The Experts below are selected from a list of 12363 Experts worldwide ranked by ideXlab platform
Henrik Sillesen - One of the best experts on this subject based on the ideXlab platform.
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clinical and imaging features associated with an increased risk of late stroke in patients with asymptomatic carotid disease
European Journal of Vascular and Endovascular Surgery, 2014Co-Authors: A R Naylor, Torben V Schroeder, Henrik SillesenAbstract:Background The 2011 American Heart Association Guidelines on the management of asymptomatic carotid disease recommends that carotid endarterectomy (CEA) (with carotid artery stenting (CAS) as an alternative) may be considered in highly selected patients with 70–99% stenoses. However, no guidance was provided as to what “highly selected” meant. This caveat is, however, important as up to 95% of asymptomatic individuals undergoing prophylactic CEA or CAS will ultimately undergo an Unnecessary Procedure. Even if the procedural risk following CEA or CAS could be reduced to 0%; 93% of patients would still undergo an Unnecessary intervention. This, coupled with growing awareness that the risk of stroke in medically treated patients appears to be diminishing, has led to a renewed drive towards identifying patients with the highest risk of suffering a stroke whilst on medical therapy in whom to target CEA/CAS. Methods Review of clinical and/or imaging based scoring systems, predictive algorithms and imaging parameters that may be associated with an increased (or decreased) risk of stroke in patients with asymptomatic carotid disease. Results Parameters associated with an increased risk of late stroke include: (a) silent infarction on CT/MRI; (b) stenosis progression; (c) hypoechoic plaques or GSM 80 mm2; (i) juxta-luminal black area >10 mm2; and (j) tandem intracranial disease. Conclusions A number of imaging parameters have been shown to be predictive of an increased risk of late stroke in previously asymptomatic patients. None have been independently validated, but many could easily be evaluated in natural history studies or randomized trials in order to identify a “high risk for stroke” cohort in whom CEA/CAS could be prioritized.
A R Naylor - One of the best experts on this subject based on the ideXlab platform.
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clinical and imaging features associated with an increased risk of late stroke in patients with asymptomatic carotid disease
European Journal of Vascular and Endovascular Surgery, 2014Co-Authors: A R Naylor, Torben V Schroeder, Henrik SillesenAbstract:Background The 2011 American Heart Association Guidelines on the management of asymptomatic carotid disease recommends that carotid endarterectomy (CEA) (with carotid artery stenting (CAS) as an alternative) may be considered in highly selected patients with 70–99% stenoses. However, no guidance was provided as to what “highly selected” meant. This caveat is, however, important as up to 95% of asymptomatic individuals undergoing prophylactic CEA or CAS will ultimately undergo an Unnecessary Procedure. Even if the procedural risk following CEA or CAS could be reduced to 0%; 93% of patients would still undergo an Unnecessary intervention. This, coupled with growing awareness that the risk of stroke in medically treated patients appears to be diminishing, has led to a renewed drive towards identifying patients with the highest risk of suffering a stroke whilst on medical therapy in whom to target CEA/CAS. Methods Review of clinical and/or imaging based scoring systems, predictive algorithms and imaging parameters that may be associated with an increased (or decreased) risk of stroke in patients with asymptomatic carotid disease. Results Parameters associated with an increased risk of late stroke include: (a) silent infarction on CT/MRI; (b) stenosis progression; (c) hypoechoic plaques or GSM 80 mm2; (i) juxta-luminal black area >10 mm2; and (j) tandem intracranial disease. Conclusions A number of imaging parameters have been shown to be predictive of an increased risk of late stroke in previously asymptomatic patients. None have been independently validated, but many could easily be evaluated in natural history studies or randomized trials in order to identify a “high risk for stroke” cohort in whom CEA/CAS could be prioritized.
Jan S Kirschke - One of the best experts on this subject based on the ideXlab platform.
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mr and ct imaging to optimize ct guided biopsies in suspected spondylodiscitis
World Neurosurgery, 2017Co-Authors: S C Foreman, Benedikt J Schwaiger, Jens Gempt, Pia M Jungmann, Victoria Kehl, Claire Delbridge, Nina Wantia, Claus Zimmer, Jan S KirschkeAbstract:Background The diagnostic value of computed tomography (CT)-guided spinal biopsy in patients with suspected spondylodiscitis is reported inconsistently in the literature. Our aim was to evaluate associations between procedural, clinical, and imaging parameters and the diagnostic yield of CT-guided spinal biopsy. Methods One hundred and two Procedures performed in 87 patients with clinically suggested spondylodiscitis were analyzed retrospectively. Preprocedural magnetic resonance (MR) and CT images were evaluated regarding signal alterations, vertebral destruction, and soft-tissue involvement. The position of the biopsy needle in correlation with MR imaging findings was assessed. Patient characteristics and clinical details were noted. Parameters were compared in patients with positive and negative microbiological and histologic results. Results Following microbiologic and histologic analysis, infectious spondylodiscitis was diagnosed in 29 and 23 biopsies, respectively. Microbiology results were significantly higher in biopsy specimens with central needle positioning within contrast enhancing tissue in correlation with the MR images (36% vs. 7%; P = 0.005). Biopsy specimens positioned in fluid-equivalent hyperintense discs in T2-weighted sequences yielded significantly lower microbiology results (6% vs. 33%; P = 0.036). Purely lytic endplate destruction and mixed vertebral density as shown by CT increased microbiology results (60% vs. 24%; P = 0.028). Previous antibiotic treatment for any cause did not influence microbiology yields significantly ( P = 0.232). Conclusions MR imaging is mandatory to determine the optimal biopsy position. No clinical or imaging parameter could rule out a positive biopsy result and thus omit an Unnecessary Procedure. Biopsy should not be avoided if antibiotic treatment has previously been administered.
Benedikt J Schwaiger - One of the best experts on this subject based on the ideXlab platform.
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mr and ct imaging to optimize ct guided biopsies in suspected spondylodiscitis
World Neurosurgery, 2017Co-Authors: S C Foreman, Benedikt J Schwaiger, Jens Gempt, Pia M Jungmann, Victoria Kehl, Claire Delbridge, Nina Wantia, Claus Zimmer, Jan S KirschkeAbstract:Background The diagnostic value of computed tomography (CT)-guided spinal biopsy in patients with suspected spondylodiscitis is reported inconsistently in the literature. Our aim was to evaluate associations between procedural, clinical, and imaging parameters and the diagnostic yield of CT-guided spinal biopsy. Methods One hundred and two Procedures performed in 87 patients with clinically suggested spondylodiscitis were analyzed retrospectively. Preprocedural magnetic resonance (MR) and CT images were evaluated regarding signal alterations, vertebral destruction, and soft-tissue involvement. The position of the biopsy needle in correlation with MR imaging findings was assessed. Patient characteristics and clinical details were noted. Parameters were compared in patients with positive and negative microbiological and histologic results. Results Following microbiologic and histologic analysis, infectious spondylodiscitis was diagnosed in 29 and 23 biopsies, respectively. Microbiology results were significantly higher in biopsy specimens with central needle positioning within contrast enhancing tissue in correlation with the MR images (36% vs. 7%; P = 0.005). Biopsy specimens positioned in fluid-equivalent hyperintense discs in T2-weighted sequences yielded significantly lower microbiology results (6% vs. 33%; P = 0.036). Purely lytic endplate destruction and mixed vertebral density as shown by CT increased microbiology results (60% vs. 24%; P = 0.028). Previous antibiotic treatment for any cause did not influence microbiology yields significantly ( P = 0.232). Conclusions MR imaging is mandatory to determine the optimal biopsy position. No clinical or imaging parameter could rule out a positive biopsy result and thus omit an Unnecessary Procedure. Biopsy should not be avoided if antibiotic treatment has previously been administered.
Torben V Schroeder - One of the best experts on this subject based on the ideXlab platform.
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clinical and imaging features associated with an increased risk of late stroke in patients with asymptomatic carotid disease
European Journal of Vascular and Endovascular Surgery, 2014Co-Authors: A R Naylor, Torben V Schroeder, Henrik SillesenAbstract:Background The 2011 American Heart Association Guidelines on the management of asymptomatic carotid disease recommends that carotid endarterectomy (CEA) (with carotid artery stenting (CAS) as an alternative) may be considered in highly selected patients with 70–99% stenoses. However, no guidance was provided as to what “highly selected” meant. This caveat is, however, important as up to 95% of asymptomatic individuals undergoing prophylactic CEA or CAS will ultimately undergo an Unnecessary Procedure. Even if the procedural risk following CEA or CAS could be reduced to 0%; 93% of patients would still undergo an Unnecessary intervention. This, coupled with growing awareness that the risk of stroke in medically treated patients appears to be diminishing, has led to a renewed drive towards identifying patients with the highest risk of suffering a stroke whilst on medical therapy in whom to target CEA/CAS. Methods Review of clinical and/or imaging based scoring systems, predictive algorithms and imaging parameters that may be associated with an increased (or decreased) risk of stroke in patients with asymptomatic carotid disease. Results Parameters associated with an increased risk of late stroke include: (a) silent infarction on CT/MRI; (b) stenosis progression; (c) hypoechoic plaques or GSM 80 mm2; (i) juxta-luminal black area >10 mm2; and (j) tandem intracranial disease. Conclusions A number of imaging parameters have been shown to be predictive of an increased risk of late stroke in previously asymptomatic patients. None have been independently validated, but many could easily be evaluated in natural history studies or randomized trials in order to identify a “high risk for stroke” cohort in whom CEA/CAS could be prioritized.
