RESUMEN
Optical Coherence Tomography Angiography (OCTA) is a crucial tool in the clinical screening of retinal diseases, allowing for accurate 3D imaging of blood vessels through non-invasive scanning. However, the hardware-based approach for acquiring OCTA images presents challenges due to the need for specialized sensors and expensive devices. In this paper, we introduce a novel method called TransPro, which can translate the readily available 3D Optical Coherence Tomography (OCT) images into 3D OCTA images without requiring any additional hardware modifications. Our TransPro method is primarily driven by two novel ideas that have been overlooked by prior work. The first idea is derived from a critical observation that the OCTA projection map is generated by averaging pixel values from its corresponding B-scans along the Z-axis. Hence, we introduce a hybrid architecture incorporating a 3D adversarial generative network and a novel Heuristic Contextual Guidance (HCG) module, which effectively maintains the consistency of the generated OCTA images between 3D volumes and projection maps. The second idea is to improve the vessel quality in the translated OCTA projection maps. As a result, we propose a novel Vessel Promoted Guidance (VPG) module to enhance the attention of network on retinal vessels. Experimental results on two datasets demonstrate that our TransPro outperforms state-of-the-art approaches, with relative improvements around 11.4% in MAE, 2.7% in PSNR, 2% in SSIM, 40% in VDE, and 9.1% in VDC compared to the baseline method. The code is available at: https://github.com/ustlsh/TransPro.
Asunto(s)
Imagenología Tridimensional , Vasos Retinianos , Tomografía de Coherencia Óptica , Tomografía de Coherencia Óptica/métodos , Humanos , Vasos Retinianos/diagnóstico por imagen , Imagenología Tridimensional/métodos , Heurística , Enfermedades de la Retina/diagnóstico por imagen , Algoritmos , Angiografía/métodosRESUMEN
Diabetic retinopathy is one of the leading causes of blindness around the world. This makes early diagnosis and treatment important in preventing vision loss in a large number of patients. Microaneurysms are the key hallmark of the early stage of the disease, non-proliferative diabetic retinopathy, and can be detected using OCT angiography quickly and non-invasively. Screening tools for non-proliferative diabetic retinopathy using OCT angiography thus have the potential to lead to improved outcomes in patients. We compared different configurations of ensembled U-nets to automatically segment microaneurysms from OCT angiography fundus projections. For this purpose, we created a new database to train and evaluate the U-nets, created by two expert graders in two stages of grading. We present the first U-net neural networks using ensembling for the detection of microaneurysms from OCT angiography en face images from the superficial and deep capillary plexuses in patients with non-proliferative diabetic retinopathy trained on a database labeled by two experts with repeats.
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Retinopatía Diabética , Microaneurisma , Tomografía de Coherencia Óptica , Retinopatía Diabética/diagnóstico por imagen , Humanos , Microaneurisma/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Redes Neurales de la Computación , Angiografía/métodos , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/patología , Angiografía con Fluoresceína/métodosRESUMEN
Haemangioma of the ribs is considered an extremely rare benign tumour. Here, we present a case of a young male with left tenth rib haemangioma vascularised by a costal artery giving the artery of Adamkiewicz presented as chronic cough. This was successfully treated through preoperative embolisation and surgical resection. A preoperative angiogram was performed to identify the origin of the artery of Adamkiewicz. The final diagnosis was confirmed histopathologically. There were no complications in the postoperative course and no recurrence during 12 months of follow-up.
Asunto(s)
Hemangioma , Costillas , Humanos , Masculino , Costillas/diagnóstico por imagen , Costillas/cirugía , Costillas/irrigación sanguínea , Hemangioma/cirugía , Hemangioma/diagnóstico por imagen , Embolización Terapéutica/métodos , Neoplasias Óseas/cirugía , Neoplasias Óseas/diagnóstico por imagen , Adulto , Resultado del Tratamiento , Angiografía , Tos/etiologíaRESUMEN
The internal iliac artery arises as a terminal extension of the common iliac artery and supplies blood to the pelvic region. This study aims to identify the anatomic variations of the internal iliac artery (IIA) in a Mexican population sample. This is a retrospective cross-sectional observational study. A total of 81 angiographies via the femoral artery approach performed on patients undergoing various medical procedures were included. Variations in the IIA branching patterns were identified by evaluating the angiographic images and grouped according to Adachi's classification into five types (I-V). A total of 139 hemipelvises were analyzed (78 right and 61 left). The frequencies of each type of variation were as follows: Type I (71.2%), Type II (10.79%), Type III (0 cases), Type IV (0.7%), Type V (12.94%), and unclassified (4.31%). The most frequent anatomical variants of the IIA in the western Mexican population sample were Type I, followed by Types V and II. Even though Type V is rare in most populations, it was the second most frequent variant in this study. Understanding the variants of the IIA branching pattern is necessary for performing invasive procedures in the pelvic region with precision and minimizing complications.
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Variación Anatómica , Arteria Ilíaca , Humanos , México , Arteria Ilíaca/anatomía & histología , Arteria Ilíaca/diagnóstico por imagen , Femenino , Masculino , Persona de Mediana Edad , Estudios Transversales , Estudios Retrospectivos , Prevalencia , Adulto , Anciano , Angiografía , Anciano de 80 o más AñosRESUMEN
Alzheimer's disease is a type of neurodegenerative disorder that is characterized by the progressive degeneration of brain cells, leading to cognitive decline and memory loss. It is the most common cause of dementia and affects millions of people worldwide. While there is currently no cure for Alzheimer's disease, early detection and treatment can help to slow the progression of symptoms and improve quality of life. This research presents a diagnostic tool for classifying mild cognitive impairment and Alzheimer's diseases using feature-based machine learning applied to optical coherence tomographic angiography images (OCT-A). Several features are extracted from the OCT-A image, including vessel density in five sectors, the area of the foveal avascular zone, retinal thickness, and novel features based on the histogram of the range-filtered OCT-A image. To ensure effectiveness for a diverse population, a large local database for our study was collected. The promising results of our study, with the best accuracy of 92.17,% will provide an efficient diagnostic tool for early detection of Alzheimer's disease.
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Enfermedad de Alzheimer , Disfunción Cognitiva , Tomografía de Coherencia Óptica , Humanos , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/patología , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico , Tomografía de Coherencia Óptica/métodos , Angiografía/métodos , Aprendizaje Automático , Masculino , Anciano , FemeninoRESUMEN
BACKGROUND AND OBJECTIVES: To develop and test VMseg, a new image processing algorithm performing automatic segmentation of retinal non-perfusion in widefield OCT-Angiography images, in order to estimate the non-perfusion index in diabetic patients. METHODS: We included diabetic patients with severe non-proliferative or proliferative diabetic retinopathy. We acquired images using the PlexElite 9000 OCT-A device with a photomontage of 5 images of size 12 x 12 mm. We then developed VMseg, a Python algorithm for non-perfusion detection, which binarizes a variance map calculated through convolution and morphological operations. We used 70% of our data set (development set) to fine-tune the algorithm parameters (convolution and morphological parameters, binarization thresholds) and evaluated the algorithm performance on the remaining 30% (test set). The obtained automatic segmentations were compared to a ground truth corresponding to manual segmentation from a retina expert and the inference processing time was estimated. RESULTS: We included 51 eyes of 30 patients (27 severe non-proliferative, 24 proliferative diabetic retinopathy). Using the optimal parameters found on the development set to tune the algorithm, the mean dice for the test set was 0.683 (sd = 0.175). We found a higher dice coefficient for images with a higher area of retinal non-perfusion (rs = 0.722, p < 10-4). There was a strong correlation (rs = 0.877, p < 10-4) between VMseg estimated non-perfusion indexes and indexes estimated using the ground truth segmentation. The Bland-Altman plot revealed that 3 eyes (5.9%) were significantly under-segmented by VMseg. CONCLUSION: We developed VMseg, an automatic algorithm for retinal non-perfusion segmentation on 12 x 12 mm OCT-A widefield photomontages. This simple algorithm was fast at inference time, segmented images in full-resolution and for the OCT-A format, was accurate enough for automatic estimation of retinal non-perfusion index in diabetic patients with diabetic retinopathy.
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Algoritmos , Retinopatía Diabética , Tomografía de Coherencia Óptica , Humanos , Retinopatía Diabética/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Procesamiento de Imagen Asistido por Computador/métodos , Vasos Retinianos/diagnóstico por imagen , Retina/diagnóstico por imagen , Retina/patología , Angiografía/métodos , Angiografía con Fluoresceína/métodosRESUMEN
OBJECTIVES: The abnormal anatomical alterations of blood vessels during DSA angiography in patients with hematological disorders were retrospectively examined, and the influencing factors of short-term (≤ 6 months) recurrent hemoptysis were statistically analyzed, and the consistency between admission diagnosis and intraoperative diagnosis was evaluated. METHODS: The intraoperative angiography data of patients who underwent selective bronchial artery embolization for hemoptysis in our hospital from January 2022 to December 2022 were reviewed. They were divided into the observation group and the control group based on whether there was recurrent hemoptysis. The Logistic regression model and forest map were employed to analyze the factors influencing the recurrence rate. RESULTS: A total of 104 patients were encompassed in this study (12 cases of tuberculosis, 35 cases of infection, 4 cases of lung cancer, 8 cases of bronchiectasis, 22 cases of arteriovenous fistula, 16 cases of aneurysm, and 7 cases of pulmonary hypertension). The coincidence rate of preoperative and intraoperative diagnoses was 73.1%. Pulmonary arteriovenous fistula and aneurysm were the predominant types of diseases that were misdiagnosed. The short-term recurrence rate was 16.3%, mainly attributed to the reopening of responsible vessels related to embolization, angiography leakage, and leaky embolization of specific types of vessels. The recurrence rate of only patients with arteriovenous fistula and aneurysm accounted for 47% of the total recurrence rate. The right bronchial artery, right internal thoracic artery, right thyroid neck trunk, and age were the independent factors influencing the recurrence of hemoptysis (p < 0.05). CONCLUSIONS: The main reason for angiographic leakage and embolization leakage in cases of hemoptysis is the lack of understanding of the anatomic variations of the vessels responsible. Careful examination of the specific types and locations of the vessels is the principal approach to reducing secondary operations.
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Angiografía , Embolización Terapéutica , Hemoptisis , Recurrencia , Humanos , Hemoptisis/diagnóstico por imagen , Hemoptisis/terapia , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: Spontaneous hemopneumothorax is a rare condition that can be life-threatening if not promptly diagnosed and treated. We report a case of early treatment with transcatheter arterial embolization and video-assisted thoracoscopic surgery. CASE PRESENTATION: A 19-year-old Japanese male was diagnosed with left pneumothorax and underwent chest tube drainage. A total of 10 hours after admission, the patient developed dyspnea, chest pain, and sudden massive bloody effusion. Contrast-enhanced computed tomography revealed contrast extravasation near the left lung apex, and spontaneous hemopneumothorax was diagnosed. Angiography revealed bleeding from a branch of the subscapular artery and transcatheter arterial embolization was performed. The patient underwent video-assisted thoracoscopic surgery and recovered uneventfully. CONCLUSIONS: Anesthesiologists involved in urgent surgeries must be aware that a patient with spontaneous pneumothorax can develop a hemopneumothorax, even when full lung expansion has been obtained following chest tube drainage, owing to latent aberrant artery disruption. Interprofessional team engagement is essential for spontaneous hemopneumothorax management.
Asunto(s)
Drenaje , Embolización Terapéutica , Hemoneumotórax , Cirugía Torácica Asistida por Video , Humanos , Masculino , Hemoneumotórax/terapia , Hemoneumotórax/diagnóstico por imagen , Hemoneumotórax/etiología , Adulto Joven , Tomografía Computarizada por Rayos X , Tubos Torácicos , Resultado del Tratamiento , Hemorragia/terapia , Hemorragia/etiología , Neumotórax/etiología , Neumotórax/terapia , Neumotórax/diagnóstico por imagen , AngiografíaRESUMEN
BACKGROUND: The extent of perfusion of a deep inferior epigastric artery perforator (DIEP) flap is a primary concern for surgeons. This study aimed to determine whether the flap area or volume can be estimated using perforator and flap characteristics. METHODS: Intraoperative flap perfusion was assessed using indocyanine green angiography in patients who underwent DIEP flap breast reconstruction between November 2018 and February 2023. The area perfused by a single dominant perforator was delineated on the surface of the flap and measured using the ImageJ software. Multiple linear regression analysis was conducted to estimate the 'perfusion ratio,' defined as the perfused area divided by the total flap area. Potential predictor variables included flap size (cm2), flap thickness (mm), perforator diameter (mm), perforator rows (medial/lateral), vertical location of perforator (at or above/below the umbilicus), and perforator eccentricity (vertical distance from upper flap margin to perforator, cm). RESULTS: In total, 101 patients were included in this analysis. The mean 'perfusion ratio' was 67.8% ± 11.5%, predicted by perforator diameter (p = 0.022) and vertical location below umbilicus (p < 0.001) with positive correlations and negatively correlated with flap thickness (p = 0.003) in the multivariable analysis. Both perfusion area and weight were predicted by perforator diameter, vertical location of perforator, flap size, and flap thickness (p < 0.001). The coefficient of determination (adjusted R2) for prediction of perfusion weight was higher than that for the perfusion area (75.5% vs. 69.4%). CONCLUSIONS: Flap volume, rather than area, is determined by a perforator of a given diameter and location.
Asunto(s)
Arterias Epigástricas , Mamoplastia , Colgajo Perforante , Humanos , Colgajo Perforante/irrigación sanguínea , Femenino , Arterias Epigástricas/trasplante , Mamoplastia/métodos , Persona de Mediana Edad , Adulto , Verde de Indocianina , Angiografía/métodos , Estudios RetrospectivosRESUMEN
INTRODUCTION: Indocyanine green (ICG) angiography for the intraoperative evaluation of tissue perfusion is commonly used in implant-based breast reconstruction (IBR). The assessment of ICG images depends on the surgeon's interpretation and is qualitative or semiqualitative in nature. To quantify ICG metrics, this study aimed to apply a novel assessment of fill-rate dynamics to predict wound-healing complications and provide pragmatic assessment tools in IBR. METHODS: This was a retrospective cohort study of patients who underwent IBR with ICG using the photodynamic eye (PDE-Neo II) qualitative imaging system between April 2021 and September 2023. ICG recordings were reviewed to quantify the relative surface area and fluorescence intensity of visual perfusion deficits using ImageJ. The primary outcome was the incidence of wound-healing complications. t-tests and logistic regression were performed for statistical testing. RESULTS: A total of 112 patients (201 breasts) were included. The incidence of wound-healing complications was 12.9%. A higher relative surface area of ischemic regions was significantly associated with wound-healing complications (3.3% vs. 0.90%; p = 0.001). The rate of change in the surface area of ischemic regions was significantly associated with wound-healing complications (0.35% per second vs. 1.29% per second; p = 0.003%). On average, the duration of transient ischemic areas was significantly longer in breasts with wound-healing complications (46.0 s vs. 36.0 s, p = 0.01). CONCLUSION: A transient ischemic area of > 5% of the breast and/or failure to resolve transient ischemic areas after 60 s may predict wound-healing complications and inform surgical reconstructive decision-making in IBR.
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Verde de Indocianina , Complicaciones Posoperatorias , Cicatrización de Heridas , Humanos , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Cicatrización de Heridas/fisiología , Colorantes/administración & dosificación , Adulto , Implantación de Mama/métodos , Implantación de Mama/efectos adversos , Angiografía/métodos , Neoplasias de la Mama/cirugía , Mamoplastia/métodos , Mamoplastia/efectos adversos , Implantes de Mama/efectos adversos , Angiografía con Fluoresceína/métodosRESUMEN
BACKGROUND: Over the last decade, microsurgical soft-tissue transfer became the gold standard for various reconstructions throughout the body. Continuous improvement of instruments and surgical techniques, such as intraoperative indocyanine green angiography (ICG-A), allowed for a very high success rate. This study aimed to assess and validate the role of a standard intraoperative ICG-A in free and pedicled flap surgery to improve overall outcomes. PATIENTS AND METHODS: From April 2018 to April 2023, 400 consecutive patients who underwent reconstruction using free and pedicled flaps were enrolled. ICG-A was always performed in a free flap after flap elevation, after microsurgical anastomosis, immediately after the flap inset, and after wound closure. In the pedicled flap, the sequential procedure was performed after flap elevation, flap inset, and wound closure. RESULTS: All 400 patients who underwent flap reconstruction using intraoperative ICG-A had an extremely low incidence of necrosis (0.75% partial necrosis among free and pedicled flaps) and reoperation for perfusion-related complications (0.75% due to acute ischemia and 0.50% due to flap congestion). Minor complications, such as hematoma, seroma, wound dehiscence, and wound infections, were managed with a second operation. No flaps were lost, and all patients were successfully treated. CONCLUSIONS: This study showed how systematic multistep ICG-A for intraoperative assessment of free and pedicled flap perfusion can significantly reduce the complication rate, including flap loss and re-exploration surgeries, in a time- and cost-effective manner.
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Verde de Indocianina , Microcirugia , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Humanos , Femenino , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Microcirugia/métodos , Adulto , Anciano , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Tisulares Libres/irrigación sanguínea , Complicaciones Posoperatorias , Colorantes , Angiografía/métodos , Adolescente , Adulto JovenRESUMEN
BACKGROUND: The existence of multiple code systems and standards has highlighted the necessity for innovative solutions to bridge these discrepancies. OBJECTIVES: This research investigates the utilisation of TermX to tackle the challenges of interoperability in radiology procedures, with a specific emphasis on angiography and X-ray modalities. RESULTS: The study produced a revised RadLex data model and mapping guide, designed to classify radiology services using TermX. In total, 380 concepts were required to comprehensively describe all 622 procedures examined. CONCLUSIONS: Our study demonstrates the effectiveness of TermX in simplifying the process of mapping between code systems, thus enabling more efficient analysis, and reporting of data.
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Systematized Nomenclature of Medicine , Estonia , Angiografía , Codificación Clínica/normas , HumanosRESUMEN
PURPOSE: Transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) is performed after a mapping angiogram involving infusion of radiolabeled macroaggregated albumin to assess for non-target embolization and pulmonary shunting. The purpose of this case series was to evaluate the safety and feasibility of single-session TARE without the initial procedure. MATERIALS AND METHODS: A single-institution case series of 16 consecutive procedures on 15 patients with 18 tumors who underwent an attempted single-session TARE procedures with glass microspheres are presented. A lung shunt fraction (LSF) of 5% was assumed for planning purposes. RESULTS: Sixty-seven percent (10/15) of patients were male with a median age of 72 years. Median tumor size was 2.5 cm (IQR 2.0-3.2 cm). Sixteen of the 18 targeted tumors were untreated prior to the single-session TARE. Rate of technical success was 88% (14/16). Two patients did not ultimately receive a single-session TARE due to intraprocedural findings. The mean administered activity was 2.0 GBq, and the mean MIRD dose was 464 Gy based on pre-treatment anatomic imaging and 800 Gy based on cone-beam CT. There were no cases of radiation pneumonitis. Mean post-procedural calculated lung dose was 4.9 Gy (range 3.1-9.3) based on SPECT. CONCLUSIONS: An initial experience with single-session TARE using Y-90 glass microspheres without pre-procedural mapping angiography and lung shunt estimation demonstrates that it is a feasible and safe treatment option for select patients with small (< 5 cm) HCC. LEVEL OF EVIDENCE IV: Level 4 case series.
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Carcinoma Hepatocelular , Embolización Terapéutica , Neoplasias Hepáticas , Microesferas , Humanos , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/terapia , Masculino , Anciano , Femenino , Embolización Terapéutica/métodos , Persona de Mediana Edad , Resultado del Tratamiento , Radioisótopos de Itrio/uso terapéutico , Estudios de Factibilidad , Anciano de 80 o más Años , Angiografía , Radiofármacos , Estudios RetrospectivosRESUMEN
BACKGROUND AND AIMS: Drug-coated balloons (DCBs) have demonstrated favourable outcomes following endovascular therapy for femoropopliteal artery (FPA) disease. However, uncertainty remains whether the use of intravascular ultrasound (IVUS) can improve the outcomes of DCBs. METHODS: This prospective, multicentre, randomized trial, conducted at seven centres in South Korea, compared the outcomes of IVUS-guided vs. angiography-guided angioplasty for treating FPA disease with DCBs. Patients were assigned to receive IVUS-guided (n = 119) or angiography-guided (n = 118) angioplasty using DCBs. The primary endpoint was 12-month primary patency. RESULTS: Between May 2016 and August 2022, 237 patients were enrolled and 204 (86.0%) completed the trial (median follow-up; 363 days). The IVUS guidance group showed significantly higher primary patency [83.8% vs. 70.1%; cumulative difference 19.6% (95% confidence interval 6.8 to 32.3); P = .01] and increased freedom from clinically driven target lesion revascularization [92.4% vs. 83.0%; difference 11.6% (95% confidence interval 3.1 to 20.1); P = .02], sustained clinical improvement (89.1% vs. 76.3%, P = .01), and haemodynamic improvement (82.4% vs. 66.9%, P = .01) at 12 months compared with the angiography guidance group. The IVUS group utilized larger balloon diameters and pressures for pre-dilation, more frequent post-dilation, and higher pressures for post-dilation, resulting in a greater post-procedural minimum lumen diameter (3.90 ± 0.59 vs. 3.71 ± 0.73 mm, P = .03). CONCLUSIONS: Intravascular ultrasound guidance significantly improved the outcomes of DCBs for FPA disease in terms of primary patency, freedom from clinically driven target lesion revascularization, and sustained clinical and haemodynamic improvement at 12 months. These benefits may be attributed to IVUS-guided optimization of the lesion before and after DCB treatment.
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Angioplastia de Balón , Arteria Femoral , Enfermedad Arterial Periférica , Arteria Poplítea , Ultrasonografía Intervencional , Grado de Desobstrucción Vascular , Humanos , Ultrasonografía Intervencional/métodos , Masculino , Angioplastia de Balón/métodos , Arteria Femoral/diagnóstico por imagen , Femenino , Arteria Poplítea/diagnóstico por imagen , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/diagnóstico por imagen , Estudios Prospectivos , Anciano , Persona de Mediana Edad , Materiales Biocompatibles Revestidos , Resultado del Tratamiento , AngiografíaRESUMEN
Pulmonary angiography is an important invasive diagnostic technique for pulmonary vascular diseases. With the development of pulmonary vascular interventions, pulmonary angiography has been applied more frequently. We focused on the history of pulmonary angiography, anatomy of pulmonary artery, the indications and contraindications of pulmonary angiography, preoperative preparation, operating procedures, the interpretation of pulmonary angiography results and the prevention and management of complications, with the aim of standardizing the operating procedures of pulmonary angiography and improving the diagnosis of pulmonary vascular diseases.Recommendation 1:Given the complexity of pulmonary artery anatomy, pulmonary angiography should be performed in a variety of positions to clearly visualise the morphology of pulmonary artery lesions.Recommendation 2:Pulmonary angiography, as an invasive vascular procedure, should only be performed after the indications have been clearly established, the risks and benefits have been weighed, and informed consent has been obtained.Recommendation 3:Secondary hypertonic or isotonic iodinated contrast agents with iodine concentrations>300 mg/ml are recommended for pulmonary angiography.Recommendation 4:Pulmonary angiography may be performed using the digital subtraction angiography (DSA) mode or cine radiography mode, depending on the patient's cooperation in breath-holding and the needs of the interventional procedure.Recommendation 5:Pulmonary Flow Grade is recommended to depict the blood flow status of pulmonary artery.Recommendation 6:Following pulmonary angiography, the vital signs, oxygenation status and the condition of the puncture site should be closely monitored.
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Arteria Pulmonar , Humanos , Arteria Pulmonar/diagnóstico por imagen , Angiografía/métodos , Consenso , Angiografía de Substracción Digital/métodos , Medios de ContrasteRESUMEN
OBJECTIVE: The objective of this study was to evaluate whether a systematic image assessment protocol using SPY Elite images (LifeCell Corp., US) of viable tissue at the periphery of the surgical field was associated with positive wound healing outcomes following mastectomy and breast reconstruction. METHOD: Patients undergoing mastectomy and subsequent breast reconstruction surgery at a single tertiary medical centre were included. SPY images were prospectively analysed using a systematic image assessment protocol, and an absolute value of mean fluorescence was calculated by measuring peripheral, in-situ tissue from each image. Patient medical records were retrospectively reviewed for demographics, surgical characteristics and postoperative outcomes. These variables were statistically tested for associations with mean fluorescence. RESULTS: A total of 63 patients were included in the final analysis. We found that objectively determined mean fluorescence values were not statistically significantly associated with postoperative complications. CONCLUSION: In this study, objectively measured mean fluorescence values representing breast tissue remaining after dissection showed little utility in the assessment of postoperative wound healing outcomes as they did not identify patients who would later have complications of wound healing. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare.
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Mamoplastia , Mastectomía , Cicatrización de Heridas , Humanos , Femenino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Angiografía , Neoplasias de la Mama/cirugía , Anciano , Estudios ProspectivosRESUMEN
Identification of vascular injuries is crucial for complete postmortem evaluation and understanding of trauma deaths by the Medical Examiner. Some vascular injuries are difficult to evaluate due to challenging anatomic locations, especially in the head and neck. Documenting injuries of the facial and vertebral arteries is challenging and necessitates time-consuming dissections that can create artifacts and disfigurement. In busy medical examiner offices with a significant number of traumatic injuries, finding a creative solution to employ reliable postmortem angiography is desirable. At the Office of the Chief Medical Examiner for the State of Maryland (OCME), we created and effectively implemented a selective angiography procedure using traditional indwelling Foley catheters and water-soluble barium swallow contrast to evaluate arterial injuries using either digital radiography or computed tomography imaging modalities. This technique and imaging interpretation can be performed by a medical examiner or forensic pathology fellow after basic technical training and basic radiology training. This study outlines the technique, methods, and utilization of the procedure and describes the findings of six deaths due to vascular lesions from different injury mechanisms and disease processes and describes the ease of implementation on a broader scale in busy Medical Examiner's offices.
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Medios de Contraste , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Angiografía/métodos , Lesiones del Sistema Vascular/diagnóstico por imagen , Cuello/diagnóstico por imagen , Cabeza/diagnóstico por imagen , Cabeza/irrigación sanguínea , Médicos Forenses , Tomografía Computarizada por Rayos X , Angiografía por Tomografía Computarizada , Patologia Forense/métodos , AncianoRESUMEN
Haemorrhagic shock, which arises as a complication of pelvic fracture subsequent to severe trauma, represents a perilous state. The utilization of interventional endovascular haemostasis assumes a pivotal role in the management of patients with vascular injury following pelvic fracture. This article reports the treatment of a patient with pelvic fracture caused by a serious work-related vehicle accident. Despite the implementation of timely blood and fluid transfusion to combat shock, the application of aortic balloon obstruction, and interventional iliac artery embolization for haemostasis, the patient's condition failed to display any discernible improvement. Repeat angiography further revealed a displacement of the interventional embolization material, and the patient subsequently died of multiple organ failure. The occurrence of spring coil displacement is infrequent, but the consequences thereof are considered grave, necessitating meticulous discernment in the selection of haemostatic materials for this type of patient. The diagnostic and therapeutic processes encompassing the particular case described here were analysed and are discussed with the objective of augmenting the efficacy and success rate of treatment modalities for patients in similar circumstances.
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Embolización Terapéutica , Fracturas Óseas , Huesos Pélvicos , Humanos , Embolización Terapéutica/métodos , Embolización Terapéutica/instrumentación , Huesos Pélvicos/lesiones , Huesos Pélvicos/diagnóstico por imagen , Fracturas Óseas/terapia , Fracturas Óseas/complicaciones , Masculino , Adulto , Choque Hemorrágico/etiología , Choque Hemorrágico/terapia , Arteria Ilíaca/lesiones , Arteria Ilíaca/diagnóstico por imagen , Resultado Fatal , Accidentes de Tránsito , AngiografíaRESUMEN
The preclinical study of atherosclerosis has traditionally centred around the use of small animal models, translating to large animal models, prior to first-in-man studies. We propose to disrupt this paradigm by designing an ex vivo pump perfused human limb model. The novel model consists of taking a freshly amputated limb and incorporating it into an ex situ pump-perfused bypass system (akin to extracorporeal membrane oxygenation), circulating warmed, oxygenated blood. The circuit incorporates an introducer sheath and guiding catheter for intravascular imaging and X-ray angiography. Regular monitoring is performed using blood gas analysis, aiming for physiological parameters. The model maintains oxygen saturations > 99% for the length of perfusion (up to 6-h). Clinical grade X-ray angiography, intravascular ultrasound and optical coherence tomography have been successfully performed. Indocyanine green, a near-infrared fluorescent dye that localises to atherosclerotic plaque, has been injected into the system and left to circulate for 90-min. Fluorescence reflectance imaging of the dissected arterial bed confirmed uptake in areas of calcific atherosclerotic plaque on intravascular imaging. This is the first demonstration of an ex vivo pump-perfused "living" limb experimental model of atherosclerosis, which shows promise for future studies in translational interventional imaging and molecular targeting.
Asunto(s)
Aterosclerosis , Humanos , Aterosclerosis/diagnóstico por imagen , Extremidades/irrigación sanguínea , Investigación Biomédica Traslacional , Amputación Quirúrgica , Placa Aterosclerótica/diagnóstico por imagen , Tomografía de Coherencia Óptica , Perfusión , AngiografíaRESUMEN
BACKGROUND AND OBJECTIVE: This paper proposes a fully automated and unsupervised stochastic segmentation approach using two-level joint Markov-Gibbs Random Field (MGRF) to detect the vascular system from retinal Optical Coherence Tomography Angiography (OCTA) images, which is a critical step in developing Computer-Aided Diagnosis (CAD) systems for detecting retinal diseases. METHODS: Using a new probabilistic model based on a Linear Combination of Discrete Gaussian (LCDG), the first level models the appearance of OCTA images and their spatially smoothed images. The parameters of the LCDG model are estimated using a modified Expectation Maximization (EM) algorithm. The second level models the maps of OCTA images, including the vascular system and other retina tissues, using MGRF with analytically estimated parameters from the input images. The proposed segmentation approach employs modified self-organizing maps as a MAP-based optimizer maximizing the joint likelihood and handles the Joint MGRF model in a new, unsupervised way. This approach deviates from traditional stochastic optimization approaches and leverages non-linear optimization to achieve more accurate segmentation results. RESULTS: The proposed segmentation framework is evaluated quantitatively on a dataset of 204 subjects. Achieving 0.92 ± 0.03 Dice similarity coefficient, 0.69 ± 0.25 95-percentile bidirectional Hausdorff distance, and 0.93 ± 0.03 accuracy, confirms the superior performance of the proposed approach. CONCLUSIONS: The conclusions drawn from the study highlight the superior performance of the proposed unsupervised and fully automated segmentation approach in detecting the vascular system from OCTA images. This approach not only deviates from traditional methods but also achieves more accurate segmentation results, demonstrating its potential in aiding the development of CAD systems for detecting retinal diseases.