Variation in CT perfusion protocol has implications on defining irreversibly damaged ischemic brain parenchyma.

• Computed tomographic perfusion (CTP) is increasingly being used in the characterization of brain ischemia.• Variations in post-processing protocols continue to be a challenge, resulting in a slight variation of CTP results.• We need to adopt a universal acquisition protocol to help optimize output of CTP.

Imaging for Predicting Hemorrhagic Transformation of Acute Ischemic Stroke-A Narrative Review.

Hemorrhagic transformation is caused by extravasation of blood products from vessels after acute ischemic stroke. It is an undesirable and potentially devastating complication, which occurs in 10%-40% of clinical cases. Hemorrhagic transformation is classified into four subtypes based on European cooperative acute stroke study II.

Early diagnosis of mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI): protocol for a prospective cohort study.

Introduction: Severe traumatic brain injury (TBI) is a catastrophic neurological condition with significant economic burden. Early in-hospital mortality (<48 hours) with severe TBI is estimated at 50%. Several clinical examinations exist to determine brain death; however, most are difficult to elicit in the acute setting in patients with severe TBI.

Bleomycin for orbital and peri-orbital veno-lymphatic malformations - A systematic review.

Background: Orbital and peri-orbital venolymphatic malformations (VLM) are low flow vascular malformations. Intralesional bleomycin is now commonly being used to treat such malformations.

Objective: The purpose of this systematic review is to synthesize evidence on the safety and efficacy of bleomycin/pingyangmycin sclerotherapy for the treatment of orbital and peri-orbital VLM.

Bleomycin for Head and Neck Venolymphatic Malformations: A Systematic Review.

Background: Venolymphatic malformations are rare benign vascular lesions of the head and neck. Sclerotherapy has become the first-line therapy of these lesions with bleomycin being a sclerosing agent commonly used.

Purpose: To perform a systematic review of the published literature to synthesize evidence on the safety and efficacy of bleomycin for the treatment of head and neck venolymphatic malformations.

Comprehensive Aneurysm Management (CAM): An All-Inclusive Care Trial for Unruptured Intracranial Aneurysms.

Background: In the absence of randomized evidence, the optimal management of patients with unruptured intracranial aneurysms (UIA) remains uncertain.

Methods: Comprehensive Aneurysm Management (CAM) is an all-inclusive care trial combined with a registry. Any patient with a UIA (no history of intracranial hemorrhage within the previous 30 days) can be recruited, and treatment allocation will follow an algorithm combining clinical judgment and randomization.

Diagnostic Yield of MRI for Sensorineural Hearing Loss - An Audit.

Purpose: Contrast-enhanced magnetic resonance imaging (CEMRI) of the head is frequently employed in investigations of sensorineural hearing loss (SNHL). The yield of these studies is perceptibly low and seemingly at odds with the aims of wise resource allocation and risk reduction within the Canadian healthcare system. The purpose of our study was to audit the use and diagnostic yield of CEMRI for the clinical indication of SNHL in our institution and to identify characteristics that may be leveraged to improve yield and optimize resource utilization.

Endovascular Thrombectomy for Stroke Effectiveness Study-An Audit From a Small Tertiary Care Center.

Purpose: Endovascular thrombectomy (EVT) treatment for acute ischemic stroke is now recommended as a standard of care. However, implementing EVT in routine clinical practice poses many challenges, even in countries with advanced health-care systems. The aim of the current study is to delineate if EVT at our institution is an effective treatment for acute ischemic stroke.

Admission Perfusion CT for Classifying Early In-Hospital Mortality of Patients With Severe Traumatic Brain Injury: A Pilot Study.

The purposes of this study were to assess the feasibility and safety of perfusion CT of patients with severe traumatic brain injury (TBI) at hospital admission and to examine whether early in-hospital mortality could be characterized with perfusion CT (PCT). The hypothesis was that PCT can be used to characterize brain death, when present, in patients with severe TBI at hospital admission. In this prospective cohort pilot study, PCT was performed on patients with severe TBI at first imaging workup at hospital admission.

T2 Hypointensity Aids in the Diagnosis of Intracranial Metastatic Adenocarcinoma.

Background: The T2 hypointensity has been suggested to be associated with intracranial metastatic adenocarcinomas (IMA). The purpose of our study was to determine the association of T2 hypointensity with IMA.

Methods: All patients with pathologically confirmed metastatic brain tumors who had a magnetic resonance imaging (MRI) at our institution in the last 10 years were retrospectively assessed.

Clinico-radiological correlation of magnetic resonance imaging findings in patients with idiopathic intracranial hypertension.

Purpose: Although several studies have reported imaging findings associated with idiopathic intracranial hypertension (IIH), less is known about the correlation between imaging findings and IIH-related symptoms or signs. Our study aimed to determine if clinical features of IIH are correlated with magnetic resonance imaging (MRI) features.

Methods: A retrospective chart review was conducted on consecutive patients presenting at the neuro-ophthalmology department over the last 15 years.

Imaging Improves Efficacy of Vertebroplasty - A Systematic Review and Meta-Analysis.

Background: Clinical trials with percutaneous vertebral augmentation (PVA) for intractable pain from vertebral compression fractures (VCF) have shown variable results. Variation in the outcomes may be related to poor patient selection on imaging.

Objective: To assess if PVA augmentation for osteoporotic VCF results in better improvement in pain when patients were selected based on clinical examination plus imaging vs clinical examination only.

Are Anterior Communicating Aneurysms Truly Anterior Communicating Aneurysms? An Observational Study.

Objective: The term anterior communicating (ACom) aneurysm is often broadly used to classify any aneurysm formed on the A1-A2 junction, A1, A2, or ACom arteries. Aneurysm location has been associated with rupture risk, so whether an aneurysm is truly formed on the ACom artery can critically affect treatment decisions. The aim of this study was to reclassify broadly termed ACom aneurysms into 4 subgroups (A1, A2, true ACom, and A1-A2 junction) based on their location.

Diffusion weighted imaging may help differentiate intracranial hemangiopericytoma from meningioma.

Background And Purpose: Hemangiopericytoma and meningioma appear similar on routine diagnostic imaging and hence are difficult to distinguish. The purpose of our study was to examine the diffusion weighted imaging (DWI) characteristics of these two types of tumours.

Methods: In a retrospective study, each patient with hemangiopericytoma was matched with two meningioma patients based on tumour location and size.

The Role of Neuroimaging in the Determination of Brain Death.

Background And Purpose: Brain death determination (BDD) is primarily a clinical diagnosis, where death is defined as the permanent loss of brainstem function. In scenarios where clinical examinations are inaccurate, ancillary imaging tests are required. The choice of ancillary imaging test is variable, but the common denominator for all of them is to establish a lack of cerebral blood flow.

Computed Tomography Perfusion Aids in the Prognostication of Comatose Postcardiac Arrest Patients.

Early assessment of the potential for neurologic recovery in comatose cardiac arrest patients (CCAP) has been a challenge despite significant evolution in management and imaging techniques. The purpose of study was to determine if the use of computed tomography perfusion (CTP) in CCAPs is feasible and if this technique can predict the likelihood that CCAPs will have a devastating outcome at hospital discharge. We prospectively enrolled 10 newly admitted comatose adults who had an out-of-hospital cardiac arrest and were treated with standard therapeutic hypothermia protocols.

Diagnosing Neoplastic Hematoma: Role of MR Perfusion.

Background: The imaging appearance of neoplastic hematoma can be complicated by the presence of a large hematoma, even on magnetic resonance imaging (MRI). We describe the role of MR perfusion (MRP) in detecting neoplastic hematomas in patients with intraparenchymal hematoma (IPH).

Material And Methods: A retrospective review was performed for consecutive patients with IPH, where MRP was performed.

Digital Subtraction Angiography-Dynavision in Pretreatment Planning for Embolization of Dural Arterio-Venous Fistulas.

Background And Purpose: We have found DSA-Dynavision with multiplanar reconstruction very helpful in understanding the complex anatomy and planning of treatment of carotico-cavernous fistulas. The purpose of our study was to examine whether using DSA-Dynavision in pretreatment planning results in better outcome after endovascular treatment of dural arterio-venous fistulas (dAVFs).

Methods: Patients with dAVF treated with endovascular embolization were retrospectively identified from our interventional neuroradiology database.

Use of Noncontrast Computed Tomography and Computed Tomographic Perfusion in Predicting Intracerebral Hemorrhage After Intravenous Alteplase Therapy.

Background And Purpose: Intracerebral hemorrhage is a feared complication of intravenous alteplase therapy in patients with acute ischemic stroke. We explore the use of multimodal computed tomography in predicting this complication.

Methods: All patients were administered intravenous alteplase with/without intra-arterial therapy.

Regional Comparison of Multiphase Computed Tomographic Angiography and Computed Tomographic Perfusion for Prediction of Tissue Fate in Ischemic Stroke.

Background And Purpose: Within different brain regions, we determine the comparative value of multiphase computed tomographic angiography (mCTA) and computed tomographic perfusion (CTP) in predicting follow-up infarction.

Methods: Patients with M1-middle cerebral artery occlusions were prospectively included in this multicenter study. Regional analysis was performed for each patient within Alberta Stroke Program Early CT Score regions M2 to M6.

CT Perfusion in Acute Stroke: "Black Holes" on Time-to-Peak Image Maps Indicate Unsalvageable Brain.

Background And Purpose: CT perfusion is becoming important in acute stroke imaging to determine optimal patient-management strategies. The purpose of this study was to examine the predictive value of time-to-peak image maps and, specifically, a phenomenon coined a "black hole" for assessing infarcted brain tissue at the time of scan.

Methods: Acute stroke patients were screened for the presence of black holes and their follow-up imaging (noncontrast CT or MR) was reviewed to assess for infarcted brain tissue.