lorio F

Carotid stenosis : a comparison between MR and spiral CT angiography

Abstract We performed a preliminary study comparing three-dimensional time-of-flight (3 D TOF) magnetic resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and assessment of internal carotid artery stenosis. Digital subtraction angiography (DSA) was the reference examination. We examined 20 patients with signs of cerebrovascular insufficiency, who underwent MRA, SCTA and DSA within a 3 day period. Both internal carotid arteries were assessed by three blinded readers for degree of stenosis at two different levels (bulb and remaining section) giving a total of 80 assessments. Interobserver variability, sensitivity, specificity, diagnostic accuracy, concordance, overestimation and underestimation were assessed. Interobserver variability was not statistically significant. MRA showed higher sensitivity, specificity, diagnostic accuracy and concordance than SCTA (92.0 % vs 80.8 %, 98.2 % vs 96.4 %, 96.3 % vs 91.3 % and 96.0 % vs 88.0 %, respectively). MRA gave rise to a 5.0 % overestimation rate, whereas SCTA occasioned a 7.5 % underestimation rate. These differences are not statistically significant. These results suggest that MRA is a more useful, noninvasive modality for assessment of the internal carotid artery with a more than 70 % stenosis.

Congenital Absence of the Internal Carotid Artery

Abstract We report three cases of congenital absence of an internal carotid artery (ICA), diagnosed incidentally by digital subtraction angiography. The analysis of the cases is based on the classification of segmental ICA agenesis proposed by Lasjaunias and Berenstein. Usually the patients with this rare vascular anomaly are asymptomatic; some may have symptoms related to cerebrovascular insufficiency, compression by enlarged intracranial collateral vessels, or complications associated with cerebral aneurysms. Diagnosis of congenital absence of ICA is made by skull base computed tomography (CT) scan, CT and magnetic resonance angiography, and conventional or digital subtraction angiography.

Congenital intrahepatic portosystemic shunt

The authors report a congenital intrahepatic portosystemic shunt detected by angiography in a young patient with acute onset of hyperammoniemia and hepatic encephalopathy.

Treatment of hepatocellular carcinoma: a single-center experience.

PurposeThe comparative efficacy of transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC) was investigated.MethodsTwo hundred and sixty consecutive patients were retrospectively analyzed: 156 had received between one and six chemoembolization sessions at 3-month intervals, 33 had had PEI, and the remaining 71 patients refused any treatment. The follow-up ranged from 3 to 36 months. Survival rates were statistically analyzed by life-table analysis.ResultsPatients’ survival was affected by the number of nodules and by the Child’s and Okuda’s classes; no relationship was found between survival rates and the histologic grade or vascular supply of the tumor. In the case of a single lesion of Okuda’s class I, TACE was more effective than PEI. In multifocal HCC, TACE was better than no treatment in Okuda’s class I and Child’s class A.ConclusionWe suggest TACE as the treatment of choice in Child A or Okuda I patients with multifocal HCCs; it seems of little help in Child B-C or Okuda II–III patients.

Treatment of Large and Giant Intracranial Aneurysms with Onyx. Preliminary Findings

Large and giant aneurysms account for three to seven per cent of intracranial aneurysms. They are mainly located in the carotid siphon or vertebrobasilar junction and usually give rise to mass effect, headache, haemorrhage or ischaemia. Treatment consists of surgical clipping or endovascular embolization and aims to exclude the aneurysm from the cerebral circulation to prevent haemorrhage. We describe our preliminary clinical and angiographic findings after endovascular embolization of large and giant intracranial aneurysms using Onyx and the remodelling technique. Six patients with large or giant intracranial aneurysms were treated. The maximum diameter of the aneurysmal sac varied from 15 to 33 mm, the neck measured from 5 to 10 mm and the sac-neck ratio varied from 2.14 a 4.7. Treatment (planned sessions in five patients and one in emergency) was performed in the angiography suite after detailed angiographic diagnosis including 3D formatting of the area of interest. Informed consent was obtained from the patients and their relatives. Intracranial compensation was tested angiographically and clinically before treatment. The polymer (Onyx HD 500 – 20% EVOH; 80% DMSO) was selectively injected into the lumen of the aneurysmal sac during balloon catheter occlusion of the aneurysm neck and parent vessel. Clinical and angiographic follow-up varied from three to 12 months and all patients were assessed angiographically 12 months after treatment. Complete occlusion was achieved after treatment in two aneurysms, both treated by Onyx alone. Occlusion was between 95 and 100% in two patients (one treated with Onyx alone, the other with GDCs + Onyx). Occlusion was more than 90% and less than 95% in one patient (GDCs + Onyx). Occlusion was less than 90% in the remaining patient treated with GDC + Onyx. In the four aneurysms not completely occluded, the residual part involved the neck region. Only one complication arose during treatment consisting of controlateral hemiparesis at the site of the aneurysm due to thrombus occlusion of the middle cerebral artery trifurcation, with full recovery of neurological deficit a month after treatment. Angiographic follow-up disclosed findings the same as those at the end of treatment in three patients whereas the residual aneurysm had increased by 5% in one patient. Two giant aneurysms showed a major recanalization of the aneurysmal sac. At clinical follow-up three patients reported a progressive reduction of ocular symptoms caused by compression: symptoms had slightly improved in one patient after treatment and in the remaining two with aneurysm recanalization diplopia and palpebral ptosis remained unchanged. All patients treated reported a mild progressive reduction of headache except for the patient presenting recanalization at follow-up after ten months. No major complications were found at follow-up. We plan to reserve this procedure for selected cases of large aneurysms not amenable to other treatments. Embolization should always be undertaken by physicians skilled in the remodelling technique and complete embolization of the aneurysm is crucial. The availability of new materials, easier to handle and more viscous and adhesive than Onyx, will simplify the procedure and prevent aneurysm recanalization.

Stenosi carotidea: Confronto tra angio-RM e angio-TC spirale

A preliminary study comparing three dimensional time of flight (TOF 3D) Magnetic Resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and evaluation of internal carotid stenosis. Digital subtraction angiography (DSA) was the gold standard. Twenty patients with clinical signs of cerebrovascular insufficiency underwent MRA, SCTA and DSA within a three day period. Both internal carotid arteries were evaluated for absence or degree of stenosis. Sensitivity, specificity, diagnostic accuracy, concordance, overstimation and understimation were assessed. MRA showed a higher sensitivity, specificity, diagnostic accuracy and concordance compared to SCTA (92% versus 80%, 98,2% versus 96,4%, 96,3% versus 88%, respectively). MRA demonstrated a 5% overstimation rate whereas SCTA demonstrated a 7,5% understimation rate. These differences are not statistically significant. These results suggest that MRA is the more useful, non invasive modality for the detection and evaluation of the internal carotid artery with a greater than 70% stenoses.

Vertebroplasty in Elderly Patients: A Clinical Effectiveness Analysis

Purpose of ReviewMinimally invasive vertebral augmentation procedures (VAP) have been first introduced to provide pain relief in patients with osteoporotic vertebral fractures (VF). However, in the last decade scientific literature revealed to be quite controversial about their efficacy. The aim of this review was to analyze clinical evidences from current literature, supported by our own experience.Recent FindingsCompared to conservative therapies, VAP represent an effective treatment for recent VF and, in elderly patients, reduce mortality and morbidity. Advances in technology have widened the fields of application towards other spine pathologies typical of elderly, such as primary and metastatic tumors.SummaryIn patients with severe pain for recent or un-healed vertebral fracture, VAP are clinically more effective than conservative treatment. Accurate pain assessment and pre-procedural Magnetic Resonance Imaging are highly recommended to obtain optimal patient selection and best treatment results.

Angiography and Vascular Disorders of the Hand

The study of the anatomy and vascular pathology of the hand appears problematic due to the hands anatomical complexity, and the variety of clinical-pathological situations involving the hand. Currently, the use of diagnostic angiographic methods (arteriography and venography) has to be considered in the context of a multidisciplinary approach to vascular pathology, which gives increasing importance to noninvasive techniques (echo-color Doppler, magnetic resonance angiography). Furthermore, a diagnostic angiographic approach cannot be considered separately from the possibility of using interventional radiology treatments, directly connected to the angiographic technique.