Introdução. A dupla antiagregação plaquetária traz benefícios no tratamento do infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMSST). Há variabilidade intra e interindividual no uso do clopidogrel e isso influencia no benefício do seu uso nesse grupo de pacientes. O objetivo desta pesquisa foi avaliar os efeitos de novo antiagregantes plaquetários (prasugrel e ticagrelor) administrados na sala de emergência (\"upstream\") sobre o resultado angiográfico da angioplastia primária, levando em conta o fluxo coronariano TIMI, o blush miocárdico e a carga de trombo. Métodos. Foi realizado um ensaio clínico, randomizado, cego, com 131 pacientes admitidos com IAMSST. Todos os pacientes receberam ácido acetilsalicílico (AAS). Os pacientes foram randomizados para receber clopidogrel (n=44), prasugrel (n=41) ou ticagrelor (n=46) como dose de ataque ainda na emergência. Todos os pacientes foram submetidos a aspiração manual de trombos. Ao término do procedimento, o resultado angiográfico foi avaliado quanto ao fluxo TIMI, o blush miocárdico e a carga de trombo. Resultados. O fluxo coronariano TIMI >= 1 antes do procedimento foi observado mais frequentemente com o uso de ticagrelor (n = 10, 21,7%) do que com o clopidogrel (n = 1, 2,3%) e prasugrel (n = 5, 12,2%; p = 0,019). O fluxo TIMI coronária no fim do procedimento não diferiu significativamente entre os grupos (p = 0,101). Melhor resultado no que diz respeito ao blush miocárdico foi observada com prasugrel, que produziu um grau de blush III em 85,4% (n = 35) dos pacientes, em comparação com o clopidogrel (54,5%; n = 24) e ticagrelor (67,4%; n = 31; p = 0,025). A carga de trombo pré-procedimento foi maior no grupo de clopidogrel, em que 97,7% (n = 43) dos casos denotaram carga de trombo grau 4/5, enquanto 87,8% (n = 36) do grupo prasugrel tiveram respostas semelhantes, e 80,4% (n = 37) foram observadas no grupo ticagrelor (p = 0,03). Conclusão. Os novos antiagregantes plaquetários ticagrelor e prasugrel parecem exercer efeito sobre o resultado angiográfico dos pacientes submetidos a angioplastia primária. O uso do ticagrelor propiciou menor carga de trombo e um fluxo TIMI melhor no pré-procedimento e o uso do prasugrel ensejou melhor perfusão miocárdica analisada pelo blush miocárdico. Não houve diferença no fluxo angiográfico TIMI pós procedimento / Introduction. Dual antiplatelet therapy has benefits in the treatment of acute myocardial infarction with ST-segment elevation (STEMI). There is variability intra and inter individual in the use of clopidogrel and this influences the benefit of its use in this group of patients. The objective of this research was to evaluate the angiographic results of Upstream Clopidogrel, Prasugrel, or Ticagrelor For Patients Treated With Primary Angioplasty. Methods. A clinical trial was conducted, randomized, double blind, with 131 patients admitted with STEMI. All patients received acetylsalicylic acid (ASA). Patients were randomized to receive clopidogrel (n = 44), prasugrel (n = 41) or ticagrelor (n = 46) as loading dose even in emergency. All patients were submitted to manual thrombus aspiration. At the end of the procedure, the angiographic result was evaluated for TIMI flow, myocardial blush and thrombus burden. Results. A coronary TIMI flow >= 1 before the percutaneous procedure was observed more frequently with the use of ticagrelor (n=10, 21.7%) than with clopidogrel (n=1, 2.3%) and prasugrel (n=5, 12.2%; p=0.019). The coronary TIMI flow at the end of the procedure did not significantly differ between the groups (p=0.101). A better result with respect to myocardial blush was observed with prasugrel, which yielded a blush grade of III in 85.4% (n=35) of patients, compared with clopidogrel (54.5%; n=24) and ticagrelor (67.4%; n=31; p=0.025). The pre-procedural thrombus burden was found to be of a higher grade in the clopidogrel group, in which 97.7% (n=43) of the cases exhibited thrombus burdens grade 4/5, whereas 87.8% (n=36) of the prasugrel group had similar responses, and 80.4% (n=37) were observed in the ticagrelor group (p=0.03). Conclusions. The novel antiplatelet agents represented by ticagrelor and prasugrel appear to have effect on the angiographic outcome of patients undergoing primary angioplasty. The use of ticagrelor led to a smaller thrombus burden and better TIMI flow at the beginning of the procedure and the use of prasugrel produced a better myocardial perfusion analyzed by myocardial blush. There was no difference in post angioplasty TIMI flow

The sciatic nerve is the largest nerve in the human body giving both motor and sensory innervations to the lower limb. It can be affected in chronic diseases, such as diabetes, or compressed anatomically by structures such as piriformis and aneurysms leading to sciatica or paralysis of the lower limb. The current study therefore focuses on the arterial supply of the sciatic nerve as well as its course. Embryologically, the sciatic nerve is supplied via the axial artery during the first trimester. As the axial artery regresses, the iliac system develops. A failure of sciatic artery regression leads to several variations of pelvic and femoral arteries, with a risk of iatrogenic injury/trauma for those patients undergoing pelvic, gluteal and thigh surgical procedures. An understanding of the variability of the pelvic arteries in relation to a coexistent sciatic artery will provide an appropriate background for clinicians. The present study proposes a new theory of sciatic artery development and persistence, as well as new theories for the superior and inferior gluteal, internal pudendal and obturator arteries. The thesis is in two parts: first an anatomical study on the dissection of 171 cadavers including the pelvic, gluteal and thigh regions to observe (i) the patterns of the arteries these regions, and (ii) the course of the sciatic nerve. With variable course of sciatic nerve, there is a variability of its blood supply. Moreover, it includes a new classification of sciatic nerve with respect to clinical implications. The thesis clarifies the origins of the sciatic artery and its course. The second part is a literature review of sciatic artery aneurysm cases in 171 patients, which clarifies the risk of aneurysm, together with its incidence with respect to pathologic finding and associated disorders. Radiologists have to be aware of the internal iliac artery classifications to be able to alert general surgeons, orthopaedic surgeons, obstetricians, gynecologists, and urologists so that they can improve patient management.

INTRODUÇÃO: Os tomógrafos multidetectores (TCMD) aumentaram a sensibilidade na detecção do tromboembolismo pulmonar (TEP). Observa-se, no entanto, um substancial aumento no número de imagens e, conseqüentemente, no tempo de análise pelo radiologista. Uma possível solução, para este problema, é a realização de reconstruções em projeção de intensidade máxima (MIP) que reduz o número de imagens para análise. Existe ainda uma nova modalidade de imagem utilizando reconstrução MIP em planos rotacionais sobre um eixo horizontal ao nível dos hilos pulmonares (reformatação em pás de roda moinho, PRM), que tem demonstrado melhor a continuidade dos ramos arteriais que irradiam dos hilos. No entanto, estudos são necessários para determinar se o uso de reformatações MIP pode reduzir o número de imagens a serem analisadas, sem perda significativa de informações, e se a adição de reformatação PRM pode melhorar o diagnóstico de TEP. OBJETIVOS: Testar a hipótese de que imagens utilizando reconstruções em projeção de intensidade máxima de 2,0 mm e 4,0 mm de espessura, multiplanares, têm o mesmo valor diagnóstico para detecção de TEP nas grandes e pequenas artérias pulmonares, quando comparadas a imagens multiplanares de 1 mm, realizadas em TCMD de 10 e 16 fileiras de detectores. Avaliar se há influência no valor diagnóstico de TEP o acréscimo de reformatações PRM, nas imagens reconstruídas em MIP de 2 mm. CASUÍSTICA E MÉTODOS: Cinqüenta pacientes com suspeita diagnóstica de TEP (30 com TEP positivo e 20 com TEP negativo, detectados no exame tomográfico), realizaram tomografia computadorizada do tórax para avaliação das artérias pulmonares em TCMD com 16 e 10 fileiras de detectores (120 kV, 200 mAs e 1 mm de colimação). Cada exame foi reconstruído em 4 tipos de séries de imagens multiplanares: imagens multiplanares (MPR) de 1 mm e 3 tipos de reconstrução MIP, com espessuras de 2 mm, 4 mm e 2 mm acrescidas de reformatação PRM. Dois observadores avaliaram, independentemente, em estação de trabalho, a presença ou ausência de êmbolos nas artérias principais, lobares, segmentares e subsegmentares dos 50 pacientes em cada uma das reconstruções MIP, as quais foram comparadas usando-se a reformatação MPR de 1 mm como padrão de referência. RESULTADOS: As reconstruções MIP de 2 mm tiveram melhor acurácia, estatisticamente significativa, em relação a MIP de 4 mm, com valores de sensibilidade 100,0 e 100.0 para as artérias principais e lobares; 92,6 e 85,5 para as segmentares e 94,3 e 86,8 para as subsegmentares. Utilizando as imagens multiplanares de 1 mm como referência padrão. Todos pacientes com TEP foram detectados com imagens em MIP de 2 mm. Dois pacientes com TEP não foram diagnosticados com imagens em MIP de 4 mm. Não houve diferença estatisticamente significativa entre a reformatação MIP de 2 mm e 2 mm + PRM na detecção de êmbolos. CONCLUSÃO: Com um número de imagens equivalente a metade da reconstrução MPR de 1 mm, a reconstrução em MIP de 2 mm conseguiu detectar todos os pacientes com TEP positivo que foram diagnosticados pelas imagens multiplanares de 1 mm, com sensibilidade de 100,0 e 100,0 nas artérias principais e lobares, de 92,6 e 85,5 para as artérias segmentares e 94,3 e 86,8 para as artérias subsegmentares. O acréscimo de reformatações PRM às imagens em MIP de 2 mm não aumentou a acurácia na detecção de êmbolos, mas melhorou a visualização da continuidade dos êmbolos, principalmente, nas artérias centrais. / INTRODUCTION: Multidetector computed tomography (MDCT) has been making possible the increase of the sensibility in the detection of the pulmonary embolism (PE). It is observed, however, that there is a substantial increase in the number of images and, consequently, in the time of analysis for the radiologist. A possible solution to this problem is accomplishing a maximum intensity projection reconstruction (MIP) that reduces the number of images for analysis. Still, there is a new image modality using MIP reconstructions in rotational plans that pivot on a central horizontal axis between the lung hila (paddlewheel reformations, PDW). It provides a continuous display of branching arteries that radiate from both hila. However, studies are necessary to determine if the use of multiplan MIP reformation can reduce the number of images to be analyzed, without significant loss of information; and, if the addition of PDW reformation can improve the diagnosis of PE. OBJECTIVE: To test the hypothesis that images using maximum intensity projection reconstructions of 2,0 mm and 4,0 mm of thickness, multiplan, have the same diagnosis value for detection of pulmonary embolism in the big and small pulmonary arteries, when compared to multiplan images of 1 mm collimation, accomplished in 16 and 10 slice MDTC; and to evaluate if there is influence on the diagnosis value of PE the increment of PDW reformation, in the images rebuilt in MIP of 2 mm. CASUISTIC AND METHODS: Fifty patients suspected of having an acute PE (30 with positive PE and 20 with negative PE, detected during the tomography exam) accomplished computerized tomography of the thorax for evaluation of the pulmonary arteries by 16 and 10 slice MDTC (120 kV, 200 mAs and 1 mm collimation). Four kind of images series (1 mm thick multiplan images and 3 kinds of reconstructed images using the MIP tecnhnique with slab thicknesses of 2 mm, 4 mm and 2 mm added of PDW reformation) were obtained from each exam. Two observers independently evaluated, in work station, the presence or absence of emboli in the main and lobar, segmental and subsegmental arteries in the 50 patients in each one of the reconstructions in MIP, which they were compared using the reformation of 1 mm of thickness as reference pattern. RESULTS: The reconstructions in MIP of 2 mm had better accuracy than MIP of 4 mm, statistically significant with values of sensibility 100,0 and 100,0 for the main and lobar pulmonary arteries; 92,6 and 85,5 for the segmental and 94,3 and 86,8 for the subsegmental. The images in MPR of 1 mm were used as a reference pattern. All patients with PE were detected with images in MIP of 2 mm; two patients with PE were not diagnosed with images in MIP of 4 mm. There was not difference statisticament significant among reformation in MIP of 2 mm and 2 mm plus PDW in the detection of emboli. CONCLUSION: Reconstruction in MIP of 2 mm reduced the number of images for the half and it detected all patients with positive PE that were diagnosed by the multiplans images of 1 mm, with sensibility of 100,0 and 100,0 in the main and lobar arteries, of 92,6 and 85,5 and 79,2 for the segmental arteries and 94,3 and 86,8 for the subsegmental arteries. The increment of PDW reformation to the images in MIP of 2 mm didn\'t increase the accuracy in the detection of emboli, but it improved the visualization of the continuity of the emboli, mainly, in the central arteries.

Au cours des dernières décennies, l'angiographie par résonance magnétique a été utilisée comme routine clinique pour l'exploration précise et non invasive des vaisseaux sanguins, ainsi que pour le diagnostic des affections neurovasculaires les plus courantes. Plusieurs méthodes spécifiques ont été développées pour simuler numériquement le procédé de formation des angiographies. Cependant, à ce jour, la plupart des logiciels de simulation IRM avancés sont exclusivement spécialisés dans l'imagerie des tissus statiques. Le présent travail a donc été réalisé pour étendre les possibilités d'un logiciel existant afin de proposer un outil complet pour la simulation IRM des écoulements fluides. L'efficacité de cette approche est démontrée en reproduisant les principales séquences angiographiques et les artéfacts de flux les plus courants. Pour finir, des applications sur des simulations de flux sanguins dans des géométries de vaisseaux réalistes sont présentées. / During the last decades, magnetic resonance angiography has been used as a clinical routine for precise and non-invasive exploration of vessels, as well as for diagnosis of the most common neurovascular diseases. Several dedicated methods were developed to simulate specifically the process of angiographic acquisitions. Though, currently, most of advanced MRI simulators are exclusively specialized in static tissues imaging. This work was carried out to expand the possibilities of one of those simulators in order to propose a complete tool for MRI simulation of flow motion.The efficiency of this approach is proven by replicating the main angiographic pulse sequences and the most common flow artifacts. Finally, applications are provided on simulations of blood flow in realistic vessels geometries.

<p>Mice have become the preferred model system for studying brain function and disease. With the powerful genetic tools available, mouse models can be created to study the underlying molecular basis of neurobiology in vivo. Just as magnetic resonance imaging is the dominant tool for evaluating the human brain, high-resolution MRI--magnetic resonance microscopy (MRM)--is a useful tool for studying the brain of mouse models. However, the need for high spatial resolution limits the signal-to-noise ratio (SNR) of the MRM images. To address this problem, T1-shortening contrast agents can be used, which not only improve the tissue contrast-to-noise ratio (CNR) but also increase SNR by allowing the MR signal to recover faster between pulses. By "actively staining" the tissue with these T1-shortening agents, MRM can be performed with higher resolution, greater contrast, and shorter scan times. In this work, active staining with T1-shortening agents was used to enhance three types of in vivo mouse brain MRM: (1) angiographic imaging of the neurovasculature, (2) anatomical imaging of the brain parenchyma, and (3) functional imaging of neuronal activity.</p> <p></p> <p>For magnetic resonance angiography (MRA) of the mouse, typical contrast agents are not useful because they are quickly cleared by the body and/or extravasate from the blood pool before a high-resolution image can be acquired. To address these limitations, a novel contrast agent--SC-Gd liposomes--has been developed, which is cleared slowly by the body and is too large to extravasate from the blood pool. In this work, MRA protocols were optimized for both the standard technique (time-of-flight contrast) and SC-Gd liposomes. When the blood was stained with SC-Gd liposomes, small vessel CNR improved to 250% that of time-of-flight. The SC-Gd liposomes could also be used to reduce scan time by 75% while still improving CNR by 32%.</p> <p>For MRM of the mouse brain parenchyma, active staining has been used to make dramatic improvements in the imaging of ex vivo specimens. However for in vivo imaging, the blood-brain barrier (BBB) prevents T1-shortening agents from entering the brain parenchyma. In this work, a noninvasive technique was developed for BBB opening with microbubbles and ultrasound (BOMUS). Using BOMUS, the parenchyma of the brain could be actively stained with the T1-shortening contrast agent, Gd-DTPA, and MRM images could be acquired in vivo with unprecedented resolution (52 x 52 x 100 micrometers3) in less than 1 hour.</p> <p>Functional MRI (fMRI), which uses blood oxygen level dependant (BOLD) contrast to detect neuronal activity, has been a revolutionary technique for studying brain function in humans. However, in mice, BOLD contrast has been difficult to detect and thus routine fMRI in mice has not been feasible. An alternative approach for detecting neuronal activity uses manganese (Mn2+). Mn2+ is a T1-shortening agent that can enter depolarized neurons via calcium channels. Thus, Mn2+ is a functional contrast agent with affinity for active neurons. In this work, Mn2+ (administered with the BOMUS technique) was used to map the neuronal response to stimulation of the vibrissae. The resultant activation map showed close agreement to published maps of the posterior-lateral and anterior-medial barrel field of the primary sensory cortex.</p> <p>The use of T1-shortening agents to actively stain tissues of interest--blood, brain parenchyma, or active neurons--will facilitate the use of MRM for studying mouse models of brain development, function, and disease.</p> / Dissertation

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Anatomical variants of hepatic arteries are frequent. One of the most common origins of aberrant (atypically branching) hepatic arteries is superior mesenteric artery. Many physiologic and pathologic features influence hemodynamics of the latter artery. There were some sporadic cases in literature about the influence of aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics of the latter artery, but no evidence based large extent studies were performed. Therefore the aim of this study was to evaluate how significant the aberrant hepatic artery branching from the superior mesenteric artery influences the hemodynamics of superior mesenteric artery. Anatomical variants of the hepatic arteries were evaluated by computed tomography angiography also the candidates for Doppler ultrasound were selected. Doppler ultrasound was used to evaluate the hemodynamics of the superior mesenteric artery in patients with aberrant hepatic artery arising from the superior mesenteric artery and in those with typical hepatic artery anatomy. The influence of the aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics (resistance) of the superior mesenteric artery was assessed. The results of the investigation show that anatomical variants of the hepatic arteries are frequent. The aberrant hepatic artery arising from superior mesenteric artery significantly lowers resistance of the superior mesenteric artery. Practical recommendations were set... [to full text] / Kepenų arterijų anatominiai variantai yra dažni. Viena dažniausių aberantinių (netipiškai atsišakojančių) kepenų arterijų atsišakojimo vietų yra viršutinė pasaito arterija. Pastarosios arterijos kraujotaka yra įtakojama daugybės fiziologinių ir patologinių veiksnių. Literatūroje taip pat aprašyti pavieniai atvejai apie iš viršutinės pasaito arterijos atsišakojančios aberantinės kepenų arterijos įtaką viršutinės pasaito arterijos hemodinamikai, tačiau didesnės apimties įrodymais pagrįstų tyrimų šioje srityje iki šiol nebuvo atlikta. Todėl šio tyrimo tikslas buvo įvertinti, ar aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai įtakoja pastarosios kraujagyslės hemodinamiką. Šiame tyrime kompiuterinės tomografijos angiografijos pagalba įvertinti kepenų arterijų anatominiai variantai, atrinkti pacientai doplerio ultragarso tyrimams. Pastaruoju metodu tirta viršutinės pasaito arterijos kraujotaka pacientams, kurių vieni turėjo aberantinę kepenų arteriją, atsišakojančią iš viršutinės pasaito arterijos, o kiti turėjo įprastą kepenų arterijų anatomiją. Vertinta aberantinės kepenų arterijos, atsišakojančios iš viršutinės pasaito arterijos, įtaka pastarosios arterijos hemodinamikai (rezistentiškumui). Remiantis tyrimo duomenimis nustatyta, kad kepenų arterijų anatominiai variantai yra dažni. Aberantinė kepenų arterija, atsišakojanti iš viršutinės pasaito arterijos, reikšmingai mažina pastarosios arterijos rezistentiškumą. Pateiktos praktinės... [toliau žr. visą tekstą]

Thirty-four patients with acute hemispheric ischemic strokes underwent both CT angiography and contrast-enhanced transcranial color-coded duplexsonography (TCCD) to study the effectiveness of the combined noninvasive techniques for evaluation of the circle of Willis. In 3/34 patients, CT angiography and contrast-enhanced TCCD demonstrated middle cerebral artery (MCA) occlusion, in 5 others MCA stenosis. A severe posterior cerebral artery stenosis was missed by CT angiography. In 8 patients, contrast-enhanced TCCD failed because of poor bone windows. In these patients, CT angiography was normal. CT angiography and contrast-enhanced TCCD are complementary noninvasive diagnostic tools. Disagreements between the diagnostic findings of these methods still need further evaluation by digital subtraction angiography. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Computed tomography is one of the most evolving fields of modern radiology. The current CT applications permit among other things angiography, 3D image reconstructions, material decomposition and tissue characterization. CT is an important tool in the assessment of specific patient populations prior to an invasive or surgical procedure. The aim of this dissertation was to demonstrate the decisive role of CT with 3D-image reconstructions in haemodialysis patients scheduled to undergo fistulography, in patients undergoing surgical breast reconstructions with a perforator flap and in patients with complicated renal calculi scheduled to undergo percutaneous nephrolithotomy. CT Angiography with 3D image reconstructions was performed in 31 patients with failing arteriovenous fistulas and grafts, illustrating the vascular anatomy in a comprehensive manner in 93.5% of the evaluated segments and demonstrating a sensitivity of 95% compared to fistulography. In 59 mastectomy patients scheduled to undergo reconstructive breast surgery with a deep inferior epigastric perforator flap, the preoperative planning with CT Angiography with 3D image reconstructions of the anterior abdominal wall providing details of its vascular supply, reduced surgery time significantly (p&lt; 0.001) and resulted in fewer complications. Dual Energy CT Urography with advanced image reconstructions in 31 patients with complicated renal calculi scheduled to undergo PNL, resulted in a new method of material characterisation (depicting renal calculi within excreted contrast) and in the possibility of reducing radiation dose by 28% by omitting the nonenhanced scanning phase. Detailed analysis of the changes renal calculi undergo when virtually reconstructed was performed and a comparison of renal calculi number, volume, height and attenuation between virtual nonenhanced and true nonenhanced images was undertaken. All parameters were significantly underestimated in the virtual nonenhanced images. CT with 3D-reconstructions is more than just “flashy images”. It is crucial in preoperative planning, optimizes various procedures and can reduce radiation dose.

Over the last decade, there has been a growing interest in assessing cerebral aneurysmal wall motion, because of its potential connections to the biomechanical conditions of the vessel wall, which could eventually aid the prediction of aneurysmal rupture risk. Such quantification could provide a valid surrogate for the vascular wall status and integrity. However, the vast majority of current morphological indices used in the literature to predict growth and rupture in cerebral aneurysms do not take into account the temporal changes that occur during the cardiac cycle. This is because these indices are derived from image modalities that do not provide sufficient temporal and/or spatial resolution to obtain dynamic aneurysm information, which is expected to be similar to or below image resolution. Among currently available vascular imaging techniques, 3D rotational angiography (3DRA) and digital subtraction angiography (DSA) have the highest spatial (and temporal) resolution. Still, for a human operator relying solely on qualitative visual observation, even when using images from these modalities, to objectively analyze the small motion and shape changes of the cerebrovasculature of an individual throughout the cardiac cycle is difficult, if not impossible. Therefore, the availability of a robust morphodynamic analysis tool is needed. In this context, this thesis focuses on developing techniques to estimate, quantify and analyze cerebrovascular wall motion, particularly aneurysmal wall motion, using such modalities. The main contributions of the thesis are: 1) a first methodology to estimate and model patient-specific cerebrovascular morphodynamics over one cardiac cycle, through a proposed multiple 2D to 3D image registration framework; 2) an extension of this methodology to provide robust and efficient estimates of cerebrovascular wall motion for clinical evaluation and for further biomechanical modeling of the cerebrovascular wall; 3) a patient study that demonstrates the validity of the developed techniques from clinical practice, through an analysis of 3DRA and DSA images. Each of these contributions is published in or submitted to a peerreviewed international journal. / Durante la última década se ha dado un creciente interés en la evaluación del movimiento de la pared vascular en aneurismas cerebrales. Éste hecho ha sido motivado en gran medida por la relación existente entre dicha motilidad y sus condiciones biomecánicas, pudiendo éstas llegar a ser útiles en la predicción del riesgo de ruptura del aneurisma cerebral analizado. De este modo, de ésta cuantificación, se podría llegar a derivar un indicador indirecto del estado e integridad de la pared vascular. Sin embargo, la gran mayoría de los índices morfológicos utilizados en la actualidad para predecir crecimiento y ruptura de aneurismas cerebrales no consideran los cambios que se producen en el tiempo a lo largo del ciclo cardíaco. Esto se debe a que dichos índices se obtienen a partir de modalidades de imagen que no proporcionan suficiente resolución espacial y/o temporal para obtener información dinámica del aneurisma, cuyo rango de variación se espera sea similar o inferior a la resolución de la imagen. Entre las técnicas de imagen vascular disponibles en la actualidad, la angiografía rotacional 3D (3DRA) y la angiografía de substracción digital (DSA) son las que ofrecen la mayor resolución espacial (y temporal). De todos modos, aún utilizando imágenes de estas modalidades, el análisis objetivo de pequeñas diferencias de forma y movimiento en los vasos cerebrales de un individuo a lo largo de un ciclo cardíaco es difícil, si no imposible para un operador humano utilizando únicamente medidas cualitativas guiadas por inspección visual. Por lo tanto, la disponibilidad de herramientas robustas para el análisis morfodinámico de la vasculatura cerebral resulta necesaria. En este contexto, la investigación de esta tesis se concentra en el desarrollo de técnicas para estimar, cuantificar y analizar el movimiento de las paredes de los vasos cerebrales, con particular énfasis en el movimiento de la pared en aneurismas, utilizando las modalidades indicadas anteriormente. En líneas generales, esta tesis presenta tres contribuciones principales: 1) una primera metodología de estimación y modelado morfodinámico de vasos cerebrales a lo largo de un ciclo cardíaco, utilizando una técnica de registrado de imágenes 2D-3D; 2) una metodología extendida para proporcionar una estimación robusta y eficiente del movimiento de las paredes de los vasos cerebrales para su evaluación clínica y posterior modelado biomecánico de dichas paredes; 3) un estudio sobre una población de pacientes que demuestra la validez de las técnicas desarrolladas en la práctica clínica, a través del análisis en imágenes de 3DRA y DSA. Cada una de estas contribuciones ha sido publicada o se encuentra en fase de revisión en revistas internacionales indexadas.