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Dorrepaal DJ, Goedegebuure WJ, Smagge L, van der Steen M, van der Lugt A, Hokken-Koelega ACS. Cerebrovascular Abnormalities in Adults Born SGA at 12 Years After Growth Hormone Cessation Compared to Controls. J Clin Endocrinol Metab 2024; 109:e1185-e1193. [PMID: 37855389 PMCID: PMC10876403 DOI: 10.1210/clinem/dgad622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 10/20/2023]
Abstract
CONTEXT Increased cerebrovascular morbidity was reported in adults born small for gestational age (SGA) who were treated with growth hormone (GH) during childhood compared to the general population. However, previous studies did not have an appropriate control group, which is a major limitation. OBJECTIVE To study cerebrovascular abnormalities (aneurysms, previous intracerebral hemorrhages and microbleeds) using magnetic resonance imaging (MRI) in adults born SGA at 12 years after cessation of childhood GH treatment (SGA-GH) compared to appropriate controls. METHODS In this single-center, prospective study, brain MRIs were performed between May 2016 and December 2020 on a 3T MRI system. MRI images were scored by 2 neuroradiologists who were blinded to patient groupings. Participants included adults born SGA previously treated with GH and 3 untreated control groups: adults born SGA with persistent short stature (SGA-S), adults born SGA with spontaneous catch-up growth to a normal height (SGA-CU) and adults born appropriate for gestational age with a normal height (AGA). The intervention was long-term GH treatment during childhood and the main outcome measure was cerebrovascular abnormalities. RESULTS A total of 301 adults were investigated. Aneurysms were found in 6 adults: 3 (3.6%) SGA-GH, 1 (2.9%) SGA-S and 2 (2.2%) AGA adults, without differences between SGA-GH adults and the controls. Previous intracerebral hemorrhages were only found in 2 SGA-S adults (4.8%). Microbleeds were found in 17 adults: 4 (4.3%) SGA-GH, 4 (9.5%) SGA-S, 3 (4.3%) SGA-CU and 6 (6.3%) AGA adults, without differences between SGA-GH adults and the controls. CONCLUSION Our findings suggest that SGA-GH adults at 12 years after GH cessation have no increased prevalence of cerebrovascular abnormalities compared to appropriate controls. Further research is needed to confirm our findings.
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Affiliation(s)
- Demi Justine Dorrepaal
- Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands
| | - Wesley Jim Goedegebuure
- Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands
| | - Lucas Smagge
- Department of Radiology, Erasmus Medical Center, 3015 CN Rotterdam, The Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, 3015 CN Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Center, 3015 CN Rotterdam, The Netherlands
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Putora PM, Almeida GG, Wildermuth S, Weber J, Dietrich T, Vernooij MW, van Doormaal PJ, Smagge L, Zeleňák K, Krainik A, Bonneville F, van Den Hauwe L, Möhlenbruch M, Bruno F, Ramgren B, Ramos-González A, Schellhorn T, Waelti S, Fischer T. Diagnostic imaging strategies of acute intracerebral hemorrhage in European academic hospitals-a decision-making analysis. Neuroradiology 2023; 65:729-736. [PMID: 36633612 DOI: 10.1007/s00234-022-03110-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate and compare which factors are relevant to the diagnostic decision-making and imaging workup of intracerebral hemorrhages in large, specialized European centers. METHODS Expert neuroradiologists from ten large, specialized centers (where endovascular stroke treatment is routinely performed) in nine European countries were selected in cooperation with the European Society of Neuroradiology (ESNR). The experts were asked to describe how and when they would investigate specific causes in a patient who presented with an acute, atraumatic, intracerebral hemorrhage for two given locations: (1) basal ganglia, thalamus, pons or cerebellum; (2) lobar hemorrhage. Answers were collected, and decision trees were compared. RESULTS Criteria that were considered relevant for decision-making reflect recommendations from current guidelines and were similar in all participating centers. CT Angiography or MR angiography was considered essential by the majority of centers regardless of other factors. Imaging in clinical practice tended to surpass guideline recommendations and was heterogeneous among different centers, e.g., in a scenario suggestive of typical hypertensive hemorrhage, recommendations ranged from no further follow-up imaging to CT angiography and MR angiography. In no case was a consensus above 60% achieved. CONCLUSION In European clinical practices, existing guidelines for diagnostic imaging strategies in ICH evaluation are followed as a basis but in most cases, additional imaging investigation is undertaken. Significant differences in imaging workup were observed among the centers. Results suggest a high level of awareness and caution regarding potentially underlying pathology other than hypertensive disease.
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Affiliation(s)
- Paul Martin Putora
- Department of Radio-Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gonçalo G Almeida
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Simon Wildermuth
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Johannes Weber
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Tobias Dietrich
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Pieter Jan van Doormaal
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Lucas Smagge
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Kamil Zeleňák
- Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia
| | - Alexandre Krainik
- Department of Neuroradiology, University Hospital of Grenoble, Grenoble, France
| | - Fabrice Bonneville
- Department of Neuroradiology, Toulouse University Hospital, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Luc van Den Hauwe
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Birgitta Ramgren
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ana Ramos-González
- Department of Neuroradiology, University Hospital, 12 de Octubre, Madrid, Spain
| | - Till Schellhorn
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Stephan Waelti
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Tim Fischer
- Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
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Velasco González A, Buerke B, Görlich D, Chapot R, Smagge L, Velasco MDV, Sauerland C, Heindel W. Variability in the decision-making process of acute ischemic stroke in difficult clinical and radiological constellations: analysis based on a cross-sectional interview-administered stroke questionnaire. Eur Radiol 2019; 29:6275-6284. [PMID: 31076863 DOI: 10.1007/s00330-019-06199-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Notwithstanding guidelines, indications for mechanical thrombectomy (MT) in acute ischemic stroke are multifactorial and can be complex. Our aim was to exploratively evaluate decision-making on the advisability of performing MT in cases presented as an interview-administered questionnaire. METHODS Fifty international raters assessed 12 cases and decided to recommend or exclude MT. Each case contained a brief summary of clinical information and eight representative images of the initial multimodal CT. The demographic characteristics and stroke protocols were recorded for raters. For each case, the reasons for excluding MT were recorded. Uni- and multivariate logistic regression analysis were performed for the different demographic and case characteristics to identify factors that might influence decision-making. RESULTS All raters performed MT (median MTs/hospital/year [IQR], 100 [50-141]) with a median of 7 years of experience as first operator (IQR, 4-12). Per case, diversity in decision-making ranged between 1 (case 6, 100% yes MT) and 0.50 (case 12, 54.2% yes MT and 45.8% no MT). The most common reasons for excluding MT were small CBV/CBF mismatch (17%, 102/600), size of infarct core on the CBV map (15.2%, 91/600), and low NIHSS score (National Institute of Health Stroke Scale, 8.3%, 50/600). All clinical and radiological characteristics significantly affected the decision regarding MT, but the general characteristics of the raters were not a factor. CONCLUSIONS Clinical and imaging characteristics influenced the decision regarding MT in stroke. Nevertheless, a consensus was reached in only a minority of cases, revealing the current divergence of opinion regarding therapeutic decisions in difficult cases. KEY POINTS • This is the first study to explore differences in decision-making in respect of mechanical thrombectomy in ischemic stroke with complex clinical and radiological constellations. • Fifty experienced international neurointerventionalists answered this interview-administered stroke questionnaire and made decisions as to whether to recommend or disadvise thrombectomy in 12 selected cases. • Diversity in decision-making for thrombectomy ranged from 1 (100% of raters offered the same answer) to 0.5 (50% indicated mechanical thrombectomy). There was a consensus in only a minority of cases, revealing the current disparity of opinion regarding therapeutic decisions in difficult cases.
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Affiliation(s)
- Aglaé Velasco González
- Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
| | - Boris Buerke
- Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany
| | - Rene Chapot
- Department of Neuroradiology, Alfried-Krupp Krankenhaus Hospital, Alfried-Krupp Straße 21, 45131, Essen, Germany
| | - Lucas Smagge
- Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Maria Del Valle Velasco
- University Hospital of the Canary Islands, Carretera de la Cuesta, Taco 0, 38320, Santa Cruz de Tenerife, Spain
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany
| | - Walter Heindel
- Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
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Marquering HA, Nederkoorn PJ, Smagge L, Gratama van Andel HA, van den Berg R, Majoie CB. Performance of semiautomatic assessment of carotid artery stenosis on CT angiography: clarification of differences with manual assessment. AJNR Am J Neuroradiol 2011; 33:747-54. [PMID: 22194365 DOI: 10.3174/ajnr.a2838] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Semiautomated methods for ICA stenosis measurements have the potential to reduce interobserver variability and to speed up its analysis. In this study, we estimate the precision and accuracy of a semiautomated measurement for carotid artery stenosis degree and identify and explain differences compared with the manual method. MATERIALS AND METHODS In this retrospective study involving 90 patients, 2 observers determined the stenosis degree twice, with both the semiautomated and the manual method. Intra- and interobserver correlations were calculated for both methods. The accuracy was estimated by comparing average semiautomated with manual measurements. The semiautomated stenosis calculations were performed using either the minimal or maximal intersection at the reference site. Individual cases with large differences in measurement were retrospectively inspected by 3 observers. RESULTS Intra- (R = 0.93, 0.96) and interobserver (R = 0.98) correlations for the semiautomated method were excellent and exceeded the manual performance correlations (R = 0.87, 0.86). The semiautomated measurements correlated well with the manual measurements (R = 0.87), with high specificity of 96% and lower sensitivity of 63%. Large differences were caused by misinterpretations of the semiautomated method associated with calcified plaques, resulting in overestimations of the minimal diameter, underestimation of stenosis degree, and incorrect centerlines. The effect of using the minimal diameter at the reference position resulted in a small, but significant, underestimation of the stenosis degree by the semiautomated method. CONCLUSIONS The semiautomated method showed an excellent reproducibility and good correlation with manual measurements with a high specificity and lower sensitivity for detecting a significant stenosis. Erroneous semiautomatic stenosis measurements were associated with the presence of calcium.
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Affiliation(s)
- H A Marquering
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
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Marquering HA, Majoie CBLM, Smagge L, Kurvers AG, Gratama van Andel HA, van den Berg R, Nederkoorn PJ. The relation of carotid calcium volume with carotid artery stenosis in symptomatic patients. AJNR Am J Neuroradiol 2011; 32:1182-7. [PMID: 21659483 DOI: 10.3174/ajnr.a2519] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recent research showed a strong correlation of calcium volume scores with degree of stenosis, suggesting that calcium volume could be used in the diagnosis of carotid artery stenosis. We investigated the accuracy of the use of calcium volume scores to diagnose carotid artery stenosis in our target population of recently symptomatic patients. MATERIALS AND METHODS Ninety symptomatic patients suspected of having carotid artery stenosis underwent CTA, resulting in images of 159 evaluable arteries. The correlation between calcium volume and degree of stenosis was calculated by using the Pearson correlation coefficient. With thresholds of 0.03 and 0.09 mL, we assessed the diagnostic performance of a calcium volume-based evaluation of stenosis for a previously reported stenosis cutoff of 40% and for the clinically important cutoffs of 50% and 70%. RESULTS In our patients series, the calcium volume score was not related to the stenosis degree on the symptomatic side (R = 0.04, P = .7) and was weakly related on the asymptomatic side (R = 0.29, P = .005). The diagnostic accuracy of the calcium volume score to estimate 40% stenosis was relatively low: a sensitivity of 47% or 64% and a specificity of 52% or 82%, for the 0.09 and 0.03 mL thresholds, respectively. The diagnostic accuracy decreased with increasing degree of stenosis. CONCLUSIONS We could not confirm the previously reported strong correlation of calcium volume with stenosis degree in our population of patients with recent neurologic symptoms. We conclude that in this particular domain, calcium volume cannot be used to estimate the degree of stenosis.
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Affiliation(s)
- H A Marquering
- Departments of Radiology, Academic Medical Center Amsterdam, The Netherlands.
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