101
|
Gao P, Gui L, Yang B, Krings T, Jiao L. Optical Coherence Tomography of Spontaneous Basilar Artery Dissection in a Patient With Acute Ischemic Stroke. Front Neurol 2018; 9:858. [PMID: 30459699 PMCID: PMC6232774 DOI: 10.3389/fneur.2018.00858] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
The diagnosis of intracranial arterial dissection (IAD) may be challenging and multimodal imaging techniques are often needed to confirm the diagnosis. Previous studies have based their criteria for diagnosis of IAD on conventional angiography, computed tomography, or magnetic resonance imaging. We report a case with acute ischemic stroke due to spontaneous basilar artery dissection in which intravascular optical coherence tomography (OCT) was used to show features of IAD. A 59-years-old woman presented with symptoms of acute ischemic stroke. Thrombosis related to basilar artery (BA) stenosis was assumed on conventional angiography; however, no clot was retrieved after mechanical thrombectomy (MT) and a restored BA caliber was observed after a rescue recanalization with the detachment of a self-expanding stent was performed. Spontaneous IAD was suspected; however, angiographic findings were ambiguous for confirming IAD. The patient remained symptom-free until 18-months follow-up. At this point, angiography showed restenosis at the proximal tapered length of the stent. In vivo OCT was performed to assess the pathological changes of the restenosis and confirm the diagnosis of IAD.OCT revealed BA dissection with the presence of remnant transverse flap, double lumen and mural hematoma. Imaging at multiple levels identified intimal disruption that originated in the right vertebral artery and extended distally to the BA. The use of intravascular imaging with OCT enabled the accurate diagnosis of IAD. Care should be taken as the procedure may add additional risks to the patient. Future studies are needed to validate the safety of OCT in IAD.
Collapse
Affiliation(s)
- Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqiang Gui
- Department of Neurosurgery, Langfang Changzheng Hospital, Langfang, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Timo Krings
- Division of Neuroradiology, Toronto Western Hospital, Toronto, ON, Canada
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
102
|
Heit JJ, Wintermark M. New developments in clinical ischemic stroke prevention and treatment and their imaging implications. J Cereb Blood Flow Metab 2018; 38:1533-1550. [PMID: 28195500 PMCID: PMC6125964 DOI: 10.1177/0271678x17694046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Acute ischemic stroke results from blockage of a cerebral artery or impaired cerebral blood flow due to cervical or intracranial arterial stenosis. Ischemic stroke prevention seeks to minimize the risk of developing impaired cerebral perfusion by controlling vascular and cardiac disease risk factors. Similarly, ischemic stroke treatment aims to restore cerebral blood flow through recanalization of an occluded artery or dilation of a severely narrowed artery that supplies cerebral tissue. Stroke prevention and treatment are increasingly informed by imaging studies, and neurovascular and cerebral perfusion imaging has become essential in in guiding ischemic stroke prevention and treatment. Here we review the latest advances in ischemic stroke prevention and treatment with an emphasis on the neuroimaging principles emphasized in recent randomized trials. Future research directions that should be explored in ischemic stroke prevention and treatment are also discussed.
Collapse
Affiliation(s)
- Jeremy J Heit
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University Hospital, Stanford, CA, USA
| | - Max Wintermark
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University Hospital, Stanford, CA, USA
| |
Collapse
|
103
|
Al-Sharydah A, Al-Abdulwahhab A, Al-Suhibani S, Al-Issawi W, Al-Safran F. Primary central nervous system vasculitis disguised as tumor-like granulomatous angiitis and multifocal subdural hematomas: A case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2018.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
104
|
Chen CY, Chen SP, Fuh JL, Lirng JF, Chang FC, Wang YF, Wang SJ. Vascular wall imaging in reversible cerebral vasoconstriction syndrome - a 3-T contrast-enhanced MRI study. J Headache Pain 2018; 19:74. [PMID: 30167985 PMCID: PMC6117223 DOI: 10.1186/s10194-018-0906-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/13/2018] [Indexed: 01/03/2023] Open
Abstract
Background Limited histopathology studies have suggested that reversible cerebral vasoconstriction syndromes (RCVS) does not present with vascular wall inflammation. Previous vascular imaging studies have had inconsistent vascular wall enhancement findings in RCVS patients. The aim of this study was to determine whether absence of arterial wall pathology on imaging is a universal finding in patients with RCVS. Methods We recruited patients with RCVS from Taipei Veterans General Hospital prospectively from 2010 to 2012, with follow-up until 2017 (n = 48). We analyzed the characteristics of vascular wall enhancement in these patients without comparisons to a control group. All participants received vascular wall imaging by contrasted T1 fluid-attenuated inversion recovery with a 3-T magnetic resonance machine. The vascular wall enhancement was rated as marked, mild or absent. Results Of 48 patients with RCVS, 22 (45.8%) had vascular wall enhancement (5 marked and 17 mild). Demographics, clinical profiles, and cerebral artery flow velocities were similar across patients with versus without vascular wall enhancement, except that patients with vascular wall enhancement had fewer headache attacks than those without (p = 0.04). Follow-up imaging completed in 14 patients (median interval, 7 months) showed reduced enhancement in 9 patients, but persistent enhancement in 5. Conclusion Almost half of our RCVS patients exhibited imaging enhancement of diseased vessels, and it was persistent for approximately a third of those patients with follow-up imaging. Both acute and persistent vascular wall enhancement may be unhelpful for differentiating RCVS from central nervous system vasculitis or subclinical atherosclerosis.
Collapse
Affiliation(s)
- Chun-Yu Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan. .,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Chi Chang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
105
|
Middle Cerebral Artery Atherosclerosis and Deep Subcortical Infarction: A 3T Magnetic Resonance Vessel Wall Imaging Study. J Stroke Cerebrovasc Dis 2018; 27:3387-3392. [PMID: 30145026 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/31/2018] [Accepted: 08/08/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Deep subcortical infarction is a major subtype of stroke in middle cerebral artery (MCA) territory. This study aims to evaluate the relationship between characteristics of MCA plaque and features of deep subcortical infarction. METHODS Patients with recent acute ischemic stroke and deep subcortical infarction were prospectively enrolled. Both multicontrast brain sequences and 3D high-resolution vessel wall imaging (VWI) sequences were scanned for all patients. MCA plaque characteristics, including plaque presence, location, maximum vessel wall thickness (Max WT), signal intensity and luminal stenosis, and deep subcortical infarction features, including lowest infarct layer index (LILI), area, volume, maximum area, and infarct quantity were evaluated. Infarct feature differences were compared between MCA plaque+ group and MCA plaque- group. The correlations between MCA plaque characteristics and deep subcortical infarction features were analyzed. RESULTS Of all 50 patients included in this study, 30 (60%) had MCA plaques. All deep subcortical infarction was single lesion for patients without MCA plaque. The average number of deep subcortical infarction for patients with MCA plaque was 3.10 ± 4.44. The LILI (P = .036) and infarct quantity (P = .030) showed significant differences between 2 groups. Max WT (P = .025) and stenosis degree (P = .023) were negatively correlated with LILI. Intraplaque hemorrhage was positively correlated with maximum area (P = .029) and infarct volume (P = .030). CONCLUSIONS MCA plaque characteristics were correlated with deep subcortical infarct features. Magnetic resonance VWI may provide more information for etiological evidence of deep subcortical infarction.
Collapse
|
106
|
Park JH, Park KA, Cha J, Kim ST, Chung CS, Lee MJ. A case report of isolated orbital vasculitis mimicking retinal migraine: A potential cause of recurrent transient monocular blindness and ipsilateral headache. Cephalalgia 2018; 39:792-798. [PMID: 30099954 DOI: 10.1177/0333102418794482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Retinal migraine is an important differential diagnosis of recurrent transient monocular blindness accompanied by headache when other etiologies are excluded. Here, we report a case of orbital vasculitis which initially mimicked retinal migraine. CASE REPORT A 47-year-old woman had recurrent episodes of fully reversible transient monocular blindness accompanied by ipsilateral headache for 15 months. The patient's neuroimaging and cardiac and ophthalmologic evaluations were normal. With a diagnosis of retinal migraine, her symptoms remitted in response to prophylactic treatment with topiramate and propranolol for 8 months. Three months after discontinuation of medications, transient monocular blindness recurred. High-resolution vessel wall magnetic resonance imaging revealed enhancement of the ipsilateral orbital vessels. Isolated orbital vasculitis was diagnosed. Complete remission of transient monocular blindness was achieved after steroid pulse therapy. DISCUSSION Isolated orbital vasculitis should be considered in differential diagnosis of recurrent transient monocular blindness and ipsilateral headache. High-resolution vessel wall magnetic resonance imaging can be helpful for the diagnosis.
Collapse
Affiliation(s)
- Ji-Hyung Park
- 1 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- 2 Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihoon Cha
- 3 Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Tae Kim
- 4 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- 1 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,5 Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Mi Ji Lee
- 1 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,5 Neuroscience Center, Samsung Medical Center, Seoul, Korea
| |
Collapse
|
107
|
Van Rooij JLM, Rutgers DR, Spliet WGM, Frijns CJM. Vessel wall enhancement on MRI in the diagnosis of primary central nervous system vasculitis. Int J Stroke 2018; 13:NP24-NP27. [DOI: 10.1177/1747493018789276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Josephus LM Van Rooij
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dirk R Rutgers
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wim GM Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catharina JM Frijns
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
108
|
Mackay MT, Steinlin M. Recent developments and new frontiers in childhood arterial ischemic stroke. Int J Stroke 2018; 14:32-43. [PMID: 30079825 DOI: 10.1177/1747493018790064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review will discuss important developments in childhood arterial ischemic stroke over the past decade, focusing on improved understanding of the causes, consequences, and targets for intervention. Risk factors for childhood arterial ischemic stroke are different to adults. Infections, particularly herpes group viruses, are important precipitants for stroke. Non-atherosclerotic arteriopathies are the most common cause of childhood arterial ischemic stroke and an important predictor of recurrent events. Recent advances include the identification of serum biomarkers for inflammation and endothelial injury, and imaging biomarkers to monitor for vascular progression. Multicenter trials of immunotherapies in focal cerebral arteriopathies are currently in development. Recognition of clinical and radiological phenotypic patterns has facilitated the discovery of multisystem disorders associated with arterial ischemic stroke including ACTA2 arteriopathy and adenosine deaminase 2 deficiency. Identification of these Mendelian disorders provide insights into genetic mechanisms of disease and have implications for medical and surgical management. In contrast to adults, there are long diagnostic delays in childhood arterial ischemic stroke. Refinement of pediatric Code Stroke protocols and clinical decision support tools are essential to improve diagnostic certainty and improve access to reperfusion therapies. Children do not recover better than adults following arterial ischemic stroke, with more than half of survivors having long-term impairments. The physical, cognitive, and behavioral consequences of childhood arterial ischemic stroke are increasingly reported but further research is required to understand their impact on participation, quality of life, psychosocial, and family functioning. Longitudinal studies and the use of advanced imaging techniques, to understand neurobiological correlates of functional reorganization, are essential to developing targeted intervention strategies to facilitate recovery.
Collapse
Affiliation(s)
- Mark T Mackay
- 1 Department of Neurology, Royal Children's Hospital, Parkville, Australia.,2 Murdoch Children's Research Institute, Parkville, Australia.,3 Department of Paediatrics, University of Melbourne, Parkville, Australia.,4 Florey Institute of Neurosciences and Mental Health, Parkville, Australia
| | - Maja Steinlin
- 5 Division of Paediatric Neurology, Development and Rehabilitation, University Children's Hospital, Bern, Switzerland.,6 Department of Paediatrics, University of Bern, Bern, Switzerland
| |
Collapse
|
109
|
Beuker C, Schmidt A, Strunk D, Sporns PB, Wiendl H, Meuth SG, Minnerup J. Primary angiitis of the central nervous system: diagnosis and treatment. Ther Adv Neurol Disord 2018; 11:1756286418785071. [PMID: 30034536 PMCID: PMC6048610 DOI: 10.1177/1756286418785071] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/02/2018] [Indexed: 12/16/2022] Open
Abstract
Primary angiitis of the central nervous system (PACNS) represents a rare
inflammatory disease affecting the brain and spinal cord. Stroke,
encephalopathy, headache and seizures are major clinical manifestations. The
diagnosis of PACNS is based on the combination of clinical presentation, imaging
findings (magnetic resonance imaging and angiography), brain biopsy, and
laboratory and cerebral spinal fluid (CSF) values. PACNS can either be confirmed
by magnetic resonance angiography (MRA)/conventional angiography or tissue
biopsy showing the presence of typical histopathological patterns.
Identification of PACNS mimics is often challenging in clinical practice, but
crucial to avoid far-reaching treatment decisions. In view of the severity of
the disease, with considerable morbidity and mortality, early recognition and
treatment initiation is necessary. Due to the rareness and heterogeneity of the
disease, there is a lack of randomized data on treatment strategies.
Retrospective studies suggest the combined administration of cyclophosphamide
and glucocorticoids as induction therapy. Immunosuppressants such as
azathioprine, methotrexate or mycophenolate mofetil are often applied for
maintenance therapy. In addition, the beneficial effects of two biological
agents (anti-CD20 monoclonal antibody rituximab and tumour necrosis factor-α
blocker) have been reported. Nevertheless, diagnosis and treatment is still a
clinical challenge, and further insights into the immunopathogenesis of PACNS
are required to improve the diagnosis and management of patients. The present
review provides a comprehensive overview of diagnostics, differential diagnoses,
and therapeutic approaches of adult PACNS.
Collapse
Affiliation(s)
- Carolin Beuker
- Department of Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, D-48149, Germany
| | - Antje Schmidt
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Daniel Strunk
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Peter B Sporns
- Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Jens Minnerup
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| |
Collapse
|
110
|
Bang OY, Toyoda K, Arenillas JF, Liu L, Kim JS. Intracranial Large Artery Disease of Non-Atherosclerotic Origin: Recent Progress and Clinical Implications. J Stroke 2018; 20:208-217. [PMID: 29886713 PMCID: PMC6007295 DOI: 10.5853/jos.2018.00150] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/15/2018] [Accepted: 03/18/2018] [Indexed: 12/18/2022] Open
Abstract
Intracranial large artery disease (ILAD) is the major cause of stroke worldwide. With the application of recently introduced diagnostic techniques, the prevalence of non-atherosclerotic ILAD is expected to increase. Herein, we reviewed recent reports and summarized progress in the diagnosis and clinical impact of differentiation between ILAD of atherosclerotic and non-atherosclerotic origin. Our review of the literature suggests that more careful consideration of non-atherosclerotic causes and the application of appropriate diagnostic techniques in patients with ILAD may not only provide better results in the treatment of patients, but it may also lead to more successful clinical trials for the treatment of intracranial atherosclerosis.
Collapse
Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Juan F Arenillas
- Department of Neurology, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
111
|
Lindenholz A, Harteveld AA, Zwanenburg JJM, Siero JCW, Hendrikse J. Comparison of 3T Intracranial Vessel Wall MRI Sequences. AJNR Am J Neuroradiol 2018; 39:1112-1120. [PMID: 29674412 DOI: 10.3174/ajnr.a5629] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 02/17/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial vessel wall MR imaging plays an increasing role in diagnosing intracranial vascular diseases. For a complete assessment, pre- and postcontrast sequences are required, and including other sequences, these result in a long scan duration. Ideally, the scan time of the vessel wall sequence should be reduced. The purpose of this study was to evaluate different intracranial vessel wall sequence variants to reduce scan duration, provided an acceptable image quality can be maintained. MATERIALS AND METHODS Starting from the vessel wall sequence that we use clinically (6:42 minutes), 6 scan variants were tested (scan duration ranging between 4:39 and 8:24 minutes), creating various trade-offs among spatial resolution, SNR, and contrast-to-noise ratio. In total, 15 subjects were scanned on a 3T MR imaging scanner: In 5 subjects, all 7 variants were performed precontrast-only, and in 10 other subjects, the fastest variant (4:39 minutes) and our clinically used variant (6:42 minutes) were performed pre- and postcontrast. RESULTS The fastest variant (4:39 minutes) had higher or comparable SNRs/contrast-to-noise ratios of the intracranial vessel walls compared with the reference sequence (6:42 minutes). Qualitative assessment showed that the contrast-to-noise ratio was most suppressed in the fastest variant of 4:39 minutes and the variant of 6:42 minutes pre- and postcontrast. SNRs/contrast-to-noise ratios of the fastest variant were all, except one, higher compared with the variant of 6:42 minutes (P < .008). Furthermore, the fastest variant (4:39 minutes) detected all vessel wall lesions identified on the 6:42-minute variant. CONCLUSIONS A 30% faster vessel wall sequence was developed with high SNRs/contrast-to-noise ratios that resulted in good visibility of the intracranial vessel wall.
Collapse
Affiliation(s)
- A Lindenholz
- From the Department of Radiology (A.L., A.A.H., J.J.M.Z., J.C.W.S., J.H.) University Medical Center Utrecht, Utrecht, the Netherlands
| | - A A Harteveld
- From the Department of Radiology (A.L., A.A.H., J.J.M.Z., J.C.W.S., J.H.) University Medical Center Utrecht, Utrecht, the Netherlands
| | - J J M Zwanenburg
- From the Department of Radiology (A.L., A.A.H., J.J.M.Z., J.C.W.S., J.H.) University Medical Center Utrecht, Utrecht, the Netherlands
| | - J C W Siero
- From the Department of Radiology (A.L., A.A.H., J.J.M.Z., J.C.W.S., J.H.) University Medical Center Utrecht, Utrecht, the Netherlands.,Spinoza Center for Neuroimaging (J.C.W.S.), Amsterdam, the Netherlands
| | - J Hendrikse
- From the Department of Radiology (A.L., A.A.H., J.J.M.Z., J.C.W.S., J.H.) University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
112
|
Xue S, Cheng W, Wang W, Song X, Wu J, Song H. The association between the ring finger protein 213 gene R4810K variant and intracranial major artery stenosis/occlusion in the Han Chinese population and high-resolution magnetic resonance imaging findings. Brain Circ 2018; 4:33-39. [PMID: 30276334 PMCID: PMC6057703 DOI: 10.4103/bc.bc_9_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 03/08/2018] [Accepted: 03/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE: The ring finger protein 213 (RNF213) gene R4810K variant, a susceptibility locus for moyamoya disease (MMD), has recently been identified to be associated with intracranial major artery stenosis/occlusion (ICASO) without satisfying the diagnostic criteria of MMD in the Japanese population. However, further studies are needed to determine whether this variant is associated with ICASO in other populations and whether R4810K variant-related ICASO could be categorized as MMD. The aim of this study is to elucidate whether the R4810K variant was associated with ICASO among the Han Chinese population and potential histopathology of R4810K variant-related ICASO. MATERIALS AND METHODS: We conducted a case–control study to evaluate association and performed high-resolution (HR) magnetic resonance imaging (MRI) to investigate arterial wall feature of ICASO. The R4810K variant was genotyped in 114 ICASO patients and 268 controls. Then, patients with R4810K variant-related ICASO were subjected to HR MRI examination and presumptively diagnosed based on the characteristics thus observed. STATISTICAL ANALYSIS: The relationship between R4810K variant and ICASO was evaluated by Fisher's exact test with odds ratios (OR) and 95% confidence interval (CI). RESULTS: The R4810K variant was associated with ICASO and increased the risk for ICASO (P < 0.01; OR: 20.2; 95% CI: 2.5–163.11). Presumptive MMD was diagnosed in all female patients with R4810K variant. However, presumptive intracranial atherosclerotic stenosis was diagnosed in one of three males harboring this variant. CONCLUSIONS: The R4810K variant is a genetic risk factor for ICASO among the Han Chinese population and that R4810K variant-related ICASO should be identified as MMD in female but not uncertain in male patients.
Collapse
Affiliation(s)
- Sufang Xue
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Weiyang Cheng
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wanqian Wang
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| |
Collapse
|
113
|
Shi Z, Zhu C, Degnan AJ, Tian X, Li J, Chen L, Zhang X, Peng W, Chen C, Lu J, Jiang T, Saloner D, Liu Q. Identification of high-risk plaque features in intracranial atherosclerosis: initial experience using a radiomic approach. Eur Radiol 2018; 28:3912-3921. [PMID: 29633002 PMCID: PMC6081255 DOI: 10.1007/s00330-018-5395-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate a quantitative radiomic approach based on high-resolution magnetic resonance imaging (HR-MRI) to differentiate acute/sub-acute symptomatic basilar artery plaque from asymptomatic plaque. METHODS Ninety-six patients with basilar artery stenosis underwent HR-MRI between January 2014 and December 2016. Patients were scanned with T1- and T2-weighted imaging, as well as T1 imaging following gadolinium-contrast injection (CE-T1). The stenosis value, plaque area/burden, lumen area, minimal luminal area (MLA), intraplaque haemorrhage (IPH), contrast enhancement ratio and 94 quantitative radiomic features were extracted and compared between acute/sub-acute and asymptomatic patients. Multi-variate logistic analysis and a random forest model were used to evaluate the diagnostic performance. RESULTS IPH, MLA and enhancement ratio were independently associated with acute/subacute symptoms. Radiomic features in T1 and CE-T1 images were associated with acute/subacute symptoms, but the features from T2 images were not. The combined IPH, MLA and enhancement ratio had an area under the curve (AUC) of 0.833 for identifying acute/sub-acute symptomatic plaques, and the combined T1 and CE-T1 radiomic approach had a significantly higher AUC of 0.936 (p = 0.01). Combining all features achieved an AUC of 0.974 and accuracy of 90.5%. CONCLUSIONS Radiomic analysis of plaque texture on HR-MRI accurately distinguished between acutely symptomatic and asymptomatic basilar plaques. KEY POINTS • High-resolution magnetic resonance imaging can assess basilar artery atherosclerotic plaque. • Radiomic features in T1 and CE-T1 images are associated with acute symptoms. • Radiomic analysis can accurately distinguish between acute symptomatic and asymptomatic plaque. • The highest accuracy may be achieved by combining radiomic and conventional features.
Collapse
Affiliation(s)
- Zhang Shi
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Andrew J Degnan
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Xia Tian
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Jing Li
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Luguang Chen
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Xuefeng Zhang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Wenjia Peng
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Chao Chen
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Tao Jiang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - David Saloner
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Qi Liu
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
| |
Collapse
|
114
|
Dlamini N, Yau I, Muthusami P, Mikulis DJ, Elbers J, Slim M, Askalan R, MacGregor D, deVeber G, Shroff M, Moharir M. Arterial Wall Imaging in Pediatric Stroke. Stroke 2018; 49:891-898. [DOI: 10.1161/strokeaha.117.019827] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/02/2018] [Accepted: 01/25/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Nomazulu Dlamini
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| | - Ivanna Yau
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| | - Prakash Muthusami
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| | - David J. Mikulis
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| | - Jorina Elbers
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| | - Mahmoud Slim
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| | - Rand Askalan
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| | - Daune MacGregor
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| | - Gabrielle deVeber
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| | - Manohar Shroff
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| | - Mahendranath Moharir
- From the Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON (N.D., I.Y., M.S., R.A., D.M., G.d.V., M.M.); Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (P.M., M.S.); Department of Diagnostic Imaging, Toronto Western Hospital, ON (D.M.); and Division of Neurology, Lucile Packard Children’s Hospital Stanford, CA (J.E.)
| |
Collapse
|
115
|
ACR Appropriateness Criteria ® Cerebrovascular Disease. J Am Coll Radiol 2018; 14:S34-S61. [PMID: 28473091 DOI: 10.1016/j.jacr.2017.01.051] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 11/23/2022]
Abstract
Diseases of the cerebral vasculature represent a heterogeneous group of ischemic and hemorrhagic etiologies, which often manifest clinically as an acute neurologic deficit also known as stroke or less commonly with symptoms such as headache or seizures. Stroke is the fourth leading cause of death and is a leading cause of serious long-term disability in the United States. Eighty-seven percent of strokes are ischemic, 10% are due to intracerebral hemorrhage, and 3% are secondary to subarachnoid hemorrhage. The past two decades have seen significant developments in the screening, diagnosis, and treatment of ischemic and hemorrhagic causes of stroke with advancements in CT and MRI technology and novel treatment devices and techniques. Multiple different imaging modalities can be used in the evaluation of cerebrovascular disease. The different imaging modalities all have their own niches and their own advantages and disadvantages in the evaluation of cerebrovascular disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
|
116
|
De Cocker LJ, Lindenholz A, Zwanenburg JJ, van der Kolk AG, Zwartbol M, Luijten PR, Hendrikse J. Clinical vascular imaging in the brain at 7T. Neuroimage 2018; 168:452-458. [PMID: 27867089 PMCID: PMC5862656 DOI: 10.1016/j.neuroimage.2016.11.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/30/2016] [Accepted: 11/16/2016] [Indexed: 01/23/2023] Open
Abstract
Stroke and related cerebrovascular diseases are a major cause of mortality and disability. Even at standard-field-strengths (1.5T), MRI is by far the most sensitive imaging technique to detect acute brain infarctions and to characterize incidental cerebrovascular lesions, such as white matter hyperintensities, lacunes and microbleeds. Arterial time-of-flight (TOF) MR angiography (MRA) can depict luminal narrowing or occlusion of the major brain feeding arteries, and this without the need for contrast administration. Compared to 1.5T MRA, the use of high-field strength (3T) and even more so ultra-high-field strengths (7T), enables the visualization of the lumen of much smaller intracranial vessels, while adding a contrast agent to TOF MRA at 7T may enable the visualization of even more distal arteries in addition to veins and venules. Moreover, with 3T and 7T, the arterial vessel walls beyond the circle of Willis become visible with high-resolution vessel wall imaging. In addition, with 7T MRI, the brain parenchyma can now be visualized on a submillimeter scale. As a result, high-resolution imaging studies of the brain and its blood supply at 7T have generated new concepts of different cerebrovascular diseases. In the current article, we will discuss emerging clinical applications and future directions of vascular imaging in the brain at 7T MRI.
Collapse
Affiliation(s)
- Laurens Jl De Cocker
- Department of Radiology, University Medical Center Utrecht, The Netherlands; Department of Radiology, Kliniek Sint-Jan, Brussels, Belgium.
| | - Arjen Lindenholz
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Jaco Jm Zwanenburg
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | | | - Maarten Zwartbol
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| |
Collapse
|
117
|
Ide S, Kakeda S, Miyata M, Iwata S, Ohkubo N, Nakayamada S, Futatsuya K, Watanabe K, Moriya J, Fujino Y, Tanaka Y, Korogi Y. Intracranial vessel wall lesions in patients with systematic lupus erythematosus. J Magn Reson Imaging 2018; 48:1237-1246. [DOI: 10.1002/jmri.25966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Satoru Ide
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Shingo Kakeda
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Mari Miyata
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Shigeru Iwata
- University of Occupational and Environmental Health School of Medicine, First Department of Internal Medicine; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Naoaki Ohkubo
- University of Occupational and Environmental Health School of Medicine, First Department of Internal Medicine; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Shingo Nakayamada
- University of Occupational and Environmental Health School of Medicine, First Department of Internal Medicine; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Koichiro Futatsuya
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Keita Watanabe
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Junji Moriya
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Yoshihisa Fujino
- University of Occupational and Environmental Health School of Medicine, Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Yoshiya Tanaka
- University of Occupational and Environmental Health School of Medicine, First Department of Internal Medicine; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| | - Yukunori Korogi
- University of Occupational and Environmental Health School of Medicine, Department of Radiology; Yahatanishi-ku Kitakyushu-shi Fukuoka Japan
| |
Collapse
|
118
|
Tan HW, Chen X, Maingard J, Barras CD, Logan C, Thijs V, Kok HK, Lee MJ, Chandra RV, Brooks M, Asadi H. Intracranial Vessel Wall Imaging with Magnetic Resonance Imaging: Current Techniques and Applications. World Neurosurg 2018; 112:186-198. [PMID: 29360586 DOI: 10.1016/j.wneu.2018.01.083] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 11/19/2022]
Abstract
Vessel wall magnetic resonance imaging (VW-MRI) is a modern imaging technique with expanding applications in the characterization of intracranial vessel wall pathology. VW-MRI provides added diagnostic capacity compared with conventional luminal imaging methods. This review explores the principles of VW-MRI and typical imaging features of various vessel wall pathologies, such as atherosclerosis, dissection, and vasculitis. Radiologists should be familiar with this important imaging technique, given its increasing use and future relevance to everyday practice.
Collapse
Affiliation(s)
- Haur Wey Tan
- Department of Radiology, Austin Hospital, Melbourne, Australia.
| | - Xiao Chen
- Department of Radiology, Austin Hospital, Melbourne, Australia
| | - Julian Maingard
- Department of Radiology, Austin Hospital, Melbourne, Australia; Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Christen D Barras
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom; The South Australian Health and Medical Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Vincent Thijs
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Hong Kuan Kok
- Department of Interventional Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland; Interventional Radiology Service, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons Ireland, Dublin, Ireland
| | - Ronil V Chandra
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia; Department of Imaging, Monash University, Melbourne, Victoria, Australia
| | - Mark Brooks
- Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Department of Radiology, Interventional Neuroradiology Service, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hamed Asadi
- Department of Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia; Faculty of Health, School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| |
Collapse
|
119
|
Gao BL, Li ZS, Li TX, Xue JY, Feng G, Wang ZL, Bai WX, Zhao TY, Liang XD. Endovascular Treatment of Intracranial Aneurysms Concomitant with Severe Adjacent Atherosclerotic Stenosis. World Neurosurg 2018; 111:e927-e932. [PMID: 29325952 DOI: 10.1016/j.wneu.2018.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/31/2017] [Accepted: 01/04/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the effect and safety of endovascular treatment of intracranial aneurysms concomitant with severe adjacent atherosclerotic stenosis. MATERIALS AND METHODS Twenty-six patients with aneurysms and adjacent stenosis were prospectively enrolled. The characteristics of the aneurysm, parent artery, atherosclerotic stenosis and endovascular treatment methods were analyzed. RESULTS All aneurysms were successfully embolized (100%), with stent-assisted coiling in 14 (53.8%) cases, coiling alone in 10 (38.5%), double microcatheter coiling in 1 (3.8%), and balloon-assisted coiling in the remaining 1 (3.8%). Immediately after embolization, complete occlusion was achieved in 10 cases (38.5%), nearly complete occlusion in 6 (23.1%) and non-complete occlusion in 10 (38.5%). Ten aneurysms were type I and were managed with coiling alone in 8 cases and stent-assisted coiling in the remaining 2 cases, with complete occlusion achieved in 6 cases (60%), nearly complete in 2 (20%), and noncomplete in the other 2 (20%). Sixteen aneurysms were type II and treated with stent-assisted coiling in 12 cases (75%), single coiling in 2 (12.5%), double microcatheters in 1 (6.3%), and balloon-assisted coiling in the remaining aneurysm (6.3%). Aneurysm occlusion was complete in 4 cases (25%), nearly complete in 4 (25%), and noncomplete in the other 8 (50%). Clinical follow-up of 2 months to 5 years (mean 26 ± 11 months) demonstrated no rebleeding, with the modified Rankin scale score of 0-2 in 20 patients, 3 in 4, and 6 in the remaining 2. CONCLUSIONS Intracranial aneurysms concomitant with severe adjacent atherosclerotic stenosis can be successfully treated endovascularly, and careful evaluation of the characteristics of the aneurysm, parent artery, stenosis and collateral circulation can help reducing complications.
Collapse
Affiliation(s)
- Bu-Lang Gao
- Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, PR China
| | - Zhao-Shuo Li
- Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, PR China
| | - Tian-Xiao Li
- Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, PR China.
| | - Jiang-Yu Xue
- Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, PR China
| | - Guang Feng
- Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, PR China
| | - Zi-Liang Wang
- Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, PR China
| | - Wei-Xing Bai
- Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, PR China
| | - Tong-Yuan Zhao
- Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, PR China
| | - Xiao-Dong Liang
- Henan Provincial People's Hospital and Zhengzhou University People's Hospital, Zhengzhou, PR China
| |
Collapse
|
120
|
Zhu Z, Xu Y, Wang Y, Zhou Z, Han X, Liu A, Peng J, Xu Y, Wang L. Chinese Cervicocephalic artery dissection study (CCADS): rationale and protocol for a multicenter prospective cohort study. BMC Neurol 2018; 18:6. [PMID: 29325539 PMCID: PMC5765701 DOI: 10.1186/s12883-018-1011-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cervicocephalic artery dissection (CAD) is an important etiology of stroke in the youth. Findings from recent studies suggest it a “group of disease entities” with different underlying etiologies, presentations and prognosis, necessitating an integral study including various types of CAD to get a better understanding of this disease. In addition, Chinese patients with CAD are likely to carry different features from their western counterparts, which remains uncertain yet. Chinese Cervicocephalic Artery Dissection Study (CCADS) therefore aims at exploring the epidemiology, risk factors, clinical/radiological features, diagnosis and prognosis of CAD in Chinese patients. Methods/design CCADS is a multicenter prospective cohort study enrolling patients age ≥ 18 years with recent (<14 days after onset) CAD. Baseline clinical data, laboratory tests and imaging studies are performed within 3 days after admission, and follow-ups will be conducted through face-to-face interviews at discharge, 3 months, 6 months and 12 months after admission, when the modified Rankin Scale (mRS), cerebrovascular events, medication compliance, CAD evolution and so on are evaluated. Additional blood samples will also be collected at baseline, 3 and 12 months follow-up. The primary outcome is radiographic evolution of CAD; secondary outcomes include cerebrovascular events, major bleeding complications, all-cause mortality and functional independence. Discussion Through the integration of information on epidemiology, risk factors, clinical/radiological features and prognosis of various types of CAD in Chinese population, combined with the application of advanced imaging techniques, collection of potential blood biomarkers, and assessment of novel treatment strategies. CCADS will provide thorough information on CAD - the major cause of stroke in the youth, and play a role in prevention and treatment determination in the future. Electronic supplementary material The online version of this article (10.1186/s12883-018-1011-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Zhu Zhu
- Department of Neurology, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyuan Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zhenhua Zhou
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiang Han
- Department of Neurology, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jing Peng
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yi Xu
- Department of Neurology, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Luyao Wang
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| |
Collapse
|
121
|
Lindenholz A, van der Kolk AG, Zwanenburg JJM, Hendrikse J. The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It. Radiology 2018; 286:12-28. [DOI: 10.1148/radiol.2017162096] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Arjen Lindenholz
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Anja G. van der Kolk
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Jaco J. M. Zwanenburg
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology, Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3508GA Utrecht, the Netherlands
| |
Collapse
|
122
|
Lants SK, Watchmaker JM, Juttukonda MR, Davis LT, Donahue MJ, Fusco MR. Treatment of Progressive Herpes Zoster-Induced Vasculopathy with Surgical Revascularization: Effects on Cerebral Hemodynamics. World Neurosurg 2017; 111:132-138. [PMID: 29274451 DOI: 10.1016/j.wneu.2017.12.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Herpes zoster ophthalmicus (HZO) is caused by reactivation of the herpes simplex virus in the trigeminal nerve. HZO-initiated cerebral vasculopathy is well characterized; however, there are no documented cases that report the efficacy of surgical revascularization for improving cerebral hemodynamics following progressive HZO-induced vasculopathy. We present a case in which quantitative anatomic and hemodynamic imaging were performed longitudinally before and after surgical revascularization in a patient with HZO and vasculopathic changes. CASE DESCRIPTION A 57-year-old female with history of right-sided HZO presented with left-sided hemiparesis and dysarthria and multiple acute infarcts. Angiography performed serially over a 2-month duration revealed progressive middle cerebral artery stenosis, development of new moyamoya-like lenticulostriate collaterals, and evidence of fibromuscular dysplasia in cervical portions of the internal carotid artery. Hemodynamic imaging revealed right hemisphere decreased blood flow and cerebrovascular reserve capacity. In addition to medical therapy, right-sided surgical revascularization was performed with the intent to reestablish blood flow. Follow-up imaging 13 months post revascularization demonstrated improved blood flow and vascular reserve capacity in the operative hemisphere, which paralleled symptom resolution. CONCLUSIONS HZO can lead to progressive, symptomatic intracranial stenoses. This report suggests that surgical revascularization techniques can improve cerebral hemodynamics and symptomatology in patients with aggressive disease when medical management is unsuccessful; similar procedures could be considered in managing HZO patients with advanced or progressive vasculopathy.
Collapse
Affiliation(s)
- Sarah K Lants
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Jennifer M Watchmaker
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Meher R Juttukonda
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Larry T Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, USA
| | - Matthew R Fusco
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
123
|
Mackay MT, Monagle P, Babl FE. Improving diagnosis of childhood arterial ischaemic stroke. Expert Rev Neurother 2017; 17:1157-1165. [DOI: 10.1080/14737175.2017.1395699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mark T. Mackay
- Department of Neurology, Royal Children’s Hospital, Parkville, Australia
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Florey Institute of Neurosciences and Mental Health, Parkville, Australia
| | - Paul Monagle
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Haematology, Royal Children’s Hospital, Parkville, Australia
| | - Franz E. Babl
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Emergency Department, Royal Children’s Hospital Melbourne, Parkville, Australia
| |
Collapse
|
124
|
Chinese specialist consensus on imaging diagnosis of intracranial arterial dissection. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-017-0095-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
125
|
Mossa-Basha M, Shibata DK, Hallam DK, de Havenon A, Hippe DS, Becker KJ, Tirschwell DL, Hatsukami T, Balu N, Yuan C. Added Value of Vessel Wall Magnetic Resonance Imaging for Differentiation of Nonocclusive Intracranial Vasculopathies. Stroke 2017; 48:3026-3033. [PMID: 29030476 DOI: 10.1161/strokeaha.117.018227] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/08/2017] [Accepted: 09/18/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Our goal is to determine the added value of intracranial vessel wall magnetic resonance imaging (IVWI) in differentiating nonocclusive vasculopathies compared with luminal imaging alone. METHODS We retrospectively reviewed images from patients with both luminal and IVWI to identify cases with clinically defined intracranial vasculopathies: atherosclerosis (intracranial atherosclerotic disease), reversible cerebral vasoconstriction syndrome, and inflammatory vasculopathy. Two neuroradiologists blinded to clinical data reviewed the luminal imaging of defined luminal stenoses/irregularities and evaluated the pattern of involvement to make a presumed diagnosis with diagnostic confidence. Six weeks later, the 2 raters rereviewed the luminal imaging in addition to IVWI for the pattern of wall involvement, presence and pattern of postcontrast enhancement, and presumed diagnosis and confidence. Analysis was performed on per-lesion and per-patient bases. RESULTS Thirty intracranial atherosclerotic disease, 12 inflammatory vasculopathies, and 12 reversible cerebral vasoconstriction syndrome patients with 201 lesions (90 intracranial atherosclerotic disease, 64 reversible cerebral vasoconstriction syndrome, and 47 inflammatory vasculopathy lesions) were included. For both per-lesion and per-patient analyses, there was significant diagnostic accuracy improvement with luminal imaging+IVWI when compared with luminal imaging alone (per-lesion: 88.8% versus 36.1%; P<0.001 and per-patient: 96.3% versus 43.5%; P<0.001, respectively). There was substantial interrater diagnostic agreement for luminal imaging+IVWI (κ=0.72) and only slight agreement for luminal imaging (κ=0.04). Although there was a significant correlation for both luminal and IVWI pattern of wall involvement with diagnosis, there was a stronger correlation for IVWI finding of lesion eccentricity and intracranial atherosclerotic disease diagnosis than for luminal imaging (κ=0.69 versus 0.18; P<0.001). CONCLUSIONS IVWI can significantly improve the differentiation of nonocclusive intracranial vasculopathies when combined with traditional luminal imaging modalities.
Collapse
Affiliation(s)
- Mahmud Mossa-Basha
- From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.).
| | - Dean K Shibata
- From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.)
| | - Danial K Hallam
- From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.)
| | - Adam de Havenon
- From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.)
| | - Daniel S Hippe
- From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.)
| | - Kyra J Becker
- From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.)
| | - David L Tirschwell
- From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.)
| | - Thomas Hatsukami
- From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.)
| | - Niranjan Balu
- From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.)
| | - Chun Yuan
- From the Department of Radiology (M.M.-B., D.K.S., D.K.H., D.S.H., N.B., C.Y.), Department of Neurology (K.J.B., D.L.T.), and Department of Surgery (T.H.), University of Washington, Seattle; and Department of Neurology, University of Utah, Salt Lake City (A.D.H.)
| |
Collapse
|
126
|
Wintermark M, Hills NK, DeVeber GA, Barkovich AJ, Bernard TJ, Friedman NR, Mackay MT, Kirton A, Zhu G, Leiva-Salinas C, Hou Q, Fullerton HJ. Clinical and Imaging Characteristics of Arteriopathy Subtypes in Children with Arterial Ischemic Stroke: Results of the VIPS Study. AJNR Am J Neuroradiol 2017; 38:2172-2179. [PMID: 28982784 DOI: 10.3174/ajnr.a5376] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 07/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Childhood arteriopathies are rare but heterogenous, and difficult to diagnose and classify, especially by nonexperts. We quantified clinical and imaging characteristics associated with childhood arteriopathy subtypes to facilitate their diagnosis and classification in research and clinical settings. MATERIALS AND METHODS The Vascular Effects of Infection in Pediatric Stroke (VIPS) study prospectively enrolled 355 children with arterial ischemic stroke (2010-2014). A central team of experts reviewed all data to diagnose childhood arteriopathy and classify subtypes, including arterial dissection and focal cerebral arteriopathy-inflammatory type, which includes transient cerebral arteriopathy, Moyamoya disease, and diffuse/multifocal vasculitis. Only children whose stroke etiology could be conclusively diagnosed were included in these analyses. We constructed logistic regression models to identify characteristics associated with each arteriopathy subtype. RESULTS Among 127 children with definite arteriopathy, the arteriopathy subtype could not be classified in 18 (14%). Moyamoya disease (n = 34) occurred mostly in children younger than 8 years of age; focal cerebral arteriopathy-inflammatory type (n = 25), in children 8-15 years of age; and dissection (n = 26), at all ages. Vertigo at stroke presentation was common in dissection. Dissection affected the cervical arteries, while Moyamoya disease involved the supraclinoid internal carotid arteries. A banded appearance of the M1 segment of the middle cerebral artery was pathognomonic of focal cerebral arteriopathy-inflammatory type but was present in <25% of patients with focal cerebral arteriopathy-inflammatory type; a small lenticulostriate distribution infarct was a more common predictor of focal cerebral arteriopathy-inflammatory type, present in 76%. It remained difficult to distinguish focal cerebral arteriopathy-inflammatory type from intracranial dissection of the anterior circulation. We observed only secondary forms of diffuse/multifocal vasculitis, mostly due to meningitis. CONCLUSIONS Childhood arteriopathy subtypes have some typical features that aid diagnosis. Better imaging methods, including vessel wall imaging, are needed for improved classification of focal cerebral arteriopathy of childhood.
Collapse
Affiliation(s)
- M Wintermark
- From the Department of Radiology (M.W.), Neuroradiology Division, Stanford University, Stanford, California
| | - N K Hills
- Departments of Neurology (N.K.H., H.J.F.).,Biostatistics and Epidemiology (N.K.H.)
| | - G A DeVeber
- Department of Neurology (G.A.D.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - A J Barkovich
- Radiology (A.J.B., H.J.F.).,Pediatrics (A.J.B.),University of California, San Francisco, San Francisco, California
| | - T J Bernard
- Department of Pediatrics (T.J.B.), University of Colorado, Denver, Colorado
| | - N R Friedman
- Center for Pediatric Neurology (N.R.F.), Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - M T Mackay
- Children's Stroke Program (M.T.M.), Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - A Kirton
- Departments of Pediatrics and Clinical Neurosciences (A.K.), Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - G Zhu
- Department of Neurology (G.Z.), Military General Hospital of Beijing PLA, Beijing, China
| | - C Leiva-Salinas
- Department of Radiology (C.L.-S.), University of Virginia, Charlottesville, Virginia
| | - Q Hou
- Department of Neurology (Q.H.), Guangdong No.2 Provincial People's Hospital, Guangzhou, China
| | - H J Fullerton
- Departments of Neurology (N.K.H., H.J.F.).,Radiology (A.J.B., H.J.F.)
| | | |
Collapse
|
127
|
Lee S, Rivkin MJ, Kirton A, deVeber G, Elbers J. Moyamoya Disease in Children: Results From the International Pediatric Stroke Study. J Child Neurol 2017; 32:924-929. [PMID: 28715924 DOI: 10.1177/0883073817718730] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to describe children with moyamoya disease from an international multicenter stroke database, and explore risk factors for stroke recurrence. We reviewed data of children >28-days old with moyamoya disease enrolled in the International Pediatric Stroke Study from January 2003 to March 2013. A total of 174 children from 32 sites and 14 countries had moyamoya disease; median age 7.4 years, 49% male. Of these, 90% presented with ischemic stroke, 7.5% with transient ischemic attack, and 2.5% with hemorrhagic stroke. One-third of patients had moyamoya syndrome. Stroke recurrence was 20% over median follow-up of 13 months; 9% had multiple recurrences. Children treated with surgical revascularization were less likely to have stroke recurrence ( P = .046). Moyamoya disease accounted for 8% of arterial strokes in this international pediatric stroke registry. One-third of pediatric patients with moyamoya disease have an underlying syndromic condition. Surgical revascularization is effective at reducing the incidence of stroke recurrence.
Collapse
Affiliation(s)
- Sarah Lee
- 1 Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Michael J Rivkin
- 2 Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Adam Kirton
- 3 Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada
| | - Gabrielle deVeber
- 4 Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jorina Elbers
- 1 Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | | |
Collapse
|
128
|
Schuster S, Bachmann H, Thom V, Kaufmann-Buehler AK, Matschke J, Siemonsen S, Glatzel M, Fiehler J, Gerloff C, Magnus T, Thomalla G. Subtypes of primary angiitis of the CNS identified by MRI patterns reflect the size of affected vessels. J Neurol Neurosurg Psychiatry 2017; 88:749-755. [PMID: 28705900 DOI: 10.1136/jnnp-2017-315691] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/08/2017] [Accepted: 05/11/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe patterns of diagnostic findings, and identify subgroups of primary angiitis of the central nervous system (PACNS). METHODS We retrospectively analysed 31 patients with PACNS. Cases were selected by predetermined diagnostic criteria and stratified into biopsy-proven and imaging-based PACNS. We compared clinical characteristics, cerebrospinal fluid (CSF) findings and imaging results including high-resolution vessel wall MRI between groups. RESULTS There were 31 cases of PACNS (mean age 45.6 years, 58.1% female), of whom 17 (55%) were biopsy-proven, 14 (45%) were based on imaging findings. Patients with a positive biopsy had fewer infarcts (29.4% vs 85.7%, p=0.003), were more likely to have meningeal and parenchymal contrast enhancement (76.5% vs 28.6%, p=0.012), were less likely to have abnormal MR angiography (11.8% vs 100%, p<0.001) and did not show vessel wall enhancement at the time of diagnosis (0% vs 76.9%, p<0.001). In contrast, patients with imaging-based diagnosis showed more frequently multiple infarcts and vessel abnormalities, with vessel wall enhancement in most of the cases. Clinical characteristics and CSF analysis did not reveal marked differences between groups. INTERPRETATION Multi-parametric MRI distinguishes two subtypes of PACNS that most likely differ concerning the affected vessel size. Biopsy-proven PACNS primarily involves smaller vessels beyond the resolution of vascular imaging, while imaging-based PACNS affects predominantly medium-sized vessels leading to false-negative biopsy results. Using distinct MRI patterns may be helpful for selecting patients for appropriate invasive diagnostic modalities.
Collapse
Affiliation(s)
- Simon Schuster
- Department of Neurology, University Hospital Hamburg-Eppendorf, Germany
| | - Henrike Bachmann
- Department of Neurology, University Hospital Hamburg-Eppendorf, Germany
| | - Vivien Thom
- Department of Neurology, University Hospital Hamburg-Eppendorf, Germany
| | | | - Jakob Matschke
- Institute of Neuropathology, University Hospital Hamburg-Eppendorf, Germany
| | - Susanne Siemonsen
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Hospital Hamburg-Eppendorf, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Germany
| | - Christian Gerloff
- Department of Neurology, University Hospital Hamburg-Eppendorf, Germany
| | - Tim Magnus
- Department of Neurology, University Hospital Hamburg-Eppendorf, Germany
| | - Götz Thomalla
- Department of Neurology, University Hospital Hamburg-Eppendorf, Germany
| |
Collapse
|
129
|
Chung MS, Jung SC, Kim SO, Kim HS, Choi CG, Kim SJ, Kwon SU, Kang DW, Kim JS. Intracranial Artery Steno-Occlusion: Diagnosis by Using Two-dimensional Spatially Selective Radiofrequency Excitation Pulse MR Imaging. Radiology 2017; 284:834-843. [DOI: 10.1148/radiol.2017161490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mi Sun Chung
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Seung Chai Jung
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Seon-Ok Kim
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Ho Sung Kim
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Choong Gon Choi
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Sang Joon Kim
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Sun U. Kwon
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Dong-Wha Kang
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| | - Jong S. Kim
- From the Department of Radiology and Research Institute of Radiology (M.S.C., S.C.J., H.S.K., C.G.C., S.J.K.), Department of Clinical Epidemiology and Biostatistics (S.O.K.), and Department of Neurology (S.U.K., D.W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul 138-736, Korea
| |
Collapse
|
130
|
Coolen BF, Calcagno C, van Ooij P, Fayad ZA, Strijkers GJ, Nederveen AJ. Vessel wall characterization using quantitative MRI: what's in a number? MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:201-222. [PMID: 28808823 PMCID: PMC5813061 DOI: 10.1007/s10334-017-0644-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022]
Abstract
The past decade has witnessed the rapid development of new MRI technology for vessel wall imaging. Today, with advances in MRI hardware and pulse sequences, quantitative MRI of the vessel wall represents a real alternative to conventional qualitative imaging, which is hindered by significant intra- and inter-observer variability. Quantitative MRI can measure several important morphological and functional characteristics of the vessel wall. This review provides a detailed introduction to novel quantitative MRI methods for measuring vessel wall dimensions, plaque composition and permeability, endothelial shear stress and wall stiffness. Together, these methods show the versatility of non-invasive quantitative MRI for probing vascular disease at several stages. These quantitative MRI biomarkers can play an important role in the context of both treatment response monitoring and risk prediction. Given the rapid developments in scan acceleration techniques and novel image reconstruction, we foresee the possibility of integrating the acquisition of multiple quantitative vessel wall parameters within a single scan session.
Collapse
Affiliation(s)
- Bram F Coolen
- Department of Biomedical Engineering and Physics, Academic Medical Center, PO BOX 22660, 1100 DD, Amsterdam, The Netherlands. .,Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Claudia Calcagno
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pim van Ooij
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Academic Medical Center, PO BOX 22660, 1100 DD, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
131
|
Rapid contralateral progression of focal cerebral arteriopathy distinguished from RNF213-related moyamoya disease and fibromuscular dysplasia. Childs Nerv Syst 2017; 33:1405-1409. [PMID: 28497183 DOI: 10.1007/s00381-017-3451-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Focal cerebral arteriopathy includes unifocal or multifocal lesions that are unilateral or bilateral. Large- and/or medium-sized vessels are involved and can be visualized on angiography. CASE REPORT We report a case of cerebral infarction in a 9-year-old Japanese female who presented with a transient ischemic attack. Steno-occlusion involving the distal part of the internal carotid artery, proximal middle cerebral artery, and anterior cerebral artery was observed. Digital subtraction angiography demonstrated a beaded appearance in the cervical portion of the diseased internal carotid artery. Revascularization surgery was performed 45 days after the onset. A new infarction appeared on the other side of the anterior cerebral artery territory 7 months after the first onset. Antiplatelets and vasodilators were administered, and no progression was observed during 18 months of follow-up. Genetic analysis did not show ring finger protein 213 (RNF213)-related moyamoya disease, and pathological examination revealed no characteristics of fibromuscular dysplasia. CONCLUSION The radiological and genetic features coincided with focal cerebral arteriopathy, which is a distinct entity from fibromuscular dysplasia and RNF213-related moyamoya disease.
Collapse
|
132
|
Xu YY, Li ML, Gao S, Jin ZY, Sun ZY, Chen J, Hou B, Zhou HL, Feng F, Xu WH. Etiology of intracranial stenosis in young patients: a high-resolution magnetic resonance imaging study. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:319. [PMID: 28861416 DOI: 10.21037/atm.2017.06.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Using high-resolution magnetic resonance imaging (HRMRI), we sought to investigate the underlying etiology of intracranial stenosis in young patients. METHODS We retrospectively studied 122 Chinese young adult patients (from 18 to 45 years old, mean age 36.2±7.5 years) with unilateral middle cerebral artery (MCA) stenosis based on a prospectively established HRMRI database. The eccentricity, degree of stenosis, and remodeling types of MCA lesions were analyzed. The MCA lesions were classified as eccentric (presumed atherosclerosis) or concentric stenosis (presumed non-atherosclerosis). The clinical data and vessel wall properties were compared between the patients >35 years old and the patients ≤35 years old. RESULTS Eccentric stenosis was observed in 98 (80.3%) patients and concentric stenosis in 24 (19.7%) patients. The patients with eccentric stenosis were older (37.5±6.8 vs. 31.4±8.4 years old, P<0.001) and more likely had atherosclerosis risk factors (56.1% vs. 25.0%, P=0.006). The patients >35 years old had higher prevalence (90.1% vs. 66.7%, P=0.001) of eccentric stenosis and atherosclerosis factors (60.6% vs. 35.3%, P=0.006) than the patients ≤35 years old. Most of the patients with concentric stenosis were ≤35 years old (17/24, 70.8%) and were female (16/24, 66.7%). Binary Logistic analysis suggested smoking (OR =3.171; 95% CI, 1.210-8.314) and remodeling ratio (OR =1.625; 95% CI, 1.001-2.636) were independent predictive factors for symptomatic stenosis. CONCLUSIONS Atherosclerosis is the most common cause of intracranial stenosis in Chinese young patients. Non-atherosclerosis disease is an important etiology in young female, especially in the patients aged 35 years old or younger.
Collapse
Affiliation(s)
- Yu-Yuan Xu
- Departments of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ming-Li Li
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Shan Gao
- Departments of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zheng-Yu Jin
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zhao-Yong Sun
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jie Chen
- Departments of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Bo Hou
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Hai-Long Zhou
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Feng Feng
- Departments of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei-Hai Xu
- Departments of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|
133
|
Harteveld AA, van der Kolk AG, van der Worp HB, Dieleman N, Zwanenburg JJM, Luijten PR, Hendrikse J. Detecting Intracranial Vessel Wall Lesions With 7T-Magnetic Resonance Imaging: Patients With Posterior Circulation Ischemia Versus Healthy Controls. Stroke 2017; 48:2601-2604. [PMID: 28701579 DOI: 10.1161/strokeaha.117.017868] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Vessel wall magnetic resonance imaging sequences have been developed to directly visualize the intracranial vessel wall, enabling detection of vessel wall changes, including those that have not yet caused luminal narrowing. In this study, vessel wall lesion burden was assessed in patients with recent posterior circulation ischemia using 7T-magnetic resonance imaging and compared with matched healthy controls. METHODS Fifty subjects (25 patients and 25 matched healthy controls) underwent 7T-magnetic resonance imaging with an intracranial vessel wall sequence before and after contrast administration. Two raters scored the presence and contrast enhancement of arterial wall lesions in individual segments of the circle of Willis and its primary branches. Total burden and distribution of vessel wall lesions and lesion characteristics (configuration, thickening pattern, and contrast enhancement) were compared both between and within both groups. RESULTS Overall, vessel wall lesion burden and distribution were comparable between patients and controls. Regarding individual arterial segments, only vessel wall lesions in the posterior cerebral artery were more frequently observed in patients (18.0%) than in controls (5.4%; P=0.003). Many of these lesions showed enhancement, both in patients (48.9%) and in controls (43.5%; P=0.41). In patients, the proportion of enhancing lesions was higher in the posterior circulation (53.3%) than in the anterior circulation (20.6%; P=0.008). CONCLUSIONS Although overall intracranial vessel wall lesion burden and contrast enhancement were comparable between patients with recent posterior circulation ischemia and healthy controls, this study also revealed significant differences between the 2 groups, suggesting an association between posterior circulation lesion burden/enhancement and ischemic events. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl. Unique identifier: NTR5688.
Collapse
Affiliation(s)
- Anita A Harteveld
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands.
| | - Anja G van der Kolk
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - H Bart van der Worp
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Nikki Dieleman
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Jaco J M Zwanenburg
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Peter R Luijten
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Jeroen Hendrikse
- From the Department of Radiology (A.A.H., A.G.v.d.K., N.D., J.J.M.Z., P.R.L., J.H.) and Department of Neurology and Neurosurgery (H.B.v.d.W.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| |
Collapse
|
134
|
Jiang Y, Peng W, Tian B, Zhu C, Chen L, Wang X, Liu Q, Wang Y, Xiang Z, Degnan AJ, Teng Z, Saloner D, Lu J. Identification and Quantitative Assessment of Different Components of Intracranial Atherosclerotic Plaque by Ex Vivo 3T High-Resolution Multicontrast MRI. AJNR Am J Neuroradiol 2017; 38:1716-1722. [PMID: 28684455 DOI: 10.3174/ajnr.a5266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/23/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE High-resolution 3T MR imaging can visualize intracranial atherosclerotic plaque. However, histologic validation is still lacking. This study aimed to evaluate the ability of 3T MR imaging to identify and quantitatively assess intracranial atherosclerotic plaque components ex vivo with histologic validation. MATERIALS AND METHODS Fifty-three intracranial arterial specimens with atherosclerotic plaques from 20 cadavers were imaged by 3T MR imaging with T1, T2, and proton-density-weighted FSE and STIR sequences. The signal characteristics and areas of fibrous cap, lipid core, calcification, fibrous tissue, and healthy vessel wall were recorded on MR images and compared with histology. Fibrous cap thickness and maximum wall thickness were also quantified. The percentage of areas of the main plaque components, the ratio of fibrous cap thickness to maximum wall thickness, and plaque burden were calculated and compared. RESULTS The signal intensity of the lipid core was significantly lower than that of the fibrous cap on T2-weighted, proton-density, and STIR sequences (P < .01) and was comparable on T1-weighted sequences (P = 1.00). Optimal contrast between the lipid core and fibrous cap was found on T2-weighted images. Plaque component mean percentages were comparable between MR imaging and histology: fibrous component (81.86% ± 10.59% versus 81.87% ± 11.59%, P = .999), lipid core (19.51% ± 10.76% versus 19.86% ± 11.56%, P = .863), and fibrous cap (31.10% ± 11.28% versus 30.83% ± 8.51%, P = .463). However, MR imaging overestimated mean calcification (9.68% ± 5.21% versus 8.83% ± 5.67%, P = .030) and plaque burden (65.18% ± 9.01% versus 52.71% ± 14.58%, P < .001). CONCLUSIONS Ex vivo 3T MR imaging can accurately identify and quantitatively assess intracranial atherosclerotic plaque components, providing a direct reference for in vivo intracranial plaque imaging.
Collapse
Affiliation(s)
- Y Jiang
- From the Department of Radiology (Y.J.), Wuhan General Hospital of the People's Liberation Army, Wuhan, China.,Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - W Peng
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - B Tian
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - C Zhu
- Department of Radiology and Biomedical Imaging (C.Z., D.S.), University of California, San Francisco, San Francisco, California
| | - L Chen
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - X Wang
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - Q Liu
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| | - Y Wang
- Pathology (Y.W., Z.X.), Changhai Hospital, Shanghai, China
| | - Z Xiang
- Pathology (Y.W., Z.X.), Changhai Hospital, Shanghai, China
| | - A J Degnan
- Department of Radiology (A.J.D.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Z Teng
- Department of Radiology (Z.T.), University of Cambridge, Cambridge, UK
| | - D Saloner
- Department of Radiology and Biomedical Imaging (C.Z., D.S.), University of California, San Francisco, San Francisco, California
| | - J Lu
- Departments of Radiology (Y.J., W.P., B.T., L.C., X.W., Q.L., J.L.)
| |
Collapse
|
135
|
Park JE, Jung SC, Lee SH, Jeon JY, Lee JY, Kim HS, Choi CG, Kim SJ, Lee DH, Kim SO, Kwon SU, Kang DW, Kim JS. Comparison of 3D magnetic resonance imaging and digital subtraction angiography for intracranial artery stenosis. Eur Radiol 2017; 27:4737-4746. [PMID: 28500366 DOI: 10.1007/s00330-017-4860-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/09/2017] [Accepted: 04/19/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare three-dimensional high-resolution magnetic resonance imaging (3D HR-MRI) and digital subtraction angiography (DSA) for diagnosing and evaluating stenosis in the entire circle of Willis. METHODS The study included 516 intracranial arteries from 43 patients with intracranial artery stenosis (ICAS) who underwent both 3D HR-MRI and DSA within 1 month. Two readers independently diagnosed atherosclerosis, dissection, moyamoya disease and vasculitis, rated their diagnostic confidence for each vessel and measured the luminal diameters. Reference standard was made from clinico-radiologic diagnosis. Diagnostic accuracy, diagnostic confidence, the degree of stenosis and luminal diameter were assessed and compared between both modalities. RESULTS For atherosclerosis, 3D HR-MRI showed better diagnostic accuracy (P = .03-.003), sensitivity (P = .006-.01) and positive predictive value (P ≤ .001-.006) compared to DSA. Overall, the readers were more confident of their diagnosis of ICAS when using 3D HR-MRI (reader 1, P ≤ .001-.007; reader 2, P ≤ .001-.015). 3D HR-MRI showed similar degree of stenosis (P > .05) and higher luminal diameter (P < .05) compared to DSA. CONCLUSIONS 3D HR-MRI might be useful to evaluate atherosclerosis, with better diagnostic confidence and comparable stenosis measurement compared to DSA in the entire circle of Willis. KEY POINTS • 3D HR-MRI showed better diagnostic accuracy for atherosclerosiscompared to DSA • 3D HR-MRI showed better overall diagnostic confidence for stenosiscompared to DSA • 3D HR-MRI and DSA showed similar degree of stenosis.
Collapse
Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
| | - Sang Hun Lee
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Ji Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, 420-767, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Choong-Gon Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Dong-Wha Kang
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jong S Kim
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
| |
Collapse
|
136
|
Pediatric brain MRI, Part 2: Advanced techniques. Pediatr Radiol 2017; 47:544-555. [PMID: 28409252 DOI: 10.1007/s00247-017-3792-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/13/2016] [Accepted: 01/26/2017] [Indexed: 10/19/2022]
Abstract
Pediatric neuroimaging is a complex and specialized field that uses magnetic resonance (MR) imaging as the workhorse for diagnosis. MR protocols should be tailored to the specific indication and reviewed by the supervising radiologist in real time. Targeted advanced imaging sequences can be added to provide information regarding tissue microstructure, perfusion, metabolism and function. In part 2 of this review, we highlight the utility of advanced imaging techniques for superior evaluation of pediatric neurologic disease. We focus on the following techniques, with clinical examples: phase-contrast imaging, perfusion-weighted imaging, vessel wall imaging, diffusion tensor imaging, task-based functional MRI and MR spectroscopy.
Collapse
|
137
|
Song X, Lv H, Tang J, Zhang Q, Wang Q. M2 segment dissection of middle cerebral artery diagnosed using high-resolution magnetic resonance imaging. J Int Med Res 2017; 45:1802-1804. [PMID: 28447493 PMCID: PMC5805201 DOI: 10.1177/0300060517706603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Middle cerebral artery (MCA) dissection is a rare cause of ischemic stroke,
especially in the M2 or M3 segments. Diagnosis of intracranial artery dissection
remains challenging. We herein report a case of M2 segment dissection of the MCA
with typical features of an intimal flap and intramural hematoma diagnosed using
high-resolution 3T magnetic resonance imaging. This imaging technique might be a
more effective noninvasive method by which to diagnose M2 segment dissection of
the MCA than either computed tomography angiography or digital subtraction
angiography.
Collapse
Affiliation(s)
- Xiaoyan Song
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Lv
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjun Tang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiaoshu Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
138
|
Abraham P, Scott Pannell J, Santiago-Dieppa DR, Cheung V, Steinberg J, Wali A, Gupta M, Rennert RC, Lee RR, Khalessi AA. Vessel wall signal enhancement on 3-T MRI in acute stroke patients after stent retriever thrombectomy. Neurosurg Focus 2017; 42:E20. [PMID: 28366071 DOI: 10.3171/2017.1.focus16492] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In vivo and in vitro studies have demonstrated histological evidence of iatrogenic endothelial injury after stent retriever thrombectomy. However, noncontrast vessel wall (VW)-MRI is insufficient to demonstrate vessel injury. Authors of this study prospectively evaluated iatrogenic endothelial damage after stent retriever thrombectomy in humans by utilizing high-resolution contrast-enhanced VW-MRI. Characterization of VW-MRI changes in vessels subject to mechanical injury from thrombectomy may allow better understanding of the biological effects of this intervention. METHODS The authors prospectively recruited 11 patients for this study. The treatment group included 6 postthrombectomy patients and the control group included 5 subjects undergoing MRI for nonvascular indications. All subjects were evaluated on a Signa HD× 3.0-T MRI scanner with an 8-channel head coil. Both pre- and postcontrast T1-weighted Cube VW images as well as MR angiograms were acquired. Sequences obtained for evaluation of the brain parenchyma included diffusion-weighted, gradient echo, and T2-FLAIR imaging. Two independent neuroradiologists, who were blinded to the treatment status of each patient, determined the presence of VW enhancement. Patient age, National Institutes of Health Stroke Scale score on presentation, location of occlusion, stroke etiology, type of device used, number of device deployments, Thrombolysis in Cerebral Infarction (TICI) reperfusion score, stroke volume, and 90-day modified Rankin Scale score were also noted. RESULTS Postcontrast T1-weighted VW enhancement was detected in the M2 segment in 100% of the thrombectomy patients, in the M1 segment in 83%, and in the internal carotid artery in 50%. One patient also demonstrated A1 segment enhancement, which was attributable to thrombectomy treatment of that vessel segment during the same procedure. None of the control patients demonstrated VW enhancement of their intracranial vasculature on T1-weighted images. CONCLUSIONS The study findings suggest that VW injury incurred during stent retriever thrombectomy can be reliably detected utilizing contrast-enhanced 3-T VW-MRI. The results further demonstrate that endothelial injury is associated with oversizing of stent retrievers relative to the treated vessel. Further studies are needed to evaluate the clinical significance of endothelial injury and to characterize the differential effects of various devices.
Collapse
Affiliation(s)
- Peter Abraham
- Department of Neurosurgery, University of California, San Diego, California
| | - J Scott Pannell
- Department of Neurosurgery, University of California, San Diego, California
| | | | - Vincent Cheung
- Department of Neurosurgery, University of California, San Diego, California
| | - Jeffrey Steinberg
- Department of Neurosurgery, University of California, San Diego, California
| | - Arvin Wali
- Department of Neurosurgery, University of California, San Diego, California
| | - Mihir Gupta
- Department of Neurosurgery, University of California, San Diego, California
| | - Robert C Rennert
- Department of Neurosurgery, University of California, San Diego, California
| | - Roland R Lee
- Department of Neurosurgery, University of California, San Diego, California
| | | |
Collapse
|
139
|
Domi T, Vossough A, Stence NV, Felling RJ, Leung J, Krishnan P, Watson CG, Grant PE, Kassner A. The Potential for Advanced Magnetic Resonance Neuroimaging Techniques in Pediatric Stroke Research. Pediatr Neurol 2017; 69:24-36. [PMID: 28237248 DOI: 10.1016/j.pediatrneurol.2016.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This article was written to provide clinicians and researchers with an overview of a number of advanced neuroimaging techniques in an effort to promote increased utility and the design of future studies using advanced neuroimaging in childhood stroke. The current capabilities of advanced magnetic resonance imaging techniques provide the opportunity to build on our knowledge of the consequences of stroke on the developing brain. These capabilities include providing information about the physiology, metabolism, structure, and function of the brain that are not routinely evaluated in the clinical setting. METHODS During the Proceedings of the Stroke Imaging Laboratory for Children Workshop in Toronto in June 2015, a subgroup of clinicians and imaging researchers discussed how the application of advanced neuroimaging techniques could further our understanding of the mechanisms of stroke injury and repair in the pediatric population. This subgroup was established based on their interest and commitment to design collaborative, advanced neuroimaging studies in the pediatric stroke population. RESULTS In working toward this goal, we first sought to describe here the magnetic resonance imaging techniques that are currently available for use, and how they have been applied in other stroke populations (e.g., adult and perinatal stroke). CONCLUSIONS With the continued improvement in advanced neuroimaging techniques, including shorter acquisition times, there is an opportunity to apply these techniques to their full potential in the research setting and learn more about the effects of stroke in the developing brain.
Collapse
Affiliation(s)
- Trish Domi
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas V Stence
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ryan J Felling
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jackie Leung
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Department of Neuroradiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher G Watson
- Department of Computational Neuroscience, Division of Graduate Medical Sciences, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - P Ellen Grant
- Division of Newborn Medicine, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea Kassner
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
140
|
Dlamini N, Wintermark M, Fullerton H, Strother S, Lee W, Bjornson B, Guilliams KP, Miller S, Kirton A, Filippi CG, Linds A, Askalan R, deVeber G. Harnessing Neuroimaging Capability in Pediatric Stroke: Proceedings of the Stroke Imaging Laboratory for Children Workshop. Pediatr Neurol 2017; 69:3-10. [PMID: 28259513 DOI: 10.1016/j.pediatrneurol.2017.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 12/22/2022]
Abstract
On June 5, 2015 the International Pediatric Stroke Study and the Stroke Imaging Laboratory for Children cohosted a unique workshop focused on developing neuroimaging research in pediatric stroke. Pediatric neurologists, neuroradiologists, interventional neuroradiologists, physicists, nurse practitioners, neuropsychologists, and imaging research scientists from around the world attended this one-day meeting. Our objectives were to (1) establish a group of experts to collaborate in advancing pediatric neuroimaging for stroke, (2) develop consensus clinical and research magnetic resonance imaging protocols for pediatric stroke patients, and (3) develop imaging-based research strategies in pediatric ischemic stroke. This article provides a summary of the meeting proceedings focusing on identified challenges and solutions and outcomes from the meeting. Further details on the workshop contents and outcomes are provided in three additional articles in the current issue of Pediatric Neurology.
Collapse
Affiliation(s)
- Nomazulu Dlamini
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Max Wintermark
- Division of Neuroradiology, Department of Radiology, Stanford University, Stanford, California
| | - Heather Fullerton
- Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Stephen Strother
- Department of Medical Biophysics, Rotman Research Institute at Baycrest, University of Toronto, Toronto, Ontario, Canada
| | - Wayne Lee
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Bjornson
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kristin P Guilliams
- Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri; Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Steven Miller
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Kirton
- Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher G Filippi
- Department of Radiology, Northwell Health, Manhasset, New York; Department of Neurology, University of Vermont Medical Center, Burlington, Vermont
| | - Alexandra Linds
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rand Askalan
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gabrielle deVeber
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
141
|
Cheron J, Wyndham-Thomas C, Sadeghi N, Naeije G. Response of Human Immunodeficiency Virus-Associated Cerebral Angiitis to the Combined Antiretroviral Therapy. Front Neurol 2017; 8:95. [PMID: 28348548 PMCID: PMC5347115 DOI: 10.3389/fneur.2017.00095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/27/2017] [Indexed: 11/13/2022] Open
Abstract
When secondary causes are excluded, mechanisms underlying central nervous system angiitis (ACNS) in human immunodeficiency virus (HIV)-infected patients are still not understood and optimal treatment remains undefined. We report here a patient with an untreated HIV infection who presented multiple ischemic strokes probably due to HIV-ACNS. ACNS signs on vessel-wall imaging magnetic resonance monitoring retracted with combined antiretroviral therapy without adjunct immunosuppressive drugs.
Collapse
Affiliation(s)
- Julian Cheron
- Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles , Brussels , Belgium
| | - Chloé Wyndham-Thomas
- Immunodeficiency Treatment Unit, Erasme University Hospital, Université Libre de Bruxelles , Brussels , Belgium
| | - Niloufar Sadeghi
- Department of Neuro-Radiology, Erasme University Hospital, Université Libre de Bruxelles , Brussels , Belgium
| | - Gilles Naeije
- Department of Neurology, Erasme University Hospital, Université Libre de Bruxelles , Brussels , Belgium
| |
Collapse
|
142
|
Zhu XJ, Wang W, Liu ZJ. High-resolution Magnetic Resonance Vessel Wall Imaging for Intracranial Arterial Stenosis. Chin Med J (Engl) 2017; 129:1363-70. [PMID: 27231176 PMCID: PMC4894049 DOI: 10.4103/0366-6999.182826] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging (HRMR VWI) for intracranial arterial stenosis. DATE SOURCES We retrieved information from PubMed database up to December 2015, using various search terms including vessel wall imaging (VWI), high-resolution magnetic resonance imaging, intracranial arterial stenosis, black blood, and intracranial atherosclerosis. STUDY SELECTION We reviewed peer-reviewed articles printed in English on imaging technique of VWI and characteristic findings of various intracranial vasculopathies on VWI. We organized this data to explain the value of VWI in clinical application. RESULTS VWI with black blood technique could provide high-quality images with submillimeter voxel size, and display both the vessel wall and lumen of intracranial artery simultaneously. Various intracranial vasculopathies (atherosclerotic or nonatherosclerotic) had differentiating features including pattern of wall thickening, enhancement, and vessel remodeling on VWI. This technique could be used for determining causes of stenosis, identification of stroke mechanism, risk-stratifying patients, and directing therapeutic management in clinical practice. In addition, a new morphological classification based on VWI could be established for predicting the efficacy of endovascular therapy. CONCLUSIONS This review highlights the value of HRMR VWI for discrimination of different intracranial vasculopathies and directing therapeutic management.
Collapse
Affiliation(s)
- Xian-Jin Zhu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wu Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zun-Jing Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| |
Collapse
|
143
|
The Contrast Enhancement of Intracranial Arterial Wall on High-resolution MRI and Its Clinical Relevance in Patients with Moyamoya Vasculopathy. Sci Rep 2017; 7:44264. [PMID: 28276529 PMCID: PMC5381100 DOI: 10.1038/srep44264] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/07/2017] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study is to investigate the characteristics of intracranial vessel wall enhancement and its relationship with ischemic infarction in patients with Moyamoya vasculopathy (MMV). Forty-seven patients with MMV confirmed by angiography were enrolled in this study. The vessel wall enhancement of the distal internal carotid artery, anterior cerebral artery and middle cerebral artery was classified into eccentric and concentric patterns, as well as divided into three grades: grade 0, grade 1 and grade 2. The relationship between ischemic infarction and vessel wall enhancement was also determined. Fifty-six enhanced lesions were found in patients with (n = 25) and without acute infarction (n = 22). The incidence of lesions with grade 2 enhancement in patients with acute infarction was greater than that in those without acute infarction (p = 0.011). In addition, grade 2 enhancement of the intracranial vessel wall was significantly associated with acute ischemic infarction (Odds ratio, 26.7; 95% confidence interval: 2.8-258.2; p = 0.005). Higher-grade enhancement of the intracranial vessel wall is independently associated with acute ischemic infarction in patients with MMV. The characteristics of intracranial vessel wall enhancement may serve as a marker of its stability and provide important insight into ischemic stroke risk factors.
Collapse
|
144
|
Bertrand A, Leclercq D, Martinez-Almoyna L, Girard N, Stahl JP, De-Broucker T. MR imaging of adult acute infectious encephalitis. Med Mal Infect 2017; 47:195-205. [PMID: 28268128 DOI: 10.1016/j.medmal.2017.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Imaging is a key tool for the diagnosis of acute encephalitis. Brain CT scan must be urgently performed to rule out a brain lesion with mass effect that would contraindicate lumbar puncture. Brain MRI is less accessible than CT scan, but can provide crucial information with patients presenting with acute encephalitis. METHOD We performed a literature review on PubMed on April 1, 2015 with the search terms "MRI" and "encephalitis". RESULTS We first described the various brain MRI abnormalities associated with each pathogen of acute encephalitis (HSV, VZV, other viral agents targeting immunocompromised patients or travelers; tuberculosis, listeriosis, other less frequent bacterial agents). Then, we identified specific patterns of brain MRI abnomalies that may suggest a particular pathogen. Limbic encephalitis is highly suggestive of HSV; it also occurs less frequently in encephalitis due to HHV6, syphillis, Whipple's disease and HIV primary infection. Rhombencephalitis is suggestive of tuberculosis and listeriosis. Acute ischemic lesions can occur in patients presenting with severe bacterial encephalitis, tuberculosis, VZV encephalitis, syphilis, and fungal infections. CONCLUSION Brain MRI plays a crucial role in the diagnosis of acute encephalitis. It detects brain signal changes that reinforce the clinical suspicion of encephalitis, especially when the causative agent is not identified by lumbar puncture; it can suggest a particular pathogen based on the pattern of brain abnormalities and it rules out important differential diagnosis (vascular, tumoral or inflammatory causes).
Collapse
Affiliation(s)
- A Bertrand
- Service de neuroradiologie diagnostique et fonctionnelle, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'hôpital, 75651 Paris cedex 13, France; Sorbonne universités, UPMC université Paris 06, Inserm, CNRS, institut du cerveau et la moelle (ICM), Inria Paris, Aramis project-team, 75013 Paris, France
| | - D Leclercq
- Service de neuroradiologie diagnostique et fonctionnelle, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'hôpital, 75651 Paris cedex 13, France
| | | | - N Girard
- Service de neuroradiologie, CHU La-Timone, AP-HM, 13015 Marseille, France
| | - J-P Stahl
- Service d'infectiologie, CHU de Grenoble, « European study Group for the Infections of the Brain (ESGIB) », 38043 Grenoble, France.
| | - T De-Broucker
- Service de neurologie, CH Saint-Denis, BP 279, 93205, France
| |
Collapse
|
145
|
Abstract
In this chapter we review the optimal imaging modalities for subacute and chronic stroke. We discuss the utility of computed tomography (CT) and multimodal CT imaging. Further, we analyze the importance of specific magnetic resonance imaging sequences, such as diffusion-weighted imaging for acute ischemic stroke, T2/fluid-attenuated inversion recovery for subacute and chronic stroke, and susceptibility imaging for detection of intracranial hemorrhages. Different ischemic stroke mechanisms are reviewed, and how these imaging modalities may aid in the determination of such. Further, we analyze how topographic patterns in ischemic stroke may provide important clues to the diagnosis, in addition to the temporal evolution of the stroke. Lastly, specific cerebrovascular occlusive diseases are reviewed, with emphasis on the optimal imaging modalities and their findings in each condition.
Collapse
|
146
|
Jang J, Kim TW, Hwang EJ, Choi HS, Koo J, Shin YS, Jung SL, Ahn KJ, Kim BS. Assessment of Arterial Wall Enhancement for Differentiation of Parent Artery Disease from Small Artery Disease: Comparison between Histogram Analysis and Visual Analysis on 3-Dimensional Contrast-Enhanced T1-Weighted Turbo Spin Echo MR Images at 3T. Korean J Radiol 2017; 18:383-391. [PMID: 28246519 PMCID: PMC5313527 DOI: 10.3348/kjr.2017.18.2.383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/01/2016] [Indexed: 01/23/2023] Open
Abstract
Objective The purpose of this study was to compare the histogram analysis and visual scores in 3T MRI assessment of middle cerebral arterial wall enhancement in patients with acute stroke, for the differentiation of parent artery disease (PAD) from small artery disease (SAD). Materials and Methods Among the 82 consecutive patients in a tertiary hospital for one year, 25 patients with acute infarcts in middle cerebral artery (MCA) territory were included in this study including 15 patients with PAD and 10 patients with SAD. Three-dimensional contrast-enhanced T1-weighted turbo spin echo MR images with black-blood preparation at 3T were analyzed both qualitatively and quantitatively. The degree of MCA stenosis, and visual and histogram assessments on MCA wall enhancement were evaluated. A statistical analysis was performed to compare diagnostic accuracy between qualitative and quantitative metrics. Results The degree of stenosis, visual enhancement score, geometric mean (GM), and the 90th percentile (90P) value from the histogram analysis were significantly higher in PAD than in SAD (p = 0.006 for stenosis, < 0.001 for others). The receiver operating characteristic curve area of GM and 90P were 1 (95% confidence interval [CI], 0.86–1.00). Conclusion A histogram analysis of a relevant arterial wall enhancement allows differentiation between PAD and SAD in patients with acute stroke within the MCA territory.
Collapse
Affiliation(s)
- Jinhee Jang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Tae-Won Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Eo-Jin Hwang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Hyun Seok Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jaseong Koo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - So-Lyung Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Kook-Jin Ahn
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Bum-Soo Kim
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| |
Collapse
|
147
|
Yang Q, Deng Z, Bi X, Song SS, Schlick KH, Gonzalez NR, Li D, Fan Z. Whole-brain vessel wall MRI: A parameter tune-up solution to improve the scan efficiency of three-dimensional variable flip-angle turbo spin-echo. J Magn Reson Imaging 2017; 46:751-757. [PMID: 28106936 DOI: 10.1002/jmri.25611] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/08/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To propose and evaluate a parameter tune-up solution to expedite a three-dimensional (3D) variable-flip-angle turbo spin-echo (TSE) sequence for whole-brain intracranial vessel wall (IVW) imaging. MATERIALS AND METHODS Elliptical k-space sampling and prolonged echo train length (ETL), were used to expedite a 3D variable-flip-angle TSE-based sequence. To compensate for the potential loss in vessel wall signal, optimal combination of prescribed T2 and ETL was experimentally investigated on 22 healthy volunteers at 3 Tesla. The optimized protocol (7-8 min) was then compared with a previous protocol (reference protocol, 11-12 min) in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel wall sharpness, and wall delineation quality on a 4-point scale (0:poor; 3:excellent) in 10 healthy volunteers. A pilot study of five patients was performed and lesion delineation score was used to demonstrate the diagnostic quality. RESULTS A protocol with ETL = 52 and prescribed T2 = 170 ms was deemed an optimized one, which, compared with the reference protocol, provided significantly improved wall SNR (12.0 ± 1.3 versus 10.0 ± 1.1; P = 0.002), wall-lumen CNR (9.7 ± 1.2 versus 8.0 ± 0.9; P = 0.002), wall-CSF CNR (2.8 ± 1.0 versus 1.7 ± 1.0; P = 0.026), similar vessel wall sharpness at both inner (1.59 ± 0.18 versus 1.58 ± 0.14, P = 0.87) and outer (1.71 ± 0.25 versus 1.83 ± 0.30; P = 0.18) boundaries, and comparable vessel wall delineation score for individual segments (1.95-3; P > 0.06). In all patients, atherosclerotic plaques (10) or wall dissection (5) were identified with a delineation score of 3 or 2. CONCLUSION A parameter tune-up solution can accelerate 3D variable-flip-angle TSE acquisitions, particularly allowed for expedited whole-brain IVW imaging with preserved wall delineation quality. LEVEL OF EVIDENCE 2. Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:751-757.
Collapse
Affiliation(s)
- Qi Yang
- Department of Radiology, Xuanwu Hospital, Beijing, China.,Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zixin Deng
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, California, USA
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Konrad H Schlick
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nestor R Gonzalez
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
148
|
Dutra LA, de Souza AWS, Grinberg-Dias G, Barsottini OGP, Appenzeller S. Central nervous system vasculitis in adults: An update. Autoimmun Rev 2017; 16:123-131. [PMID: 28087351 DOI: 10.1016/j.autrev.2016.12.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 11/27/2022]
Abstract
Primary central nervous system vasculitis (PCNSV) is a challenging diagnosis due to broad clinical manifestations and variable specificity and sensitivity of laboratory and imaging diagnostic tools. Differential diagnosis includes reversible cerebral vasoconstriction syndrome (RCVS), secondary vasculitis of the CNS and other noninflammatory vasculopathies. Brain biopsy is essential for definitive diagnosis and to exclude mimickers. Recent data show that data large-vessel PCNSV present worse prognosis when compared to small-vessel PCNSV. Herein we review diagnosis and management of PCNSV, secondary vasculitis of CNS and RCVS.
Collapse
Affiliation(s)
- Lívia Almeida Dutra
- General Neurology Division, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | - Simone Appenzeller
- Rheumatology Division, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil.
| |
Collapse
|
149
|
Cogswell PM, Davis TL, Strother MK, Faraco CC, Scott AO, Jordan LC, Fusco MR, Frederick BD, Hendrikse J, Donahue MJ. Impact of vessel wall lesions and vascular stenoses on cerebrovascular reactivity in patients with intracranial stenotic disease. J Magn Reson Imaging 2017; 46:1167-1176. [PMID: 28061015 DOI: 10.1002/jmri.25602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To compare cerebrovascular reactivity (CVR) and CVR lagtimes in flow territories perfused by vessels with vs. without proximal arterial wall disease and/or stenosis, separately in patients with atherosclerotic and nonatherosclerotic (moyamoya) intracranial stenosis. MATERIALS AND METHODS Atherosclerotic and moyamoya patients with >50% intracranial stenosis and <70% cervical stenosis underwent angiography, vessel wall imaging (VWI), and CVR-weighted imaging (n = 36; vessel segments evaluated = 396). Angiography and VWI were evaluated for stenosis locations and vessel wall lesions. Maximum CVR and CVR lagtime were contrasted between vascular territories with and without proximal intracranial vessel wall lesions and stenosis, and a Wilcoxon rank-sum was test used to determine differences (criteria: corrected two-sided P < 0.05). RESULTS CVR lagtime was prolonged in territories with vs. without a proximal vessel wall lesion or stenosis for both patient groups: moyamoya (CVR lagtime = 45.5 sec ± 14.2 sec vs. 35.7 sec ± 9.7 sec, P < 0.001) and atherosclerosis (CVR lagtime = 38.2 sec ± 9.1 sec vs. 35.0 sec ± 7.2 sec, P = 0.001). For reactivity, a significant decrease in maximum CVR in the moyamoya group only (maximum CVR = 9.8 ± 2.2 vs. 12.0 ± 2.4, P < 0.001) was observed. CONCLUSION Arterial vessel wall lesions detected on noninvasive, noncontrast intracranial VWI in patients with intracranial stenosis correlate on average with tissue-level impairment on CVR-weighted imaging. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1167-1176.
Collapse
Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA
| | - Taylor L Davis
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Carlos C Faraco
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA
| | - Allison O Scott
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA
| | - Lori C Jordan
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA.,Department of Neurology, Vanderbilt University, Nashville, Tennessee, USA
| | - Matthew R Fusco
- Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Manus J Donahue
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA.,Department of Neurology, Vanderbilt University, Nashville, Tennessee, USA.,Department of Psychiatry, Vanderbilt University, Nashville, Tennessee, USA
| |
Collapse
|
150
|
Yu LB, Zhang Q, Shi ZY, Wang MQ, Zhang D. High-resolution Magnetic Resonance Imaging of Moyamoya Disease. Chin Med J (Engl) 2016; 128:3231-7. [PMID: 26612300 PMCID: PMC4794888 DOI: 10.4103/0366-6999.170257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To introduce the imaging characteristics of moyamoya disease (MMD) using high-resolution magnetic resonance imaging (HR-MRI) and to discuss the role of HR-MRI in differentiating MMD from other intracranial artery diseases, especially intracranial atherosclerotic disease (ICAD). Data Sources: This review was based on the data in articles published between 2005 and 2015, which were obtained from PubMed. The keywords included HR-MRI, MMD, ICAD, and intracranial artery diseases. Study Selection: Articles related to HR-MRI for MMD or other intracranial artery diseases were selected for review. Results: There are differences between the characteristic patterns of HR-MRI in MMD and ICAD. MMD is associated with inward remodeling, smaller outer diameters, concentric occlusive lesions and homogeneous signal intensity, while ICAD is more likely to be associated with outward remodeling, normal outer diameters, eccentric occlusive lesions, and heterogeneous signal intensity. Other intracranial artery diseases, such as dissection and vasculitis, also have distinctive characteristics in HR-MRI. HR-MRI may become a useful tool for the differential diagnosis of MMD in the future. Conclusions: HR-MRI of MMD provides a more in-depth understanding of MMD, and it is helpful in evaluating pathological changes in the vessel wall and in differentiating MMD from other intracranial artery steno-occlusive diseases, particularly ICAD.
Collapse
Affiliation(s)
| | | | | | | | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| |
Collapse
|