Aortic regurgitation (AR) in five healthy volunteers and 26 patients (mean age, 60.3 years; range, 25-83 years) was quantitatively measured with magnetic resonance (MR) imaging velocity mapping. Cine transverse images of the ascending aorta (32 phases per cardiac cycle) were acquired by using a gradient-echo sequence with a velocity-encoding bipolar pulse applied in the section-selection direction with a 1.5-T MR imaging unit. The aortic flow was calculated by integrating the product of area and mean velocity of the ascending aorta at each phase over a cardiac cycle. The negative and positive velocity values indicated antegrade and regurgitant flow, respectively, which allowed calculation of forward and regurgitant flow. Inter- and intraobserver variation of regurgitant fraction (RF) measurement was small (r = .956, standard error of the estimate [SEE] = 1.2%, n = 31; and r = .998, SEE = 0.35%, n = 10, respectively). RF determined with MR imaging agreed well with Doppler echocardiographic (n = 26) and aortographic (n = 9) grading of AR. Reproducible, quantitative, and noninvasive measurement of AR is possible with MR velocity mapping.
Symptoms of cavernous sinus dural arteriovenous fistula depend on the drainage patterns and are very diverse. Among these, brainstem dysfunction is a rare but serious complication. Here, we describe a case with isolated and rapidly progressive brainstem dysfunction due to cavernous sinus dural arteriovenous fistula. An 80-year-old woman presented with a 2-day history of progressive gait disturbance. Neurological examination revealed mild confusion, dysarthria, and left hemiparesis. Magnetic resonance imaging (MRI) revealed pontine swelling without evidence of infarction. Magnetic resonance angiography suggested a faint abnormality near the cavernous sinus. Dural arteriovenous fistula was suspected, and digital subtraction angiography was planned for the next day. Her condition had progressed to coma by the next morning. Pontine swelling worsened, and hyperintensity appeared on diffusion-weighted imaging. Digital subtraction angiography revealed a right-sided cavernous sinus dural arteriovenous fistula with venous reflux into the posterior fossa. Orbital or ocular symptoms had preceded brainstem symptoms in all nine previously reported cases, but brainstem symptoms were the only presentation in our case, making the diagnosis difficult. Some dural arteriovenous fistulas mimic inflammatory diseases when the clinical course is acute. Prompt diagnosis using enhanced computed tomography or MRI and emergent treatment are needed to avoid permanent sequelae.
Preclipping ICG-VA may enhance the advantage of direct surgery for dissecting aneurysm by allowing visualization of the extent of the dissected vascular wall and the related branching arteries. ICG-VA can be an indispensable adjunct to minimize the compromise from the surgical treatment for intracranial dissecting aneurysms.
Objective: We report the usefulness of magnetic resonance MR plaque imaging for treatment planning of cervical carotid artery stenosis. Carotid plaque lesions that show high-signal intensity on T weighted black-blood magnetic resonance imaging BB MRI are regarded as high risk indicators for carotid artery stenting CAS . We believe carotid endarterectomy CEA should be performed in such cases. We retrospectively examined the outcome of CAS in patients with plaques assessed by BB MRI. Methods: We electively performed CAS in cases between September and March . We also used BB MRI to quantitate carotid artery stenosis, assess plaque characteristics before treatment, and evaluate the relative overall signal intensity roSI , which we defined as the ratio of signal intensity in carotid plaques to that in sternocleidomastoid muscles. Results: The average roSI was . ± . and markedly higher > . in lesions . % . Ipsilateral diff usion-weighted imaging showed that lesions were new in cases . % . Within days after surgery, patients . % experienced stroke and myocardial infarction and eventually died. Conclusions: Non-invasive preoperative MR plaque imaging is useful for screening patients with a high risk for CAS, and this screening can ensure safe outcomes after CAS.
Summary:The treatment strategy for carotid stenosis in patients 80 years has been changing following many clinical trials. We retrospectively examined the surgical results of carotid stenosis in octogenarians in our hospital. Between January 2004 and November 2010, 223 patients underwent 143 carotid endarterectomies (CEA) and 80 carotid angioplasties with stentings (CAS) in our hospital. We regarded MRI plaque imaging using black-blood T1 sequence as important to select the treatment strategy.Nineteen octogenarian patients underwent nine CEA and 10 CAS. MRI plaque imaging revealed that relative overall signal intensity of carotid plaque was significantly higher in the CEA cases than in CAS cases. Perioperative and long-term stroke, myocardial infarction and death rates did not differ significantly between the two treatment groups.Our strategy using MRI plaque imaging for carotid stenosis in octogenarians is useful.
We report a case of intramedullary neurenteric cyst in a 7 − year
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