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23 September 2021, 3:24 pm
Guilliams, K. P., Gupta, N., Srinivasan, S., Binkley, M. M., Ying, C., Couture, L., Gross, J., Wallace, A., McKinstry, R. C., Vo, K., Lee, J.- M., An, H., Goyal, M. S.
BACKGROUND AND PURPOSE:

Asymmetries in the circle of Willis have been associated with several conditions, including migraines and stroke, but they may also be age-dependent. This study examined the impact of age and age-dependent changes in cerebral perfusion on circle of Willis anatomy in healthy children and adults.

MATERIALS AND METHODS:

We performed an observational, cross-sectional study of bright and black-blood imaging of the proximal cerebral vasculature using TOF-MRA and T2 sampling perfection with application-optimized contrasts by using different flip angle evolution (T2-SPACE) imaging at the level of the circle of Willis in 23 healthy children and 43 healthy adults (4–74 years of age). We compared arterial diameters measured manually and cerebral perfusion via pseudocontinuous arterial spin-labeling between children and adults.

RESULTS:

We found that the summed cross-sectional area of the circle of Willis is larger in children than in adults, though the effect size was smaller with T2-SPACE-based measurements than with TOF-MRA. The circle of Willis is also more symmetric in children, and nonvisualized segments occur more frequently in adults than in children. Moreover, the size and symmetry of the circle of Willis correlate with cerebral perfusion.

CONCLUSIONS:

Our results demonstrate that the circle of Willis is different in size and symmetry in healthy children compared with adults, likely associated with developmental changes in cerebral perfusion. Further work is needed to understand why asymmetric vasculature develops in some but not all adults.


23 September 2021, 3:23 pm
Schmidbauer, V. U., Dovjak, G. O., Yildirim, M. S., Mayr-Geisl, G., Weber, M., Diogo, M. C., Gruber, G. M., Prayer, F., Milos, R.- I., Stuempflen, M., Ulm, B., Binder, J., Bettelheim, D., Kiss, H., Prayer, D., Kasprian, G.
BACKGROUND AND PURPOSE:

On the basis of a single multidynamic multiecho sequence acquisition, SyMRI generates a variety of quantitative image data that can characterize tissue-specific properties. The aim of this retrospective study was to evaluate the feasibility of SyMRI for the qualitative and quantitative assessment of fetal brain maturation.

MATERIALS AND METHODS:

In 52 fetuses, multidynamic multiecho sequence acquisitions were available. SyMRI was used to perform multidynamic multiecho–based postprocessing. Fetal brain maturity was scored qualitatively on the basis of SyMRI-generated MR imaging data. The results were compared with conventionally acquired T1-weighted/T2-weighted contrasts as a standard of reference. Myelin-related changes in T1-/T2-relaxation time/relaxation rate, proton density, and MR imaging signal intensity of the developing fetal brain stem were measured. A Pearson correlation analysis was used to detect correlations between the following: 1) the gestational age at MR imaging and the fetal brain maturity score, and 2) the gestational age at MR imaging and the quantitative measurements.

RESULTS:

SyMRI provided images of sufficient quality in 12/52 (23.08%) (range, 23 + 6–34 + 0) fetal multidynamic multiecho sequence acquisitions. The fetal brain maturity score positively correlated with gestational age at MR imaging (SyMRI: r = 0.915, P < .001/standard of reference: r = 0.966, P < .001). Myelination-related changes in the T2 relaxation time/T2 relaxation rate of the medulla oblongata significantly correlated with gestational age at MR imaging (T2-relaxation time: r = –0.739, P = .006/T2-relaxation rate: r = 0.790, P = .002).

CONCLUSIONS:

Fetal motion limits the applicability of multidynamic multiecho–based postprocessing. However, SyMRI-generated image data of sufficient quality enable the qualitative assessment of maturity-related changes of the fetal brain. In addition, quantitative T2 relaxation time/T2 relaxation rate mapping characterizes myelin-related changes of the brain stem prenatally. This approach, if successful, opens novel possibilities for the evaluation of structural and biochemical aspects of fetal brain maturation.


23 September 2021, 3:17 pm
Malinova, V., Döring, K., Psychogios, M.- N., Rohde, V., Mielke, D.
BACKGROUND AND PURPOSE:

The acute phase of aneurysmal SAH is characterized by a plethora of impending complications with the potential to worsen patients’ outcomes. The aim of this study was to evaluate whether an elaborated CTP-based imaging protocol during the acute aneurysmal SAH phase is able to prevent delayed infarctions and contribute to a better outcome.

MATERIALS AND METHODS:

In 2012, an elaborated CTP-based protocol was implemented for the management of patients with aneurysmal SAH. Retrospective analysis of patients with aneurysmal SAH treated from 2010 to 2013 was performed, comparing the patients treated before (group one, 2010–2011) with those treated after the protocol implementation (group two, 2012–2013) with regard to delayed infarctions and outcome according to the mRS at 3-months’ follow-up.

RESULTS:

A total of 133 patients were enrolled, of whom 57 were included in group 1, and 76, in group 2. There were no significant differences between the groups concerning baseline characteristics. In the multivariate analysis, independent predictors of a good outcome (mRS ≤ 2) were younger age (P < .001), lower World Federation of Neurosurgical Societies grade (P < .001), absence of delayed infarction (P = .01), and management according to the CTP protocol (P = .01). Larger or multiple infarctions occurred significantly more often in group 1 compared with group 2 (88% versus 33% of all delayed infarctions, P = .03). The outcome in group 2 was significantly better compared with group 1 (P = .005).

CONCLUSIONS:

The findings suggest that implementation of an elaborated CTP protocol is associated with a better outcome. An earlier initiation of further diagnostics and treatment with prevention of large territorial and/or multiple infarctions might have led to this finding.


23 September 2021, 3:16 pm
Altunisik, E., Baykan, A. H., Sahin, S., Aydin, E., Erturk, S. M.
BACKGROUND AND PURPOSE:

Anosmia or hyposmia, often accompanied by changes in taste, is recognized as a common symptom that can assist in the diagnosis of coronavirus disease 2019 (COVID-19). The pathogenesis of olfactory dysfunction in COVID-19 is not yet fully understood. MR imaging represents a useful anatomic imaging method for the evaluation of olfactory dysfunction associated with varying etiologies, including viral infection, trauma, and neurodegenerative processes. This case-control study was conducted to compare quantitative measurements of olfactory anatomic structures between patients diagnosed with COVID-19 associated with persistent olfactory dysfunction and healthy controls.

MATERIALS AND METHODS:

This study has a retrospective design. Cranial MR imaging was performed on all participants in both the patient and control groups. The bilateral olfactory bulb volume, olfactory tract length, and olfactory sulcus depth were measured in all patients.

RESULTS:

A total of 116 people aged 18–60 years, including 36 patients diagnosed with COVID-19 and 80 controls, were included in the study. All measured values were compared between the patient and control groups. The right, left, and total olfactory bulb volume values were significantly lower in the patient group than in the control group. The patient group also had significantly lower right and left olfactory sulcus depth and olfactory tract length values compared with those in the control group.

CONCLUSIONS:

MR imaging findings can be used to demonstrate olfactory injury in patients with COVID-19. The olfactory pathway may represent an alternative route for virus entry into the central nervous system.


23 September 2021, 3:15 pm
Hendrix, P., Chaudhary, D., Avula, V., Abedi, V., Zand, R., Noto, A., Melamed, I., Goren, O., Schirmer, C. M., Griessenauer, C. J.
BACKGROUND AND PURPOSE:

Current stroke care recommendations for patient selection for mechanical thrombectomy in the extended time window demand advanced imaging to determine the stroke core volume and hypoperfusion mismatch, which may not be available at every center. We aimed to determine outcomes in patients selected for mechanical thrombectomy solely on the basis of noncontrast CT and CTA in the early (<6-hour) and extended (≥6-hour) time windows.

MATERIALS AND METHODS:

Consecutive mechanical thrombectomies performed for acute large-vessel occlusion ischemic (ICA, M1, M2) stroke between February 2016 and August 2020 were retrospectively reviewed. Eligibility was based solely on demographics and noncontrast CT (ASPECTS) and CTA, due to the limited availability of perfusion imaging during the study period. Propensity score matching was performed to compare outcomes between time windows.

RESULTS:

Of 417 mechanical thrombectomies performed, 337 met the inclusion criteria, resulting in 205 (60.8%) and 132 (39.2%) patients in the 0- to 6- and 6- to 24-hour time windows, respectively. The ASPECTS was higher in the early time window (9; interquartile range = 8–10) than the extended time window (9; interquartile range = 7–10; P = .005). Propensity score matching yielded 112 well-matched pairs. Equal rates of TICI 2b/3 revascularization and symptomatic intracranial hemorrhage were observed. A favorable functional outcome (mRS 0–2) at 90 days was numerically more frequent in the early window (45.5% versus 33.9%, P = .091). Mortality was numerically more frequent in the early window (25.9% versus 17.0%, P = .096).

CONCLUSIONS:

Patients selected for mechanical thrombectomy in the extended time window solely on the basis of noncontrast CT and CTA still achieved decent rates of favorable 90-day functional outcomes, not statistically different from patients in the early time window.