Journal of neuroimaging : official journal of the American Society of Neuroimaging
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To evaluate visualization and signal characteristics of macroscopic changes in patients with ophthalmologically stated papilledema and to find a suitable high-resolution magnetic resonance imaging (MRI) protocol. ⋯ An MRI protocol consisting of a 5-mm transverse T2w TSE sequence; a T2*w, 3D CISS sequence; a T1w, 3D MP-RAGE sequence with and without contrast medium; and a transverse T1w, (2-mm) 2D TSE sequence with fat-suppression technique with intravenous contrast medium is suitable to visualize the macroscopic changes in papilledema. In addition, this combination is an excellent technique for the examination of the orbits and the brain.
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Electroencephalography (EEG) is traditionally used to assess the duration of hemispheric anesthetization and to monitor return of function in the anesthetized hemisphere during the intracarotid amobarbital procedure (IAP), but EEG changes are not consistently seen. The authors evaluated the role of continuous transcranial Doppler (TCD) monitoring as an alternative to EEG. ⋯ Continuous TCD monitoring may be a more sensitive method than EEG in determining the duration of hemispheric anesthetization during IAP. Because the items for assessment of memory are presented during the period of hemispheric anesthetization, TCD may be useful in more precisely defining the time window for memory testing.
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Patients with objective evidence of memory impairment have been considered to be at risk for developing Alzheimer's disease (AD). However, little is known about patterns of regional cerebral blood flow abnormalities and their prognostic significance in these patients. ⋯ These results demonstrate that (1) subjects with an earlier onset of memory loss have an increased risk for developing AD, (2) SPECT can be useful for distinguishing subjects with memory loss who will rapidly progress to AD from those who will not, and (3) perfusion impairment typical of AD was evident even in subjects with memory impairment who remained nondemented.
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A persistent trigeminal artery (PTA) has been found in a number of cerebrovascular diseases. A 73-year-old asymptomatic woman was noted to have a left PTA and left subclavian steal by catheter angiography. Carotid duplex revealed a peak systolic flow velocity of 294 cm/s in the internal carotid artery (ICA) and an ICA to common carotid artery ratio > 4, suggestive of a high-grade stenosis. ⋯ Transcranial Doppler found an alternating flow pattern in the basilar artery (mean flow velocity [MFV] = 18 cm/s) and left vertebral artery (MFV = 43 cm/s). During brachial hyperemia, the MFV increased by 178% in the basilar artery and 102% in the left vertebral artery. The data suggest that a PTA may compensate for subclavian steal and may have a protective hemodynamic role in this setting.
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Today's vascular laboratory technology offers broad applications throughout vascular medicine. We explore the diagnostic work-up and management of selected peripheral vascular diseases by benchmarking the institutional mix of invasive and noninvasive technology utilization and associated cost burdens. ⋯ Benchmark indices reveal near total adoption of noninvasive technology for vascular diagnostic workups at our center. The benefits to institutions of benchmarking their technology utilization mix and costs are discussed in relation to identifying potential for cost-containment from modifying technology utilization practices.