Neuroradiology

von Kummer, Rüdiger

doi: 10.1007/s00234-021-02868-8pmid: 34859287

Sundgren, Pia; Lövblad, Karl-Olof

doi: 10.1007/s00234-021-02870-0pmid: 34837496

Talaat, Maichael; Premat, Kévin; Lenck, Stéphanie; Shotar, Eimad; Boch, Anne-Laure; Bessar, Awad; Taema, Mohammed; Hassan, Farouk; Elserafy, Tamer S.; Degos, Vincent; Sourour, Nader; Clarençon, Frédéric

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Gaddamanugu, Siddhartha; Shafaat, Omid; Sotoudeh, Houman; Sarrami, Amir Hossein; Rezaei, Ali; Saadatpour, Zahra; Singhal, Aparna

doi: 10.1007/s00234-021-02819-3pmid: 34596716

Diffusion-weighted imaging (DWI) is a well-established MRI sequence for diagnosing early stroke and provides therapeutic implications. However, DWI yields pertinent information in various other brain pathologies and helps establish a specific diagnosis and management of other central nervous system disorders. Some of these conditions can present with acute changes in neurological status and mimic stroke. This review will focus briefly on diffusion imaging techniques, followed by a more comprehensive description of the utility of DWI in common neurological entities beyond stroke.

Smits, Marion; Vernooij, M. W.; Bargalló, N.; Ramos, A.; Yousry, T. A.

doi: 10.1007/s00234-021-02722-xpmid: 33974110

PurposeThe purpose of this survey was to understand the impact the Covid-19 pandemic has or has had on the work, training, and wellbeing of professionals in the field of diagnostic neuroradiology.MethodsA survey was emailed to all ESNR members and associates as well as distributed via professional social media channels. The survey was held in the summer of 2020 when the first wave had subsided in most of Europe, while the second wave was not yet widespread. The questionnaire featured a total of 46 questions on general demographics, the various phases of the healthcare crisis, and the numbers of Covid-19 patients.ResultsOne hundred sixty-seven responses were received from 48 countries mostly from neuroradiologists (72%). Most commonly taken measures during the crisis phase were reduction of outpatient exams (87%), reduction of number of staff present in the department (83%), reporting from home (62%), and shift work (54%). In the exit phase, these measures were less frequently applied, but reporting from home was still frequent (33%). However, only 22% had access to a fully equipped work station at home. While 81% felt safe at work during the crisis, fewer than 50% had sufficient personal protection equipment for the duration of the entire crisis. Mental wellbeing is an area of concern, with 61% feeling (much) worse than usual. Many followed online courses/congresses and considered these a viable alternative for the future.ConclusionThe Covid-19 pandemic substantially affected the professional life as well as personal wellbeing of neuroradiologists.

Arnett, Nathan; Pavlou, Athanasios; Burke, Morgan P.; Cucchiara, Brett L.; Rhee, Rennie L.; Song, Jae W.

doi: 10.1007/s00234-021-02724-9pmid: 33938989

PurposeBeyond vessel wall enhancement, little is understood about vessel wall MR imaging (VW-MRI) features of vasculitis affecting the central nervous system (CNS). We reviewed vessel wall MR imaging patterns of inflammatory versus infectious vasculitis and also compared imaging patterns for intracranial versus extracranial arteries of the head and neck.MethodsStudies reporting vasculitis of the CNS/head and neck and included MR imaging descriptions of vessel wall features were identified by searching PubMed, Scopus, Cochrane, Web of Science, and EMBASE up to June 10, 2020. From 6065 publications, 115 met the inclusion criteria. Data on study characteristics, vasculitis type, MR details, and VW-MRI descriptions were extracted.ResultsStudies used VW-MRI for inflammatory (64%), infectious (17%), or both inflammatory and infectious vasculitides (19%). Vasculitis affecting intracranial versus extracranial arteries were reported in 58% and 39% of studies, respectively. Commonly reported VW-MRI features were vessel wall enhancement (89%), thickening (72%), edema (10%), and perivascular enhancement (16%). Inflammatory vasculitides affecting the intracranial arteries were less frequently reported to have vessel wall thickening (p = 0.006) and perivascular enhancement (p = 0.001) than extracranial arteries. Varicella zoster/herpes simplex vasculitis (VZV/HSV, 45%) and primary angiitis of the CNS (PACNS, 22%) were the most commonly reported CNS infectious and inflammatory vasculitides, respectively. Patients with VZV/HSV vasculitis more frequently showed decreased or resolution of vessel wall enhancement after therapy compared to PACNS (89% versus 59%).ConclusionsTo establish imaging biomarkers of vessel wall inflammation in the CNS, VW-MRI features of vasculitis accounting for disease mechanism and anatomy should be better understood.

Johansson, Elias; Gu, Thomas; Fox, Allan J.

doi: 10.1007/s00234-021-02728-5pmid: 33944975

PurposeCreate a new definition of near-occlusion with full collapse to predicting recurrent stroke.MethodsPooled analysis of two studies. Patients with symptomatic ≥ 50% carotid stenoses were included. Outcome was preoperative recurrent ipsilateral ischemic stroke or retinal artery occlusion within 28 days of presenting event. We analyzed several artery diameters on computed tomography angiography and stenosis velocity on ultrasound.ResultsA total of 430 patients with symptomatic ≥ 50% carotid stenosis were included, 27% had near-occlusion. By traditional definition, 27% with full collapse and 11% without full collapse reached the outcome (p = 0.047). Distal internal carotid artery (ICA) diameter, ICA ratio, and ICA-to-external carotid artery ratio were associated with the outcome. Best new definition of full collapse was distal ICA diameter ≤ 2.0 mm and/or ICA ratio ≤ 0.42. With this new definition, 36% with full collapse and 4% without full collapse reached the outcome (p < 0.001).ConclusionsDefining near-occlusion with full collapse as distal ICA diameter ≤ 2.0 mm and/or ICA ratio ≤ 0.42 seems to yield better prognostic discrimination than the traditional appearance-based definition. This novel definition can be used in prognostic and treatment studies of near-occlusion with full collapse.

Bernsen, Marie Louise E.; Veendrick, Peter B.; Martens, Jasper M.; Pijl, Milan E. J.; Hofmeijer, Jeannette; van Gorp, Maarten J.

doi: 10.1007/s00234-021-02736-5pmid: 34046731

PurposeTo determine whether spectral detector CT (SDCT) with a plain non-enhanced monochromatic CT, a water-weighted image after iodine removal, an iodine map, and Mono energetic images changes the diagnosis and classification of intracranial hemorrhage based on single energy CT after endovascular treatment (EVT) for ischemic stroke.MethodsTwo readers evaluated single energy and SD CT data collected from 63 patients within one week after EVT. They diagnosed ICH or contrast staining, and graded ICH according to the Heidelberg and Safe Implementation of Thrombolysis in Stroke–Monitoring Study (SITS-MOST) classification. Differences in diagnosis between single energy and SD CT were tested with Pearson's chi-squared test. Diagnostic values of single energy CT were calculated. Interrater agreement was based on Cohen’s Kappa.ResultsWhen spectral data were added to single energy CT, the diagnosis of ICH changed in 8 CT scans (13%): in 4, the diagnosis of ICH was rejected and in 4, initially undetected ICH was diagnosed. In an additional 3 patients, the ICH grade was modified. CT alone had 88% sensitivity, 87% specificity, 88% positive diagnostic value, 87% negative diagnostic value, and 87% overall accuracy for ICH compared to SDCT. Interreader agreement on the presence of ICH was 0.84 (95% CI 0.51–0.86) for spectral CT and 0.84 (95% CI 0.73–0.97) for single energy CT.ConclusionSD CT after endovascular treatment contributes to the distinction between intracranial hemorrhage and contrast staining.

Kulanthaivelu, Karthik; Peer, Sameer; Biswas, Shamick; Prasad, Chandrajit; Saini, Jitender; Pendharkar, Hima S.; Gupta, Arun Kumar; Ramalingaiah, Arvinda Hanumanthapura; Srinivas, Dwarakanath

doi: 10.1007/s00234-021-02721-ypmid: 34128085

Ben, Zhifei; Wang, Jue; Zhan, Jinyong; Chen, Saijun

doi: 10.1007/s00234-021-02757-0pmid: 34251500

PurposeThis study aimed to retrospectively analyze the ultrasonographic images of 46 cases of carotid web (CW) and summarize their manifestations to reduce the rate of misdiagnosis.MethodsFor the analysis of ultrasonic manifestations, 46 patients with a confirmed diagnosis of CW by digital subtraction angiography (DSA) and CT angiography (CTA) in our hospital from January 2015 to October 2020 were collected. The location and the morphology of CW, the presence of a plaque at the base and thrombus at the surrounding of the CW, and whether they resulted in arteriostenosis were discussed.ResultsThe average age of 46 patients was 43.23 ± 4.89 years old and there were 18 males and 28 females. Fifteen patients were admitted with cerebral infarction. The CW was located at the initial segment of the internal carotid artery in 22 cases, the bifurcation of the carotid artery in 20 cases, and the common carotid artery in 4 cases. CW in 5 patients was longer than half of the artery diameter, two patients with “cliff-like” arteriostenosis, 29 patients with plaques, and 16 patients with thrombi. The CW grew in the direction of the blood flow without obvious fluttering. The CW has a higher display rate on the ultrasound longitudinal section than the transverse section.ConclusionWe identified some typical ultrasound characteristics of CW. Recognizing them will improve diagnostic accuracy of CW by ultrasonography.