Risultati per: L'imaging nella urolitiasi

Hirschsprung disease is defined by the absence of enteric nervous system (ENS) from distal bowel. Primary treatment is “pull-through” surgery to remove bowel that lacks ENS with re-anastomosis of “normal” bowel near the anal verge. Problems after pull-through are common and some may be due to retained hypoganglionic bowel (i.e., low ENS density). Testing this hypothesis has been difficult because counting enteric neurons in tissue sections is unreliable even for experts. Tissue clearing and 3-dimensional imaging provides better data about ENS structure than sectioning.

Stroke, Ahead of Print. Vascular cognitive impairment is common after stroke, in memory clinics, medicine for the elderly services, and undiagnosed in the community. Vascular disease is said to be the second most common cause of dementia after Alzheimer disease, yet vascular dysfunction is now known to predate cognitive decline in Alzheimer disease, and most dementias at older ages are mixed. Neuroimaging has a major role in identifying the proportion of vascular versus other likely pathologies in patients with cognitive impairment. Here, we aim to provide a pragmatic but evidence-based summary of the current state of potential imaging biomarkers, focusing on magnetic resonance imaging and computed tomography, which are relevant to diagnosing, estimating prognosis, monitoring vascular cognitive impairment, and incorporating our own experiences. We focus on markers that are well-established, with a known profile of association with cognitive measures, but also consider more recently described, including quantitative tissue markers of vascular injury. We highlight the gaps in accessibility and translation to more routine clinical practice.

Objectives
During a precommissioning inspection of a new biocontainment centre, radiographers noted structural features of quarantine rooms that could compromise staff and patient safety and the X-ray image quality, even after significant modifications had been made to an earlier radiography protocol. The aim of this study was to explore the safety and effectiveness of the modified protocol, in the new space, and identify improvements, if required.

Design
A qualitative study using in situ simulation and video-reflexive methods.

Setting
A newly built biocontainment centre, prior to its commissioning in 2021, in a large, tertiary hospital in Sydney, Australia.

Participants
Five radiographers, and a nurse and a physician from the biocontainment centre, consented to participate. All completed the study.

Interventions
Two simulated mobile X-ray examinations were conducted in the unit prior to its commissioning; simulations were videoed. Participants and other stakeholders analysed video footage, collaboratively, and sessions were audio recorded, transcribed and analysed thematically. Problems and potential solutions identified were collated and communicated to the hospital executive, for endorsement and actioning, if possible.

Results
Four themes were identified from the data: infection exposure risks, occupational health and exposure risks, communication and X-ray image quality. Facilitated group reviews of video footage identified several important issues, across these four areas of risk, which had not been identified previously.

Conclusions
In situ simulation is used, increasingly, to evaluate and improve healthcare practices. This study confirmed the added value of video-reflexive methods, which provided experienced participants with a richer view of a familiar protocol, in a new setting. Video footage can be examined immediately, or later if required, by a broader group of stakeholders, with diverse experience or expertise. Using video reflexivity, clinicians identified potential safety risks, which were collated and reported to the hospital executive, who agreed to implement modifications.

Introduction
Positron emission tomography (PET) imaging can be used to evaluate arterial wall inflammation in extracranial vascular diseases. However, the application of PET imaging in unruptured intracranial aneurysms (UIA) remains unexplored. Our objective is to investigate feasibility of PET imaging using 18F-FDG and 68Ga-DOTANOC tracers to evaluate arterial wall inflammation in UIA.

Methods and analysis
This PET imaging feasibility study will enrol patients scheduled for surgical treatment of UIA. The study subjects will undergo PET imaging of the intracranial arteries within 1 month before planned surgery. The imaging protocol includes 18F-FDG PET MRI, MRA with gadolinium enhancement, and 68Ga-DOTANOC PET CT. The study will also involve preoperative blood samples, intraoperative cerebrospinal fluid (CSF) samples, and aneurysm sac biopsy. Planned sample size is at least 18 patients. Primary outcome is uptake of 18F-FDG or 68Ga-DOTANOC in intracranial arterial aneurysms compared with contralateral normal vessel as maximum standardised uptake value or target-to-blood pool ratio and correlation of uptake of 18F-FDG or 68Ga-DOTANOC to aneurysm histological findings. Secondary outcomes include estimating the correlations between uptake of 18F-FDG or 68Ga-DOTANOC and histological findings with blood and CSF miRNA-levels, arterial wall enhancement in gadolinium enhanced MRA, aneurysm size and shape, smoking, hypertension, and location of the aneurysm.

Ethics and dissemination
This study is approved by the Human Research Ethics Committee of the Hospital District of Southwest Finland, Finnish Medicines Agency Fimea, and Turku University Hospital. Findings will be disseminated through peer-reviewed journal articles and presentations at national and international conferences.

Trial registration number
NCT04715503

Circulation, Volume 149, Issue 7, Page 542-544, February 13, 2024.

New England Journal of Medicine, Ahead of Print.

Introduction
Cystic fibrosis (CF) is a life-limiting autosomal recessive genetic condition. It is caused by mutations in the gene that encodes for a chloride and bicarbonate conducting transmembrane channel. X-ray velocimetry (XV) is a novel form of X-ray imaging that can generate lung ventilation data through the breathing cycle. XV technology has been validated in multiple animal models, including the β-ENaC mouse model of CF lung disease. It has since been assessed in early-phase clinical trials in adult human subjects; however, there is a paucity of data in the paediatric cohort, including in CF. The aim of this pilot study was to investigate the feasibility of performing a single-centre cohort study in paediatric patients with CF and in those with normal lungs to demonstrate the appropriateness of proceeding with further studies of XV in these cohorts.

Methods and analysis
This is a cross-sectional, single-centre, pilot study. It will recruit children aged 3–18 years to have XV lung imaging performed, as well as paired pulmonary function testing. The study will aim to recruit 20 children without CF with normal lungs and 20 children with CF. The primary outcome will be the feasibility of recruiting children and performing XV testing. Secondary outcomes will include comparisons between XV and current assessments of pulmonary function and structure.

Ethics and dissemination
This project has ethical approval granted by The Women’s and Children’s Hospital Human Research Ethics Committee (HREC ID 2021/HRE00396). Findings will be disseminated through peer-reviewed publication and conferences.

Trial registration number
ACTRN12623000109606.

Stroke, Volume 55, Issue Suppl_1, Page ATP140-ATP140, February 1, 2024. Background:The treatment of acute ischemic stroke (AIS) aims to achieve early vascular recanalization and reperfusion of the penumbra. However, the effect of early penumbral imaging within 6 hours on clinical outcomes remains unclear.Objective:The objective of this study was to determine the effect of magnetic resonance-guided (MR-guided) perfusion imaging within 6 hours after symptom onset on endovascular thrombectomy outcomes in AIS patients.Methods:We prospectively collected the clinical information of consecutive AIS patients undergoing endovascular thrombectomy based on MR-guided perfusion imaging within 6 hours after symptom onset from AISRNA and EVTRNA studies. The primary outcome was defined as the poor outcome (mRS > 2 within 90 days). The perfusion-weighted imaging/diffusion-weighted imaging (PWI/DWI) mismatch was assessed by an automated software.Results:We enrolled 84 patients (25 in the mismatch ≤ 1.8 group and 59 in the mismatch > 1.8 group). Significant difference was found between the mismatch >1.8 group and the mismatch≤1.8 group for the incidence of disabling stroke (mRS > 2) within 90 days (40.7% vs. 68.0%, OR: 3.099, 95% CI: 1.154-8.323, P =0.025). Intracranial hemorrhage occurred in 8 patients (13.6%) in the mismatch > 1.8 group and 10 patients in the mismatch ≤ 1.8 group (40.0%) (P = 0.010). The risk of severe cerebral edema was 2/59 (3.4%) vs. 7/25 (28.0%) (P = 0.004). These findings remained stable after adjustment.Conclusion:MR-guided perfusion imaging mismatch profiles within 6 hours after symptom onset may be feasible to improve clinical outcomes and reduce clinically ineffective reperfusion after endovascular thrombectomy.

Stroke, Volume 55, Issue Suppl_1, Page ATP52-ATP52, February 1, 2024. Background:Delays in IV thrombolytic and thrombectomy treatments are associated with worse outcomes after ischemic stroke. The objective of our study was to compare door-to-CT imaging times among Code Stroke patients who presented by private vehicle and were evaluated by a physician in the emergency department (ED) either in the triage hallway or the emergency department room.Methods:We prospectively collected real-time data on Code Stroke patients presenting by private vehicle to a primary stroke center from May 1, 2022 through September 18, 2022. A Code Stroke was activated for all patients presenting to the emergency room with positive BE-FAST symptoms occurring within 24 hours from last known normal time. Patients were evaluated by a physician either in the triage hallway or an ED room prior to CT imaging. We compared baseline demographic data, NIHSS scores and door-to-CT times in patients evaluated by the physician in the ED triage hallway versus the ED room.Results:Of 55 patients who presented to the ED by private vehicle during the study period, the mean age was 54 ± 15 years, 53% were female and 45% non-white. The median NIHSS score was 1 [IQR 0-4]. There were 27 (49%) patients who underwent physician evaluation in the triage hallway and the remaining went into a patient room before going to CT. The median NIHSS scores for evaluations in the room were higher than in the triage hallway (2 vs 0, p=0.037). Overall, median time from door-to-CT was 11 minutes for patients who went directly from the triage hallway to CT and 21 minutes for patients who were roomed prior to CT (p=0.005).Conclusions:This study found that Code Stroke patients presenting by private vehicle and evaluated by an emergency physician in the triage hallway saved 10 minutes in door-to-CT time compared with physician evaluation in a room.

Stroke, Volume 55, Issue Suppl_1, Page A144-A144, February 1, 2024. Introduction:CTP has increasingly been incorporated into the evaluation of all patients with suspected acute ischemic stroke (AIS), including those with minor symptoms. We aimed to assess the incremental value of CTP in acute treatment decision-making among patients with low NIHSS.Methods:We performed a retrospective cohort study of all patients who underwent CTP upon presentation to the ED at three academic, urban hospitals in Philadelphia, PA between January 1, 2022 and December 31, 2022. We collected data on initial NIHSS score, AIS treatment decisions, subsequent neuroimaging, and final diagnosis.Results:There were 531 patients with a median age of 64.5 years (IQR 54-73) and 56% were women. 73% were Black or African American, 20% White, and 4% Asian. Frequency of CTP imaging by initial NIHSS score is presented in the Figure. Among 90 patients (16.9%) with NIHSS≤2, CTP imaging was cited as justification for AIS treatment (thrombolysis, thrombectomy, or both) in 0 (0%, 95% CI: 0-4%). Specifically, among 41 patients (7.7%) with NIHSS≤1, 0 received thrombolysis or thrombectomy, and 12 (29.2%) were ultimately diagnosed with AIS on CT/MRI. Among 49 with NIHSS=2 (9.2%), 2 patients received thrombolysis (based on clinical exam, CTP was normal) and one later underwent thrombectomy based on clinical decompensation with repeat NIHSS=7, and 28.6% had AIS on CT/MRI. Meanwhile, among 33 patients with NIHSS=3, acute treatment was given to 3 and CTP influenced AIS treatment decisions in 2 (6.1%). Among 59 patients with NIHSS=4, acute treatment was given to 4 and CTP influenced decision-making in 3 (5.1%). CTP mismatch ratio was > 1.7 in all 5 patients who received acute treatment and had NIHSS of 3 or 4.Conclusions:CTP is frequently performed in patients with low NIHSS. It had limited impact on acute treatment decisions, notably none among those with NIHSS≤2, suggesting that CTP may be over-utilized in this subset of patients with AIS.

Stroke, Volume 55, Issue Suppl_1, Page A41-A41, February 1, 2024. Background:The optimal imaging modality for treatment selection in the extended stroke window is uncertain. VESTA study (NCT05299034) compared conventional imaging (noncontrast CT + CT angiography) with advanced imaging (adding perfusion) in extended window stroke patients, focusing on EVT selection rate, safety and functional outcome.Methods:From the prospective Catalan Stroke Registry (CICAT, 29 centers) ischemic stroke patients within 6-24h of symptom onset and NIHSS ≥6 (Jan 2019 -Dec 2021) were selected. Imaging modality was decided according to the local site protocol. Images were re-evaluated by a central core lab with full access to each patient’s images. LVO was defined as intracranial ICA, M1 or proximal M2 occlusion. Blinded investigators centrally assessed 90-day functional independence, defined as mRS≤2. We employed a propensity score matching algorithm to adjust for age, sex, NIHSS, established infarct, and time from onset to arrival.Results:We included 1405 patients in the analysis (median age 76y, median NIHSS 11; 48% women). Conventional imaging was performed in 48% of patients, while 52% received advanced imaging. Patients receiving conventional vs. advanced imaging showed lower NIHSS (11 vs. 12, p=0.006), and lower rates of LVO (45% vs. 58%, p

Stroke, Volume 55, Issue Suppl_1, Page ATP131-ATP131, February 1, 2024. Background:Large vessel occlusion (LVO) stroke patients are often transferred from regional hospitals to comprehensive stroke centers (CSC) for thrombectomy. The need for repeat imaging at CSCs prior to intervention is unclear. We compared regional hospital and CSC perfusion imaging results for interfacility transfers in a single health system.Methods:We analyzed a cohort of patients in western Michigan who received CT perfusion imaging before and after transfer to a CSC. Perfusion mismatch (MM), core infarct volume (CIV), and favorability of imaging for mechanical thrombectomy (MT) candidacy were compared between the regional and CSC studies. A favorable imaging profile was defined as the presence of LVO, MM volume >10 mL, and MM/CIV ratio of >1.2. Linear regression was used to examine predictors of infarct growth during transfer.Results:Over a 10-month period, 25 patients met inclusion criteria. The median age was 76 (IQR 66-81), 60% were male, median NIHSS was 11 (IQR 2-18), and most patients had occlusion of the internal carotid or middle cerebral arteries (72%). The median time from last known well to initial CT was 250 minutes (IQR 85-620). Regional median MM volume was 52 mL (IQR 8-97), CIV was 0 mL (IQR 0-13), and hypoperfusion intensity ratio (HIR) was 0.25 (IQR 0-0.34). The median time between CTs was 152 minutes (IQR 139-226). The median change in MM volume was -3 mL (IQR -27-3) and median CIV growth rate was 0 mL/hr (IQR 0-2.0). In a multivariable regression model, higher HIR (β=23.2, p=0.012) and minutes between imaging studies (β=0.10, p=0.021) were associated with CIV growth. Sixteen patients (64%) had favorable imaging profiles for MT at the regional hospital. Of these, 15 (93.8%) continued to have a favorable CSC imaging profiles and 9 (56.2%) underwent MT. Of the 9 patients without favorable regional imaging profiles, 1 (11.1%) had a favorable CSC imaging profile and 2 (22.2%) underwent MT.Conclusion:In our sample, regional and CSC perfusion imaging patterns were similar and patients infrequently crossed thresholds for MT candidacy between studies. Initial HIR and longer delays between were independently associated with infarct growth during transfers, however overall infarct growth was very small.

Stroke, Volume 55, Issue Suppl_1, Page AWP118-AWP118, February 1, 2024. Introduction:Circadian rhythms have recently been shown to influence stroke incidence and progression of infarct. We aimed to describe the diurnal variations in the incidence and perfusion profiles of patients with ischemic stroke using a large, multi-center, automated imaging database.Methods:The RAPID Insights database was queried from 02/01/2016 to 01/31/2022 for patients with perfusion imaging and automated detection of an ischemic stroke due to a presumed large vessel occlusion. Exclusion criteria included: patient age ≤25, mismatch volume of 10s]/[Tmax >6s]), where a higher HIR suggests poorer collateral status. All perfusion parameters were analyzed on a 24-hour continuous cycle. Statistical significance was tested using a sinusoidal regression analysis.Results:A total of 18,137 cases were analyzed. The peak incidence of ischemic stroke occurred around noon. A sinusoidal pattern was present, with larger ischemic core volumes and higher HIR during the night compared to the day: peak ischemic core volume of 23.40 cc occurred with imaging performed at 3:56 AM (p

Stroke, Volume 55, Issue Suppl_1, Page ATMP16-ATMP16, February 1, 2024. Introduction:Urgent inter-hospital transfer ensures timely access to therapies for acute ischemic stroke. Door-in-door-out (DIDO) represents the total amount of time a patient spends in the transferring emergency department (ED) before transfer. DIDO time is an important quality metric for the care of acute stroke; however, little is known about the influence of process steps on DIDO times and which steps most often cause delays.Methods:This was a retrospective cohort study of patients in the American Heart Association Get With The Guidelines®-Stroke registry with ischemic stroke presenting January 2019 to December 2021 transferred from the ED at the presenting hospital to another acute care hospital for evaluation of thrombolytics, endovascular therapy or post-thrombolytic care. The primary independent variables were door-to-imaging and imaging-to-door times, and the primary outcome was DIDO time. Multivariate GEE regression models were performed to assess the comparative contributions of interval process times to variation in DIDO time, controlling for patient and hospital-level characteristics.Results:Among 24,662 patients (50.5% male, mean age 68.3 years, 73.2% White), mean DIDO time was 171.4 min (SD: 149.5), mean door-to-imaging time was 18.3 min (SD: 34.1) and mean imaging-to-door time was 153.1 min (SD: 141.5). A 1 min increase in door-to-imaging time was associated with a 1.33 min increase in the mean DIDO time, while a 1 min increase in imaging-to-door time was associated with a 1.02 min increase in mean DIDO time. The baseline model (without door-to-imaging or imaging-to-door included) had an R2 of 0.03. With door-to-imaging included in the GEE model, R2 was 0.13; whereas the model with imaging-to-door included had an R2 of 0.95.Conclusion:Imaging-to-door time accounts for a greater proportion of the variance in DIDO times than door-to-imaging time. Though the opportunity for improvement in DIDO is greater through reduction of imaging-to-door time, door-to-imaging time has greater per-minute effect on DIDO. While existing guidelines and care resources heavily focus on reducing door-to-imaging times, further attention is warranted to reduce imaging-to-door times in the management of acute ischemic stroke.

Stroke, Volume 55, Issue Suppl_1, Page ATMP9-ATMP9, February 1, 2024. Background:FLAIR vascular hyperintensities (FVH) are high signal intensities on MRI resulting from sluggish flow through collateral vessels in patients with acute arterial ischemic stroke (AIS). Data from adults suggest they may be a marker of penumbra. In this first investigation of FVH in children, I measured the prevalence and identified risk factors for FVH in pediatric patients with AIS.Methods:Retrospective review of patients prospectively enrolled in the CHOP Stroke Registry from 2006-2022. Patients with AIS age 29 days to 18 years with MRI within 72 hours of last known well were included. Children with pre-existing strokes, vasculopathy, prior brain surgery, radiation, or vascular compression from intracranial mass were excluded. MRIs were assessed by a blinded reviewer and adjudicated by a neuroradiologist for presence of LVO, FVH score, modASPECTS score, and AIS lesion volume. Clinical data were abstracted from chart review. Independent sample t-test compared FVH score and LVO presence. Pearson’s correlation assessed the relationship between total FVH score and age, stroke size, modASPECTS, and pedNIHSS scores. Multivariable logistic regression evaluated predictors of significant FVH (score >= 3) and included time to MRI, large vessel occlusion, modASPECTS, pedNIHSS, stroke size, and age as independent variables.Results:83 patients met inclusion criteria. Median time to MRI was 26 hours (95% CI 26-33). FVH were present in 45 patients (54%). Mean FVH score was higher in patients with LVO (5.22 ± 0.64) compared to those without (1.21 ± 0.24;p= 0.00). There was a positive correlation between total FVH score and age (p < 0.05), stroke size (p < 0.0001), modASPECTS (p < 0.0000), and pedNIHSS (p < 0.0002). In the multivariate logistic regression, only older age (OR 1.50, 95% CI 1.12-2.01, p < 0.006) and presence of LVO (OR 0.002, 95% CI 4.85x10-5-0.08, p

Stroke, Volume 55, Issue Suppl_1, Page A36-A36, February 1, 2024. Background and Objectives:This study aimed to investigate the association between high-resolution magnetic resonance imaging (HR-MRI) characteristics and recurrent ipsilateral stroke in patients with symptomatic intracranial atherosclerotic steno-occlusive disease (ICAS).Methods:This multicenter, observational study recruited first-ever acute ischemic stroke patients attributed to ICAS ( >50% stenosis or occlusion) within 7 days after onset. Participants were assessed by multi-parametric MRI including diffusion-weighted imaging, three-dimension time-of-flight magnetic resonance angiography, and three-dimensional T1-weighted HR-MRI. The patients were recommended to receive best medical therapy and were systematically followed up for 12 months. The association between HR-MRI characteristics and the time to recurrent ipsilateral stroke was investigated by univariable and multivariable analysis.Results:Two hundred and fifty-five consecutive patients were enrolled from 15 centers. The cumulative 12-month ipsilateral recurrence incidence was 4.1% (95% confidence interval [CI]: 1.6-6.6%). The plaque length (5.69±2.21 mm vs. 6.67±4.16 mm), plaque burden (78.40±7.37% vs. 78.22±8.32%), degree of stenosis (60.25±18.95% vs. 67.50±22.09%) and remodeling index (1.07±0.27 vs. 1.03±0.35) on HR-MRI did not exhibit discernible difference between patients with and without recurrent ipsilateral stroke. Patients with recurrent ipsilateral stroke exhibited higher rates of intraplaque hemorrhage (IPH) (30.0% vs. 6.5%) and eccentric plaque (90.0% vs. 48.2%), and lower occurrence of occlusive thrombus (10.0% vs. 23.7%). In the multivariable Cox regression analysis, IPH (hazard ratio: 7.05, 95% CI: 1.53-32.41, p=0.012) was significantly associated with recurrent ipsilateral stroke after adjustment.Discussion:We found IPH is significantly associated with recurrent ipsilateral stroke. Our results suggest IPH has potential value in the selection of patients for aggressive treatment strategies.