Table of Contents
Perspectives
Review Articles
Level 1 Evidence-Based Medicine
- Does Increasing Packing Density Using Larger Caliber Coils Improve Angiographic Results of Embolization of Intracranial Aneurysms at 1 Year: A Randomized Trial
Does Embolization with Larger Coils Lead to Better Treatment of Aneurysms (DELTA) was an investigator-initiated multicenter prospective, parallel, randomized, controlled clinical trial. Patients had 4- to 12-mm unruptured aneurysms. Treatment allocation to either 15- (experimental group) or 10-caliber coils (control group) was randomized 1:1 using a Web-based platform. The primary efficacy outcome was a major recurrence or a residual aneurysm at follow-up angiography at 12 ± 2 months adjudicated by an independent core lab blinded to the treatment allocation. The trial was stopped after 210 patients were recruited between November 2013 and June 2017 when funding was interrupted. On an intent-to-treat analysis, the primary outcome was reached in 37 patients allocated to 15-caliber coils and 36 patients allocated to 10-caliber coils. Safety and other clinical outcomes were similar. Coiling of aneurysms randomized to 15-caliber coils achieved higher packing densities compared with 10-caliber coils, but this had no impact on the angiographic outcomes at 1 year, which were primarily driven by aneurysm size and initial angiographic results.
Practice Perspectives
General Contents
- Deep Transfer Learning and Radiomics Feature Prediction of Survival of Patients with High-Grade Gliomas
Fifty patients with high-grade gliomas from the authors’ hospital and 128 patients with high-grade gliomas from The Cancer Genome Atlas were included in this study. For each patient, the authors calculated 348 hand-crafted radiomics features and 8192 deep features generated by a pretrained convolutional neural network. They then applied feature selection and Elastic Net-Cox modeling to differentiate patients into long- and short-term survivors. In the 50 patients with high-grade gliomas from their institution, the combined feature analysis framework classified the patients into long- and short-term survivor groups with a log-rank test P value <.001. In the 128 patients from The Cancer Genome Atlas, the framework classified patients into long- and short-term survivors with a log-rank test P value of .014. In conclusion, the authors report successful production and initial validation of a deep transfer learning model combining radiomics and deep features to predict overall survival of patients with glioblastoma from postcontrast T1-weighed brain MR imaging.
- Prediction of Hemorrhage after Successful Recanalization in Patients with Acute Ischemic Stroke: Improved Risk Stratification Using Dual-Energy CT Parenchymal Iodine Concentration Ratio Relative to the Superior Sagittal Sinus
The authors evaluated whether, in acute ischemic stroke, iodine concentration within contrast-stained parenchyma compared with an internal reference in the superior sagittal sinus on dual-energy CT could predict subsequent intracerebral hemorrhage in 71 patients. Forty-three of 71 patients had parenchymal hyperdensity on initial dual-energy CT. The median relative iodine concentration compared with the superior sagittal sinus was significantly higher in those with subsequent intracerebral hemorrhage (137.9% versus 109.2%). They conclude that in dual-energy CT performed within 1 hour following thrombectomy that the relative iodine concentration within contrast-stained brain parenchyma compared with that in the superior sagittal sinus was a more reliable predictor of ICH compared with the absolute maximum iodine concentration.
- Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease
Twenty-nine patients with Moyamoya disease were enrolled in this study. The median age at symptom onset was 12 years. A total of 166 steno-occlusive lesions were detected by high-resolution intracranial vessel wall imaging. Eleven lesions with concentric wall thickening (6.6%) were noted in 9 patients. Ten concentric contrast-enhancing lesions were observed in 8 patients, of which 4 lesions in 3 patients showed grade II enhancement. The presence of contrast enhancement and wall thickening showed a statistically significant association with ischemic events within 3 months before and after the vessel wall imaging. The presence of wall thickening and enhancement may predict future ischemic events in patients with MMD.
- Flow-Diversion Treatment for Unruptured Nonsaccular Intracranial Aneurysms of the Posterior and Distal Anterior Circulation: A Meta-Analysis
The authors’ aim was to analyze the outcomes after flow diversion among nonsaccular unruptured lesions. Fifteen studies (213 aneurysms) were included in the analysis. The long-term adequate occlusion rate was 85.3%. Treatment-related complications were 17.4%. Overall, 15% were ischemic events. They conclude that unruptured nonsaccular aneurysms located in the posterior and distal anterior circulations can be effectively treated with a flow-diversion strategy. Nevertheless, treatment-related complications are not negligible, with about 15% ischemic events and 8% morbidity. Larger size (>10 mm) significantly increased the risk of procedure-related adverse events among nonsaccular lesions.
- Number Needed to Treat with Vertebral Augmentation to Save a Life
The purpose of this study was to calculate the number needed to treat to save 1 life at 1 year and up to 5 years after vertebral augmentation. A 10-year sample of the 100% US Medicare data base was used to identify patients with vertebral compression fractures treated with nonsurgical management, balloon kyphoplasty, and vertebroplasty. The number needed to treat was calculated between augmentation and nonsurgical management groups from years 1–5 following a vertebral compression fracture diagnosis, using survival probabilities for each management approach. The adjusted number needed to treat to save 1 life for nonsurgical management versus kyphoplasty ranged from 14.8 at year 1 to 11.9 at year 5. The adjusted number needed to treat for nonsurgical management versus vertebroplasty ranged from 22.8 at year 1 to 23.8 at year 5. The authors conclude that the NNT analysis of more than 2 million patients with VCF reveals that only 15 patients need to be treated to save 1 life at 1 year. This has an obvious clinically significant impact and given that all augmentation clinical trials are underpowered to detect a mortality benefit, this large dataset analysis reveals that vertebral augmentation provides a significant mortality benefit over nonsurgical management with a low NNT.
35 Years Ago in AJNR
Online Features
Letters
