Early CT Findings Research Articles

CT findings in temporal bone sites in skull base osteomyelitis from malignant otitis externa.

To identify the earliest sites and spread patterns of bony erosions on high-resolution temporal bone computerized tomographic (HRTBCT) scans and conjugate the radiological findings with clinical/laboratory data for guiding the interpretation of CT images of skull base osteomyelitis (SBOM) from malignant otitis externa (MOE). Retrospective and prospective medical records analysis. The medical records of all patients who presented to a referral medical center during 2015-2022 and initially diagnosed with SBOM. Radiological assessment of each sub-site was performed by 2 qualified neuro-radiologist, who were blind to the clinical data. 33 patients were enrolled. All patients suffered edema and exudates of the external auditory canal (EAC). The most common osseous markers for SBOM were dehiscence or irregularity of the anterior EAC wall and temporomandibular joint (TMJ) medial wall (21/33, 64% patients, each), followed by a fistula from the TMJ to the EAC (20/33, 61% patients). Eustachian tube bony walls and condylar irregularity and/or dehiscence were as prevalent as 16/33, 48% of patients, each. EAC inferior and posterior walls of the EACs were irregular or dehiscent in patients with more advanced disease. The high symptomatologic overlap between SBOM and other aural pathologies might cause diagnostic (and subsequent treatment) delay and result in dire complications. EAC edema and irregularity or dehiscence of the anterior EAC wall are the most common early CT findings associated with SBOM caused by MOE.

CT presentations of adult and pediatric SARS-CoV-2 patients: A review of early COVID-19 data

ObjectiveInitial COVID-19 reports described a variety of clinical presentations, but lower respiratory abnormalities are most common and chest CT findings differ between adult and pediatric patients. We aim to summarize early CT findings to inform healthcare providers on the frequency of COVID-19 manifestations specific to adult or pediatric patients, and to determine if the sensitivity of CT justifies its use in these populations. MethodsPubMed was searched for the presence of the words “CT, imaging, COVID-19” in the title or abstract, and 17 large-scale PubMed and/or Scopus studies and case reports published between January 1, 2020 and April 15, 2020 were selected for data synthesis. ResultsInitial CT scans identified ground-glass opacities and bilateral abnormalities as more frequent in adults (74%, n = 698, and 89%, n = 378, respectively) than children (60%, n = 25, and 37%, n = 46). At 14+ days, CT scans evidenced varied degrees of improvement in adults but no resolution until at least 26 days after the onset of flu-like symptoms. In pediatric patients, a third (n = 9) showed additional small nodular GGOs limited to a single lobe 3–5 days after an initial CT scan. ConclusionEarly adult CT findings suggest the limited use of CT as a supplemental tool in diagnosing COVID-19 in symptomatic adult patients, with a particular focus on identifying right and left lower lobe abnormalities, GGOs, and interlobular septal thickening. Early pediatric CT findings suggest against the use of CT if RT-PCR is available given its significantly lower sensitivity in this population and radiation exposure.

Comparación de los hallazgos en la tomografía computarizada de pacientes adultos y pediátricos con COVID-19

ObjectiveInitial COVID-19 reports described a variety of clinical presentations, but lower respiratory abnormalities are most common and chest CT findings differ between adult and pediatric patients. We aim to summarize early CT findings to inform healthcare providers on the frequency of COVID-19 manifestations specific to adult or pediatric patients, and to determine if the sensitivity of CT justifies its use in these populations. MethodsPubMed was searched for the presence of the words “CT, imaging, COVID-19” in the title or abstract, and 17 large-scale PubMed and/or Scopus studies and case reports published between January 1, 2020 and April 15, 2020 were selected for data synthesis. ResultsInitial CT scans identified ground-glass opacities and bilateral abnormalities as more frequent in adults (74%, n=698, and 89%, n=378, respectively) than children (60%, n=25, and 37%, n=46). At 14+ days, CT scans evidenced varied degrees of improvement in adults but no resolution until at least 26 days after the onset of flu-like symptoms. In pediatric patients, a third (n=9) showed additional small nodular GGOs limited to a single lobe 3-5 days after an initial CT scan. ConclusiónEarly adult CT findings suggest the limited use of CT as a supplemental tool in diagnosing COVID-19 in symptomatic adult patients, with a particular focus on identifying right and left lower lobe abnormalities, GGOs, and interlobular septal thickening. Early pediatric CT findings suggest against the use of CT if RT-PCR is available given its significantly lower sensitivity in this population and radiation exposure.

Remarkable vessel enlargement within lung consolidation in COVID-19 compared to AH1N1 pneumonia: A retrospective study in Italy

PurposeTo investigate the early CT findings in COVID-19 pneumonia as compared to influenza A virus H1N1 (AH1N1), with focus on vascular enlargement within consolidation or ground glass opacity (GGO) areas. Methods50 patients with COVID-19 pneumonia were retrospectively compared to 50 patients with AH1N1 pneumonia diagnosed during the 2009 pandemic. Two radiologists reviewed chest CT scans independently and blindly, with discordance resolved by consensus. Dilated or tortuous vessels within hyperdense lesions were recorded. ResultsCOVID-19 pneumonia presented with bilateral (96%), peripheral areas of GGO (22%), consolidation (4%) or combined GGO-consolidation (74%). The vascular enlargement sign in COVID-19 pneumonia was much more commonly present in COVID-19 (45/50, 90%) versus AH1N1 pneumonia (12/50, 24%) (p < 0.001). Vascular enlargement was more often present in lower lobes with a peripheral distribution. ConclusionsVascular enlargement in consolidative/GGO areas may represent a reasonably common early CT marker in COVID-19 patients and is of uncertain etiology. Although speculative, theoretical mechanisms could potentially reflect acute inflammatory changes, pulmonary endothelial activation, or acute stasis. Further studies are necessary to verify specificity and to study if prognostic for clinical outcomes.

Early CT in dogs following traumatic brain injury has limited value in predicting short-term prognosis.

Traumatic brain injury is associated with a high risk of mortality in veterinary patients, however publications describing valid prognostic indicators are currently lacking. The objective of this retrospective observational study was to determine whether early CT findings are associated with short-term prognosis following traumatic brain injury (TBI) in dogs. An electronic database was searched for dogs with TBI that underwent CT within 72h of injury; 40 dogs met the inclusion criteria. CT findings were graded based on a Modified Advanced Imaging System (MAIS) from grade I (normal brain parenchyma) to VI (bilateral lesions affecting the brainstem with or without any foregoing lesions of lesser grades). Other imaging features recorded included presence of midline shift, intracranial hemorrhage, brain herniation, skull fractures, and percentage of total brain parenchyma affected. Outcome measures included survival to discharge and occurrence of immediate onset posttraumatic seizures. Thirty dogs (75%) survived to discharge. Seven dogs (17.5%) suffered posttraumatic seizures. There was no association between survival to discharge and posttraumatic seizures. No imaging features evaluated were associated with the study outcome measures. Therefore, the current study failed to identify any early CT imaging features with prognostic significance in canine TBI patients. Limitations associated with CT may preclude its use for prognostication; however, modifications to the current MAIS and evaluation in a larger study population may yield more useful results. Despite this, CT is a valuable tool in the detection of structural abnormalities following TBI in dogs that warrants further investigation.

Guidance and Best Practices for Nuclear Cardiology Laboratories During the COVID-19 Pandemic: An Information Statement From ASNC and SNMMI.

Guidance and Best Practices for Nuclear Cardiology Laboratories During the COVID-19 Pandemic: An Information Statement From ASNC and SNMMI.

Early chest CT features of patients with 2019 novel coronavirus (COVID-19) pneumonia: relationship to diagnosis and prognosis.

ObjectiveTo determine the consistency between CT findings and real-time reverse transcription–polymerase chain reaction (RT-PCR) and to investigate the relationship between CT features and clinical prognosis in COVID-19.MethodsThe clinical manifestations, laboratory parameters, and CT imaging findings were analyzed in 34 COVID-19 patients, confirmed by RT-PCR from January 20 to February 4 in Hainan Province. CT scores were compared between the discharged patients and the ICU patients.ResultsFever (85%) and cough (79%) were most commonly seen. Ten (29%) patients demonstrated negative results on their first RT-PCR. Of the 34 (65%) patients, 22 showed pure ground-glass opacity. Of the 34 (50%) patients, 17 had five lobes of lung involvement, while the 23 (68%) patients had lower lobe involvement. The lesions of 24 (71%) patients were distributed mainly in the subpleural area. The initial CT lesions of ICU patients were distributed in both the subpleural area and centro-parenchyma (80%), and the lesions were scattered. Sixty percent of ICU patients had five lobes involved, while this was seen in only 25% of the discharged patients. The lesions of discharged patients were mainly in the subpleural area (75%). Of the discharged patients, 62.5% showed pure ground-glass opacities; 80% of the ICU patients were in the progressive stage, and 75% of the discharged patients were at an early stage. CT scores of the ICU patients were significantly higher than those of the discharged patients.ConclusionChest CT plays a crucial role in the early diagnosis of COVID-19, particularly for those patients with a negative RT-PCR. The initial features in CT may be associated with prognosis.Key Points• Chest CT is valuable for the early diagnosis of COVID-19, particularly for those patients with a negative RT-PCR.• The early CT findings of COVID-19 in ICU patients differed from those of discharged patients.

CT imaging features of 34 patients infected with COVID-19

ObjectiveTo retrospectively analyze the CT findings in patients infected with Coronavirus disease 2019 (COVID-19). Materials and methodsThe thirty-four cases, 15 females and 19 males, with an age ranging from 7 to 88 years old, confirmed by real-time reverse-transcriptase-polymerase chain reaction (RT-PCR), were used for our study. All thin-section CT scans of the lungs were performed in all of patients. The clinical, laboratory and CT imaging were available to evaluate in all patients. ResultsThe patients present with fever (85.29%, n = 29), cough (67.65%, n = 23), fatigue or myalgia (26.47%, n = 9), and pharyngalgia (8.82%, n = 3). The 4 patients (11.76%) with no symptoms were identified during screening for close contacts, who had typical CT findings. On initial CT scans, the bilateral lung involved was shown in 24 cases (70.59%), while 29 (82.35%) cases were distributed in peripheral. The pure ground glass opacity (GGO) was shown in 18 cases (52.94%), the GGO with consolidation was in 12 cases (35.29%), and full consolidation only in 3 cases. The lesion with air bronchogram was seen in 14 (41.18%) cases, with enlarged blood vessel in 17 (50.00%) cases, with crazy-paving pattern in 8 (23.53%) cases, with fine reticular pattern in 4 (11.77%) cases, and with intralesional vacuole sign in 6 (17.65%) cases. The pleural effusion was seen in one patient. Follow-up imaging in 19 patients during the study time window demonstrated mild, moderate or severe progression of disease, as manifested by increasing extent and density of lung opacities. ConclusionsThe bilateral GGO with air bronchogram, enlarged blood vessel, fine reticular pattern, and peripheral distribution are the early CT findings of COVID-19. The crazy-paving pattern and intralesional vacuole sign are the features of progressive stage.

Radiologic chest CT findings from COVID-19 in Orleans Parish, Louisiana.

Orleans Parish in Louisiana is in the midst of an exponentially increasing number of patient admissions with COVID‐19 and respiratory symptoms. Patients have been described having CT findings most consistent with an early‐stage (<7 days from symptoms onset) or an advanced stage (8‐14 days from symptoms onset). We describe and illustrate those early and advanced stage CT findings from patients with documented COVID‐19 who have been admitted to University Medical Center in New Orleans, Louisiana.

Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review

To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2 (COVED-19), SARS-CoV (SARS) and MERS-CoV (MERS) using a systemic review.MethodsElectronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19, SARS and MERS pneumonia respectively. Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists. Vote-counting method was employed to include cases of each group. Data of patients' manifestations in early chest CT including lesion patterns, distribution of lesions and specific imaging signs for the three groups were extracted and recorded. Data were compared and analyzed using SPSS 22.0.ResultsA total of 24 studies were included, composing of 10 studies of COVED-19, 5 studies of MERS and 9 studies of SARS. The included CT exams were 147, 40, and 122 respectively. For the early CT features of the 3 pneumonias, the basic lesion pattern with respect to “mixed ground glass opacity (GGO) and consolidation, GGO mainly, or consolidation mainly” was similar among the 3 groups (χ2 = 7.966, p > 0.05). There were no significant differences on the lesion distribution (χ2= 13.053, p > 0.05) and predominate involvement of the subpleural area of bilateral lower lobes (χ2 = 4.809, p > 0.05) among the 3 groups. The lesions appeared more focal in COVID-19 pneumonia at early phase (χ2= 23.509, p < 0.05). The proportions of crazy-paving pattern (χ2 = 23.037, p < 0.001), organizing pneumonia pattern (p < 0.05) and pleural effusions (p < 0.001) in COVID-19 pneumonia were significantly lower than the other two. Although rarely shown in the early CT findings of all three viral pneumonias, the fibrotic changes were more frequent in SAKS than COVID-19 and MERS (χ2 = 6.275, P<0.05). For other imaging signs, only the MERS pneumonia demonstrated tree-in-buds, cavitation, and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia (χ2 = 22.412, p < 0.05). No pneumothorax, pneumomediastinum and lymphadenopathy was present for each group.ConclusionsImaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns, including GGO and consolidation, bilateral distribution, and predominant involvement of the subpleural area and the lower lobes. Early signs of COVID-19 pneumonia showed less severity of inflammation. Early fibrotic changes appeared in SAKS only, MERS had more severe inflammatory changes including cavitation and pleural effusion. The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.

CT Findings of Acute Stroke– Study of 321 Cases

Stroke ranks first in frequency among all the neurological diseases of adult life and about 50% of all neurological disorders in a hospital are of this type. It is the third leading cause of death throughout the world. The purpose of the present study was to find out the presence or absence of haemorrhage or infarct and to detect the early signs of stroke on the basis of CT scanning. Three-hundred twenty one consecutive acute stroke patients (mean age 64 ±9.75 years) were included in our study. Each underwent cranial computed tomography without intravenous contrast injection within the first 24 hours. CT findings of stroke were analyzed using SPSS software. Among 321 patients, 209(65.11%) had ischemic stroke, 99(30.84%) had parenchymal haemorrhage and 13(4.05%) had subarachnoid haemorrhage. Total amount of haemorrhagic stroke was 112(34.89%). Early CT findings of ischaemic stroke were low attenuation area (83.25%), sulcal effacement (69.89%), loss of the insular ribbon (17.70%), hyperdense artery sign (1.43%). CT scanning should be the first line of investigation for diagnosis of acute stroke as it is more available than MRI and is easily performed in severely ill patients who are dependent on support and monitoring devices&#x0D; TAJ 2019; 32(1): 17-24

Factors Influencing the Progression Trend of Early Lung Cancer and CT Findings

背景与目的不同类型的肺部结节具有不同的体积倍增时间（volume doubling time, VDT）。目前针对不同病理类型早期肺腺癌VDT的研究较少。本研究通过回顾性分析143例早期肺腺癌的影像资料，探讨早期肺腺癌的进展趋势及相关影响因素，为临床制订其随访策略提供参考。方法依据2015版世界卫生组织肺肿瘤分类标准和第8版肿瘤肿瘤-淋巴结-转移（tumor-node-metastasis, TNM）分期标准，对143例早期肺腺癌进行分类及分期。参考修正版Schwartz公式计算不同病理类型肺腺癌的VDT。结果143例早期肺腺癌中，有50例（34.97%）出现进展，多因素分析显示影响因素包括随访时间、结节大小、病理类型、结节类型和病理分期。附壁生长为主型肺腺癌（lepidic predominant adenocarcinoma, LPA）的VDT为（594±272）d，伴少量附壁生长成分浸润性腺癌的VDT为（520±285）d，完全浸润性腺癌的VDT为（371±183）d，3类进展性早期肺腺癌的VDT有统计学差异（P=0.044）。结论在早期肺腺癌中，约有35%的肿瘤处于进展阶段，是否含有附壁生长成分是影响肿瘤进展速度的重要因素。

Assessment and agreement of the CT appearance pattern and its severity grading of radiation-induced lung injury after stereotactic body radiotherapy for lung cancer.

PurposeRadiographic severity of radiation-induced lung injury (RILI) has not been well-studied. The goal of this study was to assess the CT appearance pattern and severity of RILI without consideration of the clinical presentation.Material and methodsA total of 49 patients, 41 with primary lung cancer and 8 with metastatic lung cancer, were treated by 4-fraction stereotactic body radiotherapy (SBRT). RILI after SBRT was separately assessed by two observers. The early and late CT appearance patterns and CT-based severity grading were explored.ResultsThe median follow-up period was 39.0 months. In the early CT findings of observers 1 and 2, there was diffuse consolidation in 15 and 8, diffuse ground glass opacity (GGO) in 0 and 0, patchy consolidation and GGO in 17 and 20, patchy GGO in 3 and 3, and no changes in 10 and 14, respectively (kappa = 0.61). In late CT findings of observer 1 and 2, there were modified conventional pattern in 28 and 24, mass-like pattern in 8 and 11, scar-like pattern in 12 and 12, and no changes in 1 and 2, respectively (kappa = 0.63). In the results of the CT-based grading by observers 1 and 2, there were grade 0 in 1 and 2, grade 1 in 10 and 14, grade 2 in 31 and 29, grade 3 in 7 and 4, and none of grade 4 or more, respectively (kappa = 0.66). According to multivariate analyses (MVA), the significant predicting factors of grade 2 or more CT-based RILI were age (p = 0.01), oxygen dependence (p = 0.03) and interstitial shadow (p = 0.03).ConclusionsThe agreement of the CT appearance and CT-based grading between two observers was good. These indicators may be able to provide us with more objective information and a better understanding of RILI.

Accuracy of the first interpretation of early brain CT images for predicting the prognosis of post-cardiac arrest syndrome patients at the emergency department

BackgroundEarly brain CT is one of the most useful tools for estimating the prognosis in patients with post-cardiac arrest syndrome (PCAS) at the emergency department (ED). The aim of this study was to evaluate the prognosis-prediction accuracy of the emergency physicians’ interpretation of the findings on early brain CT in PCAS patients treated by targeted temperature management (TTM).MethodsThis was a double-center, retrospective, observational study. Eligible subjects were cardiac arrest patients admitted to the intensive care unit (ICU) for TTM between April 2011 and March 2017. We performed the McNemar test to compare the predictive accuracies of the interpretation by emergency physicians and radiologists and calculated the kappa statistic for determining the concordance rate between the interpretations by these two groups.ResultsOf the 122 eligible patients, 106 met the inclusion criteria for this study. The predictive accuracies (sensitivity, specificity) of the interpretations by the emergency physicians and radiologists were (0.34, 1.00) and (0.41, 0.93), respectively, with no significant difference in either the sensitivity or specificity as assessed by the McNemar test. The kappa statistic calculated to determine the concordance between the two interpretations was 0.66 (0.48–0.83), which showed a good conformity.ConclusionsThe emergency physicians’ interpretation of the early brain CT findings in PCAS patients treated by TTM was as reliable as that of radiologists, in terms of prediction of the prognosis.

Do early postoperative CT findings following type A aortic dissection repair predict early clinical outcome?

The purposes of this study are to determine the prevalence of specific postoperative CT findings following Stanford type A aortic dissection repair in the early postoperative period and to determine if these postoperative findings are predictive of adverse clinical outcome. Patients who underwent type A dissection repair between January 2012 and December 2014 were identified from our institutional cardiac surgery database. Postoperative CT exams within 1month of surgery were retrospectively reviewed to determine sizes and attenuation of mediastinal, pericardial, and pleural fluid, and the presence or absence of pneumomediastinum, pneumothorax, or lung consolidation. Poor early clinical outcome was defined as length of stay (LOS)>14days. Student's t test and chi-square test were used to determine the relationship between postoperative CT features and early clinical outcome. Thirty-nine patients (24 M, 15 F, mean age 58.5±13.7years) underwent type A dissection repair and mean LOS was 17.3±21.2days. A subset of 19 patients underwent postoperative CTs within 30days of surgery, and there was no significant relationship between LOS and sizes and attenuation of mediastinal, pericardial, and pleural fluid, and the presence or absence of pneumomediastinum, pneumothorax, or lung consolidation. CT features such as mediastinal, pericardial, and pleural fluid were ubiquitous in the early postoperative period. There was no consistent CT feature or threshold that could reliably differentiate between "normal postoperative findings" and early postoperative complications.

Added value of CT perfusion and CT angiography in detection of early ischemic stroke: Comparison with noncontrast CT

The purpose of this study was to determine whether PCT and CTA increase the sensitivity of NCT in early diagnosis of acute ischemic stroke. Patients and methodsSixty-four patients of acute stroke were retrospectively evaluated with respect to early CT findings. This included findings on noncontrast CT, perfusion defects and angiographic findings of vascular occlusion. Inclusion criteria comprised a clinical and radiological diagnosis of ischemic stroke based on clinical data and the presence of infarction in follow-up MRI scans done 12–24h after the onset of the neurologic deficit. ResultsCT perfusion showed evidence of cerebral hypo-perfusion in the form of prolonged MTT and decreased CBF in all stroke cases giving 100% sensitivity. The CBV was decreased in only 24 cases and was normal in 24 cases and increased in 16 cases. Analysis of the CTA revealed artery occlusion in 55 (86%) cases, while it was normal in 8 (12.5%) cases. ConclusionCT perfusion and CTA provide effective diagnostic tools in acute stroke with increased sensitivity to detect acute cerebral ischemia compared with noncontrast CT alone.

Early Head CT Findings Are Associated With Outcomes After Pediatric Out-of-Hospital Cardiac Arrest.

Head CT after out-of-hospital cardiac arrest is often obtained to evaluate intracranial pathology. Among children admitted to the PICU following pediatric out-of-hospital cardiac arrest, we hypothesized that loss of gray-white matter differentiation and basilar cistern and sulcal effacement are associated with mortality and unfavorable neurologic outcome. Retrospective, cohort study. Single, tertiary-care center PICU. Seventy-eight patients less than 18 years old who survived out-of-hospital cardiac arrest to PICU admission and had a head CT within 24 hours of return of spontaneous circulation were evaluated from July 2005 through May 2012. None. Median time to head CT from return of spontaneous circulation was 3.3 hours (1.0, 6.0). Median patient age was 2.3 years (0.4, 9.5). Thirty-nine patients (50%) survived, of whom 29 (74%) had favorable neurologic outcome. Nonsurvivors were more likely than survivors to have 1) loss of gray-white matter differentiation (Hounsfield unit ratios, 0.96 [0.88, 1.07] vs 1.1 [1.07, 1.2]; p < 0.001), 2) basilar cistern effacement (93% vs 7%; p = 0.001; positive predictive value, 94%; negative predictive value, 59%), and 3) sulcal effacement (100% vs 0%; p ≤ 0.001; positive predictive value, 100%; negative predictive value, 68%). All patients with poor gray-white matter differentiation or sulcal effacement had unfavorable neurologic outcomes. Only one patient with basilar cistern effacement had favorable outcome. Loss of gray-white matter differentiation and basilar cistern effacement and sulcal effacement are associated with poor outcome after pediatric out-of-hospital cardiac arrest. Select patients may have favorable outcomes despite these findings.

Abstract 27: Unique ASPECTS of Conditioning? Prior TIA or Atrial Fibrillation and Early CT Findings in FAST-MAG

Background: Ischemic conditioning, or endogenous protection of brain tissue, may be elicited by prior TIA or absent due to sudden cardioembolic occlusion in atrial fibrillation (AF). We hypothesized that such specific co-morbidities may be manifest by the extent of early ischemic changes, or ASPECTS score, on CT in the prehospital NINDS FAST-MAG trial. Methods: All FAST-MAG subjects with a final diagnosis of cerebral ischemia were included in these analyses of baseline clinical variables and ASPECTS, scored on the initial non-contrast CT acquired at ED arrival. The relationship between prior medical conditions and total ASPECTS score was determined by bivariate analyses, Mann-Whitney U, and Kruskal-Wallis tests. Results: 1,240 patients (mean age 69 SD 13; 45% women) had ASPECTS scored on initial imaging, CT in 1227 (97%), MRI in 42. ASPECTS (median 10, range 1-10) was notably higher, signifying less ischemic changes in those with history of prior TIA, median 10 (IQR 10-10) vs. 10 (8-10), p=0.012 by Mann-Whitney, whereas prior history of stroke revealed no difference. Conversely, substantially lower ASPECTS or greater ischemic changes were noted in those with history of AF, median 10 (7-10) vs. 10 (8-10), p=0.010) and presence of AF on EKG in ED, median 10 (6-10) vs. 10 (8-10), p=0.041. Interestingly, other cardiac history and all other co-morbidities demonstrated no relationship with ASPECTS. Elevated prehospital systolic blood pressure was linked with higher ASPECTS (r=0.098, p=0.001), as was the change in blood pressure from field to ED (ANOVA, p=0.049). Initial ASPECTS was linked with 90-day mRS outcomes (r=-.259, p&lt;0.001). Conclusions: Prior TIA and AF exhibit striking, yet opposite relationships with the extent of early CT findings in this large cohort of patients enrolled in a prehospital stroke trial. These findings suggest that patient-specific factors, such as conditioning, may be pivotal in the course of cerebral ischemia.

Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center

Early postoperative head CT scanning is routinely performed following intracranial procedures for detection of complications, but its real value remains uncertain: so-called abnormal results are frequently found, but active, emergency intervention based on these findings may be rare. The authors' objective was to analyze whether early postoperative CT scans led to emergency surgical interventions and if the results of neurological examination predicted this occurrence. The authors retrospectively analyzed 892 intracranial procedures followed by an early postoperative CT scan performed over a 1-year period at Rush University Medical Center and classified these cases according to postoperative neurological status: baseline, predicted neurological change, unexpected neurological change, and sedated or comatose. The interpretation of CT results was reviewed and unexpected CT findings were classified based on immediate action taken: Type I, additional observation and CT; Type II, active nonsurgical intervention; and Type III, surgical intervention. Results were compared between neurological examination groups with the Fisher exact test. Patients with unexpected neurological changes or in the sedated or comatose group had significantly more unexpected findings on the postoperative CT (p < 0.001; OR 19.2 and 2.3, respectively) and Type II/III interventions (p < 0.001) than patients at baseline. Patients at baseline or with expected neurological changes still had a rate of Type II/III changes in the 2.2%-2.4% range; however, no patient required an immediate return to the operating room. Over a 1-year period in an academic neurosurgery service, no patient who was neurologically intact or who had a predicted neurological change required an immediate return to the operating room based on early postoperative CT findings. Obtaining early CT scans should not be a priority in these patients and may even be cancelled in favor of MRI studies, if the latter have already been planned and can be performed safely and in a timely manner. Early postoperative CT scanning does not assure an uneventful course, nor should it replace accurate and frequent neurological checks, because operative interventions were always decided in conjunction with the neurological examination.

Prognostic Factors Including Clinical Manifestation and Paraclinic Finding in Sever Methanol Toxicity

Objective: Ingested methanol (a toxic alcohol) undergoes enzymatic oxidation to toxic formic acid, resulting in acidosis and formaldehyde which resulted in neurotoxicity specifically optic neuritis and blindness and death in severe poisoning. According to Iranian law, selling, buying and consumption of alcoholic beverages is a punishable crime and people who wish to drink alcohol use industrial or homemade ethanol. Due to depressant effects of methanol on the central nervous system, the objective of this study was to assess the pathologic findings on brain CT scan in methanol poisoned patients beside of their clinical information. Material and method: This prospective study was from Jan 2013 to May 2013. All 20 methanol poisoned patients examined and questionnaires were filled by physician. Brain CT scans without contrast medium were obtained. Results: All of cases were male; their mean age was 33.1 ± 9.2 years. The mortality rate was 15%. Hemodialysis was performed in 85% cases. Mean primary Methanol Level was 22.4 ± 10.5 mg/dL and after hemodialysis was 7.3 ± 6.1. Totally serum methanol levels pre and post hemodialysis were 22.4 and 7.3, respectively. Brain death was recorded in 2 patients. The most common findings at admission were loss of consciousness (n=11) and blurred vision (n=9). The early pathologic brain CT findings were bilateral hypo density lesion in putamen, low attenuation in sub cortical, white matter bilateral hemorrhagic necrosis in putamen and bilateral hypo density in globuspallidus, respectively. Conclusion: In conclusion, it seems CT finding are important as Methanol concentration before any other Para clinic findings and even clinical manifestations.