Depiction of intracranial hemorrhage on FPCT and MDCT.

<p>Figure shows axial reconstructions from FPCT and MDCT in a patient with intracerebral and intraventricular hemorrhage. In the upper row, regions of interest were drawn on the MDCT image and superimposed onto the co-registered FPCT image. The same images without superimposed regions of interest are shown in the bottom row.</p

Patient characteristics and imaging of hemorrhagic lesions in FPCT compared to MDCT.

<p>Patient characteristics and imaging of hemorrhagic lesions in FPCT compared to MDCT.</p

Multiclass Support Vector Machine-Based Lesion Mapping Predicts Functional Outcome in Ischemic Stroke Patients

<div><p>Purpose</p><p>The aim of this study was to investigate if ischemic stroke final infarction volume and location can be used to predict the associated functional outcome using a multi-class support vector machine (SVM).</p><p>Material and Methods</p><p>Sixty-eight follow-up MR FLAIR datasets of ischemic stroke patients with known modified Rankin Scale (mRS) functional outcome after 30 days were used. The infarct regions were segmented and used to calculate the percentage of lesioned voxels in the predefined MNI, Harvard-Oxford cortical and subcortical atlas regions as well as using four problem-specific VOIs, which were identified from the database using voxel-based lesion symptom mapping. An overall of 12 SVM classification models for predicting the corresponding mRS score were generated using the lesion overlap values from the different brain region definitions, stroke laterality information, and the optional parameters infarct volume, admission NIHSS, and patient age.</p><p>Results</p><p>Leave-one-out cross validations revealed that including information about the stroke location in terms of lesion overlap measurements led to improved mRS prediction results compared to classification models not utilizing the stroke location information. Furthermore, integration of the optional features led to improved mRS prediction results in all cases tested. The problem-specific brain regions and additional integration of the optional features led to the best mRS predictions with a precise multi-value mRS prediction accuracy of 56%, sliding window multi-value mRS prediction accuracy (mRS±1) of 82%, and binary mRS (0-2 vs. 3-5) prediction accuracy of 85%.</p><p>Conclusion</p><p>Therefore, a graded SVM-based functional stroke outcome prediction using the problem-specific brain regions for lesion overlap quantification leads to promising results but needs to be further validated using an independent database to rule out a potential methodical bias and overfitting effects. The prediction of the graded mRS functional outcome could be a valuable tool if combined with voxel-wise tissue outcome predictions based on multi-parametric datasets acquired at the acute phase.</p></div

Correlation coefficients between the follow-up mRS outcome and the three optional parameters (lesion volume, age, and admission NIHSS), the lesion-based t-score sum, as well as lesion overlap measures of the predefined MNI brain structures and automatically determined problem-specific VOIs.

<p>Correlation coefficients between the follow-up mRS outcome and the three optional parameters (lesion volume, age, and admission NIHSS), the lesion-based t-score sum, as well as lesion overlap measures of the predefined MNI brain structures and automatically determined problem-specific VOIs.</p

Sequence parameters of FLAIR, DWI, and T2*/SWI of the different scanners.

<p>Sequence parameters of FLAIR, DWI, and T2*/SWI of the different scanners.</p

Lesion only detectable on review of both the axial and sagittal DWI together.

<p>B-1000 images and ADC-maps of the lesion (arrows) that was only detected on review both the axial (left) and the sagittal (right) DWI together (R_ax+sag).</p

Perihematomal diffusion restriction as a common finding in large intracerebral hemorrhages in the hyperacute phase

<div><p>Purpose</p><p>There is growing evidence that a perihematomal area of restricted diffusion (PDR) exists in intraparenchymal hemorrhages (IPH) within 1 week of symptom onset (SO). Here, we study characteristics and the clinical impact of the PDR in patients with hyperacute (≤ 6 hours from SO) IPH by means of apparent diffusion coefficient (ADC).</p><p>Methods</p><p>This monocentric, retrospective study includes 83 patients with first-ever primary IPH from 09/2002-10/2015. 3D volumetric segmentation was performed for the IPH, PDR, and perihematomal edema (PHE) on fluid-attenuated inversion recovery, T2*/susceptibility weighted images, and ADC images.</p><p>Results</p><p>A PDR was seen in 56/83 patients (67.5%) presenting with hyperacute IPH. Multivariate logistic regression analysis revealed every 10-year increase of age (HR 1.929, 95% CI 1.047–3.552, <i>P</i> = .035) and male gender (HR 5.672, 95% CI 1.038–30.992, <i>P</i> = .045) as significant predictors of the presence of a PDR, but not IPH size, IPH location, nor National Institutes of Health Stroke Scale Score (NIHSS) at admission. We found no difference in NIHSS at discharge, hematoma removal, or mortality rate in PDR-positive patients. ADC values of the PDR show a step-wise normalization with increasing time from SO.</p><p>Conclusions</p><p>Occurrence of a PDR is a common finding in supratentorial hyperacute IPH, but shows no adverse short-term clinical impact. It may represent transient oligemic and metabolic changes.</p></div

Findings of the consensus rating of R_AX, R_SAG and R_ax+sag compared to the clinical diagnosis.

<p>Findings of the consensus rating of R_AX, R_SAG and R_ax+sag compared to the clinical diagnosis.</p

Improved detectability of acute and subacute brainstem infarctions by combining standard axial and thin-sliced sagittal DWI

<div><p>Background and purpose</p><p>Most false negative findings in DWI of ischemic stroke are in patients with minor deficits clinically localized to the brainstem. Our goal was to evaluate the benefit of a thin-sliced sagittal DWI in addition to conventional axial DWI at 1.5T for the detection of brainstem infarctions.</p><p>Methods</p><p>Data of patients with symptoms consistent with acute and subacute brainstem infarction and an MRI examination including standard axial DWI and thin-sliced sagittal DWI were retrospectively analyzed. Patients with the later diagnosis of a TIA, an inflammation or a tumor of the brainstem were excluded from analysis. Diffusion restrictions were identified by two independent raters blinded for the final clinical diagnosis in three separate reading steps: First, only axial DWI, secondly only sagittal DWI, and lastly both DWIs together. Presence and size of DWI-lesions were documented for each plane. Differences between the observers were settled in consensus in a separate joint reading.</p><p>Results</p><p>Of 73 included patients, 46 patients were clinically diagnosed with brainstem infarction. Inter-observer agreement was excellent for the detection of brainstem lesions in axial and sagittal DWI (kappa = 0.94 and 0.97). In 28/46 patients (60.9%) lesions were detected in the axial plane alone, whereas in 6 more patients (73.9%) lesions were detected in the review of both sequences together. All lesions undetectable in the axial plane were smaller than 5 mm in cranio-caudal direction.</p><p>Conclusions</p><p>Thin-sliced sagittal DWI in addition to axial DWI improves the detection rate of brainstem infarction with little additional expenditure of time.</p></div

DSA-based rating of aneurysm opacification.

<p>Diagram shows receiver operating characteristic curves for classification of dichotomized neck coverage ratings based on early, intermediate and late phase DSA images. Intrasaccular stasis observed on late phase images had the highest area under the curve for discriminating favorable from unfavorable neck coverage.</p