Pericarotid Fat Stranding at Computed Tomography Angiography: A Marker of the Short-Term Prognosis of Acute Ischemic Stroke.

PURPOSE: Perivascular epicardial fat stranding detected in the coronary computed tomography (CT) angiography is associated with culprit lesions and provides helpful information on the risk of acute coronary syndrome. This study aimed to evaluate the potential clinical significance of pericarotid fat stranding (PCFS) and investigate the association between PCFS and short-term prognosis in acute stroke using head and neck CT angiography (CTA). METHODS: This study included 80 patients (mean age, 69.69 ± 11.03; 58 men) who underwent both head and neck CTA and magnetic resonance imaging within a 1-week period. Baseline characteristics, pericarotid adipose tissue attenuation, plaque characteristics, ischemic penumbra, infarct core volume, infarct core growth rate (CGR), and the grade of collateral status were recorded and compared between a PCFS group and a non-PCFS group. Data were compared using the 2-sample t test, Mann-Whitney U test, Fisher exact test, and Spearman rank correlation analysis. RESULTS: We found that patients with PCFS had a significantly higher pericarotid adipose tissue density than patients without PCFS (-55.75 ± 5.53 vs -65.82 ± 9.65, P < 0.001). Patients with PCFS showed a larger infarct core volume (166.43 ± 73.07 vs 91.43 ± 55.03, P = 0.001) and faster CGR (39.57 ± 12.01 vs 19.83 ± 32.77; P < 0.001), and the frequency of adverse prognosis was more significant than in control participants (83.33% vs 19.11%). CONCLUSIONS: Individuals with PCFS showed higher CGR, which was substantially related to worse outcomes in patients with acute stroke with ipsilateral carotid atherosclerosis. Recognition of PCFS may help predict stroke prognosis and allow doctors to take early action to improve patient prognosis.

Value of nerve root sedimentation sign in diagnosis and surgical indication of lumbar spinal stenosis.

BACKGROUND: Lumbar spinal stenosis (LSS) is a prevalent and disabling cause of low back and leg pain in elderly people and nerve root sedimentation sign (NRSS) has been demonstrated to have high sensitivity and specificity in diagnosing LSS in selected patients. The purpose of this study was to investigate the diagnosis of LSS and the predictive value of NRSS. METHODS: The clinical and imaging data of 176 patients diagnosed with LSS and 156 patients with non-specific low back pain (LBP) were analyzed retrospectively. Transverse magnetic resonance images (MRI) of the narrowest spinal canal in all patients were acquired and graded by two experienced doctors using the Braz classification, Schizas classification and Chen Jia classification. Receiver operating curve (ROC) was used to compare the diagnostic efficacy of the three classifications. Univariate and multivariate logistic regression models were established to predict the surgical indications of LSS patients. RESULT: The diagnostic efficacy of Schizas classification (AUC:0.943; 95%CI:0.918,0.969) and Chen Jia classification (AUC:0.942; 95%CI:0.918,0.966) was significantly higher than that of Braz classification (AUC:0.853; 95%CI:0.808,0.898). Chen Jia classification had the highest correlation with the degree of dural sac cross-sectional area (DCSA) stenosis. In the multivariate analysis of LSS surgical indications, Chen Jia classification (odds ratio [OR], 2.127; 95%CI:1.596,2.835), DCSA (OR,0.398; 95%CI:0.169,0.802) and intermittent claudication (OR,9.481; 95%CI:3.439,26.142) were associated with surgical indications. CONCLUSION: Among the three types, it is found that Chen Jia classification has better diagnostic efficacy in differentiating LSS from LBP. In addition, Chen Jia classification is simple to be implemented in clinical practice and has high clinical application value. Hence, Chen Jia classification can be used as an effective surgical treatment indicator for LSS patients.

High-Resolution Magnetic Resonance Imaging (HR-MRI) Evaluation of the Distribution and Characteristics of Intra-Aneurysm Thrombosis to Improve Clinical Diagnosis of Thrombotic Intracranial Aneurysm.

BACKGROUND We aimed to analyze the related factors of intracranial anterior circulation saccular artery thrombosis and its characteristics on high-resolution magnetic resonance imaging (HR-MRI) images to provide a basis for neurosurgeons to select the precise treatment strategy for thrombotic intracranial aneurysms (TIA). MATERIAL AND METHODS This retrospective analysis included 136 patients with unruptured intracranial anterior circulation artery aneurysms who underwent HR-MRI. The 136 aneurysms were divided into thrombus (41) and non-thrombus (95) groups. Single factor analysis of morphological and clinical indicators were conducted to select meaningful indicators for logistic regression analysis; the optimal diagnostic threshold was calculated through ROC curve analysis. The location and signal characteristics of thrombi were analyzed to inform clinical treatment. RESULTS Single factor analysis revealed significant differences in patient age, aneurysm size, aneurysm neck, aspect ratio, size ratio, and hyperlipidemia between the 2 groups (P<0.05). Multi-factor regression analysis demonstrated that aneurysm size (OR=2.180) and aspect ratio value (OR=7.495) were correlated with intracranial thrombosis. ROC curve analysis showed that for aneurysms larger than 8 mm, the sensitivity and specificity of TIA prediction were 83% and 93%, respectively. For aneurysms with aspect ratio values greater than 2.5, sensitivity and specificity of TIA predication were 75% and 95%, respectively. The proportion of aneurysm wall enhancement and clinical symptoms in the thrombus group was significantly higher than that in the non-thrombus group. CONCLUSIONS Intracranial unruptured aneurysms with the size larger than 8 mm or with aspect ratio values higher than 2.5 indicated the possible formation of thrombosis in the aneurysm.

Study on the Correlation between different Levels of Patients with Vertebrobasilar Dolichoectasia and Posterior Circulation Blood Perfusion.

OBJECTIVE: This study investigates the differences and changing trend of posterior circulation blood perfusion between different levels of vertebrobasilar dolichoectasia(VBD) patients. The relationship between the deviation of the basilar artery(BA) in different directions and the location of pontine infarction are also investigated. METHODS: A cohort of 106 patients(74 males and 32 females) who satisfied the diagnostic criteria for VBD were recruited for this study and classified according to the bifurcation height and the deviation position of the BA, as well as the measured blood perfusion value of the pontine, which includes rCBF, rCBV, MTT, and TTP. RESULTS: Out of the 106 patients, 19 cases were classified as Level 1, 74 cases were classified as Level 2, and 13 cases were classified as Level 3. The different levels between the VBD groups were statistically significant (P<0.05, P<0.01), and it was found that as the level increases, rCBF and rCBV gradually decreased, while MTT and TTP gradually increased. The statistic results of different perfusion parameters were also significant, when pairwise comparisons between Level 1 and Level 3, and Level 2 and Level 3 were performed. However, when comparing Level 1 and Level 2, only the TTP showed significant result. Among 106 patients, 22 cases had brainstem infarction, 13 cases had left brainstem infarction, 8 cases had right brainstem infarction, and 1 case had brainstem infarction on both sides. Brainstem infarction generally occurs on the opposite side of the direction of BA deviation(P<0.05). Regardless of the BA was deviated to the left or right, perfusion analysis showed that there was significant difference in blood perfusion on both sides of the pontine when BA is deviated(P<0.05, P<0.01). The rCBF and rCBV on the contralateral side of deviation were lower than those on the same side, and the MTT and TTP were longer than those on the same side. There were 37 cases with vertebral artery dominance(VAD), 16 cases with left VAD, and 21 cases with right VAD. Statistical analysis showed that BA was more likely to deflect to the opposite side of the dominant artery(P<0.05), and compared with non-VAD, there was no significant difference in pontine blood perfusion (p>0.05). CONCLUSION: As VBD level increases, rCBF and rCBV will gradually decreases while MTT and TTP showed sign of increasing. The location of brainstem infarction is opposite to the direction of the BA deviation, and BA is more likely to deviate to the opposite side of the dominant artery.

Impact of H-Type Hypertension on Pericarotid Adipose Tissue and Plaque Characteristics Based on Computed Tomography (CT) Angiography: A Propensity Score Matching Study.

BACKGROUND We analyzed the correlation among the inflammatory changes in pericarotid adipose tissue (PCAT), plaque characteristics, and H-type hypertension on CT angiography (CTA) and explored the utility of CTA in the prevention and treatment of carotid atherosclerosis. MATERIAL AND METHODS A total of 135 patients who underwent head and neck CTA to investigate carotid artery atherosclerosis were retrospectively analyzed. The plaque characteristic parameters (plaque burden and remodeling index), PCAT attenuation value, and net enhancement value around the carotid artery, where the plaques were located, were recorded, and confounding factors were matched by propensity score analysis. A paired t test was used to compare the differences in fat tissue inflammatory changes and plaque characteristic parameters between the 2 groups, and logistic regression analysis was used to evaluate the relationship between plaque characteristics and the attenuation values and net enhancement values of PCAT. The correlation coefficient was calculated between type H hypertension and plaque risk grade. RESULTS The results of the experiment indicate that PCAT attenuation values and net enhancement values gradually increased as the degree of hypertension increased. Compared with those of patients in the normal Hcy group, these values increased more clearly in patients with high Hcy (HHcy) (r=0.641, P<0.001, r=0.581, P<0.001), although, regardless of whether the Hcy value increased, there were significant differences between the groups. However, this effect was more pronounced in patients with H-type hypertension. Logistic regression analysis of risk factors for carotid atherosclerotic plaque suggests that Hcy (OR=1.391, 95% CI 1.146-1.689, P=0.001), PCAT attenuation values (OR=1.212, 95% CI 1.074-1.367, P=0.002), and net enhancement values (OR=1.201, 95% CI 1.042-1.383, P=0.011) were independent risk factors for plaque vulnerability. CONCLUSIONS Our results suggest that H-type hypertension is significantly associated with PCAT attenuation and net enhancement and that PCAT net enhancement values are useful in predicting plaque risk as attenuation.

High-Resolution Magnetic Resonance Imaging (HR-MRI) Imaging Characteristics of Vertebral Artery Dissection with Negative MR Routine Scan and Hypoperfusion in Arterial Spin Labeling.

BACKGROUND Unruptured vertebral artery dissection (VAD) that causes ischemic infarction may require anticoagulant therapy or other treatments. However, anticoagulation therapy is not recommended for patients without ischemic infarction. To date, there has been no research on the imaging characteristics of patients with ischemic hypoperfusion that have a negative routine MRI scan. MATERIAL AND METHODS Patients with suspected VAD were recruited between June 2015 and June 2020 in order to perform high-resolution magnetic resonance imaging (HR-MRI). In total, 26 patients with negative MRI routine scans that underwent arterial spin labeling (ASL) examination were included in the study. The patients were divided into the hypoperfusion group and normal group based on whether hypoperfusion was found in ASL. The clinical features and HR-MRI features between these 2 groups were analyzed. RESULTS There were no statistical differences between the hypoperfusion group and normal group based on the patient's clinical characteristics (P>0.05). According to imaging characteristics between the 2 groups, the effective lumen index and the vertebrobasilar artery minimum angle were statistically significant (P.

Risk Factors for Asymptomatic Intracranial Small Aneurysm Rupture Determined by Electrocardiographic-Gated 4D Computed Tomographic (CT) Angiography.

BACKGROUND To study the risk predictors of intracranial asymptomatic small aneurysm rupture by electrocardiographic (ECG)-gated 4D-CT angiography (4D-CTA). MATERIAL AND METHODS A total of 168 patients with intracranial aneurysms <7 mm who underwent 4D-CTA examinations were retrospectively analyzed and divided into a ruptured group and an unruptured group. The original scanning data of all cases were reconstructed to obtain 20 groups of data in 5% time intervals in the cardiac cycle. After processing with 3D workstation software, 20 sets of images and dynamic images were achieved. The morphological characteristics and clinical features of the 2 groups of aneurysms were analyzed through univariate analysis, then logistic regression analysis was performed for the meaningful indicators. Finally, the optimum diagnostic cut-off point was calculated by ROC curve analysis. RESULTS Univariate analysis showed that sex, smoking history, vascular bifurcation point, pulsation point appearance, aneurysm height, aspect ratio (AR), and size ratio (SR) were significantly different (P<0.05) between the ruptured group and unruptured group. Multivariate regression analysis indicated that the pulsation points (OR=8.188, 95% CI: 3.984-17.198) and high SR values (OR=5.325, 95% CI: 1.503-18.867) were independent predictors of asymptomatic small aneurysm rupture. When the SR value was higher than 1.65, the area below the ROC curve was 0.723, the diagnostic sensitivity was 75%, and the specificity was 80%. CONCLUSIONS The occurrence of pulsation points and SR values >1.65 were independent predictors for the rupture of asymptomatic small intracranial aneurysms <7 mm in diameter.

Dynamic Volume Change Rate and Aspect Ratio Are Correlated to the Formation of an Irregular Morphology of Unruptured Intracranial Aneurysm.

OBJECTIVE: The aim of this research was to study the factors influencing the formation of intracranial aneurysms with irregular morphology by observing the dynamic volume change rate of intracranial unruptured aneurysms and other aneurysm characteristics. METHOD: Sixty-five unruptured intracranial aneurysms of 51 consecutive patients from 1 center were included in this study. All patients underwent a dual-source computed tomography electrocardiogram-gated 4-dimensional computed tomography angiography examination. The original data at the end of the scan were reconstructed, and 20 sets of data packages through a cardiac cycle with 5% interval were obtained. Data packages were processed by a 3-dimensional software workstation to obtain 20 sets of images and dynamic diagrams. The volume of each aneurysm in the 20 sets of images was measured, and the volume change was calculated by a specific formula. The other data features of the aneurysm such as aneurysm neck, aneurysm height, aspect ratio (AR), location at bifurcation, and clinical features such as age, sex, hypertension history, type 2 diabetes history, smoking history, family history, multiple aneurysm history, and subarachnoid hemorrhage history, were documented in detail. After single factor analysis data, logistic regression analysis of the meaningful indicator was conducted to study the predictive factors of irregular aneurysms. RESULTS: Of the 65 aneurysms, 25 possessed an irregular shape and 40 were of regular shape; 51 were anterior circulatory aneurysms and 14 were posterior circulatory aneurysms. Single factor analysis showed that AR (P = 0.001), volume change rate (P = 0.002), and location of aneurysm at the bifurcation (P = 0.038) of the vessel were significantly correlated with irregular aneurysms, but not correlated with age, sex, hypertension history, type 2 diabetes history, smoking history, family history, multiple aneurysm history, and subarachnoid hemorrhage history. Multifactor analysis showed that volume change rate greater than 30% (P = 0.008; odds ratio, 6.934) and AR greater than 1.4 (P = 0.004; odds ratio, 8.258) were independent correlative factors of the formation of intracranial aneurysm with irregular shape. CONCLUSION: The volume change rate and AR are independent correlative factors of the formation of intracranial aneurysm with irregular shape.

A novel predictive model based on pericarotid adipose tissue and lumen stenosis for stroke risk in patients with asymptomatic carotid stenosis.

The study aimed to investigate the predictive value of clinical characteristics, major computed tomography angiography (CTA) indexes of carotid AS (carotid lumen stenosis and plaque burden), and inflammatory pericarotid adipose tissue for acute stroke risk in patients with a moderate or higher degree of carotid stenosis. In all, 119 patients with unilateral carotid stenosis who underwent head and neck computed tomography angiography were included and assigned to the stroke group or non-stroke group according to magnetic resonance imaging. Pericarotid adipose tissue attenuation value, net enhancement value in the base phase and the enhancement phase, and atherosclerotic features (plaque burden and lumen stenosis) were recorded. Multivariate logistic regression analysis and the operating characteristic curve (ROC) were performed to establish a predictive model for the presence of acute ischemic stroke. ROC analysis showed that pericarotid adipose tissue attenuation value and lumen stenosis were predictive factors for stroke. The AUC of pericarotid adipose tissue attenuation (PCAT) attenuation, lumen stenosis, the novel prediction model independently constructed based on PCAT attenuation, and lumen stenosis resulted in 0.838 (95% CI 0.759-0.899), 0.700 (95% CI 0.826-0.944), and 0.942 (95% CI 0.884-0.977), respectively. The model had a sensitivity and specificity of 0.909 and 0.893, respectively, when the cutoff value was 0.388. We found that the risk model combining pericarotid adipose tissue attenuation value and lumen stenosis has significant predictive values for the presence of symptomatic stroke among patients with a moderate or higher degree of carotid stenosis.

A clinically applicable deep-learning model for detecting intracranial aneurysm in computed tomography angiography images.

Intracranial aneurysm is a common life-threatening disease. Computed tomography angiography is recommended as the standard diagnosis tool; yet, interpretation can be time-consuming and challenging. We present a specific deep-learning-based model trained on 1,177 digital subtraction angiography verified bone-removal computed tomography angiography cases. The model has good tolerance to image quality and is tested with different manufacturers. Simulated real-world studies are conducted in consecutive internal and external cohorts, in which it achieves an improved patient-level sensitivity and lesion-level sensitivity compared to that of radiologists and expert neurosurgeons. A specific cohort of suspected acute ischemic stroke is employed and it is found that 99.0% predicted-negative cases can be trusted with high confidence, leading to a potential reduction in human workload. A prospective study is warranted to determine whether the algorithm could improve patients' care in comparison to clinicians' assessment.