Neuroradiology 0028-3940

von Kummer, Rüdiger

doi: 10.1007/s00234-020-02608-4pmid: 33216152

Ganesh, Aravind; Ospel, Johanna M.; Kromm, Julie; Goyal, Mayank

doi: 10.1007/s00234-020-02592-9pmid: 33128573

Di Nora, Concetta; Nalli, Chiara; Vendramin, Igor; Livi, Ugolino

doi: 10.1007/s00234-020-02572-zpmid: 33026462

Pasquini, Luca; Guarnera, Alessia; Rossi-Espagnet, Maria Camilla; Napolitano, Antonio; Diodato, Daria; Martinelli, Diego; Longo, Daniela

doi: 10.1007/s00234-020-02593-8pmid: 33145628

Leonini, Sara; Bertelli, Eugenio; Bracco, Sandra; Guasti, Andrea

doi: 10.1007/s00234-020-02587-6pmid: 33074360

Opitz, Marcel; Wetter, Axel; Guberina, Nika

doi: 10.1007/s00234-020-02594-7pmid: 33141236

de Morais, Rafaela Queiroz; de Melo, Alessandro Severo Alves; Corrêa, Diogo Goulart

doi: 10.1007/s00234-020-02544-3pmid: 32889580

Sun, Yingying; Guo, Zhen-Ni; Yan, Xiuli; Wang, Meiqi; Zhang, Peng; Qin, Haiqiang; Wang, Yan; Zhu, Hongjing; Yang, Yi

doi: 10.1007/s00234-020-02530-9pmid: 32844236

Endovascular treatment (EVT) has been widely used for treating acute ischemic stroke (AIS). However, the safety and efficacy of treating AIS with tirofiban combined with EVT remain controversial. Therefore, we conducted a meta-analysis to evaluate this treatment. Randomized controlled trials and cohort studies that compared treatment with tirofiban combined with EVT and EVT alone were included in our meta-analysis. Those published from inception to March 31, 2020, were searched using the PubMed, Web of Science, Embase, and Cochrane Library databases. Safety was assessed based on symptomatic intracranial hemorrhage (sICH) incidence and 3-month mortality. Efficacy was assessed based on modified Rankin Scale (mRS) scores at 3 months post-EVT and recanalization rates. Data were analyzed using either the random-effects or fixed-effects model based on the heterogeneity of studies. In total, one RCT, six prospective studies, and four retrospective studies (2387 AIS cases) were assessed. Our meta-analysis showed that tirofiban combined with EVT did not increase sICH risk (RR, 1.06; 95%CI, 0.79 to 1.42; P = 0.72) and 3-month mortality (RR, 0.87; 95%CI, 0.74 to 1.04; P = 0.12). Recanalization rates were not significantly different between patients treated with tirofiban combined with EVT and those treated with EVT alone (RR, 1.04; 95%CI, 1.00 to 1.08; P = 0.07), but tirofiban combined with EVT was significantly associated with favorable functional outcomes (mRS score, 0–2) in AIS patients (RR, 1.13; 95%CI, 1.02 to 1.25; P = 0.02). Tirofiban combined with EVT appears to be safe and potentially effective in treating AIS.

Miah, Ishita P.; Tank, Yeliz; Rosendaal, Frits R.; Peul, Wilco C.; Dammers, Ruben; Lingsma, Hester F.; den Hertog, Heleen M.; Jellema, Korné; van der Gaag, Niels A.; ,

doi: 10.1007/s00234-020-02558-xpmid: 33094383

PurposeChronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery.MethodsElectronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity.ResultsTwenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69–4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04–1.80 and RR 1.76 95% CI 1.38–2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45–2.21 and RR 1.38, 95% CI 1.11–1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98–1.84).LimitationsLimitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study.ConclusionsHyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures.

van Ommen, Fasco; Dankbaar, Jan Willem; Zhu, Guangming; Wolman, Dylan N.; Heit, Jeremy J.; Kauw, Frans; Bennink, Edwin; de Jong, Hugo W. A. M.; Wintermark, Max

doi: 10.1007/s00234-020-02492-ypmid: 32728777

PurposeEarly infarcts are hard to diagnose on non-contrast head CT. Dual-energy CT (DECT) may potentially increase infarct differentiation. The optimal DECT settings for differentiation were identified and evaluated.MethodsOne hundred and twenty-five consecutive patients who presented with suspected acute ischemic stroke (AIS) and underwent non-contrast DECT and subsequent DWI were retrospectively identified. The DWI was used as reference standard. First, virtual monochromatic images (VMI) of 25 patients were reconstructed from 40 to 140 keV and scored by two readers for acute infarct. Sensitivity, specificity, positive, and negative predictive values for infarct detection were compared and a subset of VMI energies were selected. Next, for a separate larger cohort of 100 suspected AIS patients, conventional non-contrast CT (NCT) and selected VMI were scored by two readers for the presence and location of infarct. The same statistics for infarct detection were calculated. Infarct location match was compared per vascular territory. Subgroup analyses were dichotomized by time from last-seen-well to CT imaging.ResultsA total of 80–90 keV VMI were marginally more sensitive (36.3–37.3%) than NCT (32.4%; p > 0.680), with marginally higher specificity (92.2–94.4 vs 91.1%; p > 0.509) for infarct detection. Location match was superior for VMI compared with NCT (28.7–27.4 vs 19.5%; p < 0.010). Within 4.5 h from last-seen-well, 80 keV VMI more accurately detected infarct (58.0 vs 54.0%) and localized infarcts (27.1 vs 11.9%; p = 0.004) than NCT, whereas after 4.5 h, 90 keV VMI was more accurate (69.3 vs 66.3%).ConclusionNon-contrast 80–90 keV VMI best differentiates normal from infarcted brain parenchyma.