Background
Embolic stroke of undetermined source (ESUS) accounts for up to 25% of ischemic strokes. Identification of biomarkers that could improve the prediction of stroke subtype and subsequently ...of stroke prevention still remains a major issue.
Methods
The HIBISCUS‐STROKE cohort includes ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy following admission magnetic resonance imaging. Presence and length of susceptibility vessel sign (SVS) were assessed by gradient‐recalled echo T2*‐weighted imaging. Matrix metalloproteinase‐9 (MMP‐9) was measured on sera collected at admission. A multiple logistic regression model was performed to detect independent markers distinguishing cardioembolic (CE) from large‐artery atherosclerosis (LAA) subtype.
Results
A total of 147 patients were included, of them the etiology was distributed as follows: 86 (58.5%) CE, 26 (17.7%) LAA, and 35 (23.8%) ESUS. The optimal cutoff for differentiating CE from LAA subtype was 14.5 mm for SVS length (sensitivity, 79.7%; specificity, 72.7%) and 1110 ng/ml for admission MMP‐9 level (sensitivity, 85.3%; specificity, 52.2%). Multivariate analysis revealed that current smoking (odds ratio OR 0.07, 95% confidence interval CI 0.01–0.93), tandem occlusion (OR 0.01, 95% CI 0.01–0.21), SVS length (OR 0.78, 95% CI 0.63–0.97), and admission MMP‐9 level (OR 0.99, 95% CI 0.99–1.00) were inversely associated with CE subtype. SVS length and MMP‐9 level did not differ between ESUS and CE subtypes.
Conclusion
SVS length and admission MMP‐9 level may improve the prediction of CE subtype whose profile is close to ESUS, thus suggesting a common cardiac embolic source.
ABSTRACTWe evaluated the reproducibility of I-ioflupane (I-FP-CIT) SPECT with shorter scan times using a CZT camera. One hundred ninety-nine I-FP-CIT SPECT scans obtained with standard scan time (30 ...minutes) were truncated to provide 24-, 18-, and 15-minute study simulations. Striatal binding ratios were automatically calculated and remained stable for all series. At 15 minutes, only 10 of 398 striata (2.5%) showed statistically significant different striatal binding ratios compared with reference series. These series were reviewed by 2 operators, and a perfect agreement was found for each patient. Therefore, CZT camera allows a 2-fold scan time reduction in I-FP-CIT SPECT.
Objective
Currently, the diagnosis of bone flap osteomyelitis (BFO) remains a challenge for medical imaging. The present study aimed to identify predictive scintigraphic patterns of BFO.
Methods
This ...retrospective study reviewed planar bone scan of patients with suspected BFO between 2010, and 2016. A total of 15 patients were included. Final diagnosis of BFO was obtained by histological and bacteriological documentation. Eight scintigraphic signs potentially helpful were reviewed and correlated with the final diagnosis individually or in combination through Fischer exact test.
Results
Eight patients out of 15 (53.3%) were diagnosed with BFO. Radionuclide uptake inside the bone flap during blood-pool phase was predictive for BFO (
p
= 0.007) with 75.0% sensitivity 100% specificity, and 86.7% accuracy. In combination, radionuclide uptake inside the bone flap or a spreading wavefront between blood-pool and delayed phases was associated with BFO (
p
= 0.007). It did not improve diagnostic performance.
Conclusion
Using well-defined and reproducible scintigraphic signs, bone scan is helpful for the diagnosis of BFO.
Purpose
Atlas-duplication is an exceedingly rare dysplasia of the craniocervical junction. To the best of our knowledge, only two cases of atlas-duplication have been reported and these were ...associated with complete anterior rachischisis and
os odontoideum
. We aimed to report a case of isolated atlas-duplication of incidental finding and without attributable symptoms which makes it unique.
Methods
Following a normal coronarography for a suspected myocardial infarction, a 60-year-old-man with no significant medical history developed a transient ischemic attack that justified brain computed-tomography angiography.
Results
There was no evidence for cerebral ischemic lesion, intracranial occlusion or significant artery disease. Bone analysis revealed eight cervical vertebral segments with an additional vertebral level located between the occiput and the atlas. This vertebra presented all the morphological characteristics of an atlas vertebra except for hypoplasia of the left transverse process. An incomplete anterior rachischisis was associated, and there was no other abnormality of craniocervical junction. The clinical examination revealed no neck pain, no limitation of joint amplitude and no neurological deficit. Apart from preventive treatment of ischemic stroke, no orthopedic or surgical treatment was undertaken. After 1.5 years of radiological monitoring, the patient remains symptom-free.
Conclusions
Atlas-duplication is an exceedingly rare dysplasia of the craniocervical junction that may be found isolated and incidentally. If this variation does not necessarily warrant specific treatment, brain CT angiography is recommended to detect anatomical variations of the vertebral arteries.
Background
One of the main limitations of
99m
technetium-dimercaptosuccinic acid (DMSA) scan is the long acquisition time.
Objective
To evaluate the feasibility of short DMSA scan acquisition times ...using a cadmium-zinc-telluride-based single-photon emission computed tomography (SPECT) system in children.
Materials and methods
The data of 27 children (median age: 4 years; 16 girls) who underwent DMSA SPECT were retrospectively analyzed. Both planar and SPECT DMSA were performed. SPECT images were analyzed using coronal-simulated planar two-dimensional images. A reduction in SPECT acquisition time was simulated to provide 4 series (SPECT-15 min, SPECT-10 min, SPECT-5 min and SPECT-2.5 min). A direct comparison of the planar and SPECT series was performed, including semi-quantification reproducibility, image quality (mean quality score on a scale of 0 to 2) and inter- and intra-observer reproducibility of the scintigraphic patterns.
Results
The overall image quality score (± standard deviation) was 1.3 (± 0.6) for the planar data set, 1.6 (± 0.5) for the SPECT-15 min data set, 1.4 (± 0.5) for the SPECT-10 min data set, 1.0 (± 0.5) for the SPECT-5 min data set and 0.6 (± 0.6) for the SPECT-2.5 min data set. Median Kappa coefficients for inter-observer agreement between planar and SPECT images were greater than 0.83 for all series and all readers except one reader for the SPECT-2.5 min series (median Kappa coefficient = 0.77).
Conclusion
Shortening SPECT acquisitions to 5 min is feasible with minimal impact on images in terms of quality and reproducibility.
Graphical Abstract
Previous studies have suggested the role of microcalcifications in plaque vulnerability. This exploratory study sought to assess the potential of hybrid positron-emission tomography (PET)/magnetic ...resonance imaging (MRI) using 18F-sodium fluoride (18F-NaF) to check simultaneously 18F-NaF uptake, a marker of microcalcifications, and morphological criteria of vulnerability.
We included 12 patients with either recently symptomatic or asymptomatic carotid stenosis. All patients underwent 18F-NaF PET/MRI. 18F-NaF target-to-background ratio (TBR) was measured in culprit and nonculprit (including contralateral plaques of symptomatic patients) plaques as well as in other arterial walls. Morphological criteria of vulnerability were assessed on MRI. Mineral metabolism markers were also collected. 18F-NaF uptake was higher in culprit compared to nonculprit plaques (median TBR 2.6 2.2-2.8 vs 1.7 1.3-2.2; P = 0.03) but was not associated with morphological criteria of vulnerability on MRI. We found a positive correlation between 18F-NaF uptake and calcium plaque volume and ratio but not with circulating tissue-nonspecific alkaline phosphatase (TNAP) activity and inorganic pyrophosphate (PPi) levels. 18F-NaF uptake in the other arterial walls did not differ between symptomatic and asymptomatic patients.
18F-NaF PET/MRI may be a promising tool for providing additional insights into the plaque vulnerability.
Differentiating neoplastic from non-neoplastic spinal cord pathologies may be challenging due to overlapping clinical and radiological features. Spinal cord tumors, which comprise only 2-4% of ...central nervous system tumors, are rarer than non-tumoral myelopathies of inflammatory, vascular, or infectious origins. The risk of neurological deterioration and the high rate of false negatives or misdiagnoses associated with spinal cord biopsies require a cautious approach. Facing a spinal cord lesion, prioritizing more common non-surgical myelopathies in differential diagnoses is essential. A comprehensive radiological diagnostic approach is mandatory to identify spinal cord tumor mimics. The diagnostic process involves a multi-step approach: detecting lesions primarily using MRI techniques, precise localization of lesions, assessing lesion signal intensity characteristics, and searching for potentially associated anomalies at spinal cord and cerebral MRI. This review aims to delineate the radiological diagnostic approach for spinal cord lesions that may mimic tumors and briefly highlight the primary pathologies behind these lesions.
PURPOSEThe aim of this study was to determine the minimum acquisition time without decreasing lesion detectability of bone SPECT using a whole-body cadmium-zinc-telluride camera.
METHODSPatients ...referred for bone SPECT were retrospectively included. SPECT of 30 patients were reframed from native data (16 s/projection) to produce 10-, 5-, and 3-s/projection data sets. A “critical” acquisition time/projection was defined as that below which the SPECT quality becomes insufficient for interpretation, as determined by 3 reviewers using a 4-point scale (0 = quality insufficient for interpretation, 1 = average, 2 = good, 3 = excellent). Three reviewers (blinded to the acquisition time) evaluated SPECT data sets (n = 79), native and reframed with “critical” acquisition times, in a randomized order. A lesion was defined as any uptake considered pathological by a reviewer. Lesion detectability equivalence between native SPECT and reframed SPECT was assessed by calculating a coefficient (κ) for each reviewer.
RESULTSImage quality of the first sample (n = 30) was significantly and progressively less well graded for the reframed data sets by all reviewers. Only 1 patient was graded 0 by each reviewer for the 5-s/projection data set. For the 3-s/projection data set, 3 patients were graded 0. No patients were graded 0 for 10-s/projection data set. The minimal acquisition time, for each projection, was defined as 5 s/projection. The coefficient κ, between native and reframed, with critical acquisition time/projection SPECT was greater than 0.9 for each reviewer.
CONCLUSIONSThe more contrasted images of the cadmium-zinc-telluride camera allow performance of 5-s/projection SPECT without loss of lesion detectability. This suggests the possibility of performing whole-body SPECT in a reasonable time or reducing injected doses, especially in pediatric patients.
The relevance of the brush-sign remained poorly documented in large vessel occlusion (LVO). We aimed to assess the relationship between the brush-sign and collateral status and its potential impact ...on baseline diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) in acute ischemic stroke (AIS) patients eligible to mechanical thrombectomy (MT).
Consecutive patients admitted in the Lyon Stroke Center with anterior circulation AIS due to intracranial internal carotid artery (ICA) and/or M1 or M2 segment of the middle cerebral artery (MCA) occlusion eligible for MT were included. The brush-sign was assessed on T2-gradient-echo MRI. Collateral status was assessed on digital subtraction angiography according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score.
In this study, 504 patients were included, among which 171 (33.9%) patients had a brush-sign. Patients with a brush-sign more frequently had a poor collateral status 72 (42.1%) vs. 103 (30.9%);
= 0.017. In univariable analysis, a DWI-ASPECTS < 7 was associated with a brush sign. Following multivariable analysis, the brush-sign no longer affected DWI-ASPECTS < 7 while the latter remained associated with younger age odds ratio (OR) 0.97, 95% CI.96-0.99, male sex (OR 1.79, 95% CI 1.08-2.99), a higher National Institutes of Health Stroke Scale (NIHSS) score (OR 1.16, 95% CI 1.1-1.21), a poor collateral status (OR 9.35, 95% CI 5.59-16.02), MCA segment (OR 2.54, 95% CI 1.25-5.38), and intracranial ICA (OR 3.01, 95% CI 1.16-8) occlusion.
The brush-sign may be a marker of poor collateral status but did not independently predict a lower DWI-ASPECTS.
ClinicalTrials.gov, identifier: NCT04620642.
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