Tailored Vessel-Catheter Diameter Ratio in a Direct Aspiration First-Pass Technique: Is It a Matter of Caliber?

BACKGROUND AND PURPOSE: The aspiration technique has gained a prominent role in mechanical thrombectomy. The thrombectomy goal is successful revascularization (modified TICI ≥ 2b) and first-pass effect. The purpose of this study was to evaluate the impact of the vessel-catheter ratio on the modified TICI ≥ 2b and first-pass effect. MATERIALS AND METHODS: This was a retrospective, single-center, cohort study. From January 2018 to April 2020, 111/206 (53.9%) were eligible after applying the exclusion criteria. Culprit vessel diameters were measured by 2 neuroradiologists, and the intraclass correlation coefficient was calculated. The receiver operating characteristic curve was used for assessing the vessel-catheter ratio cutoff for modified TICI ≥ 2b and the first-pass effect. Time to groin puncture and fibrinolysis were weighted using logistic regression. All possible intervals (interval size, 0.1; sliding interval, 0.01) of the vessel-catheter ratio were plotted, and the best and worst intervals were compared using the χ2 test. RESULTS: Modified TICI ≥ 2b outcome was achieved in 75/111 (67.5%), and first-pass effect was achieved in 53/75 (70.6%). The MCA diameter was 2.1 mm with an intraclass correlation coefficient of 0.92. The optimal vessel-catheter ratio cutoffs for modified TICI ≥ 2b were ≤1.51 (accuracy = 0.67; 95% CI, 0.58-0.76; P = 0.001), and for first-pass effect, they were significant (≤1.33; P = .31). The modified TICI ≥ 2b odds ratio and relative risk were 9.2 (95% CI, 2.4-36.2; P = 0.002) and 3.2 (95% CI, 1.2-8.7; P = .024). The odds ratio remained significant after logistic regression (7.4; 95% CI, 1.7-32.5; P = .008). First-pass effect odds ratio and relative risk were not significant (2.1 and 1.5; P > .05, respectively). The modified TICI ≥ 2b best and worst vessel-catheter ratio intervals were not significantly different (55.6% versus 85.7%, P = .12). The first-pass effect best vessel-catheter ratio interval was significantly higher compared with the worst one (78.6% versus 40.0%, P = .03). CONCLUSIONS: The aspiration catheter should be selected according to culprit vessel diameter. The optimal vessel-catheter ratio cutoffs were ≤1.51 for modified TICI ≥ 2b with an odds ratio of 9.2 and a relative risk of 3.2.

Diffuse leptomeningeal gliomatosis with osteoblastic metastases and no evidence of intraaxial lesions.

An autopsy-proved case of cerebral and medullary leptomeningeal gliomatosis and diffuse osteoblastic metastases without evidence of intraaxial tumor is described. MR findings included diffuse thickening of the cerebral and medullary leptomeninges on T1-weighted, proton density-weighted, and T2-weighted images and abnormal enhancement of the sulci and cisterns of the cerebrum, brain stem, cerebellum, and medulla on postcontrast T1-weighted images. MR also showed several areas of replacement of the normal bone marrow of the skull. No intraaxial lesion was seen.

De Quervain's disease: diagnostic imaging.

De Quervain's disease constitutes the most frequently occurring stenotic tenosynovitis. The authors have studied which imaging technique allows for the best representation of anatomopathologic modifications. Ultrasound examination appeared to be the most appropriate and advantageous method as it reveals involvement of the sheaths and tendons in the simplest, most complete, and least expensive manner.

[A comparison between computed tomography and magnetic resonance in the verification of prolactinomas]. / Confronto tra tomografia computerizzata e risonanza magnetica nell'accertamento dei prolattinomi.

First, computer tomography and subsequently magnetic resonance have profoundly changed the diagnostic protocol for the study pituitary pathology. Conventional X-ray and examination with the use of contrast media are being employed less and less. Tomographic techniques (CT and RM) permit direct identification of anomalies as well as precise evaluation of their relationship with surrounding structures.

[The role of magnetic resonance in the study of cerebrospinal malformations in childhood. An analysis of 51 clinical cases]. / Ruolo della Risonanza Magnetica nello studio delle malformazioni cerebro-midollari dell'infanzia. Analisi di 51 casi clinici.

This study was aimed at assessing MR utility in the evaluation of cerebral-medullar malformative pathologic conditions in infants. Among 274 patients 2 months to 15 years old examined by means of MR imaging, 51 (18.6%) were affected with cerebral-medullar abnormalities. Seventeen different types of pathologic conditions were identified, some of which single and some multiple; tethered cord was the most frequent finding. 45/51 patients affected with malformative pathologic conditions required sedation. The high incidence of malformative pathologic conditions in pediatrics highlights the importance of this subject for all the radiologists dealing with MR imaging in pediatrics. MR imaging appears to be the method of choice for the evaluation of cerebral-medullar abnormalities.

[MR in the evaluation of schizencephaly]. / La RM nella valutazione della schizencefalia.

This study was aimed at evaluating MR utility in the diagnosis of schizencephaly in patients with seizures and developmental delay. In 7 patients, 8 months to 15 years old, MR imaging detected the presence of unilateral (5 cases) and bilateral (2 cases) hemisferic clefts. Moreover, MR imaging allowed the presence of such anomalies as dysgenesis of the corpus callosum, and agenesis of the septum pellucidum to be demonstrated, together with areas of polymicrogyria and heterotopic gray matter.

[CT in the evaluation of carcinoma of the pancreas]. / La TC nella valutazione del carcinoma del pancreas.

The routine use of CT has given a great contribution both to the diagnosis and to the evaluation of the extent of pancreatic carcinomas. Forty-three patients clinically suspected of pancreatic carcinoma were examined with CT. Forty of them underwent surgical control. This study was conducted to evaluate the role of CT in the diagnosing and staging of pancreatic carcinomas. 31/43 neoplasms were identified, with a diagnostic accuracy of 90%. CT was extremely accurate in the demonstration of late metastases, while it had lower accuracy in assessing the involvement of lymph nodes and peripancreatic vessels (60-70%). CT proved to be extremely useful in diagnosing pancreatic carcinomas, for it allows the detection of masses associated with Wirsung's duct dilatation and atrophy, which are a highly pathognomonic sign of pancreatic neoplasms. Moreover, CT proved useful in the staging, by assessing the presence of lymph nodes and metastases.

[Evaluation of parietal infiltration in carcinoma of the bladder: comparison of MR imaging, CT and histology]. / Valutazione dell'infiltrazione parietale da carcinoma della vescica: confronto tra RM, TC e istologia.

Twenty-two patients with bladder carcinoma were examined by MR imaging and CT to determine the degree of parietal involvement. The results were then compared with the surgical and histological findings. A classification in CT and MR stages was elaborated in order to supply corresponding models to clinical TNM staging. Three groups were thus formed, corresponding to the evolutive phases of the tumor. The first MR group included T1-T2 forms (accuracy: 75%); the second group included T3a forms (accuracy: 75%), and the third T3b-T4 forms (accuracy: 90%). Overall MR accuracy was 81.81%. The first CT group included T1 forms (acc. 71.42%), the second group T2-T3a forms (acc. 60%), and the third group included T3b-T4 forms (acc. 90%). Overall CT accuracy was 77.27%. MR imaging proved thus more accurate than CT in the staging of bladder tumors, especially thanks to its allowing deep muscular involvement to be assessed.