Influence of inferior petrosal sinus drainage symmetry on detection of adenomas in Cushing's syndrome.

Background: Asymmetric inferior petrosal sinuses (IPS) are not infrequently encountered during bilateral IPS sampling. There is little data on whether IPS symmetry influences success in predicting the adenoma side in patients with ACTH-dependent Cushing's syndrome (CS).

Objective: To assess the influence of IPS drainage patterns on detection of an adenoma in CS.

Anomalies and Normal Variants of the Cerebral Arterial Supply: A Comprehensive Pictorial Review with a Proposed Workflow for Classification and Significance.

Cerebral arteries may exhibit a wide range of variation from normal anatomy, which can be incidentally discovered during imaging. Knowledge of such variants is crucial to differentiate them from pathologies, to understand the etiology of certain pathologies directly related to a vascular variant, and to depict the changes in collateral circulation in patients with certain variants. Detection of particular variants may lead to the discovery of other nonvascular or vascular anomalies, especially aneurysms, and may also affect planning of endovascular or neurosurgical interventions.

Reconsidering the logic of World Federation of Neurosurgical Societies grading in patients with severe subarachnoid hemorrhage.

Objective: Current data show a favorable outcome in up to 50% of patients with World Federation of Neurosurgical Societies (WFNS) Grade V subarachnoid hemorrhage (SAH) and a rather poor prediction of worst cases. Thus, the usefulness of the current WFNS grading system for identifying the worst scenarios for clinical studies and for making treatment decisions is limited. One reason for this lack of differentiation is the use of "negative" or "silent" diagnostic signs as part of the WFNS Grade V definition.

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage.

Object: After subarachnoid hemorrhage (SAH), seizure occurs in up to 26% of patients. The impact of seizure on outcome has been studied, yet its impact on grading is unknown. The authors evaluated the impact of early-onset seizures (EOS) on grading of spontaneous SAH and on outcome.

Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral artery with NIHSS score of less than 5: comparison between thrombolysed and non-thrombolysed patients.

Background And Purpose: The use of thrombolysis in patients with minor neurological deficits and large vessel occlusion is controversial.

Methods: We compared the outcome of patients with low National Institutes of Health Stroke Scale (NIHSS) scores and large vessel occlusions between thrombolysed and non-thrombolysed patients.

Results: 88 (1.

Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients.

Object: The etiology of chronic subdural hematoma (CSDH) in nongeriatric patients (≤ 60 years old) often remains unclear. The primary objective of this study was to identify spinal CSF leaks in young patients, after formulating the hypothesis that spinal CSF leaks are causally related to CSDH.

Methods: All consecutive patients 60 years of age or younger who underwent operations for CSDH between September 2009 and April 2011 at Bern University Hospital were included in this prospective cohort study.

Diagnostic and Prognostic Impact of pc-ASPECTS Applied to Perfusion CT in the Basilar Artery International Cooperation Study.

Background And Purpose: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-APECTS) applied to CT angiography source images (CTA-SI) predicts the functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). We assessed the diagnostic and prognostic impact of pc-ASPECTS applied to perfusion CT (CTP) in the BASICS registry population.

Methods: We applied pc-ASPECTS to CTA-SI and cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) parameter maps of BASICS patients with CTA and CTP studies performed.

Age dependency of safety and outcome of endovascular therapy for acute stroke.

Elderly patients generally experience less favorable outcomes and higher mortality after acute stroke than younger patients. The aim of this study was to analyze the influence of age on outcome and safety after endovascular therapy in a large cohort of patients aged between 20 and 90 years. We prospectively acquired data of 1,000 stroke patients treated with endovascular therapy at a single center.

Desmoplastic small round cell tumor: a rare cause of a progressive brachial plexopathy.

Introduction: Desmoplastic small round cell tumor (DSRCT) is an uncommon, embryonic-type neoplasm, typically presenting as an abdominal mass in young men. A single case of DSRCT arising in the peripheral nervous system has been reported previously.

Methods: The clinical course, imaging, electrophysiological, intraoperative, histopathological, molecular findings, and postoperative follow-up are reported.

The Importance of Patency in Patients with Critical Limb Ischemia Undergoing Endovascular Revascularization for Infrapopliteal Arterial Disease.

Critical limb ischemia (CLI) represents the most severe form of peripheral arterial disease (PAD) and frequently occurs in medically frail patients. CLI patients frequently exhibit multi-segmental PAD commonly including the tibial arterial segment. Endovascular therapy has been established as first-line revascularization strategy for most CLI patients.

CT dose and image quality in the last three scanner generations.

Aim: To compare the computed tomography (CT) dose and image quality with the filtered back projection against the iterative reconstruction and CT with a minimal electronic noise detector.

Methods: A lung phantom (Chest Phantom N1 by Kyoto Kagaku) was scanned with 3 different CT scanners: the Somatom Sensation, the Definition Flash and the Definition Edge (all from Siemens, Erlangen, Germany). The scan parameters were identical to the Siemens presetting for THORAX ROUTINE (scan length 35 cm and FOV 33 cm).

Characterization of microcirculation in multiple sclerosis lesions by dynamic texture parameter analysis (DTPA).

Objective: Texture analysis is an alternative method to quantitatively assess MR-images. In this study, we introduce dynamic texture parameter analysis (DTPA), a novel technique to investigate the temporal evolution of texture parameters using dynamic susceptibility contrast enhanced (DSCE) imaging. Here, we aim to introduce the method and its application on enhancing lesions (EL), non-enhancing lesions (NEL) and normal appearing white matter (NAWM) in multiple sclerosis (MS).

Detecting subarachnoid hemorrhage: comparison of combined FLAIR/SWI versus CT.

Objectives: Aim of this study was to compare the utility of susceptibility weighted imaging (SWI) with the established diagnostic techniques CT and fluid attenuated inversion recovery (FLAIR) in their detecting capacity of subarachnoid hemorrhage (SAH), and further to compare the combined SWI/FLAIR MRI data with CT to evaluate whether MRI is more accurate than CT.

Methods: Twenty-five patients with acute SAH underwent CT and MRI within 6 days after symptom onset. Underlying pathology for SAH was head trauma (n=9), ruptured aneurysm (n=6), ruptured arteriovenous malformation (n=2), and spontaneous bleeding (n=8).

National Institutes of Health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke.

Background And Purpose: There is some controversy on the association of the National Institutes of Health Stroke Scale (NIHSS) score to predict arterial occlusion on MR arteriography and CT arteriography in acute stroke.

Methods: We analyzed NIHSS scores and arteriographic findings in 2152 patients (35.4% women, mean age 66 ± 14 years) with acute anterior or posterior circulation strokes.

Retrograde cochlear implantation in postmeningitic basal turn ossification.

Objectives/hypothesis: Postmeningitic basal turn ossification is a challenge for successful cochlear implantation despite the availability of sophisticated implants and advanced drill-out procedures. A less complex concept consisting of a cochleostomy near the apex with retrograde array insertion is evaluated clinically and experimentally with emphasis on imaging of intracochlear array morphology.

Study Design: Retrospective case-control study.

Myelography in the Age of MRI: Why We Do It, and How We Do It.

Myelography is a nearly ninety-year-old method that has undergone a steady development from the introduction of water-soluble contrast agents to CT myelography. Since the introduction of magnetic resonance imaging into clinical routine in the mid-1980s, the role of myelography seemed to be constantly less important in spinal diagnostics, but it remains a method that is probably even superior to MRI for special clinical issues. This paper briefly summarizes the historical development of myelography, describes the technique, and discusses current indications like the detection of CSF leaks or cervical root avulsion.

Determination of language dominance: Wada test and fMRI compared using a novel sentence task.

Background And Purpose: This study aimed to develop a new linguistic based functional magnetic resonance imaging (fMRI)-sentence decision task that reliably detects hemispheric language dominance.

Methods: FMRI was performed in 13 healthy right-handed controls and 20 patients at 1.5 T prior to neurosurgery.

Selective inferior petrosal sinus sampling without venous outflow diversion in the detection of a pituitary adenoma in Cushing's syndrome.

Introduction: Conventional MRI may still be an inaccurate method for the non-invasive detection of a microadenoma in adrenocorticotropin (ACTH)-dependent Cushing's syndrome (CS). Bilateral inferior petrosal sinus sampling (BIPSS) with ovine corticotropin-releasing hormone (oCRH) stimulation is an invasive, but accurate, intervention in the diagnostic armamentarium surrounding CS. Until now, there is a continuous controversial debate regarding lateralization data in detecting a microadenoma.

Susceptibility-weighted imaging of the brain: does gadolinium administration matter?

Objective: Susceptibility-weighted MR imaging (SWI) is usually obtained without administration of intravenous gadolinium (Gd). However, it is occasionally necessary to perform SWI after Gd is injected. The effects of Gd on SWI have not been systematically examined.

Chorioretinal nocardiosis.

Purpose: Description of ocular involvement in a case of disseminated nocardiosis.

Methods: Case report of an immunosuppressed patient displaying a unilateral extramacular choroidal lesion presumed to be due to nocardia species. The patient received sulfonamide treatment for a culture-proven generalized nocardia infection.

Surgical approach for synovial cyst of the atlantoaxial joint: a case report and review of the literature.

Study Design: Case report and review of the literature.

Objective: We describe the first case of a synovial cyst arising from pseudarthrosis of a previous dens fracture. The literature is reviewed and etiological, diagnostic, and therapeutic options of atlantoaxial cysts are discussed.

Stent placement in the endovascular treatment of intracranial aneurysms.

Objective: To analyze the immediate and midterm angiographic and clinical results of stent placement in the endovascular treatment of intracranial cerebral aneurysms.

Methods: Out of 330 cerebral aneurysms treated by endovascular approach in our neurovascular centre, stents have been used in 18 patients. Twelve aneurysms (66.

A novel method for analyzing DSCE-images with an application to tumor grading.

Objectives: (a) The development of a novel analysis method, named Dynamic pixel intensity Histogram Analysis (DHA) allowing for pixel intensity-histogram-model-parameter fitting of arbitrary-shaped regions defined in dynamic-susceptibility-contrast-enhanced (DSCE) difference MR-image time-series, and (b) its prospective application and evaluation for glioma grading.

Materials And Methods: For each difference-image, pixel intensity histograms of arbitrary-shaped ROIs were computed and fitted using the Levenberg-Marquardt algorithm. Time-dependent histogram center-position- and width-parameters are computed during bolus-passage.