Very late stent thrombosis (VLST) is increasingly being regarded as a complication of drug-eluting stents (DES), and delayed endothelization, local hypersensitivity reactions, and late stent malapposition due to excessive positive remodeling have been postulated as mechanisms. Considering that stent endothelialization seems to be completed within 4 weeks following bare-metal stent (BMS) placement and that BMS do not possess antiproliferative coating, the mechanism of VLST may differ between patients with DES and those with BMS. We report a case of VLST 9 years after BMS implantation, in which thrombus from the ruptured neointima was confirmed by intravascular ultrasound. This finding suggests that de novo plaque rupture at the neointimal layer within the stent may be one of the explanations for VLST.
Aged ; Humans ; Male ; Stents ; adverse effects ; Thrombosis ; diagnostic imaging ; Ultrasonography

OBJECTIVE: To study the feasibility of ultrasonic molecular imaging of immediately blood-mediated inflammatory reaction (IBMIR) in vitro.
 METHODS: IBMIR models in vitro were divided into 3 groups: Group A, no microbubbles were added; Group B, non-targeted micro-bubbles were added; Group C, Lys-Gly-Asp-Ser (KGDS)-targeted microbubbles (MBK) were added. The ultrasonic enhancement of IBMIR in loops by ultrasonic contrast imaging was evaluated.
 RESULTS: The contrast-enhanced US imaging did not show thrombus formation in the group A, whereas the thrombus was found in the Group B and C with a change in filling defects or ring enhancement, respectively. The time for detecting thrombosis was (7.3 ± 0.5) min and (13.2 ± 0.6) min in Group B and Group C, respectively (P<0.05). The average-gray scales of thrombus in Group B and Group C were 31.22 ± 3.56 and 75.85 ± 5.21, respectively (P<0.05). The fluorescence microscope also showed that MBK was attached to thrombus surrounding islets.
 CONCLUSION IBMIR model in vitro showed that KGDS-targeted ultrasound contrast agent could adhere to thrombus shell surrounding islets and molecular target ultrasonography could image these thrombi noninvasively and effectively.
Contrast Media ; Humans ; Inflammation ; diagnostic imaging ; Islets of Langerhans Transplantation ; Microbubbles ; Thrombosis ; diagnostic imaging ; Ultrasonography

This study was conducted to assess time-sensitive magnetic resonance (MR) changes in canine blood using low-field MR. Arterial and venous blood samples were collected from eight healthy beagle dogs. Samples were placed in 5-mL tubes and imaged within 3 hours of collection at 1 day intervals from day 1 to day 30. The following sequences were used: T1-weighted (T1W), T2-weighted (T2W), fluid-attenuated inversion recovery (FLAIR), short tau inversion recovery (STIR), and T2-star gradient-echo (T2*-GRE). Visual comparison of the images revealed that four relatively homogenous blood clots and twelve heterogeneous blood clots developed. The margination of the clot and plasma changed significantly on day 2 and day 13. On day 2, heterogeneous blood clots were differentiated into 2 to 3 signal layers in the T2W, T1W, and especially the STIR images. Hypointense signal layers were also detected in the blood clots in STIR images, which have T2 hypo, FLAIR hypo, and T1 hyper intense signals. In all images, these signal layers remained relatively unchanged until day 13. Overall, the results suggest that hematomas are complex on low-field MRI. Accordingly, it may not be feasible to accurately characterize hemorrhages and predict clot age based on low-field MRI.
Animals ; Blood/*diagnostic imaging ; Blood Coagulation ; Blood Physiological Phenomena ; Dogs ; Female ; Hematoma/diagnostic imaging ; Hemorrhage/diagnostic imaging ; *Magnetic Resonance Imaging ; Thrombosis/diagnostic imaging ; Time

Dural sinus thrombosis (DST), or cerebral venous thrombosis, is an uncommon cause of stroke. It has a variable presentation, and the symptoms and signs can be non-specific. The diagnosis of DST can be difficult to make and is often delayed or missed. Computed tomography venography or magnetic resonance venography are the typical imaging modalities used to diagnose DST. However, computed tomography venography and magnetic resonance venography both have limitation for emergency department patients. In this article, we report the use of point-of-care ultrasound to facilitate the diagnosis of DST.
Diagnosis ; Diagnostic Imaging ; Emergencies ; Emergency Service, Hospital ; Humans ; Phlebography ; Point-of-Care Systems* ; Sinus Thrombosis, Intracranial* ; Stroke ; Thrombosis ; Ultrasonography* ; Venous Thrombosis

OBJECTIVETo explore the relationship between blood stasis (BS) syndrome and coronary lesion in patients with coronary heart disease (CHD).

METHODSSyndrome types of 500 patients collected from multiple centers whose diagnosis of CHD confirmed by coronary angiography were differentiated. And the relationship between BS syndrome, its subtypes, and coronary lesion (affected branches, degree of constriction) were analyzed.

RESULTSThe affected branches of coronary artery in patients of BS syndrome was 2.28 +/- 0.28, while that in the non-BS syndrome patients was 2.07 +/- 0.86, showing significant difference between them (P < 0.05); as compared to patients of non-BS syndrome, the coronary lesions in patients of BS syndrome were mostly multi-vascular, and of more severe degree (P < 0.05). In patients of various BS syndrome subtypes, the average number of affected coronary branches in patients of yang-deficiency subtype was 2.58 +/- 0.65, which was significantly more than the number in patients of other BS syndrome subtypes. The constriction degree of coronary lesions in patients of yang-deficiency BS syndrome subtype were mostly severe or moderate, and single branch lesion was rarely seen, as compared with those in patients of phlegm-stasis obstruction subtype, the difference was significant (P < 0.05). The corresponding correlative analysis showed that close correlation was found between yang-deficiency subtype of BS syndrome and severe coronary constriction with the correlation distance of 0.1899.

CONCLUSIONRelationship between BS syndrome and coronary lesion (its number of branches and degree of constriction) truly exists to a certain extent.

Adult ; Aged ; Coronary Angiography ; Coronary Disease ; diagnosis ; diagnostic imaging ; Coronary Thrombosis ; diagnosis ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged

Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated vasculitis is an autoimmune disease usually with severe multiple dysfunction syndrome, especially prominent acute renal failure. A 65-year-old woman was admitted with progressive dyspnoea for six months and fever, sputum with blood, pain of the lower extremities and intermittent claudication for two days, indicating multiple organ involvement (respiratory system, blood vessels). The renal involvement was relatively mild, presenting with microscopic haematuria. The chest computed tomography demonstrated multiple pulmonary embolisms. Ultrasound and computed tomography angiography for the lower extremity vessels showed venous and arterial thrombosis. Exclusion of other diseases that can cause multiple organ damage and thrombosis, the positive perinuclear ANCA and MPO-ANCA strongly support the diagnosis of MPO-ANAC-associated vasculitis. The patient's physical condition has been greatly improved by treatment with corticosteroids and anticoagulation.
Aged ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis* ; Female ; Humans ; Lower Extremity/diagnostic imaging* ; Peroxidase ; Pulmonary Embolism/diagnostic imaging* ; Thrombosis

BACKGROUNDThere is increasing evidence that CT pulmonary arteriography and venography allow a better diagnostic yield for deep vein thrombosis (DVT) in suspected acute pulmonary embolism (PE). The aim was to investigate the value for using such an approach in a multiracial Asian population.

METHODSA total of 135 consecutive subjects with clinically suspected PE in various clinical settings (postoperative in 23 subjects) were referred and evaluated for venous thromboembolism using CT pulmonary arteriography and venography in a tertiary hospital, Malaysia. The distribution of DVT was assessed based on the frequency rate of thrombosis in a particular anatomical region (inferior vena cava, pelvic, femoral and popliteal).

RESULTSIn 130 subjects, excluding 5 subjects having poor images, both DVT and PE were detected in 11.5% (15/130) subjects and DVT alone was detected in 6.9% (9/130) subjects giving a combined rate of venous thromboembolism of 18.4%. A history of malignancy was significantly associated with positive scans, P = 0.02. It was found that left pelvic veins (18.2%) and left femoral veins (19.5%) were more commonly thrombosed in this population.

CONCLUSIONCT pulmonary arteriography and venography is a useful technique in the evaluation of venous thromboembolism in a multi-racial Asian population.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Artery ; diagnostic imaging ; Pulmonary Embolism ; diagnostic imaging ; Pulmonary Veins ; diagnostic imaging ; Tomography, X-Ray Computed ; methods ; Venous Thromboembolism ; diagnostic imaging ; Venous Thrombosis ; diagnostic imaging

The present study aimed to improve the processing of data acquired from laser speckle contrast imaging (LSCI) to provide a standardization method to explore changes in regional cerebral blood flow (rCBF) and to determine the correlations among rCBF, cerebral ischemic lesion volume and microvascular density over time in a focal ischemic region. C57BL/6J mice were subjected to focal photothrombotic (PT) ischemia. rCBF was measured using LSCI at different time points before and after PT ischemia through an intact skull. Standardized rCBF (SrCBF), defined as the ratio of rCBF measured in the ipsilateral region of interest (ROI) to that in the corresponding contralateral region, was calculated to evaluate potential changes. In addition, the volume of the ischemic lesion and the microvascular density were determined using Nissl staining and immunofluorescence, respectively. The relationships among the ischemic lesion volume, microvascular density and SrCBF were analyzed over time. The results showed that the cortical rCBF measured using LSCI following PT ischemia in the C57BL/6J mice gradually increased. Changes in the cerebral ischemic lesion volume were negatively correlated with SrCBF in the ischemic region. Changes in the microvascular density were similar to those observed in SrCBF. Our findings indicate that LSCI is a practical technique for observing changes in murine cortical rCBF without skull opening and for analyzing the relationships among the ischemic lesion volume, microvascular density and SrCBF following focal cerebral ischemia. Preliminary results also suggest that the use of LSCI to observe the formation of collateral circulation is feasible.
Animals ; Brain Ischemia ; diagnostic imaging ; etiology ; Cerebrovascular Circulation ; Diagnostic Imaging ; methods ; Intracranial Thrombosis ; diagnostic imaging ; etiology ; Laser-Doppler Flowmetry ; methods ; Light ; adverse effects ; Male ; Mice ; Mice, Inbred C57BL

Adult ; Echocardiography ; Heart Atria ; pathology ; Heart Diseases ; complications ; diagnostic imaging ; Humans ; Male ; Pulmonary Embolism ; complications ; diagnostic imaging ; Thrombosis ; complications ; diagnostic imaging

BACKGROUNDDifferential diagnosis of isolated calf muscle vein thrombosis (ICMVT) and gastrocnemius hematoma is essential for early identification of deep vein thrombosis (DVT). This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.

METHODSA retrospective case series of 35 ICMVT (M:F, 21:14; mean age (64.5 ± 10.6) years) and 23 gastrocnemius hematoma (M:F, 16:7; mean age (75.4 ± 11.8) years) patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012. Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein, great saphenous vein, calf muscles, skin, and soft tissue were examined.

RESULTSICMVT hypoechoic signals were characterized by long, tube-like masses on longitudinal sections and oval masses on transverse sections, with apparent muscle thrombosis boundaries, distal and proximal venous connections, and, often, lower limb DVT. Gastrocnemius hematoma hypoechoic signals were characterized by large volumes, enhanced posterior hematoma echo, hyperechoic muscle boundaries, no hematoma blood flow, and no DVT, and clear differences in trauma/exercise- and oral anticoagulant-induced hematomas were readily apparent. According to the measurement, the ratio of long diameter/transverse diameter (D/T) in ICMVT patients was about less than 2.0, whereas in gastrocnemius hematoma patients the ratio was more than 2.0. Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas. Partial muscle fibers in the hematoma due to muscle fractures were apparent.

CONCLUSIONHigh-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.

Aged ; Diagnosis, Differential ; Female ; Humans ; Leg ; diagnostic imaging ; Male ; Middle Aged ; Muscle, Skeletal ; diagnostic imaging ; Retrospective Studies ; Ultrasonography ; Venous Thrombosis ; diagnostic imaging