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Bath PM, Appleton JP, Beridze M, Christensen H, Dineen RA, Duley L, England TJ, Heptinstall S, James M, Krishnan K, Markus HS, Pocock S, Ranta A, Robinson T, Flaherty K, Scutt P, Venables GS, Woodhouse L, Sprigg N. Abstract WP76: Baseline Characteristics of the 3,096 Patients Recruited Into the ‘Triple Antiplatelets for Reducing Dependency After Ischaemic Stroke’ (TARDIS) Trial. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The risk of recurrence following ischaemic stroke (IS) or transient ischaemic attack (TIA) is highest immediately after the event. Antiplatelet agents are effective in reducing the risk of recurrence and two agents are superior to one in the early phase after ictus.
Design:
The Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) trial was an international multicentre prospective randomised open-label blinded-endpoint trial that assessed the safety and efficacy of short-term intensive antiplatelet therapy with three agents (combined aspirin, clopidogrel and dipyridamole) as compared with guideline treatment in acute IS or TIA. The primary outcome was stroke recurrence and its severity, measured using the modified Rankin Scale at 90 days. Secondary outcomes included recurrent vascular events, functional measures (cognition, disability, mood, quality of life) and safety (bleeding, death, serious adverse events). Data are number (%) or mean (standard deviation, SD).
Results:
Recruitment ran from April 2009 to March 2016. 3,096 patients were recruited from 106 sites in 4 countries (Denmark 1.6%, Georgia 2.7%, New Zealand 0.2%, UK 95.4%). Randomisation characteristics included: age 69.0 (10.1) years; male 1945 (62.8%); time onset to randomisation 29.4 (11.9) hours; stroke severity (National Institutes for Health Stroke Scale) 2.8 (3.6); blood pressure 143.5 (18.2)/79.5 (11.4) mmHg; IS 2143 (69.2%), TIA 953 (30.8%).
Conclusion:
TARDIS was a large international trial of intensive/triple antiplatelet therapy in acute IS and TIA, and included participants representative of patients in many western stroke services.
Funders:
National Institute of Health Research Health Technology Assessment Programme and British Heart Foundation.
Trial registration:
ISRCTN47823388
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Affiliation(s)
- Philip M Bath
- Stroke, Div of Clinical Neuroscience, Univ of Nottingham, Nottingham, United Kingdom
| | - Jason P Appleton
- Stroke, Div of Clinical Neuroscience, Univ of Nottingham, Nottingham, United Kingdom
| | | | - Hanne Christensen
- Dept of Neurology, Bispebjerg and Frederiksberg Hosp, Copenhagen NV, Denmark
| | - Robert A Dineen
- Div of Clinical Neuroscience, Univ of Nottingham, Nottingham, United Kingdom
| | - Lelia Duley
- Nottingham Clinical Trials Unit, Univ of Nottingham, Nottingham, United Kingdom
| | - Timothy J England
- Div of Med Sciences & GEM, Univ of Nottingham, Nottingham, United Kingdom
| | - Stan Heptinstall
- Stroke, Div of Clinical Neuroscience, Univ of Nottingham, Nottingham, United Kingdom
| | - Marilyn James
- Health Economics, Div of Rehibiliation and Ageing, Univ of Nottingham, Nottingham, United Kingdom
| | - Kailash Krishnan
- Stroke, Div of Clinical Neuroscience, Univ of Nottingham, Nottingham, United Kingdom
| | - Hugh S Markus
- Dept of Clinical Neurosciences, Univ of Cambridge, Cambridge, United Kingdom
| | - Stuart Pocock
- Med Statistics Unit, London Sch of Hygiene & Tropical Medicine, London, United Kingdom
| | - Annemarei Ranta
- Dept of Neurology, Wellington Hosp and Univ of Otago, Wellington, New Zealand
| | - Thompson Robinson
- Dept of Cardiovascular Sciences, Univ of Leicester, Leicester, United Kingdom
| | - Katie Flaherty
- Stroke, Div of Clinical Neuroscience, Univ of Nottingham, Nottingham, United Kingdom
| | - Polly Scutt
- Stroke, Div of Clinical Neuroscience, Univ of Nottingham, Nottingham, United Kingdom
| | - Graham S Venables
- Dept of Neurology, Sheffield Teaching Hosps NHS Foundation Trust, Sheffield, United Kingdom
| | - Lisa Woodhouse
- Stroke, Div of Clinical Neuroscience, Univ of Nottingham, Nottingham, United Kingdom
| | - Nikola Sprigg
- Stroke, Div of Clinical Neuroscience, Univ of Nottingham, Nottingham, United Kingdom
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Bath PM, Appleton JP, Beridze M, Christensen H, Dineen RA, Duley L, England TJ, Heptinstall S, James M, Krishnan K, Markus HS, Pocock S, Ranta A, Robinson TG, Flaherty K, Scutt P, Venables GS, Woodhouse LJ, Sprigg N. Baseline characteristics of the 3096 patients recruited into the 'Triple Antiplatelets for Reducing Dependency after Ischemic Stroke' trial. Int J Stroke 2016; 12:524-538. [PMID: 27811309 DOI: 10.1177/1747493016677988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The risk of recurrence following ischemic stroke or transient ischemic attack is highest immediately after the event. Antiplatelet agents are effective in reducing the risk of recurrence and two agents are superior to one in the early phase after ictus. Design The triple antiplatelets for reducing dependency after ischemic stroke trial was an international multicenter prospective randomized open-label blinded-endpoint trial that assessed the safety and efficacy of short-term intensive antiplatelet therapy with three agents (combined aspirin, clopidogrel and dipyridamole) as compared with guideline treatment in acute ischemic stroke or transient ischemic attack. The primary outcome was stroke recurrence and its severity, measured using the modified Rankin Scale at 90 days. Secondary outcomes included recurrent vascular events, functional measures (cognition, disability, mood, quality of life), and safety (bleeding, death, serious adverse events). Data are number (%) or mean (standard deviation, SD). Results Recruitment ran from April 2009 to March 2016; 3096 patients were recruited from 106 sites in four countries (Denmark 1.6%, Georgia 2.7%, New Zealand 0.2%, UK 95.4%). Randomization characteristics included: age 69.0 (10.1) years; male 1945 (62.8%); time onset to randomization 29.4 (11.9) h; stroke severity (National Institutes for Health Stroke Scale) 2.8 (3.6); blood pressure 143.5 (18.2)/79.5 (11.4) mmHg; IS 2143 (69.2%), transient ischemic attack 953 (30.8%). Conclusion Triple antiplatelets for reducing dependency after ischemic stroke was a large trial of intensive/triple antiplatelet therapy in acute ischemic stroke and transient ischemic attack, and included participants from four predominantly Caucasian countries who were representative of patients in many western stroke services.
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Affiliation(s)
- Philip Mw Bath
- 1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, UK.,2 Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - Jason P Appleton
- 1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, UK.,2 Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | | | - Hanne Christensen
- 4 Department of Neurology, University of Copenhagen, Copenhagen Bispebjerg and Frederiksberg Hospital, Denmark
| | - Robert A Dineen
- 5 Radiological Sciences Research Group, Division of Clinical Neuroscience, University of Nottingham, Queens Medical Centre Campus, Nottingham, UK
| | - Lelia Duley
- 6 Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Timothy J England
- 7 Vascular Medicine, Division of Medical Sciences & GEM, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - Stan Heptinstall
- 1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, UK
| | - Marilyn James
- 8 Health Economics, Division of Rehabilitation and Ageing, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Kailash Krishnan
- 1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, UK
| | - Hugh S Markus
- 9 Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Stuart Pocock
- 10 Medical Statistics Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Annemarei Ranta
- 11 Department of Neurology, Wellington Hospital and University of Otago, Wellington, New Zealand
| | - Thompson G Robinson
- 12 Department of Cardiovascular Sciences, University of Leicester, Leicester Royal Infirmary, Infirmary Square, and NIHR Cardiovascular Biomedical Unit, The Glenfield Hospital, Leicester, UK
| | - Katie Flaherty
- 1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, UK
| | - Polly Scutt
- 1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, UK
| | - Graham S Venables
- 13 Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Lisa J Woodhouse
- 1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, UK
| | - Nikola Sprigg
- 1 Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, UK.,2 Stroke, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
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Szeszak S, Man R, Love A, Langmack G, Wharrad H, Dineen RA. Animated educational video to prepare children for MRI without sedation: evaluation of the appeal and value. Pediatr Radiol 2016; 46:1744-1750. [PMID: 27568023 DOI: 10.1007/s00247-016-3661-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/06/2016] [Accepted: 06/21/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND MRI scans can be distressing for children and often require sedation. Educating children about what to expect reduces anxiety and increases likelihood of successful non-sedated MRI scans. Multimedia tools are a popular means of education. Animated video could provide a free, accessible method of preparing children for MRI scans. OBJECTIVE To evaluate a new animation video for preparing children for MRI, specifically for decreasing in-scanner motion and examination failure. MATERIALS AND METHODS We recruited 24 healthy children ages 5-11 years. Participants underwent pre- and post-viewing questionnaires and structured interviews. We then compared median Likert scale score changes between pre- and post-animation questions and analyzed the interview framework. Participants were filmed viewing the animation to calculate time spent looking at the screen to assess how well the video retained children's attention. RESULTS There were significant improvements in median scores regarding what to expect, checking for metal and keeping still. There were no significant changes in other knowledge-based topics. There were significant improvements in median scores for anxiety-based topics. On average, children watched the screen for 98.9% of the 174-s animation. CONCLUSION The animation improved knowledge, reduced anxiety, retained attention and was enjoyed by participants. It can be accessed freely via the Internet to help prepare children ages 5-11 for having an MRI scan.
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Affiliation(s)
- Szofia Szeszak
- Radiological Sciences, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK
| | - Rachel Man
- School of Art & Design, Nottingham Trent University, Nottingham, UK
| | - Andrew Love
- School of Art & Design, Nottingham Trent University, Nottingham, UK
| | - Gill Langmack
- Health E-learning and Media group, School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Heather Wharrad
- Health E-learning and Media group, School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Robert A Dineen
- Radiological Sciences, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK. .,Sir Peter Mansfield Imaging Centre, Queen's Medical Centre, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK.
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Welton T, Ather S, Proudlock FA, Gottlob I, Dineen RA. Altered whole-brain connectivity in albinism. Hum Brain Mapp 2016; 38:740-752. [PMID: 27684406 DOI: 10.1002/hbm.23414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 12/15/2022] Open
Abstract
Albinism is a group of congenital disorders of the melanin synthesis pathway. Multiple ocular, white matter and cortical abnormalities occur in albinism, including a greater decussation of nerve fibres at the optic chiasm, foveal hypoplasia and nystagmus. Despite this, visual perception is largely preserved. It was proposed that this may be attributable to reorganisation among cerebral networks, including an increased interhemispheric connectivity of the primary visual areas. A graph-theoretic model was applied to explore brain connectivity networks derived from resting-state functional and diffusion-tensor magnetic resonance imaging data in 23 people with albinism and 20 controls. They tested for group differences in connectivity between primary visual areas and in summary network organisation descriptors. Main findings were supplemented with analyses of control regions, brain volumes and white matter microstructure. Significant functional interhemispheric hyperconnectivity of the primary visual areas in the albinism group were found (P = 0.012). Tests of interhemispheric connectivity based on the diffusion-tensor data showed no significant group difference (P = 0.713). Second, it was found that a range of functional whole-brain network metrics were abnormal in people with albinism, including the clustering coefficient (P = 0.005), although this may have been driven partly by overall differences in connectivity, rather than reorganisation. Based on the results, it was suggested that changes occur in albinism at the whole-brain level, and not just within the visual processing pathways. It was proposed that their findings may reflect compensatory adaptations to increased chiasmic decussation, foveal hypoplasia and nystagmus. Hum Brain Mapp 38:740-752, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Thomas Welton
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Room W/B 1441, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, United Kingdom
| | - Sarim Ather
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Room W/B 1441, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, United Kingdom.,Leicester Royal Infirmary, Ulverscroft Eye Unit, Ophthalmology, University of Leicester, Knighton Street Offices, Leicester, LE2 7LX, United Kingdom
| | - Frank A Proudlock
- Leicester Royal Infirmary, Ulverscroft Eye Unit, Ophthalmology, University of Leicester, Knighton Street Offices, Leicester, LE2 7LX, United Kingdom
| | - Irene Gottlob
- Leicester Royal Infirmary, Ulverscroft Eye Unit, Ophthalmology, University of Leicester, Knighton Street Offices, Leicester, LE2 7LX, United Kingdom
| | - Robert A Dineen
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Room W/B 1441, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, United Kingdom
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55
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Alshuft HM, Condon LA, Dineen RA, Auer DP. Cerebral Cortical Thickness in Chronic Pain Due to Knee Osteoarthritis: The Effect of Pain Duration and Pain Sensitization. PLoS One 2016; 11:e0161687. [PMID: 27658292 PMCID: PMC5033394 DOI: 10.1371/journal.pone.0161687] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/10/2016] [Indexed: 12/27/2022] Open
Abstract
Objective This study investigates associations between cortical thickness and pain duration, and central sensitization as markers of pain progression in painful knee osteoarthritis. Methods Whole brain cortical thickness and pressure pain thresholds were assessed in 70 participants; 40 patients with chronic painful knee osteoarthritis (age = 66.1± 8.5 years, 21 females, mean duration of pain = 8.5 years), and 30 healthy controls (age = 62.7± 7.4, 17 females). Results Cortical thickness negatively correlated with pain duration mainly in fronto-temporal areas outside of classical pain processing areas (p<0.05, age-controlled, FDR corrected). Pain sensitivity was unrelated to cortical thickness. Patients showed lower cortical thickness in the right anterior insula (p<0.001, uncorrected) with no changes surviving multiple test correction. Conclusion With increasing number of years of suffering from chronic arthritis pain we found increasing cortical thinning in extended cerebral cortical regions beyond recognised pain-processing areas. While the mechanisms of cortical thinning remain to be elucidated, we show that pain progression indexed by central sensitization does not play a major role.
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Affiliation(s)
- Hamza M. Alshuft
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, United Kingdom
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Pain Centre, Radiological Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | - Laura A. Condon
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, United Kingdom
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
- Division of Rehabilitation and Aging, the University of Nottingham, Nottingham, United Kingdom
| | - Robert A. Dineen
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Pain Centre, Radiological Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | - Dorothee P. Auer
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, United Kingdom
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Pain Centre, Radiological Sciences, Queen's Medical Centre, Nottingham, United Kingdom
- * E-mail:
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Meng D, Hosseini AA, Simpson RJ, Shaikh Q, Tench CR, Dineen RA, Auer DP. Lesion Topography and Microscopic White Matter Tract Damage Contribute to Cognitive Impairment in Symptomatic Carotid Artery Disease. Radiology 2016; 282:502-515. [PMID: 27598537 PMCID: PMC5283872 DOI: 10.1148/radiol.2016152685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Subcortical disconnection of cognitive neural networks is a key mechanism of cognitive impairment in patients with probable vascular cognitive disorder. Purpose To investigate associations between neuroimaging markers of cerebrovascular disease, including lesion topography and extent and severity of strategic and global cerebral tissue injury, and cognition in carotid artery disease (CAD). Materials and Methods All participants gave written informed consent to undergo brain magnetic resonance imaging and the Addenbrooke’s Cognitive Examination–Revised. One hundred eight patients with symptomatic CAD but no dementia were included, and a score less than 82 represented cognitive impairment. Group comparison and interrelations between global cognitive and fluency performance, lesion topography, and ultrastructural damage were assessed with voxel-based statistics. Associations between cognition, medial temporal lobe atrophy (MTA), lesion volumes, and global white matter ultrastructural damage indexed as increased mean diffusivity were tested with regression analysis by controlling for age. Diagnostic accuracy of imaging markers selected from a multivariate prediction model was tested with receiver operating characteristic analysis. Results Cognitively impaired patients (n = 53 [49.1%], classified as having probable vascular cognitive disorder) were older than nonimpaired patients (P = .027) and had more frequent MTA (P < .001), more cortical infarctions (P = .016), and larger volumes of acute (P = .028) and chronic (P = .009) subcortical ischemic lesions. Lesion volumes did not correlate with global cognitive performance (lacunar infarctions, P = .060; acute lesions, P = .088; chronic subcortical ischemic lesions, P = .085). In contrast, cognitive performance correlated with presence of chronic ischemic lesions within the interhemispheric tracts and thalamic radiation (P < .05, false discovery rate corrected). Skeleton mean diffusivity showed the closest correlation with cognition (R2 = 0.311, P < .001) and promising diagnostic accuracy for vascular cognitive disorder (area under the curve, 0.82 [95% confidence interval: 0.75, 0.90]). Findings were confirmed in subjects with a low risk of preclinical Alzheimer disease indexed by the absence of MTA (n = 85). Conclusion Subcortical white matter ischemic lesion locations and severity of ultrastructural tract damage contribute to cognitive impairment in symptomatic CAD, which suggests that subcortical disconnection within large-scale cognitive neural networks is a key mechanism of vascular cognitive disorder. Online supplemental material is available for this article.
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Affiliation(s)
- Dewen Meng
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Akram A Hosseini
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Richard J Simpson
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Quratulain Shaikh
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Christopher R Tench
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Robert A Dineen
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Dorothee P Auer
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
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57
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Samaraweera APR, Clarke MA, Whitehead A, Falah Y, Driver ID, Dineen RA, Morgan PS, Evangelou N. The Central Vein Sign in Multiple Sclerosis Lesions Is Present Irrespective of the T2* Sequence at 3 T. J Neuroimaging 2016; 27:114-121. [PMID: 27300318 DOI: 10.1111/jon.12367] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous T2*-weighted magnetic resonance imaging (MRI) studies have used white matter lesion (WML) central veins to distinguish multiple sclerosis (MS) from its mimics. To be clinically applicable, the "central vein sign" needs to be detectable across different T2* sequences. Our objective was to determine if the central vein sign is reliably present in MS and absent in patients with ischemic small vessel disease (SVD) across different T2* sequences at 3T MRI. METHODS Ten patients with MS and 10 with SVD were each scanned on a 3 T Philips and GE scanner. The MRI protocol included 3-dimensional (3D) T2* GRE, T2* with high echo planar imaging (EPI) factor and susceptibility-weighted angiography (SWAN). Total WML numbers, central vein numbers, and proportion of WMLs with central veins were calculated using each sequence. Three blinded raters identified a subset of six WMLs with central veins to diagnose MS or SVD. RESULTS Irrespective of the sequence, MS patients were identified based on a higher proportion of WMLs with central veins. This proportion was dependent on the T2* sequence used. T2* with high EPI allowed the highest median proportion (69.6%) in MS patients; 6.1% in SVD patients (P < .0004). Rater reproducibility varied depending on the T2* sequence used. T2* with high EPI produced good agreement with the clinical diagnosis (Cohen's kappa range; .78-.89), as did SWAN imaging with some raters; ĸ = .69. CONCLUSIONS The central vein sign can diagnose MS in the clinical setting of modern 3T scanners. However, variations in the T2* sequences need to be considered when defining a threshold for diagnosis.
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Affiliation(s)
| | - Margareta A Clarke
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Amy Whitehead
- University of Nottingham Medical School, Nottingham, UK
| | - Yasser Falah
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Ian D Driver
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Robert A Dineen
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Paul S Morgan
- Department of Medical Physics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nikos Evangelou
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Krishnan K, Scutt P, Woodhouse L, Adami A, Becker JL, Cala LA, Casado AM, Chen C, Dineen RA, Gommans J, Koumellis P, Christensen H, Collins R, Czlonkowska A, Lees KR, Ntaios G, Ozturk S, Phillips SJ, Sprigg N, Szatmari S, Wardlaw JM, Bath PM. Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial. J Stroke Cerebrovasc Dis 2016; 25:1017-1026. [PMID: 26853137 PMCID: PMC4851456 DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/29/2015] [Accepted: 01/02/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND PURPOSE More than 50% of patients with acute intracerebral hemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH remains unclear, a question that was addressed in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. METHODS ENOS was an international multicenter, prospective, randomized, blinded endpoint trial. Among 629 patients with ICH and systolic blood pressure between 140 and 220 mmHg, 246 patients who were taking antihypertensive drugs were assigned to continue (n = 119) or to stop (n = 127) taking drugs temporarily for 7 days. The primary outcome was the modified Rankin Score at 90 days. Secondary outcomes included death, length of stay in hospital, discharge destination, activities of daily living, mood, cognition, and quality of life. RESULTS Blood pressure level (baseline 171/92 mmHg) fell in both groups but was significantly lower at 7 days in those patients assigned to continue antihypertensive drugs (difference 9.4/3.5 mmHg, P < .01). At 90 days, the primary outcome did not differ between the groups; the adjusted common odds ratio (OR) for worse outcome with continue versus stop drugs was .92 (95% confidence interval, .45-1.89; P = .83). There was no difference between the treatment groups for any secondary outcome measure, or rates of death or serious adverse events. CONCLUSIONS Among patients with acute ICH, immediate continuation of antihypertensive drugs during the first week did not reduce death or major disability in comparison to stopping treatment temporarily.
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Affiliation(s)
- Kailash Krishnan
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Polly Scutt
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Lisa Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Alessandro Adami
- Stroke Centre, Ospedale Sacro Cuore Via Sempreboni, Verona, Italy
| | - Jennifer L Becker
- Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson, Arizona
| | - Lesley A Cala
- School of Pathology and Laboratory Medicine, The University of Western Australia, Nedlands, Australia
| | - Ana M Casado
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom
| | - Christopher Chen
- Department of Pharmacology, National University Hospital of Singapore, Singapore
| | - Robert A Dineen
- Radiological Sciences Research Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - John Gommans
- Department of Medicine, Hawke's Bay Hospital, Hastings, New Zealand
| | - Panos Koumellis
- Department of Neuroradiology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom
| | | | - Ronan Collins
- Stroke Service, Adelaide and Meath Hospital, Dublin, Ireland
| | - Anna Czlonkowska
- Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Kennedy R Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
| | - Serefnur Ozturk
- Department of Neurology, Selcuk University Medical Faculty, Konya, Turkey
| | - Stephen J Phillips
- Division of Neurology, Queen Elizabeth II Health Sciences Centre, and Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Szabolcs Szatmari
- Department of Neurology, Clinical County Emergency Hospital, Targu Mures, Romania
| | - Joanna M Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
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Krishnan K, Scutt P, Woodhouse L, Adami A, Becker JL, Berge E, Cala LA, Casado AM, Caso V, Chen C, Christensen H, Collins R, Czlonkowska A, Dineen RA, Gommans J, Koumellis P, Lees KR, Ntaios G, Ozturk S, Phillips SJ, Pocock SJ, de Silva A, Sprigg N, Szatmari S, Wardlaw JM, Bath PM. Glyceryl Trinitrate for Acute Intracerebral Hemorrhage. Stroke 2016; 47:44-52. [DOI: 10.1161/strokeaha.115.010368] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/26/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Kailash Krishnan
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Polly Scutt
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Lisa Woodhouse
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Alessandro Adami
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Jennifer L. Becker
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Eivind Berge
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Lesley A. Cala
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Ana M. Casado
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Valeria Caso
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Christopher Chen
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Hanna Christensen
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Ronan Collins
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Anna Czlonkowska
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Robert A. Dineen
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - John Gommans
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Panos Koumellis
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Kennedy R. Lees
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - George Ntaios
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Serefnur Ozturk
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Stephen J. Phillips
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Stuart J. Pocock
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Asita de Silva
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Nikola Sprigg
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Szabolcs Szatmari
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Joanna M. Wardlaw
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
| | - Philip M. Bath
- From the Stroke Trials Unit, Division of Clinical Neuroscience (K.K., P.S., L.W., N.S., P.M.B.) and Radiological Sciences Research Group, Division of Clinical Neuroscience (R.A.D.), University of Nottingham, Nottingham, United Kingdom; Stroke Centre, Ospedale Sacro Cuore, Verona, Italy (A.A.); Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson (J.L.B.); Department of Internal Medicine, Oslo University Hospital, Oslo, Norway (E.B.); School of Pathology and
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Dineen RA, Avula S, Chambers T, Dutta M, Liu JF, Soria D, Quilan P, MacArthur D, Howarth S, Harave S, Ong CC, Mallucci C, Kumar R, Pizer B, Walker D. NIMG-70DEVELOPMENT OF A POTENTIAL PRE-OPERATIVE RISK STRATIFICATION TOOL OF CEREBELLAR MUTISM SYNDROME IN CHILDREN WITH POSTERIOR FOSSA TUMOUR - A PRELIMINARY RISK SCORING SCHEME. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov225.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Krishnan K, Mukhtar SF, Lingard J, Houlton A, Walker E, Jones T, Sprigg N, Cala LA, Becker JL, Dineen RA, Koumellis P, Adami A, Casado AM, Bath PMW, Wardlaw JM. Performance characteristics of methods for quantifying spontaneous intracerebral haemorrhage: data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial. J Neurol Neurosurg Psychiatry 2015; 86:1258-66. [PMID: 25575847 PMCID: PMC4680163 DOI: 10.1136/jnnp-2014-309845] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/08/2014] [Indexed: 12/03/2022]
Abstract
BACKGROUND Poor prognosis after intracerebral haemorrhage (ICH) is related to haemorrhage characteristics. Along with developing therapeutic interventions, we sought to understand the performance of haemorrhage descriptors in large clinical trials. METHODS Clinical and neuroimaging data were obtained for 548 participants with ICH from the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Independent observers performed visual categorisation of the largest diameter, measured volume using ABC/2, modified ABC/2, semiautomated segmentation (SAS), fully automatic measurement methods; shape, density and intraventricular haemorrhage were also assessed. Intraobserver and interobserver reliability were determined for these measures. RESULTS ICH volume was significantly different among standard ABC/2, modified ABC/2 and SAS: (mean) 12.8 (SD 16.3), 8.9 (9.2), 12.8 (13.1) cm(3), respectively (p<0.0001). There was excellent agreement for haemorrhage volume (n=193): ABC/2 intraobserver intraclass correlation coefficient (ICC) 0.96-0.97, interobserver ICC 0.88; modified ABC/2 intraobserver ICC 0.95-0.97, interobserver ICC 0.91; SAS intraobserver ICC 0.95-0.99, interobserver ICC 0.93; largest diameter: (visual) interadjudicator ICC 0.82, (visual vs measured) adjudicator vs observer ICC 0.71; shape intraobserver ICC 0.88 interobserver ICC 0.75; density intraobserver ICC 0.86, interobserver ICC 0.73. Graeb score (mean 3.53) and modified Graeb (5.22) scores were highly correlated. Using modified ABC/2, ICH volume was underestimated in regular (by 2.2-2.5 cm(3), p<0.0001) and irregular-shaped haemorrhages (by 4.8-4.9 cm(3), p<0.0001). Fully automated measurement of haemorrhage volume was possible in only 5% of cases. CONCLUSIONS Formal measurement of haemorrhage characteristics and visual estimates are reproducible. The standard ABC/2 method is superior to the modified ABC/2 method for quantifying ICH volume. CLINICAL TRIAL REGISTRATION ISRCTN9941422.
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Affiliation(s)
- Kailash Krishnan
- Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Siti F Mukhtar
- Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - James Lingard
- Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Aimee Houlton
- Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Elizabeth Walker
- Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Tanya Jones
- Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Nikola Sprigg
- Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Lesley A Cala
- School of Pathology and Laboratory Medicine, The University of Western Australia, Nedlands, Australia
| | - Jennifer L Becker
- Department of Medical Imaging, College of Medicine, The University of Arizona, Arizona, USA
| | - Robert A Dineen
- Radiological Sciences Research Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Panos Koumellis
- Department of Neuroradiology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Alessandro Adami
- Stroke Centre, Ospedale Sacro Cuore Via Sempreboni, Verona, Italy
| | - Ana M Casado
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, UK
| | - Philip M W Bath
- Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Joanna M Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, UK
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Abstract
This systematic review aimed to assess the reproducibility of graph-theoretic brain network metrics. Primary research studies of test-retest reliability conducted on healthy human subjects were included that quantified test-retest reliability using either the intraclass correlation coefficient (ICC) or the coefficient of variance. The MEDLINE, Web of Knowledge, Google Scholar, and OpenGrey databases were searched up to February 2014. Risk of bias was assessed with 10 criteria weighted toward methodological quality. Twenty-three studies were included in the review (n=499 subjects) and evaluated for various characteristics, including sample size (5-45), retest interval (<1 h to >1 year), acquisition method, and test-retest reliability scores. For at least one metric, ICCs reached the fair range (ICC 0.40-0.59) in one study, the good range (ICC 0.60-0.74) in five studies, and the excellent range (ICC>0.74) in 16 studies. Heterogeneity of methods prevented further quantitative analysis. Reproducibility was good overall. For the metrics having three or more ICCs reported for both functional and structural networks, six of seven were higher in structural networks, indicating that structural networks may be more reliable over time. The authors were also able to highlight and discuss a number of methodological factors affecting reproducibility.
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Affiliation(s)
- Thomas Welton
- Sir Peter Mansfield Imaging Centre, University of Nottingham , Nottingham, United Kingdom
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Welton T, Kent D, Constantinescu CS, Auer DP, Dineen RA. Functionally relevant white matter degradation in multiple sclerosis: a tract-based spatial meta-analysis. Radiology 2014; 275:89-96. [PMID: 25426773 DOI: 10.1148/radiol.14140925] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To identify statistical consensus between published studies for distribution and functional relevance of tract white matter (WM) degradation in multiple sclerosis (MS). MATERIALS AND METHODS By systematically searching online databases, tract-based spatial statistics studies were identified that compared fractional anisotropy (FA; a marker for WM integrity) in MS patients to healthy control subjects, correlated FA in MS patients with physical disability, or correlated FA in MS patients with cognitive performance. Voxelwise meta-analysis was performed by using the Signed Differential Mapping method for each comparison. Moderating effects of mean age, mean physical disability score, imager magnet strength, lesion load, and number of diffusion directions were assessed by means of meta-regression. RESULTS Meta-analysis was performed on data from 495 patients and 253 control subjects across 12 studies. MS diagnosis was significantly associated with widespread lower tract FA (nine studies; largest cluster, 4379 voxels; z = 7.1; P < .001). Greater physical disability was significantly associated with lower FA in the right posterior cingulum, left callosal splenium, right inferior fronto-occipital fasciculus, and left fornix crus (six studies; 323 voxels; z = 1.7; P = .001). Impaired cognition was significantly associated with lower FA in the callosal genu, thalamus, right posterior cingulum, and fornix crus (seven studies; largest cluster, 980 voxels; z = 2.5; P < .001). CONCLUSION WM damage is widespread in MS with differential and only minimally overlapping distributions of low FA that relates to physical disability and cognitive impairment. The higher number of clusters of lower FA in relation to cognition and their higher z scores suggest that cerebral WM damage may have a greater relevance to cognitive dysfunction than physical disability in MS, and that low anterior callosal and thalamic FA have specific importance to cognitive status.
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Affiliation(s)
- Thomas Welton
- From the Departments of Radiological Sciences (T.W., D.K., D.P.A., R.A.D.) and Clinical Neurology (C.S.C.), Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Derby Rd, Nottingham NG7 2UH, England
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Abstract
Diffusion tensor imaging is increasingly available on clinical magnetic resonance scanners and can be acquired in a relatively short time. There has been an explosion of applications in the research field but the use to the practicing radiologist may seem obscure. This paper aims to highlight how diffusion tensor imaging can be used to prompt a dedicated neuroanatomical search for white matter lesions in clinical presentations relating to motor, sensory, language, and visuospatial deficits. The enhanced depiction of white matter tracts in the temporal stem is also highlighted, which is a region of importance in epilepsy surgery planning.
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Affiliation(s)
- Amy C Gerrish
- Department of Imaging, Leicester Royal Infirmary, Leicester, UK
| | - Adam G Thomas
- Department of Imaging, Leicester Royal Infirmary, Leicester, UK; Department of Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Robert A Dineen
- Department of Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Sprigg N, Renton CJ, Dineen RA, Kwong Y, Bath PMW. Tranexamic acid for spontaneous intracerebral hemorrhage: a randomized controlled pilot trial (ISRCTN50867461). J Stroke Cerebrovasc Dis 2014; 23:1312-8. [PMID: 24680087 DOI: 10.1016/j.jstrokecerebrovasdis.2013.11.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 10/31/2013] [Accepted: 11/05/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) can be devastating, particularly if hematoma expansion (HE) occurs. Tranexamic acid (TA), an antifibrinolytic drug, significantly reduced mortality in bleeding patients after trauma in the large CRASH-2 trial. The CRASH-2 ICH substudy found that TA nonsignificantly reduced mortality and dependency in traumatic ICH. The aim of this study was to assess the feasibility of performing a randomized controlled trial of tranexamic acid in spontaneous ICH, ahead of a definitive study. METHODS We performed a single-center, prospective, randomized (2:1), double-blind, placebo-controlled blinded endpoint trial of TA (intravenous 1 g bolus, 1 g infusion/8 h) in acute (<24 hours) spontaneous ICH. The primary objective was to test the feasibility of recruiting to the trial. Other objectives included tolerability (adverse events) and the effect of TA on HE and death and dependency. RESULTS The trial was feasible, with 24 patients enrolled (TA, n=16; placebo, n=8) between March 2011 and March 2012, and acceptable-only 3 patients declined to participate. All patients received the correct randomized treatment; 1 patient in the TA group did not complete the infusion because of neurologic deterioration. There were no significant differences in secondary outcomes including adverse events, HE, death, and dependency. One patient in the TA group had a deep vein thrombosis . CONCLUSIONS This, the first randomized controlled trial of TA in ICH, found that the protocol could be delivered on schedule (2 patients/mo) and was feasible. Larger studies are needed to assess safety and efficacy of TA in ICH.
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Affiliation(s)
- Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Cheryl J Renton
- Stroke Trials Unit, Division of Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Robert A Dineen
- Stroke Trials Unit, Division of Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Yune Kwong
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Philip M W Bath
- Stroke Trials Unit, Division of Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
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Rodriguez Gutierrez D, Awwad A, Meijer L, Manita M, Jaspan T, Dineen RA, Grundy RG, Auer DP. Metrics and textural features of MRI diffusion to improve classification of pediatric posterior fossa tumors. AJNR Am J Neuroradiol 2013; 35:1009-15. [PMID: 24309122 DOI: 10.3174/ajnr.a3784] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Qualitative radiologic MR imaging review affords limited differentiation among types of pediatric posterior fossa brain tumors and cannot detect histologic or molecular subtypes, which could help to stratify treatment. This study aimed to improve current posterior fossa discrimination of histologic tumor type by using support vector machine classifiers on quantitative MR imaging features. MATERIALS AND METHODS This retrospective study included preoperative MRI in 40 children with posterior fossa tumors (17 medulloblastomas, 16 pilocytic astrocytomas, and 7 ependymomas). Shape, histogram, and textural features were computed from contrast-enhanced T2WI and T1WI and diffusivity (ADC) maps. Combinations of features were used to train tumor-type-specific classifiers for medulloblastoma, pilocytic astrocytoma, and ependymoma types in separation and as a joint posterior fossa classifier. A tumor-subtype classifier was also produced for classic medulloblastoma. The performance of different classifiers was assessed and compared by using randomly selected subsets of training and test data. RESULTS ADC histogram features (25th and 75th percentiles and skewness) yielded the best classification of tumor type (on average >95.8% of medulloblastomas, >96.9% of pilocytic astrocytomas, and >94.3% of ependymomas by using 8 training samples). The resulting joint posterior fossa classifier correctly assigned >91.4% of the posterior fossa tumors. For subtype classification, 89.4% of classic medulloblastomas were correctly classified on the basis of ADC texture features extracted from the Gray-Level Co-Occurence Matrix. CONCLUSIONS Support vector machine-based classifiers using ADC histogram features yielded very good discrimination among pediatric posterior fossa tumor types, and ADC textural features show promise for further subtype discrimination. These findings suggest an added diagnostic value of quantitative feature analysis of diffusion MR imaging in pediatric neuro-oncology.
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Affiliation(s)
- D Rodriguez Gutierrez
- From the Division of Radiological and Imaging Sciences (D.R.G., A.A., M.M., R.A.D., R.G.G., D.P.A.)Children's Brain Tumor Research Centre (D.R.G., L.M., R.G.G., D.P.A.), University of Nottingham, Nottingham, UK
| | - A Awwad
- From the Division of Radiological and Imaging Sciences (D.R.G., A.A., M.M., R.A.D., R.G.G., D.P.A.)Nottingham University Hospital Trust (A.A., L.M., T.J., R.A.D.), Nottingham, UK
| | - L Meijer
- Children's Brain Tumor Research Centre (D.R.G., L.M., R.G.G., D.P.A.), University of Nottingham, Nottingham, UKNottingham University Hospital Trust (A.A., L.M., T.J., R.A.D.), Nottingham, UK
| | - M Manita
- From the Division of Radiological and Imaging Sciences (D.R.G., A.A., M.M., R.A.D., R.G.G., D.P.A.)
| | - T Jaspan
- Nottingham University Hospital Trust (A.A., L.M., T.J., R.A.D.), Nottingham, UK
| | - R A Dineen
- From the Division of Radiological and Imaging Sciences (D.R.G., A.A., M.M., R.A.D., R.G.G., D.P.A.)Nottingham University Hospital Trust (A.A., L.M., T.J., R.A.D.), Nottingham, UK
| | - R G Grundy
- From the Division of Radiological and Imaging Sciences (D.R.G., A.A., M.M., R.A.D., R.G.G., D.P.A.)Children's Brain Tumor Research Centre (D.R.G., L.M., R.G.G., D.P.A.), University of Nottingham, Nottingham, UK
| | - D P Auer
- From the Division of Radiological and Imaging Sciences (D.R.G., A.A., M.M., R.A.D., R.G.G., D.P.A.)
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Affiliation(s)
- S H Wilne
- Department of Paediatric Oncology, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham NG7 2UH, UK
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Abstract
OBJECTIVE To describe the range of intracranial injuries encountered in 0-2-year-olds in cases of accidental head injury where the mechanism of trauma was well characterised and to assess the clinical consequences. DESIGN A retrospective review of imaging and clinical data. SETTING Two tertiary paediatric referral centres. PATIENTS All children aged 0-2 undergoing cranial CT as indicated by National Institute for Health and Clinical Excellence guidance for head injury from 2006 to 2011. After exclusion criteria, 149 patients were included. MAIN OUTCOME MEASURES Rates of skull fracture, intracranial haemorrhage, parenchymal injuries and ischaemic change per type of mechanism of injury. Rates of neurological sequelae on follow-up. RESULTS Skull fractures were demonstrated in 54 (36%) patients of whom 17 (11%) had thin underlying subdural haemorrhage (SDH). Extradural haemorrhage complicated one fracture and two cases of isolated subdural haematomas were seen without skull fracture. Radiologically evident brain parenchymal injuries were present in three patients, all with mechanisms of injury involving high levels of force; severe neurological sequelae were only seen in one patient, who had diffuse hypoxic-ischaemic damage at presentation and whose (accidental) mechanism of injury involved extensive acceleration/deceleration/translational forces. CONCLUSIONS Skull fractures and focal SDH are relatively common following minor trauma in this age group but in the vast majority of cases there are no long-term neurological sequelae. Conversely, diffuse brain injury with severe subsequent neurological impairment was only seen in patients with a correspondingly severe mechanism of injury.
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Affiliation(s)
- A G Thomas
- Radiology Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, , Leicester, UK
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Rodriguez Gutierrez D, Manita M, Jaspan T, Dineen RA, Grundy RG, Auer DP. Serial MR diffusion to predict treatment response in high-grade pediatric brain tumors: a comparison of regional and voxel-based diffusion change metrics. Neuro Oncol 2013; 15:981-9. [PMID: 23585630 PMCID: PMC3714149 DOI: 10.1093/neuonc/not034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Assessment of treatment response by measuring tumor size is known to be a late and potentially confounded response index. Serial diffusion MRI has shown potential for allowing earlier and possibly more reliable response assessment in adult patients, with limited experience in clinical settings and in pediatric brain cancer. We present a retrospective study of clinical MRI data in children with high-grade brain tumors to assess and compare the values of several diffusion change metrics to predict treatment response. METHODS Eighteen patients (age range, 1.9-20.6 years) with high-grade brain tumors and serial diffusion MRI (pre- and posttreatment interval range, 1-16 weeks posttreatment) were identified after obtaining parental consent. The following diffusion change metrics were compared with the clinical response status assessed at 6 months: (1) regional change in absolute and normalized apparent diffusivity coefficient (ADC), (2) voxel-based fractional volume of increased (fiADC) and decreased ADC (fdADC), and (3) a new metric based on the slope of the first principal component of functional diffusion maps (fDM). RESULTS Responders (n = 12) differed significantly from nonresponders (n = 6) in all 3 diffusional change metrics demonstrating higher regional ADC increase, larger fiADC, and steeper slopes (P < .05). The slope method allowed the best response prediction (P < .01, η(2) = 0.78) with a classification accuracy of 83% for a slope of 58° using receiver operating characteristic (ROC) analysis. CONCLUSIONS We demonstrate that diffusion change metrics are suitable response predictors for high-grade pediatric tumors, even in the presence of variable clinical diffusion imaging protocols.
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Abstract
OBJECTIVES Post-stroke neglect is common and an independent predictor of functional outcome. Assessment of neglect is very demanding, the treatment extremely difficult and the literature vast; we performed a literature search for all aspects of this difficult subject. METHODS We searched the PubMed, EMBASE databases and historical manuals for authoritative studies on post stroke neglect between 1951 and 2011. FINDINGS There is a great dearth of randomised controlled data on neglect because standardised assessment does not occur frequently. Eighty-eight manuscripts were identified in the literature, which were quite heterogeneous in their content and addressing diverse aspects of this clinical entity. INTERPRETATION AND IMPLICATIONS The most important historical papers were selected along with the most widely accepted and proven strategies for assessment and treatment. Standardised assessment of neglect does not always occur, but several useful strategies are available and are described in the following sections.
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Affiliation(s)
- C Maxton
- Department of Stroke Medicine, Nottingham University Hospital, Nottingham, UK
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Dineen RA, Bradshaw CM, Constantinescu CS, Auer DP. Extra-hippocampal subcortical limbic involvement predicts episodic recall performance in multiple sclerosis. PLoS One 2012; 7:e44942. [PMID: 23056187 PMCID: PMC3466267 DOI: 10.1371/journal.pone.0044942] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/15/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Episodic memory impairment is a common but poorly-understood phenomenon in multiple sclerosis (MS). We aim to establish the relative contributions of reduced integrity of components of the extended hippocampal-diencephalic system to memory performance in MS patients using quantitative neuroimaging. METHODOLOGY/PRINCIPAL FINDINGS 34 patients with relapsing-remitting MS and 24 healthy age-matched controls underwent 3 T MRI including diffusion tensor imaging and 3-D T1-weighted volume acquisition. Manual fornix regions-of-interest were used to derive fornix fractional anisotropy (FA). Normalized hippocampal, mammillary body and thalamic volumes were derived by manual segmentation. MS subjects underwent visual recall, verbal recall, verbal recognition and verbal fluency assessment. Significant differences between MS patients and controls were found for fornix FA (0.38 vs. 0.46, means adjusted for age and fornix volume, P<.0005) and mammillary body volumes (age-adjusted means 0.114 ml vs. 0.126 ml, P<.023). Multivariate regression analysis identified fornix FA and mammillary bodies as predictor of visual recall (R(2) = .31, P = .003, P = .006), and thalamic volume as predictive of verbal recall (R(2) = .37, P<.0005). No limbic measures predicted verbal recognition or verbal fluency. CONCLUSIONS/SIGNIFICANCE These findings indicate that structural and ultrastructural alterations in subcortical limbic components beyond the hippocampus predict performance of episodic recall in MS patients with mild memory dysfunction.
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Affiliation(s)
- Robert A Dineen
- Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, United Kingdom.
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Abstract
The fornix is a discrete white matter tract bundle that is critical for normal cognitive functioning. Although clearly visualized at magnetic resonance imaging, its involvement in pathologic processes is often overlooked. Certain disease processes show a predilection for involvement of the fornix; in other pathologic conditions, its involvement is a rare but recognized finding. As part of the Papez circuit, it is critical in formation of memory, with damage or disease resulting in anterograde amnesia. Many different pathologic conditions can affect the fornix. Midline tumors such as gliomas or lymphoma can infiltrate it. As part of the limbic system, it may be affected by herpes simplex encephalitis. Involvement by inflammatory conditions such as multiple sclerosis may illustrate its importance in global cognitive function. An appreciation of forniceal atrophy may aid in assessment of mesial temporal sclerosis. Metabolic conditions such as Wernicke encephalopathy have been reported to involve it. The original discoveries of its role in memory arose from surgical trauma, but as a midline structure, it is susceptible to the shearing forces of diffuse axonal injury. Infarction of the fornix is rare but can result in acute amnesic syndromes. Its role in degenerative conditions such as Alzheimer disease and psychiatric conditions such as schizophrenia is a topic of research interest. Recognition of involvement of the fornix by various pathologic processes may aid in explaining the troubling clinical symptoms of amnesia.
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Affiliation(s)
- Adam G Thomas
- Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, England.
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Walker MF, Sunderland A, Fletcher-Smith J, Drummond A, Logan P, Edmans JA, Garvey K, Dineen RA, Ince P, Horne J, Fisher RJ, Taylor JL. The DRESS trial: a feasibility randomized controlled trial of a neuropsychological approach to dressing therapy for stroke inpatients. Clin Rehabil 2011; 26:675-85. [PMID: 22180445 PMCID: PMC3479683 DOI: 10.1177/0269215511431089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate two approaches to treating patients with persistent dressing problems and cognitive difficulties following stroke. DESIGN Pilot randomized controlled trial. SETTING Inpatient stroke rehabilitation service. SUBJECTS Seventy consecutive stroke patients with persistent dressing problems and accompanying cognitive difficulties at two weeks after their stroke. INTERVENTIONS Patients were randomly allocated to six weeks of either a systematic neuropsychological approach, based on analysis of dressing problems and further cognitive testing, or to the control group who received conventional (functional) dressing practice. Both groups received treatment three times a week in accordance with two separately prepared manuals. MAIN MEASURES Nottingham Stroke Dressing Assessment (NSDA), Line Cancellation, 10-hole peg transfer test, Object Decision, Gesture Imitation. Patients were assessed at six weeks after randomization by an independent assessor masked to group allocation. RESULTS Both neuropsychological and functional groups improved performance on the NSDA over the treatment period (31% and 22%, respectively) but there was no significant difference between groups at six weeks. However, the neuropsychological group showed a significantly greater improvement on a line cancellation test of visual neglect (t(62) = 2.1, P < 0.05) and a planned subanalysis for those with right hemisphere damage showed a trend towards better dressing outcome (P = 0.07, one-tailed). CONCLUSIONS Results demonstrate the potential benefits of a systematic neuropsychological approach to dressing therapy, particularly for patients with right hemisphere damage. This study suggests the need for a phase III study evaluating the efficacy of a systematic neuropsychological approach in treating dressing difficulties, targeting patients with right hemisphere stroke and visuospatial impairments.
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Affiliation(s)
- Marion F Walker
- Division of Rehabilitation and Ageing, Community Health Sciences, University of Nottingham, UK.
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McMahon MA, Fenwick A, Banks A, Dineen RA. Prevention of supine hypotensive syndrome in pregnant women undergoing computed tomography – A national survey of current practice. Radiography (Lond) 2009. [DOI: 10.1016/j.radi.2008.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stead RE, Dineen RA, Dua HS, Mathew MRK. Multidetector Computed Tomographic Angiography in Horner Syndrome. Neuroophthalmology 2009. [DOI: 10.1080/01658100802676909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Dineen RA, Vilisaar J, Hlinka J, Bradshaw CM, Morgan PS, Constantinescu CS, Auer DP. Disconnection as a mechanism for cognitive dysfunction in multiple sclerosis. ACTA ACUST UNITED AC 2008; 132:239-49. [PMID: 18953055 DOI: 10.1093/brain/awn275] [Citation(s) in RCA: 274] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Disconnection of cognitively important processing regions by injury to the interconnecting white matter provides a potential mechanism for cognitive dysfunction in multiple sclerosis. The contribution of tract-specific white matter injury to dysfunction in different cognitive domains in patients with multiple sclerosis has not previously been studied. We apply tract-based spatial statistics (TBSS) to diffusion tensor imaging (DTI) in a cohort of multiple sclerosis patients to identify loci where reduced white matter tract fractional anisotropy (FA) predicts impaired performance in cognitive testing. Thirty-seven multiple sclerosis patients in remission (median age 43.5 years; Expanded Disability Status Scale range 1.5-6.5; 35 relapsing remitting, two secondary-progressive) underwent 3 T MRI including high-resolution DTI. Multiple sclerosis patients underwent formal testing of performance in multiple cognitive domains. Normalized cognitive scores were used for voxel-wise statistical analysis using TBSS, while treating age as a covariate of no interest. Permutation-based inference on cluster size (t > 2, P <0.05 corrected) was used to correct for multiple comparisons. Statistical mapping revealed differential patterns of FA reduction for tests of sustained attention, working memory and processing speed, visual working memory and verbal learning and recall. FA was not associated with frontal lobe function or visuospatial perception. Cognitively relevant tract localizations only partially overlapped with areas of high FLAIR lesion probability, confirming the contribution of normal-appearing white matter abnormality to cognitive dysfunction. Of note, tract localizations showing significant associations with cognitive impairment were found to interconnect cortical regions thought to be involved in processing in these cognitive domains, or involve possible compensatory processing pathways. This suggests that TBSS reveals functionally relevant tract injury underlying cognitive dysfunction in patients with multiple sclerosis.
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Affiliation(s)
- R A Dineen
- Department of Academic Radiology, Queen's Medical Centre, University of Nottingham, Nottingham, UK .
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Goode S, Altaf N, Dineen RA, Krishnan S, Auer D. Intraplaque haemorrhage mimicking carotid pseudoaneurysm on magnetic resonance angiography. Br J Radiol 2007; 80:e271-4. [DOI: 10.1259/bjr/35231226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Rutherford GC, Dineen RA, O'Connor A. Imaging in the investigation of paraneoplastic syndromes. Clin Radiol 2007; 62:1021-35. [PMID: 17920860 DOI: 10.1016/j.crad.2007.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 06/04/2007] [Accepted: 06/08/2007] [Indexed: 01/13/2023]
Abstract
Paraneoplastic syndromes are a heterogeneous group of disease presentations caused by underlying tumours. As they are non-metastatic in nature an intensive diagnostic evaluation is warranted to identify potentially curable lesions. The selection of the appropriate method of imaging is important in these cases, especially when history and physical examination are unrevealing. In this review the important paraneoplastic syndromes and underlying malignancies are discussed along with relevant imaging strategies.
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Affiliation(s)
- G-C Rutherford
- Department of Diagnostic Imaging, Queen's Medical Centre, Nottingham UK.
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Dineen RA, Lewis NR, Altaf N. Small bowel infarction complicating rectus sheath haematoma in an anticoagulated patient. Med Sci Monit 2005; 11:CS57-9. [PMID: 16192903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Accepted: 07/22/2005] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND A rectus sheath haematoma is a difficult condition to diagnose and is usually treated by conservative measures. However, significant sized haematomas can result in severe haemodynamic repercussions, especially in those patients with co-morbidities and anticoagulation. CASE REPORT The case reported here is of a 68 year old anticoagulated patient with severe medical co-morbidity who presented with abdominal pain and hypotension. An abdominal CT scan demonstrated a large rectus sheath haematoma and small bowel infarction. The relationship between these two separate causes of an acute abdomen is discussed and imaging findings are illustrated. CONCLUSIONS A careful history and a high index of suspicion are necessary to diagnose a rectus sheath haematoma. Further imaging such as CT may be required and if diagnosed early enough, it should be treated aggressively based on the clinical findings.
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Affiliation(s)
- Robert A Dineen
- Department of Academic Radiology, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
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Dineen RA, Lenthall RK. Aneurysmal sub-arachnoid haemorrhage in patients with Noonan syndrome: a report of two cases and review of neurovascular presentations in this syndrome. Neuroradiology 2004; 46:301-5. [PMID: 15034699 DOI: 10.1007/s00234-004-1185-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Accepted: 02/02/2004] [Indexed: 11/25/2022]
Abstract
To date, intracranial aneurysms have been reported in two patients with Noonan syndrome. We report two unrelated patients with Noonan syndrome who presented with sub-arachnoid haemorrhage secondary to intracranial aneurysms. These cases are discussed and other cerebrovascular abnormalities that have been described in association with Noonan syndrome are reviewed. Ultrastructural and genetic factors contributing to these associations are considered.
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Affiliation(s)
- R A Dineen
- Department of Radiology, University Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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