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To provide an accurate 3D volumetric analysis of one-year remodeling in patients with isolated mesenteric artery dissection (IMAD).Patients with type I/II (classification of Yun) treated by conservative therapy between January 2018 and January 2020 were prospectively included. The semi-automatic morphological analysis of the superior mesenteric artery (SMA) included volumetric measurements of the true (TL), false (FL) and overall lumen (OL), and 3D aortomesenteric angles from computed tomography angiogram data at admission (T0), one month (T1) and twelve months (T12). The SMA morphology of IMAD patients (n=15, 53±7 years; 87% male) was also compared to control individuals (n=51, 56±4 years; 94% male).A significant reduction of the OL volume was observed (p0.001) whereas the TL volume remained stable (p=0.23). The (TL/OL) volume ratio significantly increased over time (p=0.001), from 53% at T1 to 78% at T12. Aortomesenteric 3D angles at 2, 4 and 6 cm from the ostium showed a progressive decrease towards values observed in the control group (p=0.013, p=0.002 and p=0.027, respectively). At T12, five patients (33%) had a complete remodeling and aneurysmal change was observed in two (20mm). Smoking and (T0) SMA angle at 6 cm distance from the ostium were the only factors affecting negatively remodeling at T12.One-year remodeling in IMAD followed an overall decrease of the OL volume related to FL volume decrease. Smokers and patients with larger SMA angles at baseline showed a poorer remodeling. Spontaneous arterial remodeling in IMAD might favor conservative therapy.

Background and Purpose: Pediatric nontraumatic intracerebral hemorrhage accounts for half of stroke in children. Early diagnostic of the causative underlying lesion is the first step toward prevention of hemorrhagic recurrence. We aimed to investigate the performance of arterial spin labeling sequence (ASL) in the acute phase etiological workup for the detection of an arteriovenous shunt (AVS: including malformation and fistula), the most frequent cause of pediatric nontraumatic intracerebral hemorrhage. Methods: Children with a pediatric nontraumatic intracerebral hemorrhage between 2011 and 2019 enrolled in a prospective registry were retrospectively included if they had undergone ASL-magnetic resonance imaging before any etiological treatment. ASL sequences were reviewed using cerebral blood flow maps by 2 raters for the presence of an AVS. The diagnostic performance of ASL was compared with admission computed tomography angiography, other magnetic resonance imaging sequences including contrast-enhanced sequences and subsequent digital subtraction angiography. Results: A total of 121 patients with pediatric nontraumatic intracerebral hemorrhage were included (median age, 9.9 [interquartile range, 5.8–13]; male sex 48.8%) of whom 76 (63%) had a final diagnosis of AVS. Using digital subtraction angiography as an intermediate reference, visual ASL inspection had a sensitivity and a specificity of, respectively, 95.9% (95% CI, 88.5%–99.1%) and 79.0% (95% CI, 54.4%–94.0%). ASL had a sensitivity, specificity, and accuracy of 90.2%, 97.2%, and 92.5%, respectively for the detection of the presence of an AVS, with near perfect interrater agreement (κ=0.963 [95% CI, 0.912–1.0]). The performance of ASL alone was higher than that of other magnetic resonance imaging sequences, individually or combined, and higher than that of computed tomography angiography. Conclusions: ASL has strong diagnostic performance for the detection of AVS in the initial workup of intracerebral hemorrhage in children. If our findings are confirmed in other settings, ASL may be a helpful diagnostic imaging modality for patients with pediatric nontraumatic intracerebral hemorrhage. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: 3618210420, 2217698.

This study aimed to investigate the prevalence, risk factors, and outcomes of colonic involvement in patients with acute mesenteric ischemia (AMI). CT scans from a prospective cohort of 114 AMI patients treated in an intestinal stroke center between 2009 and 2018 were blindly reviewed by two radiologists. Colon involvement was defined on CT scan by the presence of at least one of the following CT colonic features: wall thickening, pneumatosis, decreased wall enhancement, dilatation, or perforation. In addition, the clinical, biological, and radiological characteristics of patients with and without colonic involvement were compared to identify risk factors for colonic involvement on CT and its impact on morbidity and mortality. Colonic involvement was identified in 32/114 (28%) patients with AMI, the right colon being more frequently involved (n = 29/32, 91%). Wall thickening (n = 27/32) was the most common CT finding. Occlusion of the inferior mesenteric artery was the only statistically significant risk factor for colonic involvement (35% vs. 15%, p = 0.02). Patients with colonic involvement on CT vs. those without had more frequently transmural colonic necrosis (13% vs. 0%, p = 0.006), short bowel syndrome (16% vs. 4%, p = 0.04), need for long-term parenteral support (19% vs. 5%, p = 0.03), and death during follow-up (22% vs. 10%, p = 0.03). In patients with AMI, colonic involvement is associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment. • In a prospective cohort of acute mesenteric ischemia patients from an intestinal stroke center, 28% had an associated colonic involvement on CT. • Colonic involvement on CT most commonly affected the right colon, and the occlusion of the inferior mesenteric artery was the only risk factor. • Colonic involvement on CT was associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment.

OBJECTIVE The clinical outcome of pediatric intracerebral hemorrhage (pICH) is rarely reported in a comprehensive way. In this cohort study, systematic review, and meta-analysis of patients with pICH, the authors aimed to describe the basic clinical outcomes of pICH. METHODS Children who received treatment for pICH at the authors’ institution were prospectively enrolled in the cohort in 2008; data since 2000 were retrospectively included, and data through October 2019 were analyzed. The authors then searched PubMed and conducted a systematic review of relevant articles published since 1990. Data from the identified populations and patients from the cohort study were pooled into a multicategory meta-analysis and analyzed with regard to clinical outcomes. RESULTS Among 243 children screened for inclusion, 231 patients were included. The median (IQR) age at ictus was 9.6 (4.6–12.5) years, and 128 patients (53%) were male. After a median (IQR) follow-up of 33 (13–63) months, 132 patients (57.4%) had a favorable clinical outcome, of whom 58 (44%) had no residual symptoms. Nineteen studies were included in the meta-analysis. Overall, the proportion of children with complete recovery was 27% (95% CI 19%–36%; Q = 49.6; I2 = 76%); of those with residual deficits, the complete recovery rate was 48.1% (95% CI 40%–57%; Q = 75.3; I2 = 81%). When pooled with the cohort study, the aggregate case-fatality rate at the last follow-up was 17.3% (95% CI 12%–24%; Q = 101.6; I2 = 81%). CONCLUSIONS Here, the authors showed that 1 in 6 children died after pICH, and the majority of children had residual neurological deficits at the latest follow-up. Results from the cohort study also indicate that children with vascular lesions as the etiology of pICH had significantly better clinical functional outcomes.

Background and Purpose: Significant hemorrhage expansion (sHE) is a known predictor of poor outcome after an intracerebral hemorrhage (ICH) in adults but remains poorly reported in children. In a large inception cohort, we aimed to explore the prevalence of sHE, its associations with clinical outcomes, and its clinical-imaging predictors in children. Methods: Children admitted between January 2000 and March 2020 at a quaternary care pediatric hospital were screened for inclusion. Sample was restricted to children with 2 computed tomography scans within 72 hours of ICH onset, and a minimal clinical follow-up of months. sHE was defined as an increase from baseline ICH volume by 6 cc or 33% on follow-up computed tomography. Clinical outcome was assessed at 12 months with the King’s Outcome Scale for Childhood Head Injury score and defined as favorable for scores ≥5. Results: Fifty-two children met inclusion criteria, among which 8 (15%) demonstrated sHE, and 18 (34.6%) any degree of expansion. Children with sHE had more frequent coagulation disorders (25.0% versus 2.3%; P =0.022). After multivariable adjustment, only the presence of coagulation disorders at baseline remained independently associated with sHE (adjusted odds ratio, 14.4 [95% CI, 1.04–217]; P =0.048). sHE was independently associated with poor outcome (King’s Outcome Scale for Childhood Head Injury P =0.043). Conclusions: sHE is a frequent phenomenon after admission for a pediatric ICH and more so in children with coagulation defects. As sHE was strongly associated with poorer clinical outcomes, these data mandate a baseline coagulation work up and questions the need for protocolized repeat head computed tomography in children admitted for pediatric ICH.

MRI is the reference for the diagnosis of arterial cerebral ischemia, but its role in acute mesenteric ischemia (AMI) is poorly known.To assess MRI detection of early ischemic bowel lesions in a porcine model of arterial AMI.Prospective/cohort.Porcine model of arterial AMI obtained by embolization of the superior mesenteric artery (seven pigs).A 5-T. T1 gradient-echo-weighted-imaging (WI), half-Fourier-acquisition-single-shot-turbo-spin-echo, T2 turbo-spin-echo, true-fast-imaging-with-steady-precession (True-FISP), diffusion-weighted-echo-planar (DWI).T1-WI, T2-WI, and DWI were performed before and continuously after embolization for 6 hours. The signal intensity (SI) of the ischemic bowel was assessed visually and quantitatively on all sequences. The apparent diffusion coefficient (ADC) was assessed.Paired Student's t-test or Mann-Whitney U-test, significance at P 0.05.One pig died from non-AMI-related causes. The remaining pigs underwent a median 5 h53 (range 1 h24-6 h01) of ischemia. Visually, the ischemic bowel showed signal hyperintensity on DWI-b800 after a median 85 (57-276) minutes compared to the nonischemic bowel. DWI-b800 SI significantly increased after 2 hours (+19%) and the ADC significant decrease within the first hour (-31%). The ischemic bowel was hyperintense on precontrast T1-WI after a median 87 (70-171) minutes with no significant quantitative changes over time (P = 0.46-0.93). The ischemic bowel was hyperintense on T2-WI in three pigs with a significant SI increase on True-FISP after 1 and 2 hours.Changes in SI and ADC can be seen early after the onset of arterial AMI with DWI. The value of T2-WI appears to be limited.1 TECHNICAL EFFICACY: Stage 2.

BACKGROUND AND PURPOSE: Whether architectural characteristics of ruptured brain AVMs vary across the life span is unknown. We aimed to identify angioarchitectural features associated with brain AVMs ruptured early in life. MATERIALS AND METHODS: Patients with ruptured brain AVMs referred to 2 distinct academic centers between 2000 and 2018 were pooled and retrospectively analyzed. Imaging was retrospectively reviewed for angioarchitectural characteristics, including nidus size, location, Spetzler-Martin grade, venous drainage, and arterial or nidal aneurysm. Angioarchitecture variations across age groups were analyzed using uni- and multivariable models; then cohorts were pooled and analyzed using Kaplan-Meier and Cox models to determine factors associated with earlier rupture. RESULTS: Among 320 included patients, 122 children (mean age, 9.8 ± 3.8 years) and 198 adults (mean age, 43.3 ± 15.7 years) were analyzed. Pediatric brain AVMs were more frequently deeply located (56.3% versus 21.2%, P

To report the 3-year experience of endovascular revascularization of acute arterial mesenteric ischemia (AMI) from an intestinal stroke center unit (ISCU).All data from patients admitted to the ISCU between January 2016 and January 2019 for arterial AMI who underwent endovascular recanalization were prospectively acquired and retrospectively analyzed. Patient demographics, clinical and laboratory characteristics at presentation, and CT scans were reviewed. The type (thrombolysis, thrombectomy, stenting) and the outcome of endovascular procedures (technical success or failure, complications) were noted. Care pathways were described focusing on post-procedural treatments (surgical revascularization, bowel resection) and the mortality rate was evaluated in subgroups.Fifty-eight patients (34 men [59%], mean 69 ± 29 years) were included. Endovascular revascularization was technically successful in 51/58 (88%) patients, and 10 (17%) patients had post-procedural complications. Stenting and in situ thrombolysis were performed in most patients (n = 33 and n = 19, respectively). Thirty-two patients (55%) were recurrence-free and required no further treatment after the procedure, while 9 (16%), 5 (9%), and 5 (9%) patients underwent 2nd-line bowel resection, surgical revascularization, or both. Overall, 46 (79%), 45 (78%), and 34 patients (63%) were alive at 3 months, 1 year, and 3 years. No significant difference in survival was found in care pathways or baseline characteristics.Endovascular revascularization is highly feasible for the treatment of arterial AMI, and is associated with an acceptable rate of complications. Results of endovascular revascularization shall only be interpreted as part of a multidisciplinary patient management strategy.• Endovascular revascularization is highly feasible for the treatment of arterial AMI, and is associated with an acceptable rate of complications. • Several techniques are available to perform endovascular revascularization, and their use depends on the cause, the location, and the quality of underlying arteries of patients. • Results of endovascular revascularization shall only be interpreted in relation to its role in an integrated multidisciplinary and patient management strategy.

Brain arteriovenous malformations (bAVM) are the main cause of pediatric intracerebral hemorrhage (pICH). Embolization with Onyx (ev3, Irvine, CA, USA) in children with ruptured bAVM has been infrequently reported. The aim of this study was to assess the safety and efficacy profile of Onyx embolization as first line endovascular treatment of ruptured pediatric bAVMs. Children with non-traumatic pICH due to bAVM rupture at a pediatric quaternary care center were prospectively enrolled in a registry and retrospectively analyzed between 2013 and 2018. Clinical and demographic data, treatment modalities and clinical imaging follow-up were retrieved, and detailed procedural data were retrospectively assessed by two investigators. The safety (procedural morbidity and mortality) and efficacy (obliteration and interval rebleeding) were evaluated. In this study 29 children treated for a bAVM by Onyx embolization were included (14 girls, 48%; median age 11.1 years, interquartile range, IQR 8.1–12.7 years) with a total of 72 endovascular sessions (median of 2 sessions per patient IQR 1–3). The AVMs were deeply located in 23 patients (79%). No systemic complications occurred, and no child experienced embolization-related persistent neurological deficits. Non-clinically relevant complications were observed during five procedures, unrelated to Onyx. After a mean follow-up of 31 months from rupture complete obliteration rates were 100%, 89%, 29%, 14% in bAVM Spetzler Martin grades I, II, III and IV–V, respectively. It was found that Onyx embolization is safe and represents a good option for an initial treatment approach, in a sequential treatment strategy for pediatric ruptured brain AVMs. Younger age may not be an argument to deny Onyx embolization.

OBJECTIVE Rupture of brain arteriovenous malformation (AVM) is the main etiology of intracerebral hemorrhage (ICH) in children. Ensuing intracranial hypertension is among the modifiable prognosis factors and sometimes requires emergency hemorrhage evacuation (HE). The authors aimed to analyze variables associated with HE in children with ruptured AVM. METHODS This study was a single-center retrospective analysis of children treated for ruptured AVM. The authors evaluated the occurrence of HE, its association with other acute surgical procedures (e.g., nidal excision, decompressive hemicraniectomy), and clinical outcome. Variables associated with each intervention were analyzed using univariable and multivariable models. Clinical outcome was assessed at 18 months using the ordinal King’s Outcome Scale for Childhood Head Injury. RESULTS A total of 104 patients were treated for 112 episodes of ruptured AVM between 2002 and 2018. In the 51 children (45.5% of cases) who underwent HE, 37 procedures were performed early (i.e., within 24 hours after initial cerebral imaging) and 14 late. Determinants of HE were a lower initial Glasgow Coma Scale score (adjusted odds ratio [aOR] 0.83, 95% CI 0.71–0.97 per point increase); higher ICH/brain volume ratio (aOR 18.6, 95% CI 13–26.5 per percent increase); superficial AVM location; and the presence of a brain herniation (aOR 3.7, 95% CI 1.3–10.4). Concurrent nidal surgery was acutely performed in 69% of Spetzler-Martin grade I–II ruptured AVMs and in 25% of Spetzler-Martin grade III lesions. Factors associated with nidal surgery were superficial AVMs, late HE, and absent alteration of consciousness at presentation. Only 8 cases required additional surgery due to intracranial hypertension. At 18 months, overall mortality was less than 4%, 58% of patients had a favorable outcome regardless of surgical intervention, and 87% were functioning independently. CONCLUSIONS HE is a lifesaving procedure performed in approximately half of the children who suffer AVM rupture. The good overall outcome justifies intensive initial management.

BackgroundRecurrence following obliteration of brain arteriovenous malformations (AVMs) is common in children surgically treated, but recurrences following endovascular (EVT) and radiosurgical approaches are scantily reported.ObjectiveTo analyze the rates and risk factors for AVM recurrence after obliteration in a single-center cohort of children with ruptured AVMs treated with multimodal approaches, and to carry out a comprehensive review and meta-analysis of current data.MethodsChildren with ruptured AVMs between 2000 and 2019 enrolled in a prospective registry were retrospectively screened and included after angiographically determined obliteration to differentiate children with/without recurrence. A complementary systematic review and meta-analysis of studies investigating AVM recurrence in children between 2000 and 2020 was aggregated to explore the overall recurrence rates across treatment modalities by analyzing surgery versus other treatments.ResultsSeventy children with obliterated AVMs were included. AVM recurrences (n=10) were more commonly treated with EVT as final treatment (60% in the recurrence vs 13.3% in the no-recurrence group, p=0.018). Infratentorial locations were associated with earlier and more frequent recurrences (adjusted relative risk=4.62, 95% CI 1.08 to 19.04; p=0.04).In the aggregate analysis, the pooled rate of AVM recurrence was 10.9% (95% CI 8.7% to 13.5%). Younger age at presentation was associated with more frequent recurrences (RR per year increase, 0.97, 95% CI 0.93 to 0.99; p=0.046).ConclusionLocation of infratentorial AVMs and younger age at presentation may be associated with earlier and more frequent recurrences. The higher rates of recurrence in patients with AVMs obliterated with EVT questions its role in an intent-to-cure approach and reinforces its position as an adjunct to surgery and/or radiosurgery.

OBJECTIVEUnderstanding the etiological spectrum of nontraumatic pediatric intracerebral hemorrhage (pICH) is key to the diagnostic workup and care pathway. The authors aimed to evaluate the etiological spectrum of diseases underlying pICH.METHODSChildren treated at the authors’ institution for a pICH were included in an inception cohort initiated in 2008 and retrospectively inclusive to 2000, which was analyzed in October 2019. They then conducted a systematic review of relevant articles in PubMed published between 1990 and 2019, identifying cohorts with pICH. Identified populations and patients from the authors’ cohort were pooled in a multicategory meta-analysis.RESULTSA total of 243 children with pICH were analyzed in the cohort study. The final primary diagnosis was an intracranial vascular lesion in 190 patients (78.2%), a complication of a cardiac disease in 17 (7.0%), and a coagulation disorder in 14 (5.8%). Hematological and cardiological etiologies were disproportionately more frequent in children younger than 2 years (p < 0.001). The systematic review identified 1309 children in 23 relevant records pooled in the meta-analysis. Overall, there was significant heterogeneity. The dominant etiology was vascular lesion, with an aggregate prevalence of 0.59 (95% CI 0.45–0.64; p < 0.001, Q = 302.8, I2 = 92%). In 18 studies reporting a detailed etiological spectrum, arteriovenous malformation was the dominant etiology (68.3% [95% CI 64.2%–70.9%] of all vascular causes), followed by cavernoma (15.7% [95% CI 13.0%–18.2%]).CONCLUSIONSThe most frequent etiology of pICH is brain arteriovenous malformation. The probability of an underlying vascular etiology increases with age, and, conversely, hematological and cardiac causes are dominant causes in children younger than 2 years.

Early S100B protein serum elevation is associated with poor prognosis in patients with ruptured brain arteriovenous malformations (BAVM). The purpose of this study is to determine whether a secondary elevation of S100B is associated with early complications or poor outcome in this population. This is a retrospective study of patients admitted for BAVM rupture. A secondary increase of S100B was defined as an absolute increase by 0.1 &mu, g/L within 30 days of admission. Fisher&rsquo, s and unpaired t tests followed by multivariate analysis were performed to identify markers associated with this increase. Two hundred and twenty-one ruptures met inclusion criteria. Secondary S100B protein serum elevation was found in 17.1% of ruptures and was associated with secondary infarction (p &lt, 0.001), vasospasm-related infarction (p &lt, 0.001), intensive care (p = 0.009), and hospital length of stay (p = 0.005), but not with early rebleeding (p = 0.07) or in-hospital mortality (p = 0.99). Secondary infarction was the only independent predictor of secondary increase of S100B (OR 9.9, 95% CI (3&ndash, 35), p &lt, 0.001). Secondary elevation of S100B protein serum levels is associated with secondary infarction in ruptured brain arteriovenous malformations.

OBJECTIVE. The purpose of this article is to provide an overview of the diagnostic and prognostic roles of CT in the management of acute mesenteric ischemia. CONCLUSION. Acute mesenteric ischemia is defined as inadequate blood supply to the gastrointestinal tract resulting in ischemic and inflammatory injury. The prognosis is poor without treatment. Contrast-enhanced CT has become the cornerstone of diagnosis to identify features of vascular disorders and of intestinal ischemic injury and to visualize bowel necrosis.

Purpose Usefulness of Intracranial Vessel Wall Imaging (VWI) on 3 Tesla Magnetic Resonance Imaging (3T MRI) performed on Postcontrast 3D Turbo Spin-Echo MR Imaging Sequence (CUBE, GE Healthcare, Chicago, United-States) has been demonstrated in the management of intra-cranial aneurysm. Our purpose was to describe patterns and prevalence of wall enhancement in brain arterio-venous malformations (bAVM). Methods Pediatric and adult patients diagnosed with bAVM and referred respectively to a pediatric quaternary care center between 2016 and 2018 and to a tertiary care center between 2013 and 2018 who underwent at least one CUBE sequence (initially or during follow-up) were pooled and retrospectively analyzed. Baseline clinical, demographic and imaging data were retrospectively analyzed. Imaging were reviewed for key bAVMs angioarchitectural characteristics, i.e, nidus size, location, Spetzler Grade, venous drainage, arterial or nidal aneurysm and the presence of vessel wall enhancement (nidal, venous or arterial). Chi-squared test was used with a threshold of p Results 52 patients, 19 children and 33 adults (mean age: 31 y.o; median: 43 y.o) with 52 bAVM were included. 47% patients were untreated when the first CUBE was performed. 21 bAVM were ruptured, more frequently in children (12/19 versus 9/33; p=0.01). Parietal wall enhancement was observed in 16/21 ruptured bAVM and 27/31 unruptured bAVM. In ruptured bAVM, the site of the rupture, either venous ectasia or nidal aneurysm, demonstrated a wall enhancement in 30% of cases. In unruptured bAVM, enhancement rate did not differ between children and adults (6/7 versus 21/24). Conclusion The prevalence of wall enhancement in bAVM vascular constituent is high, in both ruptured and unruptured lesions and was similar in adult and pediatric population. Further studies are warranted to determine the potential role of VWI in bAVM. Disclosures L. Garzelli: None. G. Boulouis: None. T. Blauwblomme: None. R. Levy: None. N. Boddaert: None. W. Ben Hassen: None. D. Trystram: None. C. Rodriguez: None. V. Dangouloff-Ross: None. F. Nataf: None. C. Oppenheim: None. F. Brunelle: None. M. Edjlali-Goujon: None. O. Naggara: None.

Objectifs Le fait que les caracteristiques angio-architecturales des malformations arterio-veineuses cerebrales (MAVc) rompues puissent variees au cours de la vie est inconnu [1] , [2] . Notre objectif etait d’identifier les caracteristiques associees a une rupture precoce des MAVc. Materiel et methodes Les patients ayant une MAVc rompue referee dans deux centres academiques distincts entre 2000 et 2018 ont ete inclus retrospectivement. L’imagerie a ete retrospectivement evaluee a la recherche de caracteristiques angio-architecturales incluant, la taille du nidus, la localisation, le grade de Spetzler–Martin, le drainage veineux et la presence d’anevrysme intra ou pre-nidaux. Les variations de l’angio-architecture au travers des groupes d’âge ont ete analysees en utilisant des modeles uni- et multivaries puis les cohortes ont ete groupees et analysees en utilisant des modeles Kaplan–Meier et Cox afin de determiner les facteurs associes avec une rupture precoce. Resultats Sur les 320 patients inclus, 122 enfants (moyenne d’âge ± SD : 9.8 ± 3.8 ans) et 198 adultes (43.3 ± 15.7 ans) ont ete analyse. Les MAVc pediatriques etaient plus frequemment profondes (56.3 % vs 21.2 %, p Tableau 1 ) ( Fig. 1 ). Conclusion L’angio-architecture des MAVc rompues varie significativement au cours de la vie et la presence de certaines caracteristiques pourraient orienter vers une prise en charge therapeutique chez les patients avec une MAVc rompue.

Objective L’hydrocephalie est un facteur pronostic independant et modifiable de mauvais devenir neurologique apres une hemorragie intracerebrale (HIC). Chez l’enfant, les malformations arterio-veneuses cerebrales (MAVc) sont la cause plus frequente d’HIC. Dans une large cohorte prospective d’enfants avec des MAVc rompues, nous avons analyse les facteurs predictifs d’hydrocephalie necessitante une derivation ventriculaire externe (DVE) dans la phase aigue ou une derivation ventriculo-peritoneale (DVP). Methodes Il s’agit d’une analyse retrospective des donnees d’une base de donnees maintenue d’une facon prospective d’enfants (âge moins 18 ans) adresses a l’hopital Necker apres une rupture de MAVc entre 2002 et 2019. Les facteurs predictifs radiologiques et cliniques pour la necessite d’une DVE ou une DVP ont ete analyses en utilisant des modeles statistiques uni- et multivaries. Resultats Parmi 114 patients (âge moyenne 9,8 ans ± 3,9 ans DS), avec 125 episodes d’HIC apres rupture de MAVc, 55 (44 %) patients ont necessite une DVE et 5 (4,4 %) une DVP. Le modele de regression nominale multiple a identifie : un Glascow Coma Scale initial (GCSi) bas, une hydrocephalie sur le scanner cerebrale initial, la presence d’une hemorragie intraventriculaire (HIV) et un modified Graeb score (mGS) eleve comme facteurs associes a la necessite d’une DVE (tous p Conclusion Dans une grande cohorte pediatrique des MAVc rompues, presque la moitie des patients ont necessite une DVE et 4,4 % une DVP. Un GCSi bas et l’imagerie initiale par la mesure semi-quantitative de l’HIV par le mGS peuvent guider les decisions de prise en charge invasive dans ces situations.

To evaluate the value of a vessel removal algorithm in segmentation of subsolid nodules by comparing the software solid component measurement on CT, before and after vessel removal, with the measurement of the invasive component on pathology in lung adenocarcinomas manifesting as subsolid nodules.Between January 2014 and June 2015, 73 subsolid nodules with an invasive component of ≤10 mm on pathology were selected for analyses. For each nodule, semi-automated segmentation was performed by 2 radiologists and 3-dimensional (D) longest, axial longest and effective diameters of solid component were obtained from software, before and after using a vessel removal tool. These measurements were compared with the invasive component diameter on pathology using the paired t-test and Pearson's correlation test.Sixty-eight successfully segmented subsolid nodules were included. The mean maximal diameter of the invasive component on pathology was 4.6 mm (range, 0-10 mm). The correlation between software and pathology measurements was significant (p 0.01) and the correlation after vessel removal (r = 0.49-0.54) was better than before vessel removal (r = 0.27-0.41). The mean measurement difference between solid component on CT and invasive tumor on pathology was significantly larger before vessel removal than after vessel removal in all measurements. The smallest mean measurement difference was obtained with 3D longest diameter of solid component after vessel removal in both readers (-0.26 mm to 0.10 mm), with no significant difference from pathology (p = 0.53-0.83).By adding a vessel removal algorithm in software segmentation of subsolid nodules, the prediction of invasive component in lung adenocarcinomas can be improved.