BACKGROUND: A third of endovascularly treated patients with stroke experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction [eTICI] <3), and the natural evolution of this incomplete reperfusion remains unknown. We systematically reviewed the literature and performed a meta-analysis on the natural evolution of incomplete reperfusion after endovascular therapy. METHODS: A systematic review of MEDLINE, Embase, and PubMed up until March 1, 2024, using a predefined strategy. Only full-text English-written articles reporting rates of either favorable (ie, delayed reperfusion (DR) or no new infarct) or unfavorable progression (ie, persistent perfusion deficit or new infarct) of incompletely reperfused tissue were included. The primary outcome was the rate of DR and its association with functional independence (modified Rankin Scale score, 0-2) at 90 days postintervention. Pooled odds ratios with 95% CIs were calculated using a random-effects model. RESULTS: Six studies involving 950 patients (50.7% female; median age, 71 years; interquartile range, 60-79) were included. Four studies assessed the evolution of incomplete reperfusion on magnetic resonance imaging perfusion imaging, while 2 studies used diffusion-weighted imaging and noncontrast computed tomography imaging, where new infarct was used to denote unfavorable progression. Five studies defined incomplete reperfusion as eTICI 2b50 or 2c. DR occurred in 41% (interquartile range, 33%-51%) of cases 24 hours postintervention. Achieving DR was associated with a higher likelihood of functional independence at 90 days (odds ratio, 2.5 [95% CI, 1.9-3.4]). CONCLUSIONS: Nearly half of eTICI <3 patients achieve DR, leading to favorable clinical outcomes. This subgroup may derive limited or potentially harmful effects from pursuing additional reperfusion strategies (eg, intra-arterial lytics or secondary thrombectomy). Accurately predicting the evolution of incomplete reperfusion could optimize patient selection for adjunctive reperfusion strategies at the end of an intervention. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT05499832.

• MeSH
• Endovascular Procedures * methods   MeSH
• Ischemic Stroke * surgery   diagnostic imaging   therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Reperfusion methods   MeSH
• Aged MeSH
• Thrombolytic Therapy methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Systematic Review MeSH

The clinical assessment of microvascular pathologies (in diabetes and in inflammatory skin diseases, for example) requires the visualization of superficial vascular anatomy. Photoacoustic tomography (PAT) scanners based on an all-optical Fabry-Perot ultrasound sensor can provide highly detailed 3D microvascular images, but minutes-long acquisition times have precluded their clinical use. Here we show that scan times can be reduced to a few seconds and even hundreds of milliseconds by parallelizing the optical architecture of the sensor readout, by using excitation lasers with high pulse-repetition frequencies and by exploiting compressed sensing. A PAT scanner with such fast acquisition minimizes motion-related artefacts and allows for the volumetric visualization of individual arterioles, venules, venous valves and millimetre-scale arteries and veins to depths approaching 15 mm, as well as for dynamic 3D images of time-varying tissue perfusion and other haemodynamic events. In exploratory case studies, we used the scanner to visualize and quantify microvascular changes associated with peripheral vascular disease, skin inflammation and rheumatoid arthritis. Fast all-optical PAT may prove useful in cardiovascular medicine, oncology, dermatology and rheumatology.

• MeSH
• Skin blood supply   MeSH
• Humans MeSH
• Microvessels diagnostic imaging   MeSH
• Photoacoustic Techniques * methods   instrumentation   MeSH
• Arthritis, Rheumatoid diagnostic imaging   MeSH
• Imaging, Three-Dimensional * methods   instrumentation   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Smrť mozgu zostáva klinickou diagnózou, vo väčšine prípadov založenou na klinickej diagnostike. Doplnkové testy vrátane zobrazovacích vyšetrení sa používajú na potvrdenie absencie cerebrálnej perfúzie, keď sú klinické nálezy nejednoznačné. Zobrazovacie metódy ako DSA, perfúzna scintigrafia a transkraniálny Doppler môžu poskytnúť kľúčové, zákonom vyžadované údaje na podporu diagnózy. Napriek prebiehajúcim snahám neexistuje celosvetový konsenzus o optimálnom doplnkovom teste a prax sa líši podľa regiónov. Moderné vyšetrenia ako CT angiografia (CTA), MR techniky, CT perfúzia a časovo invariantná CTA ponúkajú stále presnejšie výstupy. Je však potrebná ich ďalšia validácia, zvlášť v prípade pediatrických pacientov. Včasná diagnóza smrti mozgu minimalizuje zbytočné výkony a umožňuje následný efektívny transplantačný program.

Brain death remains a clinical diagnosis, based mainly on clinical criteria. Ancillary tests, including diagnostic imaging, are used to confirm the absence of cerebral perfusion when clinical findings are inconclusive. Imaging methods like DSA, perfusion scintigraphy and transcranial Doppler can provide critical, legally required data to support the diagnosis. Despite ongoing efforts, there is no global consensus on the optimal ancillary test, with practices varying by the region. Modern techniques like CT angiography (CTA), MR imaging, CT perfusion and time-invariant CTA, offer increasingly accurate outcomes. However, further validation is needed, particularly for pediatric patients. Early brain death diagnosis is crucial to avoid unnecessary interventions and to support timely organ transplantation.

• MeSH
• Diagnostic Imaging methods   MeSH
• Humans MeSH
• Brain Death * diagnostic imaging   MeSH
• Neuroimaging methods   MeSH
• Radionuclide Imaging methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Celotělovápostmortem CTangiografie(PMCTA) představujevcelosvětovémměřítkuexperimentálnímetoduzávisloupředevšímnadostupnostiinterdisciplinární spolupráce, personálním a technickém vybavení a finančních možnostech pracoviště. Autoři prezentují technické poznámky k etablovaní PMCTA na pracovišti, které od roku 2015 rutinně provádělo nativní CT vyšetření. Aplikaci této diagnosticky i vědecko-výzkumně výtěžné metody do soudnělékařské praxe umožnila mezioborová spolupráce společně s institucionální podporou rozvoje nových diagnostických metod.

Whole-body post mortem CT angiography (PMCTA) is an innovative and experimental imaging technique that relies heavily on interdisciplinary collaboration, access to skilled personnel, advanced technical equipment and the financial possibilities of the workplace. Native CT examinations (PMCT) prior to autopsy are already a standard procedure in certain forensic departments in the Czech Republic (e.g., murders, suicides, deaths of children, traffic accidents etc.). Nonetheless, the progression of forensic sciences all over the world shows the necessity to integrate other advanced imaging modalities in routine forensic practice. Incorporating PMCTA into standard forensic workflows enhances the precision of forensic diagnostics, supplements traditional autopsy findings, and elevates the objectivity of forensic outputs. This paper presents technical notes on the development of PMCTA in forensic practice in a department that since 2015 until now has routinely performed native CT examinations. Institutional support was crucial in enabling the adoption of the imaging technique, which has so far been applied to more than thirty cases. The department is currently conducting a comparative study focused on the application of three different types of perfusion media – polyethylene glycol (PEG), saline, paraffin oil – and assessing the diagnostic efficacy of PMCTA relative to conventional autopsy. Based on our experience, PMCTA is suitable for all corpses except those with advanced post-mortem decomposition or extensive open injuries. The highest diagnostic yield is achieved in cases involving suspected gastrointestinal bleeding or vascular pathologies and lesions especially of large vessels (e.g., dissection/rupture of the aorta). The protocol for whole-body PMCTA can be adapted to meet the specific needs and conditions of individual forensic departments, providing a flexible yet robust framework for enhancing forensic medical investigations.

• MeSH
• Computed Tomography Angiography methods   MeSH
• Diagnostic Imaging methods   MeSH
• Humans MeSH
• Autopsy * methods   MeSH
• Tomography, X-Ray Computed * methods   MeSH
• Forensic Medicine methods   trends   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Arterial spin labeling (ASL) je neinvazivní metoda MR využívaná k zobrazení mozkové perfuze. S rostoucími obavami týkajícími se používání kontrastních látek obsahujících gadolinium a zároveň významnými technickými pokroky v implementaci ASL se tato metoda stává středem zájmu různých diagnostických aplikací. V přehledovém článku se zaměřujeme na seznámení čtenářů se základy implementace sekvence ASL v neuroradiologii, diskutujeme optimální parametry skenování pro dosažení nejlepší kvality a přesnosti interpretace dat a poskytujeme přehled diagnostických aplikací v oblastech cerebrovaskulárních onemocnění, neuroonkologie, epilepsie a neurodegenerace. Kromě toho představujeme ukázkové radiologické případy a komentujeme potenciální budoucí vývoj neinvazivních ASL metod.

Arterial spin labeling (ASL) is a non-invasive MRI method used to image cerebral perfusion. Given increasing concerns regarding the use of gadolinium-based contrast agents and significant technical advancements in ASL implementation, the method is gaining attention in various diagnostic applications. This review article aims to familiarize readers with the fundamentals of ASL sequence implementation in neuroradiology, discuss optimal scanning parameters for achieving the highest quality and accuracy in data interpretation, and provide an overview of its diagnostic applications in the areas of cerebrovascular diseases, neuro-oncology, epilepsy, and neurodegeneration. Furthermore, we present illustrative radiological cases and explore the potential future developments of non-invasive ASL techniques.

• MeSH
• Cerebral Arteries diagnostic imaging   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Cerebral Angiography MeSH
• Cerebrovascular Circulation MeSH
• Neuroimaging * methods   MeSH
• Perfusion Imaging * methods   MeSH
• Spin Labels MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH
• Practice Guideline MeSH

Pro zlepšení přesnosti při zobrazování perfuze myokardu je nezbytné nahrávat další projekci při změněné pozici těla nebo používat CT atenuační korekci (AC). Technicky jednoduché je nahrávat AC CT na hybridní SPECT/CT kameře. Pro kamery, které jsou pouze SPECT, typicky pro kardiologické kadmium zinek telluridové (Cadmium Zinc Telluride, CZT) kamery, můžeme pro AC použít externí CT. Pro AC můžeme dokonce použít i EKG-gated CT koronární kalciové skóre. Cílem práce je podělit se o zkušenosti s fúzi SPECT a CT pro AC na CZT kameře.

To improve the accuracy of myocardial perfusion imaging, it is necessary to acquire the additional study in a changed body position, or to use a CT attenuation correction (AC). AC can be technically easil performed on a hybrid SPECT/CT camera. For AC on SPECT only camera, typically cardiac Cadmium Zinc Telluride (CZT) camera, we can use an external CT. Moreover, even ECG-gated CT coronary artery calcium scoring can be used for AC. The aim of our study is to present our experience with the fusion of SPECT and CT for AC on CZT camera.

The effects of a large arteriovenous fistula (AVF) on pulmonary perfusion remains to be elucidated. We aimed to study, for the first time, the real-time acute effects of a large AVF on regional distribution of pulmonary perfusion in a novel porcine model. Ten healthy swine under general anesthesia were studied. AVF was created by the connection of femoral artery and femoral vein using high-diameter perfusion cannulas. The AVF was closed and after 30 min of stabilization the first values were recorded. The fistula was then opened, and new data were collected after reaching stable state. Continuous hemodynamic monitoring was performed throughout the protocol. The following functional images were analyzed by electrical impedance tomography (EIT): perfusion and ventilation distributions. We found an increased cardiac output and right ventricular work, which was strongly correlated to an increased pulmonary artery mean pressure (r=0.878, P=0.001). The ventral/dorsal ratio of pulmonary perfusion decreased from 1.9+/-1.0 to 1.5+/-0.7 (P=0.025). The percentage of total pulmonary blood flow through the dorsal lung region increased from 38.6+/-11.7 to 42.2+/-10.4 (P=0.016). In conclusion, we have used EIT for the first time for studying the acute effects of a large AVF on regional distribution of pulmonary perfusion in a novel porcine model. In this new experimental model of hyperkinetic circulation caused by AVF, we documented an increased percentage of total pulmonary blood flow through the dorsal lung region and a more homogeneous perfusion distribution. Key words Arteriovenous fistula, Hyperkinetic circulation, Tissue perfusion, Animal model, Pulmonary blood flow.

• MeSH
• Pulmonary Artery diagnostic imaging   physiopathology   MeSH
• Arteriovenous Fistula physiopathology   diagnostic imaging   MeSH
• Arteriovenous Shunt, Surgical MeSH
• Lung blood supply   diagnostic imaging   MeSH
• Pulmonary Circulation * physiology   MeSH
• Swine MeSH
• Femoral Vein diagnostic imaging   MeSH
• Animals MeSH
• Check Tag
• Female MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

Despite extensive research on neuroimaging correlates of human brain aging, there is little mechanistic insight into how they are linked to loss of brain function. Previous studies on the role of cerebral blood flow (CBF) in supporting brain function have focused on delivery of nutrients, namely oxygen and glucose. However, CBF is required also to clear the byproducts of energy metabolism, namely CO2 and protons. With the goal of determining whether age-associated reduction in regional CBF may lead to abnormal brain partial pressure of carbon dioxide (pCO2) and pH levels that are sufficient to alter brain activity and cognitive function, we applied a recently introduced homeostatic modeling of nutrients and waste products to human neuroimaging PET data acquired in young and older adults (Goyal et al. in Cell Metab 26(2):353-360, 2017). Our results demonstrate that age-associated reductions in CBF, in the presence of virtually unaltered oxygen consumption rates, show concurrent regional age-associated increases in pCO2 and associated pH acid-shifts of possible functional relevance. We conclude that the implications of altered vascular health in older adults needs to be revisited in light of its central role in removing waste products from energy metabolism at resting state and, in future studies, during external stimulations.

• MeSH
• Adult MeSH
• Energy Metabolism * MeSH
• Hydrogen-Ion Concentration MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Brain * metabolism   MeSH
• Cerebrovascular Circulation * physiology   MeSH
• Carbon Dioxide * metabolism   MeSH
• Positron-Emission Tomography * MeSH
• Aged MeSH
• Oxygen Consumption MeSH
• Aging * metabolism   physiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BackgroundSulodexide is a glycosaminoglycan-based drug prescribed to patients with angiopathy. We performed a pilot study to investigate whether sulodexide positively modulates the endothelial glycocalyx (EG) layer and the microcirculation in a porcine model of EG enzymatic damage. The EG is a sugar-based endothelial lining that is involved in the physiology of the capillary wall and the pathogenesis of many diseases.MethodsEG damage was induced in eight piglets by hyaluronidase III and heparanase I given intravenously. Four animals received sulodexide 600 IU intravenously before the enzymes and four animals after the enzymes were administered. Four animals constituted a control group. Sublingual microcirculation by side-stream dark field imaging and plasmatic concentration of syndecan-1 by ELISA were measured at baseline, 20 min after intervention, and at the 40th, and 60th minute onwards. The statistics were performed with a one-way ANOVA test with Turkey's correction for multiple comparisons testing. Timepoint comparison was performed by Student t-test or Mann-Whitney test.ResultsAt baseline, there were no statistically significant differences between the animal groups. After the intervention, the levels of syndecan-1 were significantly lower in the control group. While there were no differences between the two intervention groups. The sublingual microcirculation analysis showed that the DeBacker score was significantly higher in the control group. At 60 min, there was also a statistically significant difference in DeBacker score between the groups (8.1 ± 1.6 mm-1 in the group with enzymes given first and 11 ± 0.92 mm-1 in the group with sulodexide given first, p = 0.03). The analysis of the proportion of perused vessels did not show any statistically significant differences.ConclusionThe results of the study demonstrated a working model of EG damage but no specific action of sulodexide on EG modulation. In the sublingual microcirculation analysis, the sulodexide reduced the fall in absolute tissue perfusion in 60 min.

• MeSH
• Endothelium, Vascular * drug effects   MeSH
• Glycocalyx * drug effects   metabolism   MeSH
• Glycosaminoglycans * pharmacology   MeSH
• Hyaluronoglucosaminidase MeSH
• Microcirculation drug effects   MeSH
• Disease Models, Animal MeSH
• Pilot Projects MeSH
• Swine MeSH
• Syndecan-1 blood   MeSH
• Animals MeSH
• Check Tag
• Animals MeSH
• Publication type
• Journal Article MeSH

A case report of a 68-year-old otherwise-healthy female patient with Spetzler-Martin (SM) grade I arteriovenous malformation (AVM) in her left frontal region is presented. After an uneventful surgery, cerebral venous infarction developed, and the patient was rendered hemiparetic with motor aphasia. After bony decompression, slow improvement was seen, and 3 months after surgery, the patient was neurologically intact. Six months after AVM resection, cranioplasty was performed. Infarction was caused by the thrombosis of a long primary draining vein, which finished its course in the normal cortical venous system. The case supports the venous origin of postoperative bleeding after AVM resection instead of the normal perfusion pressure phenomenon.

• MeSH
• Cerebral Infarction * etiology   surgery   MeSH
• Intracranial Arteriovenous Malformations * surgery   complications   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Cerebral Veins surgery   diagnostic imaging   MeSH
• Postoperative Complications etiology   surgery   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH