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Kneihsl M, Hinteregger N, Nistl O, Deutschmann H, Horner S, Poltrum B, Fandler-Höfler S, Hatab I, Haidegger M, Pinter D, Pichler A, Willeit K, Knoflach M, Enzinger C, Gattringer T. Post-reperfusion hyperperfusion after endovascular stroke treatment: a prospective comparative study of TCD versus MRI. J Neurointerv Surg 2023; 15:983-988. [PMID: 36137745 DOI: 10.1136/jnis-2022-019213] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increased middle cerebral artery (MCA) blood flow velocities on transcranial duplex sonography (TCD) were recently reported in individual patients after successful mechanical thrombectomy (MT) and were related to intracranial hemorrhage and poor outcome. However, the retrospective study design of prior studies precluded elucidation of the underlying pathomechanisms, and the relationship between TCD and brain parenchymal perfusion still remains to be determined. METHODS We prospectively investigated consecutive patients with stroke successfully recanalized by MT with TCD and MRI including contrast-enhanced perfusion sequences within 48 hours post-intervention. Increased MCA flow on TCD was defined as >30% mean blood flow velocity in the treated MCA compared with the contralateral MCA. MRI blood flow maps served to assess hyperperfusion rated by neuroradiologists blinded to TCD. RESULTS A total of 226 patients recanalized by MT underwent post-interventional TCD and 92 patients additionally had perfusion MRI. 85 patients (38%) had increased post-interventional MCA flow on TCD. Of these, 10 patients (12%) had an underlying focal stenosis. Increased TCD blood flow in the recanalized MCA was associated with larger infarct size, vasogenic edema, intracranial hemorrhage and poor 90-day outcome (all p≤0.005). In the subgroup for which both TCD and perfusion MRI were available, 29 patients (31%) had increased ipsilateral MCA flow velocities on TCD. Of these, 25 patients also showed parenchymal hyperperfusion on MRI (sensitivity 85%; specificity 62%). Hyperperfusion severity on MRI correlated with MCA flow velocities on TCD (rs=0.379, p<0.001). CONCLUSIONS TCD is a reliable bedside tool to identify post-reperfusion hyperperfusion, correlates well with perfusion MRI, and indicates risk of reperfusion injury after MT.
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Affiliation(s)
- Markus Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Nicole Hinteregger
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Oliver Nistl
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Susanna Horner
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Birgit Poltrum
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Isra Hatab
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Karin Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Micheal Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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Maier O, Spann SM, Pinter D, Gattringer T, Hinteregger N, Thallinger GG, Enzinger C, Pfeuffer J, Bredies K, Stollberger R. Non-linear fitting with joint spatial regularization in arterial spin labeling. Med Image Anal 2021; 71:102067. [PMID: 33930830 DOI: 10.1016/j.media.2021.102067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/05/2020] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
Multi-Delay single-shot arterial spin labeling (ASL) imaging provides accurate cerebral blood flow (CBF) and, in addition, arterial transit time (ATT) maps but the inherent low SNR can be challenging. Especially standard fitting using non-linear least squares often fails in regions with poor SNR, resulting in noisy estimates of the quantitative maps. State-of-the-art fitting techniques improve the SNR by incorporating prior knowledge in the estimation process which typically leads to spatial blurring. To this end, we propose a new estimation method with a joint spatial total generalized variation regularization on CBF and ATT. This joint regularization approach utilizes shared spatial features across maps to enhance sharpness and simultaneously improves noise suppression in the final estimates. The proposed method is evaluated at three levels, first on synthetic phantom data including pathologies, followed by in vivo acquisitions of healthy volunteers, and finally on patient data following an ischemic stroke. The quantitative estimates are compared to two reference methods, non-linear least squares fitting and a state-of-the-art ASL quantification algorithm based on Bayesian inference. The proposed joint regularization approach outperforms the reference implementations, substantially increasing the SNR in CBF and ATT while maintaining sharpness and quantitative accuracy in the estimates.
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Affiliation(s)
- Oliver Maier
- Institute of Medical Engineering, Graz University of Technology, Stremayrgasse 16/III, Graz 8010, Austria.
| | - Stefan M Spann
- Institute of Medical Engineering, Graz University of Technology, Stremayrgasse 16/III, Graz 8010, Austria.
| | - Daniela Pinter
- Department of Neurology, Division of General Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria.
| | - Thomas Gattringer
- Department of Neurology, Division of General Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria; Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria.
| | - Nicole Hinteregger
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria.
| | - Gerhard G Thallinger
- Institute of Biomedical Informatics, Graz University of Technology, Stremayrgasse 16/I, Graz 8010, Austria; BioTechMed-Graz, Mozartgasse 12/II, Graz 8010, Austria.
| | - Christian Enzinger
- Department of Neurology, Division of General Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria; Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 22, Graz 8036, Austria.
| | - Josef Pfeuffer
- Application Development, Siemens Healthcare, Henkestraße 127, Erlangen 91052, Germany.
| | - Kristian Bredies
- Institute of Mathematics and Scientific Computing, University of Graz, Heinrichstraße 36, Graz 8010, Austria; BioTechMed-Graz, Mozartgasse 12/II, Graz 8010, Austria.
| | - Rudolf Stollberger
- Institute of Medical Engineering, Graz University of Technology, Stremayrgasse 16/III, Graz 8010, Austria; BioTechMed-Graz, Mozartgasse 12/II, Graz 8010, Austria.
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Afifi K, Bellanger G, Buyck PJ, Zuurbier SM, Garcia-Esperon C, Barboza MA, Costa P, Escudero I, Renard D, Lemmens R, Hinteregger N, Fazekas F, Jimenez-Conde J, Giralt-Steinhauer E, Hiltunen S, Arauz A, Pezzini A, Montaner J, Putaala J, Weimar C, Schlamann M, Gattringer T, Tatlisumak T, Coutinho JM, Demaerel P, Thijs V. Correction to: Features of intracranial hemorrhage in cerebral venous thrombosis. J Neurol 2020; 267:3299-3300. [PMID: 32785839 DOI: 10.1007/s00415-020-10082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The original version of this article unfortunately contained mistakes. The correct information is given below.
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Affiliation(s)
- K Afifi
- Department of Neurology, Menoufia University, Al Minufya, Menoufia, Egypt.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia
| | - G Bellanger
- Department of Neuroradiology, Purpan University Hospital, Toulouse, France.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia
| | - P J Buyck
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - S M Zuurbier
- Department of Neurology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - C Garcia-Esperon
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia
| | - M A Barboza
- Stroke Department, Instituto Nacional de Neurología Y Neurocirugía Dr. Manuel Velasco Suárez, México City, México
| | - P Costa
- Department of Head and Neck, Neurology Clinic, University of Brescia, Brescia, Italy
| | - I Escudero
- Neurology Department, University Hospital Virgen del Rocio, Sevilla, Spain.,Neurovascular Lab, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - D Renard
- Department of Neurology, Nîmes University Hospital, Nîmes, France
| | - R Lemmens
- Department of Neurosciences, Experimental Neurology and Leuven Institute for Neuroscience and Disease (LIND), KU Leuven-University of Leuven, Leuven, Belgium.,Laboratory of Neurobiology, Center for Brain and Disease Research, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - N Hinteregger
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - F Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - J Jimenez-Conde
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona, Spain.,Universitat Autònoma de Barcelon, Barcelona, Spain
| | - E Giralt-Steinhauer
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona, Spain.,Universitat Autònoma de Barcelon, Barcelona, Spain
| | - S Hiltunen
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - A Arauz
- Stroke Department, Instituto Nacional de Neurología Y Neurocirugía Dr. Manuel Velasco Suárez, México City, México
| | - A Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic University of Brescia, Brescia, Italy
| | - J Montaner
- Neurovascular Lab, Instituto de Biomedicina de Sevilla, Sevilla, Spain.,Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - J Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - C Weimar
- Institute of Medical Informatics, Biometry and Epidemiology and Department of Neurology, University Hospital Essen, Essen, Germany
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany
| | - T Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Tatlisumak
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - P Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - V Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, 245 Burgundy Street, Heidelberg, VIC, 3084, Australia. .,Department of Neurology, Austin Health, Heidelberg, VIC, Australia.
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Birner A, Bengesser SA, Seiler S, Dalkner N, Queissner R, Platzer M, Fellendorf FT, Hamm C, Maget A, Pilz R, Lenger M, Reininghaus B, Pirpamer L, Ropele S, Hinteregger N, Magyar M, Deutschmann H, Enzinger C, Kapfhammer HP, Reininghaus EZ. Total gray matter volume is reduced in individuals with bipolar disorder currently treated with atypical antipsychotics. J Affect Disord 2020; 260:722-727. [PMID: 31563071 DOI: 10.1016/j.jad.2019.09.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIMS Recent evidence indicates that the intake of atypical antipsychotics (AAP) is associated with gray matter abnormalities in patients with psychiatric disorders. We explored if patients with bipolar disorder (BD) who are medicated with AAP exhibit total gray matter volume (TGV) reduction compared to BD individuals not medicated with AAP and healthy controls (HC). METHODS In a cross-sectional design, 124 individuals with BD and 86 HC underwent 3T-MRI of the brain and clinical assessment as part of our BIPFAT-study. The TGV was estimated using Freesurfer. We used univariate covariance analysis (ANCOVA) to test for normalized TGV differences and controlled for covariates. RESULTS ANCOVA results indicated that 75 BD individuals taking AAP had significantly reduced normalized TGV as compared to 49 BD not taking AAP (F = 9.995, p = .002., Eta = 0.084) and 86 HC (F = 7.577, p = .007, Eta = 0.046). LIMITATIONS Our cross-sectional results are not suited to draw conclusions about causality. We have no clear information on treatment time and baseline volumes before drug treatment in the studied subjects. We cannot exclude that patients received different psychopharmacologic medications prior to the study point. We did not included dosages into the calculation. Many BD individuals received combinations of psychopharmacotherapy across drug classes. We did not have records displaying quantitative alcohol consumption and drug abuse in our sample. CONCLUSIONS Our data provide further evidence for the impact of AAP on brain structure in BD. Longitudinal studies are needed to investigate the causal directions of the proposed relationships.
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Affiliation(s)
- Armin Birner
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria.
| | - Stephan Seiler
- Imaging of Dementia and Aging (IDeA), Laboratory Department of Neurology and Center for Neuroscience, University of California, Davis, USA
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Rene Pilz
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Bernd Reininghaus
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Austria; Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Nicole Hinteregger
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Marton Magyar
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Austria; Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
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Afifi K, Bellanger G, Zuurbier Y, Garcia Esperon C, Barboza M, Buyck PJ, Costa P, Escudero I, Renard D, Lemmens R, Hinteregger N, Fazekas F, Jimenez Conde J, Giralt-Steinhauer E, Hiltunen S, Pezzini A, Montaner J, Weimar C, Churilov L, Gattringer T, Asadi H, Tatlisumak T, Coutinho J, Demaerel P, Thijs V. Abstract TP423: Risk Factors for Intracranial Hemorrhage in Cerebral Venous Thrombosis. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cerebral venous thrombosis is associated with intracranial hemorrhage. The occurrence of brain bleeding complicates management and is associated with worse outcomes. We aimed to identify clinical and imaging risk factors for intracerebral hemorrhage. We hypothesized that higher clot burden would be associated with a higher risk of intracerebral hemorrhage.
Methods:
We performed a retrospective analysis of an international, multicenter cohort of patients with cerebral venous thrombosis who underwent CT within 2 weeks of symptom onset and who had a subsequent confirmed diagnosis of CVT on MRV, CTV or DSA. Clinical and imaging features were compared between patients with and without intracranial hemorrhage. Clot burden was assessed by counting the number of thrombosed venous sinuses and veins on confirmatory imaging.
Results:
We recruited 260 patients with cerebral venous thrombosis from 10 institutions in Europe and Mexico. The mean age was 42 and 74% were female. Intracranial hemorrhage was found in 102 (39%). Intracerebral hemorrhage occurred in 64 (63%), small juxtacortical hemorrhage in 30 (29%), subarachnoid hemorrhage in 24 (24%) and subdural hemorrhage in 11 (11%). Combinations of these types of hemorrhage occurred in 23 (23%). Intraparenchymal hemorrhages in multiple locations occurred in 6 (6%). Older age, presence of hematological disease and superior sagittal thrombosis involvement were significantly associated with presence of hemorrhage. The number of thrombosed venous sinuses was not associated with intracerebral hemorrhage (average number of sinuses/veins involved with hemorrhage 2.1 versus 1.9 without hemorrhage, p=0.4).
Conclusion:
The high rate of intracranial hemorrhage in cerebral venous thrombosis is not explained by widespread involvement of the venous sinuses. Superior sagittal sinus involvement is associated with the presence of intracranial hemorrhage.
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Affiliation(s)
- Khaled Afifi
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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- Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | | | | | | | | | | | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Buyck PJ, Zuurbier SM, Garcia-Esperon C, Barboza MA, Costa P, Escudero I, Renard D, Lemmens R, Hinteregger N, Fazekas F, Conde JJ, Giralt-Steinhauer E, Hiltunen S, Arauz A, Pezzini A, Montaner J, Putaala J, Weimar C, Churilov L, Gattringer T, Asadi H, Tatlisumak T, Coutinho JM, Demaerel P, Thijs V. Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis. Neurology 2019; 92:e841-e851. [DOI: 10.1212/wnl.0000000000006959] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/18/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo assess the added diagnostic value of semiquantitative imaging markers on noncontrast CT scans in cerebral venous thrombosis (CVT).MethodsIn a retrospective, multicenter, blinded, case-control study of patients with recent onset (<2 weeks) CVT, 3 readers assessed (1) the accuracy of the visual impression of CVT based on a combination of direct and indirect signs, (2) the accuracy of attenuation values of the venous sinuses in Hounsfield units (with adjustment for hematocrit levels), and (3) the accuracy of attenuation ratios of affected vs unaffected sinuses in comparison with reference standard MRI or CT angiography. Controls were age-matched patients with (sub)acute neurologic presentations.ResultsWe enrolled 285 patients with CVT and 303 controls from 10 international centers. Sensitivity of visual impression of thrombosis ranged from 41% to 73% and specificity ranged from 97% to 100%. Attenuation measurement had an area under the curve (AUC) of 0.78 (95% confidence interval [CI] 0.74–0.81). After adjustment for hematocrit, the AUC remained 0.78 (95% CI 0.74–0.81). The analysis of attenuation ratios of affected vs unaffected sinuses had AUC of 0.83 (95% CI 0.8–0.86). Adding this imaging marker significantly improved discrimination, but sensitivity when tolerating a false-positive rate of 20% was not higher than 76% (95% CI 0.70–0.81).ConclusionSemiquantitative analysis of attenuation values for diagnosis of CVT increased sensitivity but still failed to identify 1 out of 4 CVT.Classification of evidenceThis study provides Class II evidence that visual analysis of plain CT with or without attenuation measurements has high specificity but only moderate sensitivity for CVT.
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Szurian K, Till H, Amerstorfer E, Hinteregger N, Mischinger HJ, Liegl-Atzwanger B, Brcic I. Rarity among benign gastric tumors: Plexiform fibromyxoma - Report of two cases. World J Gastroenterol 2017; 23:5817-5822. [PMID: 28883708 PMCID: PMC5569297 DOI: 10.3748/wjg.v23.i31.5817] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/03/2017] [Accepted: 05/04/2017] [Indexed: 02/06/2023] Open
Abstract
Plexiform fibromyxoma is a very rare mesenchymal tumor of the stomach, found almost exclusively in the antrum/pylorus region. The most common presenting symptoms are anemia, hematemesis, nausea and unintentional weight loss, without sex or age predilection. We describe here two cases of plexiform fibromyxoma, involving a 16-year-old female and a 34-year-old male. Both patients underwent complete resection (R0) by distal gastrectomy and retrocolic gastrojejunostomy (according to Billroth 2); for both, the postoperative course was uneventful. Histology showed multiple intramural and subserosal nodules with characteristic plexiform growth, featuring bland spindle cells situated in an abundant myxoid stroma with low mitotic activity. Immunohistochemistry showed α-smooth muscle actin-positive spindle cells, focal positivity for CD10, and negative staining for KIT, DOG1, CD34, S100, β-catenin, STAT-6 and anaplastic lymphoma kinase. One of the cases showed focal positivity for h-caldesmon and desmin. Upon follow-up, no sign of disease was found. In the differential diagnosis of plexiform fibromyxoma, it is important to exclude the more common gastrointestinal stromal tumors as they have greater potential for aggressive behavior. Other lesions, like neuronal and vascular tumors, inflammatory fibroid polyps, abdominal desmoid-type fibromatosis, solitary fibrous tumors and smooth muscle tumors, must also be excluded.
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Affiliation(s)
- Kinga Szurian
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria
| | - Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Eva Amerstorfer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Nicole Hinteregger
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, 8036 Graz, Austria
| | | | | | - Iva Brcic
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria
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