Objectives
To describe the efficacy and safety of stent‐retriever thrombectomy in infants with thrombosis of the superior vena cava (SVC) and innominate vein.
Background
Thrombosis of the SVC and of ...the innominate vein is a potentially life threatening complication in infants during intensive care treatment following major surgical procedures. To avoid reoperations, we evaluated interventional revascularization by stent‐retriever thrombectomy.
Methods
From 2015 to 2017, five infants were diagnosed with acute thrombosis of the SVC and innominate vein following major cardiac or pediatric surgery. Using a femoral venous access and 4 or 5 French guiding catheters stent‐retriever systems (4/20 mm or 6/30 mm) were placed into the thrombus and retrieved under suction. We aimed to revascularize not only the SVC but also the innominate, jugular, and subclavian veins.
Results
Following repeated stent retrieving manoeuvers, we were able to reestablish flow in the major veins of all patients. Due to significant residual thrombotic material, we decided to perform additional balloon dilatation of the SVC and innominate vein in 3/5 patients. There were no complications related to the procedure and none of our patients required blood transfusion. Following the intervention, the patients received treatment with low‐molecular‐weight heparin. Interventional treatment achieved persistent patency of the SVC and innominate vein in all patients.
Conclusion
Stent‐retriever thrombectomy is a safe and effective method for interventional treatment of acute thrombosis of the central veins in infants. Due to the large amount of thrombotic material, it is frequently required to combine this method with balloon compression of residual thrombotic material.
To evaluate the feasibility of a multimodal approach involving dynamic contrast-enhanced (DCE) perfusion imaging and diffusion kurtosis imaging (DKI) in the preoperative imaging of brain tumors in a ...multicenter setting, and to evaluate the effect on diagnostic confidence and accuracy for tumor grade and type prediction.
One hundred and thirty-three patients with brain tumors were imaged in six hospitals with a standardized multimodal protocol. Standard imaging and six parameter maps derived from DCE and DKI sequences were reviewed off-site by two independent readers. Image quality and diagnostic confidence were evaluated in qualitative analyses. Quantitative analyses were performed to assess diagnostic accuracy and the performance of DKI and DCE parameters for tumor grade differentiation and molecular tumor type determination.
Standardized acquisition of DCE and DKI maps was feasible with excellent image quality. Diagnostic confidence was significantly improved from 85 % to 96 % (p = 0.0005) by additional review of the DCE and DKI maps. The combination of mean kurtosis and CBV was particularly advantageous for differentiating low-grade and high-grade glioma, oligodendroglial vs. astrocytic, and IDH1/2 wild type vs. mutated tumors.
A multimodal imaging approach with DCE and DKI improves diagnostic confidence and yields higher diagnostic accuracy for predicting tumor grade and type in adult-type glioma.
Aim
To assess how atypical language organization after early left‐hemispheric brain lesions affects grey matter in the contralesional hemisphere.
Method
This was a cross‐sectional study with ...between‐group comparisons of 14 patients (six female, 8–26 years) with perinatal left‐hemispheric brain lesions (two arterial ischemic strokes, 11 periventricular haemorrhagic infarctions, one without classification) and 14 typically developing age‐matched controls (TDC) with functional magnetic resonance imaging (fMRI) documented left‐hemispheric language organization (six female, 8–28 years). MRI data were analysed with SPM12, CAT12, and custom scripts. Language lateralization indices were determined by fMRI within a prefrontal mask and right‐hemispheric grey matter group differences by voxel‐based morphometry (VBM).
Results
FMRI revealed left‐dominance in seven patients with typical language organization (TYP) and right‐dominance in seven patients with atypical language organization (ATYP) of 14 patients. VBM analysis of all patients versus controls showed grey matter reductions in the middle temporal gyrus of patients. A comparison between the two patient subgroups revealed an increase of grey matter in the middle frontal gyrus in the ATYP group. Voxel‐based regression analysis confirmed that grey matter increases in the middle frontal gyrus were correlated with atypical language organization.
Interpretation
Compatible with a non‐specific lesion effect, we found areas of grey matter reduction in patients as compared to TDC. The grey matter increase in the middle frontal gyrus seems to reflect a specific compensatory effect in patients with atypical language organization.
What this paper adds
Perinatal stroke leads to decreased grey matter in the contralesional hemisphere.
Atypical language organization is associated with grey matter increases in contralesional language areas.
What this paper adds
Perinatal stroke leads to decreased grey matter in the contralesional hemisphere.
Atypical language organization is associated with grey matter increases in contralesional language areas.
This study assessed how unilateral early left‐hemispheric brain lesions affect grey matter volume in the contralesional hemisphere. We demonstrated that such patients had lower grey matter volumes in the contralesional hemisphere (middle temporal gyrus and supramarginal gyrus) as compared to typically developing controls. The major finding was an increase of grey matter volume in the middle frontal gyrus in patients with right‐hemispheric language as a consequence of early left‐sided stroke, suggesting a structural correlate of language reorganization in the right hemisphere.
This original article is commented on by Martin and Turkeltaub on pages 278–279 of this issue.
Background and Purpose
This study explores the use of deep learning (DL) techniques in MRI of the orbit to enhance imaging. Standard protocols, although detailed, have lengthy acquisition times. We ...investigate DL‐based methods for T2‐weighted and T1‐weighted, fat‐saturated, contrast‐enhanced turbo spin echo (TSE) sequences, aiming to improve image quality, reduce acquisition time, minimize artifacts, and enhance diagnostic confidence in orbital imaging.
Methods
In a 3‐Tesla MRI study of 50 patients evaluating orbital diseases from March to July 2023, conventional (TSES) and DL TSE sequences (TSEDL) were used. Two neuroradiologists independently assessed the image datasets for image quality, diagnostic confidence, noise levels, artifacts, and image sharpness using a randomized and blinded 4‐point Likert scale.
Results
TSEDL significantly reduced image noise and artifacts, enhanced image sharpness, and decreased scan time, outperforming TSES (p < .05). TSEDL showed superior overall image quality and diagnostic confidence, with relevant findings effectively detected in both DL‐based and conventional images. In 94% of cases, readers preferred accelerated imaging.
Conclusion
The study proved that using DL for MRI image reconstruction in orbital scans significantly cut acquisition time by 69%. This approach also enhanced image quality, reduced image noise, sharpened images, and boosted diagnostic confidence.
Spinal arachnoid web (SAW) is a rare disease entity characterized as band-like arachnoid tissue that can cause spinal cord compression and syringomyelia. This study aimed to analyze the surgical ...management of the spinal arachnoid web in patients with syringomyelia, focusing on surgical strategies and outcomes. A total of 135 patients with syringomyelia underwent surgery at our department between November 2003 and December 2022. All patients underwent magnetic resonance imaging (MRI), with a special syringomyelia protocol (including TrueFISP and CINE), and electrophysiology. Among these patients, we searched for patients with SAW with syringomyelia following careful analysis of neuroradiological data and surgical reports. The criteria for SAW were as follows: displacement of the spinal cord, disturbed but preserved CSF flow, and intraoperative arachnoid web. Patients were evaluated for initial symptoms, surgical strategies, and complications by reviewing surgical reports, patient documents, neuroradiological data, and follow-up data. Of the 135 patients, 3 (2.22%) fulfilled the SAW criteria. The mean patient age was 51.67 ± 8.33 years. Two patients were male, and one was female. The affected levels were T2/3, T6, and T8. Excision of the arachnoid web was performed in all cases. No significant change in intraoperative monitoring was noted. Postoperatively, none of the patients presented new neurological symptoms. The MRI 3 months after surgery revealed that the syringomyelia improved in all cases, and caliber variation of the spinal cord could not be detected anymore. All clinical symptoms improved. In summary, SAW can be safely treated by surgery. Even though syringomyelia usually improves on MRI and symptoms also improve, residual symptoms might be observed. We advocate for clear criteria for the diagnosis of SAW and a standardized diagnostic (MRI including TrueFISP and CINE).
In diffusion MRI, the advent of high angular resolution diffusion imaging (HARDI) and HARDI with compressed sensing (HARDI+CS) has led to clinically practical signal acquisition techniques which ...allow for the assessment of white matter architecture in routine patient studies. However, the reconstruction and visualization of fiber pathways by tractography has not yet been established as a standard methodology which can easily be applied. This is due to various algorithmic problems, such as a lack of robustness, error propagation and the necessity of fine-tuning parameters depending on the clinical question. In the framework of a clinical study of glioma patients, we compare two different whole-brain tracking methods to a local connectivity mapping approach which has recently shown promising results in an adaptation to diffusion MRI. The ability of the three methods to correctly depict fiber affection is analyzed by comparing visualization results to representations of local diffusion profiles provided by orientation distribution functions (ODFs). Our results suggest that methods beyond fiber tractography, which visualize local connectedness rather than global connectivity, should be evaluated further for pre-surgical assessment of fiber affection.
Early postnatal infection with human cytomegalovirus (hCMV) may contribute to an adverse cognitive outcome in early preterm-born children (PT). We here set out to explore whether long-term ...neurobiological consequences of such an infection are detectable using fMRI in children and adolescents who were born very preterm and who either did (PThCMV+ ) or did not (PT(hCMV-)) suffer from an early postnatal hCMV-infection, when compared with typically developing healthy control (HC) subjects. Overall, data from 71 children and adolescents could be included, 34 PT (of which 15 were PT(hCMV+) and 19 were PT(hCMV-)) and 37 HC. Using a recently established "dual use" fMRI task, we investigated language and visuospatial functions. There were significant activation differences in the left hippocampus (PT > HC and PT(hCMV+) > HC), and in the right anterior cingulate cortex (PT(hCMV-) > PT(hCMV+)) when performing the language task. Surprisingly, only a small region in the occipital cortex showed a significant activation difference (HC > PT(HCMV-)) when performing the visuospatial task. Targeted analyses revealed differences in gray matter volume, but not density, in several brain regions. Our results suggest that long-term neurobiological consequences of an early postnatal hCMV infection are detectable even in older children and adolescents formerly born very preterm, compatible with a higher effort when performing a cognitive task. This suggests that measures to prevent such an infection are warranted. Furthermore, an interrelation of brain structure and function was detected that may constitute a severe confound when using fMRI to compare structurally differing groups.
Fluid-attenuated inversion recovery (FLAIR) imaging is playing an increasingly significant role in the detection of brain metastases with a concomitant increase in the number of magnetic resonance ...imaging (MRI) examinations. Therefore, the purpose of this study was to investigate the impact on image quality and diagnostic confidence of an innovative deep learning-based accelerated FLAIR (FLAIR
) sequence of the brain compared to conventional (standard) FLAIR (FLAIR
) imaging.
Seventy consecutive patients with staging cerebral MRIs were retrospectively enrolled in this single-center study. The FLAIR
was conducted using the same MRI acquisition parameters as the FLAIR
sequence, except for a higher acceleration factor for parallel imaging (from 2 to 4), which resulted in a shorter acquisition time of 1:39 minute instead of 2:40 minutes (-38%). Two specialized neuroradiologists evaluated the imaging datasets using a Likert scale that ranged from 1 to 4, with 4 indicating the best score for the following parameters: sharpness, lesion demarcation, artifacts, overall image quality, and diagnostic confidence. Additionally, the image preference of the readers and the interreader agreement were assessed.
The average age of the patients was 63 ± 11years. FLAIR
exhibited significantly less image noise than FLAIR
, with P-values of< .001 and< .05, respectively. The sharpness of the images and the ability to detect lesions were rated higher in FLAIR
, with a median score of 4 compared to a median score of 3 in FLAIR
(P-values of<.001 for both readers). In terms of overall image quality, FLAIR
was rated superior to FLAIR
, with a median score of 4 vs 3 (P-values of<.001 for both readers). Both readers preferred FLAIR
in 68/70 cases.
The feasibility of deep learning FLAIR brain imaging was shown with additional 38% reduction in examination time compared to standard FLAIR imaging. Furthermore, this technique has shown improvement in image quality, noise reduction, and lesion demarcation.
Purpose
Patients with Moyamoya Angiopathy (MMA) require hemodynamic evaluation to assess the risk of stroke. Assessment of cerebral blood flow with
15
Owater PET and acetazolamide challenge is the ...diagnostic standard for the evaluation of the cerebral perfusion reserve (CPR). Estimation of the cerebrovascular reactivity (CVR) by use of breath-hold-triggered fMRI (bh-fMRI) as an index of CPR has been proposed as a reliable and more readily available approach. Recent findings suggest the use of resting-state fMRI (rs-fMRI) which requires minimum patient compliance. The aim of this study was to compare rs-fMRI to bh-fMRI and
15
Owater PET in patients with MMA.
Methods
Patients with MMA underwent rs-fMRI and bh-fMRI in the same MRI session. Maps of the CVR gained by both modalities were compared retrospectively by calculating the correlation between the mean CVR of 12 volumes of interest. Additionally, the rs-maps of a subgroup of patients were compared to CPR-maps gained by
15
Owater PET.
Results
The comparison of the rs-maps and the bh-maps of 24 patients revealed a good correlation (Pearson’s
r
= 0.71 ± 0.13; preoperative patients: Pearson’s
r
= 0.71 ± 0.17; postoperative patients: Pearson’s
r
= 0.71 ± 0.11). The comparison of 7 rs-fMRI data sets to the corresponding
15
Owater PET data sets also revealed a high level of agreement (Pearson’s
r
= 0.80 ± 0.19).
Conclusion
The present analysis indicates that rs-fMRI might be a promising non-invasive method with almost no patient cooperation needed to evaluate the CVR. Further prospective studies are required.
Purpose
Vessel-encoded arterial spin labeling (VE-ASL) is able to provide noninvasive information about the contribution of individual arteries to the cerebral perfusion. The aim of this study was to ...compare VE-ASL to the diagnostic standard digital subtraction angiography (DSA) with respect to its ability to visualize vascular territories.
Methods
In total, 20 VE-ASL and DSA data sets of 17 patients with Moyamoya angiopathy with and without revascularization surgery were retrospectively analyzed. Two neuroradiologists independently assessed the agreement between VE-ASL and DSA using a 4-point Likert scale (no- very high agreement). Additionally, grading of the vascular supply of subterritories (A1-A2, M1-M6) on the VE-ASL images and angiograms was performed. The intermodal agreement was calculated for all subterritories in total and for the subdivision into without and after revascularization (direct or indirect bypass).
Results
There was a very high agreement between the VE-ASL and the DSA data sets (median = 1, modus = 1) with a substantial inter-rater agreement (
k
w
= 0.762 (95% CI 0.561–0.963)). The inter-modality agreement between VE-ASL and DSA in vascular subterritories was almost perfect for all subterritories (
k
= 0.899 (0.865–0.945)), in the subgroup of direct revascularized subterritories (
k
= 0.827 (0.738–0.915)), in the subgroup of indirect revascularized subterritories (
k
= 0.843 (0.683–1.003)), and in the subgroup of never revascularized subterritories (
k
= 0.958 (0.899–1.017)).
Conclusion
Vessel-encoded ASL seems to be a promising non-invasive method to depict the contributions of individual arteries to the cerebral perfusion before and after revascularization surgery.
PDF
