Abstract
Synthetic MR provides qualitative and quantitative multi-parametric data about tissue properties in a single acquisition. Its use in stroke imaging is not yet established. We compared ...synthetic and conventional image quality and studied synthetic relaxometry of acute and chronic ischemic lesions to investigate its interest for stroke imaging. We prospectively acquired synthetic and conventional brain MR of 43 consecutive adult patients with suspected stroke. We studied a total of 136 lesions, of which 46 DWI-positive with restricted ADC (DWI + /rADC), 90 white matter T2/FLAIR hyperintensities (WMH) showing no diffusion restriction, and 430 normal brain regions (NBR). We assessed image quality for lesion definition according to a 3-level score by two readers of different experiences. We compared relaxometry of lesions and regions of interest. Synthetic images were superior to their paired conventional images for lesion definition except for sFLAIR (sT1 or sPSIR vs. cT1 and sT2 vs. cT2 for DWI + /rADC and WMH definition;
p
values < .001) with substantial to almost perfect inter-rater reliability (κ ranging from 0.711 to 0.932,
p
values < .001). We found significant differences in relaxometry between lesions and NBR and between acute and chronic lesions (T1, T2, and PD of DWI + /rADC or WMH vs. mirror NBR;
p
values < .001; T1 and PD of DWI + /rADC vs. WMH;
p
values of 0.034 and 0.008). Synthetic MR may contribute to stroke imaging by fast generating accessible weighted images for visual inspection derived from rapidly acquired relaxometry data. Moreover, this synthetic relaxometry could differentiate acute and chronic ischemic lesions.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Abstract
Brain hypoxia can occur after non-traumatic subarachnoid hemorrhage (SAH), even when levels of intracranial pressure (ICP) remain normal. Brain tissue oxygenation (PbtO
2
) can be measured ...as a part of a neurological multimodal neuromonitoring. Low PbtO
2
has been associated with poor neurologic recovery. There is scarce data on the impact of PbtO
2
guided-therapy on patients’ outcome. This single-center cohort study (June 2014–March 2020) included all patients admitted to the ICU after SAH who required multimodal monitoring. Patients with imminent brain death were excluded. Our primary goal was to assess the impact of PbtO
2
-guided therapy on neurological outcome. Secondary outcome included the association of brain hypoxia with outcome. Of the 163 patients that underwent ICP monitoring, 62 were monitored with PbtO
2
and 54 (87%) had at least one episode of brain hypoxia. In patients that required treatment based on neuromonitoring strategies, PbtO
2
-guided therapy (OR 0.33 CI 95% 0.12–0.89) compared to ICP-guided therapy had a protective effect on neurological outcome at 6 months. In this cohort of SAH patients, PbtO
2
-guided therapy might be associated with improved long-term neurological outcome, only when compared to ICP-guided therapy.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Various surgical methods to prevent postoperative cerebrospinal fluid (CSF) leaks during transsphenoidal surgery have been reported. However, comparative studies are scarce. We aimed to compare the ...efficacy of a fibrin-coated collagen fleece (TachoSil) versus a dural sealant (DuraSeal) to prevent postoperative CSF leakage. We perform a retrospective study comparing two methods of sellar closure during endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenoma resection: TachoSil patching versus DuraSeal packing. Data concerning diagnosis, reconstruction technique, and surgical outcomes were analyzed. The primary endpoint was postoperative CSF leak rate. We reviewed 198 consecutive patients who underwent 219 EETS for pituitary adenoma from February 2007 and July 2018. Intraoperative CSF leak occurred in 47 cases (21.5%). A total of 33 postoperative CSF leaks were observed (15.1%). A reduction of postoperative CSF leaks in the TachoSil application group compared to the conventional technique using Duraseal was observed (7.7% and 18.2%, respectively; p = 0.062; Pearson exact test) although non-statistically significant. Two patients required lumbar drainage, and no revision repair was necessary to treat postoperative CSF rhinorrhea in Tachosil group. Fibrin-coated collagen fleece patching may be a valuable method to prevent postoperative cerebrospinal fluid (CSF) leaks during EETS for pituitary adenoma resection.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background
Intracranial multimodality monitoring (iMMM) is increasingly used in acute brain-injured patients; however, safety and reliability remain major concerns to its routine implementation.
...Methods
We performed a retrospective study including all patients undergoing iMMM at a single European center between July 2016 and January 2020. Brain tissue oxygenation probe (PbtO
2
), alone or in combination with a microdialysis catheter and/or an 8-contact depth EEG electrode, was inserted using a triple-lumen bolt system and targeting normal-appearing at-risk brain area on the injured side, whenever possible. Surgical complications, adverse events, and technical malfunctions, directly associated with iMMM, were collected. A blinded imaging review was performed by an independent radiologist.
Results
One hundred thirteen patients with 123 iMMM insertions were included for a median monitoring time of 9 3–14 days. Of those, 93 (76%) patients had only PbtO
2
probe insertion and 30 (24%) had also microdialysis and/or iEEG monitoring. SAH was the most frequent indication for iMMM (
n
= 60, 53%). At least one complication was observed in 67/123 (54%) iMMM placement, corresponding to 58/113 (51%) patients. Misplacement was observed in 16/123 (13%), resulting in a total of 6/16 (38%) malfunctioning PbtO
2
catheters. Intracranial hemorrhage was observed in 14 iMMM placements (11%), of which one required surgical drainage. Five placements were complicated by pneumocephalus and 4 with bone fragments; none of these requires additional surgery. No CNS infection related to iMMM was observed. Seven (6%) probes were accidentally dislodged and 2 probes (2%) were accidentally broken. Ten PbtO
2
probes (8%) presented a technical malfunction after a median of 9 ranges: 2–24 days after initiation of monitoring and 4 of them were replaced.
Conclusions
In this study, a high occurrence of complications related to iMMM was observed, although most of them did not require specific interventions and did not result in malfunctioning monitoring.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Posterior pituitary tumors (PPT) expressing thyroid transcription factor-1 (TTF-1) are extremely rare low-grade neoplasms. The recent discovery of BRAF mutations in these tumors offers a potential ...alternative treatment using targeted therapies. We present the case of a 57-year-old female with recurrent
BRAF
V600E-mutated TTF-1-positive PPT treated with a BRAF inhibitor monotherapy (dabrafenib) leading to tumor regression. After 18 months of uninterrupted treatment, ongoing radiological tumor regression was observed and the patient remained asymptomatic without any significant adverse event. BRAF inhibitor is potentially a valuable treatment option for recurrent TTF-1-positive PPT with BRAF mutation.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background: The implantation of SEEG electrodes with robotic assistance has become a standard procedure for invasive intracranial recordings in drug-resistant epilepsy. As compared with laser ...registration, the use of bony fiducials enables to reach a superior accuracy but requires the placement of 5 to 6 bony markers prior to imaging. Defining bony landmarks on Leskell G-frame is an option whose theoretical registration accuracy (rms value provided by the software) seems satisfactory. However data regarding the applicative accuracy on that method on a great number of procedures in real word conditions has been largely unknown until now. The objective of the present study was to assess the applicative accuracy obtained through this registration method.Methods: Monocentric retrospective analysis of the concordance between the planned and actual trajectories in 73 consecutive patients undergoing intracranial recordings for intractable epilepsy between Oct 2018 and Feb 2023. For each lead, the coordinates of the entry point and target point of the planned trajectory and those of the actual trajectory defined on the postoperative CT were automatically extracted via a dedicated MatLab® script. The Euclidian distance of error in mm at the entry point and target point were computed, as well as the angular deviation in degree between the trajectories. The statistical analysis (uni, multivariate, mixed model) was conducted with R software® (Version 2022.12.0+353)Results: A total of 1090 trajectories (73 patients) were evaluated. The mean Euclidian distance of error at the entry point was 0.86 mm (+/-0.58). At the target point, it was 2.15 mm (+/- 0.72). The mean angle of deviation in degree was 1.23. For orthogonal trajectories, the mean error was 0.55 and 0.43 mm in y and z respectively. The orthogonality of the trajectory was significantly associated with a smaller error at the entry point and target point (p<0.0001). No correlation was found between the rms value of registration quality and the error at the entry and target points (p> 0.05). The length of the trajectory was significantly correlated to the magnitude of error at the target (p < 0.001; r=0.37). This was found to be ascribable to a certain degree of flexibility of the electrode not to the registration method.Conclusions: These applicative accuracy data show that this registration method does not differ significantly from the one based on additional bony markers. It has the advantage of a homogeneous distribution of the markers around the whole volume of the skull. In addition, it does not require the placement of bony fiducials, which saves time. The mean error at the entry remains infra-millimetric and is consistent with the results of similar studies. The order of magnitude of the difference is not clinically relevant and derives mainly from methodological differences in the metrics for quantifying accuracy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Brain tissue oxygenation (PbtO2)-guided therapy can improve the neurological outcome of traumatic brain injury (TBI) patients. With several Phase-III ongoing studies, most of the existing evidence is ...based on before-after cohort studies and a phase-II randomized trial. The aim of this study was to assess the effectiveness of PbtO2-guided therapy in a single-center cohort. We performed a retrospective analysis of consecutive severe TBI patients admitted to our center who received either intracranial pressure (ICP) guided therapy (from January 2012 to February 2016) or ICP/PbtO2-guided therapy (February 2017 to December 2019). A genetic matching was performed based on covariates including demographics, comorbidities, and severity scores on admission. Intracranial hypertension (IH) was defined as ICP > 20 mmHg for at least 5 min. Brain hypoxia (BH) was defined as PbtO2 < 20 mmHg for at least 10 min. IH and BH were targeted by specific interventions. Mann−Whitney U and Fisher’s exact tests were used to assess differences between groups. A total of 35 patients were matched in both groups: significant differences in the occurrence of IH (ICP 85.7% vs. ICP/PbtO2 45.7%, p < 0.01), ICU length of stay 6 (3−13) vs. 16 (9−25) days, p < 0.01 and Glasgow Coma Scale at ICU discharge 10 (5−14) vs. 13 (11−15), p = 0.036 were found. No significant differences in ICU mortality and Glasgow Outcome Scales at 3 months were observed. This study suggests that the role of ICP/PbtO2-guided therapy should await further confirmation in well-conducted large phase III studies.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
...the authors acknowledge a significant limitation of their methodology: the reliance on GPT-4's natural language processing (NLP) capabilities, absent its vision capacity. ...the study's title and ...claims regarding GPT-4's proficiency in “electrocardiography assessment” may inadvertently mislead readers about this AI's capabilities in this clinical context. ...the study design inadvertently highlights the issue of overfitting, a common pitfall in machine learning applications. ...while Günay et al.'s exploration into the GPT-4 application for NLP of textual human interpretation of ECG provides an academic contribution regarding potential educational applications, the leap to asserting its research or clinical relevance appears weak.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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