Background and Purpose-The noninvasive diagnosis of cerebral vasospasm with the use of conventional transcranial Doppler ultrasonography (TCD) is based on a velocity study of the middle cerebral artery (MCA). The authors report a prospective comparative study between transcranial color-coded sonography (TCCS), conventional transcranial Doppler (TCD), and angiography in the diagnosis of cerebral vasospasm after surgical treatment for aneurysm. Methods-Thirty consecutive patients underwent routine angiography after surgical treatment for intracranial aneurysm.The distribution of vasospasm was determined after a prospective calculation of the angiographic diameter of the MCA, internal carotid artery (ICA), and anterior cerebral artery (ACA). The blood flow velocities (systolic and maximum) of the MCA, ICA, and ACA were evaluated by TCCS and TCD. Results-The correlation between mean maximum velocity and angiographic diameter was significant for the MCA (rϭϪ0.637, PϽ0.0001), ICA (rϭϪ0.676, PϽ0.0001), and ACA (rϭϪ0.425, PϽ0.01). TCCS sensitivity and specificity were higher than those for TCD for MCA (100% and 93%, respectively) and ICA (100% and 96.6%, respectively). For ACA, the sensitivity and specificity were 71.4% and 84.8%, respectively. Conclusions-The authors suggest that TCCS is useful for accurate monitoring of cerebral vasospasm in the MCA and ICA. In the ACA, TCCS monitors the hemodynamic state of the anterior part of the circle of Willis, which could expose the patient to a delayed ischemic deficit.

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• Dual-energy AICTA before TAVI results in a 50 % reduction of iodine load. •The reduction of iodine load maintains sufficient image quality despite increased noise. • Using 375 mA in dual-energy mode results in a reduction of radiation dose. • A high tube current setting (600 mA) should be used in overweight patients.

PurposeThe purpose of this study was to assess the influence of iodine concentration on diagnostic efficacy in multi-detector-row computed tomography (MDCT) angiography of the abdominal aorta and abdominal arteries.MethodsIRB approval and informed consent were obtained. In this double-blind trial, patients were randomised to undergo MDCT angiography of the abdominal arteries during administration of iobitridol (350 mgI/ml) or iomeprol (400 mgI/ml). Each centre applied its own technique for delivery of contrast medium, regardless of iodine concentration. Diagnostic efficacy, image quality, visualisation of the arterial wall and arterial enhancement were evaluated. A total of 153 patients received iobitridol and 154 received iomeprol.ResultsThe ability to reach a diagnosis was “satisfactory” to “totally satisfactory” in 152 (99.3%) and 153 (99.4%) patients respectively. Image quality was rated as being “good” to “excellent” in 94.7 and 94.8% segments respectively. Similar results were observed for image quality of arterial walls (84.3 vs. 83.2%). The mean relative changes in arterial enhancement between baseline and arterial phase images showed no statistically significant differences.ConclusionThis study demonstrated the non-inferiority of the 350 versus 400 mgI/ml iodine concentration, in terms of diagnostic efficacy, in abdominal MDCT angiography. It also confirmed the high robustness and reliability of this technique across multi-national practices.

Aims: Liver transplantation is universally accepted as the treatment of choice for patients with end-stage chronic liver disease and acute liver failure. The overall 1 year survival rates are exceeding 90%. Set up transplant procedures are being cancelled due to various factors, which causes distress to patients and burden to the healthcare system. The objective of this study to evaluate, the eventual outcomes of patients in the transplant operation was set up and cancelled at least once, within a pre-defined study period. Methods: Data was collated from a transplant database held at the Queen Elizabeth Hospital Birmingham and all transplants set up and cancelled between January 2012 and December 2013 was reviewed. Total cancellation episodes, number of times each patient cancelled, reason for cancellation, eventual outcome of those patients after the cancellation were recorded. Results: There were total of 259 episodes of cancellation of liver transplants involving 158 patients. The reason for cancellations were, Donor related 43% (112), graft related 33% (88), recipient related 11% (28), logistics 10% ( 27) and there were no records found for 2% (4) cancellations. The main donor related factor was DCD donors who did not progress. 128 (81%) patients were eventually transplanted. Total of 18 (13%) patients were removed from the list and 8 (5%) patients died whilst on the list. Among these 26 patients, 14 patients (8.8%) would have survived if the set up transplants went ahead, as their transplants were cancelled due to non-recipient factors. Conclusions: Whilst the majority of patients who had their liver transplantation cancelled, eventually got transplanted however, for nearly 9% patient, this was a lost opportunity. Cancelled liver transplants may carry a significant burden to the patients and families and alternative ways of managing patients when chosen for marginal grafts that are unlikely to go ahead should be explored.