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Almansour H, Mustafi M, Lescan M, Grosse U, Andic M, Schmehl J, Artzner C, Grözinger G, Walter SS. Dynamic Radial MR Imaging for Endoleak Surveillance after Endovascular Repair of Abdominal Aortic Aneurysms with Inconclusive CT Angiography: A Prospective Study. J Clin Med 2024; 13:2913. [PMID: 38792455 PMCID: PMC11122363 DOI: 10.3390/jcm13102913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: To assess free-breathing, dynamic radial magnetic resonance angiography (MRA) for detecting endoleaks post-endovascular aortic repair (EVAR) in cases with inconclusive computed tomography angiography (CTA). Methods: This prospective single-center study included 17 participants (mean age, 70 ± 9 years; 13 males) who underwent dynamic radial MRI (Golden-angle RAdial Sparse Parallel-Volumetric Interpolated BrEath-hold, GRASP-VIBE) after inconclusive multiphasic CT for the presence of endoleaks during the follow-up of EVAR-treated abdominal aortic aneurysms. CT and MRI datasets were independently assessed by two radiologists for image quality, diagnostic confidence, and the presence/type of endoleak. Statistical analyses included interrater and intermethod agreement, and diagnostic performance (sensitivity, specificity, area under the curve (AUC)). Results: Subjective image analysis demonstrated good image quality and interrater agreement (k ≥ 0.6) for both modalities, while diagnostic confidence was significantly higher in MRA (p = 0.03). There was significantly improved accuracy for detecting type II endoleaks on MRA (AUC 0.97 [95% CI: 0.87, 1.0]) compared to CTA (AUC 0.66 [95% CI: 0.41, 0.91]; p = 0.03). Although MRA demonstrated higher values for sensitivity, specificity, AUC, and interrater agreement, none of the other types nor the overall detection rate for endoleaks showed differences in the diagnostic performance over CT (p ≥ 0.12). CTA and MRA revealed slight to moderate intermethod concordance in endoleak detection (k = 0.3-0.64). Conclusions: The GRASP-VIBE MRA characterized by high spatial and temporal resolution demonstrates clinical feasibility with good image quality and superior diagnostic confidence. It notably enhances diagnostic performance in detecting and classifying endoleaks, particularly type II, compared to traditional multiphase CTA with inconclusive findings.
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Affiliation(s)
- Haidara Almansour
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; (H.A.); (J.S.); (C.A.); (G.G.); (S.S.W.)
| | - Migdat Mustafi
- Klinik für Thoraxchirurgie-Lungentransplantation und Klinik für Kinderherzchirurgie, Universitätsklinikum des Saarlandes, 66421 Homburg, Germany;
| | - Mario Lescan
- Department of Cardiovascular Surgery, University Hospital Freiburg, 79106 Freiburg, Germany;
| | - Ulrich Grosse
- Department of Radiology, Cantonal Hospital Frauenfeld, Switzerland Pfaffenholzstrasse 4, 8500 Frauenfeld, Switzerland
| | - Mateja Andic
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Jörg Schmehl
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; (H.A.); (J.S.); (C.A.); (G.G.); (S.S.W.)
| | - Christoph Artzner
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; (H.A.); (J.S.); (C.A.); (G.G.); (S.S.W.)
- Diakonie Klinikum Stuttgart, Department for Radiology, 70176 Stuttgart, Germany
| | - Gerd Grözinger
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; (H.A.); (J.S.); (C.A.); (G.G.); (S.S.W.)
| | - Sven S. Walter
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076 Tuebingen, Germany; (H.A.); (J.S.); (C.A.); (G.G.); (S.S.W.)
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Black SM, Maclean C, Barrientos PH, Ritos K, Kazakidi A. Reconstruction and Validation of Arterial Geometries for Computational Fluid Dynamics Using Multiple Temporal Frames of 4D Flow-MRI Magnitude Images. Cardiovasc Eng Technol 2023; 14:655-676. [PMID: 37653353 PMCID: PMC10602980 DOI: 10.1007/s13239-023-00679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Segmentation and reconstruction of arterial blood vessels is a fundamental step in the translation of computational fluid dynamics (CFD) to the clinical practice. Four-dimensional flow magnetic resonance imaging (4D Flow-MRI) can provide detailed information of blood flow but processing this information to elucidate the underlying anatomical structures is challenging. In this study, we present a novel approach to create high-contrast anatomical images from retrospective 4D Flow-MRI data. METHODS For healthy and clinical cases, the 3D instantaneous velocities at multiple cardiac time steps were superimposed directly onto the 4D Flow-MRI magnitude images and combined into a single composite frame. This new Composite Phase-Contrast Magnetic Resonance Angiogram (CPC-MRA) resulted in enhanced and uniform contrast within the lumen. These images were subsequently segmented and reconstructed to generate 3D arterial models for CFD. Using the time-dependent, 3D incompressible Reynolds-averaged Navier-Stokes equations, the transient aortic haemodynamics was computed within a rigid wall model of patient geometries. RESULTS Validation of these models against the gold standard CT-based approach showed no statistically significant inter-modality difference regarding vessel radius or curvature (p > 0.05), and a similar Dice Similarity Coefficient and Hausdorff Distance. CFD-derived near-wall hemodynamics indicated a significant inter-modality difference (p > 0.05), though these absolute errors were small. When compared to the in vivo data, CFD-derived velocities were qualitatively similar. CONCLUSION This proof-of-concept study demonstrated that functional 4D Flow-MRI information can be utilized to retrospectively generate anatomical information for CFD models in the absence of standard imaging datasets and intravenous contrast.
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Affiliation(s)
| | - Craig Maclean
- Research and Development, Terumo Aortic, Glasgow, UK
| | - Pauline Hall Barrientos
- Clinical Physics, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Konstantinos Ritos
- Department of Mechanical and Aerospace Engineering, Glasgow, UK
- Department of Mechanical Engineering, University of Thessaly, Volos, Greece
| | - Asimina Kazakidi
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
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Zhang Y, Li J, Chen L, Liang R, Liu Q, Wang Z. Identification of co-diagnostic effect genes for aortic dissection and metabolic syndrome by multiple machine learning algorithms. Sci Rep 2023; 13:14794. [PMID: 37684281 PMCID: PMC10491590 DOI: 10.1038/s41598-023-41017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Aortic dissection (AD) is a life-threatening condition in which the inner layer of the aorta tears. It has been reported that metabolic syndrome (MS) has a close linkage with aortic dissection. However, the inter-relational mechanisms between them were still unclear. This article explored the hub gene signatures and potential molecular mechanisms in AD and MS. We obtained five bulk RNA-seq datasets of AD, one single cell RNA-seq (scRNA-seq) dataset of ascending thoracic aortic aneurysm (ATAA), and one bulk RNA-seq dataset of MS from the gene expression omnibus (GEO) database. Identification of differentially expressed genes (DEGs) and key modules via weighted gene co-expression network analysis (WGCNA), functional enrichment analysis, and machine learning algorithms (Random Forest and LASSO regression) were used to identify hub genes for diagnosing AD with MS. XGBoost further improved the diagnostic performance of the model. The receiver operating characteristic (ROC) and precision-recall (PR) curves were developed to assess the diagnostic value. Then, immune cell infiltration and metabolism-associated pathways analyses were created to investigate immune cell and metabolism-associated pathway dysregulation in AD and MS. Finally, the scRNA-seq dataset was performed to confirm the expression levels of identified hub genes. 406 common DEGs were identified between the merged AD and MS datasets. Functional enrichment analysis revealed these DEGs were enriched for applicable terms of metabolism, cellular processes, organismal systems, and human diseases. Besides, the positively related key modules of AD and MS were mainly enriched in transcription factor binding and inflammatory response. In contrast, the negatively related modules were significantly associated with adaptive immune response and regulation of nuclease activity. Through machine learning, nine genes with common diagnostic effects were found in AD and MS, including MAD2L2, IMP4, PRPF4, CHSY1, SLC20A1, SLC9A1, TIPRL, DPYD, and MAPKAPK2. In the training set, the AUC of the hub gene on RP and RR curves was 1. In the AD verification set, the AUC of the Hub gene on RP and RR curves were 0.946 and 0.955, respectively. In the MS set, the AUC of the Hub gene on RP and RR curves were 0.978 and 0.98, respectively. scRNA-seq analysis revealed that the SLC20A1 was found to be relevant in fatty acid metabolic pathways and expressed in endothelial cells. Our study revealed the common pathogenesis of AD and MS. These common pathways and hub genes might provide new ideas for further mechanism research.
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Affiliation(s)
- Yang Zhang
- Kunming Medical University, Kunming, 650000, Yunnan, China
- Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650000, Yunnan, China
| | - Jinwei Li
- Department of Neurosurgery, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, 545000, Guangxi, China
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610000, China
| | - Lihua Chen
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Rui Liang
- College of Bioengineering, Chongqing University, Chongqing, 400030, China
| | - Quan Liu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, 545000, Guangxi, China
| | - Zhiyi Wang
- Vascular Surgery, the First Affiliated Hospital of Dali University, Dali, 671000, China.
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A Novel Tool for a Challenging Disease: Stasis Leg Ulcers Assessed Using QFlow in Triggered Angiography Noncontrast Enhanced Magnetic Resonance Imaging. J Pers Med 2021; 11:jpm11090857. [PMID: 34575634 PMCID: PMC8472672 DOI: 10.3390/jpm11090857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023] Open
Abstract
Imaging characteristics of stasis leg ulcers (SLUs) are not easily demonstrated through existing diagnostic tools. Early diagnosis and treatment are crucial. This pilot study was conducted to assess the quantitative flow (QFlow) in triggered angiography noncontrast enhanced (TRANCE) magnetic resonance imaging (MRI) to identify the hemodynamics of victims with stasis leg ulcers (SLUs). This study included 33 patients with SLUs and 14 healthy controls (HC). The 33 patients with SLUs were divided into a reflux (15 patients) and a nonreflux group (18 patients). QFlow was done in the reflux, the nonreflux, and the HC. The stroke volume (SV), forward flow volume (FFV), absolute flow volume (AFV), mean flow (MF), and mean velocity (MV) were higher in the reflux than in the HC group in most segments, namely the external iliac vein (EIV), popliteal vein (PV), and great saphenous vein (GSV) (SV, p = 0.008; FFV, p = 0.008; absolute stroke volume (ASV), p = 0.008; MF, p = 0.002; MV, p = 0.009). No differences in the QFlow patterns were found in the GSV segment between the nonreflux group and the HC. Excellent performance in discriminating SLU with superficial venous reflux was reported for SV in the EIV and the PV (area under the curve (AUC) = 0.851 and 0.872), FFV in the EIV and PV (AUC = 0.854 and 0.869), ASV in the EIV and PV (AUC = 0.848 and 0.881), and MF in the EIV and PV (AUC = 0.866 and 0.868). The cutoff levels of SV/FFV/ASV/MF in the EIV/FV/PV/GSV for discriminating the SLU with superficial venous reflux were identified (p < 0.005). In conclusion, SLUs present different QFlow patterns by different etiology. The QFlow parameters of all vessel segments were higher in the morbid limbs of the reflux group than HC. The GSV segment of the nonreflux group displayed a pattern like the HC.
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Chen CW, Tseng YH, Wong MY, Lin YH, Yang TY, Hsu YC, Lin BS, Huang YK. Using Non-Contrast MRA to Discriminate between Obstructive and Nonobstructive Venous Diseases of the Legs. Diagnostics (Basel) 2021; 11:1392. [PMID: 34441326 PMCID: PMC8394703 DOI: 10.3390/diagnostics11081392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Venous interventions of the legs are less predictable owing to a lock of objective tools. METHODS One hundred and twenty patients with lower extremity venous disease were evaluated anatomically using TRANCE MRI. Then, a QFlow analysis was performed in 53 patients with only one leg affected for hemodynamic evaluation. Those patients with complete QFlow were classified into obstructive and nonobstructive. RESULTS The QFlow-namely, stroke volume, forward flow volume, mean flux, stroke distance (SD), and mean velocity (MV) in the external iliac vein (EIV), femoral vein (FV), popliteal vein (PV), and great saphenous vein (GSV). The obstructed group had a shorter SD and lower MV in the EIV, EIV/FV, and GSV/PV (SD: p-values of 0.025, 0.05, and 0.043, respectively; MV: p-values of 0.02, 0.05, and 0.048, respectively). A good performance in discriminating obstructive venous disease was reported for SD in the EIV (area under the curve (AUC) = 67.9%, 95% confidence interval (CI) = 53.2-82.7%), EIV/FV (AUC = 72.4%, 95% CI = 58.2-86.5%), and GSV/PV (AUC = 67.9%, 95% CI = 51.7-84.1%). The SD in the EIV, EIV/FV, and GSV/PV had the ability to discriminate between obstructive and nonobstructive diseases (p-values of 0.025, 0.005, and 0.043). The MV in the EIV, EIV/FV, and GSV/PV had ability to discriminate between obstructive and nonobstructive venous diseases (p-values of 0.02, 0.005, and 0.048). CONCLUSIONS The SD and MV were lower for obstructive than nonobstructive disease in the EIV.
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Affiliation(s)
- Chien-Wei Chen
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Chiayi 61363, Taiwan; (C.-W.C.); (Y.-C.H.)
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yu-Hui Lin
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Teng-Yao Yang
- Department of Cardiology, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan;
| | - Yin-Chen Hsu
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Chiayi 61363, Taiwan; (C.-W.C.); (Y.-C.H.)
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University and Department of Medical Research, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 33323, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
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Chen CW, Tseng YH, Fang YF, Wong MY, Lin YH, Huang YK. Superficial Venous Reflux Intervention Guided by Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging: Different QFlow Pattern from Health Controls. J Pers Med 2021; 11:jpm11080751. [PMID: 34442395 PMCID: PMC8398290 DOI: 10.3390/jpm11080751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: To assess the effectiveness of triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) in superficial venous reflux and its difference from health controls. (2) Methods: Thirty patients underwent TRANCE MRI before surgical intervention of their superficial venous reflux of the legs. Ten healthy volunteers were included as a control. (3) Results: TRANCE MRI involves the major tributaries, thus enhances the additional ablations in 20% of patients. QFlow pattern of superficial venous reflux (QFlow GSV/PV MF ratio > 1) was compared with the duplex scan (SFJ reflux) using Cohen’s kappa coefficient at 0.967. The 30 morbid legs undergoing TRANCE MRI-guide interventions and the healthy volunteers’ legs on the same side were compared. The stroke volumes (SV) are higher in EIV (p = 0.021) in the left-leg-intervention group. The mean flux (MF) is higher in the EIV (p = 0.012) and trend of increasing in GSV segment (p = 0.087) in the left-leg-intervention group. The QFlow of 10 patients with right leg intervention are higher in GSV in the right-leg-intervention group (SV p = 0.002; FFV p = 0.001; MF p = 0.001). QFlow data is shown for all legs for superficial venous intervention with GSV/PV (MF) ratio > 1. (4) Conclusions: Typical figures in QFlow (GSV/PV MF ratio > 1) could be observed in the morbid limbs but not in the controls.
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Affiliation(s)
- Chien-Wei Chen
- Department of Diagnostic Radiology, Chia-Yi Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan;
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yueh-Fu Fang
- Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan;
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yu-Hui Lin
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia-Yi Chan Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan 333, Taiwan; (Y.-H.T.); (M.Y.W.); (Y.-H.L.)
- Correspondence:
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Nepal P, VanBuren W, Khandelwal K, Mileto A, Potrezke T, Khandelwal A. Problem-solving with MRI in acute abdominopelvic conditions, part 2: gynecological, obstetric, vascular, and renal diseases. Emerg Radiol 2021; 28:1173-1183. [PMID: 34287728 DOI: 10.1007/s10140-021-01961-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
The purpose of this article is to illustrate the benefits of magnetic resonance imaging (MRI) in the setting of abdominopelvic emergencies. Owing to intrinsically high soft-tissue contrast resolution, and ability to resolve different soft tissue, MRI holds notable advantages over other imaging modalities and can be used as a problem-solving tool. Additional advantages of MRI include lack of radiation-related risks to children and pregnant women, and the ability to acquire detailed diagnostic information even without intravenous contrast which can be beneficial in patients with contrast allergy and end-stage renal disease. In the part 2, the authors focus on MRI features of female pelvic gynecological diseases, pregnancy- related complications, abdominal vascular complications, and renal diseases.
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Affiliation(s)
- Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Wendaline VanBuren
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kanika Khandelwal
- Department of Hospital Internal Medicine, Mayo Clinic, Austin, MN, USA
| | - Achille Mileto
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Theodora Potrezke
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ashish Khandelwal
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Chen CW, Ting H, Chen PY, Weng JC, Hsu YC, Wang SC, Tseng YH, Huang YK. Usefulness of triggered non-contrast-enhanced magnetic resonance angiography in assessing lower extremity venous disease. Medicine (Baltimore) 2021; 100:e25809. [PMID: 34011044 PMCID: PMC8137012 DOI: 10.1097/md.0000000000025809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/15/2021] [Indexed: 01/05/2023] Open
Abstract
Although venous duplex ultrasonography (USG) is reliable for diagnosing lower extremity venous disease (LEVD), cross-sectional imaging studies were usually required before intervention or surgery. Patients of LEVD with renal insufficiency usually restrict the use of contrast-enhanced imaging modalities. In seeking an alternative imaging solution for these patients, we explore the clinical utility of triggered angiography non-contrast-enhanced magnetic resonance imaging (TRANCE-MRI) in the assessment of LEVD.We collected data from patients presenting to a tertiary wound-care center with symptoms of LEVD from April 2017-November 2019. Each participant underwent baseline USG followed by TRANCE-MRI on a 1.5T MR scanner (Philips Ingenia, Philips Healthcare, Best, The Netherlands). Inter-rater reliability was measured using Cohen's kappa (κ).All 80 participants (mean age, 61.9 ± 14.8 years; 35 males, 45 females) were assessed and were classified into one of five disease groups, deep vein thrombosis (n = 38), venous static ulcer (n = 16), symptomatic varicose veins (n = 18), recurrent varicose veins (n = 3), and lymphoedema (n = 5). The inter-rater reliability between TRANCE-MRI and doppler USG showed substantial agreement (κ, 0.73). The sensitivity, specificity, and accuracy of TRANCE-MRI were 90.5%, 88.1%, and 88.8%, respectively. In 59 (73.8%) USG-negative patients, we were able to diagnose positive findings (deep venous thrombosis, n = 7; varicose veins, n = 15; lymphedema, n = 10; iliac vein compression with thrombosis, n = 6; external venous compression, n = 5; vena cava anomaly, n = 2; occult peripheral artery disease, n = 5; ccluded bypass graft, n = 1) by using TRANCE-MRI. Of these, 9 (15.3%) patients underwent additional vascular surgery based on positive TRANCE-MRI findings.TRANCE technique provides the limb's entire venous drainage in clear images without background contamination by associated arterial imaging. Additionally, simultaneous evaluation of bilateral lower extremities can help determine the lesion's exact site. Although TRANCE-MRI can provide MR arteriography and MR venography, we recommend performing only MR venography in symptomatic LEVD patients because the incidence of occult arterial disease is low.
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Affiliation(s)
- Chien-Wei Chen
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Physical Medicine and Rehabilitation, Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung
| | - Pang-Yen Chen
- Department of Emergency Medicine, Mackay Memorial Hospital, Institute of Public Health, School of Medicine, National Yang-Ming University, Yuanpei University of Medical Technology, Taipei and Hsinchu
| | - Jun-Cheng Weng
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Psychiatry, Chang Gung Memorial Hospital Chiayi Branch, Department of Medical Imaging and Radiological Sciences
| | - Yin-Chen Hsu
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan, Taiwan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan, Taiwan
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Tseng YH, Chen CW, Wong MY, Yang TY, Lin BS, Ting H, Huang YK. Discriminating Reflux from Non-Reflux Diseases of Superficial Veins in Legs by Novel Non-Contrast MR with QFlow Technique. J Pers Med 2021; 11:jpm11040242. [PMID: 33810500 PMCID: PMC8066982 DOI: 10.3390/jpm11040242] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To find an objective diagnostic tool for the superficial veins in legs. Methods: This study included 137 patients who underwent TRANCE-MRI from 2017 to 2020 (IRB: 202001570B0). Among them, 53 with unilateral leg venous diseases underwent a QFlow scan and were classified into the reflux and non-reflux groups according to the status of the great saphenous veins. Results: The QFlow, namely stroke volume (SV), forward flow volume (FFV), mean flux (MF), stroke distance (SD), and mean velocity (MV) measured in the external iliac, femoral, popliteal, and great saphenous vein (GSV). The SV, FFV, SD, MF, SD, and MV in the GSV (morbid/non-morbid limbs) demonstrated a favorable ability to discriminate reflux from non-reflux in the ROC curve. The SD in the GSV and GSV/PV ratio (p = 0.049 and 0.047/cutoff = 86 and 117.1) and the MV in the EIV/FV ratio, GSV, and GSV/PV ratio (p = 0.035, 0.034, and 0.025/cutoff = 100.9, 86.1, and 122.9) exhibited the ability to discriminate between reflux and non-reflux group. The SD, MV, and FFV have better ability to discriminate a reflux from non-reflux group than the SV and MF. Conclusions: QFlow may be used to verify the reflux of superficial veins in the legs. An increasing GSV/PV ratio is a hallmark of reflux of superficial veins in the legs.
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Affiliation(s)
- Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 408, Taiwan;
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 300, Taiwan;
| | - Teng-Yao Yang
- Department of Cardiology, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan;
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 300, Taiwan;
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University, Taichung 408, Taiwan;
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chia-Yi and Chang Gung University, Taoyuan 33302, Taiwan; (Y.-H.T.); (M.Y.W.)
- Correspondence:
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Chen CW, Tseng YH, Lin CC, Kao CC, Wong MY, Ting H, Huang YK. Aortic dissection assessment by 4D phase-contrast MRI with hemodynamic parameters: the impact of stent type. Quant Imaging Med Surg 2021; 11:490-501. [PMID: 33532250 DOI: 10.21037/qims-20-670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background To explore the diagnostic performance of 4-dimensional phase-contrast magnetic resonance imaging (4D PC-MRI) in evaluating aortic dissection in different clinical scenarios. Methods The study group comprised 32 patients with a known aortic dissection who each underwent computed tomography angiography (CTA), and then 4D PC-MRI with a 1.5-T MR scanner. The 4D PC-MRI images were compared with the CTA images to evaluate the aortic size, branch identification, and iliac and femoral arterial access. Results The patients were divided into three groups: (I) patients diagnosed with Type B aortic dissection but did not undergo intervention (n=8); (II) patients with residual aortic dissection after open repair of Type A dissection (n=7); (III) patients who underwent endovascular aortic repair with or without open surgery (n=17). Without radiation or contrast media injection, 4D PC-MRI provided similar aortic images for patients in Group 1 and most of those in Group 2. In Group 3, stainless steel stents affected image quality in three patients. High-quality 4D PC-MRI images were obtained for the remaining 14 patients in Group 3, who had non-stainless steel stents, and provided major aortic information comparable to that provided by CTA with contrast media. The hemodynamic parameters of true and false lumens were evaluated between three patients with Type B aortic dissections and three patients who underwent thoracic endovascular aortic repair for their aortic dissection. The stroke volume was higher in the true lumen of the patients with stent-grafts than in the patients with Type B aortic dissection without intervention. The regurgitant fraction, an indicator of nonlaminar flow, was higher in the false lumens than in the true lumens. All 32 patients in this study tolerated 4D PC-MRI without adverse events. Conclusions 4D PC-MRI is radiation- and contrast media-free option for imaging aortic dissection. It not only provided images comparable in quality to those obtained with CTA but also provided information on hemodynamic parameters, including endoleak detection after thoracic endovascular aortic repair. 4D PC-MRI was safe and accurate in evaluating chronic Type B aortic dissection and residual aortic dissection after surgery for acute Type A aortic dissection. Therefore, it could be a potential tool in treating pathology in aortic dissection, especially for patients with malperfusion syndrome of visceral vessels and in young patients with renal function impairment. However, certain endograft materials, especially stainless steel, may prevent the further application of 4D PC-MRI and should be avoided.
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Affiliation(s)
- Chien-Wei Chen
- Institute of Medicine, Chung Shan Medical University, Taichung.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi.,Chang Gung University, College of Medicine, Taoyuan
| | - Chien-Chao Lin
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi.,Chang Gung University, College of Medicine, Taoyuan
| | - Chih-Chen Kao
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi.,Chang Gung University, College of Medicine, Taoyuan
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University, Taichung
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi.,Chang Gung University, College of Medicine, Taoyuan
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Hsu YC, Huang YK, Hsu LS, Chen PY, Chen CW. Using non-contrast-enhanced magnetic resonance venography for the evaluation of May-Thurner syndrome in patients with renal insufficiency: A case report. Medicine (Baltimore) 2019; 98:e18427. [PMID: 31876719 PMCID: PMC6946463 DOI: 10.1097/md.0000000000018427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Contrast-enhanced computed tomographic venography (CTV) or magnetic resonance venography (MRV) are usually used to detect May-Thurner syndrome (MTS). However, both are associated with contrast-induced nephrotoxicity. For patients who cannot receive contrast media, non-contrast-enhanced MRV using three-dimensional (3D) turbo spin-echo (TSE) is considered an alternative. We report a case of MTS to describe its clinical utility and advantages. PATIENT CONCERNS A 49-year-old male experienced isolated left leg swelling and pain for half a month. He had a history of chronic renal insufficiency that made contrast-enhanced imaging studies inadequate. DIAGNOSES A lower extremity venous Duplex scan showed a thrombus extending from the left distal femoral vein to the popliteal vein with valvular reflux, consistent with infrainguinal deep vein thrombosis (DVT). The suprainguinal DVT was evaluated by non-contrast-enhanced MRV. The results showed sandwich external compression of the left common iliac vein between the right common iliac artery and lumbar vertebrae, consistent with DVT of the left common iliac vein caused by MTS. INTERVENTIONS The patient received angioplasty with the implantation of a balloon-expandable stent over the left common iliac vein. OUTCOMES Excellent recanalization of the left iliac vein was noted postoperatively. LESSONS In the evaluation of suprainguinal venous lesions, non-contrast-enhanced MRV presents the venous structure alone at high resolution without the accompanying arterial structure, which makes it an excellent diagnostic imaging tool for MTS. These findings indicate that non-contrast-enhanced MRV could be useful for detecting systemic venous pathologies in patients with renal insufficiency.
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Affiliation(s)
- Yin-Chen Hsu
- Department of Diagnostic Radiology
- Chang Gung University College of Medicine, Taoyuan
| | - Yao-Kuang Huang
- Chang Gung University College of Medicine, Taoyuan
- Division of Thoracic and Cardiovascular Surgery, Wound Center and Plastic Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
| | - Li-Sheng Hsu
- Department of Diagnostic Radiology
- Chang Gung University College of Medicine, Taoyuan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan
| | - Pang-Yen Chen
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University
| | - Chien-Wei Chen
- Department of Diagnostic Radiology
- Chang Gung University College of Medicine, Taoyuan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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