Myocardial strain is a convenient parameter to quantify left ventricular (LV) function. Fast strain-encoding (fSENC) enables the acquisition of cardiovascular magnetic resonance images for strain-measurement within a few heartbeats during free-breathing. It is necessary to analyze inter-vendor agreement of techniques to determine strain, such as fSENC, in order to compare existing studies and plan multi-center studies. Therefore, the aim of this study was to investigate inter-vendor agreement and test-retest reproducibility of fSENC for three major MRI-vendors. fSENC-images were acquired three times in the same group of 15 healthy volunteers using 3 Tesla scanners from three different vendors: at the German Heart Institute Berlin, the Charité University Medicine Berlin-Campus Buch and the Theresien-Hospital Mannheim. Volunteers were scanned using the same imaging protocol composed of two fSENC-acquisitions, a 15-min break and another two fSENCacquisitions. LV global longitudinal and circumferential strain (GLS, GCS) were analyzed by a trained observer (Myostrain 5.0, Myocardial Solutions) and for nine volunteers repeatedly by another observer. Inter-vendor agreement was determined using Bland-Altman analysis. Test-retest reproducibility and intra-and inter-observer reproducibility were analyzed using intraclass correlation coefficient (ICC) and coefficients of variation (CoV). Inter-vendor agreement between all three sites was good for GLS and GCS, with biases of 0.01-1.88%. Test-retest reproducibility of scans before and after the break was high, shown by ICC-and CoV values of 0.63-0.97 and 3-9% for GLS and 0.69-0.82 and 4-7% for GCS, respectively. Intra-and inter-observer reproducibility were excellent for both parameters (ICC of 0.77-0.99, CoV of 2-5%). This trial demonstrates good inter-vendor agreement and test-retest reproducibility of GLS and GCS measurements, acquired at three different scanners from three different vendors using fSENC. The results indicate that it is necessary to account for a possible bias (< 2%) when comparing strain measurements of different scanners. Technical differences between scanners, which impact inter-vendor agreement, should be further analyzed and minimized.

Purpose 4D flow magnetic resonance imaging (4D‐MRI) allows time‐resolved visualization of blood flow patterns, quantification of volumes, velocities, and advanced parameters, such as wall shear stress (WSS). As 4D‐MRI enters the clinical arena, standardization and awareness of confounders are important. Our aim was to evaluate the equivalence of 4D flow‐derived aortic hemodynamics in healthy volunteers using different sequences and field strengths. Methods 4D‐MRI was acquired in 10 healthy volunteers at 1.5T using three different prototype sequences, at 3T and at 7T (Siemens Healthineers). After evaluation of diagnostic quality in three segments (ascending‐, descending aorta, aortic arch), peak velocity, flow volumes, and WSS were investigated. Equivalence limits for comparison of field strengths/sequences were based on the limits of Bland‐Altman analyses of the intraobserver variability. Results Non‐diagnostic quality was found in 10/144 segments, 9/10 were obtained at 7T. Apart for the comparison of forward flow between sequence 1 and 3, the differences in measurements between field strengths/sequences exceeded the range of agreement. Significant differences were found between field strengths/sequences for forward flow (1.5T vs. 3T, 3T vs. 7T, sequence 1 vs. 3, 2 vs. 3 [P < .001]), WSS (1.5T vs. 3T [P < .05], sequence 1 vs. 2, 1 vs. 3, 2 vs. 3 [P < .001]), and peak velocity (1.5T vs. 7T, sequence 1 vs. 3 [P > .001]). All parameters at all field strengths/with all sequences correlated moderately to strongly (r ≥ 0.5). Conclusion Data from all sequences could be acquired and resulting images showed sufficient quality for further analysis. However, the variability of the measurements of peak velocity, flow volumes, and WSS was higher when comparing field strengths/sequences as the equivalence limits defined by the intraobserver assessments.

Cephalosporins, particularly cefepime, exert neurotoxic side effects that can lead to status epilepticus. These neurotoxic side effects include myoclonus, dystonic movements, tremor, asterixis, seizure, status epilepticus, encephalopathy, and sometimes coma. Status epilepticus, particularly nonconvulsive status epilepticus (NCSE), is a well-known but unusual complication in patients with altered renal function who were receiving treatment with intravenous cephalosporins, especially cefepime. We reviewed the clinical and electroencephalographic (EEG) characteristics of 7 patients with renal failure who developed consciousness alterations with changes in EEG activity while being treated with cephalosporins. All patients developed renal failure: six patients had chronic renal failure, one patient had acute renal failure, and two patients were administered hemodialysis. Nonconvulsive status epilepticus was observed between 2 and 8 days (average of 5.6 days) after initiation of cephalosporins. Cephalosporins are epileptogenic drugs, especially when used in excessive doses or when renal function is impaired. Critically ill patients with chronic kidney disease are particularly susceptible to cefepime neurotoxicity. Clinical and electrophysiological results of patients guide the diagnosis of NCSE by healthcare providers.

Background Implementation of four‐dimensional flow magnetic resonance (4D Flow MR) in clinical routine requires awareness of confounders. Purpose To investigate inter‐vendor comparability of 4D Flow MR derived aortic hemodynamic parameters, assess scan‐rescan repeatability, and intra‐ and interobserver reproducibility. Study Type Prospective multicenter study. Population Fifteen healthy volunteers (age 24.5 ± 5.3 years, 8 females). Field Strength/Sequence 3 T, vendor‐provided and clinically used 4D Flow MR sequences of each site. Assessment Forward flow volume, peak velocity, average, and maximum wall shear stress (WSS) were assessed via nine planes (P1–P9) throughout the thoracic aorta by a single observer (AD, 2 years of experience). Inter‐vendor comparability as well as scan‐rescan, intra‐ and interobserver reproducibility were examined. Statistical Tests Equivalence was tested setting the 95% confidence interval of intraobserver and scan‐rescan difference as the limit of clinical acceptable disagreement. Intraclass correlation coefficient (ICC) and Bland–Altman plots were used for scan‐rescan reproducibility and intra‐ and interobserver agreement. A P‐value <0.05 was considered statistically significant. ICCs ≥ 0.75 indicated strong correlation (>0.9: excellent, 0.75–0.9: good). Results Ten volunteers finished the complete study successfully. 4D flow derived hemodynamic parameters between scanners of three different vendors are not equivalent exceeding the equivalence range. P3–P9 differed significantly between all three scanners for forward flow (59.1 ± 13.1 mL vs. 68.1 ± 12.0 mL vs. 55.4 ± 13.1 mL), maximum WSS (1842.0 ± 190.5 mPa vs. 1969.5 ± 398.7 mPa vs. 1500.6 ± 247.2 mPa), average WSS (1400.0 ± 149.3 mPa vs. 1322.6 ± 211.8 mPa vs. 1142.0 ± 198.5 mPa), and peak velocity between scanners I vs. III (114.7 ± 12.6 cm/s vs. 101.3 ± 15.6 cm/s). Overall, the plane location at the sinotubular junction (P1) presented most inter‐vendor stability (forward: 78.5 ± 15.1 mL vs. 80.3 ± 15.4 mL vs. 79.5 ± 19.9 mL [P = 0.368]; peak: 126.4 ± 16.7 cm/s vs. 119.7 ± 13.6 cm/s vs. 111.2 ± 22.6 cm/s [P = 0.097]). Scan‐rescan reproducibility and intra‐ and interobserver variability were good to excellent (ICC ≥ 0.8) with best agreement for forward flow (ICC ≥ 0.98). Data Conclusion The clinical protocol used at three different sites led to differences in hemodynamic parameters assessed by 4D flow. Level of Evidence 2 Technical Efficacy Stage 2

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In the present study, the authors presented the intrathecal gadolinium enhanced MR-myelography findings of patients with spontaneous intracranial hypotension. Materials and Methods: Intrathecal gadolinium enhanced MR-myelography (Gd-MR-myelography) examinations between October 2012 and September 2018 in patients having clinical and radiological findings of spontaneous intracranial hypotension were evaluated retrospectively. Sites and types of contrast leakages in 20 patients who met inclusion criteria were reviewed. All patients had undergone T1-fat suppressed sagittal images of cervical, thoracic and lumbar region after the off label intrathecal injection of 1 ml gadolinium-based contrast agent. Results: Patients (18 female, 2 male) are aged between 23 and 62 years-old (mean age: 41.1). Cerebrospinal fluid (CSF) leakages were cervical in 6 patients, thoracic in 5 patients, lumbar in 5 patients. One patient had leakage in multiple levels on both cervical and thoracic region and another patient on both cervicalthoracic and lumbar regions. No patients had adverse effects related to intrathecal injection of gadolinium. Conclusions: Gd-MR-myelography is effective imaging modality to reveal spinal CSF leakages in patients with spontaneous intracranial hypotension.

Ictal kissing is mainly associated with right TL and female gender, although association with left TL may also occurs, possibly related to the circuits involving temporo-insular structures.

Hashimoto's encephalopathy is a rare disease which is thought to be autoimmune and steroid responsive. The syndrome is characterized by cognitive impairment, encephalopathy, psychiatric symptoms, and seizures associated with increased level of anti-thyroid antibodies. The exact pathophysiology underlying cerebral involvement is still lesser known. Although symptoms suggest a nonlesional encephalopathy in most of the cases, sometimes the clinical appearance can be subtle and may not respond to immunosuppressants or immunomodulatory agents. Here we report a case who presented with drowsiness and amnestic complaints associated with paroxysmal electroencephalography (EEG) abnormalities which could be treated only with an antiepileptic drug.