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Johansson, E., Aviv, R. I. & Fox, A. J. (2019). Atherosclerotic ICA stenosis coinciding with ICA asymmetry associated with Circle of Willis variations can mimic near-occlusion. Neuroradiology
Open this publication in new window or tab >>Atherosclerotic ICA stenosis coinciding with ICA asymmetry associated with Circle of Willis variations can mimic near-occlusion
2019 (English)In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920Article in journal (Refereed) Epub ahead of print
Abstract [en]

Differentiating carotid near-occlusion (tight atherosclerotic stenosis causing distal artery size reduction) from conventional stenosis is the first step when grading carotid stenoses with NASCET method. The internal carotid artery (ICA) can be asymmetrically associated with Circle of Willis variations. When such ICA asymmetry coincides with stenosis, it may mimic near-occlusion. We studied ICA anatomical variant prevalence in 4042 consecutive CTA exams from all indications, 53 excluded due to carotid occlusion, 814 with any >= 50% steno-occlusive disease intra- or extracranially, 3228 without. Of the 3989 included cases, 568 (14%) had ICA asymmetry, of which 335 (59%) were from associated with Circle of Willis variations. Of 3228 patients without >= 50% stenosis or other steno-occlusive disease intra- and extracranially; 257 (8.0%) demonstrated ICA asymmetry associated with Circle of Willis variations, equally common among sexes and age unrelated and most frequently attributed to an ipsilateral A1 hypoplasia/aplasia, less often attributed to large contralateral posterior communicating artery. As ICA asymmetry associated with Circle of Willis variations are common, caution should be exercised diagnosing near-occlusion on asymmetry alone.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Computed tomography angiography, Carotid artery, Carotid stenosis, Near-occlusion
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-165315 (URN)10.1007/s00234-019-02309-7 (DOI)000495219000001 ()31705180 (PubMedID)
Funder
Knut and Alice Wallenberg FoundationVästerbotten County Council
Available from: 2019-12-03 Created: 2019-12-03 Last updated: 2019-12-03
Garoff, M., Ahlqvist, J., Edin, L.-T., Jensen, S., Levring Jäghagen, E., Petäjäniemi, F., . . . Johansson, E. (2019). Bilateral vessel-outlining carotid artery calcifications in panoramic radiographs: an independent risk marker for vascular events. BMC Cardiovascular Disorders, 19(1), Article ID 225.
Open this publication in new window or tab >>Bilateral vessel-outlining carotid artery calcifications in panoramic radiographs: an independent risk marker for vascular events
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2019 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 19, no 1, article id 225Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In odontology, panoramic radiographs (PRs) are regularly performed. PRs depict the teeth and jaws as well as carotid artery calcifications (CACs). Patients with CACs on PRs have an increased risk of vascular events compared to healthy controls without CACs, but this association is often caused by more vascular events and risk factors at baseline. However, the risk of vascular events has only been analyzed based on the presence of CACs, and not their shape. Thus, this study determined if the shape of CACs in PRs affects the risk of future vascular events.

METHODS: The study cohort included 117 consecutive patients with CACs in PRs and 121 age-matched controls without CACs. CAC shape in PRs was dichotomized into bilateral vessel-outlining CACs and other CAC shapes. Participants were followed prospectively for an endpoint of vascular events including myocardial infarction, stroke, and vascular death.

RESULTS: Patients with bilateral vessel-outlining CACs had more previous vascular events than those with other CAC shapes and the healthy controls (p < 0.001, χ2). The mean follow-up duration was 9.5 years. The endpoint was reached in 83 people. Patients with bilateral vessel-outlining CACs had a higher annual risk of vascular events (7.0%) than those with other CAC shapes (4.4%) and the controls (2.6%) (p < 0.001). In multivariate analysis, bilateral vessel-outlining CACs (hazard ratio: 2.2, 95% confidence interval: 1.1-4.5) were independent risk markers for the endpoint.

CONCLUSIONS: Findings of bilateral vessel-outlining CACs in PRs are independent risk markers for future vascular events.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Cardiovascular disease, Carotid atherosclerosis, Panoramic radiography
National Category
Medical and Health Sciences Clinical Medicine
Research subject
Medicine; Odontology
Identifiers
urn:nbn:se:umu:diva-164795 (URN)10.1186/s12872-019-1211-3 (DOI)000490832600004 ()31619183 (PubMedID)
Funder
Swedish Heart Lung FoundationVästerbotten County CouncilKnut and Alice Wallenberg Foundation
Available from: 2019-11-01 Created: 2019-11-01 Last updated: 2019-11-19Bibliographically approved
Johansson, E., Benhabib, H., Herod, W., Hopyan, J., Machnowska, M., Maggisano, R., . . . Fox, A. J. (2019). Carotid near-occlusion can be identified with ultrasound by low flow velocity distal to the stenosis. Acta Radiologica, 60(3), 396-404
Open this publication in new window or tab >>Carotid near-occlusion can be identified with ultrasound by low flow velocity distal to the stenosis
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2019 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 60, no 3, p. 396-404Article in journal (Refereed) Published
Abstract [en]

Background: Most carotid near-occlusions are indistinguishable from conventional >= 50% stenosis on ultrasound, demonstrating high peak systolic velocity (PSV) in the stenosis. Purpose To study whether the velocity distal to the stenosis can separate high PSV near-occlusion from conventional >= 50% stenosis.

Material and Methods: We included patients with >= 50% carotid stenosis with high PSV (>= 125 cm/s), examined with both computed tomography angiography (CTA) and ultrasound within 30 days, and a distal velocity measurement was performed. Based on CTA, cases were divided into three groups: conventional stenosis; near-occlusion without full collapse (NwoC; normal-appearing albeit small distal artery); and near-occlusion with full collapse (NwC; threadlike distal artery). Distal Doppler ultrasound flow velocities were compared between these groups.

Results: Sixty patients were included: 33 patients with conventional stenosis; 20 patients with NwoC; and seven patients with NwC. Mean distal PSV was 93, 63, and 21 cm/s (P < 0.001) and mean distal end-diastolic velocity was 30, 24, and 5 cm/s (P < 0.001), respectively. A distal PSV < 50 cm/s was 63% sensitive and 94% specific for separating both types of near-occlusion from conventional stenosis.

Conclusion: In high PSV carotid stenoses, the distal velocity was lower in near-occlusions than conventional carotid stenosis. Distal velocities warrant further investigation in diagnostic studies.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Stroke, carotid stenosis, near-occlusion, CT angiography, ultrasound, distal velocity
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-157204 (URN)10.1177/0284185118780900 (DOI)000458887800016 ()29896980 (PubMedID)
Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-11-19Bibliographically approved
Visona, A., Pesavento, R., Mazzolai, L., Cimminiello, C., Pecsvarady, Z., Olinic, D. & Johansson, E. (2019). ESVM integrated care pathways - a call for action. VASA, 48(2), 113-114
Open this publication in new window or tab >>ESVM integrated care pathways - a call for action
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2019 (English)In: VASA, ISSN 0301-1526, E-ISSN 1664-2872, Vol. 48, no 2, p. 113-114Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Hogrefe & Huber Publishers, 2019
Identifiers
urn:nbn:se:umu:diva-158107 (URN)10.1024/0301-1526/a000755 (DOI)000462271600002 ()30821213 (PubMedID)
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-11-19Bibliographically approved
Westlund, A., Holmlund, P., Johansson, E., Malm, J. & Eklund, A. (2019). Semi-automatic method for segmentation of the internal jugular vein in ultrasound movies evaluated at different body postures. Biomedical Physics & Engineering Express, 5(4), Article ID 045034.
Open this publication in new window or tab >>Semi-automatic method for segmentation of the internal jugular vein in ultrasound movies evaluated at different body postures
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2019 (English)In: Biomedical Physics & Engineering Express, E-ISSN 2057-1976, Vol. 5, no 4, article id 045034Article in journal (Refereed) Published
Abstract [en]

Objective: The collapse of the internal jugular vein (IJV) regulates intracranial pressure (ICP) in upright body positions. The cross-section area (CSA) is therefore of interest when studying the effects of postural changes in various neurological diseases. We have developed a semi-automatic segmentation method, which tracks the CSA of the IJV in ultrasound movies, and evaluated its performance in three body positions (supine, 16°, 71°). Approach: The proposed method utilized post-processing image filtering combined with a modified snake active contour algorithm. The ultrasound movies were retrospectively analysed (n = 231, 3s, 28 fps) based on previously collected data from 17 healthy volunteers. The computed CSAs (CA) from the segmentation method were compared to manually segmented CSAs (MA) in two frames per movie. Tracking performance were evaluated by visual inspection. Main results: In the supine position, 100% of the ultrasound movies were tracked successfully, and the mean of CA-MA was −4.4 ± 6.9 mm2 (MA, 88.4 ± 50.5 mm2). The most challenging movies occurred in upright body posture where tracking success rate was 90% and mean of CA-MA was −1.4 ± 2.2 mm2 (MA, 12.0 ± 11.1 mm2). The semi-automatic segmentations took 55 s to perform on average (per movie) compared to manual segmentations which took 50 min. Significance: Segmentations made by the proposed method were comparable to manual segmentations in all tilt-angles, however much faster. Efficient and accurate tracking of the CSA of the IJV, with respect to postural changes, could help furthering our understanding of how IJV-biomechanics relates to regulation of intracranial pressure in different neurological diseases and physiological states.

Place, publisher, year, edition, pages
Institute of Physics Publishing (IOPP), 2019
Keywords
posture, intracranial pressure, ultrasound, jugular veins, computer-assisted image analysis
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-161912 (URN)10.1088/2057-1976/ab285e (DOI)000475798800001 ()
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-11-28Bibliographically approved
Gu, T., Aviv, R. I., Fox, A. J. & Johansson, E. (2019). Symptomatic carotid near-occlusion causes a high risk of recurrent ipsilateral ischemic stroke. Journal of Neurology
Open this publication in new window or tab >>Symptomatic carotid near-occlusion causes a high risk of recurrent ipsilateral ischemic stroke
2019 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: To assess the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic near-occlusion with and without full collapse.

Methods: Included were consecutive patients eligible for revascularization, grouped into symptomatic conventional ≥ 50% carotid stenosis (n = 266), near-occlusion without full collapse (n = 57) and near-occlusion with full collapse (n = 42). The risk of preoperative recurrent ipsilateral ischemic stroke was analyzed, or, for cases not revascularized within 90 days, 90-day risk was analyzed.

Results: The risk of a preoperative recurrent ipsilateral ischemic stroke or ipsilateral retinal artery occlusion was 15% (95% CI 9–20%) for conventional ≥ 50% stenosis, 22% (95% CI 6–38%) among near-occlusion without full collapse and 30% (95% CI 16–44%) among near-occlusion with full collapse (p = 0.01, log rank test). In multivariate analysis, near-occlusion with full collapse had a higher risk of recurrent ipsilateral ischemic stroke (adjusted HR 2.6, 95% CI 1.3–5.3) and near-occlusion without full collapse tended to have a higher risk (adjusted HR 2.0, 95% CI 0.9–4.5) than conventional ≥ 50% stenosis. Only 24% of near-occlusion with full collapse underwent revascularization, common causes for abstaining were misdiagnosis as occlusion (31%), deemed surgically unfeasible (21%) and low perceived benefit (10%).

Conclusions: Symptomatic carotid near-occlusion has a high short-term risk of recurrent ipsilateral ischemic stroke, especially near-occlusion with full collapse.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Stroke, Neurology, Carotid stenosis, Large vessel disease
National Category
Radiology, Nuclear Medicine and Medical Imaging Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-165319 (URN)10.1007/s00415-019-09605-5 (DOI)000495042800003 ()31701329 (PubMedID)
Available from: 2019-12-03 Created: 2019-12-03 Last updated: 2019-12-03
Jashari, F., Ibrahimi, P., Johansson, E., Grönlund, C., Wester, P. & Henein, M. Y. (2018). Carotid IM-GSM is better than IMT for identifying patients with multiple arterial disease. Scandinavian Cardiovascular Journal, 52(2), 93-99
Open this publication in new window or tab >>Carotid IM-GSM is better than IMT for identifying patients with multiple arterial disease
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2018 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 2, p. 93-99Article in journal (Refereed) Published
Abstract [en]

Objective. Atherosclerosis is a systemic inflammatory disease that can affect more than one arterial bed simultaneously. The aim of this study was to determine the relationship between ultrasound markers of atherosclerosis and multiple arterial disease. Design. We have included 87 currently asymptomatic carotid disease patients (mean age 69 +/- 6 year, 34% females) in this study. Intima media thickness (IMT) and intima media-grey scale median (IM-GSM) were measured in the common carotid artery (CCA), and correlated with previous and/or current atherosclerotic vascular disease in the coronary, carotid and lower extremities. Patients were divided into three groups: (1) asymptomatic, (2) previous symptoms in one arterial territory and (3) previous symptoms in multiple arterial territories. Results. Patients with previous disease in the coronary arteries had higher IMT (p=.034) and lower IM-GSM (p<.001), and those with prior stroke had lower IM-GSM (p=.007). Neither IMT nor IM-GSM was different between patients with and without previous lower extremity vascular disease. IM-GSM was significantly different between groups, it decreased significantly with increasing number of arterial territories affected (37.7 +/- 15.4 vs. 29.3 +/- 16.4 vs. 20.7 +/- 12.9) p<.001, for asymptomatic, symptoms in one and in multiple arterial systems, respectively. Conventional IMT was not significantly different between groups p=.49. Conclusion. Carotid IMT was higher and IM-GSM lower in patients with symptomatic nearby arterial territories but not in those with peripheral disease. In contrast to conventional IMT, IM-GSM can differentiate between numbers of arterial territories affected by atherosclerosis, suggesting that it is a better surrogate for monitoring multiple arterial territory disease.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2018
Keywords
Atherosclerosis, carotid artery, intimal-media complex, IMT, IM-GSM
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-146595 (URN)10.1080/14017431.2018.1435903 (DOI)000428305000006 ()29402147 (PubMedID)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2019-05-20Bibliographically approved
Johansson, E. & Salzer, J. (2018). Interaction should guide management decisions [Letter to the editor]. American Journal of Neuroradiology, 39(5), E57-E57
Open this publication in new window or tab >>Interaction should guide management decisions
2018 (English)In: American Journal of Neuroradiology, ISSN 0195-6108, E-ISSN 1936-959X, Vol. 39, no 5, p. E57-E57Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
American Society of Neuroradiology, 2018
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-149381 (URN)10.3174/ajnr.A5579 (DOI)000432175900003 ()29545244 (PubMedID)2-s2.0-85047092923 (Scopus ID)
Available from: 2018-06-20 Created: 2018-06-20 Last updated: 2019-11-25Bibliographically approved
Johansson, E. (2018). Konferensrapport European Stroke Organization Conference (ESOC), Göteborg. Vaskulär medicin, 34(2), 27-27
Open this publication in new window or tab >>Konferensrapport European Stroke Organization Conference (ESOC), Göteborg
2018 (Swedish)In: Vaskulär medicin, ISSN 2000-3188, Vol. 34, no 2, p. 27-27Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Svensk förening för hypertoni, stroke och vaskulär medicin, 2018
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-149378 (URN)
Available from: 2018-06-20 Created: 2018-06-20 Last updated: 2018-06-27Bibliographically approved
Lindén, C., Qvarlander, S., Jóhannesson, G., Johansson, E., Östlund, F., Malm, J. & Eklund, A. (2018). Normal-Tension Glaucoma Has Normal Intracranial Pressure: A Prospective Study of Intracranial Pressure and Intraocular Pressure in Different Body Positions. Ophthalmology (Rochester, Minn.), 125(3), 361-368
Open this publication in new window or tab >>Normal-Tension Glaucoma Has Normal Intracranial Pressure: A Prospective Study of Intracranial Pressure and Intraocular Pressure in Different Body Positions
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2018 (English)In: Ophthalmology (Rochester, Minn.), ISSN 0161-6420, E-ISSN 1549-4713, Vol. 125, no 3, p. 361-368Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To test the hypothesis that normal-tension glaucoma (NTG) is caused by an increased pressure difference across the lamina cribrosa (LC) related to a low intracranial pressure (ICP).

DESIGN: Prospective case-control study.

PARTICIPANTS: Thirteen NTG patients (9 women; median 71 [range: 56-83] years) were recruited for investigation with the same protocol as 11 healthy volunteers (8 women; 47 [30-59] years). A larger control group (n = 51; 30 women; 68 [30-81] years) was used only for ICP comparison in supine position.

METHODS: ICP and intraocular pressure (IOP) were simultaneously measured in supine, sitting, and 9° head-down tilt (HDT) positions. Trans-lamina cribrosa pressure difference (TLCPD) was calculated using ICP and IOP together with geometric distances estimated from magnetic resonance imaging to adjust for hydrostatic effects.

MAIN OUTCOME MEASURES: ICP, IOP, and TLCPD in different body positions.

RESULTS: Between NTG patients and healthy volunteers, there were no differences in ICP, IOP, or TLCPD in supine, sitting, or HDT (P ≥ 0.11), except for IOP in HDT (P = 0.04). There was no correlation between visual field defect and TLCPD, IOP, or ICP and in any body position (P ≥ 0.39). Mean ICP in supine was 10.3 mmHg (SD = 2.7) in the NTG group (n = 13) and 11.3 (2.2) mmHg in the larger control group (n = 51) (P = 0.24).

CONCLUSIONS: There was no evidence of reduced ICP in NTG patients as compared with healthy controls, either in supine or in upright position. Consequently, the hypothesis that NTG is caused by an elevated TLCPD from low ICP was not supported.

National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-142423 (URN)10.1016/j.ophtha.2017.09.022 (DOI)000425377300015 ()29096996 (PubMedID)
Funder
Swedish Research Council, 2015-05616
Available from: 2017-11-30 Created: 2017-11-30 Last updated: 2018-06-21Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5317-4563

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