Computed tomography findings in patients with primarily unknown causes of severe or recurrent epistaxis.

ObjectiveIn addition to rhinoscopy, computed tomography of paranasal sinuses (CT) may be performed on patients with primary unknown cause of severe epistaxis (SE) or recurrent epistaxis (RE) to further assess the potential cause of bleeding. The aim of this study was to evaluate CT findings during the work-up of intractable epistaxis patients.Methods6937 patients were treated in our emergency department with acute epistaxis between 2009-2018. 304/6937 patients underwent CT and rhinoscopy due to intractable SE or RE. 33 patients presented with head trauma prior to epistaxis and were excluded from the final analysis. In 271 cases the primary causes of SE (n = 252) or RE (n = 19) remained unknown. Two observers retrospectively evaluated CT scans for potential sources of epistaxis. Disagreement was settled by consensus. CT and rhinoscopy findings were compared.ResultsIn 247/271 (91.1%) SE patients no related pathology was found on CT. A possible cause for epistaxis was found in all RE patients, but only in 5/252 (1.9%) patients with SE. Most tumours (10/11) and inflammatory conditions (9/10) were found in patients with RE. In three SE cases, a tumour was suspected on CT, from which two suspicions were refuted during rhinoscopy. CT revealed 10 cases of inflammatory conditions of the sinus and anatomical variant as potential cause of bleeding.ConclusionFor patients with unknown causes of epistaxis, supplementary CT imaging may be a useful diagnostic add-on to rhinoscopy in the event of RE, tumour suspicion or inflammation of the paranasal sinuses. However, in most cases of first-time SE, CT does not necessarily add to the diagnosis. In these cases, the marginal benefit of CT needs to be weighed carefully against its risks

Magnetic particle imaging for high temporal resolution assessment of aneurysm hemodynamics

The purpose of this work was to demonstrate the capability of magnetic particle imaging (MPI) to assess the hemodynamics in a realistic 3D aneurysm model obtained by additive manufacturing. MPI was compared with magnetic resonance imaging (MRI) and dynamic digital subtraction angiography (DSA)

Heterogeneity of Multiple Sclerosis Lesions in Multislice Myelin Water Imaging

<div><p>Purpose</p><p>To assess neuroprotection and remyelination in Multiple Sclerosis (MS), we applied a more robust myelin water imaging (MWI) processing technique, including spatial priors into image reconstruction, which allows for lower SNR, less averages and shorter acquisition times. We sought to evaluate this technique in MS-patients and healthy controls (HC).</p><p>Materials and Methods</p><p>Seventeen MS-patients and 14 age-matched HCs received a 3T Magnetic Resonance Imaging (MRI) examination including MWI (8 slices, 12 minutes acquisition time), T2w and T1mprage pre and post gadolinium (GD) administration. Black holes (BH), contrast enhancing lesions (CEL) and T2 lesions were marked and registered to MWI. Additionally, regions of interest (ROI) were defined in the frontal, parietal and occipital normal appearing white matter (NAWM)/white matter (WM), the corticospinal tract (CST), the splenium (SCC) and genu (GCC) of the corpus callosum in patients and HCs. Mean values of myelin water fraction (MWF) were determined for each ROI.</p><p>Results</p><p>Significant differences (p≤0.05) of the MWF were found in all three different MS-lesion types (BH, CEL, T2 lesions), compared to the WM of HCs. The mean MWF values among the different lesion types were significantly differing from each other. Comparing MS-patients vs. HCs, we found a significant (p≤0.05) difference of the MWF in all measured ROIs except of GCC and SCC. The mean reduction of MWF in the NAWM of MS-patients compared to HCs was 37%. No age, sex, disability score and disease duration dependency was found for the NAWM MWF.</p><p>Conclusion</p><p>MWF measures were in line with previous studies and lesions were clearly visible in MWI. MWI allows for quantitative assessment of NAWM and lesions in MS, which could be used as an additional sensitive imaging endpoint for larger MS studies. Measurements of the MWF also differ between patients and healthy controls.</p></div

Mean MWF values in the NAWM of MS-patients and WM of HCs in total study cohort.

<p>Mean MWF values in the NAWM of MS-patients and WM of HCs in total study cohort.</p

ROI localization in the NAWM.

<p>Figure showing regions of interest (ROI) placement on an exemplary T2w image of a healthy control (HC). ROIs have been defined in the normal appearing white matter (NAWM) of both hemispheres in the frontal and parietal NAWM (left side) as well as in the occipital NAWM, the genu and splenium of corpus callosum and cortico-spinal-tractus (right side).</p

Comparison between different MS-lesion types and the MWF in the WM of all HCs in the study.

<p>Boxplot depiction of the mean myelin water fractions (MWF) of different lesion types related to the mean MWF in the white matter (WM) of all healthy controls (HC).</p

Mean MWFs in specific MS-lesion types compared to the MWF in the WM of all HCs.

<p>Mean MWFs in specific MS-lesion types compared to the MWF in the WM of all HCs.</p

Heat map of myelin water fraction.

<p>Left side: T2w image of a Multiple-Sclerosis (MS) patient. Right side: heat map of a myelin water imaging (MWI). T2-hyperintense MS-lesions show clear reductions of myelin water fraction (MWF) (white arrows, right side).</p

Patient´s characteristics: overview of demographic data and clinical parameters of MS-patients and HCs.

<p>Patient´s characteristics: overview of demographic data and clinical parameters of MS-patients and HCs.</p

Boxplots of mean MWFs in the NAWM of all MS-patients compared to WM of healthy controls.

<p>Black boxes indicate the mean myelin water fraction (MWF) of healthy controls (HC) and grey boxes display the mean MWF of MS-patients in the specific Region of Interest (ROI) localization. NAWM = normal appearing white matter; WM = white matter of healthy controls; GCC = genu of corpus callosum; SCC = splenium of corpus callosum; CST = corticospinal tract.</p