BACKGROUND AND PURPOSE: The rupture of an intracranial aneurysm is a serious incident, causing subarachnoid hemorrhage associated with high fatality and morbidity rates. Because the demand for radiologic examinations is steadily growing, physician fatigue due to an increased workload is a real concern and may lead to mistaken diagnoses of potentially relevant findings. Our aim was to develop a sufficient system for automated detection of intracranial aneurysms. MATERIALS AND METHODS: In a retrospective study, we established a system for the detection of intracranial aneurysms from 3D TOF-MRA data. The system is based on an open-source neural network, originally developed for segmentation of anatomic structures in medical images. Eighty-five datasets of patients with a total of 115 intracranial aneurysms were used to train the system and evaluate its performance. Manual annotation of aneurysms based on radiologic reports and critical revision of image data served as the reference standard. Sensitivity, false-positives per case, and positive predictive value were determined for different pipelines with modified pre- and postprocessing. RESULTS: The highest overall sensitivity of our system for the detection of intracranial aneurysms was 90% with a sensitivity of 96% for aneurysms with a diameter of 3–7 mm and 100% for aneurysms of >7 mm. The best location-dependent performance was in the posterior circulation. Pre- and postprocessing sufficiently reduced the number of false-positives. CONCLUSIONS: Our system, based on a deep learning convolutional network, can detect intracranial aneurysms with a high sensitivity from 3D TOF-MRA data.

BACKGROUND AND PURPOSE: Large-bore catheters allow mechanical thrombectomy in ischemic stroke by engaging and retrieving clots without additional devices (direct aspiration first-pass technique [ADAPT]). The purpose of this study was to establish a model for minimal catheter diameters needed for ADAPT. MATERIALS AND METHODS: We established a theoretic model for the calculation of minimal catheter diameters needed for ADAPT. We then verified its validity in 28 ADAPT maneuvers in a porcine in vivo model. To account for different mechanical thrombectomy techniques, we factored in ADAPT with/without a hypothetic 0.021-inch microcatheter or 0.014-inch microwire inside the lumen of the aspiration catheter and aspiration with a 60-mL syringe versus an aspiration pump. RESULTS: According to our calculations, catheters with an inner diameter of >0.040 inch and >0.064 inch, respectively, are needed to be effective in the middle cerebral artery (2.5-mm diameter) or in the internal carotid artery (4 mm) in an average patient. There was a significant correlation between predicted and actual thrombectomy results (P = .010). Our theoretic model had a positive and negative predictive value of 78% and 79%, respectively. Sensitivity and specificity were 88% and 64%, respectively. CONCLUSIONS: Our theoretic model allows estimating the minimal catheter diameters needed for successful mechanical thrombectomy with ADAPT, as demonstrated by the good agreement with our animal experiments. Our model will be helpful to interventionalists in avoiding selecting catheters that are likely too small to be effective.

Current classifications of cerebral cavernous malformations focus solely on morphologic aspects. Our aim was to provide a morphologic classification that reflects hemorrhage rates. We retrospectively categorized 355 cavernous malformations of 70 children and adolescents according to their morphologic appearance on MR imaging and calculated prospective hemorrhage rates on the basis of survival functions for 255 lesions in 25 patients with a radiologic observation period of >180 days. Overall, there were 199 MR imaging examinations with 1558 distinct cavernous malformation observations during a cumulative observation period of 1094.2 lesion-years. The mean hemorrhage rate of all 355 cavernous malformations was 4.5% per lesion-year. According to Kaplan-Meier survival models, Zabramski type I and II cavernous malformations had a significantly higher hemorrhage rate than type III and IV lesions. The presence of acute or subacute blood-degradation products was the strongest indicator for an increased hemorrhage risk (P = .036, Cox regression): The mean annual hemorrhage rate and mean hemorrhage-free interval for cavernous malformations with and without signs of acute or subacute blood degradation products were 23.4% and 22.6 months and 3.4% and 27.9 months, respectively. Dot-sized cavernous malformations, visible in T2* and not or barely visible in T1WI and T2WI sequences, had a mean annual hemorrhage rate of 1.3% and a mean hemorrhage-free interval of 37.8 months. It is possible to predict hemorrhage rates based on the Zabramski classification. Our findings imply a tripartite classification distinguishing lesions with and without acute or subacute blood degradation products and dot-sized cavernous malformations.