Factors Associated with Pathway-Concordant Neuroimaging for Pediatric Ischemic Stroke.

OBJECTIVE: To determine factors associated with magnetic resonance imaging (MRI) and noninvasive diagnostic angiography among children presenting to the emergency department (ED) with acute ischemic stroke. STUDY DESIGN: We performed a cross-sectional study using data from >50 US children's hospitals. We included children 29 days through 17 years old hospitalized from the ED with an International Classification of Diseases, Tenth Revision, Clinical Modification, diagnosis code for acute ischemic stroke between October 1, 2015, and November 30, 2022. We excluded children with a principal diagnosis code of trauma/external injury, without neuroimaging on day of presentation, and into-ED transfers. Our outcomes were defined as acquisition of MRI (vs computed tomography only) and angiography (vs no angiography) on day of presentation. We performed generalized linear mixed modeling with hospital as a random effect to determine the association of demographics, known comorbidities, and treatment factors with each outcome. RESULTS: We included 1601 children. In multivariable analysis, younger age, mechanical ventilation, and Black race were associated with lower odds of MRI acquisition, whereas history of moyamoya disease and sickle cell disease were associated with greater odds. Younger age, mechanical ventilation, Hispanic ethnicity, Black race, other races, history of metabolic disease, and history of seizures were associated with lower odds of angiography. CONCLUSIONS: Younger and non-White children experienced lower odds of MRI and angiography, which may be driven by health system limitations or provider implicit biases or both. Our results expose risk factors for underdiagnosis of ischemic stroke and provide opportunities to tailor institutional pathways reflective of underlying pathophysiology.

Progress in noninvasive coronary artery imaging using multislice CT.

Conventional coronary angiography (CAG) has been the reference standard for the assessment of coronary artery disease since its introduction in 1958. However, several studies have shown that diagnostic CAG has an average morbidity of 2% and a mortality of approximately 0.1%. In the last decade, progress in medical imaging has opened the way to noninvasive assessment of the coronary arteries at lower cost and risk. Of the different modalities, multislice CT (MSCT) has made the biggest step forward. At the 2005 European Congress of Radiology (ECR), experiences with the latest developments in noninvasive coronary artery imaging were reported. This report summarises the advances in the use of MSCT in coronary stenosis detection, emergency decision-making, plaque imaging, and the analysis of cardiac function and late enhancement. Also, attention is paid to new strategies to reduce MSCT-related radiation exposure.

Noninvasive investigation of deep vascular pathologies of exudative macular diseases by high-penetration optical coherence angiography.

PURPOSE: A newly developed high-penetration Doppler optical coherence angiography (HP-OCA) with a 1-µm probe beam for noninvasive investigation of vascular pathology of exudative macular diseases is introduced. A descriptive case series is presented to discuss the clinical utility of HP-OCA. METHODS: Eleven eyes of 10 subjects with exudative macular disease, including two eyes with myopic choroidal neovascularization (mCNV); four eyes with AMD; and five eyes with polypoidal choroidal vasculopathy (PCV) were investigated. Two Doppler scanning modes (bidirectional and high-sensitive) of HP-OCA were used for the investigation. HP-OCA provides depth-resolved and en face angiograms and a structural OCT noninvasively. The HP-OCA images were compared with fluorescein angiography (FA); indocyanine green angiography (ICGA); and color fundus images. RESULTS: The abnormal vasculature patterns observed with high-sensitive HP-OCA presented high similarity to the midphase of ICGA. Several abnormal Doppler signals were observed in the en face high-sensitive HP-OCA and were colocated with FA leakage. This colocation was found in one eye with mCNV, four eyes with AMD, and one eye with PCV. Doppler tomogram of the bidirectional mode showed abnormal Doppler signals in three of five PCV cases beneath the pigment epithelium detachment. With the high-sensitive mode, Doppler signals were found beneath the elevated retinal pigment epithelium in all untreated cases. CONCLUSIONS: HP-OCA revealed depth-resolved abnormal vasculatures in exudative macular diseases. The en face HP-OCA images showed high similarity with FA and ICGA images. These results suggest HP-OCA can be used for noninvasive and three-dimensional angiography in a clinical routine.