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- Latini, Francesco, et al.
(author)
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Rapid and Accurate MRI Segmentation of Peritumoral Brain Edema in Meningiomas
- 2017
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In: Clinical neuroradiology. - : Springer Science and Business Media LLC. - 1869-1447 .- 1869-1439. ; 27:2, s. 145-152
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Journal article (peer-reviewed)abstract
- PURPOSE:The extent of peritumoral brain edema (PTBE) in meningiomas commonly affects the clinical outcome. Despite its importance, edema volume is usually highly inaccurately approximated to a spheroid shape. We tested the accuracy and the reproducibility of semiautomatic lesion management software for the analysis of PTBE in a homogeneous case series of surgically confirmed intracranial meningiomas.METHODS:PTBE volume was calculated on magnetic resonance images in 50 patients with intracranial meningiomas using commercial lesion management software (Vue PACS Livewire, Carestream, Rochester, NY, USA). Inter and intraobserver agreement evaluation and a comparison between manual volume calculation, the semiautomatic software and spheroid approximation were performed in 22 randomly selected patients.RESULTS:The calculation of edema volume was possible in all cases irrespective of the extent of the signal changes. The median time for each calculation was 3 min. Interobserver and intraobserver agreement confirmed the reproducibility of the method. Comparison with standard (fully manual) calculation confirmed the accuracy of this software.CONCLUSIONS:Our study showed a high level of reproducibility of this semiautomatic computational method for peritumoral brain edema. It is rapid and easy to use after relatively short training and is suitable for implementation in clinical practice.
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- Ospel, Johanna M., et al.
(author)
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What is a Challenging Clot? : A DELPHI Consensus Statement from the CLOTS 7.0 Summit
- 2023
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In: Clinical Neuroradiology. - 1869-1439 .- 1869-1447. ; 33:4, s. 1007-1016
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Journal article (peer-reviewed)abstract
- Background: Predicting a challenging clot when performing mechanical thrombectomy in acute stroke can be difficult. One reason for this difficulty is a lack of agreement on how to precisely define these clots. We explored the opinions of stroke thrombectomy and clot research experts regarding challenging clots, defined as difficult to recanalize clots by endovascular approaches, and clot/patient features that may be indicative of such clots. Methods: A modified DELPHI technique was used before and during the CLOTS 7.0 Summit, which included experts in thrombectomy and clot research from different specialties. The first round included open-ended questions and the second and final rounds each consisted of 30 closed-ended questions, 29 on various clinical and clot features, and 1 on number of passes before switching techniques. Consensus was defined as agreement ≥ 50%. Features with consensus and rated ≥ 3 out of 4 on the certainty scale were included in the definition of a challenging clot. Results: Three DELPHI rounds were performed. Panelists achieved consensus on 16/30 questions, of which 8 were rated 3 or 4 on the certainty scale, namely white-colored clots (mean certainty score 3.1), calcified clots under histology (3.7) and imaging (3.7), stiff clots (3.0), sticky/adherent clots (3.1), hard clots (3.1), difficult to pass clots (3.1) and clots that are resistant to pulling (3.0). Most panelists considered switching endovascular treatment (EVT) techniques after 2–3 unsuccessful attempts. Conclusion: This DELPHI consensus identified 8 distinct features of a challenging clot. The varying degree of certainty amongst the panelists emphasizes the need for more pragmatic studies to enable accurate a priori identification of such occlusions prior to EVT.
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- Sandborg, Michael, et al.
(author)
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Patient Organ Radiation Doses During Treatment for Aneurysmal Subarachnoid Hemorrhage
- 2012
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In: Clinical neuroradiology. - : Springer. - 1869-1447 .- 1869-1439. ; 22:4, s. 315-325
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Journal article (peer-reviewed)abstract
- PURPOSE: The aim of this retrospective study was to estimate risk organ doses and to estimate radiation risks during the imaging work-up and treatment for aneurysmal subarachnoid hemorrhage (SAH). METHODS: The imaging procedures comprised computed tomography and digital subtraction angiography studies for diagnosis or endovascular interventional procedures in 50 consecutive patients. Equivalent organ doses (H(T)) to skin, brain, eye lens, salivary glands, thyroid and oral mucosa were measured using thermoluminescence dosimeters in an anthropomorphic head phantom. Picture archiving and communication system (PACS) and radiological information system (RIS) records were analyzed and the frequency of each imaging procedure was recorded as well as the registered individual kerma-length product (P(KL)) and the kerma-area product (P(KA)). The doses were computed by multiplying the recorded P(KL) and P(KA) values by the conversion coefficients H(T)/P(KL) and H(T)/P(KA) from the head phantom. RESULTS: The mean fluoroscopy time, P(KL) and P(KA) were 38 min, 7269 mGy cm and 286 Gy cm(2), respectively. The estimated mean equivalent doses were as follows: skin 2.51 Sv, brain 0.92 Sv, eye lens 0.43 Sv and salivary glands 0.23 Sv. Maximum organ doses were 2.3-3.5 times higher than the mean. Interventional procedures contributed 66 % to skin dose, 55 % to brain dose and 25 % to eye lens dose. Of the patients with an estimated skin dose exceeding 6 Sv, only 1 developed temporary epilation. CONCLUSION: The risk for radiation-induced cancer for SAH patients is low (2-3 cases per 1,000 patients, of which 90 % are expected to be benign types) compared with the risk of tissue reactions on the head such as skin erythema and epilation (1 temporary epilation per 50 patients).
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