Influence of Stroke Onset Location on the Efficacy of Endovascular Thrombectomy: Comparison of Outcomes Between In-hospital vs. Community-Onset Strokes.

BACKGROUND AND PURPOSE: Previous studies have suggested that patients suffering an in-hospital stroke (IHS) may face delays in treatment and worse outcomes compared to patients with community-onset strokes (COS). However, most studies occurred when intravenous thrombolysis was the primary treatment. This study aimed to examine the outcomes of patients experiencing an IHS in the endovascular thrombectomy (EVT) era. MATERIALS AND METHODS: Single-center retrospective cohort study of patients older than 18 years with acute ischemic stroke (AIS) treated with EVT within 12 hours of stroke onset from January 1, 2015, to April 30, 2021. Patients were classified into two groups: in-hospital strokes (IHS) and community-onset strokes (COS). We compared time metrics of stroke care delivery, rate of successful reperfusion, and functional outcome as scored using the modified Rankin Scale (mRS) score at 90 days (favorable outcome was defined as mRS 0-2). Differences in proportions were assessed using Fisher's exact and Chi-Square tests as appropriate. For continuous variables, differences in medians between groups were evaluated using Mann-Whitney U tests. RESULTS: A total of 676 consecutive patients were included, with 69 (10%) comprising the IHS group. IHS patients were more likely to have diabetes (36% vs. 18%, p=0.02) and less likely to receive thrombolysis (25% vs 68%, p<0.001) than the COS group but were otherwise similar. IHS patients had significantly faster overall time metrics, most notably from stroke recognition to imaging (median [IQR], 70 [38-141] min vs 121 [74-228] min, p<0.001). Successful recanalization was achieved in > 75% in both groups (p=0.39), with a median NIHSS at discharge <4 (p=0.18). The 90-day mRS was similar in both groups, with a trend of higher in-hospital mortality in the IHS group (p=0.06). CONCLUSIONS: IHS patients had shorter workflow delays to initiation of EVT compared to their community counterparts but with a similar rate of successful recanalization and clinical outcomes. Importantly, 90 day mortality and mRS scores were equivalent between IHS and COS. ABBREVIATIONS: AIS = acute ischemic stroke; LVO = large vessel occlusion; IHS= in-hospital stroke; COS= community-onset stroke; EVT= endovascular thrombectomy; CSC= comprehensive stroke center; TOAST= Trial of Org 10172 in Acute Stroke Treatment.

Pre-operative spine tumour embolization: Clinical outcomes and effect of embolization completeness.

INTRODUCTION: To assess the association between the impact of the completeness of pre-operative spine tumour embolisation and clinical outcomes, including estimated blood loss (EBL), neurological status and complications. METHODS: Retrospective chart review of all preoperative spine tumour embolisation procedures performed over 11 years by a single operator (2007-2018) at Vancouver General Hospital on 44 consecutive patients (mean age 57; 77% males) with 46 embolisation procedures, of which surgery was done en bloc in 26 cases and intralesional in the remaining 20. A multivariable negative binomial regression model was fit to examine the association between EBL and surgery type, tumour characteristics, embolisation completeness and operative duration. RESULTS: Among intralesional surgeries, complete versus incomplete embolisation was associated with reduced blood loss (772 vs 1428 mL, P < 0.01). There was no statistically significant difference in neurological outcomes or complications between groups. Highly vascular tumours correlated with greater blood loss than their less vascular counterparts, but tumour location did not have a statistically significant effect. CONCLUSION: This study provides evidence in support of our hypothesis that complete as opposed to incomplete tumour embolisation correlates with reduced blood loss in intralesional surgeries. Randomised control trials with larger samples are necessary to confirm this benefit and to ascertain other potential clinical benefits.

MRI Markers of Degenerative Disc Disease in Young Patients With Multiple Sclerosis.

Background and Purpose: Evidence has emerged for an association between degenerative disc disease (DDD) and multiple sclerosis (MS). The purpose of the current study is to determine the presence and extent of cervical DDD in young patients (age <35) with MS, an age cohort that is less well studied for these changes. Methods: Retrospective chart review of consecutive patients aged <35 referred from the local MS clinic who were MRI scanned between May 2005 and November 2014. 80 patients (51 female and 29 male) with MS of any type ranging between 16 and 32 years of age (average 26) were included. Images were reviewed by 3 raters and assessed for presence and extent of DDD, as well as cord signal abnormalities. Interrater agreement was assessed using Kendall's W and Fleiss' Kappa statistics. Results: Substantial to very good interrater agreement was observed using our novel DDD grading scale. At least some degree of DDD was found in over 91% of patients. The majority scored mild (grade 1, 30-49%) to moderate (grade 2, 39-51%) degenerative changes. Cord signal abnormality was seen in 56-63%. Cord signal abnormality, when present, occurred exclusively at degenerative disc levels in only 10-15%, significantly lower than other distributions (P < .001 for all pairwise comparisons). Conclusions: MS patients demonstrate unexpected cervical DDD even at a young age. Future study is warranted to investigate the underlying etiology, such as altered biomechanics. Furthermore, cord lesions were found to occur independently of DDD.

Clinical Features, Non-Contrast CT Radiomic and Radiological Signs in Models for the Prediction of Hematoma Expansion in Intracerebral Hemorrhage.

PURPOSE: Rapid identification of hematoma expansion (HE) risk at baseline is a priority in intracerebral hemorrhage (ICH) patients and may impact clinical decision making. Predictive scores using clinical features and Non-Contract Computed Tomography (NCCT)-based features exist, however, the extent to which each feature set contributes to identification is limited. This paper aims to investigate the relative value of clinical, radiological, and radiomics features in HE prediction. METHODS: Original data was retrospectively obtained from three major prospective clinical trials ["Spot Sign" Selection of Intracerebral Hemorrhage to Guide Hemostatic Therapy (SPOTLIGHT)NCT01359202; The Spot Sign for Predicting and Treating ICH Growth Study (STOP-IT)NCT00810888] Patients baseline and follow-up scans following ICH were included. Clinical, NCCT radiological, and radiomics features were extracted, and multivariate modeling was conducted on each feature set. RESULTS: 317 patients from 38 sites met inclusion criteria. Warfarin use (p=0.001) and GCS score (p=0.046) were significant clinical predictors of HE. The best performing model for HE prediction included clinical, radiological, and radiomic features with an area under the curve (AUC) of 87.7%. NCCT radiological features improved upon clinical benchmark model AUC by 6.5% and a clinical & radiomic combination model by 6.4%. Addition of radiomics features improved goodness of fit of both clinical (p=0.012) and clinical & NCCT radiological (p=0.007) models, with marginal improvements on AUC. Inclusion of NCCT radiological signs was best for ruling out HE whereas the radiomic features were best for ruling in HE. CONCLUSION: NCCT-based radiological and radiomics features can improve HE prediction when added to clinical features.

Bibliometric evaluation of systematic review and meta analyses published in the top 5 "high-impact" radiology journals.

INTRODUCTION: Meta-analyses provide high-level evidence and understanding their trends may provide understanding of the field as a whole. Bibliometric analysis was undertaken to understand research trends in a particular field or subfield and to assess citation as a measure of impact. METHODS: All journals categorised as "Radiology, Nuclear Medicine & Medical Imaging" under the Web of Science subject category were included. After analyzing impact factors of the journals in up to 2018, the top five journals were identified. The retrieved results were ordered by citation count based on Web of Science and Scopus. Specific parameters regarding the title, journal, publication year, authors, country of origin, institution and university, field of study and funding sources were analyzed. RESULTS: A total of 139 articles were identified. The mean number of citations per article was 25.3 and 22.6 in Scopus and Web of Science respectively, with four articles receiving 100 or more citations. European Radiology had the greatest number of top cited articles (n = 68; 49%). Most number of articles originated from South Korea (n = 60; 43%) and the commonest field of focus with the most common being oncology (n = 51; 27%). CONCLUSION: The top 5 high impact journals published a large number of meta-analysis and systematic reviews. The greatest number of top-cited articles were from South Korea, shifting away from the United States. Large number of studies focused on oncologic imaging, consistent with recent trends towards development of imaging biomarkers and personalized medicine. Author H index did not predict citation number or density.

The evolution of pre-operative spine tumour embolization.

Pre-operative spine tumour embolization is a useful adjunct to minimize operative complications and blood loss during complex resections. While the efficacy of this procedure has been well studied, relatively little is documented regarding how to optimize technical parameters for tumour characteristics. This pictorial case series seeks to review our centre's experience over the last decade in using a range of embolization techniques. As experience with this procedure has matured, we propose an approach based on the patient's vascular anatomy and tumour angioarchitecture. This includes the use of coils as protective barriers rather than primary embolics; particle embolization to permeate fine capillary networks; consideration for liquid embolic agents in the presence of large caliber tumour vessels with associated arteriovenous shunting; and percutaneous intralesional embolization when endovascular access is insufficient to achieve the desired outcome. In many cases, a combination of these methods is needed, and close communication with the surgeon ensures the best outcome. Despite these advances, continued work is needed to determine how to optimize complete devascularization, and thus surgical benefit, while safely sparing critical neuroanatomical structures.