Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis.

We aimed was to assess the factors influencing therapy choice and clinical outcome after 3-4 months in patients with cerebral venous sinus thrombosis (CVST). In a retrospective, bi-centric study, the set consisted of 82 consecutive CVST patients (61 females; mean age 33.5 ± 15.7 years). Following data were collected: baseline characteristics, presence of gender-specific risk factors (GSRF), location and extent of venous sinus impairment, clinical presentation, type of treatment, recanalization, presence of parenchymal lesions, and clinical outcome after 3-4 months (assessed using the modified Rankin Scale [mRS], with excellent outcome defined as mRS 0-1). Multivariate logistic regression analysis was used for statistical evaluation. After 3-4 months, complete recovery was achieved in 41 (50%) and excellent clinical outcome in 67 (81.7%) patients. Female sex (OR 0.11; p = 0.0189) and presence of focal neurologic deficit (OR 0.16; p = 0.0165) were identified as significant independent negative predictors and, the presence of GSRF (OR 15.63; p = 0.0011) as significant independent positive predictor of excellent clinical outcome. In conclusion, in our CVST patients, the presence of GSRF was associated with excellent clinical outcome, while the female sex itself was associated with poorer clinical outcome.

Cerebral Venous Sinus Thrombosis: Clinical Characteristics and Factors Influencing Clinical Outcome.

The frequency of patients diagnosed with cerebral venous sinus thrombosis (CVST) has increased due to the expanded use of noninvasive brain imaging methods. The aim of this study was to assess the correlations between the location and extent of venous sinus impairment, clinical presentation during the acute phase, recanalization, the presence of parenchymal lesions, and clinical outcome after 3 to 4 months in patients with CVST. In a retrospective study, clinical and magnetic resonance imaging data from a cohort of 51 consecutive patients with CVST (mean age 33.1 ± 15.4 years) were collected and analyzed. Good clinical outcome after 3 to 4 months, which was assessed using the modified Rankin scale, significantly negatively correlated with a thrombosis location in the left transverse, left sigmoid, or superior sagittal sinus (P = .022, P = .045, and P = .046, respectively) and positively correlated with recanalization (P = .048). The clinical outcome was significantly more favorable in the females with gender-specific risk factors than in the males (P = .029). In conclusion, successful recanalization substantially helps to achieve good clinical outcome in patients with CVST.

Common yew intoxication: a case report.

INTRODUCTION: Taxine alkaloids cause fatal poisoning, in particular due to the compound's toxic effect on the cardiovascular apparatus. CASE PRESENTATION: We describe the case of a 39-year-old Caucasian man with common yew intoxication for whom cardiopulmonary resuscitation using all available methods, although delayed and extended, was successful. CONCLUSIONS: Extended and delayed cardiopulmonary resuscitation can be used successfully to treat common yew intoxication.

Iterative reconstruction of pulmonary MDCT angiography: effects on image quality, effective dose and estimated organ dose to the breast.

AIMS: To compare the image characteristics, effective dose and estimated organ dose to the female breast in pulmonary MDCT angiography (MDCTA), reconstructed with either standard filtered back projection (FBP), or iterative reconstruction in image space (IRIS). METHODS: Pulmonary MDCTA performed in 116 females (age 18 - 77 years; body mass index 15 - 48) was reconstructed with FBP (n=52) or IRIS (n=64). Scans were acquired on a 128-row MDCT system using automatic tube current modulation, 100 kV tube voltage, and a quality reference mAs value of 120 (FBP) and 80 (IRIS). Dose was calculated from CT dose index (CTDIvol) and dose length product (DLP) values utilising ImPACT software. Image noise was measured within the pulmonary artery. Qualitative visual assessment of the scans was performed (1=negligible noise, 5=noise obscuring diagnostic information). RESULTS: The average CTDIvol yielded 4.33 mGy for FBP and 3.54 mGy for IRIS, respectively (18.2% decrease). The average effective scan dose was 2.73±0.57 mSv (FBP) and 2.29±0.68 mSv (IRIS), respectively (16.1% decrease). The estimated average organ dose to the breast decreased from 5.1±1.1 mGy (FBP) to 4.2±1.2 mGy (IRIS, 17.6% decrease). No non-diagnostic scans (score 5) were encountered in either group. Significant improvement in image noise levels (P<0.01) and subjective image quality (P<0.02) were noted in IRIS group. CONCLUSION: Pulmonary MDCTA utilizing a 100 kV technique, automatic tube current modulation, and iterative image reconstruction offers robust results in routine conditions among an unselected female population, with breast doses being comparable to two-view digital mammography. Moreover, iterative reconstruction offers improvements in both image noise and visual perception of the scans, thus suggesting a potential for further dose reduction.

Reduction of effective dose and organ dose to the eye lens in head MDCT using iterative image reconstruction and automatic tube current modulation.

AIMS: To compare the effective and eye lens radiation dose in helical MDCT brain examinations using automatic tube current modulation in conjunction with either standard filtered back projection (FBP) technique or iterative reconstruction in image space (IRIS). METHODS: Of 400 adult brain MDCT examinations, 200 were performed using FBP and 200 using IRIS with the following parameters: tube voltage 120 kV, rotation period 1 second, pitch factor 0.55, automatic tube current modulation in both transverse and longitudinal planes with reference mAs 300 (FBP) and 200 (IRIS). Doses were calculated from CT dose index and dose length product values utilising ImPACT software; the organ dose to the lens was derived from the actual tube current-time product value applied to the lens. Image quality was assessed by two independent readers blinded to the type of image reconstruction technique. RESULTS: The average effective scan dose was 1.47±0.26 mSv (FBP) and 0.98±0.15 mSv (IRIS), respectively (33.3% decrease). The average organ dose to the eye lens decreased from 40.0±3.3 mGy (FBP) to 26.6±2.0 mGy (IRIS, 33.5% decrease). No significant change in diagnostic image quality was noted between IRIS and FBP scans (P=0.17). CONCLUSION: Iterative reconstruction of cerebral MDCT examinations enables reduction of both effective and organ eye lens dose by one third without signficant loss of image quality.

Natalizumab in the treatment of pediatric multiple sclerosis.

Pediatric cerebrospinal multiple sclerosis (MS) constitutes about 2-5% of all MS cases. The International Pediatric MS Study Group (IPMSSG) applies diagnostic criteria for adults to MS in childhood and adolescence. Recent publications highlight an increasing number of MS in children resistant to the first-line treatment, i.e. disease modifying therapy (DMT). Furthermore, the number of published case studies on children with highly active MS treated with natalizumab also rises, whereas long-term risks as well as therapeutic potential of this therapy in pediatric population have been at the centre of attention. This paper presents a group of 5 children in whom natalizumab was selected to manage highly active disease or resistance to conventional MS treatment and provided very good clinical as well as MRI results.

Comparison of duplex ultrasonography and magnetic resonance imaging in the detection of significant renal artery stenosis.

OBJECTIVE: The aim of our study was to evaluate duplex ultrasonography (DUS) and magnetic resonance angiography (MRA) in detection of haemodynamically significant renal artery stenosis (RAS). METHODS: The study included patients with high clinical suspicion of renovascular hypertension (RVH). The imaging of renal arteries was performed by DUS, MRA and digital subtraction angiography (DSA). Significant RAS was defined as maximum systolic velocity > or =180 cm/sec (DUS) or as 60% reduction of the endoluminal arterial diameter (MRA, DSA). The results of DUS and MRA were assessed in respect to the results of DSA. RESULTS: Arterial supply of 186 kidneys in 94 patients was evaluated. DSA revealed significant RAS in 61 kidneys evaluated. DUS was not able to examine arterial supply in 18 kidneys of 13 patients. In the detection of significant RAS, DUS was characterized by sensitivity and specificity of 85% and 84%. MRA achieved satisfactory imaging quality in all but one kidney evaluated. The sensitivity and specificity of MRA in the detection of significant RAS was 93% and 93%, respectively. CONCLUSION: In patients with high clinical probability of RVH, MRA proved to be more reliable and superior in both sensitivity and specificity to DUS in the detection of significant RAS.

Contrast-enhanced MR angiography utilizing parallel acquisition techniques in renal artery stenosis detection.

Significant renal artery stenosis (RAS) is a potentially curable cause of renovascular hypertension and/or renal impairment. It is caused by either atherosclerosis or fibromuscular dysplasia. Correct and timely diagnosis remains a diagnostic challenge. MR angiography (MRA) as a minimally invasive method seems to be suitable for RAS detection, however, its diagnostic value widely differs in the literature (sensitivity 62-100% and specificity 75-100%). The aim of our prospective study was to compare the diagnostic value of contrast-enhanced MRA utilizing parallel acquisition techniques in the detection of significant RAS with digital subtraction angiography (DSA). A total of 78 hypertensive subjects with suspected renal artery stenosis were examined on a 1.5 Tesla MR system using a body array coil. Bolus tracking was used to monitor the arrival of contrast agent to the abdominal aorta. The MRA sequence parameters were as follows: TR 3.7 ms; TE 1.2 ms; flip angle 25 degrees; acquisition time 18s; voxel size 1.1 mm x1.0 mm x 1.1 mm; centric k-space sampling; parallel acquisition technique with acceleration factor of 2 (GRAPPA). Renal artery stenosis of 60% and more was considered hemodynamically significant. The results of MRA were compared to digital subtraction angiography serving as a standard of reference. Sensitivity and specificity of MRA in the detection of hemodynamically significant renal artery stenosis were 90% and 96%, respectively. Prevalence of RAS was 39% in our study population. Contrast-enhanced MRA with high spatial resolution offers sufficient sensitivity and specificity for screening of RAS.

The percutaneous closure of a large pseudoaneurysm of the ascending aorta with an atrial septal defect Amplatzer occluder: two-year follow-up.

Pseudoaneurysm of the ascending aorta is a high-risk complication following cardiac surgery. The present report describes excellent two-year follow-up results after the percutaneous closure of a very large pseudoaneurysm with an Amplatzer atrial septal defect occluder. The original cavity in the anterior mediastinum with maximal diameter 15 cm remained as only a small scar. The patient was without serious health problems both early and after two years.

Comparison of magnetic resonance imaging and cardiac catheterization in patients with suspected severe aortic stenosis.

OBJECTIVE: Magnetic resonance imaging (MRI) is a novel technique used in the assessment of aortic stenosis. The aim of the study was to compare MRI and cardiac catheterization (CAT) that is still considered to be a "golden standard" in this indication. METHODS: Thirty-four patients referred to CAT for the evaluation of aortic stenosis were enrolled into the study. CAT was performed according to the standardized protocol. Cardiac output was measured by thermodilution and mean aortic gradient was determined using simultaneous blood pressure measurement in aorta and left ventricle. MRI was performed within the period of 3 weeks after CAT. True FISP sequence with retrospective ECG gating was used for the imaging of the aortic valve orifice. Planimetry of the aortic valve area (AVA) was performed at the time of maximal opening of the valve during systole. RESULTS: MRI enabled the measurement of AVA in all patients enrolled. Mean AVA defined by CAT and MRI were 0,97 (+/- 0,41) cm2 and 1,38 (+/- 0,55) cm2, respectively. The correlation between the evaluated methods was statistically significant (p=0,003), but not very strong (r=0,43). The comparison of both methods in the identification of the severe aortic stenosis was characterized by kappa value of 0,331. CONCLUSION: Our study shows low agreement between cardiac catheterization and magnetic resonance imaging in the assessment of aortic stenosis. However, MRI might have a role in the diagnostic algorithm in patients with suspected severe aortic stenosis and moderate mean aortic gradient or concomitant valvular insufficiency.

Dynamic and delayed contrast enhancement in upper abdominal MRI studies: comparison of gadoxetic acid and gadobutrol.

OBJECTIVE: To prospectively compare contrast properties of extracelullar (gadobutrol) and hepatospecific (gadoxetic acid) contrast agents in upper abdominal MRI studies. MATERIALS AND METHODS: Standardized (0.1 ml/kg) dose of gadobutrol (56 subjects) and gadoxetic acid (51 subjects) was administered intravenously by MRI-compatible injector at 2 ml/s, followed by 20 ml saline flush. MR signal intensity changes (SIC) between precontrast scans and arterial phase, portal venous phase, equilibrium, and delayed scans at 10 and 20 min were measured in abdominal aorta, portal vein, common bile duct, liver, and spleen. Mean SIC values for gadobutrol and gadoxetic acid were compared by a two-sample t-test with p-value <0.05 considered significant. RESULTS: In abdominal aorta, the mean SIC in the arterial phase did not significantly differ between gadobutrol (330%) and gadoxetic acid (295%). In portal vein, the mean SIC in the portal venous phase significantly differed between gadobutrol (267%) and gadoxetic acid (176%). Liver parenchyma enhancement was significantly higher for gadobutrol than for gadoxetic acid in both arterial phase (28 versus 13%) and portal venous phase (81 versus 46%). On the contrary, gadobutrol reached significantly lower mean SIC in the liver on delayed scans at 10 min (47 versus 59%) and 20 min (40 versus 67%), as well as in common bile duct at 10 min (54 versus 133%) and 20 min (57 versus 457%), respectively. In the spleen, mean SIC for gadobutrol was significantly higher at all phases. CONCLUSION: Gadobutrol showed superior enhancement of upper abdominal structures in the dynamic phases whereas gadoxetic acid showed better enhancement of the hepatobiliary structures on delayed scans.

Clinical use of magnetic resonance imaging for the diagnosis of acute myocardial infarction in the survivors of cardiac arrest.

The ventricular arrhythmias with underlying coronary artery disease are a leading cause of sudden cardiac death (SCD). While the SCD survivors with proven AMI are considered to be at low risk of SCD recurrence, those without the evidence of AMI represent a high risk group that benefits from implantable cardioverter defibrillator. Therefore, the evaluation of SCD survivors for the presence of acute myocardial infarction (AMI) as a triggering factor of cardiac arrest is essential. In SCD survivors, the use of the standard diagnostic criteria of AMI may be difficult, as both serum cardiac biomarkers and electrocardiogram can be influenced by previous cardiac arrest. A novel technique that may be used for the diagnosis of AMI is magnetic resonance imaging (MRI). We report its use in four patients after cardiopulmonary resuscitation where the diagnosis of AMI could not be definitely established or excluded by means of other diagnostic procedures.

Contrast-enhanced magnetic resonance and thallium scintigraphy in the detection of myocardial viability: a prospective comparative study.

The aim of the present study was to prospectively compare contrast-enhanced magnetic resonance imaging (CE-MRI) with single-photon emission tomography using (201)Thallium chloride (SPECT Tl) in the detection of myocardial viability. Patients with chronic coronary artery disease and systolic dysfunction defined by an ejection fraction (EF)

Liver, meconium, haemorrhage: the value of T1-weighted images in fetal MRI.

BACKGROUND: Ultrafast T2-weighted (T2-W) MRI sequences are currently considered a routine technique for fetal MR imaging. Limited experience exists with fetal T1-weighted (T1-W) imaging techniques. OBJECTIVE: To determine MRI patterns of some fetal abdominal or haemorrhagic disorders with particular respect to the diagnostic value of T1-W images. MATERIALS AND METHODS: In addition to standard T2-W single-shot sequences, T1-W single-shot and/or multislice sequences were employed in 25 MR examinations performed in 23 fetuses between 20 and 36 weeks of gestation for more detailed assessment of liver, meconium-filled digestive tract, haemorrhage, or further characterization of a fetal abdominal mass. Diagnostic value and presence of motion artefacts on T1-W images was recorded in each case. RESULTS: T1-W images enabled superior delineation of fetal liver and large intestine. They provided additional diagnostic information in 9 (39%) of 23 fetuses. One false-positive and one false-negative MRI diagnosis of malrotation anomaly were encountered. Use of single-shot T1-W sequences reduced the occurrence of motion artefacts in 64%. CONCLUSION: Our results suggest that the specific signal properties of methaemoglobin, meconium and liver are sufficiently important for T1-W sequences to become a routine part of fetal MRI protocols when dealing with digestive tract anomalies, diaphragmatic and abdominal wall defects, intraabdominal masses, and fetal haemorrhage.

Vascular compression of rostral medulla oblongata: prospective MR imaging study in hypertensive and normotensive subjects.

PURPOSE: To prospectively evaluate prevalence of neurovascular contacts (NVCs) at the rostral medulla oblongata in normotensive and hypertensive subjects. MATERIALS AND METHODS: Forty-three patients with severe essential hypertension and 45 normotensive subjects were matched for age, sex, and body mass index. Magnetic resonance (MR) imaging included transverse and coronal T2-weighted turbo spin-echo (section thickness, 3.0 mm), transverse three-dimensional (3D) time-of-flight MR angiographic (section thickness, 0.8 mm), and 3D constructive interference in steady state (CISS) (section thickness, 1.0 mm) sequences. All MR images were reviewed by two radiologists who were blinded to the hypertensive status of subjects. Presence and degree of NVC at rostral medulla and left/right rostral ventrolateral medulla (RVLM) were evaluated together with conspicuity of anatomic structures on MR images. Differences in prevalence of NVC among normotensive and hypertensive subjects were tested for statistical significance (P <.05) by using nonparametric tests. RESULTS: Among hypertensive patients, 34 (79%) of 43 showed NVC of rostral medulla at any location, and 14 (33%) of 43 had NVC at the left RVLM. In controls (normotensive subjects), 35 (78%) of 45 showed NVC of rostral medulla, and 17 (38%) of 45 had NVC at left RVLM. Prevalence of NVC was not significantly different between both groups at any location of rostral medulla. Compared with T2-weighted turbo spin-echo and 3D time-of-flight MR imaging sequences, 3D CISS offered better contrast resolution of neural and vascular structures and superior delineation of outer vascular contours. CONCLUSION: Vascular compression of the rostral medulla oblongata is a frequent finding in both hypertensive and normotensive subjects. Results of this study do not support NVC at left RVLM as an etiologic factor in essential hypertension.