Search Results for: L'imaging nella urolitiasi

Stroke, Volume 56, Issue Suppl_1, Page A94-A94, February 1, 2025. Introduction:Ischemic stroke is a leading cause of death and disability worldwide, but there has been limited success in translating putative treatments from preclinical trials to patients. The Stroke Preclinical Assessment Network (SPAN) is a large-scale multicenter trial (six sites plus a coordinating center).Methods:SPAN implemented a multiparametric MRI protocol with minimal human input to assess tissue outcomes after mouse endovascular middle cerebral artery occlusion (MCAO). Imaging from 1766 mice was used in this study. The sample size includes three comorbidity models (Young mice, Aging mice, and diet-induced hyperglycemia/ obesity mice.Results:Infarct volumes were variable across the network but right-skewed at all sites. Striatal and cortical infarcts were more common than thalamic and hippocampal infarcts (present in 75%, 65%, 20%, and 22% of mice, respectively). Total lesion was more associated with striatal and cortical infarct volumes (R=0.94 and 0.97). Infarct volumes were strongly associated with midline shift on days 2 (R=0.74) and 30 (R=-0.80), reflecting ischemic swelling and encephalomalacia, respectively. Factor analysis identified the underpinnings of the covariance among MRI variables (Figure 1). We found 13 MRI readouts linked to the injury severity after MCAO. These included the total, striatal, and cortical infarct volumes, indices of ischemic edema on day 2, and indices of tissue loss on day 30. Five variables were linked to infarction involving the posterior cerebral artery. Another set of five variables was linked to ventricular volume, suggesting an independent contributing factor, such as age. Average R2ratein the contralateral tissue was lower in diet-induced obesity and aged mice compared with normal young mice, suggesting higher brain water content. Within the infarct, the R2ratewas significantly lower only in diet-induced obese mice versus the other groups.Conclusion:Our data revealed critical insight into the stroke model regarding lesion distribution, swelling, and atrophy. Our findings also shed light on previously underappreciated biological associations among these variables.

Stroke, Volume 56, Issue Suppl_1, Page AWP178-AWP178, February 1, 2025. Background and Objective:Cerebral amyloid angiopathy (CAA) is a major cause of lobar intracerebral hemorrhage and cognitive dysfunction in the elderly, and frequently coexists with Alzheimer’s disease (AD) and tau pathology. Dual-phase11C-PiB PET can determine amyloid deposition and cerebral perfusion changes, and may have diagnostic value for detecting tau in CAA. This study aimed to assess the diagnostic utility of combining early- and late-phase PiB PET images in predicting tau pathology in CAA.Methods:We prospectively enrolled patients with probable CAA for dynamic PiB and AV1451 scans. Tau positivity was defined as a standardized uptake value ratio (SUVR) > 1.26 in the meta-temporal region on static AV1451 PET. We compared early-stage (0-6 minutes after tracer injection) and late-phase (40-70 minutes) PiB PET between the tau(+) and tau(-) groups. Relationships between PiB PET parameters and tau burden were assessed using a linear regression model. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic value of PET parameters.Results:No significant differences in age, sex, educational years,ApoE2orApoE4carrier status were observed between the CAA/tau(+) vs. CAA/tau(-) groups. As expected, the CAA/tau(+) group had lower MMSE scores (p=0.021) and was associated with a lower hippocampal volume (p=0.036). On PET analysis, CAA/tau(+) was associated with lower early-phase temporal lobe PiB uptake than CAA/tau(-) (SUVR 0.87 [0.81-0.93] vs. 0.92 [0.89-0.98],p=0.014) and higher late-phase PiB uptake in the whole cortex and temporal and parietal lobes (allp

Stroke, Volume 56, Issue Suppl_1, Page AWP170-AWP170, February 1, 2025. Introduction:Faster reperfusion from initial presentation was associated with improved outcomes after endovascular thrombectomy(EVT) in patients with small core strokes. However, the relationship between time and different workflow metrics with outcomes in not well-established in patients with large strokes. We aimed to analyze the clinical workflow and time measures and their effect on overall procedure and functional outcomes from SELECT2 trial.Methods:Patients enrolled in SELECT2 trial were stratified based on treatment arm and transfer status and various workflow metrics, both in-hospital and outside (limited to transferred patients) were compared and their effect on clinical outcomes were evaluated.Results:Of 352 enrolled, 141 patients (72 EVT, 69 MM) presented directly to EVT-capable centers, whereas 211(106 EVT, 105 MM) were transferred from referral centers. Among patients presenting directly, no difference was observed between time from LKW to arrival(EVT:376.5(119.5-638)min vs MM:435(118-802)min,p=0.50), arrival to imaging acquisition(EVT:14(10-21)min vs MM:16.5(11-25)min,p=0.21) or time from imaging to randomization(EVT:55(40.5-72.5)min vs MM:64(44-84)min,p=0.083)-Fig1a. For patients transferred to EVT-capable centers, no difference was observed between treatment arms in time from LKW to arrival – EVT:418(63-757)min vs MM:313(87.5-713)min,p=0.77; time from arrival to imaging – EVT:12(3.5-24)min vs MM:13.5(10-20)min,p=0.12; time from imaging to departure – EVT:123.5(82-195)min vs MM:128.5(85-197.5)min,p=0.95; transit time to EVT center – EVT:39(21.5-67)min vs MM:38.5(25.5-67.5)min,p=0.73); time from imaging to randomization – EVT:43(21-70)min vs MM:39(21-68)min,p=0.96)-Fig1b. Longer procedure time was associated with worse mRS (aGenOR:0.92, 95%CI:0.87-0.96,p-value:0.001 for every 10min). Longer time from perfusion imaging to reperfusion was associated with worse mRS in both direct(aGenOR:0.99(0.99-1.00),p=0.003 for every 10min) and transferred patients(aGenOR:0.98(0.95-1.00),p=0.038 for every 10min) fig2, but Interfacility transfer times or other time metrics were not significantly associated with functional outcomes.Conclusion:In large ischemic core infarct patients randomized in the SELECT2 trial, longer times from imaging to reperfusion and procedure time were associated with worse clinical outcomes after thrombectomy. Expedited and efficient workflow protocols at thrombectomy centers are vital to optimize outcomes in large core patients.

Stroke, Volume 56, Issue Suppl_1, Page A84-A84, February 1, 2025. Background:Direct oral anticoagulants (DOAC) are associated with an increased risk ofhematoma expansion (HE) in spontaneous intracerebral hemorrhage (ICH). However, thecritical DOAC level influencing this risk remains unclear. This study investigates the impact of DOAC levels on the risk of HE in patients with DOAC-associated ICH.Methods:We conducted a retrospective analysis of patients with DOAC-associated ICH who had DOAC-calibrated anti-Xa or -IIa activity levels measured upon admission. Patients were categorized based on a clinically established cutoff for subtherapeutic DOAC levels (

Stroke, Volume 56, Issue Suppl_1, Page A83-A83, February 1, 2025. Introduction:The recent update (version 2.0) to the Boston criteria for cerebral amyloid angiopathy (CAA) adds two additional neuroimaging markers to increase the sensitivity of CAA detection: multispot white matter hyperintensity (WMH) pattern and severe centrum semiovale enlarged perivascular spaces (CSO EPVS). While the presence of these novel non-hemorrhagic markers, together with well-established hemorrhagic markers such as lobar cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS), increases the likelihood of underlying CAA in patients with intracerebral hemorrhage (ICH), it is unclear whether these markers have a prognostic impact on clinical outcomes.Methods:Brain MRIs from a prospective database of consecutive non-traumatic ICH patients admitted to a tertiary care center were reviewed for the presence of CMBs, cSS, multispot WMH pattern, and CSO EPVS. Patients who met the diagnostic criteria for CAA were selected for inclusion in this study. Clinical and neuroimaging predictors of an unfavorable discharge outcome (modified Rankin score ≥ 4) were assessed in univariate and multivariable models.Results:Between 2003 and 2019, 1,791 patients were admitted with non-traumatic ICH. Of the 1,297 (72%) patients who received a brain MRI, 645 (36%) were found to have CAA (mean age 74±11 years, 49% female). An unfavorable discharge was observed in 75% of patients. Lobar CMBs occurred in 326 (51%) patients, cSS occurred in 197 (31%), multispot WMH pattern occurred in 123 (19%), and severe centrum semiovale EPVS occurred in 156 (24%). In univariate analyses, age, hypertension, diabetes, ischemic stroke history, dementia, admission Glasgow Coma Scale (GCS) scores, intubation, external ventricular drain placement, hematoma evacuation, intraventricular extension, and cSS were associated with an unfavorable discharge outcome (allp< 0.05). When entered into a multivariable model subjected to backward elimination, age (aOR 1.05, 95% CI 1.03–1.08), hypertension (aOR 1.66, 95% CI 1.06–2.62), dementia (aOR 8.40, 95% CI 1.97–35.81), GCS score (aOR 0.85, 95% CI 0.75–0.96), intubation (aOR 2.59, 95% CI 1.09–6.15), intraventricular extension (aOR 1.75, 95% CI 1.67–4.84), and cSS (aOR 1.75, 95% CI 1.07–2.88) remained significantly associated with an unfavorable discharge outcome.Conclusion:Although non-hemorrhagic imaging markers are common in CAA patients with ICH, only the presence of cSS is significantly associated with unfavorable clinical outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATMP78-ATMP78, February 1, 2025. Background:Successful recanalization following endovascular thrombectomy (EVT) in vertebrobasilar artery occlusions (VBAOs) does not uniformly translate into favorable functional outcomes. Identifying predictors of futile recanalization is critical for improving patient selection and treatment strategies. This study aimed to compare patients with good versus poor functional outcomes despite successful recanalization in VBAO and to establish predictive factors for futile recanalization.Methods:We retrospectively analyzed patients who achieved successful recanalization after EVT for VBAO from a prospectively maintained database between 2014-2024. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days; dichotomized into good (mRS 0-3) and poor (mRS 4-6) outcomes. Demographic data, clinical characteristics, procedural variables, and imaging findings were compared between the groups using pairwise comparisons and multivariable logistic regression models to identify predictors of futile recanalization.Results:Among the 163 patients who qualified for final analysis, 73 (44.8%) had good functional outcomes, while 90 (55.2%) had poor outcomes despite successful recanalization. Age (72 years vs. 64 years, p=0.0014), baseline NIHSS score (22 vs. 14, p

Stroke, Volume 56, Issue Suppl_1, Page ATP111-ATP111, February 1, 2025. Non-invasive transcranial direct current stimulation (tDCS) can modulate activity of targeted brain regions. Whether tDCS can reliably and repeatedly modulate intrinsic connectivity of entire brain networks is unclear. We used concurrent tDCS-MRI to investigate the effect of high dose anodal tDCS (4mA) on resting state connectivity between cortical regions within the Arcuate Fasciculus (AF) network, which spans the temporal, parietal, and frontal lobes and is connected via a structural backbone, the Arcuate Fasciculus (AF) white matter tract. The Arcuate Fasciculus Network plays an important role in the auditory-motor feedforward and feedback control of vocalizations and speech-language functions. The degree of injury to the Acuate Fasciculus Network on the dominant hemisphere is related to speech motor/language impairment after stroke. A rudimentary AF-network typically exists on the non-dominant hemisphere that might be enhanced and fostered to show plastic changes after stroke. We tested this approach with non-invasive high dose electrical stimulation. Effects of high-dose tDCS (4mA) delivered via a single electrode placed over one of the AF nodes (single electrode stimulation, SE-S) was compared to the same dose split between multiple electrodes placed over AF-network nodes (multielectrode network stimulation, ME-NETS). While both SE-S and ME-NETS significantly modulated connectivity between AF network nodes (increasing connectivity during stimulation epochs), ME-NETS had a significantly larger and more reliable effect than SE-S. Moreover, comparison with a control network, the Inferior Longitudinal Fasciculus (ILF) network on the same hemisphere targeted by tDCS suggested that the effect of ME-NETS on connectivity was specific to the targeted AF-network. This finding was further supported by the results of a seed-to-voxel analysis wherein we found ME-NETS primarily modulated connectivity between AF-network nodes, meaning cortical regions such as the Inferior Frontal Gyrus, the Supramarginal Gyrus, and the posterior superior temporal gyrus, which constitute the nodal regions of the AF network. Finally, an exploratory analysis looking at dynamic connectivity using sliding window correlation found strong and immediate modulation of connectivity during three stimulation epochs intermingled with no-stimulation epochs within the same imaging session suggesting that the intrinsic connectivity between these regions can reliably and repeatedly be modulated.

Stroke, Volume 56, Issue Suppl_1, Page ATMP77-ATMP77, February 1, 2025. Ischemic strokes often disrupt white matter (WM) microstructure, particularly affecting the corticospinal tract (CST) in the internal capsule (IC), leading to significant motor deficits. While evidence shows that axon sprouting occurs post-stroke, it often follows erratic paths, limiting functional recovery. Recent advances in 3D-printed hydrogel scaffolds have shown promise in guiding axon regeneration in spinal cord injury models. We hypothesize that implanting these scaffolds at white matter sites affected by stroke, aligned with CST fibers, will enhance functional axonal regeneration and motor recovery. Our aim is to develop and validate a precise and clinically applicable scaffold delivery system for future human studies.We have developed a novel, minimally invasive stereotaxic method for the precise deployment of 1.3 mm diameter scaffolds within the IC of non-human primates (NHPs). Our approach utilizes a clinically available stereotactic robot (ROSA, ZimmerBiomet) combined with a linear cannula system (AlphaOmega) to plan scaffold placement. Then, we attempted to deploy scaffolds devices into thermally coagulated lesions in NHPs (n=2) and simulated lesions within hydrogel phantoms (n=2). Post-implant MRI, co-registered with high-resolution diffusion tensor imaging were applied to check for scaffold placement accuracy (n=4). We further complement the scaffold placement method by using a novel neurosurgical microrobot (Robeauté) designed for navigation along 3D nonlinear curves, with accuracy confirmed by CBCT imaging in phantom tests.Our implantation methods accurately placed scaffolds in the intended locations and orientations, aligning with CST fibers in both phantom models and NHP brains. The deviation angle between the scaffold and CST fibers was 17.83° (SD 6.71°, n=3). The scaffolds were precisely positioned within the IC, validating our approach. Our robot-guided method accurately steered them to their intended position, demonstrating minimal errors in targeted white matter regions.The methods described are poised for clinical translation, potentially extending the applicability of scaffold technology for improving motor function post-stroke. We are preparing NHPs for behavioral and upper limb motor assessments to evaluate the impact of scaffold implantation on axon regeneration, recovery, and performance. This research aims to enhance our understanding of ischemic stroke and develop innovative therapies to restore motor function in patients.

Stroke, Volume 56, Issue Suppl_1, Page ATMP60-ATMP60, February 1, 2025. Background:Identifying optimal candidates for endovascular treatment (EVT) remains an ongoing priority to maximize treatment efficacy. The recent large core trials have called into question the use of infarct volume alone for selecting patients. This study aimed at exploring the feasibility of using routinely acquired Computed Tomography Perfusion (CTP) to capture how lesion location impacts brain connectivity and how this in turn affects the ability to benefit from EVT.Methods:Consecutive patients from a multi-centric stroke imaging registry were included in this study if they had a proven anterior circulation large vessel occlusion (LVO) and available baseline CTP data. Hypoperfusion (Tmax >6 seconds) and ischemic core (relative cerebral blood flow

Stroke, Volume 56, Issue Suppl_1, Page ATP349-ATP349, February 1, 2025. Background:Inflammation, a key player in both acute and chronic cerebral ischemia, is activated in brain tissues by bilateral carotid stenosis (BCAS)- induced chronic cerebral hypoperfusion. Our study aimed to investigate whether the deletion of the NLRP3inflammasome could abolish the deleterious effects of BCAS-induced chronic hypoperfusion in an experimental model of VCID.Methods:Microcoil-induced BCAS was used to induce chronic hypoperfusion. Middle-young (8-10 mice per group,4-5 months old, male) NLRP3WT and NLRP3KO were randomly assigned to BCAS-induced chronic hypoperfusion for four weeks. Cerebral blood flow was measured by laser speckle contrast imaging (LCSI) and CBF-ASL perfusion by MRI, and novel object recognition (NOR) and wire-hanging tests were also measured. Biochemical and histopathological staining was also assessed on the brain tissues.Results:At four weeks, there was a significant increase in CBF by LSCI and CBF-ASL perfusion by MRI in NLRP3KO mice compared to NLRP3WT groups. More importantly, the cognitive and motor function, as measured by NOR and wire-hanging tests, showed a remarkable improvement in NLRP3KO mice compared to WT.Conclusions:The findings suggest that deletion of NLRP3 inflammasome not only mitigates the cognitive impairment and motor effects of chronic hypoperfusion but also significantly improves cerebral blood flow. This indicates that targeting the NLRP3 inflammasome may be a new therapeutic approach against VCID.

Stroke, Volume 56, Issue Suppl_1, Page ATMP65-ATMP65, February 1, 2025. Background:We aimed to evaluate whether the implementation of regional prehospital transport to comprehensive stroke center (CSC) protocol has any impact on inter-hospital transfer rate and neurologic outcomes of intracranial hemorrhage (ICH) patients.Methods:We performed a retrospective multicenter study comparing outcomes in patients with ICH arriving at 15 Primary Stroke Centers (PSC) and 8 CSC in Chicago, Illinois via emergency medical services transport from January 1 2017 and December 31 2023 – before and after implementation of a prehospital transport protocol in September 2018 which uses a 3-item stroke scale to identify patients with more severe stroke types and

Stroke, Volume 56, Issue Suppl_1, Page ATP107-ATP107, February 1, 2025. Introduction:The intricate network of neurons orchestrates essential functions within the human body. Ischemic stroke, a major neurological disorder, challenges this network, leading to irreversible damage and functional impairment due to the limited regenerative capacity of neuronal tissues. Stem cells, with their unique properties of self-renewal and differentiation into various cell types, present a promising therapeutic avenue. This systematic review evaluates the efficacy and safety of stem cell therapies in treating ischemic stroke, aiming to restore neuronal structure and function.Objective:Our goal is to provide insights into the therapeutic potential of stem cell interventions for ischemic stroke, specifically their impact on clinical outcomes, functional recovery, and quality of life. This review synthesizes evidence from randomized clinical trials conducted between 2015 and 2024.Methods:A comprehensive search of databases such as PubMed, MEDLINE, and Cochrane Library identified relevant randomized clinical trials involving stem cell therapy for ischemic stroke.Results:Current data shows that various types of stem cell therapy are safe for treating neurological diseases, particularly ischemic stroke. While these therapies have enhanced motor recovery and neuroplasticity, their effectiveness in reducing scar size remains to be conclusively demonstrated. Notable improvements in patient outcomes include significant enhancements in the Modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Additionally, imaging studies have shown increased neurogenesis and enhanced integrity of the corticospinal tract in the peri-infarct area.Conclusion:The review highlights a remarkable finding: a single administration of stem cells can yield measurable clinical improvements lasting at least 12 months post-treatment. This long-term effect is unprecedented among non-device or non-acute treatments for ischemic stroke, challenging current therapeutic approaches like thrombolysis.This systematic review underscores the transformative potential of stem cell therapy in addressing the challenges of ischemic stroke. Despite significant advancements, further research is essential to fully understand the mechanisms, optimize treatments, and fully harness the regenerative capabilities of stem cells, paving the way for innovative treatments that offer renewed hope for stroke patients.

Stroke, Volume 56, Issue Suppl_1, Page ATP361-ATP361, February 1, 2025. Introduction:Stroke is a leading cause of death and disability worldwide, with diabetes being a significant risk factor that exacerbates stroke outcomes. While previous studies have identified various cell populations characteristic of stroke and other neurological diseases through transcriptomic analysis of brain and blood cells, the interaction between leukocytes and brain endothelial cells during stroke remains inadequately understood. This study aimed to investigate these intercellular interactions in the context of diabetes and stroke.Methods:We utilized a permanent ischemic stroke model in leptin receptor-deficient db/db mice (a model for type 2 diabetes) and their non-diabetic counterparts, db/+ mice. Three days post-stroke, brain cells and circulating leukocytes were isolated and subjected to single-cell RNA sequencing (scRNAseq). The CellChat tool was employed to analyze the intercellular communication between these cells. Additionally, in vivo two-photon microscopy was used to observe real-time interactions between leukocytes and brain endothelial cells in cortical veins.Results:scRNAseq analysis revealed that diabetic mice had a higher proportion of myeloid cells in the blood compared to controls. Post-stroke, both diabetic and non-diabetic mice showed an increased presence of microglia and macrophages in the brain. CellChat analysis indicated that both diabetes and stroke significantly elevated the number and strength of cell-cell interactions, with the highest levels observed in the diabetic stroke group. Notably, interactions involving the integrin family and ICAM/VCAM, known for their roles in cell adhesion between blood leukocytes and brain endothelial cells, were particularly prominent in the diabetic mice. In vivo imaging confirmed significant leukocyte accumulation in the cortical veins immediately after stroke in both genotypes, with delayed clearance observed in the diabetic group.Conclusion:The findings suggest that diabetes exacerbates the inflammatory response in stroke by enhancing leukocyte-endothelial interactions, leading to prolonged leukocyte retention in the cerebral vasculature, which likely contributes to increased inflammation and worsened stroke outcomes in diabetic conditions.

Stroke, Volume 56, Issue Suppl_1, Page ATMP58-ATMP58, February 1, 2025. Introduction:An apparent diffusion coefficient (ADC) threshold of ≤ 620 × 10-6 mm2/s identifies irreversible infarcts and guides endovascular thrombectomy (EVT) decisions. However, in hyperacute ischemic infarcts, diffusion-weighted imaging (DWI) hyperintense lesions can show varying ADC values. This study investigates DWI-ADC mismatch, defined as the significant difference between DWI hyperintense lesion volume and ADC ≤ 620 × 10-6 mm2/s volume.Methods:This retrospective, single-center study included patients with acute large vessel occlusion in the anterior circulation who: (1) underwent MRI within 24 hours of stroke onset, (2) received EVT, and (3) had follow-up MRI within 5 days of EVT from January 2018 to January 2020. Neuroradiologists segmented DWI hyperintense infarcts with ADC hypointensity on pre- and post-EVT MRI, using Fluid-attenuated inversion recovery (FLAIR) sequences to avoid T2 shine-through effects. The DWI/ADC volume ratio was calculated by dividing DWI volume by ADC ≤ 620 × 10-6 mm2/s volume. DWI-ADC mismatch was defined as a DWI/ADC ratio ≥ 2, with no mismatch indicated by a ratio < 2. Final infarct segmentation included hemorrhagic transformation. DWI lesion reversal (DWIR) was defined as the volume of normal-appearing voxels on follow-up DWI but previously hyperintense. DWIR% = (DWIR/baseline DWI volume) × 100 was calculated. We compared demographics, radiological findings, clinical outcomes, and follow-up results between mismatch and no mismatch groups.Results:Among 73 patients, 20 (27.4%) had DWI-ADC mismatch. Baseline demographics and National Institutes of Health Stroke Scale (NIHSS) were similar between groups. The DWI/ADC ratio was higher in the mismatch group (2.9 vs. 1.5, P < 0.0001). Follow-up lesion volumes and functional outcomes were similar; however, the mismatch group showed a slower infarct growth rate (3.8 ml/h vs. 7.5 ml/h, P = 0.04), a higher likelihood of parent artery stenosis (65% vs. 20.8%, P < 0.001), and increased need for angioplasty or stenting (50% vs. 17%, P < 0.001). The mismatch group also had a higher DWIR% (37.7% vs. 21.2%, P = 0.02).Conclusions:DWI-ADC mismatch is associated with slower infarct growth, greater likelihood of parent artery stenosis, increased need for angioplasty or stenting, and more DWI lesion reversal in anterior circulation large vessel occlusion patients undergoing EVT. These findings suggest DWI-ADC mismatch could be important in EVT decision-making and outcome prediction.

Stroke, Volume 56, Issue Suppl_1, Page ATMP52-ATMP52, February 1, 2025. Introduction:A recent randomized-controlled trial confirmed the value of minimally-invasive intracerebral hemorrhage (ICH) evacuation to improve outcomes in properly-selected patients. Yet, there remains a need to optimize patient selection and prognosis following ICH evacuation. Magnetic resonance diffusion tensor imaging (DTI) allows visualization and quantification of critical white matter tracts. Corticospinal tract DTI (CST-DTI) in particular can be associated with motor function, which may improve prognosis and patient selection for ICH evacuation.Methods:Patients who underwent minimally-invasive ICH evacuation and had perioperative DTI performed were retrospectively reviewed. CST metrics including fractional anisotropy, radial diffusivity, axial diffusivity, geodesic anisotropy, fiber count, and tract volume were associated with motor function pre- and postoperatively. Motor function was scored on each hemibody via the weakest muscle group in each extremity according to the Medical Research Council grading scale (maximum score of 10 on each hemibody).Results:Eighteen patients with available peri-operative DTI data were included, 12 each with preoperative and postoperative DTI, seven with matched pre- and postoperative DTI. Preoperative geodesic anisotropy was significantly associated with both preoperative motor function on the contralateral hemibody (R=0.616, p=0.032, Pearson correlation) and at postoperative day one (R=0.606, p=0.038). Restoration of a deformed CST could be seen in several patients from preoperative to the immediate postoperative period (Figure 1). However, no preoperative or postoperative CST-DTI metrics were associated with motor scores at a median follow-up of 6.3 months post-ICH (p >0.05 for all comparisons). There was a significant increase in motor scores on the affected hemibody from postoperative day one to last follow-up (3.8±3.5 vs 6.3±6.8; p = 0.038, Wilcox signed-rank test).Conclusions:Preoperative CST-DTI metrics are associated with both preoperative and immediate postoperative motor function after minimally invasive ICH evacuation. A restored CST after ICH evacuation could be seen in a subset of patients. However, neither preoperative nor immediate postoperative CST-DTI metrics were associated with longer-term motor function. Tractography from the perioperative period should be used with caution in providing motor prognosis.

Stroke, Volume 56, Issue Suppl_1, Page ATMP53-ATMP53, February 1, 2025. Introduction:Cervical artery dissections (CAD) are a leading cause of stroke, particularly among younger individuals. Timely and accurate diagnosis is crucial for appropriate treatment and preventing further complications. This study compares a commonly used imaging modality for evaluating CAD; computed tomography angiography (CTA) with a novel imaging modality; Vessel Wall MR Imaging (VW-MRI). The aim is to highlight distinguishing features of CAD on VW-MRI, demonstrating its ability to offer better visualization of vessel wall abnormalities in select cases compared to conventional CTA.Methodology:Patients were selected from the University of Washington (UW) hospital system between 2022 and 2024. The screened patients included those either admitted directly from the Emergency Department due to new onset of neurological symptoms or transferred from Telehealth and affiliated hospitals after extensive disease was detected on CTA head and neck scans as part of stroke protocols. In accordance with our institutional stroke protocol all patients had initial vessel imaging with CTA followed by a VW-MRI which was obtained using a 3.0 Tesla scanner.Results:A total of 47 patients were identified with intracranial abnormalities initially picked on CTA. Of the total cases, 20 were initially suspected of CAD based on CTA, but only 13 were confirmed with dissections on VW-MRI. Amongst the seven cases which did not have a CAD on VW-MRI – two of them turned out to be artifactual, one of them was Fibromuscular Dysplasia (FMD), three showed atherosclerotic plaque and one was suggestive of a vasculitic process. In two cases, intracranial dissections were easily picked on VW-MRI, and in one case mural hematoma and in other two cases intraluminal thrombus were seen easily on VW-MRI, which were primarily missed on CTA.Conclusion:Upon reviewing the patients during this period, it is evident that VW-MRI not only aids in localizing acute ischemic strokes but also plays a critical role in identifying CAD. Additionally, intracranial artery dissections, intramural hematomas, intraluminal thromboses and pseudoaneurysms had a better visualization on VW-MRI than on conventional CTA. VW-MRI adds value to the diagnosis of CAD, which can be beneficial in determining etiology of acute ischemic strokes for cases which have some degree of uncertainty and eventually may prove to be helpful in their long-term management.