Detection of intra-cardiac thrombi and congestive heart failure in cats using computed tomographic angiography

Background: Reconstruction with the use of perforator flaps makes it possible to make the skin surface resistant to the influence of mechanical factors and as similar to the lost skin cover as possible. However, while planning any flap, along with the design of the required shape and size, its blood supply should be taken into account to ensure optimal viability. Therefore, the task to precisely determine the topographic–anatomical relationships suitable for the formation of a pedicle of perforators is still relevant. The aim of this study was to increase the efficiency of surgical reconstruction of wound defects by transposition of locoregional perforator flaps. Methods: The authors conducted a retrospective analysis of 72 cases of reconstruction by means of locoregional perforator flaps with vascular pedicle detachment to determine the efficiency of preoperative diagnostic preparation with the help of multidetector-row computed tomographic angiography (MDCT) in the process of reconstruction. Thirty-seven individual cases of surgical interventions were chosen using a case-controlled study from the study group when MDCT with angiography was used for preoperative planning of perforator flaps, as well as 35 control cases similar in terms of important predictive peculiarities with the reconstruction at the same level of difficulty. The patient groups were precisely matched by gender ( P = .950), age ( P = .804), flap area ( P = .192), and type of reconstruction that was performed. Results: In all cases, the location of the perforator with a diameter greater than 1.0 mm was marked. All perforators determined during MDCT scanning were faultlessly localized intraoperatively. The distance between the intraoperative position of the perforator and the position obtained in the result of the examination did not exceed 1 cm. There was no need to change the planned design of the flap intraoperatively. In all cases where MDCT was performed, the duration of the surgical procedure varied from 60 to 150 minutes (average: 120.77 [18.90] minutes) and was reduced by 49.40 minutes (95% CI: 39.17-59.63) compared with the patients who did not undergo preoperative visualization of perforators where the average duration of the operation was 170.17 (19.19) minutes (from 140 to 220 minutes). Among the patients examined by MDCT, surgical complications were noted in 5 cases (13.51%) compared to 14 cases (40.00%) in the control group. Conclusions: The preoperative MDCT for the locoregional perforator flap reconstruction makes it possible to increase the efficiency of patient treatment given the reduction in surgery duration by 49.40 minutes (95% CI: 39.17-59.63) on average and the reduction in the level of postsurgery complications from 40% to 13.5% compared with the group of patients in whom presurgical visualization was not performed ( P = .031).

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Microsurgical Anatomy of the Anterior Circulation of the Brain Adjusted to the Neurosurgeon’s Daily Practice

Brain Sciences ◽

10.3390/brainsci11040519 ◽

2021 ◽

Vol 11 (4) ◽

pp. 519

Author(s):

Tomas Poblete ◽

Daniel Casanova ◽

Miguel Soto ◽

Alvaro Campero ◽

Jorge Mura

Keyword(s):

Daily Practice ◽

Computed Tomographic Angiography ◽

Poor Quality ◽

Surgical Anatomy ◽

Microsurgical Anatomy ◽

Anterior Circulation ◽

Computed Tomographic ◽

Intrinsic Complexity ◽

Tomographic Angiography

The study of cerebrovascular anatomy can be difficult and may take time due to its intrinsic complexity. However, it can also be difficult for the following reasons: the excessive description of neuroanatomy making articles hard to read, the unclear clinical application of what is written, the use of simplified or intricate schematic drawings that are not always appropriate for effective teaching, the poor quality of neuroanatomy dissections and the use of unusual views of figures that are not strictly related to the most frequent neuroimages to be interpreted in daily practice. Because of this, we designed an article that incorporates original and accurate anatomical dissections in an attempt to improve its comprehensibility. Five formalin-fixed adult cadaveric heads, whose vessels were injected with a colored silicone mixture (red for arteries and blue for veins), were dissected and examined under a microscope with magnifications from 3× to 40×. Special emphasis has been placed on correlating topographic anatomy with routine neuroimaging studies from computed tomographic angiography (CTA) and digital subtraction angiography (DSA). The essential surgical anatomy in a neurosurgeon’s daily practice is also described. The cadaveric dissections included in this study contribute to the understanding of the cerebrovascular anatomy necessary for the neurosurgeon’s daily practice.

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Management of a spontaneous supra-aortic arterial dissection: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02886-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Omar M. Sharaf ◽

Tomas D. Martin ◽

Eric I. Jeng

Keyword(s):

Innominate Artery ◽

Operative Management ◽

Computed Tomographic Angiography ◽

Artery Dissection ◽

Term Therapy ◽

Type I ◽

Computed Tomographic ◽

Tomographic Angiography ◽

Aortic Dissections ◽

Isolated Innominate Artery

Abstract Background Acute DeBakey type I and type II aortic dissections are indications for emergent surgical repair; however, there are currently no standard protocols in the management of isolated supra-aortic dissections. Prompt diagnosis and management of an isolated innominate artery dissection are necessary to prevent distal malperfusion and thromboembolic sequelae. Case presentation A 50-year-old Caucasian gentleman presented with chest pain radiating to his jaw and right arm. He had no recent history of trauma. On physical exam, he was neurologically intact and malignantly hypertensive. Computed tomographic angiography of the chest and neck confirmed a spontaneous isolated innominate artery dissection without ascending aorta involvement. Given the lack of evidence for rupture, distal emboli, and/or end-organ malperfusion, the decision was made for initial non-operative management—anti-impulse regimen, antiplatelet therapy, and close follow-up. Conclusions Medical management of a spontaneous isolated innominate artery dissection is appropriate for short-term and potentially long-term therapy. This not only spares the patient from a potentially unnecessary surgical operation but also provides the surgeon and the patient the time to plan for a surgical approach if it becomes necessary.

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Feasibility of Subtraction Coronary Computed Tomographic Angiography and Influencing Factor Analysis: a Retrospective Study

Current Medical Science ◽

10.1007/s11596-021-2413-3 ◽

2021 ◽

Vol 41 (4) ◽

pp. 821-826

Author(s):

Chao Huang ◽

Wei-jia Wan ◽

Yu-huan Yao ◽

Li-ming Xia ◽

Wen-hua Huang

Keyword(s):

Factor Analysis ◽

Retrospective Study ◽

Influencing Factor ◽

Computed Tomographic Angiography ◽

Coronary Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography

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Additional value of deep learning computed tomographic angiography-based fractional flow reserve in detecting coronary stenosis and predicting outcomes

Acta Radiologica ◽

10.1177/0284185120983977 ◽

2021 ◽

pp. 028418512098397

Author(s):

Yang Li ◽

Hong Qiu ◽

Zhihui Hou ◽

Jianfeng Zheng ◽

Jianan Li ◽

...

Keyword(s):

Deep Learning ◽

Unstable Angina ◽

Fractional Flow Reserve ◽

Predictive Value ◽

Computed Tomographic Angiography ◽

Fractional Flow ◽

Computed Tomographic ◽

Flow Reserve ◽

Sensitivity Specificity ◽

Tomographic Angiography

Background Deep learning (DL) has achieved great success in medical imaging and could be utilized for the non-invasive calculation of fractional flow reserve (FFR) from coronary computed tomographic angiography (CCTA) (CT-FFR). Purpose To examine the ability of a DL-based CT-FFR in detecting hemodynamic changes of stenosis. Material and Methods This study included 73 patients (85 vessels) who were suspected of coronary artery disease (CAD) and received CCTA followed by invasive FFR measurements within 90 days. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristics curve (AUC) were compared between CT-FFR and CCTA. Thirty-nine patients who received drug therapy instead of revascularization were followed for up to 31 months. Major adverse cardiac events (MACE), unstable angina, and rehospitalization were evaluated and compared between the study groups. Results At the patient level, CT-FFR achieved 90.4%, 93.6%, 88.1%, 85.3%, and 94.9% in accuracy, sensitivity, specificity, PPV, and NPV, respectively. At the vessel level, CT-FFR achieved 91.8%, 93.9%, 90.4%, 86.1%, and 95.9%, respectively. CT-FFR exceeded CCTA in these measurements at both levels. The vessel-level AUC for CT-FFR also outperformed that for CCTA (0.957 vs. 0.599, P < 0.0001). Patients with CT-FFR ≤0.8 had higher rates of rehospitalization (hazard ratio [HR] 4.51, 95% confidence interval [CI] 1.08–18.9) and MACE (HR 7.26, 95% CI 0.88–59.8), as well as a lower rate of unstable angina (HR 0.46, 95% CI 0.07–2.91). Conclusion CT-FFR is superior to conventional CCTA in differentiating functional myocardial ischemia. In addition, it has the potential to differentiate prognoses of patients with CAD.

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