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Teiji Tominaga - One of the best experts on this subject based on the ideXlab platform.
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cognard type v intracranial dural arteriovenous shunt case reports and literature review with special consideration of the pattern of Spinal venous drainage
Neurosurgery, 2014Co-Authors: Shinya Haryu, Toshiki Endo, Kenichi Sato, Akira Takahashi, Takashi Inoue, Teiji TominagaAbstract:BACKGROUND AND IMPORTANCE: Prompt diagnosis of intracranial dural arteriovenous shunt (DAVS) with Spinal venous drainage, classified as Cognard type V, is difficult. We investigated the angiographic and magnetic resonance imaging (MRI) characteristics of Cognard type V DAVS to determine the reason for the difficulty in early diagnosis. CLINICAL PRESENTATION: We systematically reviewed 54 published and 3 new cases of Cognard type V DAVS. The pattern of venous drainage was classified on the basis of relative dominance of the anterior and posterior Spinal Veins with the use of angiograms. T2-weighted sagittal MRIs were used to detect signal flow voids of enlarged Spinal Veins. Types of venous drainage were determined in 49 of the 57 cases. Twenty-eight and 8 cases showed a dominance of anterior and posterior Spinal venous drainage, respectively. In 13 cases, venous drainage was equally distributed through the anterior and posterior Spinal Veins. Of 41 cases with an abnormally dilated anterior Spinal vein, MRIs were available for 25 cases. Signal flow voids of enlarged anterior Spinal Veins were detected in 9 cases (36.0%), whereas dilatation of the posterior Spinal Veins was apparent in 9 of 16 cases (56.3%). Overall, MRI detected enlargement of either anterior or posterior Spinal Veins in 15 of 41 cases (36.6%). CONCLUSION: In Cognard type V DAVS, anterior venous drainage is dominant. Because the anterior Spinal Veins are located subpially, flow voids are less prominent on sagittal T2-weighted MRI. This may lead to difficulties in diagnosing. Evaluation with MR angiography may compensate for these limitations.
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cognard type v intracranial dural arteriovenous shunt case reports and literature review with special consideration of the pattern of Spinal venous drainage
Neurosurgery, 2014Co-Authors: Shinya Haryu, Toshiki Endo, Kenichi Sato, Akira Takahashi, Takashi Inoue, Teiji TominagaAbstract:BACKGROUND AND IMPORTANCE Prompt diagnosis of intracranial dural arteriovenous shunt (DAVS) with Spinal venous drainage, classified as Cognard type V, is difficult. We investigated the angiographic and magnetic resonance imaging (MRI) characteristics of Cognard type V DAVS to determine the reason for the difficulty in early diagnosis. CLINICAL PRESENTATION We systematically reviewed 54 published and 3 new cases of Cognard type V DAVS. The pattern of venous drainage was classified on the basis of relative dominance of the anterior and posterior Spinal Veins with the use of angiograms. T2-weighted sagittal MRIs were used to detect signal flow voids of enlarged Spinal Veins. Types of venous drainage were determined in 49 of the 57 cases. Twenty-eight and 8 cases showed a dominance of anterior and posterior Spinal venous drainage, respectively. In 13 cases, venous drainage was equally distributed through the anterior and posterior Spinal Veins. Of 41 cases with an abnormally dilated anterior Spinal vein, MRIs were available for 25 cases. Signal flow voids of enlarged anterior Spinal Veins were detected in 9 cases (36.0%), whereas dilatation of the posterior Spinal Veins was apparent in 9 of 16 cases (56.3%). Overall, MRI detected enlargement of either anterior or posterior Spinal Veins in 15 of 41 cases (36.6%). CONCLUSION In Cognard type V DAVS, anterior venous drainage is dominant. Because the anterior Spinal Veins are located subpially, flow voids are less prominent on sagittal T2-weighted MRI. This may lead to difficulties in diagnosing. Evaluation with MR angiography may compensate for these limitations.
Philippe Gailloud - One of the best experts on this subject based on the ideXlab platform.
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the arrow tipped loop is a marker of radiculomedullary vein thrombosis linked to the anti reflux mechanism angiographic anatomy and clinical implications
Neuroradiology, 2014Co-Authors: Philippe GailloudAbstract:Introduction This article proposes that the “arrow-tipped” loop or anastomosis classically described as an anatomic variant represents in fact a pathological phenomenon resulting from the partial thrombosis of a radiculomedullary vein (RMV) with a duplicated origin (double-rooted RMVs). Methods Thearrow-tip loopconcept proposedinthisreportis illustrated with angiographic observations of patients with underlying pathologies of the Spinal venous system, three cases of Spinal arteriovenous fistulas, and one case of Spinal venous insufficiency. Results In each clinical case, the presence of arrow-tip loops was associated with diffuse alteration of the perimedullary venous system, including the lack of detectable RMVs. The angiographic appearance of the arrow-tip loops suggested partially thrombosed double-rooted RMVs, with rootlets originating either from the anterior or posterior Spinal Veins, or from both. Conclusion While a thrombosed single-rooted RMV typically becomes anatomically and angiographically undetectable, double-rooted MRVs keep a flowing proximal segment made of their two rootlets of origin. This residual proximal segment takes the appearance of an arrow-tip loop, which therefore be seen as an indicator of Spinal venous thrombosis.
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flat panel catheter angiotomography of the Spinal venous system an enhanced venous phase for Spinal digital subtraction angiography
American Journal of Neuroradiology, 2012Co-Authors: James X Chen, T Ethiati, Philippe GailloudAbstract:BACKGROUND AND PURPOSE: While Spinal DSA remains the reference standard technique for spinovascular imaging, visualizing Spinal Veins remains challenging due to their small size and motion artifacts. This study evaluates the ability of FPCA to overcome these obstacles. MATERIALS AND METHODS: Sixty-three FPCAs, performed by intersegmental artery injections in 57 patients, were prospectively evaluated. Entrance skin doses were compared with standard Spinal DSA runs, including a venous phase and cerebral FPCAs. FPCA contributions were stratified as 1) provided no added information, 2) complemented Spinal DSA findings, 3) assisted therapy planning, and 4) contributed principal diagnostic findings. RESULTS: No complications were observed. Diagnoses included vascular malformations (44%), stroke (9%), venous anomalies (10%), other (9%), and unremarkable (28%). Mean entrance skin doses were of 419 mGy for FPCA, 161 mGy for Spinal DSA with venous phase, and 309 mGy for cerebral FPCAs. FPCA contributed the principal diagnostic finding in 16 cases (25.4%), assisted therapy planning in 13 cases (20.6%), complemented Spinal DSA findings in 12 cases (19.1%), and provided no additional information in 20 cases (31.7%). In 8 of these 20 cases, FPCA documented a Spinal venous anatomy that was poorly visualized or not visualized on Spinal DSA. CONCLUSIONS: Spinal FPCA is safe, with a moderate increase in radiation dose, compared with Spinal DSA with venous phase or cerebral FPCA. It proved particularly valuable for therapy planning and the diagnosis of venous abnormalities. This study suggests that FPCA has an important role to play in the evaluation of the Spinal venous system.
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angiographic detection and characterization of cryptic venous anomalies associated with Spinal cord cavernous malformations using flat panel catheter angiotomography
Neurosurgery, 2012Co-Authors: Monica S Pearl, James X Chen, Lydia Gregg, Diego San Millan, Allan J Belzberg, George I Jallo, Philippe GailloudAbstract:Background Spinal cord cavernous malformations (CMs) are associated with 2 types of angiographically occult "cryptic venous anomalies," which differ in location with respect to the Spinal cord. The anatomic distinction between superficial and intramedullary is important in that the latter heighten the risks of CM resection. Objective To report the observations of both types of cryptic venous anomalies documented during Spinal digital subtraction angiography enhanced with flat-panel catheter angiotomography (FPCA). Methods Spinal digital subtraction angiography enhanced with FPCA was performed in 2 adult patients with magnetic resonance imaging--documented intramedullary Spinal cord CMs and prominent, nonspecific flow voids at the same levels. FPCA was obtained by selective injection of left T4 (case 1) and left T9 (case 2) with 5F Cobra 2 catheters (Terumo, Japan) during a 20-second rotational acquisition. Thirty milliliters of a 75% saline and 25% contrast solution (Omnipaque 300; GE) was administered. The rotational data set was reconstructed on a dedicated workstation (Leonardo; Siemens, Erlangen, Germany) through the use of regular and high-resolution matrixes, 0.4- and 0.1-mm voxel size, respectively. Results Spinal digital subtraction angiography was unremarkable in both cases. In case 1, FPCA findings indicated an atypical network of prominent posterior perimedullary Veins. In case 2, FPCA identified radially oriented channels forming a caput medusae pattern collecting into an enlarged intramedullary vein. Conclusion The unique ability of FPCA to image the Spinal venous system enables the angiographic detection and characterization of abnormal Spinal Veins associated with CMs. Differentiating between the types of associated cryptic venous malformations may aid in surgical planning because the intramedullary type is associated with a higher risk of surgical complication.
Shinya Haryu - One of the best experts on this subject based on the ideXlab platform.
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cognard type v intracranial dural arteriovenous shunt case reports and literature review with special consideration of the pattern of Spinal venous drainage
Neurosurgery, 2014Co-Authors: Shinya Haryu, Toshiki Endo, Kenichi Sato, Akira Takahashi, Takashi Inoue, Teiji TominagaAbstract:BACKGROUND AND IMPORTANCE: Prompt diagnosis of intracranial dural arteriovenous shunt (DAVS) with Spinal venous drainage, classified as Cognard type V, is difficult. We investigated the angiographic and magnetic resonance imaging (MRI) characteristics of Cognard type V DAVS to determine the reason for the difficulty in early diagnosis. CLINICAL PRESENTATION: We systematically reviewed 54 published and 3 new cases of Cognard type V DAVS. The pattern of venous drainage was classified on the basis of relative dominance of the anterior and posterior Spinal Veins with the use of angiograms. T2-weighted sagittal MRIs were used to detect signal flow voids of enlarged Spinal Veins. Types of venous drainage were determined in 49 of the 57 cases. Twenty-eight and 8 cases showed a dominance of anterior and posterior Spinal venous drainage, respectively. In 13 cases, venous drainage was equally distributed through the anterior and posterior Spinal Veins. Of 41 cases with an abnormally dilated anterior Spinal vein, MRIs were available for 25 cases. Signal flow voids of enlarged anterior Spinal Veins were detected in 9 cases (36.0%), whereas dilatation of the posterior Spinal Veins was apparent in 9 of 16 cases (56.3%). Overall, MRI detected enlargement of either anterior or posterior Spinal Veins in 15 of 41 cases (36.6%). CONCLUSION: In Cognard type V DAVS, anterior venous drainage is dominant. Because the anterior Spinal Veins are located subpially, flow voids are less prominent on sagittal T2-weighted MRI. This may lead to difficulties in diagnosing. Evaluation with MR angiography may compensate for these limitations.
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cognard type v intracranial dural arteriovenous shunt case reports and literature review with special consideration of the pattern of Spinal venous drainage
Neurosurgery, 2014Co-Authors: Shinya Haryu, Toshiki Endo, Kenichi Sato, Akira Takahashi, Takashi Inoue, Teiji TominagaAbstract:BACKGROUND AND IMPORTANCE Prompt diagnosis of intracranial dural arteriovenous shunt (DAVS) with Spinal venous drainage, classified as Cognard type V, is difficult. We investigated the angiographic and magnetic resonance imaging (MRI) characteristics of Cognard type V DAVS to determine the reason for the difficulty in early diagnosis. CLINICAL PRESENTATION We systematically reviewed 54 published and 3 new cases of Cognard type V DAVS. The pattern of venous drainage was classified on the basis of relative dominance of the anterior and posterior Spinal Veins with the use of angiograms. T2-weighted sagittal MRIs were used to detect signal flow voids of enlarged Spinal Veins. Types of venous drainage were determined in 49 of the 57 cases. Twenty-eight and 8 cases showed a dominance of anterior and posterior Spinal venous drainage, respectively. In 13 cases, venous drainage was equally distributed through the anterior and posterior Spinal Veins. Of 41 cases with an abnormally dilated anterior Spinal vein, MRIs were available for 25 cases. Signal flow voids of enlarged anterior Spinal Veins were detected in 9 cases (36.0%), whereas dilatation of the posterior Spinal Veins was apparent in 9 of 16 cases (56.3%). Overall, MRI detected enlargement of either anterior or posterior Spinal Veins in 15 of 41 cases (36.6%). CONCLUSION In Cognard type V DAVS, anterior venous drainage is dominant. Because the anterior Spinal Veins are located subpially, flow voids are less prominent on sagittal T2-weighted MRI. This may lead to difficulties in diagnosing. Evaluation with MR angiography may compensate for these limitations.
Kenichi Sato - One of the best experts on this subject based on the ideXlab platform.
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cognard type v intracranial dural arteriovenous shunt case reports and literature review with special consideration of the pattern of Spinal venous drainage
Neurosurgery, 2014Co-Authors: Shinya Haryu, Toshiki Endo, Kenichi Sato, Akira Takahashi, Takashi Inoue, Teiji TominagaAbstract:BACKGROUND AND IMPORTANCE: Prompt diagnosis of intracranial dural arteriovenous shunt (DAVS) with Spinal venous drainage, classified as Cognard type V, is difficult. We investigated the angiographic and magnetic resonance imaging (MRI) characteristics of Cognard type V DAVS to determine the reason for the difficulty in early diagnosis. CLINICAL PRESENTATION: We systematically reviewed 54 published and 3 new cases of Cognard type V DAVS. The pattern of venous drainage was classified on the basis of relative dominance of the anterior and posterior Spinal Veins with the use of angiograms. T2-weighted sagittal MRIs were used to detect signal flow voids of enlarged Spinal Veins. Types of venous drainage were determined in 49 of the 57 cases. Twenty-eight and 8 cases showed a dominance of anterior and posterior Spinal venous drainage, respectively. In 13 cases, venous drainage was equally distributed through the anterior and posterior Spinal Veins. Of 41 cases with an abnormally dilated anterior Spinal vein, MRIs were available for 25 cases. Signal flow voids of enlarged anterior Spinal Veins were detected in 9 cases (36.0%), whereas dilatation of the posterior Spinal Veins was apparent in 9 of 16 cases (56.3%). Overall, MRI detected enlargement of either anterior or posterior Spinal Veins in 15 of 41 cases (36.6%). CONCLUSION: In Cognard type V DAVS, anterior venous drainage is dominant. Because the anterior Spinal Veins are located subpially, flow voids are less prominent on sagittal T2-weighted MRI. This may lead to difficulties in diagnosing. Evaluation with MR angiography may compensate for these limitations.
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cognard type v intracranial dural arteriovenous shunt case reports and literature review with special consideration of the pattern of Spinal venous drainage
Neurosurgery, 2014Co-Authors: Shinya Haryu, Toshiki Endo, Kenichi Sato, Akira Takahashi, Takashi Inoue, Teiji TominagaAbstract:BACKGROUND AND IMPORTANCE Prompt diagnosis of intracranial dural arteriovenous shunt (DAVS) with Spinal venous drainage, classified as Cognard type V, is difficult. We investigated the angiographic and magnetic resonance imaging (MRI) characteristics of Cognard type V DAVS to determine the reason for the difficulty in early diagnosis. CLINICAL PRESENTATION We systematically reviewed 54 published and 3 new cases of Cognard type V DAVS. The pattern of venous drainage was classified on the basis of relative dominance of the anterior and posterior Spinal Veins with the use of angiograms. T2-weighted sagittal MRIs were used to detect signal flow voids of enlarged Spinal Veins. Types of venous drainage were determined in 49 of the 57 cases. Twenty-eight and 8 cases showed a dominance of anterior and posterior Spinal venous drainage, respectively. In 13 cases, venous drainage was equally distributed through the anterior and posterior Spinal Veins. Of 41 cases with an abnormally dilated anterior Spinal vein, MRIs were available for 25 cases. Signal flow voids of enlarged anterior Spinal Veins were detected in 9 cases (36.0%), whereas dilatation of the posterior Spinal Veins was apparent in 9 of 16 cases (56.3%). Overall, MRI detected enlargement of either anterior or posterior Spinal Veins in 15 of 41 cases (36.6%). CONCLUSION In Cognard type V DAVS, anterior venous drainage is dominant. Because the anterior Spinal Veins are located subpially, flow voids are less prominent on sagittal T2-weighted MRI. This may lead to difficulties in diagnosing. Evaluation with MR angiography may compensate for these limitations.
Toshiki Endo - One of the best experts on this subject based on the ideXlab platform.
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cognard type v intracranial dural arteriovenous shunt case reports and literature review with special consideration of the pattern of Spinal venous drainage
Neurosurgery, 2014Co-Authors: Shinya Haryu, Toshiki Endo, Kenichi Sato, Akira Takahashi, Takashi Inoue, Teiji TominagaAbstract:BACKGROUND AND IMPORTANCE: Prompt diagnosis of intracranial dural arteriovenous shunt (DAVS) with Spinal venous drainage, classified as Cognard type V, is difficult. We investigated the angiographic and magnetic resonance imaging (MRI) characteristics of Cognard type V DAVS to determine the reason for the difficulty in early diagnosis. CLINICAL PRESENTATION: We systematically reviewed 54 published and 3 new cases of Cognard type V DAVS. The pattern of venous drainage was classified on the basis of relative dominance of the anterior and posterior Spinal Veins with the use of angiograms. T2-weighted sagittal MRIs were used to detect signal flow voids of enlarged Spinal Veins. Types of venous drainage were determined in 49 of the 57 cases. Twenty-eight and 8 cases showed a dominance of anterior and posterior Spinal venous drainage, respectively. In 13 cases, venous drainage was equally distributed through the anterior and posterior Spinal Veins. Of 41 cases with an abnormally dilated anterior Spinal vein, MRIs were available for 25 cases. Signal flow voids of enlarged anterior Spinal Veins were detected in 9 cases (36.0%), whereas dilatation of the posterior Spinal Veins was apparent in 9 of 16 cases (56.3%). Overall, MRI detected enlargement of either anterior or posterior Spinal Veins in 15 of 41 cases (36.6%). CONCLUSION: In Cognard type V DAVS, anterior venous drainage is dominant. Because the anterior Spinal Veins are located subpially, flow voids are less prominent on sagittal T2-weighted MRI. This may lead to difficulties in diagnosing. Evaluation with MR angiography may compensate for these limitations.
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cognard type v intracranial dural arteriovenous shunt case reports and literature review with special consideration of the pattern of Spinal venous drainage
Neurosurgery, 2014Co-Authors: Shinya Haryu, Toshiki Endo, Kenichi Sato, Akira Takahashi, Takashi Inoue, Teiji TominagaAbstract:BACKGROUND AND IMPORTANCE Prompt diagnosis of intracranial dural arteriovenous shunt (DAVS) with Spinal venous drainage, classified as Cognard type V, is difficult. We investigated the angiographic and magnetic resonance imaging (MRI) characteristics of Cognard type V DAVS to determine the reason for the difficulty in early diagnosis. CLINICAL PRESENTATION We systematically reviewed 54 published and 3 new cases of Cognard type V DAVS. The pattern of venous drainage was classified on the basis of relative dominance of the anterior and posterior Spinal Veins with the use of angiograms. T2-weighted sagittal MRIs were used to detect signal flow voids of enlarged Spinal Veins. Types of venous drainage were determined in 49 of the 57 cases. Twenty-eight and 8 cases showed a dominance of anterior and posterior Spinal venous drainage, respectively. In 13 cases, venous drainage was equally distributed through the anterior and posterior Spinal Veins. Of 41 cases with an abnormally dilated anterior Spinal vein, MRIs were available for 25 cases. Signal flow voids of enlarged anterior Spinal Veins were detected in 9 cases (36.0%), whereas dilatation of the posterior Spinal Veins was apparent in 9 of 16 cases (56.3%). Overall, MRI detected enlargement of either anterior or posterior Spinal Veins in 15 of 41 cases (36.6%). CONCLUSION In Cognard type V DAVS, anterior venous drainage is dominant. Because the anterior Spinal Veins are located subpially, flow voids are less prominent on sagittal T2-weighted MRI. This may lead to difficulties in diagnosing. Evaluation with MR angiography may compensate for these limitations.