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Endovascular Thrombectomy for Large Ischemic Strokes with ASPECTS 0–2: a Meta-analysis of Randomized Controlled Trials 针对 ASPECTS 0-2 大面积缺血性脑卒中的血管内血栓切除术:随机对照试验的 Meta 分析
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-30 DOI: 10.1007/s00062-024-01414-2
Laurens Winkelmeier, Máté Maros, Fabian Flottmann, Christian Heitkamp, Gerhard Schön, Götz Thomalla, Jens Fiehler, Uta Hanning

Purpose

Randomized controlled trials (RCTs) demonstrated a treatment effect of endovascular thrombectomy in acute ischemic stroke with large infarct, commonly defined as an Alberta Stroke Program Early CT Score (ASPECTS) of 3–5. However, data on endovascular thrombectomy in patients with very low ASPECTS of 0–2 remain scarce.

Methods

We conducted a systematic review and meta-analysis of RCTs comparing endovascular thrombectomy versus medical treatment alone in acute ischemic anterior circulation stroke with very large infarct, defined as ASPECTS of 0–2. The primary outcome was the shift toward better functional outcomes on the 90-day modified Rankin Scale (mRS). Random effects meta-analysis was performed using the generic inverse variance method.

Results

Literature research identified four RCTs which evaluated the treatment effect of endovascular thrombectomy for large infarcts and provided a subgroup analysis of the mRS shift in patients with ASPECTS of 0–2. The pooled analysis showed a significant shift toward better 90-day mRS scores in favor of endovascular thrombectomy (pooled odds ratio, 1.62, 95% confidence interval, 1.29–2.04, P < 0.001).

Conclusion

This meta-analysis suggests a treatment effect of endovascular thrombectomy in specific patients with very low ASPECTS of 0–2, challenging the use of ASPECTS for treatment selection in acute ischemic stroke due to large vessel occlusion. An individual patient meta-analysis of RCTs would strengthen evidence in the treatment of patients with ASPECTS of 0–2.

Graphic abstract

目的 随机对照试验(RCT)显示,血管内血栓切除术对急性缺血性卒中大面积梗死(通常定义为阿尔伯塔卒中计划早期 CT 评分(ASPECTS)3-5 分)有治疗效果。方法我们进行了一项系统性回顾和荟萃分析,比较了在急性缺血性前循环卒中伴有大面积梗死(定义为 ASPECTS 为 0-2)时进行血管内血栓切除术与单纯药物治疗的 RCT。主要结果是 90 天改良 Rankin 量表(mRS)的功能转归更好。结果文献研究确定了四项RCT研究,这些研究评估了血管内血栓切除术对大面积心梗的治疗效果,并对ASPECTS为0-2的患者的mRS变化进行了亚组分析。结论该荟萃分析表明,血管内血栓切除术对 ASPECTS 为 0-2 的极低患者有治疗效果,这对使用 ASPECTS 选择大血管闭塞所致急性缺血性卒中的治疗方法提出了挑战。对 RCT 进行个体患者荟萃分析将加强 ASPECTS 为 0-2 的患者的治疗证据。
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引用次数: 0
Advanced diffusion MRI provides evidence for altered axonal microstructure and gradual peritumoral infiltration in GBM in comparison to brain metastases 与脑转移瘤相比,高级弥散核磁共振成像为 GBM 的轴突微结构改变和瘤周逐渐浸润提供了证据
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-29 DOI: 10.1007/s00062-024-01416-0
U. Würtemberger, A. Rau, M. Diebold, L. Becker, M. Hohenhaus, J. Beck, P. C. Reinacher, D. Erny, M. Reisert, H. Urbach, T. Demerath

Purpose

In contrast to peritumoral edema in metastases, GBM is histopathologically characterized by infiltrating tumor cells within the T2 signal alterations. We hypothesized that depending on the distance from the outline of the contrast-enhancing tumor we might reveal imaging evidence of gradual peritumoral infiltration in GBM and predominantly vasogenic edema around metastases. We thus investigated the gradual change of advanced diffusion metrics with the peritumoral zone in metastases and GBM.

Methods

In 30 patients with GBM and 28 with brain metastases, peritumoral T2 hyperintensity was segmented in 33% partitions based on the total volume beginning at the enhancing tumor margin and divided into inner, middle and outer zones. Diffusion Tensor Imaging (DTI)-derived fractional anisotropy and mean diffusivity as well as Diffusion Microstructure Imaging (DMI)-based parameters Dax-intra, Dax-extra, V‑CSF and V-intra were employed to assess group-wise differences between inner and outer zones as well as within-group gradients between the inner and outer zones.

Results

In metastases, fractional anisotropy and Dax-extra were significantly reduced in the inner zone compared to the outer zone (FA p = 0.01; Dax-extra p = 0.03). In GBM, we noted a reduced Dax-extra and significantly lower intraaxonal volume fraction (Dax-extra p = 0.008, V‑intra p = 0.006) accompanied by elevated axial intraaxonal diffusivity in the inner zone (p = 0.035). Between-group comparison of the outer to the inner zones revealed significantly higher gradients in metastases over GBM for FA (p = 0.04) as well as the axial diffusivity in the intra- (p = 0.02) and extraaxonal compartment (p < 0.001).

Conclusion

Our findings provide evidence of gradual alterations within the peritumoral zone of brain tumors. These are compatible with predominant (vasogenic) edema formation in metastases, whereas our findings in GBM are in line with an axonal destructive component in the immediate peritumoral area and evidence of tumor cell infiltration with accentuation in the tumor’s vicinity.

目的与转移瘤的瘤周水肿不同,GBM 的组织病理学特征是 T2 信号改变内有浸润的肿瘤细胞。我们假设,根据与造影剂增强肿瘤轮廓的距离,我们可能会发现 GBM 肿瘤周围逐渐浸润的成像证据,而转移瘤周围主要是血管源性水肿。方法 在 30 例 GBM 患者和 28 例脑转移瘤患者中,根据从增强肿瘤边缘开始的总体积,将瘤周 T2 高密度划分为 33% 的区域,并分为内区、中区和外区。采用弥散张量成像(DTI)得出的分数各向异性和平均扩散率以及基于弥散微结构成像(DMI)的参数Dax-intra、Dax-extra、V-CSF和V-intra来评估内外区之间的组间差异以及内外区之间的组内梯度。结果在转移瘤中,与外区相比,内区的分数各向异性和 Dax-extra 明显降低(FA p = 0.01;Dax-extra p = 0.03)。在 GBM 中,我们注意到内区的 Dax-extra 减少,轴内体积分数明显降低(Dax-extra p = 0.008,V-intra p = 0.006),同时轴内扩散性升高(p = 0.035)。外区与内区的组间比较显示,转移瘤的 FA 梯度(p = 0.04)以及轴内(p = 0.02)和轴外(p < 0.001)的轴向扩散性均明显高于 GBM。这些变化与转移瘤的主要(血管源性)水肿形成相一致,而我们在 GBM 中的发现则与紧邻瘤周区域的轴突破坏性成分以及肿瘤细胞浸润的证据相一致,并且在肿瘤附近更为突出。
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引用次数: 0
Association of Imaging-based Predictors with Outcome in Different Treatment Options for Intracerebral Hemorrhage. 脑出血不同治疗方案中基于成像的预测因素与预后的关系
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-26 DOI: 10.1007/s00062-024-01406-2
R. Krzyżewski, B. Kwinta, Krzysztof Stachura, Tadeusz J Popiela, R. Pułyk, Agnieszka Słowik, Jerzy Gąsowski, K. Kliś
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引用次数: 0
Thalamo-mesencephalic Branches of the Posterior Cerebral Artery: a 3D Rotational Angiography Study. 大脑后动脉的丘脑-间脑分支:三维旋转血管造影研究。
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-26 DOI: 10.1007/s00062-024-01418-y
Maximilian Rauch, Joachim Berkefeld, Madleen Klonowski, E. Hattingen, S. Weidauer
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引用次数: 0
Answer to: Complications During Ozone Therapy as a Result of Malpractice and Lack of Guidelines. 回答:臭氧治疗过程中的并发症是渎职和缺乏指导造成的。
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-23 DOI: 10.1007/s00062-024-01411-5
Daniel S. Marín-Medina, Adriana P Ortega-Quintero
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引用次数: 0
Comparison of Flow Reduction Efficacy of Nominal and Oversized Flow Diverters Using a Novel Measurement-assisted in Silico Method. 使用一种新颖的硅胶辅助测量方法,比较标称导流板和超大导流板的减流效果。
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-23 DOI: 10.1007/s00062-024-01404-4
B. Csippa, Levente Sándor, Gábor Závodszky, I. Szikora, György Paál
{"title":"Comparison of Flow Reduction Efficacy of Nominal and Oversized Flow Diverters Using a Novel Measurement-assisted in Silico Method.","authors":"B. Csippa, Levente Sándor, Gábor Závodszky, I. Szikora, György Paál","doi":"10.1007/s00062-024-01404-4","DOIUrl":"https://doi.org/10.1007/s00062-024-01404-4","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667179","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}
引用次数: 0
Complications During Ozone Therapy as a Result of Malpractice and Lack of Guidelines. 渎职和缺乏指南导致臭氧治疗过程中出现并发症。
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-23 DOI: 10.1007/s00062-024-01412-4
S. Chirumbolo, S. Pandolfi, L. Valdenassi, Marianna Chierchia, M. Franzini
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引用次数: 0
Societies' Communications. 社团通讯。
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-22 DOI: 10.1007/s00062-024-01413-3
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引用次数: 0
Endovascular Thrombectomy for Extensive Infarction (ASPECTS 0-2) in Acute Ischemic Stroke. 急性缺血性脑卒中大面积脑梗死的血管内血栓切除术(ASPECTS 0-2)。
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-22 DOI: 10.1007/s00062-024-01408-0
P. Dhillon, Vinicius Carraro do Nascimento, L. de Villiers, Hal Rice
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引用次数: 0
Multi-Dynamic-Multi-Echo-based MRI for the Pre-Surgical Determination of Sellar Tumor Consistency: a Quantitative Approach for Predicting Lesion Resectability 基于多动态多回波的核磁共振成像在手术前确定ellar肿瘤一致性:预测病变可切除性的定量方法
IF 2.8 3区 医学 Q2 Medicine Pub Date : 2024-04-19 DOI: 10.1007/s00062-024-01407-1
Mehmet Salih Yildirim, Victor Ulrich Schmidbauer, Alexander Micko, Lisa Lechner, Michael Weber, Julia Furtner, Stefan Wolfsberger, Intesar-Victoria Malla Houech, Anna Cho, Gregor Dovjak, Gregor Kasprian, Daniela Prayer, Wolfgang Marik

Purpose

Pre-surgical information about tumor consistency could facilitate neurosurgical planning. This study used multi-dynamic-multi-echo (MDME)-based relaxometry for the quantitative determination of pituitary tumor consistency, with the aim of predicting lesion resectability.

Methods

Seventy-two patients with suspected pituitary adenomas, who underwent preoperative 3 T MRI between January 2020 and January 2022, were included in this prospective study. Lesion-specific T1-/T2-relaxation times (T1R/T2R) and proton density (PD) metrics were determined. During surgery, data about tumor resectability were collected. A Receiver Operating Characteristic (ROC) curve analysis was performed to investigate the diagnostic performance (sensitivity/specificity) for discriminating between easy- and hard-to-remove by aspiration (eRAsp and hRAsp) lesions. A Mann-Whitney-U-test was done for group comparison.

Results

A total of 65 participants (mean age, 54 years ± 15, 33 women) were enrolled in the quantitative analysis. Twenty-four lesions were classified as hRAsp, while 41 lesions were assessed as eRAsp. There were significant differences in T1R (hRAsp: 1221.0 ms ± 211.9; eRAsp: 1500.2 ms ± 496.4; p = 0.003) and T2R (hRAsp: 88.8 ms ± 14.5; eRAsp: 137.2 ms ± 166.6; p = 0.03) between both groups. The ROC analysis revealed an area under the curve of 0.72 (95% CI: 0.60–0.85) at p = 0.003 for T1R (cutoff value: 1248 ms; sensitivity/specificity: 78%/58%) and 0.66 (95% CI: 0.53–0.79) at p = 0.03 for T2R (cutoff value: 110 ms; sensitivity/specificity: 39%/96%).

Conclusion

MDME-based relaxometry enables a non-invasive, pre-surgical characterization of lesion consistency and, therefore, provides a modality with which to predict tumor resectability.

目的 手术前了解肿瘤的一致性有助于制定神经外科手术计划。本研究采用基于多动态多回波(MDME)的弛豫测量法对垂体瘤的一致性进行定量测定,旨在预测病变的可切除性。方法这项前瞻性研究纳入了在2020年1月至2022年1月期间接受术前3 T磁共振成像检查的72例疑似垂体腺瘤患者。研究确定了病变特异性T1/T2松弛时间(T1R/T2R)和质子密度(PD)指标。在手术过程中,收集了有关肿瘤可切除性的数据。进行了接收者操作特征曲线(ROC)分析,以研究区分易切除病灶和难切除病灶(ERAsp和hRAsp)的诊断性能(灵敏度/特异性)。结果 共有 65 名参与者(平均年龄为 54 岁±15 岁,33 名女性)参与了定量分析。24 个病灶被归类为 hRAsp,41 个病灶被评估为 eRAsp。两组的 T1R(hRAsp:1221.0 ms ± 211.9;eerasp:1500.2 ms ± 496.4;p = 0.003)和 T2R(hRAsp:88.8 ms ± 14.5;eerasp:137.2 ms ± 166.6;p = 0.03)有明显差异。ROC 分析显示,在 p = 0.003 时,T1R(临界值:1248 ms;敏感性/特异性:78%/58%)的曲线下面积为 0.72(95% CI:0.60-0.85);在 p = 0.003 时,T2R(临界值:1248 ms;敏感性/特异性:78%/58%)的曲线下面积为 0.66(95% CI:0.53-0.79)。结论:基于 MDME 的弛豫测量可在手术前对病变的一致性进行无创鉴定,因此是预测肿瘤可切除性的一种方法。
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Clinical Neuroradiology
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