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Thomann P, Häni L, Vulcu S, Schütz A, Frosch M, Jesse CM, El-Koussy M, Söll N, Hakim A, Raabe A, Schucht P. P18.10.B Natural history of meningiomas - a serial volumetric analysis of 240 tumors. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The management of asymptomatic intracranial meningiomas is controversial. Through the assessment of growth predictors, we aimed to create the basis for practicable clinical pathways for the management of these tumors.
Material and Methods
We volumetrically analyzed meningiomas radiologically diagnosed at our institution between 2003 and 2015. For this purpose, we used exclusively thin-layered MR images (i.e. ≤ 2mm slice thickness). The primary endpoint was tumor growth defined as a 14.35% increase in tumor volume. We identified predictive clinical and radiological characteristics and used the significant variables from a multivariable regression model to construct a decision tree based on the exhaustive Chi-squared Automatic Interaction Detection (exhaustive CHAID) algorithm.
Results
Of 240 meningiomas, 159 (66.3%) demonstrated growth during a mean observation period of 46.9 months. On multivariable logistic regression analysis, older age (OR=0.979 (0.958-1.000), p=0.048) and presence of calcification (OR=0.442 (0.224-0.872), p=0.019) had a negative predictive value for tumor growth, while T2-signal iso-/hyperintensity (OR=4.415 (2.056-9.479), p<0.001) had a positive predictive value. A decision tree model yielded three growth risk groups based on T2-signal intensity and presence of calcifications with a proportion of growing tumors of 34.1% in the low risk group, 60.0% in the intermediate risk group and 80.2% in the high risk group. Median tumor volume doubling time (Td) was 185.7 months in the low risk, 100.1 months in the intermediate risk and 51.7 months in the high risk group (p<0.001). While 0% of meningiomas in the low and intermediate risk group had a Td of ≤12 months, 8.9% in the high risk group did so (p=0.021).
Conclusion
Most meningiomas demonstrated growth during follow-up. The presence or absence of calcifications and the signal intensity on T2-weighted imaging allow a practical and simple stratification of meningiomas into low, intermediate and high risk tumors. Small tumors in the low or intermediate risk categories can be monitored with longer follow-up intervals, whereas in the high risk category proactive management decisions can be justified.
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Affiliation(s)
- P Thomann
- University Hospital Bern , Bern , Switzerland
| | - L Häni
- University Hospital Bern , Bern , Switzerland
| | - S Vulcu
- University Hospital Bern , Bern , Switzerland
| | - A Schütz
- University Hospital Bern , Bern , Switzerland
| | - M Frosch
- Medical Center - University of Freiburg , Freiburg , Germany
| | - C M Jesse
- University Hospital Bern , Bern , Switzerland
| | - M El-Koussy
- Hospital of Emmental , Burgdorf , Switzerland
| | - N Söll
- University Hospital Bern , Bern , Switzerland
| | - A Hakim
- University Hospital Bern , Bern , Switzerland
| | - A Raabe
- University Hospital Bern , Bern , Switzerland
| | - P Schucht
- University Hospital Bern , Bern , Switzerland
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Hakim A, Kurmann C, Pospieszny K, Meinel TR, Shahin MA, Heldner MR, Umarova R, Jung S, Arnold M, El-Koussy M. Diagnostic Accuracy of High-Resolution 3D T2-SPACE in Detecting Cerebral Venous Sinus Thrombosis. AJNR Am J Neuroradiol 2022; 43:881-886. [PMID: 35618422 DOI: 10.3174/ajnr.a7530] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/12/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Assessment of cerebral venous sinus thrombosis on MR imaging can be challenging. The aim of this study was to evaluate the diagnostic accuracy of high-resolution 3D T2 sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE) in patients with cerebral venous sinus thrombosis and to compare its performance with contrast-enhanced 3D T1-MPRAGE. MATERIALS AND METHODS We performed a blinded retrospective analysis of T2-SPACE and contrast-enhanced MPRAGE sequences from patients with cerebral venous sinus thrombosis and a control group. The results were compared with a reference standard, which was based on all available sequences and clinical history. Subanalyses were performed according to the venous segment involved and the clinical stage of the thrombus. RESULTS Sixty-three MR imaging examinations from 35 patients with cerebral venous sinus thrombosis and 51 examinations from 40 control subjects were included. The accuracy, sensitivity, and specificity calculated from the initial MR imaging examination for each patient were 100% each for T2-SPACE and 95%, 91%, and 98%, respectively, for contrast-enhanced MPRAGE. The interrater reliability was high for both sequences. In the subanalysis, the accuracy for each venous segment involved and if subdivided according to the clinical stage of thrombus was ≥95% and ≥85% for T2-SPACE and contrast-enhanced MPRAGE, respectively. CONCLUSIONS Both T2-SPACE and contrast-enhanced MPRAGE offer high accuracy for the detection and exclusion of cerebral venous sinus thrombosis; however, T2-SPACE showed a better overall performance and thus could be a useful tool if included in a multiparametric MR imaging protocol for the diagnosis of cerebral venous sinus thrombosis, especially in scenarios where gadolinium administration is contraindicated.
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Affiliation(s)
- A Hakim
- From the University Institute of Diagnostic and Interventional Neuroradiology (A.H., C.K., K.P., M.E.), Bern University Hospital, Inselspital, Inselspital, University of Bern, Bern, Switzerland
| | - C Kurmann
- From the University Institute of Diagnostic and Interventional Neuroradiology (A.H., C.K., K.P., M.E.), Bern University Hospital, Inselspital, Inselspital, University of Bern, Bern, Switzerland
| | - K Pospieszny
- From the University Institute of Diagnostic and Interventional Neuroradiology (A.H., C.K., K.P., M.E.), Bern University Hospital, Inselspital, Inselspital, University of Bern, Bern, Switzerland
| | - T R Meinel
- Department of Neurology (T.R.M., M.R.H., R.U., S.J., M.A.), Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - M A Shahin
- Department of Radiodiagnosis (M.A.S.), Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - M R Heldner
- Department of Neurology (T.R.M., M.R.H., R.U., S.J., M.A.), Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - R Umarova
- Department of Neurology (T.R.M., M.R.H., R.U., S.J., M.A.), Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - S Jung
- Department of Neurology (T.R.M., M.R.H., R.U., S.J., M.A.), Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - M Arnold
- Department of Neurology (T.R.M., M.R.H., R.U., S.J., M.A.), Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - M El-Koussy
- From the University Institute of Diagnostic and Interventional Neuroradiology (A.H., C.K., K.P., M.E.), Bern University Hospital, Inselspital, Inselspital, University of Bern, Bern, Switzerland
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3
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Andereggen L, Frey J, Andres RH, Luedi MM, El-Koussy M, Widmer HR, Beck J, Mariani L, Seiler RW, Christ E. First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center. J Endocrinol Invest 2021; 44:2621-2633. [PMID: 33847973 PMCID: PMC8572196 DOI: 10.1007/s40618-021-01569-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/31/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT Although consensus guidelines recommend dopamine agonists (DAs) as the first-line approach in prolactinomas, some patients may opt instead for upfront surgery, with the goal of minimizing the need for continuation of DAs over the long term. While this approach can be recommended in selected patients with a microprolactinoma, the indication for upfront surgery in macroprolactinomas remains controversial, with limited long-term data in large cohorts. We aimed at elucidating whether first-line surgery is equally safe and effective for patients with micro- or macroprolactinomas not extending beyond the median carotid line (i.e., Knosp grade ≤ 1). METHODOLOGY Retrospective study of patients with prolactinomas Knosp grade ≤ 1 treated with upfront surgery. The primary endpoint was patients' dependence on DAs at last follow-up. The secondary endpoint was postoperative complications. Independent risk factors for long-term dependence on DAs were analyzed. RESULTS A microadenoma was noted in 45 patients (52%) and a macroadenoma in 41 (48%), with 17 (20%) harboring a Knosp grade 1 prolactinoma. Median follow-up was 80 months. First-line surgery resulted in long-term remission in 31 patients (72%) with a microprolactinoma and in 18 patients (45%) with a macroprolactinoma (p = 0.02). DA therapy was ultimately required in 11 patients (24%) with microadenomas vs. 20 (49%) with macroadenomas (p = 0.03). As for the latter, DA was required in 13 patients (76%) with Knosp grade 1 macroadenomas vs. 7 patients (29%) with Knosp grade 0 macroadenomas (p = 0.004). There was no mortality, and morbidity was minimal. Knosp grade 1 prolactinomas (OR 7.3, 95% CI 1.4-37.7, p = 0.02) but not adenoma size (i.e., macroprolactinomas) were an independent predictor of long-term dependence on DAs. CONCLUSIONS First-line surgery in patients with microprolactinomas or macroprolactinomas Knosp grade 0 resulted in a good chance of non-dependency on DA therapy. However, in patients with prolactinomas Knosp grade 1, first-line surgery cannot be recommended, as adjuvant DA therapy after surgery is required in the majority of them over the long term.
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Affiliation(s)
- L Andereggen
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - J Frey
- Department of Endocrinology, Diabetes, Nutrition and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Gynecology and Obstetrics, Kantonsspital Lucerne, Lucerne, Switzerland
| | - R H Andres
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - M M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M El-Koussy
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - H R Widmer
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - J Beck
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - L Mariani
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - R W Seiler
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - E Christ
- Department of Endocrinology, Diabetes and Metabolism, University Hospital of Basel, Basel, Switzerland
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Balsiger F, Steindel C, Arn M, Wagner B, El-Koussy M, Rösler K, Valenzuela W, Reyes M, Scheidegger O. P13. Semi-automatic, machine-learning based segmentation of peripheral nerves for quantitative morphometry: Comparison of low- and high-resolution MR neurography. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kellner-Weldon F, El-Koussy M, Jung S, Jossen M, Klinger-Gratz PP, Wiest R. Cerebellar Hypoperfusion in Migraine Attack: Incidence and Significance. AJNR Am J Neuroradiol 2018; 39:435-440. [PMID: 29326138 DOI: 10.3174/ajnr.a5508] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/05/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients diagnosed with migraine with aura have an increased lifetime risk of ischemic stroke. It is not yet clear whether prolonged cortical hypoperfusion during an aura increases the immediate risk of cerebellar infarction because it may induce crossed cerebellar diaschisis and subsequent tissue damage. To address this question, we retrospectively analyzed potential relationships between cortical oligemia and cerebellar hypoperfusion in patients with migraine with aura and their potential relation to small infarct-like cerebellar lesions. MATERIALS AND METHODS One hundred six migraineurs who underwent MR imaging, including DSC perfusion, were included in the study. In patients with apparent perfusion asymmetry, we used ROI analysis encompassing 18 infra- and supratentorial ROIs to account for differences in regional cerebral blood flow and volume. The presence of cerebellar hypoperfusion was calculated using an asymmetry index, with values of >10% being considered significant. RESULTS We observed perfusion asymmetries in 23/106 patients, 22 in patients with migraine with aura (20.8%). Cerebellar hypoperfusion was observed in 12/23 patients (52.2%), and crossed cerebellar diaschisis, in 9/23 patients (39.1%) with abnormal perfusion. In none of the 106 patients were DWI restrictions observed during migraine with aura. CONCLUSIONS Cerebellar hypoperfusion and crossed cerebellar diaschisis are common in patients with migraine with aura and cortical perfusion abnormalities. Crossed cerebellar diaschisis in migraine with aura may be considered a benign phenomenon because we observed no association with DWI restriction or manifest cerebellar infarctions, even in patients with prolonged symptom-related perfusion abnormalities persisting for up to 24 hours.
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Affiliation(s)
- F Kellner-Weldon
- From the Support Center for Advanced Neuroimaging (F.K.-W., M.E.-K., M.J., P.P.K.-G., R.W.), Institute for Diagnostic and Interventional Neuroradiology
| | - M El-Koussy
- From the Support Center for Advanced Neuroimaging (F.K.-W., M.E.-K., M.J., P.P.K.-G., R.W.), Institute for Diagnostic and Interventional Neuroradiology
| | - S Jung
- Department of Neurology (S.J.), University Hospital Inselspital, Bern, Switzerland
| | - M Jossen
- From the Support Center for Advanced Neuroimaging (F.K.-W., M.E.-K., M.J., P.P.K.-G., R.W.), Institute for Diagnostic and Interventional Neuroradiology
| | - P P Klinger-Gratz
- From the Support Center for Advanced Neuroimaging (F.K.-W., M.E.-K., M.J., P.P.K.-G., R.W.), Institute for Diagnostic and Interventional Neuroradiology
- Department of Radiology (P.P.K.-G.), University of Basel, Basel, Switzerland
| | - R Wiest
- From the Support Center for Advanced Neuroimaging (F.K.-W., M.E.-K., M.J., P.P.K.-G., R.W.), Institute for Diagnostic and Interventional Neuroradiology
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6
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De Marchis GM, Katan M, Barro C, Fladt J, Traenka C, Seiffge DJ, Hert L, Gensicke H, Disanto G, Sutter R, Peters N, Sarikaya H, Goeggel-Simonetti B, El-Koussy M, Engelter S, Lyrer PA, Christ-Crain M, Arnold M, Kuhle J, Bonati LH. Serum neurofilament light chain in patients with acute cerebrovascular events. Eur J Neurol 2018; 25:562-568. [PMID: 29281157 DOI: 10.1111/ene.13554] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Serum neurofilaments are markers of axonal injury. We addressed their diagnostic and prognostic role in acute ischemic stroke (AIS) and transient ischemic attack (TIA). METHODS Nested within a prospective cohort study, we compared levels of serum neurofilament light chain (sNfL) drawn within 24 h from symptom onset in patients with AIS or TIA. Patients without magnetic resonance imaging on admission were excluded. We assessed whether sNfL was associated with: (i) clinical severity on admission, (ii) diagnosis of AIS vs. TIA, (iii) infarct size on admission magnetic resonance diffusion-weighted imaging (MR-DWI) and (iv) functional outcome at 3 months. RESULTS We analyzed 504 patients with AIS and 111 patients with TIA. On admission, higher National Institutes of Health Stroke Scale (NIHSS) scores were associated with higher sNfL: NIHSS score < 7, 13.1 pg/mL [interquartile range (IQR), 5.3-27.8]; NIHSS score 7-15, 16.7 pg/mL (IQR, 7.4-34.9); and NIHSS score > 15, 21.0 pg/mL (IQR, 9.3-40.4) (P = 0.01). Compared with AIS, patients with TIA had lower sNfL levels [9.0 pg/mL (95% confidence interval, 4.0-19.0) vs. 16.0 pg/mL (95% confidence interval, 7.3-34.4), P < 0.001], also after adjusting for age and NIHSS score (P = 0.006). Among patients with AIS, infarct size on admission MR-DWI was not associated with sNfL, either in univariate analysis (P = 0.15) or after adjusting for age and NIHSS score on admission (P = 0.56). Functional outcome 3 months after stroke was not associated with sNfL after adjusting for established predictors. CONCLUSIONS In conclusion, among patients admitted within 24 h of AIS or TIA onset, admission sNfL levels were associated with clinical severity on admission and TIA diagnosis, but not with infarct size on MR-DWI acquired on admission or functional outcome at 3 months.
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Affiliation(s)
- G M De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - M Katan
- Department of Neurology, University Hospital Zurich, Zurich
| | - C Barro
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - J Fladt
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - C Traenka
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - D J Seiffge
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - L Hert
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - H Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - G Disanto
- Department of Neurology, Neurocenter of Southern Switzerland, Lugano
| | - R Sutter
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel.,Department of Intensive Care Medicine, University Hospital Basel, University of Basel, Basel
| | - N Peters
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - H Sarikaya
- Department of Neurology, Inselspital, Bern
| | - B Goeggel-Simonetti
- Department of Neurology, Inselspital, Bern.,Department of Pediatrics, San Giovanni Hospital, Bellinzona
| | - M El-Koussy
- Department of Neuroradiology, Inselspital, Bern
| | - S Engelter
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - P A Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - M Christ-Crain
- Department of Internal Medicine and Department of Clinical Research, Division of Endocrinology, Diabetology and Metabolism, University Hospital Basel, University of Basel, Basel, Switzerland
| | - M Arnold
- Department of Neurology, Inselspital, Bern
| | - J Kuhle
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
| | - L H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel
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McKinley R, Häni L, Gralla J, El-Koussy M, Bauer S, Arnold M, Fischer U, Jung S, Mattmann K, Reyes M, Wiest R. Fully automated stroke tissue estimation using random forest classifiers (FASTER). J Cereb Blood Flow Metab 2017; 37:2728-2741. [PMID: 27798267 PMCID: PMC5536784 DOI: 10.1177/0271678x16674221] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several clinical trials have recently proven the efficacy of mechanical thrombectomy for treating ischemic stroke, within a six-hour window for therapy. To move beyond treatment windows and toward personalized risk assessment, it is essential to accurately identify the extent of tissue-at-risk ("penumbra"). We introduce a fully automated method to estimate the penumbra volume using multimodal MRI (diffusion-weighted imaging, a T2w- and T1w contrast-enhanced sequence, and dynamic susceptibility contrast perfusion MRI). The method estimates tissue-at-risk by predicting tissue damage in the case of both persistent occlusion and of complete recanalization. When applied to 19 test cases with a thrombolysis in cerebral infarction grading of 1-2a, mean overestimation of final lesion volume was 30 ml, compared with 121 ml for manually corrected thresholding. Predicted tissue-at-risk volume was positively correlated with final lesion volume ( p < 0.05). We conclude that prediction of tissue damage in the event of either persistent occlusion or immediate and complete recanalization, from spatial features derived from MRI, provides a substantial improvement beyond predefined thresholds. It may serve as an alternative method for identifying tissue-at-risk that may aid in treatment selection in ischemic stroke.
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Affiliation(s)
- Richard McKinley
- 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Levin Häni
- 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - M El-Koussy
- 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - S Bauer
- 2 Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - M Arnold
- 3 Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - U Fischer
- 3 Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - S Jung
- 3 Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Kaspar Mattmann
- 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Mauricio Reyes
- 2 Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - Roland Wiest
- 1 Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
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Mueller L, Pult F, Meisterernst J, Heldner MR, Mono ML, Kurmann R, Buehlmann M, Fischer U, Mattle HP, Arnold M, Mordasini P, Gralla J, Schroth G, El-Koussy M, Jung S. Impact of intravenous thrombolysis on recanalization rates in patients with stroke treated with bridging therapy. Eur J Neurol 2017. [DOI: 10.1111/ene.13330] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L. Mueller
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - F. Pult
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - J. Meisterernst
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - M. R. Heldner
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - M.-L. Mono
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - R. Kurmann
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - M. Buehlmann
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - U. Fischer
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - H. P. Mattle
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - M. Arnold
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
| | - P. Mordasini
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - J. Gralla
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - G. Schroth
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - M. El-Koussy
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
| | - S. Jung
- Department of Neurology; Inselspital; University Hospital Bern, Bern and University of Bern; Bern
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Bern; Bern Switzerland
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Wapp M, Everts R, Burren Y, Kellner-Weldon F, El-Koussy M, Wiest R, Federspiel A, Michel P, Schroth G. Cognitive improvement in patients with carotid stenosis is independent of treatment type. Swiss Med Wkly 2015; 145:w14226. [DOI: 10.4414/smw.2015.14226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Gratz PP, Schroth G, Gralla J, Mattle HP, Fischer U, Jung S, Mordasini P, Hsieh K, Verma RK, Weisstanner C, El-Koussy M. Whole-Brain Susceptibility-Weighted Thrombus Imaging in Stroke: Fragmented Thrombi Predict Worse Outcome. AJNR Am J Neuroradiol 2015; 36:1277-82. [PMID: 25792535 DOI: 10.3174/ajnr.a4275] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/11/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE The prevalence and clinical importance of primarily fragmented thrombi in patients with acute ischemic stroke remains elusive. Whole-brain SWI was used to detect multiple thrombus fragments, and their clinical significance was analyzed. MATERIALS AND METHODS Pretreatment SWI was analyzed for the presence of a single intracranial thrombus or multiple intracranial thrombi. Associations with baseline clinical characteristics, complications, and clinical outcome were studied. RESULTS Single intracranial thrombi were detected in 300 (92.6%), and multiple thrombi, in 24 of 324 patients (7.4%). In 23 patients with multiple thrombi, all thrombus fragments were located in the vascular territory distal to the primary occluding thrombus; in 1 patient, thrombi were found both in the anterior and posterior circulation. Only a minority of thrombus fragments were detected on TOF-MRA, first-pass gadolinium-enhanced MRA, or DSA. Patients with multiple intracranial thrombi presented with more severe symptoms (median NIHSS scores, 15 versus 11; P = .014) and larger ischemic areas (median DWI ASPECTS, 5 versus 7; P = .006); good collaterals, rated on DSA, were fewer than those in patients with a single thrombus (21.1% versus 44.2%, P = .051). The presence of multiple thrombi was a predictor of unfavorable outcome at 3 months (P = .040; OR, 0.251; 95% CI, 0.067-0.939). CONCLUSIONS Patients with multiple intracranial thrombus fragments constitute a small subgroup of patients with stroke with a worse outcome than patients with single thrombi.
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Affiliation(s)
- P P Gratz
- From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.)
| | - G Schroth
- From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.)
| | - J Gralla
- From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.)
| | - H P Mattle
- Neurology (H.P.M., U.F., S.J.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - U Fischer
- Neurology (H.P.M., U.F., S.J.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - S Jung
- From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.) Neurology (H.P.M., U.F., S.J.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - P Mordasini
- From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.)
| | - K Hsieh
- From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.)
| | - R K Verma
- From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.)
| | - C Weisstanner
- From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.)
| | - M El-Koussy
- From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G., G.S., J.G., S.J., P.M., K.H., R.K.V., C.W., M.E.-K.)
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Heldner MR, Mattle HP, Jung S, Fischer U, Gralla J, Zubler C, El-Koussy M, Schroth G, Arnold M, Mono ML. Thrombolysis in patients with prior stroke within the last 3 months. Eur J Neurol 2014; 21:1493-9. [DOI: 10.1111/ene.12519] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 05/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. R. Heldner
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
| | - H. P. Mattle
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
| | - S. Jung
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - U. Fischer
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
| | - J. Gralla
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - C. Zubler
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - M. El-Koussy
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - G. Schroth
- Institute of Diagnostic and Interventional Neuroradiology; Inselspital; University of Bern; Bern Switzerland
| | - M. Arnold
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
| | - M.-L. Mono
- Department of Neurology and Stroke Center; Inselspital; University of Bern; Bern Switzerland
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12
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De Marchis GM, Katan M, Weck A, Fluri F, Foerch C, Findling O, Schuetz P, Buhl D, El-Koussy M, Gensicke H, Seiler M, Morgenthaler N, Mattle HP, Mueller B, Christ-Crain M, Arnold M. Copeptin adds prognostic information after ischemic stroke: Results from the CoRisk study. Neurology 2013; 80:1278-86. [DOI: 10.1212/wnl.0b013e3182887944] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Fischer U, Mono ML, Schroth G, Jung S, Mordasini P, El-Koussy M, Weck A, Brekenfeld C, Findling O, Galimanis A, Heldner MR, Arnold M, Mattle HP, Gralla J. Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery. Eur J Neurol 2013; 20:1017-24, e87. [DOI: 10.1111/ene.12094] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/11/2012] [Indexed: 11/28/2022]
Affiliation(s)
- U. Fischer
- Department of Neurology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - M.-L. Mono
- Department of Neurology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - G. Schroth
- Department of Neuroradiology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - S. Jung
- Department of Neurology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
- Department of Neuroradiology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - P. Mordasini
- Department of Neuroradiology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - M. El-Koussy
- Department of Neuroradiology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - A. Weck
- Department of Neurology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - C. Brekenfeld
- Department of Neuroradiology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - O. Findling
- Department of Neurology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - A. Galimanis
- Department of Neurology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - M. R. Heldner
- Department of Neurology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - M. Arnold
- Department of Neurology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - H. P. Mattle
- Department of Neurology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
| | - J. Gralla
- Department of Neuroradiology; Inselspital; University Hospital Bern; University of Bern; Bern Switzerland
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14
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Jung S, Gralla J, Fischer U, Mono ML, Weck A, Lüdi R, Heldner MR, Findling O, El-Koussy M, Brekenfeld C, Schroth G, Mattle HP, Arnold M. Safety of endovascular treatment beyond the 6-h time window in 205 patients. Eur J Neurol 2013; 20:865-71. [DOI: 10.1111/ene.12069] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 11/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - J. Gralla
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - U. Fischer
- Department of Neurology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - M.-L. Mono
- Department of Neurology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - A. Weck
- Department of Neurology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - R. Lüdi
- Department of Neurology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - M. R. Heldner
- Department of Neurology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - O. Findling
- Department of Neurology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - M. El-Koussy
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - C. Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - G. Schroth
- Department of Diagnostic and Interventional Neuroradiology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - H. P. Mattle
- Department of Neurology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
| | - M. Arnold
- Department of Neurology; Inselspital; University Hospital Bern and University of Berne; Berne; Switzerland
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Andereggen L, El-Koussy M, Gralla J, Arnold M, Andres R, Beck J, Schroth G, Raabe A, Reinert M. Quantification of Blood Flow after Carotid Endarterectomy Using Quantitative MR-Phasecontrast Technology: Is there a Predictive Value for Hyperperfusion? J Neurol Surg A Cent Eur Neurosurg 2012. [DOI: 10.1055/s-0032-1316253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Mordasini P, Brekenfeld C, Fischer U, Arnold M, El-Koussy M, Schroth G, Mattle HP, Gralla J. Passing the thrombus in endovascular treatment of acute ischemic stroke: do we penetrate the thrombus? Neuroradiol J 2012; 25:243-50. [PMID: 24028923 DOI: 10.1177/197140091202500216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 03/13/2012] [Indexed: 11/16/2022] Open
Abstract
Mechanical thrombectomy is increasingly applied during the treatment of acute stroke. Various devices have been advocated with different sites of force effect at the thrombus. The purpose of this study was to evaluate the angiographic route of passing systematically and therefore to assess the site of deployment of mechanical devices in correlation to the thrombus in interventional stroke treatment. Twenty-one consecutive patients with endovascular treatment for acute ischemic stroke with 26 passing procedures were evaluated prospectively. Occlusion site was the M1-segment in 17 cases (65.4%), ICA termination in five cases (19.2%), M2-segment in two cases (7.7%), the A2-segment in one case (3.8%) and basilar artery in one case (3.8%). On angiographic images the microwire and microcatheter passage was evaluated by illustrating the entry point and course across the occlusion site in relation to the thrombus in different projections and in correlation to the recanalisation result. Results were correlated to the origin of the thrombi according to the TOAST criteria. In all cases the point of entry to the occlusion site was delineated laterally to the thrombus in at least one projection. The course of the wire across the occluded segment in relation to the thrombus was found to be laterally in 22 procedures (84.6%). In the majority of M1-occlusions (12/17, 70.6%) the passage was found in the cranial aspect of the thrombus. In four procedures (15.4%) angiograms in different projections did not unequivocally confirm a passage laterally to the thrombus. The route of passing the thrombus was independent of thrombus origin according to the TOAST criteria. In the majority of cases the complete route of passing the occlusion site was visualized angiographically. Entrance of the microwire and microcatheter at proximal surface of the thrombus takes place laterally to the thrombus and accordingly the passage takes place between the thrombus and the vessel wall independent of thrombus origin. A penetration of the thrombus was not observed. This route of passing has implications on deployment and transmission of force in relation to the thrombus in mechanical approaches and consequently on the development of retrieval devices.
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Affiliation(s)
- P Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University of Berne; Berne, Switzerland -
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17
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Mordasini P, El-Koussy M, Brekenfeld C, Schroth G, Fischer U, Beck J, Gralla J. Applicability of tableside flat panel detector CT parenchymal cerebral blood volume measurement in neurovascular interventions: preliminary clinical experience. AJNR Am J Neuroradiol 2012; 33:154-8. [PMID: 21960501 DOI: 10.3174/ajnr.a2715] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CBV is a vital perfusion parameter in estimating the viability of brain parenchyma (eg, in cases of ischemic stroke or after interventional vessel occlusion). Recent technologic advances allow parenchymal CBV imaging tableside in the angiography suite just before, during, or after an interventional procedure. The aim of this work was to analyze our preliminary clinical experience with this new imaging tool in different neurovascular interventions. MATERIALS AND METHODS FPD-CBV measurement was performed on a biplane FPD angiographic system. Eighteen patients (11 women, 7 men) were examined (age range, 18-86 years; median, 58.7 years). In the 10 patients with stroke, the extent of intracranial hypoperfusion was evaluated. The remaining 8 patients had an intracranial hemorrhage; periprocedural CBV was evaluated during the course of interventional treatment. RESULTS In the 18 cases studied, 23 CBV measurements were performed. Twenty acquisitions were of sufficient diagnostic quality. The remaining 3 acquisitions failed technically, 1 due to motion artifacts and 2 due to injection technique and/or hardware failure. CONCLUSIONS FPD-CBV measurement in the angiography suite provides a feasible and helpful tool for peri-interventional neuroimaging. It extends the intraprocedural imaging modalities to the level of tissue perfusion. However, the technique has technical limitations and shows room for improvement in the future.
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Affiliation(s)
- P Mordasini
- Department of Interventional and Diagnostic Neuroradiology, Inselspital, University of Bern, Switzerland
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18
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El-Koussy M, Schroth G, Gralla J, Brekenfeld C, Andres RH, Jung S, Shahin MA, Lovblad KO, Kiefer C, Kottke R. Susceptibility-weighted MR imaging for diagnosis of capillary telangiectasia of the brain. AJNR Am J Neuroradiol 2011; 33:715-20. [PMID: 22194370 DOI: 10.3174/ajnr.a2893] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE BCT is a benign entity, whose appearance on conventional MR imaging makes its differentiation from neoplastic, inflammatory, or subacute ischemic disease challenging. SWI is sensitive to susceptibility effects from deoxyhemoglobin with excellent spatial resolution. Only scarce case reports have described the utility of SWI in cases of BCT. Our aim was to show the diagnostic value of SWI applied to a larger series of cases. MATERIALS AND METHODS This was an observational retrospective study of 33 BCTs in 27 consecutive patients examined from August 2009 to January 2011 with MR imaging, including SWI. Morphology, signal intensity characteristics, and additional vascular malformations were analyzed. Preceding or follow-up examinations were available in 18 patients with a median time interval of 14.5 months (range, 2-115 months). RESULTS Twenty-five pontine and 8 supratentorial BCTs demonstrated distinct signal-intensity loss on SWI in combination with postcontrast enhancement. Mean lesion diameter was 4.9 mm (range, 1.5-17 mm). Thirty-nine percent showed slight signal-intensity changes on T1 and/or T2; the remainder were isointense to normal brain. In 30%, a prominent draining vessel was observed. Additional cerebral vascular malformations were found in 5 patients. CONCLUSIONS SWI represents a valuable tool for confirmation of presumed BCT. Demonstration of signal-intensity loss on SWI in an enhancing focal brain lesion, otherwise unremarkable on conventional MR images, is highly specific for BCT, thus excluding serious pathology and reassuring the patient and referring physician. This is particularly helpful for BCT in less typical locations.
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Affiliation(s)
- M El-Koussy
- Institute of Diagnostic and Interventional Neuroradiology, University Bern, Inselspital, Bern, Switzerland.
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Brekenfeld C, Schroth G, Mordasini P, Fischer U, Mono ML, Weck A, Arnold M, El-Koussy M, Gralla J. Impact of retrievable stents on acute ischemic stroke treatment. AJNR Am J Neuroradiol 2011; 32:1269-73. [PMID: 21566010 DOI: 10.3174/ajnr.a2494] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Retrievable stents combine the high recanalization rate of stents and the capability of removing the thrombus offered by mechanical thrombectomy devices. We hypothesized that retrievable stents shorten time to recanalization in the multimodal approach for endovascular stroke treatment. MATERIALS AND METHODS Forty consecutive patients with acute ischemic stroke and undergoing endovascular therapy were included. Treatment included thromboaspiration, thrombus disruption, thrombolysis, PTA, and stent placement. In 17 patients, a retrievable stent was used (group A) in addition to multimodal therapy. The remaining 23 patients constituted group B. Baseline characteristics, occlusion sites, urokinase dose, recanalization rate, and time to recanalization were compared between the groups. RESULTS Median NIHSS scores were higher in group A compared with group B on admission (19 versus 12.5; P = .018) but were not significantly different at day 1 (14 versus 10; P = .6). Intra-arterial thrombolysis was used in significantly fewer patients of group A than group B (53% versus 87%, respectively; P = .017), and median urokinase dose was lower in group A than in group B (250,000 IU versus 700,000 IU; P = .006). Time to recanalization was significantly shorter in group A compared with group B (median time to recanalization 52.5 minutes versus 90 minutes, respectively; P = .001). Recanalization rate was higher in group A than group B (94% versus 78%; P = .17). CONCLUSIONS Addition of retrievable stents to the multimodal endovascular approach for acute ischemic stroke treatment significantly reduces time to recanalization and further increases the recanalization rate.
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Affiliation(s)
- C Brekenfeld
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland.
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Brekenfeld C, Gralla J, Mattle HP, El-Koussy M, Schroth G. Thrombolyse der Arteria cerebri media. Radiologe 2009; 49:312-8. [DOI: 10.1007/s00117-008-1773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Brekenfeld C, Tinguely P, Schroth G, Arnold M, El-Koussy M, Nedeltchev K, Byrne JV, Gralla J. Percutaneous transluminal angioplasty and stent placement in acute vessel occlusion: evaluation of new methods for interventional stroke treatment. AJNR Am J Neuroradiol 2009; 30:1165-72. [PMID: 19299491 DOI: 10.3174/ajnr.a1541] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The major goal of acute ischemic stroke treatment is fast and sufficient recanalization. Percutaneous transluminal balloon angioplasty (PTA) and/or placement of a stent might achieve both by compressing the thrombus at the occlusion site. This study assesses the feasibility, recanalization rate, and complications of the 2 techniques in an animal model. MATERIALS AND METHODS Thirty cranial vessels of 7 swine were occluded by injection of radiopaque thrombi. Fifteen vessel occlusions were treated by PTA alone and 15, by placement of a stent and postdilation. Recanalization was documented immediately after treatment and after 1, 2, and 3 hours. Thromboembolic events and dissections were documented. RESULTS PTA was significantly faster to perform (mean, 16.6 minutes versus 33.0 minutes for stent placement; P < .001), but the mean recanalization rate after 1 hour was significantly better after stent placement compared with PTA alone (67.5% versus 14.6%, P < .001). Due to the self-expanding force of the stent, vessel diameter further increased with time, whereas the recanalization result after PTA was prone to reocclusion. Besides thromboembolic events related to the passing maneuvers at the occlusion site, no thrombus fragmentation and embolization occurred during balloon inflation or stent deployment. Flow to side branches could also be restored at the occlusion site because it was possible to direct thrombus compression. CONCLUSIONS Stent placement and postdilation proved to be much more efficient in terms of acute and short-term vessel recanalization compared with PTA alone.
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Affiliation(s)
- C Brekenfeld
- Institute of Interventional and Diagnostic Neuroradiology, University of Bern, Switzerland
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22
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Guzman R, Lovblad KO, Altrichter S, Remonda L, de Koning P, Andres RH, El-Koussy M, Kelly ME, Reiber JHC, Schroth G, Oswald H, Barth A. Clinical validation of an automated vessel-segmentation software of the extracranial-carotid arteries based on 3D-MRA: a prospective study. J Neuroradiol 2008; 35:278-85. [PMID: 18707758 DOI: 10.1016/j.neurad.2008.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the accuracy of automated vessel-segmentation software for vessel-diameter measurements based on three-dimensional contrast-enhanced magnetic resonance angiography (3D-MRA). METHOD In 10 patients with high-grade carotid stenosis, automated measurements of both carotid arteries were obtained with 3D-MRA by two independent investigators and compared with manual measurements obtained by digital subtraction angiography (DSA) and 2D maximum-intensity projection (2D-MIP) based on MRA and duplex ultrasonography (US). In 42 patients undergoing carotid endarterectomy (CEA), intraoperative measurements (IOP) were compared with postoperative 3D-MRA and US. RESULTS Mean interoperator variability was 8% for measurements by DSA and 11% by 2D-MIP, but there was no interoperator variability with the automated 3D-MRA analysis. Good correlations were found between DSA (standard of reference), manual 2D-MIP (rP=0.6) and automated 3D-MRA (rP=0.8). Excellent correlations were found between IOP, 3D-MRA (rP=0.93) and US (rP=0.83). CONCLUSION Automated 3D-MRA-based vessel segmentation and quantification result in accurate measurements of extracerebral-vessel dimensions.
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Affiliation(s)
- R Guzman
- Department of Neurosurgery, Inselspital, Bern, Switzerland
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Hruz P, Lövblad K, Nirkko A, Thoeny H, El-Koussy M, Danuser H. Identification of brain structures involved in micturition with functional magnetic resonance imaging (fMRI). J Neuroradiol 2008; 35:144-9. [DOI: 10.1016/j.neurad.2007.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Guzman R, Altrichter S, El-Koussy M, Gralla J, Weis J, Barth A, Seiler RW, Schroth G, Lövblad KO. Contribution of the apparent diffusion coefficient in perilesional edema for the assessment of brain tumors. J Neuroradiol 2008; 35:224-9. [PMID: 18420272 DOI: 10.1016/j.neurad.2008.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Diffusion-weighted MRI is sensitive to molecular motion and has been applied to the diagnosis of stroke. Our intention was to investigate its usefulness in patients with brain tumor and, in particular, in the perilesional edema. METHODS We performed MRI of the brain, including diffusion-weighted imaging and mapping of the apparent diffusion coefficient (ADC), in 16 patients with brain tumors (glioblastomas, low-grade gliomas and metastases). ADC values were determined by the use of regions of interest positioned in areas of high signal intensities as seen on T2-weighted images and ADC maps. Measurements were taken in the tumor itself, in the area of perilesional edema and in the healthy contralateral brain. RESULTS ADC mapping showed higher values of peritumoral edema in patients with glioblastoma (1.75 x 10(-3)mm(2)/s) and metastatic lesions (1.61 x 10(-3)mm(2)/s) compared with those who had low-grade glioma (1.40 x10(-3)mm(2)/s). The higher ADC values in the peritumoral zone were associated with lower ADC values in the tumor itself. CONCLUSIONS The higher ADC values in the more malignant tumors probably reflect vasogenic edema, thereby allowing their differentiation from other lesions.
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Affiliation(s)
- R Guzman
- Department of Neurosurgery, Inselspital, University of Berne, Berne, Switzerland
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Lövblad KO, Altrichter S, Viallon M, Sztajzel R, Delavelle J, Vargas MI, El-Koussy M, Federspiel A, Sekoranja L. Neuro-imaging of cerebral ischemic stroke. J Neuroradiol 2008; 35:197-209. [PMID: 18329713 DOI: 10.1016/j.neurad.2008.01.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Major progress has recently been made in the neuro-imaging of stroke as a result of improvements in imaging hardware and software. Imaging may be based on either magnetic resonance imaging (MRI) or computed tomography (CT) techniques. Imaging should provide information on the entire vascular cervical and intracranial network, from the aortic arch to the circle of Willis. Equally, it should also give information on the viability of brain tissue and brain hemodynamics. CT has the advantage in the detection of acute hemorrhage whereas MRI offers more accurate pathophysiological information in the follow-up of patients.
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Affiliation(s)
- K O Lövblad
- Unité de neuroradiologie, service de radiologie, DISIM, hôpitaux universitaires de Genève, 24, rue Micheli-du-Crest, 1211 Genève 4, Switzerland.
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26
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Guyer S, Kosel M, Altrichter S, El-Koussy M, Haemmig R, Fisch HU, Lovblad KO, Schlaepfer TE. Pattern of regional cerebral blood-flow changes induced by acute heroin administration--a perfusion MRI study. J Neuroradiol 2007; 34:322-9. [PMID: 18022231 DOI: 10.1016/j.neurad.2007.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Although both the subjective and physiological effects of abused psychotropic substances have been characterized, less is known about their effects on brain function. We examined the actions of intravenous diacetylmorphine (heroin), the most widely abused opioid, on regional cerebral blood flow (rCBF), as assessed by perfusion-weighted MR imaging (PWI) in a double-blind and placebo-controlled setting. MATERIAL AND METHODS Eight male subjects dependent of diacetylmorphine (mean age 36 years, range: 26 to 44 years), who had participated in a clinical diacetylmorphine maintenance program, underwent PWI with gadolinium injection. At two sessions separated by 2-7 days, the participants were examined 80 s after intravenous administration of either diacetylmorphine or saline. rCBF in four regions of interest (amygdala, vermis of the cerebellum, anterior cingulated cortex and thalamus) was compared with heroin versus placebo. RESULTS In the cerebellum, thalamus and cingulated cortex, there were no significant differences in perfusion values between diacetylmorphine and placebo. In the amygdala, perfusion values were 0.8+/-0.4 and 0.5+/-0.2 on the left, and 0.9+/-0.4 and 0.6+/-0.3 on the right, with diacetylmorphine and with placebo, respectively (t-test results were P=0.044 and P=0.033 on the left and right sides, respectively). Other differences in perfusion values between the drug and placebo did not reach statistical significance. CONCLUSION Perfusion MRI demonstrated differences in brain hemodynamics induced by drug intake.
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Affiliation(s)
- S Guyer
- Psychiatric Neuroimaging Group, Department of Psychiatry, University Hospital, Bern, Switzerland
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Gralla J, Burkhardt M, Schroth G, El-Koussy M, Reinert M, Nedeltchev K, Slotboom J, Brekenfeld C. Occlusion length is a crucial determinant of efficiency and complication rate in thrombectomy for acute ischemic stroke. AJNR Am J Neuroradiol 2007; 29:247-52. [PMID: 17974616 DOI: 10.3174/ajnr.a0790] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although mechanical thrombectomy (MT) has an encouragingly high recanalization rate in treating stroke, it is associated with severe complications of which the underlying factors have yet to be identified. Because MT is a mechanical approach, the mechanical properties of the thrombus might be crucial for its success. The present study assesses the effect of thrombus length on the in vivo effectiveness and complication rate of MT. MATERIALS AND METHODS Angiography and embolization of 21 cranial vessels with radiopaque whole-blood thrombi 10, 20, and 40 mm in length (7 occlusions each) were performed in 7 swine. MT was carried out using a distal snarelike device (BCR Roadsaver) with proximal balloon occlusion. A total of 61 retrievals were attempted. RESULTS In the group of 10-mm occlusions, 77.8% of the attempts achieved complete recanalisation. For longer occlusions, the success rates decreased significantly to 20% of attempts for 20-mm occlusions (odds ratio [OR], 14; 95% confidence interval [CI], 2.2-89.2) and 11.1% for 40-mm occlusions (OR, 28; 95% CI, 3.9-202.2; P < .005). The low success rates were largely due to complications associated with thrombus compaction during retrieval. Similarly, the rate of thromboembolic events increased from 0% in 10-mm occlusions to 14.8% in 40-mm occlusions. CONCLUSIONS MT using a distal device proved to be a fast, effective, and safe procedure for recanalizing short (10-mm) occlusions in the animal model. However, occlusion length emerged as a crucial determinant for MT with a significant decrease in recanalization success per attempt and increased complication rates. These findings suggest limitations of MT in the clinical application.
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Affiliation(s)
- J Gralla
- Department of Interventional and Diagnostic Neuroradiology, University of Bern, Bern, Switzerland.
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Brekenfeld C, Gralla J, Wiest R, El-Koussy M, Remonda L, Ozdoba C, Schroth G. Neuroradiological Emergency Interventions. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lövblad KO, Wetzel SG, Somon T, Wilhelm K, Mehdizade A, Kelekis A, El-Koussy M, El-Tatawy S, Bishof M, Schroth G, Perrig S, Lazeyras F, Sztajzel R, Terrier F, Rüfenacht D, Delavelle J. Diffusion-weighted MRI in cortical ischaemia. Neuroradiology 2004; 46:175-82. [PMID: 14749911 DOI: 10.1007/s00234-003-1133-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2003] [Accepted: 08/23/2003] [Indexed: 11/30/2022]
Abstract
We carried out MRI on 16 male and three female comatose patients, aged 2 days to 79 years, with suspected cortical ischaemia referred from our intensive care units. Using a head coil, and following standard imaging, including coronal fluid-attenuated inversion-recovery images, we performed diffusion-weighted imaging (DWI) using a whole-brain multislice single-shot echo-planar sequence with b 0 and 1000 s/mm2: 5-mm slices covering the whole brain, TR 7000 TE 106 ms, 128 x 128 pixels, field of view 250 mm, one excitation. Maps of apparent diffusion coefficients (ADC) were generated automatically. DWI showed cortical, basal ganglia and watershed-area high signal in all cases, associated with a decrease in ADC to 60- 80% of normal. DWI showed lesions not seen (40%) or underestimated (40%) on conventional T2-weighted imaging. Within 24 h of the onset of symptoms, DWI showed changes not readily detectable on T2-weighted images. The cortical high signal on DWI and the ADC changes, suggesting severe ischaemia rather than oedema, was found in areas known to be affected by cortical laminar necrosis. Extension to the brain stem and white matter was associated with a higher likelihood of death.
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Affiliation(s)
- K O Lövblad
- Unité de Neuroradiologie, Service de Radiodiagnostic, DRRI, Hôpital Cantonal Un iversitaire de Genève, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.
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30
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El-Koussy M, Lövblad KO, Kiefer C, Zeller O, Arnold M, Wels T, Buerki M, Oswald H, Schroth G. Apparent diffusion coefficient mapping of infarcted tissue and the ischaemic penumbra in acute stroke. Neuroradiology 2002; 44:812-8. [PMID: 12389128 DOI: 10.1007/s00234-002-0827-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2001] [Accepted: 06/14/2002] [Indexed: 10/27/2022]
Abstract
MRI assessment of diffusion changes in acute cerebral ischaemia necessitates analysis of the apparent diffusion coefficient (ADC). We used the concept of relative weighted mean ADC (rwmADC) to obtain an accurate estimate of the extent of infarcted tissue. We studied ten patient with of acute ischaemic stroke, using diffusion- and perfusion- weighted MRI. The rwmADC was used to calculate a corrected ADC-lesion volume (DLVR), which was compared with the diffusion-lesion volume (DLV), initial perfusion lesion volumes and the follow-up infarct volume on T2-weighted images. We looked at correlations between the MRI and clinical findings. DLVR was closest to the final infarct size and had the best clinicoradiological correlation (r=0.77). Weighting the mean ADC within the ischaemic and normal parenchyma can give a more correct estimate of the volume of infarcted brain parenchyma, thus improving the definition of the penumbra.
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Affiliation(s)
- M El-Koussy
- Department of Neuroradiology, University of Bern, Inselspital, Freiburgstrasse, 3010 Bern, Switzerland
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El-Koussy M, Mathis J, Lövblad KO, Stepper F, Kiefer C, Schroth G. Focal status epilepticus: follow-up by perfusion- and diffusion MRI. Eur Radiol 2002; 12:568-74. [PMID: 11870471 DOI: 10.1007/s003300100999] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2000] [Revised: 05/04/2001] [Accepted: 05/10/2001] [Indexed: 11/25/2022]
Abstract
Diffusion-weighted MRI demonstrated bright right temporoparietal cortex, right hippocampus, and left cerebellum in a 63-year-old female suffering a focal convulsive status epilepticus. Hyperperfusion was noted in the right temporoparietal region. Two days later, a tendency to normalization of most of the diffusion and perfusion changes was noted, apart from the right hippocampus which became brighter on diffusion- and T2-weighted images. On the tenth day the apparent diffusion coefficient was slightly elevated, getting brighter on T2-weighted images with suspected mild post-contrast enhancement. We postulate that the discharging right hippocampus suffered cytotoxic edema, which later progressed to cell damage.
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Affiliation(s)
- M El-Koussy
- Department of Neuroradiology, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern, Switzerland.
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Lövblad KO, Bassetti C, Schneider J, Guzman R, El-Koussy M, Remonda L, Schroth G. Diffusion-weighted mr in cerebral venous thrombosis. Cerebrovasc Dis 2001; 11:169-76. [PMID: 11306763 DOI: 10.1159/000047634] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The diagnosis of cerebral venous thrombosis is often difficult both clinically and radiologically and until now there is no method available to predict if brain lesions, detected clinically and using conventional brain imaging methods, may lead to full recovery, as expected in vasogenic edema or ischemic infarcts and even a hematoma. New fast neuroimaging techniques such as diffusion-weighted imaging (DWI) are sensitive to different reasons of changes in local tissular water concentration thus giving further insight into the pathophysiological mechanism as well as prognosis of cerebral venous thrombosis. We report the cases of 18 consecutive patients with a diagnosis of cerebral venous thrombosis based on clinical and imaging criteria. All patients underwent magnetic resonance imaging (MRI) of the brain, which comprised isotropic diffusion-weighted MR. Diffusion-weighted MRI showed positive findings in 17/18 cases. In 7 cases the clot could be directly visualized as an area of hyperintensity in the affected vein on DWI. In 7 cases DWI showed areas of signal loss corresponding to hematomas. In 6 cases DWI showed changes in signal intensity that were more subtle. In 4 cases of superficial venous thrombosis, there were areas of decreased ADC values (0.65-0.79 x 10(-3) mm(2)/s) whereas in 2 cases of deep venous thrombosis, increased DWI intensities could be found that corresponded to both an increase and a decrease in ADC, corresponding to a coexistence of cytotoxic and vasogenic edemas. Diffusion-weighted MRI can demonstrate directly the presence of an intravenous clot in a select number of patients. It can also demonstrate early ischemic changes, and can differentiate conventional T2-weighted MR areas of cytotoxic from vasogenic edema.
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Affiliation(s)
- K O Lövblad
- Department of Neuroradiology, Inselspital, University of Bern, Switzerland.
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Taleb M, Lövblad KO, El-Koussy M, Guzman R, Bassetti C, Arnold M, Oswald H, Remonda L, Schroth G. Reperfusion demonstrated by apparent diffusion coefficient mapping after local intra-arterial thrombolysis for ischaemic stroke. Neuroradiology 2001; 43:591-4. [PMID: 11512594 DOI: 10.1007/s002340100555] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diffusion-weighted MRI (DWI) is becoming important for diagnosis and investigation of acute cerebral ischaemia. It has been reported that apparent diffusion coefficient (ADC) maps could be an indicator of reperfusion. Our aim was to use echo-planar technology to investigate this phenomenon. We report 19 patients treated by local intra-arterial thrombolysis for middle cerebral artery stroke within 6 h of the onset of symptoms, in whom we performed follow-up DWI. ADC were found to be higher in the patients with angiographically proven reperfusion.
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Affiliation(s)
- M Taleb
- Department of Neuroradiology, Inselspital, University of Bern, Switzerland
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Abstract
We report the case of a woman presenting with an acute onset of hemiplegia. MRI was performed and showed a hyperintense mass on diffusion-weighted imaging, with areas of high signal intensity on T2* imaging and T2/PD imaging. T1-weighted imaging showed a more inhomogeneous lesion with a central isointense part corresponding to the acute clot, as well as a peripheral crescent of hypointense plasma; since another mass lesion could not be acutely excluded, computed tomography was performed immediately afterwards, showing a hyperdense hematoma. The patient was taken to the neurosurgical operating theater, where she underwent decompressive craniotomy and evacuation of the hematoma.
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Affiliation(s)
- M El-Koussy
- Department of Neuroradiology, Inselspital, Bern, Switzerland
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