- Flow-Diversion Treatment for Unruptured Nonsaccular Intracranial Aneurysms of the Posterior and Distal Anterior Circulation: A Meta-Analysis
The authors’ aim was to analyze the outcomes after flow diversion among nonsaccular unruptured lesions. Fifteen studies (213 aneurysms) were included in the analysis. The long-term adequate occlusion rate was 85.3%. Treatment-related complications were 17.4%. Overall, 15% were ischemic events. They conclude that unruptured nonsaccular aneurysms located in the posterior and distal anterior circulations can be effectively treated with a flow-diversion strategy. Nevertheless, treatment-related complications are not negligible, with about 15% ischemic events and 8% morbidity. Larger size (>10 mm) significantly increased the risk of procedure-related adverse events among nonsaccular lesions.
- Prediction of Hemorrhage after Successful Recanalization in Patients with Acute Ischemic Stroke: Improved Risk Stratification Using Dual-Energy CT Parenchymal Iodine Concentration Ratio Relative to the Superior Sagittal Sinus
The authors evaluated whether, in acute ischemic stroke, iodine concentration within contrast-stained parenchyma compared with an internal reference in the superior sagittal sinus on dual-energy CT could predict subsequent intracerebral hemorrhage in 71 patients. Forty-three of 71 patients had parenchymal hyperdensity on initial dual-energy CT. The median relative iodine concentration compared with the superior sagittal sinus was significantly higher in those with subsequent intracerebral hemorrhage (137.9% versus 109.2%). They conclude that in dual-energy CT performed within 1 hour following thrombectomy that the relative iodine concentration within contrast-stained brain parenchyma compared with that in the superior sagittal sinus was a more reliable predictor of ICH compared with the absolute maximum iodine concentration.
- Intracranial Atherosclerotic Burden on 7T MRI Is Associated with Markers of Extracranial Atherosclerosis: The SMART-MR Study
Intracranial atherosclerosis, a major risk factor for ischemic stroke, is thought to have different atherogenic mechanisms than extracranial atherosclerosis. Studies investigating their relationship in vivo are sparse and report inconsistent results. Within the Second Manifestations of ARTerial disease–Magnetic Resonance (SMART) Study, cross-sectional analyses were performed in 130 patients with a history of vascular disease and with assessable 7T intracranial vessel wall MR imaging data. Intracranial atherosclerosis burden was defined as the number of intracranial vessel wall lesions in the circle of Willis and its major branches. Significant associations were observed between higher intracranial atherosclerosis burden and carotid intima-media thickness, 50%–100% carotid stenosis versus no stenosis, ankle-brachial index, and estimated glomerular filtration rate. No significant differences in intracranial atherosclerosis burden were found among different categories of vascular disease.
- Ultra-High-Field Targeted Imaging of Focal Cortical Dysplasia: The Intracortical Black Line Sign in Type IIb
Between 2013 and 2019, the authors performed a standardized 7T MR imaging protocol in patients with drug-resistant focal epilepsy. They focused on 12 patients in whom postsurgical histopathology revealed focal cortical dysplasia and explored the diagnostic yield of preoperative 7T versus 1.5/3T MR imaging and the correlations of imaging findings with histopathology. They observed clear abnormalities in 10/12 patients using 7T versus 9/12 revealed by 1.5/3T MR imaging. In patients with focal cortical dysplasia I, 7T MR imaging did not disclose morphologic abnormalities (n= 0/2). In patients with focal cortical dysplasia II, 7T uncovered morphologic signs that were not visible on clinical imaging in 1 patient with focal cortical dysplasia IIa (n= 1/4) and in all those with focal cortical dysplasia IIb (n= 6/6). T2*WI provided the highest added value. The authors conclude that the high sensitivity of 7T T2*-weighted images provides an additional tool in defining potential morphologic markers of high epileptogenicity within the dysplastic tissue of focal cortical dysplasia IIb and will likely help to more precisely plan epilepsy surgery.
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