- Comparison of Enhancement of the Vestibular Perilymph between Variable and Constant Flip Angle–Delayed 3D-FLAIR Sequences in Menière Disease
The authors compared the degree of perilymphatic enhancement and the detection rate of endolymphatic hydrops using constant and variable flip angle sequences in 16 patients with 3T MR imaging. Both for symptomatic and asymptomatic ears, the median signal intensity ratio was significantly higher with the constant flip angle than with the heavily-T2 variable flip angle. Cochlear blood-labyrinth barrier impairment was observed in 4/18 symptomatic ears with the heavily-T2 variable flip angle versus 8/19 with constant flip angle sequences. They conclude that 3D-FLAIR constant flip angle sequences provide a higher signal intensity ratio and are superior to heavily-T2 variable flip angle sequences in reliably evaluating the cochlear blood-labyrinth barrier impairment.
- CT Angiography in Evaluating Large-Vessel Occlusion in Acute Anterior Circulation Ischemic Stroke: Factors Associated with Diagnostic Error in Clinical Practice
This study included 520 consecutive patients with a clinical diagnosis of acute ischemic stroke (49.4% men; mean age, 72 years) who underwent CTA to evaluate large-vessel occlusion of the proximal anterior circulation. CTA scans were retrospectively reviewed by a consensus panel of 2 neuroradiologists. The prevalence of large-vessel occlusion was 16% (84/520 patients); 20% (17/84) of large-vessel occlusions were missed atthe initial CTA evaluation. In multivariate analysis, non-neuroradiologists were more likely to miss large-vessel occlusion compared with neuroradiologists, and occlusions of the M2 segment were more likely to be missed compared with occlusions of the distal internal carotid artery and/or M1 segment. Calcified emboli were present in 4 of 17 (24%) initially missed or misinterpreted large-vessel occlusions.
- Reliability of CT Angiography in Cerebral Vasospasm: A Systematic Review of the Literature and an Inter- and Intraobserver Study
In Part I of this study, articles reporting the reliability of CTA up to May 2018 were systematically searched and evaluated. In Part II, 11 raters independently graded 17 arterial segments in each of 50 patients with SAH for the presence of vasospasm using a 4-category scale. Raters were additionally asked to judge the presence of any moderate/severe vasospasm and whether findings would justify augmentation of medical treatment or conventional angiography ± balloon angioplasty. The systematic review revealed few studies with heterogeneous vasospasm definitions. In Part II, the authors found interrater reliability to be moderate at best (ϰ > 0.6), even when results were stratified according to specialty and experience. They conclude that the diagnosis of vasospasm using CTA alone was not sufficiently repeatable among observers to support its general use to guide decisions in the clinical management of patients with SAH.
- MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke
The authors compared vessel wall enhancement after intra-arterial thrombosuction with that in patients not treated by thrombosuction in a group of 49subjects with ischemic stroke with 7T MR imaging within 3 months after symptom onset. In the intra-arterial treatment group, 11 of 14 patients (79%) showed vessel wall enhancement compared with 17 of 35 patients without intra-arterial treatment (49%). In the intra-arterial treatment group, more enhancing foci were detected on the ipsilateral side compared with the contralateral side. They conclude that patients with intra-arterial treatment by means of thrombosuction showed more (concentric) enhancing foci of the vessel wall ipsilateral compared with contralateral to the treated artery than the patients without intra-arterial treatment, suggesting reactive changes of the vessel wall.
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