- Email: [email protected]
Condition of the cerebral arterial system in the patients with low radiation doses: duplex scans investigation
S18
ABSTRACTS
stenosis (0.1-29, 30-49, 50-69, 70-99 % and occl.). The arterial DSA was used as gold standard. Results: The degree of stenosis was overestimated by both the DU (with 4.2 %) and MRA (with 6.7 %). The DU evaluation with ECST method was 9.5% higher than with NASCET method. The DU had a sensitivity of 0.85, a specificity of 0.97. The MRA had a sensitivity of 0.76 a specificity of 0.96. The collective application had a sensitivity of 0.96, a specificity of 0.99. When the correct measuring of stenosis under 50% wasn’t required, the diagnostic accuracy significantly improved. DU had a sensitivity of 0.92 a specificity of 0.95 vs MRA had a sensitivity of 0.77, and a specificity of 0.93 for the identification of 70-991 stenosis. In the case of collective application they had a sensitivity and specificity of 1.0 each. In the course of observing vertebral arteriae 1 false positive and 1 false negative occlusion was found by DU, vs 2 false positive and 2 false negative occlusions were found by MRA. For the identification of intracerebral arterial stenosis MRA cotlerated with DSA with a sensitivity of 0.86 and a specificity of 0.87. Conclusions: On the basis of the authors experience and as shown by literature they can state that both MRA and DU fail in the correct quantification of carotid stenosis and of vertebral occlusion, but the collective application increases the number of the correct diagnosis. Before indicating the carotid endarterectomy to account the state of intracerebral artery, and if the results of DU and MRA are different, arterial DSA is required.
P13 tl
Comparative study of carotid artery duplex scanning and MRI in patients witb cerebral circulation disorders
F. Todua, M. Berala, D. Gachechiladze.
Institute of
Radiology Tbibsi. Rep. Georgia Purpose:
To compare MRI and MRA with carotid duplex US and evaluate the relationship between stenosis severity and plaque morphology in patients with symptomatic cerebral &hernia. Methods and materials: 58 patients /age 57 + 5.8y/ with symptomatic cerebral discirculation /37-TIA, 21stroke/ underwent MRI, MRI /time of flight/ duplex US and conventional angiography. Results: Symptomatic cerebral ischemia was noted in 6 cases when plaques were not present. In 41.4% of cases more than 60% ICA stenosis was marked. In 43.1% of
cases the prevalence of hyperechoic, heterogenous, irregular surface lessions increased and correlated to ICA stenosis severity. Statistically significant difference between MR angiography and duplex US in quantifying ICA stenosis and plaque morphology was not noted. MRA of arterial impairment comprise extra end intracranial arteries. MRI picture of the brain was changed in mild and moderate arterial hypertension and CA cincing. In atherosclerosis of the major cerebral arteries MRI detected strokes in 87% of ischemic cases. A direct relationship between the degree of arterial stenosis and incidence of the strokes was not found. Conclusion: The prevalance of symptomatic cerebral ischemia increases when heterogenous irregular surface plaques were present. MRA is screening method for ICA stenosis well correlated with duplex US. Additionally duplex US offers high sensitivity for the assesment of the morphology and constitution of the plaque. Combination of MRI and duplex US can give all necessary information for patients preoperative evalution.
P14 0
Condition of the cerebml arterial system in the patients with low mdiation doses: duplex scans investigation
V.G. Leliuk, A.K. Guskova, S.E. Leliuk. SRC, Institute of Biophysics, Moscow, Russia
Five hundred and fifty six patients (1 group) of average age 52.9 + 9.6 (range 28-84) involved in different radiation accidents with low radiation doses (without acute irradiation syndrome) were examined from October 1994 to January 1997. Radiation doses are known in 63% of patients (of 12.9 cGy average individual dose). Control consisted of 2500 persons (2 group) of average age 51 f 12.4 (range 17-91) which were out of radiation exposure contact. All person under study were examined by duplex scans of carotid and vertebral arteries (extracranial parts). In each examination we estimated: thickness and structure of intima-media complex, vascular geometry, presence of intraarterial pathology (plaques, thrombus), diameter of vessel. Absence of pathological lesions of arterial system in 1 group was observed in 9,7% of cases and in 2 group-in 11.2% cases; thickening and changes in structure of the intima-media complex-in 26.6% (1 gr.) and in 24.1% (2 gr.); stenotic atherosclerotic lesion-in 42.8% of cases in 1 gr., 41.4%&i 2 gr., different deformations of arteries58.8% (1 gr.1, 56.1% (2 gr.), hypoplasia of VA-11.8% (1
ABSTRACTS
gr.), 12% (2 gr.). Linear correlative dependencies were revealed for atherosclerotic lesion versus age: 1 gr. r= 0.89, P
P15 0
Stroke patterns and ipsilateral carotid stenosis among ischemic stroke patients in Singapore
N. Venketasubramanian,
s19
patterns of infarction nor S > 60 was correlated with age, sex, race, I-IT, DM, SM, PE or hyperlipidemia. Conclusions: LAC and NLAC are equally frequent. S > 60 is found in a small proportion of ischemic stroke patients in Singapore. S > 60 is more frequently found with NL4C than with L,AC. NLAC is more frequently found with S > 60; I.&J is infrequently found with S > 60. Infarction patterns seen among those with S > 60 tend to be NLAC. S < 60 was not clearly associated with either LAC or NLAC.
P16 tl
A combination of antithrombotic procedures reduces carotid thrombi due to essential thorn-bocythemia
A.K.Y. Tan, S. Balaji. Tan
Tack Seng Hospital, Singapore
A. Allardt, R. Baron, A. Georgiadis, G. Deuschl, P. Zunker. Department of Neumlogy, University Hospital CA U Kiel, Germany
Aim: This study was performed to evaluate patterns of ischemic stroke and ipsilateral carotid stenosis (ICS) in a Singapore hospitalized stroke population. Methods: Of a cohort of 1200 consecutive patients admitted to our Hospital within 1 week of stroke and studied prospectively as part of our Stroke Data Bank, those with CT-proven anterior circulation ischemic stroke were identified for this study. A standard questionnaire was used for data collection. History of hypertension (HT), diabetes mellitus (DM), smoking (SM), prior cerebrovascular events (PE) was sought. Serum lipids and electrocardiograms were performed - those with atrial fibrillation were excluded. Stroke was classified into lacunar &AC) and non-lacunar (NLAC) based on CT findings - LAC were < 1.5 cm diameter and located in the internal capsule or corona radiata; NLAC comprised cortical, large subcortical and borderzone infarcts. Color-coded Duplex carotid ultrasound was performed using the Diasonics Prisma (France) machine using a 7.5 MHz hand-held probe, and ICS estimated by Doppler criteria. Results: Of the first 230 patients enrolled, median age was 68.7 yr (range 30.7-96.2 yr); 56.1% male, 43.9% female; 79.1% were Chinese, 10.2% Indian, 8.8% Malay, 1.8% Other races. 49.6% were LAC, 50.4% NLAC. 43/230 (18.7%) had ICS exceeding 60% (S > 60) - 3 had 60-79%, 6 had 80-99%, 34 had 100% occlusion or a distal severe stenosis or occlusion; 8 had LAC, 35 NLAC. 187/230 (81.3%) had ICS below 60% (S < 60) - 106 had LAC, 81 NLAC. S,60 was found in 7.1% of LAC, 30.2% of NLAC (P < 0.001). Neither
Essential thrombocythemia has been reported to be associated with embolic events. There is no established procedure for the prevention of ischemic events in these patients. We report a case of successful treatment of symptomatic m-situ thrombosis of both carotid arteries by essential thrombocythemia. A 31-year-old man had intermittent cerebral and systemic ischemic events for 4 years. Before admission he suffered from left-sided sensory motor deficits lasting 20-90 min up to four times per week and one episode of right-handed paresthesia under ASA 100 mg/d. Increasing stenosis of the right distal ACC, left ECA and ICA, as well as a constant high grade right ECAstenosis due to partly floating thrombi in the intraarterial lumen, were documented by i.a.DSA and Duplex. The patient had recurrent TIAs under full dose heparinisation. Duplex scan showed an increase in the size of the partly floating left ICA-thrombus. A bone marrow tap established the diagnosis of a myeloproliferative syndrome. Under additional ASA 300 mg/d and isovolemic hemodilution the recurrent TIAs could be stopped. Within the following weeks the thrombus in the left ICA disappeared, the thrombus in the right distal CCA appeared smaller. The patient remained asymptomatic with ASA 300 mg/d and Ticlopidine 500 mg/d. A second bone marrow tap 2 months later confirmed the diagnosis of essential thrombocythemia. Hydroxyurea was given and antiplatelet drugs reduced to ASA 100 mg/d. No further TIA occured.
ABSTRACTS
stenosis (0.1-29, 30-49, 50-69, 70-99 % and occl.). The arterial DSA was used as gold standard. Results: The degree of stenosis was overestimated by both the DU (with 4.2 %) and MRA (with 6.7 %). The DU evaluation with ECST method was 9.5% higher than with NASCET method. The DU had a sensitivity of 0.85, a specificity of 0.97. The MRA had a sensitivity of 0.76 a specificity of 0.96. The collective application had a sensitivity of 0.96, a specificity of 0.99. When the correct measuring of stenosis under 50% wasn’t required, the diagnostic accuracy significantly improved. DU had a sensitivity of 0.92 a specificity of 0.95 vs MRA had a sensitivity of 0.77, and a specificity of 0.93 for the identification of 70-991 stenosis. In the case of collective application they had a sensitivity and specificity of 1.0 each. In the course of observing vertebral arteriae 1 false positive and 1 false negative occlusion was found by DU, vs 2 false positive and 2 false negative occlusions were found by MRA. For the identification of intracerebral arterial stenosis MRA cotlerated with DSA with a sensitivity of 0.86 and a specificity of 0.87. Conclusions: On the basis of the authors experience and as shown by literature they can state that both MRA and DU fail in the correct quantification of carotid stenosis and of vertebral occlusion, but the collective application increases the number of the correct diagnosis. Before indicating the carotid endarterectomy to account the state of intracerebral artery, and if the results of DU and MRA are different, arterial DSA is required.
P13 tl
Comparative study of carotid artery duplex scanning and MRI in patients witb cerebral circulation disorders
F. Todua, M. Berala, D. Gachechiladze.
Institute of
Radiology Tbibsi. Rep. Georgia Purpose:
To compare MRI and MRA with carotid duplex US and evaluate the relationship between stenosis severity and plaque morphology in patients with symptomatic cerebral &hernia. Methods and materials: 58 patients /age 57 + 5.8y/ with symptomatic cerebral discirculation /37-TIA, 21stroke/ underwent MRI, MRI /time of flight/ duplex US and conventional angiography. Results: Symptomatic cerebral ischemia was noted in 6 cases when plaques were not present. In 41.4% of cases more than 60% ICA stenosis was marked. In 43.1% of
cases the prevalence of hyperechoic, heterogenous, irregular surface lessions increased and correlated to ICA stenosis severity. Statistically significant difference between MR angiography and duplex US in quantifying ICA stenosis and plaque morphology was not noted. MRA of arterial impairment comprise extra end intracranial arteries. MRI picture of the brain was changed in mild and moderate arterial hypertension and CA cincing. In atherosclerosis of the major cerebral arteries MRI detected strokes in 87% of ischemic cases. A direct relationship between the degree of arterial stenosis and incidence of the strokes was not found. Conclusion: The prevalance of symptomatic cerebral ischemia increases when heterogenous irregular surface plaques were present. MRA is screening method for ICA stenosis well correlated with duplex US. Additionally duplex US offers high sensitivity for the assesment of the morphology and constitution of the plaque. Combination of MRI and duplex US can give all necessary information for patients preoperative evalution.
P14 0
Condition of the cerebml arterial system in the patients with low mdiation doses: duplex scans investigation
V.G. Leliuk, A.K. Guskova, S.E. Leliuk. SRC, Institute of Biophysics, Moscow, Russia
Five hundred and fifty six patients (1 group) of average age 52.9 + 9.6 (range 28-84) involved in different radiation accidents with low radiation doses (without acute irradiation syndrome) were examined from October 1994 to January 1997. Radiation doses are known in 63% of patients (of 12.9 cGy average individual dose). Control consisted of 2500 persons (2 group) of average age 51 f 12.4 (range 17-91) which were out of radiation exposure contact. All person under study were examined by duplex scans of carotid and vertebral arteries (extracranial parts). In each examination we estimated: thickness and structure of intima-media complex, vascular geometry, presence of intraarterial pathology (plaques, thrombus), diameter of vessel. Absence of pathological lesions of arterial system in 1 group was observed in 9,7% of cases and in 2 group-in 11.2% cases; thickening and changes in structure of the intima-media complex-in 26.6% (1 gr.) and in 24.1% (2 gr.); stenotic atherosclerotic lesion-in 42.8% of cases in 1 gr., 41.4%&i 2 gr., different deformations of arteries58.8% (1 gr.1, 56.1% (2 gr.), hypoplasia of VA-11.8% (1
ABSTRACTS
gr.), 12% (2 gr.). Linear correlative dependencies were revealed for atherosclerotic lesion versus age: 1 gr. r= 0.89, P
P15 0
Stroke patterns and ipsilateral carotid stenosis among ischemic stroke patients in Singapore
N. Venketasubramanian,
s19
patterns of infarction nor S > 60 was correlated with age, sex, race, I-IT, DM, SM, PE or hyperlipidemia. Conclusions: LAC and NLAC are equally frequent. S > 60 is found in a small proportion of ischemic stroke patients in Singapore. S > 60 is more frequently found with NL4C than with L,AC. NLAC is more frequently found with S > 60; I.&J is infrequently found with S > 60. Infarction patterns seen among those with S > 60 tend to be NLAC. S < 60 was not clearly associated with either LAC or NLAC.
P16 tl
A combination of antithrombotic procedures reduces carotid thrombi due to essential thorn-bocythemia
A.K.Y. Tan, S. Balaji. Tan
Tack Seng Hospital, Singapore
A. Allardt, R. Baron, A. Georgiadis, G. Deuschl, P. Zunker. Department of Neumlogy, University Hospital CA U Kiel, Germany
Aim: This study was performed to evaluate patterns of ischemic stroke and ipsilateral carotid stenosis (ICS) in a Singapore hospitalized stroke population. Methods: Of a cohort of 1200 consecutive patients admitted to our Hospital within 1 week of stroke and studied prospectively as part of our Stroke Data Bank, those with CT-proven anterior circulation ischemic stroke were identified for this study. A standard questionnaire was used for data collection. History of hypertension (HT), diabetes mellitus (DM), smoking (SM), prior cerebrovascular events (PE) was sought. Serum lipids and electrocardiograms were performed - those with atrial fibrillation were excluded. Stroke was classified into lacunar &AC) and non-lacunar (NLAC) based on CT findings - LAC were < 1.5 cm diameter and located in the internal capsule or corona radiata; NLAC comprised cortical, large subcortical and borderzone infarcts. Color-coded Duplex carotid ultrasound was performed using the Diasonics Prisma (France) machine using a 7.5 MHz hand-held probe, and ICS estimated by Doppler criteria. Results: Of the first 230 patients enrolled, median age was 68.7 yr (range 30.7-96.2 yr); 56.1% male, 43.9% female; 79.1% were Chinese, 10.2% Indian, 8.8% Malay, 1.8% Other races. 49.6% were LAC, 50.4% NLAC. 43/230 (18.7%) had ICS exceeding 60% (S > 60) - 3 had 60-79%, 6 had 80-99%, 34 had 100% occlusion or a distal severe stenosis or occlusion; 8 had LAC, 35 NLAC. 187/230 (81.3%) had ICS below 60% (S < 60) - 106 had LAC, 81 NLAC. S,60 was found in 7.1% of LAC, 30.2% of NLAC (P < 0.001). Neither
Essential thrombocythemia has been reported to be associated with embolic events. There is no established procedure for the prevention of ischemic events in these patients. We report a case of successful treatment of symptomatic m-situ thrombosis of both carotid arteries by essential thrombocythemia. A 31-year-old man had intermittent cerebral and systemic ischemic events for 4 years. Before admission he suffered from left-sided sensory motor deficits lasting 20-90 min up to four times per week and one episode of right-handed paresthesia under ASA 100 mg/d. Increasing stenosis of the right distal ACC, left ECA and ICA, as well as a constant high grade right ECAstenosis due to partly floating thrombi in the intraarterial lumen, were documented by i.a.DSA and Duplex. The patient had recurrent TIAs under full dose heparinisation. Duplex scan showed an increase in the size of the partly floating left ICA-thrombus. A bone marrow tap established the diagnosis of a myeloproliferative syndrome. Under additional ASA 300 mg/d and isovolemic hemodilution the recurrent TIAs could be stopped. Within the following weeks the thrombus in the left ICA disappeared, the thrombus in the right distal CCA appeared smaller. The patient remained asymptomatic with ASA 300 mg/d and Ticlopidine 500 mg/d. A second bone marrow tap 2 months later confirmed the diagnosis of essential thrombocythemia. Hydroxyurea was given and antiplatelet drugs reduced to ASA 100 mg/d. No further TIA occured.