Does Intravenous Thrombolysis Within 4.5 to 9 Hours Increase Clot Migration Leading to Endovascular Inaccessibility?

BACKGROUND AND PURPOSE: Distal clot migration is a recognized event following intravenous thrombolysis (IVT) in the setting of acute ischemic stroke. Of note, clots that were initially retrievable by endovascular thrombectomy may migrate to a distal nonretrievable location and compromise clinical outcome. We investigated the incidence of clot migration leading to clot inaccessibility following IVT in the time window of 4.5 to 9 hours. METHODS: We performed a retrospective analysis of the EXTEND trial (Extending the Time for Thrombolysis in Emergency Neurological Deficits) data. Baseline and 12- to 24-hour follow-up clot location was determined on computed tomography angiogram or magnetic resonance angiogram. The incidence of clot migration leading to a change from retrievable to nonretrievable location was identified and compared between the two treatment groups (IVT versus placebo). RESULTS: Two hundred twenty patients were assessed. Clot migration from a retrievable to nonretrievable location occurred in 37 patients: 21 patients (19.3%) in the placebo group and 16 patients (14.4%) in the IVT group. No significant difference was identified in the incidence of clot migration leading to inaccessibility between groups (P=0.336). CONCLUSIONS: Our results did not show increased clot migration leading to clot inaccessibility in patients treated with IVT.

Geometric Distortion Correction of Renal Diffusion Tensor Imaging Using the Reversed Gradient Method.

ABSTRACT: Renal echo planar diffusion tensor imaging (DTI) has clinical potential but suffers from geometric distortion. We evaluated feasibility of reversed gradient distortion correction in 10 diabetic patients and 6 volunteers. Renal area, apparent diffusion coefficient, fractional anisotropy, and tensor eigenvalues were measured on uncorrected and distortion-corrected DTI. Corrected DTI correlated better than uncorrected DTI (r = 0.904 vs 0.840, P = 0.002) with reference anatomic T2-weighted imaging, with no significant difference in DTI metrics.

Multidetector (64+) Computed Tomography Angiography of the Lower Limb in Symptomatic Peripheral Arterial Disease: Assessment of Image Quality and Accuracy in a Tertiary Care Setting.

OBJECTIVE: The aim of this study was to evaluate image quality and accuracy of 64+ detector multidetector computed tomography angiography (MDCTA) for hemodynamically significant (≥50%) stenosis in patients with symptomatic peripheral arterial disease (PAD) using digital subtraction angiography as the reference standard. METHODS: This is a retrospective study of 29 patients with PAD (19 men, 10 women) who underwent lower limb MDCTA (64- or 80-detector) and digital subtraction angiography. Image quality and accuracy of MDCTA for hemodynamically significant stenosis were assessed in the infrarenal aorta and 15 lower extremity segments. RESULTS: Four hundred fifty-three segments were adequately visualized at both modalities. Multidetector CTA had 84.8% sensitivity, 87.7% specificity, and 86.3% accuracy for significant stenosis. Accuracy was decreased in the calf when compromising arterial wall calcifications were present versus absent (55.9% vs 82.4%, P < 0.0001). CONCLUSIONS: 64+ MDCTA is accurate in patients with symptomatic PAD. However, diagnostic accuracy in below-knee vessels remains relatively poorer. Alternative imaging modalities should be considered where below-knee disease is suspected.

A semi-automated "blanket" method for renal segmentation from non-contrast T1-weighted MR images.

OBJECTIVE: To investigate the precision and accuracy of a new semi-automated method for kidney segmentation from single-breath-hold non-contrast MRI. MATERIALS AND METHODS: The user draws approximate kidney contours on every tenth slice, focusing on separating adjacent organs from the kidney. The program then performs a sequence of fully automatic steps: contour filling, interpolation, non-uniformity correction, sampling of representative parenchyma signal, and 3D binary morphology. Three independent observers applied the method to images of 40 kidneys ranging in volume from 94.6 to 254.5 cm(3). Manually constructed reference masks were used to assess accuracy. RESULTS: The volume errors for the three readers were: 4.4% ± 3.0%, 2.9% ± 2.3%, and 3.1% ± 2.7%. The relative discrepancy across readers was 2.5% ± 2.1%. The interactive processing time on average was 1.5 min per kidney. CONCLUSIONS: Pending further validation, the semi-automated method could be applied for monitoring of renal status using non-contrast MRI.

Probabilistic MRI tractography of the optic radiation using constrained spherical deconvolution: a feasibility study.

BACKGROUND AND PURPOSE: Imaging the optic radiation (OR) is of considerable interest in studying diseases affecting the visual pathway and for pre-surgical planning of temporal lobe resections. The purpose of this study was to investigate the clinical feasibility of using probabilistic diffusion tractography based on constrained spherical deconvolution (CSD) to image the optic radiation. It was hypothesized that CSD would provide improved tracking of the OR compared with the widely used ball-and-stick model. METHODS: Diffusion weighted MRI (30 directions) was performed on twenty patients with no known visual deficits. Tractography was performed using probabilistic algorithms based on fiber orientation distribution models of local white matter trajectories. The performance of these algorithms was evaluated by comparing computational times and receiver operating characteristic results, and by correlation of anatomical landmark distances to dissection estimates. RESULTS: The results showed that it was consistently feasible to reconstruct individual optic radiations from clinically practical (4.5 minute acquisition) diffusion weighted imaging data sets using CSD. Tractography based on the CSD model resulted in significantly shorter computational times, improved receiver operating characteristic results, and shorter Meyer's loop to temporal pole distances (in closer agreement with dissection studies) when compared to the ball-and-stick based algorithm. CONCLUSIONS: Accurate tractography of the optic radiation can be accomplished using diffusion MRI data collected within a clinically practical timeframe. CSD based tractography was faster, more accurate and had better correlation with known anatomical landmarks than ball-and-stick tractography.