Subject(s)
Spinal Neoplasms/diagnostic imaging , Accidental Falls , Aged , Back Pain/diagnostic imaging , Back Pain/etiology , Biopsy , Carcinoma, Hepatocellular/pathology , Fractures, Compression/diagnostic imaging , Humans , Liver Neoplasms/pathology , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/injuries , Magnetic Resonance Imaging , Male , Spinal Fractures/diagnostic imaging , Spinal Neoplasms/pathology , Spinal Neoplasms/secondary , Tomography, X-Ray ComputedABSTRACT
The 2018 American Heart Association/American Stroke Association (AHA/ASA) guidelines stated that the administration of intravenous recombinant tissue-type plasminogen activator (rTPA) for acute ischaemic stroke is probably safe for patients with small (i.e. <10â¯mm) unruptured intracranial aneurysms. We present 2 cases of small (2 and 5â¯mm) lenticulostriate artery (LSA) aneurysms which ruptured immediately following rtPA infusion. The ensuing acute intracranial haemorrhages resulted in the death of one patient and severe functional impairment for the other. Given the limited literature available, the natural history of LSA aneurysms is largely unknown. This report suggests that LSA aneurysms, regardless of size, be considered separately from other conventional aneurysms as "high-risk" lesions and a contraindication to thrombolysis.
Subject(s)
Aneurysm, Ruptured/pathology , Basal Ganglia Cerebrovascular Disease/pathology , Fibrinolytic Agents/adverse effects , Intracranial Aneurysm/pathology , Tissue Plasminogen Activator/adverse effects , Administration, Intravenous , Aged , Basal Ganglia Cerebrovascular Disease/complications , Female , Humans , Intracranial Hemorrhages/etiology , Male , Middle Aged , Stroke/complications , Stroke/drug therapy , Thrombolytic Therapy/adverse effects , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/administration & dosageABSTRACT
Tablet computers such as the iPad, which have a large format, improved graphic display resolution and a touch screen interface, may have an advantage compared to existing mobile devices such as smartphones and laptops for viewing radiological images. We assessed their potential for emergency radiology teleconsultation by reviewing multi-image CT and MRI studies on iPad tablet computers compared to Picture Archival and Communication Systems (PACS) workstations. Annonymised DICOM images of 79 CT and nine MRI studies comprising a range of common on-call conditions, reported on full-featured diagnostic PACS workstation by one Reporting Radiologist, were transferred from PACS to three iPad tablet computers running OsiriX HD v 2.02 DICOM software and viewed independently by three reviewing radiologists. Structured documentation was made of major findings (primary diagnosis or other clinically important findings), minor findings (incidental findings), and user feedback. Two hundred and sixty four readings (88 studies read by three reviewing radiologists) were compared, with 3.4 % (nine of 264) major discrepancies and 5.6 % (15 of 264) minor discrepancies. All reviewing radiologists reported favorable user experience but noted issues with software stability and limitations of image manipulation tools. Our results suggest that emergency conditions commonly encountered on CT and MRI can be diagnosed using tablet computers with good agreement with dedicated PACS workstations. Shortcomings in software and application design should be addressed if the potential of tablet computers for mobile teleradiology is to be fully realized.
