Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Comparative Study
Comparative Analysis of Markers of Mass Effect after Ischemic Stroke.
Midline shift determined on magnetic resonance imaging (MRI) or computed tomography (CT) images is a well-validated marker of mass effect after large hemispheric infarction and associated with mortality. In this study, we targeted a population with moderately sized strokes. We compared midline shift to other imaging markers and determined their ability to predict long-term outcome. ⋯ The ratio of ipsilateral to contralateral hemisphere volume, baseline lesion volume and lesional swelling volume best predicted poor outcome across a spectrum of stroke sizes.
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Embryonal tumor with multilayered rosettes (ETMR), C19MC-altered, is a recently described, rare central nervous system tumor. To our knowledge, the imaging findings of this tumor have not been systematically evaluated in the neuroradiology literature. We present here the clinical, radiological, and pathological correlation of a case series of this very rare tumor, including the full range of anatomic compartment presentations (supratentorial, infratentorial, and spinal). ⋯ We demonstrate the conventional and advanced imaging characteristics of ETMR, including MRS and diffusion tensor imaging, which, to our knowledge, have not been systematically evaluated in the radiology literature. The knowledge gained may potentially impact patient management, especially in inoperable cases and in locations where it is risky to perform a biopsy.
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Imaging may identify patients with very large infarcts who are unlikely to benefit from intra-arterial therapy. Although computed tomography (CT) is widely used, it suffers from poor sensitivity. We sought to evaluate whether combined evaluation of noncontrast CT (NCCT) and CT angiography (CTA) collaterals would improve the detection of large infarcts. ⋯ Combined evaluation of NCCT ASPECTS and CTA collaterals identifies patients with infarcts >100 mL with high accuracy, and can improve patient selection using current CT techniques.
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Early prognostication of the outcome in resuscitated post cardiac arrest (CA) patients remains challenging especially if treated with therapeutic hypothermia. Brain edema caused by hypoxic-ischemic encephalopathy (HIE) can indirectly be estimated by transorbital sonography (TOS) taking in account the optic nerve sheath diameter (ONSD). The prognostic value of this easy, safe, and reproducible technique was investigated in this study. ⋯ Early and reliable prognostication of outcomes in patients with HIE can be simplified by ONSD values gathered with the use of TOS. Main advantages compared to other established markers are prognostication within the first 24 hours and independence from therapy with hypothermia. A higher level of accuracy can be reached by combining computed tomography (gray-to-white matter ratio values) and ONSD values.
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Review
Transcranial Doppler and Transcranial Color Duplex in Defining Collateral Cerebral Blood Flow.
In an acute stroke setting, transcranial Doppler (TCD) and transcranial color-coded duplex (TCCD) have an important diagnostic utility in the monitoring of an arterial occlusion and microemboli detection. In addition, TCD has proven to be a very useful tool in the detection and progression of cerebral vasospasm in patients with subarachnoid hemorrhage. ⋯ It is a noninvasive technique and can be utilized repeatedly allowing for changes in the blood flow dynamics as treatment is delivered. In this review, we outlined the evolving role of TCD/TCCD in defining CF in patients with an acute ischemic stroke, predicting clinical outcome and monitoring the treatment's efficacy of the CF augmentation.