In this part of presentation we will discuss the role of Doppler Ultrasound in the Diagnosis of other causes of stenosis and variable pattern in circulation.
In my opinion this presentation will help u to identify even rare pathologies.
Doppler ultrasound of visceral arteriesSamir Haffar
Doppler ultrasound of different diseases of visceral arteries including arterial stenosis and occlusion, arterial aneurysm, artrial pseudoaneurysm, arterio-venous fistula, artrial dissection, and abdominal vascular compression syndromes
Doppler ultrasound of visceral arteriesSamir Haffar
Doppler ultrasound of different diseases of visceral arteries including arterial stenosis and occlusion, arterial aneurysm, artrial pseudoaneurysm, arterio-venous fistula, artrial dissection, and abdominal vascular compression syndromes
Carotid artery disease is commonly seen in association with atherosclerosis and complicate the situation. clearcut guidelines with necessary surgical details are provided in presentations.
Similar to Carotid doppler II Dr. Muhammad Bin Zulfiqar (20)
Dislocation of joint is very tricky. In this presentation radiological evaluation of Dislocation of various joints will be discussed.
This is one of the best pictoral review of important joint dislocations
Renal Color Doppler Ultrasound.
After studying this presentation one will be able to perform and interpret ultrasound.
This presntation in my opinion is best short analog to text.
In this presentation we will discuss the bone age assessment mainly focusing wrist radiograph.
we shall also highlights some points in adult bone age
Basically it is an introduction. We shall not discuss its judicial importance
Role of medical imaging in developemental dysplasia of Hip Dr muhammad Bin Zu...Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss the role of medical imaging---plain Radiography, Ultrasound,Arthrography, CT and MRI in the evaluation of Developemental dysplasia of hip. Our main focuss will be on Sonographic evaluation.
In this presentation we will discuss the basic of axial trauma from head to pelvis. We will discuss the important key points that aids in the diagnosis of axial trauma
This is a chapter from Grainger and Allison. I have Coolected all images from chapter 21 with caption in this presentation.
In my opinion it will be very benificial to have this in your android.
This presentation is the first series of the MR imaging of Knee.
In this presentation MRI anatomy has been discussed. As we all know good knowledge of medical imaging three dimensional anatomy is key for good reporting.
Hope we all get benifitted.
Suggestions are most welcome
This is a chapter from Grainger and Allison. I have Coolected all images from chapter 20 with caption in this presentation.
In my opinion it will be very benificial to have this in your android. ,
This presentation is almost a complete Pictoral view of Radiograph chest.
This presentation will help radiologist in daily reporting.
This presentation will help physicians, surgeons, anesthetist and almost all medical professionals in diagnosing commonly presenting cardiac diseases.
This will also help all in preparaing TOACS examination.
This is a chapter from Grainger and Allison. I have Coolected all images from chapter 19 with caption in this presentation.
In my opinion it will be very benificial to have this in your android. ,
In this presentation we will dscuss the imp imaging features of Posterior fossa tumors in pediatric age group.
Medulloblastoma
Pilocytic Astrocytoma
Ependymoma
Brainstem Glioma
Schwanoma
Meningioma
Epidermoid Cyst
Arachnoid Cyst
In this presentation we will discuss about the
Anatomy of Prostate
Technique of Transrectal US
Carcinoma Prostate and
Different modes of prostatic biopsy.
In this presentation we shall discuss all fractures with specific names .
This is a pictoral review.
This presentation will be very helpful for radiologist to have in their androids to help them in rapid reporting
In this presentation all images of Chapter 18 from Grainger and Allison have been discussed.
Our aim is to discuss authentic material .
This is only for educational purposes.
In this chapter air space infilteration have been discussed. Ground glass haze and consolidation are discussed in detail.
This presentation is a selection of images from 17th chapter of grainger and allison.
Our aim is to provide standard and proved cases of the disease process.
This all is for educational purpose
Objectives of this presentation are
Introduction to ct
Cross sectional anatomy
Common important pathologies
This presentation is aimed to educate beginers to help in ct interpretetion.
16 High Resolution Computed Tomography of Interstitial and Occupational Lung ...Dr. Muhammad Bin Zulfiqar
This presentation is collection of images from chapter 16 of Grainger and Allison.
Inthis we will discuss the ILD.
This is only for educational purposes.
This Presentation is a collection of chapter 5 images from Grainger and Allison.
Our aim is to study authentic data.
This is only for educational purposes
In this presentation we will discuss role of high resolution in characterizing normal variant and pathologies of spinal pathologies.
This is a pictoral review.
This presentation provides sufficient material for anyone who wants is interested in interventional radiology. Here we will discuss the available facilities, mechanisms and equipments.
In my opinion this presentation will prove a footstep in interventional radiology
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
4. PART II
1. Vertebral Artery
2. Pathologies other than Arteriosclerotic
Disease
3. Effect of extra-carotid diseases
5. Vertebral artery course
V1
V0
V2
V3
V4
BA
VAs asymmetric in 75 % – Left dominant in 80 %
Posteriorly directed loop when exists C1 transverse process
2 VAs unite to form basilar artery: collateralization
6. Ultrasound of normal vertebral vessels
Cephalad flow throughout cardiac cycle
Low resistance flow pattern
VA origin regularly seen by experienced sonographers
Size: variable & asymmetric – Mean diameter 4 mm
PSV: 20 – 40 cm/sec – <10 cm/sec potentially abnormal
Vertebral artery
Vertebral vein
May occasionally be seen adjacent to VA
Flow caudad & nonpulsatile
10. Subclavian steal phenomenon
refers to steno-occlusive disease of
the proximal subclavian artery with
retrograde flow in ipsilateral
vertebral artery
11. Types of subclavian steal
Transient reversal of vertebral flow during systole
Converted to partial or complete by provocative
maneuver
Pre-steal or bunny waveform
Striking deceleration of velocity in mid or late systole
High-grade stenosis of subclavian rather than occlusion
Incomplete steal
Complete reversal of flow within vertebral artery
Complete steal
12. Vertebral to subclavian steal
Presteal
Incomplete steal
Complete steal
Compared to bunny in profile
13. Provocative maneuver in steal syndrome
Conversion of pre-steal waveform to more pronounced steal
following deflation of pressure cuff
Inflation of pressure cuff on arm for 3 min & rapid deflation
By exercising the diseased limb also cause provocation
Pre-steal More pronounced steal
14. Causes of carotid artery diseases
Arteriosclerotic disease
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
Most common cause
15. Fibromuscular dysplasia
Middle age women – Renal arteries – String of beads pattern
Alternating zones of vasoconstriction & vasodilatation for 3 – 5 cm
ICA frequently – VA less frequently
Usually bilateral
ICA
16. Causes of carotid artery diseases
Arteriosclerotic disease
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
Most common cause
17. Carotid & vertebral dissection
• Spontaneous dissection Bleeding from vasa vasorum
Most common ICA & VA (atlas loop)
Intramural hematoma
Pain – Stenosis – Horner
• Vascular injury Iatrogenic: puncture – surgery
CCA
Intramural hematoma ± intimal tear
• Stanford A dissection Intimal rupture in ascending aorta
CCA
18. Dissection of aorta & cervical arteries
Patho-anatomy
Intimal rupture with false lumen
Open or secondarily thrombosed
Aorta
External intramural hematoma
Lumen constriction
Rare intimal rupture
Cervical
19. Spontaneous dissection of ICA
Asymmetric wall hematoma – Lumen stenosis – Expansion to outside
Diagnostic criteria (one sufficient)
Intramural hematoma
Intimal rupture/double lumen
Distal stenosis or occlusion
Symptoms: acute pain, Horner,
Course: recanalization in few weeks
a Longitudinal color Doppler ultrasound (US) image of an acute dissection of the
internal carotid artery (ICA) with the dissection of the lumen (arrowhead)
demonstrating color flow. ICA large arrow, external carotid artery (ECA) long
arrow. b An abnormal high-resistance spectral Doppler US waveform is
demonstrated in the dissection lumen (arrowhead). ICA large arrow, ECA long
arrow. c. On day 14, there is intramural thrombus formation (arrowhead) with
no evidence of color Doppler US flow within the dissection false lumen. CCA star,
ICA large arrow, ECA long arrow
20. Spontaneous dissection of VA
Wall hematoma in V1
Diagnostic criteria (one sufficient):
Intramural hematoma (asymmetric, not concentric)
Intimal rupture/double lumen (rare)
Double lumen in V2
21. Dissection of common carotid artery
Transverse view Longitudinal view
Detection of two lumina & dissection membrane
22. Dissection of CCA / Stenosis
Residuum after end of aortic dissection
Doppler of true lumen
Enlargement of false lumen
before cranial end
Doppler of false lumen
Stenosis of true lumen
23. Causes of carotid artery diseases
Arteriosclerotic disease
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
Most common cause
24. Vasospasm
• Causes Migraine, eclampsia, vasculitis, drug abuse,
idiopathic
• Incidence Rarely identified (short duration)
Occur frequently & remain undetected
• Symptoms Cerebral or ocular ischemia
• US Direct &/or indirect signs of severe stenosis
Far above bifurcation – Sometimes bilateral
Complete regression in hours to days – Relapse
• DD Dissection: wall hematoma – regression in weeks
• Treatment Calcium antagonists
26. Causes of carotid artery diseases
Arteriosclerotic disease
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
Most common cause
27. Extra-cranial ICA aneurysms
Color Doppler US Power Doppler US
Incomplete delineation of aneurysm – Thrombi could not be excluded
Difficult definition for extracranial carotid artery aneurysms
due to normal dilatation of bulb
30. CCA pseudoaneurysm / Rare
One month after bilateral neck dissection
CCA Pseudoaneurysm
Large connecting neck
Color Doppler US CE multidetector CT
CCA Pseudoaneurysm
Large connecting neck
31. Causes of carotid artery diseases
Arteriosclerotic disease
Non-arteriosclerotic diseases
Fibro muscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
Most common cause
32. Arterio-venous fistula
Attempt to perform US-guided jugular catheter insertion
Turbulent flow in fistula track High-velocity turbulent flow in track
Suspicion of communication between CCA & IJV
CCA
IJV
33. Causes of carotid artery diseases
Arteriosclerotic disease
Non-arteriosclerotic diseases
Fibro muscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
Most common cause
34. Doppler ultrasound in arteritis
“macaroni sign” & “halo sign”
• 2 types Takayasu Young female – SCA & CCA
Horton Old female – SCA, AA & Temporal A
Cannot be differentiated using US
• US signs Macaroni Concentric hypoechoic wall
thickening
Halo Dark halo around colorful lumen
All grades of stenosis – Thrombotic vessel
• DD Dissection Eccentric hypoechoic wall thickening
Pronounced outward expansion
35. Takayasu’s arteritis
Young female – SCA [‘pulseless’ disease] – CCA
CCA
Long hypoechoic wall thickening
Visualized in color Doppler as dark halo around vascular lumen
37. Causes of carotid artery diseases
Arteriosclerotic disease
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arteriovenous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
Most common cause
38. Carotid body tumor / Rare
Histology Paraganglioma of low malignant potential
Presentation Palpable neck mass – Headache – Neck pain
US Highly vascular mass in carotid bifurcation
Arteriography Performed preoperatively – Embolization
Treatment Resection to prevent local adverse events:
Laryngeal nerve palsy – carcinoma invasion
Result Local recurrence 6% – Distant metastasis 2%
40. Causes of carotid artery diseases
Arteriosclerotic disease
Non-arteriosclerotic diseases
Fibromuscular dysplasia
Dissection
Vasospasm
Aneurysm & pseudoaneurysm
Arterio-venous fistula
Arteritis: Takayasu – Horton
Carotid body tumor
Idiopathic carotidynia
Most common cause
41. Diagnosis of idiopathic carotidynia
International Headache Society (IHS)1
• At least one of following over CA: Tenderness
Swelling
Increased pulsations
• Pain over affected side of neck that may project to head
• Appropriate investigations without structural
abnormality
Recent publications demonstrate radiological findings2
• Self-limiting syndrome of less than 2 weeks duration
42. Idiopathic carotidynia
US findings comparable to dissection
Enhanced tissue
around carotid artery
CE T1-weighted MRIUS of distal CCA
Hypo-echoic soft tissue
around carotid artery
Three months later
Resolution of abnormal
soft tissue
43. Spontaneous dissection & carotidynia
Spontaneous dissection Carotidynia
Location Beyond bifurcation At or near bifurcation
Thickening layers One wall layer 2 wall layers
Stenosis May be detectable Not detectable
Pain Head Neck
In unclear cases, MRI enables differentiation
44. Doppler US of carotid arteries
Anatomy of carotid arteries
Normal Doppler US of carotid arteries
Causes of carotid artery disease
Effect of extra-carotid diseases
45. Effect of extra-carotid diseases
• Idiopathic dilated cardiomyopathy
• Aortic regurgitation
• Aortic stenosis
• Stenosis of right innominate artery or origin of LCCA
• High & low PSV in CCA
• Stenosis of intra-cranial ICA
47. Aortic regurgitation
Bisferiens waveform [“beat twice” in Latin]
Two systolic peaks separated by midsystolic retraction
Dicrotic notch
Found also with hypertrophic obstructive cardiomyopathy
48. Severe aortic regurgitation
Normal or elevated PSV followed by precipitous decline
Revered flow during diastole
Water-hammer spectral appearance
CCA
52. High cardiac output: Hypertensive patients
Young athletes
High flow > 125 cm/sec in both CCAs
Poor cardiac output: Cardiomyopathies
Valvular heart disease
Extensive myocardial
infarction
Low flow < 45 cm/sec in both CCAs
Arrhythmias can be real problem
Normal PSV in CCA (45 – 125 cm/sec)
53. ICA
High-grade stenosis distally (intracranial ICA)
Major occlusive lesions of cerebral arteries (MCA, ACA)
Massive spasm of cerebral arteries from intracranial hemorrhage
Stenosis of intra-cranial ICA
High resistance waveform
54. Advantages of power mode Doppler
• Angle independent
• No aliasing
• Increases accuracy of grading stenosis
• Distinguish pre-occlusive from occlusive lesions
“detect low-velocity blood flow”
• Superior depiction of plaque surface morphology
55. Disadvantages of power mode Doppler
• Does not provide direction of flow
New machines provide direction of flow in power mode
• Does not provide velocity flow information
• Very motion sensitive (poor temporal resolution)
56. Causes of image/Doppler mismatch
• Cardiac arrhythmia
• Severe aortic stenosis
• Hypotension or hypertension
• Tortuous vessels
• Hypoechoic, anechoic or calcified plaques
• Long segment high grade stenosis
• Pre-occlusive lesion
• Tandem lesion
• Contra-lateral carotid stenosis
• Carotid dissection
57. Limitations of carotid US examination
• Short muscular neck
• High carotid bifurcation
• Tortuous vessels
• Calcified shadowing plaques
• Surgical sutures, postoperative hematoma, central line
• Inability to lie flat in respiratory or cardiac disease
• Inability to rotate head in patients with arthritis
• Uncooperative patient
The ECA is an important collateral pathway in patients with ipsilateral ICA occlusion and recurrent symptoms.This may influence the surgical decisions involving revascularization of the stenotic ECA.
Differentiation between these causes is important, as some centers are performing vertebral artery angioplasty and stent placement for significant vertebral artery stenosis.
Wall hematoma: Wall hematoma might be incorrectly interpreted as arteritis.However, an important differentiation criterion is the eccentric location of the wall thickening in the case of dissection as known from MRI findings, while vasculitis is characterized by concentric wall thickening.Double lumen:If double are detected, a pathological Doppler curve (showing stenosis or oscillating flow) will be found in at least one of the lumina. Therefore, fenestration of the VA (an anomaly with a double lumen in one vessel segment) cannot be confused with dissection becauseof the normal flow pulse curve in both lumina.Horner:
If 2 lumina are detected, a pathological Doppler curve (showing stenosis or oscillating flow) will be found in at least one of the lumina. Therefore, fenestration of the VA (an anomaly with a double lumen in one vessel segment) cannot be confused with dissection because of the normal flow pulse curve in both lumina.
True aneurysm generally defined as dilation of an artery to more than 150% of its normal diameterDifficult definition for extracranial carotid artery aneurysms due to normal dilatation of bulbDe Jong et al. proposed that ECAA of the bifurcation are better defined as a bulb dilatation greater than 200% of the diameter of the ICA or 150% of the diameter of the common carotid artery, and distal aneurysms of the extracranial internal carotid arteries (EICAA) as a dilatation greater than 120% of the diameter of the normal ipsilateral ICA.
Temporal (giant cell) arteritis affects the superficial temporal arteries in older women.The specificity of the method under qualified application is 97%. Therefore, given a clear vasculitis finding in the ultrasound image and an experienced examiner, a vascular biopsy can be dispensed with.In the case of unclear ultrasound findings or ultrasound findings without pathological findings and a clinical suspicion of arteritis, biopsy is still necessary.
“carotidynia” was initially described by Fay in 1927.Clinical criteria for dg of idiopathic carotidynia were established in 1988 by International Headache Society Classification Committee.The existence of this entity remained controversial and led the International Headache Society to remove carotidynia from their main classification of Headache Disorders in 2004.Severe pain on one side in the upper cervical region that responds well to cortisone or NSAIDs.
Pulsus alternans: نبض متناوبPatient with pulsus alternans caused by idiopathic dilated cardiomyopathy.
Pulsus bisferiens, Latin for ‘‘beat twice,’’ is the term used to describe a waveform characterized by two systolic peaks with an interposed midsystolic retraction. Visualization of this waveform suggests the presence of aortic insufficiency with or without concomitant aortic stenosis or hypertrophicobstructive cardiomyopathy.Mechanism of Pulsus bisferiens in aortic insufficiency is not well understood. One view is that first peak represents initial high-volume ejection of blood, which is followed by abrupt mid systolic flow deceleration caused by regurgitant valve, and second peak represents tidal wave reflected from distended aorta as it relaxes or from periphery of body.
Water Hammer: الطرق المائي (صوت طرق الماء على جوانب الأنبوب الذي يحتويه)Hammer: مطرقةSpectral waveforms mirror physical examination finding of water-hammer pulses in patients with severe aortic regurgitation.
Reduced right arm systolic blood pressure. A right-to-left difference of 20 mm Hg is considered significant.