Publications by authors named "Eoin Kavanagh"

128 Publications

Imaging of groin pain in athletes: patterns of injury at MRI and gender differences therein.

Ir J Med Sci 2022 Aug 16. Epub 2022 Aug 16.

Department of Radiology, National Orthopaedic Hospital of Ireland, Cappagh, Dublin, Ireland.

Aim: The purpose of our study was to review a large cohort of athletes of all levels presenting with groin pain who underwent investigation with MRI and to determine what the commonest patterns of injury were. We aimed to explore whether particular findings were commonly found in association and whether measurable gender differences exist in the incidence of specific injuries.

Materials And Methods: Imaging records were reviewed to identify MRI studies of the pelvis performed for the investigation of groin pain in patients who were active in sports/athletic pursuits. Findings were classified and recorded as follows: injury to the common rectus abdominis/adductor longus origin, injury to the short adductor muscles, pubic bone oedema, pubic symphysis degenerative changes, hip joint injury and 'other'. The prevalence of specific injuries in female athletes compared to males was analysed using relative risk ratios.

Results: A total of 470 athletes underwent MRI for the investigation of groin pain during the study period. Forty-six were female, and 424 were male. Female athletes were significantly less likely to have rectus abdominis-adductor longus (RR = 0.31, p = .017), short adductor (RR = 0.14, p = .005) or hip (RR = 0.41, p = .003) injuries. Pubic bone degenerative changes were much more common in female athletes (RR = 7.37, p = .002).

Conclusion: Significant gender differences exist in the frequency with which specific injuries are observed. Female athletes are also significantly underrepresented; this is likely a multifactorial phenomenon; however, the possibility of unconscious referrer bias must be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11845-022-03126-3DOI Listing
August 2022

Ischemic stroke with extensive vasculopathy in a patient with neurofibromatosis type 1.

Radiol Case Rep 2022 Sep 16;17(9):3370-3372. Epub 2022 Jul 16.

Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.

Neurofibromatosis type 1 is an autosomal dominant genetic disorder with multisystem manifestations including vascular abnormalities. The condition is also associated with an increased risk of both ischemic and hemorrhagic stroke. Here we report a case of a 60-year-old male with known neurofibromatosis who presented with right sided hemiparesis. Neuroimaging work-up revealed left internal carotid artery dissection and tandem occlusion of the left internal carotid artery and left middle cerebral artery. There was associated territorial ischemic infarction. The patient was found to have extensive intra and extra cranial vasculopathy including gross basilar dolichoectasia and a right-sided cervical internal carotid artery pseudoaneurysm. This case highlights the clinical significance of neurofibromatosis associated vasculopathy which can result in stroke.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radcr.2022.05.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9294049PMC
September 2022

MRA-detected intracranial atherosclerotic disease in patients with TIA and minor stroke.

Ir J Med Sci 2022 Jul 15. Epub 2022 Jul 15.

Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.

Objectives: Patients with TIA and minor stroke commonly undergo CT and CTA in the emergency department with subsequent MRI with MRA for further workup. The purpose of this study was to review outpatient MRIs for TIA/stroke patients to assess the additional benefit, if any, of the MRA sequence in the detection of intracranial atherosclerotic disease in patients for whom CTA had already been performed.

Methods: The radiology reports of outpatient MRIs of the brain for TIA/minor stroke patients were retrospectively reviewed via the hospital PACS system. Following this, the imaging report from the patient's initial presentation to the emergency department was reviewed. This index imaging and subsequent MRI were compared to assess the incidence of new vascular findings detected on the MRA sequence in patients for whom CTA had already been performed. Where new lesions had been identified at follow-up, the imaging was retroactively reviewed to assess if they were present on the index imaging.

Results: Two hundred seven consecutive patients were reviewed. Significant (> 50%) intracranial atherosclerotic disease was present on MRA in 18 patients (8.7%). This was a new finding in 11 patients. Five had initial CTA where the atherosclerosis was not detected. All 5 of these cases were located in the posterior cerebral arteries. Incidental aneurysms were seen in 14 (6.7%); 12 were a new finding at time of MRI.

Conclusion: The MRA sequence provides additional value by increasing the detection of clinically important intracranial atherosclerotic disease which may inform management in patients with minor stroke and TIA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11845-022-03094-8DOI Listing
July 2022

Acetabular paralabral cysts demonstrating perineural propagation.

Br J Radiol 2022 Aug 11;95(1136):20211306. Epub 2022 Jul 11.

Department of Radiology, National Orthopaedic Hospital of Ireland, Cappagh, Ireland.

Objective: Acetabular paralabral cysts are common and are almost always associated with labral tears. Uncommonly, they extend into the periacetabular soft tissues or may propagate along peripheral nerves causing pain and hip dysfunction. The aim was to evaluate the clinical and MRI presentations of such cases including perineural propagation.

Methods: Retrospective cross-sectional study with a search of electronic health records for cases of acetabular paralabral cysts demonstrating perineural propagation was performed. Clinical and MR imaging features were tabulated after re-review by experienced musculoskeletal radiologists, and available outcomes were recorded. Descriptive statistics were performed.

Results: 14 cases were recorded. The mean age was 56.9 years (range = 30-79 years) and female:male ratio was 1:2.6. The commonest presenting complaint was hip pain (10/14, 71.4%). Other complaints included groin pain, perineal pain and hip dysfunction. No symptoms were attributed to the acetabular paralabral cyst in 3/14 patients (21.4%). None had foot drop. The cysts were multilocular in all cases and were homogenously T2 hyperintense in 13/14 (92.9%). Labral tears were identified in 11/14 cases (78.6%). The sciatic nerve was most commonly involved in 5/14 cases (35.7%) with the obturator, medial femoral cutaneous nerve, femoral nerve, superior and inferior gluteal nerves also affected.No intervention was undertaken in 9/14 cases (64.3%). 5/14 (35.7%) underwent image guided aspiration and corticosteroid injection. 4/5 such patients reported reduced pain following the procedure.

Conclusion: Paralabral cysts demonstrating perineural propagation are uncommon and exhibit varied presentations. Most patients who underwent image-guided or surgical interventions reported an improvement in symptoms.

Advances In Knowledge.: This is the first description of a series of patients with acetabular paralabral cysts demonstrating perineural propagation in the literature. A comprehensive description of their clinical and imaging characteristics and interventions/outcomes where relevant is provided.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1259/bjr.20211306DOI Listing
August 2022

Complications in image-guided musculoskeletal injections.

Skeletal Radiol 2022 May 27. Epub 2022 May 27.

Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin 11, Republic of Ireland.

Complications in musculoskeletal interventions are rare and where they do occur tend to be minor, and often short-lived or self-limiting. Nonetheless, the potential for significant complications exists, and a thorough understanding of both the mechanisms which contribute and the manner in which they may clinically present is of critical importance for all musculoskeletal radiologists involved in performing procedures, both to mitigate against the occurrence of complications and to aid rapid recognition. The purpose of this review is to analyse the relevant literature to establish the frequency with which complications occur following musculoskeletal intervention. Furthermore, we highlight some of the more commonly discussed and feared complications in musculoskeletal intervention, such as the risk of infection, potential deleterious articular consequences including accelerated joint destruction and the poorly understood and often underestimated systemic effects of locally injected corticosteroids. We also consider both extremely rare but emergent scenarios such as anaphylactic reactions to medications, and much more common but less significant complications such as post-procedural pain. We suggest that meticulous attention to detail including strict adherence to aseptic technique and precise needle placement may reduce the frequency with which complications occur.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00256-022-04076-8DOI Listing
May 2022

MRI findings in atraumatic shoulder pain-patterns of disease correlated with age and gender.

Ir J Med Sci 2022 May 10. Epub 2022 May 10.

Department of Radiology, National Orthopaedic Hospital, CappaghDublin 11, Finglas, Ireland.

Background: The rotator cuff is a group of muscles and tendons which support the shoulder joint. Rotator cuff disease is a frequent cause of morbidity in adulthood.

Aims: The aims of his study are to determine the prevalence and patterns of rotator cuff derangement in symptomatic patients using MRI and to attempt to correlate identified patterns of disease with age and gender METHODS: Five hundred ninety-seven patients attending for MRI of the shoulder with atraumatic shoulder pain were included for study. Patients' age and gender was recorded. Record was made of the presence or absence of rotator cuff derangement and of degenerative change in the AC and glenohumeral joints. Correlation was made between age and gender.

Results: There were 358 males (60%) and 239 females (40%) with a mean age of 49.4 ± 17.1 years. Subacromial bursitis was identified in 517 patients. A normal supraspinatus tendon was identified in 219 patients and supraspinatus full thickness tearing was identified in 102 patients. A normal AC joint was identified in 267 patients while degenerative AC joint changes were identified in 370 patients. A significant correlation was identified between age and rotator cuff derangement (p < .001) and between age and AC joint derangement (p < .001). No significant difference was identified between gender and patterns of cuff derangement CONCLUSION: The extent of rotator cuff and AC joint derangement increases with ageing. Impingement appears to trigger a cascade of events in sequence, from isolated subacromial bursitis through to supraspinatus tendon tearing. Patterns of rotator cuff derangement are similar in men and women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11845-022-03012-yDOI Listing
May 2022

Association of Plaque Inflammation With Stroke Recurrence in Patients With Unproven Benefit From Carotid Revascularization.

Neurology 2022 07 13;99(2):e109-e118. Epub 2022 Apr 13.

From the Stroke Unit (P.C.-R., J.M.-F., R.D.-M., M.G.-J., D.G.-A., A.M.-D., L.P.-S.), Department of Neurology, Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Health Research Board Stroke Clinical Trials Network Ireland (J.M., S.C., E.D., J.A.H., G.H., M.M., S.M., P.J.K.); Neurovascular Clinical Science Unit (J.M., G.H., M.M., S.M., P.J.K.), Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin; Radiography & Diagnostic Imaging (N.G., J.P.M., S.F.), School of Medicine, University College Dublin, Ireland; Discipline of Medical Imaging Science (N.G.), School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Australia; Department of Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology (J.-C.B.), Université de Paris, Hopital Sainte-Anne, France; Department of Vascular Surgery (M.B.), St. Vincent's University Hospital and University College Dublin, Ireland; Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (S.C.), Cork University Hospital; Department of Clinical Neuroscience (S.C.), College of Medicine and Health, University College Cork, Ireland; Connolly Hospital Dublin and Royal College of Surgeons (E.D.); Stroke Service, Department of Geriatric Medicine (J.A.H.), St. James' Hospital and Trinity College; Departments of Radiology (E.C.K., M.O.C.) and Vascular Surgery (C.M.), Mater University Hospital and University College Dublin, Ireland; Division of Neurology (V.K.S.), National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore; and Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences/Beaumont Hospital, Dublin, Ireland.

Background And Objectives: In pooled analyses of endarterectomy trials for symptomatic carotid stenosis, several subgroups experienced no net benefit from revascularization. The validated symptomatic carotid atheroma inflammation lumen-stenosis (SCAIL) score includes stenosis severity and inflammation measured by PET and improves the identification of patients with recurrent stroke compared with lumen-stenosis alone. We investigated whether the SCAIL score improves the identification of recurrent stroke in subgroups with uncertain benefit from revascularization in endarterectomy trials.

Methods: We did an individual-participant data pooled analysis of 3 prospective cohort studies (Dublin Carotid Atherosclerosis Study [DUCASS], 2008-2011; Biomarkers and Imaging of Vulnerable Atherosclerosis in Symptomatic Carotid Artery Disease [BIOVASC], 2014-2018; Barcelona Plaque Study, 2015-2018). Eligible patients had a recent nonsevere (modified Rankin Scale score ≤3) anterior circulation ischemic stroke/TIA and ipsilateral mild carotid stenosis (<50%); ipsilateral moderate carotid stenosis (50%-69%) plus at least 1 of female sex, age <65 years, diabetes mellitus, TIA, or delay >14 days to revascularization; or monocular loss of vision. Patients underwent coregistered carotid F-fluorodeoxyglucosePET/CT angiography (≤7 days from inclusion). The primary outcome was 90-day ipsilateral ischemic stroke. Multivariable Cox regression modeling was performed.

Results: We included 135 patients. All patients started optimal modern-era medical treatment at admission, and 62 (45.9%) underwent carotid revascularization (36 within the first 14 days and 26 beyond). At 90 days, 18 (13.3%) patients had experienced at least 1 stroke recurrence. The risk of recurrence increased progressively according to the SCAIL score (0.0% in patients scoring 0-1, 15.1% scoring 2-3, and 26.7% scoring 4-5; = 0.04). The adjusted (age, smoking, hypertension, diabetes, carotid revascularization, antiplatelets and statins) hazard ratio for ipsilateral recurrent stroke per 1-point SCAIL increase was 2.16 (95% CI 1.32-3.53; = 0.002). A score ≥2 had a sensitivity of 100% for recurrence.

Discussion: The SCAIL score improved the identification of early recurrent stroke in subgroups who did not experience benefit in endarterectomy trials. Randomized trials are needed to test whether a combined stenosis-inflammation strategy will improve selection for carotid revascularization when benefit is currently uncertain.

Classification Of Evidence: This study provides Class II evidence that, in patients with recent anterior circulation ischemic stroke who do not benefit from carotid revascularization, the SCAIL score accurately distinguishes those at risk for recurrent ipsilateral ischemic stroke.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000200525DOI Listing
July 2022

Voriconazole-induced periostitis post lung transplantation.

Radiol Case Rep 2022 May 11;17(5):1587-1590. Epub 2022 Mar 11.

Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.

Voriconazole is a broad-spectrum triazole antifungal used to treat invasive fungal infections. It is commonly used prophylactically in immunocompromized patient cohorts, including transplant recipients. Diffuse periostitis is a very rare complication of chronic voriconazole use. It is associated with diffuse bone pain, elevated serum alkaline phosphatase and fluorine levels. Characteristic imaging findings include periosteal thickening with a dense, nodular, irregular and often bilateral pattern. We describe the case of a 71-year-old female who presented with multifocal bone pain six years following double lung transplantation. Her post transplantation course had been complicated by a life threatening episode of sepsis secondary to Scedosporium apiospermum, a rare invasive fungal infection following which lifelong prophylaxis with oral Voriconazole was commenced. We discuss the characteristic clinical and imaging manifestations of this rare condition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radcr.2022.01.078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8924534PMC
May 2022

Glomangiomatosis of the lower leg.

Radiol Case Rep 2022 Mar 18;17(3):963-966. Epub 2022 Jan 18.

Department of Radiology, National Orthopaedic Hopsital Cappagh, Dublin, Ireland.

This paper demonstrates a case of multiple glomangiomas, or glomangiomatosis, including clinical presentation, imaging appearances, and subsequent management. Differentiating features from typical glomus tumors are described. To the best of our knowledge, this is the first reported case of a glomangioma involving the distal tibiofibular syndesmosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radcr.2022.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8784297PMC
March 2022

Association Between 18-FDG Positron Emission Tomography and MRI Biomarkers of Plaque Vulnerability in Patients With Symptomatic Carotid Stenosis.

Front Neurol 2021 23;12:731744. Epub 2021 Dec 23.

School of Medicine, University College Dublin, Dublin, Ireland.

Pathologic studies suggest that unstable plaque morphology and inflammation are associated with cerebrovascular events. F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a validated technique for non-invasive imaging of inflammation-related plaque metabolism, and MRI can identify morphologic features of plaque instability. The aim of this study was to investigate the association of selected imaging characteristics of plaque vulnerability measured with MRI and PET in patients with symptomatic carotid stenosis. Patients from the BIOVASC study were selected based on the following inclusion criteria: (1) age ≥ 50 years; (2) recent (<30 days) ischaemic stroke (modified Rankin scale ≤3) or motor/speech/vision TIA; (3) ipsilateral internal carotid artery stenosis (≥5 0% lumen-narrowing); (4) carotid PET/CTA and MRI completed. Semi-automated plaque analysis of MRI images was performed to quantify morphologic features of plaque instability. PET images were co-registered with CTA and inflammation-related metabolism expressed as maximum standardised uptake value (SUV). Twenty-five patients met inclusion criteria (72% men, mean age 65 years). MRI-measured plaque volume was greater in men (1,708-1,286 mm, = 0.03), patients who qualified with stroke (1,856-1,440 mm, = 0.05), and non-statin users (1,325-1,797 mm, = 0.03). SUV was associated with MRI-measured plaque lipid-rich necrotic core (LRNC) in the corresponding axial slice ( = 0.64, p < 0.001) and was inversely associated with whole-plaque fibrous cap thickness ( = -0.4, = 0.02) and calcium volume ( = -0.4, = 0.03). This study demonstrated novel correlations of non-invasive imaging biomarkers of inflammation-related plaque metabolism with morphological MRI markers of plaque instability. If replicated, our findings may support the application of combined MRI and PET to detect vulnerable plaque in future clinical practise and randomised trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.731744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732361PMC
December 2021

Does MRI Knee in Those over 50 Years with Knee Pain in Osteoarthritis Alter Management? A Retrospective Review.

J Knee Surg 2021 Dec 8. Epub 2021 Dec 8.

Department of Orthopaedic Surgery, The National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland.

Knee osteoarthritis (OA) is a significant cause of pain and disability worldwide. Imaging provides diagnosis, prognostication, and follow-up. Radiographs are first line, useful, and inexpensive. Magnetic resonance imaging (MRI) can detect additional features not seen on radiograph, but it is of questionable usefulness in the management of knee OA. Our aim was to investigate the usefulness of MRI in the workup of knee OA and whether MRI alters management in knee OA. A retrospective review was performed of consecutive MRI knees performed for knee pain in those over 50 years. Clinical information and documentation of management plan pre- and post-MRI were collected. Assessment was made whether the MRI results influenced the final management plan. Of the 222 MRI knees included for study, the majority (62.2%) had not had a recent radiograph. OA was reported in 86.9% of radiographs and 89.6% of MRI. On MRI, the most prevalent finding was tearing/abnormality of the medial meniscus, seen in 47% of MRIs overall, increasing to all in severe OA. MRI assisted with management in 9.5% of all (21/222) patients, and changed management plans in 23% of those that had documented management plans prior to the MRI (6/26 patients). MRIs can guide tailored management in knee OA and are useful for surgical planning; however, they should only be ordered in certain cases, and a radiograph should always be performed first. MRI should be considered if symptoms are not explained by OA alone or the appropriate treatment option requires MRI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0041-1740390DOI Listing
December 2021

Carotid Plaque Inflammation Imaged by PET and Prediction of Recurrent Stroke at 5 Years.

Neurology 2021 12 5;97(23):e2282-e2291. Epub 2021 Oct 5.

From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., S. Coveney, S.M., J.H., S. Cronin, D.W., G.H., E.D., T.C., S. Collins, M.M., P.J.K.); School of Medicine (J.J.M., N.G., J.P.M., S.M., S.F., M.M., P.J.K.), University College Dublin (UCD), Ireland; Departments of Neurology (P.C.-R., R.D.-M., J.M.-F.) and Nuclear Medicine (A.F.-L.), Hospital de la Santa Creu i Sant Pau; Biomedical Research Institute Sant Pau (IIB Sant Pau) (P.C.-R., R.D.-M., J.M.-F.), Universitat Autònoma de Barcelona (Department of Medicine), Spain; Departments of Vascular Surgery (M.B.) and Geriatric Medicine (T.C.), St. Vincent's University Hospital; Stroke Service (J.H.), Department of Geriatric Medicine, St. James' Hospital, Dublin; Department of Neurology (S. Cronin), Cork University Hospital; Department of Clinical Neuroscience (S. Cronin), College of Medicine and Health, University College Cork; Department of Geriatric and Stroke Medicine (D.W.), Royal College of Surgeons in Ireland University of Medicine and Health Sciences; Department of Geriatric Medicine (E.D.), James Connolly Memorial Hospital; and Departments of Vascular Surgery (C.M.) and Radiology (E.K., M.O.), Mater Misericordiae University Hospital, Dublin, Ireland.

Background And Objectives: To determine whether carotid plaque inflammation identified by F-fluorodeoxyglucose (FDG)-PET is associated with late (5-year) recurrent stroke.

Methods: We did an individual-participant data pooled analysis of 3 prospective studies with near-identical study methods. Eligible patients had recent nonsevere (modified Rankin Scale score ≤3) ischemic stroke/TIA and ipsilateral carotid stenosis (50%-99%). Participants underwent carotid FDG-PET/CT angiography ≤14 days after recruitment. FDG uptake was expressed as maximum standardized uptake value (SUV) in the axial single hottest slice of symptomatic plaque. We calculated the previously validated Symptomatic Carotid Atheroma Inflammation Lumen-Stenosis (SCAIL) score, which incorporates a measure of stenosis severity and FDG uptake. The primary outcome was 5-year recurrent ipsilateral ischemic stroke after PET imaging.

Results: Of 183 eligible patients, 181 patients completed follow-up (98.9%). The median duration of follow-up was 4.9 years (interquartile range 3.3-6.4 years, cumulative follow-up period 901.8 patient-years). After PET imaging, 17 patients had a recurrent ipsilateral ischemic strokes at 5 years (recurrence rate 9.4%, 95% confidence interval [CI] 5.6%-14.6%). Baseline plaque SUV independently predicted 5-year ipsilateral recurrent stroke after adjustment for age, sex, carotid revascularization, stenosis severity, NIH Stroke Scale score, and diabetes mellitus (adjusted hazard ratio [HR] 1.98, 95% CI 1.10-3.56, = 0.02 per 1-g/mL increase in SUV). On multivariable Cox regression, SCAIL score predicted 5-year ipsilateral stroke (adjusted HR 2.73 per 1-point increase, 95% CI 1.52-4.90, = 0.001).

Discussion: Plaque inflammation-related FDG uptake improved identification of 5-year recurrent ipsilateral ischemic stroke. Addition of plaque inflammation to current selection strategies may target patients most likely to have late and early benefit from carotid revascularization.

Classification Of Evidence: This study provides Class I evidence that in individuals with recent ischemic stroke/TIA and ipsilateral carotid stenosis, carotid plaque inflammation-related FDG uptake on PET/CT angiography was associated with 5-year recurrent ipsilateral stroke.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/WNL.0000000000012909DOI Listing
December 2021

Varicella-Zoster Vasculopathy Causing Carotid Artery Dissection.

Neurol Clin Pract 2021 Jun;11(3):e373-e375

Department of Neurology (LW, MM), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Radiology (FD, EK), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Stroke Medicine (GK, SM), Mater Misericordiae University Hospital, Dublin, Ireland; and Department of Infectious Diseases (GS), Mater Misericordiaae University Hospital, Dublin, Ireland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1212/CPJ.0000000000000802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8382362PMC
June 2021

Nomenclature for groin pain in athletes.

Br J Radiol 2021 Oct 30;94(1126):20201333. Epub 2021 Jul 30.

Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland.

Currently, there is much variation in the terminology used to describe groin pain in athletes. Several groups have attempted to reach consensus on nomenclature in this area. This article outlines the current status of groin pain nomenclature for the radiologist, highlighting inherent heterogeneity, recent attempts to reach a consensus, the need for a radiological consensus and why imprecise terminology should be avoided when reporting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1259/bjr.20201333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9328050PMC
October 2021

The Evolving Roles of MRI and Ultrasound in First-Line Imaging of Rotator Cuff Injuries.

AJR Am J Roentgenol 2021 12 23;217(6):1390-1400. Epub 2021 Jun 23.

The University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada.

Rotator cuff tears are the most likely source of shoulder pain in adults and may cause protracted disability. Management of rotator cuff tears is associated with considerable costs. Accurate diagnosis can guide surgical planning and help achieve a favorable clinical outcome. Although radiography remains the initial imaging test for shoulder injury, the roles of MRI and ultrasound (US) as first-line imaging after radiography are evolving. This article leverages current literature and the practical experience of subspecialty musculoskeletal radiologists from different institutions in describing a practical approach to imaging rotator cuff pathology. Both MRI and US are accurate for identifying rotator cuff tears, but each has advantages and shortcomings. As both modalities currently represent reasonable first-line approaches, considerable practice variation has evolved. Given the low cost of US, imagers should strive to optimize the quality of shoulder US examinations and to build referrer confidence in this modality. The roles of direct CT and MR arthrography as well as imaging evaluation of the postoperative rotator cuff are also considered. Through careful selection among the available imaging modalities and optimal performance and interpretation of such examinations, radiologists can positively contribute to the diagnosis and treatment of patients with rotator cuff injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.21.25606DOI Listing
December 2021

Tenosynovial chondromatosis of the flexor pollicis longus tendon: A subtype of primary synovial chondromatosis.

Radiol Case Rep 2021 Mar 18;16(3):487-492. Epub 2020 Dec 18.

Radiology Department, Cappagh National Orthopaedic Hospital, Cappagh Road, Cappoge, Dublin 11, D11 EV29, Ireland.

Primary synovial chondromatosis is a rare benign neoplastic process, in which cartilaginous nodules are produced in the subsynovial tissue. It has 3 main subtypes (intra-articular, tenosynovial and bursal). We present the case of a 61-year-old female, with a mass involving her right thumb for at least 5 years, which had recently increased in size. X-ray showed a soft tissue mass, without calcification or any underlying bony abnormality. Ultrasound and MRI showed a 6-cm mass surrounding the right flexor pollicis longus tendon of the right thumb. The patient went on to have surgical resection and was given a diagnosis of tenosynovial chondromatosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radcr.2020.12.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753090PMC
March 2021

Multimodal imaging of composite carbon fiber-based implants for orthopedic spinal fixation.

Skeletal Radiol 2021 May 17;50(5):1039-1045. Epub 2020 Oct 17.

Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland.

Objective: As cancer treatments continue to improve, the incidence of spinal metastases and the need for surgical management of these with fixation procedures are growing rapidly. Traditionally metallic implants, composed of titanium alloy, have been used in surgical fixation of unstable or symptomatic vertebral metastases or traumatic injuries. Metallic implants, however, cause significant artifact on post-operative imaging, degrading image quality and limiting interpretation, and can also impair the planning and delivery of radiotherapy. Composite carbon fiber-based materials, such as carbon fiber-reinforced polyetheretherketone (PEEK), have been developed to overcome these issues and are now available for spinal fixation procedures. We aimed to review the multimodal imaging features of these new implants.

Materials And Methods: Current literature and a case example from our institution were used to describe the multimodal imaging characteristics and considerations of new carbon fiber-based spinal fixation implants.

Results: New carbon fiber-based spinal implants allow far greater visualization of surrounding structures on post-operative cross-sectional imaging, significantly improving diagnostic accuracy and precision of radiotherapy planning, and do not significantly absorb or scatter X-ray photons during radiotherapy delivery. There are, however, important surgical and radiologic considerations associated with the use of carbon fiber-based implants which radiologists must be aware of, such as implications for surgical planning and intra-operative fluoroscopic and post-operative plain radiographic imaging.

Conclusion: The use of carbon fiber-based implants, rather than traditional metallic implants, for spinal fixation offers significant advantages for post-operative diagnostic imaging and radiotherapy planning and delivery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00256-020-03622-6DOI Listing
May 2021

Gaelic Sport Injuries.

Semin Musculoskelet Radiol 2020 Jun 28;24(3):214-226. Epub 2020 Sep 28.

Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland.

The Gaelic sports of hurling and football, native to Ireland, are increasing in popularity worldwide. The injury profile of these sports requires multidisciplinary management by sports physicians, orthopaedic surgeons, and musculoskeletal (MSK) radiologists, among others. Advances in imaging modalities and interventional techniques have aided the diagnosis and treatment of sport injuries. In this article, we review the literature and our own institutional experience to describe common injury patterns identified in Gaelic games athletes, their main imaging features and relevant therapeutic interventions. We discuss the increasing prevalence of imaging services at sporting events and the central role of MSK radiologists in sports injury management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1708872DOI Listing
June 2020

Periprosthetic Hip Joint Infection and Its Diagnosis.

Radiology 2020 10 18;297(1):E240. Epub 2020 Aug 18.

Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2020202755DOI Listing
October 2020

Complications in image-guided musculoskeletal injections.

Skeletal Radiol 2021 Feb 30;50(2):343-349. Epub 2020 Jul 30.

Mater Misericordiae University Hospital, Dublin, Republic of Ireland.

Objective: To establish the incidence and define the nature of complications occurring following image-guided musculoskeletal injections at our institution.

Materials And Methods: All patients undergoing image-guided musculoskeletal injection during the study period (16/3/2016 to 24/01/2020) were included. Departmental records were reviewed to identify all patients describing possible complications following injection, what therapy was required (if any) and what the outcome was. No patients were excluded. Complications were classified as minor or major. Injections were categorised as follows: cervical spine, lumbar facet joint, lumbar nerve root, caudal epidural and 'other'. The complication rate for each individual category of procedure was compared with the combined complication rate for all other categories by constructing contingency tables and using Fisher's exact test.

Results: A total of 8226 patients underwent image-guided musculoskeletal injections within the study period. Exactly 100 patients were identified as having reported a complication, producing an overall complication rate of 1.2%. One complication was categorised as 'major', with the patient requiring expedited surgery. The remainder (99 patients) were categorised as having experienced minor complications. The incidence of complications after 'other' injections was significantly greater than for other categories of injection (1.86%, p = 0.028). There was no significant difference in the complication rate for cervical spine (0.93%, p = 0.257), lumbar nerve root (0.85%, p = 0.401), lumbar facet joint (0.67%, p = 0.326) or caudal epidural (1.29%, p = 0.687) injections. 'Other' injections were subsequently further sub-categorised by anatomical site and imaging modality used. Glenohumeral (2.97%, p = 0.0361) and sacro-iliac (3.51%, p = 0.0498) joint injections were associated with a significantly increased risk of complications. There was no difference in the incidence of complications with fluoroscopic or ultrasound guidance.

Conclusion: In conclusion, image-guided musculoskeletal injections are safe and well-tolerated procedures. Complications are rare, occurring in just 1.2% of patients. 99% of complications are minor, either not requiring intervention or resolving with simple supportive treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00256-020-03565-yDOI Listing
February 2021

Cohort profile: BIOVASC-late, a prospective multicentred study of imaging and blood biomarkers of carotid plaque inflammation and risk of late vascular recurrence after non-severe stroke in Ireland.

BMJ Open 2020 07 19;10(7):e038607. Epub 2020 Jul 19.

Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland.

Purpose: Inflammation is important in stroke. Anti-inflammatory therapy reduces vascular events in coronary patients. F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) identifies plaque inflammation-related metabolism. However, long-term prospective cohort studies investigating the association between carotid plaque inflammation, identified on F-FDG PET and the risk of recurrent vascular events, have not yet been undertaken in patients with stroke.

Participants: The Biomarkers Imaging Vulnerable Atherosclerosis in Symptomatic Carotid disease (BIOVASC) study and Dublin Carotid Atherosclerosis Study (DUCASS) are two prospective multicentred observational cohort studies, employing near-identical methodologies, which recruited 285 patients between 2008 and 2016 with non-severe stroke/transient ischaemic attack and ipsilateral carotid stenosis (50%-99%). Patients underwent coregistered carotid F-FDG PET/CT angiography and phlebotomy for measurement of inflammatory cytokines. Plaque F-FDG-uptake is expressed as maximum standardised uptake value (SUV) and tissue-to-background ratio. The BIOVASC-Late study is a follow-up study (median 7 years) of patients recruited to the DUCASS/BIOVASC cohorts.

Findings To Date: We have reported that F-FDG-uptake in atherosclerotic plaques of patients with symptomatic carotid stenosis predicts early recurrent stroke, independent of luminal narrowing. The incorporation of F-FDG plaque uptake into a clinical prediction model also improves discrimination of early recurrent stroke, when compared with risk stratification by luminal stenosis alone. However, the relationship between F-FDG-uptake and late vascular events has not been investigated to date.

Future Plans: The primary aim of BIOVASC-Late is to investigate the association between SUV in symptomatic 'culprit' carotid plaque (as a marker of systemic inflammatory atherosclerosis) and the composite outcome of any late major vascular event (recurrent ischaemic stroke, coronary event or vascular death). Secondary aims are to investigate associations between: (1) SUV in symptomatic plaque, and individual vascular endpoints (2) SUV in asymptomatic contralateral carotid plaque and SUV in ipsilateral symptomatic plaque (3) SUV in asymptomatic carotid plaque and major vascular events (4) inflammatory cytokines and vascular events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-038607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371237PMC
July 2020

Placebo effects in musculoskeletal radiology procedures.

Skeletal Radiol 2020 Dec 13;49(12):1921-1924. Epub 2020 Jul 13.

Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00256-020-03542-5DOI Listing
December 2020

Multimodal imaging of Spina Ventosa (TB Dactylitis) of the foot.

Radiol Case Rep 2020 Aug 27;15(8):1373-1376. Epub 2020 Jun 27.

Department of Radiology, Mater Misericordiae University Hospital (University College Dublin), Eccles St, Dublin 7, Dublin, Ireland.

We present the case of a 29-year-old male healthcare worker with a 6 month history of progressive left foot pain resulting in presentation to the emergency department on 3 occasions. He denied systemic symptoms. Multimodal imaging demonstrated an expansile erosive inflammatory lesion centered on the neck of the second metatarsal with aggressive features. CT of the thorax, abdomen, and pelvis demonstrated calcified mediastinal lymph nodes and left inguinal adenopathy. The lesion was biopsied under ultrasound guidance demonstrating a necrotizing granulomatous osteomyelitis with acid fact bacilli. This is consistent with TB dactylitis (spina ventosa). Treatment with antimycobacterial drugs was commenced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radcr.2020.05.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327125PMC
August 2020

Pigmented villonodular synovitis of the hip joint: Three cases demonstrating characteristic MRI features.

Radiol Case Rep 2020 Aug 24;15(8):1335-1338. Epub 2020 Jun 24.

Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin 11, Ireland.

Pigmented villonodular synovitis is a rare benign proliferative disease of synovial membranes, causing villonodular synovial hyperplasia and hemosiderin deposition. Its intra-articular forms most commonly affect the knee and less commonly the hip. PVNS of the hip is most common in the second to fifth decades and presentation is typically with pain and occasionally joint dysfunction. We review the existing literature and demonstrate characteristic magnetic resonance imaging features of pigmented villonodular synovitis in the hip joint using three biopsy-proven cases, with the aims of increasing awareness and aiding diagnosis of this rare but potentially debilitating and progressive condition. Recognition of its clinical presentation, appropriate use of magnetic resonance imaging and identification of imaging characteristics are essential to guiding biopsy interpretation and treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radcr.2020.05.067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322487PMC
August 2020

Subperiosteal hematoma of the iliac wing presenting with leg weakness in a young adult footballer.

Radiol Case Rep 2020 Apr 12;15(4):424-426. Epub 2020 Feb 12.

Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.

We present the case of a 17 year old football player with a 2 week history of left leg weakness and difficulty weight-bearing. Magnetic resonance imaging revealed a well-circumscribed lesion deep to the left iliacus muscle. The patient proceeded to computed tomography-guided biopsy. The likely diagnosis was that of a subperiosteal haematoma of the iliac wing, which was exerting mass effect upon the left femoral nerve resulting in leg pain and weakness. Imaging was repeated at an interval of 1 month, at which time the lesion had almost entirely resolved. Subperiosteal haematoma of the iliac bone is a rare entity but should be considered as a potential diagnosis in young adults, particularly where there is a history of trauma or recent sports injury.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.radcr.2020.01.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021541PMC
April 2020

Our Experience with an Exciting Addition to Contemporary Radiology Literature.

Radiology 2020 04 18;295(1):247. Epub 2020 Feb 18.

Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin, Leinster 7, Ireland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/radiol.2020192608DOI Listing
April 2020

A Risk Score Including Carotid Plaque Inflammation and Stenosis Severity Improves Identification of Recurrent Stroke.

Stroke 2020 03 17;51(3):838-845. Epub 2020 Jan 17.

From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.).

Background and Purpose- In randomized trials of symptomatic carotid endarterectomy, only modest benefit occurred in patients with moderate stenosis and important subgroups experienced no benefit. Carotid plaque F-fluorodeoxyglucose uptake on positron emission tomography, reflecting inflammation, independently predicts recurrent stroke. We investigated if a risk score combining stenosis and plaque F-fluorodeoxyglucose would improve the identification of early recurrent stroke. Methods- We derived the score in a prospective cohort study of recent (<30 days) non-severe (modified Rankin Scale score ≤3) stroke/transient ischemic attack. We derived the SCAIL (symptomatic carotid atheroma inflammation lumen-stenosis) score (range, 0-5) including F-fluorodeoxyglucose standardized uptake values (SUV <2 g/mL, 0 points; SUV 2-2.99 g/mL, 1 point; SUV 3-3.99 g/mL, 2 points; SUV ≥4 g/mL, 3 points) and stenosis (<50%, 0 points; 50%-69%, 1 point; ≥70%, 2 points). We validated the score in an independent pooled cohort of 2 studies. In the pooled cohorts, we investigated the SCAIL score to discriminate recurrent stroke after the index stroke/transient ischemic attack, after positron emission tomography-imaging, and in mild or moderate stenosis. Results- In the derivation cohort (109 patients), recurrent stroke risk increased with increasing SCAIL score (=0.002, C statistic 0.71 [95% CI, 0.56-0.86]). The adjusted (age, sex, smoking, hypertension, diabetes mellitus, antiplatelets, and statins) hazard ratio per 1-point SCAIL increase was 2.4 (95% CI, 1.2-4.5, =0.01). Findings were confirmed in the validation cohort (87 patients, adjusted hazard ratio, 2.9 [95% CI, 1.9-5], <0.001; C statistic 0.77 [95% CI, 0.67-0.87]). The SCAIL score independently predicted recurrent stroke after positron emission tomography-imaging (adjusted hazard ratio, 4.52 [95% CI, 1.58-12.93], =0.005). Compared with stenosis severity (C statistic, 0.63 [95% CI, 0.46-0.80]), prediction of post-positron emission tomography stroke recurrence was improved with the SCAIL score (C statistic, 0.82 [95% CI, 0.66-0.97], =0.04). Findings were confirmed in mild or moderate stenosis (adjusted hazard ratio, 2.74 [95% CI, 1.39-5.39], =0.004). Conclusions- The SCAIL score improved the identification of early recurrent stroke. Randomized trials are needed to test if a combined stenosis-inflammation strategy improves selection for carotid revascularization where benefit is currently uncertain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.119.027268DOI Listing
March 2020

Imaging of the Spine: A Bibliometric Analysis of the 100 Most-Cited Articles.

Spine (Phila Pa 1976) 2019 Nov;44(22):1593-1598

Department of Radiology, Mater Misericordiae, Dublin, Ireland.

Study Design: A bibliometric review of the literature.

Objective: The aim of this study was to identify the most highly cited articles relating to imaging of the spine and to analyze the most influential papers and evolving trends in spinal imaging research.

Summary Of Background Data: Spinal imaging is being performed with increasing frequency and is an essential step in the diagnosis and treatment planning of spinal pathology. A comprehensive review of the most influential articles in spinal imaging has not been performed, until now.

Methods: A selection of search terms and keywords were inputted into the "Web of Science" database and the most highly cited articles in spinal imaging were selected from high impact factor journals. The top 100 articles were analyzed for year of publication, authorship, publishing journals, institution and country of origin, subject matter, article type, and level of evidence. In addition to total citation count, the number of annual citations was also calculated. Citation counts from Scopus and Google Scholar were also obtained for comparison across other citation index platforms.

Results: The most highly cited articles in spinal imaging were published over 30 years, between 1983 and 2013. Total citation count ranged from 98 to 1243 with annual citation count ranging from 3.8 to 91.8. The greatest number of highly cited articles was produced in the United States (n = 49), involved magnetic resonance (n = 73) or multimodal (n = 17) imaging and focused on the lumbar spine (n = 42). The journals that contributed the most articles were Spine and Radiology each publishing 26 articles.

Conclusion: Our study provided an extensive list of the most historically significant spinal imaging articles, acknowledging the key contributions made to the advancement of this specialist field.

Level Of Evidence: 5.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BRS.0000000000003131DOI Listing
November 2019

Incorporating Cone-Beam CT Into the Diagnostic Algorithm for Suspected Radiocarpal Fractures: A New Standard of Care?

AJR Am J Roentgenol 2019 11 9;213(5):1117-1123. Epub 2019 Jul 9.

Department of Radiology, Whitty Bldg, N Circular Rd, Mater Misericordiae University Hospital, Dublin D07 R2WY, Ireland.

The purpose of this study was to assess the result of adding cone-beam CT to the standard imaging algorithm for patients with suspected radiographically occult traumatic radiocarpal fractures. A prospective review was performed on all patients who had cone-beam CT investigation of acute wrist pain after normal initial radiographs. Patients with no identified fractures were clinically reassessed and referred for MRI if concern for a fracture persisted. In all, 117 patients were assessed; 50.4% had fractures identified with a total of 67 radiographically occult fractures. One fracture was identified on MRI that was not seen on cone-beam CT. Cone-beam CT had sensitivity of 98.3% (95% CI, 91.1-100%), specificity of 100% (95% CI, 93.7-100%), positive predictive value of 100%, and negative predictive value of 98.3% (95% CI, 89.1-100%). Accuracy was 99.1% (95% CI, 95.3-100%). Incorporating cone-beam CT into routine clinical practice as part of a standardized diagnostic algorithm yielded a 50% fracture detection rate in patients with negative wrist radiographs but ongoing clinical concern for radiocarpal fracture. Cone-beam CT provides more diagnostic information than radiographs at a lower radiation dose than conventional MDCT. Given the poor accuracy of radiographs for acute radiocarpal fractures and the high fracture prevalence in this cohort, we feel that cone-beam CT should be regarded as the new standard of care in the investigation of these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.19.21478DOI Listing
November 2019

Carotid Plaque Inflammation Imaged by F-Fluorodeoxyglucose Positron Emission Tomography and Risk of Early Recurrent Stroke.

Stroke 2019 07 6;50(7):1766-1773. Epub 2019 Jun 6.

Department of Radiology (E.K., M. O'Connell), University College Dublin, Ireland.

Background and Purpose- Plaque inflammation contributes to stroke and coronary events. F-fluorodeoxyglucose (FDG) positron emission tomography (PET) identifies plaque inflammation-related metabolism. Almost no prospective data exist on the relationship of carotid F-FDG uptake and early recurrent stroke. Methods- We did a multicenter prospective cohort study BIOVASC (Biomarkers/Imaging Vulnerable Atherosclerosis in Symptomatic Carotid disease) of patients with carotid stenosis and recent stroke/transient ischemic attack with 90-day follow-up. On coregistered carotid F-FDG PET/computed tomography angiography, F-FDG uptake was expressed as maximum standardized uptake value (SUV) in the axial single hottest slice. We then conducted a systematic review of similar studies and pooled unpublished individual-patient data with 2 highly similar independent studies (Dublin and Barcelona). We analyzed the association of SUV with all recurrent nonprocedural stroke (before and after PET) and with recurrent stroke after PET only. Results- In BIOVASC (n=109, 14 recurrent strokes), after adjustment (for age, sex, stenosis severity, antiplatelets, statins, diabetes mellitus, hypertension, and smoking), the hazard ratio for recurrent stroke per 1 g/mL SUV was 2.2 (CI, 1.1-4.5; P=0.025). Findings were consistent in the independent Dublin (n=52, hazard ratio, 2.2; CI, 1.1-4.3) and Barcelona studies (n=35, hazard ratio, 2.8; CI, 0.98-5.5). In the pooled cohort (n=196), 37 recurrent strokes occurred (29 before and 8 after PET). Plaque SUV was higher in patients with all recurrence ( P<0.0001) and post-PET recurrence ( P=0.009). The fully adjusted hazard ratio of any recurrent stroke was 2.19 (CI, 1.41-3.39; P<0.001) and for post-PET recurrent stroke was 4.57 (CI, 1.5-13.96; P=0.008). Recurrent stroke risk increased across SUV quartiles (log-rank P=0.003). The area under receiver operating curve for all recurrence was 0.70 (CI, 0.59-0.78) and for post-PET recurrence was 0.80 (CI, 0.64-0.96). Conclusions- Plaque inflammation-related F-FDG uptake independently predicted future recurrent stroke post-PET. Although further studies are needed, F-FDG PET may improve patient selection for carotid revascularization and suggest that anti-inflammatory agents may have benefit for poststroke vascular prevention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.119.025422DOI Listing
July 2019
-->