Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians.

BACKGROUND: With the increasing age of acute stroke patients being admitted to hospitals, more data are needed on indications, complications and outcome of endovascular treatment (EVT) in the very elderly. METHODS: Retrospective observational study with data collection from Belgian, Swiss, Canadian comprehensive stroke centers and Swedish EVT National database. All patients with acute ischemic stroke were eligible if aged older than or ≥90 years and treated with EVT ± pretreatment with intravenous thrombolysis (IVT). Safety assessment comprised presence of periprocedural complications, hemorrhagic transformation or other adverse events (<7days). Efficacy and outcome measures were successful recanalization (modified Treatment In Cerebral Infarction (mTICI) score ≥2b), favorable clinical outcome (modified Rankin Score (mRS) 0-2) and 3-months mortality. RESULTS: Inclusion of 112 nonagenarians (mean age 93.3 ± 2.5 years; 76.8% women; pre-mRS ≤2 in 69.4%). Pretreatment with IVT was performed in 54.7%. In 74.6% successful recanalization (mTICI ≥2b) was achieved. Favorable outcome (mRS ≤2) was seen in 16.4% and 3-months mortality was 62.3%. Multivariate logistic regression analysis showed younger age (odds ratio [OR] 2.99; 1.29-6.95; P = .011) and lower prestroke mRS (OR 13.46; 2.32-78.30; P = .004) as significant predictors for good clinical outcome at 90 days. CONCLUSIONS: Our observational study on EVT in nonagenarians demonstrates the need for careful patient selection. A substantial proportion of nonagenarians shows an unfavorable clinical outcome and high mortality, despite acceptable recanalization rates. A high prestroke disability (mRS) and advancing age predict an unfavorable outcome. Treatment decisions should be made on case-by-case evaluation, keeping in mind limited chances of favorable outcome and high risk of mortality.

MRI of the cranial nerves--more than meets the eye: technical considerations and advanced anatomy.

Magnetic resonance (MR) imaging is the method of choice to evaluate the cranial nerves. Although the skull base foramina can be seen on CT, the nerves themselves can only be visualized in detail on MR. To see the different segments of nerves I to XII, the right sequences must be used. Detailed clinical information is needed by the radiologist so that a tailored MR study can be performed. In this article, MR principles for imaging of the cranial nerves are discussed. The basic anatomy of the cranial nerves and the cranial nerve nuclei as well as their central connections are discussed and illustrated briefly. The emphasis is on less known or more advanced extra-axial anatomy, illustrated with high-resolution MR images.

"White Thyroid" on Unenhanced Computed Tomography in Amiodarone-Induced Thyrotoxicosis Type 2.

Amiodarone-induced thyrotoxicosis is a common complication of long-term amiodarone treatment. In a patient with amiodarone-induced lung toxicity and amiodarone-induced thyrotoxicosis type 2 (AIT2), a "white thyroid" was incidentally observed on an unenhanced chest computed tomography (CT) scan. This "white thyroid" resembled a thyroid image on a contrast-enhanced CT scan. Therefore, the thyroid density was prospectively evaluated on unenhanced CT scans in cases of AIT2, in euthyroid patients on amiodarone (AEuth), and in unexposed controls. The aim was to test the hypothesis of a higher thyroid density in AIT2 compared to AEuth. The thyroid density, as measured in Hounsfield Units on unenhanced CT scans, is higher in AIT2 compared to AEuth and much higher than in controls. The causality of this association and its potential diagnostic use require further study.

Two Rare Cases of Posttraumatic Peripheral Artery Pseudoaneurysm.

Posttraumatic pseudoaneurysms of the lower limb are increasingly recognized due to the development of cross-sectional imaging. Two cases of anterior tibial artery pseudoaneurysm after blunt trauma are presented. The diagnostic technique of choice is Doppler ultrasound (US). In some cases, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) is needed to identify the feeding vessel. The treatment of choice is not yet determined. Ultrasound-guided thrombin injection is widely used as first-line treatment, but some cases are refractory to this treatment. Further investigation and optimization of therapeutic technique to definitely exclude the pseudoaneurysm from the circulation may result in faster and more cost-effective treatment than US-guided thrombin injection.

Perfusion maps of the whole liver based on high temporal and spatial resolution contrast-enhanced MRI (4D THRIVE): feasibility and initial results in focal liver lesions.

PURPOSE: To prospectively evaluate a new imaging sequence (4D THRIVE) for whole liver perfusion in high temporal and spatial resolution. Feasibility of parametric mapping and its potential for characterizing focal liver lesions (FLLs) are investigated. MATERIALS AND METHODS: Fifteen patients suspected for colorectal liver metastases (LMs) were included. Parametric maps were evaluated qualitatively (ring-enhancement and lesion heterogeneity) and compared to three-phased contrast-enhanced MRI. Quantitative analysis was based on average perfusion values of entire FLLs. Reference standard comprised surgery with histopathology or follow-up imaging. Fisher's exact test was used for qualitative and Kruskal-Wallis test for quantitative analysis. RESULTS: In total 29 LMs, 17 hemangiomas and 4 focal nodular hyperplasias were evaluated. FLLs could be differentiated by qualitative assessment of parametric maps respectively three-phased contrast-enhanced MRI (Fisher's p<0.001 for comparisons between LMs and hemangiomas and LMs and FNHs for both ring-enhancement and lesion heterogeneity) rather than by quantitative analysis of parametric maps (Chi-square for Kep=0.33 (p=0.847) and Chi-square for Kel=1.35 (p=0.509)). CONCLUSION: This preliminary study shows potential of 4D THRIVE for whole liver imaging enabling calculation of parametric maps. Qualitative rather than quantitative analysis was accurate for differentiating malignant and benign FLLs.