An optimized 1.5 Tesla MRI protocol of the brachial plexus.

PURPOSE: Creating an effective MRI protocol for examining the brachial plexus poses significant challenges, and despite the abundance of protocols in the literature, there is a lack of reference standards for basic sequences and essential parameters needed for replication. The aim of this study is to establish a reproducible 1.5 T brachial plexus imaging protocol, including patient positioning, coil selection, imaging planes, and essential sequence parameters. METHODS: We systematically investigated MRI sequences, testing each parameter through in vivo experiments, examining their effects on signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), visual quality scores, and acquisition time. Sequences were refined based on optimal quality and timing scores. The final protocol was tested on scanners from two other vendors for reliability. RESULTS: The final protocol included a combination of 2D turbo-spin-echo and 3D SPACE T1, SPACE STIR, and VIBE DIXON sequences. Recommendations for imaging planes, phase encoding, field of view, TR, TE, resolution, number of slices, slice thickness, fat and blood suppression, and acceleration strategies are provided. The protocol was successfully translated to other vendor's scanners with comparable quality. CONCLUSION: We present an optimized protocol detailing the essential parameters for reproducibility. Our comprehensive list of experiments describes the impact of each parameter on image quality and scan time, addressing common artifacts and potential solutions. This protocol can benefit both young radiologists new to the field and experienced professionals seeking to refine their existing protocols.

Anaesthetic management and complications of transvascular patent ductus arteriosus occlusion in dogs.

OBJECTIVE: To retrospectively analyse the anaesthetic management, complications and haemodynamic changes in a cohort of dogs undergoing transvascular patent ductus arteriosus (PDA) occlusion in a tertiary referral centre (from January 2017 to August 2018). STUDY DESIGN: Retrospective study. ANIMALS: A total of 49 client-owned dogs. METHODS: Anaesthetic records of dogs with PDA that underwent transvascular occlusion of the ductus were reviewed. Anaesthetic complications evaluated included tachycardia [heart rate (HR) > 160 beats minute-1], bradycardia (HR < 50 beats minute-1), hypertension [systolic arterial pressure (SAP) > 150 mmHg], hypotension [mean arterial pressure (MAP) < 60 mmHg], hypothermia (<37 °C) and the presence of arrhythmias. Cardiovascular variables [HR and invasive SAP, MAP and diastolic arterial pressure (DAP)] at the time of occlusion device deployment (time 0) were compared with variables at 5 and 10 minutes after deployment. Descriptive statistics, Shapiro-Wilk test and repeated measures analysis of variance followed by a Dunnett's post hoc test were used to analyse the data (p < 0.05). RESULTS: Crossbreed dogs were the most commonly represented followed by the Cavalier King Charles Spaniel. The median age was 8 (2-108) months, and female dogs were over-represented (65.3%). The most common American Society of Anesthesiologists score was III. Mean duration of anaesthesia was 96 ± 26 minutes and mean surgery time was 58 ± 21 minutes. Acepromazine with methadone was the most commonly used premedication combination (77.6%). Propofol was the most common induction agent (73.5%). General anaesthesia was maintained with isoflurane in oxygen in all dogs. Complications included hypotension (63%), hypothermia (34%), bradycardia (28%), arrhythmias (16%), hypertension (16%) and haemorrhage (2%). MAP and DAP increased significantly 10 minutes after device deployment compared with time 0. CONCLUSIONS: and clinical relevance: Hypotension was the most common complication reported in dogs undergoing transvascular PDA occlusion. No major adverse events were documented.

Digital subtraction angiography during transjugular intrahepatic portosystemic shunt creation or revision: data on radiation exposure and image quality obtained using a standard and a low-dose acquisition protocol in a flat-panel detector-based system.

PURPOSE: To determine whether the use of a low-dose acquisition protocol (LDP) in digital subtraction angiography during transjugular intrahepatic portosystemic shunt (TIPS) creation/revision results in significant reduction of patient radiation exposure and adequate image quality, as compared to a default reference standard-dose acquisition protocol (SDP). METHODS: Two angiographic runs were performed during TIPS creation/revision: the first following catheterization of the portal venous system and the second after stent deployment/angioplasty. Constant field of view, object to image-detector distance, and source to image-receptor distance were maintained in each patient during the two angiographic runs. 17 consecutive adult patients who underwent TIPS creation (n = 11) or TIPS revision (n = 6) from December 2013 to March 2014 were considered eligible for this single centre prospective study. In each patient, the LDP and the SDP were used in a random order for the two runs, with each patient serving as his/her own control. The dose-area product (DAP) was calculated for each image and compared. Image quality was graded by two interventional radiologists other than the operator. RESULTS: In all runs acquired with the LDP, image quality was considered adequate for a successful procedural outcome. The DAP per image of the LDP was numerically inferior as compared to the DAP per image of the SDP in all patients. The mean reduction in DAP per image was 75.24% ± 5.7% (p < 0. 001). CONCLUSION: Radiation exposure during TIPS creation/revision was significantly reduced by selecting a LDP in our flat-panel detector-based system, while maintaining adequate image quality.

Neglected primary omental pregnancy after laparoscopic and medical treatment: a difficult diagnosis?

The following case report describes a rare case of omental pregnancy in a fertile 34-year-old woman at 5 + 3 weeks of gestation who presented with abdominal pain. Clinical examination, vital signs, and laboratory values were within normal limits, so the woman was hospitalized and monitored. Laparoscopic exploration was performed according to the preoperative diagnosis of tubal pregnancy, but it showed normal pelvic organs. In view of the growth of the ß-HCG value, a medical approach was attempted, without success. Due to hemodynamic instability, an emergency laparotomy was performed, and it showed an omental pregnancy, confirmed at the pathological examination.