Background Cervicofacial vascular lesions are one of the most challenging diseases managed by intervention radiologists and specialized surgeons. These lesions were diagnosed to be vascular in origin by other imaging techniques such as Duplex and/or magnetic resonance imaging (MRI). All patients underwent computed tomographic angiography (CTA) to confirm the diagnosis as well as to decide the most effective choice of management based on multidisciplinary team (MDT). Then, Digital subtraction angiography (DSA) was done as it is offering an accurate vascular map for the vascular lesions which is inevitable for successful super-selective endovascular embolization which can be done at same sitting. Small cases of arteriovenous malformations (AVMs) were sufficiently managed by only embolization, whereas cases of adequately embolized large AVMs as well as juvenile nasopharyngeal angiofibroma (JNA) cases were followed by surgery with the advantage of less blood loss and decreasing operation time as well as complications. This prospective study was done to highlight the role of combined CTA and DSA in cervicofacial vascular lesion management. Results Twenty patients were included in our study: 16 patients were males, and 4 were females; 17 of them were under 40 years, and three were above 40 years. Preoperative embolization was done in 12 patients, which were all the cases of JNAs and large AVMs. Four patients were managed by only embolization as a definitive treatment. Complete technical success rate was about 94%, while only 6% (single case) of the partial technical success rate which was due to a very small accessory feeder that could not be catheterized even with repeated trials. Conclusions Combined CTA and DSA is the cornerstone for managing vascular lesions in the cervicofacial region, which necessitates a MDT to decide the most beneficial and least complicated way for management.

Cardiovascular complications account for about one third of the premature mortality rate in patients with sickle cell disease (SCD). Underlying this cardiac risk is a progressive cardiomyopathy which is multifactorial. Recently myocardial fibrosis is assumed to be a novel mechanism for cardiac dysfunction. This study aimed to detect cardiac fibrosis and subclinical cardiac changes in sickle cell children by; cardiac magnetic resonance imaging (CMR), Tissue Doppler Echocardiography (TDE) and Galectin-3. Children with SCD were subjected to assessment of cardiac function by TDE and had estimated serum level of Gal-3. Cardiac MRI was used to assess volumes and function by cine sequence, LGE for detection of focal myocardial fibrosis, native T1 mapping and extracellular volume (ECV) for quantification of diffuse myocardial fibrosis as well as CMR T2* for myocardial iron load. Thirty-four childrenwith SCD (mean age 13.32 ± 3.24 years) were enrolled in our study, another thirty-four healthy children served as controls. Although myocardial iron load by T2* was normal, ECV was increased among all cases with mean level 35.41 ± 5.02 %. The mean of ECV was significantly associated with the frequency of VOCs (P= 0.017) and negatively correlated to hemoglobin level (P=0.005). In consistent with ECV, Galectin-3 level was significantly higher among cases when compared to controls (7.75 ± 1.86 ng/ml versus 6.04 ±1.64 ng/ml, p<0.001) with cutoff value over the ROC curve 6.5ng/ml, sensitivity; 82.5 %, specificity; 72.8%. ECV were significantly higher for cases with Tie index > 0.4 by TDI subgroup when compared to ECV of subgroup with Tie index < 0.4 (38.17 ± 4.25 versus 34.43 ± 5.02, P: 0.03*). In conclusion: ECV is a validated CMR parameter to detect and quantify diffuse interstitial myocardial fibrosis in asymptomatic children with SCD. Cardiac fibrosis in SCD children is associated with frequent attacks of ischemic re-perfusion injury and correlated to the severity of anemia rather than myocardial iron load. Tie index by TDE and serum Gal-3 are recommended screening tools.