Detection of cerebral cortical vein thrombosis with high-resolution susceptibility weighted imaging - A comparison with MR venography and standard MR sequences.

PURPOSE: Comparison of the performance of high-resolution susceptibility weighted imaging with standard MR sequences and MR venography to identify cortical vein clots. METHODS: A retrospective review of 51 consecutive cases of cerebral venous thrombosis and 27 controls was performed with independent analysis of all MR sequences. Reference standard was obtained with consensus in a separate session by reviewing all MR sequences together. RESULTS: Cortical vein clots were observed in 30 cases including 9 males and 21 females in the age range of 1 month to 70 years (Mean 34.9 ± 20.2 years). Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of susceptibility weighted imaging for the identification of cortical vein clots were 0.93, 1.0, 1.0, 0.96 and 0.97 respectively. For all other sequences, sensitivity ranged from 0.06 to 0.39 and accuracy from 0.60 to 0.73. Combination of all sequences yielded a value of 1.0 for sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the detection of cortical vein clots. Significant result for area under the receiver operating curve was observed only for SWI with a value of 0.91 (p - .000). CONCLUSION: Susceptibility weighted imaging demonstrates the best sensitivity and accuracy among standard MR sequences including MR venography for the detection of early stage cortical vein clots. However, it needs to be interpreted in combination with other MR sequences for the most accurate evaluation of cortical vein clots.

High-resolution susceptibility-weighted imaging of clots in cerebral venous thrombosis.

PURPOSE: To distinguish cerebral venous clots from patent dural sinuses, cortical veins, and calvarium on high-resolution susceptibility-weighted imaging, since there is lack of a well-designed study in the literature. METHODS: A retrospective review of 51 consecutive cases and 27 controls was performed with susceptibility-weighted imaging independently by two investigators. MR venography along with MR sequences other than the susceptibility-weighted imaging served as the reference standard. RESULTS: There were 29 males and 49 females in the age range of 1 month to 70 years (mean 27 ± 19.8 years). Substantial (k 0.84 to 1.0) to good (k 0.60 to 0.75) inter-rater agreement was observed on the magnitude images for the demonstration of clots in all venous segments, excluding left sigmoid sinus, jugular bulb, and internal jugular vein (k 0.43 to 0.56). Comparatively magnitude images demonstrated better sensitivity (0.83 (0.54-1.13) to 1.0), specificity (0.92 (0.85-0.99) to 1.0), and negative predictive value (0.98 (0.94-1.02) to 1.0) for the detection of clots across all venous segments. Magnitude images showed positive predictive value ranging from 0.83 (0.66-1.0) to 1.0 for clots anywhere from the anterior aspect of superior sagittal sinus to bilateral transverse sinuses. For the detection of clots from bilateral sigmoid sinuses to internal jugular veins, magnitude images showed relatively better positive predictive value ranging from 0.57 (0.20-0.94) to 0.75 (0.45-1.06) in comparison to the processed magnitude and minimum intensity pixel images. CONCLUSION: Susceptibility-weighted imaging can successfully distinguish majority of clots from patent dural sinuses, cortical veins, and calvarium with excellent inter-rater agreements.

A Neuronavigation-Assisted Endoscopic Ventriculocystocisternostomy of a Suprasellar Arachnoid Cyst: A 2D Video Case Presentation.

Background and Importance: Suprasellar arachnoid cysts are insidious and progressive ventricular cysts that cause hydrocephalus, ataxia, optic, and endocrinological symptoms. These cysts can be successfully treated via an endoscopic ventriculocystocisterostomy (VCC). Clinical Presentation: A three-year-old patient presented with emesis and bobble-head doll syndrome with a suprasellar arachnoid cyst. Through our video, we present our neuronavigation-assisted endoscopic VCC without cautery and the relevant neuroanatomy. Conclusion: Neuroendoscopic fenestration is a preferred approach over resection or shunting for a suprasellar arachnoid cyst. In addition, VCC has decreased recurrence and increased radiologic improvement over a ventriculocystostomy (VC).

Immediate postoperative hyperglycemia after peripheral arterial bypass is associated with short-term and long-term poor outcomes.

OBJECTIVE: Although the impact of poorly controlled diabetes on surgical outcomes of patients undergoing lower extremity revascularization is well-known, it is not clear if immediate postoperative hyperglycemia (IPH) itself can be used as a surrogate for poor outcomes after peripheral arterial bypass. We sought to examine the effect of IPH in this patient population with its impact on short-term and long-term outcomes. METHODS: Retrospective review was completed for 505 patients who underwent either suprainguinal bypass surgery or infrainguinal bypass surgery between July 2002 and April 2018 for the treatment of peripheral arterial disease. All patients were undergoing first-time open bypass grafting. Patients were stratified into those who were normoglycemic or hyperglycemic (glucose ≥ 140 mg/dL) within 24 hours after surgery. A comparative analysis was performed on comorbidities and outcomes. RESULTS: Of 505 patients who underwent bypass grafting, 255 patients (50.5%) were hyperglycemic. The mean age of patients was 63.5 ± 14.1 years. The median follow-up was 5.2 years (range, 0.0-15.2 years). The distribution of procedures was as follows: femoral to popliteal bypasses (29%), femoral to femoral bypasses (17%), femoral to tibial bypasses (12%), aortobifemoral bypasses (10%), iliofemoral bypasses (9%), and axillofemoral bypasses (7%). At 30 days, hyperglycemic patients had an increased incidence of limb loss (8.3% vs 4.0%) and myocardial infarction (4.8% vs 0.8%) and incurred higher costs of hospital stay ($27,701 vs $22,990) (all P < .05). At 10 years, these patients had a higher incidence of needing major amputations (15.4% vs 9.4%; P = .025). Hyperglycemia after infrainguinal bypass was associated with nearly twice the risk of limb loss at 5 years (hazard ratio, 1.91; P = .034). Among the cohort of patients who required major amputations, the time duration between index revascularization and amputation was significantly shorter as compared with normoglycemic patients (P = .003). CONCLUSIONS: In this single-institution study with long-term follow-up, IPH was associated with increased rates of 30-day amputation and myocardial infarction, as well as an increased cost of hospital stay. In the long term, postoperative hyperglycemia was associated with greater major limb loss. Among the cohort of patients who required major amputations, the time period between revascularization and amputation was shorter for those patients who had IPH. IPH is an independent marker for poor outcomes after lower extremity revascularization procedures.