Keywords:
Interventional vascular, Abdomen, Neuroradiology brain, MR, CT, Fluoroscopy, Diagnostic procedure, Intraoperative, Imaging sequences, Neoplasia, Arteriovenous malformations, Seizure disorders
Authors:
P. Watal, N. Bahri, R. Gupta; Jamnagar/IN
DOI:
10.1594/ecr2013/C-1451
Conclusion
The findings derived from the present study can be summarized as below:
- Multiple epidemiological risk factors are associated with ischemic brain lesions on CT,
with strongest association being seen with diabetes mellitus in studied population.
- No significant association has been noted between symptoms and degree of stenosis.
This finding is variably supported in the previous literature.
- Severe vascular stenosis (>70%) alone is shown to have NO significant association with CT brain lesions as compared to patients having <70% stenosis,
however when associated with fatty plaque the association becomes significant
- A significant association is seen between nature of plaque and severity of CT brain lesions.
The risk of brain ischemia appears to increase considerably with presence of fatty and mixed density plaque alone (more for fatty plaque).
Fatty plaques also show significant association with severe stenosis category (>70% stenosis).
calcific plaques appear significantly associated with absence of CT brain lesion and less severe degrees of stenosis (<70 %)
- Calcified plaques show no association with severe stenosis or ulceration and thus appear to have inverse association with symptoms and presence of brain lesions.
- Presence of ‘NEAR STENOSIS’ phenomena appears to be protective against brain lesions even in presence of severe stenosis or fatty plaques with or without ulceration.
This emphasizes importance of accurate diagnosis of “Near Stenosis” on management and prognostication.
- Direct linear diameter calculation of stenosis showed that <50% stenosis correlated with diameter (ICA) of 2.3 mm or more,
50-69% stenosis correlated with diameter of 1.4-2.2 mm,
severe stenosis correlated with diameter of 1.3 mm or less.
This allows prediction of NASCET-type percent ratios from millimeter stenosis.
- Most ulcers in present study are noted proximal to point of maximal stenoisis.
however the overall incidence was low since the study sample compared to previous study is small.
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summarizing,
the present study appears in agreement with previous literature on a range of findings.
However there are points of disagreement as well.
As per our analysis,
the most important reason for the disparity in findings was the different patient sampling protocol used in our study.
Most of previous studies in the reference literature selected patients on basis of imaging criteria,
irrespective of symptomatology.
This also resulted in previous studies having larger number of sample population.
On the contrary in the current study patients were included predominantly on basis of symptomatology.
This resulted in smaller study population and since all patients were symptomatic higher association rates were noted as compared to previous studies.