Introduction: Cushing syndrome (CS) is a medical condition resulting from prolonged hypercortisolemia. The most common reason for endogenous CS is ACTH overproduction by pituitary adenoma, and then it is called Cushing disease (CD). The gold standard of CD diagnostic remains bilateral inferior petrosal sinus sampling (BIPSS); nevertheless, non-invasive diagnostic methods are being sought to provide a higher safety profile. The aim of this study was to evaluate whether [¹¹C]C-MET PET/CT can serve as a non-invasive alternative to BIPSS and MRI in CD diagnosis. Methods: This prospective study included 21 patients with CD who underwent BIPSS, MRI of the pituitary, and [¹¹C]C-MET PET/CT. Results: Sensitivity of BIPSS, MRI and [¹¹C]C-MET PET/CT was 100%, 59% and 24%, respectively, while specificity was 100%, 75%, and 13%. Next, we retrospectively compared PET/CT results for patients with corticotrope pituitary adenomas (n = 18) with those for individuals with no pituitary pathology (n = 18), and the results showed significantly higher SUV_max in the study group (3.74 ± 0.90 vs. 1.87 ± 1.17; p < 0.001). In ROC curve analysis, the area under the curve (AUC) was 0.889 (p <0.001; 95% CI 0.784–0.994). For SUV_max 2.60, the calculated sensitivity and specificity were 89% and 78% respectively, and for SUV_max 3.56, sensitivity and specificity were 67% and 89%, respectively. Conclusions: [¹¹C]C-MET PET/CT seems not to be a reliable diagnostic option in the diagnosis of pituitary corticotropic adenomas. BIPSS proved still to be the best diagnostic option for CD. Nevertheless, a higher than normal pituitary accumulation of the radiotracer may suggest the presence of increased amino acid metabolism, thus, the presence of adenoma.

Introduction: This study was designed to assess quantitatively a safe position of the microcatheter during the SIRT (Selective Internal Radiation Therapy) procedure, in order to minimize the risk of non-target spheres leaking. Materials and Methods: Retrospective analysis of the distance of the tip of the microcatheter from coiled or patent non-target arteries was measured during ^99mTc-MAA work-up procedure. Frequency of extrahepatic leaking during work-up and SIRT procedures was evaluated. Results: There were 85 patients who underwent 98 work-up procedures. There were 64 radioembolizations. There were 44 gastroduodenal, 51 right gastric, and 54 cystic artery embolizations performed. Extrahepatic ^99mTc-MAA leaking was observed in 33 cases: 16 to gallbladder, four to a gastric wall, nine to the duodenum, one to the intestinal wall, and three to the abdominal wall. Leak in ^99mTc-MAA was also related to the presence of additional arteries (p = 0.009). There were 34 proximal and 31 distal to cystic artery ^99mTc-MAA injections resulting in 12 vs. four leaks, respectively (p = 0.039, RR-2.5). Mean distance of the tip of the microcatheter from the origin of the cystic artery was 20 mm (minimum of 2.1 mm and maximum of 53 mm) proximally and 10 mm (minimum 1 mm and maximum 51 mm) distally (ns). Conclusions: Leaking in ^99mTc-MAA (^99mTc - labelled macroaggregated albumin) was related to the presence of additional arteries. Regardless of cystic artery embolization, it is 2.5 times safer to inject microspheres distal to its origin, compared to proximal injection. Cystic artery origin relative to the right hepatic artery division usually necessitates embolization of the former.

Background/Objectives: The optimal anesthetic strategy during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains debated. Although randomized trials suggest broadly comparable outcomes between general anesthesia (GA) and conscious sedation (CS), real-world data may be influenced by baseline severity, airway management, and postprocedural complications. We evaluated associations between anesthetic strategy, functional outcomes, mortality, and infectious and hemorrhagic complications after MT. Methods: This retrospective observational study included 257 consecutive adults with AIS treated with MT at a single comprehensive stroke center. Patients were managed under CS or GA according to clinical and procedural considerations. Outcomes, mortality, infectious and hemorrhagic complications were compared between groups. Multivariable logistic regression assessed associations with 90-day functional independence and mortality, adjusting for baseline and procedural factors. In an exploratory GA subgroup analysis, outcomes were compared according to extubation timing, defined as early (≤6 h) or delayed (>6 h). Results: Of 257 patients, 155 (60.3%) underwent MT under CS and 102 (39.7%) under GA. GA-treated patients had higher baseline NIHSS scores and worse unadjusted functional outcomes throughout follow-up. After adjustment, GA remained associated with higher 90-day mortality (OR 4.39, 95% CI 1.50–12.84; p = 0.007) and lower odds of 90-day functional independence (OR 0.29, 95% CI 0.10–0.82; p = 0.020). Pneumonia was more frequent with GA (49.0% vs. 26.5%; p < 0.001), although attenuated in adjusted analyses. Delayed extubation was associated with worse outcomes, higher pneumonia rates, and more frequent symptomatic intracranial hemorrhage. Conclusions: GA was associated with worse functional outcomes and higher mortality after MT, but residual confounding and differences in baseline stroke severity likely contributed to these associations. Pneumonia and hemorrhagic complications may identify patients at increased risk of poor outcome, especially when extubation is delayed. Findings require prospective confirmation.