ObjectiveTo investigate differences in procedure times, safety and efficacy outcomes comparing 2 different protocols to enable thrombolysis in the extended or unknown time window after stroke onset using either multimodal CT or MRI.MethodsPatients with ischemic stroke in the extended or unknown time window, who received IV-thrombolysis between January 2011 and May 2019 were identified from an institutional registry. Imaging based selection was done by multimodal CT or MRI according to institutional treatment algorithms.ResultsIV-thrombolysis was performed in 100 patients (54.3%) based on multimodal CT-imaging and in 84 patients (45.7%) based on MRI. Baseline clinical data including stroke severity and time from last seen normal to hospital admission were similar in CT- and MRI-patients. Door-to-needle times were shorter in patients with CT-based selection (median [IQR] 45 minutes [37–62] vs 75 minutes [59–90]; mean difference [95% CI] −28 minutes [−35 to −21]). No differences were detected regarding the incidence of symptomatic intracranial hemorrhage (2 [2.0%] vs 4 [4.8%]; aOR [95% CI]: 0.47 [0.08–2.83]) and favorable outcome at day 90: 25 (33.8%) vs 33 (42.9%); aOR 0.95 (0.45–2.02).ConclusionIV-thrombolysis in ischemic stroke in the unknown or extended time window appeared safe in CT and MRI selected patients while the use of CT-imaging led to faster door-to-needle times.Classification of evidenceThis study provides Class IV evidence that for patients with ischemic stroke in the extended or unknown time window, imaging-based selection for IV-thrombolysis by multimodal CT compared to MRI led to shorter door-to-needle times.
BackgroundThere is evidence that glaucoma is a neurodegenerative disease involving the whole visual pathway. We prospectively examined potential benefits of volumetry of the lateral geniculate nucleus (LGN) and diffusion tensor imaging (DTI) using a new 7T scanner.Methods20 patients with normal tension glaucoma and 16 control individuals were examined. LGN volume and fractional anisotropy (FA) of the optic tract (OT) and the optic radiation (OR) and their correlation with RNFL (retinal nerve fiber layer) thickness were analyzed.ResultsLGN volume was significantly reduced in NTG (60.9 vs 88.3; p < 0.05). FA of the OT (right: 0.35 vs 0.66, left: 0.36 vs 0.67; p < 0.05) and of the OR (right: 0.41 vs 0.70, left: 0.41 vs 0.69; p < 0.05) was also significantly reduced. Nasal RNFL thickness correlated with the volume of the contralateral LGN (r = 0.471, p = 0.05). Temporal RNFL thickness correlated with the volume of the ipsilateral LGN (r = 0.603, p = 0.015).ConclusionNTG leads to significant atrophy of the LGN compared to controls. FA of the optic tract and the optic radiation is reduced in NTG as sign of axonal degeneration. RNFL thickness but not FA correlates with LGN volume.
ObjectivesIntracranial aneurysm (IA) is the main cause of subarachnoid hemorrhages. Time-of-flight (TOF) magnetic resonance angiography (MRA) at 1.5 T or 3 T magnetic resonance imaging (MRI) is a well-established method for the diagnosis of IA. The aim of this prospective study was to evaluate the performance of a modern 0.55 T MRI in the diagnosis of IAs in comparison to digital subtraction angiography (DSA) as a standard of reference.Materials and MethodsSeventeen patients with suspicion of single or multiple IAs underwent TOF MRA at 0.55 T MRI 1 day before DSA. Two neuroradiologists independently measured the aneurysm neck, width, and height on 0.55 T, 1.5 T, and 3 T 3D-TOF MRA source images and 2D/3D rotational angiography. The main analysis assessed the intermodality agreement between 0.55 T TOF MRA and DSA using Bland-Altman plots, a Wilcoxon test, and the intraclass correlation coefficient (ICC). In a secondary analysis, aneurysm dimensions were compared between 0.55 T TOF MRA and 1.5/3 T TOF MRA. Interreader agreement was evaluated by ICC. A third neuroradiologist blinded to patient history screened 0.55 T TOF MRA data sets of the aforementioned 17 patients and 15 additional healthy patients for the presence and location of aneurysms.ResultsA total of 19 aneurysms in 16 patients were identified in both 0.55 T MRA and DSA. Measurements of the 2 nonblinded readers showed no significant differences between 0.55 T TOF MRA and DSA in the overall aneurysm size (calculated as the mean from height/width/neck) (P = 0.178), as well as in the mean width (P = 0.778) and neck values (P = 0.190). The mean height was significantly larger in 0.55 T TOF MRA in comparison to DSA (P = 0.020). Intermodality (1.5/3 T TOF MRA) and interrater agreement were excellent (ICC > 0.94). Of the 32 data sets of patients with and without IA, the blinded reader detected all aneurysms correctly by using 0.55 T images.ConclusionsTOF-MRA acquired with a modern 0.55 T MRI is a reliable tool for the detection and initial assessment of IAs.
Compared to GT, the use of GB results in a significantly higher SNR and CNR in cervical and cerebral CE-MRA, leading to a better delineation of the intracranial vasculature. Present results underline the potential of GB for improved CE-MRA assessment of vasculature in CVD patients.
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