5Noncontrast CT is used in initial evaluation of AIS, in part, because of fast acquisition time, widespread availability, and ease of interpretation in the emergency setting. The introduction of multislice technology has expanded the CT armamentarium to make multimodal CT that includes CT angiography and whole-brain coverage perfusion CT feasible in the acute stroke setting. This technology has dramatically increased the speed and simplicity of CT techniques and has set a high standard for alternative imaging modalities. A comprehensive CT stroke algorithm, including parenchymal imaging (noncontrast head CT), CT angiography, and perfusion/penumbral Background and Purpose-If magnetic resonance imaging (MRI) is to compete with computed tomography for evaluation of patients with acute ischemic stroke, there is a need for further improvements in acquisition speed. Methods-Inclusion criteria for this prospective, single institutional study were symptoms of acute ischemic stroke within 24 hours onset, National Institutes of Health Stroke Scale ≥3, and absence of MRI contraindications. A combination of echo-planar imaging (EPI) and a parallel acquisition technique were used on a 3T magnetic resonance (MR) scanner to accelerate the acquisition time. Image analysis was performed independently by 2 neuroradiologists. Results-A total of 62 patients met inclusion criteria. A repeat MRI scan was performed in 22 patients resulting in a total of 84 MRIs available for analysis. Diagnostic image quality was achieved in 100% of diffusion-weighted imaging, 100% EPI-fluid attenuation inversion recovery imaging, 98% EPI-gradient recalled echo, 90% neck MR angiography and 96% of brain MR angiography, and 94% of dynamic susceptibility contrast perfusion scans with interobserver agreements (k) ranging from 0.64 to 0.84. Fifty-nine patients (95%) had acute infarction. There was good interobserver agreement for EPI-fluid attenuation inversion recovery imaging findings (k=0.78; 95% confidence interval, 0.66-0.87) and for detection of mismatch classification using dynamic susceptibility contrast-Tmax (k=0.92; 95% confidence interval, 0.87-0.94). Thirteen acute intracranial hemorrhages were detected on EPI-gradient recalled echo by both observers. A total of 68 and 72 segmental arterial stenoses were detected on contrast-enhanced MR angiography of the neck and brain with k=0.93, 95% confidence interval, 0.84 to 0.96 and 0.87, 95% confidence interval, 0.80 to 0.90, respectively. Conclusions-A 6-minute multimodal MR protocol with good diagnostic quality is feasible for the evaluation of patients with acute ischemic stroke and can result in significant reduction in scan time rivaling that of the multimodal computed tomographic protocol. (Stroke. 2014;45:1985-1991.)
A good knowledge of the radiological findings in methanol poisoning seems to be necessary for radiologists. The present study is unique in that it enables us to include in a single report most of the radiological findings that have been reported previously.
Background and Purpose To compare the diagnostic performance of arterial spin-labeled (ASL) and dynamic susceptibility contrast (DSC) perfusion in detection of cerebral blood flow (CBF) changes before and after endovascular recanalization in acute ischemic syndrome (AIS). Methods The inclusion criteria for this retrospective study were patients with AIS who underwent endovascular recanalization and acquisition of both ASL and DSC before and after revascularization. ASL CBF and multiparametric DSC maps were evaluated for image quality, location and type of perfusion abnormality. Relative CBF (rCBF) was calculated in the infarction core and hypoperfused areas using coregistered ASL and DSC. Core and hypoperfused rCBF were used for paired pre- and post-treatment comparisons. Interobserver and intermodality agreement were evaluated by Kappa test. T-test was calculated for ASL and DSC rCBF values. Results Twenty-five patients were met our inclusion criteria. Five studies were rated non-diagnostic, resulting in 45 pair of DSC-ASL available for comparison. ASL and DSC agreed on type and location of the perfusion abnormality in 71% and 80% of cases respectively. The image quality of ASL was lower than DSC, resulting in interobserver variability for the type (k =0.45) and location (k=0.56) of perfusion abnormality. ASL was unable to show any type of perfusion abnormality in 11% of patients. In successfully recanalized patients, hyperperfusion (rCBF> 1) was detected in 100% on DSC and 47% on ASL. Conclusions ASL is less sensitive than DSC for detection of rCBF changes in patients with AIS, particularly with respect to hyperperfusion after successful recanalization.
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