Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion

Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions.     

55例大型脑膜瘤术前栓塞的应用评价

目的：研究大型脑膜瘤的术前栓塞的的应用价值。方法选择55例大型脑膜瘤患者（最大径＞5 cm）,分成栓塞组(n=28)和对照组(n=27),栓塞组术前先予以DSA（digital subtraction angiography）造影了解肿瘤血供情况,并予以PAV颗粒或栓塞微球颗粒（200～300 um）栓塞,对照组未予以栓塞,对比2组肿瘤切除出血量、手术时间,观察手术并发症情况;术后1～2周复查增强MR观察肿块切除程度。结果研究组术中出血量（456±145）mL,明显小于对照组（913±134）mL,差异有统计学意义（P<0.05）。手术时间,研究组与对照组分别为（4.45±2.13）h和（5.23±1.45）h,差异有统计学意义（P<0.05）。栓塞组提高了肿瘤的切除率,4例出现栓塞后颅内高压,头痛加重,1例出现颅神经一过性麻痹,3例出现局部头皮坏死,经支持治疗后均缓解。结论大型脑膜瘤术前血管造影可以了解肿瘤血管情况,指导外科手术切除,栓塞术后可以明显减少术中出血,缩短手术时间,提高肿瘤切除程度。     

16层螺旋CT血管成像对蛛网膜下腔出血病因的诊断价值

目的：探讨分析16层螺旋CT血管成像对蛛网膜下腔出血(SAH)病因的诊断价值。方法58例蛛网膜下腔出血患者,均先行16层螺旋CT平扫,再行CT血管成像(CTA),之后应用多平面重建、容积再现、最大密度投影等技术,对图像进行处理,观察患者的脑血管情况并对SAH病因进行分析。结果经3D-CTA共发现46例患者有56个动脉瘤、动静脉畸形8例、烟雾病3例、阴性1例;与数字减影血管造影(DSA)或外科手术作为参照,提示3D-CTA诊断颅内动脉瘤的敏感性与特异性分别为97.83%与100.00%。结论16层螺旋CT血管成像在蛛网膜下腔出血的病因诊断中具有较高应用价值,可作为诊断蛛网膜下腔出血病因的首选方法。     

Computed Tomography Angiography with Three‐dimensional Reconstruction for Pulmony Venous Definition in High‐risk Infants with Congenital Heart Disease

Background. Pulmonary venous anomalies may be difficult to define in small, critically ill infants using standard echocardiography. In many centers, invasive cardiac catheterization is used if the diagnosis remains inconclusive. We evaluated computed tomography angiography (CTA) as a low‐risk alternative to cardiac catheterization in these infants. Methods. All infants <7 kg with congenital heart disease who had undergone CTA in a tertiary care pediatric institution during a 30‐month period were included. All had undergone preceding echocardiography, with pulmonary veins defined as normal (group A, n = 40), or abnormal (group B, n = 16). In 6 group B patients, a conclusive diagnosis could not be made by echocardiogram alone. CTAs were analyzed only if contrast density in the left atrium exceeded 200 Houndsfield units. CTA diagnoses (using axial and reformatted 3‐dimensional still frame images, and audio video interleaved loops) were compared with preceding echocardiograms (group A), or echocardiography, catheterization angiography, or surgical findings (group B). Results. Fifty‐six patients (mean age 12.4 weeks; range 0–64; mean weight 4.19 kg; range 1.4–7) were included. There were no scan complications. Mean scan duration was 4.6 seconds (range 1.84–11). Scan indications in group A were related mainly to arch (57.5%) and airway issues (17.5%). In group B, most patients had variations of anomalous pulmonary venous return (43.75%), with postsurgical stenosis the second largest group (31.25%). CTA diagnoses were confirmed in all patients. Additional diagnostic confirmation in group B was made at catheterization (1/16) or during surgical intervention (15/16). Conclusion. Normal and abnormal pulmonary veins could be defined accurately, safely, and rapidly by CTA in all cases. Three‐dimensional reformatting provided additional assistance with surgical planning. Echocardiography remains the first‐line choice for diagnostic imaging in all patients with pulmonary venous anomalies. However, when echo diagnosis is inconclusive, CTA and not catheterization should be considered the next imaging modality of choice.     

冠状动脉轻中度狭窄病变的血管内超声特征

通过分析病变的结构特点 ,探讨轻中度狭窄病变斑块不稳定的机制。对冠状动脉造影显示轻中度狭窄(直径狭窄率 2 0 %～ 6 0 % ) 6 2例及重度狭窄 2 6例冠心病患者行血管内超声显像检查 ,分析粥样硬化斑块性质及其狭窄程度。结果发现 ,轻中度狭窄患者中软斑块 (6 8.2 %比 15 .4 % ,P <0 .0 1)、薄纤维帽 (6 5 .9%比 7.7% ,P <0 .0 1)显著多于重度狭窄患者 ,并且斑块破裂 (2 8.2 %比 7.7% ,P <0 .0 1)及正性重构 (5 1.8%比 0 % ,P <0 .0 1)也显著多于重度狭窄患者。轻中度狭窄患者偏心斑块检出率显著多于重度狭窄者 (84 .7%比 30 .1% ,P <0 .0 1) ,但钙化少见 (16 .5 %比 84 .6 % ,P <0 .0 1)。结果提示 ,冠状动脉造影轻中度狭窄患者多数具有不稳定性斑块的结构特点 ,这些特点导致轻中度狭窄者容易发生急性冠状动脉综合征。     

Dynamic CT Myocardial Perfusion Imaging in Patients without Obstructive Coronary Artery Disease: Quantification of Myocardial Blood Flow according to Varied Heart Rate Increments after Stress

ObjectiveThe present study aimed to investigate the association between myocardial blood flow (MBF) quantified by dynamic CT myocardial perfusion imaging (CT-MPI) and the increments in heart rate (HR) after stress in patients without obstructive coronary artery disease.Materials and MethodsWe retrospectively included 204 subjects who underwent both dynamic CT-MPI and coronary CT angiography (CCTA). Patients with more than minimal coronary stenosis (diameter ≥ 25%), history of myocardial infarction/revascularization, cardiomyopathy, and microvascular dysfunction were excluded. Global MBF at stress was measured using hybrid deconvolution and maximum slope model. Furthermore, the HR increments after stress were recorded.ResultsThe median radiation dose of dynamic CT-MPI plus CCTA was 5.5 (4.5–6.8) mSv. The median global MBF of all subjects was 156.4 (139.8–180.4) mL/100 mL/min. In subjects with HR increment between 10 to 19 beats per minute (bpm), the global MBF was significantly lower than that of subjects with increment between 20 to 29 bpm (153.3 mL/100 mL/min vs. 171.3 mL/100 mL/min, p = 0.027). This difference became insignificant when the HR increment further increased to ≥ 30 bpm.ConclusionThe global MBF value was associated with the extent of increase in HR after stress. Significantly higher global MBF was seen in subjects with HR increment of ≥ 20 bpm.     

How to Treat Peripheral Arteriovenous Malformations

Arteriovenous malformations (AVMs) are direct communications between primitive reticular networks of dysplastic vessels that have failed to mature into capillary vessels. Based on angiographic findings, peripheral AVMs can be classified into six types: type I, type IIa, type IIb, type IIc, type IIIa, and type IIIb. Treatment strategies vary with the types. Type I is treated by embolizing the fistula between the artery and the vein with coils. Type II (IIa, IIb, and IIc) AVM is treated as follows: first, reduce the blood flow velocity in the venous segment of the AVM with coils; second, perform ethanol embolotherapy of the residual shunts. Type IIIa is treated by transarterial catheterization of the feeding arteries and injection of diluted ethanol. Type IIIb is treated by transarterial or direct puncture approaches. A high concentration of ethanol is injected through the transarterial catheter or direct puncture needle. When the fistula is large, coil insertion is required to reduce the amount of ethanol. Type I and type II AVMs showed the best clinical results; type IIIb showed a satisfactory response rate. However, type IIIa showed the poorest response rate, either alone or in combination with other types. Clinical success can be achieved by using different treatment strategies for different angiographic AVM types.     

双能量血管成像技术在颅内动脉瘤诊治中的应用

目的:探讨双源CT双能量减影CT血管成像(DE-CTA)在颅内动脉瘤诊治中的作用。方法:回顾性分析我院自2017年1月至2019年12月经手术或介入治疗证实为颅内动脉瘤63例的DE-CTA的影像学资料,所有病例均完成容积再现(VR)和最大密度投影(MIP),并与手术或DSA进行对照,以评价DE-CTA诊断颅内动脉瘤的敏感性、特异性和术后复查的应用价值。结果:DE-CTA诊断63例共67个动脉瘤,均经手术或DSA证实,漏诊1个,其诊断颅内动脉瘤的敏感性、特异性分别为98.53%、100%;DE-CTA能清晰显示动脉瘤瘤体大小、瘤颈宽度、瘤轴指向、动脉瘤钙化斑块、动脉瘤与载瘤动脉的空间关系,但与动脉瘤相关的穿支血管显示欠佳;术后复查无瘤颈残留,金属光束硬化伪影在介入治疗患者中更为明显。结论:DE-CTA作为一种快捷、无创的检查技术,在动脉瘤的临床诊断和术后复查中具有较高的应用价值。     

Unusual disposition of lateral circumflex femoral artery: Anatomical description and clinical implications

The anatomical knowledge of arterial variations of lower limb is of utmost significance for the present day surgeons and interventional radiologists for minimizing complications during vascular reconstructive procedures, catheterization procedures and surgical intervention for embolism. Lateral Circumflex Femoral Artery(LCFA) isan important branch of Profunda Femoris artery and precise knowledge of its variations can be of great relevance during surgical and radiological procedures in femoral region. The present study reports a unique case of anomalous route taken by LCFA posterior to femoral nerve associated with a prominent muscular branch from Femoral artery mimicking the course of LCFA. Documentation of such variations is highly significant. It may serve as guideline for surgeons in reducing the incidence of postoperative complications where LCFA is used as a long vascular pedicle in anterolateral perforator thigh flap and in breast reconstruction after mastectomy. Ignorance of such variations can lead to fatal intraoperative haemorrhage and incapacitating sensory and motor deficit due to injury to femoral nerve branches which are closely related to these vessels.