Can Short Tau Inversion Recovery (STIR) Imaging Be Used as a Stand-Alone Sequence To Assess a Perianal Fistulous Tract on MRI?:A Retrospective Cohort Study Comparing STIR and T1-Post Contrast Imaging

Introduction: Perianal fistulas demand precise preoperative assessment for optimal surgical outcomes. MRI, using Short Tau Inversion Recovery (STIR) and T1-post contrast sequences, plays a crucial role in this evaluation.This retrospective cohort study compared STIR imaging's diagnostic efficacy with T1-post contrast sequences in identifying perianal fistulous tracts. The study investigated whether STIR imaging could serve as the sole diagnostic sequence, simplifying clinical practice.Methods: In a tertiary care hospital, 100 patients underwent pelvic MRI for suspected perianal fistulas. Radiologists independently evaluated STIR and T1-post contrast sequences for internal openings, tract extent, distinction, abscess presence, and tract type. Sensitivity, specificity, area under the curve (AUC), and Cohen's kappa analysis were used for diagnostic assessment.Results: STIR imaging showed notable sensitivity (79.8-97.9%) and specificity (100%) for identifying internal openings and tracts. Combined with T1-post contrast, diagnostic accuracy improved significantly, with near-perfect AUC values. Kappa values indicated moderate to substantial agreement between radiological assessments and clinical diagnosis. The combined sequences achieved 100% sensitivity and specificity for tract visualization.Conclusion: STIR imaging presents promise as a singular diagnostic tool for perianal fistulas, especially when combined with T1-post contrast sequences. While offering potential clinical diagnosis simplifications, further studies are warranted to validate its utility and ensure comprehensive diagnostic accuracy.</p

Can Short Tau Inversion Recovery (STIR) Imaging Be Used as a Stand-Alone Sequence To Assess a Perianal Fistulous Tract on MRI?:A Retrospective Cohort Study Comparing STIR and T1-Post Contrast Imaging

Introduction: Perianal fistulas demand precise preoperative assessment for optimal surgical outcomes. MRI, using Short Tau Inversion Recovery (STIR) and T1-post contrast sequences, plays a crucial role in this evaluation.This retrospective cohort study compared STIR imaging's diagnostic efficacy with T1-post contrast sequences in identifying perianal fistulous tracts. The study investigated whether STIR imaging could serve as the sole diagnostic sequence, simplifying clinical practice.Methods: In a tertiary care hospital, 100 patients underwent pelvic MRI for suspected perianal fistulas. Radiologists independently evaluated STIR and T1-post contrast sequences for internal openings, tract extent, distinction, abscess presence, and tract type. Sensitivity, specificity, area under the curve (AUC), and Cohen's kappa analysis were used for diagnostic assessment.Results: STIR imaging showed notable sensitivity (79.8-97.9%) and specificity (100%) for identifying internal openings and tracts. Combined with T1-post contrast, diagnostic accuracy improved significantly, with near-perfect AUC values. Kappa values indicated moderate to substantial agreement between radiological assessments and clinical diagnosis. The combined sequences achieved 100% sensitivity and specificity for tract visualization.Conclusion: STIR imaging presents promise as a singular diagnostic tool for perianal fistulas, especially when combined with T1-post contrast sequences. While offering potential clinical diagnosis simplifications, further studies are warranted to validate its utility and ensure comprehensive diagnostic accuracy.</p

Assessment of landfill protection systems in Japan - a case study

Landfilling of untreated waste is still seen as an acceptable practice in many developed countries. Sanitary landfills are facilities for the disposal of untreated mixed municipal solid waste as a major waste stream. The Waste Management and Public Cleansing Act of 1970 is the main waste legislation in Japan. Waste management methods differ in Japan from the European Union and other countries. As waste incineration is prevalent in Japan, the final waste disposal rate in landfills is extremely low, occupying less than 5% of the waste generated. In Japan, there are obligatory barrier systems, treatment facilities for leachate and concrete structures for major facilities (waste storage structures, barriers, and leachate treatment facilities), landfill operations (dumping and soil covering) and management facilities (weighing and monitoring equipment) which are identified in the Guideline Manual of Landfill Site. This work examines the landfill protection systems in Japan based on two case studies from selected research facilitiesO

Direct mechanical thrombectomy without intravenous thrombolysis versus bridging therapy for acute ischemic stroke:A meta-analysis of randomized controlled trials

Background: Direct mechanical thrombectomy may result in similar outcomes compared to a bridging approach with intravenous thrombolysis (IVT + MT) in acute ischemic stroke. Recent randomized controlled trials have varied in their design and noninferiority margin. Aim: We sought to meta-analyze accumulated trial data to assess the difference and non-inferiority in clinical and procedural outcomes between direct mechanical thrombectomy and bridging therapy. Summary of review: We conducted a systematic review of electronic databases following the preferred reporting items for systematic reviews and meta-analyses guidelines. Random effects meta-analyses were conducted for the pooled data. The primary outcome was good functional outcome at 90 days (modified Rankin scale (mRS) ≤ 2). Secondary outcomes included excellent functional outcome (mRS ≤ 1), mortality, any intracranial hemorrhage, symptomatic intracranial hemorrhage, successful reperfusion (thrombolysis in cerebral infarction ≥ 2 b), and procedure-related complications. Four randomized controlled trials comprising 1633 patients (817 direct mechanical thrombectomy, 816 bridging therapy) were included. There were no statistical differences for the 90-day good functional outcome (OR = 1.02, 95% CI 0.84–1.25, p = 0.54, I2= 0%), and the absolute risk difference was 1% (95% CI: −4% to 5%). The lower 95% CI falls within the strictest noninferiority margin of −10% among included randomized control trials. Direct mechanical thrombectomy reduced the odds of successful reperfusion (OR = 0.76, 95% CI: 0.60–0.97, p = 0.03, I2= 0%) and any intracranial hemorrhage (OR = 0.65, 95% CI: 0.49–0.86, p = 0.003, I2= 38%). There was no difference in the remaining secondary outcomes. The risk of bias for all studies was low. Conclusion: The combined trial data assessing direct mechanical thrombectomy versus bridging therapy showed no difference in improving good functional outcome. The wide noninferiority thresholds set by individual trials are in contrast with the clinical consensus on minimally important differences. However, our pooled analysis indicates noninferiority of direct mechanical thrombectomy with a 4% margin of confidence. The application of these findings is limited to patients presenting directly to mechanical thrombectomy-capable centers and real-world workflow times may differ against those achieved in a trial setting

Magnetic Resonance Imaging as a Prognostic Disability Marker in Clinically Isolated Syndrome and Multiple Sclerosis:A Systematic Review and Meta-Analysis

To date, there are no definite imaging predictors for long-term disability in multiple sclerosis (MS). Magnetic resonance imaging (MRI) is the key prognostic tool for MS, primarily at the early stage of the disease. Recent findings showed that white matter lesion (WML) counts and volumes could predict long-term disability for MS. However, the prognostic value of MRI in the early stage of the disease and its link to long-term physical disability have not been assessed systematically and quantitatively. A meta-analysis was conducted using studies from four databases to assess whether MS lesion counts and volumes at baseline MRI scans could predict long-term disability, assessed by the expanded disability status scale (EDSS). Fifteen studies were eligible for the qualitative analysis and three studies for meta-analysis. T2 brain lesion counts and volumes after the disease onset were associated with disability progression after 10 years. Four or more lesions at baseline showed a highly significant association with EDSS 3 and EDSS 6, with a pooled OR of 4.10 and 4.3, respectively. The risk increased when more than 10 lesions were present. This review and meta-analysis confirmed that lesion counts and volumes could be associated with disability and might offer additional valid guidance in treatment decision making. Future work is essential to determine whether these prognostic markers have high predictive potential.</p

Magnetic Resonance Imaging as a Prognostic Disability Marker in Clinically Isolated Syndrome and Multiple Sclerosis:A Systematic Review and Meta-Analysis

To date, there are no definite imaging predictors for long-term disability in multiple sclerosis (MS). Magnetic resonance imaging (MRI) is the key prognostic tool for MS, primarily at the early stage of the disease. Recent findings showed that white matter lesion (WML) counts and volumes could predict long-term disability for MS. However, the prognostic value of MRI in the early stage of the disease and its link to long-term physical disability have not been assessed systematically and quantitatively. A meta-analysis was conducted using studies from four databases to assess whether MS lesion counts and volumes at baseline MRI scans could predict long-term disability, assessed by the expanded disability status scale (EDSS). Fifteen studies were eligible for the qualitative analysis and three studies for meta-analysis. T2 brain lesion counts and volumes after the disease onset were associated with disability progression after 10 years. Four or more lesions at baseline showed a highly significant association with EDSS 3 and EDSS 6, with a pooled OR of 4.10 and 4.3, respectively. The risk increased when more than 10 lesions were present. This review and meta-analysis confirmed that lesion counts and volumes could be associated with disability and might offer additional valid guidance in treatment decision making. Future work is essential to determine whether these prognostic markers have high predictive potential.</p

Thrombectomy-capable stroke centre—a key to acute stroke care system improvement?:Retrospective analysis of safety and efficacy of endovascular treatment in cardiac Cathlab

The optimal structure of the acute ischaemic stroke treatment network is unknown and eagerly sought. To make it most effective, different treatment and transportation strategies have been developed and investigated worldwide. Since only a fraction of acute stroke patients with large vessel occlusion are treated, a new entity—thrombectomy-capable stroke centre (TCSC)—was introduced to respond to the growing demand for timely endovascular treatment. The purpose of this study was to present the early experience of the first 70 patients treated by mechanical means in a newly developed cardiac Cathlab-based TCSC. The essential safety and efficacy measures were recorded and compared with those reported in the invasive arm of the HERMES meta-analysis—the largest published dataset on the subject. We found no significant differences in terms of clinical and safety outcomes, such as early neurological recovery, level of functional independence at 90 days, symptomatic intracranial haemorrhage, parenchymal haematoma type 2, and mortality. These encouraging results obtained in the small endovascular centre may be an argument for the introduction of the TCSC into operating stroke networks to increase patient access to timely treatment and to improve clinical outcomes

Skala ASPECTS w udarze niedokrwiennym

Skala ASPECTS (Alberta Stroke Program Early CT Score) powstała na początku XXI wieku jako kwantyfikator wczesnych zmian niedokrwiennych na obrazach tomografii komputerowej u pacjentów podejrzanych o ostry udar niedokrwienny mózgu. Obejmuje zakres od 0 do 10 pkt., gdzie 10 pkt. oznacza stan prawidłowy. Jest ona skorelowana z rokowaniem. Obecnie jest jednym z kryteriów podczas kwalifikacji chorych do trombektomii mechanicznej.  W artykule omówiono historię, rozwój i przyszłość skali ASPECTS oraz opisano praktyczny protokół oceny.