Background/Objectives: Digital subtraction angiography (DSA) is the gold standard in the diagnosis of cerebral vasospasm, frequently observed after subarachnoid hemorrhage (SAH). However, less-invasive methods, such as computed tomography angiography (CTA), may be equally accurate. To further clarify comparability, this study evaluated the reliability of CTA in detecting cerebral vasospasm. Methods: This retrospective study included 51 patients with SAH who underwent both CTA and DSA within 24 h. The smallest diameter of the proximal cerebral arterial segments was measured in both modalities at admission and during the vasospasm period. The mean difference in diameter, the intraclass correlation coefficient (ICC) of CTA and DSA, the difference in grade of vasospasm and sensitivity, the specificity and the positive predictive value (PPV) for CTA were calculated. Results: A total of 872 arterial segments were investigated. At time of admission, arterial diameters were significantly smaller on CTA compared to DSA in all segments (-0.26 ± 0.12 mm; p < 0.05). At time of suspected vasospasm (day 9 ± 5), these differences remained significant only for the M1 segment (-0.18 ± 0.37 mm, p = 0.02), the P1 segment (-0.13 ± 0.24 mm, p = 0.04) and the basilar artery (-0.20 ± 0.37 mm, p = 0.0.04). The ICC between CTA and DSA was good (0.5-0.8). The sensitivity of CTA for predicting angiographic vasospasm was 99%, the specificity was 50% and the PPV was 92%. Conclusions: Arterial diameters measured on CTA may underestimate the arterial caliber observed in DSA; however, these absolute differences were minor. Importantly, vessel diameter alone does not fully reflect malperfusion, requiring additional imaging techniques such as CT perfusion.

Purpose This special report outlines a retrospective observational study of CT fractional flow reserve (CT-FFR) analysis using dual-source coronary CT angiography (CTA) scans performed without heart rate control and its impact on clinical outcomes. Materials and Methods All patients who underwent clinically indicated coronary CTA between August 2020 and August 2021 were included in this retrospective observational study. Scans were performed in the late systolic to early diastolic period without heart rate control and analyzed at the interpreting physician\'s discretion. Demographics, coronary CTA features, and rates of invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), myocardial infarction, and all-cause death at 3 months were assessed by chart review. Results During the study period, 3098 patients underwent coronary CTA, of whom 113 with coronary bypass grafting were excluded. Of the remaining 2985 patients, 292 (9.7%) were referred for CT-FFR analysis. Two studies (0.7%) were rejected from CT-FFR analysis, and six (2.1%) analyses did not evaluate the lesion of concern. A total of 160 patients (56.3%) had CT-FFR greater than 0.80. Among patients with significant stenosis at coronary CTA, patients who underwent CT-FFR analysis presented with lower rates of ICA (74.5% vs 25.5%, P = .04) and PCI (78.9% vs 21.1%, P = .05). Conclusion CT-FFR was implemented in patients not requiring heart rate control by using dual-source coronary CTA acquisition and showed the potential to decrease rates of ICA and PCI without compromising safety in patients with significant stenosis and an average heart rate of 65 beats per minute. Keywords: Angiography, CT, CT-Angiography, Fractional Flow Reserve, Cardiac, Heart, Arteriosclerosis Supplemental material is available for this article. © RSNA, 2024.

OBJECTIVE: To evaluate the diagnostic performance and generalizability of the winning DL algorithm of the RSNA 2020 PE detection challenge to a local population using CTPA data from two hospitals.
METHODS: Consecutive CTPA images from patients referred for suspected PE were retrospectively analysed. The winning RSNA 2020 DL algorithm was retrained on the RSNA-STR Pulmonary Embolism CT (RSPECT) dataset. The algorithm was tested in hospital A on multidetector CT (MDCT) images of 238 patients and in hospital B on spectral detector CT (SDCT) and virtual monochromatic images (VMI) of 114 patients. The output of the DL algorithm was compared with a reference standard, which included a consensus reading by at least two experienced cardiothoracic radiologists for both hospitals. Areas under the receiver operating characteristic curve (AUCs) were calculated. Sensitivity and specificity were determined using the maximum Youden index.
RESULTS: According to the reference standard, PE was present in 73 patients (30.7%) in hospital A and 33 patients (29.0%) in hospital B. For the DL algorithm the AUC was 0.96 (95% CI 0.92-0.98) in hospital A, 0.89 (95% CI 0.81-0.94) for conventional reconstruction in hospital B and 0.87 (95% CI 0.80-0.93) for VMI.
CONCLUSIONS: The RSNA 2020 pulmonary embolism detection on CTPA challenge winning DL algorithm, retrained on the RSPECT dataset, showed high diagnostic accuracy on MDCT images. A somewhat lower performance was observed on SDCT images, which suggest additional training on novel CT technology may improve generalizability of this DL algorithm.

Cystic artery pseudoaneurysm (CAP) is a rare entity, with just a few cases reported in the literature. The most common presentation of CAP is described by Quincke\'s triad of upper gastrointestinal bleeding, jaundice and right upper quadrant abdominal pain. We report the case of an 83-year-old male who presented to the adult emergency with a history of an acute cholecystitis 5 weeks prior for which responded to conservative management. Despite this patient not presenting with Quincke\'s triad, early suspicion of CAP was considered in light of his history of acute cholecystitis and a computed tomographic CT abdomen ordered promptly which showed a 6 mm cystic artery pseudoaneurysm and a thick-walled gallbladder with surrounding inflammatory changes. Management with an endovascular approach followed by an elective cholecystectomy was done.

The authors report a case of pathologically proven intracardiac bronchogenic cyst embedded within the interatrial septum of a 30-year-old woman presenting with chest pain and first-degree AV block. Multimodality imaging played an essential role in the discovery, investigation, and diagnosis of this extremely rare entity.

UNASSIGNED: The aim of this retrospective study was to evaluate the added value of pre-procedural computed tomography angiography (CTA) prior to bronchial artery embolization for patients presenting with hemoptysis.
UNASSIGNED: In this retrospective study, we evaluated patients admitted for hemoptysis from 2010 to 2021 and treated by catheter-directed embolization. After establishing quality criteria for pre-procedural computed tomography (CT), patients were divided into two groups depending on their pre-procedural imaging assessment: Quality CT-angiography (QCTA group) and suboptimal pre-procedural imaging (suboptimal CTA, unenhanced or no CT evaluation; control group). Groups were compared based on radiological success, procedure-related complications, and clinical success, including cessation of hemoptysis, recurrence rates, and overall mortality.
UNASSIGNED: We included 31 patients in the QCTA group, and 35 in the control group. Clinical success was n = 24/31 (77.4%) in the QCTA group and n = 27/35 (77.1%) in the control group (p = 0.979). Technical success was n = 37/42 (88.1%) in the QCTA group and n = 39/42 (92.86%) in the control group (p = 0.820). Overall recurrence was 10.6%. Minor complications occurred in 27.3%, and one major complication was reported.The concordance between the affected bleeding lung and the identification of pathological arteries during angiography was better in the QCTA group (p = 0.045).The average number of culprit arteries (bronchial, non-bronchial systemic arteries [NBSA] or pulmonary) in the QCTA group was not significantly higher than that in the control group.
UNASSIGNED: Preprocedural QCTA better identifies the affected bleeding lung and bleeding vessels compared to direct angiography. No difference in clinical success, complications, recurrence rates, or mortality was observed.

The article describes a 45-year-old female patient with recurrent transient ischemic attacks and ischemic stroke due to spontaneous spasm of the middle cerebral artery, the anterior cerebral artery and distal part of the internal cerebral artery on the left, verified by MR angiography and CT angiography. It is assumed that the spasm caused damage to the vascular wall, an increase in its permeability, the development of edema, inflammation and subsequent fibrosis, therefore a complete restoration of the arterial lumen did not occur.
Представлен клинический случай пациентки 45 лет с повторными преходящими нарушениями мозгового кровообращения и ишемическим инсультом вследствие спонтанного спазма средней мозговой артерии, передней мозговой артерии и дистального отдела внутренней сонной артерии слева, верифицированного с помощью МР-ангиографии и КТ-ангиографии. Предполагается, что спазм вызвал повреждение сосудистой стенки с повышением ее проницаемости, развитием отека, воспаления и последующего фиброза, в связи с чем полного восстановления просвета артерий у пациентки не произошло.

BACKGROUND: As guidelines endorse the use of computed tomography (CT) for examining coronary artery disease (CAD), it is important to compare the advantages and disadvantages of the novel photon counting detector CT (PCD-CT) technology with the established energy integrating detector CT (EID-CT).
OBJECTIVE: To compare the image quality of coronary computed tomography angiography (CCTA) and the Agatston scores (AS) derived from EID-CT and PCD-CT.
METHODS: In this prospective observational study, 28 patients underwent clinical calcium score and CCTA scans on an EID-CT and a PCD-CT scanner. CCTA images were qualitatively analyzed by five observers using visual grading characteristics. The correlation and agreement of the AS were assessed using Spearman\'s rank correlation and Bland-Altman plots.
RESULTS: This qualitative analyses demonstrated a high fraction of \"good\" or \"excellent\" ratings for the image criteria in both CT systems. The sharpness of the distal lumen and image quality regarding motion artifacts were rated significantly higher for EID-CT (P < 0.05). However, the sharpness of coronary calcification was rated significantly higher for PCD-CT (P < 0.05). Spearman\'s rank correlation and Bland-Altman plots showed good correlation (P = 0.95) and agreement regarding the AS between EID-CT and PCD-CT.
CONCLUSIONS: Both CT systems exhibited high CCTA image quality. The sharpness of calcifications was rated significantly higher for PCD-CT. A good correlation was observed between the AS derived from the two systems.

Carotid cavernous fistula (CCF) is a condition with abnormal flow from the carotid artery to the cavernous sinus. The characteristic clinical findings are ophthalmic monoplegia, ptosis, exophthalmos, chemosis, Horner\'s syndrome, facial pain, loss of sensation in the distribution of the trigeminal nerve, and headache. Digital subtraction angiography (DSA) is the gold standard modality for evaluating CCF. An 18-year-old patient came with decreased bilateral visual acuity after a traffic accident. CT angiography was performed on the patient and found a dilated right superior ophthalmic vein. CCF is present in the patient. The DSA procedure was performed on the patient, and embolization was performed on the right ophthalmic vein. On post-embolization angiography, the tubular structure is no longer visible, which is bilateral superior ophthalmic vein dilatation.

To evaluate the results of surgical treatment of arterial acute mesenteric ischemia in a single hospital over a 15-year period (from 2007 to 2022).
There were 385 patients with acute occlusion of superior or inferior mesenteric artery over a 15-year period. The causes of acute mesenteric ischemia were thromboembolism of superior mesenteric artery (51%), its thrombosis (43%) and thrombosis of inferior mesenteric artery (6%). Female patients predominated (258 or 67%), while male patients comprised 33% (n=127). Age of patients ranged from 41 to 97 years (mean 74±9). The main diagnostic method for acute intestinal ischemia was contrast-enhanced computed tomography or CT angiography. Intestinal revascularization was performed in 101 patients: 10 patients - open embolectomy or thrombectomy from superior mesenteric artery, 41 patients - endovascular intervention, 50 patients - combined surgery (revascularization with resection of necrotic bowel segments). Isolated resection of necrotic intestines was performed in 176 patients. Exploratory laparotomy was performed in 108 patients with total bowel necrosis. Prevention and treatment of reperfusion and translocation syndrome after successful intestinal revascularization implied extracorporeal hemocorrection for extrarenal indications (veno-venous hemofiltration or veno-venous hemodiafiltration).
Overall 15-year mortality rate (385 patients) for acute SMA occlusion was 71% (256 out of 360 patients), postoperative mortality excluding exploratory laparotomies for the same time period - 59%. Mortality rate for inferior mesenteric artery thrombosis was 88%. Routine CT angiography of mesenteric vessels, active and effective early intestinal revascularization (open or endovascular surgery), as well as extracorporeal hemocorrection methods for reperfusion and translocation syndrome reduced mortality rate to 49% over the past 10 years (from 2013 to 2022). Mortality in acute mesenteric ischemia in the first 5 years of this study (from 2007 to 2012) was 64% (p=0.16). The main cause of death was intestinal gangrene with multiple organ failure. Reperfusion syndrome after effective endovascular revascularization complicated by severe pulmonary edema and acute respiratory distress syndrome resulted death in 15% of patients.
Acute mesenteric ischemia is followed by high mortality rates and extremely poor prognosis. Early diagnosis of acute intestinal ischemia using modern diagnostic methods (CT angiography of mesenteric vessels), effective revascularization of superior mesenteric artery (open, hybrid or endovascular), prevention and treatment of reperfusion and translocation syndrome can improve postoperative outcomes.
Оценить результаты хирургического лечения артериальной формы острой мезентериальной ишемии в условиях одного стационара за 15-летний период (с 2007 по 2022 г.).
За 15 лет оперированы 385 пациентов с острой окклюзией верхней или нижней брыжеечной артерии. Причинами острой мезентериальной ишемии явились: тромбоэмболия верхней брыжеечной артерии (51%), ее тромбоз (43%) и тромбоз нижней брыжеечной артерии (6%). Преобладали пациенты женского пола (258/67%), мужчин было 127 (33%). Возраст пациентов варьировал от 41 года до 97 лет (в среднем 74±9 лет). Основным методом диагностики острой ишемии кишечника служила КТ с внутривенным контрастным усилением или КТ-ангиография. Реваскуляризация кишечника выполнена у 101 пациента: у 10 — открытая эмбол- или тромбэктомия из верхней брыжеечной артерии, у 41 — эндоваскулярное вмешательство, у 50 — комбинированная операция (реваскуляризация кишечника с резекцией его некротизированных участков). Изолированная резекция некротизированного кишечника произведена у 176 пациентов. Эксплоративный характер лапаротомия отмечен в 108 случаях при тотальном некрозе кишечника. В профилактике и лечении реперфузионного и транслокационного синдромов после успешной реваскуляризации кишечника использовали экстракорпоральные методы гемокоррекции по внепочечным показаниям (вено-венозная гемофильтрация или вено-венозная гемодиафильтрация).
Общая 15-летняя хирургическая летальность при острой окклюзии верхней брыжеечной артерии составила 71% (256 из 360 больных), показатель послеоперационной смертности без учета эксплоративных лапаротомий за этот же временной промежуток — 59%, летальность при тромбозе нижней брыжеечной артерии — 88%. Вследствие активного использования КТ-ангиографии мезентериальных сосудов, применения активной и эффективной ранней реваскуляризации кишечника (открытая операция или эндоваскулярные методики), а также внедрения и использования методов экстракорпоральной гемокоррекции в лечении и профилактике реперфузионного и транслокационного синдромов уменьшилась летальность до 49% за последние 10 лет (с 2013 по 2022 г.). Смертность при острой мезентериальной ишемии в первые 5 лет ведения данной работы (с 2007 по 2012 г.) составила 64% (p=0,16). Основной причиной смерти явилась гангрена кишечника с явлениями полиорганной недостаточности. Реперфузионный синдром после эффективной эндоваскулярной реваскуляризации кишечника, осложнившийся выраженным отеком легких и острым респираторным дистресс-синдромом, послужил непосредственной причиной смерти у 15% пациентов.
Острая мезентериальная ишемия остается заболеванием с высоким уровнем летальности и крайне плохим прогнозом. Ранний диагноз острой ишемии кишечника с применением современных методов диагностики (КТ-ангиография мезентериальных сосудов), эффективная реваскуляризация верхней брыжеечной артерии (открытая, гибридная или эндоваскулярная), профилактика и лечение реперфузионного и транслокационного синдромов могут улучшить результаты хирургического лечения острой ишемии кишечника.