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Advanced Cerebrovascular and Craniocervical Imaging

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (20 December 2022) | Viewed by 13005

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Special Issue Editors

Dr. Stefan Schob

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Guest Editor

Department of Neuroradiology, University Clinic and Policlinic of Radiology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
Interests: cerebral aneurysms; arteriovenous malformations; stroke; diffusion-weighted including intravoxel incoherent motion (IVIM) in neuro-oncology; perfusion-weighted imaging; imaging of cerebrovascular implants and cerebral hemodynamics; glymphatic system

Prof. Dr. Martin Skalej

E-Mail Website
Guest Editor

Department of Neuroradiology, University Clinic and Policlinic of Radiology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
Interests: cerebral aneurysms; arteriovenous malformations; stroke; cerebral hemodynamics; neurovascular diseases; functional angiography; vessel wall imaging; computational fluid dynamics; image guided minimal invasive therapy; spine diseases; medical engineering

Special Issue Information

Dear Colleagues,

In recent years, substantial progress has been made regarding the different modalities which are used in cerebrovascular and craniocervical imaging.

In computed tomography (CT), the dual energy approach is gaining significant interest, for example in the context of patient selection for endovascular therapy in case of acute ischemic stroke or for the detection of intervertebral disc herniation, or even bone marrow edema—the latter conventionally being recognized as exclusive domains of magnetic resonance imaging. Furthermore, the novel technology allows a significant reduction of artifacts and patient`s exposure to radiation.

In addition, flat-panel detector CT is incrementally recognized as a complementary technology for imaging of the brain, cranium including the temporal bone and spine, as the spatial resolution outperforms most of the standard CT scanners and functional imaging protocols like perfusion imaging and 4D angiography are now reliably applicable with flat-panel detectors in the angio suite.

In magnetic resonance imaging (MRI), the shift from qualitative to quantitative technologies is remarkable. T1- and T2 mapping, MR-elastography, diffusion-weighted - and perfusion-weighted imaging techniques as well as real-time MRI ongoingly revolutionize diagnostic imaging in a variety of clinical settings, for example, neuro-oncology, neuro-degeneration, stroke, and vascular diseases of the spine and spinal cord.

Together with advances in postprocessing technologies, most importantly the involvement of artificial intelligence, the field of cerebrovascular and craniocervical imaging is experiencing substantial evolution.

In this Special Issue, we aim to highlight and discuss recent technical developments together with novel clinical insight in the context of diagnostic aspects of cerebrovascular and craniocervical imaging. Papers investigating these areas are welcomed in this Special Issue.

Dr. Stefan Schob
Prof. Dr. Martin Skalej
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Advanced temporal bone imaging
Imaging of vascular diseases of the brain and spine
Imaging in Neurooncology
Imaging of Neurodegeneration
Hemodynamics in cerebrovascular conditions
Imaging and physiology of the glymphatic system
Flat-Panel CT
Functional imaging of brain and spine
Imaging of implants and devices in otolaryngology, neurosurgery, and neurology
Interventional imaging
Image-guided surgery
Image-guided oncology
Image-guided pediatric interventions

Published Papers (7 papers)

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Research

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10 pages, 488 KiB

Open AccessArticle

Assessment of Cost-Effectiveness of Computerized Cranial Tomography in Children with Mild Head Trauma

by Mustafa Çalik, Ayşe Hilal Ersoy, Elif Evrim Ekin, Derya Öztürk and Seda Geylani Güleç

Diagnostics 2022, 12(11), 2649; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12112649 - 31 Oct 2022

Viewed by 1196

Abstract

Purpose: Pediatric head traumas constitute the majority of admissions to emergency departments (ED) due to trauma. This study aims to draw attention to the use of cranial computerized tomography (CT) scans in the evaluation of children with head trauma under the age of 18, and to determine CT scans’ usefulness in terms of cost-effectiveness. Materials and Methods: Age, gender, mechanism of trauma and Glasgow Coma Scale (GCS), diagnosis, time of admission to hospital, hospitalization and operation, cranial computerized tomography and hospitalization costs of all cases were retrospectively analyzed. Results: A total of 26,412 patients younger than 18 years old who were admitted to the emergency department due to head trauma and who had a cranial tomography were analyzed. They had a mean age of 7.74 ± 5.66 years. In total, 26,363 (99.8%) of these patients had a GCS greater than 14. Out of these patients, only 402 (1.5%) had brain injury revealed by cranial CT, 41 (0.2%) of these patients were operated and 3 of the patients lost their lives. The total cost of patients admitted to the emergency department with a head injury amounts to USD 583,317. Furthermore, 75.78% of this cost comes from negative cranial CTs. A cost analysis according to different age groups did not show a meaningful difference between 0–2 years and 3–5 years (p = 1.000), but there was a meaningful difference for all the other age groups. Conclusion: Our findings show that applying algorithms to predict traumatic brain injury in children with mild head injury rather than scanning all patients with cranial CT will enable more reliable and cost-effective patient care. Current practices should be reviewed to avoid unnecessary radiation exposure and expense in the ED. It is also necessary to inform and educate parents about the risk/benefit ratio of cranial CT scans. Full article

(This article belongs to the Special Issue Advanced Cerebrovascular and Craniocervical Imaging)

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17 pages, 1551 KiB

Open AccessArticle

Reference Values of Cerebral Artery Diameters of the Anterior Circulation by Digital Subtraction Angiography: A Retrospective Study

by Dirk Halama, Helena Merkel, Robert Werdehausen, Khaled Gaber, Stefan Schob, Ulf Quäschling, Svitlana Ziganshyna, Karl-Titus Hoffmann, Dirk Lindner and Cindy Richter

Diagnostics 2022, 12(10), 2471; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102471 - 12 Oct 2022

Cited by 3 | Viewed by 1875

Abstract

A threshold-based classification of cerebral vasospasm needs reference values for intracranial vessel diameters on digital subtraction angiography (DSA). We aimed to generate adjusted reference values for this purpose by retrospectively analyzing angiograms and potential influencing factors on vessel diameters. Angiograms of the anterior circulation were evaluated in 278 patients aged 18–81 years. The vessel diameters of 453 angiograms (175 bilateral) were gathered from nine defined measuring sites. The effect sizes of physical characteristics (i.e., body weight and height, body mass index, gender, age, and cranial side) and anatomical variations were calculated with MANOVA. Segments bearing aneurysms were excluded for the calculation of reference values. Adjusted vessel diameters were calculated via linear regression analysis of the vessel diameter data. Vessel diameters increased with age and body height. Male and right-sided vessels were larger in diameter. Of the anatomical variations, only the hypoplastic/aplastic A1 segment had a significant influence (p < 0.05) on values of the anterior cerebral artery and the internal carotid artery with a small effect size (|ω²| > 0.01) being excluded from the reference values. We provide gender-, age-, and side-adjusted reference values and nomograms of arterial vessel diameters in the anterior circulation. Full article

(This article belongs to the Special Issue Advanced Cerebrovascular and Craniocervical Imaging)

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19 pages, 3222 KiB

Open AccessArticle

The Supratrochlear Artery Sign—A New Piece in the Puzzle of Cerebral Vasospasm

by Cindy Richter, Robert Werdehausen, Jennifer Jentzsch, Dirk Lindner, Thilo Gerhards, Torsten Hantel, Khaled Gaber, Stefan Schob, Dorothee Saur, Ulf Quäschling, Karl-Titus Hoffmann, Svitlana Ziganshyna and Dirk Halama

Diagnostics 2022, 12(9), 2185; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12092185 - 09 Sep 2022

Viewed by 1600

Abstract

Background: Cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) has been extensively investigated, but the impact of collateralization remains unclear. We investigated the predictive value of collateral activation for delayed cerebral ischemia (DCI)-related infarctions and functional outcome. Methods: Data from 43 patients with CVS (January 2014 to August 2021) were evaluated for the angiographic presence of leptomeningeal and ophthalmic collaterals (anterior falcine artery (AFA), supratrochlear artery (STA), dorsal nasal artery (DNA)) on internal carotid artery angiograms. Vasospasm-related infarction and the modified Rankin Scale (mRS) score after six months were chosen as the endpoints. Results: 77% of the patients suffered from DCI-related infarctions. In 233 angiograms (at hospitalization, before spasmolysis, after six months), positive vessel signs were observed in 31 patients for STA, 35 for DNA, and 31 for AFA. The STA sign had the highest positive (84.6%) and negative (85.7%) predictive value for unfavorable outcome (mRS 4–6) in patients aged ≥50 years. DNA and AFA signs were not meaningful predictors for either endpoint. Leptomeningeal collaterals showed a positive Pearson’s correlation with the STA sign in 87.5% (p = 0.038) without providing any prediction for either endpoint. Conclusions: The STA sign is associated with clinical outcome in patients with CVS after SAH aged ≥50 years, and was correlated with the occurrence of leptomeningeal collaterals. Full article

(This article belongs to the Special Issue Advanced Cerebrovascular and Craniocervical Imaging)

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12 pages, 3909 KiB

Open AccessArticle

Selective Angiographic Flat Detector Computer Tomography Blood Volume Imaging in Pre-Operative Vascular Mapping and Embolization of Hypervascular Intracranial Tumors—Preliminary Clinical Experience

by Thijs van der Zijden, Annelies Mondelaers, Caro Franck, Maurits Voormolen and Tomas Menovsky

Diagnostics 2022, 12(5), 1185; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12051185 - 10 May 2022

Cited by 1 | Viewed by 1308

Abstract

Pre-operative embolization of hypervascular intracranial tumors can be performed to reduce bleeding complications during resection. Accurate vascular mapping of the tumor is necessary for both the correct indication setting for embolization and for the evaluation of the performed embolization. We prospectively examined the role of whole brain and selective parenchymal blood volume (PBV) flat detector computer tomography perfusion (FD CTP) imaging in pre-operative angiographic mapping and embolization of patients with hypervascular intracranial tumors. Whole brain FD CTP imaging with a contrast injection from the aortic root and selective contrast injection in the dural feeding arteries was performed in five patients referred for tumor resection. Regional relative PBV values were obtained pre- and post-embolization. Total tumor volumes with selective external carotid artery (ECA) supply volumes and post-embolization devascularized tumor volumes were determined as well. In all patients, including four females and one male, with a mean age of 54.2 years (range 44–64 years), the PBV scans were performed without adverse events. The average ECA supply was 54% (range 31.5–91%). The mean embolized tumor volume was 56.5% (range 25–94%). Relative PBV values decreased from 5.75 ± 1.55 before embolization to 2.43 ± 1.70 post-embolization. In one patient, embolization was not performed because of being considered not beneficial for the resection. Angiographic FD CTP imaging of the brain tumor allows 3D identification and quantification of individual tumor feeder arteries. Furthermore, the technique enables monitoring of the efficacy of pre-operative endovascular tumor embolization. Full article

(This article belongs to the Special Issue Advanced Cerebrovascular and Craniocervical Imaging)

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13 pages, 5053 KiB

Open AccessArticle

Metallic Component Preserving Algorithm Based on the Cerebral Computed Tomography Angiography in Aneurysm Surgery

by Jina Shim, Su Hwan Lee, Youngjin Lee, Kyu Bom Kim and Kyuseok Kim

Diagnostics 2022, 12(2), 338; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020338 - 28 Jan 2022

Cited by 1 | Viewed by 1994

Abstract

The purpose of this study was to investigate the viability of the proposed method in preventing the loss of metallic components including the clip and coil in cerebral computed tomography angiography (CTA). Forty patients undergoing surgery for aneurysms carried metallic materials. The proposed method is based on conventional bone subtraction CTA (BS-CTA) system. Briefly, the position of metal components was determined using the threshold value and a region of interest (ROI). An appropriate threshold was used to separate the background from the target materials based on the Otsu method. A three-dimensional (3D) rendering was performed from the proposed BS-CTA data carrying the extracted target information. The accuracy of clip and coil region measured using the dice similarity coefficient (DSC) and bidirectional Hausdorff distance (HD) is reported. The metallic components of the proposed BS-CTA were significantly visualized in various patient cases. Quantitative evaluation using the proposed method is based on the mean DSC of 0.93 with a standard deviation (SD) of ±0.05 (e.g., maximum value = 0.99, minimum value = 0.75, 95% confidence interval (CI) = 0.91 to 0.95, and all p < 0.05). The mean HD was 1.50 voxels with an SD of ± 0.58 (e.g., maximum value = 5.95, minimum value = 0.12, 95% CI = 1.10 to 1.90, and all p < 0.05). The proposed method demonstrates effective segmentation of the metallic component and application to the existing conventional BS-CTA system. Full article

(This article belongs to the Special Issue Advanced Cerebrovascular and Craniocervical Imaging)

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10 pages, 1673 KiB

Open AccessArticle

Intracranial Flow Velocity Quantification Using Non-Contrast Four-Dimensional Flow MRI: A Prospective Comparative Study with Transcranial Doppler Ultrasound

by Sam-Yeol Ha, Yeonah Kang, Ho-Joon Lee, Moonjung Hwang, Jiyeon Baik and Seongho Park

Diagnostics 2022, 12(1), 23; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12010023 - 23 Dec 2021

Cited by 2 | Viewed by 2338

Abstract

Four-dimensional (4D) flow magnetic resonance imaging (MRI) allows three-dimensional velocity encoding to measure blood flow in a single scan, regardless of the intracranial artery direction. We compared blood flow velocity quantification by non-contrast 4D flow MRI and by transcranial Doppler ultrasound (TCD), the most widely used modality for measuring velocity. Twenty-two patients underwent both TCD and non-contrast 4D flow MRI. The mean time interval between TCD and non-contrast 4D flow MRI was 0.7 days. Subsegmental velocities were measured bilaterally in the middle cerebral and basilar arteries using TCD and non-contrast 4D flow MRI. Intracranial velocity measurements using TCD and non-contrast 4D flow MRI demonstrated a strong correlation in the bilateral M1, especially at the proximal segment (right r = 0.74, left r = 0.78; all p < 0.001). Mean velocities acquired with 4D flow MRI were approximately 8 to 10% lower than those acquired with TCD according to the location of M1. Intracranial arterial flow measurements estimated using non-contrast 4D flow MRI and TCD showed strong correlation. 4D flow MRI enables simultaneous assessment of vascular morphology and quantitative hemodynamic measurement, providing three-dimensional blood flow visualization. 4D flow MRI is a clinically useful sequence with a promising role in cerebrovascular disease. Full article

(This article belongs to the Special Issue Advanced Cerebrovascular and Craniocervical Imaging)

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Review

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18 pages, 9184 KiB

Open AccessReview

Flat Detector CT with Cerebral Pooled Blood Volume Perfusion in the Angiography Suite: From Diagnostics to Treatment Monitoring

by Thijs van der Zijden, Annelies Mondelaers, Maurits Voormolen, Tomas Menovsky, Maarten Niekel, Thomas Jardinet, Thomas Van Thielen, Olivier D’Archambeau and Paul M. Parizel

Diagnostics 2022, 12(8), 1962; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12081962 - 13 Aug 2022

Cited by 3 | Viewed by 1662

Abstract

C-arm flat-panel detector computed tomographic (CT) imaging in the angiography suite increasingly plays an important part during interventional neuroradiological procedures. In addition to conventional angiographic imaging of blood vessels, flat detector CT (FD CT) imaging allows simultaneous 3D visualization of parenchymal and vascular structures of the brain. Next to imaging of anatomical structures, it is also possible to perform FD CT perfusion imaging of the brain by means of cerebral blood volume (CBV) or pooled blood volume (PBV) mapping during steady state contrast administration. This enables more adequate decision making during interventional neuroradiological procedures, based on real-time insights into brain perfusion on the spot, obviating time consuming and often difficult transportation of the (anesthetized) patient to conventional cross-sectional imaging modalities. In this paper we review the literature about the nature of FD CT PBV mapping in patients and demonstrate its current use for diagnosis and treatment monitoring in interventional neuroradiology. Full article

(This article belongs to the Special Issue Advanced Cerebrovascular and Craniocervical Imaging)

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