RESUMO
Bow Hunter's syndrome, also referred to as rotational occlusion of the vertebral artery, is caused by dynamic compression of a patient's dominant vertebral artery. We reported a case of successful clinical and imaging work up of Bow Hunter's Syndrome that occurred in a 79-year-old female patient. We discussed the clinical presentation, imaging findings, and subsequent management options of this rare syndrome. The gold standard for diagnosis is dynamic cerebral angiography, which allows the reproduction of symptoms with head turn greater than 30-45 degrees. Subsequent management is based on the underlying etiology causing rotational compression.
Assuntos
Exoftalmia , Metilprednisolona/administração & dosagem , Policondrite Recidivante/complicações , Tomografia Computadorizada por Raios X/métodos , Administração Intravenosa , Idoso , Exoftalmia/diagnóstico por imagem , Exoftalmia/tratamento farmacológico , Exoftalmia/etiologia , Humanos , Imunossupressores/administração & dosagem , Masculino , Policondrite Recidivante/terapia , Resultado do TratamentoRESUMO
OBJECTIVE: There are known interoperator, intraoperator, and intervendor software differences that can influence the reproducibility of quantitative CT perfusion values. The purpose of this study was to determine the relative impact of operator and software differences in CT perfusion variability. MATERIALS AND METHODS: CT perfusion imaging data were selected for 11 patients evaluated for suspected ischemic stroke. Three radiologists each independently postprocessed the source data twice, using four different vendor software applications. Results for cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) were recorded for the lentiform nuclei in both hemispheres. Repeated variables multivariate analysis of variance was used to assess differences in the means of CBV, CBF, and MTT. Bland-Altman analysis was used to assess agreement between pairs of vendors, readers, and read times. RESULTS: Choice of vendor software, but not interoperator or intraoperator disagreement, was associated with significant variability (p < 0.001) in CBV, CBF, and MTT. The mean difference in CT perfusion values was greater for pairs of vendors than for pairs of operators. CONCLUSION: Different vendor software applications do not generate quantitative perfusion results equivalently. Intervendor difference is, by far, the largest cause of variability in perfusion results relative to interoperator and intraoperator difference. Caution should be exercised when interpreting quantitative CT perfusion results because these values may vary considerably depending on the postprocessing software.
