up, additional 2 ICAs developed and treated with embolization. CTA three months later showed a complete resolution of the IH and obliteration of all treated ICAs. Infectious, inflammatory and connective tissue disease investigations were undertaken without a clear etiology. Conclusions: This is a case of IH and ICAs, in the absence of a clear etiology which were successfully treated by endovascular procedures TEVAR and coil embolization. It is not clear whether the hematoma was the source of the ICA or the other way round. Lack of ICAs in the initial CTA might be due to the pressure exerted by the hematoma or that they were too small to be detected but continued to grow on follow up. Rupture of these micro-aneurysms is a possible mechanism of intramural aortic hematoma.

Association of Bleb Formation With Peri-aneurysmal Contact in Unruptured Intracranial Aneurysms

The mechanism of bleb formation in unruptured intracranial aneurysms (UIAs) remains unclear. This study aimed to investigate the association between peri-aneurysmal contact (PAC) and bleb formation. Forty-five aneurysms were classified depending on the presence of blebs and PAC using computed tomographic angiography and magnetic resonance imaging. Aneurysmal hemodynamics were assessed using computational fluid dynamics. The independent variables associated with bleb formation were statistically assessed. Fourteen aneurysms (31.1%) had blebs, all of which were located at the site of PAC (group A). Thirty-one aneurysms (68.9%) had no bleb, of which 13 had a PAC (group B) and 18 had no PAC (group C). PAC was the only independent variable associated with bleb formation (p < 0.05). Aneurysmal volumes were significantly higher in group A, followed by groups B and C in series. Aneurysmal wall shear stress (WSS) tended to be lowest in group A, followed by groups B and C in series. The maximum WSS at the blebs was only 17% of the maximum WSS at the aneurysmal domes. This study demonstrated that bleb formation in UIAs was associated with the establishment of PAC during their growth, which may have more detrimental effects on bleb formation than hemodynamics.

A Novel End-to-End Deep Learning Solution for Automatic Coronary Artery Segmentation from CCTA: Algorithm Development and Validation Study (Preprint)

BACKGROUND Coronary computed tomographic angiography (CCTA) plays a vital role in the diagnosis of cardiovascular diseases, among which automatic Coronary Artery Segmentation (CAS) serves as one of the most challenging tasks. To computationally assist the task, this paper proposes a novel DL solution. OBJECTIVE This study introduces an end-to-end novel deep learning-based (DL) solution for automatic CAS. METHODS Inspired by the Di-Vnet network, a fully automatic multistage DL solution is proposed. The new solution aims to preserve the integrity of blood vessels in terms of both their shape details and continuity. The solution is developed using 338 CCTA cases, among which 133 cases (33865 axial images) have their groundtruth cardiac masks pre-annotated and 205 cases (53365 axial images) have their groundtruth coronary artery (CA) masks pre-annotated. DSC and 95% HD scores are used to measure the solution’s accuracy in CAS. RESULTS The proposed solution attains (90.29±1.38) % in its DSC and (2.11±0.24) mm in its 95% HD respectively, which consumes 0.112 seconds per image and 30 seconds per case on average. CONCLUSIONS The proposed solution attains (90.29±1.38) % in its DSC and (2.11±0.24) mm in its 95% HD respectively, which consumes 0.112 seconds per image and 30 seconds per case on average.

The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection

Background The knowledge of the anatomy of the facial vein (FV) is essential for plastic surgery and filler injection. Objectives The purpose of this study was to investigate the variation and three-dimensional course of FV using computed tomographic angiography (CTA). Methods The CTA images of 300 FVs from 150 Asian patients were included in this study. The distance between each anatomical landmark and FV was measured to position the course. The depth of FV beneath the skin and the height of FV above the periosteum were measured at five anatomical planes. Results The facial vein showed a relatively constant course with a frequency of 7.0% variation. The average diameter of FVs was 2.42 ± 0.58 mm. The vertical distance between medial canthus, the midpoint of inferior orbital rim or external canthus and the facial vein was 10.28 ± 2.17 mm, 6.86 ± 2.02 mm, or 48.82 ± 7.26 mm, respectively. The horizontal distance between medial canthus, nasal alar or oral commissure and the facial vein was 6.04 ± 1.44 mm, 22.34 ± 3.79 mm, or 32.21 ± 4.84 mm, respectively. The distance between mandibular angle or oral commissure and the facial vein at the inferior of mandible was 24.99 ± 6.23 mm, or 53.04 ± 6.56 mm. The mean depth of FV beneath the skin at the plane of medial canthus, infraorbital, nasal ala, oral commissure, and mandible was 1.16 ± 0.99 mm, 5.83 ± 1.64 mm, 16.07 ± 4.56 mm, 14.92 ± 2.49 mm, and 9.67 ± 2.88 mm, respectively. The mean height of FV above the periosteum at the plane of medial canthus, infraorbital, nasal ala, and mandible was 1.17 ± 1.32 mm, 3.59 ± 1.48 mm, 3.92 ± 1.95 mm, and 3.50 ± 2.03 mm, respectively. Conclusions This study revealed the three-dimensional course of the facial vein with reference to the anatomical landmarks. The detailed findings of the facial vein will provide a valuable reference for plastic surgery and filler injection.

Swiss cheese interventricular septum presenting with catastrophic stroke: the potential role of ECG-gated CTA

Ventricular septal defect is a common congenital cardiac condition that presents in a variety of morphologies. Less commonly, when an individual patient is found to have multiple ventricular septal defects, the term “Swiss cheese ventricular septal defect” is applied. Although not routinely utilized in clinical practice, Electrocardiogram (ECG)-gated computed tomographic angiography (CTA) has been shown to provide utility in detecting intracardiac shunts, demonstrating promise in preventing acute strokes secondary to a paradoxical embolus from occurring; this is especially important when atypical cardiac septa are suspected. This case seeks to illustrate how usage of ECG-gated CTA can assist in early detection and prevention of adverse outcomes resulting from an atypical presentation of a ventricular septal defect.