DOCSLIB.ORG

Evaluation of Cerebral Hemispheric Contrast Transit with Intravenous Digital Subtraction Angiography

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Evaluation of Cerebral Hemispheric Contrast Transit with Intravenous Digital Subtraction Angiography 333 Evaluation of Cerebral Hemispheric Contrast Transit with Intravenous Digital Subtraction Angiography Joachim F. Seeger,1 Raymond F. Carmody, Janice R. L. Smith, Theron W. Ovitt, and Kevin McNeill Thirty-six patients with varying degrees of stenosis of one and with minimal or no stenosis on th e opposite side with intrave­ internal carotid artery were studied using intravenous digital nous DSA. Our intravenous technique has been described [6]. subtraction angiography, assessing relative hemispheric wash­ Images were obtained with a speciall y designed system using an in and washout of contrast medium. Ipsilateral delayed contrast image intensifier with 14, 10, and 6 in ch (35.6, 25.4, and 15.2 cm) transit was seen in 16 of 18 patients with a 70% or greater field capabilities. Th e initial arch aortogram covered a fi eld from th e carotid artery stenosis. Decreased hemispheric peak contrast aorti c arch to just beyond the common carotid artery bifurcations. den sity was also seen in most of these patients. With further Subsequent oblique views of th e neck, to demonstrate the common improvements in the computer program and faster imaging rates, carotid bifurcations optimall y, in cluded th e distal common carotid intravenous digital subtraction angiography has the capability of arteries and bifurcations, as well as th e en tire internal caroti d providing valuable physiologic data along with anatomic infor­ arteries, including their cavernou s segments. The vertebral arteries mation in patients with suspected cerebral ischemia. also were generall y seen in their en tirety. The fin al anteroposterior (or posteroanterior) head images were collimated to th e skull pe­ ri phery wi th a lead template and comprised th e distal internal carotid In an attempt to identify or quantify changes in cerebral perfusion and vertebral arteries and the entire intracranial vasculature, in­ in patients with transient ischemi c attacks (TIAs), studies of cere­ cluding the peripheral middle cerebral artery territori es. Images brovascular transit times have been perform ed in nuclear medicine were obtained at a rate of one/ sec with a 512 x 512 matrix and at with radionuclide angiography, using either visual or computer­ two/ sec with a 512 x 256 matrix. assisted analysis [1 , 2]. Similar principles have been used with Th e digital head images were acquired in a linear mode and rapid , sequential (dynamic) computed tomographic (CT) scanning could be amplified in ei ther a linear or logarithmic fash ion. Logarith­ of the brain after intravenous bolus infusion of iodinated contrast mic amplification was generall y optimal for demonstratin g vessels medium [3, 4], taking advantage of the more precise intracranial passing through the dense skull base, but th e linear mode was anatomic detail of CT. However, neither technique provides what often superior in areas of more uniform background density, such many consider to be the most important information, namely, the as the peripheral cerebral vascular territori es. The relative wash in morphology of the arteries in the neck and head. This information and washout of contrast materi al in the distal internal carotid arteries can only be supplied by cervicocerebral angiography. However, and middle cerebral artery territories were evalu ated by visual angiography carries a small but definite ri sk and a significant examination, from initial opacificati on through the venous phase. expense and generally is not used as a screening examination. More recently, in an attempt to increase the sensitivity of the study The recent advent of intravenous digital subtraction angiography in cases with subtle differences on visual inspection, time-density (DSA ) has provided a new, safe, and relatively simple means of cu rves have been derived from computer-defined regions of interest assessing, on an outpatient basis, the anatomy of the aortic arch obtained from identical areas in each middle cerebral artery terri­ and great vessel origins, the common and intern al carotid arteri es, tory. We are currently im proving the program to all ow th e examin er th e vertebral arteries, and th e major intracranial arteri es [5, 6]. It more flexibility in defining the contours of the regions of interest. can be used as a screening procedure and in many instances has replaced conventional angiography as the definitive preoperative examination in patients with TIAs. Since an intravenous injection Results simultaneously delivers contrast material to all the vessels leading Eighteen pati ents had a measured 70% or greater diameter to the brain, intravenous DSA should also be able to provide stenosis of one distal common or proximal intern al carotid artery at physiologic transit time information similar to radionuclide angiog­ intravenous DSA. Sixteen of these showed a delay of contrast raphy. The objective of this preliminary study was to determin e if transit distal to the stenosis compared with the unaffected side, but intravenous DSA can demonstrate changes in contrast transit on three could not be studied beyond the arterial phase because of th e side of a carotid stenosis. image-deg rad ing motion artifacts. The other 13 patients showed a relative delay in washin and washout of contrast material in th e middle cerebral artery territory on the side of stenosis, even though Subjects and Methods there was a variable degree of demonstrable coll ateral circulation We studied 36 consecutive patients with a 50% or greater through th e circle of Willis. Three patients had computer-generated diameter stenosis of one common and/ or internal carotid artery time-density curves that confirmed the contrast delay and also I All authors: Department of Rad iology. University of Arizona Health Sciences Center. Tu cson. AZ 85724. Address reprint requ ests 10 J. F. Seege r. AJNR 4:333-337, May / June 1983 0 195-6108/ 83/ 0403-0333 $00.00 © Ameri can Roentgen Ray Soc iety 334 NEW CONTRAST AGENTS AJNR:4, May/ June 1982 Fig. 1 .- Case 1. A, Oblique view of neck. A high-grade stenosis of left internal carotid artery origin (arrow). B, Serial one/ sec images show relative delay in both opacification and clearing of left intern al carotid and left middle cerebral arteries, and decreased contrast density in lef; convexity region compared with right. Note lack of collateral flow to left middle cerebral artery Left posterior cerebral artery (arrow) should not be mistaken for A 1 segment, which presumabl, is hypoplastic. A 1 \, 6 3 B showed a decrease in peak contrast density compared with th e wash in and washout on the side of stenosis occurred in an asyml - unaffected side. A fourth case showed a delay but an in crease in tomati c patient. peak contrast density on th e side of th e stenosis. Only one of th e 18 cases with less th an 70% stenosis (a measured 66%) showed an observable, albeit ve ry subtl e, relati ve delay in contrast transit, Representative Case Reports confirmed by computer-generated time-density curves. Case 1 Since nearl y all patients were stud ied for transient cerebral ischemia, and because of the lim ited numbers in thi s preliminary A 70-year-old man noted a bruit in th e left neck wh il e lyin g in bed report, no good correlation was fou nd between th e degree of at night. He gave no hi story of TIAs or oth er evidence of cerebr" ­ delayed transit or the decrease in peak contrast density and clinical vascular in suffic iency. An abnorm al left oculopleth ysmog ram led a symptoms. In fact, one of th e most clear-cut examples of delayed intravenous DSA, which demonstrated a hi gh-grade stenosis at lie AJNR:4, May/ June 1983 NEW CONTRAST AGENTS 335 Fig. 2.-Case 2. A, Serial paired im­ ages show technique of obtaining re­ gions of interest from right (left of pair) and left (right of pair) middle cerebral artery territories for time-density meas­ urements. Visual in spection alone shows 1 2 delay in contrast transil and decreased peak cortical ··stain ·· on right. B, Time- I density curves derived from A show de- lay as well as lower peak on right. .. 3 4 I· I 5· 6 J orig in of the left internal carotid artery (fig. 1 A) . Delayed opacifica­ Case 2 tion and clearing of the left internal carotid and left middle cerebral artery were demonstrated on serial head images (figs. 1 B and 1 C). A 65-year-old man who had undergone a recent left carotid The st udy also provided additional important intracranial anatomic endarterectomy was seen after 1 day of several attacks of left body in formation by reveali ng a very hypoplastic proximal left anterior weakness and numbness. A focal stenosis at the right internal cerebral artery, which prevented significant right-to-Ieft coll ateral carotid artery origin was beli eved to be present but was difficult to circulation into the proxim al middle cerebral artery. Although con­ define with intravenous DSA due to vertebral artery superimposition. jectural, it could be argued that this patient was at a higher risk for However, serial head images clearly showed a relative delay of in farction because of this variation in the circle of Willis. Left carotid contrast flow on th e right (fig. 2A), and subsequent computer­ endarterectomy was performed without incident. generated time-density measurements showed both a delay and a 336 NEW CONTRAST AGENTS AJNR:4, May/ June 1983 Fig. 3. - 75-year-old man with clini­ cally suspected vertebrobasilar in suffi­ ciency. Four serial paired images show lefl internal carotid and left vertebral ar­ tery occlusion. Visual inspection shows simultaneous opacification of middle cerebral arteri es but slightly less density over left midconvexity (image 4).
Load more

Recommended publications
  • Minimally Invasive Superficial Femoral Artery Endarterectomy: Early Experience with a Modified Technique
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Eur J Vasc Endovasc Surg 16, 254-258 (1998) ENDOVASCULAR AND SURGICAL TECHNIQUES Minimally Invasive Superficial Femoral Artery Endarterectomy: Early Experience with a Modified Technique M. S. Whiteley 1, T. R. Magee 1, E. P. H. Torrie 2 and R. B. Galland* Department of ~Surgery and 2Radiology, Royal Berkshire Hospital, London Road, Reading, U.K. Objectives: To describe our experience of a modified technique for carrying out remote endarterectomy for superficial femoral artery occlusive disease. Methods: A 4-French arterial dilator is inserted using a Smart needle into the popliteal artery below the occlusion. A remote endarterectomy is carried out through an arteriotomy in the proximal superficial femoral artery. The atheroma is cut distal to the lower extent of disease using a Moll ring cutter. The lower flap of atheroma is secured with an intraluminaI stent inserted from the arteriotomy in the superficial femoral artery. The arteriotomy is extended into the common femoral artery and closed with a vein patch. Results: The procedure was completed in 21 of 26 limbs. In 18 cases the superficial femoral artery remained patent at 30 days. Of the 21 cases all but four stayed in hospital for one night. A successful femoropopliteal bypass was carried out in the five patients in whom the procedure was not completed. Conclusion: Insertion of the dilator into the popliteal artery distal to the occlusion before carrying out the remote endarterectomy has two advantages. Firstly, the stent insertion is carried out in the correct plane and prevents dissection of the distal cut atheroma when attempting to pass the guidewire from above.
    [Show full text]
  • Are You Ready for ICD-10-PCS? Expert Tips, Tools, and Guidance to Make the Transition Simple
    Are You Ready for ICD-10-PCS? Expert Tips, Tools, and Guidance to Make the Transition Simple By Amy Crenshaw Pritchett February 19, 2014 1 Agenda In this webinar: Expand your understanding of ICD-10-PCS with can’t miss ICD-10-PCS coding conventions & guidelines. Understand the basic differences between ICD-9-CM Volume 3 and ICD-10-PCS. Learn code structure, organization, & characters: Step 1 to coding section “0” ICD-10-PCS? Pinpoint the body system. To build your ICD-10-PCS code, you must identify the root operation. Study 7 options when assigning your PCS code’s 5th character. Master how to determine the device value for your PCS code’s character. Raise your awareness of unique ICD-10-PCS challenges pertaining to documentation and specificity: Prepare physicians now for more detailed transfusion notes under ICD- 10-PCS. Discover why writing “Right Carotid Endarterectomy” won’t be enough. Know where to find ICD-10-PCS tools, techniques, and best practices. 2 Understanding ICD-10-PCS ICD-10-PCS is a major departure from ICD-9-CM procedure coding, requiring you to know which root word applies. Effective October 1, 2014, this procedure coding system will be used to collect data, determine payment, and support the electronic health record for all inpatient procedures performed in the US. 3 Gear Up for ICD-10-PCS This procedure coding system is starkly different from ICD-9-CM procedure coding: Every ICD-10-PCS code has seven characters, each character defining one aspect of the procedure performed. For instance, not correctly identifying your physician’s approach – the fifth character – and not being able to distinguish between similar root operations can throw off your claims accuracy! 4 Converting to ICD-10-PCS Have your inpatient coders and clinical documentation specialists begun preparing for ICD-10-PCS yet? That’s why we’re here today … to ease your transition from ICD-9-CM procedure coding to ICD-10-PCS.
    [Show full text]
  • Equilibrium Radionuclide Angiography/ Multigated Acquisition
    EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY/ MULTIGATED ACQUISITION Equilibrium Radionuclide Angiography/ Multigated Acquisition S van Eeckhoudt, Bravis ziekenhuis, Roosendaal VJR Schelfhout, Rijnstate, Arnhem 1. Introduction Equilibrium radionuclide angiography (ERNA), also known as radionuclide ventriculography (ERNV), gated synchronized angiography (GSA), blood pool scintigraphy or multi gated acquisition (MUGA), is a well-validated technique to accurately determine cardiac function. In oncology its high reproducibility and low inter observer variability allow for surveillance of cardiac function in patients receiving potentially cardiotoxic anti-cancer treatment. In cardiology it is mostly used for diagnosis and prognosis of patients with heart failure and other heart diseases. 2. Methodology This guideline is based on available scientifi c literature on the subject, the previous guideline (Aanbevelingen Nucleaire Geneeskunde 2007), international guidelines from EANM and/or SNMMI if available and applicable to the Dutch situation. 3. Indications Several Class I (conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective) indications exist: • Evaluation of left ventricular function in cardiac disease: - Coronary artery disease - Valvular heart disease - Congenital heart disease - Congestive heart failure • Evaluation of left ventricular function in non-cardiac disease: - Monitoring potential cardiotoxic side effects of (chemo)therapy - Pre-operative risk stratifi cation in high risk surgery • Evaluation of right ventricular function: - Congenital heart disease - Mitral valve insuffi ciency - Heart-lung transplantation 4. Contraindications None 5. Medical information necessary for planning • Clear description of the indication (left and/or right ventricle) • Previous history of cardiac disease • Previous or current use of cardiotoxic medication PART I - 211 Deel I_C.indd 211 27-12-16 14:15 EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY/ MULTIGATED ACQUISITION 6.
    [Show full text]
  • A Common Occurrence After Coronary Bypass Surgery
    CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector lACC Vol. 15, No.6 1261 May 1990:1261-9 Acute Myocardial Dysfunction and Recovery: A Common Occurrence After Coronary Bypass Surgery WARREN M. BREISBLATT, MD, FACC, KEITH L. STEIN, MD, CYNTHIA J. WOLFE, RN, WILLIAM P. FOLLANSBEE, MD, FACC, JOHN CAPOZZI, CNMT, JOHN M. ARMITAGE, MD, ROBERT L. HARDESTY, MD, FACC Pittsburgh, Pennsylvania To evaluate whether acute myocardial dysfunction was min after coronary bypass and showed complete recovery common in the early postoperative period, serial hemody• within 48 h. Left ventricular end-systolic and end-diastolic namic measurements and radionuclide evaluation of ven• volume index increased significantly postoperatively, but tricular function were performed before and after opera• recovery in left ventricular ejection fraction was mostly due tion in 24 patients undergoing elective coronary bypass to decreases in end-systolic volume index (50 ± 22 ml at surgery. All patients had uncomplicated surgery, and no trough and 32 ± 16 ml at recovery). Depressed myocardial patient sustained an intraoperative infarction. In 96% of function was independent of bypass time, number of grafts patients, significant depression in right and left ventricular placed, preoperative medications or core temperatures ejection fraction was seen postoperatively, reaching a nadir postoperatively. Postoperative therapy with pressors or at 262 ± 116 min after coronary bypass. Left ventricular inotropic agents delayed but did
    [Show full text]
  • Evicore Ped Cardiac Imaging Guidelines V19.0
    CLINICAL GUIDELINES Pediatric Cardiac Imaging Policy Version 19.0 Effective May 22nd, 2017 eviCore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and symptom complexes. Imaging requests for individuals with atypical symptoms or clinical presentations that are not specifically addressed will require physician review. Consultation with the referring physician, specialist and/or individual’s Primary Care Physician (PCP) may provide additional insight. CPT® (Current Procedural Terminology) is a registered trademark of the American Medical Association (AMA). CPT® five digit codes, nomenclature and other data are copyright 2016 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in the CPT® book. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein. © 2017 eviCore healthcare. All rights reserved. PEDIATRIC CARDIAC IMAGING GUIDELINES PEDIATRIC CARDIAC IMAGING GUIDELINES PEDCD-1~GENERAL GUIDELINES 3 PEDCD-2~CONGENITAL HEART DISEASE 8 PEDCD-3~HEART MURMUR 10 PEDCD-4~CHEST PAIN 11 PEDCD-5~SYNCOPE 13 PEDCD-6~KAWASAKI DISEASE 15 PEDCD-7~PEDIATRIC PULMONARY HYPERTENSION 16 PEDCD-8~ECHOCARDIOGRAPHY—OTHER INDICATIONS 17 PEDCD-9~CARDIAC MRI—OTHER INDICATIONS 21 PEDCD-10~CT HEART AND CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CCTA)—OTHER INDICATIONS 24 V19.0- Pediatric Cardiac Imaging Page 2 of 26 PEDIATRIC CARDIAC
    [Show full text]
  • Arteriography After Carotid Endarterectomy
    325 Arteriography after Carotid Endarterectomy John Holder 1 Of 55 patients undergoing carotid endarterectomy, 16 had abnormal postoperative Eugene F. Binet2 angiograms by accepted literature criteria. Five of the 16 were symptomatic. The other Stevenson Flanigan3 11 were neurologically stable or improved from their preoperative condition. None of the 16 patients underwent reoperation. Of those 11 who had abnormal postoperative Ernest J. Ferris 1 angiograms but a good clinical result, four had a second postoperative angiogram some months later that demonstrated marked improvement in the appearance of the endarterectomy site. Patients undergoing carotid endarterectomy should not be sub­ jected to routine postoperative angiography without clinical indications nor should they undergo reoperation on the basis of angiographic findings alone without consideration of their clinical status. Cerebral angiography remains th e most precise method to evaluate the path­ ologic changes that occur in extracrani al cerebrovascular disease involving th e internal carotid artery in th e neck. Several authors have strongly endorsed its use in the immediate postoperative period to evalu ate the patency of th e end­ arterectomy site. In some institutions reoperation is performed if the angiographic findings appear unsatisfactory without consideration of the patient's neurologic status. This report will examine the preoperative and postoperative angiograms of patients who were not subjected to reoperation despite having abnormal appearing postoperative carotid angiograms. Materials and Methods Postoperative arteriography has been routinely perform ed on all pati ents subiected to carotid endarterectomy by the Neurosurgery Service at the Little Rock Veterans Adminis­ tration Medical Center. The angiographic studies of 55 such patients operated on during a Received August 28, 1980; accepted after re­ 6 year period were evaluated.
    [Show full text]
  • Mobile Multiwire Gamma Camera for First-Pass Radionuclide Angiography
    IMAGING Mobile Multiwire Gamma Camera for First-Pass Radionuclide Angiography Gerald W. Guidry, Jeffrey L. Lacy, Shigeyuki Nishimura, John J. Mahmarian, Terri M. Boyce, and Mario S. Verani Baylor College ofMedicine and The Methodist Hospital, Houston, Texas The purpose of this paper is to describe this new, portable In this paper, we describe a compact mobile multiwire gamma MWGC, the improved technique to acquire and process camera (MWGC) dedicated to first-pass radionuclide an­ FPRNA, and the new portable 178W j178Ta generator. The giography (FPRNA). Studies with this camera are performed portability of the system allows studies to be performed at the utilizing the short-lived (T•;, = 9.3 min) isotope tantalum-178 patient's bedside anywhere in the hospital. In this report, we 178 ( Ta), eluted (up to 100 mCi doses) at the patient's bedside illustrate the use of the system in the catheterization labora­ from a portable tungsten-tantalum generator. Processing is tory. completed on-site within -8 min, including calculation of right and left ventricular (LV) ejection fraction (EF), ejection rate, peak filling rate (PFR), and time to peak ejection and MATERIALS AND METHODS filling. Regional ventricular volume curves allow assessment of segmental ejection and filling indices. In a recent study, Multlwlre Gamma Camera high count-rate FPRNA was performed before and during The MWGC has a lightweight detector (23 kg), an onboard coronary angioplasty in the cardiac catheterization labora­ computer for imaging acquisition and processing, and a high tory. During coronary angioplasty, a significant transient resolution display for image processing and interpretation. depression in LV function was seen: the LV EF fell from 52% The basic design of the wire chamber detector has been ± 12% to 40% ± U% (p 0.0001) and the PFRfrom 2.4 ± = previously reported (1 ).
    [Show full text]
  • Carotid Endarterectomy Compared with Angioplasty and Stenting: the Status of the Debate
    Neurosurg Focus 5 (6):Article 2, 1998 Carotid endarterectomy compared with angioplasty and stenting: the status of the debate Felipe C. Albuquerque, M.D., George P. Teitelbaum, M.D., Donald W. Larsen, M.D., and Steven L. Giannotta, M.D. Department of Neurological Surgery, Los Angeles County and University of Southern California Medical Center, Los Angeles, California Endarterectomy is the treatment of choice for patients with symptomatic stenosis of the internal carotid artery. Recently, debate has arisen over the potential benefits of endovascular techniques. Although retrospective analyses of angioplasty and stenting procedures suggest comparable clinical efficacy to endarterectomy, prospective evaluation is pending. The authors review the status of the debate and discuss those issues on both sides that are particularly contentious and clinically relevant. Key Words * carotid endarterectomy * angioplasty * stenting Atherosclerotic disease of the common carotid artery bifurcation is associated with 20 to 30% of cerebrovascular accidents.[13,15,27] Stroke is the third leading cause of death in the United States and the most common and disabling neurological disorder among the elderly worldwide.[13,15,27] In light of these public health concerns, research in the last half of this century has been focused on the optimum treatment of carotid artery stenosis. Prospective analyses such as those performed by the North American Symptomatic Carotid Endarterectomy Trial (NASCET), the Asymptomatic Carotid Atherosclerosis Study (ACAS), and the European Carotid Surgery Trial have demonstrated superior reduction in stroke incidence among symptomatic and a select group of asymptomatic patients who undergo carotid endarterectomy (CEA).[17,18,36] In fact, these studies have established CEA as the "gold standard" for the treatment of carotid artery atherosclerosis.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • EANM Procedural Guidelines for Radionuclide Myocardial Perfusion Imaging with SPECT and SPECT/CT
    EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT Chair of writing committee (responsible for the coordination of the overall process): Hein J. Verberne and Birger Hesse Authors: Hein J. Verberne, Wanda Acampa, Constantinos Anagnostopoulos, Jim Ballinger, Frank Bengel, Pieter De Bondt, Ronny R. Buechel, Alberto Cuocolo, Berthe L.F. van Eck-Smit, Albert Flotats, Marcus Hacker, Cecilia Hindorf, Philip A. Kaufmann, Oliver Lindner, Michael Ljungberg, Markus Lonsdale, Alain Manrique, David Minarik, Arthur J.H.A. Scholte, Riemer H.J.A. Slart, Elin Trägårdh, Tim C. de Wit, Birger Hesse Correspondence to: H.J. Verberne, MD PhD Department of Nuclear Medicine, F2-238 Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam The Netherlands Tel: *31-20-5669111, pager 58 436 Fax: *31-20-5669092 E-mail: [email protected] 1 Author affiliations: H.J. Verberne Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Tel: +31 20 566 9111, pager 58 436 Fax: +31 20 566 9092 E-mail: [email protected] W. Acampa Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy Tel: +39 0812203409 Fax: +39 0815457081 E-mail: [email protected] C. Anagnostopoulos Center for Experimental surgery, Clinical and Translational Research, Biomedical research foundation, Academy of Athens, Greece Tel: +30 210 65 97 126 or +30 210 65 97 067 Fax: +30 210 65 97 502 E-mail: [email protected] J. Ballinger Department of Nuclear Medicine, Guy's Hospital - Guy's & St Thomas' Trust Foundation, London, United Kingdom Tel: +44 207 188 5521 Fax: +44 207 188 4094 E-mail: [email protected] F.
    [Show full text]
  • Carotid Endarterectomy— an Evidence-Based Review
    Special Article Carotid endarterectomy— CME An evidence-based review Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology S. Chaturvedi, MD; A. Bruno, MD; T. Feasby, MD; R. Holloway, MD, MPH; O. Benavente, MD; S.N. Cohen, MD; R. Cote, MD; D. Hess, MD; J. Saver, MD; J.D. Spence, MD; B. Stern, MD; and J. Wilterdink, MD Abstract—Objective: To assess the efficacy of carotid endarterectomy for stroke prevention in asymptomatic and symp- tomatic patients with internal carotid artery stenosis. Additional clinical scenarios, such as use of endarterectomy combined with cardiac surgery, are also reviewed. Methods: The authors selected nine important clinical questions. A systematic search was performed for articles from 1990 (the year of the last statement) until 2001. Additional articles from 2002 through 2004 were included using prespecified criteria. Two reviewers also screened for other relevant articles from 2002 to 2004. Case reports, review articles, technical studies, and single surgeon case series were excluded. Results: For several questions, high quality randomized clinical trials had been completed. Carotid endarterectomy reduces the stroke risk compared to medical therapy alone for patients with 70 to 99% symptomatic stenosis (16% absolute risk reduction at 5 years). There is a smaller benefit for patients with 50 to 69% symptomatic stenosis (absolute risk reduction 4.6% at 5 years). There is a small benefit for asymptomatic patients with 60 to 99% stenosis if the perioperative complication rate is low. Aspirin in a dose of 81 to 325 mg per day is preferred vs higher doses (650 to 1,300 mg per day) in patients undergoing endarterectomy.
    [Show full text]
  • Importance of Computed Tomography in Defining Segmental Disease in Chronic Thromboembolic Pulmonary Hypertension
    ORIGINAL ARTICLE PULMONARY VASCULAR DISEASE Importance of computed tomography in defining segmental disease in chronic thromboembolic pulmonary hypertension Micheal C. McInnis 1, David Wang1, Laura Donahoe2, John Granton3, John Thenganatt3, Kongteng Tan1, John Kavanagh1 and Marc de Perrot2 Affiliations: 1Dept of Medical Imaging, University of Toronto, Toronto, ON, Canada. 2Division of Thoracic Surgery, Dept of Surgery, University of Toronto, Toronto, ON, Canada. 3Division of Respirology, Dept of Medicine, University of Toronto, Toronto, ON, Canada. Correspondence: Micheal C. McInnis, Dept of Medical Imaging, Toronto General Hospital, 1 PMB-273, 585 University Avenue, Toronto, ON M5G 2N2, Canada. E-mail: [email protected] ABSTRACT Background: Radiological assessment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is critical to decide whether patients should be treated with pulmonary endarterectomy (PEA). Although computed tomography pulmonary angiography (CTPA) is increasingly used for decision making in CTEPH, the value of CTPA to predict surgical findings and outcome has never been explored. Methods: We retrospectively reviewed 100 consecutive patients with high-quality CTPA undergoing PEA for CTEPH between May 2015 and December 2017. The most proximal level of disease in the pulmonary artery on CTPA was classified by two blinded radiologists as level 1 (main pulmonary artery), 2a (lobar pulmonary artery), 2b (origin of basal segmental pulmonary artery), 3 (segmental pulmonary artery) or 4 (predominantly subsegmental pulmonary artery). Results: CTPA demonstrated level 1 in 20%, level 2a in 43%, level 2b in 11%, level 3 in 23% and level 4 in 3%. A majority of males presented with level 1 (55%) and level 2 (57%), and a majority of females (83%) with level 3 (p=0.01).
    [Show full text]