Role of CT Angiography in Detection of Extracranial Carotid and Vertebral Artery Disease in Patients With Acutely Ruptured Intracranial Aneurysms

Introduction: Computed tomography (CT) and CT angiography are standard imaging modalities for suspected acute intracerebral hemorrhage due to ruptured intracranial aneurysms. In this clinical setting, several protocols of computed tomography and CT angiography may be implemented. The standard CT angiography protocol is limited to intracranial vessels. The extended protocol may also include carotid and vertebral arteries and the aortic arch.Objective: To define the CT angiography role in detection of extracranial carotid and vertebral artery disease and clinical significance of this method for patients with suspected acute intracerebral hemorrhages due to ruptured intracranial aneurysms.Materials and methods: The study included 275 neurosurgical patients with acute nontraumatic intracranial hemorrhages due to ruptured intracranial aneurysms who were treated in Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) from September 2017 to August 2020. Computed tomography and CT angiography were performed in all patients. The scanned area included both intracranial and extracranial arteries (an arch-to-vertex angiogram) to detect extracranial carotid and vertebral artery diseases such as stenoses, occlusions, tortuosity, and hypoplasia.Results: Atherosclerosis of internal carotid and vertebral arteries was diagnosed in 95 patients (34.5% of the total number of patients included in the study). In 13 (4.7%) patients these stenoses were hemodynamically significant. We identified a high frequency of tortuous carotid and vertebral arteries (122 cases, 44.3%) and vertebral artery hypoplasia (59 cases, 21.5%). The carotid and vertebral artery stenoses and congenital anomalies of vertebral arteries (however, not of carotid arteries) were associated with a higher incidence of unfavorable outcomes after endovascular treatment of intracranial aneurysms.Conclusions: The optimal CT angiography protocol for acute nontraumatic intracranial hemorrhage should focus on the arteries of the head and neck (up to the aortic arch). This protocol shows higher detection rate of concomitant anomalies of carotid and vertebral arteries. These findings are important for planning and successful performance of endovascular treatment for intracranial aneurysms

CT ANGIOGRAPHY FOR DETECTING THE CAUSE OF INTRACRANIAL HEMORRHAGE IN THE EMERGENCY DEPARTMENT

Background Intracranial hemorrhage is the most serious manifestation of a ruptured cerebral aneurysm, and subarachnoid hemorrhage (SAH) is the most common clinical and anatomical form. The treatment strategy for SAH varies from conservative to emergency surgical treatment and depends on the source of the hemorrhage. Currently, the search for sources is carried out using various methods of diagnostic radiology.Objective To compare the images of intracranial arteries obtained by computed tomography (CT)  angiography with the data of cerebral angiography in the acute period of hemorrhage in the subarachnoid space.Material and Methods We retrospectively analyzed the medical records of 242 patients with acute SAHs from September 2017 to September 2019, examined in the emergency room of the Research Institute – Ochapovsky Regional Hospital no. 1.Results According to CT angiography, the initially occult vascular lesion was verified in 212 patients (87%), of which in 84.0% of cases (205 patients) the cause of SAH was ruptured cerebral aneurysms. In 3 patients, ruptures of arteriovenous malformations were detected (1.2%). In 4 patients, the “cerebral aneurysms” diagnosis was excluded due to the establishment of a hypertensive nature of intracranial hemorrhage (1.7%). In 30 patients, CT angiography revealed no vascular pathology. According to the results of CT angiography only, 225 patients (93%) were microsurgically operated on, and 12 patients (5%) were operated on using intravascular access. Among 30 patients whose vascular pathology was not detected by CT angiography, 6 patients were found to have single aneurysms according to cerebral angiography: the internal carotid artery – in 3 patients, the middle cerebral artery – in 2, and the pericallous artery – in 1 patient.Conclusion CT angiography is a key tool of non-invasive diagnosis of the source of SAH in emergency  departments. The absence of vascular pathology on CT angiography in the presence of massive basal SAH, the detection of multiple and “complex” aneurysms, as well as cerebral arteriovenous malformations of the brain during CT angiography remain indications for cerebral angiography

Quantitative assessment of the ischemic damage to the brain parenchyma in patients with acute cerebrovascular accident using the Olea Sphere automated software

Objective: To evaluate the capabilities of the Olea Sphere automated software for the quantitative assessment of ischemic damage to the brain parenchyma during computed tomography (CT) in patients with acute cerebrovascular accident and its role in choosing the optimal treatment strategy in everyday clinical practice.Materials and methods: We retrospectively analyzed the data from 129 patients with suspected stroke who underwent perfusion CT within 24 hours of admission to the hospital. The Olea Sphere data were used to assess the volume of the infarct core, which was defined as an area with a relative cerebral blood flow less than 40%, the volume of the penumbra area, where Tmax exceeded 6 s, and ultimately the core-penumbra ratio.Results: With the Olea Sphere automated software, we were able to assess the volume of the ischemic changes in the brain parenchyma, particularly, the average volume of the infarct core in 129 patients was 21.95 (1-206) ml, the average volume of the penumbra area was 57.01 (2-357) ml, the core-penumbra ratio was 2.65, and mean time from CT to the start of treatment was 1.2 (0.9-1.9) hours. This quantitative data processing powered by the Olea Sphere provided the indications for the following endovascular treatment in patients with stroke: thrombus extraction in the acute period was performed in 51 patients (72.8%), transluminal balloon angioplasty with stent placement – in 12 patients (17.1%), and carotid endarterectomy in the long-term period – in 5 (9.6%) patients.Conclusions: We discovered that the Olea Sphere automated software can be used to assess ischemic changes in the brain and to make decisions related to patients with acute cerebrovascular accident in emergency conditions

The role of magnetic resonance angiography in the intracranial aneurysm treatment assessment and the follow-up of the patients

The presented literature review shows up-to-date information about the possibilities and new methods of magnetic resonance angiography in patients with cerebral aneurysms who have undergone surgical treatment. The articles for analyses have been taken from the PubMed database. The most important aspects of the implementation and the possibilities of improving magnetic resonance angiography protocols for visualization and postoperative control of treated cerebral aneurysm have been considered

3D convolutional neural networks for detecting intracranial aneurysms on brachiocephalic arteries CTA scans

Background: Computed tomography angiography (CTA) is the primary and minimally invasive imaging modality currently used for diagnosis and monitoring of intracranial aneurysms as well as preoperative planning of their treatment. However, its interpretation is time-consuming even for specially trained neuroradiologists. Nowadays little is known whether trained neural networks contribute to analyzing medical images and reduce the time to diagnosis, and how effective they are in detecting intracranial aneurysms according to the CTA findings.Objective: To assess the diagnostic value of a convolutional neural network prototype in the intracranial aneurysm detection according to the brachiocephalic arteries CTA findings.Materials and methods: We analyzed the 3D convolutional neural network prototype based at Kuban State University (Krasnodar, Russian Federation).This prototype was to determine the probability of intracranial aneurysms according to the brachiocephalic arteries CTA findings, obtained in the Radiology Department of Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1. The study included 451 CTA scans of 205 patients with confirmed intracranial aneurysms and 246 patients without aneurysms.Results: The sensitivity of the 3D convolutional neural network prototype in the aneurysms detection according to the brachiocephalic arteries CTA findings was 85.1%, the specificity was 95.1%, and the overall accuracy was 91%.Conclusions: The 3D convolutional systems may predict aneurysms with a high accuracy as well as localize them with an accuracy of more than 90%. Such results require a larger dataset

Роль КТ-ангиографии в оценке лечения аневризм интракраниальных артерий

The review provides information on the possibilities and significance of computed tomography (CT) angiography as a method of postoperative control of cerebral aneurysms after treatment (surgical clipping or endovascular embolization). The comparison of the diagnostic value of CT and cerebral angiography as a routine method of postoperative control is shown. The possibilities of improving the methods of scanning and post-processing in the framework of CT angiography are described for better visualization of the completeness of aneurysm shutdown, as well as minimizing artifacts from surgical clips and coils.В обзоре представлена информация о возможностях и значимости применения компьютерной томографической ангиографии (КТА) как метода послеоперационного контроля церебральных аневризм после хирургического клипирования или эндоваскулярной эмболизации. Показано сравнение диагностической ценности КТА и церебральной ангиографии в отношении рутинного послеоперационного контроля. Описаны возможности усовершенствования методик сканирования и постобработки в рамках КТА для более качественной визуализации полноты выключения аневризм, а также минимизации артефактов от хирургических клипс и катушек

Quantitative visualization assessment of the vascular wall in patients with surgical pathology of the aortic valve, aorta and brachiocephalic arteries

Objective: Identification of the quantitative characteristics of changes in the arterial wall according to ultrasound, CT and MRI; development of the roadmap for the use of radiology diagnostic methods.Material and methods: 548 studies of 483 patients with atherosclerosis were analyzed (15 ultrasound studies, 483 – CTA and 50 – MRI). In the comparison group (n = 17) in patients without atherosclerosis, an analysis of MRI data of the aortic wall was performed. According to CTA, signs of atherosclerotic degeneration were assessed. According to the MRI data, indicators of aortic distensibility, Young’s modulus of the aortic wall (MPa), systolic distension of the aorta (ml), aortic wall enhancement index during contrast enhancement were calculated.Results: During the performance of ultrasound in all cases (n = 15), the analysis of the elastic properties of the aortic wall is difficult due to the artifact from calcification. Adverse CT signs of the occurrence of intraoperative vascular complications: the presence of an intraluminal thrombus, an uneven internal aortic contour of more than half of the circumference with an aortic wall thickness of more than 5 mm. According to MRI data in patients with atherosclerosis, aortic distensibility was reduced to 14.42 ± 2.95%, Young’s modulus for the aortic wall was 0.77 ± 0.26 MPa, the index of contrast enhancement of the aortic wall was 1.73 ± 0.5, the volume of systolic aortic distension was 11.48 ± 1.84 ml. In patients with vascular events in the perioperative period, systolic aortic dilatation was 9.2 ml.Conclusion: The signs which are expedient to consider when making a decision on surgical treatment have been identified. Significant limitations were identified in the assessment of elasticity by ultrasound. The wider use of MRI in atherosclerotic lesions looks promising

МУЛЬТИСПИРАЛЬНАЯ КОМПЬЮТЕРНАЯ ТОМОГРАФИЯ В ДИАГНОСТИКЕ ПАЦИЕНТОВ С ПАТОЛОГИЕЙ ВОСХОДЯЩЕГО ОТДЕЛА АОРТЫ В ДО- И ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ

This review presents current information on the diagnosis of patients with pathology of the ascending aorta in the pre and postoperative period using multispiral computed tomography. The authors paid attention to the importance of valuation of the valvular apparatus elements, the geometry of the root of the aorta (effective coaptation height, Henle triangles, aortic regurgitation area, etc.), the features of which are necessary for the surgeon to solve technical issues of the forthcoming operation. A comparison of the diagnostic value of multispiral computed tomography and transthoracic echocardiography with respect to the visualization of valvular structures is shown. The role of multispiral computed tomography in the planning of transcatheter aortic valve replacement and the determination of results after intervention is described. With the help of multispiral computed tomography, assessing the state of the ascending aorta, the aortic root and aortic valve elements, the surgeon has an opportunity to choose the optimal variant of the valve-preserving operation and to evaluate postoperative results in the preoperative period.В обзоре представлена актуальная информация о диагностике пациентов с патологией восходящего отдела аорты в до- и послеоперационном периоде с помощью мультиспиральной компьютерной томографии. Авторы уделили внимание важности оценки элементов клапанного аппарата, геометрии корня аорты (эффективная высота коаптации, треугольники Генле, площадь аортальной регургитации и др.), особенности которой необходимы хирургу для решения технических вопросов предстоящей операции. Показано сравнение диагностической ценности мультиспиральной компьютерной томографии и трансторакальной эхокардиографии в отношении визуализации клапанных структур. Описана роль мультиспиральной компьютерной томографии в планировании транскатетерного протезирования аортального клапана и определении результатов после интервенции. С помощью мультиспиральной компьютерной томографии, оценивая состояние восходящего отдела аорты, элементов корня аорты и аортального клапана, хирург в предоперационном периоде получает возможность выбора оптимального варианта клапаносохраняющей операции и оценки послеоперационных результатов

COMPLICATED DIAGNOSIS: RETROPERITONEAL ALVEOCOCCOSIS IN THE GUISE OF ORMOND’S DISEASE

Diagnosis of parasitic diseases, in a type of their rarity and diversity, always presents considerable difficulties. Clinical observation of an alveococcosis with invasion in the retroperitoneal space with distribution on mediastinal fat proceeding with progressing retroperitoneal fibrosis with ureteral obstruction and hydronephrosis development, with an aorta lumen stenosis, with formation of SVC syndrome in the absence of changes in other parts of the body, first of all in the liver, in the absence of eosinophilia in the peripheral blood throughout all disease and lack of antibodies to echinococci in the blood serum, twice during observation determined by an immunofermental method is presented in this article

Multispiral computed coronary angioography in diagnostics of a coronary atherosclerosis

Surgical treatment is effective but with a certain risk of serious complications which repeatedly increase in the presence of IHD. Intraoperative myocardial revascularization can reduce this risk. Much attention is paid to noninvasive method of diagnostics of coronary atherosclerosis. Multispiral computer tomography is the leading non invasive method of diagnostics. Modern computer tomographs demonstrate high sensitivity and specificity in the assessment of coronary arteries