INTRODUCTION: Non-contrast computed tomography (CT) and CT angiography are the gold standard in neuroimaging diagnostics in the case of suspected stroke. CT perfusion (CTP) may play an important role in the diagnosis of stroke mimics (SM), but currently, it is not a standard part of the stroke diagnostic procedure. The project is a multicentre prospective observational clinical research focused on refining the diagnostics of stroke and stroke mimics (SM) in hospital care. AIM: This study aimed to evaluate the degree of specificity and sensitivity of multimodal CT (NCCT, CTA, and CTP) in the diagnosis of SM versus stroke. METHODOLOGY: In this study, we will include 3,000 patients consecutively admitted to the comprehensive stroke centres with a diagnosis of suspected stroke. On the basis of clinical parameters and the results of multimodal CT and magnetic resonance imaging (MRI), the diagnosis of stroke and SM will be established. To clarify the significance of the use of the multimodal CT scan, the analysis will include a comparison of the blinded results for each imaging scan performed by radiologists and AI technology and a comparison of the initial and final diagnosis of the enrolled patients. Based on our results, we will compare the economic indicators and costs that would be saved by not providing inadequate treatment to patients with SM. CONCLUSION: The expected outcome is to present an optimised diagnostic procedure that results in a faster and more accurate diagnosis, thereby eliminating the risk of inadequate treatment in patients with SM. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, NCT06045455.

• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

BACKGROUND AND PURPOSE: Manual segmentation of infarct volume on follow-up MRI diffusion-weighted imaging (MRI-DWI) is considered the gold standard but is prone to rater variability. We assess the variability of manual segmentations of MRI-DWI infarct volume. METHODS: Consecutive patients (May 2018 to May 2019) with the anterior circulation stroke and endovascularly treated were enrolled. All patients underwent 24- to 32-hour follow-up MRI. Three users manually segmented DWI infarct volumes slice by slice twice. The reference standard of DWI infarct volume was generated by the STAPLE algorithm. Intra- and interrater reliability was evaluated using the intraclass correlation coefficient (ICC) by comparing manual segmentations with the reference standard. Spatial measurements were evaluated using metrics of the Dice similarity coefficient (DSC). Volumetric measurements were compared using the lesion volume. RESULTS: The dataset consisted of 44 patients, mean (SD) age was 70.1 years (±10.3), 43% were women, and median baseline NIHSS score was 16. Among three users, the mean DSC for MRI-DWI infarct volume segmentations ranged from 80.6% ± 11.7% to 88.6% ± 7.5%, and the mean absolute volume difference was 2.8 ± 6.8 to 13.0 ± 14.0 ml. Interrater ICC among the users for DSC and infarct volume was .86 (95% confidence interval [95% CI]: .78-.91) and .997 (95% CI: .995-.998). Intrarater ICC for the three users was .83 (95% CI: .69-.93), .84 (95% CI: .72-.91), and .80 (95% CI: .64-.89) for DSC, and .99 (95% CI: .987-.996), .991 (95% CI: .983-.995), and .996 (95% CI: .993-.998) for infarct volume. CONCLUSIONS: Manual segmentation of infarct volume on follow-up MRI-DWI shows excellent agreement and good spatial overlap with the reference standard, suggesting its usefulness for measuring infarct volume on 24- to 32-hour MRI-DWI.

• MeSH
• algoritmy MeSH
• difuzní magnetická rezonance metody   MeSH
• endovaskulární výkony metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozkový infarkt diagnostické zobrazování   patologie   terapie   MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

We aimed was to assess the factors influencing therapy choice and clinical outcome after 3-4 months in patients with cerebral venous sinus thrombosis (CVST). In a retrospective, bi-centric study, the set consisted of 82 consecutive CVST patients (61 females; mean age 33.5 ± 15.7 years). Following data were collected: baseline characteristics, presence of gender-specific risk factors (GSRF), location and extent of venous sinus impairment, clinical presentation, type of treatment, recanalization, presence of parenchymal lesions, and clinical outcome after 3-4 months (assessed using the modified Rankin Scale [mRS], with excellent outcome defined as mRS 0-1). Multivariate logistic regression analysis was used for statistical evaluation. After 3-4 months, complete recovery was achieved in 41 (50%) and excellent clinical outcome in 67 (81.7%) patients. Female sex (OR 0.11; p = 0.0189) and presence of focal neurologic deficit (OR 0.16; p = 0.0165) were identified as significant independent negative predictors and, the presence of GSRF (OR 15.63; p = 0.0011) as significant independent positive predictor of excellent clinical outcome. In conclusion, in our CVST patients, the presence of GSRF was associated with excellent clinical outcome, while the female sex itself was associated with poorer clinical outcome.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• trombóza nitrolebních žilních splavů terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND AND AIMS: Modern stereotactic body radiotherapy (SBRT) techniques and systems that use online image guidance offer frameless radiotherapy of spinal tumors and the ability to control intrafraction motion during treatment. These systems allow precise alignment of the patient during the entire treatment session and react immediately to random changes in this alignment. Online tracking data provide information about intrafractional changes, and this information can be useful for designing treatment strategies even if online tracking is not being used. The present study evaluated spine motion during SBRT treatment to assess the risk of verifying patient alignment only prior to starting treatment. METHODS: This study included 123 patients treated with spine SBRT. We analyzed different locations within the spine using system log files generated during treatment, which contain information about differences in the pretreatment reference spine positions by CT versus positions during SBRT treatment. The mean spine motion and intra/interfraction motion was evaluated. We defined and assessed the spine stability and spine significant shifts (SSHs) during treatment. RESULTS: We analyzed 462 fractions. For the cervical (C) spine, the greatest shifts were in the anterior-posterior (AP) direction (2.48 mm) and in pitch rotation (1.75 deg). The thoracic (Th) spine showed the biggest shift in the AP direction (3.68 mm) and in roll rotation (1.66 deg). For the lumbar-sacral (LS) spine, the biggest shift was found for left-right (LR) translation (3.81 mm) and roll rotation (3.67 deg). No C spine case exceeded 1 mm/1 deg for interfraction variability, but 7 of 54 Th spine cases exceeded 1 mm interfraction variability for translations (maximum value, 2.5 mm in the AP direction). The interfraction variability for translations exceeded 1 mm in 2 of 24 LS spine cases (maximum value, 1.7 mm in the LR direction). Only 13% of cases had no SSHs. The mean times to SSH were 6.5±3.9 min, 8.1±5.9 min, and 8.8±7.1 min for the C, Th, and LS spine, respectively, and the mean recorded SSH values were 1.6±0.66, 1.43±0.33, and 1.46±0.47 mm/deg, respectively. CONCLUSION: Positional tracking during spine SBRT treatments revealed low mean translational and rotational shifts. Patient immobilization did not improve spine shifts compared with our results for the Th and LS spine without immobilization. For the most precise spine SBRT, we recommend checking the patient's position during treatment.

• MeSH
• bederní obratle MeSH
• frakcionace dávky záření MeSH
• hrudní obratle MeSH
• krční obratle MeSH
• křížová kost MeSH
• lidé MeSH
• nádory páteře radioterapie   MeSH
• počítačová rentgenová tomografie MeSH
• pohyb * MeSH
• polohování pacienta MeSH
• radiochirurgie metody   MeSH
• radioterapie řízená obrazem metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Ischemic lesion volume (ILV) is an important radiological predictor of functional outcome in patients with anterior circulation stroke. Our aim was to assess the agreement between automated ILV measurements on NCCT using the Brainomix software and manual ILV measurements on diffusion-weighted imaging (DWI). METHODS: This was a prospective single-center observational study of patients with CT angiography (CTA) proven anterior circulation occlusion treated with endovascular thrombectomy (May 2018 to May 2019). NCCT ILV was measured automatically by the Brainomix software. DWI ILV was measured manually. The McNemar's test was used to test sensitivity and specificity. The Somer's delta was used to test the differences between concordant and discordant ASPECTS regions. The Bland-Altman plot was calculated to compare the differences between Brainomix and DWI ILVs. RESULTS: Forty-five patients were included. Median Brainomix ILV was 23 ml (interquartile range [IQR], 15-39 ml), and median DWI ILV was 11.5 ml (IQR, 7-32 ml) in the TICI 2b-3 group. In the TICI 0-2a, the NCCT ILV was 39 ml (IQR, 18-62 ml) and DWI ILV was 30 (IQR, 11-105 ml). The DWI ILVs in patients with good clinical outcome (mRS 0-2) was significantly lower compared with patients with mRS ≥ 3 (10 mL vs 59 mL, p = 0.002). Similar trend was observed for Brainomix ILV measurements (21 mL vs 39 mL, p = 0.012). There was a high correlation and accuracy in the detection of follow-up ischemic changes in particular ASPECTS regions. CONCLUSION: NCCT ILV measured automatically by the Brainomix software might be considered a valuable radiological outcome measure.

• MeSH
• CT angiografie metody   MeSH
• difuzní magnetická rezonance MeSH
• ischemická cévní mozková příhoda diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• mozková angiografie metody   MeSH
• prospektivní studie MeSH
• rentgenový obraz - interpretace počítačová metody   MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• software MeSH
• strojové učení * MeSH
• trombektomie * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Cíl: Krvácení do aterosklerotického plátu (intraplaque hemorrhage; IPH) patří k potenciálním mechanizmům rozvoje nestability plátu, jež může vést k ischemickému iktu. Studie se zaměřuje na výskyt IPH v populaci pacientů se symptomatickou (SS), asymptomatickou stabilní (AS) a asymptomatickou progredující (AP) stenózou a. carotis interna (ACI) ≥ 50 %. Materiál a metodika: Pro detekci IPH u pacientů se stenózou ACI byla použita série vyšetření duplexní sonografií (DS) v 6měsíčních intervalech a vyšetření MR s využitím axiálních sekvencí 3DT1_MPRAGE. Stenózy u pacientů s ipsilaterálním ischemickým iktem nebo tranzitorní ischemickou atakou v posledních 4 týdnech nebo nálezem akutní ischemické léze na difuzí vážených sekvencích MR byly hodnoceny jako symptomatické a stenózy s progresí o > 10 % od poslední DS pak jako progredující. Echolucentní část aterosklerotického plátu > 8 mm2 na DS a hyperintenzita na sekvenci 3DT1_MPRAGE MR byly zhodnoceny jako IPH. Rozdíly ve výskytu IPH mezi SS, AS a AP stenózami ACI byly statisticky zhodnoceny. Výsledky: Celkem bylo v rozmezí 15 měsíců zařazeno do prospektivní studie 52 pacientů (33 mužů, průměrný věk 69,2 ± 9,0 let) s celkem 59 stenózami ACI; 13 stenóz bylo hodnoceno jako SS, 27 jako AS a 19 jako AP. IPH bylo detekováno pomocí DS/ MR u 6 (46 %) / 4 (30 %) SS, 12 (44 %) / 8 (30 %) AS a u 11 (58 %) / 11 (58 %) AP stenóz ACI (ve všech případech p > 0,05). Záchyt IPH při kombinaci obou metod byl u 3 (23 %) SS, 4 (15 %) AS a u 7 (36 %) AP stenóz ACI (ve všech případech p > 0,05). Závěr: IPH bylo častěji pozorováno u asymptomatické progredující než u asymptomatické stabilní stenózy ACI. Nebyl nalezen žádný statisticky signifi kantní rozdíl mezi výskytem IPH u symptomatické a progredující asymptomatické stenózy ACI. Do probíhající studie bude celkem zařazeno 200 pacientů.

Aim: Intraplaque hemorrhage (IPH) belongs to potential mechanisms of plaque instability subsequently leading to ischemic stroke. Study aims to compare the IPH occurrence in patients with symptomatic (SS), asymptomatic stable (AS) and asymptomatic progressive (AP) internal carotid artery (ICA) stenosis ≥ 50%. Materials and methods: Serial duplex ultrasound (DUS) in a 6-month period and MRI using axial 3DT1_MPRAGE sequence were used for IPH detection in patients with ICA stenosis. Stenoses in patients with ipsilateral ischemic stroke / transient ischemic attack within the previous 4 weeks or acute ischemic lesion on diffusion-weighted MRI sequencies were evaluated as symptomatic. Stenoses with progression of > 10% since last DUS examination were evaluated as progressive. Echolucent part of atherosclerotic plaque > 8 mm2 on DUS and hyperintensity on 3DT1_MPRAGE-MRI were evaluated as IPH. Differences in IPH occurrence between SS, AS and AP ICA stenoses were statistically evaluated. Results: A total of 52 patients (33 males, mean age 69.2 ± 9.0 years) with 59 ICA stenoses were enrolled in the prospective study during 15 months; 13 ICA stenoses were evaluated as SS, 27 as AS and 19 as AP. IPH was detected using DUS/ MRI in 6 (46%) / 4 (30%) of SS, 12 (44%) / 8 (30%) of AS, and 11 (58%) / 11 (58%) of AP ICA stenoses (P > 0.05 in all cases). IPH was detected using combination of both methods in 3 (23%) of SS, 4 (15%) of AS, and 7 (36%) of AP ICA stenoses (P > 0.05 in all cases). Conclusion: IPH was more frequently detected in asymptomatic progressive than asymptomatic stable ICA stenoses. No significant differences were found between occurrence of IPH in symptomatic than in asymptomatic progressive ICA stenoses. A total of 200 patients will be enrolled in the ongoing study.

• Klíčová slova
• krvácení do plátu,
• MeSH
• arteria carotis interna diagnostické zobrazování   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• pozorovací studie jako téma MeSH
• prospektivní studie MeSH
• stenóza arteria carotis * diagnostické zobrazování   patologie   MeSH
• ultrasonografie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

• MeSH
• lidé MeSH
• paréza * rehabilitace   MeSH
• porodní paralýza rehabilitace   MeSH
• předškolní dítě MeSH
• reflexní terapie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• Publikační typ
• kazuistiky MeSH

OBJECTIVE: Silent and symptomatic cerebral infarctions occur in up to 34% of patients after carotid endarterectomy (CEA). This prospective study compared the risk of new brain infarctions detected by magnetic resonance imaging (MRI) in patients with internal carotid artery stenosis undergoing CEA with local anesthesia (LA) vs general anesthesia (GA). METHODS: Consecutive patients with internal carotid artery stenosis indicated for CEA were screened at two centers. Patients without contraindication to LA or GA were randomly allocated to the LA or GA group by ZIP code randomization. Brain MRI was performed before and 24 hours after CEA. Neurologic examination was performed before and 24 hours and 30 days after surgery. The occurrence of new infarctions on the control magnetic resonance images, stroke, transient ischemic attack, and other complications was statistically evaluated. RESULTS: Of 210 randomized patients, 105 underwent CEA with LA (67 men; mean age, 68.3 ± 8.1 years) and 105 with GA (70 men; mean age, 63.4 ± 7.5 years). New infarctions were more frequently detected on control magnetic resonance images in patients after CEA under GA compared with LA (17.1% vs 6.7%; P = .031). Stroke or transient ischemic attack occurred within 30 days of CEA in three patients under GA and in two under LA (P = 1.000). There were no significant differences between the two types of anesthesia in terms of the occurrence of other complications (14.3% for GA and 21.0% for LA; P = .277). CONCLUSIONS: The risk of silent brain infarction after CEA as detected by MRI is higher under GA than under LA.

• MeSH
• arteria carotis interna diagnostické zobrazování   chirurgie   MeSH
• asymptomatické nemoci MeSH
• časové faktory MeSH
• celková anestezie škodlivé účinky   MeSH
• cerebrální infarkt diagnostické zobrazování   etiologie   MeSH
• difuzní magnetická rezonance MeSH
• hodnocení rizik MeSH
• karotická endarterektomie škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální anestezie škodlivé účinky   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• stenóza arteria carotis komplikace   diagnostické zobrazování   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH