Early single center experience with the solitaire thrombectomy device for the treatment of acute ischemic stroke.

We report the immediate technical and clinical outcome of a new self-expanding fully retrievable stent in the treatment of acute ischemic stroke. Eleven consecutive patients with acute intracerebral artery occlusions were treated with a self-expandable fully retrievable intracranial stent (Solitaire AB). Four patients had an occlusion of the basilar artery, five had a middle cerebral artery occlusion and two had terminal carotid artery occlusions. Recanalization results were assessed by follow-up angiography immediately after the procedure. Neurologic status was evaluated before and after treatment (90-day follow-up) according to the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scales (mRS).Successful revascularization (TICI 2a/b and 3) was achieved in 11 of 11 (100%) patients, a TICI 3 state was accomplished in two (18%) patients, and partial recanalization or slow distal branch filling with filling of more than two-thirds of the vessel territory (TICI 2a/2b) was achieved in nine (82%) patients. The stent was removed in all patients. The mean time from stroke symptom onset to recanalization was 339 minutes (+/- 114.3 minutes). NIHSS on admission was 16.09 (+/- 4.7). Almost two-thirds of the patients (61.2%) improved by >6 points on the NIHSS at discharge, and 30% showed a mRS of <2 at 90 days. Mortality was 9%. One patient with a BA occlusion had a massive brain stem infarction and died two days after the procedure. There were no intracranial hemorrhages.The use of the Solitaire in ischemic stroke patients shows encouraging results. However, further prospective large randomized trials are mandatory to confirm these early results.

Number of biopsies in diagnosing pulmonary nodules.

PURPOSE: To determine the number of specimens to be obtained from pulmonary lesions to get the highest possible accuracy in histological work-up. MATERIALS AND METHODS: A retrospective evaluation (January 1999 to April 2004) covered 260 patients with thoracic lesions who underwent computer tomography (CT)-guided core-cut biopsy in coaxial technique. All biopsies were performed utilizing a 19 gauge introducer needle and a 20 gauge core-cut biopsy needle. In all, 669 usable biopsies were taken (from 1-5 biopsies in each setting). The specimens were marked sequentially and each biopsy was worked up histologicaly. The biopsy results were correlated to histology after surgery, clinical follow-up or autopsy. The number of biopsies was determined that is necessary to achieve the highest possible accuracy in diagnosing pulmonary lesions. RESULTS: In 591 of 669 biopsies (88.3%), there were correct positive results. The overall accuracy was 87.4%. In 193 of 260 (74.2%) patients, a suspected malignancy was confirmed. In 50 of 260 (19.2%) patients, a benign lesion was correctly diagnosed. Seventeen (6.5%) patients were lost to follow-up. The first, second and third biopsies had cumulative accuracies of 63.6%, 89.2% and 91.5%, respectively (P < 0.02). More biopsies did not show any higher impact on accuracy. CONCLUSION: For the highest possible accuracy in diagnosing pulmonary lesions by CT-guided core-cut biopsy, at least three usable specimens are recommended to be taken.

Accuracy of MSCT Coronary Angiography with 64 Row CT Scanner-Facing the Facts.

Improvements in multislice computed tomography (MSCT) angiography of the coronary vessels have enabled the minimally invasive detection of coronary artery stenoses, while quantitative coronary angiography (QCA) is the accepted reference standard for evaluation thereof. Sixteen-slice MSCT showed promising diagnostic accuracy in detecting coronary artery stenoses haemodynamically and the subsequent introduction of 64-slice scanners promised excellent and fast results for coronary artery studies. This prompted us to evaluate the diagnostic accuracy, sensitivity, specificity, and the negative und positive predictive value of 64-slice MSCT in the detection of haemodynamically significant coronary artery stenoses.Thirty-seven consecutive subjects with suspected coronary artery disease were evaluated with MSCT angiography and the results compared with QCA. All vessels were considered for the assessment of significant coronary artery stenosis (diameter reduction >/= 50%). Thirteen patients (35%) were identified as having significant coronary artery stenoses on QCA with 6.3% (35/555) affected segments. None of the coronary segments were excluded from analysis. Overall sensitivity for classifying stenoses of 64-slice MSCT was 69%, specificity was 92%, positive predictive value was 38% and negative predictive value was 98%. The interobserver variability for detection of significant lesions had a k-value of 0.43.Sixty-four-slice MSCT offers the diagnostic potential to detect coronary artery disease, to quantify haemodynamically significant coronary artery stenoses and to avoid unnecessary invasive coronary artery examinations.

VEGF 936C > T Polymorphism and Association of BI-RADS Score in Women with Suspected Breast Cancer.

PURPOSE: Vascular endothelial growth factor (VEGF) is a potent regulator of angiogenesis and thereby involved in the development and progression of solid tumors. A 936C > T polymorphism in the VEGF gene has been associated with reduced VEGF plasma levels. Purpose of the present study was to analyze the potential association between VEGF genotype and radiological appearance of breast lesions by mammography. MATERIALS AND METHODS: Fifty two women with 54 suspected breast lesions were analyzed by the use of mammography with the standard breast imaging reporting and data systems (BI-RADS). Germline VEGF genotype was determined in all subjects by allele-specific digestion of amplification products. An open biopsy was performed on all lesions. RESULTS: VEGF CC, CT and TT genotypes were found in 41 (79%), 9 (17%) and 2 (4%) patients. By mammography 26, 16 and 12 suspected breast lesions were classified as BI-RADS scores 3, 4 and 5, respectively. Both carriers of the TT genotype were classified as BI-RADS 5, whereas among CT or CC carriers, BI-RADS scores 3, 4 and 5 were found in 26, 16 and 10 subjects (P < 0.026). CONCLUSION: The VEGF 936C > T polymorphism seems to be associated with a high BI-RADS score in women with suspicious breast lesions.

Thick curved planar reformation of unenhanced multislice computed tomography demonstrating urolithiasis.

OBJECTIVES: To determine what slice thickness provides optimal curved planar reformation (CPR) images of the urinary tract. METHODS: A total of 75 consecutive patients with acute flank pain were included in a retrospective pilot study and underwent unenhanced multislice computed tomography (MSCT) (collimation 3.75 mm, pitch 6, reconstruction increment 3 mm, working voltage 120 kV, and tube current 100 mA) with CPR reconstruction of the urinary tract. CPRs with differing slice thicknesses of 3-20 mm at 1-mm increments to reformat each ureter were assessed in each patient separately. Two radiologists and a urologist evaluated the quality of the reformatted images by judging each ureter in terms of the delineation of all its parts using a 5-point scale (insufficient, poor, moderate, good, and excellent). RESULTS: Of the 75 patients in our cohort, 52 (69%) had urolithiasis. CPR images could be made of all ureters in all patients. Good to excellent image quality was found in the CPRs performed with a slice thickness of 8-12 mm: 27.7% at 8 mm, 14.3% at 9 mm, 26.9% at 10 mm, 12.6% at 11 mm, and 18.5% at 12 mm. Thus, a slice thickness of 8-12 mm determined a cumulative likelihood of 96.7% to demonstrate the ureter totally. CONCLUSIONS: The results of our study have shown that CPR is a feasible and quick useful tool. CPRs of the urinary tract with a slice thickness of 8-12 mm are best for good delineation of the whole ureter.