Outcome of Stroke Patients with Unknown Onset and Unknown Time Last Known Well Undergoing Endovascular Therapy.

PURPOSE: Endovascular treatment (ET) in patients with large vessel occlusion stroke (LVOS) with unknown onset or an extended time window can be safe and effective if patients are selected by defined clinical and imaging criteria; however, it is unclear if these criteria should also be applied to patients with unknown onset and unknown time last known well. In this study, we aimed to assess whether absent information on the time patients were last known to be well impacts outcome in patients with unknown onset LVOS. METHODS: We analyzed patients who were enrolled in the German Stroke Registry-Endovascular Treatment between 2015 and 2019. Patients with unknown onset and unknown time last known well (LKWu) were compared to patients with known onset (KO) and to patients with unknown onset but known time last known well (LKWk) regarding clinical and imaging baseline characteristics and outcome. RESULTS: Out of 5909 patients, 561 presented with LKWu (9.5%), 1849 with LKWk (31.3%) and 3499 with KO (59.2%). At 90 days, functional independency was less frequent in LKWu (27.0%) compared to KO (42.6%) and LKWk patients (31.8%). These differences were not significant after adjusting for confounders. A main confounder was the initial Alberta stroke program early CT score. CONCLUSION: The LKWu patients had a similar outcome after ET as KO and LKWk patients after adjusting for confounders. Thus, ET should not be withheld if the time last known well is unknown. Instead, LKWu patients may be selected for ET using the same criteria as in LKWk patients.

Structured Reporting of Acute Ischemic Stroke - Consensus-Based Reporting Templates for Non-Contrast Cranial Computed Tomography, CT Angiography, and CT Perfusion. / Strukturierte Befundung beim ischämischen Schlaganfall: Konsensbasierte Befundvorlagen für die native Computertomografie, CT-Angiografie und CT-Perfusion des Neurokraniums.

PURPOSE: Structured reporting is an essential step in establishing standardized quality standards in diagnostic radiology. The German Society of Radiology and the German Society of Neuroradiology aim to provide templates for the structured reporting of different radiological examinations. METHOD: The Information Technology working group of the German Society of Radiology developed structured templates for the radiological reporting of different indications in consensus with specialist support by experts. RESULTS: We present a template for the structured reporting of examinations of patients with acute ischemic stroke by non-contrast computed tomography, CT angiography, and CT perfusion. This template is provided on the website www.befundung.drg.de for free use. CONCLUSION: Implementation of the structured template may increase quality and provide a minimum standard for radiological reports in patients with acute ischemic stroke. KEY POINTS: · The German Society of Radiology and the German Society of Neuroradiology are providing support for the development of structured templates in German.. · We present a template for the structured reporting of examinations of patients with acute ischemic stroke by non-contrast computed tomography, CT angiography, and CT perfusion. This template is provided on the website www.befundung.drg.de for free use.. · Implementation of the structured template may increase quality and provide a minimum standard for radiological reports in patients with acute ischemic stroke.. CITATION FORMAT: · Brendle C, Bender B, Selo N et al. Structured Reporting of Acute Ischemic Stroke - Consensus-Based Reporting Templates for Non-Contrast Cranial Computed Tomography, CT Angiography, and CT Perfusion. Fortschr Röntgenstr 2021; 193: 1315 - 1317.

Advanced Virtual Monoenergetic Imaging: Improvement of Visualization and Differentiation of Intramuscular Lesions in Portal-Venous-phase Contrast-enhanced Dual-energy CT.

PURPOSE: To evaluate the effect of advanced monoenergetic imaging (MEI+) postprocessing algorithm on the visualization of various intramuscular lesions on portal-venous-phase contrast-enhanced dual-energy computed tomography (DECT). MATERIAL AND METHODS: Thirty-nine patients (64.3 ± 11.1 years; 26 males) with various intramuscular lesions ranging from malignancy, bleeding, inflammation, edematous changes, and benign neoplasms were included and underwent DECT (100/Sn150kV). Postprocessing with MEI+ technique was used to reconstruct images at four different keV levels (40, 60, 80, 100) and compared to the standard portal-venous-phase CT (CTpv) images. Image quality was assessed qualitatively (conspicuity, delineation, sharpness, noise, and confidence) by two independent readers using 5-point Likert scales, 5 = excellent; as well as quantitatively by calculating signal-to-noise ratios (SNR), contrast-to-noise ratios (CNR), and area under the receiver operating characteristic (ROC) curve (AUC) for lesion characterization. RESULTS: Highest lesion enhancement and diagnostic confidence were observed in MEI+ 40 keV, with significant differences to CTpv (p < 0.001), as well as for malignant lesions (highest conspicuity, noise, and sharpness in MEI+ 40 keV; p < 0.001). CNR calculations revealed highest values for MEI+ 40 keV followed by 60 keV with significant differences to CTpv, and increasing energy levels. ROC analysis showed highest diagnostic accuracy for 40-keV MEI+ datasets regarding the detection of malignant/benign lesions with AUC values of 98.9% (95%-confidence interval: 96.5, 100) and a standard error of 1.2, further AUC values decreased to 83.6% for MEI+100. CONCLUSION: MEI+ at low keV levels can significantly improve lesion detection of benign versus malignant intramuscular entities in patients undergoing portal-venous-phase DECT scans due to increased CNR.

Spinal dual-energy computed tomography: improved visualisation of spinal tumorous growth with a noise-optimised advanced monoenergetic post-processing algorithm.

INTRODUCTION: The aim of this study was to evaluate the effect of advanced monoenergetic post-processing (MEI+) on the visualisation of spinal growth in contrast-enhanced dual-energy CT (DE-CT). METHODS: Twenty-six oncologic patients (age, 61 ± 17 years) with spinal tumorous growth were included. Patients underwent contrast-enhanced dual-energy CT on a third-generation dual-source CT scanner. Image acquisition was in dual-energy mode (100/Sn150kV), and scans were initiated 90 s after contrast agent administration. Virtual monoenergertic images (MEI+) were reconstructed at four different kiloelectron volts (keV) levels (40, 60, 80, 100) and compared to the standard blended portal venous computed tomography (CTpv). Image quality was assessed qualitatively (conspicuity, delineation, sharpness, noise, confidence; two independent readers; 5-point Likert scale; 5 = excellent) and quantitatively by calculating signal-to-noise (SNR) and contrast-to-noise-ratios (CNR). For a subgroup of 10 patients with MR imaging within 4 months of the DE-CT, we compared the monoenergetic images to the MRIs qualitatively. RESULTS: Highest contrast of spinal growth was observed in MEI+ at 40 keV, with significant differences to CTpv and all other keV reconstructions (60, 80, 100; p < 0.01). Highest conspicuity, delineation and sharpness were observed in MEI+ at 40 keV, with significant differences to CTpv (p < 0.001). Similarly, MEI+ at 40 keV yielded highest diagnostic confidence (4.6 ± 0.6), also with significant differences to CTpv (3.45 ± 0.9, p < 0.001) and to high keV reconstructions (80, 100; p ≤ 0.001). Similarly, CNR calculations revealed highest scores for MEI+ at 40 keV followed by 60 keV and CTpv, with significant differences to high keV MEI+ reconstructions. Qualitative analysis scores peaked for MR images followed by the MEI+ 40-keV reconstructions. CONCLUSION: MEI+ at low keV levels can significantly improve image quality and delineation of spinal growth in patients with portal-venous phase CT scans due to increased CNR and limited image noise.

[Endocrine abnormalities in a patient with borderline personality disorder--case 8/2014]. / Endokrinopathie bei einer Patientin mit Persönlichkeitsstörung vom Borderline-Typ--Fall 8/2014.

HISTORY AND ADMISSION FINDINGS: We report on a 44-year-old woman who was treated for borderline personality disorder in the Department of Psychiatry. In addition, symptoms of hyperthyroidism (anxiety, weight loss, hyperdefecation) were noticeable. Thyroid stimulating hormone (TSH) was marginally elevated, free triiodothyronine (T3) and free thyroxine (T4) were clearly elevated. Hence, the patient was transferred to the Department of Endocrinology. INVESTIGATIONS: Thyroid ultrasound revealed a diffuse goiter with a total volume of 24,8 ml. Antibody screening did not show elevated titers. The thyrotropin releasing hormone (TRH) test depicted a blunted TSH response. Serum levels of free glycoprotein hormone alpha-subunit, prolactin and insulin-like growth factor 1 were increased. DIAGNOSIS, TREATMENT AND COURSE: In cranial magnetic resonance imaging (MRI), a hypointense lesion on the left side of the anterior pituitary gland was detected indicating a thyrotropin-secreting microadenoma with concomitant secretion of prolactin and possible secretion of human growth hormone (HGH). A thyreostatic therapy was initiated aiming at euthyreosis. For symptom control, betablockers were administered. Subsequently, the patient underwent an uncomplicated transsphenoidal resection. Histological examination confirmed the diagnosis of a pituitary adenoma with expression of TSH, prolactin and HGH. As expected, thyroid hormones declined afterwards. CONCLUSIONS: TSHoma is rare. Diagnosis is confirmed by endocrinological testing and cranial imaging. Therapeutic options comprise transsphenoidal adenomectomy, drug therapy (somatostatin analogues, dopaminergic agonists) and irradiation. Resistance to thyroid hormones should be included in the differential diagnosis.

Acute toxicity profile of radiotherapy in 690 children and adolescents: RiSK data.

BACKGROUND AND PURPOSE: The "Registry for the evaluation of side effects after radiation in childhood and adolescence" (risk) was introduced to characterize adverse effects of radiotherapy in childhood and adolescence prospectively. The aim of this analysis was to characterize the pattern of acute side effects. MATERIALS AND METHODS: Since 2001, patients receiving radiotherapy in one of the German pediatric therapy trials have been registered in RiSK with detailed information regarding radiation doses to organs at risk and characterization of acute toxicities. RESULTS: From 2001 to May 2009, 690 patients have been characterized for acute toxicity in primary therapy. Acute toxicity ≥ grade 1 was observed in 506 patients. In patients irradiated in their lung and liver, patients with grade 1 or 2 acute toxicities showed higher organ volumes exposed to radiation doses <20 Gray (Gy) compared to patients without toxicities. For the salivary glands, there was a positive correlation between the acute toxicity grade and the maximum radiation dose to the organ; the lower GI tract showed a similar trend. The impact of different chemotherapy regimens on these acute side effects remains unclear. Age did not have any impact on side effects. CONCLUSION: This analysis gives a comprehensive overview of the acute toxicities of radiotherapy in children and adolescents. With prolongation of follow-up, detailed analyses regarding late toxicities will be possible with the characterization of dose-volume-effect relationships.