A Case of Conservative Treatment of Postsurgical Aortic False Aneurysm

A 51-year-old male underwent replacement of the ascending aorta for acute type A dissection. The post-operative course was uncomplicated, and he was discharged home. Approximately a month later, control CT revealed an enlarging pseudoaneurysm of the proximal anastomosis. The patient was re-operated, and a Bentall operation with mechanical prosthesis was performed. Again, surgery was uncomplicated, but follow-up CT scan revealed a recurrent small pseudoaneurysm of the proximal suture line. He was managed with close observation, and control CT at four months showed complete resolution. Conservative treatment of small postsurgical pseudoaneurysms is discussed. </p

Assessment of Functional Connectome in End-Stage Organ Disease Patients After Life-Threatening Surgery

Purpose The purpose of this study was to assess the organization of intrinsic functional brain networks (functional connectome) in neurologically asymptomatic patients with end-stage organ disease who had undergone major surgery for life-threating conditions and compare it to a control group. Materials and Methods Resting-state functional magnetic resonance imaging (rest-fMRI) was performed in 10 adult, post-operative patients with end-stage organ disease. The patients (7 men, 3 women, mean age 57.9 ± 7.4 years) had undergone: n=4 coronary artery bypass graft for heart failure, n=2 orthotopic liver transplantation for non-alcoholic cirrhotic liver failure, n=3 mitral valve repair for heart failure, n=1 pancreaticoduodenectomy for pancreatic papillary tumor. Rest-fMRI was acquired within 48 hours after intensive care unit discharge. Structural brain MR imaging was acquired with T1-weighted, T2-weighted, diffusion weighted imaging, and susceptibility weighted imaging along with 3D isotropic T1-weighted MR images. MR examinations were performed on a 3T MR scanner (Discovery 750w, General Electric Healthcare, Milwaukee, WI, USA). Ten age- and sex-matched healthy controls were studied with the same protocol. Brain functional networks were analyzed by calculating the interregional correlation of low-frequency fluctuations in spontaneous brain activity. Weighted graph-based models were employed to topologically recognize reproducibly determined large-scale functional networks, including default mode, salience, dorsal attention, sensorimotor, visual and language networks using a seed-based approach with Functional Connectivity Toolbox (CONN) (https://web.conn-toolbox.org/) running under MatLab (The MathWorks Inc., Natick, MA, USA). A p-uncorrected &lt; 0.0025 was used to threshold connectomes for voxel-wise paired statistical analysis to take in account the lateralization effect. Network comparisons were thresholded using a false discovery rate (FDR) cluster-level correction approach in patients and controls using the MatLab function “mafdr” for p-uncorrected &lt;0.0025 obtaining the p-FDR &lt; 0.077. Results Functional connectivity in patients and controls was successfully assessed for the default mode, salience, dorsal attention, sensorimotor, visual, and language networks of the brain. There was statistically significant (p &lt;0.05) reduced connectivity between seeds in the default mode, salience, sensorimotor, and language networks in patients compared to controls (Fig. 1). No acute structural lesions were observed in patients at MR imaging. Conclusion Assessment of functional connectome in end-stage organ disease patients is feasible in routine clinical setting. Rest-fMRI can demonstrate reduced connectivity of several intrinsic functional networks in critically ill, post-operative patients and it may be a useful prognostic indicator of early and long-term clinical outcome. References Ma X, et al. Aberrant functional connectome in neurologically asymptomatic patients with end-stage renal disease. PloS One 2015;10:e0121085. Lariviere S, et al. Disrupted functional network integrity and flexibility after stroke: Relation to motor impairments. NeuroImage. Clinical 2018;19:883–891. Cheng Y, et al. Longitudinal Intrinsic Brain Activity Changes in Cirrhotic Patients before and One Month after Liver Transplantation. Korean Journal of Radiology, 2017;18,370–377. Zhang XD, et al. Long-and short-range functional connectivity density alteration in non-alcoholic cirrhotic patients one month after liver transplantation: A resting-state fMRI study. Brain Research, 2015;1620:177–187. Whitfield-Gabrieli S, Nieto-Castanon A. Conn: a functional connectivity toolbox for correlated and anticorrelated brain networks. Brain Connect. 2012; 2:125-141. Additional Video Material: https://youtu.be/15lzif0MOO

Assessment of cerebral microbleeds by susceptibility-weighted imaging at 3T in patients with end-stage organ failure

Purpose: Cerebral microbleeds (CMBs) are small rounded lesions representing cerebral hemosiderin deposits surrounded by macrophages that results from previous microhemorrhages. The aim of this study was to review the distribution of cerebral microbleeds in patients with end-stage organ failure and their association with specific end-stage organ failure risk factors. Materials and methods: Between August 2015 and June 2017, we evaluated 15 patients, 9 males, and 6 females, (mean age 65.5 years). Patients population was subdivided into three groups according to the organ failure: (a) chronic kidney failure (n = 8), (b) restrictive cardiomyopathy undergoing heart transplantation (n = 1), and (c) end-stage liver failure undergoing liver transplantation (n = 6). The MR exams were performed on a 3T MR unit and the SWI sequence was used for the detection of CMBs. CMBs were subdivided in supratentorial lobar distributed, supratentorial non-lobar distributed, and infratentorial distributed. Results: A total of 91 microbleeds were observed in 15 patients. Fifty-nine CMBs lesions (64.8%) had supratentorial lobar distribution, 17 CMBs lesions (18.8%) had supratentorial non-lobar distribution and the remaining 15 CMBs lesions (16.4%) were infratentorial distributed. An overall predominance of supratentorial multiple lobar localizations was found in all types of end-stage organ failure. The presence of CMBs was significantly correlated with age, hypertension, and specific end-stage organ failure risk factors (p &lt; 0.001). Conclusions: CMBs are mostly founded in supratentorial lobar localization in end-stage organ failure. The improved detection of CMBs with SWI sequences may contribute to a more accurate identification of patients with cerebral risk factors to prevent complications during or after the organ transplantation

Brain-core temperature of patients before and after orthotopic liver transplantation assessed by DWI thermometry

To assess brain-core temperature of end-stage liver disease patients undergoing orthotopic liver transplantation (OLT) using a temperature measurement technique based on the apparent diffusion coefficient of the cerebrospinal fluid in the lateral ventricles

Imaging of hepatocellular carcinoma recurrence after liver transplantation

Liver transplantation (LT) provides the highest survival benefit to patients with unresectable hepatocellular carcinoma (HCC). The Milan criteria have been developed for the selection of LT candidates with the goal of improving survival and maintaining an acceptable risk of HCC recurrence. Despite this, recurrence of HCC after LT occurs in up to 20% of cases and represents a major concern due to the poor prognosis of these patients. Furthermore, several extended criteria for the selection of LT candidates have been proposed to account for the growing demand for organs and the resultant increase in the risk of HCC recurrence. Radiologists should be aware that HCC can recur after LT with multiple organ involvement. Knowledge of the location and radiologic appearance of recurrent HCC is necessary to ensure the choice of the most appropriate therapy. This paper aims to comprehensively summarize the spectrum of HCC recurrence after LT and to examine and discuss the imaging features of these lesions. CRITICAL RELEVANCE STATEMENT: This paper aims to share a review of imaging findings of HCC recurrence after LT and to make radiologists familiar with the spectrum of this disease

A Case of Conservative Treatment of Postsurgical Aortic False Aneurysm

A 51-year-old male underwent replacement of the ascending aorta for acute type A dissection. The post-operative course was uncomplicated, and he was discharged home. Approximately a month later, control CT revealed an enlarging pseudoaneurysm of the proximal anastomosis. The patient was re-operated, and a Bentall operation with mechanical prosthesis was performed. Again, surgery was uncomplicated, but follow-up CT scan revealed a recurrent small pseudoaneurysm of the proximal suture line. He was managed with close observation, and control CT at four months showed complete resolution. Conservative treatment of small postsurgical pseudoaneurysms is discussed

A Case of Conservative Treatment of Postsurgical Aortic False Aneurysm

A 51-year-old male underwent replacement of the ascending aorta for acute type A dissection. The post-operative course was uncomplicated, and he was discharged home. Approximately a month later, control CT revealed an enlarging pseudoaneurysm of the proximal anastomosis. The patient was re-operated, and a Bentall operation with mechanical prosthesis was performed. Again, surgery was uncomplicated, but follow-up CT scan revealed a recurrent small pseudoaneurysm of the proximal suture line. He was managed with close observation, and control CT at four months showed complete resolution. Conservative treatment of small postsurgical pseudoaneurysms is discussed. </p

Resting-State Functional Magnetic Resonance Imaging for Surgical Neuro-Oncology Planning: Towards a Standardization in Clinical Settings

Resting-state functional magnetic resonance imaging (rest-f-MRI) is a neuroimaging technique that has demonstrated its potential in providing new insights into brain physiology. rest-f-MRI can provide useful information in pre-surgical mapping aimed to balancing long-term survival by maximizing the extent of resection of brain neoplasms, while preserving the patient’s functional connectivity. Rest-fMRI may replace or can be complementary to task-driven fMRI (t-fMRI), particularly in patients unable to cooperate with the task paradigm, such as children or sedated, paretic, aphasic patients. Although rest-fMRI is still under standardization, this technique has been demonstrated to be feasible and valuable in the routine clinical setting for neurosurgical planning, along with intraoperative electrocortical mapping. In the literature, there is growing evidence that rest-fMRI can provide valuable information for the depiction of glioma-related functional brain network impairment. Accordingly, rest-fMRI could allow a tailored glioma surgery improving the surgeon’s ability to increase the extent of resection (EOR), and simultaneously minimize the risk of damage of eloquent brain structures and neuronal networks responsible for the integrity of executive functions. In this article, we present a review of the literature and illustrate the feasibility of rest-fMRI in the clinical setting for presurgical mapping of eloquent networks in patients affected by brain tumors, before and after tumor resection