Radiologie (Heidelberg, Germany)最新文献

{"title":"[Secondary stroke prevention].","authors":"Armin Bachhuber","doi":"10.1007/s00117-024-01411-z","DOIUrl":"10.1007/s00117-024-01411-z","url":null,"abstract":"<p><strong>Background: </strong>The treatment of strokes is based on two pillars: the efficient management of acute strokes to minimize permanent neurological deficits, and secondary prevention to avoid recurrence.</p><p><strong>Objective: </strong>To summarize current recommendations for secondary stroke prevention.</p><p><strong>Materials and methods: </strong>Guidelines and recent studies on the most common causes of strokes, and their treatment and prevention are reviewed. Special attention is given to endovascular therapy and cardioembolic strokes.</p><p><strong>Conclusion: </strong>A brief overview of recommended therapies is provided.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"127-130"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Recent clinical studies and the S3 guidelines on stroke].","authors":"Wolfgang Reith, Armin Bachhuber","doi":"10.1007/s00117-024-01415-9","DOIUrl":"10.1007/s00117-024-01415-9","url":null,"abstract":"<p><strong>Background: </strong>Treatment of patients with acute stroke requires hospitalization. Cooperation of neurologists, neuroradiologists, intensive care physicians, internists, and cardiologists is required to achieve best possible outcome.</p><p><strong>Objective: </strong>A summary of the current recommendations for stroke treatment is provided.</p><p><strong>Methods: </strong>This update is based on the S3 guidelines and incorporates additional results of the latest clinical studies; pubmed.gov was used as the database.</p><p><strong>Results: </strong>Computed tomography (CT) or magnetic resonance imaging (MRI) are essential to differentiate between ischemic and hemorrhagic stroke. The S3 guideline recommends thrombolysis within 4.5 h after the onset of symptoms, while mechanical thrombectomy for large vessel occlusions may be indicated up to 24 h after stroke onset in certain cases. Therapy should be initiated for an internal carotid artery (ICA) stenosis of at least 50%.</p><p><strong>Conclusion: </strong>Thrombolysis, mechanical thrombectomy, and the treatment of ICA stenosis are the three cornerstones of acute stroke treatment.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"94-99"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A short history of stroke].","authors":"Umut Yilmaz","doi":"10.1007/s00117-024-01398-7","DOIUrl":"10.1007/s00117-024-01398-7","url":null,"abstract":"<p><strong>Clinical/methodical issue: </strong>The history of stroke dates back to antiquity, where it was first described as \"apoplexia\" in Hippocratic writings. For centuries, understanding of the pathology was limited, based on Galen's theories and humoral pathology. Significant advances were made by Islamic scholars who expanded the knowledge and addressed existing contradictions. Only with Harvey's 17th-century description of blood circulation did a deeper understanding emerge, followed by the work of Wepfer and Virchow, who uncovered the role of vascular occlusions and embolisms. The discovery of carotid stenosis and the description of specific stroke syndromes by researchers like Chiari and Fisher further advanced modern diagnostics. The development of thrombolysis in the 1930s and advances in imaging paved the way for initial causal therapies. The breakthrough of mechanical thrombectomy, highlighted by the 2015 MR-CLEAN study, marked a turning point in stroke treatment and influenced new guidelines. Subsequent studies such as DAWN and DEFUSE‑3 expanded the therapeutic window. These milestones reflect the evolution from limited pathophysiological understanding to highly specialized, effective treatment approaches.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"80-84"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Complications of mechanical thrombectomy].","authors":"Josef Mohamad","doi":"10.1007/s00117-024-01401-1","DOIUrl":"10.1007/s00117-024-01401-1","url":null,"abstract":"<p><strong>Clinical problem: </strong>Ischemic stroke is the most common cause of disability in adults and an important disease for society; therefore, the prevention, diagnosis, and treatment play an important role. Endovascular mechanical recanalization to reopen large occlusions of the intracerebral vessels has established itself as the gold standard in therapy, which is why knowledge of the most important complications and their management is essential for interventionalists.</p><p><strong>Practical recommendations: </strong>Intracranial hemorrhages, which include intracerebral and subarachnoid hemorrhages, are dreaded complications that significantly worsen the clinical outcome. Early monitoring and optimal management are therefore essential. Cerebral air embolism is a rare but dangerous complication whose prevention is paramount, as treatment options are limited.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"123-126"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Stroke in octogenarians].","authors":"Wolfgang Reith, Armin Bachhuber","doi":"10.1007/s00117-024-01405-x","DOIUrl":"10.1007/s00117-024-01405-x","url":null,"abstract":"<p><p>Stroke is one of the most common causes of disability in older adults. It remains a common cause of death and permanent functional limitation in individuals who are older than 80 years. Approximately 50% of all strokes occur in people over the age of 75, and 30% in those over 85. Top priorities in primary stroke prevention include the treatment of hypertension, anticoagulation for patients with atrial fibrillation, and lifestyle modifications such as smoking cessation.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"85-93"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Stroke update].","authors":"Wolfgang Reith","doi":"10.1007/s00117-024-01404-y","DOIUrl":"https://doi.org/10.1007/s00117-024-01404-y","url":null,"abstract":"","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":"65 2","pages":"77-79"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Thrombectomy : Stent retriever vs aspiration].","authors":"Ruben Mühl-Benninghaus","doi":"10.1007/s00117-024-01406-w","DOIUrl":"10.1007/s00117-024-01406-w","url":null,"abstract":"<p><p>Besides intravenous thrombolysis, endovascular therapy (EVT) is also a standard treatment option for acute ischemic stroke. The clinical efficacy and safety of this procedure was proven in 2015 by several randomized controlled trials. The aim of EVT is to achieve the fastest possible recanalization of an occluded artery supplying the brain and, thus, reperfusion of the brain tissue. In EVT, the thrombus is thrombectomized mechanically using wire-mounted self-expanding stents (so-called stent retrievers) and/or aspirated through aspiration catheters. The extent of brain tissue reperfusion influences the clinical outcome of the affected patients. High reperfusion scores (Thrombolysis in Cerebral Infarction [TICI]) correlate positively with more favorable clinical outcomes. However, even after achieving high TICI scores, the clinical outcome of stroke patients with large vessel occlusions varies considerably. There are many reasons for this. In addition to the collateral supply and the perfusion pressure of the affected brain area, the period of tissue ischemia plays a particularly important role in preservation of brain function. In addition to the TICI score, the number of thrombectomy maneuvers performed and consequently the duration of the intervention has an influence on the clinical outcome of the treated patients.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"118-122"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Spontaneous craniocervical dissection].","authors":"Malvina Garner","doi":"10.1007/s00117-024-01399-6","DOIUrl":"10.1007/s00117-024-01399-6","url":null,"abstract":"<p><strong>Performance: </strong>Spontaneous dissections of the cerebral arteries are among the leading causes of stroke in young adults. They result from hemorrhage into the outer layers of the arterial wall, which can lead to stenosis or even complete vessel occlusion. Clinical presentations vary, ranging from localized pain to cerebral ischemic complications. Early recognition of dissection warning signs and diagnosis through imaging is crucial due to the high risk of recurrent transient ischemic attack (TIA) or stroke within the first two weeks following a dissection, necessitating immediate therapeutic or prophylactic intervention.</p><p><strong>Achievements: </strong>Magnetic resonance imaging (MRI) is the imaging modality of choice, as it can reliably visualize all characteristic features of dissection. Typically, thin-slice, fat-saturated 3D black-blood sequences are sufficient to detect the pathognomonic intramural hematoma.</p><p><strong>Practical recommendations: </strong>Acute treatment and secondary prevention depend on the extent of neurological deficits, the location and size of the dissection, any sequelae, concomitant pathologies, and risk factors. In most cases, spontaneous vascular recanalization or regression of vessel stenosis occurs within several months due to resorption of the mural hematoma.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"100-109"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffusion tensor imaging features of white matter pathways in the brain after COVID-19 infection.","authors":"Serdar Balsak, Bahar Atasoy, Fatma Yabul, Ahmet Akcay, Ismail Yurtsever, Hayrettin Daskaya, Yasemin Akkoyunlu, Zeynep Donmez, Aslı Yaman Kula, Ozlem Toluk, Alpay Alkan","doi":"10.1007/s00117-024-01414-w","DOIUrl":"https://doi.org/10.1007/s00117-024-01414-w","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether there is a difference in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in white matter pathways in the subacute period after COVID-19 infection and to evaluate the correlation between diffusion tensor imaging (DTI) metrics and laboratory findings.</p><p><strong>Material and methods: </strong>The study included 64 healthy controls and 91 patients. Patients were classified as group 1 (all patients, n = 91), group 2 (outpatients, n = 58), or group 3 (inpatients, n = 33). The ADC and FA values were calculated from 10 distinct neuroanatomic localizations; DTI values were compared between groups.</p><p><strong>Results: </strong>Decreased FA values in the cingulum, corpus callosum splenium and genu (CCS-CCG), forceps major, inferior fronto-occipital fasciculus (IFOF), and middle cerebellar peduncle (MCP) observed in group 1 compared with the control group. Group 1 showed elevated ADC values in CCG. Lower FA and higher ADC values in CCG were shown in group 3. The FA values for CCS, IFOF, and MCP in group 3 were lower than those in the control group. Group 3 had the highest ADC values in the CCS. Additionally, the FA values of the CCG were lower in group 3 than in group 2. Oxygen saturation levels and FA values in the CCG and SFOF exhibited a positive correlation.</p><p><strong>Conclusion: </strong>We speculate that DTI changes in white matter pathways may be associated with axonal damage and demyelination due to impaired white matter integrity following COVID-19 infection during the subacute period.</p><p><strong>Clinical significance: </strong>Our study showed with DTI findings that there is microstructural damage in white matter pathways in the subacute period of COVID-19 infection and that this damage is related to oxygen saturation levels. Many studies in the literature show that microstructural damage in white matter pathways can lead to clinical neurocognitive dysfunction. We suggest that these cases require more comprehensive studies investigating whether chronic white matter damage is reversible and examining its relationship with neurocognitive dysfunctions in the future.</p><p><strong>Main points: </strong>Neurological involvement is not rare in COVID-19 infection. We examined various white matter pathways with DTI during the subacute period of COVID-19 infection. We showed changes in DTI parameters indicating a decrease in white matter integrity and microstructural damage in the subacute period follow-up of cases with COVID-19. We found that there was a positive correlation between oxygen saturation levels and decreased FA values in white matter tracts.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiomics-based diagnosis of patellar chondromalacia using sagittal T2-weighted images.","authors":"Ying Shu","doi":"10.1007/s00117-024-01413-x","DOIUrl":"https://doi.org/10.1007/s00117-024-01413-x","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore and evaluate a novel method for diagnosing patellar chondromalacia using radiomic features from patellar sagittal T2-weighted images (T2WI).</p><p><strong>Methods: </strong>The experimental data included sagittal T2WI images of the patella from 40 patients with patellar chondromalacia and 40 healthy volunteers. The training set comprised 30 cases of chondromalacia and 30 healthy volunteers, while the test set included 10 cases of each. A machine learning algorithm was used to train the classification model, which was then evaluated using standard performance metrics.</p><p><strong>Results: </strong>In the training set, the model achieved 24 true negatives (TN), 18 true positives (TP), 12 false negatives (FN), and six false positives (FP). Sensitivity, specificity, accuracy, and F1 score for the training set were 0.6, 0.8, 0.7, and 0.667, respectively. The model achieved six true negatives, eight true positives, two false negatives, and four false positives in the test set. Sensitivity, specificity, accuracy, and F1 score for the test set were 0.8, 0.6, 0.7, and 0.727, respectively.</p><p><strong>Conclusion: </strong>The radiomic analysis method based on patellar sagittal fat-suppressed T2WI images demonstrates good diagnostic capability for patellar bone marrow edema.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}