Herramientas para el tamizaje de aneurisma de aorta abdominal / Tools for abdominal aortic aneurysm screening

Introducción. El aneurisma de la aorta abdominal (AAA) es la dilatación de la aorta abdominal mayor de 1,5 veces el diámetro esperado. Su prevalencia es variable, con tasas reportadas de hasta el 12,5 %. Se considera como causa de muerte de más de 10.000 personas al año en los Estados Unidos. El objetivo de esta revisión de la literatura fue describir los factores de riesgo y las herramientas de tamizaje de AAA. Métodos. Se realizó una búsqueda de la literatura utilizando dos ecuaciones en bases de datos electrónicas, empleando términos seleccionados de "Medical Subject Heading" (MeSH) y "Descriptores en Ciencias de la Salud" (DeCS). Se evaluó la calidad de los estudios con la herramienta STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Resultados. Se recolectaron 40 artículos y a partir de ellos se construyó el texto de revisión, identificando en estos, los factores de riesgo asociados al desarrollo de AAA, tales como sexo masculino, tabaquismo, hipertensión arterial, antecedente familiar y obesidad, entre otros. La diabetes mellitus parece actuar como factor protector. Dentro de los instrumentos de tamizaje, el ultrasonido abdominal es uno de los más usados. Conclusión. El AAA es una patología multifactorial. En la actualidad la ultrasonografía de aorta es el método de elección para el tamizaje, permitiendo la detección precoz. El tamizaje de AAA con métodos no invasivos, como el ultrasonido, es útil sobre todo en zonas con prevalencia alta de la patología y en pacientes con determinados factores de riesgo.

Introduction. Abdominal aortic aneurysm (AAA) is a dilation of the abdominal aorta greater than 1.5 times the expected diameter. Its prevalence is variable, with reported rates of up to 12.5%. It is considered the cause of death of more than 10,000 people a year in the United States. The objective of this literature review was to describe risk factors and screening tools for AAA. Methods. A literature search was conducted using two equations in electronic databases, using terms selected from "Medical Subject Heading" (MeSH) and "Descriptors in Health Sciences" (DeCS). The quality of the studies was evaluated with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) tool. Results. Forty articles were collected and from them the review text was constructed, identifying the risk factors associated with the development of AAA, such as male sex, smoking, high blood pressure, family history and obesity, among others. Diabetes mellitus seems to act as a protective factor. Among the screening instruments, abdominal ultrasound is one of the most used. Conclusion. AAA is a multifactorial pathology. Currently, aortic ultrasonography is the method of choice for screening, allowing early detection. Screening for AAA with non-invasive methods, such as ultrasound, is useful especially in areas with a high prevalence of this pathology and in patients with certain risk factors.

Clinical application of perforator vessel location guide plate for fibular musculocutaneous flaps / 口腔疾病防治

Objective@#Based on 3D printing technology, explore the precision of a perforator vessel location guide plate for fibular musculocutaneous flaps before the transplantation of fibular osteocutaneous flaps and evaluate its application effects.@*Methods@#This study was reviewed and approved by the ethics committee, and informed consent was obtained from the patients. From May 2019 to October 2022, 14 patients with jaw defects who needed to undergo fibular perforator flap transplantation at the First Affiliated Hospital of Xinjiang Medical University were selected. For the seven patients in the guide plate group, CTA was combined with Mimics software to reconstruct both lower limbs, and the perforator vessel positioning guide for locating perforator vessels was designed; the two ends of the guide plate were designed as fixed ends, with the upper end fixed to the knee joint and the lower end fixed to the ankle joint, and the guide plate was fabricated by a 3D printer. For the seven patients in the control group, a conventional handheld Doppler probe was used for perforator vessel location. The average operation time, bleeding volume, recovery time, deviation of perforator vessel location, postoperative flap-related complications, postoperative donor site shape satisfaction, and lower extremity functional scale (LEFS) score were recorded. SPSS 25.0 software was used for statistical analysis.@*Results@#The average operation time, bleeding volume, recovery time, deviation of perforator vessel location and postoperative donor site shape satisfaction were significantly better in the guide plate group than in the control group (P<0.05); moreover, the differences in postoperative flap-related complications and LEFS scores were not statistically significant (P>0.05).@*Conclusion@#Based on 3D printing technology, fibular musculocutaneous flap perforator vessels can be more accurately located using a guide plate and the knee and ankle as fixed points, and this method can effectively stabilize the guide position, prevent soft tissue offset, and improve positioning accuracy and thus deserves to be generalized.

Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome / Avaliação da relação entre escores colaterais da angiotomografia computadorizada e evolução clínica

Abstract Background The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies. Objective In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used. Methods Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated. Results Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS ≤ 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis. Conclusion mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.

Resumo Antecedentes A relação entre circulação colateral e prognóstico após tratamento endovascular em acidentes vasculares cerebrais de circulação anterior tem sido relatada em muitos estudos. Objetivo Neste estudo, nosso objetivo foi comparar o poder preditivo do desfecho clínico comparando cinco escores colaterais diferentes que são frequentemente utilizados. Métodos Entre os pacientes submetidos a tratamento endovascular em nossa clínica entre novembro de 2019 e dezembro de 2021, foram incluídos no estudo pacientes com mRS pré-mórbido < 3, oclusão intracraniana de ICA e/ou MCA M1 e exame de CTA multifásico pré-procedimento. Foram registradas informações demográficas, técnicas e de duração sobre o procedimento, eventos importantes após o procedimento e resultados clínicos em três meses. Foram avaliados os escores colaterais mCTA, Tan, Maas, Miteff e rLMC dos pacientes. Resultados Os resultados clínicos aos três meses foram bons em 37 dos 68 pacientes incluídos no estudo (mRS ≤ 2). Apenas os escores colaterais mCTA e rLMC foram estatisticamente significativamente maiores naqueles com boa evolução clínica. Correlação significativa com mRS de três meses foi detectada apenas nos escores mCTA e rLMC. Embora os escores colaterais de rLMC e mCTA tenham mostrado uma associação estatisticamente significativa com o prognóstico, eles não foram suficientes para serem um preditor independente de prognóstico. Conclusão Verificou-se que mCTA e rLMC têm o maior poder preditivo do resultado clínico e a maior correlação com o resultado clínico de três meses. Nosso estudo sugere que seria benéfico desenvolver um novo sistema de pontuação em vez de CTA multifásico, que combinasse avaliação regional e temporal, que são os pontos fortes de ambas as pontuações colaterais.

Evaluation of the mesenteric arterial vasculature by computed tomography angiography and its implications for colorectal cancer surgery / Avaliação da vasculatura arterial mesentérica pela angiotomografia computadorizada e suas implicações na cirurgia do câncer colorretal

Abstract Objective: To determine the branching patterns of the inferior mesenteric artery (IMA) and to describe the clinical applicability of computed tomography (CT) angiography in the evaluation of these vessels to facilitate the planning of colorectal cancer surgery. Materials and Methods: We included 100 patients who underwent CT angiography of the abdomen and pelvis. The branching patterns of the IMA were examined and classified as type 1 (bifurcated), including 1A (sigmoid and left colic arteries arising from a common trunk), 1B (sigmoid and superior rectal arteries arising from a common trunk) and 1C (sigmoid arteries arising from both trunks); type 2 (trifurcated); and type 3 (no left colic branch). Results: Among the 100 patients evaluated, we found the variant to be type 1A in 9%, type 1B in 47%, type 1C in 24%, type 2 in 16%, and type 3 in 4%. Conclusion: Preoperative CT angiography for evaluating the IMA branching pattern could inform decisions regarding the surgical approach to colorectal cancer.

Resumo Objetivo: Determinar os padrões de ramificação da artéria mesentérica inferior (AMI) e descrever a aplicabilidade clínica da angiografia por tomografia computadorizada na avaliação desses vasos na elaboração das estratégias pré-operatórias de cirurgia de câncer colorretal. Materiais e Métodos: Foram incluídos 100 pacientes submetidos a angiografia por tomografia computadorizada abdominal e pélvica. Os padrões de ramificação da AMI foram examinados e classificados como tipo 1 (bifurcado), incluindo 1A (artérias sigmoide e cólica esquerda originando-se de um tronco comum), 1B (artérias sigmoide e retal superior originando-se de um tronco comum) e 1C (artérias sigmoide originando-se de ambos os troncos); tipo 2 (trifurcado); e tipo 3 (sem ramo cólico esquerdo). Resultados: Do total de participantes incluídos no estudo, a variante do tipo 1A foi observada em 9%, a do tipo 1B em 47%, e a do tipo 1C em 24%. Com relação à variante tipo 2, esta foi observada em 16% dos pacientes, e a do tipo 3, em 4% dos casos. Conclusão O uso da angiografia por tomografia computadorizada pré-operatória para avaliar o padrão de ramificação da AMI pode ajudar a escolher a abordagem cirúrgica no câncer colorretal.

Accuracy of duplex ultrasonography versus angiotomography for the diagnosis of extracranial internal carotid stenosis / Acurácia da ultrassonografia duplex comparada à angiotomografia para o diagnóstico de estenose de carótida interna extracraniana

ABSTRACT Introduction: Internal carotid artery (ICA) stenosis causes about 15% of ischemic strokes. Duplex ultrasonography (DUS) is the first line of investigation of ICA stenosis, but its accuracy varies in the literature and it is usual to complement the study with another more accurate exam when faced with significant stenosis. There is a lack of studies that compare DUS with angiotomography (CTA) in the present literature. Methods: we performed an accuracy study, which compared DUS to CTA of patients in a tertiary hospital with a maximum interval of three months between tests. Patients were selected retrospectively, and two independent and certified vascular surgeons evaluated each image in a masked manner. When there was discordance, a third evaluator was summoned. We evaluated the diagnostic accuracy of ICA stenosis of 50-94% and 70-94%. Results: we included 45 patients and 84 arteries after inclusion and exclusion criteria applied. For the 50-94% stenosis range, DUS accuracy was 69%, sensitivity 89%, and specificity 63%. For the 70-94% stenosis range, DUS accuracy was 84%, sensitivity 61%, and specificity 93%. There was discordance between CTA evaluators with a change from clinical to surgical management in at least 37.5% of the conflicting reports. Conclusion: DUS had an accuracy of 69% for stenoses of 50-94% and 84% for stenoses of 70-94% of the ICA. The CTA analysis depended directly on the evaluator with a change in clinical conduct in more than 37% of cases.

RESUMO Introdução: a estenose da artéria carótida interna (ACI) causa cerca de 15% dos acidentes vasculares cerebrais isquêmicos. A ultrassonografia duplex (USD) é a primeira linha de investigação da estenose de ACI, mas sua acurácia varia na literatura e é comum complementar o estudo com outro exame de maior acurácia diante de estenose significativa. Há uma escassez de estudos que comparem a USD com a angiotomografia computadorizada (ATC) na literatura atual. Métodos: realizamos um estudo de acurácia, que comparou a USD à ATC de pacientes de um hospital terciário com um intervalo máximo de três meses entre os exames. Os pacientes foram selecionados retrospectivamente e dois cirurgiões vasculares independentes e certificados avaliaram cada imagem de maneira mascarada. Quando houve discordância, um terceiro avaliador foi convocado. Avaliou-se a precisão diagnóstica da estenose da ACI de 50-94% e 70-94%. Resultados: foram incluídos 45 pacientes e 84 artérias após a aplicação dos critérios de inclusão e exclusão. Para a faixa de estenose de 50-94%, a acurácia da USD foi 69%, sensibilidade 89% e especificidade 63%. Para a faixa de estenose de 70-94%, a acurácia da USD foi 84%, sensibilidade 61% e especificidade 93%. Ocorreu discordância entre avaliadores da ATC com mudança de conduta clínica para cirúrgica em pelo menos 37,5% dos laudos conflitantes. Conclusão: a USD teve uma acurácia de 69% para estenoses de 50-94% e de 84% para estenoses de 70-94% da ACI. A análise das ATC dependeu diretamente do avaliador com mudança de conduta clínica em mais de 37% dos casos.

Quadricuspid Aortic Valve with Ruptured Sinus of Valsalva Aneurysm: a Case Report

Abstract Quadricuspid aortic valve (QAV) and sinus of Valsalva aneurysm (SVA) are rare congenital anomalies. We report an elderly patient with QAV associated with a ruptured SVA to the right atrium. Transthoracic echocardiographic and computed tomographic images are presented. We emphasize the important role of computed tomography angiography in establishing and confirming the diagnosis and facilitating treatment planning. The patient was successfully operated by a minimally invasive approach.

Preoperative vascular evaluation of perforator flap of peroneal artery: A comparative study between CT angiography and colour Doppler ultrasound / 中华显微外科杂志

Objective:To compare the clinical value of CTA and CDU in perforator flap of peroneal artery.Methods:From February 2013 to October 2016, 47 patients who suffered with soft tissue defects and were hospitalised in the Department of Orthopaedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA were retrospectively reviewed and evaluated. All the defects were reconstructed by the perforator flap of peroneal artery. All patients received preoperative CTA and CDU scans before surgery. Appropriate perforator vessels were selected and the locating points in body surface and external diameters of the perforator vessels were recorded and compared with intraoperative findings. SPSS 22.0 statistical software was used for data analysis. P<0.05 was considered statistically significant. Results:The intraoperative coincidence rate of the proposed perforator vessels was 97.87% for CDU and 95.74% for CTA, with no significant difference between the 2 groups( P>0.05). It was found that the preoperative CTA and CDU measurements were consistent with the actual intraoperative measurements, and there was no significant difference between the 2 groups( P>0.05). For CTA combined with CDU, an intraoperative coincidence rate was 100% in the location of peroneal perforating vessels. All flaps were followed-up for 1 to 18(mean 13.5) months. All the flaps survived well with good texture and appearance without complication. Conclusion:CDU and CTA are reliable and useful in preoperative vascular evaluation of peroneal perforator flap, and both can be used in a complementary or combined manner.

Impact of Coronary Plaque on the Precision of Computational Fractional Flow Reserve Derived from CTA / 中山大学学报(医学科学版)

ObjectiveThe fractional flow reserve （FFR） computed from coronary computed tomographic （CT） angiograms makes it possible to noninvasively assess coronary artery disease， but the impact of plaque on FFR derived from computed tomography angiography （CTA） is still unknown. The study used invasive FFR as the reference standard to analyze the impact of plaque on coronary computed tomography angiography （CCTA）-based quantitative flow ratio （CT-QFR）. MethodsThe retrospective study included 108 patients with suspected coronary heart disease （CHD） who underwent both CCTA and FFR within 60 days. CCTA images were analyzed by the software. We obtained the CT-QFR of target vessels， perfomed the quantitative and qualitative analyses on target vascular plaques， including total plaque volume （TPV）， plaque burden， calcified plaque volume （CPV）， fibrous plaque volume （FPV）， lipid plaque volume （LPV）， and the presence or absence of high-risk plaque. ResultsAccording to the difference between CT-QFR and FFR at blood vessel level， 137 target vessels of 108 patients were divided into the overestimated group （difference＞0.03， n＝29）， reference group （-0.03≤difference≤0.03， n＝88） and underestimated group （difference＜-0.03， n＝20）. The underestimated group （14.81mm3） presented higher LPV than overestimated group （1.97mm3， P < 0.05）. There was a negative correlation between LPV and the difference （P＜0.05）. ConclusionsWhen CT-QFR is used to estimate hemodynamics of coronary artery stenosis， the presence of lipid plaque may underestimate the virtual FFR.

Application of Targeted Coronary Angiography in the Diagnosis of Sudden Cardiac Death / 法医学杂志

OBJECTIVES@#To diagnose coronary artery stenosis by using the postmortem computed tomography angiography (PMCTA), and to explore the diagnostic value of PMCTA in sudden cardiac death.@*METHODS@#Six death cases were selected, and the contrast medium iohexol was injected under high pressure through femoral artery approach with 5F pigtail catheter to obtain coronary image data and then the data was analyzed. The results of targeted coronary imaging and coronary artery calcium score (CaS) were compared with the results of conventional autopsy and histopathological examination.@*RESULTS@#The autopsy and histopathological examination of cases with coronary artery stenosis obtained similar results in targeted coronary angiography, with a diagnostic concordance rate of 83.3%. Targeted coronary angiography could effectively show coronary artery diseases, and the CaS was consistent with the results of conventional autopsy and histopathological examination.@*CONCLUSIONS@#Targeted coronary angiography can be used as an effective auxiliary method for conventional autopsy in cases of sudden cardiac death.

Current status and prospect of preoperative assessment of heart disease risk in liver transplant recipients / 器官移植

With the changes of the disease spectrum of liver transplantation and organ allocation system, more and more patients complicated with cardiovascular complications have entered the waiting list for liver transplantation. However, surgical stress, severe infection and adverse reactions of immunosuppressive drugs will significantly increase the risk of postoperative cardiac complications and affect the short-and long-term survival of the recipients. Therefore, comprehensive evaluation of cardiac structure and function of the recipients before liver transplantation is of significance for improving clinical prognosis of the recipients. In this article, the main causes for the increased risk of heart disease during the perioperative period of liver transplantation, the time and methods of heart disease risk assessment for liver transplant recipients were reviewed, and existing assessment approaches for common heart diseases before liver transplantation were illustrated, aiming to provide reference for further reducing the incidence of heart complications after liver transplantation, improving the survival rates of grafts and recipients and enhancing clinical prognosis.

Takayasu Arteritis as a Secondary Cause of Arterial Hypertension

Abstract Takayasu arteritis (TA) is a rare type of vasculitis that affects mainly the aorta and its major branches. It is highly similar to giant cell arteritis (GCA), and differentiation between them may not be achieved even by histological examination. Arterial hypertension is typical of TA and is caused by stenosis of the renal arteries. Here we report the case of a 59-year-old woman, with a history of dyslipidemia and anemia, seen in the Internal Medicine department for resistant hypertension. Evaluation of secondary causes led to stenosis of the renal arteries. Assessment of target organ involvement was performed by computed tomography angiograph which revealed ectasia of the aortic arch and ascending aorta, tortuous course of the brachiocephalic trunk and the proximal portion of the right common carotid artery; positron-emission tomography which showed diffuse increased uptake in the ascending aorta, compatible with large vessels vasculitis. The patient was submitted to aortic valve replacement with a biological prosthesis combined with myocardial revascularization (Bentall-De Bono procedure). Aortic biopsy specimens showed anatomical and pathological features of GCA and TA. Due to persistently uncontrolled hypertension, prednisone 60 mg was initiated,with significant improvement in patient's condition.

Doença coronariana em jovens: novas formas de detecção, prevenção e tratamento / Coronary heart disease in young individuals: novel ways to detect, prevent and treat

Apesar dos grandes avanços nas estratégias de manejo e prevenção da aterosclerose, a prevalência da doença arterial coronariana aumenta em todo o mundo, tendo início em idade precoce. As doenças cardiovasculares em adultos jovens caracterizam-se como um grupo heterogêneo de doenças que ocorrem por causas congênitas ou adquiridas. Múltiplos fatores de risco, como dislipidemia, doença coronária prematura, diabetes melito e tabagismo, potencializam o risco do paciente para a coronariopatia precoce. A avaliação precoce de pacientes com doença arterial coronariana pode ser feita por meio de vários métodos de imagem não invasivos, que facilitam a seleção precoce de condutas preventivas e terapêuticas efetivas para manejo da doença arterial coronariana; no entanto, ela está associada a várias dificuldades, devido às limitações dos escores de risco e à sensibilidade limitada de vários métodos de rastreamento. Neste manuscrito, discutimos sobre fisiopatologia, fatores de risco, métodos de imagem invasivos e não invasivos e várias estratégias de manejo na prevenção precoce da doença coronariana em adultos jovens e, mais importante, os rumos futuros e a prevenção de doenças e da morte súbita cardíaca.

In spite of major advancements in the management and prevention strategies of atherosclerosis, the prevalence of coronary artery disease has risen worldwide, and might start at an early age. Cardiovascular diseases among young adults are characterized as a heterogeneous group of disorders due to congenital or acquired causes. Multiple risk factors, such as dyslipidemia, premature coronary heart disease, diabetes mellitus and cigarette smoking potentiate the patient's risk for early coronary heart disease. Early assessment of patients with coronary artery disease can be performed using various non-invasive imaging methods, which facilitate early selection of effective and preventative therapies for coronary artery disease management; however, it is associated with several challenges due to limitations in risk calculators, and limited sensitivity of various screening methods. In this manuscript, we will discuss about pathophysiology, risk factors, invasive and non- invasive imaging methods, and various management strategies for the early prevention of coronary heart disease in young adults and, importantly, the future directions and preventing disease and sudden cardiac death.

Abernethy Malformation: Possible Diagnosis for Patients with Congenital Heart Disease and Persistent Cyanosis

ABSTRACT Clinical data: Infant, nine months of age, female, diagnosed with congenital heart disease, with signs of heart failure associated with cyanosis and difficulty in gaining weight. Chest radiography: Cardiomegaly with prevalence of pulmonary vascular network. Electrocardiogram: Ectopic atrial rhythm with right ventricular overload and left anterosuperior divisional block. Echocardiogram: Single atrium with absent interatrial septum, atrioventricular connection with a single valve and two orifices, with increased pulmonary pressure and high Qp/Qs. Computed tomography: Absence of portal vein and intrahepatic segment of the inferior vena cava. Infrahepatic portion continuing with the azygos system at the level of the thoracic cavity, presence of mesenteric-caval communication associated with signs suggestive of hepatic peribiliary fibrosis. Diagnosis: Abernethy malformation is a rare condition and represents an extrahepatic portosystemic shunt that develops between the mesenteric-portal vasculature and the systemic veins. It may be associated with cardiac malformations and advance with pulmonary hypertension and even the need for liver transplantation. Persistent cyanosis after corrective surgery led to a deeper investigation and correct diagnosis of this malformation. Operation: Sternotomy with 68 minutes of cardiopulmonary bypass and nine minutes of total circulatory arrest. In the postoperative period, persistence of cyanosis was evident, even though there were no immediate complications. Patient was discharged on the 10th postoperative day. An abdominal computed tomography angiography confirmed the diagnosis of Abernethy type I malformation, and the patient was transferred for liver transplantation after congenital heart disease treatment.

Abnormal Origin of the Pulmonary Artery from the Ascending Aorta in the Neonate

ABSTRACT The anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital heart disease, generally diagnosed based on the clinical information and on echocardiographic and computed tomography angiography findings. Here we report two neonates successfully treated with surgery early in life.

The role of neuroimaging in the determination of brain death / O papel da neuroimagem na determinação da morte encefálica

Abstract Brain death is the irreversible cessation of all brain function. Although protocols for its determination vary among countries, the concept of brain death is widely accepted, despite ethical and religious issues. The pathophysiology of brain death is related to hypoxia and ischemia in the setting of extensive brain injury. It is also related to the effects of brain edema, which increases intracranial pressure, leading to cerebral circulatory arrest. Although the diagnosis of brain death is based on clinical parameters, the use of neuroimaging to demonstrate diffuse brain injury as the cause of coma prior to definitive clinical examination is a prerequisite. Brain computed tomography (CT) and magnetic resonance imaging (MRI) demonstrate diffuse edema, as well as ventricular and sulcal effacement, together with brain herniation. Angiography (by CT or MRI) demonstrates the absence of intracranial arterial and venous flow. In some countries, electroencephalography, cerebral digital subtraction angiography, transcranial Doppler ultrasound, or scintigraphy/single-photon emission CT are currently used for the definitive diagnosis of brain death. Although the definition of brain death relies on clinical features, radiologists could play an important role in the early recognition of global hypoxic-ischemic injury and the absence of cerebral vascular perfusion.

Resumo A morte encefálica é a cessação irreversível de todas as funções cerebrais. Embora os protocolos para sua determinação variem entre os países, o conceito de morte encefálica é amplamente aceito, apesar de questões éticas e religiosas. A fisiopatologia da morte encefálica está relacionada a hipóxia e isquemia no cenário de uma lesão cerebral difusa. Também está relacionada aos efeitos do edema cerebral, que aumenta a pressão intracraniana, levando à parada da circulação cerebral. Embora o diagnóstico de morte encefálica seja baseado em parâmetros clínicos, o uso de neuroimagem para demonstrar lesão cerebral difusa como causa do coma antes do exame clínico definitivo é um pré-requisito. A tomografia computadorizada (TC) e a ressonância magnética (RM) de crânio demonstram edema difuso e apagamento de ventrículos e sulcos, associados a herniações transcompartimentais. A angio-TC e a angio-RM demonstram a ausência de fluxo arterial e venoso intracraniano. Em alguns países, a eletroencefalografia, a angiografia por subtração digital cerebral, a ultrassonografia transcraniana com Doppler ou a cintilografia/TC por emissão de fóton único são atualmente usadas para o diagnóstico definitivo de morte encefálica. Embora a definição de morte encefálica dependa de características clínicas, os radiologistas podem desempenhar papel importante no reconhecimento precoce da lesão hipóxico-isquêmica global e da ausência de perfusão vascular cerebral.

Computed tomography angiography in the planning of transcatheter aortic valve replacement: a step-by-step approach / Angiotomografia computadorizada no planejamento de substituição transcateter da válvula aórtica: uma abordagem passo a passo

Abstract Aortic valve stenosis is the most common acquired valvular heart disease. Transcatheter aortic valve implantation, also known as transcatheter aortic valve replacement (TAVR), is an important treatment option for symptomatic aortic stenosis in patients at any level of surgical risk. The role of computed tomography angiography (CTA) has expanded considerably in recent years, and it has now become the imaging method of choice for the planning of TAVR. Therefore, radiologists should understand the main aspects of this imaging modality, including the appropriate technique and protocol to acquire reliable CTA images and to create a useful radiology report. The aim of this study was to review the most important aspects of CTA for TAVR planning.

Resumo A estenose da válvula aórtica é a doença cardíaca valvar adquirida mais comum. A substituição transcateter da válvula aórtica (TAVR), ou implante transcateter da válvula aórtica, é uma importante opção no tratamento da estenose aórtica sintomática, independente do risco cirúrgico do paciente. O papel da angiotomografia computadorizada cresceu consideravelmente nos últimos anos e tornou-se o método de escolha no planejamento de TAVR. Assim, o radiologista deve compreender os principais aspectos dessa modalidade, incluindo técnica e protocolo, a fim de adquirir imagens confiáveis e compor um relatório para a realização do procedimento. O objetivo deste ensaio é revisar os pontos mais importantes que precisam ser avaliados na angiotomografia no planejamento de TAVR.

Cefalea mortal: aneurisma en espejo a propósito de un caso

Introducción: Los aneurismas intracerebrales son hallazgos incidentales en estudios de imágenes realizado por otros diagnósticos. Reporte de Caso: Paciente femenino de 35 años, que presentó sincope después de cefalea de gran intensidad sin ceder a tratamiento convencional de AINES; con antecedente de cefalea de larga data y tratamiento esporádico. Al examen: neurológico: despierta, asimetría facial, disartria, fuerza muscular disminuida en ambos miembros inferiores, no signos meníngeos; el informe tomográfico cerebral sin contraste indicó: lesiones cerebrales expansivas de etiología a determinar a nivel de ambos lados de diencéfalo: descartar glioma vs aneurismas; Angiotac cerebral con contraste, refleja aneurismas de carótida interna intracraneal bilateral y cerebral media (en espejo). Posteriormente la paciente fue evaluada por neurocirujano de turno, quien indica referir a centro de mayor complejidad, por no contar con instrumental necesario para intervención quirúrgica; paciente fallece camino a centro de referencia. Conclusiones: Al ser una patología poco frecuente, no es considerada como una primera opción de sospecha diagnostica tras un evento de cefalea.

Background: Intracerebral aneurysms are incidental findings in imaging studies performed for other diagnoses. Case Report: 35- year-old female patient, who presented syncope after severe headache without yielding to conventional treatment with NSAIDs; with a history of long-standing headache and sporadic treatment. On examination: neurological: awake, facial asymmetry, dysarthria, decreased muscle strength in both lower limbs, no meningeal signs; the brain tomographic report without contrast indicated: expansive brain lesions of etiology to be determined at both sides of the diencephalon: rule out glioma vs aneurysms; cerebral Angiotac with contrast, reflects bilateral intracranial internal carotid and middle cerebral (mirror) aneurysms. Subsequently the patient was evaluated by the neurosurgeon on duty, who indicated to refer to a center of higher complexity, for not having the necessary instruments for surgery; patient died on the way to the referral center. Conclusions: Being a rare pathology, it is not considered as a first option for diagnostic suspicion after a headache event.

Dual left anterior descending artery: Case series based on novel classification and its therapeutic implications

Angiographically, a “dual LAD” is described as two distinct arteries supplying the vascular territory of the LAD in parts, identified as the short LAD/LAD1 and the long LAD/LAD2. Using an easy-to-understand three-step approach, Jariwala et al unveiled a novel classification strategy for dual LAD systems in an attempt to decrease ambiguity in diagnosis and management of the anomaly. As part of our research, we looked at a wide range of published cases and case series in the literature, and also those reported from our hospital. In our novel classification system, we divide dual LADs into three main groups based on their origin and vascular territory, each of which is further divided into subgroups based on the course of LAD1/LAD2 and the variable feature that is a distinguishing attribute of the type of anomaly to be specified. A review of 144 publications in the world literature revealed 340 patients eligible for the study. The median age was 58.8 years (SD - 11.42; range - 29e89) with male predominance (3.3:1). Cases in Group I comprised 60.6% of the total cases, followed by Group II (36.2%), and Group III (3.2%). Subgroup I-A was the most common in terms of dual LAD, followed by subgroup II-A. Acute coronary syndrome (45.5%) and chronic coronary syndrome (55.8%) were the most common clinical presentations in patients with significant coronary artery disease (30.8%).

Hallazgos posoperatorios esperables en cirugías de aorta torácica ascendente con angiotomografía computada multicorte: todo lo que un médico radiólogo debe conocer / Expected postoperative findings in ascending thoracic aortic surgeries with multislice angiotomography: Everything a radiologist should know

Resumen Para la reconstrucción y el tratamiento de anomalías que comprometen la aorta torácica pueden emplearse diversas técnicas quirúrgicas abiertas, las cuales estarán determinadas por la patología que presente el paciente. La angiotomografía computada multicorte (ATCMC) es el método de elección para su control y seguimiento. El médico radiólogo debe estar familiarizado con las técnicas quirúrgicas empleadas (Wheat, Bentall de Bono, Cabrol, entre otras), con las reparaciones estructurales que se realizan y con los materiales protésicos utilizados con el fin de evitar una interpretación errónea de las imágenes. El fieltro espontáneamente hiperdenso, los conductos protésicos y sus anastomosis, tanto con la aorta como con los grandes vasos, puede generar errores en el informe final y en el diagnóstico.

Abstract Multiple surgical techniques can be used for the reconstruction and treatment of abnormalities that compromise the thoracic aorta, which will be determined by the patient’s pathology. Multislice computed tomography angiography is the method of choice for their control and monitoring. The radiologist should be familiar with the surgical techniques used (Wheat, Bentall de Bono, and Cabrol, among others), as well as with the structural repairs that are performed and the prosthetic materials used in order to avoid an erroneous interpretation of the images. Spontaneously hyperdense felt, the prosthetic ducts and their anastomosis, both with the aorta and the large vessels, can generate pitfalls in the final report and error in the diagnosis.