Delayed ipsilateral parenchymal hemorrhage following treatment of intracranial aneurysms with flow diverter.

INTRODUCTION: The use of flow diverters (FDs) has shown promising results, particularly in the treatment of large or complex intracranial aneurysms. However, some complications can occur both during and after FD treatment, including delayed ipsilateral parenchymal hemorrhage (DIPH). The clinical presentation, etiopathogeny, and management of this complication are not well understood. We report a series of four patients with DIPH and discuss the potential mechanisms and modalities of treatment. METHODS: Four patients treated with FDs and presenting with DIPH were diagnosed in two different centers. Clinical and imaging data were reviewed before and after the procedure. Characteristics of the intraparenchymal hematomas, the modalities of treatment, and clinical course were analyzed. RESULTS: Intraparenchymal hemorrhage occurred 1 to 4 days after aneurysm treatment with FDs. All hemorrhages were situated in the ipsilateral hemisphere and were anatomically remote from the treated aneurysm. The four patients were treated with emergency surgery (hematoma evacuation). All patients had a favorable clinical outcome (mRS = 1) at midterm evaluation. Follow-up imaging showed good permeability of the FD in all subjects and complete aneurysm occlusion in all patients. CONCLUSION: From the literature review, DIPH appears to be more frequent than delayed aneurysm rupture and may be a cause of increasing concern for the use of flow diverters. However, the mechanisms of DIPH are not completely understood. Surgical evacuation of the hematoma seems to be feasible with acceptable safety and good clinical outcomes.

Diagnostic value of diffusion-weighted magnetic resonance imaging in pelvic abscesses.

OBJECTIVE: The objective of this study was to prospectively assess the added value of gadolinium-enhanced and diffusion-weighted (DWI) magnetic resonance imaging (MRI) to pelvic T2-weighted MRI for diagnosis of deep pelvic abscesses. METHODS: Twenty-nine patients with suspected abscess and a control group of 43 patients underwent T2-weighted, gadolinium-enhanced, T1-weighted and DWI magnetic resonance sequences. Three readers (R1, R2, R3) scored likelihood of abscess on standard MRI, standard MRI + gadolinium, and standard MRI + DWI. RESULTS: Twenty-nine patients had 36 abscesses. On standard MRI, R1 achieved area under the receiver operating characteristic (ROC) curve (AUC) of 0.97, sensitivity 92%, and specificity 100%. For R2, these figures were 0.87, 81%, and 100%, and for R3, these were 0.85, 83%, and 79%. After gadolinium, R2 improved AUC to 0.97 (P = 0.005), and R3 to 0.95 (P = 0.006). Standard MRI + DWI yielded improved AUC for all readers (P = 0.15, 0.001, and 0.001 for R1, R2, R3, respectively). CONCLUSIONS: Addition of gadolinium or DWI to T2-weighted MRI improves performances for the diagnosis of deep pelvic abscess. Diffusion-weighted imaging may replace gadolinium.

Combined use of a double-lumen remodeling balloon and a low-profile stent in the treatment of intracranial aneurysms ('remostent' technique): a technical note.

Remodeling technique and stenting represent important options for intracranial aneurysm treatment, and they sometimes need to be combined. The technology of remodeling balloons and stents has recently evolved with the development of the double-lumen remodeling balloon (Scepter and Ascent) and the low-profile stent (LVIS Jr). This report describes our initial experience with and feasibility of the deployment of the low-profile stent through the balloon's internal guidewire lumen, thereby reducing the number of manoeuvres by combining remodeling and stenting.

Update on imaging of Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease linked to a mutation of the STK 11 gene and is characterized by the development of benign hamartomatous polyps in the gastrointestinal tract in association with a hyperpigmentation on the lips and oral mucosa. Patients affected by PJS have an increased risk of developing gastrointestinal and extra-digestive cancer. Malignancy most commonly occurs in the small-bowel. Extra-intestinal malignancies are mostly breast cancer and gynecological tumors or, to a lesser extent, pancreatic cancer. These polyps are also at risk of acute gastrointestinal bleeding, intussusception and bowel obstruction. Recent guidelines recommend regular small-bowel surveillance to reduce these risks associated with PJS. Small-bowel surveillance allows for the detection of large polyps and the further referral of selected PJS patients for endoscopic enteroscopy or surgery. Video capsule endoscopy, double balloon pushed enteroscopy, multidetector computed tomography and magnetic resonance enteroclysis or enterography, all of which are relatively new techniques, have an important role in the management of patients suffering from PJS. This review illustrates the pathological, clinical and imaging features of small-bowel abnormalities as well as the role and performance of the most recent imaging modalities for the detection and follow-up of PJS patients.