Risultati per: L'imaging nella urolitiasi

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 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 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 AWP177-AWP177, February 1, 2025. Introduction:Automated imaging analysis tools are increasingly used in clinical decision-making for stroke. Rapid ASPECTS (iSchemaView, Menlo Park, CA) assists physicians by automatically calculating Alberta Stroke Program Early CT Scores (ASPECTS) and reducing inter-reader variability. To understand why the tool’s performance in real-world settings sometimes varies compared to published literature, we investigated how different imaging acquisition protocols affect its performance.Materials&Methods:Consecutive code stroke NCCT scans with thin (1.25 mm slice; 0.625 mm spacing) and thick (5.0 mm slice; 3 mm spacing) series were collected from a retrospective database between February 2020 and May 2021. Ground truth ASPECTS reads were collected from radiology reports, which neuroradiologists determined in real-time. Automated reads were obtained using Rapid ASPECTS 1.0 and 3.0 (iSchemaView, Menlo Park, CA). Agreement between automated and manual reads was defined as ASPECTS scores within two points.Results:A total of 682 cases were included in this analysis. 67 cases were excluded for technical inadequacy (hemorrhages, tumors, and artifacts). A review of the source imaging revealed that many cases had thick overlapping slices and incorrect head positioning (neck extended instead of the standard neutral position). These cases required significant tilt correction to align the patient data with the Rapid ASPECTS regions template. These corrections led to partial voluming artifacts, which caused lower Hounsfield unit (HU) values and ASPECTS scores. When adjusting protocols from thick to thin slices, agreement between ASPECTS V1 and manual reads improved from 85% (581/682) to 89% (606/682). ASPECTS V3 showed further improvement, with agreements of 91% (619/682) and 95% (648/682) for thick and thin slice scans, respectively.Conclusion:The combination of neck extension head positioning and thick overlapping slices caused partial voluming artifacts, resulting in artificially low ASPECTS scores on automated software. Our findings indicate that adjusting imaging protocols and working with the AI provider can enhance an algorithm’s accuracy. To ensure that commercially available automated analysis tools deliver accurate results, it is crucial to follow the recommended imaging acquisition protocols.

Stroke, Volume 56, Issue Suppl_1, Page ATP303-ATP303, February 1, 2025. Background:Prior studies indicate a relationship between migraine and MACE. Here we assess whether brain white matter hyperintensities (WMH), which are a common imaging finding in patient with migraine, contribute to the risk of MACE above demographics and common risk factors for MACE.Methods:60,454 patients, ages 18-89, with a ICD-9 or ICD-10 migraine diagnosis code in 2010 or later were identified from the Mayo Clinic electronic health record. Only patients who were seen for migraine in the Neurology Department were included. Patients with a migraine diagnosis who did not have MACE were included only if they had at least two visits at Mayo Clinic during five years. Only patients with sex and race information were included. The final cohort included 577 migraine patients with and 598 migraine patients without MACE. Presence of WMH was determined from radiology notes. Individuals without a brain MRI were assumed not to have WMH. A logistic regression model that included sex, race, known lifetime MACE risk factors (atrial fibrillation, diabetes, hypertension, hyperlipidemia, tobacco use) and WMH as independent variables to predict MACE outcome was fit.Results:Significant factors that increased the risk of MACE in individuals with migraine included being Black or African American (adjusted OR: 2.9, 95% CI: 1.24-6.82, p = 0.014), presence of atrial fibrillation (adj. OR: 1.63, 95% CI: 1.23-2.17, p < 0.001), diabetes (adj. OR: 1.34, 95% CI: 1.02-1.75, p = 0.036), hypertension (adj. OR: 1.9, 95% CI: 1.39-2.6, p < 0.001), tobacco use (adj. OR: 1.66, 95% CI: 1.29-2.14, p < 0.001), and the presence of WMH (adj. OR: 1.43, 95% CI: 1.1-1.87, p = 0.008). Hyperlipidemia showed a marginal association (adj. OR: 1.34, 95% CI: 0.99-1.81, p = 0.061), while other variables such as sex and other racial/ethnic groups did not significantly alter the risk of MACE outcome.Discussion:Results indicate that African American race and presence of WMH in addition to common comorbidities independently increase the risk of MACE outcome.

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

Stroke, Volume 56, Issue Suppl_1, Page AWP195-AWP195, February 1, 2025. Introduction:Randomized clinical trials evaluating the effects of endovascular treatment (EVT) for medium vessel occlusion (MeVO) are ongoing. However, it remains unclear how clinicians determine the indication for EVT in MeVO cases in real-world practiceHypothesis:We hypothesize that in actual clinical practice, there is a threshold of clinical symptoms and perfusion imaging findings that guide the decision to intervene with EVT for MeVO.Methods:We conducted a single-center retrospective registry from April 2019 to April 2024, enrolling consecutive patients with acute ischemic stroke due to MeVO. We compared the outcomes of MeVO patients who received EVT with those who received medical treatment (MT). The primary outcome was defined as a good functional outcome, indicated by a modified Rankin scale score of 0-2 at 90 days post-stroke onset. Secondary outcomes included exploring the optimal thresholds for EVT intervention in real-world clinical practice, based on clinical symptoms indicated by the National Institutes of Health Stroke Scale and perfusion imaging using RAPID software.Results:We analyzed 162 patients (EVT, n = 102; MT, n = 60). The mean age was 80 years, with 53.7% being men. Recombinant tissue plasminogen activator was used more frequently in the EVT group (42.2% vs. 18.3%). The median NIHSS was higher in the EVT group (median [interquartile range, IQR]; 13 [6–19] vs. 7 [2–14]). In terms of perfusion imaging, there was no significant difference between the two groups in CBF < 30% (median [IQR]; 4 [0–17] vs. 4 [0–22]). However, the median T max > 6 sec and mismatch volume were significantly higher in the EVT group (median [IQR]; 44 [27–82] vs. 28 [6–49] and 35 [21–55] vs. 12 [2–28], respectively). The primary outcome was not significantly different between the EVT and MT groups (41 [40.2%] vs. 25 [41.7%]; adjusted odds ratio [aOR]: 1.10 [95% CI: 0.42–2.89]). Receiver-operating characteristic analyses showed that the areas under the curves for NIHSS, CBF < 30%, T max > 6 sec, and mismatch volume were 0.64, 0.49, 0.68, and 0.74, respectively. Mismatch volume had the best discriminatory power with respect to EVT intervention, with a threshold of 20 ml.Conclusions:A mismatch volume of ≥ 20 ml may be a useful criterion for determining EVT intervention in MeVO cases in real-world practice.

Stroke, Volume 56, Issue Suppl_1, Page ATMP59-ATMP59, February 1, 2025. Introduction:Diffusion-weighted imaging (DWI) is key for detecting acute ischemic brain lesions but struggles with hyperacute or small lesions that mimic artifacts. This randomized crossover trial assessed whether an artificial intelligence (AI) solution enhances diagnostic accuracy for these challenging lesions compared to conventional interpretation.Methods:From February 2017 to November 2021, 4,071 suspected acute ischemic stroke patients underwent initial and follow-up DWI. A neurologist assessed ischemic stroke based on medical records, and a neuroradiologist established the ground truth using the neurologist’s evaluation, MRI reports, and AI-marked DWI images. The accuracy of AI and MRI reports was then evaluated against this ground truth.For a reader performance study, 874 challenging cases were selected: (1) infarct volume < 0.5 mL in the posterior circulation on follow-up DWI or (2) initial DWI within 3 hours of onset with infarct volume < 1.0 mL in the anterior circulation. Additionally, 80 negative and 40 positive control cases were included. Five readers (a neuroradiologist, two radiology residents, and two neurology residents) interpreted the DWIs, half with AI assistance and half without. After a 4-week washout, cases were re-evaluated with the groups reversed. We compared the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and Dice similarity coefficient (DSC) between readings with and without AI.Results:Of 3,981 patients, 3,465 had acute ischemic strokes, and 516 had MRI-negative transient ischemic attacks. The AI alone showed a positive predictive value (PPV) of 93.1% and a negative predictive value (NPV) of 81.3%. The PPV of AI varied significantly with predicted infarction volume: 81.7% for ≤ 0.5 mL vs. 99.5% for > 0.5 mL. With AI, the sensitivity of MRI reports could potentially increase from 98.5% to 99.7%, ensuring identification of all false negatives.In the challenging case reader study, AI significantly increased AUC (0.848 vs. 0.927; p < 0.001) and sensitivity (74.59% to 90.59%; p < 0.001), with minimal impact on specificity (88.75% vs. 84.00%; p = 0.0496). AI-assisted segmentation also showed higher DSC compared to non-AI segmentation (0.742 vs. 0.523; p < 0.001).Conclusions:AI significantly improved the diagnostic performance for challenging acute ischemic lesions on DWI, demonstrating the potential to enhance stroke care.

Stroke, Volume 56, Issue Suppl_1, Page ATP165-ATP165, February 1, 2025. Background:Posterior circulation (PC) large-vessel occlusion (LVO) strokes have significant morbidity and mortality, but patient selection for acute interventions remains understudied. Multiple computed tomography (CT)-based scores exist, including the CT-perfusion-based CAPS score, CT-angiogram(CTA)-based BATMAN and PC-CTA scores, and CTA source image or non-contrast-CT-based PC-ASPECTS score, but their predictive values for long-term outcomes after thrombectomy have not been directly compared.Methods:We conducted a retrospective multicenter cohort study of patients with basilar artery occlusions treated with endovascular thrombectomy. Four CT-based scores were assessed: PC-ASPECTS, BATMAN, PC-CTA, and CAPS. The primary outcome of interest for the study was favourable functional outcome at 3 months (mRS of 0-3). We generated receiver operating characteristic curves measuring area under the curve (AUC) for poor functional outcomes and compared AUCs with non-parametric methods.Results:98 patients were included for analysis, with an average age of 64.9±15.6 years.The median National Institute of Health Stroke Severity Score (NIHSS) was 13.5 (IQR 7.0 – 23.0). AUC values were highest for the CAPS score (AUC 0.72 (95%CI 0.63 – 82)), and lowest for the pc-CTA score (AUC 0.57 (95%CI 0.45 – 0.68)), p=0.019. There was a trend towards the CAPS score outperforming the BATMAN (AUC 0.66 (95%CI 0.55 – 0.77) and PC-ASPECTS scores (AUC 0.63 (95%CI 0.52 – 0.75)), though this difference was not statistically significant (p=0.29 and p=0.23, respectively). However, the CAPS score was the only score with 100% specificity for predicting inability to achieve good functional outcome after thrombectomy: 0/12 patients with CAPS score of 4-6 went on to have a good functional outcome at 3 months after thrombectomy.Conclusion:Our analysis demonstrated that the CT-perfusion-based CAPS score outperformed three other imaging-based scores for predicting outcomes after 3 months. The CAPS score could be implemented to inform patient selection for endovascular thrombectomy in basilar artery occlusions.

Stroke, Volume 56, Issue Suppl_1, Page ATP164-ATP164, February 1, 2025. Background:Ischemic stroke is a leading causes of death and disability and imaging is essential when determining treatment. Currently, both computed tomography (CT) and magnetic resonance (MR) are accepted as options for first imaging of stroke. Whether MR or CT is more advantageous for first stroke imaging has yet to be determined in a randomized study. The goal of this study was to determine feasibility of randomizing code stroke patients to MR or CT.Methods:Multisite, randomized, prospective study of code stroke patients presenting within a 12-week window to 4 certified stroke centers. Hospital-level cluster randomization assigned each site 6 CT-first weeks, and 6 MR-first weeks. Patients ≥18 years presenting with stroke symptoms < 24 hours with active code strokes at time of first imaging were included. Patients transferred from another hospital or who received prior imaging at an outside facility were excluded. Demographics, clinical stroke variables, and workflow metrics were extracted from the local stroke database or patient electronic health records. A univariate logistic regression model was used to evaluate the primary outcome: compliance (i.e. proportion of patients scanned according to assigned imaging). We hypothesized compliance would be comparable to that seen when MR-first was the preferred standard of care, ≥60%, demonstrating feasibility.Results:406 patients (199 females; mean age 67 years, range 24 - 103) were included in the analysis (Table 1). Compliance with assignment to CT was 90%, compliance with MR was 66%. Those assigned to MR were significantly less likely to be scanned as assigned (OR: 0.21, 95% CI [0.12-0.36]). Reasons for non-compliance included both process-related (e.g. MR scanner in use) and patient-related reasons (e.g. medically unstable). Most frequently, the reason for non-compliance was not documented.Conclusion:This study is the first step in evaluating feasibility for a large-scale randomized clinical trial to determine whether MR or CT is preferable as the first stroke imaging modality. Compliance with assignment (MR or CT) our preset threshold of 60%, with significantly higher compliance when CT was assigned compared to MR. With mitigation of process-related barriers to randomization compliance, these results inform next steps in optimizing a future trial.