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Several different techniques allow a functional assessment of neuronal activations by magnetic resonance imaging (fMRI). The by far most influential fMRI technique is based on a local T2*-sensitive hemodynamic response to neuronal activation, also known as the blood oxygenation level dependent or BOLD effect. Consequently, the term 'fMRI' is often used synonymously with BOLD imaging. Because interpretations of fMRI brain activation maps often appear intuitive and compelling, the reader might be tempted not to critically question the fundamental processes and assumptions. We review some essential processes and assumptions of BOLD fMRI and discuss related confounds and pitfalls in fMRI - from the underlying physiological effect, to data acquisition, data analysis and the interpretation of the results including clinical fMRI. A background framework is provided for the systematic and critical interpretation of fMRI results. [ABSTRACT FROM AUTHOR]

Acute macular neuroretinopathy (AMN) is a rare disease entity. It is mainly observed in young women with a history of influenza-like infection or who have been taking oral contraceptives for several years. Patients typically describe subjective visual deterioration and mono- or bilateral paracentral relative scotomas. In some cases, funduscopic ophthalmic examination may reveal subtle sharply demarcated flat lesions of reddish-brown or orange colour in the macular region. Diagnosis is usually made by near-infrared fundus imaging which shows hyporeflective areas, and SD-OCT imaging which manifests changes in the outer retinal layers. In the following, three patient cases with bilateral AMN are described which occurred in direct temporal relationship to a recent SARS-CoV-2 infection., Competing Interests: Prof. Dr. med. C. Mardin und PD Dr. med. Dr. rer. biol. hum. B. Hohberger: Heidelberg Engineering GmbH; Dr. med. A. J. Bartsch und A. A. Skornia: kein Interessenkonflikt/Prof. Dr. med. C. Mardin und PD Dr. med. Dr. rer. biol. hum. B. Hohberger: Heidelberg Engineering GmbH; Dr. med. A. J. Bartsch and A. A. Skornia: no conflict of interest, (Thieme. All rights reserved.)

In the first half of the 20th century, well before the antipsychotic era, paratonia, Gegenhalten and psychomotor hypertonia were described as new forms of hypertonia intrinsic to particular psychoses and catatonic disorders. A series of astute clinical observations and experiments supported their independence from rigidity seen in Parkinson's disease. After World War II, motor disorders went out of fashion in psychiatry, with drug-induced parkinsonism becoming the prevailing explanation for all involuntary resistance to passive motion. With the 'forgetting' of paratonia and Gegenhalten, parkinsonism became the prevailing reading grid, such that the rediscovery of hypertonia in antipsychotic-naive patients at the turn of the 21st century is currently referred to as "spontaneous parkinsonism", implicitly suggesting intrinsic and drug-induced forms to be the same. Classical descriptive psychopathology gives a more nuanced view in suggesting two non-parkinsonian hypertonias: (i) locomotor hypertonia corresponds to Ernest Dupré's paratonia and Karl Kleist's reactive Gegenhalten; it is a dys-relaxation phenomenon that often needs to be activated. (ii) Psychomotor hypertonia is experienced as an admixture of assistance and resistance that partially overlaps with Kleist's spontaneous Gegenhalten, but was convincingly isolated by Henri Claude and Henri Baruk thanks to electromyogram recordings; psychomotor hypertonia is underpinned by "anticipatory contractions" of cortical origin, occurrence of which in phase or antiphase with the movement accounted for facilitation or opposition to passive motions. This century-old knowledge is not only of historical interest. Some results have recently been replicated in dementia and as now known to involve specific premotor systems., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022. Published by Elsevier B.V.)

Abnormal movements are intrinsic to some forms of endogenous psychoses. Spontaneous dyskinesias are observed in drug-naïve first-episode patients and at-risk subjects. However, recent descriptions of spontaneous dyskinesias may actually represent the rediscovery of a more complex phenomenon, 'parakinesia' which was described and documented in extensive cinematographic recordings and long-term observations by German and French neuropsychiatrists decades before the introduction of antipsychotics. With the emergence of drug induced movement disorders, the description of parakinesia has been refined to emphasize the features enabling differential diagnosis with tardive dyskinesia. Unfortunately, parakinesia was largely neglected by mainstream psychiatry to the point of being almost absent from the English-language literature. With the renewed interest in motor phenomena intrinsic to SSD, it was timely not only to raise awareness of parakinesia, but also to propose a scientifically usable definition for this phenomenon. Therefore, we conducted a Delphi consensus exercise with clinicians familiar with the concept of parakinesia. The original concept was separated into hyperkinetic parakinesia (HPk) as dyskinetic-like expressive movements and parakinetic psychomotricity (PPM), i.e., patient's departing from the patient's normal motion style. HPk prevails on the upper part of the face and body, resembling expressive and reactive gestures that not only occur inappropriately but also appear distorted. Abnormal movements vary in intensity depending on the level of psychomotor arousal and are thus abated by antipsychotics. HPk frequently co-occurs with PPM, in which gestures and mimics lose their naturalness and become awkward, disharmonious, stiff, mannered, and bizarre. Patients are never spontaneously aware of HPk or PPM, and the movements are never experienced as self-dystonic or self-alien. HPk and PPM are highly specific to endogenous psychoses, in which they are acquired and progressive, giving them prognostic value. Their differential diagnoses and correspondences with current international concepts are discussed., Competing Interests: Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest., (Copyright © 2022. Published by Elsevier B.V.)

Purpose: Functional MRI (fMRI) has well-established uses to inform risks and plan maximally safe approaches in neurosurgery. In the field of brain tumour surgery, however, fMRI is currently in a state of clinical equipoise due to debate around both its sensitivity and specificity., Materials and Methods: In this review, we summarise the role and our experience of fMRI in neurosurgery for gliomas and metastases. We discuss nuances in the conduct and interpretation of fMRI that, based on our practise, most directly impact fMRI's usefulness in the neurosurgical setting., Results: Illustrated examples in which fMRI in our hands directly influences the neurosurgical treatment of brain tumours include evaluating the probability and nature of functional risks, especially for language functions. These presurgical risk assessments, in turn, help to predict the resectability of tumours, select or deselect patients for awake surgery, indicate the need for neurophysiological monitoring and guide the optimal use of intra-operative stimulation mapping. A further emerging application of fMRI is in measuring functional adaptation of functional networks after (partial) surgery, of potential use in the timing of further surgery., Conclusions: In appropriately selected patients with a clearly defined surgical question, fMRI offers a valuable complementary tool in the pre-surgical evaluation of brain tumours. However, there is a great need for standards in the administration and analysis of fMRI as much as in the techniques that it is commonly evaluated against. Surprisingly little data exists that evaluates the accuracy of fMRI not just against complementary methods, but in terms of its ultimate clinical aim of minimising post-surgical morbidity.

Neuroradiologists and neurosurgeons increasingly opt to use functional magnetic resonance imaging (fMRI) to map functionally relevant brain regions for noninvasive presurgical planning and intraoperative neuronavigation. This application requires a high degree of spatial accuracy, but the fMRI signal-to-noise ratio (SNR) decreases as spatial resolution increases. In practice, fMRI scans can be collected at multiple spatial resolutions, and it is of interest to make more accurate inference on brain activity by combining data with different resolutions. To this end, we develop a new Bayesian model to leverage both better anatomical precision in high resolution fMRI and higher SNR in standard resolution fMRI. We assign a Gaussian process prior to the mean intensity function and develop an efficient, scalable posterior computation algorithm to integrate both sources of data. We draw posterior samples using an algorithm analogous to Riemann manifold Hamiltonian Monte Carlo in an expanded parameter space. We illustrate our method in analysis of presurgical fMRI data, and show in simulation that it infers the mean intensity more accurately than alternatives that use either the high or standard resolution fMRI data alone.

Impacts to the back of the head due to rearward falls, also referred to as "backfall" events, represent a common source of TBI for athletes and soldiers. A new experimental apparatus is described for replicating the linear and rotational kinematics of the head during backfall events. An anthropomorphic test device (ATD) with a head-borne sensor suite was configured to fall backwards from a standing height, inducing contact between the rear of the head and a ground surface simulant. A pivoting swing arm and release strap were used to generate consistent and realistic head kinematics. Backfall experiments were performed with the ATD fitted with an American football helmet and the resulting linear and rotational head kinematics, as well as calculated injury metrics, compared favorably with those of football players undergoing similar impacts during games or play reconstructions. This test method complements existing blunt impact helmet performance experiments, such as drop tower and pneumatic ram test methods, which may not be able to fully reproduce head-neck-torso kinematics during a backfall event., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

The objective of this study was to compare head impact data acquired with an impact monitoring mouthguard (IMM) to the video-observed behavior of athletes' post-collision relative to their pre-collision behaviors. A total of n = 83 college and high school American football players wore the IMM and were video-recorded over 260 athlete-exposures. Ex-athletes and clinicians reviewed the video in a two-step process and categorized abnormal post-collision behaviors according to previously published Obvious Performance Decrement (OPD) definitions. Engineers qualitatively reviewed datasets to check head impact and non-head impact signal frequency and magnitude. The ex-athlete reviewers identified 2305 head impacts and 16 potential OPD impacts, 13 of which were separately categorized as Likely-OPD impacts by the clinical reviewers. All 13 Likely-OPD impacts were in the top 1% of impacts measured by the IMM (ranges 40-100 g, 3.3-7.0 m/s and 35-118 J) and 12 of the 13 impacts (92%) were to the side or rear of the head. These findings require confirmation in a larger data set before proposing any type of OPD impact magnitude or direction threshold exists. However, OPD cases in this study compare favorably with previously published impact monitoring studies in high school and college American football players that looked for OPD signs, impact magnitude and direction. Our OPD findings also compare well with NFL reconstruction studies for ranges of concussion and sub-concussive impact magnitudes in side/rear collisions, as well as prior theory, analytical models and empirical research that suggest a directional sensitivity to brain injury exists for single high-energy impacts.

Although concussion continues to be a major source of acute and chronic injury in automotive, athletic and military arenas, concussion injury mechanisms and risk functions are ill-defined. This lack of definition has hindered efforts to develop standardized concussion monitoring, safety testing and protective countermeasures. Recent research has provided evidence of the role of repetitive head impact exposure as a predisposing factor for the onset of concussion using developed instrumented helmets and mouthguards.To overcome this knowledge gap, we have developed, tested and deployed a head impact monitoring mouthguard (IMM) system. In this study, we deployed the IMM system to gather high quality estimates of athlete head impacts in situ. And with enough longer-term data collection, potential concussive events or mild traumatic brain injuries (mTBIs) will be gathered and ideally will provide actionable risk-based threshold.

Purpose: To improve the reconstruction quality for quantitative T 1 and T 2 measurements using the inversion recovery (IR) TrueFISP sequence and to demonstrate the potential for multicomponent analysis., Methods: The iterative reconstruction method takes advantage of the high redundancy in the smooth exponential signals using principle component analysis (PCA). Multicomponent information is preserved and allows voxel-by-voxel computation of relaxation time spectra with an inverse Laplace transform. Off-resonance effects are analytically and numerically investigated and a correction approach is presented., Results: Single-shot IR TrueFISP in vivo measurements on healthy volunteers demonstrate the improved reconstruction performance compared to a view sharing (k-space weighted image contrast [KWIC]) reconstruction. Especially, tissue components with short apparent relaxation times T 1 * are not filtered out and can be identified in the relaxation time spectra. These components include myelin in the human brain (T 1 * ≈ 130 ms) and extra cranial subcutaneous fat., Conclusion: The PCA-based reconstruction method improves the temporal accuracy and preserves multicomponent information. Spatially resolved relaxation time spectra can be obtained and allow the identification of tissue types with short, apparent relaxation times., (© 2019 International Society for Magnetic Resonance in Medicine.)

Spatial resolution plays an important role in functional magnetic resonance imaging studies as the signal-to-noise ratio increases linearly with voxel volume. In scientific studies, where functional magnetic resonance imaging is widely used, the standard spatial resolution typically used is relatively low which ensures a relatively high signal-to-noise ratio. However, for pre-surgical functional magnetic resonance imaging analysis, where spatial accuracy is paramount, high-resolution functional magnetic resonance imaging may play an important role with its greater spatial resolution. High spatial resolution comes at the cost of a smaller signal-to-noise ratio. This begs the question as to whether we can leverage the higher signal-to-noise ratio of a standard functional magnetic resonance imaging study with the greater spatial accuracy of a high-resolution functional magnetic resonance imaging study in a pre-operative patient. To answer this question, we propose to regress the statistic image from a high resolution scan onto the statistic image obtained from a standard resolution scan using a mixed-effects model with spatially varying coefficients. We evaluate our model via simulation studies and we compare its performance with a recently proposed model that operates at a single spatial resolution. We apply and compare the two models on data from a patient awaiting tumor resection. Both simulation study results and the real data analysis demonstrate that our newly proposed model indeed leverages the larger signal-to-noise ratio of the standard spatial resolution scan while maintaining the advantages of the high spatial resolution scan.

Oncolytic virotherapy may be a means of improving the dismal prognosis of malignant brain tumors. The rat H-1 parvovirus (H-1PV) suppresses tumors in preclinical glioma models, through both direct oncolysis and stimulation of anticancer immune responses. This was the basis of ParvOryx01, the first phase I/IIa clinical trial of an oncolytic parvovirus in recurrent glioblastoma patients. H-1PV (escalating dose) was administered via intratumoral or intravenous injection. Tumors were resected 9 days after treatment, and virus was re-administered around the resection cavity. Primary endpoints were safety and tolerability, virus distribution, and maximum tolerated dose (MTD). Progression-free and overall survival and levels of viral and immunological markers in the tumor and peripheral blood were also investigated. H-1PV treatment was safe and well tolerated, and no MTD was reached. The virus could cross the blood-brain/tumor barrier and spread widely through the tumor. It showed favorable pharmacokinetics, induced antibody formation in a dose-dependent manner, and triggered specific T cell responses. Markers of virus replication, microglia/macrophage activation, and cytotoxic T cell infiltration were detected in infected tumors, suggesting that H-1PV may trigger an immunogenic stimulus. Median survival was extended in comparison with recent meta-analyses. Altogether, ParvOryx01 results provide an impetus for further H-1PV clinical development., (Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: Atrial fibrillation (AF) is frequently detected after ischemic stroke for the first time, and brain regions involved in autonomic control have been suspected to trigger AF. We examined whether specific brain regions are associated with newly detected AF after ischemic stroke., Methods: Patients with acute cerebral infarctions on diffusion-weighted magnetic resonance imaging were included in this lesion mapping study. Lesions were mapped and modeled voxelwise using Bayesian Spatial Generalised Linear Mixed Modeling to determine differences in infarct locations between stroke patients with new AF, without AF and with AF already known before the stroke., Results: 582 patients were included (median age 68 years; 63.2% male). AF was present in 109/582 patients [(18.7%); new AF: 39/109 (35.8%), known AF: 70/109 (64.2%)]. AF patients had larger infarct volumes than patients without AF (mean: 29.7 ± 45.8 ml vs. 15.2 ± 35.1 ml; p<0.001). Lesions in AF patients accumulated in the right central middle cerebral artery territory. Increasing stroke size predicted progressive cortical but not pontine and thalamic involvement. Patients with new AF had more frequently lesions in the right insula compared to patients without AF when stroke size was not accounted for, but no specific brain region was more frequently involved after adjustment for infarct volume. Controlled for stroke size, left parietal involvement was less likely for patients with new AF than for those without AF or with known AF., Conclusions: In the search for brain areas potentially triggering cardiac arrhythmias infarct size should be accounted for. After controlling for infarct size, there is currently no evidence that ischemic stroke lesions of specific brain areas are associated with new AF compared to patients without AF. This challenges the neurogenic hypothesis of AF according to which a relevant proportion of new AF is triggered by ischemic brain lesions of particular locations.

Medical imaging has enormous potential for early disease prediction, but is impeded by the difficulty and expense of acquiring data sets before symptom onset. UK Biobank aims to address this problem directly by acquiring high-quality, consistently acquired imaging data from 100,000 predominantly healthy participants, with health outcomes being tracked over the coming decades. The brain imaging includes structural, diffusion and functional modalities. Along with body and cardiac imaging, genetics, lifestyle measures, biological phenotyping and health records, this imaging is expected to enable discovery of imaging markers of a broad range of diseases at their earliest stages, as well as provide unique insight into disease mechanisms. We describe UK Biobank brain imaging and present results derived from the first 5,000 participants' data release. Although this covers just 5% of the ultimate cohort, it has already yielded a rich range of associations between brain imaging and other measures collected by UK Biobank., Competing Interests: PW and ID are employees of Siemens Healthcare UK, the vendor of MRI scanners for UK Biobank selected under a competitive bidding process. Other authors declare no competing financial interests.

Introduction: Professional boxing can lead to chronic traumatic encephalopathy, a variant of traumatic brain injury (TBI). Its occurrence in amateur boxers is a matter of debate since amateur boxing is considered to be less harmful due to more strict regulations. However, several studies using different methodological approaches have revealed subtle signs of TBI even in amateurs. Diffusion tensor imaging (DTI) is sensitive to microscopic white matter changes and has been proven useful in TBI when routine MR imaging often is unrevealing., Methods: DTI, with tract-based spatial statistics (TBSS) together with neuropsychological examination of executive functions and memory, was used to investigate a collective of 31 male amateur boxers and 31 age-matched controls as well as a subgroup of 19 individuals, respectively, who were additionally matched for intellectual performance (IQ)., Results: All participants had normal findings in neurological examination and conventional MR. Amateur boxers did not show deficits in neuropsychological tests when their IQ was taken into account. Fractional anisotropy was significantly reduced, while diffusivity measures were increased along central white matter tracts in the boxers group. These changes were in part associated with the number of fights., Conclusions: TBSS revealed widespread white matter disturbance partially related to the individual fighting history in amateur boxers. These findings closely resemble those in patients with accidental TBI and indicate similar histological changes in amateur boxers.

The authors present the development and laboratory system-level testing of an impact monitoring "Intelligent Mouthguard" intended to help with identification of potentially concussive head impacts and cumulative head impact dosage. The goal of Intelligent Mouthguard is to provide an indicator of potential concussion risk, and help caregiver identify athletes needing sideline concussion protocol testing. Intelligent Mouthguard may also help identify individuals who are at higher risk based on historical dosage. Intelligent Mouthguard integrates inertial sensors to provide 3-degree of freedom linear and rotational kinematics. The electronics are fully integrated into a custom mouthguard that couples tightly to the upper teeth. The combination of tight coupling and highly accurate sensor data means the Intelligent Mouthguard meets the National Football League (NFL) Level I validity specification based on laboratory system-level test data presented in this study.

Spatial smoothing is an essential step in the analysis of functional magnetic resonance imaging (fMRI) data. One standard smoothing method is to convolve the image data with a three-dimensional Gaussian kernel that applies a fixed amount of smoothing to the entire image. In pre-surgical brain image analysis where spatial accuracy is paramount, this method, however, is not reasonable as it can blur the boundaries between activated and deactivated regions of the brain. Moreover, while in a standard fMRI analysis strict false positive control is desired, for pre-surgical planning false negatives are of greater concern. To this end, we propose a novel spatially adaptive conditionally autoregressive model with variances in the full conditional of the means that are proportional to error variances, allowing the degree of smoothing to vary across the brain. Additionally, we present a new loss function that allows for the asymmetric treatment of false positives and false negatives. We compare our proposed model with two existing spatially adaptive conditionally autoregressive models. Simulation studies show that our model outperforms these other models; as a real model application, we apply the proposed model to the pre-surgical fMRI data of two patients to assess peri- and intra-tumoral brain activity.

Background: Surgical resection of intra-axial tumors is a challenging procedure because of indistinct tumor margins, infiltration, and displacement of white matter tracts surrounding the lesion. Hence, gross total tumor resection without causing new neurologic deficits is demanding, especially in tumor sites adjoining eloquent structures. Feasibility of the combination of navigated probabilistic fiber tracking to identify eloquent fiber pathways and navigated ultrasonography to control brain shift was tested., Methods: Eleven patients with lesions adjacent to eloquent white matter structures (pyramidal tract, optic radiation and arcuate fascicle) were preoperatively subjected to magnetic resonance imaging including diffusion-weighted imaging on a 3-T magnetic resonance system (Trio [Siemens, Erlangen, Germany]). Probabilistic fiber tracking was performed using the tools of the FMRIB Software Library (FSL). Results of probabilistic fiber tracking and high-resolution anatomic images were integrated into the neuronavigation system Stealth Station (Medtronic, Minneapolis, Minnesota, USA) together with the navigated ultrasonography (SonoNav [Medtronic])., Results: FSL-based probabilistic fiber tracking depicted the pyramidal tract, the optic radiation, and arcuate fascicle anatomically plausibly. Integration of the probabilistic fiber tracking into neuronavigation was technically feasible and allowed visualization of the reconstructed fiber pathways. Navigated ultrasonography controlled brain shift., Conclusions: Integration of probabilistic fiber tracking and navigated ultrasonography into intraoperative neuronavigation facilitated anatomic orientation during glioma resection. FSL-based probabilistic fiber tracking integrated sophisticated fiber tracking algorithms, including modeling of crossing fibers. Combination with navigated ultrasonography provided a three-dimensional estimation of intraoperative brain shift and, therefore, improved the reliability of neuronavigation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background and Purpose: As yet, there are no in vivo data on tissue water changes and associated morphometric changes involved in the osmo-adaptation of normal brains. Our aim was to evaluate osmoadaptive responses of the healthy human brain to osmotic challenges of de- and rehydration by serial measurements of brain volume, tissue fluid, and metabolites., Materials and Methods: Serial T1-weighted and (1)H-MR spectroscopy data were acquired in 15 healthy individuals at normohydration, on 12 hours of dehydration, and during 1 hour of oral rehydration. Osmotic challenges were monitored by serum measures, including osmolality and hematocrit. MR imaging data were analyzed by using FreeSurfer and LCModel., Results: On dehydration, serum osmolality increased by 0.67% and brain tissue fluid decreased by 1.63%, on average. MR imaging morphometry demonstrated corresponding decreases of cortical thickness and volumes of the whole brain, cortex, white matter, and hypothalamus/thalamus. These changes reversed during rehydration. Continuous fluid ingestion of 1 L of water for 1 hour within the scanner lowered serum osmolality by 0.96% and increased brain tissue fluid by 0.43%, on average. Concomitantly, cortical thickness and volumes of the whole brain, cortex, white matter, and hypothalamus/thalamus increased. Changes in brain tissue fluid were related to volume changes of the whole brain, the white matter, and hypothalamus/thalamus. Only volume changes of the hypothalamus/thalamus significantly correlated with serum osmolality., Conclusions: This is the first study simultaneously evaluating changes in brain tissue fluid, metabolites, volume, and cortical thickness. Our results reflect cellular volume regulatory mechanisms at a macroscopic level and emphasize that it is essential to control for hydration levels in studies on brain morphometry and metabolism in order to avoid confounding the findings., (© 2015 by American Journal of Neuroradiology.)

Purpose: Recently, the (Resolution Enhanced-) T1 insensitive steady-state imaging (TOSSI) approach has been proposed for the fast acquisition of T2 -weighted images. This has been achieved by balanced steady-state free precession (bSSFP) imaging between unequally spaced inversion pulses. The purpose of this work is to present an extension of this technique, considerably increasing both the efficiency and possibilities of TOSSI., Theory and Methods: A radial trajectory in combination with an appropriate view-sharing reconstruction is used. Because each projection traverses the contrast defining k-space center, several different contrasts can be extracted from a single-shot measurement. These contrasts include various T2 -weightings and T2 /T1 -weighting if an even number of inversion pulses is used, while an odd number allow the generation of several images with predefined tissue types cancelled., Results: The approach is validated for brain and abdominal imaging at 3.0 Tesla. Results are compared with RE-TOSSI, bSSFP, and turbo spin-echo images and are shown to provide similar contrasts in a fraction of scan time. Furthermore, the potential utility of the approach is illustrated by images obtained from a brain tumor patient., Conclusion: Radial T1 sensitive and insensitive steady-state imaging is able to generate multiple contrasts out of one single-shot measurement in a short scan time., (© 2014 Wiley Periodicals, Inc.)

Background and Purpose: Cavum-trigeminale-cephaloceles (CTCs) are rare lesions of Meckel's cave and the petrous apex. Despite distinctive imaging features, they are frequently mistaken for other petrous apex lesions. In contrast to many of these entities, CTCs do--when asymptomatic--not require any invasive work-up or even surgical excision. Since correct diagnosis has profound impact on clinical decision-making, we report on a series of CTCs with distinct imaging features and their important differential diagnoses., Material and Methods: We report a retrospective series of 5 patients with CTCs and the associated imaging features including the absence of diffusion restriction and solid contrast enhancement as well as their size, anatomical location with regard to adjacent structures and the remodeling or erosion of surrounding bony structures., Results: Our series contains the largest CTC that has, to the best of our knowledge, been reported so far. It revealed a deep cervical extension and was initially mistaken for a branchial cleft cyst. Furthermore, we show that CTCs can erode or remodel important structures such as canalis nervi hypoglossi, canalis Vidiani, foramen rotundum, ovale, lacerum and spinosum without causing clinical symptoms., Conclusion: In contrast to previous reports in which asymptomatic CTC did not include critical structures such as the foramina rotundum, ovale, lacerum or spinosum or the hypoglossal or Vidian canal, we show that CTCs can be asymptomatic even when eroding or remodeling such clinically important structures. When extending below the skull base, CTCs are a rare differential diagnosis to cystic cervical lesions such as type II branchial cleft cysts., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background Context: Decompressive procedures such as laminectomy, facetectomy, and costotransversectomy are routinely performed for various pathologies in the thoracic spine. The thoracic spine is unique, in part, because of the sternocostovertebral articulations that provide additional strength to the region relative to the cervical and lumbar spines. During decompressive surgeries, stability is compromised at a presently unknown point., Purpose: To evaluate thoracic spinal stability after common surgical decompressive procedures in thoracic spines with intact sternocostovertebral articulations., Study Design: Biomechanical cadaveric study., Methods: Fresh-frozen human cadaveric spine specimens with intact rib cages, C7-L1 (n=9), were used. An industrial robot tested all spines in axial rotation (AR), lateral bending (LB), and flexion-extension (FE) by applying pure moments (±5 Nm). The specimens were first tested in their intact state and then tested after each of the following sequential surgical decompressive procedures at T4-T5 consisting of laminectomy; unilateral facetectomy; unilateral costotransversectomy, and subsequently instrumented fusion from T3-T7., Results: We found that in all three planes of motion, the sequential decompressive procedures caused no statistically significant change in motion between T3-T7 or T1-T12 when compared with intact. In comparing between intact and instrumented specimens, our study found that instrumentation reduced global range of motion (ROM) between T1-T12 by 16.3% (p=.001), 12% (p=.002), and 18.4% (p=.0004) for AR, FE, and LB, respectively. Age showed a negative correlation with motion in FE (r = -0.78, p=.01) and AR (r=-0.7, p=.04)., Conclusions: Thoracic spine stability was not significantly affected by sequential decompressive procedures in thoracic segments at the level of the true ribs in all three planes of motion in intact thoracic specimens. Age appeared to negatively correlate with ROM of the specimen. Our study suggests that thoracic spinal stability is maintained immediately after unilateral decompression at the level of the true ribs. These preliminary observations, however, do not depict the long-term sequelae of such procedures and warrant further investigation., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To compare a novel combined acquisition technique (CAT) of turbo-spin-echo (TSE) and echo-planar-imaging (EPI) with conventional TSE. CAT reduces the electromagnetic energy load transmitted for spin excitation. This radiofrequency (RF) burden is limited by the specific absorption rate (SAR) for patient safety. SAR limits restrict high-field MRI applications, in particular., Material and Methods: The study was approved by the local Medical Ethics Committee. Written informed consent was obtained from all participants. T2- and PD-weighted brain images of n = 40 Multiple Sclerosis (MS) patients were acquired by CAT and TSE at 3 Tesla. Lesions were recorded by two blinded, board-certificated neuroradiologists. Diagnostic equivalence of CAT and TSE to detect MS lesions was evaluated along with their SAR, sound pressure level (SPL) and sensations of acoustic noise, heating, vibration and peripheral nerve stimulation., Results: Every MS lesion revealed on TSE was detected by CAT according to both raters (Cohen's kappa of within-rater/across-CAT/TSE lesion detection κCAT = 1.00, at an inter-rater lesion detection agreement of κLES = 0.82). CAT reduced the SAR burden significantly compared to TSE (p<0.001). Mean SAR differences between TSE and CAT were 29.0 (± 5.7) % for the T2-contrast and 32.7 (± 21.9) % for the PD-contrast (expressed as percentages of the effective SAR limit of 3.2 W/kg for head examinations). Average SPL of CAT was no louder than during TSE. Sensations of CAT- vs. TSE-induced heating, noise and scanning vibrations did not differ., Conclusion: T2-/PD-CAT is diagnostically equivalent to TSE for MS lesion detection yet substantially reduces the RF exposure. Such SAR reduction facilitates high-field MRI applications at 3 Tesla or above and corresponding protocol standardizations but CAT can also be used to scan faster, at higher resolution or with more slices. According to our data, CAT is no more uncomfortable than TSE scanning.

Objective: To investigate functional connectivity between the default mode network (DMN) and other networks in disorders of consciousness., Methods: We analyzed MRI data from 11 patients in a vegetative state and 7 patients in a minimally conscious state along with age- and sex-matched healthy control subjects. MRI data analysis included nonlinear spatial normalization to compensate for disease-related anatomical distortions. We studied brain connectivity data from resting-state MRI temporal series, combining noninferential (independent component analysis) and inferential (seed-based general linear model) methods., Results: In DMN hypoconnectivity conditions, a patient's DMN functional connectivity shifts and paradoxically increases in limbic structures, including the orbitofrontal cortex, insula, hypothalamus, and the ventral tegmental area., Conclusions: Concurrently with DMN hypoconnectivity, we report limbic hyperconnectivity in patients in vegetative and minimally conscious states. This hyperconnectivity may reflect the persistent engagement of residual neural activity in self-reinforcing neural loops, which, in turn, could disrupt normal patterns of connectivity.

Functional magnetic resonance imaging (fMRI) has become a powerful and influential method to non-invasively study neuronal brain activity. For this purpose, the blood oxygenation level-dependent (BOLD) effect is most widely used. T2* weighted echo planar imaging (EPI) is BOLD sensitive and the prevailing fMRI acquisition technique. Here, we present an alternative to its standard Cartesian recordings, i.e. k-space density weighted EPI, which is expected to increase the signal-to-noise ratio in fMRI data. Based on in vitro and in vivo pilot measurements, we show that fMRI by k-space density weighted EPI is feasible and that this new acquisition technique in fact boosted spatial and temporal SNR as well as the detection of local fMRI activations. Spatial resolution, spatial response function and echo time were identical for density weighted and conventional Cartesian EPI. The signal-to-noise ratio gain of density weighting can improve activation detection and has the potential to further increase the sensitivity of fMRI investigations.

Object: Clinical 3 T MRI systems are rapidly increasing and MRI systems with a static field of 7 T or even more have been installed. The RF power deposition is proportional to the square of the static magnetic field strength and is characterized by the specific absorption rate (SAR). Therefore, there exist defined safety limits to avoid heating of the patient. Here, we describe a hybrid method to significantly reduce the SAR compared to a turbo-spin-echo (TSE) sequence., Materials and Methods: We investigate the potential benefits of a combined acquisition technique (CAT) for high-field neuroimaging at 3 and 7 T. The TSE/EPI CAT experiments were performed on volunteers and patients and compared with standard TSE and GRASE protocols. Problems and solutions regarding T2 weighted CAT imaging are discussed., Results: We present in vivo images with T2 and proton density contrast obtained on 3 and 7 T with significant SAR reduction (up to 60%) compared with standard TSE. Image quality is comparable to TSE but CAT shows fewer artifacts than a GRASE sequence., Conclusion: CAT is a promising candidate for neuroimaging at high fields up to 7 T. The SAR reduction allows one to shorten the waiting time between two excitations or to image more slices thereby reducing the overall measurement time.

The Potts model has enjoyed much success as a prior model for image segmentation. Given the individual classes in the model, the data are typically modeled as Gaussian random variates or as random variates from some other parametric distribution. In this article, we present a non-parametric Potts model and apply it to a functional magnetic resonance imaging study for the pre-surgical assessment of peritumoral brain activation. In our model, we assume that the Z-score image from a patient can be segmented into activated, deactivated, and null classes, or states. Conditional on the class, or state, the Z-scores are assumed to come from some generic distribution which we model non-parametrically using a mixture of Dirichlet process priors within the Bayesian framework. The posterior distribution of the model parameters is estimated with a Markov chain Monte Carlo algorithm, and Bayesian decision theory is used to make the final classifications. Our Potts prior model includes two parameters, the standard spatial regularization parameter and a parameter that can be interpreted as the a priori probability that each voxel belongs to the null, or background state, conditional on the lack of spatial regularization. We assume that both of these parameters are unknown, and jointly estimate them along with other model parameters. We show through simulation studies that our model performs on par, in terms of posterior expected loss, with parametric Potts models when the parametric model is correctly specified and outperforms parametric models when the parametric model in misspecified.

Object: In spite of ample literature pointing to rotational and combined impact dosage being key contributors to head and neck injury, boxing and mixed martial arts (MMA) padding is still designed to primarily reduce cranium linear acceleration. The objects of this study were to quantify preliminary linear and rotational head impact dosage for selected boxing and MMA padding in response to hook punches; compute theoretical skull, brain, and neck injury risk metrics; and statistically compare the protective effect of various glove and head padding conditions., Methods: An instrumented Hybrid III 50th percentile anthropomorphic test device (ATD) was struck in 54 pendulum impacts replicating hook punches at low (27-29 J) and high (54-58 J) energy. Five padding combinations were examined: unpadded (control), MMA glove-unpadded head, boxing glove-unpadded head, unpadded pendulum-boxing headgear, and boxing glove-boxing headgear. A total of 17 injury risk parameters were measured or calculated., Results: All padding conditions reduced linear impact dosage. Other parameters significantly decreased, significantly increased, or were unaffected depending on padding condition. Of real-world conditions (MMA glove-bare head, boxing glove-bare head, and boxing glove-headgear), the boxing glove-headgear condition showed the most meaningful reduction in most of the parameters. In equivalent impacts, the MMA glove-bare head condition induced higher rotational dosage than the boxing glove-bare head condition. Finite element analysis indicated a risk of brain strain injury in spite of significant reduction of linear impact dosage., Conclusions: In the replicated hook punch impacts, all padding conditions reduced linear but not rotational impact dosage. Head and neck dosage theoretically accumulates fastest in MMA and boxing bouts without use of protective headgear. The boxing glove-headgear condition provided the best overall reduction in impact dosage. More work is needed to develop improved protective padding to minimize linear and rotational impact dosage and develop next-generation standards for head and neck injury risk.

Soccer is the world's most popular sport and unique in that players use their unprotected heads to intentionally deflect, stop, or redirect the ball for both offensive and defensive strategies. Headed balls travel at high velocity pre- and postimpact. Players, coaches, parents, and physicians are justifiably concerned with soccer heading injury risk. Furthermore, risk of long-term neurocognitive and motor deficits caused by repetitively heading a soccer ball remains unknown. We review the theoretical concerns, the results of biomechanical laboratory experiments, and the available clinical data regarding the effects of chronic, subconcussive head injury during heading in soccer.

Age is one of the most salient aspects in faces and of fundamental cognitive and social relevance. Although face processing has been studied extensively, brain regions responsive to age have yet to be localized. Using evocative face morphs and fMRI, we segregate two areas extending beyond the previously established face-sensitive core network, centered on the inferior temporal sulci and angular gyri bilaterally, both of which process changes of facial age. By means of probabilistic tractography, we compare their patterns of functional activation and structural connectivity. The ventral portion of Wernicke's understudied perpendicular association fasciculus is shown to interconnect the two areas, and activation within these clusters is related to the probability of fiber connectivity between them. In addition, post-hoc age-rating competence is found to be associated with high response magnitudes in the left angular gyrus. Our results provide the first evidence that facial age has a distinct representation pattern in the posterior human brain. We propose that particular face-sensitive nodes interact with additional object-unselective quantification modules to obtain individual estimates of facial age. This brain network processing the age of faces differs from the cortical areas that have previously been linked to less developmental but instantly changeable face aspects. Our probabilistic method of associating activations with connectivity patterns reveals an exemplary link that can be used to further study, assess and quantify structure-function relationships.

Purpose: To assess nerve T2 signal and caliber as diagnostic signs at magnetic resonance (MR) neurography in ulnar neuropathy at the elbow (UNE)., Materials and Methods: This prospective study was approved by the institutional review board, and written informed consent was obtained from all participants. Twenty patients with UNE were graded by using clinical criteria and nerve conduction studies as mild (n = 12) and severe (n = 8) and were compared with 20 healthy control subjects. All subjects underwent ulnar nerve MR neurography (in-plane resolution of 0.4 × 0.4 mm) covering the elbow region, including T2-weighted imaging with fat suppression (turbo inversion-recovery magnitude sequence: repetition time msec/echo time msec/inversion time msec, 6, 120/66/180) and T1-weighted turbo spin-echo imaging (843/16). Nerve T2 signal increase, measured by using T2-weighted contrast-to-noise ratios across the cubital tunnel, and nerve caliber, determined by using T1-weighted pixelwise measurement of cross-sectional nerve area, were evaluated as diagnostic signs. Qualitative assessment by using visual grading was performed additionally., Results: Diagnostic performance, as determined with area under the receiver operating characteristic curve (AUC), was excellent for nerve T2 signal to discriminate UNE from a normal finding (AUC = 0.94; 95% confidence interval [CI]: 0.87, 1.00) and was excellent for nerve caliber to discriminate severe from mild UNE (AUC = 0.95; 95% CI: 0.85, 1.00). Qualitative assessment demonstrated sensitivity of 83% and specificity of 85% for MR neurography of UNE., Conclusion: Nerve T2 signal increase seems to be an accurate sign to determine the presence of UNE. Nerve caliber enlargement discriminates severe from mild UNE. UNE may be diagnosed with high accuracy by means of quantitative or qualitative evaluation of these signs.

Background and Purpose: MRN is an emerging diagnostic method for disorders of peripheral nerves. However, it is unclear whether the influence of the MA on intraneural T2 signal is severe enough to provoke false-positive findings., Materials and Methods: Twenty-five healthy subjects underwent MRN of the sciatic nerve of the proximal thigh at 3T. The T2(app) was calculated from a DE-TSE sequence (TR = 3000 ms, TE1 = 12 ms, TE2 = 69 ms) at 7 angles of the sciatic nerve relative to B0 = 0°, 30°, 35°, 40°, 45°, 50°, and 55°. Precise angle adjustments were performed with a dedicated in-bore positioning aid. Qualitative evaluation of intraneural T2-weighted contrast between this group of healthy subjects and 14 patients with neuropathic lesions was performed by comparing CNRs of a TIRM sequence (TR = 5000 ms, TE = 76 ms, TI = 180 ms)., Results: In healthy subjects, the prolongation of T2(app) from 0° to 55° was from 74.5 ± 13.4 to 104.0 ± 16.9 ms (P < .001). The increase in T2(app) relative to baseline (0°) was 9.6% (30°), 18.4% (35°), 25% (40°), 27.6% (45°), and 37% (55°). Intraneural CNR increased by 1.98 ± 0.69 at 40° and 2.93 ± 0.46 at 55°. Nevertheless, the mean CNR of healthy subjects was substantially lower than that in patients at 40° (P < .0001) and even at the position of maximum MA (55°: 20.6 ± 5.11 versus 52.6 ± 7.12, P < .0001)., Conclusions: Neuropathic lesions are clearly distinguishable from an artificial increase of intraneural T2 by the MA. Even at a maximum MA (55°), the false-positive determination of a neuropathic lesion is unlikely.

Background: Inhibition of early platelet adhesion by blockade of glycoprotein-IB (GPIb) protects mice from ischemic stroke. To elucidate underlying mechanisms in-vivo, infarct development was followed by ultra-high field MRI at 17.6 Tesla., Methods: Cerebral infarction was induced by transient-middle-cerebral-artery-occlusion (tMCAO) for 1 hour in C57/BL6 control mice (N = 10) and mice treated with 100 µg Fab-fragments of the GPIb blocking antibody p0p/B 1 h after tMCAO (N = 10). To control for the effect of reperfusion, additional mice underwent permanent occlusion and received anti-GPIb treatment (N = 6; pMCAO) or remained without treatment (N = 3; pMCAO). MRI 2 h and 24 h after MCAO measured cerebral-blood-flow (CBF) by continuous arterial-spin labelling, the apparent-diffusion-coefficient (ADC), quantitative-T2 and T2-weighted imaging. All images were registered to a standard mouse brain MRI atlas and statistically analysed voxel-wise, and by cortico-subcortical ROI analysis., Results: Anti-GPIb treatment led to a relative increase of postischemic CBF vs. controls in the cortical territory of the MCA (2 h: 44.2±6.9 ml/100 g/min versus 24 h: 60.5±8.4; p = 0.0012, F((1,18)) = 14.63) after tMCAO. Subcortical CBF 2 h after tMCAO was higher in anti-GPIb treated animals (45.3±5.9 vs. controls: 33.6±4.3; p = 0.04). In both regions, CBF findings were clearly related to a lower probability of infarction (Cortex/Subcortex of treated group: 35%/65% vs. controls: 95%/100%) and improved quantitative-T2 and ADC. After pMCAO, anti-GPIb treated mice developed similar infarcts preceded by severe irreversible hypoperfusion as controls after tMCAO indicating dependency of stroke protection on reperfusion., Conclusion: Blockade of platelet adhesion by anti-GPIb-Fab-fragments results in substantially improved CBF early during reperfusion. This finding was in exact spatial correspondence with the prevention of cerebral infarction and indicates in-vivo an increased patency of the microcirculation. Thus, progression of infarction during early ischemia and reperfusion can be mitigated by anti-platelet treatment.

Intrinsic coagulation factor XII deficient (FXII(-/-)) mice are protected from ischemic stroke. To elucidate underlying mechanisms we investigated the early ischemic period in vivo by multimodal magnetic resonance imaging (MRI) at 17.6 Tesla. Cerebral ischemia was induced by either transient (60 min) or permanent occlusion of the middle cerebral artery (t/pMCAO). 10 FXII(-/-) mice underwent t- , 10 FXII(-/-) mice p- and 10 Wildtype (Wt) mice tMCAO. Cerebral blood flow (CBF), diffusion-weighted-imaging (DWI) and T2-relaxometry were measured at 2 h and 24 h after MCAO. Outcome measures were evaluated after motion correction and normalization to atlas space. 2 h after tMCAO CBF reduction was similar in FXII(-/-) and Wt mice extending over cortical (CBF (ml/100 g/min) 33.6+/-6.9 vs. 35.3+/-4.6, p=0.42) and subcortical regions (25.7+/-4.5 vs. 31.6+/-4.0, p=0.17). At 24 h, recovery of cortical CBF by +36% was observed only in tMCAO FXII(-/-) mice contrasting a further decrease of -30% in Wt mice after tMCAO (p=0.02, F((1,18))=6.24). In FXII(-/-) mice in which patency of the MCA was not restored (pMCAO) a further decrease of -75% was observed. Cortical reperfusion in tMCAO FXII(-/-) mice was related to a lower risk of infarction of 59% vs. 93% in Wt mice (p=0.04). Subcortical CBF was similarly decreased in both tMCAO groups (Wt and FXII(-/-)) relating to a similar risk of infarction of 89% (Wt) vs. 99% (FXII(-/-), p=0.17). Deficiency of FXII allows neocortical reperfusion after tMCAO and rescues brain tissue by this mechanism. This study supports the concept of FXII as a promising new target for stroke prevention and therapy., (Copyright 2009 Elsevier Inc. All rights reserved.)

The effect of echoplanar imaging (EPI) acoustic background noise on blood oxygenation level dependent (BOLD) activations was investigated. Two EPI pulse sequences were compared: (i) conventional EPI with a pulsating sound component of typically 8-10 Hz, which is a potent physiological stimulus, and (ii) the more recently developed continuous-sound EPI, which is perceived as less distractive despite equivalent peak sound pressure levels. Sixteen healthy subjects performed an established demanding visual n-back working memory task. Using an exploratory data analysis technique (tensorial probabilistic independent component analysis; tensor-PICA), we studied the inter-session/within-subject response variability introduced by continuous-sound versus conventional EPI acoustic background noise in addition to temporal and spatial signal characteristics. The analysis revealed a task-related component associated with the established higher-level working memory and motor feedback response network, which exhibited a significant 19% increase in its average effect size for the continuous-sound as opposed to conventional EPI. Stimulus-related lower-level activations, such as primary visual areas, were not modified. EPI acoustic background noise influences much more than the auditory system per se. This analysis provides additional evidence for an enhancement of task-related, extra-auditory BOLD activations by continuous-sound EPI due to less distractive acoustic background gradient noise.

The effect ethanol exerts on the human brain has not yet been addressed by longitudinal magnetic resonance (MR) spectroscopic experiments. Therefore, we longitudinally characterized cerebral metabolite changes in 15 healthy individuals by proton magnetic resonance spectroscopy ((1)H-MRS) subsequent to the ingestion of a standard beverage (mean peak blood alcohol concentration (BAC): 51.43 +/- 10.27 mg/dL). Each participant was examined before, over 93.71 +/- 11.17 mins immediately after and 726.36 +/- 94.96 mins (12.11 +/ -1.58 h) past per os alcohol exposure. Fronto-mesial and cerebellar ethanol concentrations over time were similar as determined by the LCModel analysis of spectral data. Alcohol-induced changes of fronto-mesial creatine, choline, glucose, inositol and aspartate levels at 5.79 +/- 2.94 [corrected] mins upon ingestion as well as cerebellar choline and inositol levels at 8.64 +/- 2.98 [corrected] mins past exposure. Closely associated with ethanol concentrations, supratentorial creatine, choline, inositol and aspartate levels decreased after ethanol administration, whereas glucose levels increased. Similarly, infratentorial choline and inositol concentrations were negatively correlated with ethanol levels over time. There were no changes in N-acetyl-aspartate levels upon alcohol exposure. Furthermore, no influence of ethanol on brain water integrals was detected. Ethanol consumption may directly increase oxidative stress and the neuronal vulnerability to it. In addition, our results are compatible with ethanol-induced cell membrane modifications and alternative energy substrate usage upon alcohol exposure.

In the United States there is currently a paucity of available real world minor rear crash data with struck vehicle delta-V, or speed change, less than or equal to 15 kilometers per hour. These data are essential as researchers attempt to define 'whiplash' injury risk potential in these minor crashes. This study analyzed a new set of 105 U.S. minor rear aligned crashes between passenger vehicles. Mean struck vehicle delta-V and acceleration were 6.3 km/h (s.d. = 2.1 km/h) and 1.4 g (s.d. = 0.5 g), respectively. A total of 113 struck vehicle occupants were diagnosed within five weeks post-crash with 761 ICD-9-CM complaints and 427 AIS injuries (99.5% AIS1) attributed to the crashes. No striking vehicle occupants reported complaints. The main ICD-9-CM diagnoses were 40.6% cervical, 22.5% lumbar/sacral and 10.2% thoracic and the main AIS1 diagnoses were 29.7% cervical, 23.2% lumbar/sacral and 14.3% thoracic. The diagnosis disparity was mainly due to coding for pre-existing degenerative diagnosis in ICD-9-CM. Degenerative spine conditions were not significant for increased AIS1 injury risk. Surprisingly, many non-'whiplash' diagnoses were found. The AIS injury diagnosis distribution and frequency in these minor delta-V crashes did not correspond with previous minor rear crash studies. A prospectively collected and unbiased minor rear crash databank in the model of CIREN or NASS is highly desirable to verify or refute these results for the U.S. population since the current study cohort may have been influenced by litigation.

Objective: Vasospasm of the cerebral vessels remains a major source for morbidity and mortality after aneurysmal subarachnoid hemorrhage. The purpose of this study was to evaluate the frequency of infarction after transluminal balloon angioplasty (TBA) in patients with severe subarachnoid hemorrhage-related vasospasm., Methods: We studied 38 patients (median Hunt and Hess Grade II and median Fisher Grade 4) with angiographically confirmed severe vasospasm (>70% vessel narrowing). A total of 118 vessels with severe vasospasm in the anterior circulation were analyzed. Only the middle cerebral artery, including the terminal internal carotid artery, was treated with TBA (n = 57 vessel segments), whereas the anterior cerebral artery was not treated (n = 61 vessel segments). For both the treated and the untreated vessel territories, infarction on unenhanced computed tomographic scan was assessed as a marker for adverse outcome., Results: Infarction after TBA occurred in four middle cerebral artery territories (four out of 57 [7%]), whereas the infarction rate was 23 out of 61 (38%) in the anterior cerebral artery territories not subjected to TBA (P < 0.001, Fisher exact test). Three procedure-related complications occurred during TBA (dissection, n = 1; temporary vessel occlusions, n = 2). One of these remained asymptomatic, whereas this may have contributed to the development of infarction on follow-up computed tomographic scans in two cases., Conclusion: In a population of patients with a high risk of infarction resulting from vasospasm after subarachnoid hemorrhage, the frequency of infarction in the distribution of vessels undergoing TBA amounts to 7% and is significantly lower than in vessels not undergoing TBA despite some risk inherent to the procedure.

Background and Purpose: To assess safety and efficacy data of a new bioactive coil (Cerecyte) which is loaded with polyglycolic acid on the inside of the coil., Methods: Fifty-four patients harboring 55 aneurysms were treated with Cerecyte coils. These aneurysms were matched in localization and size with aneurysms treated with bare platinum coils., Results: Periprocedural complications and handling did not differ between both groups. Initial aneurysm occlusion was comparable in both treatment groups. At 6 months angiographic follow-up, the aneurysms occluded with Cerecyte coils had a higher chance for complete occlusion (P=0.045) and tended to a lower retreatment rate (P=0.056)., Conclusions: Cerecyte coils are as safe as bare platinum coils in the endovascular occlusion of aneurysms. This matched pair analysis indicates a higher occlusion rate of aneurysms occluded with Cerecyte coils.

Objective: To prospectively assess the diagnostic accuracy of CT perfusion (CTP) and transcranial Doppler sonography (TCD) for the prediction of secondary cerebral infarction (SCI) after aneurysmal subarachnoid hemorrhage (SAH)., Methods: During 2 weeks after SAH, 38 consecutive patients completed an average of 3.5 CT/CTP and 10.7 TCD examinations at regular intervals as required by the study protocol. SCI was defined as delayed infarction on native CT between 3 and 14 days after SAH and developed in n = 14 patients (n = 24 without SCI). Analysis was based on examination dates before SCI. Common measures of diagnostic accuracy were calculated for qualitative CTP (visual color-map ratings from two blinded observers) and TCD assessments (mean flow velocity >120 cm/s in anterior, middle, and posterior cerebral artery territories). Quantitative measures, which for CTP were obtained from cortical a priori regions of interest corresponding to the vascular territories, were analyzed by binary logistic regression., Results: Time of prediction for SCI by CTP was at a median of 3 days (range 2 to 5 days) before manifestation of complete infarction on native CT. Visual assessment of time-to-peak (TTP) color maps performed best for the prediction of SCI with 0.93 sensitivity (95% CI: 0.7 to 1.0) and 0.67 specificity (95% CI: 0.53 to 0.7). On quantitative analysis, the odds ratio (OR) for 1 second of side-to-side delay in TTP was 1.4 (p = 0.01, Wald chi(2) = 8.57, CI: 1.07 to 1.82). Daily TCD measures were not significantly related to SCI at any time before complete infarction on native CT., Conclusions: Time to peak as indicated by CT perfusion is a sensitive and early predictor of secondary cerebral infarction.