Clarkeburke8652
Many small, regularly shaped cerebral aneurysms rupture; however, they usually receive a low score based on current risk-assessment methods. Our goal was to identify patient and aneurysm characteristics associated with rupture of small, regularly shaped aneurysms and to develop and validate predictive models of rupture in this aneurysm subpopulation.
Cross-sectional data from 1079 aneurysms smaller than 7 mm with regular shapes (without blebs) were used to train predictive models for aneurysm rupture using machine learning methods. These models were based on the patient population, aneurysm location, and hemodynamic and geometric characteristics derived from image-based computational fluid dynamics models. An independent data set with 102 small, regularly shaped aneurysms was used for validation.
Adverse hemodynamic environments characterized by strong, concentrated inflow jets, high speed, complex and unstable flow patterns, and concentrated, oscillatory, and heterogeneous wall shear stress patterns were associated with rupture in small, regularly shaped aneurysms. Additionally, ruptured aneurysms were larger and more elongated than unruptured aneurysms in this subset. A total of 5 hemodynamic and 6 geometric parameters along with aneurysm location, multiplicity, and morphology, were used as predictive variables. The best machine learning rupture prediction-model achieved a good performance with an area under the curve of 0.84 on the external validation data set.
This study demonstrated the potential of using predictive machine learning models based on aneurysm-specific hemodynamic, geometric, and anatomic characteristics for identifying small, regularly shaped aneurysms prone to rupture.
This study demonstrated the potential of using predictive machine learning models based on aneurysm-specific hemodynamic, geometric, and anatomic characteristics for identifying small, regularly shaped aneurysms prone to rupture.
In infants born very preterm, monitoring of early brain growth could contribute to prediction of later neurodevelopment. Therefore, our aim was to investigate associations between 2 early cranial ultrasound markers (corpus callosum-fastigium and corpus callosum length) and neurodevelopmental outcome and the added value of both markers in the prediction of neurodevelopmental outcome based on neonatal risk factors and head circumference in very preterm infants.
This prospective observational study included 225 infants born at <30 weeks' gestational age, of whom 153 were without any brain injury on cranial ultrasound. Corpus callosum-fastigium and corpus callosum length and head circumference were measured at birth, 29 weeks' gestational age, transfer from the neonatal intensive care unit to a level II hospital, and 2 months' corrected age. We analyzed associations of brain markers and their growth with cognitive, motor, language, and behavioral outcome at 2 years' corrected age.
In infants without brais the added clinical utility in predicting neurodevelopmental outcome.
Cerebral small vessel disease contributes to stroke and cognitive impairment and interacts with Alzheimer disease pathology. Because of the small dimensions of the affected vessels, in vivo characterization of blood flow properties is challenging but important to unravel the underlying mechanisms of the disease.
A 2D phase-contrast sequence at 7T MR imaging was used to assess blood flow velocity and the pulsatility index of the perforating basal ganglia arteries. We included patients with cerebral amyloid angiopathy (
= 8; identified through the modified Boston criteria), hypertensive arteriopathy (
= 12; identified through the presence of strictly deep or mixed cerebral microbleeds), and age- and sex-matched controls (
= 28; no cerebral microbleeds).
Older age was related to a greater pulsatility index, irrespective of cerebral small vessel disease. In hypertensive arteriopathy, there was an association between lower blood flow velocity of the basal ganglia and the presence of peri-basal ganglia WM hyperintensities.
Our results suggest that age might be the driving factor for altered cerebral small vessel hemodynamics. Furthermore, this study puts cerebral small vessel disease downstream pathologies in the basal ganglia region in relation to blood flow characteristics of the basal ganglia microvasculature.
Our results suggest that age might be the driving factor for altered cerebral small vessel hemodynamics. Furthermore, this study puts cerebral small vessel disease downstream pathologies in the basal ganglia region in relation to blood flow characteristics of the basal ganglia microvasculature.
Most patients with tuberous sclerosis complex (TSC) do not receive prenatal diagnosis. Our aim was to describe MR imaging findings to determine the following 1. Whether normal fetal MR imaging is more common in fetuses imaged at ≤24 weeks' gestation compared with >24 weeks 2. A939572 The frequency of cardiac rhabdomyoma 3. The range of MR imaging phenotypes in fetal tuberous sclerosis complex.
Our institutional fetal MR imaging data base was searched between January 1, 2011 and June 30, 2021, for cases of TSC confirmed either by genetic testing, postnatal imaging, postmortem examination, or composite prenatal imaging findings and family history. A MEDLINE search was performed on June 8, 2021.
Forty-seven published cases and 4 of our own cases were identified. Normal findings on fetal MR imaging were seen at a lower gestational age (mean, 24.7 [SD, 4.5 ] weeks) than abnormal findings on MR imaging (mean, 30.0 [SD, 5.3] weeks) (
= .008). Nine of 42 patients with abnormal MR imaging findings were ≤24 weeks' gestation. Subependymal nodules were present in 26/45 cases (57.8%), and cortical/subcortical lesions, in 17/46 (37.0%). A foramen of Monro nodule was present in 15 cases; in 2/7 cases in which this was unilateral, it was the only abnormal cerebral finding. Cardiac rhabdomyoma was absent in 3/48 cases at the time of fetal MR imaging but was discovered later. Megalencephaly or hemimegalencephaly was observed in 3 cases.
Fetuses with abnormal cranial MR imaging findings were older than those with negative findings. Fetal hemimegalencephaly and megalencephaly should prompt fetal echocardiography. Cardiac rhabdomyoma was not always present at the time of fetal MR imaging.
Fetuses with abnormal cranial MR imaging findings were older than those with negative findings. Fetal hemimegalencephaly and megalencephaly should prompt fetal echocardiography. Cardiac rhabdomyoma was not always present at the time of fetal MR imaging.
Photon-counting detector CT is a new technology with a limiting spatial resolution of ≤150 μm. In vivo comparisons between photon-counting detector CT and conventional energy-integrating detector CT are needed to determine the clinical impact of photon counting-detector CT in temporal bone imaging.
Prospectively recruited patients underwent temporal bone CT examinations on an investigational photon-counting detector CT system after clinically indicated temporal bone energy-integrating detector CT. Photon-counting detector CT images were obtained at an average 31% lower dose compared with those obtained on the energy-integrating detector CT scanner. Reconstructed images were evaluated in axial, coronal, and Pöschl planes using the smallest available section thickness on each system (0.4 mm on energy-integrating detector CT; 0.2 mm on photon-counting detector CT). Two blinded neuroradiologists compared images side-by-side and scored them using a 5-point Likert scale. A post hoc reassignment of readers' scorrior spatial resolution and better critical structure visualization than those obtained on a conventional energy-integrating detector scanner, even with a substantial dose reduction.
Several CT findings are thought to be indicative of vocal cord paralysis; however, these signs have never been validated in a blinded fashion. This study attempts to compare and validate these signs and determine their accuracy in predicting vocal cord paralysis.
A retrospective chart review was performed, and CT scans from patients with known unilateral vocal cord paralysis and known normal vocal cord movement were reviewed by 3 radiologists who were blinded to the status of the patients' laryngeal function. The scans were reviewed and scored for 8 accepted signs of vocal cord paralysis as well as for predicting a final diagnostic conclusion. Statistical analysis using odds ratios for signs and the Fleiss κ for criterion agreement among the radiologists was performed for diagnostic accuracy.
The presence of medial displacement of the posterior ipsilateral vocal fold margin and ipsilateral laryngeal ventricular dilation yielded the greatest positive predictive value. Other signs demonstrated high specificity, but interrater discrepancy was greater than expected and diminished the reliability of these signs in predicting vocal cord paralysis. Overall, sensitivity and negative predictive values were low.
Predicting vocal cord paralysis on the basis of CT findings is not as accurate or straightforward in prospectively predicting vocal cord paralysis as implied in prior studies.
Predicting vocal cord paralysis on the basis of CT findings is not as accurate or straightforward in prospectively predicting vocal cord paralysis as implied in prior studies.Lateral decubitus CT myelography is a sensitive technique for detecting CSF-venous fistulas in patients with spontaneous intracranial hypotension. It might be necessary to perform bilateral studies to locate a fistula. We report on the feasibility of obtaining diagnostic-quality bilateral decubitus CT myelography in a single session, avoiding the need to schedule separate examinations for the left and right sides on different days.
Single intrauterine fetal death increases the risk of antenatal brain lesions in the surviving twin. We evaluated the prevalence of structural brain lesions, biometry, and diffusivity on routine third trimester MR imaging performed following single intrauterine fetal death.
In a retrospective MR imaging-based cohort study, we compared 29 monochorionic twins complicated with single intrauterine fetal death (14 following laser ablation treatment for twin-to-twin transfusion syndrome, 8 following selective fetal reduction, and 7 spontaneous) with 2 control cohorts (49 singleton fetuses and 28 uncomplicated twin fetuses). All fetuses in the single intrauterine fetal death group underwent fetal brain MR imaging as a routine third trimester evaluation. Structural brain lesions were analyzed. Cerebral biometry and diffusivity were measured and compared.
Brain lesions consistent with the evolution of prior ischemic injury were found in 1 of 29 fetuses, not detected by ultrasound. No acute brain infarction, hemong twins suggests normal parenchymal microstructure. The rate of cerebral structural injury was relatively low in our cohort, arguing against the routine use of fetal brain MR imaging in twin pregnancies complicated with single intrauterine fetal death. Larger prospective studies are necessary to guide appropriate surveillance protocol and parental counseling in twin pregnancies complicated by single intrauterine fetal death.
