Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Review Case Reports
Transcranial Color-Coded Duplex in Acute Encephalitis: Current Status and Future Prospects.
There are limited data regarding the diagnostic yield of transcranial color-coded Doppler (TCCD) in acute encephalitis. We present our preliminary observations of consecutive ultrasound evaluations in 2 patients with acute encephalitis and we review the possible diagnostic role of TCCD in such cases. ⋯ The focal transient increase in left M1 MCA PI may be attributed to focally increased intracranial pressure or peripheral vasospasm of distal left MCA branches. Since there are limited reports in the literature concerning TCCD evaluation of patients with central nervous system infections, our preliminary findings require independent confirmation in a larger series of patients.
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Change in lesion volume over time, measured on brain magnetic resonance imaging (MRI) scans, is an important outcome measure for natural history studies and clinical trials in multiple sclerosis (MS). ⋯ Use of the subtraction algorithm leads to improved reliability and lower operator fatigue in clinical trials and studies of the natural history of MS.
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Review
Susceptibility-Weighted Imaging of Glioma: Update on Current Imaging Status and Future Directions.
Susceptibility-weighted imaging (SWI) provides invaluable insight into glioma pathophysiology and internal tumoral architecture. The physical contribution of intratumoral susceptibility signal (ITSS) may correspond to intralesional hemorrhage, calcification, or tumoral neovascularity. In this review, we present emerging evidence of ITSS for assessment of intratumoral calcification, grading of glioma, and factors influencing the pattern of ITSS in glioblastoma. ⋯ Significant higher concentration of gadolinium accumulates at the border of the tumoral invasion zone as seen on the SWI sequence; this results from contrast-induced phase shift that clearly delineates the tumor margin. Lastly, absence of ITSS may aid in differentiation between high-grade glioma and primary CNS lymphoma, which typically shows absence of ITSS. We conclude that SWI and CE-SWI are indispensable tools for diagnosis, preoperative grading, posttherapy surveillance, and assessment of glioma.
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Case Reports
Performance of CT Angiography on a Mobile Stroke Treatment Unit: Implications for Triage.
There is a strong inverse relationship between outcome in patients with acute ischemic stroke from emergent large vessel occlusion (ELVO), and time to reperfusion from intra-arterial therapy. Delay in transferring patients to thrombectomy-capable centers is currently a major limitation. The mobile stroke unit (MSU) concept with onboard portable computed tomography (CT) scanner enables rapid performance of CT angiography (CTA) of the intracranial vessels to detect ELVO in the field, and allows for rapid triage of patients to interventional-capable centers. ⋯ CTA is possible on an MSTU, enabling rapid detection and triage of ELVO cases directly to thrombectomy-capable centers, which significantly reduces time to endovascular treatment.
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The safety and feasibility of intravenous thrombolysis using recombinant tissue plasminogen activator (IV-tPA) were retrospectively compared between patients with unknown onset time and no ischemia on fluid-attenuated inversion recovery (negative FLAIR) and patients receiving standard therapy. ⋯ IV-tPA may safely increase the rate of dramatic recovery in acute stroke patients with unknown onset times and negative FLAIR.