Pub Date : 2024-03-01Epub Date: 2023-03-31DOI: 10.1007/s00062-023-01282-2
Piotr Radojewski, Tomas Dobrocky, Mattia Branca, William Almiri, Manuel Correia, Andreas Raabe, David Bervini, Jan Gralla, Roland Wiest, Pasquale Mordasini
Purpose: Differentiating normal anatomical variants such as an infundibulum or a vascular loop from true intracranial aneurysms is crucial for patient management. We hypothesize that high-resolution 7 T magnetic resonance imaging (MRI) improves the detection and characterization of normal anatomical variants that may otherwise be misdiagnosed as small unruptured aneurysms.
Methods: This is a retrospective, single-center study. All patients were scanned on a clinically approved 7 T MRI scanner and on a 3 T scanner. Image analysis was performed independently by three neuroradiologists blinded to clinical information. The presence of an unruptured intracranial aneurysm (UIA) and level of diagnostic certainty were assessed and the interrater agreement was calculated. If an aneurysm was present, the anatomic location and shape were recorded and compared.
Results: In total, 53 patients with equivocal cerebrovascular findings on 1.5 T or 3 T MRI referred for a 7T MRI examination were included. Aneurysms were suspected in 42 patients examined at 3 T and in 23 patients at 7 T (rate difference 36%, 95% confidence interval, CI, 19-53%, p-value < 0.001). Major disagreement between the field strengths was observed in the A1 segment of anterior cerebral artery/anterior communicating artery (A1/ACOM) complex. The interrater agreement among the readers on the presence of an aneurysm on 7 T MRI was higher than that for 3 T MRI (0.925, 95% CI 0.866-0.983 vs. 0.786, 95% CI 0.700-0.873).
Conclusion: Our analysis demonstrates a significantly higher interrater agreement and improved diagnostic certainty when small intracranial aneurysms are visualized on 7 T MRI compared to 3 T. In a selected patient cohort, clinical implementation of 7 T MRI may help to establish the definitive diagnosis and thus have a beneficial impact on patient management.
目的：从真正的颅内动脉瘤中分辨出正常的解剖变异，如底腔或血管环，对患者的管理至关重要。我们假设，高分辨率 7 T 磁共振成像（MRI）可改善正常解剖变异的检测和定性，否则可能会被误诊为未破裂的小动脉瘤：这是一项回顾性单中心研究。所有患者均在临床认可的 7 T MRI 扫描仪和 3 T 扫描仪上进行扫描。图像分析由三位神经放射学专家独立完成，他们对临床信息视而不见。评估是否存在未破裂的颅内动脉瘤（UIA）以及诊断的确定性水平，并计算三人之间的一致性。如果存在动脉瘤，则记录解剖位置和形状并进行比较：共纳入了 53 名在 1.5 T 或 3 T 核磁共振成像检查中发现脑血管情况不明确的患者，这些患者被转诊至 7 T 核磁共振成像检查。在 3 T 检查中，42 名患者怀疑有动脉瘤，在 7 T 检查中，23 名患者怀疑有动脉瘤（比率差异为 36%，95% 置信区间，CI，19-53%，P-值 结论：我们的分析表明，动脉瘤患者之间的比率差异明显更高：我们的分析表明，与 3 T 磁共振成像相比，7 T 磁共振成像可观察到颅内小动脉瘤时，医生之间的一致性明显更高，诊断的确定性也更高。在选定的患者群中，7 T 磁共振成像的临床应用可能有助于确定最终诊断，从而对患者管理产生有利影响。
{"title":"Diagnosis of Small Unruptured Intracranial Aneurysms : Comparison of 7 T versus 3 T MRI.","authors":"Piotr Radojewski, Tomas Dobrocky, Mattia Branca, William Almiri, Manuel Correia, Andreas Raabe, David Bervini, Jan Gralla, Roland Wiest, Pasquale Mordasini","doi":"10.1007/s00062-023-01282-2","DOIUrl":"10.1007/s00062-023-01282-2","url":null,"abstract":"<p><strong>Purpose: </strong>Differentiating normal anatomical variants such as an infundibulum or a vascular loop from true intracranial aneurysms is crucial for patient management. We hypothesize that high-resolution 7 T magnetic resonance imaging (MRI) improves the detection and characterization of normal anatomical variants that may otherwise be misdiagnosed as small unruptured aneurysms.</p><p><strong>Methods: </strong>This is a retrospective, single-center study. All patients were scanned on a clinically approved 7 T MRI scanner and on a 3 T scanner. Image analysis was performed independently by three neuroradiologists blinded to clinical information. The presence of an unruptured intracranial aneurysm (UIA) and level of diagnostic certainty were assessed and the interrater agreement was calculated. If an aneurysm was present, the anatomic location and shape were recorded and compared.</p><p><strong>Results: </strong>In total, 53 patients with equivocal cerebrovascular findings on 1.5 T or 3 T MRI referred for a 7T MRI examination were included. Aneurysms were suspected in 42 patients examined at 3 T and in 23 patients at 7 T (rate difference 36%, 95% confidence interval, CI, 19-53%, p-value < 0.001). Major disagreement between the field strengths was observed in the A1 segment of anterior cerebral artery/anterior communicating artery (A1/ACOM) complex. The interrater agreement among the readers on the presence of an aneurysm on 7 T MRI was higher than that for 3 T MRI (0.925, 95% CI 0.866-0.983 vs. 0.786, 95% CI 0.700-0.873).</p><p><strong>Conclusion: </strong>Our analysis demonstrates a significantly higher interrater agreement and improved diagnostic certainty when small intracranial aneurysms are visualized on 7 T MRI compared to 3 T. In a selected patient cohort, clinical implementation of 7 T MRI may help to establish the definitive diagnosis and thus have a beneficial impact on patient management.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"45-49"},"PeriodicalIF":2.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10881608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9222875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2023-10-13DOI: 10.1007/s00062-023-01346-3
Sophia Hohenstatt, Christian Ulfert, Christian Herweh, Tim Hilgenfeld, Niclas Schmitt, Silvia Schönenberger, Min Chen, Martin Bendszus, Markus A Möhlenbruch, Dominik F Vollherbst
Introduction: This study focuses on long-term outcomes after aneurysm treatment with either the Flow Re-Direction Endoluminal Device (FRED) or the FRED Jr. to investigate the durability of treatment effect and long-term complications.
Methods: This study is based on a retrospective analysis of a prospectively maintained patient data base. Patients treated with either FRED or FRED Jr. between 2013 and 2017 at our institution, and thus a possibility for ≥ 5 years of follow-up, were included. Aneurysm occlusion rates, recurrence rates, modified Rankin scale score shifts to baseline, and delayed complications were assessed.
Results: In this study 68 patients with 84 aneurysms had long-term follow-up with a mean duration of 57.3 months and 44 patients harboring 52 aneurysms had a follow-up ≥ 5 years with a mean follow-up period of 69.2 months. Complete occlusion was reached in 77.4% at 2 years and increased to 84.9% when the latest available imaging result was considered. Younger age and the absence of branch involvement were predictors for aneurysm occlusion in linear regression analysis. After the 2‑year threshold, there were 3 reported symptomatic non-serious adverse events. Of these, one patient had a minor stroke, one a transitory ischemic attack and one had persistent mass effect symptoms due to a giant aneurysm, none of these resulted in subsequent neurological disability.
Conclusion: This long-term follow-up study demonstrates that the FRED and FRED Jr. are safe and effective for the treatment of cerebral aneurysms in the long term, with high rates of complete occlusion and low rates of delayed adverse events.
{"title":"Long-term Follow-up After Aneurysm Treatment with the Flow Redirection Endoluminal Device (FRED) Flow Diverter.","authors":"Sophia Hohenstatt, Christian Ulfert, Christian Herweh, Tim Hilgenfeld, Niclas Schmitt, Silvia Schönenberger, Min Chen, Martin Bendszus, Markus A Möhlenbruch, Dominik F Vollherbst","doi":"10.1007/s00062-023-01346-3","DOIUrl":"10.1007/s00062-023-01346-3","url":null,"abstract":"<p><strong>Introduction: </strong>This study focuses on long-term outcomes after aneurysm treatment with either the Flow Re-Direction Endoluminal Device (FRED) or the FRED Jr. to investigate the durability of treatment effect and long-term complications.</p><p><strong>Methods: </strong>This study is based on a retrospective analysis of a prospectively maintained patient data base. Patients treated with either FRED or FRED Jr. between 2013 and 2017 at our institution, and thus a possibility for ≥ 5 years of follow-up, were included. Aneurysm occlusion rates, recurrence rates, modified Rankin scale score shifts to baseline, and delayed complications were assessed.</p><p><strong>Results: </strong>In this study 68 patients with 84 aneurysms had long-term follow-up with a mean duration of 57.3 months and 44 patients harboring 52 aneurysms had a follow-up ≥ 5 years with a mean follow-up period of 69.2 months. Complete occlusion was reached in 77.4% at 2 years and increased to 84.9% when the latest available imaging result was considered. Younger age and the absence of branch involvement were predictors for aneurysm occlusion in linear regression analysis. After the 2‑year threshold, there were 3 reported symptomatic non-serious adverse events. Of these, one patient had a minor stroke, one a transitory ischemic attack and one had persistent mass effect symptoms due to a giant aneurysm, none of these resulted in subsequent neurological disability.</p><p><strong>Conclusion: </strong>This long-term follow-up study demonstrates that the FRED and FRED Jr. are safe and effective for the treatment of cerebral aneurysms in the long term, with high rates of complete occlusion and low rates of delayed adverse events.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"181-188"},"PeriodicalIF":2.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10881684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41193603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The objective of this study was to evaluate the relationship between arterial transit artifact (ATA), arterial spin labeling (ASL) perfusion imaging, and the outcome of patients with acute ischemic stroke (AIS) due to occlusion of large vessels in anterior circulation after endovascular thrombectomy (EVT).
Methods: Patients with anterior circulation occlusion treated with EVT between October 2017 and December 2021 were enrolled in this retrospective study, and ATA was quantified by a 4-point scale. A favorable outcome was defined by modified Rankin Scale (mRS) scores of 0-2 at 3 months. To identify independent predictors of favorable outcome, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, site of occlusion, cause of stroke, and early reperfusion were evaluated with univariate and multivariate analyses. Predictive accuracy was evaluated by calculating the area under the receiver operating characteristic (ROC) curve (AUC) for the model.
Results: In this study 187 patients (age, 65.0 ± 12.5 years; men, 55%) were evaluated. Younger age (odds ratio, OR, 0.95; 95% confidence interval, CI, 0.92-0.98, p = 0.002), lower baseline NIHSS score (OR, 0.88; 95% CI, 0.82-0.94, p < 0.001), and lower ATA score (OR, 1.14; 95% CI, 1.06-1.22, p < 0.001) were independently associated with favorable outcomes in multivariate analysis. The ATA score has moderate to good accuracy in predicting favorable outcomes (AUC, 0.753).
Conclusion: A high ATA score as a potential predictor, can help identify patients who may benefit from EVT.
{"title":"Predicting 3-month Functional Outcome After Endovascular Thrombectomy in Patients with Anterior Circulation Occlusion with an Arterial Transit Artifact Grading System.","authors":"Xiaobo Zhang, Nannan Han, Yu Zhang, Wenting Yuan, Shangguang Kan, Gejuan Zhang, Haojun Ma, Hanming Ge, Chengxue Du, Yanjun Gao, Shilin Li, Xudong Yan, Wenzhen Shi, Ye Tian, Mingze Chang","doi":"10.1007/s00062-023-01362-3","DOIUrl":"10.1007/s00062-023-01362-3","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study was to evaluate the relationship between arterial transit artifact (ATA), arterial spin labeling (ASL) perfusion imaging, and the outcome of patients with acute ischemic stroke (AIS) due to occlusion of large vessels in anterior circulation after endovascular thrombectomy (EVT).</p><p><strong>Methods: </strong>Patients with anterior circulation occlusion treated with EVT between October 2017 and December 2021 were enrolled in this retrospective study, and ATA was quantified by a 4-point scale. A favorable outcome was defined by modified Rankin Scale (mRS) scores of 0-2 at 3 months. To identify independent predictors of favorable outcome, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, site of occlusion, cause of stroke, and early reperfusion were evaluated with univariate and multivariate analyses. Predictive accuracy was evaluated by calculating the area under the receiver operating characteristic (ROC) curve (AUC) for the model.</p><p><strong>Results: </strong>In this study 187 patients (age, 65.0 ± 12.5 years; men, 55%) were evaluated. Younger age (odds ratio, OR, 0.95; 95% confidence interval, CI, 0.92-0.98, p = 0.002), lower baseline NIHSS score (OR, 0.88; 95% CI, 0.82-0.94, p < 0.001), and lower ATA score (OR, 1.14; 95% CI, 1.06-1.22, p < 0.001) were independently associated with favorable outcomes in multivariate analysis. The ATA score has moderate to good accuracy in predicting favorable outcomes (AUC, 0.753).</p><p><strong>Conclusion: </strong>A high ATA score as a potential predictor, can help identify patients who may benefit from EVT.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"241-249"},"PeriodicalIF":2.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138486854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Automated methods for quantifying brain tissue volumes have gained clinical interest for their objective assessment of neurological diseases. This study aimed to establish reference curves for brain volumes and fractions in the Indian population using Synthetic MRI (SyMRI), a quantitative imaging technique providing multiple contrast-weighted images through fast postprocessing.
Methods
The study included a cohort of 314 healthy individuals aged 15–65 years from multiple hospitals/centers across India. The SyMRI-quantified brain volumes and fractions, including brain parenchymal fraction (BPF), gray matter fraction (GMF), white matter fraction (WMF), and myelin.
Results
Normative age-stratified quantification curves were created based on the obtained data. The results showed significant differences in brain volumes between the sexes, but not after normalization by intracranial volume.
Conclusion
The findings provide normative data for the Indian population and can be used for comparative analysis of brain structure values. Furthermore, our data indicate that the use of fractions rather than absolute volumes in normative curves, such as BPF, GMF, and WMF, can mitigate sex and population differences as they account for individual differences in head size or brain volume.
{"title":"Age-stratified Assessment of Brain Volumetric Segmentation on the Indian Population Using Quantitative Magnetic Resonance Imaging","authors":"Nisha Syed Nasser, Vasantha K. Venugopal, Cynthia Veenstra, Peter Johansson, Sriram Rajan, Kabir Mahajan, Swati Naik, Ravi Masand, Pratiksha Yadav, Sachin Khanduri, Suman Singhal, Rajat Bhargava, Utkarsh Kabra, Sanjay Gupta, Kavita Saggar, Balaji Varaprasad, Kushagra Aggrawal, Adinarayana Rao, Manoj K.S., Atul Dakhole, Abhimanyu Kelkar, Geena Benjamin, Varsha Sodani, Pradeep Goyal, Harsh Mahajan","doi":"10.1007/s00062-023-01374-z","DOIUrl":"https://doi.org/10.1007/s00062-023-01374-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background and Purpose</h3><p>Automated methods for quantifying brain tissue volumes have gained clinical interest for their objective assessment of neurological diseases. This study aimed to establish reference curves for brain volumes and fractions in the Indian population using Synthetic MRI (SyMRI), a quantitative imaging technique providing multiple contrast-weighted images through fast postprocessing.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The study included a cohort of 314 healthy individuals aged 15–65 years from multiple hospitals/centers across India. The SyMRI-quantified brain volumes and fractions, including brain parenchymal fraction (BPF), gray matter fraction (GMF), white matter fraction (WMF), and myelin.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Normative age-stratified quantification curves were created based on the obtained data. The results showed significant differences in brain volumes between the sexes, but not after normalization by intracranial volume.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The findings provide normative data for the Indian population and can be used for comparative analysis of brain structure values. Furthermore, our data indicate that the use of fractions rather than absolute volumes in normative curves, such as BPF, GMF, and WMF, can mitigate sex and population differences as they account for individual differences in head size or brain volume.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"16 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139518223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-29DOI: 10.1007/s00062-023-01372-1
Jürgen Panholzer, Gertraud Walli, Bettina Grün, Ognian Kalev, Michael Sonnberger, Robert Pichler
Purpose
Perfusion-weighted (PWI) magnetic resonance imaging (MRI) and O‑(2-[18F]fluoroethyl-)-l-tyrosine ([18F]FET) positron emission tomography (PET) are both useful for discrimination of progressive disease (PD) from radiation necrosis (RN) in patients with gliomas. Previous literature showed that the combined use of FET-PET and MRI-PWI is advantageous; hhowever the increased diagnostic performances were only modest compared to the use of a single modality. Hence, the goal of this study was to further explore the benefit of combining MRI-PWI and [18F]FET-PET for differentiation of PD from RN. Secondarily, we evaluated the usefulness of cerebral blood flow (CBF), mean transit time (MTT) and time to peak (TTP) as previous studies mainly examined cerebral blood volume (CBV).
Methods
In this single center study, we retrospectively identified patients with WHO grades II–IV gliomas with suspected tumor recurrence, presenting with ambiguous findings on structural MRI. For differentiation of PD from RN we used both MRI-PWI and [18F]FET-PET. Dynamic susceptibility contrast MRI-PWI provided normalized parameters derived from perfusion maps (r(relative)CBV, rCBF, rMTT, rTTP). Static [18F]FET-PET parameters including mean and maximum tumor to brain ratios (TBRmean, TBRmax) were calculated. Based on histopathology and radioclinical follow-up we diagnosed PD in 27 and RN in 10 cases. Using the receiver operating characteristic (ROC) analysis, area under the curve (AUC) values were calculated for single and multiparametric models. The performances of single and multiparametric approaches were assessed with analysis of variance and cross-validation.
Results
After application of inclusion and exclusion criteria, we included 37 patients in this study. Regarding the in-sample based approach, in single parameter analysis rTBRmean (AUC = 0.91, p < 0.001), rTBRmax (AUC = 0.89, p < 0.001), rTTP (AUC = 0.87, p < 0.001) and rCBVmean (AUC = 0.84, p < 0.001) were efficacious for discrimination of PD from RN. The rCBFmean and rMTT did not reach statistical significance. A classification model consisting of TBRmean, rCBVmean and rTTP achieved an AUC of 0.98 (p < 0.001), outperforming the use of rTBRmean alone, which was the single parametric approach with the highest AUC. Analysis of variance confirmed the superiority of the multiparametric approach over the single parameter one (p = 0.002). While cross-validation attributed the highest AUC value to the model consisting of TBRmean and rCBVmean, it also suggested that the addition of rTTP resulted in the highest accuracy. Overall, multiparametric models performed better than single parameter ones.
{"title":"Multiparametric Analysis Combining DSC-MR Perfusion and [18F]FET-PET is Superior to a Single Parameter Approach for Differentiation of Progressive Glioma from Radiation Necrosis","authors":"Jürgen Panholzer, Gertraud Walli, Bettina Grün, Ognian Kalev, Michael Sonnberger, Robert Pichler","doi":"10.1007/s00062-023-01372-1","DOIUrl":"https://doi.org/10.1007/s00062-023-01372-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Perfusion-weighted (PWI) magnetic resonance imaging (MRI) and O‑(2-[18F]fluoroethyl-)-l-tyrosine ([18F]FET) positron emission tomography (PET) are both useful for discrimination of progressive disease (PD) from radiation necrosis (RN) in patients with gliomas. Previous literature showed that the combined use of FET-PET and MRI-PWI is advantageous; hhowever the increased diagnostic performances were only modest compared to the use of a single modality. Hence, the goal of this study was to further explore the benefit of combining MRI-PWI and [18F]FET-PET for differentiation of PD from RN. Secondarily, we evaluated the usefulness of cerebral blood flow (CBF), mean transit time (MTT) and time to peak (TTP) as previous studies mainly examined cerebral blood volume (CBV).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this single center study, we retrospectively identified patients with WHO grades II–IV gliomas with suspected tumor recurrence, presenting with ambiguous findings on structural MRI. For differentiation of PD from RN we used both MRI-PWI and [18F]FET-PET. Dynamic susceptibility contrast MRI-PWI provided normalized parameters derived from perfusion maps (r(relative)CBV, rCBF, rMTT, rTTP). Static [18F]FET-PET parameters including mean and maximum tumor to brain ratios (TBR<sub>mean</sub>, TBR<sub>max</sub>) were calculated. Based on histopathology and radioclinical follow-up we diagnosed PD in 27 and RN in 10 cases. Using the receiver operating characteristic (ROC) analysis, area under the curve (AUC) values were calculated for single and multiparametric models. The performances of single and multiparametric approaches were assessed with analysis of variance and cross-validation.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>After application of inclusion and exclusion criteria, we included 37 patients in this study. Regarding the in-sample based approach, in single parameter analysis rTBR<sub>mean</sub> (AUC = 0.91, <i>p</i> < 0.001), rTBR<sub>max</sub> (AUC = 0.89, <i>p</i> < 0.001), rTTP (AUC = 0.87, <i>p</i> < 0.001) and rCBV<sub>mean</sub> (AUC = 0.84, <i>p</i> < 0.001) were efficacious for discrimination of PD from RN. The rCBF<sub>mean</sub> and rMTT did not reach statistical significance. A classification model consisting of TBR<sub>mean</sub>, rCBV<sub>mean</sub> and rTTP achieved an AUC of 0.98 (<i>p</i> < 0.001), outperforming the use of rTBR<sub>mean</sub> alone, which was the single parametric approach with the highest AUC. Analysis of variance confirmed the superiority of the multiparametric approach over the single parameter one (<i>p</i> = 0.002). While cross-validation attributed the highest AUC value to the model consisting of TBR<sub>mean</sub> and rCBV<sub>mean</sub>, it also suggested that the addition of rTTP resulted in the highest accuracy. Overall, multiparametric models performed better than single parameter ones.</p><h3 data-test","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"31 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139069839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-18DOI: 10.1007/s00062-023-01365-0
Martha Marko, Nishita Singh, Johanna M. Ospel, Kazutaka Uchida, Mohammed A. Almekhlafi, Andrew M. Demchuk, Raul G. Nogueira, Ryan A. McTaggart, Alexandre Y. Poppe, Jeremy L. Rempel, Michael Tymianski, Michael D. Hill, Mayank Goyal, Bijoy K. Menon
Purpose
Non-stenotic (< 50%) carotid disease may play an important etiological role in ischemic stroke classified as embolic stroke of undetermined source (ESUS). We aimed to assess the prevalence of non-stenotic carotid disease and its association with ipsilateral ischemic stroke.
Methods
Data are from ESCAPE-NA1, a randomized controlled trial investigating the neuroprotectant nerinetide in patients with acute ischemic stroke and large vessel occlusion (LVO). The degree of stenosis of the extracranial internal carotid artery (ICA) and high-risk plaque features were assessed on baseline computed tomography (CT) angiography. We evaluated the association of non-stenotic carotid disease and ipsilateral stroke by age-adjusted and sex-adjusted logistic regression and calculated the attributable risk of ipsilateral stroke caused by non-stenotic carotid disease.
Results
After excluding patients with non-assessable imaging, symptomatic > 50% carotid stenosis and extracranial dissection, 799/1105 (72.1%) patients enrolled in ESCAPE-NA1 remained for this analysis. Of these, 127 (15.9%) were classified as ESUS. Non-stenotic carotid disease occurred in 34/127 ESUS patients (26.8%) and was associated with the presence of ipsilateral ischemic stroke (odds ratio, OR 1.6, 95% confidence interval, CI 1.0–2.6, p = 0.049). The risk of ipsilateral ischemic stroke attributable to non-stenotic carotid disease in ESUS was estimated to be 19.7% (95% CI −5.7% to 39%), the population attributable risk was calculated as 4.3%. Imaging features such as plaque thickness, plaque irregularity or plaque ulceration were not different between non-stenotic carotids with vs. without ipsilateral stroke.
Conclusion
Non-stenotic carotid disease frequently occurs in patients classified as ESUS and is associated with ipsilateral ischemic stroke. Our findings support the role of non-stenotic carotid disease as stroke etiology in ESUS, but further prospective research is needed to prove a causal relationship.
{"title":"Symptomatic Non-stenotic Carotid Disease in Embolic Stroke of Undetermined Source","authors":"Martha Marko, Nishita Singh, Johanna M. Ospel, Kazutaka Uchida, Mohammed A. Almekhlafi, Andrew M. Demchuk, Raul G. Nogueira, Ryan A. McTaggart, Alexandre Y. Poppe, Jeremy L. Rempel, Michael Tymianski, Michael D. Hill, Mayank Goyal, Bijoy K. Menon","doi":"10.1007/s00062-023-01365-0","DOIUrl":"https://doi.org/10.1007/s00062-023-01365-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Non-stenotic (< 50%) carotid disease may play an important etiological role in ischemic stroke classified as embolic stroke of undetermined source (ESUS). We aimed to assess the prevalence of non-stenotic carotid disease and its association with ipsilateral ischemic stroke.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Data are from ESCAPE-NA1, a randomized controlled trial investigating the neuroprotectant nerinetide in patients with acute ischemic stroke and large vessel occlusion (LVO). The degree of stenosis of the extracranial internal carotid artery (ICA) and high-risk plaque features were assessed on baseline computed tomography (CT) angiography. We evaluated the association of non-stenotic carotid disease and ipsilateral stroke by age-adjusted and sex-adjusted logistic regression and calculated the attributable risk of ipsilateral stroke caused by non-stenotic carotid disease.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>After excluding patients with non-assessable imaging, symptomatic > 50% carotid stenosis and extracranial dissection, 799/1105 (72.1%) patients enrolled in ESCAPE-NA1 remained for this analysis. Of these, 127 (15.9%) were classified as ESUS. Non-stenotic carotid disease occurred in 34/127 ESUS patients (26.8%) and was associated with the presence of ipsilateral ischemic stroke (odds ratio, OR 1.6, 95% confidence interval, CI 1.0–2.6, <i>p</i> = 0.049). The risk of ipsilateral ischemic stroke attributable to non-stenotic carotid disease in ESUS was estimated to be 19.7% (95% CI −5.7% to 39%), the population attributable risk was calculated as 4.3%. Imaging features such as plaque thickness, plaque irregularity or plaque ulceration were not different between non-stenotic carotids with vs. without ipsilateral stroke.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Non-stenotic carotid disease frequently occurs in patients classified as ESUS and is associated with ipsilateral ischemic stroke. Our findings support the role of non-stenotic carotid disease as stroke etiology in ESUS, but further prospective research is needed to prove a causal relationship.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"93 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138715759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-14DOI: 10.1007/s00062-023-01280-4
Robert M. Kwee, Maan T. Almaghrabi, Thomas C. Kwee
Purpose
It is unclear if undesired practices such as scientific fraud, publication bias, and honorary authorship are present in neuroradiology. Therefore, the objective was to explore the integrity of clinical neuroradiological research using a survey method.
Methods
Corresponding authors who published in one of four top clinical neuroradiology journals were invited to complete a survey about integrity in clinical neuroradiology research.
Results
A total of 232 corresponding authors participated in our survey. Confidence in the integrity of published scientific work in clinical neuroradiology (0–10 point scale) was rated as a median score of 8 (range 3–10). In linear regression analysis, respondents from Asia had significantly higher confidence (beta coefficient of 0.569, 95% confidence interval, CI: 0.049–1.088, P = 0.032). Of the respondents 8 (3.4%) reported to have committed scientific fraud in the past 5 years, whereas 66 respondents (28.4%) reported to have witnessed or suspected scientific fraud by anyone from their department in the past 5 years. A total of 192 respondents (82.8%) thought that a study with positive results is more likely to be accepted by a journal than a similar study with negative results and 96 respondents (41.4%) had an honorary author on any of their publications in the past 5 years.
Conclusion
Experts in the field have overall high confidence in published clinical neuroradiology research; however, scientific integrity concerns are not negligible, publication bias is a problem and honorary authorship is common. The findings from this survey may help to increase awareness and vigilance among anyone involved in clinical neuroradiological research.
目的神经放射学中是否存在诸如科学欺诈、发表偏倚和名誉作者等不良行为尚不清楚。因此，目的是探讨完整性的临床神经放射学研究使用调查方法。方法邀请在临床神经放射学四种顶级期刊之一发表文章的作者对临床神经放射学研究的完整性进行调查。结果共有232位通讯作者参与了我们的调查。对临床神经放射学发表的科学工作的完整性的信心(0-10分制)被评为中位数8分(范围3-10)。在线性回归分析中，亚洲受访者的置信度显著较高(β系数为0.569,95%置信区间，CI: 0.049 ~ 1.088, P = 0.032)。在回应者中，有8人(3.4%)报告在过去5年中有过科学欺诈行为，而66人(28.4%)报告在过去5年中目睹或怀疑其部门的任何人有科学欺诈行为。192名受访者(82.8%)认为具有积极结果的研究比具有消极结果的类似研究更容易被期刊接受，96名受访者(41.4%)在过去5年的任何出版物上都有荣誉作者。结论专家对已发表的临床神经放射学研究成果总体信任度较高;然而，科学诚信问题不容忽视，发表偏倚是一个问题，荣誉作者是常见的。这项调查的结果可能有助于提高任何参与临床神经放射学研究的人的认识和警惕。
{"title":"Integrity of Clinical Neuroradiological Research","authors":"Robert M. Kwee, Maan T. Almaghrabi, Thomas C. Kwee","doi":"10.1007/s00062-023-01280-4","DOIUrl":"https://doi.org/10.1007/s00062-023-01280-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>It is unclear if undesired practices such as scientific fraud, publication bias, and honorary authorship are present in neuroradiology. Therefore, the objective was to explore the integrity of clinical neuroradiological research using a survey method.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Corresponding authors who published in one of four top clinical neuroradiology journals were invited to complete a survey about integrity in clinical neuroradiology research.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 232 corresponding authors participated in our survey. Confidence in the integrity of published scientific work in clinical neuroradiology (0–10 point scale) was rated as a median score of 8 (range 3–10). In linear regression analysis, respondents from Asia had significantly higher confidence (beta coefficient of 0.569, 95% confidence interval, CI: 0.049–1.088, <i>P</i> = 0.032). Of the respondents 8 (3.4%) reported to have committed scientific fraud in the past 5 years, whereas 66 respondents (28.4%) reported to have witnessed or suspected scientific fraud by anyone from their department in the past 5 years. A total of 192 respondents (82.8%) thought that a study with positive results is more likely to be accepted by a journal than a similar study with negative results and 96 respondents (41.4%) had an honorary author on any of their publications in the past 5 years.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Experts in the field have overall high confidence in published clinical neuroradiology research; however, scientific integrity concerns are not negligible, publication bias is a problem and honorary authorship is common. The findings from this survey may help to increase awareness and vigilance among anyone involved in clinical neuroradiological research.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"16 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138630462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-11DOI: 10.1007/s00062-023-01363-2
Christian M. Boßelmann, Josua Kegele, Leonie Zerweck, Uwe Klose, Silke Ethofer, Constantin Roder, Alexander M. Grimm, Till-Karsten Hauser
Purpose
Individuals with drug-resistant epilepsy may benefit from epilepsy surgery. In nonlesional cases, where no epileptogenic lesion can be detected on structural magnetic resonance imaging, multimodal neuroimaging studies are required. Breath-hold-triggered BOLD fMRI (bh-fMRI) was developed to measure cerebrovascular reactivity in stroke or angiopathy and highlights regional network dysfunction by visualizing focal impaired flow increase after vasodilatory stimulus. This regional dysfunction may correlate with the epileptogenic zone. In this prospective single-center single-blind pilot study, we aimed to establish the feasibility and safety of bh-fMRI in individuals with drug-resistant non-lesional focal epilepsy undergoing presurgical evaluation.
Methods
In this prospective study, 10 consecutive individuals undergoing presurgical evaluation for drug-resistant focal epilepsy were recruited after case review at a multidisciplinary patient management conference. Electroclinical findings and results of other neuroimaging were used to establish the epileptogenic zone hypothesis. To calculate significant differences in cerebrovascular reactivity in comparison to the normal population, bh-fMRIs of 16 healthy volunteers were analyzed. The relative flow change of each volume of interest (VOI) of the atlas was then calculated compared to the flow change of the whole brain resulting in an atlas of normal cerebral reactivity. Consequently, the mean flow change of every VOI of each patient was tested against the healthy volunteers group. Areas with significant impairment of cerebrovascular reactivity had decreased flow change and were compared to the epileptogenic zone localization hypothesis in a single-blind design.
Results
Acquisition of bh-fMRI was feasible in 9/10 cases, with one patient excluded due to noncompliance with breathing maneuvers. No adverse events were observed, and breath-hold for intermittent hypercapnia was well tolerated. On blinded review, we observed full or partial concordance of the local network dysfunction seen on bh-fMRI with the electroclinical hypothesis in 6/9 cases, including cases with extratemporal lobe epilepsy and those with nonlocalizing 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).
Conclusion
This represents the first report of bh-fMRI in individuals with epilepsy undergoing presurgical evaluation. We found bh-fMRI to be feasible and safe, with a promising agreement to electroclinical findings. Thus, bh-fMRI may represent a potential modality in the presurgical evaluation of epilepsy. Further studies are needed to establish clinical utility.
{"title":"Breath-Hold-Triggered BOLD fMRI in Drug-Resistant Nonlesional Focal Epilepsy—A Pilot Study","authors":"Christian M. Boßelmann, Josua Kegele, Leonie Zerweck, Uwe Klose, Silke Ethofer, Constantin Roder, Alexander M. Grimm, Till-Karsten Hauser","doi":"10.1007/s00062-023-01363-2","DOIUrl":"https://doi.org/10.1007/s00062-023-01363-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Individuals with drug-resistant epilepsy may benefit from epilepsy surgery. In nonlesional cases, where no epileptogenic lesion can be detected on structural magnetic resonance imaging, multimodal neuroimaging studies are required. Breath-hold-triggered BOLD fMRI (bh-fMRI) was developed to measure cerebrovascular reactivity in stroke or angiopathy and highlights regional network dysfunction by visualizing focal impaired flow increase after vasodilatory stimulus. This regional dysfunction may correlate with the epileptogenic zone. In this prospective single-center single-blind pilot study, we aimed to establish the feasibility and safety of bh-fMRI in individuals with drug-resistant non-lesional focal epilepsy undergoing presurgical evaluation.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this prospective study, 10 consecutive individuals undergoing presurgical evaluation for drug-resistant focal epilepsy were recruited after case review at a multidisciplinary patient management conference. Electroclinical findings and results of other neuroimaging were used to establish the epileptogenic zone hypothesis. To calculate significant differences in cerebrovascular reactivity in comparison to the normal population, bh-fMRIs of 16 healthy volunteers were analyzed. The relative flow change of each volume of interest (VOI) of the atlas was then calculated compared to the flow change of the whole brain resulting in an atlas of normal cerebral reactivity. Consequently, the mean flow change of every VOI of each patient was tested against the healthy volunteers group. Areas with significant impairment of cerebrovascular reactivity had decreased flow change and were compared to the epileptogenic zone localization hypothesis in a single-blind design.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Acquisition of bh-fMRI was feasible in 9/10 cases, with one patient excluded due to noncompliance with breathing maneuvers. No adverse events were observed, and breath-hold for intermittent hypercapnia was well tolerated. On blinded review, we observed full or partial concordance of the local network dysfunction seen on bh-fMRI with the electroclinical hypothesis in 6/9 cases, including cases with extratemporal lobe epilepsy and those with nonlocalizing 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>This represents the first report of bh-fMRI in individuals with epilepsy undergoing presurgical evaluation. We found bh-fMRI to be feasible and safe, with a promising agreement to electroclinical findings. Thus, bh-fMRI may represent a potential modality in the presurgical evaluation of epilepsy. Further studies are needed to establish clinical utility.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"9 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138576806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-08DOI: 10.1007/s00062-023-01364-1
Andrea M. Alexandre, Luca Scarcia, Frédéric Clarençon, Arianna Camilli, Andrea Bartolo, Francesca Incandela, Dario Antonio Mele, Mario Rigante, Marco Natola, Iacopo Valente, Francesco D’Argento, Jacopo Galli, Yamume Tshomba, Alessandro Pedicelli
Purpose
This retrospective study aimed to assess the safety and technical efficacy of preoperative direct puncture embolization using a nonadhesive ethylene vinyl alcohol (EVOH) copolymer-based liquid embolic agent (LEA) combined with balloon occlusion at the origin of the external carotid artery for head and neck paragangliomas (HNP).
Methods
We conducted a review of all consecutive cases of HNPs treated with direct puncture embolization using EVOH-based LEAs between 2017 and 2022 in 2 tertiary high-volume hospitals.
Results
A total of 25 cases of HNPs in 24 patients underwent direct puncture embolization (12 males, 12 females, mean age 50.9 ± 15.6 years). The average lesion volume was 299.95 mm3. The mean procedure time was 139.11 min, and the mean volume of EVOHs used per case was 19.38 mL. Successful complete devascularization was achieved in all cases, with a homogeneous and deep penetration of the embolic agent into the tumor vessel bed regardless of the LEA type.
Conclusion
Preoperative embolization of HNPs using a direct puncture technique and EVOHs is a safe, efficient, and feasible treatment option with a low risk of complications. This procedure facilitates surgery by transforming tumors into avascular masses that are well-delineated against the surrounding normal tissue.
{"title":"Preoperative Direct Puncture Embolization Using a Nonadhesive Ethylene Vinyl Alcohol (EVOH) Liquid Embolic Agent for Head and Neck Paragangliomas","authors":"Andrea M. Alexandre, Luca Scarcia, Frédéric Clarençon, Arianna Camilli, Andrea Bartolo, Francesca Incandela, Dario Antonio Mele, Mario Rigante, Marco Natola, Iacopo Valente, Francesco D’Argento, Jacopo Galli, Yamume Tshomba, Alessandro Pedicelli","doi":"10.1007/s00062-023-01364-1","DOIUrl":"https://doi.org/10.1007/s00062-023-01364-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>This retrospective study aimed to assess the safety and technical efficacy of preoperative direct puncture embolization using a nonadhesive ethylene vinyl alcohol (EVOH) copolymer-based liquid embolic agent (LEA) combined with balloon occlusion at the origin of the external carotid artery for head and neck paragangliomas (HNP).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a review of all consecutive cases of HNPs treated with direct puncture embolization using EVOH-based LEAs between 2017 and 2022 in 2 tertiary high-volume hospitals.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 25 cases of HNPs in 24 patients underwent direct puncture embolization (12 males, 12 females, mean age 50.9 ± 15.6 years). The average lesion volume was 299.95 mm<sup>3</sup>. The mean procedure time was 139.11 min, and the mean volume of EVOHs used per case was 19.38 mL. Successful complete devascularization was achieved in all cases, with a homogeneous and deep penetration of the embolic agent into the tumor vessel bed regardless of the LEA type.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Preoperative embolization of HNPs using a direct puncture technique and EVOHs is a safe, efficient, and feasible treatment option with a low risk of complications. This procedure facilitates surgery by transforming tumors into avascular masses that are well-delineated against the surrounding normal tissue.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"5 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138562663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-06-06DOI: 10.1007/s00062-023-01303-0
Felix Bärenfänger, Peter Schramm, Stefan Rohde
Purpose: To evaluate patient-related radiation exposure in interventional stroke treatment by analyzing data from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society of Neuroradiology (DGNR) quality registry from 2019-2021.
Methods: The DeGIR/DGNR registry is the largest database of radiological interventions in Germany. Since the introduction of the registry in 2012, the participating hospitals have entered clinical and dose-related data on the procedures performed. To evaluate the current diagnostic reference level (DRL) for mechanical thrombectomy (MT) in stroke patients, we analyzed interventional data from 2019 to 2021 with respect to the reported dose area product (DAP) and factors that might contribute to the radiation dose, such as the localization of the occlusion, technical success using the modified treatment in cerebral ischemia (mTICI) score, number of passages, technical approach, additional intracranial/extracranial stenting, and case volume per center.
Results: A total of 41,538 performed MTs from 180 participating hospitals were analyzed. The median DAP for MT was 7337.5 cGy∙cm2 and the corresponding interquartile range (IQR) Q25 = 4064 cGy∙cm2 to Q75 = 12,263 cGy∙cm2. In addition, we discovered that the dose was significantly influenced by occlusion location, number of passages, case volume per center, recanalization score, and additional stenting.
Conclusion: We conducted a retrospective study on radiation exposure during MT in Germany. Based on the results of more than 41,000 procedures, we observed that the DRL of 14,000 cGy·cm2 is currently appropriate but may be lowered over the next years. Furthermore, we identified several factors that contribute to high radiation exposure. This can aid in detecting the cause of an exceeded DRL and optimize the treatment workflow.
{"title":"Radiation Exposure in Interventional Stroke Treatment : Analysis of the German Neurointerventional Database (DeGIR/DGNR) from 2019 to 2021.","authors":"Felix Bärenfänger, Peter Schramm, Stefan Rohde","doi":"10.1007/s00062-023-01303-0","DOIUrl":"10.1007/s00062-023-01303-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate patient-related radiation exposure in interventional stroke treatment by analyzing data from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Society of Neuroradiology (DGNR) quality registry from 2019-2021.</p><p><strong>Methods: </strong>The DeGIR/DGNR registry is the largest database of radiological interventions in Germany. Since the introduction of the registry in 2012, the participating hospitals have entered clinical and dose-related data on the procedures performed. To evaluate the current diagnostic reference level (DRL) for mechanical thrombectomy (MT) in stroke patients, we analyzed interventional data from 2019 to 2021 with respect to the reported dose area product (DAP) and factors that might contribute to the radiation dose, such as the localization of the occlusion, technical success using the modified treatment in cerebral ischemia (mTICI) score, number of passages, technical approach, additional intracranial/extracranial stenting, and case volume per center.</p><p><strong>Results: </strong>A total of 41,538 performed MTs from 180 participating hospitals were analyzed. The median DAP for MT was 7337.5 cGy∙cm<sup>2</sup> and the corresponding interquartile range (IQR) Q<sub>25</sub> = 4064 cGy∙cm<sup>2</sup> to Q<sub>75</sub> = 12,263 cGy∙cm<sup>2</sup>. In addition, we discovered that the dose was significantly influenced by occlusion location, number of passages, case volume per center, recanalization score, and additional stenting.</p><p><strong>Conclusion: </strong>We conducted a retrospective study on radiation exposure during MT in Germany. Based on the results of more than 41,000 procedures, we observed that the DRL of 14,000 cGy·cm<sup>2</sup> is currently appropriate but may be lowered over the next years. Furthermore, we identified several factors that contribute to high radiation exposure. This can aid in detecting the cause of an exceeded DRL and optimize the treatment workflow.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"1023-1033"},"PeriodicalIF":2.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9585970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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