Risultati per: L'imaging nella urolitiasi

Stroke, Ahead of Print. BACKGROUND:Fluid-attenuated inversion recovery vascular hyperintensities (FVH) are high signal intensities on magnetic resonance imaging resulting from sluggish or stagnant flow through vessels. This investigation describes the prevalence, risk factors, and outcomes associated with FVH in pediatric arterial ischemic stroke (AIS).METHODS:Retrospective review of children aged 29 days to 18 years in a single institution stroke registry from 2006 to 2022 with AIS. Magnetic resonance imaging were assessed for large vessel occlusion (LVO), FVH score, modified Alberta Stroke Program Early Computed Tomography Score, and AIS volume. The association between demographic and imaging factors with the presence of and high FVH burden was assessed using Fisher exact, Pearson χ2, or Kruskal-Wallis tests. Wilcoxon rank-sum test evaluated the association of FVH score with the presence of LVO and poor outcome. The relationship between FVH score and age, time to magnetic resonance imaging, stroke volume, modified Alberta Stroke Program Early Computed Tomography Score, Pediatric National Institutes of Health Stroke Scale, and Pediatric Stroke Outcome Measure score were assessed using Spearman correlation. A multivariable logistic regression was used to evaluate predictors of FVH.RESULTS:In total, 273 patients with AIS were screened, and 83 met the inclusion criteria. Patients were a median age of 11.6 years (range, 1 month–18 years) and 37% were female. FVH were present in 53% of the cohort. Median FVH score was 0 (interquartile range, 0–2) in those without LVO and 5.5 (interquartile range, 3–7) in those with LVO (P

Introduction
Precision oncology aims to provide individualised treatment recommendations based on patient-specific characteristics. In this rapidly evolving field with increasing numbers of biomarkers and potential therapeutic targets, there is a growing unmet need for evidence guiding these individualised treatment recommendations. The Precision Oncology Program (POP) harnesses real-world data (RWD) and imaging mass cytometry (IMC) to evaluate the feasibility and utility of integrating different data modalities to inform personalised treatment recommendations. This program uses patient-matched clinicogenomic data and spatial single-cell proteomics analysis to support profiling-driven decision-making for patients with cancer at the Molecular Tumor Board.

Methods and analysis
The collaborative POP project recruits patients across all tumour entities and stages at the Comprehensive Cancer Center Zurich (CCCZ). For patients in the POP, a clinically and molecularly matched cohort is identified within the nationwide (US-based) de-identified Flatiron Health-Foundation Medicine clinicogenomic database (CGDB). It assesses whether clinical, genomic and outcome data of the CGDB cohort can inform treatment recommendations. In addition, multiplexed imaging mass cytometry (IMC) is performed in formalin-fixed paraffin-embedded tissue to assess the potential impact of spatial proteomics on personalised treatment decisions. RWD and IMC information is reviewed in the Molecular Tumor Board to assess the potential impact of this information on therapy decisions. However, since this is an observational study, these additional recommendations remain nonprescriptive and will not be forwarded to the treating physician.

Ethics and dissemination
The study is registered at ClinicalTrials.gov (NCT06680726) and approved by the Canton of Zurich Ethics Committee (Project ID: 2022-02289). Project-specific informed consent is obtained from all participants. Deceased patients may also be included. In this case, a signed general consent form must be available. Data privacy is ensured by unique patient numbers for pseudo-anonymised data. Study findings will be disseminated through international peer-reviewed journals, conferences, and direct communication with participants and relevant organisations.

Trial registration number
NCT06680726.

Stroke, Volume 56, Issue 4, Page 915-925, April 1, 2025. BACKGROUND:Diffusion-weighted magnetic resonance imaging is essential for diagnosing ischemic stroke and identifying targets for emergency revascularization. Apparent diffusion coefficient (ADC) maps derived from diffusion-weighted magnetic resonance imaging are commonly used to locate the infarct core, but they are not strictly quantitative and can vary across platforms and sites due to technical factors. This retrospective study was conducted to examine how differences in ADC map generation, resulting from varied protocols across platforms and sites, affect the determination of infarct core size, location, and related clinical outcomes in acute stroke.METHODS:In this retrospective study, 726 patients with acute anterior circulation stroke from a cohort of 1210 unique visits to the Lausanne University Hospital between May 2018 and January 2021 were selected, excluding patients with poor quality imaging or no magnetic resonance imaging or clinical information available. Diffusion-weighted magnetic resonance imaging data were used to generate ADC maps as they would appear from different protocols: 2 simulated with low- and medium-angular resolution (4 and 12 diffusion gradient directions) and 1 with high-angular resolution (20 directions). Using DEFUSE criteria and image postprocessing, ischemic cores were localized; core volume, location, and associations to the National Institutes of Health Stroke Scale and modified Rankin Scale scores were compared between the 2 imaging sequences.RESULTS:Significant differences were observed in the ADC distribution within white matter, particularly in the kurtosis and skewness, with the segmented infarct core volume being higher in protocols with reduced angular resolution compared with the 20-directions data (7.63 mL versus 3.78 mL). The volumetric differences persisted after correcting for age, sex, and type of intervention. Infarcted voxel’s locations varied significantly between the 2 protocols. This variability affected associations between infarct core volume and clinical scores, with lower associations observed for 4-direction data compared with 20-direction data for the National Institutes of Health Stroke Scale at admission and after 24 hours, and modified Rankin Scale after 3 months, further confirmed by multivariate regression.CONCLUSIONS:Imaging protocol heterogeneity leads to significant changes in the ADC distribution, ischemic core location, size, and association with clinical scores. Work is needed in standardizing imaging protocols to improve the reliability of ADC as an imaging biomarker in stroke management protocols to improve the reliability of ADC as an imaging biomarker in stroke management.

Introduction
This prospective observational study of patients with transthyretin amyloid cardiomyopathy (ATTR-CM) undergoing treatment with tafamidis aims at identifying quantitative image markers and comparing imaging modalities regarding the follow-up and prognostication of these patients, with the goal of providing a multiparametric score to predict treatment response.

Methods and analysis
Patients with a board-approved decision to receive tafamidis will undergo, in addition to standard of care, baseline and follow-up cardiovascular magnetic resonance (CMR) scans at 9 and 18 months. In total, the study plans to recruit and scan 60 patients. A blinded read will take place in a CMR research core laboratory. The final statistical analysis will be based on developing a multiparametric score for the prediction of treatment response. The study will be managed through the Amyloidosis Center Charité Berlin, a clinical unit formed from the three clinical campus sites of the Charité in Berlin, using the Berlin Research Network for CMR.

Ethics and dissemination
The study was approved by the Charité—Universitätsmedizin Berlin ethics committee EA1/262/23. The results of the study will be disseminated through international peer-reviewed publications and congress presentations.

Trial registration number
Approved WHO primary register: German Clinical Trials Register: https://www.drks.de/DRKS00033884. WHO International Clinical Registry Platform: https://trialsearch.who.int/?TrialID=DRKS00033884. Recruitment started on 1 July 2024.

Treatment with antibiotics alone was safe and allowed two thirds of patients to avoid appendectomy within 1 year.

Colonoscopy is the gold standard for detecting and resecting adenomas and early-stage cancers to reduce colorectal cancer (CRC) incidence and mortality rates. This study aimed to confirm the superiority of texture and color enhancement imaging (TXI) over white light imaging (WLI) in detecting colorectal lesions.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Stroke, Ahead of Print.

Objective
To investigate the relationship between eosinophil (EOS) and CT imaging, we quantitatively evaluated the bronchial wall thickening, emphysema index (EI) and pulmonary vascular parameters in patients with chronic obstructive pulmonary disease (COPD) based on different EOS levels.

Design
Retrospective observational study.

Setting
A tertiary hospital in China.

Participants
448 patients with COPD from January 2020 to January 2023.

Main outcome measures
Laboratory data, chest CT and pulmonary function based on different EOS levels:

Our review highlights the potential for the use of AI algorithms applied to retina images, particularly CFP, to screen, predict, or diagnose the various microvascular and macrovascular complications of diabetes. However, we identified few studies with longitudinal data and a paucity of randomized control trials, reflecting a gap between the development of AI algorithms and real-world implementation and translational studies.

Introduction
Postsurgical hypoparathyroidism (PoSH) is an iatrogenic condition that occurs as a complication of several different procedures with thyroid surgery being the most common. PoSH has significant short- and long-term morbidities. The volume of thyroid surgery is increasing, and PoSH is therefore likely to increase. Some studies have shown promising results using near-infrared fluorescence (NIRF) imaging in reducing the risk of PoSH which has the potential to significantly reduce morbidity and costs associated with monitoring and treatment.

Methods and analysis
NIFTy is an unblinded, parallel group, multicentre, seamless phase II/III randomised controlled trial in patients undergoing total or completion thyroidectomy. The trial incorporates a process evaluation (IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up framework) 2a) to inform the trial protocol, a phase II (IDEAL 2b) analysis using a surrogate primary outcome of 1 day transient hypocalcaemia to determine early futility and phase III (IDEAL 3) assessment of the primary outcome of PoSH at 6 months after surgery. 454 participants will be randomised on a 1:1 basis to evaluate thyroid surgery with NIRF and indocyanine green against standard thyroid surgery in reducing PoSH at 6 months after surgery, with the phase II analysis occurring once data are available for 200 participants. Analysis in both phases will be using multilevel logistic regression incorporating random effects with respect to surgeon and adjusting for minimisation factors. Phase III secondary outcomes include protracted hypoparathyroidism, hypercalcaemia, complications, length of stay, readmissions and patient reported quality of life using the Short Form 36 Health Survey Questionnaire and Hypoparathyroid Patient Questionnaire instruments.

Ethics and dissemination
NIFTy is funded by National Institute for Health and Care Research Efficacy and Mechanism Evaluation Programme (Grant Ref: 17/11/27) and approved by a Research Ethics Committee (reference: 21/WA/0375) and Health Research Authority (HRA). Trial results will be disseminated through conference presentations, peer-reviewed publication and through relevant patient groups.

Trial registration number
ISRCTN59074092.

Stroke, Volume 56, Issue Suppl_1, Page AWP184-AWP184, February 1, 2025. Objective:High calcium (Ca), low phosphate(P), and Ca-P product (CPP) levels are associated with cardiovascular disease and coronary artery atherosclerosis in patients with chronic kidney disease. However, whether this relationship persists in individuals with carotid artery atherosclerosis of acute ischemic stroke is unknown. We investigated the association of serum Ca, P, and CPP to carotid artery atherosclerotic plaque assessed by high-resolution MR vessel wall imaging in acute ischemic stroke patients.Methods:A total of 251 ischemic stroke participants with carotid artery atherosclerosis (mean age 68 years old, male 80.1%) were consecutively included in a comprehensive stroke center. Serum Ca, and P were obtained from blood tests after admission, and carotid artery plaque characteristics including plaque burden and vulnerability were evaluated using high-resolution MR vessel wall imaging, then the association between serum Ca, P, CPP, and atherosclerosis plaque characteristics was analyzed in multi-variate linear or logistic regression analysis； Finally, the consistency was also explored in different subgroups.Results:The mean±SD of serum Ca and P in this population is 2.26±0.11 and 1.16±0.19 individually. Serum P and CPP were associated with carotid artery plaque burden, presented as maximum wall thickness (max WT), wall area, and lipid-rich necrotic core (LRNC), in univariate analysis, with β=-0.205，95% CI (-0.348,-0.061), β=-0.258，95% CI (-0.405,-0.113), OR=0.182, 95% CI (0.034,0.975) for P, and β=-0.203，95% (-0.346,-0.059), β=-0.221，95% CI (-0.366,-0.074), OR=0.466, 95% CI (0.237,0.915) for CPP, respectively. In multivariate regression analysis, after further correction of age, sex in model 1 and cardiovascular risk factors in model 2, P level is associated with wall area independently, β=-0.211, 95% CI (-0.367, -0.052), while CPP is associated with wall area marginally, with β=-0.147, 95%CI (-0.300, 0.008) in model 1, and β=-0.157, 95%(-0.314, 0.004) in model 2. In subgroup analysis, the independent relationship between P and wall area can still be consistent in age＞65 years (β=-0.222, 95%CI [-0.400, -0.011]), male (β=-0.219， 95%CI [-0.446,-0.045], and hypertension (β=-0.314， 95%CI [-0.513, -0.130] subgroups.Conclusion:Lower serum P was associated with increased carotid artery plaque burden presented with wall area, and this relationship could differ in different age, sex, and hypertension subgroups.

Stroke, Volume 56, Issue Suppl_1, Page AWP185-AWP185, February 1, 2025. Introduction:Branch atheromatous disease involving the lenticulostriate artery (LSA) is strongly associated with early neurological deterioration. We aimed to investigate whether an apparent thalamostriate vein (TSV) or brush sign on susceptibility-weighted imaging (SWI) can predict infarct growth.Methods:Consecutive patients with the small subcortical infarction of the LSA presenting within 24 h of onset were retrospectively evaluated. MRI, including SWI, was performed on admission and within 1 week of admission. An apparent TSV was defined as a difference in the diameter of the TSV between the right and left sides on SWI upon admission. Infarct growth was defined as an increase in infarct size on axial or coronal diffusion-weighted imaging from 1 point.Results:Of the 76 patients (median age, 76 [67.25–82] years, 48 male) with the small subcortical infarction of the LSA, 22 (median age, 75.5 [64.75–82.5] years, 13 male) presented with an apparent TSV and/or brush sign. On univariable logistic analysis, only the presence of apparent TSV and/or brush sign (OR, 3.12; 95% CI, 1.11–8.73;p=0.03) was associated with infarct growth. In multivariable logistic regression analysis, age (OR, 1.07; 95% CI, 1.01–1.14;p=0.02) and infarct growth (OR, 4.46; 95% CI, 1.37–14.54;p=0.01) were independently associated with progressive paralysis.Conclusion:An apparent TSV or brush sign could indicate infarct growth in cases of the small subcortical infarction of the LSA.

Stroke, Volume 56, Issue Suppl_1, Page AWP181-AWP181, February 1, 2025. Background:Timely intervention is crucial for patients with acute ischemic stroke. The RapidAI imaging system (RAPID) was implemented to enhance the speed and efficiency of care delivery. We evaluated the impact of RAPID on various metrics in the patient care pathway.Methods:In this retrospective observational study, we analyzed consecutive patients who presented to our hospital ER with acute ischemic stroke and who were treated with Intravenous Thrombolysis (IVT) or mechanical thrombectomy between December 20, 2014, and April 20, 2024. Patients were divided into pre-RAPID (n =186) and post-RAPID (n =264) groups based on the implementation date of the RAPID system (September 1, 2019). We compared Door to Non-contrast CT (NCCT), Door to CT Angiography (CTA) / Perfusion Imaging, Door to IVT, and Door to Puncture / first pass for thrombectomy, between the two groups using Fisher’s exact test.Results:For Door to CT, no significant difference was observed between pre-RAPID and post-RAPID groups; 74% of patients in the post-RAPID group and 71% in the pre-RAPID group received NCCT within 45 minutes (p= 0.44). Significant improvements were observed in Door to CTA/Perfusion times; 90% of patients received vessel or perfusion imaging within 150 minutes post-RAPID compared to 70% pre-RAPID (p= 0.01), and 87% received imaging within 120 minutes post-RAPID compared to 70% pre-RAPID (p= 0.031). For Door to IVT, 96% of patients received treatment within 120 minutes post-RAPID compared to 82% pre-RAPID (p= 0.015). For thrombectomy, there was a trend toward faster door to puncture post-RAPID; 70% of patients were treated within 150 minutes post-RAPID compared to 62% pre-RAPID (p= 0.36), and 90% were treated within 210 minutes post-RAPID compared to 81% pre-RAPID (p= 0.12). Similarly, a trend toward faster Door to First Pass times was observed post-RAPID, with 88% treated within 240 minutes compared to 80% pre-RAPID (p= 0.20).Conclusions:RapidAI Implementation was associated with significant improvements in key workflow metrics, notably in Door to Vessel/Perfusion Imaging and Door to IVT. These findings suggest that RAPID enhances the efficiency of patient care delivery in acute ischemic stroke. Further studies with larger sample sizes are warranted.

Stroke, Volume 56, Issue Suppl_1, Page ATMP11-ATMP11, February 1, 2025. Introduction:Moyamoya disease (MMD) is a rare cerebrovascular disease causing nonatherosclerotic intracranial arterial stenosis in children and young adults. TheRNF213gene variant plays an important role in the pathophysiology of MMD, particularly among East Asian populations. However, this variant is rarely found in patients of other ethnicity. Previous studies have shown thatRNF213gene variant is related to vascular structures such as the extent of moyamoya collaterals and posterior cerebral artery involvement. In this study, we utilize an imaging-based approach to investigate vascular structural features in MMD, which may offer novel insights into the pathophysiology of MMD.Methods:We retrospectively reviewed 770 patients with MMD or Moyamoya syndrome (MMS) from diverse ethnic backgrounds at Stanford University Medical Center treated between 2015 and 2024 (Fig. 1). After selecting sporadic non-hemorrhagic bilateral MMD patients aged 18-50 years old, the vascular structures acquired on MRA were visually assessed to evaluate the degree of intracranial arterial stenosis and basal moyamoya collaterals. T2 weighted images were reviewed to assess negative remodeling – shrinkage of the outer diameter of middle cerebral arteries (MCA) and internal cerebral arteries (ICA) as defined by Kuroda et al.2015, Neurol Med Chir (Tokyo).Results:Detailed demographic and clinical characteristics of 107 patients evaluated were listed in Table 1. By reviewing MRA, we have identified a subset of patients with unique imaging features characterized by ICA stenosis localized proximal to the terminal portion of ICA, differing from the typical lesion sites seen in MMD (Fig. 2). This non-terminal ICA stenosis was more frequently observed in Caucasian than in Asian patients (17.5% vs. 5.7%, P=0.007). Compared to patients with terminal ICA and/or MCA stenosis, patients with non-terminal ICA stenosis were older (P=0.03), had less advanced disease stages (P