Biomedical subjects

Walter Heindel

Publications and source records attributed to Walter Heindel.

At least 37 records · Page 2Linked to original sources

PubMed2006

MDCT determination of volume and function of the left ventricle: are short-axis image reformations necessary?

OBJECTIVE: Determination of left ventricular (LV) volumes and global function parameters from MDCT data sets is usually based on short-axis reformations from primarily reconstructed axial images, which prolong postprocessing time. The aim of this study was to evaluate the feasibility of LV volumetry and global LV function assessment from axial images in comparison with short-axis image reformations. SUBJECTS AND METHODS: This study consisted of 20 patients with either coronary artery disease or dilated cardiomyopathy. We evaluated MDCT results using cine MRI as the reference technique. RESULTS: LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) were significantly overestimated by the axial MDCT approach in comparison with volume measurements from short-axis CT image reformations. The mean LV ejection fraction (LVEF) was not significantly different (41.2% vs 42.7%). Short-axis and axial MDCT determination of LVEF revealed a systematic underestimation by a mean +/- SD of -2.1% +/- 3.6% versus -3.6% +/- 8.2%, respectively, when compared with LVEF values based on cine MRI. The interobserver variability for volume and function measurements from axial images (LVEDV = 8.5%, LVESV = 10.8%, LVEF = 9.6%) was slightly higher than those measurements from short-axis reformations (LVEDV = 7.2%, LVESV = 9.5%, LVEF = 8.7%). The mean total evaluation time was significantly shorter using axial images (14.1 +/- 3.9 min) compared with short-axis reformations (16.9 +/- 5.2 min) (p < 0.05). CONCLUSION: Determination of LV volumes and assessment of global LV function from axial MDCT image reformations is feasible and time efficient. This approach might be a clinically useful alternative to established short-axis-based measurements in patients with normal or near-normal LV function. A progressive underestimation of LVEF with increasing LV volumes may limit the clinical applicability of the axial approach in patients with dilated cardiomyopathy.

Cardiomyopathy, Dilated↗

PubMed2005

FLAIR imaging for multiple sclerosis: a comparative MR study at 1.5 and 3.0 Tesla.

The purpose of this study was (1) to identify the optimal TE for FLAIR-imaging at 3.0 T assessing three different echo times qualitatively and quantitatively and (2) to evaluate the diagnostic efficacy of high-field 3.0-T FLAIR imaging in comparison to conventional 1.5-T MRI in patients with multiple sclerosis (MS). Twenty-two patients with clinically definite MS underwent axial FLAIR imaging at 1.5 and 3.0 T. In 15 of these patients further FLAIR images with a TE of 100, 120 and 140 ms were acquired at 3.0 T. Imaging protocols were modified for 3.0 T using the increased SNR to acquire more and thinner slices while maintaining a comparable scan time. FLAIR images of either different TEs or different field strengths were ranked for each patient qualitatively by two observers. Signal intensity measurements were obtained in the gray and white matter, CSF and representative white matter lesions (WML). At 3.0 T, a TE of 100 and 120 ms proved superior in all qualitative categories when compared to 140 ms. In the quantitative assessment CNR of WML was highest for 120 ms (CNR: 19.8), intermediate for 100 ms (17.2) and lowest for 140 ms (15.3) (P<0.003). For lesion conspicuity and overall image quality, 3.0 T was judged superior to 1.5 T, whereas no difference was found for gray-white differentiation and image noise. With regard to artifacts, 3.0 T was inferior to 1.5 T. The CNR for WML was slightly lower at 3.0 T, but the difference was not significant (22.6 vs. 28.0, P=ns). However, significantly more WML were detected at 3.0 T than at 1.5 T (483 vs. 341, P<0.0001). The optimal echo time for FLAIR imaging at 3.0 T is 120 ms due to the significantly higher CNR of WML. By trading the higher SNR at 3.0 T for better spatial resolution, nearly the same CNR level could be maintained, increasing lesion detectability at 3.0 T compared to 1.5 T. Thus, high-field MRI may further strengthen the role of MRI as the most sensitive paraclinical test for the early diagnosis of MS.

Adult↗

PubMed2005

64-slice multidetector coronary CT angiography: in vitro evaluation of 68 different stents.

The purpose of this study was to test a large sample of different coronary artery stents using four image reconstruction approaches with respect to lumen visualization, lumen attenuation, and image noise in 64-slice multidetector-row computed tomography (MDCT) in vitro and to provide a catalogue of currently used coronary artery stents when imaged with state-of the-art MDCT. We examined 68 different coronary artery stents (57 stainless steel, four cobalt-chromium, one cobalt-alloy, two nitinol, four tantalum) in a coronary artery phantom (vessel diameter 3 mm, intravascular attenuation 250 HU, extravascular density -70). Stents were imaged in axial orientation with standard parameters: 32 x 0.6 collimation, pitch 0.24, 680 mAs, 120 kV, rotation time 0.37 s. Four different image reconstructions were obtained with varying convolution kernels and section thicknesses: (1) soft, 0.6 mm, (2) soft, 0.75, (3) medium soft, 0.6, and (4) stent-optimized sharp, 0.6. To evaluate visualization characteristics of of the stent, the lumen diameter, intraluminal density and noise were measured. The high-resolution kernel offered significantly better average lumen visualization (57% +/-10%) and more realistic lumen attenuation (222 HU +/-66 HU) at the expense of increased noise (15.3 HU +/-3.7 HU) compared with the soft and medium-soft CT angiography (CTA) protocol (p<0.001 for all). Stents with a lumen visibility of more than 66% were: Arthos pico, Driver, Flex, Nexus2, S7, Tenax complete, Vision (all 67%), Symbiot, Teneo (70%), and Radius (73%). Only ten stents showed a lumen visibility of less than 50%. Stent lumen visibility largely varies depending on the stent type. Even with the improved spatial resolution of 64-slice CT, a stent-optimized kernel remains beneficial for stent visualization when compared with the standard medium-soft CTA protocol. Using 64-slice CT and high-resolution kernel, the majority of stent products show a lumen visibility of more than 50% of the stent diameter.

Alloys↗

PubMed2005

Abnormal brain activation during movement observation in patients with conversion paralysis.

Dissociative paralysis in conversion disorders has variably been attributed to a lack of movement initiation or an inhibition of movement. While psychodynamic theory suggests altered movement conceptualization, brain activation associated with observation and replication of movements has so far not been assessed neurobiologically. Here, we measured brain activation by functional magnetic resonance imaging during observation and subsequent imitative execution of movements in four patients with dissociative hand paralysis. Compared to healthy controls conversion disorder patients showed decreased activation of cortical hand areas during movement observation. This effect was specific to the side of their dissociative paralysis. No brain activation compatible with movement inhibition was observed. These findings indicate that in dissociative paralysis, there is not only derangement of movement initiation but already of movement conceptualization. This raises the possibility that strategies targeted at reestablishing appropriate movement conceptualization may contribute to the therapy of dissociative paralysis.

Adult↗

PubMed2005

Experimental evaluation of a portable indirect flat-panel detector for the pediatric chest: comparison with storage phosphor radiography at different exposures by using a chest phantom.

PURPOSE: To compare the exposure dose requirements and performance of a portable indirect flat-panel detector for pediatric use in the depiction of catheters, simulated pulmonary nodules, and simulated interstitial lung disease with those of storage phosphor radiography. MATERIALS AND METHODS: Catheters and simulated nodules and subtle interstitial lung disease (miliary, reticular, linear, and ground-glass patterns) were superimposed over an anthropomorphic chest phantom. Images were obtained with different exposures corresponding to simulated speeds of 400 and 800 with a portable flat-panel detector and printed on hard copies. These images were compared with those from storage phosphor radiography at a simulated speed of 400, which is typically used in pediatric radiology. Four independent readers recorded 7200 observations per pattern (for a total of 600 statistically independent observations), and these observations were subjected to receiver operating characteristic (ROC) analysis. Differences were considered significant at a P value of .05. RESULTS: Catheters over obscured chest areas, nodules 10 mm or smaller and larger than 10 mm over lucent lung, nodules 10 mm or smaller over obscured chest areas, and miliary and linear patterns over lucent lung showed higher areas under the ROC curve (A(z)) with the flat-panel detector at 400 and 800 digital speed compared with storage phosphor radiography. A(z) values for reticular and ground-glass patterns with the flat-panel detector were equal to or less than those with storage phosphor radiography. These differences, however, were not statistically significant. CONCLUSION: In the detection of catheters, nodules, and almost all interstitial lung disease, A(z) values were higher with the portable flat-panel detector than with storage phosphor radiography at equivalent and reduced speeds. These results suggest that the portable flat-panel detector could be used with reduced exposure dose in pediatric patients.

Analysis of Variance↗

PubMed2005

Association of the functional -1019C/G 5-HT1A polymorphism with prefrontal cortex and amygdala activation measured with 3 T fMRI in panic disorder.

Serotonergic genes have been implicated in the pathogenesis of panic disorder and amygdala function in response to fearful stimuli. Regional brain activation on visual presentation of emotional facial stimuli was investigated in 20 patients with panic disorder by means of fMRI at 3 T. All patients were genotyped for the functional -1019C/G 5-HT1A and 5-HTTLPR polymorphisms. In patients homozygous for the 5-HT1A -1019G risk allele (n=5), fearful stimuli were associated with a decreased activation of right prefrontal cortex regions. Patients homozygous for the 5-HT1A -1019G risk allele or patients carrying the short risk allele of the 5-HTTLPR (n=13) showed higher amygdala activation in response to happy faces. This exploratory study suggests a role of the functional -1019C/G 5-HT1A and 5-HTTLPR polymorphisms on prefrontal cortex and amygdala activation patterns in response to emotional facial stimuli. These serotonergic polymorphisms might increase the risk for panic disorder by contributing to an altered processing of emotional stimuli.

Adult↗

PubMed2005

Cell tagging with clinically approved iron oxides: feasibility and effect of lipofection, particle size, and surface coating on labeling efficiency.

PURPOSE: To evaluate the effect of lipofection, particle size, and surface coating on labeling efficiency of mammalian cells with superparamagnetic iron oxides (SPIOs). MATERIALS AND METHODS: Institutional Review Board approval was not required. Different human cell lines (lung and breast cancer, fibrosarcoma, leukocytes) were tagged by using carboxydextran-coated SPIOs of various hydrodynamic diameters (17-65 nm) and a dextran-coated iron oxide (150 nm). Cells were incubated with increasing concentrations of iron (0.01-1.00 mg of iron [Fe] per milliliter), including or excluding a transfection medium (TM). Cellular iron uptake was analyzed qualitatively at light and electron microscopy and was quantified at atomic emission spectroscopy. Cell visibility was assessed with gradient- and spin-echo magnetic resonance (MR) imaging. Effects of iron concentration in the medium and of lipofection on cellular SPIO uptake were analyzed with analysis of variance and two-tailed Student t test, respectively. RESULTS: Iron oxide uptake increased in a dose-dependent manner with higher iron concentrations in the medium. The TM significantly increased the iron load of cells (up to 2.6-fold, P < .05). For carboxydextran-coated SPIOs, larger particle size resulted in improved cellular uptake (65 nm, 4.37 microg +/- 0.08 Fe per 100 000 cells; 17 nm, 2.14 microg +/- 0.06 Fe per 100 000 cells; P < .05). Despite larger particle size, dextran-coated iron oxides did not differ from large carboxydextran-coated particles (150 nm, 3.81 microg +/- 0.46 Fe per 100 000 cells; 65 nm, 4.37 microg +/- 0.08 Fe per 100 000 cells; P > .05). As few as 10 000 cells could be detected with clinically available MR techniques by using this approach. CONCLUSION: Lipofection-based cell tagging is a simple method for efficient cell labeling with clinically approved iron oxide-based contrast agents. Large particle size and carboxydextran coating are preferable for cell tagging with endocytosis- and lipofection-based methods.

Cells, Cultured↗

PubMed2005

Evidence for glutamatergic neuronal dysfunction in the prefrontal cortex in chronic but not in first-episode patients with schizophrenia: a proton magnetic resonance spectroscopy study.

Based upon pharmacological challenge and postmortem studies, schizophrenia has been hypothesized to be caused by decreased glutamatergic neurotransmission. We investigated the glutamatergic neuronal metabolism of the dorsolateral prefrontal cortex with localized 1H magnetic resonance spectroscopy in 18 first-episode patients, 21 chronic patients with schizophrenia, and 21 age-matched controls. Chronic patients had significantly lower levels of glutamate/glutamine (Glx) and N-acetylaspartate (NAA) compared to healthy controls and first-episode patients. Reduced metabolite levels were not correlated with duration of illness or medication. Our results indicate glutamatergic dysfunction in chronic schizophrenia that could be evidence of a progressive brain disorder.

Adult↗

PubMed2005

Assessment of coronary artery stents using 16-slice MDCT angiography: evaluation of a dedicated reconstruction kernel and a noise reduction filter.

To compare the effect of different reconstruction kernels and a noise-reducing postprocessing filter on the delineation of coronary artery stents in 16-slice CT-angiography. Ten patients with coronary stents (seven LAD, five RCX and three RCA) were examined with a 16-slice MDCT using standard acquisition parameters. Images were reconstructed using a medium soft (B30f) and a dedicated, edge-enhancing kernel (B46f). Additional postprocessing with an edge-preserving filter was performed on B46f images to reduce the image noise. In multiplanar reformations (MPRs) along and perpendicular to the stent axis, intraluminal attenuation values and the visible lumen diameter were measured. Image noise was measured in the subcutaneous fat using a region of interest (ROI) technique. Arterial enhancement in the aorta was 275.1 HU. Attenuation in the stent lumen was 390.4, 340.0 and 346.8 HU in MPRs derived from B30f, original B46 and postprocessed B46f images. The mean noise level was 20.4, 35.0 and 24.9 HU respectively. The visible lumen diameter was significantly greater in B46f and postprocessed B46f images (2.17 and 2.16 mm), compared to 1.93 mm in B30f images (p<0.01). Edge-enhancing reconstruction kernels increase the visible stent lumen, but also increase image noise. Dedicated postprocessing filters can reduce the introduced noise without a loss of spatial resolution.

Artifacts↗

PubMed2005

3.0 T vs. 1.5 T MR angiography: in vitro comparison of intravascular stent artifacts.

PURPOSE: To evaluate the signal characteristics of different iliac artery stents in MR angiography (MRA) at 3 T in comparison with 1.5 T. MATERIALS AND METHODS: Sixteen iliac artery stents were implanted in plastic tubes filled with a solution of Gd-DTPA and imaged at 3 T and 1.5 T using a T1-weighted 3D spoiled gradient-echo sequence. Image analysis included a subjective assessment of artifact characteristics, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements in stented and unstented vessel parts, and quantitative measurements of total artifact size. RESULTS: The pattern of stent artifacts inside the stents evidently did not differ at 3 T and 1.5 T. The average total size of the artifact areas surrounding the stents was significantly larger at 3 T (P < 0.03). However, within the stented part of the vessel phantom, the signal of the lumen and its contrast to modeled surrounding tissue was significantly higher at the higher field. The mean SNR of the lumen increased from 95.5 at 1.5 T to 127.3 at 3 T, and the CNR of the vessel increased from 70.3 to 93. CONCLUSION: Assessment of the stent lumen in iliac artery stents in a phantom model is not compromised by imaging at 3 T compared to 1.5 T. The signal gain inside the stented part of the vessel lumen at higher field compensates for the higher degree of stent artifacts seen in stents made of steel or cobalt.

Artifacts↗

PubMed2005

Virtual colonography: identification and differentiation of colorectal lesions using multi-detector computed tomography.

OBJECTIVE: Early detection of precancerous or malignant lesions may be decisive for prognosis of patients with colorectal cancer. In this prospective feasibility study, multi-detector spiral computed tomography (CT) colonography was compared with conventional colonoscopy for the detection of colorectal polyps. MATERIAL AND METHODS: Seventy-eight patients underwent CT colonography (standard colonoscopy preparation, distension with room air, prone and supine position) immediately before colonoscopy. Sixty-five (83%) were asymptomatic screening subjects, while the rest had symptoms suggestive of colorectal disease. Presence, location, and size of lesions were prospectively assessed. Sensitivity, specificity, and positive and negative predictive values of CT colonography were calculated using conventional colonoscopy as the reference standard. RESULTS: Conventional colonoscopy was normal in 52 patients. In 26 patients a total of 49 polyps and 3 carcinomas were identified. All three carcinomas and 39 polyps (80%) were identified by CT colonography. Seven of 7 polyps > or = 10 mm (100%), 13 of 16 polyps of 6 to 9 mm (81%), and 19 of 26 polyps < or = 5 mm (73%) in diameter were identified. Fourteen false-positive findings (10 of which were < or = 5 mm in diameter) were related to 8 patients (specificity at the patient level was 86%). In 10 patients, a total of 10 polyps were missed by CT colonography, 7 of which were < or = 5 mm in diameter. CONCLUSIONS: In this feasibility study, multi-detector spiral CT colonography allows accurate detection of polyps > 5 mm in diameter, but at the expense of low specificity in the small size range.

Colonic Polyps↗

PubMed2005

Optical imaging of spontaneous breast tumors using protease sensing 'smart' optical probes.

OBJECTIVE: The objective of this study was to determine if spontaneous breast cancer lesions can be detected by fluorescence reflectance imaging (FRI) and fluorescence mediated tomography (FMT) using protease-sensing optical probes. MATERIALS AND METHODS: Transgenic (FVB/N-TgN (WapHRAS)69Lin Y)) mice, which spontaneously develop breast cancer, were injected intravenously with a cathepsin-sensing fluorescent imaging probe. FRI and FMT were performed 24 hours after probe injection and region of interest (ROI) analysis was performed. Magnetic resonance images were acquired for anatomic coregistration with the FMT data. Moreover, correlative immunohistochemistry and fluorescence microscopy were performed. RESULTS: All tumor nodules were clearly delineated by FRI showing an average signal intensity of 380 +/- 106 AU. Similarly, tumors were clearly detected by FMT imaging. Immunohistochemistry confirmed cathepsin-B expression of primary tumors and fluorescence microscopy revealed a strong Cy 5.5 deposition in the tissue. CONCLUSIONS: FRI and FMT using "smart" protease sensing probes permits detection of experimental spontaneous breast cancers. Because the expression levels of various proteases correlate with patient outcome, this technique may not only help to detect, but also to differentiate breast cancers noninvasively.

Animals↗

PubMed2005

Portable flat-panel detector for low-dose imaging in a pediatric intensive care unit: comparison with an asymmetric film-screen system.

OBJECTIVE: We sought to evaluate the diagnostic performance of a portable indirect flat-panel detector for low-dose imaging as compared with an asymmetric film-screen system in a pediatric intensive care unit. MATERIALS AND METHODS: A total of 120 neonates underwent chest radiographs using a portable flat-panel detector (digital speed 800) and an asymmetric film-screen system (400 speed). Four readers evaluated the detection of 11 anatomic and 5 pathologic landmarks and 4 support devices. Statistical analysis was performed using repeated analysis of variance. The level of statistical significance was P = 0.05. RESULTS: The detection of 4 anatomic/4 pathologic landmarks and 2 support devices was significantly better using the flat-panel detector as compared with the asymmetric film-screen system (P < 0.05). Another 8 anatomic and one pathologic landmarks were detected equally well or slightly better with the flat-panel detector (P > 0.05). CONCLUSIONS: The portable flat-panel detector offers the potential of a 50% dose reduction with equal or significantly better detection of clinically important structures.

Humans↗

PubMed2005

Safe performance of magnetic resonance imaging on a patient with an ICD.

This is a report on a patient with an implanted cardioverter defibrillator (ICD) who intentionally underwent magnetic resonance imaging (MRI) of a malignant brain tumor. To avoid inadequate detection of ventricular tachycardia (VT) or ventricular fibrillation (VF), the ICD was inactivated by programming the VT-detection and VT/VF-therapy status off. The patient came through the protocol safely and without any difficulty or discomfort. There was no arrhythmic event. MRI affected neither programmed data nor the function of the ICD system.

Brain Neoplasms↗

PubMed2005

Comparison of 3D segmented gradient-echo and steady-state free precession coronary MRI sequences in patients with coronary artery disease.

OBJECTIVE: Our objective was to compare two state-of-the-art coronary MRI (CMRI) sequences with regard to image quality and diagnostic accuracy for the detection of coronary artery disease (CAD). SUBJECTS AND METHODS: Twenty patients with known CAD were examined with a navigator-gated and corrected free-breathing 3D segmented gradient-echo (turbo field-echo) CMRI sequence and a steady-state free precession sequence (balanced turbo field-echo). CMRI was performed in a transverse plane for the left coronary artery and a double-oblique plane for the right coronary artery system. Subjective image quality (1- to 4-point scale, with 1 indicating excellent quality) and objective image quality parameters were independently determined for both sequences. Sensitivity, specificity, and accuracy for the detection of significant (> or = 50% diameter) coronary artery stenoses were determined as defined in invasive catheter X-ray coronary angiography. RESULTS: Subjective image quality was superior for the balanced turbo field-echo approach (1.8 +/- 0.9 vs 2.3 +/- 1.0 for turbo field-echo; p < 0.001). Vessel sharpness, signal-to-noise ratio, and contrast-to-noise ratio were all superior for the balanced turbo field-echo approach (p < 0.01 for signal-to-noise ratio and contrast-to-noise ratio). Of the 103 segments, 18% of turbo field-echo segments and 9% of balanced turbo field-echo segments had to be excluded from disease evaluation because of insufficient image quality. Sensitivity, specificity, and accuracy for the detection of significant coronary artery stenoses in the evaluated segments were 92%, 67%, 85%, respectively, for turbo field-echo and 82%, 82%, 81%, respectively, for balanced turbo field-echo. CONCLUSION: Balanced turbo field-echo offers improved image quality with significantly fewer nondiagnostic segments when compared with turbo field-echo. For the detection of CAD, both sequences showed comparable accuracy for the visualized segments.

Aged↗

PubMed2004

Multi-detector row computed tomography of the heart: does a multi-segment reconstruction algorithm improve left ventricular volume measurements?

A multi-segment cardiac image reconstruction algorithm in multi-detector row computed tomography (MDCT) was evaluated regarding temporal resolution and determination of left ventricular (LV) volumes and global LV function. MDCT and cine magnetic resonance (CMR) imaging were performed in 12 patients with known or suspected coronary artery disease. Patients gave informed written consent for the MDCT and the CMR exam. MDCT data were reconstructed using the standard adaptive cardiac volume (ACV) algorithm as well as a multi-segment algorithm utilizing data from three, five and seven rotations. LV end-diastolic (LV-EDV) and end-systolic volumes and ejection fraction (LV-EF) were determined from short-axis image reformations and compared to CMR data. Mean temporal resolution achieved was 192+/-24 ms using the ACV algorithm and improved significantly utilizing the three, five and seven data segments to 139+/-12, 113+/-13 and 96+/-11 ms (P<0.001 for each). Mean LV-EDV was without significant differences using the ACV algorithm, the multi-segment approach and CMR imaging. Despite improved temporal resolution with multi-segment image reconstruction, end-systolic volumes were less accurately measured (mean differences 3.9+/-11.8 ml to 8.1+/-13.9 ml), resulting in a consistent underestimation of LV-EF by 2.3-5.4% in comparison to CMR imaging (Bland-Altman analysis). Multi-segment image reconstruction improves temporal resolution compared to the standard ACV algorithm, but this does not result in a benefit for determination of LV volume and function.

Adult↗

PubMed2004

Detection of pulmonary nodules at multirow-detector CT: effectiveness of double reading to improve sensitivity at standard-dose and low-dose chest CT.

The purpose of this study was to assess the effectiveness of double reading to increase the sensitivity of lung nodule detection at standard-dose (SDCT) and low-dose multirow-detector CT (LDCT). SDCT (100 mAs effective tube current) and LDCT (20 mAs) of nine patients with pulmonary metastases were obtained within 5 min using four-row detector CT. Softcopy images reconstructed with 5-mm slice thickness were read by three radiologists independently. Images with 1.25-mm slice thickness served as the gold standard. Sensitivity was assessed for single readers and combinations. The effectiveness of double reading was expressed as the increase of sensitivity. Average sensitivity for detection of 390 nodules (size 3.9+/-3.2 mm) for single readers was 0.63 (SDCT) and 0.64 (LDCT). Double reading significantly increased sensitivity to 0.74 and 0.79, respectively. No significant difference between sensitivity at SDCT and LDCT was observed. The percentage of nodules detected by all three readers concordantly was 52% for SDCT and 47% for LDCT. Although double reading increased the detection rate of pulmonary nodules from 63% to 74-79%, a considerable proportion of nodules remained undetected. No difference between sensitivities at LDCT and SDCT for detection of small nodules was observed.

Adult↗

PubMed2004

Acute stroke assessment with CT: do we need multimodal evaluation?

PURPOSE: To assess detection of stroke and prediction of extent of infarction with multimodal computed tomographic (CT) evaluation (unenhanced CT, perfusion CT, and CT angiography) in patients suspected of having acute stroke. MATERIALS AND METHODS: Forty-four consecutive patients with a mean National Institutes of Health Stroke Scale score of 10.45 and suspected of having ischemic stroke of the anterior circulation were examined with multi-detector row CT within 8 hours (mean, 3.05 hours) of onset of symptoms. All evaluations were performed with the knowledge that acute stroke was suspected but without detailed clinical information. The extent of ischemia or final infarction on the baseline unenhanced CT scan and follow-up images was assessed with the Alberta Stroke Program Early CT score. Different perfusion maps and follow-up images were assessed to determine the percentage of the ischemia-affected hemisphere. Each component, as well as the multimodal CT evaluation, was compared with follow-up unenhanced CT scans or magnetic resonance images after a mean time of 2.32 days. RESULTS: Multimodal CT revealed true-positive findings in 30 of 41 patients and true-negative findings in three, resulting in a sensitivity of 78.9%. Unenhanced CT, CT angiography, and perfusion CT showed sensitivities of 55.3%, 57.9%, and 76.3%, respectively. In eight patients, small infarctions (mean size, 1.47 cm) that were proved at follow-up were missed with all modalities at initial multimodal CT. With perfusion CT, four of these small infarctions were missed within the white matter of the section levels. Maps of cerebral blood flow showed the best correlation with the final size of infarction with an r(2) value of 0.71. CONCLUSION: The presented multimodal CT evaluation improves detection rate and prediction of the final size of infarction in comparison with unenhanced CT, CT angiography, and perfusion CT alone.

Adult↗