IFSCC Magazine, 12 (2009) (1) 9–15Measurement of water concentration profiles across living human skin by confocal Raman spectroscopy has developed into a powerful tool for a better understanding of distribution and function of water in the epidermis. From the water profile across the epidermis the border between stratum corneum and stratum granulosum can be estimated. This is due to the steep drop in water concentration from the inner to the outer side of the stratum corneum. Water content drops from approximately 70% at the inner stratum corneum to only 30% at the skin surface. This slope of the curve becomes clearly flatter in the stratum granulosum. A second parameter is usually taken from confocal Raman spectroscopy to define the stratum corneum border. This is the content of natural moisturization factor (NMF), which should be present only in the stratum corneum. Located at the depth at which the NMF content levels off and the slope of the water profile curve changes is the stratum corneum border. The goal of this work was to develop stratum corneum thickness detection into a robust and semi‐automated measurement relying only on the water profile. Further, the aim was to base the empirical findings of water distribution in the epidermis on a well established theory, Fick's law of diffusion. A mathematical model was developed to fit the water profile curve for a robust and automated detection of the stratum corneum border. In addition, the new model automatically resulted in an accurately determined slope of the water concentration curve in the stratum corneum. This slope, or more exactly the gradient, is one of two parameters directly related to transepidermal water transport across the stratum corneum.Keywords: Barrier function, Fick's law, Raman spectroscopy, stratum corneum, transepidermal water loss

The objective of this study is to determine the effect of emollients in a propanol-based hand rub on skin dryness and erythema. In this prospective, randomized, controlled, double-blind trial, 35 subjects participated; of them approximately half were atopic (modified Erlanger atopy score > or =8). 2 propanol-based formulations were tested in a repeated open application test, 1 contained a mixture of emollients (0.81%, w/w). 2 aliquots of 0.7 ml of each formulation were applied twice per day over 2 weeks to the cubital fossa of each subject after random assignment of the preparations. Treatment areas were assessed before each application and 3 days postfinal application by visual inspection for erythema and dryness according to a standard scale. The sum score over all assessment time-points served as primary parameter. The mean sum score for erythema and dryness was significantly lower for the hand rub with emollients (0.8 +/- 2.4) in comparison with that for the hand rub without emollients (1.5 +/- 3.5; P = 0.022; Wilcoxon signed rank test). A comparison of the atopic and non-atopic subjects revealed no significant difference for any of the products (P > 0.05; Mann-Whitney U-test). It is concluded that the addition of emollients to a propanol-based hand rub can significantly decrease irritant contact dermatitis under frequent-use conditions.

BACKGROUND AND PURPOSE: The volume of decreased cerebral blood flow (CBF) in acute stroke perfusion-weighted imaging frequently overestimates final infarct volume. We hypothesized that surviving tissue exists even in patients without recanalization and tried to determine perfusion thresholds from initial MR imaging. METHODS: Stroke MR imaging including MR angiography was carried out at days 0, 1, and 7 after stroke onset in 19 patients without recanalization at least until day 1. The following lesions were defined: L0 = diffusion restriction at day 0; LG1 = lesion growth until day 1; LG7 = lesion growth until day 7; ST7 = initially hypoperfused, but surviving tissue. These lesions were transferred on initial MR imaging within 4.7 hours and perfusion values at day 0 were determined. RESULTS: Median lesion volume L0 at day 0 was 18.2 mL and increased to 39.4 and 43.8 mL at days 1 and 7. Volume of decreased rCBF not progressing to infarction was 148.5 mL (ST7). Mean ST7 perfusion values were different from L0 and LG1, but only mean relative cerebral blood volume (rCBV) was different from LG7, discriminating survival against death of tissue. A threshold value of 0.82 CBV for death versus survival was determined with a sensitivity of 0.56 and specificity of 0.95. Carotid T occlusions showed the greatest potential of lesion growth. CONCLUSION: Even when vessel occlusion persists, hypoperfused tissue on MR imaging does not necessarily progress toward infarction. The most conclusive inferences can be drawn from CBV images. The site of arterial occlusion also determines progression to infarction.

PURPOSE:To retrospectively evaluate known criteria for assessment of dural ectasia by using magnetic resonance (MR) imaging in children, adolescents, and young adults with and those without Marfan syndrome.MATERIALS AND METHODS:Local ethics committee approval and informed consent were obtained. MR images of the lumbar spine in 28 patients with clinically proved Marfan syndrome (group A; 17 male, 11 female; age range, 4-21 years; mean, 12.1 years), seven patients with suspicion of Marfan syndrome (group B; six male, one female; age range, 6-18 years; mean, 10.4 years), and 55 patients without Marfan syndrome (group C; 26 male, 29 female; age range, 4-20 years; mean, 10.7 years) were evaluated retrospectively for dural ectasia criteria (scalloping, dural sac ratio, nerve root sleeve diameter, sagittal dural sac width at S1 greater than that at L4) and according to classifications by Ahn et al and Fattori et al. For statistical comparison of results, one-way analysis of variance with Scheffe post hoc comparisons was used, with an overall two-tailed significance at alpha = .05.RESULTS:No significant differences in scalloping and nerve root sleeve diameter were shown between groups. A significant difference was measured for dural sac ratios at L5 and S1 (F test, P = .003 and P < .001 at L5 and S1, respectively; post hoc t test for groups A vs C, P = .004 and P < .001 at L5 and S1, respectively). Significant differences were also obtained between groups A and C for sagittal dural sac width at S1 greater than that at L4 according to the calculated mean difference (for both F test and post hoc t test, P < .001 and P = .003 at S1 and L4, respectively). The Ahn et al and Fattori et al classifications were of limited value.CONCLUSION:The data suggest that only dural sac ratio at L5 and S1 and a sagittal dural sac width at S1 greater than that at L4 are statistically significant criteria for the assessment of dural ectasia in children, adolescents, and young adults.

PURPOSE:To investigate the feasibility of diffusion-weighted (DW) echo-planar imaging (EPI) for measuring different functional conditions of the parotid gland and to compare different measurement approaches. MATERIALS AND METHODS:Parotid glands of 27 healthy volunteers were examined with a DW EPI sequence (TR 1,500 msec, TE 77 msec, field-of-view 250 x 250 mm, pixel size 2.10 x 1.95 mm, section thickness 5 mm) before and after oral stimulation with commercially available lemon juice. The b factors used were 0, 500, and 1,000 sec/mm (2). Apparent diffusion coefficient (ADC) maps were digitally transferred to MRIcro (Chris Rorden, University of Nottingham, Great Britain) and evaluated with a manually placed circular region of interest (ROI) containing 100 - 200 pixel. Additional ROIs including the entire parotid gland were placed on either side. The results of both measurements were compared, using the Student's t test based on the median ADC values for each person. A two-tailed p-value of less than.05 was determined to indicate statistical significance. To compare both measurement approaches, the Pearson's correlation coefficient (r) was calculated. RESULTS:Diffusion-weighted echo-planar MR imaging successfully visualized the parotid glands of all volunteers. In a first step, the median ADC value per person was computed. Using ROIs of 100 - 200 pixels, the mean was calculated to be 1.08 x 10 (- 3) mm (2)/sec +/- 0.12 x 10 (- 3) mm (2)/sec for both parotid glands prior to stimulation. After stimulation, the mean ADC was measured at 1.15 x 10 (- 3) mm (2)/sec +/- 0.11 x 10 (- 3) mm (2)/sec for both parotid glands. Evaluating the entire parotid gland, the ADC was 1.12 x 10 (- 3) mm (2)/sec +/- 0.08 x 10 (- 3) mm (2)/sec prior to stimulation, whereas the ADC increased to 1.18 x 10 (- 3) mm (2)/sec +/- 0.09 x 10 (- 3) mm (2)/sec after stimulation with lemon juice. For both types of measurements, the increase in ADC after stimulation proved to be significant (p < 0.001). High correlations between both measurement types were found (r >.83). CONCLUSION:Diffusion-weighted echo-planar MR imaging allows non-invasive quantification of functional changes in the parotid glands.

PURPOSETo optimize the examination protocols of multislice CT (MSCT) of the pelvis for dose reduction with regard to image quality.MATERIALS AND METHODSMSCT of the pelvis was performed on 5 cadaver specimens with stepwise reduction of the tube current at 140 kV (250, 200, 150, 100, 75, 50, 35, 25 mAs) and 120 kV (50, 27 mAs). The remaining scan parameters like collimation (4 x 1 mm) and table speed of 4 mm per rotation remained unchanged. Axial sections and coronal reconstructions were used to evaluate cortex, trabecular structures, subjective image quality, image noise and detail detectability (pelvis and SI joint), with evaluation performed independently by four blinded experienced radiologists on a 5-point scale. Kappa coefficient, accuracy of the observers to sort the films with regard to dose reduction and mean scores of image evaluation were determined for statistical analysis.RESULTSThe deterioration of the image quality was most pronounced for all criteria between 75 mAs and 50 mAs at 140 kV. Good results with adequate image quality were obtained for detail detectability at 50 mAs and 140 kV (effective dose [E]: 3.3 mSv) and for the remaining four criteria at 75 mAs (E: 4.9 mSv). There was a moderate agreement between the four observers (kappa coefficient: 0.27). All observers were excellent in arranging the images according to the increasing dose reduction.CONCLUSIONSImage quality of MSCT of the pelvis appears to be acceptable at 75 mAs and 140 kV with the dose reduced to 46% of the average value of the nation-wide survey of the German Roentgen Society in 1999 for this type of examination.

PURPOSE:To evaluate the image quality of thin-section MSCT examinations of low-contrast objects such as liver lesions, and to find out whether a thin slice technique requires an increase in radiation dose.MATERIALS AND METHODS:MSCT examinations of the liver were performed in the portal venous phase on a Volume Zoom Scanner (Siemens, Erlangen) with a collimation of 4 x 2.5 mm, 120 kV, 125 mAs and table speed of 12.5 mm. Forty small hypodense liver lesions with a mean size of 3 mm (1 to 8 mm) were reconstructed using a slice thickness of 3, 5, 7, and 10 mm. All lesions were evaluated for each slice thickness by 3 independent radiologists using a 5-point scale (excellent to poor) for the following 7 criteria: contrast, demarcation and contour of the lesion, image noise and quality, demarcation of liver veins and liver contour. The mean values of the reviewers' scores were calculated. The correlation of the three observers in the evaluation of the criteria was determined using the Kendall's Tau coefficient.RESULTS:The 3-mm thin sections were excellent in the evaluation of lesion detection, lesion contrast and lesion contour with a mean score of 1.4 compared to 4.1 for 10-mm sections. Concerning the criteria image quality and liver contour, thin sections achieved the best results in our series. Image noise was pronounced in thin sections but did not affect negatively the image analysis. Interrater agreement was 0.53 for the criterium image noise.CONCLUSION:Thin sections in MSCT examinations of low contrast objects such as liver lesions do not require an increase in radiation dose because the increase in image noise is compensated by improved lesion contrast.

The aim of this pilot study was to establish quality control in neurological intensive care medicine. During a one year-period 2000/2001 core data of consecutive patients of four neurological intensive care units (centers I-IV) were collected prospectively using questionnaires. The data, analysed in detail, include patient-illness related data, data concerning diagnosis, related illnesses and complications, treatment and prognosis. Data of 813 patients could be included in the analysis. The most common diagnoses were stroke (n = 278), intracerebral hemorrhage (n = 203), subarachnoidal hemorrhage (n = 143) and status epilepticus (n = 75). At admittance the median of patient's age was 62 years, they had a mean Barthel-Index of 20 and a mean stay of 9,9 days (median = 5 days). At discharge from the neurological intensive care units their condition resulted in a mean Barthel-Index of 40.151 (19%) patients deceased. Concerning related illnesses hypertension, coronary heart disease and diabetes mellitus were the most important ones, concerning complications pneumonia was the most common one. Out of a total of 406 high risk patients with zero Barthel-Index at admittance 138 (34%) patients improved, whereas 120 (29%) deceased. It is shown, that with the simple and descriptive methodology used in this pilot study not only relevant data could be collected concerning the treated collective of patients, course of illness and prognosis, but also differences could be established between the four centers concerning the severity of illness of treated patients, indications of invasive procedures and rate of occurrence of complications. The discussion and interpretation of these results might lead to an improvement of the quality of treatment.

PURPOSE:To compare the performance of helical computed tomography (CT) and endoscopic ultrasonography (US) in the preoperative staging of gastric cancer.MATERIALS AND METHODS:Fifty-one consecutive patients with a primary malignant gastric tumor (stage T2-T4) were preoperatively evaluated with both helical CT and endoscopic US within 3 days. Each tumor was staged according to the TNM classification system with both modalities. All patients subsequently underwent surgery. Results of CT and endoscopic US were compared with histologic staging of tumor invasion depth and regional lymph node metastasis. For comparison of CT and endoscopic US data, the marginal homogeneity test was used, and a P value of less than.05 was determined to indicate statistical significance.RESULTS:In comparison with histologic results, CT achieved correct T staging in 39 patients (76%) and correct N staging in 35 patients (70%). The corresponding results for endoscopic US achieved correct T staging in 44 patients (86%) and correct N staging in 45 patients (90%). There was no significant difference between T staging (P =.55) and N staging (P >.99). Because of challenging detection of wall layers, correct T staging was difficult for CT and endoscopic US in the differentiation of T2 and T3 lesions.CONCLUSION:Compared with endoscopic US, helical CT focused on the stomach provides valuable results regarding T and N staging in patients with gastric cancer.

Purpose: Detection of malignant liver lesions with gadolinium-enhanced volumetric interpolated breath-hold examination (VIBE) in comparison with SPIO-enhanced MRT (four different SPIO-enhanced T2w sequences) and histological and imaging follow-up in non-cirrhotic livers at 1.5 T. Patients and Methods: Twenty-two patients with suspected focal liver lesions prospectively underwent a gadolinium-enhanced 3D VIBE. Four T2w sequences (HASTE sequence, fast spin-echo-sequence with and without fat-saturation, FLASH 2D gradient echo-sequence) after administration of superparamagnetic iron oxide (SPIO) served as gold standard combined with histological work-up in 17 patients and histological and imaging follow-up in five patients. The image quality was evaluated and the detectability of intrahepatic lesions was rated by the alternative free-response receiver operating characteristic (AFROC) analysis. In addition, the contrast-to-noise ratio was compared. Results: Altogether 49 malignant and 35 benign liver lesions were found. Concerning the image quality, VIBE turned out to be of slightly poorer image quality than the SPIO-enhanced examination with HASTE sequence (4.95 vs. 5.0). The fast spin-echo-sequence without fat-saturation demonstrated the highest contrast-to-noise ratio. All sequences showed a comparable certainty in detecting lesion (area under the curve 0.68-0.73) and identifying malignant liver lesions. Conclusion: Despite the small number of patients, VIBE seems to be a comparable, inexpensive and fast method in diagnosing malignant liver lesions.

BACKGROUND AND PURPOSE:Previous acute stroke studies found diffusion-weighted (DW) imaging superior to CT for detection of early ischemic signs (EIS). However, these findings were confounded by a large time interval in favor of DW imaging. We compared DW images and CT scans obtained with a short time delay in patients with acute stroke to define the sensitivity and interrater agreement of both imaging techniques. METHODS:CT scans and DW images were obtained within 6 hours of symptom onset in 46 patients with acute stroke. Three neuroradiologists and three neurologists reviewed the images for EIS in five regions of the middle cerebral artery (MCA) territory and estimated the extent of EIS (< or > one-third of the MCA territory). RESULTS:The mean delay between imaging with both modalities was 24.5 minutes (range, 10-41 minutes). Forty-five of 46 patients had an ischemic stroke. EIS were seen on 33 of 45 CT scans (73% sensitivity; 95% confidence interval [CI]: 58-85%) and on 42 of 45 DW images (93% sensitivity; 94% CI: 82-99%). Interrater agreement was moderate (kappa = 0.57) for CT and excellent (kappa = 0.85) for DW imaging. CT studies had a moderate interrater agreement for estimation of EIS greater than one-third of the MCA territory (kappa = 0.40), whereas DW imaging showed good results (kappa = 0.68). Sensitivity for detection of greater than one-third of the MCA territory was equally poor (57%, 95% CI: 29-82%) for both CT and DW imaging. CONCLUSION:DW imaging helped identify EIS with higher sensitivity than that of CT. The interrater variability of the one-third rule was high for CT, and thus the clinical applicability of CT is limited. Our results support the application of stroke MR imaging for the treatment of patients with acute stroke.

OBJECTIVE:Combined dorsoventral stabilization provides superior mechanical stability in the operative treatment of thoracolumbar spine fractures. Currently, there are no data available reflecting the quality of life in trauma patients following the combined procedure. The aim of this investigation was to study the health-related quality of life after dorsoventral stabilization of the thoracolumbar junction using the SF-36 Health Survey.METHODS:In order to assess the quality of life, 30 patients from a consecutive series with unstable fractures of the thoracolumbar junction were investigated in a clinical study. After posterior stabilization with an internal fixator (USS, Synthes),anterior arthrodesis was performed subsequently by autogenous iliac bone grafting in combination with osteosynthesis (MACS, Aesculap; VentroFix, Synthes). The quality of life was investigated 2 years after surgery. Additionally, plain X-rays were obtained and the degree of kyphotic deformation was measured.RESULTS:The evaluation of the data obtained from the SF-36 revealed a reduced quality of life, especially regarding the "physical functioning index", the "bodily pain index", and the "emotional functioning index". Of the patients, 42% still suffered from moderate to severe pain. Measurement of the Cobb angle showed a slight loss of correction without occurrence of a relevant kyphotic deformity. Our statistical analyses did not show any correlation between the data obtained from the SF-36 and the clinical results. Especially there was no correlation between the "bodily pain index" and the Cobb angle ( r=0.112, Spearman's rank order correlation).CONCLUSION:The patients studied here showed a reduced quality of life 2 years after dorsoventral stabilization of the thoracolumbar junction predominantly resulting in long-term pain symptoms. As these findings could not be related to the radiological results (i.e., the occurrence of a kyphotic deformation), other factors such as injury of the motion segment of the spine and the major surgical procedure have to be considered as the main reasons for the reduced quality of life. In summary, it can be concluded that the SF-36 is a suitable tool for the investigation of the postoperative outcome following dorsoventral stabilization of the thoracolumbar junction in trauma patients.

Background and Purpose— We tested the hypothesis that early diffusion- and perfusion-weighted MRI (DWI and PWI, respectively) allows the prediction of malignant middle cerebral artery (MCA) infarction (MMI). Methods— Thirty-seven patients with acute MCA infarction and proximal vessel occlusion (carotid-T, MCA main stem) were studied by DWI, PWI, and MR angiography within 6 hours of symptom onset. Eleven patients developed MMI, defined by decline of consciousness and radiological signs of space-occupying brain edema. Lesion volumes were retrospectively defined as apparent diffusion coefficient <80% (ADC <80% ) and time to peak >+4 seconds (TTP >+4s ) compared with the unaffected hemisphere. ADC decrease within the infarct core (ADC core ) and relative ADC within the ADC <80% lesion (rADC lesion ) were measured. Neurological deficit at admission was assessed with the National Institutes of Health Stroke Scale (NIHSS). Results— Patients with MMI showed larger ADC <80% (median, 157 versus 22 mL; P <0.001) and TTP >+4s (208 versus 125 mL; P <0.001) lesion volumes, smaller TTP/ADC mismatch ratio (1.5 versus 5.5; P <0.001), lower ADC core values (290 versus 411 mm 2 /s; P <0.001), lower rADC lesion (0.60 versus 0.66; P =0.001), higher frequency of carotid-T occlusion (64% versus 15%; P =0.006), and higher NIHSS score at admission (20 versus 15; P =0.001). Predictors of MMI were as follows for sensitivity and specificity, respectively: ADC <80% >82 mL, 87%, 91%; TTP >+4s >162 mL, 83%, 75%; TTP/ADC mismatch ratio <2.4, 80%, 79%; ADC core <300 mm 2 /s, 83%, 85%; rADC lesion <0.62, 79%, 74%; and NIHSS score at admission ≥19, 96%, 72%. Conclusions— Quantitative analysis of early DWI and PWI parameters allows the prediction of MMI and can help in the selection of patients for aggressive tissue-protective therapy.

Aufgrund der höheren mechanischen Stabilität hat diekombinierte dorsoventrale Stabilisierung von Frakturen desthorakolumbalen Übergangs in den letzten Jahren zunehmend anBedeutung gewonnen. Bislang liegen nur wenige Daten zumpostoperativen Verlauf nach einer dorsoventralenInstrumentierung vor. Unklar ist insbesondere, welcheAuswirkungen sich auf die Lebensqualität ergeben.Zielsetzungdieser Untersuchung war es,die allgemeine gesundheitsbezogeneLebensqualität nach einer dorsoventralen Stabilisierung desthorakolumbalen Übergangs zu erfassen. Dabei sollte eruiertwerden, ob bestimmte Faktoren die Entwicklung chronischerBeschwerden bei diesem Krankengut begünstigen.

PURPOSE Evaluation of TSE- and T 1 -3D-GRE-sequences for focal cartilage lesions in vitro in comparison to ultrahigh resolution multi-slice CT. MATERIALS AND METHODS Forty artificial cartilage lesions in ten bovine patellae were immersed in a solution of iodinated contrast medium and assessed with ultrahigh resolution multi-slice CT. Fat-suppressed TSE images with intermediate- and T 2 -weighting at a slice thickness of 2, 3 and 4 mm as well as fat-suppressed T 1 -weighted 3D-FLASH images with an effective slice thickness of 1, 2 and 3 mm were acquired at 1.5 T. After adding Gd-DTPA to the saline solution containing the patellae, the T 1 -weighted 3D-FLASH imaging was repeated. RESULTS All cartilage lesions were visualised and graded with ultrahigh resolution multi-slice CT. The TSE images had a higher sensitivity and a higher inter- and intraobserver kappa compared to the FLASH-sequences (TSE: 70 - 95 %; 0.82 - 0.83; 0.85 - 0.9; FLASH: 57.5 - 85 %; 0.53 - 0.72; 0.73 - 0.82, respectively). An increase in slice thickness decreased the sensitivity, whereby deep lesions were even reliably depicted on TSE images at a slice thickness of 3 and 4 mm. Adding Gd-DTPA to the saline solution increased the sensitivity by 10 % with no detectable advantage over the T 2 -weighted TSE images. CONCLUSION TSE sequences and application of Gd-DTPA seemed to be superior to T 1 -weighted 3D-FLASH sequences without Gd-DTPA in the detection of focal cartilage lesions. The ultrahigh resolution multi-slice CT can serve as in vitro reference standard for focal cartilage lesions.

Ziel: Beurteilung von TSE- und FLASH-MRT-Sequenzen im Vergleich zur ultrahochauflösenden Mehrzeilencomputertomographie (UHR-MS-CT). Material und Methoden: 40 artefizielle Knorpelläsionen bei 10 bovinen Patellae wurden in jodhaltiger Kontrastmittel-(KM)-Lösung gelagert und mittels der UHR-MS-CT dargestellt. Bei 1,5 T wurden fettsupprimierte (FS) TSE mit Intermediär- und T2-Gewichtung und Schichtdicken (SD) von 2, 3 und 4 mm sowie FS-T1-3D-FLASH mit 1, 2 und 3 mm effektiver SD akquiriert. Nach Applikation von Gd-DTPA zu der Kochsalzlösung, in der die Patellae lagerten, wurde eine T1-3D-FLASH wiederholt. Ergebnisse: Alle Knorpelläsionen konnten mit der UHR-MS-CT dargestellt und graduiert werden. Die Sensitivitäten sowie inter- und intrarater-Kappas waren bei den TSE höher (70 - 95 %; 0,82 - 0,83; 0,85 - 0,9) als bei den FLASH (57,5 - 85 %; 0,53 - 0,72; 0,73 - 0,82). Eine Zunahme der SD führte zu einer Sensitivitätsabnahme, wobei mit den TSE auch bei 3 und 4 mm SD tiefe Läsionen zuverlässig erkannt werden konnten. Die Applikation von MRT-KM führte zu einer Zunahme der Sensitivität um 10 %, wobei sich hier kein Vorteil gegenüber den T2-TSE abzeichnete. Schlussfolgerung: TSE-Sequenzen sowie die Applikation von MRT-KM scheinen bei der Detektion fokaler Knorpeldefekte den T1-3D-FLASH ohne KM überlegen zu sein. Die UHR-MS-CT kann als in vitro Referenzstandard für fokale Knorpeldefekte dienen.

Background and Purpose— The goals of this study were to examine MRI baseline characteristics of patients with acute ischemic stroke (AIS) and to study the influence of intravenous tissue plasminogen activator (tPA) on MR parameters and functional outcome using a multicenter approach. Methods— In this open-label, nonrandomized study of AIS patients with suspected anterior circulation stroke, subjects received a multiparametric stroke MRI protocol (diffusion- and perfusion-weighted imaging and MR angiography) within 6 hours after symptom onset and on follow-up. Patients were treated either with tPA (thrombolysis group) or conservatively (no thrombolysis group). Functional outcome was assessed on day 90 (modified Rankin Score; mRS). Results— We enrolled 139 AIS patients (no thrombolysis group, n=63; thrombolysis group, n=76). Patients treated with tPA were more severely affected (National Institutes of Health Stroke Scale score, 10 versus 13; P =0.002). Recanalization rates were higher in the thrombolysis group (Thrombolysis in Myocardial Infarction criteria 1 through 3 on day 1; 66.2% versus 32.7%; P <0.001). Proximal vessel occlusions resulted in larger infarct volumes and worse outcome ( P =0.02). Thrombolysis was associated with a better outcome regardless of the time point of tPA treatment (≤3 hours or 3 to 6 hours) (univariate analysis: mRS ≤2, P =0.017; mRS ≤1, P =0.023). Age ( P =0.003), thrombolytic therapy at 0 to 6 hours ( P =0.01), recanalization ( P =0.016), lesion volume on day 7 ( P =0.001), and initial National Institutes of Health Stroke Scale score ( P =0.001) affected functional outcome (mRS on day 90) positively (multivariate analysis). The time point of tPA therapy affected the recanalization rate ( P =0.024) but not final infarct volume. Conclusions— In this pilot study, tPA therapy had a beneficial effect on vessel recanalization and functional outcome. Multiparametric MRI delineates tissue at risk of infarction in AIS patients, which may be helpful for the selection of patients for tPA therapy. tPA therapy appeared safe and effective beyond a 3-hour time window. This study delivers the rationale for a randomized, MR-based tPA trial.

VENTURA, R., et al. : A Randomized and Controlled Pilot Trial of b‐Blockers for the Treatment of Recurrent Syncope in Patients with a Positive or Negative Response to Head‐Up Tilt Test. The aim of this study was to assess the efficacy of lipophilic β‐blockers in preventing recurrent neurocardiogenic syncope and the value of head‐up tilt test (HUT) in predicting response to therapy. The efficacy of β‐blockers in recurrent syncope is controversial. The value of HUT in predicting efficacy of therapy has not been investigated. Fifty‐six patients ( 44 ± 18 years, 36 women ) with recurrent syncope ( > 1 event in the last 6 months ) of suspected neurocardiogenic origin were included in the study. Independent of the response to HUT, patients were randomized to receive metoprolol or propanolol at the maximal tolerated dose ( 28 patients, group A, 86 ± 23 vs 98 ± 29 mg/d ) or no pharmacological therapy (28 patients, group B). The primary endpoint was the first recurrence of syncope. During the 1‐year of follow‐up, 20 patients of group A and 8 of group B had no recurrence. In group A, of 20 patients without recurrences 12 had a positive and 8 a negative HUT result while of 8 patients with recurrences 5 had a positive and 3 a negative response to HUT. In the group B, of 20 patients with recurrences 10 had a positive and 10 a negative HUT result while of 8 patients without recurrences 4 had a positive and 4 a negative response to HUT. In a multivariate Cox‐regression analysis, medical therapy was the only independent factor for predicting recurrence of syncope ( P = 0.004 ); HUT had no influence in this regard ( P = 0.773 ). In conclusion, lipophilic β‐blockers appear efficacious in preventing recurrent syncope of suspected neurocardiogenic origin. The efficacy of therapy seems to be not predicted by HUT.