Interventional Ischemic Stroke Treatment--A (R)evolution

In recent years ischemic stroke caused by an intracranial vessel occlusion has become a treatable disease. Over decades intravenous thrombolysis by recombinant tissue plasminogen activator was the only accepted causal treatment of ischemic stroke supported by the results of randomized, controlled trials. However, there has been continuous development of endovascular treatment strategies over recent years. Today there are 5 prospective, randomized multicenter studies showing the highly significant superiority of endovascular, mechanical recanalization over intravenous thrombolysis in cases of acute occlusion of an intracranial vessel of the anterior circulation. In all those studies endovascular treatment resulted in a tremendous increase in functional independence together with a reduction of mortality without a significant increase in complications. This article reviews the developments resulting in the current data and gives an overview of the present studies focusing on endovascular stroke treatment.

KEY POINTS

• In the last 20 years ischemic stroke due to an main stem occlusion has become a potentially treatable disease. • Several in 2015 published randomized Multicenter trials could prove the superiority of endovascular, mechanical recanalization over i.v. thrombolysis alone. • Acute ischemic stroke due to a main stem occlusion should be treated with swift endovascular stent-retriever based recanalization in specialized neurovascular centers.

Validating New Software for Semiautomated Liver Volumetry--Better than Manual Measurement?

PURPOSE

This prospective study compared a manual program for liver volumetry with semiautomated software. The hypothesis was that the semiautomated software would be faster, more accurate and less dependent on the evaluator's experience.

MATERIALS AND METHODS

Ten patients undergoing hemihepatectomy were included in this IRB approved study after written informed consent. All patients underwent a preoperative abdominal 3-phase CT scan, which was used for whole liver volumetry and volume prediction for the liver part to be resected. Two different types of software were used: 1) manual method: borders of the liver had to be defined per slice by the user; 2) semiautomated software: automatic identification of liver volume with manual assistance for definition of Couinaud segments. Measurements were done by six observers with different experience levels. Water displacement volumetry immediately after partial liver resection served as the gold standard. The resected part was examined with a CT scan after displacement volumetry.

RESULTS

Volumetry of the resected liver scan showed excellent correlation to water displacement volumetry (manual: ρ = 0.997; semiautomated software: ρ = 0.995). The difference between the predicted volume and the real volume was significantly smaller with the semiautomated software than with the manual method (33% vs. 57%, p = 0.002). The semiautomated software was almost four times faster for volumetry of the whole liver (manual: 6:59 ± 3:04 min; semiautomated: 1:47 ± 1:11 min).

CONCLUSION

Both methods for liver volumetry give an estimated liver volume close to the real one. The tested semiautomated software is faster, more accurate in predicting the volume of the resected liver part, gives more reproducible results and is less dependent on the user's experience.

KEY POINTS

Both tested types of software allow exact volumetry of resected liver parts. Preoperative prediction can be performed more accurately with the semiautomated software. The semiautomated software is nearly four times faster than the tested manual program and less dependent on the user's experience.

[Spondylosclerosis hemispherica: a rare radiological syndrome of the spine]

BACKGROUND

Spondylosclerosis hemispherica is a rare syndrome of the spine and was described first by Dihlmann. The typical radiographic appearance is a hemispherical sclerosis of the vertebral body, which is accompanied by pain in the affected region. Usually it appears at the lower lumbar spine. The etiology varies and includes degenerative disk diseases, scoliosis, bacterial infections, ankylosing spondylitis, osteoid osteoma, and malignant diseases.The radiological findings of 2 patients with spondylosclerosis hemispherica are presented and the current literature discussed.

MATERIAL AND METHODS

Two women (33 and 60 years old) with spondylosclerosis hemispherica of the lower spine suffered from low back pain and fulfilled all criteria of Dihlmann's description. Malignant disease was excluded in both cases with a broad diagnostic workup (lab values, x-ray, CT scan, MRI) and in one case a biopsy from the affected vertebra was taken.

RESULTS

In both cases all radiological findings demonstrated the typical changes of spondylosclerosis hemispherica with sclerosis of the vertebra body and erosions at the upper and inferior end plates. Malignant disease was excluded in one case with a biopsy and in the other case with noninvasive diagnostic procedures. Both patients were treated nonsurgically. During clinical follow-up, the patients were in a good condition with decreasing regional low back pain and no ongoing radiological changes in the affected vertebral bodies.

CONCLUSION

Spondylosclerosis hemispherica is a syndrome with a typical radiographic appearance. The etiology of spondylosclerosis hemispherica is manifold; however, malignancy must be excluded. In most cases, noninvasive diagnostics are sufficient to rule out malignant growth even in cases with concomitant degenerative changes of the affected segment. Thus, there is no need for a biopsy except in cases with ambiguous results. Subsequently, close clinical and radiological follow-up of the patients with spondylosclerosis hemispherica is necessary.

Frühes klinisches Management nach Polytrauma mit 1- und 4-Schicht-Spiral-CT

In the early clinical phase the comprehensive imaging of patients with multiple trauma using helical CT is already established. Aim of this study was to assess whether MSCT may improve the patient management and the diagnostic results. The procedure is designed as follows: after life-thretening treatment x-ray of chest and ultrasound are carried out in the emergency room. Then the patient is moved to CT. From 1998 to december 2000 241 patients were examined using a single slice helical CT (Somatom plus 4), in 2001 79 patients using a 4-slice helical CT (Somatom VZ, Siemens Med.Sol.). After CT selected radiograms of the extremities were taken. 359 of 360 procedures were carried out successfully. Excluding 1 case (death during 1-sl.h CT) all relevant lesions of head, neck, and body were diagnosed. Although the patients had an injury severity score of approximately 30. The change from 1 slice-helical CT to 4 slice-helical CT allowed us to reduce the stay in the CT room from 28 to 16 min. The total lethality decreased by approximately 4%. Advantages for the patient arose from the standardized examination protocol using multislice CT. If integrated in an interdisciplinary management concept, it is a good compromise between examination time, comprehensive diagnostic imaging, life-saving therapeutic procedures, and therapy planning.