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Psychogios MN, Tsogkas I, Blackham K, Schulze-Zachau V, Rusche T, Ntoulias N, Brehm A, Fischer U, Sporns PB. The Quattro Technique for Medium Distal Vessel Occlusion Stroke. Clin Neuroradiol 2024; 34:257-262. [PMID: 37378841 DOI: 10.1007/s00062-023-01317-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Affiliation(s)
| | - Ioannis Tsogkas
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Kristine Blackham
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | | | - Thilo Rusche
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Nikos Ntoulias
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Alex Brehm
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Peter B Sporns
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
- Department of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland
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2
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Rusche T, Yaldizli Ö, Galbusera R, Mutke M, Halter JP, Lieb J, Matteazzi F, Stelmes A, Bittner J, Grzonka P, Frank N, Cordier D, Hench J, Frank S, Hirsch HH, Fischer U, Kuhle J, Sutter R, Rüegg S, Fisch U. Anti-GABA A receptor encephalitis 14 months after allogeneic haematopoietic stem-cell transplant for acute myeloid leukaemia. Lancet 2024; 403:469-470. [PMID: 38309783 DOI: 10.1016/s0140-6736(23)02831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/17/2023] [Accepted: 12/17/2023] [Indexed: 02/05/2024]
Affiliation(s)
- Thilo Rusche
- Department of Radiology and Nuclear Medicine, Diagnostic and Interventional NeuroRadiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Özgür Yaldizli
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Riccardo Galbusera
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matthias Mutke
- Department of Radiology and Nuclear Medicine, Diagnostic and Interventional NeuroRadiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jörg P Halter
- Department of Haematology, University Hospital Basel, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Johanna Lieb
- Department of Radiology and Nuclear Medicine, Diagnostic and Interventional NeuroRadiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Francesca Matteazzi
- Department of Haematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Anne Stelmes
- Department of Haematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan Bittner
- Department of Anaesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Pascale Grzonka
- Department of Intensive Care, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Frank
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dominik Cordier
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jürgen Hench
- Institute of Pathology, Division of Neuropathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stephan Frank
- Institute of Pathology, Division of Neuropathology, University Hospital Basel, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Hans H Hirsch
- Clinical Virology, University Hospital Basel, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland; Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care, University Hospital Basel, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Urs Fisch
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.
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Breit HC, Vosshenrich J, Hofmann V, Rusche T, Kovacs BK, Bach M, Manneck S, Harder D. Image Quality of Lumbar Spine Imaging at 0.55T Low-Field MRI is Comparable to Conventional 1.5T MRI - Initial Observations in Healthy Volunteers. Acad Radiol 2023; 30:2440-2446. [PMID: 36841743 DOI: 10.1016/j.acra.2023.01.037] [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: 10/13/2022] [Revised: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 02/27/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the potential of 0.55T low-field MRI system in lumbar spine imaging with and without the use of additional advanced postprocessing techniques. MATERIALS AND METHODS The lumbar spine of 14 volunteers (32.9 ± 3.6 years) was imaged both at 0.55T and 1.5T using sequences from clinical routine. On the 0.55T scanner system, additional sequences with simultaneous multi-slice acquisition and artificial intelligence-based postprocessing techniques were acquired. Image quality of all 28 examinations was assessed by three musculoskeletal radiologists with respect to signal/contrast, resolution, and assessability of the spinal canal and neuroforamina using a 5-point Likert scale (1 = non-diagnostic to 5 = perfect quality). Interrater agreement was evaluated with the Intraclass Correlation Coefficient and the Mann-Whitney U test (significance level: p < 0.05). RESULTS Image quality at 0.55T was rated lower on the 5-point Likert scale compared to 1.5T regarding signal/contrast (mean: 4.16 ± 0.29 vs. 4.54 ± 0.29; p < 0.001), resolution (4.07 ± 0.31 vs. 4.49 ± 0.30; p < 0.001), assessability of the spinal canal (4.28 ± 0.13 vs. 4.73 ± 0.26; p < 0.001) and the neuroforamina (4.14 ± 0.28 vs. 4.70 ± 0.27; p < 0.001). Image quality for the AI-processed sagittal T1 TSE and T2 TSE at 0.55T was also rated slightly lower, but still good to perfect with a concomitant reduction in measurement time. Interrater agreement was good to excellent (range: 0.60-0.91). CONCLUSION While lumbar spine image quality at 0.55T is perceived inferior to imaging at 1.5T by musculoskeletal radiologists, good overall examination quality was observed with high interrater agreement. Advanced postprocessing techniques may accelerate intrinsically longer acquisition times at 0.55T.
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Affiliation(s)
- Hanns-Christian Breit
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jan Vosshenrich
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Verena Hofmann
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Thilo Rusche
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Balázs K Kovacs
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Michael Bach
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sebastian Manneck
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Radiology, Gesundheitszentrum Fricktal AG, Rheinfelden, Switzerland
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
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Rusche T, Wasserthal J, Breit HC, Fischer U, Guzman R, Fiehler J, Psychogios MN, Sporns PB. Machine Learning for Onset Prediction of Patients with Intracerebral Hemorrhage. J Clin Med 2023; 12:jcm12072631. [PMID: 37048712 PMCID: PMC10094957 DOI: 10.3390/jcm12072631] [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] [Received: 02/16/2023] [Revised: 03/13/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: Intracerebral hemorrhage (ICH) has a high mortality and long-term morbidity and thus has a significant overall health–economic impact. Outcomes are especially poor if the exact onset is unknown, but reliable imaging-based methods for onset estimation have not been established. We hypothesized that onset prediction of patients with ICH using artificial intelligence (AI) may be more accurate than human readers. Material and Methods: A total of 7421 computed tomography (CT) datasets between January 2007–July 2021 from the University Hospital Basel with confirmed ICH were extracted and an ICH-segmentation algorithm as well as two classifiers (one with radiomics, one with convolutional neural networks) for onset estimation were trained. The classifiers were trained based on the gold standard of 644 datasets with a known onset of >1 and <48 h. The results of the classifiers were compared to the ratings of two radiologists. Results: Both the AI-based classifiers and the radiologists had poor discrimination of the known onsets, with a mean absolute error (MAE) of 9.77 h (95% CI (confidence interval) = 8.52–11.03) for the convolutional neural network (CNN), 9.96 h (8.68–11.32) for the radiomics model, 13.38 h (11.21–15.74) for rater 1 and 11.21 h (9.61–12.90) for rater 2, respectively. The results of the CNN and radiomics model were both not significantly different to the mean of the known onsets (p = 0.705 and p = 0.423). Conclusions: In our study, the discriminatory power of AI-based classifiers and human readers for onset estimation of patients with ICH was poor. This indicates that accurate AI-based onset estimation of patients with ICH based only on CT-data may be unlikely to change clinical decision making in the near future. Perhaps multimodal AI-based approaches could improve ICH onset prediction and should be considered in future studies.
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Affiliation(s)
- Thilo Rusche
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
- Correspondence:
| | - Jakob Wasserthal
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Hanns-Christian Breit
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, 4031 Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 55131 Hamburg, Germany
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Peter B. Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 55131 Hamburg, Germany
- Department of Radiology and Neuroradiology, Stadtspital Zürich, 8063 Zürich, Switzerland
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Sporns PB, Rusche T, Lee S, Hanning U, Meyer L, Faizy T, Fiehler J, Psychogios M, Kemmling A, Broocks G. Impact of edema formation on functional outcome in pediatric stroke patients. Eur J Neurol 2023; 30:150-154. [PMID: 36168926 DOI: 10.1111/ene.15576] [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: 08/18/2022] [Accepted: 09/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quantitative lesion net water uptake (NWU) has been described as an imaging biomarker reflecting vasogenic edema as an early indicator of infarct progression. We hypothesized that edema formation measured by NWU is higher in children compared to adults but despite this functional outcome may be better in children. METHODS This study analyzed children enrolled in the Save ChildS Study who had baseline and follow-up computed tomography available and the data were compared to adult patients. RESULTS Some 207 patients, of whom 13 were children and 194 were adults, were analyzed. Median NWU at baseline was 7.8% (IQR: 4.3-11.3), and there were no significant differences between children and adults (7.5% vs. 7.8%; p = 0.87). The early edema progression rate was 3.0%/h in children and 2.3%/h in adults. Median ΔNWU was 15.1% in children and 10.5% in adults. Children had significantly more often excellent (mRS 0-1; children 10/13 = 77% vs. adults 28/196 = 14%; p < 0.0001) and favorable clinical outcomes (mRS 0-2, 12/13 = 92% vs. 39/196 = 20%; p < 0.0001). CONCLUSIONS In this study, clinical outcomes in children with large vessel occlusion strokes were better than in adults despite similar clinical and imaging characteristics and similar edema formation. This may be impacted by the generally better outcomes of children after strokes but may demonstrate that the degree of early ischemic changes using Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and edema progression rate may not be a reason for exclusion from endovascular thrombectomy.
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Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Andre Kemmling
- Department of Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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6
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Rusche T, Vosshenrich J, Winkel DJ, Donners R, Segeroth M, Bach M, Merkle EM, Breit HC. More Space, Less Noise-New-generation Low-Field Magnetic Resonance Imaging Systems Can Improve Patient Comfort: A Prospective 0.55T-1.5T-Scanner Comparison. J Clin Med 2022; 11:jcm11226705. [PMID: 36431182 PMCID: PMC9692643 DOI: 10.3390/jcm11226705] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The objectives of this study were to assess patient comfort when imaged on a newly introduced 0.55T low-field magnetic resonance (MR) scanner system with a wider bore opening compared to a conventional 1.5T MR scanner system. MATERIALS AND METHODS In this prospective study, fifty patients (mean age: 66.2 ± 17.0 years, 22 females, 28 males) underwent subsequent magnetic resonance imaging (MRI) examinations with matched imaging protocols at 0.55T (MAGNETOM FreeMax, Siemens Healthineers; Erlangen, Germany) and 1.5T (MAGNETOM Avanto Fit, Siemens Healthineers; Erlangen, Germany) on the same day. MRI performed between 05/2021 and 07/2021 was included for analysis. The 0.55T MRI system had a bore opening of 80 cm, while the bore diameter of the 1.5T scanner system was 60 cm. Four patient groups were defined by imaged body regions: (1) cranial or cervical spine MRI using a head/neck coil (n = 27), (2) lumbar or thoracic spine MRI using only the in-table spine coils (n = 10), (3) hip MRI using a large flex coil (n = 8) and (4) upper- or lower-extremity MRI using small flex coils (n = 5). Following the MRI examinations, patients evaluated (1) sense of space, (2) noise level, (3) comfort, (4) coil comfort and (5) overall examination impression on a 5-point Likert-scale (range: 1= "much worse" to 5 = "much better") using a questionnaire. Maximum noise levels of all performed imaging studies were measured in decibels (dB) by a sound level meter placed in the bore center. RESULTS Sense of space was perceived to be "better" or "much better" by 84% of patients for imaging examinations performed on the 0.55T MRI scanner system (mean score: 4.34 ± 0.75). Additionally, 84% of patients rated noise levels as "better" or "much better" when imaged on the low-field scanner system (mean score: 3.90 ± 0.61). Overall sensation during the imaging examination at 0.55T was rated as "better" or "much better" by 78% of patients (mean score: 3.96 ± 0.70). Quantitative assessment showed significantly reduced maximum noise levels for all 0.55T MRI studies, regardless of body region compared to 1.5T, i.e., brain MRI (83.8 ± 3.6 dB vs. 89.3 ± 5.4 dB; p = 0.04), spine MRI (83.7 ± 3.7 dB vs. 89.4 ± 2.6 dB; p = 0.004) and hip MRI (86.3 ± 5.0 dB vs. 89.1 ± 1.4 dB; p = 0.04). CONCLUSIONS Patients perceived 0.55T new-generation low-field MRI to be more comfortable than conventional 1.5T MRI, given its larger bore opening and reduced noise levels during image acquisition. Therefore, new concepts regarding bore design and noise level reduction of MR scanner systems may help to reduce patient anxiety and improve well-being when undergoing MR imaging.
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Labeit B, Muhle P, von Itter J, Slavik J, Wollbrink A, Sporns P, Rusche T, Ruck T, Hüsing-Kabar A, Gellner R, Gross J, Wirth R, Claus I, Warnecke T, Dziewas R, Suntrup-Krueger S. Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults. Front Aging Neurosci 2022; 14:912691. [PMID: 35966778 PMCID: PMC9366332 DOI: 10.3389/fnagi.2022.912691] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background “Presbyphagia” refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity. Materials and methods 64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule. Results 32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model. Conclusions Swallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
- *Correspondence: Bendix Labeit,
| | - Paul Muhle
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Jonas von Itter
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Janna Slavik
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Peter Sporns
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Ruck
- Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Hüsing-Kabar
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Reinhold Gellner
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Herne, Germany
| | - Inga Claus
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
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8
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Rusche T, Kaufmann J, Voges J. Nucleus accumbens projections: Validity and reliability of fiber reconstructions based on high-resolution diffusion-weighted MRI. Hum Brain Mapp 2021; 42:5888-5910. [PMID: 34528323 PMCID: PMC8596959 DOI: 10.1002/hbm.25657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/02/2021] [Accepted: 08/29/2021] [Indexed: 12/17/2022] Open
Abstract
Clinical effects of deep brain stimulation are largely mediated by the activation of myelinated axons. Hence, increasing attention has been paid in the past on targeting white matter tracts in addition to gray matter. Aims of the present study were: (i) visualization of discrete afferences and efferences of the nucleus accumbens (NAc), supposed to be a major hub of neural networks relating to mental disorders, using probabilistic fiber tractography and a data driven approach, and (ii) validation of the applied methodology for standardized routine clinical applications. MR‐data from 11 healthy subjects and 7 measurement sessions each were acquired on a 3T MRI‐scanner. For probabilistic fiber tracking the NAc as a seed region and the medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), amygdala (AMY), hippocampus (HPC), dorsomedial thalamus (dmT) and ventral tegmental area (VTA) as target regions were segmented for each subject and both hemispheres. To quantitatively assess the reliability and stability of the reconstructions, we filtered and clustered the individual fiber‐tracts (NAc to target) for each session and subject and performed a point‐by‐point calculation of the maximum cluster distances for intra‐subject comparison. The connectivity patterns formed by the obtained fibers were in good concordance with published data from tracer and/or fiber‐dissection studies. Furthermore, the reliability assessment of the (NAc to target)‐fiber‐tracts yielded to high correlations between the obtained clustered‐tracts. Using DBS with directional lead technology, the workflow elaborated in this study may guide selective electrical stimulation of NAc projections.
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Affiliation(s)
- Thilo Rusche
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Department of Radiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University Basel, Basel, Switzerland
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jürgen Voges
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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9
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Broocks G, Faizy TD, Meyer L, Groffmann M, Elsayed S, Kniep H, Flottmann F, Bechstein M, Rusche T, Schön G, Nawabi J, Sporns P, Fiehler J, Kemmling A, Hanning U. Posterior circulation collateral flow modifies the effect of thrombectomy on outcome in acute basilar artery occlusion. Int J Stroke 2021; 17:761-769. [PMID: 34569885 DOI: 10.1177/17474930211052262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In basilar artery occlusion stroke, the impact of the collateral circulation on infarct progression in the context of endovascular treatment is yet poorly studied. AIM This study investigates the impact of the posterior circulation collateral score (PCCS) on functional outcome according to the extent of early ischemic changes and treatment. We hypothesized that the presence of collaterals, quantified by the PCCS, mediates the effect of endovascular treatment on functional outcome in patients with acute basilar artery occlusion. METHODS In this multicenter observational study, patients with basilar artery occlusion and admission computed tomography were analyzed. At baseline, Posterior circulation Acute Stroke Prognosis Early Computed Tomography score (pcASPECTS) was assessed and PCCS was quantified using an established 10-point grading system. Logistic regression analyses were performed to identify factors associated with good functional outcome (modified Rankin Scale scores 0-2 at day 90). RESULTS A total of 151 patients were included, of which 112 patients (74%) underwent endovascular treatment. In patients with a better PCCS (>5), the rate of good outcome was significantly higher (55% vs. 11%; p = 0.001). After adjusting for PCCS, vessel recanalization was significantly associated with improved functional outcome (aOR: 4.53, 95%CI: 1.25-16.4, p = 0.02), while there was no association between recanalization status and outcome in univariable analysis. Patients with low pcASPECTS generally showed very poor outcomes (mean modified Rankin Scale score 5.3, 95%CI: 4.9-5.8). CONCLUSION PCCS modified the effect of recanalization on functional outcome, particularly in patients with less pronounced ischemic changes in admission computed tomography. These results should be validated to improve patient selection for endovascular treatment in basilar artery occlusion, particularly in uncertain indications, or to triage patients at risk for very poor outcomes.
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Affiliation(s)
- Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Groffmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Elsayed
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, Universitätsspital Basel, Basel, Switzerland.,Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jawed Nawabi
- Department of Radiology, Charité University Medical Center, Berlin, Germany
| | - Peter Sporns
- Department of Neuroradiology, Universitätsspital Basel, Basel, Switzerland
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andre Kemmling
- Department of Neuroradiology, 9377University of Marburg, Marburg, Germany.,Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Broocks G, Elsayed S, Kniep H, Kemmling A, Flottmann F, Bechstein M, Faizy TD, Meyer L, Lindner T, Sporns P, Rusche T, Schön G, Mader MM, Nawabi J, Fiehler J, Hanning U. Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake. Neurosurgery 2021; 88:531-537. [PMID: 33040147 DOI: 10.1093/neuros/nyaa438] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Malignant cerebellar edema (MCE) is a life-threatening complication of ischemic posterior circulation stroke that requires timely diagnosis and management. Yet, there is no established imaging biomarker that may serve as predictor of MCE. Early edematous water uptake can be determined using quantitative lesion water uptake, but this biomarker has only been applied in anterior circulation strokes. OBJECTIVE To test the hypothesis that lesion water uptake in early posterior circulation stroke predicts MCE. METHODS A total 179 patients with posterior circulation stroke and multimodal admission CT were included. A total of 35 (19.5%) patients developed MCE defined by using an established 10-point scale in follow-up CT, of which ≥4 points are considered malignant. Posterior circulation net water uptake (pcNWU) was quantified in admission CT based on CT densitometry and compared with posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) as predictor of MCE using receiver operating curve (ROC) analysis and logistic regression analysis. RESULTS Acute pcNWU within the early ischemic lesion was 24.6% (±8.4) for malignant and 7.2% (±7.4) for nonmalignant infarctions, respectively (P < .0001). Based on ROC analysis, pcNWU above 14.9% identified MCE with high discriminative power (area under the curve: 0.94; 95% CI: 0.89-0.97). Early pcNWU (odds ratio [OR]: 1.28; 95% CI: 1.15-1.42, P < .0001) and pc-ASPECTS (OR: 0.71, 95% CI: 0.53-0.95, P = .02) were associated with MCE, adjusted for age and recanalization status. CONCLUSION Quantitative pcNWU in early posterior circulation stroke is an important marker for MCE. Besides pc-ASPECTS, lesion water uptake measurements may further support identifying patients at risk for MCE at an early stage indicating stricter monitoring and consideration for further therapeutic measures.
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Affiliation(s)
- Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Elsayed
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andre Kemmling
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany.,Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Radiology, Stanford University, Stanford, California
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Lindner
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Sporns
- Department of Neuroradiology, Universitätsspital Basel, Basel, Switzerland
| | - Thilo Rusche
- Department of Neuroradiology, Universitätsspital Basel, Basel, Switzerland.,Department of Radiology, University Hospital Münster, Münster, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marius M Mader
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jawed Nawabi
- Department of Radiology, Charité University Medical Center, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Velasco Gonzalez A, Görlich D, Buerke B, Münnich N, Sauerland C, Rusche T, Faldum A, Heindel W. Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis. Transl Stroke Res 2020; 11:900-909. [PMID: 32447614 PMCID: PMC7496051 DOI: 10.1007/s12975-020-00784-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Abstract
Complete recanalization after a single retrieval maneuver is an interventional goal in acute ischemic stroke and an independent factor for good clinical outcome. Anatomical biomarkers for predicting clot removal difficulties have not been comprehensively analyzed and await unused. We retrospectively evaluated 200 consecutive patients who suffered acute stroke and occlusion of the anterior circulation and were treated with mechanical thrombectomy through a balloon guide catheter (BGC). The primary objective was to evaluate the influence of carotid tortuosity and BGC positioning on the one-pass Modified Thrombolysis in Cerebral Infarction Scale (mTICI) 3 rate, and secondarily, the influence of communicating arteries on the angiographic results. After the first-pass mTICI 3, recanalization fell from 51 to 13%. The regression models and decision tree (supervised machine learning) results concurred: carotid tortuosity was the main constraint on efficacy, reducing the likelihood of mTICI 3 after one pass to 30%. BGC positioning was relevant only in carotid arteries without elongation: BGCs located in the distal internal carotid artery (ICA) had a 70% probability of complete recanalization after one pass, dropping to 43% if located in the proximal ICA. These findings demonstrate that first-pass mTICI 3 is influenced by anatomical and interventional factors capable of being anticipated, enabling the BGC technique to be adapted to patient’s anatomy to enhance effectivity.
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Affiliation(s)
- Aglaé Velasco Gonzalez
- Department of Clinical Radiology, 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
| | - Boris Buerke
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Nico Münnich
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149 Muenster, Germany
| | - Thilo Rusche
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149 Muenster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, Institute of Clinical Radiology and Neuroradiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
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12
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Kniep HC, Sporns PB, Broocks G, Kemmling A, Nawabi J, Rusche T, Fiehler J, Hanning U. Posterior circulation stroke: machine learning-based detection of early ischemic changes in acute non-contrast CT scans. J Neurol 2020; 267:2632-2641. [PMID: 32394015 PMCID: PMC7419359 DOI: 10.1007/s00415-020-09859-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Triage of patients with basilar artery occlusion for additional imaging diagnostics, therapy planning, and initial outcome prediction requires assessment of early ischemic changes in early hyperacute non-contrast computed tomography (NCCT) scans. However, accuracy of visual evaluation is impaired by inter- and intra-reader variability, artifacts in the posterior fossa and limited sensitivity for subtle density shifts. We propose a machine learning approach for detecting early ischemic changes in pc-ASPECTS regions (Posterior circulation Alberta Stroke Program Early CT Score) based on admission NCCTs. METHODS The retrospective study includes 552 pc-ASPECTS regions (144 with infarctions in follow-up NCCTs) extracted from pre-therapeutic early hyperacute scans of 69 patients with basilar artery occlusion that later underwent successful recanalization. We evaluated 1218 quantitative image features utilizing random forest algorithms with fivefold cross-validation for the ability to detect early ischemic changes in hyperacute images that lead to definitive infarctions in follow-up imaging. Classifier performance was compared to conventional readings of two neuroradiologists. RESULTS Receiver operating characteristic area under the curves for detection of early ischemic changes were 0.70 (95% CI [0.64; 0.75]) for cerebellum to 0.82 (95% CI [0.77; 0.86]) for thalamus. Predictive performance of the classifier was significantly higher compared to visual reading for thalamus, midbrain, and pons (P value < 0.05). CONCLUSIONS Quantitative features of early hyperacute NCCTs can be used to detect early ischemic changes in pc-ASPECTS regions. The classifier performance was higher or equal to results of human raters. The proposed approach could facilitate reproducible analysis in research and may allow standardized assessments for outcome prediction and therapy planning in clinical routine.
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Affiliation(s)
- Helge C Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Peter B Sporns
- Institute of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - André Kemmling
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Department of Radiology, Charité University Medical Center Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Thilo Rusche
- Institute of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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13
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Velasco Gonzalez A, Buerke B, Görlich D, Fobker M, Rusche T, Sauerland C, Meier N, Jeibmann A, McCarthy R, Kugel H, Sporns P, Faldum A, Paulus W, Heindel W. Clot Analog Attenuation in Non-contrast CT Predicts Histology: an Experimental Study Using Machine Learning. Transl Stroke Res 2020; 11:940-949. [PMID: 31933117 DOI: 10.1007/s12975-019-00766-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
Exact histological clot composition remains unknown. The purpose of this study was to identify the best imaging variables to be extrapolated on clot composition and clarify variability in the imaging of thrombi by non-contrast CT. Using a CT-phantom and covering a wide range of histologies, we analyzed 80 clot analogs with respect to X-ray attenuation at 24 and 48 h after production. The mean, maximum, and minimum HU values for the axial and coronal reconstructions were recorded. Each thrombus underwent a corresponding histological analysis, together with a laboratory analysis of water and iron contents. Decision trees, a type of supervised machine learning, were used to select the primary variable altering attenuation and the best parameter for predicting histology. The decision trees selected red blood cells (RBCs) for correlation with all attenuation parameters (p < 0.001). Conversely, maximum attenuation on axial CT offered the greatest accuracy for discriminating up to four groups of clot histology (p < 0.001). Similar RBC-rich thrombi displayed variable imaging associated with different iron (p = 0.023) and white blood cell contents (p = 0.019). Water content varied among the different histologies but did not in itself account for the differences in attenuation. Independent factors determining clot attenuation were the RBCs (β = 0.33, CI = 0.219-0.441, p < 0.001) followed by the iron content (β = 0.005, CI = 0.0002-0.009, p = 0.042). Our findings suggest that it is possible to extract more and valuable information from NCCT that can be extrapolated to provide insights into clot histological and chemical composition.
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Affiliation(s)
- Aglae Velasco Gonzalez
- Department of Clinical Radiology, Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany.
| | - Boris Buerke
- Department of Clinical Radiology, Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany
| | - Manfred Fobker
- Center for Laboratory Medicine, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Thilo Rusche
- Department of Clinical Radiology, Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany
| | - Norbert Meier
- Department of Clinical Radiology, Medical Physics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Astrid Jeibmann
- Institute of Neuropathology, University Hospital Muenster, Pottkamp 2, 48149, Muenster, Germany
| | - Ray McCarthy
- Cerenovus, Galway Neuro Technology Centre, Mervue Business Park, Galway, Ireland
| | - Harald Kugel
- Department of Clinical Radiology, Medical Physics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Peter Sporns
- Department of Clinical Radiology, Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstraße 56, 48149, Muenster, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Muenster, Pottkamp 2, 48149, Muenster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, Neuroradiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany
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14
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Michl R, Rusche T, Grimm S, Limpert E, Beck J, Dost A. Outbreak of Hot-Foot Syndrome – Caused by Pseudomonas Aeruginosa. Klin Padiatr 2011; 224:252-5. [DOI: 10.1055/s-0031-1297949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractInfections with Pseudomonas aeruginosa can cause the hot-foot syndrome, presenting with painful plantar erythematous nodules. Particularly, the mechanically stressed areas of the foot are affected after contact with contaminated water from saunas, swimming pools, hot tubs, etc. We report an outbreak of hot-foot syndrome caused by Pseudomonas in 10 patients. The therapeutic regimens applied reached from local antiseptic therapy to systemic antibiotics.
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Affiliation(s)
- R. Michl
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum, Jena
| | - T. Rusche
- Klinik für Kinder- und Jugendmedizin, Sophien- und Hufeland-Klinikum GmbH, Weimar
| | - S. Grimm
- Fachdienst Gesundheit, Gesundheitsamt der Stadt Jena
| | - E. Limpert
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum, Jena
| | - J. Beck
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum, Jena
| | - A. Dost
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum, Jena
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15
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Bonitz S, Huster A, Rusche T, Hübler A. Untersuchungen zum Verlauf von Interleukin-6-Serumspiegeln bei neonatalen Risikopatienten in der ersten Lebenswoche. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rusche T, Kienast W, Radke M, Müller M. [Delayed fontanelle closure in infants with cyanotic cardiomyopathies]. Klin Padiatr 1990; 202:18-9. [PMID: 2313998 DOI: 10.1055/s-2007-1025479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In comparison with infants not suffering from cyanotic heart failures a different size (width and length) as well as a delayed time of closure of the anterior fontanelle in infants with congenital cyanotic heart failures were detected. In these patients typical phenomenons by ultrasound examinations are described also.
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Affiliation(s)
- T Rusche
- Klinik für Kinderheilkunde, Bereiches Medizin, Wilhelm-Pieck-Universität Rostock
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Rusche T, Richter I, Müller M, Radke M, Kunkel M. [Diagnosis of herpes simplex encephalitis]. Dtsch Med Wochenschr 1989; 114:810. [PMID: 2656178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Rusche T, Külz J, Hobusch D, Wagner KD, Rohmann E. [The prognosis of encephalitis in childhood]. Kinderarztl Prax 1989; 57:141-4. [PMID: 2724785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Follow-up examination of 95 former patients who had been suffering from encephalitis in infancy were performed. The coincidence of disturbance of consciousness, pathological-EEG and neurological irritation- and deficiency symptoms proved to be an unfavourable prognosis. These patients are especially handicapped in their concentration and motorial performances. Only 50% of the group with a severe course of the disease achieved a complete vocational training.
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Rusche T, Richter I, Radke M, Kunkel M. [Sonography as an aid in the early diagnosis of herpes simplex encephalitis]. Monatsschr Kinderheilkd 1988; 136:701-2. [PMID: 2853296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In 3 infants with meningoencephalitis caused by Herpes simplex viruses the findings of cerebral sonography corresponded with those of computerized tomography and electroencephalography. The therapeutic success of antiviral chemotherapeutics depends very much on their application at an early stage of the disease, which can be recognized by cerebral sonography.
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Affiliation(s)
- T Rusche
- Klinik für Kinderheilkunde, des Bereiches Medizin der Wilhelm-Pieck-Universität Rostock
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20
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Külz J, Rusche T, Reichel U. [Brain abscess in childhood]. Kinderarztl Prax 1984; 52:27-38. [PMID: 6727144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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21
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