Computed tomography perfusion stroke mimics on RAPID commercial software: A case-based review.

Acute ischemic stroke (AIS) is a leading cause of morbidity worldwide and can present with nonspecific symptoms, making diagnosis difficult. Many neurologic diseases present similarly to stroke; stroke mimics account for up to half of all hospital admissions for stroke. Stroke therapies carry risk, so accurate diagnosis of AIS is crucial for prompt treatment and prevention of adverse outcomes for patients with stroke mimics. Computed tomography (CT) perfusion techniques have been used to distinguish between nonviable tissue and penumbra. RAPID is an operator-independent, automated CT perfusion imaging software that can aid clinicians in diagnosing strokes quickly and accurately. In this case-based review, we demonstrate the applications of RAPID in differentiating between strokes and stroke mimics.

Brain MRI and clinical exam findings in women with multiple gadolinium-based contrast agent (GBCA) exposures due to screening breast MRIs.

OBJECTIVES: Multiple exposures to gadolinium-based contrast agents (GBCAs) is known to be associated with gadolinium deposition in the brain in certain patients. Such deposition has been correlated with specific brain MRI findings, although most available data is in patients with underlying neurologic disorders. We aim to prospectively evaluate brain MRI signal changes as well as neurologic and neuropsychologic testing results in women undergoing screening breast MRI. METHODS: In this IRB-approved, HIPAA-compliant prospective study, 9 women with 5 or more exposures to linear and/or macrocyclic GBCA due to screening breast MRI underwent noncontrast brain MRI, neurologic exam and neuropsychologic testing. Women with underlying neurologic, psychologic, hepatic or renal disorders were excluded. RESULTS: The mean total number of GBCA exposures was 8 (standard deviation 2.7), with 63/72 (87%) of the exposures being linear agents. There was no association between brain MRI signal changes and abnormalities on neurologic or neuropsychologic examination. There was no association between total number of GBCA exposures and abnormalities on neurologic or neuropsychologic examination. CONCLUSION: In this prospective exploratory study of 9 women with 5 or more GBCA exposures due to screening breast MRI, there was no association between brain MRI signal changes and clinical abnormalities on neurologic or neuropsychologic examination. While larger studies are needed in this patient population, the lack of clinical impact of multiple GBCA exposures in this study is reassuring.

Combination of high-resolution and color Doppler ultrasound in diagnosis of carpal tunnel syndrome.

BACKGROUND: Ultrasound has recently emerged as a diagnostic tool in carpal tunnel syndrome (CTS). PURPOSE: To evaluate the utility of a combination of high-resolution and color Doppler ultrasound as an alternative to electrodiagnostic tests (EDT), in CTS diagnosis, and to define an ultrasonographic prediction model for CTS. MATERIAL AND METHODS: A total of 85 patients with certain clinical diagnosis of CTS and 49 healthy controls were enrolled. High-resolution and color Doppler ultrasound were performed and the cross-sectional area (CSA), hypoechogenicity, and hypervascularity of the median nerve were evaluated. Receiver-operating characteristic curves were used to determine the optimal cut-off point of median nerve CSA in diagnosis of CTS. Multivariate logistic regression analysis was used to formulate a prediction model for CTS. RESULTS: The optimal cut-off point of median CSA in wrist was 10.5 mm(2). Hypervascularity (OR = 37.95), hypoechogenicity (OR = 12.30), and high CSA (OR = 34.79) of median nerve were significantly (P < 0.001) higher in CTS patients than in controls. No significant difference was found between the sensitivity and specificity of EDT and any of the above indices in prediction of CTS. An ultrasonographic model for prediction of CTS, comprised hypervascularity and/or high CSA of median nerve, could predict the CTS probability between 87-99%. The sensitivity and specificity of this model (86% and 84%) was not different from EDT (80% and 84%). CONCLUSION: A combination of high-resolution and color Doppler ultrasound can be used as a non-invasive alternative to EDT in diagnosis of CTS.