We studied the diagnostic value of computed tomographic angiography (CTA) in the posterior circulation as a noninvasive substitute for intra-arterial digital subtraction angiography (DSA). We prospectively investigated 103 patients with acute stroke in the posterior circulation. All patients underwent CTA and Doppler ultrasound, and DSA was performed in 22 patients. Vascular findings were classified in categories according to the type of lesion and the location in the vertebral, basilar, or posterior cerebral artery. In the first part of the analysis we examined the correlation between CTA and intra-arterial DSA (n=22), and in the second part that between CTA and Doppler ultrasound (n=103). Intra-arterial DSA identified 11 stenoses, 13 occlusions, and 3 hypoplasias. The correlation between DSA and CTA was best for the basilar artery (all lesions were identified with CTA). Of the 14 lesions detected in the vertebral artery by DSA 13 were also detected by CTA, but the specific type of lesion was identified in only 7 cases. The correlation between CTA and Doppler ultrasound was lower. In conclusion, CTA is thus a reliable method for detecting lesions in the posterior circulation and may replace DSA in many cases. However, particularly in the vertebral artery DSA remains the superior technique.
Cardiovascular magnetic resonance imaging (MRI) demonstrates location, activity and extent of inflammation in acute myocarditis. A combined approach, using different imaging modalities (T2-IR-weighted imaging, early and late gadolinium enhancement) provides high diagnostic accuracy. The type of myocardial virus infection (PVB19, HHV6) may be related to the pattern of inflammation demonstrated by cardiovascular MRI and the clinical course. Whether specific patterns of late gadolinium enhancement in myocarditis are associated with poor prognosis remains a subject for further investigation. Cardiovascular MRI in myocarditis is believed to become a significant imaging tool in identifying patients at risk for heart failure and ventricular arrhythmias. These patients may need specific treatment, such as antiviral or immunosuppressive medication, dependent on the result of endomyocardial biopsy.
ZusammenfassungHintergrund: Welche Informationen kann die CT-Angiographie (CTA) im Rahmen der Notfalldiagnostik bei Patienten mit operationspflichtiger nichttraumatischer Hirnmassenblutung liefern? Patienten und Methode: Bei 61 Patienten mit nichttraumatischer Hirnmassenblutung und dringlicher Operationsindikation wurde im Anschluss an das Nativ-CT eine CTA zur Blutungsquellensuche durchgeführt. Die Befunde der CTA wurden mit dem intraoperativen Befund und der histologischen Aufarbeitung der Operationspräparate verglichen. Die CTAs der Patienten mit operativ nachgewiesener Gefäßmalformation wurden retrospektiv nach spezifischen Befundkriterien analysiert. Ergebnisse: Die CTA konnte präoperativ 13 arteriovenöse Malformationen (AVM), eine Carotis-Sinus-cavernosus-Fistel und drei Aneurysmen als Blutungsquelle richtig nachweisen. In einem Fall bestätigte sich der Angiomverdacht operativ nicht. Singuläre oder komplexe pathologische Gefäßstrukturen in der CTA haben eine sichere Korrelation mit den operativen und histologischen Befunden eines AV-Angioms. Punktförmige Kontrastmittelaustritte im Hämatom sind dagegen unsichere Befundkriterien für ein Angiom. Schlussfolgerung: Bei der raumfordernden Massenblutung bleibt oft keine Zeit für eine diagnostische DSA zur Blutungsquellensuche. Mit einer im Anschluss an das Nativ-CT durchgeführten CTA lassen sich größere Angiome und periphere Aneurysmen als Blutungsursache ohne wesentlichen Zeitverzug nachweisen.
Schlüsselwörter: Intrazerebrale Blutung · CT · CTA · DSAAbstract Background: What diagnostic information can emergent CT angiography (CTA) supply in the setting of nontraumatic massive intracerebral hemorrhage requiring surgical treatment? Patients and Methods: In 61 patients with massive nontraumatic intracerebral hemorrhage requiring urgent surgical treatment a CTA following a nonenhanced CT (NECT) was performed. The results of the CTA were compared with the intraoperative and histological findings. In the cases with histologically proven vascular malformations the CTAs were retrospectively analyzed according to specified criteria. Results: CTA was able to correctly identify 13 arteriovenous malformations, one carotid cavernous fistula and three aneurysms as the underlying cause of the intracerebral hemorrhage. In one case a suspected angioma could not be confirmed intraoperatively. There is a high correlation between single or complex pathological vascular structures in the CTA and intraoperative and histological findings of AVMs. In contrast, nodular appearing extravasation of the contrast agent within the hematoma is an unreliable finding with regard to the presence of an angioma.
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