Severe canine acute pancreatitis can be fatal; imaging features that can predict the clinical course of disease are useful for clinicians. On computed tomography (CT), both pancreatic heterogeneous ...contrast enhancement and portal vein thrombosis have been correlated with poorer outcome. Perfusion CT is used in human medicine to evaluate pancreatic microcirculation to predict the future development of severe sequela to pancreatitis; this technology has yet to be explored in dogs with acute pancreatitis. The objective of this prospective, case-control study is to evaluate pancreatic perfusion using contrast-enhanced CT in dogs with acute pancreatitis and compare it with previously established values obtained in healthy dogs. Ten client-owned dogs preliminarily diagnosed with acute pancreatitis received a full abdominal ultrasound, specific canine pancreatic lipase (Spec cPL), and perfusion CT. Computer software calculated pancreatic perfusion, peak enhancement index, time to peak enhancement, and blood volume for 3-mm and reformatted 6-mm slices. The data was analyzed using Shapiro-Wilk test, linear mixed model, and Spearman's rho. Values for 3-mm slices were similar to 6-mm slices (all P < 0.05). Dogs with acute pancreatitis had a faster time to peak enhancement than healthy dogs (P = 0.04-0.06). Dogs with acute pancreatitis and homogeneous pancreatic enhancement had higher perfusion, faster time to peak enhancement, and greater blood volume compared to healthy dogs and dogs with acute pancreatitis and heterogeneous pancreatic enhancement (all P = / < 0.05). Pancreatic perfusion decreased with increased pancreatitis severity. No correlation was identified between Spec cPL and pancreatic perfusion (all P > 0.05). These findings preliminarily support perfusion CT in dogs with acute pancreatitis.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective: To evaluate the capabilities of the Olea Sphere automated software for the quantitative assessment of ischemic damage to the brain parenchyma during computed tomography (CT) in patients ...with acute cerebrovascular accident and its role in choosing the optimal treatment strategy in everyday clinical practice.Materials and methods: We retrospectively analyzed the data from 129 patients with suspected stroke who underwent perfusion CT within 24 hours of admission to the hospital. The Olea Sphere data were used to assess the volume of the infarct core, which was defined as an area with a relative cerebral blood flow less than 40%, the volume of the penumbra area, where Tmax exceeded 6 s, and ultimately the core-penumbra ratio.Results: With the Olea Sphere automated software, we were able to assess the volume of the ischemic changes in the brain parenchyma, particularly, the average volume of the infarct core in 129 patients was 21.95 (1-206) ml, the average volume of the penumbra area was 57.01 (2-357) ml, the core-penumbra ratio was 2.65, and mean time from CT to the start of treatment was 1.2 (0.9-1.9) hours. This quantitative data processing powered by the Olea Sphere provided the indications for the following endovascular treatment in patients with stroke: thrombus extraction in the acute period was performed in 51 patients (72.8%), transluminal balloon angioplasty with stent placement – in 12 patients (17.1%), and carotid endarterectomy in the long-term period – in 5 (9.6%) patients.Conclusions: We discovered that the Olea Sphere automated software can be used to assess ischemic changes in the brain and to make decisions related to patients with acute cerebrovascular accident in emergency conditions.
This study aimed to evaluate the value of low-dose dual-input computed tomography perfusion (CTP) imaging in the differential diagnosis of benign and malignant pulmonary ground-glass opacity nodules ...(GGO). A retrospective study was conducted in patients with GGO who underwent CTP in our hospital from January 2021 to October 2023. All nodules were confirmed via pathological analysis or disappeared during follow-up. Postprocessing analysis was conducted using the dual-input perfusion mode (pulmonary artery and bronchial artery) of the body perfusion software to measure the perfusion parameters of the pulmonary GGOs. A total of 101 patients with pulmonary GGOs were enrolled in this study, including 43 benign and 58 malignant nodules. The dose length product of the CTP (348 mGy.cm) was < 75% of the diagnostic reference level of the unenhanced chest CT (470 mGy.cm). The effective radiation dose was 4.872 mSV. The blood flow (BF), blood volume (BV), mean transit time (MTT), and flow extraction product (FEP) of malignant nodules were higher than those of the benign nodules (p < 0.05). The FEP had the highest accuracy for the diagnosis of malignant nodules (area under the curve AUC = 0.821, 95% confidence interval CI: 0.735–0.908) followed by BV (AUV = 0.713, 95% CI 0.608–0.819), BF (AUC = 0.688, 95% CI 0.587–0.797), and MTT (AUC = 0.616, 95% CI 0.506–0.726). When the FEP was ≥ 19.12 mL/100 mL/min, the sensitivity was 91.5% and the specificity was 62.8%. To distinguish between benign nodules and malignant nodules, the AUC of the combination of BV and FEP was 0.816 (95% CI 0.728–0.903), whereas the AUC of the combination of BF, BV, MTT, and FEP was 0.814 (95% CI 0.729–0.900). Low-dose dual-input perfusion CT was extremely effective in distinguishing between benign from malignant pulmonary GGOs, with FEP exhibiting the highest diagnostic capability.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background
Hepatocellular carcinoma (HCC) recurrence rates following locoregional treatment are high. As multireceptor tyrosine kinase inhibitors targeting vascular endothelial growth factor ...receptors (VEGFRs) are effective in advanced HCC, we assessed the efficacy and safety of neoadjuvant systemic treatment with dovitinib in early‐ and intermediate‐stage HCC.
Materials and Methods
Twenty‐four patients with modified Child‐Pugh class A early‐ and intermediate‐stage HCC received neoadjuvant oral dovitinib 500 mg daily (5 days on/2 days off) for 4 weeks, followed by locoregional therapy. Primary endpoints were objective response rates and intratumoral blood flow changes. Secondary endpoints were safety, pharmacodynamical plasma markers of VEGFR‐blockade, time to progression (TTP), and overall survival (OS).
Results
Modified RECIST overall response rate was 48%, including 13% complete remission, and despite dose reduction/interruption in 83% of patients, intratumoral perfusion index decreased significantly. Grade 3–4 adverse events, most frequently (on‐target) hypertension (54%), fatigue (25%), and thrombocytopenia (21%), occurred in 88% of patients. Plasma VEGF‐A, VEGF‐D, and placental growth factor increased significantly, whereas sTie‐2 decreased, consistent with VEGFR‐blockade. Following neoadjuvant dovitinib, all patients could proceed to their original planned locoregional treatment. No delayed toxicity occurred. Seven patients (three early, four intermediate stage) underwent orthotopic liver transplant after median 11.4 months. Censoring at transplantation, median TTP and OS were 16.8 and 34.8 months respectively; median cancer‐specific survival was not reached.
Conclusion
Already after a short 4‐week dovitinib treatment period, intratumoral blood flow reduction and modest antitumor responses were observed. Although these results support use of systemic neoadjuvant strategies, the poor tolerability indicates that dovitinib dose adaptations are required in HCC.
Implications for Practice
Orthotopic liver transplantation may cure early and intermediate‐stage hepatocellular carcinoma. Considering the expected waiting time >6 months because of donor liver scarcity, there is an unmet need for effective neoadjuvant downsizing strategies. Angiogenesis inhibition by dovitinib does not negatively affect subsequent invasive procedures, is safe to administer immediately before locoregional therapy, and may provide a novel treatment approach to improve patient outcomes if tolerability in patients with hepatocellular carcinoma can be improved by therapeutic drug monitoring and personalized dosing.
Considering the scarcity of liver donors and expected waiting time to liver transplantation, there is an unmet need for effective neoadjuvant downsizing strategies. This article reports on the safety and efficacy of neoadjuvant dovitinib in patients with hepatocellular carcinoma eligible for locoregional treatment.
Dynamic myocardial perfusion computed tomography (DMP-CT) is an effective medical imaging technique for coronary artery disease diagnosis and therapy guidance. However, the radiation dose received by ...the patient during repeated CT scans is a widespread concern of radiologists because of the increased risk of cancer. The sparse few-view CT scanning protocol can be a feasible approach to reduce the radiation dose of DMP-CT imaging; however, an advanced reconstruction algorithm is needed. In this paper, a temporal feature prior-aided separated reconstruction method (TFP-SR) for low-dose DMP-CT images reconstruction from sparse few-view sinograms is proposed. To implement the proposed method, the objective perfusion image is divided into the baseline fraction and the enhancement fraction introduced by the arrival of the contrast agent. The core of the proposed TFP-SR method is the utilization of the temporal evolution information that naturally exists in the DMP-CT image sequence to aid the enhancement image reconstruction from limited data. The temporal feature vector of an image pixel is defined by the intensities of this pixel in the pre-reconstructed enhancement sequence, and the connection between two related features is calculated via a zero-mean Gaussian function. A prior matrix is constructed based on the connections between the extracted temporal features and used in the iterative reconstruction of the enhancement images. To evaluate the proposed method, the conventional filtered back-projection algorithm, the total variation regularized PWLS (PWLS-TV) and the prior image constrained compressed sensing are compared in this paper based on studies on a digital extended cardiac-torso (XCAT) thoracic phantom and a preclinical porcine DMP-CT data set that take image misregistration into account. The experimental results demonstrate that the proposed TFP-SR method has superior performance in sparse DMP-CT images reconstruction in terms of image quality and the analyses of the time attenuation curve and hemodynamic parameters.
Objective: to compare the diagnostic effectiveness of computed tomography performed according to the standard protocol and using a perfusion program in the detection of chronic pseudotumoral ...pancreatitis complicated by obstructive jaundice and in the differential diagnosis with pancreatic head adenocarcinoma.Material and methods. The investigation enrolled 153 patients with obstructive jaundice treated at the Saint Petersburg Hospital for War Veterans from 2016 to 2020. The cause of jaundice was chronic pancreatitis in 52 (34%) cases and pancreatic head adenocarcinoma in 101 (66%). Endoscopic ultrasonography-guided histological verification using biopsy and examining the drugs after organ-sparing and radical resection interventions was obtained in all 101 patients (100%) with pancreatic adenocarcinoma, and in 32 (61.5%) with chronic pancreatitis. A control group consisted of 30 patients with no anamnestic, clinical, or laboratory evidence of pancreatic diseases. All patients underwent abdominal computed tomography according to the standard protocol and using a perfusion program.Results. The diagnostic effectiveness of the standard computed tomography protocol in the differential diagnosis of chronic pancreatitis and pancreatic adenocarcinoma was: sensitivity 95.5%, specificity 97.3%, and diagnostic accuracy 96.4%; whereas perfusion computed tomography had sensitivity 98.7%, specificity 99.3%, and diagnostic accuracy 98.6%.Conclusion. Perfusion computed tomography is a highly informative method for the differential diagnosis of chronic pancreatitis and pancreatic head adenocarcinoma in patients with obstructive jaundice.
Volatile sedation after aneurysmal subarachnoid hemorrhage (aSAH) promises several advantages, but there are still concerns regarding intracranial hypertension due to vasodilatory effects. We ...prospectively analyzed cerebral parameters during the switch from intravenous to volatile sedation with isoflurane in patients with poor-grade (World Federation of Neurosurgical Societies grade 4–5) aSAH.
Eleven patients were included in this prospective observational study. Between day 3 and 5 after admission, intravenous sedation was switched to isoflurane using the Sedaconda Anesthetic Conserving Device (Sedana Medical, Danderyd, Sweden). Intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygenation (PBrO2), cerebral mean flow velocities (MFVs; transcranial Doppler ultrasound) and regional cerebral oxygen saturation (rSO2, near-infrared spectroscopy monitoring), as well as cardiopulmonary parameters were assessed before and after the sedation switch (–12 to +12 hours). Additionally, perfusion computed tomography data during intravenous and volatile sedation were analyzed retrospectively for changes in cerebral blood flow.
There were no significant changes in mean ICP, CPP, and PBrO2 after the sedation switch to isoflurane. Mean rSO2 showed a non-significant trend towards higher values, and mean MFV in the middle cerebral arteries increased significantly after the initiation of volatile sedation. Isoflurane sedation resulted in a significantly increased norepinephrine administration. Despite an increase in mean inspiratory pressure, we observed a significant increase in mean partial arterial pressure of carbon dioxide.
Isoflurane sedation does not compromise ICP or cerebral oxygenation in poor-grade aSAH patients, but the significant depression of CPP could limit the use of volatiles in case of hemodynamic instability or high vasopressor demand.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Early blood-brain barrier (BBB) disruption in patients with acute ischemic stroke (AIS) can be detected on perfusion computed tomography (PCT) images before undergoing reperfusion therapy. In this ...study, we aimed to determine whether early disruption of the BBB predicts intracranial hemorrhage transformation (HT) in patients with AIS undergoing endovascular therapy and further identify factors influencing BBB disruption.
We retrospectively analyzed general clinical and imaging data derived from 159 consecutive patients with acute anterior circulation stroke who were admitted to the Department of Neurology of the First Hospital of Jilin University, and who underwent endovascular treatment between January 1, 2021, and March 31, 2023. We evaluated the relationship between BBB destruction and intracranial HT before endovascular reperfusion therapy and examined the risk factors for early BBB destruction.
A total of 159 patients with assessable BBB leakage were included. The median (interquartile range, IQR) age was 63 (54-70) years, 108 (67.9%) patients were male, and the median baseline National Institutes of Health Stroke Scale (NHISS) score was 12 (10-15). Follow-up non-contrast computed tomography (NCCT) detected HT in 63 patients. After logistic regression modeling adjustment, we found that BBB leakage in the true leakage area was slightly more than 2-fold risk of HT (odds ratio OR, 2.01; 95% confidence interval CI 1.02-3.92). Heart rate was also associated with HT (OR, 1.03, 95% CI, 1.00-1.05). High Blood-brain barrier permeability (BBBP) in the true leakage area was positively correlated with infarct core volume (OR, 1.03; 95% CI, 1.01-1.05).
Early BBB destruction before endovascular reperfusion therapy was associated with HT, whereas high BBBP correlated positively with infarct core volume.
Objectives
To investigate whether a novel assessment of thrombus permeability obtained from perfusion computed tomography (CTP) can act as a more accurate predictor of clinical response to mechanical ...thrombectomy (MT) in acute ischemic stroke (AIS).
Materials and methods
We performed a study including two cohorts of AIS patients who underwent MT admitted to a single-center between April 2018 and February 2022: a retrospective development cohort (
n
= 71) and a prospective independent validation cohort (
n
= 96). Thrombus permeability was determined in terms of entire thrombus time-attenuation curve (TAC) on CTP. Association between thrombus TAC distributions and histopathological results was analyzed in the development cohort. Logistic regression was used to assess the performance of the TAC for predicting 90-day modified Rankin Scale (mRS) score, and good outcome was defined as a mRS score of ≤ 2. Basic clinical characteristics was used to build a routine clinical model. A combined model gathered TAC and basic clinical characteristics was also developed. The performance of the three models is compared on the independent validation set.
Results
Two TAC distributions were observed—unimodal (uTAC) and linear (lTAC). TAC distributions achieved strong correlations (|
r
|= 0.627,
p
< 0.001) with histopathological results, in which uTAC associated with fibrin- and platelet-rich clot while lTAC associated with red blood cell–rich clot. The uTAC was independently associated with poor outcome (odds ratio, 0.08 95% confidence interval (CI), 0.02–0.31;
p
< 0.001). TAC distributions yielded an AUC of 0.78 (95% CI, 0.70–0.87) for predicting clinical outcome. When combined clinical characteristics, the performance was significantly improved (AUC, 0.85 95% CI, 0.76–0.93;
p
< 0.001) and higher than routine clinical model (AUC, 0.69 95% CI, 0.59–0.83;
p
< 0.001).
Conclusions
Thrombus TAC on CTP were found to be a promising new imaging biomarker to predict the outcomes of MT in AIS.
Clinical relevance statement
This study revealed that clot-based time attenuation curve based on admission perfusion CT could reflect the permeability and composition of thrombus and, also, provide valuable information to predict the clinical outcomes of mechanical thrombectomy in patients with acute ischemia stroke.
Key Points
• Two time-attenuation curves distributions achieved strong correlations (|r|= 0.627, p < 0.001) with histopathological results.
• The unimodal time-attenuation curve was independently associated with poor outcome (odds ratio, 0.08 0.02–0.31; p < 0.001).
• The time-attenuation curve distributions yielded a higher performance for detecting clinical outcome than routine clinical model (AUC, 0.78 0.70–0.87 vs 0.69 0.59–0.83; p < 0.001).
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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
La eficacia de la trombectomía mecánica en territorio carotídeo en las primeras 24horas se ha probado con trabajos publicados recientemente.
Revisión retrospectiva a partir de un registro prospectivo ...en nuestro centro de referencia de ictus para valorar la eficacia y seguridad del tratamiento endovascular realizado más allá de las 6horas de evolución de los síntomas en pacientes con ictus isquémico agudo y oclusión de gran vaso en territorio carotídeo, entre noviembre de 2016 y abril de 2019.
Se recopilaron datos de 59 pacientes (55,9% mujeres, mediana de edad 71 años). Treinta y tres pacientes fueron detectados al despertar. El 57,6% de los casos fueron traslados secundarios. La mediana de NIHSS basal fue 16. La mediana del ASPECTS fue 8 y el 94,9% de los pacientes presentó>50% de tejido salvable. El 88,1% de los pacientes logró una recanalización satisfactoria, en 5 pacientes después de 24horas de evolución. El 67,8% de los casos logró la independencia funcional a los 90 días de seguimiento. Los pacientes que no lograron la independencia funcional presentaban mayor edad, mayor proporción de fibrilación auricular, mayor tiempo punción-recanalización y mayor puntuación NIHSS, tanto basal como al alta.
En nuestra experiencia la trombectomía mecánica después de las 6horas se asoció con buenos resultados de funcionalidad a los 90 días. La edad, la puntuación NIHSS, el tiempo punción-recanalización y la prevalencia de fibrilación auricular fueron factores determinantes en el pronóstico funcional. La eficacia de este tratamiento por encima de las 24horas merece ser estudiada.
Thrombectomy in the carotid artery territory was recently shown to be effective up to 24hours after symptoms onset.
We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory.
Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting>50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge.
In our experience, mechanical thrombectomy beyond 6hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24hours after onset merits study.
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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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