The Relationship Between Intramural Fat Accumulation and Sarcopenia on MR Enterography Exams in Patients with Crohn's Disease.

Research on magnetic resonance enterography (MRE) and sarcopenia for assessing Crohn's disease (CD) is growing. Our study examined the connections between the presence of sarcopenia, intramural fat accumulation (IFA), and clinical, laboratory, and MRE findings.This retrospective study was conducted on 112 patients with suspected or diagnosed CD who underwent 3-tesla MRE. The study examined the correlation between sarcopenia-related parameters and MRE findings. Results of MRE exams and clinical and laboratory results were statistically analyzed. The Kruskal-Wallis, Pearson chi-square, and Fisher-Freeman-Halton tests were used for comparison.It was determined that patients with active inflammation on a chronic basis had more IFA than the others (p<0.001). There were positive relationships between IFA and intramural edema (p<0.001). There were positive correlations between IFA and high b-values and negative correlations with apparent diffusion coefficient values (p<0.05). Positively significant relationships were found between IFA and wall thickness, affected segment length, disease duration, and sedimentation values (p<0.05). Strong correlations were found between sarcopenia and the CD activity index as well as wall thickness (p<0.001/p=0.003). There was no significant relationship between steroid usage and other variables.The presence of IFA is associated with chronic inflammation. There was no clear relationship between steroid use and IFA. Our findings support the idea that sarcopenia is related to the activity of CD. Further comprehensive research is required on these subjects. · The usage of MR enterography for the management of CD is increasing day by day due to its advantages.. · There is a paucity of evidence regarding the relationship between sarcopenia and MR enterography findings in patients with CD.. · Intramural fat accumulation (IFA) is a sign of chronicity in patients with CD.. · The presence of IFA seems to be associated with active inflammation on a chronic basis.. · There was no clear relationship between steroid use and IFA.. · Algin O, Günes YC, Cankurtaran RE et al. The Relationship Between Intramural Fat Accumulation and Sarcopenia on MR Enterography Exams in Patients with Crohn's Disease. Fortschr Röntgenstr 2024; DOI 10.1055/a-2330-8148.

Predictors of Aneurysm Obliteration in Patients Treated with the WEB Device: Results of a Multicenter Retrospective Study.

BACKGROUND AND PURPOSE: Despite the numerous studies evaluating the occlusion rates of aneurysms following WEB embolization, there are limited studies identifying predictors of occlusion. Our purpose was to identify predictors of aneurysm occlusion and the need for retreatment. MATERIALS AND METHODS: This is a review of a prospectively maintained database across 30 academic institutions. We included patients with previously untreated cerebral aneurysms embolized using the WEB who had available intraprocedural data and long-term follow-up. RESULTS: We studied 763 patients with a mean age of 59.9 (SD, 11.7) years. Complete aneurysm occlusion was observed in 212/726 (29.2%) cases, and contrast stasis was observed in 485/537 (90.3%) of nonoccluded aneurysms. At the final follow-up, complete occlusion was achieved in 497/763 (65.1%) patients, and retreatment was required for 56/763 (7.3%) patients. On multivariable analysis, history of smoking, maximal aneurysm diameter, and the presence of an aneurysm wall branch were negative predictors of complete occlusion (OR, 0.5, 0.8, and 0.4, respectively). Maximal aneurysm diameter, the presence of an aneurysm wall branch, posterior circulation location, and male sex increase the chances of retreatment (OR, 1.2, 3.8, 3.0, and 2.3 respectively). Intraprocedural occlusion resulted in a 3-fold increase in the long-term occlusion rate and a 5-fold decrease in the retreatment rate (P < .001), offering a specificity of 87% and a positive predictive value of 85% for long-term occlusion. CONCLUSIONS: Intraprocedural occlusion can be used to predict the chance of long-term aneurysm occlusion and the need for retreatment after embolization with a WEB device. Smoking, aneurysm size, and the presence of an aneurysm wall branch are associated with decreased chances of successful treatment.

Association of preprocedural antiplatelet use with decreased thromboembolic complications for intracranial aneurysms undergoing intrasaccular flow disruption.

OBJECTIVE: This study was conducted to investigate the impact of antiplatelet administration in the periprocedural period on the occurrence of thromboembolic complications (TECs) in patients undergoing treatment using the Woven EndoBridge (WEB) device for intracranial wide-necked bifurcation aneurysms. The primary objective was to assess whether the use of antiplatelets in the pre- and postprocedural phases reduces the likelihood of developing TECs, considering various covariates. METHODS: A retrospective multicenter observational study was conducted within the WorldWideWEB Consortium and comprised 38 academic centers with endovascular treatment capabilities. Univariable and multivariable logistic regression analyses were performed to determine the association between antiplatelet use and TECs, adjusting for covariates. Missing predictor data were addressed using multiple imputation. RESULTS: The study comprised two cohorts: one addressing general thromboembolic events and consisting of 1412 patients, among whom 103 experienced TECs, and another focusing on symptomatic thromboembolic events and comprising 1395 patients, of whom 50 experienced symptomatic TECs. Preprocedural antiplatelet use was associated with a reduced likelihood of overall TECs (OR 0.32, 95% CI 0.19-0.53, p < 0.001) and symptomatic TECs (OR 0.49, 95% CI 0.25-0.95, p = 0.036), whereas postprocedural antiplatelet use showed no significant association with TECs. The study also revealed additional predictors of TECs, including stent use (overall: OR 4.96, 95% CI 2.38-10.3, p < 0.001; symptomatic: OR 3.24, 95% CI 1.26-8.36, p = 0.015), WEB single-layer sphere (SLS) type (overall: OR 0.18, 95% CI 0.04-0.74, p = 0.017), and posterior circulation aneurysm location (symptomatic: OR 18.43, 95% CI 1.48-230, p = 0.024). CONCLUSIONS: The findings of this study suggest that the preprocedural administration of antiplatelets is associated with a reduced likelihood of TECs in patients undergoing treatment with the WEB device for wide-necked bifurcation aneurysms. However, postprocedural antiplatelet use did not show a significant impact on TEC occurrence.

Dual Layer vs Single Layer Woven EndoBridge Device in the Treatment of Intracranial Aneurysms: A Propensity Score-Matched Analysis.

BACKGROUND: The Woven EndoBridge (WEB) devices have been used for treating wide neck bifurcation aneurysms (WNBAs) with several generational enhancements to improve clinical outcomes. The original device dual-layer (WEB DL) was replaced by a single-layer (WEB SL) device in 2013. This study aimed to compare the effectiveness and safety of these devices in managing intracranial aneurysms. METHODS: A multicenter cohort study was conducted, and data from 1,289 patients with intracranial aneurysms treated with either the WEB SL or WEB DL devices were retrospectively analyzed. Propensity score matching was utilized to balance the baseline characteristics between the two groups. Outcomes assessed included immediate occlusion rate, complete occlusion at last follow-up, retreatment rate, device compaction, and aneurysmal rupture. RESULTS: Before propensity score matching, patients treated with the WEB SL had a significantly higher rate of complete occlusion at the last follow-up and a lower rate of retreatment. After matching, there was no significant difference in immediate occlusion rate, retreatment rate, or device compaction between the WEB SL and DL groups. However, the SL group maintained a higher rate of complete occlusion at the final follow-up. Regression analysis showed that SL was associated with higher rates of complete occlusion (OR: 0.19; CI: 0.04 to 0.8, p = 0.029) and lower rates of retreatment (OR: 0.12; CI: 0 to 4.12, p = 0.23). CONCLUSION: The WEB SL and DL devices demonstrated similar performances in immediate occlusion rates and retreatment requirements for intracranial aneurysms. The SL device showed a higher rate of complete occlusion at the final follow-up.

Woven EndoBridge versus stent-assisted coil embolization for the treatment of ruptured wide-necked aneurysms: A multicentric experience.

BACKGROUND: The potentially higher risk of hemorrhagic complications is of concern in stent-assisted coiling (SAC) of ruptured wide-necked intracranial aneurysms (IAs). The Woven EndoBridge (WEB) is considered an appealing alternative since antiplatelet therapy is not required. Herein, we aimed to compare the safety and effectiveness of WEB vs. SAC for the treatment of ruptured wide-necked IAs. METHODS: This was an international cross-sectional study of consecutive patients treated for ruptured wide-neck IAs with WEB or SAC at four high-volume neurovascular centers between 2019 and 2022. Primary and secondary efficacy outcomes were radiographic aneurysm occlusion at follow-up and functional status at last follow-up. Safety outcomes included periprocedural hemorrhagic/ischemia-related complications. RESULTS: One hundred five patients treated with WEB and 112 patients treated with SAC were included. The median procedure duration of endovascular treatment was shorter for WEB than for SAC (69 vs. 76 min; p = 0.04). There were no significant differences in complete aneurysm occlusion rates (SAC: 64.5% vs. WEB: 60.9%; adjusted OR [aOR] = 0.70; 95%CI 0.34-1.43; p = 0.328). SAC had a significantly higher risk of complications (23.2% vs. 9.5%, p = 0.009), ischemic events (17% vs. 6.7%, p = 0.024), and EVD hemorrhage (16% vs. 0%, p = 0.008). The probability of procedure-related complications across procedure time was significantly lower with WEB compared with SAC (aOR = 0.40; 95%CI 0.20-1.13; p = 0.03). CONCLUSION: WEB and SAC demonstrated similar obliteration rates at follow-up when used for embolization of ruptured wide-necked IAs. However, SAC showed higher rates of procedure-related complications primarily driven by ischemic events and higher rates of EVD hemorrhage. The overall treatment duration was shorter for WEB than for SAC.

The impact of postoperative aspirin in patients undergoing Woven EndoBridge: a multicenter, institutional, propensity score-matched analysis.

BACKGROUND: The Woven EndoBridge (WEB) device is frequently used for the treatment of intracranial aneurysms. Postoperative management, including the use of aspirin, varies among clinicians and institutions, but its impact on the outcomes of the WEB has not been thoroughly investigated. METHODS: This was a retrospective, multicenter study involving 30 academic institutions in North America, South America, and Europe. Data from 1492 patients treated with the WEB device were included. Patients were categorized into two groups based on their postoperative use of aspirin (aspirin group: n=1124, non-aspirin group: n=368). Data points included patient demographics, aneurysm characteristics, procedural details, complications, and angiographic and functional outcomes. Propensity score matching (PSM) was applied to balance variables between the two groups. RESULTS: Prior to PSM, the aspirin group exhibited significantly higher rates of modified Rankin scale (mRS) mRS 0-1 and mRS 0-2 (89.8% vs 73.4% and 94.1% vs 79.8%, p<0.001), lower rates of mortality (1.6% vs 8.6%, p<0.001), and higher major compaction rates (13.4% vs 7%, p<0.001). Post-PSM, the aspirin group showed significantly higher rates of retreatment (p=0.026) and major compaction (p=0.037) while maintaining its higher rates of good functional outcomes and lower mortality rates. In the multivariable regression, aspirin was associated with higher rates of mRS 0-1 (OR 2.166; 95% CI 1.16 to 4, p=0.016) and mRS 0-2 (OR 2.817; 95% CI 1.36 to 5.88, p=0.005) and lower rates of mortality (OR 0.228; 95% CI 0.06 to 0.83, p=0.025). However, it was associated with higher rates of retreatment (OR 2.471; 95% CI 1.11 to 5.51, p=0.027). CONCLUSIONS: Aspirin use post-WEB treatment may lead to better functional outcomes and lower mortality but with higher retreatment rates. These insights are crucial for postoperative management after WEB procedures, but further studies are necessary for validation.

Quantitative radial force measurements of Woven EndoBridge devices.

BACKGROUND: Lateral/radial forces and the mechanical properties of Woven EndoBridge (WEB) devices have significant importance for therapeutic success. In other words, adequate apposition of the lateral wall of a cerebral aneurysm is critical for preventing recurrence or re-rupture risk. OBJECTIVE: This study aimed to investigate the pressure values applied by different WEB devices to the lateral walls of aneurysms and the relationships between these pressure measurements and the diameters of WEB devices. METHODS: By placing four WEB devices of different sizes and types between two rigid metal plates, the lateral forces applied by these WEB devices to plates of different apertures were measured quantitatively. We tested a single device of each size over multiple periods. The total number of examined WEB devices is four. RESULTS: There was a significant negative relationship between plate distances and pressure values (correlation coefficient:-0.956, p = 0.000). The lateral wall apposition pressure of a 4- or 5-mm aperture size was higher than a 6-mm aperture size for SL-type WEB devices with a 7-mm diameter. Similarly, the lateral wall apposition pressure detected for a 3- or 3.5-mm aperture size was higher than a 4-mm aperture size for W5-4.5-3 and W5-5-3.6. It was observed that maximum lateral wall pressure was detected in plate measurements of SLS-type devices compared to SL-type devices. The diameter and height values of 3 of the 4 unconstrained WEB devices analyzed differed from the catalog values. CONCLUSION: It seems that SLS-type devices apply more pressure on the aneurysm's lateral borders than SL-type devices.

Sarcopenia and Myosteatosis Assessed by Magnetic Resonance Enterography May Predict Negative Outcomes in Patients with Crohn's Disease.

BACKGROUND: Limited research has examined the clinical consequences of sarcopenia and myosteatosis in Crohn's disease. This study aimed to determine the prevalence, risk factors, and effects of sarcopenia and myosteatosis on prognostic outcomes in Crohn's disease patients who underwent magnetic resonance enterography. MATERIALS AND METHODS: This retrospective observational study included 116 Crohn's disease patients who underwent magnetic resonance enterography between January 2015 and August 2021. Skeletal muscle index was the ratio of the cross-sectional area of skeletal muscles at the L3 vertebral level to the square of the neck in cross-sectional imaging. Sarcopenia was defined as skeletal muscle index <38.5 cm2/m2 in women and <52.4 cm2/m2 in men. Myosteatosis was considered positive if the ratio of the mean signal intensity of the psoas muscle to the mean signal intensity of the cerebrospinal fluid was above 0.107. RESULTS: Among the negative results in the post-procedure follow-up of the patients, a significant increase was observed in the sarcopenia group regarding abscess and the need for surgery (P < .05). Anti-tumor necrosis factor initiation was found to be significantly higher in the follow-up than in patients without myosteatosis (P = .029). In the multivariate model established with these variables, the presence of sarcopenia in the surgical follow-up was odds ratio = 5.34 (CI: 1.02-28.03, P = .047) and was found to be significantly associated with the increased risk. CONCLUSIONS: The presence of myosteatosis and sarcopenia detected in magnetic resonance enterography may be a harbinger of negative outcomes in Crohn's disease patients. Nutritional support should be provided to these patients with the potential to alter the course of the disease.

Transverse sinus pathologies, vestibular migraine and intracranial hypertension without papilledema.

BACKGROUND: In the absence of papilledema, the presentation of migraine and idiopathic intracranial hypertension (IIH) is very similar. In this respect, an IIH could be presented as a vestibular migraine. Our main objective in this case report is to demonstrate the similarities between IIH and vestibular migraine. CASES: This is a report of 14 patients who have IIH without papilledema presented as vestibular migraine to the clinic and followed from 2020 to 2022. RESULTS: The common presentation of patients was ear-facial pain, dizziness, and frequent pulsatile tinnitus. One-fourth of the patients reported episodes of true episodic vertigo. The average age was 37.8, the average BMI was 37.4, and the average lumbar puncture-opening pressure was 25.6 cm H2O. Transverse sinus venous flow alterations caused neuroimaging findings of sigmoid sinus dehiscence, empty sella, or tonsillar ectopia. Most patients improved with carbonic anhydrase inhibitors, and one patient was treated with a dural sinus stent. CONCLUSION: A transverse sinus stenosis, even in the non-dominant site, may elevate the CSF pressure in obese individuals. This stenosis causes dural sinus-related pulsatile tinnitus with characteristics different from those of an arterial origin. Dizziness is a common complaint in patients with IIH, just like VM. In our opinion, episodic vertigo in these patients is the direct effect of CSF flow alterations into the inner ear's vestibule. Patients with mild elevations will be presented to the clinic, similar to migraines with or without the presence of pulsatile tinnitus. Treatment requires lowering intracranial pressure and managing migraine symptoms.

Demonstration of chewing-related areas in the brain via functional magnetic resonance imaging.

Purpose: To localize and identify chewing-related areas and their connections with other centres in the human brain using functional magnetic resonance imaging (fMRI). Material and methods: The paradigm of the present study was block designed. Spontaneous and controlled chewing with sugar-free gum was used as the main task in a 3-Tesla fMRI unit with a 32-channel birdcage coil. Our study popu-lation comprised 32 healthy volunteers. To determine possible intersections, we also put the rosary pulling (silent tell one's beads) movement in the fMRI protocol. The data analyses were performed with the Statistical Parametric Mapping (SPM) toolbox integrated into the Matlab platform. Results: The superomedial part of the right cerebellum was activated during either pulling rosary beads or spontaneous chewing. This region, however, was not activated during controlled chewing. We did not find statistically significant activation or connection related to the brain stem. Conclusion: We have confirmed that the cerebellum plays an important role in chewing. However, we could not find a definite central pattern generator (CPG) in the brain stem, which has been hypothesized to underlie spontaneous chewing.

The brainstem connections of the supplementary motor area and its relations to the corticospinal tract: Experimental rat and human 3-tesla tractography study.

Although the supplementary motor area (SMA) is a large region on the medial surface of the frontal lobe of the brain, little is known about its function. The current study uses 3-tesla high-resolution diffusion tensor tractography (DTI) in healthy individuals and biotinylated dextran amine (BDA) and fluoro-gold (FG) tracer in rats to demonstrate the afferent and efferent connections of the SMA with brainstem structures. It also aims to clarify how SMA fibers relate to the corticospinal tract (CST). The BDA (n = 6) and FG (n = 8) tracers were pressure-injected into the SMA of 14 Wistar albino rats. Light and fluorescence microscopy was used to capture images of the FG and BDA-labeled cells and axons. High-resolution 3-tesla DTI data were acquired from the Human Connectome Project database. Tracts between the SMA and brainstem structures were analyzed using diffusion spectrum imaging (DSI) studio software. The FG injections into the SMA showed afferent projections from mesencephalic (periaqueductal gray matter, substantia nigra pars reticulata, ventral tegmental area, inferior colliculus, mesencephalic reticular, tegmental, and raphe nuclei), pontine (locus coeruleus, pontine reticular and vestibular nuclei), and medullary (area postrema, parabrachial, and medullary reticular nuclei) structures. The anterograde tracer BDA injections into the SMA showed efferent connections with mesencephalic (periaqueductal gray, substantia nigra pars compacta, dorsal raphe, trigeminal motor mesencephalic, and mesencephalic reticular nuclei), pontine (locus coeruleus, nucleus of the lateral lemniscus, vestibular, cochlear, and pontine reticular nuclei), and medullary (area postrema, medullary reticular, olivary, and parabrachial nuclei) structures. The SMA had efferent but no afferent connections with the cerebellar nuclei. The DTI results in healthy human subjects highly corresponded with the experimental results. Further, the DTI results showed a distinct bundle that descended to spinal levels closely related to the CST. Understanding SMA's afferent and efferent connections will enrich our knowledge of its contribution to various brainstem networks and may provide new perspectives for understanding its motor and non-motor functions.

The role of computerized tomography angiography in the management of cases undergoing penile revascularization due to erectile dysfunction: prospective cohort study.

BACKGROUND: In this study, the role and efficiency of computerized tomography angiography (CTA) in the postoperative management of patients with penile revascularization were evaluated. METHODS: Between 2014 and 2018, penile revascularization surgery was performed in 78 patients who presented with the complaint of erectile dysfunction (ED). The mean age of the patients was 47.17 ± 13.26 (23-69) years. Patients with a regular sexual partner and relationship, who hadn't benefitted from medical treatment and who had ED complaints for at least three months were included in the study. The cases were divided into three groups according to their age (20-40, 41-60, and > 61 years). All the cases were evaluated preoperatively using the five and 15-item International Index of Erectile Dsysfunction (IIEF-5 and IIEF-15) questionnaire, cavernosometry, corpus cavernosum electromyography, and penil color doppler ultrasonography. At the postoperative third month, IIEF 5-15 questionnaire was repeated and anastomotic patency was evaluated by performing CTA scanning. RESULTS: CTA performed at the postoperative third month revealed anastomosis patency in 56. In 22 cases, the anastomosis area could not be observed. Among the patients with anastomosis patency, the rate of the IIEF-5 increase in the postoperative period was between 35.0 and 80.8%, while in those patients without anostomotic patency, the increase rate of IIEF-5 were between 12.5 and 23.3%. Increases in the IIEF-5 and IIEF-15 questionnaire scores were found to be significantly higher in the group in which anastomotic patency was observed on CTA compared to remaining patients. CONCLUSION: The CTA results and changes in the IIEF rates after penile revascularization had a high correlation. Anastomotic patency with CTA can guide the timing of more invasive procedures such as penile prosthesis implantation.

Cerebrovascular modelling for the management of aneurysm embolization using an intrasaccular flow diverter made by 3D printing.

Purpose: Using 3-dimensional (3D) printers, the creation of patient-specific models is possible before and after a therapeutic intervention. There are many articles about replicas for training and simulation of aneurysm clipping. However, no paper has focused on 3D replicas obtained from 3-tesla 3D time of flight (3D-TOF) MR angiography for intrasaccular flow diverter (WEB device) embolization of the cerebral aneurysms. In this paper, we aimed to investigate the feasibility of 3D printing models obtained from 3-tesla 3D-TOF data in the management and training of WEB-assisted embolization procedures. Case presentation: We presented a longitudinal case report with several 3D-TOF MRA prints over time. Three-tesla 3D-TOF data were converted into STL and G-code files using an open-source (3D-Slicer) program. We built patient-specific realistic 3D models of a patient with a middle cerebral artery trifurcation aneurysm, which were able to demonstrate the entire WEB device treatment procedure in the pre-intervention and post-intervention periods. The aneurysmatic segment was well displayed on the STL files and the 3D replicas. They allowed visualization of the aneurysmatic segment and changes within a 6-year follow-up period. We successfully showed the possibility of fast, cheap, and easy production of replicas for demonstration of the aneurysm, the parent vessels, and post-intervention changes in a simple way using an affordable 3D printer. Conclusions: 3D printing is useful for training the endovascular team and the patients, understanding the aneurysm/parent vessels, and choosing the optimal embolization technique/device. 3D printing will potentially lead to greater interventionalist confidence, decreased radiation dose, and improvements in patient safety.

Connections of the Dentate Nucleus with the Amygdala: Experimental Rat and Human 3-Tesla Tractography Study.

Background: The role of the cerebellum in motor function is well recognized. However, its role in higher nervous system activities such as cognition, emotion, endocrine, and autonomic activities is less known. The present study aims to show direct dento-amygdala projections using a biotinylated dextran amine (BDA) tracer in rats and 3-tesla (T) high-resolution diffusion tensor imaging (DTI)-based tractography in humans. Materials and Methods: The BDA tracer was pressure injected into the dentate nucleus of the cerebellum of Wistar albino rats. Labeled cells and axons were documented. High-resolution 3-T tractography data were obtained from the Human Connectome Project database. Dento-amygdala tracts were analyzed using diffusion spectrum imaging (DSI) Studio software. Results: The experimental study showed bilateral projections between the dentate nucleus and the central and basal nuclei and ipsilateral projections between lateral nuclei of the amygdala. The fibers from the dentate nucleus reached the amygdala through the superior cerebellar peduncle (SCP), and the contralateral fibers crossed in the decussation of SCP at the midbrain. The dento-amygdala results of the experimental study corresponded with the 3-T tractography findings on humans. Additionally, DTI findings showed that most of the dentate fibers passed through the hypothalamus before reaching the amygdala, and the amygdalae of the two sides are connected through the anterior commissure. Discussion: The 3-T DTI data of adult humans showed both direct dento-amygdala and indirect dento-hypothalamo-amygdala projections. Thus, this may indicate cerebellar contribution in modulation of emotional and autonomic functions. Furthermore, this can explain the emotional and cognitive deficits that occur in patients with cerebellar or SCP damage. Impact statement The present study showed direct dento-amygdala connections in the rat brain and human brain, which may provide evidence for cerebellar contribution in modulation of emotional and autonomic functions.

Feasibility of freehand CT and 3-T MR guided brain aspiration biopsies with 18/20-gauge coaxial needles.

BACKGROUND AND PURPOSE: An accurate histopathological examination with minimal neuronal damage is essential for optimizing treatment strategies of central nervous system lesions. We investigated the feasibility and safety of CT and 3-tesla (3 T) MR-guided freehand brain aspiration biopsies with 18/20-gauge coaxial needles in performing a single imaging unit. MATERIALS AND METHODS: We reviewed CT and 3 T-MR guided freehand aspiration biopsies with 18/20-gauge coaxial needles of 33 patients (11-female and 22-male, mean and median ages: 53 years, min-max 21-79 years) in our tertiary hospital within an 8-year-period were included in this retrospective study. Lesion sizes, diagnostic yield, morbidity, and mortality rates of these biopsies without a scalp incision, surgical burr-hole, or stereotactic-instrumentation/neuro-navigation guidance were assessed. All biopsies were performed with local anesthesia and sedation within a single imaging unit of our radiology department. All free-hand biopsies were done as in-patient procedures and the patients were closely observed after the biopsies. RESULTS: The mean diameter of the lesions was 27 mm (median 25; range 15-46 mm). The diagnostic yield of all free-hand brain biopsies was 88% [one inconclusive result (90%) for 3 T-MR; three inconclusive results (87%) for CT]. There was no major hemorrhage or hematoma, no clinical deterioration, or no infection in our patients on early- and late-phase examinations. Postprocedural minor hemorrhage with a ≤ 2 cm diameter was observed in two patients. The morbidity rate of the study population is 6%. There was no procedure-related infection or mortality in the post-procedural 3 weeks. CONCLUSIONS: Freehand CT or 3 T-MR guided aspiration biopsy was a safe and feasible method for pathological diagnosis of intracranial lesions. Biopsy workflow was simplified with this technique. It could be considered a valuable alternative for stereotaxic biopsies, especially for centers that do not have stereotaxic equipment or experience.

Long-term efficacy and safety of WovenEndoBridge (WEB)-assisted cerebral aneurysm embolization.

PURPOSE: Long-term compaction, compression, migration, and recurrence rates of the WovenEndoBridge devices remain unknown. The purpose of this study was to detect these rates and safety profiles of the WovenEndoBridge within 7 years period. MATERIALS AND METHODS: Eighty-three aneurysms of 79 patients treated with the WovenEndoBridge device were retrospectively evaluated using an occlusion scale (e.g. complete occlusion, neck remnant, and aneurysm remnant) on angiography images. RESULTS: The residual aneurysm was observed in 11 (13%) aneurysms. The mean and median diameters of the recurrent aneurysms were 6 and 7 mm. Most of the recurrent aneurysms were complex type and/or ruptured. Mean diameters and the neck-to-body ratios of all residual aneurysms in the preoperative imaging exams were above 4 mm and 0.6, respectively. The median values of preoperative height and neck measurements were higher in the recurrent aneurysms than in the adequate occlusion group (p = 0.006, p = 0.019, respectively). There was a statistically significant positive relationship between preoperative height/neck measurements and the mean diameters of residual aneurysms (rs = 0.32 and p = 0.003; rs = 0.28 and p = 0.011, respectively). The WovenEndoBridge compaction/compression and migration were observed in 5 (45%) and 2 (18%) of the recurrent aneurysms. In 7 (64%) of the residual aneurysms, thrombosed areas were found within the aneurysm. In the follow-up period, four aneurysms (4.8%) were retreated due to widened residual aneurysm. Other aneurysms were improved or stable within 7 years. DISCUSSION: Our adequate occlusion rate was 87%. Occlusion rates are less favorable than aneurysms with a long height, wide neck, or high neck-to-body ratio. Our study confirms the high safety and efficiency of the WovenEndoBridge. Compaction, compression, and/or migration of the WovenEndoBridge and the presence of intra-aneurysmal thrombosis are the main reasons for the recurrences.

Feasibility of 3D T1W sequences in contrast-material enhanced MR cisternography at 3T.

BACKGROUND: We investigated the diagnostic values and artifact severities of 3D-T1W sequences in the diagnosis of cerebrospinal fluid (CSF) leakage. METHODS: We retrospectively reviewed 3-tesla contrast-material enhanced MR cisternography exams of 22 patients with suspected CSF leakage in 4 years. The presence of the artifacts on 3D-T1W data was evaluated using a 4-point scale (0: none; 1: minimal; 2: moderate; 3: prominent). Agreements between CSF leakage results of the 3D-T1W sequences and consensus decisions were evaluated via kappa values. Artifact scores were analyzed by Fisher's exact test. RESULTS: The most compatible techniques with the consensus diagnoses were fat-saturated 3D-T1W-SPACE and 3D-T1W-VIBE sequences. The most artifact containing the 3D-T1W sequence was 3D-MPRAGE. DISCUSSION: 3D-SPACE and 3D-VIBE are more successful in evaluating CSF leakages compared to 3D-MPRAGE. 3D-SPACE has lower artifact scores compared to 3D-VIBE and 3D-MPRAGE sequences.