Performance of low-dose CT image reconstruction for detecting intracerebral hemorrhage: selection of dose, algorithms and their combinations / 南方医科大学学报

OBJECTIVE@#To investigate the performance of different low-dose CT image reconstruction algorithms for detecting intracerebral hemorrhage.@*METHODS@#Low-dose CT imaging simulation was performed on CT images of intracerebral hemorrhage at 30%, 25% and 20% of normal dose level (defined as 100% dose). Seven algorithms were tested to reconstruct low-dose CT images for noise suppression, including filtered back projection algorithm (FBP), penalized weighted least squares-total variation (PWLS-TV), non-local mean filter (NLM), block matching 3D (BM3D), residual encoding-decoding convolutional neural network (REDCNN), the FBP convolutional neural network (FBPConvNet) and image restoration iterative residual convolutional network (IRLNet). A deep learning-based model (CNN-LSTM) was used to detect intracerebral hemorrhage on normal dose CT images and low-dose CT images reconstructed using the 7 algorithms. The performance of different reconstruction algorithms for detecting intracerebral hemorrhage was evaluated by comparing the results between normal dose CT images and low-dose CT images.@*RESULTS@#At different dose levels, the low-dose CT images reconstructed by FBP had accuracies of detecting intracerebral hemorrhage of 82.21%, 74.61% and 65.55% at 30%, 25% and 20% dose levels, respectively. At the same dose level (30% dose), the images reconstructed by FBP, PWLS-TV, NLM, BM3D, REDCNN, FBPConvNet and IRLNet algorithms had accuracies for detecting intracerebral hemorrhage of 82.21%, 86.80%, 89.37%, 81.43%, 90.05%, 90.72% and 93.51%, respectively. The images reconstructed by IRLNet at 30%, 25% and 20% dose levels had accuracies for detecting intracerebral hemorrhage of 93.51%, 93.51% and 93.06%, respectively.@*CONCLUSION@#The performance of reconstructed low-dose CT images for detecting intracerebral hemorrhage is significantly affected by both dose and reconstruction algorithms. In clinical practice, choosing appropriate dose level and reconstruction algorithm can greatly reduce the radiation dose and ensure the detection performance of CT imaging for intracerebral hemorrhage.

Hemorragia cerebral durante fase ativa de infecção por SARS-CoV-2 em paciente com angiopatia amiloide: relato de caso / Cerebral hemorrhage during the active phase of SARS-CoV-2 infection in a patient with amyloid angiopathy: case report

RESUMO As alterações neurológicas associadas à COVID-19 têm sido frequentemente descritas, principalmente nos casos de maior severidade, e estão relacionadas a causas multifatoriais, como a disfunção endotelial, a liberação de mediadores inflamatórios (cytokine storm), a disfunção endotelial e a hipoxemia. Relatamos o caso de uma paciente do sexo feminino, 88 anos, com quadro de hemorragia cerebral associada à angiopatia amiloide, no contexto de infecção por SARS-CoV-2.

ABSTRACT The neurological changes associated with COVID-19 have been frequently described, especially in cases of greater severity, and are related to multifactorial causes, such as endothelial dysfunction, inflammatory mediator release (cytokine storm), endothelial dysfunction and hypoxemia. We report the case of a female patient, 88 years old, with cerebral hemorrhage associated with amyloid angiopathy in the context of SARS-CoV-2 infection.

Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates / Opções de drenagem liquórica em neonatos prematuros com hidrocefalia pós hemorrágica

ABSTRACT Objective The literature describes various cerebrospinal fluid (CSF) drainage techniques to alleviate posthemorrhagic hydrocephalus in preterm newborns; however, consensus has not been reached. The scope of this study was describing a case series of premature neonates with posthemorrhagic hydrocephalus and assessing the outcomes of different approaches used for CSF diversion. Methods A consecutive review of the medical records of neonates with posthemorrhagic hydrocephalus treated with CSF drainage was conducted. Results Forty premature neonates were included. Serial lumbar puncture, ventriculosubgaleal shunt, and ventriculoperitoneal shunt were the treatments of choice in 25%, 37.5% and 37.5% of the cases, respectively. Conclusion Cerebrospinal fluid diversion should be tailored to each case with preference given to temporary CSF drainage in neonates with lower age and lower birth-weight, while the permanent ventriculoperitoneal shunt should be considered in healthier, higher birth-weight neonates born closer to term.

RESUMO Objetivo A literatura descreve várias opções de drenagem liquórica (DL) para alivio da hidrocefalia pós-hemorrágica (HPH) em neonatos prematuros; contudo, não existe um consenso sobre a melhor abordagem. O escopo deste estudo foi descrever uma série de casos de neonatos prematuros, portadores de HPH, verificando os resultados de diferentes técnicas utilizadas para DL. Métodos Revisão consecutiva dos prontuários de neonatos com diagnostico de HPH submetidos a DL. Resultados Quarenta recém-nascidos prematuros foram incluídos. A punção lombar seriada (PL), a derivação ventriculosubgaleal (VSG) e a derivação ventrículo peritoneal (VP) foram o tratamento escolhido em 25%, 37,5% e 37,5% dos casos, respectivamente. Conclusão As opções de DL devem ser avaliadas caso a caso, sendo dada preferência às drenagens temporária em prematuros com idade e peso mais baixos ao nascer, enquanto o shunt definitivo (derivação VP) pode ser considerado naqueles prematuros mais saudáveis, com idade e peso superiores.

Asociación entre lesiones placentarias y lesiones isquémico hemorrágicas cerebrales precoces detectadas por ecografía en prematuros menores de 1500 gramos y 32 semanas / [The relationship between placental lesions and early hemorrhagic-ischemic cerebral injury in very low birth weight infants].

INTRODUCTION: The histopathological features of the placenta are central for screening a lot of pregnancy related disorders associated to hemorrhagic-ischemic cerebral injury in preterm infants that can jeopardize his long term neurodevelopment. The objective of this study was to examine the relationship between placental lesions and early hemorrhagic-ischemic cerebral injury in very low birth weight infants (VLBW). METHODS: This is a case-control study of VLBW born at Sardá Maternity Hospital, Buenos Aires, between 2006 and 2012. Inclusion criteria’s were gestational age ÔëÑ 24 and Ôëñ 32 weeks and birth weight between 500 g and 1500 g, Exclusion criteria’s were multiple pregnancy, congenital anomalies, intrauterine infections and mortality before 24 hours of life. RESULTS: 198 VLBW were included, 49 cases and 149 controls. There was no significant difference in the incidence of histopathological lesions between the groups, although inflammatory placental lesions predominated in cases (67,3

) compared with controls (48

, p= 0.018). Intraventricular hemorrhage was the most common injury. On bivariate analysis inflammation was the only placenta lesion associated with early hemorrhagic-ischemic cerebral injury (OR 7.0, 95

CI 1.54 - 31.71) whereas the risk of severe hemorrhagic-ischemic cerebral injury was twofold greater in the presence of inflammation (p= 0.20). After adjusting for perinatal variables, placental lesions were not independently associated with increased risk of hemorrhagic-ischemic cerebral injury. There was a trend towards lesser risk of hemorrhagic-ischemic cerebral injury with increasing gestational age. CONCLUSION: Placental injuries were not independently associated with hemorrhagic-ischemic cerebral injury within 72 hours of life, although inflammation showed a clear predominance un cases.

Thoracic Endovascular Aortic Repair with the Chimney Technique for Blunt Traumatic Pseudoaneurysm of the Aortic Arch in a No-Option Patient

A 42-year-old man was involved in a motor vehicle collision. Imaging studies revealed the presence of a post-traumatic aortic pseudo-aneurysm (about 34x26 cm) arising from the descending thoracic aorta at the level of the left subclavian artery (LSA), prone to rupture. Thoracic endovascular aneurysm repair (TEVAR) was the only feasible option due to his poor overall medical status. In this case, LSA needed to be covered in order to extend the proximal landing zone. Eventually, modified TEVAR was successfully performed by means of the chimney technique to preserve flow to the LSA and to prevent flow into the pseudoaneurysmal sac.

Atypical Developmental Venous Anomaly Associated with Single Arteriovenous Fistula and Intracerebral Hemorrhage: a Case Demonstrated by Superselective Angiography

We present a case of developmental venous anomaly associated with arteriovenous fistula supplied by a single arterial feeder adjacent to a large acute intracerebral hemorrhage. The arteriovenous fistula was successfully obliterated by superselective embolization while completely preserving the developmental venous anomaly. Two similar cases, including superselective angiographic findings, have been reported in the literature; however, we describe herein superselective angiographic findings in more detail and demonstrate the arteriovenous shunt more clearly than the previous reports. In addition, a literature review was performed to discuss the association of a developmental venous anomaly with vascular lesions.

Nature of lesion in cerebrovascular stroke patients: clinical stroke score and computed tomography scan brain correlation.

AIM: To differentiate between cerebral infarct and intracerebral haemorrhage on the basis of clinical stroke score (Siriraj Stroke Score and Guy's Hospital Score) and to find out the sensitivity and overall accuracy of these scoring systems by comparing it with CT scan findings. MATERIAL AND METHODS: Two hundred patients with acute stroke were analysed by Siriraj and Guy's Hospital Score simultaneously CT scan was performed and patients with subarachnoid haemorrhage, tuberculoma, tumours and trauma were excluded. RESULT: CT scan revealed cerebral infarction in 152 (76%) patients and cerebral haemorrhage in 48 (24%) patients. The sensitivity of Siriraj Stroke Score was 92.54% for infarction and 87% for haemorrhage (equivocal and infratentorial cases were excluded) and it's overall accuracy was 91.11%. The Guy's Hospital Score had a sensitivity of 93.42% for infarction, 66.66% for haemorrhage and overall accuracy was 87%. CONCLUSION: Siriraj Stroke Score is easier to use at bed side and has a greater accuracy (especially in diagnosis of haemorrhage) than the Guy's Hospital Score.

Diagnostic value of transcranial doppler in the vasospasm secondary to middle cerebral artery aneurysmal haemorrhage

This study highlights the importance of transcranial dopper [TCD] study in suspected middle cerebral artery aneurysmal subarachnoid hemorrhage. Eight middle aged patients of either sex presented with acute history of severe headache to our department for Neuroradiological investigations. The TCD study on middle cerebral artery [MCA] was positive in all the cases, suggestive of vasospasm. In seven cases CT Scan brain and cerebral angiography showed middle cerebral aretery aneurysm with its segmental narrowing suggestive of vasospasm. In one, case neither CT scan nor cerebral angiography fully confirmed the middle cerebral artery aneurysm where as surgery correlated the TCD findings of vasospasm secondary to aneurysmal bleed. The TCD is an ideal and inexpensive method in suspected middle cerebral artery aneurysmal subarachnoid hemorrhage to have clue of the aneurysm and also to monitor vasospasm which may help in proper management

Divergence Paralysis Due to a Small Hematoma in the Tegmentum of the Brainstem

There has been considerable controversy concerning divergence paralysis, an entity described as early as 1883 by Parinaud. We recently observed a patient with divergence paralysis, who on CT scan presented a small hematoma in the tegmentum of the brainstem. This case may support the theory that the center for divergence exists in the upper brainstem.