Perfusion selection extends thrombolysis to 24 hours, and dosing children's contrast by lean weight cuts the volume without losing enhancement

The edition in brief

A PROSPERO-registered meta-analysis pooled six randomised trials of intravenous thrombolysis versus best medical treatment in acute ischaemic stroke presenting between 4.5 and 24 hours, with patients selected by advanced perfusion imaging, predominantly CT perfusion: 1,182 treated and 1,176 controls. Thrombolysis increased excellent and good functional outcomes at three months, with consistent findings out to 24 hours in exploratory subgroups. Symptomatic intracranial haemorrhage was more frequent; 90-day mortality did not differ. An artificial intelligence pulmonary nodule system was tested on all 361 UK Lung Cancer Screening participants who had a 3-month follow-up scan, matching baseline nodules of 100 mm3 or larger to follow-up without manual selection. It matched 83.5% of 339 persisting nodules (95% CI 79.2-87.1), 91.8% where there was a single baseline nodule and 72.8% where there were more than five. Of the unmatched findings, 91.1% were non-nodular structures, mostly pleural plaques, leaving 1.5% of persisting nodules needing manual correction. In 136 patients with 138 rectal lesions, adding a contrast-enhanced submucosal enhancing stripe to T2-weighted features raised the area under the curve for identifying Tis-T1 disease from 0.762 to 0.915, beating endorectal ultrasound at 0.806 (p=0.003). The Korean Society of Abdominal Radiology has issued ten consensus statements on gastric cancer CT, covering distension, a dedicated arterial phase for vascular variants, staging criteria, re-staging after chemotherapy, and de-escalated surveillance in pT1aN0 disease. In 66 children randomised across three abdominal CT contrast protocols, lean body weight dosing gave lower median volumes with hepatic enhancement comparable to the institutional standard.