M Bendszus

Publications of M Bendszus

• Comment On: Curative Embolization of Brain Arteriovenous Malformations with Onyx: Patient Selection, Embolization Technique, and Results : van Rooij WJ, Jacobs S, Sluzewski M, van der Pol B, Beute GN, Sprengers ME. AJNR Am J Neuroradiol. 2012 Mar 1. [Epub ahead of print].

  Authors: M Bendszus, M Möhlenbruch, S Rohde

  Clinical neuroradiology. 05/2012;

  BACKGROUND AND PURPOSE: A new curative embolization technique with Onyx for selected small- and medium-sized superficially located brain arteriovenous malformations (AVMs) was developed, whichBACKGROUND AND PURPOSE: A new curative embolization technique with Onyx for selected small- and medium-sized superficially located brain arteriovenous malformations (AVMs) was developed, which consists of obliteration of the nidus, including incremental occlusion of the draining veins. We report our first clinical results. MATERIALS AND METHODS: Between June 2008 and July 2011, 24 patients (7 women, 17 men; mean age, 41 years; range, 6-74 years) with AVMs were selected for curative embolization with Onyx. Presentation was hemorrhage in 14 and seizures in 10 patients. AVM location was frontal in 11, occipital in six, parietal in four, and temporal in three. AVM size was a mean of 2.2 cm (median 2; range 1-3 cm). RESULTS: Complete angiographic obliteration of the AVM with Onyx in a single session was achieved in all 24 patients. There were no hemorrhagic or ischemic complications (0 %; 95 % CI, 0-16.3 %), and no new deficits induced by the treatment. Of 14 patients with ruptured AVMs, one patient who presented with a large frontal hematoma died shortly after surgical evacuation of the hematoma following complete embolization of a micro-AVM. Follow-up angiography at 3 months in 23 patients demonstrated a small AVM remnant in one that was treated with gamma knife radiosurgery. The other 22 AVMs remained completely occluded. CONCLUSIONS: In selected patients with small- and medium-sized superficial brain AVMs, as defined in our study, injection of Onyx by using a curative embolization technique in a single session seems to provide a safe and effective alternative to radiosurgery or surgery.

• Stent design lowers angiographic but not clinical adverse events in stenting of symptomatic intracranial stenosis - results of a single center study with 100 consecutive patients.

  Authors: S Rohde, J Seckinger, S Hähnel, P A Ringleb, M Bendszus, M Hartmann

  International journal of stroke : official journal of the International Stroke Society. 02/2012;

  BACKGROUND AND AIMS: Comparing safety and technical success of balloon-expandable stents and self-expanding stents for intracranial angioplasty and stenting in medically refractory intracranialBACKGROUND AND AIMS: Comparing safety and technical success of balloon-expandable stents and self-expanding stents for intracranial angioplasty and stenting in medically refractory intracranial atherosclerotic disease in a single center series. METHODS: Fifty-four self-expanding stents and 46 balloon-expandable stents were implanted in 100 consecutive patients (mean age 64 years, 74% male) from April 2000 to September 2009. All patients had symptomatic intracranial stenosis (anterior circulation, n = 40; posterior circulation, n = 60), presenting with recurrent transient ischemic attack or stroke under antithrombotic treatment. Mean degree of stenosis before treatment was 83 ± 13%. We assessed safety, defined as any stroke or death during the procedure and at 30 days follow-up, and technical success, defined as accurate delivery of the stent at the site of the target lesion. RESULTS: Safety - periprocedural stroke or hemorrhage occurred in 11 patients treated with balloon-expandable stent, and in 14 of the patients treated with a self-expanding stent. One patient with a balloon-expandable stent died because of acute vessel rupture during treatment. One balloon-expandable stent and one self-expanding stent patient developed a severe reperfusion hemorrhage that resulted in death. Overall, the combined stroke and death rate at 30-day follow-up was 25·0% (23·9% for balloon-expandable stent group and 25·9% for the self-expanding stent group, P = 0·84). Technical success - intracranial angioplasty and stenting was technically successful in 96·3% of the self-expanding stent and 89·1% of the balloon-expandable stent patients (P = 0·31). Vascular complications were significantly less frequent in patients treated with a self-expanding stent (11·1%) than with a balloon-expandable stent (36·9%, P = 0·002). CONCLUSION: Despite a high technical success, the rate of clinical adverse events at 30 days after intracranial angioplasty and stenting is high independently of the stent design. Thus, further development of intracranial stent systems and careful patient selection are mandatory.

• Stent retriever technology: concept, application and initial results.

  Authors: S Rohde, J Bösel, W Hacke, M Bendszus

  Journal of neurointerventional surgery. 11/2011;

  Stent retrievers are increasingly used for flow restoration and thrombectomy in acute embolic stroke. First clinical results support the potential of these new devices, in particular the ability toStent retrievers are increasingly used for flow restoration and thrombectomy in acute embolic stroke. First clinical results support the potential of these new devices, in particular the ability to rapidly restore flow and effectively retrieve clots from large intracranial arteries, with favorable clinical results in preliminary patient series. This article reviews the concept and technical aspects of this new technique of endovascular stroke treatment and summarizes the first clinical results.

• Neuroradiological response criteria for high-grade gliomas.

  Authors: K Lutz, A Radbruch, B Wiestler, P Bäumer, W Wick, M Bendszus

  Clinical neuroradiology. 06/2011; 21(4):199-205.

  The recently introduced new response criteria of the response assessment in neuro-oncology (RANO) working group and its clinical implications are the topic of this article. Establishing this workingThe recently introduced new response criteria of the response assessment in neuro-oncology (RANO) working group and its clinical implications are the topic of this article. Establishing this working group as a work-in-progress platform and its first report, the RANO criteria represent an important step forward in the accurate assessment of response to therapy in patients with malignant gliomas not only in clinical trials but also in daily practice. Anti-angiogenic therapy and other new treatment modalities have increased the incidence and awareness of novel imaging phenomena, such as pseudoprogression and pseudoresponse not only within clinical trials. The new RANO criteria also take clinical parameters, such as steroid medication and neurological symptoms into account. Neuroradiologists and neuro-oncologists need to be aware of and experienced in applying these new criteria to correctly assess the response to treatment in patients with malignant gliomas. Further research is needed to study new imaging techniques, such as perfusion and diffusion-weighted imaging and to investigate and incorporate these for routine tumor response criteria.

• Stent placement for flow restoration in acute ischemic stroke: a single-center experience with the Solitaire stent system.

  Authors: S Stampfl, M Hartmann, P A Ringleb, S Haehnel, M Bendszus, S Rohde

  AJNR. American journal of neuroradiology. 05/2011; 32(7):1245-8.

  In acute thromboembolic stroke, mechanical recanalization with stents may result in immediate flow restoration. The Solitaire stent can be used both for flow restoration and thrombectomy. In thisIn acute thromboembolic stroke, mechanical recanalization with stents may result in immediate flow restoration. The Solitaire stent can be used both for flow restoration and thrombectomy. In this single-center experience, we report safety and efficacy data on the application of the Solitaire stent. Between March 2009 and July 2010, 18 patients were treated with the Solitaire stent. To evaluate perfusion of the occluded vessel segment before and after the intervention, the TICI score was used (0-3). Clinical outcome was assessed by using the mRS at discharge. Overall, recanalization was successful in 16 of 18 patients (88.8%). There were no procedure-related complications. Mean TICI score after the intervention was 2.3 ± 0.8. In 5 patients, reocclusion of the treated vessel occurred immediately after retrieval of the temporarily opened stent, and permanent stent deployment was performed to maintain stable perfusion. In 3 patients, hemorrhage occurred after successful recanalization. Five patients died (infarction, n = 3; hemorrhage, n = 1; organ failure, n = 1). A good clinical outcome (mRS ≤2) was achieved in 33.3% of the patients, 5.5% had a moderate outcome (mRS, 3/4), and 61.2% had a poor outcome or died (mRS, 5/6). Application of the Solitaire stent in acute stroke results in a high recanalization rate (88.8%) without procedural complications and with a good outcome in one-third of patients. These results encourage further evaluation of the stent in larger patient populations.

• Magic angle effect: a relevant artifact in MR neurography at 3T?

  Authors: T Kästel, S Heiland, P Bäumer, A J Bartsch, M Bendszus, M Pham

  AJNR. American journal of neuroradiology. 05/2011; 32(5):821-7.

  MRN is an emerging diagnostic method for disorders of peripheral nerves. However, it is unclear whether the influence of the MA on intraneural T2 signal is severe enough to provoke false-positiveMRN is an emerging diagnostic method for disorders of peripheral nerves. However, it is unclear whether the influence of the MA on intraneural T2 signal is severe enough to provoke false-positive findings. Twenty-five healthy subjects underwent MRN of the sciatic nerve of the proximal thigh at 3T. The T2(app) was calculated from a DE-TSE sequence (TR = 3000 ms, TE1 = 12 ms, TE2 = 69 ms) at 7 angles of the sciatic nerve relative to B0 = 0°, 30°, 35°, 40°, 45°, 50°, and 55°. Precise angle adjustments were performed with a dedicated in-bore positioning aid. Qualitative evaluation of intraneural T2-weighted contrast between this group of healthy subjects and 14 patients with neuropathic lesions was performed by comparing CNRs of a TIRM sequence (TR = 5000 ms, TE = 76 ms, TI = 180 ms). In healthy subjects, the prolongation of T2(app) from 0° to 55° was from 74.5 ± 13.4 to 104.0 ± 16.9 ms (P < .001). The increase in T2(app) relative to baseline (0°) was 9.6% (30°), 18.4% (35°), 25% (40°), 27.6% (45°), and 37% (55°). Intraneural CNR increased by 1.98 ± 0.69 at 40° and 2.93 ± 0.46 at 55°. Nevertheless, the mean CNR of healthy subjects was substantially lower than that in patients at 40° (P < .0001) and even at the position of maximum MA (55°: 20.6 ± 5.11 versus 52.6 ± 7.12, P < .0001). Neuropathic lesions are clearly distinguishable from an artificial increase of intraneural T2 by the MA. Even at a maximum MA (55°), the false-positive determination of a neuropathic lesion is unlikely.

• Endovascular treatment of acute ischemic stroke: ready to go?

  Authors: M Bendszus, S Rohde

  Clinical neuroradiology. 04/2011; 21(1):1.

• 3-T contrast-enhanced MR angiography with parallel imaging in cerebral venous and sinus thrombosis.

  Authors: M Lettau, M Laible, R J Barrows, S Heiland, M Bendszus, S Hähnel

  Journal of neuroradiology. Journal de neuroradiologie. 02/2011; 38(5):275-82.

  Contrast-enhanced (CE) 3D magnetic resonance venography (MRV) and CE 3D magnetization prepared rapid acquisition of gradient echo (MP-RAGE) sequences are increasingly commonly used methods forContrast-enhanced (CE) 3D magnetic resonance venography (MRV) and CE 3D magnetization prepared rapid acquisition of gradient echo (MP-RAGE) sequences are increasingly commonly used methods for evaluation of the intracranial venous system. Our aim was to compare CE MRV, 2D time-of-flight (TOF) MRV and MP-RAGE sequences at 3 T for visualization of cerebral venous and sinus thrombosis. Patients with suspected or known cerebral venous thrombosis were examined prospectively by TOF MRV, CE MRV and MP-RAGE sequences. In 11 consecutive patients (all women; mean age, 42.5 years; age range, 25-70 years) with venous thrombosis, scores according to overall image quality, and presence or absence (score P) and differentiation (score D) of venous thrombosis were evaluated. By all measurements, overall image quality ranged from good to excellent. In 20 of 52 venous structures (38.5%), score P was the same on TOF MRV, CE MRV and MP-RAGE sequences. Venous thrombosis was definitely or almost definitely present or absent with TOF MRV in 20 of 52 (38.5%), with CE MRV in 97 of 99 (97.9%) and with MP-RAGE sequences in 86 of 99 (86.9%) venous structures. In all venous structures with uncertain diagnosis on TOF MRV, thrombosis was definitely or almost definitely present or absent on CE MRV and MP-RAGE sequences. Differentiation of thrombosis was better on CE MRV (score D: 3.33) than on MP-RAGE sequences (score D: 2.78), followed by TOF MRV (score D: 1.32). CE MRV was superior to TOF MRV and MP-RAGE sequences in visualizing cerebral venous and sinus thrombosis.

• Comment to: Parametric response map as an imaging biomarker to distinguish progression from pseudoprogression in high-grade glioma: pitfalls in perfusion MRI in brain tumors : Tsien C, Galbán CJ, Chenevert TL, Johnson TD, Hamstra DA, Sundgren PC, Junck L, Meyer CR, Rehemtulla A, Lawrence T, Ross BD. J Clin Oncol. 2010;28:2293-9.

  Authors: A Radbruch, M Bendszus, W Wick, S Heiland

  Clinical neuroradiology. 08/2010; 20(3):183-4.

• [Neuroradiological response criteria for malignant gliomas].

  Authors: M Bendszus, M Platten

  Der Nervenarzt. 08/2010; 81(8):950-5.

  This article summarizes the new response criteria of the Response Assessment in Neuro-Oncology (RANO) working group and the clinical implications. The RANO criteria represent an important stepThis article summarizes the new response criteria of the Response Assessment in Neuro-Oncology (RANO) working group and the clinical implications. The RANO criteria represent an important step forward in the accurate assessment of response to therapy in patients with malignant gliomas, not only in clinical trials but also in daily practice. The introduction of new substances to glioma therapy, such as antiangiogenic drugs, has complicated the assessment of efficacy by MRI due to profound effects on the vascular biology of these tumors. Moreover new treatment modalities have increased the incidence and awareness of imaging phenomena, such as pseudoprogression and pseudoresponse, not only within clinical trials but also outside. In addition to MRI the new RANO criteria also take clinical parameters, such as steroid medication and neurological symptoms, into account. Thus both neuroradiologists and neurologists/neurooncologists need to be aware of and experienced in applying these criteria when treating patients with malignant gliomas to be able to correctly assess the response to therapy.

• Rapid-onset central motor plasticity in multiple sclerosis.

  Authors: D Zeller, K aufm Kampe, A Biller, K Stefan, R Gentner, A Schütz, A Bartsch, M Bendszus, K V Toyka, P Rieckmann, J Classen

  Neurology. 03/2010; 74(9):728-35.

  To study rapid-onset central motor plasticity, and its relationship to motor impairment and CNS injury in patients with multiple sclerosis (MS). In this cross-sectional observational study, motorTo study rapid-onset central motor plasticity, and its relationship to motor impairment and CNS injury in patients with multiple sclerosis (MS). In this cross-sectional observational study, motor plasticity was examined neurophysiologically and behaviorally in 22 patients with moderately severe (median Expanded Disability Status Scale score 2.5 [0-6]) stable MS and matched healthy controls. First, plasticity was assessed using paired associative stimulation (PAS), a protocol modeling long-term synaptic potentiation in human cortex. PAS combines repetitive electric nerve stimulation with transcranial magnetic stimulation (TMS) of the contralateral motor cortex. Second, motor learning was tested by a force production task. Motor impairment was assessed by functional tests. CNS injury was evaluated by obtaining normalized N-acetyl-aspartate (NAA/Cr) spectra using magnetic resonance spectroscopy and by the corticomuscular latency (CML) to the abductor pollicis brevis muscle as tested by TMS. Patients with MS performed worse than controls in functional motor tests, CMLs were prolonged, and NAA/Cr was decreased. PAS-induced enhancement of corticospinal excitability and training-induced increments of motor performance were comparable between patients with MS and controls. Neither PAS-induced plasticity nor motor learning performance correlated with motor impairment or measures of CNS injury. Patients with high CNS injury and good motor performance did not differ significantly from those with high CNS injury and poor motor performance with respect to PAS-induced plasticity and motor learning success. Despite motor impairment and CNS injury in patients with multiple sclerosis (MS), rapid-onset motor plasticity is comparable to that in healthy subjects. Compensation of MS-related CNS injury is unlikely to be constrained by insufficient rapid-onset neuroplasticity.

• Enhanced cortical reperfusion protects coagulation factor XII-deficient mice from ischemic stroke as revealed by high-field MRI.

  Authors: M Pham, C Kleinschnitz, X Helluy, A J Bartsch, M Austinat, V C Behr, T Renné, B Nieswandt, G Stoll, M Bendszus

  NeuroImage. 12/2009;

  Intrinsic coagulation factor XII deficient (FXII(-/-)) mice are protected from ischemic stroke. To elucidate underlying mechanisms we investigated the early ischemic period in vivo by multimodalIntrinsic coagulation factor XII deficient (FXII(-/-)) mice are protected from ischemic stroke. To elucidate underlying mechanisms we investigated the early ischemic period in vivo by multimodal magnetic resonance imaging (MRI) at 17.6 Tesla. Cerebral ischemia was induced by either transient (60 min) or permanent occlusion of the middle cerebral artery (t/pMCAO). 10 FXII(-/-) mice underwent t- , 10 FXII(-/-) mice p- and 10 Wildtype (Wt) mice tMCAO. Cerebral blood flow (CBF), diffusion-weighted-imaging (DWI) and T2-relaxometry were measured at 2 h and 24 h after MCAO. Outcome measures were evaluated after motion correction and normalization to atlas space. 2 h after tMCAO CBF reduction was similar in FXII(-/-) and Wt mice extending over cortical (CBF (ml/100 g/min) 33.6+/-6.9 vs. 35.3+/-4.6, p=0.42) and subcortical regions (25.7+/-4.5 vs. 31.6+/-4.0, p=0.17). At 24 h, recovery of cortical CBF by +36% was observed only in tMCAO FXII(-/-) mice contrasting a further decrease of -48% in Wt mice after tMCAO (p=0.02, F((1,18))=6.24). In FXII(-/-) mice in which patency of the MCA was not restored (pMCAO) a further decrease of -75% was observed. Cortical reperfusion in tMCAO FXII(-/-) mice was related to a lower risk of infarction of 59% vs. 93% in Wt mice (p=0.04). Subcortical CBF was similarly decreased in both tMCAO groups (Wt and FXII(-/-)) relating to a similar risk of infarction of 89% (Wt) vs. 99% (FXII(-/-), p=0.17). Deficiency of FXII allows neocortical reperfusion after tMCAO and rescues brain tissue by this mechanism. This study supports the concept of FXII as a promising new target for stroke prevention and therapy.

• Carotid Artery Stents: In Vitro Comparison of Different Stent Designs and Sizes Using CT Angiography and Contrast-Enhanced MR Angiography at 1.5T and 3T.

  Authors: M Lettau, A Sauer, S Heiland, S Rohde, M Bendszus, S Hähnel

  AJNR. American journal of neuroradiology. 09/2009;

  BACKGROUND AND PURPOSE: CT angiography (CTA) and MR angiography (MRA) are increasingly used methods for evaluation of stented vessel segments. Our aim was to compare CTA, contrast-enhanced MRABACKGROUND AND PURPOSE: CT angiography (CTA) and MR angiography (MRA) are increasingly used methods for evaluation of stented vessel segments. Our aim was to compare CTA, contrast-enhanced MRA (CE-MRA) at 1.5T, and CE-MRA at 3T for the visualization of carotid artery stents and to define the best noninvasive imaging technique as an alternative to conventional angiography for each stent. MATERIALS AND METHODS: CTA and CE-MRA appearances of 18 carotid artery stents of different designs and sizes (4.0 to 10.0 mm) were investigated in vitro. For each stent, artificial lumen narrowing (ALN) was calculated. RESULTS: With CE-MRA at 3T and at 1.5T, ALN in most nitinol stents was lower than that in the groups of stainless steel and cobalt alloy stents. In most nitinol stents and in both cobalt alloy stents, ALN was lower on CE-MRA at 3T than at 1.5T. In all stainless steel stents, ALN was lower on CTA than on CE-MRA. With CTA and CE-MRA, in most stents ALN decreased with increasing stent diameter. CONCLUSIONS: CTA and CE-MRA evaluation of vessel patency after stent placement is possible but is considerably impaired by ALN. Investigators should be informed about the method of choice for every stent. Stent manufacturers should be aware of potential artifacts caused by their stents during noninvasive diagnostic methods such as CTA and CE-MRA.

• Arterial hypertension and bevacizumab treatment in glioblastoma: no correlation with clinical outcome.

  Authors: A Wick, N Schäfer, N Dörner, D Schemmer, M Platten, M Bendszus, W Wick

  Journal of neuro-oncology. 09/2009;

• [MRI as an additional diagnostic tool for the cubital tunnel syndrome]

  Authors: M Pham, M Bendszus

  Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen. 03/2009; 41(1):18-22.

  The T(2)-weighted contrast of peripheral nerve lesions and denervated muscles is the most important diagnostic criterion in neuromuscular MRI. By exactly determining the anatomic denervation patternThe T(2)-weighted contrast of peripheral nerve lesions and denervated muscles is the most important diagnostic criterion in neuromuscular MRI. By exactly determining the anatomic denervation pattern of muscles and with a particularly high spatial resolution for peripheral nerves by visualising single fascicles, MRI enables the exact localisation of ulnar nerve lesions in the cubital tunnel or at other sites. Furthermore, the extent of the lesion and the degree of its severity can be evaluated already during the early course of disease. Obviously, MRI is the method of choice for the direct visualisation of causative mass lesions such as ganglion cysts or lipoma, for example, before surgical exploration. Thus, it is a valuable diagnostic tool and supplement to conventional clinical and electrodiagnostic studies of the cubital tunnel syndrome (CuTS). The contribution of MRI to the preoperative selection of patients for either short- or long-segment decompression has to be clarified by further studies.

• Imaging of inflammation in the peripheral and central nervous system by magnetic resonance imaging.

  Authors: G Stoll, M Bendszus

  Neuroscience. 02/2009; 158(3):1151-60.

  Inflammation plays a central role in the pathophysiology of numerous disorders of the nervous system, but is also pivotal for repair processes like peripheral nerve regeneration. In this review weInflammation plays a central role in the pathophysiology of numerous disorders of the nervous system, but is also pivotal for repair processes like peripheral nerve regeneration. In this review we summarize recent advances in cellular magnetic resonance imaging (MRI) while nuclear imaging methods to visualize neuroinflammation are covered by Wunder et al. [Wunder A, Klohs J, Dirnagl U (2009) Non-invasive imaging of central nervous system inflammation with nuclear and optical imaging. Neuroscience, in press]. Use of iron oxide-contrast agents allows assessment of inflammatory processes in living organisms. Upon systemic application, circulating small (SPIO) and ultrasmall particles of iron oxide (USPIO) are preferentially phagocytosed by monocytes before clearance within the reticuloendothelial system of the liver, spleen and lymph nodes. Upon acute migration into the diseased nervous system these iron oxide-laden macrophages become visible on MRI by the superparamagnetic effects of iron oxide resulting in a signal loss on T2-w and/or bright contrast on T1-w MRI. There is an ongoing controversy, however, to what extent SPIO/USPIO also diffuses passively into the brain after disruption of the blood-brain barrier pretending macrophage invasion. Other confounding factors include circulating SPIO/USPIO particles within the blood pool, local hemorrhages, and intrinsic iron oxide-loading of phagocytes. These uncertainties can be overcome by in vitro preloading of cells with iron oxide contrast agents and consecutive systemic application into animals. Iron oxide-contrast-enhanced MRI allowed in vivo visualization of cellular inflammation during wallerian degeneration, experimental autoimmune neuritis and encephalomyelitis, and stroke in rodents, but also in patients with multiple sclerosis and stroke. Importantly, cellular MRI provides additional information to gadolinium-DTPA-enhanced MRI since cellular infiltration and breakdown of the blood-brain barrier are not closely linked. Coupling of antibodies to iron oxide particles opens new avenues for molecular MRI and has been successfully used to visualize cell adhesion molecules guiding inflammation.

• [Cerebral and spinal MRI examination in patients with clinically isolated syndrome and definite multiple sclerosis]

  Authors: M Sailer, F Fazekas, A Gass, L Kappos, E W Radue, P Rieckmann, K Toyka, H Wiendl, M Bendszus

  RöFo : Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin. 12/2008; 180(11):994-1001.

  PURPOSE: Magnetic resonance imaging (MRI) has become a valuable tool for diagnosing and monitoring multiple sclerosis (MS). The high sensitivity for the detection of hyperintense lesions in TPURPOSE: Magnetic resonance imaging (MRI) has become a valuable tool for diagnosing and monitoring multiple sclerosis (MS). The high sensitivity for the detection of hyperintense lesions in T 2-weighted scans contributes substantially to diagnosis. The initial lesion number or lesion volume stands for an increased probability of further accumulation of lesion burden, an earlier conversion to clinically definite MS and progression of disability in the next 5 - 15 years. This diagnostic and prognostic information gained from MRI early in the disease course lead in 2001 to a revision of the diagnostic criteria. MATERIALS AND METHODS: For the first time MRI criteria were defined in addition to the clinical and paraclinical criteria using the clinical terms for dissemination with respect to space and time. In particular, the defined MRI criteria are based on lesion number and location, the appearance of new lesions and lesion enhancement using contrast agent. RESULTS: Reliable detection and description of older and new lesions in the disease course by MRI represents subclinical disease activity which can substitute the clinical confirmation of a relapse leading to an earlier diagnosis. This places importance on the assessment of the subclinical disease activity in sequential MR scans requiring a standardized and reproducible approach to minimize variability despite different MR scanners. CONCLUSION: This review provides an updated proposal for the approach and management of cranial and spinal MR scans in patients with MS. We describe the influence of variables which cannot be standardized (scanner, field strength, manufacturer and software) and outline potential pitfalls of clinical MR imaging in MS resulting from a non-standardized approach. This updated proposal for slice positioning, sequences and documentation is a result of a consensus process targeting systematic and standardized use in clinical MR evaluations of MS.

• [Neuroradiological imaging in patients with sensorineural hearing loss prior to cochlear implantation]

  Authors: A Biller, A Bartsch, C Knaus, J Müller, L Solymosi, M Bendszus

  RöFo : Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin. 10/2007; 179(9):901-13.

  Cochlear implantation (CI) is an established technique for enabling speech perception in patients suffering from severe bilateral sensorineural hearing loss (SNHL). Thorough preoperative radiologicalCochlear implantation (CI) is an established technique for enabling speech perception in patients suffering from severe bilateral sensorineural hearing loss (SNHL). Thorough preoperative radiological assessment is essential for correctly evaluating the indication for surgery and safely performing cochlear implantation. CT and conventional and functional MRI are available for radiological assessment. Therefore, knowledge of the most frequent congenital syndromal, non-syndromal, and acquired malformations of inner ear structures is fundamental. This article provides information about imaging techniques prior to CI and relevant malformations of the inner ear. Safety aspects for patients with a cochlear implant undergoing MR imaging are also discussed.

• CT perfusion predicts secondary cerebral infarction after aneurysmal subarachnoid hemorrhage.

  Authors: M Pham, A Johnson, A J Bartsch, C Lindner, W Müllges, K Roosen, L Solymosi, M Bendszus

  Neurology. 09/2007; 69(8):762-5.

  OBJECTIVE: To prospectively assess the diagnostic accuracy of CT perfusion (CTP) and transcranial Doppler sonography (TCD) for the prediction of secondary cerebral infarction (SCI) after aneurysmalOBJECTIVE: To prospectively assess the diagnostic accuracy of CT perfusion (CTP) and transcranial Doppler sonography (TCD) for the prediction of secondary cerebral infarction (SCI) after aneurysmal subarachnoid hemorrhage (SAH). METHODS: During 2 weeks after SAH, 38 consecutive patients completed an average of 3.5 CT/CTP and 10.7 TCD examinations at regular intervals as required by the study protocol. SCI was defined as delayed infarction on native CT between 3 and 14 days after SAH and developed in n = 14 patients (n = 24 without SCI). Analysis was based on examination dates before SCI. Common measures of diagnostic accuracy were calculated for qualitative CTP (visual color-map ratings from two blinded observers) and TCD assessments (mean flow velocity >120 cm/s in anterior, middle, and posterior cerebral artery territories). Quantitative measures, which for CTP were obtained from cortical a priori regions of interest corresponding to the vascular territories, were analyzed by binary logistic regression. RESULTS: Time of prediction for SCI by CTP was at a median of 3 days (range 2 to 5 days) before manifestation of complete infarction on native CT. Visual assessment of time-to-peak (TTP) color maps performed best for the prediction of SCI with 0.93 sensitivity (95% CI: 0.7 to 1.0) and 0.67 specificity (95% CI: 0.53 to 0.7). On quantitative analysis, the odds ratio (OR) for 1 second of side-to-side delay in TTP was 1.4 (p = 0.01, Wald chi(2) = 8.57, CI: 1.07 to 1.82). Daily TCD measures were not significantly related to SCI at any time before complete infarction on native CT. CONCLUSIONS: Time to peak as indicated by CT perfusion is a sensitive and early predictor of secondary cerebral infarction.

• Why a positive genetic test for myotonic dystrophy type I does not always imply the right diagnosis.

  Authors: S G Meuth, C Kleinschnitz, M Frank, C Wessig, M Bendszus, W Kress, H Wiendl

  Journal of neurology, neurosurgery, and psychiatry. 01/2007; 77(12):1381-2.