Sheffield Medical Portrait Collection

Group photograph, with University boxer

Peri-procedural silent cerebral infarcts after left atrial appendage occlusion

Background and purpose To determine the rate of peri-interventional silent brain infarcts after left atrial appendage occlusion (LAAO). Methods In this prospective, uncontrolled single-center pilot study, consecutive patients with atrial fibrillation undergoing LAAO between July 2013 and January 2016 were included. The Amplatzer Cardiac Plug, WATCHMAN or Amulet device was used. A neurological examination and cranial magnetic resonance imaging (MRI) were performed within 48 h before and after the procedure. MRI was evaluated for new diffusion-weighted imaging (DWI) hyperintensities, cerebral microbleeds (CMBs) and white-matter lesions (WMLs). Results Left atrial appendage occlusion was performed in 21 patients (mean age, 73.2 ± 9.5 years). Main reasons for LAAO were previous intracerebral hemorrhage (n = 11) and major systemic bleeding (n = 6). No clinically overt stroke occurred peri-interventionally. After the intervention, one patient had a small cerebellar hyperintensity on DWI (4.8%; 95% confidence interval, 0.0–14.3) that was not present on the MRI 1 day before the procedure. Among 11 patients with available MRI just before LAAO, there were no significant changes in the number of CMBs and the severity of WMLs after LAAO. Conclusions This study of peri-interventional MRI in LAAO suggests a low rate of silent peri-procedural infarcts in this elderly population. Confirmation in larger studies is needed

Multimodality Image Fusion–Guided Procedures: Technique, Accuracy, and Applications

Personalized therapies play an increasingly critical role in cancer care; Image guidance with multimodality image fusion facilitates the targeting of specific tissue for tissue characterization, and plays a role in drug discovery and optimization of tailored therapies. PET, MRI and contrast enhanced CT may offer additional information not otherwise available to the operator during minimally invasive image guided procedures such as biopsy and ablation. With use of multimodality image fusion for image-guided interventions, navigation with advanced modalities does not require the physical presence of the PET, MRI, or CT imaging system. Several commercially available methods of image fusion and device navigation are reviewed along with an explanation of common tracking hardware and software. An overview of current clinical applications for multimodality navigation is provided