High-Resolution Magnetic Resonance Vessel Wall Imaging for the Evaluation of Intracranial Vascular Pathology.

Intracranial vessel wall imaging (IVWI) is an advanced MR imaging technique that allows for direct visualization of the walls of intracranial blood vessels and detection of subtle pathologic vessel wall changes before they become apparent on conventional luminal imaging. When performed correctly, IVWI can increase diagnostic confidence, aid in the differentiation of intracranial vasculopathies, and assist in patient risk stratification and prognostication. This review covers the essential technical underpinnings of IVWI and presents emerging clinical research highlighting its utility for the evaluation of multiple intracranial vascular pathologies.

Metastatic Breast Carcinoma to the Coronaries: A Rare Cause of Acute Myocardial Infarction.

A 63-year-old female with a history of invasive ductal breast carcinoma presented to the emergency department with symptoms characteristic of myocardial infarction. Electrocardiography showed sinus tachycardia and ST elevations in leads II, III, and aVF, consistent with inferior wall myocardial infarction. A computed tomography (CT) scan of the chest, abdomen, and pelvis with intravenous contrast demonstrated widespread intrathoracic metastatic disease. Cardiac magnetic resonance imaging (MRI) with contrast revealed obstruction of the left ventricular (LV) outflow tract by an LV mass. Cardiac MRI enabled detection of a rare case of myocardial infarction secondary to tumor emboli and intracavitary LV metastasis. This case report emphasizes the role of cross-sectional imaging including CT and cardiac MRI for unusual causes of myocardial infarction, particularly when associated with neoplastic processes.

Incidence of hypercoagulable events after image-guided percutaneous cryoablation of renal tumors: a single-center experience.

PURPOSE: To identify retrospectively hypercoagulable events that occurred over time in patients who underwent image-guided percutaneous renal cryoablation and compare the incidence with a cohort of patients who underwent surgical partial nephrectomy (PN) during the same time period. MATERIALS AND METHODS: An electronic medical record database was queried for patients who underwent percutaneous image-guided renal mass cryoablation or PN between September 2006 and June 2012. Records were examined for thrombotic events during the year following the procedure in each group. Incidence rates, Kaplan-Meier estimates, and patient demographic variables were compared using the stratified log-rank test and t test for independent samples. RESULTS: The study comprised 114 cryoablation cases. The cumulative incidence of thrombotic events after 1 year was 4.39%. The incidence per 100 person-years was 4.84. There were 105 PN cases. The cumulative incidence of thrombotic events after 1 year was 1.0%. The incidence per 100 person-years was 1.14. The person-time incidence rate difference for these two groups did not reach statistical significance (P = .0894). CONCLUSIONS: The incidence of thrombotic events in patients who underwent percutaneous renal cryoablation in this study was not significantly different than a comparable cohort who underwent surgical PN during the same time period.

Unusual cause of intraoperative hemoptysis.

We present a rare complication of sternotomy wire removal in a patient with history of coronary artery bypass graft four years prior now undergoing redo sternotomy for aortic valve replacement. Upon removal of the third sternotomy wire the patient experienced hemoptysis from intrapulmonary hemorrhage, requiring that the procedure be aborted; careful review of preoperative computed tomography (CT) demonstrated this sternotomy wire to be traversing through lung parenchyma.