Computed tomography angiography

Our goal was to present our 15-year experience (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) with the frozen elephant trunk (FET) technique. METHODS: A total of 251 patients (82 with aortic aneurysms, 96 with acute aortic dissection type A, 4 with acute type B dissections, 52 with chronic aortic dissection type A, 17 with chronic type B dissection and 67 redo cases) underwent FET implantation with either the custom-made Chavan-Haverich (n = 66), the Jotec E-vita (n = 31) or the Vascutek Thoraflex hybrid (n = 154) prosthesis. The cases were assigned to an early period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) and a contemporary period (2012-present). Mean cardiopulmonary bypass time, aortic cross-clamp time, circulatory arrest time and selective antegrade cerebral perfusion time were 241 ± 72, 125 ± 59, 56 ± 30 and 81 ± 34 min, respectively. Incidence of rethoracotomy for bleeding, stroke, spinal cord injury, prolonged ventilatory support (>96 h) and long-term dialysis were 18, 14, 2, 24 and 2%, respectively. The in-hospital mortality rate was 11% (in acute aortic dissection type A, 12%). Of the 2 patients with graft infections, 1 died and the other had a protracted hospital stay. There were 49 second-stage procedures in the downstream aorta: either open surgical [n = 25 (thoraco-abdominal, n = 15; descending, n = 6; infrarenal, n = 4)] or transfemoral endovascular (n = 23). Elective thoracic endovascular aneurysm repair R implantation was successful in all 23 cases. CONCLUSIONS: FET results are comparable with those of the published results of the conventional elephant trunk technique. FET is an ideal landing zone for subsequent transfemoral endovascular completion. Patients with graft infections may have dismal results.

in the U.S. government as the health care reform debate rages on. The era of proving cost effectiveness, not just efficacy, is upon us imagers whether we like it or not. Comparative effectiveness is the new buzzword in the imaging community. The debate in this issue of iJACC is about the utility of this standard to which newer imaging approaches are presently being held. Min et al. argue that this is a difficult standard, as assessing outcomes based on a diagnostic test is fraught with difficulty. They point out the advantages and limitations of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) as it grew into its present place in the diagnostic armamentarium. They suggest that computed tomography coronary angiography (CTCA) has similar prognostic ability, at least in the intermediate term (long-term studies are ongoing), at a lower cost. They recommend comparative effectiveness studies of CTCA and SPECT MPI. Raymond Gibbons points out the problem of spiraling imaging costs. He sets the bar high for CTCA, namely defining its additive value to existing testing before encouraging widespread adoption. He too underscores the excellent prognostic abilities of nuclear imaging. He points out limitations in the existing literature regarding CTCA, including the relatively short follow-up periods for prognostic studies due to the relative youth of the technology. Like Min et al., he stresses the importance of clinical trials to compare CTCA to existing imaging technologies in the evaluation of patients with suspected coronary artery disease (CAD). The emphasis of comparative effectiveness by the National Institutes of Health and the American Heart Association (AHA), among others, will hopefully bear fruit in this regard. We at iJACC hope that you enjoy the vigor of this debate in the imaging community. Both groups come to the same conclusion: comparative studies are sorely needed.

This study aims to assess the correlations among coronary artery calcium (CAC), self-reported exercise, and mortality in asymptomatic patients. The interaction between reported exercise habits and CAC scores for predicting clinical risk is not yet well known. We followed 10,690 asymptomatic patients who underwent CAC scanning. Patients were divided into 4 groups based on a single-item self-reported exercise. Mean follow-up was 8.9 ± 3.5 years for the occurrence of all-cause mortality (ACM). Annualized ACM progressively increased with increasing CAC score (p < 0.001) and decreasing exercise (p < 0.001). Among patients with CAC scores of 0, ACM was low regardless of the amount of exercise. Among patients with CAC scores from 1 to 399, there was a stepwise increase in ACM for each reported decrement in exercise, and this difference was markedly more pronounced among patients with CAC scores ≥400. Compared with highly active patients with a CAC score of 0, highly sedentary patient...

Diagnostic tests that use ionizing radiation play a central role in cardiology and their use has grown in recent years, leading to increasing concerns about their potential stochastic effects. The aims of this study were to compare the radiation dose of three diagnostic tests: single photon emission computed tomography (SPECT), invasive coronary angiography (ICA) and cardiac computed tomography (cardiac CT) and their evolution over time, and to assess the influence of body mass index on radiation dose. We assessed consecutive patients included in three prospective registries (SPECT, ICA and cardiac CT) over a period of two years. Radiation dose was converted to mSv and compared between the three registries. Differences over time were evaluated by comparing the first with the fourth semester. A total of 6196 exams were evaluated: 35% SPECT, 53% ICA and 22% cardiac CT. Mean radiation dose was 10.7±1.2 mSv for SPECT, 8.1±6.4 mSv for ICA, and 5.4±3.8 mSv for cardiac CT (p<0.001 for a...

Objective: To study the role of multidetector computed tomography (MDCT) in evaluating various complications following endovascular stenting of aortic aneurysms. Materials and Methods: Over a period of 2 years (June 2005 to June 2007), 50 patients with aortic aneurysm on computed tomography (CT) angiogram were prospectively studied. Images were acquired on a 64 slice multidetector row CT scanner (GE-LightSpeed VCT) after intravenous administration of nonionic iodinated contrast. Nineteen patients underwent endovascular stent-graft repair based on their medical and surgical risk factors. Stent-graft related complications were recorded by CT angiography and analyzed using descriptive statistics. Results: Most common complication related to the endovascular stent-graft placement was endoleak (44.4%), followed by puncture site hematoma (27.8%), thrombotic occlusion of a limb of the bifurcated stent graft, kinking of the stent-graft, and diffi cult catheterization with intimal tear in the common iliac artery were 5.6% each. Poststent diameter of the aneurysm was an important predictor of endoleaks. All the patients with either increase or no change in the aneurysm size had endoleaks. Conclusion: MDCT angiography is an important modality in identifying, describing, and following up the various complications following endovascular repair of aortic aneurysms, endoleaks being the most common complication. Decrease in the poststent diameter of the aneurysm suggested a good outcome.

We evaluated the feasibility and image quality of a new scan mode for coronary computed tomography angiography (CTA) with an effective dose of less than 1 mSv. In 50 consecutive patients (body weight 100 kg, sinus rhythm 60 b.p.m. after pre-medication, coronary CTA was performed using a dual-source CT system with 2 Â 128 Â 0.6 mm collimation, 0.28 s rotation time, a pitch of 3.2 or 3.4, 100 kV tube voltage and current of 320 mA s. Data acquisition was prospectively triggered at 60% of the R-R interval and completed within one cardiac cycle. Image quality was evaluated using a four-point scale (1 ¼ absence of any artefacts to 4 ¼ uninterpretable). In all 50 patients, imaging was successful. Mean duration of data acquisition was 258 + 20 ms. Mean dose-length product was 62 + 5 mGy cm, the effective dose was 0.87 + 0.07 mSv (0.78-0.99 mSv). Of the 742 coronary artery segments, 94% had an image quality score of 1, 5.0% a score of 2, 0.9% a score of 3, and 4 segments (0.5%) were 'uninterpretable'. In non-obese patients with a low and stable heart rate, prospectively ECG-triggered high-pitch spiral coronary CTA provides excellent image quality at a consistent dose below 1.0 mSv.

Background: False-positive diagnosis of acute Stanford type A aortic dissection (AAD) on computed tomography angiography (CTA) is still an issue and may lead to substantial consequences. Given that electrocardiography (ECG)-gated CTA provides greater diagnostic safety, it may be assumed that interhospital referrals with a diagnosis of AAD based on non-ECG-gated pre-referral CTA carry an elevated risk of false-positive diagnosis. Patients and methods: We reviewed a series of patients in whom a diagnosis of AAD based on non-ECG-gated pre-referral CTA was subsequently proven false by ECG-gated CTA. The artifacts that gave rise to the misdiagnosis, as well as the diagnostic pathways followed and the consequences of false-positive diagnosis were investigated. Results: In 5 patients, ECG-gated repeat CTA revealed artifacts in the pre-referral scans that had led to false-positive diagnosis and referral for emergent surgery. In the first case, the patient proceeded to surgery. In 4 subsequent cases, ECG-gated CTA was ordered because a false-positive diagnosis was suspected. We found that ECG-gated CTA rather than echocardiography provided sufficient information to rule out AAD in each of these cases. Comparison between pre-referral non-ECG-gated scans and ECG-gated repeat CTA demonstrated the wide range of artifacts that may give rise to a diagnosis of AAD. Conclusion: Patient condition permitting, the threshold to ECG-gated repeat CTA should be low when doubt arises with regard to a diagnosis of AAD based on non-ECG-gated CTA in interhospital referrals.

The aim of this study was to evaluate long-term outcomes of endovascular aneurysm repair (EVAR) using a standard suprarenal fixation endograft in abdominal aortic aneurysms (AAAs) with infrarenal neck length #10 mm (short-neck AAA [SN-AAA]). Methods: From 2005 to 2010, data of high-risk patients with SN-AAA, unfit for open repair (OR) and fenestrated EVAR, were prospectively collected. Follow-up was performed by duplex ultrasound and contrast-enhanced ultrasound or computed tomography angiography at 1 month, 6 months, and 12 months and yearly thereafter. The primary end point was AAA-related mortality. Secondary end points were proximal type I endoleak, freedom from reintervention, and AAA shrinkage (>5 mm). Results: Sixty patients (mean age, 74.9 6 6.2 years; American Society of Anesthesiologists class 3 [85%] and class 4 [15%]) were enrolled. The mean aneurysm diameter and neck length and diameter were 60.4 6 12.2 mm, 8.4 6 1.6 mm, and 23.5 6 3 mm, respectively. Four (7%) patients were symptomatic and 15 (25%) had rapid AAA enlargement (>5 mm/ 6 months). Cook Zenith Flex (Cook Medical, Bloomington, Ind) endografts (32) and Medtronic Endurant (Medtronic, Santa Rosa, Calif) endografts (28) were implanted. The mean follow-up was 51 6 18 months. Survival at 5 years was 70%. There were three (5%) type I endoleaks. One was sealed by endovascular reintervention, and two (3%) underwent conversion to OR for AAA rupture at 8 and 36 months. Both patients died (2/60; 3% AAA-related mortality). Reinterventions were necessary for another five (8%) patients, and they were not proximal neck related. Freedom from reintervention at 5 years was 90%. In 49 (82%) cases, there was AAA shrinkage; the AAA diameter remained stable in nine (15%) and increased in two (3%) cases. Severe proximal angle (a neck angle $60 degrees) was associated with type I endoleak (P [ .010) and reinterventions (P [ .010). The neck length <7 mm (P [ .030) was associated with reinterventions (P [ .017). Conclusions: Suprarenal fixation EVAR in SN-AAA with a straight, not wide neck and 7-to 10-mm aortic neck length can be considered safe and effective in patients who are unfit for OR and fenestrated EVAR. For these cases, long-term data showed acceptable results in preventing aneurysm rupture and related mortality. (

Middle aortic syndrome (MAS) results from a diffuse narrowing of the distal thoracic or abdominal aorta commonly involving both the visceral and renal arteries. Congenital, acquired, inflammatory, and infectious etiologies have been described. Symptoms typically occur within the first three decades of life and include hypertension, lower extremity claudication, and mesenteric ischemia. The condition is considered a life-threatening emergency as

Background Congenital aortic diseases (CAoD) encompass a wide variety of disorders that range from asymptomatic findings to life-threatening conditions. Multiple imaging techniques are available for the assessment of CAoD. Case summary We present seven case reports of congenital aortic diseases, including obstructions in the aortic arch (coarctation, hypoplasia, and interruption) and vascular rings, in which the clinical manifestations throughout the cases are discussed, highlighting the heterogeneity of the symptoms. Discussion Multi-imaging techniques are indispensable for the assessment of CAoD, where cardiac computed tomography angiography is the main modality for rapid acquisition of three-dimensional volume-rendered images for optimal surgical planning.

The median arcuate ligament, or celiac artery compression syndrome is a rare syndrome, caused by extrinsic compression of the celiac trunk by the median arcuate ligament. Its symptomatology mainly comprises of visceral angina. Differential diagnosis includes cardiovascular angina, other vascular events and causes of vagotonia. The case reported here refers to a middle aged male patient who presented with intermittent epigastric pain and diaphoresis after a long drive. Diagnosis was made radiologically, during computed tomography scan angiography, which revealed a hook-like appearance of the celiac artery partially loosened during inspiration. Careful history and cautious reviewing of the imaging may refrain from further, unnecessary, diagnostic investigations.

Cardiovascular disease (CVD) is one of the leading causes of death in adults in Zambia among the noncommunicable diseases. The Government of the Republic of Zambia through the Ministry of Health procured Japanese radiological systems, computed tomography, and angiography for the University Teaching Hospitals (UTHs) -Adult in 2015. However, the operation of these diagnostic systems has not been optimal due to lack of a proper maintenance service plan, lack of competent health professionals, and erratic supply of medical consumables. In this study, we report our experiences of providing intensive training to multidisciplinary healthcare teams of the radiology department at UTHs -Adult from 2017 to 2019 to strengthen the quality management system of the radiological equipment so as to provide effective healthcare services. However, the COVID-19 pandemic has had enormous negative impact on essential healthcare. Long-term support through continuous hands-on training must be provided to establish sustainable healthcare services.

Background: The anatomy of superior mesenteric artery (SMA) is complicated and has numerous variations. Awareness of aberrant branches of SMA can result in accurate interpretation of disease and vascular involvement, optimal selection of treatment options or operative planning, and help avoid iatrogenic injury from surgical and interventional radiological procedures. Objective: We determined different aberrant arterial branches of SMA and their order of frequencies by using MDCT angiography of the abdominal aorta in order to achieve accurate diagnostic interpretation and for safety of surgical, laparoscopic, and interventional procedures. Material and Methods: One hundred ninety nine MDCT angiography of abdominal aorta or whole aorta studies, done between January 1, 2007 and December 31, 2009, were retrospectively reviewed by consensus of two radiologists. Interobserver reliability is obtained using -statistics. Assessment for the presence of aberrant arterial branches of SMA was pe...

Background-Aortic diseases, including aortic aneurysms, are the 12th leading cause of death in the United States. The incidence of descending thoracic aortic aneurysms is estimated at 10.4 per 100,000 patient-years. Growing evidence suggests that stress measurements derived from structural analysis of aortic geometries predict clinical outcomes better than diameter alone. Methods-Twenty-five patients undergoing clinical and radiologic surveillance for thoracic aortic aneurysms were retrospectively identified. Custom MATLAB algorithms were employed to extract aortic wall and intraluminal thrombus geometry from computed tomography angiography scans. The resulting reconstructions were loaded with 120 mm Hg of pressure using finite element analysis. Relationships among peak wall stress, aneurysm growth, and clinical outcome were examined. Results-The average patient age was 71.6 ± 10.0 years, and average follow-up time was 17.5 ± 9 months (range, 6 to 43). The mean initial aneurysm diameter was 47.8 ± 8.0 mm, and the final diameter was 52.1 ± 10.0 mm. Mean aneurysm growth rate was 2.9 ± 2.4 mm per year. A stronger correlation (r = 0.894) was found between peak wall stress and aneurysm growth rate than between maximal aortic diameter and growth rate (r = 0.531). Aneurysms undergoing surgical intervention had higher peak wall stresses than aneurysms undergoing continued surveillance (300 ± 75 kPa versus 229 ± 47 kPa, p = 0.01). Conclusions-Computational peak wall stress in thoracic aortic aneurysms was found to be strongly correlated with aneurysm expansion rate. Aneurysms requiring surgical intervention had significantly higher peak wall stresses. Peak wall stress may better predict clinical outcome than maximal aneurysmal diameter, and therefore may guide clinical decision-making. Aortic disease, including aortic aneurysms, is the 12th leading cause of death in the United States . While abdominal and ascending aortic aneurysms are more common, the incidence of descending thoracic aortic aneurysms (TAAs) is increasing, reaching 10.4 per

Background: Time to computerized tomography (CT) is important to institute appropriate and timely hyper-acute management in stroke. We aimed to evaluate mortality outcomes in relation to age and time to CT scan. We used routinely collected data in eight National Health Service Trusts in East of England between September 2008 and April 2011. Stroke cases were prospectively identified and confirmed. Odds ratios for unadjusted and adjusted models for age categories(<65, 65-74, 75-84 and ≥85 years) as well as time to CT categories(<90 minutes, ≥90 to <180 minutes, ≥180 minutes to 24 hours and >24 hours) and the in-hospital and early(<7 days) mortality outcomes were calculated. Results: Of 7,693 patients (mean age 76.1 years, 50% male) included, 1,151(16%) died as inpatient and 336(4%) died within seven days. Older patients and those admitted from care home had a significantly longer time from admission until CT (p<0.001). Patients who had earlier CT scans were admitted to stroke units more frequently (p<0.001) but had higher inpatient(p<0.001) and seven-day mortality(p<0.001). Whilst older age was associated with increased odds of mortality outcomes, longer time to CT was associated with significantly reduced within 7 day mortality(corresponding ORs for above time periods were 1.00, 0.61(0.39-0.95), 0.39(0.24-0.64) and 0.16(0.08-0.33) and in-hospital mortality(ORs 1.00, 0.86(0.64-1.15), 0.57(0.42-0.78) and 0.71(0.52-0.98)). Older age was associated with a significantly longer time to CT. However, using CT scan time as a benchmarking tool in stroke may have inherent limitations and it does not appear to be a suitable quality marker.

Introducción: la muerte encefálica es un resultado indeseable de la medicina, pero tiene efectos beneficiosos. Los pacientes fallecidos con este criterio son el origen más frecuente de obtención de órganos, una de las piezas fundamentales de cualquier programa de trasplantes. Objetivo: caracterizar clínica e imagenológicamente la muerte encefálica en las unidades de cuidados intensivos del hospital Abel Santamaría Cuadrado de enero 2014 -diciembre 2015.

Introducción: el apropiado manejo del donante potencial antes y después del diagnóstico de muerte encefálica puede mejorar el número y calidad de los órganos procurados. Objetivo: conocer las complicaciones durante el mantenimiento del donante real de órganos en muerte encefálica en el Hospital General Docente Abel Santamaría Cuadrado durante los años 2014 y 2015. Método: se realizó una investigación descriptiva, prospectiva de corte transversal en pacientes con diagnóstico de muerte encefálica ingresados en las unidades de cuidados intensivos del hospital seleccionado. Los datos fueron obtenidos de las historias clínicas; el universo fueron 36 pacientes con diagnóstico de muerte encefálica y la muestra 15, representando los donantes reales de órganos. Resultados: existió predomino del sexo masculino (66,67%), con el mayor número de casos entre 31 y 50 años de edad. La enfermedad cerebrovascular hemorrágica fue la causa que más contribuyó al diagnóstico de muerte encefálica con 73,33%, la hipotensión arterial estuvo en el total de los casos, la hipernatremia y la diabetes insípida se presentaron en un 73,33%, seguidas por la hipopotasemia (66,67%) y la hipotermia (60%); la extracción de los órganos se realizó en un 80% entre 4 8 horas del diagnóstico de muerte encefálica. el conocimiento de las complicaciones que surgen durante el mantenimiento del donante real de órganos es de vital importancia, ya que podrían influir negativamente en la viabilidad del órgano a trasplantar; la identificación temprana y el tratamiento oportuno son tareas a perfeccionar para lograr el objetivo final, el trasplante. DeCS: Muerte encefálica; mantenimiento; obtención de tejidos y órganos.

Introduction: proper handling of potential donors before and after the diagnosis of brain death can improve the number and quality of the organs procured. Objective: to learn about the complications of keeping real-organ donors in brain death at Abel Santamaria Cuadrado General Teaching Hospital during the years 2014 and 2015. Material and Methods: a descriptive, cross-sectional prospective study in patients with the diagnosis of brain death who were admitted to the intensive care unit. Data were collected from the medical records; the target group included 36 patients with brain death and the sample was comprised of 15 real-donor patients. Results: there was a predominance of male sex (66.67%), with the highest number of cases between 31 and 50 years of age. Hemorrhagic cerebrovascular disease was the cause that most contributed to the diagnosis of brain death with 73.33%, hypotension was present in all cases, hypernatremia and diabetes insipidus appeared in  73.33%, followed by hy...

Introduction: brain death is an undesirable result in medicine field, but it has beneficial effects. Dead patients with this criterion are the most common source of organs, one of the most important clues of organ transplantation program.  Objective: to characterize brain death from the clinical and radiological point of view in the Intensive Care Units of Abel Santamaria Cuadrado general-teaching hospital (January 2014-December 2015). Methods: a descriptive, prospective and cross-sectional study was conducted at Abel Santamaria Cuadrado general teaching hospital with patients admitted to the Intensive Care Units having the diagnosis of brain death (January 2014-December 2015). Data were collected from the clinical records. The target group comprised 175 deceased patients having central nervous system damage, the sample included 36 patients. Results: the age bracket of 39-59 (41.67%), male gender (66.67%), and Caucasian race (61.11%) predominated. Hemorrhagic stroke (77.78%) was the...

Background: Aim of the study was to test the accuracy of AI-based software for detection of large vessel occlusion (LVO) with computed tomography angiography (CTA) in stroke patients using an experienced neuroradiologist's evaluation as the reference. Methods: Consecutive patients who underwent multimodal brain CT for suspected acute ischemic stroke were retrospectively identified. The presence and site (classified as proximal and distal) of LVO were assessed in CTA by an experienced neuroradiologist as a reference and compared to readings of three medical students and AI-based software, the e-CTA. Results: One-hundred-eight participants with a mean age of 70 years (±12.6); 55 (50.9%) females were included. Neuroradiologist found LVO in 70 (64.8%) cases: 45 (41.7%) proximal, and 25 (23.1%) distal. The overall sensitivity for e-CTA was 0.67 (95%CI 0.55-0.78); 0.84 (95%CI 0.71-0.94) for proximal, and 0.36 (95%CI 0.18-0.57) for distal LVOs. Overall specificity and accuracy for e-CTA were 0.95 (95%CI 0.82-0.99) and 0.77 (95%CI 0.68-0.84), respectively. The student's performance was similar to e-CTA. Conclusions: The tested software's performance is acceptable for the detection of proximal LVOs, while it appears to be not accurate enough for distal LVOs.

Background. In patients with SAH and multiple aneurysms, the ruptured lesion must be identified to prevent recurrent bleeding. Aim of the study. To assess the diagnostic value of non-enhanced computed tomography (NECT) in identifying the rupture site in patients with subarachnoid haemorrhage (SAH) and multiple aneurysms. Material and methods. We included patients with SAH revealed by NECT and multiple aneurysms detected on computed tomography angiography (CTA) in whom a ruptured aneurysm was identified during neurosurgery. Two radiologists predicted the location of the ruptured aneurysm based on the distribution of the SAH and location of intracerebral haematoma (ICH) by NECT. Results. Eighty-three patients with a mean age of 55.7 ± 14.4 years were included. Ruptured aneurysms were significantly larger (mean size 7.7 ± 4.7 mm) than unruptured aneurysms (mean size 5.9 ± 4.5 mm; p = 0.014). Interobserver agreement was 0.86 (p < 0.001). Overall sensitivity and specificity of radiological prediction were 78.3% (95% CI, 68.6%-87.1%) and 96.4% (95% CI, 94.3%-97.8%) respectively. Overall PPV and NPV were 78.3% (95% CI, 67.6%-86.3%) and 96.8% (95% CI, 94.8%-98.1%) respectively. The sensitivity and PPV for aneurysms in the anterior communicating, anterior, and middle cerebral arteries appeared to be significantly higher than in other locations (p = 0.015 and 0.019 respectively). Analysis of independent predictive factors of correct radiological location revealed that ICH predisposes to a correct radiological diagnosis with an odds ratio of 8.57 (95% CI, 1.07-68.99; p = 0.03). Conclusions. NECT has a high diagnostic value in identifying the source of bleeding in patients with multiple aneurysms for anterior circulation aneurysms, especially with coexisting ICH. For other locations, NECT is not reliable enough to base treatment decisions upon.

Background In the diagnosis of brain death (BD), computed tomography angiography (CTA) results in some cases show intracranial filling, leading to diagnostic confusion. Because cerebral circulatory arrest commences at the capillary level, we hypothesized that computed tomography perfusion (CTP) would be a more sensitive approach than CTA; therefore, the aim of the study was to compare the sensitivities of CTP and CTA in the diagnosis of BD. Material and Methods Whole brain CTP was performed in patients in the intensive care unit diagnosed with BD and CTA was derived from CTP datasets. Cerebral blood flow (CBF) and volume (CBV) were calculated in all brain regions. The CTP findings were interpreted as being consistent with a diagnosis of BD (positive) when CBF and CBV in all regions of interest (ROIs) were below 10 ml/100 g/min and 1.0 ml/100 g, respectively. The CTA findings were interpreted using a 4-point grading system. Results A total of 50 patients were included in the study. The CTP results revealed CBF from 0.00 to 9.98 ml/100 g/min (mean, 1.98 ± 1.68 ml/100 g/min) and CBV from 0.00 to 0.99 ml/100 g (mean, 0.14 ± 0.12 ml/100 g) and were thus interpreted as positive in all 50 patients. In contrast, the CTA results suggested 7 negative cases,

The aim of this study was to evaluate the effectiveness of echocardiography and compression ultrasonography in the diagnosis of pulmonary embolism and to investigate the diagnostic power of echocardiography and compression ultrasonography in patients with suspected pulmonary embolism. Methods: The cross-sectional study was conducted on patients who were admitted to the emergency department between 01.10.2020 and 30.09.2021 with complaints of shortness of breath, chest pain, palpitations, bloody cough, fainting and who were recommended to undergo pulmonary computed tomography angiography according to the YEARS protocol. The study included 52 patients according to power analysis. The patients included in our study were evaluated at the bedside with the ultrasound of the emergency department. The main echocardiographic findings and compression ultrasonography findings of the deep veins of the lower extremities were evaluated. Then pulmonary computed tomography angiography was performed to patients. The right ventricle/left ventricle diameter ratio was recorded from the computed tomography images of the patients. The patients were divided into 2 groups according to pulmonary computed tomography angiography report: pulmonary embolism and non-pulmonary embolism. To see whether pulmonary embolism could be diagnosed, the main echocardiographic findings of the criteria we defined and compression ultrasonography of the deep veins of the lower extremities were evaluated. Statistical analysis of the data was performed in IBM SPSS Statics Version 26 program. Results: There were 52 patients and 20 (38.5%) patients diagnosed with pulmonary embolism according to computed tomography. Fifty percent of the patients included in the study were male and fifty percent were female. The symptom distribution of the cases according to the diagnosis of pulmonary embolism was examined and no significant difference was found between the symptoms (p>0.05). When the distribution of echocardiography and compression ultrasonography findings of the patients according to pulmonary embolism diagnosis was analyzed, a statistically significant difference was found between the groups in terms of tricuspid regurgitation jet flow velocity, right ventricle/left ventricle diameter ratio, D-sign, McConnell's sign and deep vein thrombosis findings (p<0.05). When the results of the receiver operating characteristic curve analysis for the power of Wells and Geneva scores, echocardiography, compression ultrasonography and computed tomography findings to diagnose pulmonary embolism were analyzed; the cut-off values calculated for Wells and Geneva scores; the area under curve values calculated for the power of current echocardiography findings of tricuspid regurgitation jet flow velocity, right ventricle/left ventricle diameter ratio, D-sign, McConnell's sign findings and computed tomography right ventricle/left ventricle diameter ratio findings to diagnose pulmonary embolism were found to be statistically significant (p<0.05). The results of our study showed that in patients diagnosed with pulmonary embolism, echocardiography is easily available and can help diagnose pulmonary embolism by showing right ventricular dysfunction. The results suggest that bedside echocardiography may help emergency physicians to make faster decisions in pulmonary embolism by increasing the provider's index of suspicion.

Imaging surveillance following endovascular aneurysm repair (EVAR) is strictly recommended. This study investigates the value of endograft apposition and position relative to the aortic neck on the first postoperative computed tomography angiography (CTA) in determining patients at risk for a late type Ia endoleak (T1aEL). Materials and Methods: Patients with a T1aEL after the first postoperative CTA were selected from a consecutive database and matched with uncomplicated controls. Endograft apposition and position, including the shortest apposition length (SAL), were determined on the first postoperative CTA. The SAL is the shortest distance between the proximal endograft fabric and the first slice where circumferential apposition with the aortic wall is lost. Differences in endograft apposition at the first postoperative CTA were compared between groups. Logistic regression analysis identified independent predictors for late T1aEL. Results: A total of 32 patients with a late T1aEL were included and matched with 32 uncomplicated controls. Median follow-up after primary EVAR was 62.0 (interquartile range [IQR]: 36.8, 83.5) months in the T1aEL group compared with 47.5 (IQR: 34.0, 79.3) months in the control group; p=0.265. Median preoperative neck diameter was significantly larger in the T1aEL group than in the control group (26.6 [IQR: 24.9, 29.6] mm versus 23.4 [IQR: 22.5, 25.3] mm); p<0.001. Patients in the T1aEL group had a median SAL of 11.6 (IQR: 4.3, 20.5) mm compared with 20.7 (IQR: 13.1, 24.9) mm in the control group; p=0.002. SAL <10mm on the first postoperative CTA (odds ratio [OR]: 9.63, 95% confidence interval [CI]: 1.60-57.99) and larger neck diameter (OR: 1.80, 95% CI: 1.26-2.57) were independent predictors for developing a late T1aEL. Preoperative neck diameter and SAL on the first postoperative CTA following EVAR are important predictors for the development of a late T1aEL. Patients with a SAL of <10mm had a significantly higher risk of developing a late T1aEL. Future research should determine whether these patients would benefit from reintervention before an actual T1aEL is present. Clinical Impact Understanding the mechanisms of endovascular aneurysm repair failure is essential to further enhance clinical outcomes. Adequate proximal sealing is necessary to foster freedom from type 1a endoleak. This study demonstrates that the shortest apposition length (SAL) at the first postoperative computed tomography angiography (CTA) is able to identify patients at risk for a late type 1a endoleak. Especially patients with a SAL <10mm are at high risk. Currently, the guidelines advice repeated imaging with CTA in patients with a seal <10mm. Future research should determine whether these patients would benefit from re-intervention before an actual type 1a endoleak is present.

Background and Purpose— The spot sign score (SSS) provides risk stratification for hematoma expansion in acute intracerebral hemorrhage; however, external validation is needed. We sought to validate the SSS and assess prognostic performance of individual spot characteristics associated with hematoma expansion from a prospective multicenter intracerebral hemorrhage study. Methods— Two hundred twenty-eight intracerebral hemorrhage patients within 6 hours after ictus were enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study, a multicenter prospective intracerebral hemorrhage cohort study. Patients were evaluated with baseline noncontrast computerized tomography, computerized tomography angiography, and 24-hour follow-up computerized tomography. Primary outcome was significant hematoma expansion (&gt;6 mL or &gt;33%) and secondary outcome was absolute and relative expansion. Blinded computerized tomography angiography...

Introduction: Computed tomography angiography (CTA) represents the gold standard as a method for the diagnosis of carotid artery diseases. The current topic is the use of CTA for the evaluation of carotid arteries with a reduction in the dose of contrast agent and dose of ionizing radiation, which, with adequate preparation, would enable the use of this method in some risk groups. The aim of this study was to evaluate the feasibility and image quality of a new low-dose CTA protocol in comparison with a standard protocol. Methods: Forty patients with recumbent ischemic stroke were included in the study, twenty of whom underwent lowdose CTA, and the remaining twenty underwent a standard CTA protocol of the carotid arteries. Results: No significant difference was found between the mean values of CT number (Hounsfield unit), signal-to-noise ratio, contrast-to-noise ratio, and subjective assessment of image quality in the comparison of the control and experimental groups. CT dose index, volume, and dose length product were significantly lower in patients who underwent lowdose carotid CTA. There was no significant difference in the degree of carotid stenosis between color Doppler and CTA. The use of the low-dose protocol for carotid CTA allows the application of this method in risk groups, in which it was previously not possible to perform, with the same image quality in comparison with the standard protocol.

The purpose of this study was to evaluate the diagnostic role of three-dimensional magnetic resonance angiography in the detection of renal artery stenosis. Additionally, the results of magnetic resonance angiography were correlated with color Doppler sonographic findings. 25 patients with clinical suspicion of renovascular hypertension were examined with breath-hold, contrast-enhanced, three-dimensional magnetic resonance angiography and color Doppler sonography. İn 5 patients, who had renal artery stenosis findings in magnetic resonance angiography and color Doppler sonography, digital subtraction angiography was performed. Breath-hold, contrast-enhanced, three dimensional magnetic resonance angiography, especially using with otomated injector, is a higly sensitive, noninvasive screening method for assesment of renovascular hypertension.

Aims The CLIMA study, on the relationship between coronary plaque morphology of the left anterior descending artery and twelve months clinical outcome, was designed to explore the predictive value of multiple high-risk plaque features in the same coronary lesion [minimum lumen area (MLA), fibrous cap thickness (FCT), lipid arc circumferential extension, and presence of optical coherence tomography (OCT)-defined macrophages] as detected by OCT. Composite of cardiac death and target segment myocardial infarction was the primary clinical endpoint. Methods and results From January 2013 to December 2016, 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending coronary artery in the context of clinically indicated coronary angiogram were prospectively enrolled at 11 independent centres (clinicaltrial.gov identifier NCT02883088). At 1-year, the primary clinical endpoint was observed in 37 patients (3.7%). In a total of 1776 lipid plaques, presence of MLA ...

Coronary computed tomographic angiography (CTA) plus estimation of fractional flow reserve using CTA (FFRCT) safely and effectively guides initial care over 90 days in patients with stable chest pain. Longer-term outcomes are unknown. The study sought to determine the 1-year clinical, economic, and quality-of-life (QOL) outcomes of using FFRCT instead of usual care. Consecutive patients with stable, new onset chest pain were managed by either usual testing (n = 287) or CTA (n = 297) with selective FFRCT (submitted in 201, analyzed in 177); 581 of 584 (99.5%) completed 1-year follow-up. Endpoints were adjudicated major adverse cardiac events (MACE) (death, myocardial infarction, unplanned revascularization), total medical costs, and QOL. Patients averaged 61 years of age with a mean 49% pre-test probability of coronary artery disease. At 1 year, MACE events were infrequent, with 2 in each arm of the planned invasive group and 1 in the planned noninvasive cohort (usual care strategy)....

Recanalization of intracranial thrombus is associated with improved clinical outcome in patients with acute ischemic stroke. The association of intravenous alteplase treatment and thrombus characteristics with recanalization over time is important for stroke triage and future trial design. To examine recanalization over time across a range of intracranial thrombus occlusion sites and clinical and imaging characteristics in patients with ischemic stroke treated with intravenous alteplase or not treated with alteplase. Multicenter prospective cohort study of 575 patients from 12 centers (in Canada, Spain, South Korea, the Czech Republic, and Turkey) with acute ischemic stroke and intracranial arterial occlusion demonstrated on computed tomographic angiography (CTA). Demographics, clinical characteristics, time from alteplase to recanalization, and intracranial thrombus characteristics (location and permeability) defined on CTA. Recanalization on repeat CTA or on first angiographic acq...

Within different brain regions, we determine the comparative value of multiphase computed tomographic angiography (mCTA) and computed tomographic perfusion (CTP) in predicting follow-up infarction. Patients with M1-middle cerebral artery occlusions were prospectively included in this multicenter study. Regional analysis was performed for each patient within Alberta Stroke Program Early CT Score regions M2 to M6. Regional pial vessel filling was assessed on mCTA in 3 ways: (1) Washout of contrast within pial vessels; (2) Extent of maximal pial vessel enhancement compared with contralateral hemisphere; (3) Delay in maximal pial vessel enhancement compared with contralateral hemisphere. Cerebral blood flow, cerebral blood volume, and Tmax data were extracted within these Alberta Stroke Program Early CT Score regions. Twenty-four- to 36-hour magnetic resonance imaging/CT was assessed for infarct in each Alberta Stroke Program Early CT Score region (defined as &gt;20% infarction within t...

E arly hematoma expansion occurs in approximately one third of patients with intracerebral hemorrhage (ICH) and is strongly associated with poor clinical outcome. The computed tomographic (CT) angiography spot sign is a promising imaging predictor of hematoma expansion ; however, its usefulness is limited by its modest sensitivity and positive predictive value. Spot sign studies typically restrict the definition of significant hematoma expansion to the parenchymal component of ICH and have not consistently evaluated intraventricular hemorrhage (IVH) expansion. Decompression of ICH into the ventricular space can lead to underestimation of hematoma expansion and overestimation of false-positive spot signs. We hypothesized that a proportion of patients with ICH that fail to meet the definition for significant hematoma expansion Background and Purpose-The computed tomographic angiography spot sign as a predictor of hematoma expansion is limited by its modest sensitivity and positive predictive value. It is possible that hematoma expansion in spot-positive patients is missed because of decompression of intracerebral hemorrhage (ICH) into the ventricular space. We hypothesized that revising hematoma expansion definitions to include intraventricular hemorrhage (IVH) expansion will improve the predictive performance of the spot sign. Our objectives were to determine the proportion of ICH nonexpanders who actually have IVH expansion, determine the proportion of false-positive spot signs that have IVH expansion, and compare the known predictive performance of the spot sign to a revised definition incorporating IVH expansion. Methods-We analyzed patients from the multicenter PREDICT ICH spot sign study. We defined hematoma expansion as ≥6 mL or ≥33% ICH expansion or >2 mL IVH expansion and compared spot sign performance using this revised definition with the conventional 6 mL/33% definition using receiver operating curve analysis. Results-Of 311 patients, 213 did not meet the 6-mL/33% expansion definition (nonexpanders). Only 13 of 213 (6.1%) nonexpanders had ≥2 mL IVH expansion. Of the false-positive spot signs, 4 of 40 (10%) had >2 mL ventricular expansion. The area under the curve for spot sign to predict significant ICH expansion was 0.65 (95% confidence interval, 0.58-0.72), which was no different than when IVH expansion was added to the definition (area under the curve, 0.66; 95% confidence interval, 0.58-0.71). Conclusions-Although IVH expansion does indeed occur in a minority of ICH nonexpanders, its inclusion into a revised hematoma expansion definition does not alter the predictive performance of the spot sign.

Ocena efektywności pośredniej wenografii tomografii komputerowej (computed tomography venography -CTV) stosowanej po płucnej angiografii tomografii komputerowej (computed tomography angiography -CTA) u pacjentów z podejrzeniem zatoru płucnego. Materiał i metody: Badaniem objęto 80 pacjentów obarczonych wysokim lub średnim ryzykiem zatoru płucnego wg orzeczeń klinicznych. Wenografię tomografii komputerowej przeprowadzano 3-3,5 minuty po zrobieniu zdjęć CTA. U wszystkich pacjentów kolorową ultrasonografię dopplerowską (color doppler ultrasonography -CDUS) dolnych kończyn wykonywano przed płucnym badaniem CTA lub w ciągu 24 godzin od CTA. Wyniki: Zator płucny stwierdzono u 19 pacjentów (23%). U 6 pacjentów badanie CTV wykazało zakrzepicę żył głębokich, mimo że wyniki CDUS były prawidłowe. Przyjmując wyniki CDUS jako złoty standard, określono czułość CTV w diagnozowaniu zakrzepicy żył głębokich na 100%, swoistość -91%, dodatnią wartość predykcyjną -60%, ujemną wartość predykcyjną -100%, prawdopodobieństwo wyniku dodatniego -11,1%, a prawdopodobieństwo wyniku ujemnego -0%. Stwierdzono statystycznie znamienny, dobry stopień korelacji pomiędzy obiema metodami (r = 0,741 p < 0,001). Wnioski: Badanie CTV przeprowadzone po płucnym badaniu CTA jest szybką techniką obrazowania o wysokiej wartości diagnostycznej, która może służyć jako alternatywa dla badania CDUS, szczególnie gdy to ostatnie okazuje się niewystarczające. Słowa kluczowe: zatorowość płucna, zakrzepica żył, angiografia TK.

Introduction Eagle syndrome is a rare and an often misdiagnosed entity in otorhinolaryngology. Objective To determine the efficacy of the surgical treatment for Eagle syndrome. Methods The present prospective study included 25 patients who presented with complaints of pain in the throat, ear, and neck, as well as difficulty and/or pain while swallowing; they were assessed for Eagle syndrome. As per patient profile, we performed a clinical assessments along with orthopantomograms (OPGs), threedimensional computed tomography (3D CT) scans, and cone beam computed tomography (CBCT). Pain was assessed pre-and postoperatively through the Numerical Rating Scale-11 (NRS-11), whose score ranges from 0 to 10. Microscopic tonsillostyloidectomy was performed in cases in which the conservative treatment failed to relieve pain. The mean age of the entire study population was of 36.08 AE 7.19 years, and the male-to-female ratio was of 1.08:1. Referred otalgia was the commonest (44%) complaint. Radiologically, out of 25 patients, 20 patients presented elongated styloid processes. The longest symptomatic styloid process measured radiographically was of 64.7 mm while the shortest was of 28.2 mm. Out of 20 patients, 12 underwent surgery. The postoperative pain assessment through the NRS-11 was performed on day 0 (3.83 AE 0.83), day 7 (1.5 AE 0.52), week 4 (0.5 AE 0.52), and week 12 (0.41 AE 0.51). By 12 weeks, 7 patients were symptom-free, while 5 patients still reported mild pain. Conclusion Eagle syndrome associated with an elongated styloid process is not a rarity, but it often goes undiagnosed. Microscopic tonsillo-styloidectomy shows excellent results in the management of patients with Eagle syndrome.

Je vous remercie d'avoir accepté de diriger ce travail. Votre présence, votre gentillesse et surtout votre immense patience m'ont permis de réaliser ce travail dans une ambiance des plus agréables. Votre écoute et vos compétences pédagogiques m'ont permis d'évoluer, de m'améliorer. Veuillez trouver, dans ce travail, la marque de ma profonde gratitude et de mon admiration. A l'ensemble des membres de mon Jury : Monsieur le Professeur FAIN Olivier, Professeur en médecine interne, chef de service de médecine interne Monsieur le Professeur DHOTE Robin, Professeur en médecine interne, chef de service de médecine interne Monsieur le Docteur HYAFIL Fabien, Docteur en médecine nucléaire Monsieur le Docteur MEKINIAN Arsène, Docteur en médecine interne, Maitre de Conférence des Universités Je vous remercie de m'avoir fait l'honneur de siéger dans le jury, bien que je n'aie pas eu le plaisir de travailler à vos côtés et de prendre de votre temps pour évaluer mon travail. Je vous exprime toute ma gratitude pour m'avoir facilitée l'accès aux données des patients qui ont fait l'objet de cette étude. Je tiens, tout particulièrement, à souligner l'accompagnement, la disponibilité et l'encadrement du Docteur Mekinian dans la réalisation de l'article ayant été à l'origine de cette thèse. J'exprime, à travers ce travail, la marque de mon respect et de ma profonde reconnaissance. A ma famille, Merci pour votre soutien sans faille, au cours de toutes ces années d'études, dans les bons et les mauvais moments. Plus particulièrement, je remercie mon mari, Imad, pour son immense patience, dans mes grands moments de colère, de fatigue et mes horaires insensés, durant cet internat et la rédaction de cette thèse. A mon amie de coeur Caroline RANC, Un grand merci pour tous les footings partagés qui nous ont permis de franchir toutes ces étapes dans la décontraction le plus totale, pour tous nos souvenirs, bons ou mauvais, pour ton amitié inconditionnelle... A ma soeur Imane, Pour ton accompagnement, ton soutien, ta rigueur, je t'adresse une infinie gratitude.

Background: Computed tomography angiography (CTA) imaging is needed in current guideline-based stroke diagnosis, and infarct core size is one factor in guiding treatment decisions. We studied the efficacy of a convolutional neural network (CNN) in final infarct volume prediction from CTA and compared the results to a CT perfusion (CTP)-based commercially available software (RAPID, iSchemaView). Methods: We retrospectively selected 83 consecutive stroke cases treated with thrombolytic therapy or receiving supportive care that presented to Helsinki University Hospital between January 2018 and July 2019. We compared CNN-derived ischaemic lesion volumes to final infarct volumes that were manually segmented from follow-up CT and to CTP-RAPID ischaemic core volumes. Results: An overall correlation of r = 0.83 was found between CNN outputs and final infarct volumes. The strongest correlation was found in a subgroup of patients that presented more than 9 h of symptom onset (r = 0.90). A good correlation was found between the CNN outputs and CTP-RAPID ischaemic core volumes (r = 0.89) and the CNN was able to classify patients for thrombolytic therapy or supportive care with a 1.00 sensitivity and 0.94 specificity. Conclusions: A CTA-based CNN software can provide good infarct core volume estimates as observed in follow-up imaging studies. CNN-derived infarct volumes had a good correlation to CTP-RAPID ischaemic core volumes.

Background Computed tomography perfusion (CTP) is the mainstay to determine possible eligibility for endovascular thrombectomy (EVT), but there is still a need for alternative methods in patient triage. Purpose To study the ability of a computed tomography angiography (CTA)-based convolutional neural network (CNN) method in predicting final infarct volume in patients with large vessel occlusion successfully treated with endovascular therapy. Materials and Methods The accuracy of the CTA source image-based CNN in final infarct volume prediction was evaluated against follow-up CT or MR imaging in 89 patients with anterior circulation ischemic stroke successfully treated with EVT as defined by Thrombolysis in Cerebral Infarction category 2b or 3 using Pearson correlation coefficients and intraclass correlation coefficients. Convolutional neural network performance was also compared to a commercially available CTP-based software (RAPID, iSchemaView). Results A correlation with final inf...

BackgroundChronic pulmonary embolism (CPE) is a life-threatening disease easily misdiagnosed on computed tomography. We investigated a three-dimensional convolutional neural network (CNN) algorithm for detecting hypoperfusion in CPE from computed tomography pulmonary angiography (CTPA).MethodsPreoperative CTPA of 25 patients with CPE and 25 without pulmonary embolism were selected. We applied a 48%–12%–40% training-validation-testing split (12 positive and 12 negative CTPA volumes for training, 3 positives and 3 negatives for validation, 10 positives and 10 negatives for testing). The median number of axial images per CTPA was 335 (min–max, 111–570). Expert manual segmentations were used as training and testing targets. The CNN output was compared to a method in which a Hounsfield unit (HU) threshold was used to detect hypoperfusion. Receiver operating characteristic area under the curve (AUC) and Matthew correlation coefficient (MCC) were calculated with their 95% confidence interv...

Metal components of hip prostheses cause severe artifacts in CT images, influencing diagnostic accuracy. Metal artifact reduction (MAR) software and virtual monoenergetic reconstructions on dual-energy CT (DECT) systems are possible solutions that should be considered. In this study, we created a customized adjustable phantom to quantify the severity of artifacts on periprosthetic tissues (cortical and spongious bone, soft tissues) for hip prostheses. The severity of artifacts was classified by different thresholds of deviation from the CT numbers for reference objects not affected by artifacts. The in vitro setup was applied on four unilateral and three bilateral configurations of hip prostheses (made of titanium, cobalt, and stainless steel alloys) with a DECT system, changing the energy of virtual monoenergetic reconstructions, with and without MAR. The impact of these tools on the severity of artifacts was scored, looking for the best scan conditions for the different configurations. For titanium prostheses, the reconstruction at 110 keV, without MAR, always minimized the artifacts. For cobalt and stainless-steel prostheses, MAR should always be applied, while monoenergetic reconstruction alone did not show clear advantages. The available tools for reducing metal artifacts must therefore be applied depending on the examined prosthetic configuration.

disease diagnosed by coronary angiography. Presence and severity (by tortuosity score) of CT, as well as serum sclerostin levels, were assessed for each patient. RESULTS Patients with CT (128, 47% of study group) were significantly older (p-value <0.001), with higher prevalence of hypertension (p-value 0.001) and had significantly higher sclerostin (p-value <0.001) and hs-CRP (p-value 0.001) levels. Using ROC curve analysis, sclerostin> 650 pg/ml was predictive of CT. After multivariate regression analysis, sclerostin> 650 pg/ml was found to be independent predictor for the presence of CT (OR 8.909, 95% CI 4.9-16.2, pvalue <0.001). Moreover, significant positive correlation between sclerostin and severity of CT was found (r¼ 0.29, p-value 0.001). CONCLUSION Circulating sclerostin is an independent predictor of CT and correlates positively with tortuosity score in postmenopausal females.

Eagle syndrome is a rare anatomical and neuropathic disorder resulting from the elongation of the styloid process or calcification of the stylohyoid ligament complex, leading to irritation or compression of adjacent neurovascular structures. First described by Watt Eagle in 1937, this condition presents in two clinical forms: the classic post-tonsillectomy variant and the vascular subtype involving the internal or external carotid artery. Patients commonly present with dull pharyngeal or cervical pain, foreign body sensation in the throat, dysphagia, otalgia, and occasionally cerebrovascular symptoms like transient ischemic attacks and syncope. The syndrome predominantly affects middle-aged women, although it can affect any demographic group. Diagnosis requires a high index of clinical suspicion, detailed physical examination, and confirmatory imaging—most notably three-dimensional computed tomography (3D-CT). Management includes conservative pharmacotherapy or surgical excision of the elongated styloid process, either via an intraoral or transcervical approach, depending on anatomical complexity and symptom severity. Given the nonspecific symptom profile and significant potential for misdiagnosis, early recognition and multidisciplinary intervention are essential. This article provides a professor-level exposition on the condition's etiology, epidemiology, pathophysiology, diagnosis, treatment, and interprofessional management, complemented by a detailed clinical case.

Objetivo: Determinar la prevalencia de trombosis de mu ñón arterial (TMA) en cirugías de resección pulmonar por carcinoma broncogénico, y describir su evolución radiológica y tratamiento. Material y métodos: Estudio observacional y retrospectivo de casos de TMA detectados mediante angiotomografías con contraste intravenoso (TAC). La comparación de variables clínicas, radiológicas, y el análisis de supervivencia mediante curvas de Kaplan-Meier, se realizó planteando 3 grupos: pacientes con TMA, pacientes con tromboembolismo pulmonar (TEP) y pacientes sin TMA ni TEP. Resultados: Se detectaron 9 TMA en 473 cirugías (1,9%), 6 de ellas en el lado derecho (67% de las TMA), con una mediana de tiempo de detección desde la cirugía de 11,3 meses (rango intercuartílico 2,7-42,2 meses). Salvo el número de TAC en pacientes con TMA comparados con el grupo sin TEP ni TMA, y la recidiva tumoral en pacientes con TEP en comparación con los restantes 2 grupos, no se encontraron diferencias estadísticamente significativas en las características basales ni en las oncológicas. Igualmente no se encontraron diferencias en el análisis de supervivencia. Conclusiones: En nuestra serie, la TMA fue una patología infrecuente que tendió a localizarse en las cirugías del lado derecho, y cuya detección a lo largo del tiempo fue variable. No se asoció a factores de riesgo previos a la cirugía ni tuvo predisposición en relación con la estirpe histológica, estadificación oncológica o recidiva tumoral.

Endurance training and myocardial infarction with non-obstructive coronary artery disease may have been the cause of death of Phidippides, from present day evidence of an athlete who survived, and is discussed Phidippides was a legendary Greek runner who ran from Marathon to Athens in 490 BC to announce the victory of the Greeks over the Persians. After running about 40 km to the Acropolis in Athens, he promptly collapsed and died. To this day, the aetiology of his death remains undetermined.

nondilated native aorta; minimizing oversizing; and avoiding balloon dilatation. Despite their encouraging results, we agree with the authors that TEVAR for TBAD in patients with Marfan syndrome should only be used in those who are at high or prohibitive risk for open repair and with suitable anatomy for TEVAR. If TEVAR is performed in these patients, closer surveillance should occur, particularly if false lumen thrombosis is not achieved.

Celiac Artery (CA) injuries are very rare and are often associated with high mortality. These injuries are associated more often with penetrating trauma rather than blunt trauma injury. Our case highlights a blunt trauma injury of CA in a hemodynamically stable patient without any symptoms that was treated conservatively.

A previously developed poly-L-lactide scaffold releasing granulocyte colony-stimulating factor (PLLA/GCSF) was tested in a rabbit chronic model of myocardial infarction (MI) as a ventricular patch. Control groups were constituted by healthy, chronic MI and nonfunctionalized PLLA scaffold. PLLA-based electrospun scaffold efficiently integrated into a chronic infarcted myocardium. Functionalization of the biopolymer with GCSF led to increased fibroblast-like vimentin-positive cellular colonization and reduced inflammatory cell infiltration within the micrometric fiber mesh in comparison to nonfunctionalized scaffold; PLLA/GCSF polymer induced an angiogenetic process with a statistically significant increase in the number of neovessels compared to the nonfunctionalized scaffold; PLLA/GCSF implanted at the infarcted zone induced a reorganization of the ECM architecture leading to connective tissue deposition and scar remodeling. These findings were coupled with a reduction in end-systol...