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Franjić, Darjan, e Josip Mašković. "Value of 3D-DSA in the detection of intracranial aneurysms". Medicina Fluminensis 57, n. 3 (1 settembre 2021): 260–68. http://dx.doi.org/10.21860/medflum2021_261187.
Abstract (sommario):
Aim: To determine the value of three-dimensional (3D) digital subtraction angiography (DSA) in the detection of intracranial aneurysms and to compare 3D technique with DSA. Materials and Methods: A retrospective analysis of 50 patients with 60 intracranial aneurysms who underwent both conventional DSA and 3D-DSA for the evaluation of intracranial aneurysms was conducted. The presence of aneurysms, detection of aneurysmal neck, size, location, presence of additional and small aneurysms analyzed from the two protocols were compared. Results: Three-dimensional technique detected 54 aneurysms while conventional DSA detected 38 aneurysms. There was no correlation between aneurysm detection and aneurysm neck detection in the two technologies observed, but there was a difference in detection performance depending on the technology used. Three-dimensional technique detected 52 aneurysm necks while conventional DSA detected 24 aneurysm necks. There was a statistically significant and positive relationship between the detected size of the aneurysm using 3D technique and DSA technology. Three-dimensional technique detected 24 additional aneurysms while conventional DSA detected only six additional aneurysms. Conclusions: Three-dimensional technique are more successful in the detection of aneurysms, their necks and small aneurysms in comparison to digital subtraction angiography, but difference is not statistically significant. The size of the aneurysm statistically significant affects the aneurysm neck detection by conventional DSA.
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Nakagawa, Daichi, Yasunori Nagahama, Bruno A. Policeni, Madhavan L. Raghavan, Seth I. Dillard, Anna L. Schumacher, Srivats Sarathy et al. "Accuracy of detecting enlargement of aneurysms using different MRI modalities and measurement protocols". Journal of Neurosurgery 130, n. 2 (febbraio 2019): 559–65. http://dx.doi.org/10.3171/2017.9.jns171811.
Abstract (sommario):
OBJECTIVEAneurysm growth is considered predictive of future rupture of intracranial aneurysms. However, how accurately neuroradiologists can reliably detect incremental aneurysm growth using clinical MRI is still unknown. The purpose of this study was to assess the agreement rate of detecting aneurysm enlargement employing generally used MRI modalities.METHODSThree silicone flow phantom models, each with 8 aneurysms of various sizes at different sites, were used in this study. The aneurysm models were identical except for an incremental increase in the sizes of the 8 aneurysms, which ranged from 0.4 mm to 2 mm. The phantoms were imaged on 1.5-T and 3-T MRI units with both time-of-flight (TOF) and contrast-enhanced MR angiography. Three independent expert neuroradiologists measured the aneurysms in a blinded manner using different measurement approaches. The individual and agreement detection rates of aneurysm enlargement among the 3 experts were calculated.RESULTSThe mean detection rate of any increase in any aneurysmal dimension was 95.7%. The detection rates of the 3 observers (observers A, B, and C) were 98.0%, 96.6%, and 92.7%, respectively (p = 0.22). The detection rates of each MRI modality were 91.3% using 1.5-T TOF, 97.2% using 1.5-T with Gd, 95.8% using 3.0-T TOF, and 97.2% using 3.0-T with Gd (p = 0.31). On the other hand, the mean detection rate for aneurysm enlargement was 54.8%. Specifically, the detection rates of observers A, B, and C were 49.0%, 46.1%, and 66.7%, respectively (p = 0.009). As the incremental enlargement value increased, the detection rate for aneurysm enlargement increased. The use of 1.5-T Gd improved the detection rate for small incremental enlargement (e.g., 0.4–1 mm) of the aneurysm (p = 0.04). The location of the aneurysm also affected the detection rate for aneurysm enlargement (p < 0.0001).CONCLUSIONSThe detection rate and interobserver agreement were very high for aneurysm enlargement of 0.4–2 mm. The detection rate for at least 1 increase in any aneurysm dimension did not depend on the choice of MRI modality or measurement protocol. Use of Gd improved the accuracy of measurement. Aneurysm location may influence the accuracy of detecting enlargement.
3
Gunia, D. J., E. T. Ekvtimishvili e G. Z. Basiladze. "Necessity of follow-up cerebral digital subtraction angiography after endovascular coiling or microsurgical cliping of ruptured intracranial aneurysms to exclude de novo or aneurysmal regrow and avoid its rupture: report of 2 cases". Endovascular Neuroradiology 27, n. 1 (13 giugno 2019): 12–20. http://dx.doi.org/10.26683/2304-9359-2019-1(27)-12-20.
Abstract (sommario):
Objective – to improve treatment results of patients with ruptured brain aneurysms using follow-up cerebral digital subtraction angiography to avoid de novo or aneurismal regrow.Materials and methods. Analysis of follow-up cerebral digital subtraction angiography and treatment results of two patient (60 and 64-year-old females) with brain anterior communicated artery de novo aneurysm and regrowed aneurysm of an anterior communicated artery after microsurgical clipping.Results. Two patient underwent endovascular treatment of ruptured brain aneurysms after non follow-up cerebral digital subtraction angiography. In first case de novo aneurysm of anterior communicating artery and in second – regrowed aneurys of anterior communicating artery after surgical clipping. Both patients were discharged from the clinic in I and IV modified Rankin scale. Conclusions. Digital subtraction angiography follow-up of intracranial aneurysms treated by endovascular or microsurgical approach is important for the detection and prediction for the risk of bleeding (aneurysm recurrence and de novo aneurysm). There exist no guidelines on the frequency of monitoring and imaging modality to adopt and the monitoring is adapted on a case-by-case basis. Digital subtraction angiography is the gold standard for the evaluation of aneurysmal occlusion after coiling and microsurgical clipping and remains also necessary for evaluating other devices.
4
Huston, J., V. E. Torres, P. P. Sulivan, K. P. Offord e D. O. Wiebers. "Value of magnetic resonance angiography for the detection of intracranial aneurysms in autosomal dominant polycystic kidney disease." Journal of the American Society of Nephrology 3, n. 12 (giugno 1993): 1871–77. http://dx.doi.org/10.1681/asn.v3121871.
Abstract (sommario):
The association of intracranial aneurysms with autosomal dominant polycystic kidney disease (ADPKD), the 30-day mortality rate exceeding 50% for aneurysmal rupture, the effectiveness of surgical repair of unruptured aneurysms with a low surgical risk, and the development of noninvasive imaging techniques for their detection have led physicians to consider the value of screening patients with ADPKD for unruptured intracranial aneurysms. The sensitivity and specificity of high-resolution computed tomography and magnetic resonance imaging for the diagnosis of small intracranial aneurysms have been disappointing. To determine the value of magnetic resonance angiography (MRA), 85 patients with ADPKD without symptoms related to an intracranial aneurysm and 2 patients with ADPKD presenting with a subarachnoid hemorrhage or a suspected aneurysmal leak were studied. MRA was performed with the Multisequence Vascular Package (GE Medical Systems) with use of three-dimensional time-of-flight and three-dimensional phase-contrast techniques, and postprocessing maximum intensity projection images were generated to eliminate the problem of overlapping vessels. Asymptomatic intracranial aneurysms were detected in 6 (22%) of 27 patients with and 3 (5%) of 56 patients without a family history of intracranial aneurysm or subarachnoid hemorrhage (P = 0.02, information missing in 2 patients) and in the 2 patients who presented with a symptomatic aneurysm. A stepwise logistic regression analysis indicated that a family history of intracranial aneurysm or subarachnoid hemorrhage was independently associated with the presence of intracranial aneurysms. All of the aneurysms were < or = 6.5 mm in diameter.(ABSTRACT TRUNCATED AT 250 WORDS)
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Paralic, Martin, Kamil Zelenak, Patrik Kamencay e Robert Hudec. "Automatic Approach for Brain Aneurysm Detection Using Convolutional Neural Networks". Applied Sciences 13, n. 24 (16 dicembre 2023): 13313. http://dx.doi.org/10.3390/app132413313.
Abstract (sommario):
The paper introduces an approach for detecting brain aneurysms, a critical medical condition, by utilizing a combination of 3D convolutional neural networks (3DCNNs) and Convolutional Long Short-Term Memory (ConvLSTM). Brain aneurysms pose a significant health risk, and early detection is vital for effective treatment. Traditional methods for aneurysm detection often rely on complex and time-consuming procedures. A radiologist specialist annotates each aneurysm and supports our work with true-ground annotations. From the annotated data, we extract images to train proposed neural networks. The paper experiments with two different types of networks, specifically focusing on 2D convolutional neural networks (2DCNNs), 3D convolutional neural networks (3DCNNs), and Convolutional Long Short-Term Memory (ConvLSTM). Our goal is to create a virtual assistant to improve the search for aneurysm locations, with the aim of further realizing the virtual assistant. Subsequently, a radiologist specialist will confirm or reject the presence of an aneurysm, leading to a reduction in the time spent on the searching process and revealing hidden aneurysms. Our experimental results demonstrate the superior performance of the proposed approach compared to existing methods, showcasing its potential as a valuable tool in clinical settings for early and accurate brain aneurysm detection. This innovative fusion of 3DCNN and LSTM (3DCNN-ConvLSTM) techniques not only improves diagnostic precision but also holds promise for advancing the field of medical image analysis, particularly in the domain of neurovascular diseases. Overall, our research underscores the potential of neural networks for the machine detection of brain aneurysms.
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Dupont, Stefan A., Giuseppe Lanzino, Eelco F. M. Wijdicks e Alejandro A. Rabinstein. "The use of clinical and routine imaging data to differentiate between aneurysmal and nonaneurysmal subarachnoid hemorrhage prior to angiography". Journal of Neurosurgery 113, n. 4 (ottobre 2010): 790–94. http://dx.doi.org/10.3171/2010.4.jns091932.
Abstract (sommario):
Object In this study, the authors' goal was to minimize false-negative results in the detection of ruptured cerebral aneurysms. Methods The authors retrospectively reviewed the clinical and radiological information in consecutive adult patients admitted with acute subarachnoid hemorrhage (SAH) to their hospital between January 1, 2002, and January 1, 2008. Patients were grouped based on the presence or absence of a ruptured aneurysm, which was detected by catheter angiography. Multivariate logistic regression analysis was used to identify factors predicting detection of aneurysmal rupture by angiography. Results The authors identified 199 patients (121 women [61%]). A ruptured aneurysm was detected in 167 patients (84%). In multivariate analysis, loss of consciousness at the onset of SAH was a strong predictive factor associated with detection of a ruptured aneurysm on subsequent angiography (OR > 100, p = 0.0002). The positive predictive value of loss of consciousness at the onset of SAH for detection of a ruptured aneurysm was 100%. Conclusions Loss of consciousness at the onset of SAH is highly predictive of aneurysm rupture. A negative CT angiography study in these patients may be a false result, and a high-quality catheter angiography should be performed.
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Ajiboye, Norman, Nohra Chalouhi, Robert M. Starke, Mario Zanaty e Rodney Bell. "Unruptured Cerebral Aneurysms: Evaluation and Management". Scientific World Journal 2015 (2015): 1–10. http://dx.doi.org/10.1155/2015/954954.
Abstract (sommario):
The evolution of imaging techniques and their increased use in clinical practice have led to a higher detection rate of unruptured intracranial aneurysms. The diagnosis of an unruptured intracranial aneurysm is a source of significant stress to the patient because of the concerns for aneurysmal rupture, which is associated with substantial rates of morbidity and mortality. Therefore, it is important that decisions regarding optimum management are made based on the comparison of the risk of aneurysmal rupture with the risk associated with intervention. This review provides a comprehensive overview of the epidemiology, pathophysiology, natural history, clinical presentation, diagnosis, and management options for unruptured intracranial aneurysms based on the current evidence in the literature. Furthermore, the authors discuss the genetic abnormalities associated with intracranial aneurysm and current guidelines for screening in patients with a family history of intracranial aneurysms. Since there is significant controversy in the optimum management of small unruptured intracranial aneurysms, we provided a systematic approach to their management based on patient and aneurysm characteristics as well as the risks and benefits of intervention.
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Al Kasab, Sami, Daichi Nakagawa, Mario Zanaty, Girish Bathla, Bruno Policeni, Neetu Soni, Lauren Allan et al. "In vitro accuracy and inter-observer reliability of CT angiography in detecting intracranial aneurysm enlargement". Journal of NeuroInterventional Surgery 11, n. 10 (6 marzo 2019): 1015–18. http://dx.doi.org/10.1136/neurintsurg-2019-014737.
Abstract (sommario):
Background and purposeTo evaluate the accuracy and inter-observer variability when CT angiography is used to identify unruptured intracranial aneurysm growth.MethodsTwo silicone phantom models were used in this study. Each phantom had eight aneurysms of variable size. The size and location of aneurysms in phantom 1 were representative of real patient aneurysms who presented to our institution. Phantom 2 contained aneurysms in the same locations, but with enlargement in various directions. Three blinded board-certified neuroradiologists were asked to identify the size of each aneurysm in three dimensions using CT angiography. The individual enlargement detection rates and inter-observer agreement rates of aneurysm enlargement among the three experts were calculated.ResultsThe detection rate of aneurysm enlargement in one dimension was 58.3% among the three observers. Accurate detection of enlargement in all dimensions was 12.5% among the three observers. Detection accuracy was not related to the size of enlargement. Significant inter-observer measurement variability was present.ConclusionThe use of CT angiography was associated with a poor ability to identify aneurysm enlargementaccurately. Further human studies are required to confirm our findings.
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Imaizumi, Yohichi, Tohru Mizutani, Katsuyoshi Shimizu, Yosuke Sato e Junichi Taguchi. "Detection rates and sites of unruptured intracranial aneurysms according to sex and age: an analysis of MR angiography–based brain examinations of 4070 healthy Japanese adults". Journal of Neurosurgery 130, n. 2 (febbraio 2019): 573–78. http://dx.doi.org/10.3171/2017.9.jns171191.
Abstract (sommario):
OBJECTIVEThe purpose of this study was to evaluate the detection rate and occurrence site according to patient sex and age of unruptured intracranial aneurysms detected through MRI and MR angiography (MRA).METHODSA total of 4070 healthy adults 22 years or older (mean age [± SD] 50.6 ± 11.0 years; 41.9% women) who underwent a brain examination known as “Brain Dock” in the central Tokyo area between April 2014 and March 2015 were checked for unruptured saccular aneurysm using 3-T MRI/MRA. The following types of cases were excluded: 1) protrusions with a maximum diameter < 2 mm at locations other than arterial bifurcations, 2) conical protrusions at arterial bifurcations with a diameter < 3 mm, and 3) cases of suspected aneurysms with unclear imaging of the involved artery. When an aneurysm was definitively diagnosed, the case was included in the aneurysm group. The authors also investigated the relationship between aneurysm occurrence and risk factors (age, sex, smoking history, hypertension, diabetes, and hyperlipidemia).RESULTSOne hundred eighty-eight aneurysms were identified in 176 individuals (detection rate 4.32%), with the detection rate for women being significantly higher (6.2% vs 3.0%, p < 0.001). The average age in the aneurysm group was significantly higher than in the patients in whom aneurysms were not detected (53.0 ± 11.1 vs 50.5 ± 11.0 years). The detection rate tended to increase with age. The detection rates were 3.6% for people in their 30s, 3.5% for those in their 40s, 4.1% for those in their 50s, 6.9% for those in their 60s, and 6.8% for those in their 70s. Excluding persons in their 20s and 80s—age groups in which no aneurysms were discovered—the detection rate in women was higher in all age ranges. Of the individuals with aneurysms, 12 (6.81%) had multiple cerebral aneurysms; no sex difference was observed with respect to the prevalence of multiple aneurysms. Regarding aneurysm size, 2.0–2.9 mm was the most common size range, with 87 occurrences (46.3%), followed by 3.0–3.9 mm (67 [35.6%]) and 4.0–4.9 mm (20 [10.6%]). The largest aneurysm was 13 mm. Regarding location, the internal carotid artery (ICA) was the most common aneurysm site, with 148 (78.7%) occurrences. Within the ICA, C1 was the site of 46 aneurysms (24.5%); C2, 57 (30.3%); and C3, 29 (15.4%). The aneurysm detection rates for C2, C3, and C4 were 2.23%, 1.23%, and 0.64%, respectively, for women and 0.68%, 0.34%, and 0.21%, respectively, for men; ICA aneurysms were significantly more common in women than in men (5.27% vs 2.20%, p < 0.001). Multivariate logistic regression analysis revealed that age (p < 0.001, OR 1.03, 95% CI 1.01–1.04), female sex (p < 0.001, OR 2.28, 95% CI 1.64–3.16), and smoking history (p = 0.011, OR 1.52, 95% CI 1.10–2.11) were significant risk factors for aneurysm occurrenceCONCLUSIONSIn this study, both female sex and older age were independently associated with an increased aneurysm detection rate. Aneurysms were most common in the ICA, and the frequency of aneurysms in ICA sites was markedly higher in women.
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Kizilkilic, Osman, Eldeniz Huseynov, Sedat G. Kandemirli, Naci Kocer e Civan Islak. "Detection of wall and neck calcification of unruptured intracranial aneurysms with flat-detector computed tomography". Interventional Neuroradiology 22, n. 3 (2 febbraio 2016): 293–98. http://dx.doi.org/10.1177/1591019915626591.
Abstract (sommario):
Object Microsurgical clipping is a widely used surgical technique in intracranial aneurysm treatment. It can be difficult in large sized aneurysms, and those with wide necks, thick walls and calcification located in the vicinity of the neck. This study reviewed calcification of the intracranial aneurysm wall and its relation to patient age, gender, location and size of the aneurysm. A possible cut-off value after which the aneurysm calcification rate increases was also investigated to classify patients’ risk factors for microclipping. Methods A retrospective review of all unruptured intracranial aneurysms that underwent digital subtraction angiography at a single centre was performed. Flat-detector computed tomography images of the aneurysm were reviewed for aneurysm location, size and calcification. The independent samples t test and χ2 test were used to show the relation between aneurysm wall calcification and patient age, gender, aneurysm localisation and size. Results None of the reviewed factors were statistically significantly related to aneurysm calcification except aneurysm size ( P < 0.01). Receiver operating characteristic curves showed aneurysms greater than 10.5 mm could be predicted to be calcified with a sensitivity of 80% and specificity of 63%. Conclusion In this study, the presence of calcification was related to aneurysm size. Larger aneurysms were more likely to be calcified. Aneurysms greater than 10.5 mm should be further investigated with a modality such as flat-detector computed tomography to show the calcification in detail, especially if microclipping is considered.
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Sarkodie, Benjamin D., Bashiru B. Jimah, Dorothea Anim, Edmund Brakohiapa e Benard Botwe. "Intracranial stents in the management of wide-neck intracranial aneurysms". Third Edition of the HSI Journal: Volume 2 Issue 1, 2021 Publication. 2, n. 1 (29 giugno 2021): 205–9. http://dx.doi.org/10.46829/hsijournal.2021.6.2.1.205-209.
Abstract (sommario):
Intracranial aneurysms are bulges in vessels that are prone to rupture with attendant morbidity and mortality. Early detection and treatment can avoid rupture and its associated consequences. Endovascular treatment of aneurysms with wide neck can be challenging due to potential coil migration or protrusion. The use of intracranial stents and balloons can help overcome some of these management challenges. We present 3 cases of endovascular treatment of wide-neck intracranial aneurysms. The first patient presented with a wide-neck left middle cerebral artery aneurysm that was successfully treated with stent-assisted coiling with complete obliteration of the aneurysmal sac. The second patient presented with a large, cavernous internal carotid artery aneurysm that was successfully treated with a flow diverter stent with complete obliteration of the aneurysm while the third case presented with a wide-neck left posterior communicating artery aneurysm and was also successfully treated with stent-assisted coiling. Even though endovascular treatment of wide-neck intracranial aneurysms is technically challenging, the evolution of new treatment techniques such as the use of stents and stent-assisted coiling make these treatments safe.
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Makino, Hiroshi, Kazuya Hokamura, Takahiro Natsume, Tetsuro Kimura, Yoshinobu Kamio, Yasuhiro Magata, Hiroki Namba et al. "Successful Serial Imaging of the Mouse Cerebral Arteries Using Conventional 3-T Magnetic Resonance Imaging". Journal of Cerebral Blood Flow & Metabolism 35, n. 9 (29 aprile 2015): 1523–27. http://dx.doi.org/10.1038/jcbfm.2015.78.
Abstract (sommario):
Serial imaging studies can be useful in characterizing the pathologic and physiologic remodeling of cerebral arteries in various mouse models. We tested the feasibility of using a readily available, conventional 3-T magnetic resonance imaging (MRI) to serially image cerebrovascular remodeling in mice. We utilized a mouse model of intracranial aneurysm as a mouse model of the dynamic, pathologic remodeling of cerebral arteries. Aneurysms were induced by hypertension and a single elastase injection into the cerebrospinal fluid. For the mouse cerebrovascular imaging, we used a conventional 3-T MRI system and a 40-mm saddle coil. We used non-enhanced magnetic resonance angiography (MRA) to detect intracranial aneurysm formation and T2-weighted imaging to detect aneurysmal subarachnoid hemorrhage. A serial MRI was conducted every 2 to 3 days. MRI detection of aneurysm formation and subarachnoid hemorrhage was compared against the postmortem inspection of the brain that was perfused with dye. The imaging times for the MRA and T2-weighted imaging were 3.7 ± 0.5 minutes and 4.8 ± 0.0 minutes, respectively. All aneurysms and subarachnoid hemorrhages were correctly identified by two masked observers on MRI. This MRI-based serial imaging technique was useful in detecting intracranial aneurysm formation and subarachnoid hemorrhage in mice.
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Kumar, Subhash, Shailesh B. Gaikwad e Nalini Kant Mishra. "3D Rotational Angiography in Follow-Up of Clipped Intracranial Aneurysms". ISRN Radiology 2014 (20 gennaio 2014): 1–5. http://dx.doi.org/10.1155/2014/935280.
Abstract (sommario):
Introduction. 3D Rotational Angiography (RA) is indispensable for evaluation of intracranial aneurysms, providing infinite viewing angles and defining the aneurysm morphology. Its role in follow-up of clipped aneurysms remains unclear. We aimed to compare the aneurysm residue/recurrence detection rate of 3D RA with 2D digital subtraction angiography (DSA). Methods. 47 patients harboring 54 clipped aneurysms underwent both 2D DSA and 3D RA. The residual/recurrent aneurysms were classified into five grades and the images of both modalities were compared. Results. The residual/recurrent aneurysm detection rate was 53.70% (29/54 aneurysms) with 2D DSA and 66.67% (36/54 aneurysms) with 3D RA (P=0.05). In 12 aneurysms, 3D RA upgraded the residue/recurrence among which nine had been completely not detected on 2D DSA and were found to have grade one or two residual necks on the 3D RA, and, in three cases, a small neck on 2D DSA turned out to be aneurysm sac on 3D RA. In a total of 5 aneurysms, the classification was downgraded by 3D RA. Conclusion. 3D RA picks up more aneurysm residue/recurrence; hence, both 2D DSA and 3D RA should be performed in follow-up evaluation of clipped aneurysms.
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Sanchis, Irina M., Shehbaz Shukoor, Maria V. Irazabal, Charles D. Madsen, Fouad T. Chebib, Marie C. Hogan, Ziad El-Zoghby et al. "Presymptomatic Screening for Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease". Clinical Journal of the American Society of Nephrology 14, n. 8 (30 luglio 2019): 1151–60. http://dx.doi.org/10.2215/cjn.14691218.
Abstract (sommario):
Background and objectivesIntracranial aneurysm rupture is the most devastating complication of autosomal dominant polycystic kidney disease. Whether selective or widespread intracranial aneurysm screening is indicated remains controversial.Design, setting, participants & measurementsRecords of 3010 patients with autosomal dominant polycystic kidney disease evaluated at the Mayo Clinic between 1989 and 2017 were reviewed. Those who had presymptomatic magnetic resonance angiography screening were included.ResultsNinety-four intracranial aneurysms were diagnosed in 75 of 812 (9%) patients who underwent magnetic resonance angiography screening. Sex, age, race, and genotype were similar in the groups with and without aneurysms; hypertension and history of smoking were more frequent in the aneurysm group. Twenty-nine percent of patients with aneurysms compared with 11% of those without aneurysms had a family history of subarachnoid hemorrhage (P<0.001). Most aneurysms were small (median diameter =4 mm; range, 2–12 mm); 85% were in the anterior circulation. During a total imaging follow-up of 469 patient-years, de novo intracranial aneurysms were detected in five patients; eight intracranial aneurysms grew (median =2 mm; range, 1–3 mm). During a total clinical follow-up of 668 patient-years, seven patients had preemptive clipping or coil embolization; no intracranial aneurysms ruptured. During a total clinical follow-up of 4783 patient-years in 737 patients with no intracranial aneurysm detected on the first magnetic resonance angiography screening, two patients had an intracranial aneurysm rupture (0.04 per 100 person-years; 95% confidence interval, 0 to 0.10). The rate of intracranial aneurysm rupture in large clinical trials of autosomal dominant polycystic kidney disease was 0.04 per 100 patient-years (95% confidence interval, 0.01 to 0.06).ConclusionsIntracranial aneurysms were detected by presymptomatic screening in 9% of patients with autosomal dominant polycystic kidney disease, more frequently in those with familial history of subarachnoid hemorrhage, hypertension, or smoking. None of the patients with and two of the patients without aneurysm detection on screening suffered aneurysmal ruptures. The overall rupture rate in our autosomal dominant polycystic kidney disease cohort was approximately five times higher than that in the general population.
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Tang, Phua-Hwee, Francis Hui e Yih-Yian Sitoh. "Intracranial Aneurysm Detection with 3T Magnetic Resonance Angiography". Annals of the Academy of Medicine, Singapore 36, n. 6 (15 giugno 2007): 388–93. http://dx.doi.org/10.47102/annals-acadmedsg.v36n6p388.
Abstract (sommario):
Introduction: The new 3 Tesla (T) magnetic resonance (MR) scanners yield improved signalto-noise ratio and spatial resolution with superior background suppression compared to lower field strength systems. This is advantageous for MR angiograms. The purpose of our study was to compare unenhanced three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) at 3T with catheter digital subtraction angiography (DSA) in detecting unruptured intracranial aneurysms. Materials and Methods: Out of 1375 consecutive patients who underwent unenhanced 3D TOF MRA at 3T, 15 patients with unruptured intracranial aneurysms were retrospectively identified. Nine of these 15 patients had DSA as the reference standard for comparison. Aneurysm size, location and morphology were independently assessed on both MRA and DSA by 2 radiologists. Results: Seventeen aneurysms ranging in size from 1 mm to 24 mm were identified in 15 patients on MRA. DSA confirmed the aneurysms in 9 patients with good anatomical correlation compared with the MRA findings. Conclusions: 3D TOF MRA at 3T has good correlation with DSA and aneurysms as small as 1 mm in size can be detected. This can be a promising, non-invasive method for aneurysm surveillance. Key words: Angiography, Cerebrovascular disorders, Diagnostic imaging
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Hung, Alice L., Taylor Elise Purvis, Wuyang Yang, Tomas Garzon-Muvdi, Justin M. Caplan, Geoffrey P. Colby, Alexander Lewis Coon, Rafael Jesus Tamargo e Judy Huang. "371 Risk of De Novo Aneurysm Formation in Patients Before Obliteration of Brain Arteriovenous Malformations (AVMs)". Neurosurgery 64, CN_suppl_1 (24 agosto 2017): 287. http://dx.doi.org/10.1093/neuros/nyx417.371.
Abstract (sommario):
Abstract INTRODUCTION The risk of de novo aneurysm formation is presumed to increase because of increased arterial flow in brain AVMs Little evidence to-date has been presented regarding the risk of aneurysmal formation under the influence of a concurrent AVM. We aim to determine this risk using our institutional data. METHODS Retrospective review of brain AVM patients evaluated at our institution from 1990–2015 was performed. Demographic and baseline characteristics were examined. De novo aneurysm was defined as new aneurysm diagnosis after initial angiographic characterization of AVM. Exposure intervals were censored until obliteration for treated patients and last follow-up for untreated patients. All de novo aneurysms detected during the censored interval were captured, and the annual rate of de novo aneurysm formation was calculated. RESULTS >A total of 672 AVM patients with complete information were included. Overall age was 37.3 years (44.5% male), and overall size of AVM was 3.1 cm. Six patients(0.9%) with 8 de novo aneurysms were found in this cohort. In these six patients, the average age was 46.9 years, with 50.0% males. The average AVM size was 4.1 cm (range: 3–8 cm). Two patients had presented with AVM hemorrhage, and the most common presenting symptom was seizure (50.0%). Most patients underwent radiosurgery (83.3%). Four (66.7%) patients were diagnosed with de novo aneurysms after first AVM treatment. Six aneurysms (75.0%) were prenidal in location. The average aneurysm size at detection was 4.66 mm. Only one patient received treatment specifically for the aneurysm, which was surgically obliterated. The total non-obliterated interval for AVM was 3811.47 years, and the calculated annual rate of de novo aneurysm formation was 0.21%. CONCLUSION The annual risk of de novo aneurysm formation was relatively low at 0.21%, despite having concurrent AVMs Most of these aneurysms were prenidal. Patients developing de novo aneurysms were older in general and more likely to have larger AVMs
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Mummaneni, Sobhana, Sasi Tilak Ravi, Jashwanth Bodedla, Sree Ram Vemulapalli e Gnana Sri Kowsik Varma Jagathapurao. "A COMPREHENSIVE STUDY: INTRACRANIAL ANEURYSM DETECTION VIA VGG16-DENSENET HYBRID DEEP LEARNING ON DSA IMAGES". Informatyka, Automatyka, Pomiary w Gospodarce i Ochronie Środowiska 14, n. 1 (31 marzo 2024): 105–10. http://dx.doi.org/10.35784/iapgos.5804.
Abstract (sommario):
An intracranial aneurysm is a swelling in a weak area of a brain artery. The main cause of aneurysm is high blood pressure, smoking, and head injury. A ruptured aneurysm is a serious medical emergency that can lead to coma and then death. A digital subtraction angiogram (DSA) is used to detect a brain aneurysm. A neurosurgeon carefully examines the scan to find the exact location of the aneurysm. A hybrid model has been proposed to detect these aneurysms accurately and quickly. Visual Geometry Group 16 (VGG16) and DenseNet are two deep-learning architectures used for image classification. Ensembling both models opens the possibility of using diversity in a robust and stable feature extraction. The model results assist in identifying the location of aneurysms, which are much less prone to false positives or false negatives. This integration of a deep learning-based architecture into medical practice holds great promise for the timely and accurate detection of aneurysms. The study encompasses 1654 DSA images from distinct patients, partitioned into 70% for training (1157 images) and 30% for testing (496 images). The ensembled model manifests an impressive accuracy of 95.38%, outperforming the respective accuracies of VGG16 (94.38%) and DenseNet (93.57%). Additionally, the ensembled model achieves a recall value of 0.8657, indicating its ability to correctly identify approximately 86.57% of true aneurysm cases out of all actual positive cases present in the dataset. Furthermore, when considering DenseNet individually, it attains a recall value of 0.8209, while VGG16 attains a recall value of 0.8642. These values demonstrate the sensitivity of each model to detecting aneurysms, with the ensemble model showcasing superior performance compared to its individual components.
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Ernst, Marielle, Anika Buchholz, Romain Bourcier, Hubert Desal, Pierre-Yves Le Floch, Markus Möhlenbruch, Martin Bendszus e Jens Fiehler. "Voxel based analysis of recurrence dynamics in intracranial aneurysms after coiling". Journal of NeuroInterventional Surgery 10, n. 6 (31 ottobre 2017): 571–76. http://dx.doi.org/10.1136/neurintsurg-2017-013311.
Abstract (sommario):
BackgroundUnderstanding aneurysm growth is critical for the appropriate follow-up of patients after coil embolization and the need for retreatment. The purpose of the study was to stratify the growth dynamics of aneurysm recurrences after coiling by volumetric analysis and to determine predictive factors for aneurysm recurrences.MethodsSource images of follow-up three-dimensional time of flight MR angiography (ToF-MRA) scans were compared with the first post-interventional ToF-MRA scan and analyzed for residual flow after co-registration using ANALYZE-software. In the event of incomplete occlusion, the residual volume was segmented and calculated. Growth dynamic was determined for each aneurysm after embolization.ResultsWe analyzed 326 patients with 345 aneurysms from two centers. Each case had at least two ToF-MRA examinations after endovascular therapy. The mean observation interval was 59 months. Volumetric analysis of 1139 follow-up MRAs revealed that 218/345 aneurysms (63.2%) showed complete occlusion on initial follow-up imaging, and of these 95.0% remained stable. A steady increase in intra-aneurysmal flow was observed in 83/345 (24.1%). Less frequent observations were a steep increase (21/345; 6.1%) and a decrease (27/345; 7.8%). Independent predictors of increasing residual flow were greatest aneurysm diameter, total coil length, and incomplete occlusion.ConclusionsVolumetric analysis of registered three-dimensional ToF-MRA follow-up datasets allows the detection of different growth patterns with high precision, avoids the low inter-rater reliability, and represents a promising approach for future studies that include analysis of more complex predictors of residual flow. In cases of aneurysm recurrence after coiling, the major pattern seems to be a steady increase in intra-aneurysmal flow over several months.
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Burkhardt, Jan-Karl, Michelle H. Chua, Ethan A. Winkler, W. Caleb Rutledge e Michael T. Lawton. "Incidence, classification, and treatment of angiographically occult intracranial aneurysms found during microsurgical aneurysm clipping of known aneurysms". Journal of Neurosurgery 132, n. 2 (febbraio 2020): 434–41. http://dx.doi.org/10.3171/2018.11.jns182416.
Abstract (sommario):
OBJECTIVEDuring the microsurgical clipping of known aneurysms, angiographically occult (AO) aneurysms are sometimes found and treated simultaneously to prevent their growth and protect the patient from future rupture or reoperation. The authors analyzed the incidence, treatment, and outcomes associated with AO aneurysms to determine whether limited surgical exploration around the known aneurysm was safe and justified given the known limitations of diagnostic angiography.METHODSAn AO aneurysm was defined as a saccular aneurysm detected using the operative microscope during dissection of a known aneurysm, and not detected on preoperative catheter angiography. A prospective database was retrospectively reviewed to identify patients with AO aneurysms treated microsurgically over a 20-year period.RESULTSOne hundred fifteen AO aneurysms (4.0%) were identified during 2867 distinct craniotomies for aneurysm clipping. The most common locations for AO aneurysms were the middle cerebral artery (60 aneurysms, 54.1%) and the anterior cerebral artery (20 aneurysms, 18.0%). Fifty-six AO aneurysms (50.5%) were located on the same artery as the known saccular aneurysm. Most AO aneurysms (95.5%) were clipped and there was no attributed morbidity. The most common causes of failed angiographic detection were superimposition of a large aneurysm (type 1, 30.6%), a small aneurysm (type 2, 18.9%), or an adjacent normal artery (type 3, 36.9%). Multivariate analysis identified multiple known aneurysms (odds ratio [OR] 3.45, 95% confidence interval [CI] 2.16–5.49, p < 0.0001) and young age (OR 0.981, 95% CI 0.965–0.997, p = 0.0226) as independent predictors of AO aneurysms.CONCLUSIONSMeticulous inspection of common aneurysm sites within the surgical field will identify AO aneurysms during microsurgical dissection of another known aneurysm. Simultaneous identification and treatment of these additional undiagnosed aneurysms can spare patients later rupture or reoperation, particularly in those with multiple known aneurysms and a history of subarachnoid hemorrhage. Limited microsurgical exploration around a known aneurysm can be performed safely without additional morbidity.
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Heit, Jeremy J., R. Gilberto Gonzalez, David Sabbag, H. Bart Brouwers, Edgar Gerardo Ordonez Rubiano, Pamela W. Schaefer, Joshua A. Hirsch e Javier M. Romero. "Detection and characterization of intracranial aneurysms: a 10-year multidetector CT angiography experience in a large center". Journal of NeuroInterventional Surgery 8, n. 11 (9 novembre 2015): 1168–72. http://dx.doi.org/10.1136/neurintsurg-2015-012082.
Abstract (sommario):
BackgroundCT angiography (CTA) is increasingly used for the detection, characterization, and follow-up of intracranial aneurysms. A lower threshold to request a CT angiogram may render a patient population that differs from previous studies primarily evaluated with conventional angiography. Our objective was to broaden our knowledge of the factors associated with aneurysm rupture and patient mortality in this population.MethodsAll CTA studies performed over a 10-year period at a large neurovascular referral center were reviewed for the presence of an intracranial aneurysm. Patient demographics, mortality, CTA indication, aneurysm location, size, and rupture status were recorded.Results2927 patients with aneurysms were identified among 29 003 CTAs. 17% of the aneurysms were ruptured at the time of imaging, 24% of aneurysms were incidentally identified, and multiple aneurysms were identified in 34% of patients. Aneurysms most commonly arose from the supraclinoid internal carotid artery (22%), the middle cerebral artery (18%), and the anterior communicating artery (13%). Male sex, age <50 years, aneurysms >6 mm, and aneurysms arising from the anterior communicating artery, posterior communicating artery, or the posterior circulation were independent predictors of aneurysm rupture. Independent mortality predictors included male sex, posterior circulation aneurysms, intraventricular hemorrhage, and intraparenchymal hemorrhage.ConclusionsThese results indicate that aneurysms detected on CTA that arise from the anterior communicating artery, posterior communicating artery, or the posterior circulation, measure >6 mm in size, occur in men, and in patients aged <50 years are associated with rupture.
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Wada, Kojiro, Hirohiko Arimoto, Hidenori Ohkawa, Toshiki Shirotani, Yohsitaro Matsushita e Takashi Takahara. "Usefulness of Preoperative Three-Dimensional Computed Tomographic Angiography With Two-Dimensional Computed Tomographic Imaging for Rupture Point Detection of Middle Cerebral Artery Aneurysms". Operative Neurosurgery 62, suppl_1 (1 marzo 2008): ONS126—ONS133. http://dx.doi.org/10.1227/01.neu.0000317382.45691.1a.
Abstract (sommario):
Abstract Objective: We report the technique of three-dimensional computed tomographic (CT) angiography with a two-dimensional CT image aiding in the early operation of ruptured middle cerebral artery aneurysms. This combined image allows the prediction of the rupture point in the aneurysm and may reduce the risk of rupture during early clipping surgery. Methods: The findings for 14 patients with 14 middle cerebral artery ruptured aneurysms who underwent subsequent early clipping were analyzed. The average aneurysm size was 8.5 mm, and there were two large and one giant aneurysms. CT examinations were performed by means of a multidetector CT scanner (Aquilion M16; Toshiba Medical Systems, Tokyo, Japan) and reconstructed with a workstation (ZIO M900 QUADRA; Amin Co., Ltd., Tokyo, Japan). We constructed an operating view through three-dimensional CT angiography for a lateral transsylvian approach with a two-dimensional CT image (nonshaded volume-rendering image), which was perpendicular to the direction of the surgical approach. Using this combined image, we predicted the rupture point of the aneurysm and successfully performed clipping surgery through a lateral transsylvian approach. Rupture points were confirmed at the time of surgery. Rupture points of 13 out of 14 aneurysms appeared as we expected, but one differed; all aneurysms were successfully clipped. Thirteen of the 14 patients could be clipped without rupture at surgery, but the remaining patient experienced rupture just after craniotomy. Conclusion: The combination of three-dimensional CT angiography and two-dimensional CT images may help improve the surgical outcome by indicating aneurysmal rupture points, leading to the prevention of rupture.
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Mohammad, Nur, Jalal Uddin Mohammad Rumi, Sadia Jabeen Khan, Kalim Uddin e Patoary Mohammed Faruque. "Diagnostic Validity of 3D-Computed Tomographic Angiography in Spontaneous Subarachnoid Haemorrhage". Journal of National Institute of Neurosciences Bangladesh 5, n. 1 (12 luglio 2019): 47–52. http://dx.doi.org/10.3329/jninb.v5i1.42169.
Abstract (sommario):
Background: Diagnostic validity of different tests for the detection of spontaneous subarachnoid haemorrhage is an important issue.
Objectives: The purpose of the present study was to validate 3D-Computed tomographic angiography in spontaneous subarachnoid haemorrhage.
Methodology: This cross-sectional study was carried out in the Department of Neurosurgery and Cath Lab of DMCH in collaboration with private diagnostic centre from September 2013 to February 2015 for a period of six (06) months. Adult patients diagnosed as a case of spontaneous SAH based on clinical features and confirmed by plain CT evidence of subarachnoid blood were included as study population. Patients having current history of trauma, poor clinical grade and agitated patient, patient with renal insufficiency, known allergy to iodinated contrast agent and patients who were not willing participate in the study were excluded from this study. Then both CT angiography and DSA were performed to detect cause of bleeding and to make a treatment planning. In this study DSA was considered as reference standard for evaluation of CTA. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CTA were calculated per patient basis and per aneurysmal basis.
Result: A total number of 37 patients presented with spontaneous subarachnoid haemorrhage were recruited for this study. The mean age of patients was 58.53±7.54 years. Sensitivity and specificity in depicting intracranial aneurysms were, 93.75% and 100% respectively on a per-patient basis. Positive predictive value and negative predictive value of CTA are 100% and 71.43% respectively. CTA had shown 94.59% accuracy in detection of intracranial aneurysm. Sensitivity and specificity in depicting intracranial aneurysms were 94.74% and 100% respectively on a per-aneurysm basis. Positive predictive value and negative predictive value of CTA are 100% and 71.43% respectively. CTA had shown 95.35% accuracy in detection of intracranial aneurysm.
Conclusion: In conclusion CTA has high detection capacity of aneurysm among spontaneous subarachnoid haemorrhage patients.
Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 47-52
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Kangasniemi, Marko, Teppo Mäkelä, Seppo Koskinen, Matti Porras, Kristiina Poussa e Juha Hernesniemi. "Detection of Intracranial Aneurysms with Two-dimensional and Three-dimensional Multislice Helical Computed Tomographic Angiography". Neurosurgery 54, n. 2 (1 febbraio 2004): 336–41. http://dx.doi.org/10.1227/01.neu.0000103448.07132.e1.
Abstract (sommario):
Abstract OBJECTIVE Computed tomographic angiography (CTA) has become a diagnostic method for the detection of intracranial aneurysms in cases of subarachnoid bleeding. We sought to evaluate the detection of aneurysms with CTA with a novel multislice helical computed tomographic scanner. METHODS Prospectively, 179 patients underwent multislice CTA, followed by digital subtraction angiography (DSA) of both carotid arteries with or without the posterior circulation, DSA of one carotid artery with or without the posterior circulation, or DSA of the posterior circulation alone. The total number of carotid arteries studied was 298, and the number of vertebrobasilar arteries studied was 124. RESULTS Of 178 aneurysms verified with DSA or intraoperatively, CTA failed to detect 7 aneurysms of 1 to 2 mm and 1 partially thrombosed, 4-mm aneurysm. The sensitivity and specificity of CTA for aneurysm detection were 0.96 and 0.97, respectively. CONCLUSION The first generation of multislice computed tomographic technology does not improve CTA to surpass DSA for the detection of small aneurysms of 1 to 2 mm. In practice, however, CTA is superior as a fast noninvasive method without complications.
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Valle, Edison P., Rafael J. Tamargo e Philippe Gailloud. "Thrombosis and subsequent recanalization of a ruptured intracranial aneurysm in 2 children, demonstrating the value of repeating catheter angiography after an initial negative study". Journal of Neurosurgery: Pediatrics 5, n. 4 (aprile 2010): 346–49. http://dx.doi.org/10.3171/2009.10.peds0966.
Abstract (sommario):
The cases of 2 children with true aneurysmal subarachnoid hemorrhages (SAHs) and initial false-negative angiograms are reported. In both cases, the initial angiogram was of adequate technical quality and included the projections on which aneurysms were later documented. There was no significant vasospasm at the time of initial angiography; therefore, transient aneurysm sac thrombosis was the most likely explanation for the initial false-negative studies. It is particularly interesting to note that 1 of the 2 patients had a pattern of hemorrhage compatible with the most limited definition of a perimesencephalic SAH, that is, a small prepontine cistern hemorrhage. If a second angiogram had been deemed unnecessary based on that criterion alone, a ruptured basilar tip aneurysm would have escaped detection and treatment.
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Strayle-Batra, M., M. Skalej, A. K. Wakhloo, U. Ernemann, R. Klier e K. Voigt. "Three-dimensional spiral CT angiography in the detection of cerebral aneurysm". Acta Radiologica 39, n. 3 (maggio 1998): 233–38. http://dx.doi.org/10.1080/02841859809172186.
Abstract (sommario):
Purpose: The value of CT angiography in the detection and evaluation of aneurysms was compared to digital subtraction angiography (DSA) Material and Methods: Seventeen patients with acute subarachnoid hemorrhage (SAH) or with known or suspected aneurysm were investigated by means of spiral CT angiography, which included 3D reconstruction. These findings were compared with those at DSA Results: In 16 patients, 20 aneurysms were found; the remaining patient had an ectatic vessel that simulated an aneurysm. Seventeen of the angiographically proved aneurysms were detected at CT angiography (sensitivity 85%). One further aneurysm was identified retrospectively as the result of greater experience in the method. All the aneurysms that escaped detection at CT were 3 mm in size. All the vessels of the circle of Willis, except for the posterior communicating artery, were properly evaluated at CT angiography. Difficulties were encountered in assessing the posterior communicating artery and the extradural segment of the internal carotid artery owing to their close spatial relationship to the bony structures of the skull base and the cavernous sinus Conclusion: CT angiography is a low-risk technique with a low level of invasiveness that is useful in following up known aneurysms. The 3D reconstruction yields further topographic information that helps in the planning of endovascular or surgical intervention. The facility for rotating the reconstructed vessels and displaying them from different angles is of particular value in cases difficult to assess at angiography
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Rahmany, Ines, e Nawres Khlifa. "A priori knowledge integration for the detection of cerebral aneurysm". Biomedical Engineering / Biomedizinische Technik 63, n. 4 (26 luglio 2018): 445–52. http://dx.doi.org/10.1515/bmt-2016-0168.
Abstract (sommario):
Abstract The detection of intracranial aneurysms is of a paramount effect in the prevention of cerebral subarachnoid hemorrhage. We propose in this paper, a new approach to detect cerebral aneurysm in digital subtraction angiography (DSA) images by fusing several sources of knowledge. After a brief description of a priori knowledge that the expert has provided about cerebral aneurysm, we propose a system architecture including fuzzy modeling and data fusion. The results on the studied cases are very promising.
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Lauric, Alexandra, Kilian Greim-Kuczewski, Alexei Antonov, Gabriel Dardik, Jane K. Magida, James E. Hippelheuser, Kenichi Kono e Adel M. Malek. "Proximal Parent Vessel Tapering is Associated With Aneurysm at the Middle Cerebral Artery Bifurcation". Neurosurgery 84, n. 5 (26 maggio 2018): 1082–89. http://dx.doi.org/10.1093/neuros/nyy152.
Abstract (sommario):
Abstract BACKGROUND Cerebral aneurysm initiation and evolution have been linked to hemodynamic and morphological factors. Stenotic morphology upstream to a bifurcation can alter hemodynamic patterns and lead to destructive vessel wall remodeling and aneurysm initiation. The effect of more subtle proximal variations in vessel diameter on bifurcation aneurysm development has not been evaluated. OBJECTIVE To investigate whether vessel tapering is associated with aneurysmal presence at the middle cerebral artery (MCA) bifurcation. METHODS Bilateral catheter three-dimensional rotational angiographic datasets from 33 patients with unilateral unruptured MCA aneurysms and 44 datasets from healthy patients were analyzed. Equidistant cross-sectional cuts were generated along the MCA M1 segment with cross-sectional area measurement using edge-detection filtering. Relative tapering of the M1 segment was evaluated as the TaperingRatio. Computational fluid dynamics (CFD) simulations were performed on bilateral patient models and parametric MCAs of constant and tapered inflow vessel. RESULTS MCA leading to aneurysms had significantly lower TaperingRatio (0.88 ± 0.15) compared to contralateral (1.00 ± 0.16, P = .002) and healthy MCAs (1.00 ± 0.15, P > .001, area under the curve = 0.73), which showed little to no tapering. CFD simulations showed that vessel tapering leads to flow acceleration with higher wall shear stress (WSS) and WSS gradients at the bifurcation apex. CONCLUSION Aneurysmal but not contralateral or control MCA M1 segments demonstrate a previously undescribed progressive distal tapering phenomenon. This upstream vessel narrowing leads to flow acceleration that accentuates WSS and spatial gradients at the bifurcation apex, a pattern previously shown to favor aneurysm initiation and progression.
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Miyayama, Shiro, Masashi Yamashiro, Takahiro Ogi, Masanori Kayahashi, Kenji Kawamura, Miki Yoshida, Takuro Terada e Ikuko Kosugi. "Usefulness of automated feeder-detection software for identification of access routes to small pancreaticoduodenal artery aneurysms during embolotherapy". Vascular 23, n. 6 (13 gennaio 2015): 663–67. http://dx.doi.org/10.1177/1708538114567186.
Abstract (sommario):
The mortality rate of patients with ruptured pancreaticoduodenal artery aneurysms is high; therefore, it is recommended to treat pancreaticoduodenal artery aneurysms regardless of their size. In small pancreaticoduodenal artery aneurysms, however, identification of the access route on two-dimensional arteriography is sometimes difficult because of the superimposition of many hypertrophied branches of pancreaticoduodenal arteries on the aneurysm. We report two cases of ruptured pancreaticoduodenal artery aneurysm embolized successfully with metallic coils, assisted by automated feeder-detection software using cone-beam computed tomography data. This new technology may reduce physicians’ workload during the procedure.
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Songsaeng, Dittapong, Ittichai Sakarunchai, Sakun Mongkolnaowarat, Sasithorn Harmontree, Prapaporn Pornpunyawut, Anek Suwanbundit, Shuo Zhang e Timo Krings. "Detection and Measurement of Intracranial Aneurysm Compared between Magnetic Resonance Intracranial Black Blood Vessel Imaging and Gold Standard Cerebral Digital Subtraction Angiography". Journal of Neurosciences in Rural Practice 11, n. 04 (13 luglio 2020): 545–51. http://dx.doi.org/10.1055/s-0040-1714042.
Abstract (sommario):
Abstract Background Magnetic resonance intracranial black blood vessel imaging (MR-IBBVI) is a new noninvasive method for evaluating intracranial vessel wall pathology. No previous studies have investigated the efficacy of MR-IBBVI to determine aneurysm size. We aimed to identify the precise diagnosis of MR-IBBVI for the detection and measurement of intracranial aneurysm compared with gold standard cerebral digital subtraction angiography (cDSA). Materials and Methods The retrospective study collected patients of precoiled or postcoiled intracranial aneurysm who were treated at our institute from January 2012 to June 2019 and who had MR-IBBVI, cDSA imaging, and/or three-dimensional time-of-flight sequence of magnetic resonance angiography. The sensitivity and specificity of aneurysm detection by MR-IBBVI and the accuracy of MR-IBBVI for measuring the aneurysm and vessel size were calculated. Results One hundred and twenty patients (61% female) with 132 aneurysms were included into this study. The mean aneurysm size was 5.3 mm (range: 2.2–22.6). Sensitivity and specificity of MR-IBBVI to detect a small aneurysm were 98.74 and 91.21%, respectively. No statistically significant results were observed between MR-IBBVI and DSA for aneurysm detection or any of the evaluated measurement parameters. Conclusion MR-IBBVI is an accurate and highly sensitive method to detect and evaluate the size of an intracranial aneurysm both before and after coiling.
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Nakayama, Ken, Tadashi Furuyama, Yutaka Matsubara, Koichi Morisaki, Toshihiro Onohara, Tetsuo Ikeda e Tomoharu Yoshizumi. "Gut dysbiosis and bacterial translocation in the aneurysmal wall and blood in patients with abdominal aortic aneurysm". PLOS ONE 17, n. 12 (14 dicembre 2022): e0278995. http://dx.doi.org/10.1371/journal.pone.0278995.
Abstract (sommario):
Inflammation plays a part in the development of abdominal aortic aneurysm (AAA), and the gut microbiota affects host inflammation by bacterial translocation. The relationship between abdominal aortic aneurysm and the gut microbiota remains unknown. This study aimed to detect bacterial translocation in the aneurysmal wall and blood of patients with abdominal aortic aneurysm, and to investigate the effect of the gut microbiota on abdominal aortic aneurysm. We investigated 30 patients with abdominal aortic aneurysm from 2017 to 2019. We analysed the aneurysmal wall and blood using highly sensitive reverse transcription-quantitative polymerase chain reaction, and the gut microbiota was investigated using next-generation sequencing. In the 30 patients, bacteria were detected by reverse transcription- quantitative polymerase chain reaction in 19 blood samples (detection rate, 63%) and in 11 aneurysmal wall samples (detection rate, 37%). In the gut microbiota analysis, the Firmicutes/Bacteroidetes ratio was increased. The neutrophil-lymphocyte ratio was higher (2.94 ± 1.77 vs 1.96 ± 0.61, P < 0.05) and the lymphocyte-monocyte ratio was lower (4.02 ± 1.25 vs 5.86 ± 1.38, P < 0.01) in the bacterial carrier group than in the bacterial non-carrier group in blood samples. The volume of intraluminal thrombus was significantly higher in the bacterial carrier group than in the bacterial non-carrier group in aneurysmal wall samples (64.0% vs 34.7%, P < 0.05). We confirmed gut dysbiosis and bacterial translocation to the blood and aneurysmal wall in patients with abdominal aortic aneurysm. There appears to be a relationship between the gut microbiota and abdominal aortic aneurysm.
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Maeder, Philippe P., Reto A. Meuli e Nicolas de Tribolet. "Three-dimensional volume rendering for magnetic resonance angiography in the screening and preoperative workup of intracranial aneurysms". Journal of Neurosurgery 85, n. 6 (dicembre 1996): 1050–55. http://dx.doi.org/10.3171/jns.1996.85.6.1050.
Abstract (sommario):
✓ This study was undertaken to evaluate the capacity of three-dimensional (3-D) time-of-flight (TOF) magnetic resonance (MR) angiography with VoxelView (VV) 3-D volume rendering to detect and characterize intracranial aneurysms and to compare this rendering technique with that of maximum intensity projection (MIP). Forty patients with a total of 53 intracranial aneurysms (10 giant and subgiant, 43 saccular) were consecutively admitted to University Hospital, Lausanne, Switzerland, and investigated with 3-D TOF MR angiography. Source images of the 43 saccular aneurysms were processed with both MIP and VV. The aneurysm detection rate of the two techniques and their ability to characterize features of an aneurysm, such as its neck and its relation to the parent vessel, were compared. Intraarterial digital subtraction angiography was used as the gold standard to which these techniques could be compared and evaluated. Four aneurysms, less than 3 mm in size, were missed using MIP compared to three missed using VV. The representation of aneurysmal morphology using VV was superior to that found using conventional angiography in nine cases, equal in 16 cases, and inferior in seven cases. The representation of the aneurysm neck using VV was superior to MIP in 21 cases, equal in 17 cases, and inferior in one case; it was superior to that shown using conventional angiography in 10 cases, equal in 18 cases, and inferior in four cases. Time-of-flight MR angiography in conjunction with both MIP and VV 3-D reconstruction was able to visualize all aneurysms that were larger than 3 mm. Compared to MIP, VV provides a better definition of the aneurysm neck and the morphology of saccular aneurysms, making VV valuable for use in a preoperative diagnostic workup.
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Ignatenko, Grigory A., Ilya S. Grekov, Marina V. Grushina e Anna V. Dubovyk. "Clinical case of syphilitic mesaortitis complicated by aortic aneurysm". Journal of Clinical Practice 10, n. 4 (13 febbraio 2020): 94–98. http://dx.doi.org/10.17816/clinpract16150.
Abstract (sommario):
The modern epidemiological picture of syphilis is such that the detection of syphilitic mesaortitis, as a manifestation of cardiovascular pathology in tertiary syphilis, represents only 10% of cases. One of the most frequent and serious complications of mesaortitis is an aortic aneurysm. The nonspecific nature of symptoms and clinical course of such aneurysms sometimes complicates the timely detection of this pathology, that leads to high mortality at the hospital stage. This article describes a rare case of syphilitic mesaortitis complicated by aortic aneurysm.
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Muras, I., A. Rispo, D. Esposito, F. Rinaldi e F. P. Bernini. "Aneurismi arteriosi intracranici associati ad altre anomalie vascolari". Rivista di Neuroradiologia 10, n. 2_suppl (ottobre 1997): 179–81. http://dx.doi.org/10.1177/19714009970100s278.
Abstract (sommario):
After subarachnoid hemorrage, the first aim in performing angiographic investigation, is to recognize the cause of bleeding. The arteriography can identify an aneurysm, the most frequent vascular malformation, but also associated vascular abnormalities. We report our experience on a study using angiographic investigation to explore intracranial aneurysms. Our data confirme high occurrence of kinking, coiling and others vascular abnormalities of the Willis circle and of the vertebral arteries, associated with aneurysms. This association suggests new concepts of aneurysm formation and must induce to detection of some aneurysms before rupture.
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Zotikov, A. E., M. R. Khokonov, K. Kh Eminov, A. M. Solovieva, A. V. Kozhanova, V. S. Ostapenko, A. Yu Shchedrina et al. "A case of successful surgical treatment of a ruptured giant aneurysm of the infrarenal aorta in an elderly patient". Aterotromboz = Atherothrombosis, n. 1 (13 luglio 2021): 157–63. http://dx.doi.org/10.21518/2307-1109-2021-11-1-157-163.
Abstract (sommario):
Today, abdominal aortic aneurysm surgery is a fairly well-studied area of medicine. Nevertheless, some questions remain rather debatable. No clear criteria for giant aneurysms have been developed so far. The available foreign and domestic literature reports about 40 cases of surgical treatment of giant abdominal aortic aneurysms, 16 of which are cases of aneurysm rupture. Open surgery remains the method of choice in the treatment of giant aneurysms due to the pronounced technical difficulties of endovascular intervention. The authors present a case of successful surgical treatment of a giant aneurysm rupture in an elderly patient. The peculiarity of this patient's condition is the occurrence of aneurysm rupture after hospital admission. The patient refused surgical treatment for two years after aneurysm detection. On examination after admission, multispiral computed tomography revealed an aneurysm size of 101 mm. On the eve of surgery, pain syndrome in the left abdomen and tachycardia appeared. Aneurysm rupture was suspected and the patient was urgently admitted to the operating room. The surgery was performed under the conditions of machine reinfusion of autoblood. The patient underwent abdominal aortic aneurysm resection with linear prosthesis and retroperitoneal hematoma removal. The postoperative period had no peculiarities. On the 10th day after the operation the patient was discharged in satisfactory condition to the outpatient treatment. This clinical case demonstrates the possibility of successful surgical treatment of giant aneurysm rupture in elderly patients.
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Islam, Mahmudul, Ahmed Hossain Chowdhury, Md Shah Jahirul Hoque Chowdhury, Md Nahidul Islam, Abu Nayeem, Sharifuddin Khan, Kazi Mohibur Rahman, Rabindranath Sarkar e Quazi Deen Mohammad. "A comparative study of computed Tomographic Angiography and digital subtraction Angiography in evaluation of Aneurysmal Subarachnoid Haemorrhage". Journal of Dhaka Medical College 22, n. 2 (9 gennaio 2015): 195–200. http://dx.doi.org/10.3329/jdmc.v22i2.21542.
Abstract (sommario):
Context: The aim of the study was to retrospectively analyze the performance of Computed Tomographic Angiography (CTA) in detecting, localizing and sizing intracranial aneurysms in patients of aneurysmal subarachnoid haemorrhage using Digital Subtraction Angiography (DSA) as standard. Methods: The study was carried out from December 2009 to November 2010 in the Dept. of Neurology of Dhaka Medical College Hospital, Dhaka. Among 81 patients of SAH admitted in the above mentioned period, 30 were enrolled in the study as they met the inclusion criteria. Patients age range was 26 to 70 years; male female ratio was 1.5: 1. All the study patients underwent both DSA and CTA examinations. The findings of both procedures were recorded and compared. Results: A total of 30 aneurysms in 30 patients were identified on DSA. Among 10 small sized aneurysms (<4 mm) detected by DSA, CTA incorrectly diagnosed 2 and overlooked 2 aneurysms. Out of 14 medium sized (5- 12 mm) identified on DSA, CTA missed 2 aneurysms. But CTA correctly diagnosed all 6 large (e13 mm) aneurysms. The overall sensitivity of CTA was 60% for small, 85.7% for medium and 100% for large aneurysm. Regarding identification of aneurysmal sites, CTA correctly localized 22 (73.4%), incorrectly localized 4 (13.3%) and missed 4 (13.3%) cases. Sensitivity of CTA in identification of aneurysmal site was 73.3%. Conclusion: CTA is less sensitive than DSA in detecting small and medium sized aneurysms. However it correlated perfectly with DSA in detection of large aneurysms. The performance of CTA in identification of aneurysmal site is also lesser than DSA. So, DSA remains the standard technique for evaluation of aneurysmal SAH. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21542 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 195-200
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Nagahiro, Shinji, Jun-ichiro Hamada, Yuji Sakamoto e Yukitaka Ushio. "Follow-up evaluation of dissecting aneurysms of the vertebrobasilar circulation by using gadolinium-enhanced magnetic resonance imaging". Journal of Neurosurgery 87, n. 3 (settembre 1997): 385–90. http://dx.doi.org/10.3171/jns.1997.87.3.0385.
Abstract (sommario):
✓ The authors assessed the reliability of magnetic resonance (MR) imaging contrast enhancement for the detection and follow-up evaluation of dissecting aneurysms of the vertebrobasilar circulation. Twenty consecutively admitted patients who underwent both gadolinium-enhanced MR imaging and conventional angiography were reviewed. Enhancement of the dissecting aneurysm was seen in all but one of the 20 patients, including 10 (71%) of 14 patients examined in the chronic phases, when the T1-hyperintensity signal that corresponded to the intramural hematoma was unrecognizable. The enhanced area corresponded to the “pearl sign” or aneurysm dilation noted on the comparable angiogram. On follow-up MR studies enhancement had spontaneously disappeared in four patients at a time when comparable vertebral angiograms revealed disappearance of the aneurysm dilation. The enhancement persisted in five of nine patients examined more than 24 weeks after symptom onset; in all five patients the aneurysm dilation remained on comparable angiograms. Dynamic MR studies showed rapid and remarkable enhancements with their peaks during the immediate dynamic phase after injection of the contrast material. The authors conclude that gadolinium-enhanced MR imaging is useful for the detection and follow-up evaluation of dissecting aneurysms of the vertebrobasilar circulation.
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Mohammad Rumi, Jalal Uddin, Mohammad Aftab Haleem, Md Bashir Ahammed, Samsul Arifin, Md Rakibul Islam e Forhad Hossain Chowdhury. "Comparison of 3D-Computed Tomographic Angiography with Digital Subtraction Angiography for Detection of aneurysms among Spontaneous Subarachnoid Haemorrhagic Patients". Journal of National Institute of Neurosciences Bangladesh 8, n. 2 (15 gennaio 2023): 121–25. http://dx.doi.org/10.3329/jninb.v8i2.63745.
Abstract (sommario):
Background: Detection of aneurysms among spontaneous subarachnoid haemorrhagic patients is a crucial issue for management.
Objectives: The purpose of the present study was to compare the findings of 3D-computed tomographic angiography with digital subtraction angiography for detection of aneurysms among spontaneous subarachnoid haemorrhagic patients.
Methodology: This comparative cross-sectional study was carried out in the Department of Neurosurgery and Cath Lab of Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh in collaboration with private diagnostic centre from September 2013 to February 2015 for a period of six (06) months. Adult patients diagnosed as a case of spontaneous SAH based on clinical features and confirmed by plain CT evidence of subarachnoid blood were included as study cases. Then both CTA and DSA were done in order to detect the cause of bleeding and make a treatment planning. All spiral CTAs were performed on a helical CT-Scan. Four vessels DSA were performed via a femoral approach in DMCH Cath Lab.
Result: A total number of 37 patients presented with spontaneous subarachnoid haemorrhage were recruited for this study. CT Angiogram revealed aneurysm in 30(81.08%) patients. AVM found in 02(05.41%) patients and in 5(13.51%) patients CTA was negative for any abnormality. DSA of 37 patients revealed aneurysm in 32(86.49%) patients, AVM in 02(05.41%) patients and negative findings in 03(8.11%) patients. In CT Angiogram 25(67.57%) patients had single aneurysm. In DSA, 27(72.97%) patients had single aneurysm. The mean of the size of the aneurysms in CTA and DSA were in 6.70±3.04 mm and 6.75±2.94 mm (p>0.05). The mean of the neck width of the aneurysms in CTA and DSA were 3.86±2.06 mm and 3.41±1.67 mm (p>0.05). All aneurysm detected in CTA were also revealed in DSA.
Conclusion: In conclusion the size, neck width and the location of aneurysm are detected in CTA and DSA equally without any statistical significant difference.
Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):121-125
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Walkoff, Lara, Waleed Brinjikji, Aymeric Rouchaud, Jildaz Caroff e David F. Kallmes. "Comparing magnetic resonance angiography (MRA) and computed tomography angiography (CTA) with conventional angiography in the detection of distal territory cerebral mycotic and oncotic aneurysms". Interventional Neuroradiology 22, n. 5 (8 luglio 2016): 524–28. http://dx.doi.org/10.1177/1591019916653247.
Abstract (sommario):
Background Mycotic and oncotic aneurysms may result in devastating neurologic sequelae if undetected. The objectives of this study were to examine interobserver variability and accuracy of cross-sectional imaging for the detection of distal territory mycotic and oncotic aneurysms. Methods We searched our institutional database for all radiology reports from 2005 to 2015 with an indication or diagnosis of mycotic or oncotic aneurysm. Patients who underwent DSA and either CTA or MRA within 12 weeks of each other were identified. The cross-sectional images from each study were blinded and reviewed by two radiologists. If positive for aneurysm, location and number of aneurysms were reported. Sensitivity, specificity, positive predictive value, negative predictive value, and interobserver variability were determined for MRA and MRA/CTA. Results Twenty-five patients were included in this study. Ten (40%) harbored distal aneurysms. Cross-sectional imaging had a sensitivity of 45.5%, specificity of 90.0%, and kappa value of 0.29 (0.00–0.69) for the detection of cerebral mycotic and oncotic aneurysms. Conclusions Because of the low sensitivity and high interobserver variability of cross-sectional imaging, DSA should remain the gold standard for evaluation of suspected oncotic and mycotic aneurysms. In cases in which cross sectional imaging is negative and there is a high clinical suspicion for mycotic aneurysm, DSA should be strongly considered.
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Hirji, Sameer A., Faith C. Robertson, Sergio Casillas, James T. McPhee, Naren Gupta, Michelle C. Martin e Joseph D. Raffetto. "Asymptomatic portal vein aneurysms: To treat, or not to treat?" Phlebology: The Journal of Venous Disease 33, n. 8 (26 settembre 2017): 513–16. http://dx.doi.org/10.1177/0268355517733375.
Abstract (sommario):
Background Portal vein aneurysms are rare dilations in the portal venous system, for which the etiology and pathophysiological consequences are poorly understood. Method We reviewed the existing literature as well as present a unique anecdotal case of a patient presenting with a very large portal vein aneurysm that was successfully managed conservatively and non-operatively without anticoagulation, with close follow-up and routine surveillance. Result The rising prevalence of abdominal imaging in clinical practice has increased rates of portal vein aneurysm detection. While asymptomatic aneurysms less than 3 cm can be clinically observed, surgical intervention may be necessary in large asymptomatic aneurysms (>3 cm) with or without thrombus, or small aneurysms with evidence of evolving mural thrombus formation on imaging. Conclusion Portal vein aneurysms present a diagnostic challenge for any surgeon, and the goal for surgical therapy is based on repairing the portal vein aneurysm, and if portal hypertension is present decompressing via surgically constructed shunts.
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Sreenivasan, Sanjeev A., Neha Agarwal, Sudipta Roychowdhury, Priyank Khandelwal, Anil Nanda e Gaurav Gupta. "Sequential aneurysms with incidental persistent primitive trigeminal artery: Is this association purely coincidental? A case study and review of the literature in search for a pathobiological mechanism". Surgical Neurology International 13 (4 novembre 2022): 508. http://dx.doi.org/10.25259/sni_828_2022.
Abstract (sommario):
Background: The appearance of sequential bilateral aneurysms in patients with persistent primitive trigeminal artery (PTA) is not described in the literature. No clear guidelines on screening and follow-up of patients with incidental PTAs for the detection of associated lesions have been established. Case Description: A 55-year-old lady presented with occasional headaches. Detailed evaluation showed a left ophthalmic segment internal carotid artery (ICA) aneurysm measuring (11.2 × 5.5) mm. A bovine aortic arch configuration (type III) and a persistent left PTA were identified. A pipeline flex flow diverter was placed and aneurysm was coiled. Follow-up angiography after 6 months showed a completely occluded aneurysm with preserved PTA and a new aneurysm in the right ICA ophthalmic segment measuring 3.5 × 1.5 mm. It was followed up serially with angiography which revealed significant increase in 6 months. The base measured 5.4 mm and two blebs 3.1 mm and 2.5 mm had appeared on the dome. A SUPRASS flow diverter was placed across this aneurysm. Serial follow-up showed complete occlusion of the left aneurysm and significant reduction in filling of the right aneurysm. A review of the literature identified 34 cases of incidental PTAs associated with 50 aneurysms with increased prevalence of anterior circulation aneurysms in patients with incidental PTA. Conclusion: Sequential angiography of a patient with incidental PTA and an ICA aneurysm shows presence of a new aneurysm in contralateral circulation and its progression in size and morphology. Detailed large-scale studies are needed to assess the impact of incidental PTA on aneurysm development and management.
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Della Puppa, Alessandro, Oriela Rustemi, Marta Rossetto, Giorgio Gioffrè, Marina Munari, Fady T. Charbel e Renato Scienza. "The “Squeezing Maneuver” in Microsurgical Clipping of Intracranial Aneurysms Assisted by Indocyanine Green Videoangiography". Operative Neurosurgery 10, n. 2 (3 marzo 2014): 208–13. http://dx.doi.org/10.1227/neu.0000000000000334.
Abstract (sommario):
Abstract BACKGROUND: Indocyanine green videoangiography (ICGV) is becoming routine in intracranial aneurysm surgery to assess intraoperatively both sac obliteration and vessel patency after clipping. However, ICGV-derived data have been reported to be misleading at times. We recently noted that a simple intraoperative maneuver, the “squeezing maneuver,” allows the detection of deceptive ICGV data on aneurysm exclusion and allows potential clip repositioning. The squeezing maneuver is based on a gentle pinch of the dome of a clipped aneurysm when ICGV documents its apparent exclusion. OBJECTIVE: To present the surgical findings and the clinical outcome of this squeezing maneuver. METHODS: Data from 23 consecutive patients affected by intracranial aneurysms who underwent the squeezing maneuver were analyzed retrospectively. The clip was repositioned in all cases when the dyeing of the sac was visualized after the maneuver. RESULTS: In 22% of patients, after an initial ICGV showing the aneurysm exclusion after clipping, the squeezing maneuver caused the prompt dyeing of the sac; in all cases, the clip was consequently repositioned. A calcification/atheroma of the wall/neck was predictive of a positive maneuver (P = .001). The aneurysm exclusion rate at postoperative radiological findings was 100%. CONCLUSION: With the limits of our small series, the squeezing maneuver appears helpful in the intraoperative detection of misleading ICGV data, mostly when dealing with aneurysms with atheromatic and calcified walls.
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Dwivedi, Amit Nandan Dhar, Ananthakrishnan Srinivasan e Shivi Jain. "Multiple Mycotic Aneurysms of the Abdominal Aorta Illustrated on MDCT Scanner". Journal of Clinical Imaging Science 5 (31 agosto 2015): 49. http://dx.doi.org/10.4103/2156-7514.163993.
Abstract (sommario):
Infective mycotic aneurysm of the aorta is a rare and life-threatening disease. A patient presenting with constitutional symptoms and pulsatile abdominal mass should raise a suspicion of mycotic aneurysm. Early detection of aortic mycotic lesions in such patients should play a key role in the treatment of aortic aneurysms. Multiple mycotic aneurysms of abdominal aorta in a young male are a rare manifestation of the disease. Multidetector computerized tomography (CT) is an essential tool in identifying the etiology, pathogenesis, protean manifestations of systemic tuberculosis, and ultimately deciding the course of treatment.
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Nakagawa, Daichi, Kohsuke Kudo, Olatilewa Awe, Mario Zanaty, Yasunori Nagahama, Cameron Cushing, Vincent Magnotta et al. "Detection of microbleeds associated with sentinel headache using MRI quantitative susceptibility mapping: pilot study". Journal of Neurosurgery 130, n. 4 (aprile 2019): 1391–97. http://dx.doi.org/10.3171/2018.2.jns1884.
Abstract (sommario):
OBJECTSentinel headaches (SHs) associated with cerebral aneurysms (CAs) could be due to microbleeds, which are considered a sign that an aneurysm is unstable. Despite the prognostic importance of these microbleeds, they remain difficult to detect using routine imaging studies. The objective of this pilot study is to detect microbleeds associated with SH using a magnetic resonance imaging (MRI) quantitative susceptibility mapping (QSM) sequence and then evaluate the morphological characteristics of unstable aneurysms with microbleeds.METHODSTwenty CAs in 16 consecutive patients with an initial presentation of headache (HA) leading to a diagnosis of CA were analyzed. Headaches in 4 of the patients (two of whom had 2 aneurysms each) met the typical definition of SH, and the other 12 patients (two of whom also had 2 aneurysms each) all had migraine HA. All patients underwent imaging with the MRI-QSM sequence. Two independent MRI experts who were blinded to the patients’ clinical history performed 3D graphical analysis to evaluate for potential microbleeds associated with these CAs. Computational flow and morphometric analyses were also performed to estimate wall shear and morphological variables.RESULTSIn the 4 patients with SH, MRI-QSM results were positive for 4 aneurysms, and hence these aneurysms were considered positive for non-heme ferric iron (microbleeds). The other 16 aneurysms were negative. Among aneurysm shape indices, the undulation index was significantly higher in the QSM-positive group than in the QSM-negative group. In addition, the spatial averaged wall shear magnitude was lower in the aneurysm wall in direct contact with microbleeds.CONCLUSIONSMRI-QSM allows for objective detection of microbleeds associated with SH and therefore identification of unstable CAs. CAs with slightly greater undulation indices are associated with positive MRI-QSM results and hence with microbleeds. Studies with larger populations are needed to confirm these preliminary findings.
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van Bruggen, Ariane C., Jan J. A. Mooij e Henricus L. Journée. "The Acoustic Detection of Intracranial Aneurysms: A Clinical Study". Neurosurgery 29, n. 6 (1 dicembre 1991): 845–49. http://dx.doi.org/10.1227/00006123-199112000-00007.
Abstract (sommario):
Abstract A new recording method for the acoustical detection of intracranial aneurysms is presented. A study examining the capability of the method to discriminate between patients with an aneurysm and control patients by a simple, objective parameter is reported. Sound signals were recorded over the eyes, and a real-time spectral analysis was performed on these signals. For this study, recordings performed on 26 patients with an aneurysm were compared with recordings on 26 age-and sex-matched control patients without intracerebral abnormalities. As a result of measures taken to reduce artifacts and to improve the signal-to-noise ratio, the measuremmnts were performed reliably, with little inconvenience for the patients; all measurements could be used for analysis. The power spectra measured in the control patients showed a typical, smoothly descending pattern; those measured in the aneurysm patients clearly differed from this pattern, showing peaks of varying width, height, and dominant frequency. For the objective judgment of the power spectra, the power median is introduced. The sensitivity and specificity of this parameter were determined. Possible methods to improve the results will be discussed.
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Brown, Robert D., John Huston, Richard Hornung, Tatiana Foroud, David F. Kallmes, Dawn Kleindorfer, Irene Meissner et al. "Screening for brain aneurysm in the Familial Intracranial Aneurysm study: frequency and predictors of lesion detection". Journal of Neurosurgery 108, n. 6 (giugno 2008): 1132–38. http://dx.doi.org/10.3171/jns/2008/108/6/1132.
Abstract (sommario):
Object Approximately 20% of patients with an intracranial saccular aneurysm report a family history of intracranial aneurysm (IA) or subarachnoid hemorrhage. A better understanding of predictors of aneurysm detection in familial IA may allow more targeted aneurysm screening strategies. Methods The Familial Intracranial Aneurysm (FIA) study is a multicenter study, in which the primary objective is to define the susceptibility genes related to the formation of IA. First-degree relatives (FDRs) of those affected with IA are offered screening with magnetic resonance (MR) angiography if they were previously unaffected, are ≥ 30 years of age, and have a history of smoking and/or hypertension. Independent predictors of aneurysm detection on MR angiography were determined using the generalized estimating equation version of logistic regression. Results Among the first 303 patients screened with MR angiography, 58 (19.1%) had at least 1 IA, including 24% of women and 11.7% of men. Ten (17.2%) of 58 affected patients had multiple aneurysms. Independent predictors of aneurysm detection included female sex (odds ratio [OR] 2.46, p = 0.001), pack-years of cigarette smoking (OR 3.24 for 20 pack-years of cigarette smoking compared with never having smoked, p < 0.001), and duration of hypertension (OR 1.26 comparing those with 10 years of hypertension to those with no hypertension, p = 0.006). Conclusions In the FIA study, among the affected patients' FDRs who are > 30 years of age, those who are women or who have a history of smoking or hypertension are at increased risk of suffering an IA and should be strongly considered for screening.
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Bizjak, Žiga, e Žiga Špiclin. "A Systematic Review of Deep-Learning Methods for Intracranial Aneurysm Detection in CT Angiography". Biomedicines 11, n. 11 (28 ottobre 2023): 2921. http://dx.doi.org/10.3390/biomedicines11112921.
Abstract (sommario):
Background: Subarachnoid hemorrhage resulting from cerebral aneurysm rupture is a significant cause of morbidity and mortality. Early identification of aneurysms on Computed Tomography Angiography (CTA), a frequently used modality for this purpose, is crucial, and artificial intelligence (AI)-based algorithms can improve the detection rate and minimize the intra- and inter-rater variability. Thus, a systematic review and meta-analysis were conducted to assess the diagnostic accuracy of deep-learning-based AI algorithms in detecting cerebral aneurysms using CTA. Methods: PubMed (MEDLINE), Embase, and the Cochrane Library were searched from January 2015 to July 2023. Eligibility criteria involved studies using fully automated and semi-automatic deep-learning algorithms for detecting cerebral aneurysms on the CTA modality. Eligible studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. A diagnostic accuracy meta-analysis was conducted to estimate pooled lesion-level sensitivity, size-dependent lesion-level sensitivity, patient-level specificity, and the number of false positives per image. An enhanced FROC curve was utilized to facilitate comparisons between the studies. Results: Fifteen eligible studies were assessed. The findings indicated that the methods exhibited high pooled sensitivity (0.87, 95% confidence interval: 0.835 to 0.91) in detecting intracranial aneurysms at the lesion level. Patient-level sensitivity was not reported due to the lack of a unified patient-level sensitivity definition. Only five studies involved a control group (healthy subjects), whereas two provided information on detection specificity. Moreover, the analysis of size-dependent sensitivity reported in eight studies revealed that the average sensitivity for small aneurysms (<3 mm) was rather low (0.56). Conclusions: The studies included in the analysis exhibited a high level of accuracy in detecting intracranial aneurysms larger than 3 mm in size. Nonetheless, there is a notable gap that necessitates increased attention and research focus on the detection of smaller aneurysms, the use of a common test dataset, and an evaluation of a consistent set of performance metrics.
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O'Meara, Brian, Jason P. Rahal, Alexandra Lauric e Adel M. Malek. "Benefit of a Sharp Computed Tomography Angiography Reconstruction Kernel for Improved Characterization of Intracranial Aneurysms". Operative Neurosurgery 10, n. 1 (11 settembre 2013): 97–105. http://dx.doi.org/10.1227/neu.0000000000000167.
Abstract (sommario):
Abstract BACKGROUND: Computed tomography angiography (CTA) is the first-line imaging modality used for cerebral aneurysms because of its speed and sensitivity for detection, although digital subtraction angiography is often required for more detailed aneurysm shape delineation. OBJECTIVE: To determine whether a sharper CTA reconstruction kernel can better characterize an aneurysm and improve decision-making before intervention. METHODS: Fifteen patients presenting with aneurysmal subarachnoid hemorrhage underwent 64-row CTA. CTA data were reconstructed using the default H20f smooth kernel and a H60f sharp kernel and compared with contemporaneous catheter 3-dimensional rotational angiography (3DRA). Aneurysm neck, width, and aspect ratio measurements were made using intensity line plots of identical projections on all imaging datasets and compared by matched-pair statistics. RESULTS: Aneurysm neck measurements from the H20f smooth kernel revealed overestimation compared with both the sharp kernel (greater by 0.64 ± 0.21 mm, P < .01) and 3DRA (greater by 0.68 ± 0.19 mm, P < .01). There was no statistically significant difference between 3DRA and the sharp kernel CTA measurements. Neck measurements correlated well between the H60f kernel and 3DRA but not between the H20f Kernel and 3DRA (R 0.97 vs 0.86). CONCLUSION: H60f sharp CTA kernel reconstruction provides more accurate anatomic characterization of cerebral aneurysms than the H20f smooth kernel at the expense of less visually pleasing reconstructions. Because it does not require additional contrast, radiation, or imaging hardware and is more similar to 3DRA, it may aid in selecting the appropriate treatment strategy before to evaluation by catheter-based angiography.
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Lauric, Alexandra, Merih I. Baharoglu e Adel M. Malek. "Size Ratio Performance in Detecting Cerebral Aneurysm Rupture Status Is Insensitive to Small Vessel Removal". Neurosurgery 72, n. 4 (14 dicembre 2012): 547–54. http://dx.doi.org/10.1227/neu.0b013e318282a513.
Abstract (sommario):
Abstract BACKGROUND: The variable definition of size ratio (SR) for sidewall (SW) vs bifurcation (BIF) aneurysms raises confusion for lesions harboring small branches, such as carotid ophthalmic or posterior communicating locations. These aneurysms are considered SW by many clinicians, but SR methodology classifies them as BIF. OBJECTIVE: To evaluate the effect of ignoring small vessels and SW vs stringent BIF labeling on SR ruptured aneurysm detection performance in borderline aneurysms with small branches, and to reconcile SR-based labeling with clinical SW/BIF classification. METHODS: Catheter rotational angiographic datasets of 134 consecutive aneurysms (60 ruptured) were automatically measured in 3-dimensional. Stringent BIF labeling was applied to clinically labeled aneurysms, with 21 aneurysms switching label from SW to BIF. Parent vessel size was evaluated both taking into account, and ignoring, small vessels. SR was defined accordingly as the ratio between aneurysm and parent vessel sizes. Univariate and multivariate statistics identified significant features. The square of the correlation coefficient (R2) was reported for bivariate analysis of alternative SR calculations. RESULTS: Regardless of SW/BIF labeling method, SR was equally significant in discriminating aneurysm ruptured status (P < .001). Bivariate analysis of alternative SR had a high correlation of R2 = 0.94 on the whole dataset, and R2 = 0.98 on the 21 borderline aneurysms. CONCLUSION: Ignoring small branches from SR calculation maintains rupture status detection performance, while reducing postprocessing complexity and removing labeling ambiguity. Aneurysms adjacent to these vessels can be considered SW for morphometric analysis. It is reasonable to use the clinical SW/BIF labeling when using SR for rupture risk evaluation.
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Gomah Hamed Alaqqad, Mohamed, Rami Abou El Foul, Mohammad Seddiq Faghih, Syed Intesar Mehdi Kazmi, Reda Abdelfattah Elmowafi Badran, Leela Ram, Hytham Hassan Elshamsy e Mohamed Abouelfetouh Abouelfetouh Elsharkawi. "CASE REPORT: HEPATIC ARTERY ANEURYSM.A RARE VISCERAL ANEURYSM". International Journal of Advanced Research 10, n. 08 (31 agosto 2022): 1166–70. http://dx.doi.org/10.21474/ijar01/15282.
Abstract (sommario):
Hepatic artery aneurysm (HAA) is a rare disease (0.002%– 0.4%) but is a clinically important phenomenon [1]. HAAs are traditionally the second most common visceral aneurysms with an incidence of 20% and have the highest (44%) reported rate of rupture [2]. The clinical manifestations depending on the size of the aneurysm include epigastric pain, obstruction of biliary tract, rupture and death [3]. Imaging modalities like computed tomography (CT) and CT angiography have a valuable role in the early detection of HHA, its complications, and selecting appropriate treatments depending on the size and location of the aneurysms [4].The etiology of visceral artery aneurysms is mostly atherosclerotic. Trauma and inflammation may cause pseudoaneurysm formation, such as in case of an acute pancreatitis causing periarterial inflammation or vessel erosion from an adjacent pseudocyst[5,6]. Other conditions which are associated with hepatic artery aneurysms are medial degeneration, fibromuscular dysplasia and vasculitis [7]. Atherosclerotic aneurysms are typically extrahepatic while traumatic aneurysms or pseudoaneurysms are more commonly intrahepatic [8].
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Kiyosue, Hiro, Mika Okahara, Shuichi Tanoue, Takaharu Nakamura, Hirofumi Nagatomi e Hiromu Mori. "Detection of the Residual Lumen of Intracranial Aneurysms Immediately after Coil Embolization by Three-dimensional Digital Subtraction Angiographic Virtual Endoscopic Imaging". Neurosurgery 50, n. 3 (1 marzo 2002): 476–85. http://dx.doi.org/10.1097/00006123-200203000-00008.
Abstract (sommario):
Abstract OBJECTIVE: Detection of a small residual lumen after coil embolization is often difficult because of the coil mass and the overlap of the cerebral arteries. The purpose of this study was to assess the usefulness of virtual endoscopic (VE) analysis of three-dimensional digital subtraction angiographic (DSA) images for evaluation of aneurysmal occlusion immediately after the procedure. METHODS: Twenty-seven intracranial aneurysms were treated with coil embolization using a three-dimensional DSA system. Biplane and rotational DSA scanning was performed before and immediately after the procedures. VE images were obtained at a separate workstation, after transfer of the rotational images. Two-dimensional (2D) DSA images and VE images obtained after the procedure were assessed with respect to aneurysmal occlusion. Morphological outcomes and other factors, including location, size, volumetric ratio (coil volume/aneurysm volume), and residual sites, were also evaluated. RESULTS: Seven aneurysms were evaluated as complete occlusion (CO) on both 2D DSA images and VE images. Twelve aneurysms exhibited residual lumina on both 2D DSA images and VE images. Five aneurysms were evaluated as CO on 2D DSA images and as incomplete occlusion on VE images. There were no recurrences among the aneurysms that were evaluated as CO on VE images. Two of five aneurysms that were evaluated as CO on 2D DSA images and as incomplete occlusion on VE images demonstrated regrowth in follow-up examinations. Residual sites and volumetric ratios were correlated with aneurysmal regrowth. CONCLUSION: VE imaging can demonstrate a residual lumen more frequently than can 2D DSA imaging and is useful for evaluating aneurysmal occlusion after coil embolization.