The assessment of stroke multidimensional CT and MR imaging using eye movement analysis: does modality preference enhance observer performance?

Although CT and MR imaging is now commonplace in the radiology department, few studies have examined complex interpretative tasks such as the reading of multidimensional brain CT or MRI scans from the observer performance perspective, especially with reference to Stroke. Modality performance studies have demonstrated a similar sensitivity of less than 50% for both conventional modalities, with neither modality proving superior to the other in Stroke observer performance tasks (Mohr, 1995; Lansberg, 2000; Wintermark, 2007). Visual search studies have not extensively explored stroke imaging and an in-depth, comparative eye-movement study between CT and MRI has not yet been conducted. A computer-based, eye-tracking study was designed to assess diagnostic accuracy and interpretation in stroke CT and MR imagery. Forty eight predetermined clinical cases, with five images per case, were presented to participants (novices, trainees and radiologists; n=28). The presence or absence of abnormalities was rated on a four-point Likert scale and their locations reported. Results highlight differences in visual search patterns amongst novice, trainee and expert observers; the most marked differences occurred between novice readers and experts. In terms of modality differences; novice and expert readers spent longer appraising CT images than MR, compared with trainees, who spent longer appraising MR than CT images. Image analysis trends did not appear to differ between modalities, but time spent within clinical images, accuracy and relative confidence performing the task did differ between CT and MR reader groups. To-date few studies have explored observer performance in neuroradiology and the present study examines multi-slice image appraisal by comparing matched pairs of CT and MRI Stroke cases

Stress perfusion cardiovascular magnetic resonance and serial fractional flow reserve assessment of the left anterior descending artery in patients undergoing right coronary artery chronic total occlusion revascularization

Background: Fractional flow reserve (FFR) assessment of remote arteries, in the context of a bystander chronic total occlusion (CTO), can lead to false positive results. Adenosine stress cardiovascular magnetic resonance (CMR) evaluates perfusion defects across the entire myocardium and may therefore be a reliable tool in the work-up of remote lesions in CTO patients. The IMPACT-CTO study investigated donor artery invasive physiology before, immediately post, and at 4 months following right coronary artery (RCA) CTO percutaneous coronary intervention (PCI). The aim of this subanalysis was to assess the concordance between baseline perfusion CMR and serial FFR evaluation of left anterior descending artery (LAD) ischemia in patients from the IMPACT-CTO study.Methods: Baseline adenosine stress CMR examinations from 26 patients were analyzed for qualitative evidence of LAD ischemia. The results were correlated with the serial LAD FFR measurements.Results: The present findings demonstrated that before RCA CTO PCI, there was 62% agreement between perfusion CMR and FFR (ischemic threshold £ 0.8) in the assessment of LAD ischemia (k = 0.29; fair concordance). At 4 months after revascularization, there was 77% agreement (k = 0.52; moderate concordance) between the index CMR assessment of LAD ischemia and the follow-up LAD FFR. Concordance was improved at a LAD FFR ischemic threshold of £ 0.75.Conclusions: In this hypothesis generating study, baseline CMR assessment of LAD ischemia correlated better with the 4 months LAD FFR data (threshold £ 0.8) as compared to the FFR measurements taken prior to RCA CTO revascularization

Noncoronary Gated Transcatheter Aortic Valve Replacement Computed Tomography Scans Can Safely Replace Invasive Coronary Angiography Pre-Transcatheter Aortic Valve Replacement

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Coronary embolization from aortic valve fibroelastoma

Papillary fibroelastomas have a range of clinical presentations. The surgical removal of these tumors should always be considered as best alternative to a conservative approach.</p

Facilitating Safe Trans-femoral ACCESS for Transcatheter Aortic Valve Replacement in High Body Mass Index Patients—The FAST-ACCESS Cohort Study

Background: Transfemoral  (TF) access is the safest, quickest, and most studied access route for  transcatheter aortic valve replacement (TAVR).1  While TAVR has demonstrated excellent clinical outcomes, femoral access  site complications remain one of the most common adverse events of  TAVR,2 with attendant morbidity and even mortality. Despite  contemporary safety refinements in obtaining wide-bore TF access (e.g.,  the routine use of vascular ultrasound and micropuncture), high body  mass index (BMI)3 and increased femoral arterial depth (FAD)4  are strong predictors of vascular complications during TF-TAVR. In such  high BMI patients, panniculus retraction (by a variety of  nonstandardized methods) may reduce the FAD and thus facilitate safer TF  access. Locally, we have standardized this technique  by repurposed use of a dedicated adhesive panniculus retractor (APR)  device, initially designed for use in obese patients during caesarean  section. The FAST-ACCESS study reports our clinical experience using  this APR device during TF-TAVR in high BMI patients. Specifically, we  report (i) the reduction in FAD achieved using the dedicated APR device  and (ii) the vascular complication rate in consecutive patients with  high BMI undergoing TF-TAVR when using the dedicated APR device.</p