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Treatment of DAVFs: look for the middle meningeal artery    

M. Iacobucci1, I. Valente2, C. Colosimo1, A. PEDICELLI3; 1 Rome/IT 2 Roma/IT 3 ROMA (RM)/IT

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Aims and objectives: Dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous communications developed within a venous space contained between the two layers of the dura mater and typically vascularized by meningeal arteries. DAVFs are said to represent approximately 10% to 15% of all intracranial vascular malfor[...]

Methods and materials: We retrospectively reviewed 34 patients suffering from DAVF, treated through endovascular approach between January 2013 and September 2016 in our Centre. We excluded 6 DAVF treated with transvenous approach. The demographic, clinical presentation, angiographic and endovascular treatment data were ex[...]

Results: Twenty-eight patients (20 males and 8 females, 63±11,03 years) with types 2a, 2b, 3, 4 and 5 DAVF according to Cognard classification, were analyzed. The onset symptoms were: headache, cranial nerves palsies, pulsatile tinnitus, diplopia and exophthalmos. In 17 cases over 28 (60%) the arterial feede[...]

Conclusion: The long straight course of MMA allows distal catheterization close to the arteriovenous shunt, which facilitates penetration of Onyx with casting of the fistulous pouch and draining venous structures. The precise identification of the MMA pedicles, even tiny, feeding the DAVF, played a crucial role[...]

Personal information: Marta Iacobucci, MD Department of Radiological Sciences, Catholic University of Sacred Heart, Foundation “A. Gemelli” Hospital, Largo Agostino Gemelli 8, 00168, Rome, Italy Email: marta.iacobucci@gmail.com

References: References 1.              Gomez J, Amin AG, Gregg L, Gailloud P. Classification schemes of cranial dural arteriovenous fistulas. Neurosurg Clin N Am. 2012 Jan;23(1):55-62. 2.           [...]


Size of overlapping area from brain feeding arteries flow territories may be a predictive marker for postoperative cognitive condition

T. Lin1, Y. Lv1, Z. Lai1, H. You1, B. WU2, J. Qu3, B. Hou1, C. Liu1, F. Q. Feng1; 1 Beijing/CN 2 BEIJING/CN 3 Shanghai/CN

Aims and objectives: Due to the compensatory nature of arterial blood supply, stenosis may lead to enlarged overlapping region of the perfusion territories corresponding to different arteries[1, 2]. The aim of our study is to investigate whether the size of overlapping area contributed by flow territories of the major f[...]

Methods and materials: Eight patients (6 males and 2 females, age=64.9±4.0 years) with carotid stenosis (≥70%) diagnosed by CT angiography were enrolled in this retrospective study. All the patients underwent MR examination one week prior to surgery on a 3.0T whole body system(PLD=2025ms, Discovery MR750, GE, USA). The MR[...]

Results: Half of the patients showed improved cognitive function post-operatively. The △V values were all positive in the cognitive improvement group and all negative in the group without improvement. △V was significantly greater (P=0.021) in patients with cognitive improvement than patients without. A weak [...]

Conclusion: The area of overlapping region from each flow territory may be a predictive marker for postoperative cognitive condition. Carotid stenosis patients with larger flow territory overlapping area preoperatively are more likely to show cognitive improvement after CEA or CAS.  

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References: 1.  Van Laar, P. J. et al. In vivo flow territory mapping of major brain feeding arteries. NeuroImage 29, 136-144, doi:10.1016/j.neuroimage.2005.07.011 (2006).   2. Van Laar, P. J. et al. Altered flow territories after carotid stenting and carotid endarterectomy. Journal of vascular surger[...]


The impact of intraplaque hemorrhage on vessel remodeling in carotid arteries using MRI

K. Dilba1, A. van Dijk1, G. A. J. C. Crombag2, A. F. van der Steen1, M. J. A. P. Daemen3, P. Nederkoorn3, J. Hendrikse4, M. Kooi2, A. van der Lugt1; 1 Rotterdam/NL 2 Maastricht/NL 3 Amsterdam/NL 4 Utrecht/NL

Aims and objectives: Stroke was the second-leading global cause of death worldwide in 2013, representing ~12% of all deaths per year (6.5 million) [1]. One of the main causes of stroke is atherosclerotic plaque rupture in the carotid arteries with subsequent atherothrombosis.   Clinically, the degree of lumen steno[...]

Methods and materials: 101 symptomatic patients from the Erasmus MC and MUMC in the age from 47 to 88 with 30% to 69% carotid stenosis with plaque in the internal carotid artery (ICA) and unaffected distal portion of ipsilateral ICA and good image quality were selected from the Plaque At Risk (PARISK) cohort (clinicaltria[...]

Results: Baseline clinical characteristics of the patients are listed in Table 3. Individuals with IPH were older than individuals that had no IPH. IPH was present in 39.6% of the plaques (n=40/101). In 73% of the cases (n=29) IPH was localized within the selected slice of maximal wall area and in 27% of cas[...]

Conclusion: Discussion: This study demonstrated three main findings. Firstly, plaques with IPH had a higher plaque burden and were thicker. Secondary, plaques with IPH did not differ in vascular remodeling ratio compared to the non-IPH group. Thirdly, plaques with IPH had smaller lumen after normalization wit[...]

Personal information: K. Dilba, MD. Department of Radiology, Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands k.dilba@erasmusmc.nl     A.C. van Dijk, MD. Department of Radiology, Department of Neurology, Erasmus MC, Rotterdam, The Netherlands a.c.vandijk.1@erasmusmc.nl &n[...]

References:   [1] Writing Group, M., et al., Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation, 2016. 133(4): p. e38-360.   [2] North American Symptomatic Carotid Endarterectomy Trial, C., Beneficial effect of carotid endarterectomy in symptomat[...]


Hemodynamic Evaluation of Carotid Webs Based on CT Angiographic Data

K. Compagne1, E. Postema1, B. Emmer1, A. van Es1, C. B. L. M. Majoie2, W. Van Zwam3, J. Wentzel1, A. van der Lugt1, F. J. Gijsen1; 1 Rotterdam/NL 2 Amsterdam/NL 3 Maastricht/NL

Aims and objectives: Carotids webs are fibrous lesions causing circumferential narrowing in the proximal internal carotid bulb. Due to the morphology, carotid webs may be an important cause of (recurrent) ischemic stroke for patients without other major risk factors (1, 2).   Hemodynamic flow patterns near atheros[...]

Methods and materials: Patients and imaging data CFD simulations of carotid webs were based on computed angiography (CTA) scans originated from the Multicenter Randomized Clinical trial of Endovascular treatment of Acute Ischemic stroke in the Netherlands (MR CLEAN). Patients were included in the MR CLEAN trial if there w[...]

Results: We evaluated 9 patients with a carotid web (8 female; median age 59 years, IQR 45-70). The included patients had a carotid web on the symptomatic side of acute ischemic stroke, except in one patient where the carotid web was located on the asymptomatic side.   Severity of stenosis caused by th[...]

Conclusion: Carotid webs are associated with an increased recirculation zone compared to the contralateral carotid bifurcation within patients with acute ischemic stroke due to intracranial large vessel occlusion. The total surface of the recirculation zone is strongly correlated with the degree of stenosis cau[...]

Personal information:

References: 1. Choi PM, Singh D, Trivedi A, Qazi E, George D, Wong J, et al. Carotid Webs and Recurrent Ischemic Strokes in the Era of CT Angiography. AJNR Am J Neuroradiol. 2015;36(11):2134-9. 2. Joux J, Chausson N, Jeannin S, Saint-Vil M, Mejdoubi M, Hennequin JL, et al. Carotid-bulb atypical fibromuscular dy[...]


Portal hypertension in schistosomiasis: common computed tomographic findings of a significant cause of morbidity and mortality in an underdeveloped country

L. d. G. Farias1, I. G. Padilha1, D. Menezes1, M. Soares2, C. Miranda2; 1 São Paulo/BR 2 Maceió/BR

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Learning objectives: The purpose of this essay is to: Review structural imaging abnormalities on computed tomography (CT); Correlate important findings of portal hypertension in schistosomiasis with the clinical, anatomy and pathogenesis; Emphasize the most important radiologic features on CT; Show examples of earlier [...]

Background: Human schistosomiasis is an endemic and chronic parasitic disease caused by the trematode Schistosoma that has different species. Schistosomiasis is prevalent in tropical and subtropical areas (Fig. 1), especially in poor communities without access to safe drinking water and adequate sanitation. Sch[...]

Findings and procedure details: SCHISTOSOMIASIS AND PATOGENESIS Transmission (Fig. 2) occurs when human excreta containing parasite eggs contaminate freshwater. Miracidia hatch and infect snails where it matures into cercariae (larval forms of the parasite). Cercariae penetrates the skin of a human host during its contact with inf[...]

Conclusion: Although CT cannot provide portal flow direction, the enhancement when contrast material is administered evaluates the size and permeability of the portal venous system and portosystemic collateral circulation. Imaging findings may aid in the diagnosis of schistosomiasis with a better anatomical cor[...]

Personal information: L. P. G. Farias - Hospital Alvorada, São Paulo/SP, Brazil. I. G. Padilha - Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo/SP, Brazil.   D. C. Menezes - Hospital Alvorada, São Paulo/SP, Brazil.   M. L. L. Soares - Faculdade de Medicina da Univeridade Federal de [...]

References: Berzigotti A, Seijo S, Reverter E et al. Assessing portal hypertension in liver diseases. Expert Rev Gastroenterol Hepatol. 2013; 7: 141. Cho KC, Patel YD, Wachsberg RH et al. Varices in portal hypertension: evaluation with CT. RadioGraphics. 1995; 15(3): 609-622. García-Pagán JC, Gracia-Sancho[...]


Spectrum of peripheral vascular trauma : A comprehensive review of imaging features with surgical correlation

T. Yadav1, S. Gamanagatti2, A. KUMAR2; 1 New Delhi/IN 2 New delhi/IN

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Aims and objectives: INTRODUCTION: Early diagnosis and treatment of vascular injuries is of paramount  importance to decrease limb or life threatening ischemia. Computed tomographic (CT) angiography is the preferred imaging modality used in patients with suspected vascular trauma. AIMS AND OBJECTIVES The Objectiv[...]

Methods and materials: Retrospective analysis of CT angiographies done for suspected vascular trauma during January 2013 – March 2016. Inclusion Criteria of the patient: Patients which were followed by surgical exploration and repair or endovascular intervention. Exclusion Criteria : Patients who had normal CTA, were c[...]

Results: CT FINDINGS CORRELATION WITH SURGICAL OR ENDOVASCULAR INTERVENTION RESULTS:  CTA (N=100) Age range between 4-68 yrs. Mean age -28.7 yrs. Male:Female - 92:8 Right:Left - 42:58 Table 1. Type of injury.   TYPE OF INJURY NUMBER OF CASES  UPPER LIMB LOWER LIMB TOTAL &nbs[...]

Conclusion: CT angiography shows excellent correlation with surgical or endovascular intervention. It has replaced conventional angiography as the first diagnostic modality of choice for the evaluation of the acute peripheral vascular trauma. It can be combined with chest or abdomen scan with single bolus of c[...]

Personal information: CONTACT DETAILS 1. Taruna yadav Senior Resident, Department of Radiology All India Institute of Medical Sciences New Delhi 2. Shivanand Gamanagatti Professor, Department of Radiology Jai Prakash Narayan Apex Trauma Center, AIIMS, New Delhi All India Institute of Medical Sciences New Delhi 3. At[...]

References: Pieroni S, Foster BR, Anderson SW, Kertesz JL, Rhea JT, Soto JA. Use of 64-row multidetector CT angiography in blunt and penetrating trauma of the upper and lower extremities. RadioGraphics 2009;29:863–76. Gakhal MS, Sartip KA.CT angiography signs of lower extremity vascular trauma. Am J R[...]


Tunnelled Peripherally Inserted Central Catheter – How We Do Them

A. Vijaynanthan, O. Nawawi, B. Abdullah; Kuala Lumpur/MY

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Aims and objectives: Learning Objective: To understand the technique of performing tunnelling for peripherally inserted central catheter (PICC) with the view of reducing the risk of catheter infection and thus increasing long-term venous access.     Background:   With the advance in new chemotherap[...]

Methods and materials: Procedure Details: Fig. 1 shows the standard PICC set containing a single or double lumen 18-gauge silicon catheter (4F). The upper arm of patient is cleaned with antiseptic and draped. The 5-11 MHz linear ultrasound transducer (covered with sterile endoscope cover) is placed transversely over the[...]

Results: We prospectively performed conventional PICC and tunnelled PICC on two separate patient groups of 50 patients each between the periods of 19 months. All patients were reviewed until either the occurrence of PICC-related complication necessitated removal, completion of therapy, death or till the end [...]

Conclusion: We have described our simple technique of tunnelling PICC using standard PICC set without the need of any additional expensive or disposal equipment. We believe any operator with moderate expertise can perform this technique following the procedure described. Further improvements in the PICC with th[...]

Personal information:

References: Foley MJ. Radiologic Placement of Long-term Central Venous Peripheral Access System Ports (PAS Port): Results in 150 Patients. J Vasc Interv Radiol. 1995;6(2):255-62. Merrell SW, Peatross BG, Grossman MD, Sullivan JJ, Harker WG. Peripherally inserted central venous catheters. Low-risk alternatives f[...]


Effects of Concomitant Intra-aortic Balloon Pump on Procedural Brain Infarction in Patients with Venoarterial Extracorporeal Membrane Oxygenation Therapy

F. Ziayee1, H. Aubin2, C. schnitzler3, P. Kröpil4, P. Heusch4, G. Fürst2, G. Antoch2, B. Turowski4, C. Mathys2; 1 Dusseldorf/DE 2 Düsseldorf/DE 3 düsseldorf/DE 4 Duesseldorf/DE

Aims and objectives: Extracorporeal membrane oxygenation (ECMO) has served as an important tool in today’s extracorporeal life support [2]. Nevertheless, it has to be used with care because of the risk of severe, commonly fatal complications. Two types of ECMO-systems can be distinguished, supporting either the lung in [...]

Methods and materials: This retrospective study has been approved by the local institutional review board. Sample: This is a single-center study performed in a university hospital setting. The institutional database was searched for CT reports containing the terms ‘ECMO’, ‘ECLS’ and 204 patients were found. The criteria f[...]

Results: A total of 146 patients (36 female, 24.7%)  treated with va-ECMO (111 peripheral ECMO, 76.0 %; 35 central ECMO, 24.0%) with an average age of 61.3 years (age range: 21 - 85) were included in the study. A total of 69 patients had simultaneous IABP-treatment. Of these 69 patients 45 had a periphe[...]

Conclusion: Here, we investigated the effect of concomitant IABP therapy on procedural brain infarction in patients with va-ECMO-therapy. In this study, additional IABP-therapy showed no significant influence on the risk of brain infarction or survival. Most infarctions were caused by thromboembolism. The rate [...]

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References: [1] Schaheen, Basil W.; Thiele, Robert H.; Isbell, James M. (2015): Extracorporeal life support for adult cardiopulmonary failure. In: Best practice & research. Clinical anaesthesiology 29 (2), S. 229–239. DOI: 10.1016/j.bpa.2015.04.004.   [2] Reeb, Jeremie; Olland, Anne; Renaud, Stephane; [...]

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