Objectives
The aim of this study was to report our experience with early stage glioblastoma (e-GB) and to investigate the possible clinical and imaging features that may be helpful to the radiologist ...to correctly diagnose this entity.
Methods
We performed a retrospective research of patients diagnosed with glioblastoma at two hospitals during a 10-year period. We reviewed all pre-operative MR and included only patients with early stage GB lesions, characterized by hyperintense on T2-weighted signal, with or without contrast-enhancement at post-contrast T1-weighted images, without “classic” imaging appearance of GB (necrosis, haemorrhage, oedema). All preoperative MR were evaluated by an experienced neuroradiologist and information on patients’ demographics, clinical presentation, follow-up, and histopathology results study were collected. When available, preoperative CT examination was also evaluated.
Results
We found 14 e-GBs in 13 patients (9 males, 4 females, median age 63 years) among 660 patients diagnosed with GB between 2010 and 2020. In 10 lesions, serial imaging revealed the transformation of e-GB in classic glioblastoma in a median time of 3 months. Clinical presentation included stroke-like symptoms, vertigo, seizures and confusion. Preoperative plain CT was performed in 8/13 cases and in 7 e-GBs presented as a hyperdense lesion. Ten out of 14 lesions transformed in classic GB before surgical intervention or biopsy. All lesions revealed typical immunohistochemical pattern of primary glioblastoma.
Conclusions
E-GB is a rare entity that can often lead to misdiagnosis. However, the radiologist should be aware of its imaging appearance to suggest the diagnosis and to request close imaging follow-up, hopefully improving the prognosis of this very aggressive disease.
To evaluate outcomes and prognostic factors in patients with acute ischemic stroke caused by tandem internal carotid artery/middle cerebral artery occlusion undergoing endovascular treatment.
...Characteristics of consecutive patients with tandem occlusion (TO) were extracted from a prospective registry. Collateral vessel quality on pretreatment computed tomographic (CT) angiography was evaluated on a 4-point grading scale, and patients were dichotomized as having poor or good collateral flow. Outcome measures included successful reperfusion according to Thrombolysis In Cerebral Infarction score, good outcome at 3 months defined as a modified Rankin scale score ≤ 2, symptomatic intracranial hemorrhage (ICH; sICH), and mortality.
A total of 72 patients with TO (mean age, 65.6 y ± 12.8) were treated. Intravenous thrombolysis was performed in 54.1% of patients, and a carotid stent was inserted in 48.6%. Successful reperfusion was achieved in 64% of patients, and a good outcome was achieved in 32%. sICH occurred in 12.5% of patients, and the overall mortality rate was 32%. Univariate analysis demonstrated that good outcome was associated with good collateral flow (P = .0001), successful reperfusion (P = .001), and lower rate of any ICH (P = .02) and sICH (P = .04). On multivariate analysis, good collateral flow (odds ratio OR, 0.18; 95% confidence interval CI, 0.04-0.75; P = .01) and age (OR, 1.08; 95% CI, 1.01-1.15; P = .01) were the only predictors of good outcome. The use of more than one device for thrombectomy was the only predictor of sICH (OR, 10.74; 95% CI, 1.37-84.13; P = .02).
Endovascular treatment for TO resulted in good outcomes. Collateral flow and age were independent predictors of good clinical outcomes at 3 months.
Cerebral collateral circulation is a network of blood vessels which stabilizes blood flow and maintains cerebral perfusion whenever the main arteries fail to provide an adequate blood supply, as ...happens in ischemic stroke. These arterial networks are able to divert blood flow to hypoperfused cerebral areas. The extent of the collateral circulation determines the volume of the salvageable tissue, the so-called "
". Clinically, this is associated with greater efficacy of reperfusion therapies (thrombolysis and thrombectomy) in terms of better short- and long-term functional outcomes, lower incidence of hemorrhagic transformation and of malignant oedema, and smaller cerebral infarctions. Recent advancements in brain imaging techniques (CT and MRI) allow us to study these anastomotic networks in detail and increase the likelihood of making effective therapeutic choices. In this narrative review we will investigate the pathophysiology, the clinical aspects, and the possible diagnostic and therapeutic role of collateral circulation in acute ischemic stroke.
Background To minimize event rates in patients with elevated cardiovascular surgical risk, we investigated a new therapeutic strategy consisting of simultaneous hybrid revascularization by carotid ...artery stenting (CAS), immediately followed by coronary artery bypass grafting (CABG). Methods The study included 37 patients with severe carotid and coronary artery disease and a European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 5 or higher. Immediately after CAS, patients underwent CABG. The primary end point was the incidence of stroke, myocardial infarction, or death at 30 days. Secondary end points were a combination of transient ischemic attack, major local complications, bleeding, and systemic complications within the 30 days after treatment, and any stroke, acute myocardial infarction, or death from day 31 through to the end of the follow-up. All clinical outcomes were assessed by an independent monitoring board. Results The rate of procedural success was 97.3%. The 30-day cumulative incidence of disabling stroke, myocardial infarction, or death was 8.1%: 2 patients (5.4%) died, and 1 patient had a stroke immediately after carotid stenting. Another patient died between day 31 and 6 months after the intervention. Conclusions Our findings indicate that in elevated-surgical-risk patients with carotid stenosis and coronary artery disease suitable for CABG, hybrid revascularization by CAS, immediately followed by CABG, is a feasible and promising therapeutic strategy.
Hepatic encephalopathy (HE) is a complication of transjugular intrahepatic portosystemic shunt (TIPS).
Extend the knowledge about the early detection of multiple brain metabolic abnormalities ...following TIPS; these abnormalities can be detected and managed prior to the clinical manifestation of HE with use of Multiparametric Magnetic Resonance with Spectroscopy.
12 cirrhotic Patients underwent TIPS; each Patient underwent a 3 T MRI evaluation before and after TIPS. The spectroscopic images were processed measuring the values of the metabolites N-acetylaspartate (NAA) - Glutamine / Glutamate (Glx) - Colina (Cho) - Myinositol (mI) at the level of the nuclei of the base.
Spectroscopic examination performed before the TIPS procedure showed low values of Cho and Mi, instead following the procedure: an increase in the Glx value, a mean reduction in the values of Cho and mI, a statistically significant reduction in the Cho / Creatine ratio, in the mI / Creatine ratio and an increase of the Glx / Creatine ratio.
Our study demonstrated the efficacy of spectroscopy in Patient subjected to TIPS. MR 3 T with spectroscopy can become a valid tool for monitor the dynamics of changes in brain metabolism after TIPS and to provide an early diagnosis of HE allowing an early treatment.
Background Severely impaired patients with persisting intracranial occlusion despite standard treatment with intravenous (IV) administration of recombinant tissue plasminogen activator (rtPA) or ...presenting beyond the therapeutic window for IV rtPA may be candidates for interventional neurothrombectomy (NT). The safety and efficacy of NT by the Penumbra System (PS) were compared with standard IV rtPA treatment in patients with severe acute ischemic stroke (AIS) caused by large intracranial vessel occlusion in the anterior circulation. Methods Consecutive AIS patients underwent a predefined treatment algorithm based on arrival time, stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS) score, and site of arterial occlusion on computed tomographic angiography (CTA). NT was performed either after a standard dose of IV rtPA (bridging therapy BT) or as single treatment (stand-alone NT SAT). Rates of recanalization, symptomatic intracranial bleeding (SIB), mortality, and functional outcome in NT patients were compared with a historical cohort of IV rtPA treated patients (i.e., controls). Three-month favourable outcome was defined as a modified Rankin Scale (mRS) score ≤2. Results Forty-six AIS patients were treated with NT and 51 with IV rtPA. The 2 groups did not differ with regard to demographics, onset NIHSS score (18.5 ± 4 v 17 ± 5; P = .06), or site of intracranial occlusion. Onset-to-treatment time in the NT and IV rtPA groups was 230 minutes (±78) and 176.5 (±44) minutes, respectively ( P = .001). NT patients had significantly higher percentages of major improvement (≥8 points NIHSS score change at 24 hours; 26% v 10%; P = .03) and partial/complete recanalization (93.5% v 45%; P < .0001) compared to controls. Treatment by either SAT or BT similarly improved the chance of early recanalization and early clinical improvement. No significant differences were observed in the rate of SIB (11% v 6%), 3-month mortality (24% v 25%), or favorable outcome (40% v 35%) between NT and IV rtPA patients. Conclusions Despite significantly delayed time of intervention, NT patients had higher rates of recanalization and early major improvement, with no differences in symptomatic intracranial hemorrhages. Early NIHSS score improvement did not translate into better 3-month mortality or outcome. NT seems a safe and effective adjuvant treatment strategy for selected patients with severe AIS secondary to large intracranial vessel occlusion in the anterior circulation.
Purpose: To compare the safety and efficacy of
laser debulking (LD) and drug-eluting balloon (DEB) angioplasty to treatment
with DEB angioplasty alone in patients affected by critical limb ischemia ...(CLI)
and superficial femoral artery (SFA) chronic stent occlusion in a prospective,
randomized study.
Methods: Among 448 CLI patients treated from
December 2009 to March 2011, 48 patients (39 men; mean age 72.7±7.8
years) with chronic SFA in-stent occlusion were randomly assigned to treatment
using LD+DEB (n=24) or DEB angioplasty alone (n=24).
Patency at 12 months was the primary outcome measure; secondary outcomes were
target lesion revascularization (TLR) and clinical success at 12 months.
Results: In the LD+DEB group, the patency
rates at 6 and 12 months (91.7% and 66.7%, respectively) were
significantly higher (p=0.01) than in the DEB only patients (58.3%
and 37.5%, respectively). TLR at 12 months was 16.7% in the
LD+DEB group and 50% in the DEB only group (p=0.01). Two
(8%) patients needed major amputations in the LD+DEB group vs. 11
(46%) in the DEB only group at 12 months (p=0.003).
Conclusion: In this small initial experience,
combined treatment with LD and DEB angioplasty is correlated with better
outcomes in CLI patients with occluded SFA stents.
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