Metody i schemat okresowy kontroli obrazowej po przeznaczyniowym leczeniu tętniaków wewnątrzczaszkowych: systematyczny przegląd piśmiennictwa

Background and purpose To review the diagnostic value of angiographic methods and the optimal timetable for follow-up imaging of patients after endovascular treatment of intracranial aneurysms. Material and methods A comprehensive computer-aided search for relevant primary papers was performed using the MEDLINE, PubMed, Embase, and Cochrane Collaboration database from January 1991 to March 2011. Original papers were included that reported either diagnostic value of angiographic modalities for follow-up vs. digital subtracted angiography (DSA) or comparison of aneurysm occlusion rate in delayed vs. early follow-up. Results The systematic review identified 35 relevant studies: 3 on the diagnostic value of three-dimensional (3D) DSA, 30 on the performance of magnetic resonance angiography (MRA), and 3 on time schedules for follow-up. 3D DSA had sensitivity of 100%, and specificity of 58.3-94.7%. Magnetic resonance angiography had sensitivity of 28.4-100%, and specificity of 50.0-100%. The proportion of aneurysms that recanalized between the early follow-up examination at 6 months and the delayed imaging at 1.5-6.0 years was 0-2.5%. Conclusions Magnetic resonance angiography seems to be the best imaging method for the follow-up. In selected cases, when invasive angiography is necessary, 3D DSA should be considered to improve the diagnostic accuracy. Most patients who present with stable and adequate aneurysm occlusion at 6 months after coiling may not require further follow-up.Wstęp i cel pracy Celem pracy był przegląd opublikowanych prac oryginalnych na temat wartości diagnostycznej metod angiograficznych oraz schematów czasowych kontrolnych angiografii u chorych po przeznaczyniowym leczeniu tętniaków wewnątrzczaszkowych. Materiał i metody Przeprowadzono przegląd systematyczny piśmiennictwa indeksowanego w bazach MEDLINE, PubMed, Embase i Cochrane Collaboration w okresie od stycznia 1991 do marca 2011 r. Do analizy włączono badania oryginalne, w których określano wartość diagnostyczną metod angiograficznych w ocenie tętniaków po embolizacji w porównaniu z konwencjonalną arteriografią subtrakcyjną (DSA). Włączono również badania, w których porównywano wyniki embolizacji we wczesnej i późnej kontroli angiograficznej. Wyniki Kryteria włączenia do analizy spełniło 35 prac, w tym 3 oceniające wartość trójwymiarowej DSA (3D DSA), 30 oceniających angiografię rezonansu magnetycznego (MRA) i 3 dotyczące schematu czasowego kontroli angiograficznej. W analizowanych pracach 3D DSA miała czułość 100% i swoistość 58,3–94,7%, natomiast czułość i swoistość MRA wynosiły odpowiednio 28,4–100% i 50–100%. Odsetek tętniaków, które uległy rekanalizacji pomiędzy wczesnymi (po 6 miesiącach) i późnymi badaniami kontrolnymi (po 1,5–6 latach), wyniósł 0–2,5%. Wnioski Angiografia rezonansu magnetycznego wydaje się najlepszą metodą angiograficznej kontroli chorych po embolizacji tętniaków. W przypadkach, kiedy konieczne jest wykonanie angiografii inwazyjnej, 3D DSA może istotnie poprawić wartość diagnostyczną badania. Znaczna część chorych, u których stwierdza się prawidłowe wypełnienie tętniaka po 6 miesiącach od embolizacji, nie wymaga dalszej kontroli

Hypertension and stenosis of additional renal artery - diagnostic difficulties

Badanie ultrasonograficzne tętnic nerkowych stanowi jedno z podstawowych badań nieinwazyjnych w diagnostyce zwężenia tętnicy nerkowej. Jednak badanie to ma kilka ograniczeń wynikających z częstego występowania dodatkowych tętnic nerkowych oraz wysokiej częstości niepowodzeń technicznych badania. Przedstawiono przypadek 51-letniego pacjenta z nadciśnieniem tętniczym, u którego przyczyną trudności diagnostycznych była podwójna tętnica nerkowa po stronie lewej z krytycznym zwężeniem jednej z tętnic.Doppler duplex ultrasound is one of the main non-invasive diagnostic methods for detection of renal artery stenosis. This diagnostic method has several limitations related to high prevalence of additional renal arteries and high percentage of inadequate examinations. We present a case of 51 years old male with hypertension, in whom double left side renal artery with critical stenosis of one, was the reason of diagnostic difficulties

Predictors of residual flow in embolized intracranial ruptured aneurysms at early follow-up

Background: The possibility of recanalization and the need for retreatment are the most important drawbacks of intracranial aneurysm embolization. The purpose of the study was to prospectively analyze the results of early follow-up angiography of embolized ruptured aneurysms in an attempt to determine factors predicting the presence of residual flow. Material and Methods: Evaluation included 72 patients with 72 aneurysms, which were followed-up 3 months after the treatment. Analysis of residual flow predictors included: age and gender, clinical state in Hunt-Hess scale, aneurysm localization, aneurysm three dimensions and volume, neck width, sac-to-neck ratio, initial result of embolization, number of coils used and the use of hydrogel coils and stents. Results: Mean sac diameter was 6.5±3.9 mm, and mean neck width was 2.9±1.4 mm. Follow-up angiography presented residual flow in 26 aneurysms (36.1%): class 2 in 8 aneurysms (11.1%), and class 3 in 18 cases (25.0%). Stable aneurysm filling was observed in 45 cases (62.5%), progression of residual flow in 25 cases (34.7%), and regression in 2 cases (2.8%). According to ROC analysis independent predictors of residual flow were aneurysm neck diameter (AUC 0.857, 95% CI: 0.755-0.928, p<0.0001) and sac-to-neck ratio (AUC 0.817, 95% CI: 0.708-0.898, p<0.0001). Cut-off point of the ROC curve was established at 2.8 mm for neck diameter, and 1.73 for sac-to-neck ratio. Conclusions: Aneurysm neck diameter and sac-to-neck ratio are independently related to the residual flow in embolized ruptured aneurysms at early follow-up

Anatomical evaluation of the pulmonary veins and the left atrium using computed tomography before catheter ablation : reproducibility of measurements

BACKGROUND: Atrial fibrillation (AF) is a common supraventricular arrhythmia. ECG-gated MDCT seems to be currently a method of choice for pre-ablation anatomical mapping due to an excellent resolution and truly isotropic three-dimensional nature. The aim of this study was to establish the between-subject variability and inter-observer reproducibility of anatomical evaluation of the pulmonary veins (PV) and the left atrium (LA) using computed tomography. MATERIAL AND METHODS: A retrospective analysis included 42 patients with AF, who were scheduled for a cardiac CT for ablation planning. Images were assessed by two independent radiologists using a semi-automatic software tool. The left atrium anatomy (volume, AP diameter), anatomy of the pulmonary veins (number, ostia diameters and surface area) were evaluated. The relative between-subject variability and the inter-observer variability of measurements were calculated. RESULTS: The heart rate during scanning ranged from 50 to 133/min. (mean 79.1/min.) and all examinations were of adequate image quality. Accessory pulmonary veins were found in 24% of patients. Between-subject variability of the PV ostial cross-sectional area ranged from 33% to 48%. The variability of the left atrium size was 21% for the diameter and 35% for the volume. The inter-observer agreement for the detection of accessory pulmonary veins was good (κ=0.73; 95% CI, 0.54-0.93). CONCLUSIONS: Between-subject variability of the pulmonary vein ostial cross-sectional area and the left artial volume is substantial. The anatomical assessment of the pulmonary vein ostia and the left atrium size in computed tomography presents a good inter-observer reproducibility

Pancreaticopleural fistulas of different origin : report of two cases and a review of literature

Background: Pancreaticopleural fistula (PPF), a form of internal pancreatic fistula, is a rare complication of acute or chronic pancreatitis or pancreatic trauma. Case Report: We report two cases of PPF resulting in formation of pleural pancreatic pseudocysts. A 35-yearold male alcoholic patient with a history of recurrent episodes of acute pancreatitis was admitted due to a severe dyspnea. A CT scan showed a significant left pleural effusion with a total left lung atelectasis, compression of the mediastinum, and dislocation of the left diaphragm. A follow-up CT showed a fistula between the abdominal pancreatic pseudocyst and the left pleural cavity. The second case was a 13-year-old male patient, who was admitted for a splenic stump excision. Two weeks after the surgery the patient presented a massive pleural amylase-rich effusion. CT exam suggested a PPF, which was indirectly confirmed by a thoracoscopy. Conclusions: PPF should be considered in cases of massive pleural effusion and encapsulated pleural fluid collections in patients with a history of acute pancreatitis and surgery involving pancreas