Excessive brain atrophy in patients with severe aortic stenosis

Purpose: To assess the prevalence of the neuroradiological indices of brain atrophy in patients with severe aortic valve stenosis (AS) in magnetic resonance imaging (MRI) with particular emphasis on the assessment of atrophy areas typical of cerebral small vessel disease (CSVD). Material and methods: The group of 34 patients (age 60-90 years, 17 women and 17 men) with severe AS and 50 healthy controls (age 61-85 years, 29 women and 21 men) underwent MRI brain examinations, which were analysed for the neuroradiological indices of brain atrophy. Results: A slight but statistically significant age difference was found between the study and control groups - about 3 years on average (p = 0.040). Differences between total brain volumes in both the groups did not show statistical significance. In a comparative analysis of the main brain compartments, a statistically significant difference was found only in the volumetry of cerebral hemispheres for both the groups: mean volume of cerebral hemispheres in patients with severe AS was 884.46 cm³, while it was 17 cm³ bigger in the volunteer group, reaching 901.80 cm³ on average (p = 0.043). Comparison of the volumetry of the other major and minor regions and structures according to the clinical and anatomical division revealed statistically non-significant differences. No statistically significant relationships were observed concerning structures correlated with CSVD. Conclusions: Neuroradiological indices of the brain atrophy do not provide an unequivocal distinction in patients with severe AS. Most observations imply that brain atrophy in patients with severe AS is primarily a consequence of physiological ageing of the brain

Magnetic resonance imaging assessment of cerebral small vessel disease intensification in patients with severe aortic valve stenosis

Purpose: To assess the prevalence of the neuroradiological indices of cerebral small vessel disease (CSVD) in patients with severe aortic valve stenosis (AS) in magnetic resonance imaging (MRI). Material and methods: 34 patients (age 60-90 years, 17 women and 17 men) with severe AS and 50 healthy controls (age 61-85 years, 29 women and 21 men) underwent MRI brain examinations, which were analysed for the neuroradiological indices of CSVD: hyperintensities in periventricular white matter (PVWM) and deep white matter (DWM), enlarged perivascular spaces (ePVS), lacunar strokes, and cerebral microbleeds (CMBs). Results: PVWM hyperintensities were found in 46% of volunteers and was significantly lower (p = 0.027), corresponding to AS patients (80%), the density of lesions was higher in the AS group than in controls (p = 0.019). DWM hyperintensities were found more often in AS patients (76%) than in controls (66%) (p = 0.303), but the densities were similar in both groups. Lacunar strokes were found in 35% of AS patients and 16% of controls (p = 0.042). The average number of lacunar strokes per person was 0.9 in the AS group and 0.3 in the controls (p = 0.035). The AS group showed higher variance in the number of strokes: SD = 1.96 vs. SD = 1.06 in controls. Both prevalence and density of the ePVS and CMBs did not differ significantly between the groups. Conclusions: Neuroradiological indices of the vascular disease do not provide an unequivocal clue to the pathogenesis of CSVD in patients with severe AS. Most observations imply that CSVD is primarily a consequence of cerebral hypoperfusion caused by AS

Suture-mediated closure devices for percutaneous endovascular abdominal aneurysm repair

Purpose: Endovascular procedures such as endovascular aneurysm repair or transcatheter aortic valve implantation have become very common because of reduced patient traumatisation and the ability to use shorter or local anaesthesia. In these procedures large-bore sheath devices are used. Access with percutaneous closure is an alternative method to surgical cutdown in groins. The aim of the study was to assess the correlation between sheath size and unsuccessful haemostasis. In addition, the effectiveness of haemostasis after a percutaneous procedure and the number and type of complications were evaluated. Material and methods: There were 202 patients included in the study. Patients with abdominal aortic aneurysm were qualified to percutaneous aortic stentgraft implantation with Perclose Proglide preclosure technique. Results: There were 384 access sites performed with 12F to 22F sheaths during aortic stentgraft implantation with Perclose Proglide (Abbott Vascular, Santa Clara, CA, USA) preclosure technique. High effectiveness of haemostasis (98%), low percentage of short- and mid-term complications (2.6%), and infinitesimal number of surgical conversions (n = 5) were stated in the study. There was no correlation between diameter of used introducer sheath and lack of haemostasis observed (Fisher-Freeman-Halton test; p = 0.122). No relationship between diameter of introducer sheath and number of closure devices was observed (c2 = 2.436; df = 5; p = 0.786). Conclusions: Large-bore device percutaneous procedures with closure devices are effective and safe. High effectiveness of haemostasis (98%) was observed in the study group, with a low percentage of complications (2.6%). There was no correlation between size of the vascular access and the lack of haemostasis found in the study

Assessment of vocal fold mobility using dynamic magnetic resonance imaging and ultrasound in healthy volunteers

Purpose: To verify the value of dynamic magnetic resonance imaging (MRI) sequences, fast field echo (FFE), and balanced gradient echo (true fast imaging with steady-state free precession - TRUFI) in the evaluation of vocal fold mobility in healthy volunteers, against ultrasound examination (US) as the reference test. Material and methods: Vocal fold mobility in 35 healthy volunteers (age 20-59 years, 20 women and 15 men) with no history of laryngeal disorders and neck surgeries was determined by means of US and MRI during normal breathing and phonation of the "hiiii" sound. US images were used to determine the glottic angles. During MRI two dynamic sequences, fast field echo and balanced gradient echo, were applied to determine the minimum and maximum values of the glottic angles, along with the rima glottidis area, separately for the right and left compartments. Due to differences in larynx anatomy, the abovementioned parameters were analysed separately for women and men. Results: No significant differences were observed between the glottic angle values obtained during US and dynamic MRI (FFE and TRUFI sequences). Regardless of the dynamic MRI sequence used, a positive correlation was found between the maximum values of glottic angle and the rima glottidis area. This correlation was strong and statistically significant among men, but not in women. Conclusions: Dynamic MRI of vocal folds using FFE and TRUFI sequence is an accurate method for the objective evaluation of rima glottidis width

Assessment of the volume of intraorbital structures using the numerical segmentation image technique (NSI): the extraocular muscles

Wstęp: Stosowane współczeœnie układy obliczeniowe i ich oprogramowanie pozwalają na analizę obrazów medycznych i znaczne przyspieszenie przetwarzania danych liczbowych w informacje użyteczne klinicznie. Realne jest stworzenie aplikacji automatycznie obliczających objętość struktur obrazowanych w badaniu MR. Celem pracy była ocena przydatności klinicznej metody cyfrowej segmentacji objętościowej (NSI, numerical segmentation image) w określaniu objętości mięśni wewnątrzgałkowych. Materiał i metody: Do badania włączono 45 chorych (90 oczodołów). Wszyscy pacjenci zostali podani badaniu metodą rezonansu magnetycznego oczodołów w skanerze 1,5 T przy użyciu cewki głowowej. Stopień wytrzeszczu określono klinicznie, jak i radiologicznie w stosunku do linii międzyjarzmowej. Ocenę ilościową wszystkich mięśni zewnątrzgałkowych przeprowadzono przy użyciu aplikacji NSI, stanowiącej nowy program komputerowy opracowany przez autorów. Wyniki: Stwierdzono silną korelację statystyczną pomiędzy objętością mięśni gałkoruchowych a stopniem wytrzeszczu (r = 0,543, p = 3,13396E-08), co jest zgodne z innymi doniesieniami. Wnioski: Program NSI jest aplikacją umożliwiającą wiarygodną i precyzyjną ocenę objętości mięśni zewnątrzgałkowych. Jest tym samym użyteczny w diagnozowaniu procesów patologicznych prowadzących do wytrzeszczu. Technika NSI może być przydatna zwłaszcza w monitorowaniu dyskretnych zmian objętoœci mięśni w trakcie leczenia.Introduction: In recent years the use of computer systems has allowed numerical analysis of medical images to be introduced and has speeded up the conversion of numerical data into clinically valuable information. The creation of a software application that could almost automatically calculate the volume of anatomical structures imaged by MRI has seemed possible. The aim of our study was to determine the clinical usefulness of an numerical segmentation image technique (NSI) software application in estimating the volume of extraocular muscles. Material and methods: The study group was formed of 45 patients (90 orbits). All the patients underwent MRI examinations of the orbits by a 1.5 T scanner using a head coil. The degree of exophthalmos was determined clinically and radiologically in relation to the interzygomaticus line. The quantitative assessment of all eye muscles was carried out using the NSI application, a new software program introduced by the authors. Results: A close correlation between muscle volume and the degree of exophthalmos was revealed and confirmed by statistical analysis (r = 0.543, p = 3.13396E-08) in agreement with other papers. Conclusions: The NSI software program is an application which offers a reliable and precise estimation of eye muscle volume. It is therefore useful in the diagnosis of the pathological processes leading to exophthalmos. It has special clinical value for monitoring discrete volume changes of muscles during treatment

Ocena objętości struktur wewnątrzoczodołowych przy zastosowaniu techniki cyfrowej segmentacji obrazów (CSO): ciało tłuszczowe i gałka oczna

Introduction: Measurement of the degree of exophthalmos is one of the main methods used in the assessment of pathological processes that occur in the orbital space and is widely used. However, this only provides initial information about the volume relations between the intraorbital structures. The aims of our work were as follows: to draw up a new computer application, namely the numerical segmentation image (NSI) technique, for the automatic calculation of the volume of the intraorbital structures on the basis of magnetic resonance imaging (MRI) images, to determine its usefulness in the segmentation of fatty tissue and the eyeball and to estimate their volume in relation to the degree of exophthalmos. Material and methods: A total of 45 patients (90 orbits) were included in the study. All the patients underwent MRI examination of the orbits by a 1.5 T scanner using a head coil. The degree of exophthalmos was determined clinically and radiologically in relation to the interzygomatic line. Quantitative assessment of the eyeball and fatty tissue was made using an NSI application. Results: The influence of fatty tissue volume on the degree of exophthalmos was determined as being statistically significant (r = 0.367, p = 0.000374) but was smaller in comparison with the relationship between total eye muscle volume and degree of exophthalmos; eyeball volume was found to have the least influence (r = 0.344, p = 0.000374). Two eyeballs of significantly smaller volume were found in the group of 90 orbits analysed. Conclusions: The NSI technique is a clinically useful application, providing objective data calculated individually for each orbit. A credible protocol for estimating the degree of exophthalmos on the basis of the NSI technique should include the eye muscle volume, fatty tissue volume and, in cases where eyeball pathologies coexist, the eyeball volume as well. (Pol J Endocrinol 2007; 58 (4): 297-302)Wstęp: Pomiar stopnia wytrzeszczu jest jedną z najszerzej stosowanych metod w ocenie procesów patologicznych toczących się w przestrzeni oczodołu. Jednak zapewnia on jedynie wstępną informację o stosunkach objętościowych struktur wewnątrzoczodołowych. Celem pracy było stworzenie nowej aplikacji komputerowej niemal automatycznie liczącej objętość anatomicznych struktur oczodołu na podstawie obrazów rezonansu magnetycznego (MRI, magnetic resonance imaging), przedstawienie jej użyteczności w segmentacji tkanki tłuszczowej i gałki ocznej oraz określenie tych objętości w stosunku do stopnia wytrzeszczu. Materiał i metody: Do badania włączono 45 pacjentów (90 oczodołów. Wszystkich pacjentów poddano badaniu metodą rezonansu magnetycznego oczodołów w skanerze 1,5 T przy użyciu cewki głowowej. Stopień wytrzeszczu został określony klinicznie, jak i radiologicznie w stosunku do linii międzyjarzmowej. Ocena ilościowa ciała tłuszczowego i gałki ocznej została przeprowadzona przy zastosowaniu aplikacji CSO, stanowiącej nowy program komputerowy opracowany przez autorów. Wyniki: Wpływ objętości ciała tłuszczowego na stopień wytrzeszczu określono jako istotny statystycznie (r = 0,367; p = 0,000374), ale mniejszy w porównaniu z korelacją wytrzeszczu z objętością mięśni gałkoruchowych, natomiast wpływ objętości gałki ocznej - jako najmniejszy (r = 0,344; p = 0,000374). Ponadto w grupie badanej stwierdzono obecność dwóch gałek ocznych o znacząco mniejszej objętości. Wnioski: Rezonans magnetyczny jest użyteczną klinicznie aplikacją pozwalającą na obiektywne określenie wartości objętości w sposób indywidualny dla każdego oczodołu. Wiarygodny protokół oceny wytrzeszczu w oparciu o technikę CSO powinien uwzględniać objętość mięśni gałkoruchowych, tkanki tłuszczowej, a w niektórych przypadkach koincydencji patologii także objętość gałki ocznej

Arterio-bronchial fistula as a complication of post-traumatic subclavian artery pseudoaneurysm — radiological findings and outcome

Post-traumatic arterio-bronchial fistula is a rare cause of life-threatening hemorrhage. We present a case of a ten-year-old patientwith a post-traumatic subclavian artery pseudoaneurysm complicated by an arterio-bronchial fistula and occlusion of the subclavianartery. The patient was treated with a stent-graft. We present radiological images of the fistula and the evolution of thechanges in subsequent follow-up examinations

Hemorrhagic stroke, cerebral amyloid angiopathy, Down syndrome and the Boston criteria

A stroke, or a cerebrovascular accident (CVA) is a life-threatening condition which often results in permanent or significant disability in the adult population. Several classifications of CVAs exist, one of them being based on the mechanism of injury of brain tissue: ischemic (85–90%) and hemorrhagic (10–15%). In a hemorrhagic stroke an intercranial bleeding occurs, leading to the formation of a focal hematoma typically located in the basal ganglia of the brain (approx. 45% of cases). A common yet underestimated cause of intracerebral hemorrhage is cerebral small vessel disease with microhemorrhages, including the cerebral amyloid angiopathy (CAA). This condition is associated with the deposition of amyloid-beta in arterial walls (in soft meninges, subcortical areas and the cerebral cortex). Research has shown that causes of hemorrhagic changes in the brain include genetic disorders, such as Down syndrome. The association is caused by the so-called ‘gene dosage effect’, as the gene for the precursor protein for amyloid-beta is located in chromosome 21. We wish to present the case of a 60 year old patient with Down syndrome who suffered a hemorrhagic stroke without antecedent hypertension. Based on the history taken, diagnostic imaging and the source literature, a diagnosis of cerebral amyloid angiopathy as the source of the bleeding was made (however it must be noted that without a full post-mortem examination, the Boston criteria allow only for a ‘probable cerebral amyloid angiopathy’ diagnosis to be made). The authors hereby also report the need to modify the Boston criteria for cerebral amyloid angiopathy

Numerical segmentation image technique (NSI) in estimation of extraocular muscles volume in Graves' ophthalmopathy

Background: The volume enlargement of extraocular muscles is one of the most frequent reasons of exophthalmos in Graves' ophthalmopathy. Various diameters are widely used in clinical practice for estimating muscles' size. They are not sufficient for the precise and reliable determination of their real volume. Modern computing systems enable numerical analysis of medical images including Magnetic Resonance Imaging (MRI) in an almost automatic way. The aims of this study were: The analysis of different MRI sequences routinely used in the examination of intraorbital structures and their value for NSI application. Determination of clinical value of an NSI program in estimating extraocular muscle volume and comparing the obtained results with the degree of exophthalmos. Material/Methods: 45 patients were qualified to the study and underwent MR examinations in 1, 5 T scanner. The measurements of the degree of exophthalmos and quantity estimation of the total eye muscle volume using the NSI application were made. Results: The best sequence for the NSI application is SE T1. Correlation between muscle volume measurements obtained using the automatic method and after manual modification was the highest for this sequence. In all sequences the final values of volumes for each muscle after manual corrections were close what proves the repetitiveness of the NSI technique. Strong correlation between the total eye muscle volume determined by the NSI and the exophthalmos was found. Conclusions: T1 SE has the highest value for using NSI application for all sequences routinely used in MRI evaluation of orbital structures. The NSI technique is a clinically valuable application that provides objective volume data calculated individually for each orbit. The NSI technique allows more objective estimation of pathological processes leading to exophthalmos; it can be particularly helpful in monitoring discrete changes in muscle volume during the treatment