Cerebral perfusion in patients with unilateral internal carotid artery occlusion by dual post-labeling delays arterial spin labeling imaging

BACKGROUND Global and regional cerebral blood flow(CBF)changes in patients with unilateral internal carotid artery occlusion(ICAO)are unclear when the dual post-labeling delays(PLD)arterial spin labeling(ASL)magnetic resonance imaging(MRI)technique is used.Manual delineation of regions of interest for CBF measurement is time-consuming and laborious.AIM To assess global and regional CBF changes in patients with unilateral ICAO with the ASL-MRI perfusion technique.METHODS Twenty hospitalized patients with ICAO and sex-and age-matched controls were included in the study.Regional CBF was measured by Dr.Brain's ASL software.The present study evaluated differences in global,middle cerebral artery(MCA)territory,anterior cerebral artery territory,and Alberta Stroke Program Early Computed Tomography Score(ASPECTS)regions(including the caudate nucleus,lentiform nucleus,insula ribbon,internal capsule,and M1-M6)and brain lobes(including frontal,parietal,temporal,and insular lobes)between ICAO patients and controls at PLD 1.5 s and PLD 2.5 s.RESULTS When comparing CBF between ICAO patients and controls,the global CBF in ICAO patients was lower at both PLD 1.5 s and PLD 2.5 s;the CBF on the occluded side was lower in 15 brain regions at PLD 1.5 s,and it was lower in 9 brain regions at PLD 2.5 s;the CBF in the contralateral hemisphere was lower in the caudate nucleus and internal capsule at PLD 1.5 s and in M6 at PLD 2.5 s.The global CBF in ICAO patients was lower at PLD 1.5 s than at PLD 2.5 s.The ipsilateral CBF at PLD 1.5 s was lower than that at PLD 2.5 s in 15 regions,whereas the contralateral CBF was lower at PLD 1.5 s than at PLD 2.5 s in 12 regions.The ipsilateral CBF was lower than the contralateral CBF in 15 regions at PLD 1.5 s,and in M6 at PLD 2.5 s.CONCLUSION Unilateral ICAO results in hypoperfusion in the global and MCA territories,especially in the ASPECTS area.Dual PLD settings prove more suitable for accurate CBF quantification in ICAO.

Anomalous course of the carotid arteries in the retrooesophageal space: An unusual cause of chest pain

The differential diagnosis of chest pain, one of the most frequent symptoms referred in the emergency department, includes cardiac and noncardiac causes and represents a difficult challenge for clinicians. Noncardiac chest pain can be defined as the recurrence of chest pain episodes indistinguishable from coronary events after the exclusion of a cardiac cause. It may be of musculoskeletal, pulmonary, gastroenterological, psychosomatic or neurological aetiology, oesophageal disorders representing the most common detectable cause. In this report we describe a rare case of chest pain which appeared after dinner, due to an oesophageal spasm caused by the anomalous course of the carotid arteries. The case is relevant because it describes a very uncommon variant of the physiological course of the carotid arteries, and because it is unusual that a retro thoracic vascular abnormality can be related to the appearance of chest pain without dysphagia. Chest pain which appears after dinner in our case is probably due to the unusual anatomic connection between oesophagus and carotid arteries that probably begins to make stronger when the patient undertakes the supine position: for that reason nocturnal chest pain promptly relieves after the assumption of orthostatic or semi orthostatic decubitus. In conclusion, in a patient who refers the sudden appearance of nocturnal chest pain certainly unrelated to coronary artery disease, the physicians should consider the involvement of oesophageal system, maybe determined by vascular course abnormalities.

Evaluation of Carotid Atherosclerotic Plaque Stability with Contrast-enhanced Ultrasonography

This study was aimed to evaluate the relationship between carotid atherosclerotic plaque stability and the clinical symptoms in patients with carotid atherosclerotic plaques by using contrast-enhanced ultrasonography. Fifty patients with carotid atherosclerotic plaques were enrolled and examined with contrast-enhanced ultrasonography. The correlation of contrast agent enhancement of the carotid atherosclerotic plaques and the clinical symptoms was analyzed. The results showed that among the 50 patients, plaques were enhanced in the 23 patients with obvious clinical symptoms. In 27 patients without apparent clinical symptoms, plaques were enhanced sparsely in 15 patients and not enhanced in 12 patients. It was suggested that contrast-enhanced ultrasonography could be used for the examination of the microcirculation in carotid atherosclerotic plaques on real-time basis and serve as a new noninvasive approach for the assessment of stability of carotid atherosclerotic plaques.

Intravascular ultrasonography assisted carotid artery stenting for treatment of carotid stenosis: Two case reports

BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery sten-ting(CAS).CASE SUMMARY Case 1:A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke.Physical examination showed decreased strength(5-/5)in both lower limbs.Carotid artery ultrasound,magnetic resonance angiography,and computed tomography angiography(CTA)showed a right proximal internal carotid artery(ICA)stenosis(70%-99%),acute cerebral infarction,and severe right ICA stenosis,respectively.We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation.Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence.CTA six months postoperatively showed no significant increase in in-stent stenosis.Case 2:A 36-year-old man was admitted with a right common carotid artery(CCA)dissection detected by ultrasound.Physical examination showed no positive neurological signs.Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow(dissection or carotid web).IVUS-assisted DSA confirmed right CCA dissection.CAS was performed and intraoperative IVUS suggested a large residual false lumen.Post-stent balloon dilatation was performed reducing the false lumen.DSA three months postoperatively indicated good stent expansion with mild stenosis.CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively,dissection and stenosis morphology intraoperatively,and visualizing and confirming CAS postoperatively.

Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

AIM To assess the usefulness of intra-arterial contrastenhanced ultrasonography(IAUS) during transarterial chemoembolization(TACE) with drug-eluting beads(DEB) for hepatocellular carcinoma(HCC).METHODS Thirty two patients with 39 HCC underwent DEB-TACE guided with IAUS, and examined by contrast-enhanced ultrasonography(CEUS) or dynamic CT after DEB-TACE were enrolled in this study. CEUS findings before DEBTACE and IAUS findings were compared. Treatments judged to be complete and incomplete for lesions were appropriate and insufficient, respectively. Findings on CEUS and/or dynamic CT performed 1, 3 and 6 mo after DEB-TACE were evaluated using m RECIST(CR/PR/SD/PD).RESULTS The treatments were complete and incomplete in 26 and 13 lesions, respectively. On imaging evaluation using CEUS and/or dynamic CT one month after treatment, 25 and 1 lesions were judged to be CR and PR, respectively, and at 6 mo after treatment, the results were CR, PR, SD and PD for 24, 1, 0 and 1 of these lesions, respectively, in the 26 completely treated lesions. Of the 13 lesions in which treatment was incomplete, the results on imaging at one month after treatment were CR, PR, SD and PD for 0, 6, 4 and 3 lesions, respectively. The overall CR rate at 6 mo after treatment was 61.5%(24/39).CONCLUSION A combination of DEB-TACE with IAUS can improve the therapeutic effects in patients with HCC.

Common carotid arterial thrombosis associated with ulcerative colitis

A 26-year-old woman with ulcerative colitis was transferred to our hospital with left hemiparesis due to cerebral infarction. Cervical ultrasonography and magnetic resonance imaging angiography revealed thrombosis at the right common carotid artery and the right internal carotid artery. Antithrombotic and anticoagulant therapies were commenced. After about 2 wk of the treatment, the frequency of her diarrhea increased. She underwent emergency subtotal colectomy, but 10 d later an abundant hemorrhage from the remnant rectum occurred, so the remnant rectum was resected and an ileal pouch anal anastomosis was performed. Antithrombotic and anticoagulant therapies were continued, but neither her neurological status nor magnetic resonance imaging angiography findings showed subsequent changes. She was discharged 3 mon after operation. This is a rare case of common carotid arterial thrombosis occurring as a complication of ulcerative colitis, in which antithrombotic and anticoagulant therapies are considered to provoke a deterioration of the patient’s bowel disease.

Ultrafast pulse wave velocity technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis patients with euthyroidism

Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasound and UFPWV for carotid artery were prospectively performed in 91 HT patients with euthyroidism(HT group)and 81 healthy subjects(control group).Clinical data and ultrasonic parameters were compared between groups.Spearman correlation analysis was performed to observe the correlations of carotid pulse wave velocity in end of systole(PWV-ES)with clinical indexes and other ultrasonic parameters in HT group.Multiple stepwise linear regression analysis was used to screen the independent impact factors of increased carotid PWV-ES in HT group.Results Significant differences of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),total cholesterol(TC),low density lipoprotein and neutrophil-lymphocyte ratio(NLR)were found between groups(all P<0.05).The carotid PWV-ES in HT group was significantly higher than that in control group(P<0.05),while no significant difference of carotid artery intima-media thickness(CIMT)nor carotid pulse wave velocity in beginning of systole(PWV-BS)was found between groups(both P>0.05).Carotid PWV-ES in HT group was positively correlated with patients'age,body mass index,TPOAb,TC,triglyceride,NLR and CIMT(r=0.217—0.707,all P<0.05).Patients'age,TPOAb and NLR were all independent impact factors of increased carotid PWV-ES in HT patients with euthyroidism(all P<0.05).Conclusion UFPWV technique could be used to evaluate changes of carotid artery elasticity in HT patients with euthyroidism,among which PWV-ES was relatively sensitive.

Impact of the arterial input function on microvascularization parameter measurements using dynamic contrast-enhanced ultrasonography

AIM: To evaluate the sources of variation influencing the microvascularization parameters measured by dynamic contrast-enhanced ultrasonography (DCE-US). METHODS: Firstly, we evaluated, in vitro , the impact of the manual repositioning of the ultrasound probe and the variations in flow rates. Experiments were conducted using a custom-made phantom setup simulating a tumor and its associated arterial input. Secondly, we evaluated, in vivo , the impact of multiple contrast agent injections and of examination day, as well as the influence of the size of region of interest (ROI) associated with the arterial input function (AIF). Experiments were conducted on xenografted B16F10 female nude mice. For all of the experiments, an ultrasound scanner along with a linear transducer was used to perform pulse inversion imaging based on linear raw data throughout the experiments. Semi-quantitative and quantitative analyses were performed using two signal-processing methods. RESULTS:In vitro , no microvascularization parameters, whether semi-quantitative or quantitative, were significantly correlated (P values from 0.059 to 0.860) with the repositioning of the probe. In addition, all semiquantitative microvascularization parameters were correlated with the flow variation while only one quantitative parameter, the tumor blood flow, exhibited P value lower than 0.05 (P = 0.004). In vivo , multiple contrast agent injections had no significant impact (P values from 0.060 to 0.885) on microvascularization parameters. In addition, it was demonstrated that semi-quantitative microvascularization parameters were correlated with the tumor growth while among the quantitative parameters, only the tissue blood flow exhibited P value lower than 0.05 (P = 0.015). Based on these results, it was demonstrated that the ROI size of the AIF had significant influence on microvascularization parameters: in the context of larger arterial ROI (from 1.17 ± 0.6 mm 3 to 3.65 ± 0.3 mm 3 ), tumor blood flow and tumor blood volume were correlated with the tumor growth, exhibiting P values lower than 0.001. CONCLUSION: AIF selection is an essential aspect of the deconvolution process to validate the quantitative DCE-US method.

Association between Fundus Atherosclerosis and Carotid Arterial Atherosclerosis

Objective: To investigate the correlation between fundus atherosclerosis and carotid arterial atherosclerosis. Methods: A total of 516 people undergoing physical examination in Deyang People’s Hospital between June 2020 and December 2022 were randomly selected. Fundus atherosclerosis and carotid arterial atherosclerosis were evaluated by fundus photography and carotid artery ultrasonography, respectively. Results: Among the 516 physical examination patients, 198 (38.4%) had normal fundus examination, and 318 (61.6%) had fundus arteriosclerosis. Among them, 166 cases were of grade I (32.2%), 86 cases were of grade II (16.7%), and 66 cases were of grade III (12.8%). There were 286 cases (55.4%) without carotid atherosclerosis, 201 cases (38.9%) with carotid atherosclerotic plaque, and 33 cases (6.4%) with carotid stenosis. Fundus arteriosclerosis is independently associated with carotid artery intima-media thickness, vulnerable plaques, plaque scores, and carotid artery stenosis (P Conclusion: In summary, there is a close relationship between carotid artery disease and the degree of arteriosclerosis in the eyeground. Fundus photography is a simple, non-invasive, and easily acceptable method of inspection. The results obtained from it are useful in determining the severity of carotid atherosclerosis and guiding early detection and intervention in clinical cases. This can help reduce the incidence of cardiovascular and cerebrovascular diseases.

Segmentation of carotid arterial walls using neural networks

BACKGROUND Automated,accurate,objective,and quantitative medical image segmentation has remained a challenging goal in computer science since its inception.This study applies the technique of convolutional neural networks(CNNs)to the task of segmenting carotid arteries to aid in the assessment of pathology.AIM To investigate CNN’s utility as an ancillary tool for researchers who require accurate segmentation of carotid vessels.METHODS An expert reader delineated vessel wall boundaries on 4422 axial T2-weighted magnetic resonance images of bilateral carotid arteries from 189 subjects with clinically evident atherosclerotic disease.A portion of this dataset was used to train two CNNs(one to segment the vessel lumen and the other to segment the vessel wall)with the remaining portion used to test the algorithm’s efficacy by comparing CNN segmented images with those of an expert reader.Overall quantitative assessment between automated and manual segmentations was determined by computing the DICE coefficient for each pair of segmented images in the test dataset for each CNN applied.The average DICE coefficient for the test dataset(CNN segmentations compared to expert’s segmentations)was 0.96 for the lumen and 0.87 for the vessel wall.Pearson correlation values and the intra-class correlation coefficient(ICC)were computed for the lumen(Pearson=0.98,ICC=0.98)and vessel wall(Pearson=0.88,ICC=0.86)segmentations.Bland-Altman plots of area measurements for the CNN and expert readers indicate good agreement with a mean bias of 1%-8%.CONCLUSION Although the technique produces reasonable results that are on par with expert human assessments,our application requires human supervision and monitoring to ensure consistent results.We intend to deploy this algorithm as part of a software platform to lessen researchers’workload to more quickly obtain reliable results.

Relationship between peripheral arterial disease, carotid intima-media thickness and C-reactive protein in elderly diabetic patients

Purpose: To study the association between carotid intima media thickness (CIMT) and high sensitivity CRP (hs-CRP) level as markers for PAD in elderly patients with DM. Subjects: A case-control study on 90 participants aged 60 years and older divided into 60 cases (30 patients with DM alone and 30 patients with DM and comorbidities) and 30 healthy controls. All were assessed by measuring CIMT, ankle brachial index (AB), and markers for cardiovascular disease such as high-sensitivity CRP (hs-CRP), total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL). Results: hs-CRP levels showed statistically significant difference being highest among patients with DM and comorbidities and lowest among controls (P < 0.001). Also, symptoms of PAD were significantly higher among cases than controls. ABI was able to detect PAD in many asymptomatic patients. Color changes were present in only 43.30% (n = 26) of positive PAD cases while delayed wound healing, claudication pain, rest pain, cold extremities, and trophic changes were present in 23.30% (n = 14), 16.71% (n = 10), 16.71% (n = 10), 45.00% (n = 27), and 21.7% (n = 13). Using logistic regression analysis revealed that DM, CIMT, and hs-CRP were independent predictors for PAD (OR = 4.194, 7.236, 1.003;P value = 0.044, 0.25, 0.031) after adjustment of other coronary risk factors such as sex, smoking, hypertension, TC, and TG. Conclusion: Diabetic elderly have higher prevalence of asymptomatic PAD thannon-diabetics using solely ABI. DM, CIMT, and hs-CRP are independent predictors for the occurrence of PAD. Hs-CRP levels are highest among diabetics with comorbidities.

Accuracy of Doppler Ultrasonography in Assessment of Lower Extremity Peripheral Arterial Diseases

Doppler ultrasound scan is a non-invasive, cheap and convenient tool and it complements angiography, Computed tomography angiography (CTA), magnetic resonance angiography (MRA) and catheter digital subtraction angiography (DSA) in screening, diagnosis, treatment and follow-up of peripheral vascular diseases. Symptoms of peripheral vascular diseases are becoming more common due to rise in incidence of diseases and risk factors (diabetes mellitus, dyslipidemias, smoking, sedentary lifestyle). Due to limited availability of highly specific tools such as CT angiography, magnetic resonance angiography (MRA) and DSA (digital subtraction angiography) in many developing countries, doppler ultrasound is gaining more importance. Early determination of peripheral arterial diseases is beneficial in prevention of complications as severity increases may cause intermittent claudication, pain, tissue loss, including ulceration and gangrene (as the diseases progresses) and early management of arteriosclerosis will be beneficial to prevent these complications.

Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture:Three case reports

BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis.This article retrospectively analyzed the imaging and clinical data of three patients,to explore the imaging characteristics and treatment strategies for carotid artery occlusion,combined with severe skull base fractures.CASE SUMMARY This case included three patients,all male,aged 21,63,and 16 years.They underwent plain film skull computed tomography(CT)examination at the onset of their illnesses,which revealed fractures at the bases of their skulls.Ultimately,these cases were definitively diagnosed through CT angiography(CTA)examinations.The first patient did not receive surgical treatment,only anticoagulation therapy,and recovered smoothly with no residual limb dysfunction(Case 1).The other two patients both developed intracranial hypertension and underwent decompressive craniectomy.One of these patients had high intracranial pressure and significant brain swelling postoperatively,leading the family to choose to take him home(Case 2).The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction(Case 3).We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.CONCLUSION For patients with cranial trauma combined with skull base fractures,it is essential to complete a CTA examination as soon as possible,to screen for blunt cerebrovascular injury.

Imageology of internal carotid artery siphon in nonarteritic anterior ischaemic optic neuropathy

AIM:To evaluate whether narrowing of internal carotid artery siphon(ICAS)may increase the risk of developing non-arteritic anterior ischaemic optic neuropathy(NAION).METHODS:Totally 30 consecutive patients who had unilateral NAION and 30 gender-matched control subjects were recruited in the present study.The diameter of ICAS of all the participants were measured using head-and-neck computed tomographic angiography(CTA).Color doppler flow imaging(CDI)was used to measure the haemodynamics parameters of ICAS and short posterior ciliary arteries(SPCAs)in all subjects.Comparison of parameters between the NAION patients and controls as well as between the two sides within the patients were performed.The correlation between the diameter of ICAS and NAION was analyzed.RESULTS:A comparison of parameters between the affected side of the NAION patients and the controls,including the diameter of ICAS,the resistance index(RI)of ICAS,the blood flow velocities of SPCAs and RI of SPCAs,showed significantly difference(P<0.01),while there was no significant difference in terms of the mean blood flow velocity(Vm)of ICAS;Similar results were found while comparing all the measurements of the affected and unaffected side of patients(P for RI of SPCAs<0.05).No marked difference was detected in nearly all parameters except for RI of ICAS and SPCAs between the unaffected side of the NAION patients and the controls(P<0.05).The diameter of ICAS were significantly positive correlated with both peak systolic velocity(PSV)of SPCAs and end diastolic velocity(EDV)of SPCAs in patients with NAION(r=0.514,P<0.01 and r=0.418,P<0.05,respectively).CONCLUSION:Narrowing of ICAS may increase the risk of developing NAION.

Excision of Head and Neck Tumors Combined with Carotid Artery Resection without Arterial Blood Vessel Reconstruction

OBJECTIVE To summarize our clinical experience in treating 31 patients with neck masses undergoing carotid artery resection without arterial anastomosis （vascular reconstruction） in Tianjin Cancer Hospital during a period from 1979 to 2002. METHODS Preoperatively, patients were instructed to apply pressure to the carotid artery. Tumor excision combined with carotid artery resection （TECCAR） was conducted after an accurate testing of valid cerebral blood supply and compensation. RESULTS Among the study patients, 17 were male and 14 female, with the age ranging from 14 to 58 years. Of the 31 cases, 23 were carotid body tumors （8 malignant）, 2 vagal body tumors （1 malignant）, 4 carotid aneurysms, and 2 were metastatic tumors from the cervix involving carotid artery. Of the patients, a subtotal resection of the head and neck masses was conducted in 22 cases. Intraoperative death did not cerebrovascular complications occur, and postoperative CNS or （CVC） were not found. CONCLUSION TECCAR without arterial anastomosis is a safe and feasible procedure. In addition, this method of surgery has more advantages in comparison to an arterial anastomosis： i） Tumor resection was more complete, ii） Complications such as thrombus, infection, and lethal hemorrhage etc., were rare after surgery; iii） Postoperative radiotherapy, if needed, would be safe and acceptable; iv） It was a more simplified operational procedure.

Should We Be Concerned? Comparison of Catheter and CT Angiogram for Arterial Distensibility at the Site of Carotid Stenosis during Catheter Angiography

Purpose: During catheter angiogram (CA) there is momentary increase in intravascular volume and pressure due to intra-arterial injection that can potentially cause vascular distention at the stenotic site, whereas on CT angiogram (CTA) is unlikely due to intravenous administration. Methods: CA and CTA of the carotid artery from 29 patients were retrospectively studied. CA and CTA were obtained for each patient. Curved sagittal MPRs mirroring the carotid artery on CA were used to measure the diameter at stenosis and at the distal lumen. Mural plaque calcium content was graded on axial CTAs. Results: Accounting for repeated measurements, the likelihood that the lumen diameter from CA will be larger than CTA was higher at stenosis than distal to it but the difference in lumen diameters at stenosis was similar to CTA. There is insufficient evidence that intra-arterial hand-injection during CA leads to underestimation of the degree of stenosis. Percentage stenosis using the NASCET criteria differed between the 3 measurements, post hoc analysis showed significant difference between CA and axial CTA (p p > 0.99). The difference in lumen diameter did not depend on our calcium grading (p = 0.484). Conclusions: There is insufficient evidence to suggest that intra-arterial hand-injection contributes to vessel distention and underestimation of percent stenosis during CA in this study. Mural plaque calcium does not affect the degree of stenosis on CTA.

Bilateral Carotid Aneurysms Secondary to Catastrophic Antiphospholipid Syndrome in a Patient with Differential Diagnosis of Polyarteritis Nodosa

Background: Extracranial Carotid Artery Aneurysm is considered a therapeutic and diagnostic challenge. In an unprecedented way in the literature, we describe an aneurysm originating from the Catastrophic Antiphospholipid Syndrome. Case Presentation: A 25-year-old male patient came to the Emergency Room of the ABC University Hospital in Sao Bernardo do Campo referring to bilateral neck pain for 1 month, associated with carotid aneurysms. Due to the severity and urgency of the clinical condition, immediate surgical therapy was performed without a definitive etiological diagnosis. The initial morphological analysis of the carotid artery suggested a diagnosis of Polyarteritis Nodosa. After anamnesis, physical examination, the use of a specific primary vasculitis algorithm, and a review of the pathological anatomy was requested, which showed bilateral carotid aneurysms secondary to catastrophic antiphospholipid syndrome. Conclusion: It remains evident that Extracranial Carotid Artery Aneurysm-related morbidity and mortality caused by Catastrophic Antiphospholipid Syndrome are influenced by a quick and correct diagnosis.

Correlation of carotid contrast-enhanced ultrasonography parameters with nerve damage and plaque properties in patients with atherosclerosis cerebral infarction

Objective: To explore the correlation of carotid contrast-enhanced ultrasonography parameters with nerve damage and plaque properties in patients with atherosclerosis cerebral infarction. Methods: A total of 176 patients with atherosclerosis cerebral infarction who were sent to this hospital for medical treatment between August 2014 and February 2018 were enrolled in cerebral infarction group, and 100 healthy elderly subjects who received physical examination in this hospital during the same period were enrolled in normal control group. Carotid CEUS parameter levels as well as serum contents of indexes related to nerve injury and plaque property were compared between the two groups, and Pearson test was used to evaluate the correlation of CEUS parameters levels with nerve damage and plaque properties in patients with cerebral infarction. Results: CEUS parameter Tp level in cerebral infarction group was lower than that in normal control group whereas P and AUC levels were higher than those in normal control group;serum nerve damage-related indexes SAA, NT-proBNP, Hcy, NSE and copeptin contents were higher than those of normal control group;serum plaque property-related indexes Lp-PLA2, MMP-9, Cat S and CD62P contents were higher than those of normal control group while APN and Cys C contents were lower than those of normal control group. Correlation analysis confirmed that carotid CEUS parameter levels in patients with cerebral infarction were correlated with the contents of indexes related to nerve damage and plaque property. Conclusion: Carotid CEUS parameters are obviously abnormal in patients with atherosclerosis cerebral infarction, they are directly correlated with the specific nerve damage and plaque properties, and they can be used as the reliable indexes to forecast the risk of cerebral infarction and evaluate its severity.

Value of contrast-enhanced ultrasonography for evaluating the angiogenesis of carotid plaque in patients with cerebral infarction and its correlation with the changes of plaque properties

Objective: To study the value of contrast-enhanced ultrasonography for evaluating the angiogenesis of carotid plaque in patients with cerebral infarction and its correlation with the changes of plaque properties. Methods: The patients with carotid low-echo plaque detected by carotid artery ultrasound in Xinjiang Uygur Autonomous Region People's Hospital between January 2014 and January 2016 were selected as the research subjects, received at least 2 years of follow-up and divided into the cerebral infarction group who were with acute cerebral infarction during follow-up and the control group who were without cerebral infarction. CEUS was conducted on inclusion to measure the peak intensity (Peak) and time to peak (TP), and the serum was collected to determine the contents of angiogenesis molecules, inflammatory cytokines and collagen metabolism indexes. Results: The Peak level as well as serum VEGF, HGF, Ang-1, PDGF-BB, VE-cadherin, FKN, IL-17, ICTP, MMP10 and Caspase-3 contents of cerebral infarction group was higher than those of control group whereas TP level as well as serum IL-4, IL-10, TIMP1 and Vaspin contents was lower than those of control group;serum VEGF, HGF, Ang-1, PDGF-BB, VE-cadherin, FKN, IL-17, ICTP, MMP10 and Caspase-3 contents of cerebral infarction group were positively correlated with Peak level, and negatively correlated with TP level;serum IL-4, IL-10, TIMP1 and Vaspin contents were negatively correlated with Peak level, and positively correlated with TP level. Conclusion: CEUS parameters can be used to evaluate the angiogenesis in carotid plaque and the changes of plaque properties in patients with cerebral infarction.

Radiation induced renal arterial stenosis detected by color duplex ultrasonography: case report

Renal artery stenosis as a complication from radiation therapy is not common, but it is life threatening and needs to be corrected urgently in order to prevent renal failure even losing kidney. The diagnostic criteria of renal artery stenosis in the adults by color duplex ultrasonography have been established, which may play an important role in screening radiation induced renal artery stenosis.