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Wiesmueller M, Wuest W, May MS, Ellmann S, Heiss R, Saake M, Janka R, Uder M, Laun FB. Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics. AJNR Am J Neuroradiol 2021; 42:1305-1312. [PMID: 33926901 DOI: 10.3174/ajnr.a7112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/23/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE The high diagnostic value of DWI for cholesteatoma diagnostics is undisputed. This study compares the diagnostic value of readout-segmented echo-planar DWI and single-shot TSE DWI for cholesteatoma diagnostics. MATERIALS AND METHODS Thirty patients with newly suspected cholesteatoma were examined with a dedicated protocol, including readout-segmented echo-planar DWI and single-shot TSE DWI at 1.5T. Acquisition parameters of both diffusion-weighted sequences were as follows: b=1000 s/mm,2 axial and coronal section orientations, and section thickness of 3 mm. Image quality was evaluated by 2 readers on a 5-point Likert scale with respect to lesion conspicuity, the presence of susceptibility artifacts mimicking cholesteatomas, and overall subjective image quality. Sensitivity and specificity were calculated using histology results as the gold standard. RESULTS Twenty-five cases of histologically confirmed cholesteatomas were included in the study group. Lesion conspicuity was higher and fewer artifacts were found when using TSE DWI (both P < .001). The overall subjective image quality, however, was better with readout-segmented DWI. For TSE DWI, the sensitivity for readers 1 and 2 was 92% (95% CI, 74%-99%) and 88% (95% CI, 69%-97%), respectively, while the specificity for both readers was 80% (95% CI, 28%-99%). For readout-segmented DWI, the sensitivity for readers 1 and 2 was 76% (95% CI, 55%-91%) and 68% (95% CI, 46%-85%), while the specificity for both readers was 60% (95% CI, 15%-95%). CONCLUSIONS The use of TSE DWI is advisable for cholesteatoma diagnostics and preferable over readout-segmented DWI.
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Affiliation(s)
- M Wiesmueller
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.) .,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - W Wuest
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - M S May
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - S Ellmann
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
| | - R Heiss
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - M Saake
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - R Janka
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - M Uder
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.).,Image Science Institute (M.W., W.W., M.S.M., R.H., M.S., R.J., M.U.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - F B Laun
- From the Institute of Radiology (M.W., W.W., M.S.M., S.E., R.H., M.S., R.J., M.U., F.B.L.)
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Eller A, Wiesmüller M, Wüst W, Heiss R, Kopp M, Saake M, Brand M, Uder M, May MM. Carotid CTA at the Lowest Tube Voltage (70 kV) in Comparison with Automated Tube Voltage Adaption. AJNR Am J Neuroradiol 2019; 40:1374-1382. [PMID: 31296525 DOI: 10.3174/ajnr.a6108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/18/2018] [Accepted: 05/26/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE CTA is the imaging modality of choice in many institutions for the evaluation of the supraaortic vessels, but radiation exposure remains a matter of concern. Our aim was to evaluate a 70-kV protocol for CT angiography of the carotid arteries with respect to image quality and radiation exposure compared with automated tube voltage adaption. MATERIALS AND METHODS A total of 90 consecutive patients were included in this prospective study and randomized to the study group (n = 45, 70 kV) or control group (n = 45, automated tube voltage adaptation). Volume CT dose indices and dose-length products were recorded in the examination protocol. Image quality was assessed as arterial vessel contrast, signal-to-noise ratio, contrast-to-noise ratio, and contrast-to-noise ratio in reference to the radiation dose. Subjective overall image-quality analysis, image-artifact analysis, and diagnostic evaluation were performed by 2 observers by using a 4-point Likert scale. RESULTS Radiation exposure was significantly lower in the study group (volume CT dose index reduced by 22%, dose-length product reduction by 20%; each P < .001). Contrast (P = .15), SNR (P = .4), and contrast-to-noise ratio (P = .5) did not show significant differences between the groups. The contrast-to-noise ratio in reference to the radiation dose was not significantly increased using the study protocol (P = .2). Subjective image quality and visualization of pathologic findings did not differ significantly between the groups. CONCLUSIONS Carotid CTA using the lowest available voltage (70 kV) is feasible at very-low-dose levels, while overall image quality is comparable with protocols using automated tube voltage selection.
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Affiliation(s)
- A Eller
- From the Department of Radiology (A.E., M.W., W.W., R.H., M.K., M.S., M.B., M.U., M.M.M.), University Hospital Erlangen, Erlangen, Germany
| | - M Wiesmüller
- From the Department of Radiology (A.E., M.W., W.W., R.H., M.K., M.S., M.B., M.U., M.M.M.), University Hospital Erlangen, Erlangen, Germany
| | - W Wüst
- From the Department of Radiology (A.E., M.W., W.W., R.H., M.K., M.S., M.B., M.U., M.M.M.), University Hospital Erlangen, Erlangen, Germany
| | - R Heiss
- From the Department of Radiology (A.E., M.W., W.W., R.H., M.K., M.S., M.B., M.U., M.M.M.), University Hospital Erlangen, Erlangen, Germany
| | - M Kopp
- From the Department of Radiology (A.E., M.W., W.W., R.H., M.K., M.S., M.B., M.U., M.M.M.), University Hospital Erlangen, Erlangen, Germany
| | - M Saake
- From the Department of Radiology (A.E., M.W., W.W., R.H., M.K., M.S., M.B., M.U., M.M.M.), University Hospital Erlangen, Erlangen, Germany
| | - M Brand
- From the Department of Radiology (A.E., M.W., W.W., R.H., M.K., M.S., M.B., M.U., M.M.M.), University Hospital Erlangen, Erlangen, Germany
| | - M Uder
- From the Department of Radiology (A.E., M.W., W.W., R.H., M.K., M.S., M.B., M.U., M.M.M.), University Hospital Erlangen, Erlangen, Germany
- Imaging Science Institute (M.U., M.M.M.), Erlangen, Germany
| | - M M May
- From the Department of Radiology (A.E., M.W., W.W., R.H., M.K., M.S., M.B., M.U., M.M.M.), University Hospital Erlangen, Erlangen, Germany
- Imaging Science Institute (M.U., M.M.M.), Erlangen, Germany
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Wuest W, Lell M, May MS, Saake M, Kuwert T, Uder M, Linke R. Thoracic non-osseous lesions in cancer patients detected in low-dose CT images acquired as part of skeletal SPECT/CT examinations. Nuklearmedizin 2015; 54:173-7. [PMID: 26165684 DOI: 10.3413/nukmed-0721-15-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 02/04/2015] [Accepted: 06/28/2015] [Indexed: 12/21/2022]
Abstract
AIM Hybrid single-photon emission tomographic (SPECT) and X-ray computed tomography (CT) systems are increasingly used in oncologic imaging. With SPECT/CT not only the thoracic spine but also the surrounding soft tissue needs to be evaluated for pathological findings. The purpose of this study was to assess the prevalence of non-osseous findings detectable on low-dose CT datasets from patients studied by thoracic 99mTc-dicarboxypropane diphosphonate (DPD)-SPECT/CT. PATIENTS, METHODS 119 consecutive oncologic patients (81 breast cancer, 38 with other cancer) who underwent DPD-SPECT CT of the thoracic region were included in this study. Non-osseous findings on CT were classified as either probably benign or suspicious. Suspicious findings were correlated with retrievable previous imaging and if performed with follow up imaging (MRI, CT with contrast medium, Ultrasound) or biopsy results. RESULTS In 80/119 (67%) patients no imaging was performed before SPECT/CT. Only 7/119 subjects (6%) had no other lesions than bone lesions. In 101/119 (85%) patients lesions found on SPECT/CT images were rated as benign and in 65/119 (55%) patients as suspicious. In 8/119 (7%) patients with previously unknown suspicious lesions on SPECT/CT images suspicious findings were confirmed by biopsy. CONCLUSION 7% of patients referred to SPECT/CT of the thoracic spine for staging of malignant disease had previously unknown suspicious non-osseous lesions detectable on the low-dose CT images which were confirmed by biopsy. This could be especially relevant for cancer entities like breast and prostate, in which no thorax-CT is routinely intended for staging.
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Affiliation(s)
- W Wuest
- Wolfgang Wuest, MD, Radiological Institute, Friedrich-Alexander-University-Erlangen-Nuremberg, Maximiliansplatz 1, 91054 Erlangen, Germany, Tel. +49/(0)91 31/854 55 07, Fax +49/(0)91 31/853 60 68, E-mail:
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Saake M, Wuest W, Becker S, Uder M, Janka R. Accuracy of MRI-Compatible Contrast Media Injectors. ROFO-FORTSCHR RONTG 2013; 186:253-9. [DOI: 10.1055/s-0033-1350576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M. Saake
- Department of Radiology, University of Erlangen-Nuremberg
| | - W. Wuest
- Department of Radiology, University of Erlangen-Nuremberg
| | - S. Becker
- Institute of Process Technology and Systems Engineering, University of Erlangen-Nuremberg
| | - M. Uder
- Department of Radiology, University of Erlangen-Nuremberg
| | - R. Janka
- Department of Radiology, University of Erlangen-Nuremberg
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Schulz-Wendtland R, Dilbat G, Bani M, Fasching PA, Heusinger K, Lux MP, Loehberg CR, Brehm B, Hammon M, Saake M, Dankerl P, Jud SM, Rauh C, Bayer CM, Beckmann MW, Uder M, Meier-Meitinger M. Full Field Digital Mammography (FFDM) versus CMOS Technology, Specimen Radiography System (SRS) and Tomosynthesis (DBT) - Which System Can Optimise Surgical Therapy? Geburtshilfe Frauenheilkd 2013; 73:422-427. [PMID: 24771921 DOI: 10.1055/s-0032-1328600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 03/12/2013] [Revised: 04/16/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022] Open
Abstract
Aim: This prospective clinical study aimed to evaluate whether it would be possible to reduce the rate of re-excisions using CMOS technology, a specimen radiography system (SRS) or digital breast tomosynthesis (DBT) compared to a conventional full field digital mammography (FFDM) system. Material and Method: Between 12/2012 and 2/2013 50 patients were diagnosed with invasive breast cancer (BI-RADS™ 5). After histological verification, all patients underwent breast-conserving therapy with intraoperative imaging using 4 different systems and differing magnifications: 1. Inspiration™ (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1 mm, resolution 85 µm pixel pitch, 8 lp/mm; 2. BioVision™ (Bioptics, Tucson, AZ, USA), CMOS technology, photodiode array, flat panel, tungsten source, focus 0.05, resolution 50 µm pixel pitch, 12 lp/mm; 3. the Trident™ specimen radiography system (SRS) (Hologic, Bedford, MA, USA), amorphous selenium, tungsten source, focus 0.05, resolution 70 µm pixel pitch, 7.1 lp/mm; 4. tomosynthesis (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1 mm, resolution 85 µm pixel pitch, 8 lp/mm, angular range 50 degrees, 25 projections, scan time > 20 s, geometry: uniform scanning, reconstruction: filtered back projection. The 600 radiographs were prospectively shown to 3 radiologists. Results: Of the 50 patients with histologically proven breast cancer (BI-RADS™ 6), 39 patients required no further surgical therapy (re-excision) after breast-conserving surgery. A retrospective analysis (n = 11) showed a significant (p < 0.05) increase of sensitivity with the BioVision™, the Trident™ and tomosynthesis compared to the Inspiration™ at a magnification of 1.0 : 2.0 or 1.0 : 1.0 (tomosynthesis) (2.6, 3.3 or 3.6 %), i.e. re-excision would not have been necessary in 2, 3 or 4 patients, respectively, compared to findings obtained with a standard magnification of 1.0 : 1.0. Conclusion: The sensitivity of the BioVision™, the Trident™ and tomosynthesis was significantly (p < 0.05) higher and the rate of re-excisions was reduced compared to FFDM using a conventional detector at a magnification of 2.0 but without zooming.
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Affiliation(s)
- R Schulz-Wendtland
- Gynäkologische Radiologie, Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - G Dilbat
- Radiologische Praxis Roth und Weißenburg, Roth
| | - M Bani
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - P A Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - K Heusinger
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M P Lux
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C R Loehberg
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - B Brehm
- Gynäkologische Radiologie, Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - M Hammon
- Gynäkologische Radiologie, Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - M Saake
- Gynäkologische Radiologie, Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - P Dankerl
- Gynäkologische Radiologie, Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - S M Jud
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C Rauh
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C M Bayer
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
| | - M Meier-Meitinger
- Gynäkologische Radiologie, Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen
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Nickel F, Ott S, Möhringer S, Saake M, Dörfler A, Seifert F, Maihöfner C. Brain correlates of short-term habituation to repetitive electrical noxious stimulation. Eur J Pain 2013; 18:56-66. [DOI: 10.1002/j.1532-2149.2013.00339.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2013] [Indexed: 01/06/2023]
Affiliation(s)
- F.T. Nickel
- Department of Neurology; University of Erlangen-Nuremberg; Erlangen Germany
| | - S. Ott
- Department of Neurology; University of Erlangen-Nuremberg; Erlangen Germany
| | - S. Möhringer
- Department of Neurology; University of Erlangen-Nuremberg; Erlangen Germany
| | - M. Saake
- Department of Neuroradiology; University of Erlangen-Nuremberg; Erlangen Germany
| | - A. Dörfler
- Department of Neuroradiology; University of Erlangen-Nuremberg; Erlangen Germany
| | - F. Seifert
- Department of Neurology; University of Erlangen-Nuremberg; Erlangen Germany
| | - C. Maihöfner
- Department of Neurology; University of Erlangen-Nuremberg; Erlangen Germany
- Institute of Physiology and Experimental Pathophysiology; University of Erlangen-Nuremberg; Erlangen Germany
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Saake M, Goelitz P, Struffert T, Breuer L, Volbers B, Doerfler A, Kloska S. Comparison of conventional CTA and volume perfusion CTA in evaluation of cerebral arterial vasculature in acute stroke. AJNR Am J Neuroradiol 2012; 33:2068-73. [PMID: 22743639 DOI: 10.3174/ajnr.a3155] [Citation(s) in RCA: 26] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CTA-like datasets can be reconstructed from whole-brain VPCTA. The aim of our study was to compare VPCTA with CTA for detection of intracranial stenosis and occlusion in stroke patients. Omitting CTA from stroke CT could reduce radiation dose. MATERIALS AND METHODS One hundred sixty-three patients were included in this retrospective analysis. Inclusion criterion was suspected stroke within 4.5 hours after onset of symptoms. All examinations were performed on a 128-section multidetector CT scanner. Axial, coronal, and sagittal maximum intensity projections were reconstructed from CTA and from peak arterial phase of VPCTA. Images were scored for quality and presence of intracranial stenosis >50% or occlusion. For statistical analysis, the Wilcoxon signed-rank test and Fisher exact test were used, with a 2-tailed P value of .05 or less for statistical significance. RESULTS Average image quality was superior in CTA (P < .05). However, image quality dichotomized for diagnostic significance was without difference between CTA and VPCTA (P > .05). Comparative statistical analysis revealed no significant difference for detection of intracranial stenosis and occlusion between CTA and VPCTA (P > .05). Substitution of intracranial CTA by VPCTA would lower radiation dose by 0.5 mSv. CONCLUSIONS VPCTA is suited to assess the intracranial vasculature in patients with stroke and might have the potential to decrease radiation dose by substituting for intracranial CTA in stroke CT. Additional studies are necessary to further evaluate potential benefits of the dynamic nature of VPCTA.
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Affiliation(s)
- M Saake
- Departments of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany.
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Gölitz P, Struffert T, Knossalla F, Saake M, Ott S, Ganslandt O, Doerfler A. Angiographic CT with intravenous contrast injection compared with conventional rotational angiography in the diagnostic work-up of cerebral aneurysms. AJNR Am J Neuroradiol 2012; 33:982-7. [PMID: 22268091 DOI: 10.3174/ajnr.a2883] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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 Noninvasive imaging of cerebral aneurysms is still considered inferior to conventional angiography. The purpose of this study was to evaluate the diagnostic accuracy of ivACT in the assessment of intracranial aneurysms compared with 3D-DSA. MATERIALS AND METHODS We included 13 patients with 15 incidental unruptured saccular aneurysms scheduled for diagnostic angiographic work-up in our study. In each patient, we performed an ivACT and a conventional angiography including a 3D rotational run. During postprocessing, MPR images were generated for each technique. Maximal aneurysm diameter, neck diameter, aneurysm height, maximum width, bulge height, parent artery diameter, and angle between the parent artery and aneurysm apex were measured for each aneurysm. RESULTS 3D-DSA and ivACT both provided images of high quality without artificial disturbances (ie, motion artifacts). Measurements of all parameters resulted in comparable values for both modalities with a strong correlation (P ≤ .001). CONCLUSIONS ivACT is feasible for the noninvasive visualization of saccular cerebral aneurysms and may provide reliable diagnostic information for the assessment of aneurysm size and geometry comparable with conventional intra-arterial 3D rotational angiography. These preliminary results might be a first promising step to replacing conventional angiography in preinterventional aneurysm imaging.
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Affiliation(s)
- P Gölitz
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91052 Erlangen, Germany.
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Struffert T, Ott S, Saake M, Gölitz P, Engelhorn T, Kloska S, Deuerling-Zheng Y, Dörfler A. Intravenöse Flach-Detektor-CTA (FD-CTA) als nichtinvasive Follow-Up Modalität für intrakranielle Stents: erste Erfahrungen. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279211] [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: 10/18/2022]
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Struffert T, Ott S, Saake M, Gölitz P, Engelhorn T, Kloska S, Deuerling-Zheng Y, Kollmar R, Dörfler A. Kann die Messung des zerebralen Blutvolumens (CBV) mittels Flach-Detektor-CT nach endovaskulärer Schlaganfall Therapie das definitive Infarktvolumen vorhersagen? ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279366] [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: 10/18/2022]
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Köhrmann M, Nowe T, Huttner HB, Engelhorn T, Struffert T, Kollmar R, Saake M, Doerfler A, Schwab S, Schellinger PD. Safety and outcome after thrombolysis in stroke patients with mild symptoms. Cerebrovasc Dis 2008; 27:160-6. [PMID: 19092237 DOI: 10.1159/000185607] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 08/28/2008] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Thrombolytic therapy is frequently withheld in patients with minor stroke symptoms. However, recent studies demonstrate that a substantial proportion of these patients dies or remains permanently disabled because of underestimation of symptom severity at baseline or secondary deterioration. We aimed to assess the safety and outcome of thrombolysis therapy in patients with minor but disabling stroke symptoms. METHODS 32 patients presenting with mild symptoms were treated with intravenous recombinant tissue-type plasminogen activator between April 2006 and April 2008. Data were extracted from a prospectively collected database. Baseline demographic data, and clinical, laboratory and imaging findings were analyzed. Outcome was assessed using the modified Rankin Scale (mRS) score at 3 months and was dichotomized into favorable (mRS 0-1) versus unfavorable (mRS 2-6). RESULTS In the majority of patients, the left hemisphere was affected, with aphasia representing the most common symptom leading to treatment decision. The frequency of perfusion lesion (46%) and vessel occlusion (35%) at baseline was high but had no effect on the outcome at 3 months in our series of treated patients. Outcome was favorable in 94% of patients, and 47% recovered without any persisting symptom. Only one asymptomatic and no symptomatic hemorrhage was observed. CONCLUSION Our data support current guidelines and international licenses which give no lower National Institutes of Health Stroke Scale (NIHSS) limit for intravenous thrombolysis (IVT). Considering the accumulating evidence that the natural course in patients with mild symptoms is not as favorable as often assumed and taking the low risk of bleeding in those patients into account, patients with mild but disabling symptoms should be treated with IVT regardless of their baseline NIHSS score.
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Affiliation(s)
- M Köhrmann
- Department of Neurology, University of Erlangen, Schwabachanlage 6, Erlangen, Germany.
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