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Clingan MJ, Zhang Z, Caserta MP, Cox KL, Gupta V, Baumgarten DA, Zhai QJ, Alexander LF. Imaging Patients with Kidney Failure. Radiographics 2023; 43:e220116. [PMID: 37053100 DOI: 10.1148/rg.220116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
The approach to imaging a patient with kidney failure continues to evolve. Overstatement of the risk of iodinated contrast material-induced (ie, contrast-induced) acute kidney injury and new guidelines for administration of gadolinium-based contrast media affect screening and the choice of contrast material. Treatment of kidney failure requires dialysis or a kidney transplant. Pretransplant imaging includes assessment for the feasibility of performing a transplant and evaluation for underlying malignancy and peripheral vascular disease. Patients with kidney failure are at high risk for renal cell carcinoma. Subtypes that occur exclusively or more commonly in patients with kidney failure, such as acquired cystic kidney disease, renal cell carcinoma, and clear cell papillary renal cell carcinoma, have specific clinical-pathologic characteristics, with indolent behavior. Performing US for dialysis planning increases the success of placement of an arteriovenous fistula, while postoperative US evaluation is essential in assessment of access dysfunction. Systemic manifestations in patients with kidney failure are multifactorial and may relate to the underlying cause of renal failure or may be secondary to treatment effects. Disturbances in mineral and bone metabolism and soft-tissue and vascular calcifications are seen in patients with chronic kidney disease and mineral bone disorder. Neurologic and cardiothoracic complications are also common. The authors provide a comprehensive overview of imaging considerations for patients with kidney failure, including the appropriate use of CT, MRI, and US with their respective contrast agents; the use of imaging in transplant workup and dialysis assessment; and the common renal and extrarenal manifestations of kidney failure. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mary Jennings Clingan
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Zhao Zhang
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Melanie P Caserta
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Kelly L Cox
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Vivek Gupta
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Deborah A Baumgarten
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Qihui Jim Zhai
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
| | - Lauren F Alexander
- From the Departments of Radiology (M.J.C., Z.Z., M.P.C., K.L.C., V.G., D.A.B., L.F.A.) and Pathology (Q.J.Z.), Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL 32224
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Banerjee P, Roy S, Chakraborty S. Recent advancement of imaging strategies of the lymphatic system: Answer to the decades old questions. Microcirculation 2022; 29:e12780. [PMID: 35972391 DOI: 10.1111/micc.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/22/2022] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
The role of the lymphatic system in maintaining tissue homeostasis and a number of different pathophysiological conditions has been well established. The complex and delicate structure of the lymphatics along with the limitations of conventional imaging techniques make lymphatic imaging particularly difficult. Thus, in-depth high-resolution imaging of lymphatic system is key to understanding the progression of lymphatic diseases and cancer metastases and would greatly benefit clinical decisions. In recent years, the advancement of imaging technologies and development of new tracers suitable for clinical applications has enabled imaging of the lymphatic system in both clinical and pre-clinical settings. In this current review, we have highlighted the advantages and disadvantages of different modern techniques such as near infra-red spectroscopy (NIRS), positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI) and fluorescence optical imaging, that has significantly impacted research in this field and has led to in-depth insights into progression of pathological states. This review also highlights the use of current imaging technologies, and tracers specific for immune cell markers to identify and track the immune cells in the lymphatic system that would help understand disease progression and remission in immune therapy regimen.
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Affiliation(s)
- Priyanka Banerjee
- Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas, USA
| | - Sukanya Roy
- Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas, USA
| | - Sanjukta Chakraborty
- Department of Medical Physiology, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas, USA
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Ma C, Jiang X, Ren Y, Gu G, Fu A, Wang C, Bai P, Zhou T, Qin S, Fu S. Fiber connectivity density mapping in end-stage renal disease patients: a preliminary study. Brain Imaging Behav 2022; 16:1314-1323. [PMID: 35000065 DOI: 10.1007/s11682-021-00604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/25/2022]
Abstract
Abnormal brain structural connectivity of end-stage renal disease(ESRD) is associated with cognitive impairment. However, the characteristics of cortical structural connectivity have not been investigated in ESRD patients. Here, we study structural connectivity of the entire cerebral cortex using a fiber connectivity density(FiCD) mapping method derived from diffusion tensor imaging(DTI) data of 25 ESRD patients and 20 healthy controls, and between-group differences were compared in a vertexwise manner. We also investigated the associations between these abnormal cortical connectivities and the clinical variables using Pearson correlation analysis and multifactor linear regression analysis. Our results demonstrated that the mean global FiCD value was significantly decreased in ESRD patients. Notably, FiCD values were significantly changed(decreased or increased) in certain cortical regions, which mainly involved the bilateral dorsolateral prefrontal cortex(DLPFC), inferior parietal cortex, lateral temporal cortex and middle occipital cortex. In ESRD patients, we found a trend of negative correlation between the increased FiCD values of bilateral middle frontal gyrus and serum creatinine, urea, parathyroid hormone(PTH) levels and dialysis duration. Only the white matter hyperintensity(WMH) scores were significantly negatively correlated with the global FiCD value in multifactor regression analysis. Our results suggested that ESRD patients exhibited extensive impaired cortical structural connectivity, which was related to the severity of WMHs. A compensation mechanism of cortical structural recombination may play a role in how the brain adapts to maintain optimal network function. Additionally, the serum creatinine, urea and PTH levels may be risk factors for brain structural network decompensation in ESRD patients.
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Affiliation(s)
- Chi Ma
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xinghai Jiang
- Center for Disease Control and Prevention, West Coast New District, Qingdao, Shandong, China
| | - Yande Ren
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Gaojie Gu
- College of Electronic Information Engineering, Shandong University of Science and Technology, Qingdao, Shandong, China
| | - Airong Fu
- Department of Cardiovascular Medicine, West Coast New District Central Hospital, Qingdao, Shangdong, China
| | - Chengjian Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Peirui Bai
- College of Electronic Information Engineering, Shandong University of Science and Technology, Qingdao, Shandong, China
| | - Tong Zhou
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shanshan Qin
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shengli Fu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Herrington JD, Hartung EA, Laney NC, Hooper SR, Furth SL. Decreased Neural Connectivity in the Default Mode Network Among Youth and Young Adults With Chronic Kidney Disease. Semin Nephrol 2021; 41:455-461. [PMID: 34916007 DOI: 10.1016/j.semnephrol.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An increasing amount of literature has indicated that chronic kidney disease (CKD) is associated with cognitive deficits that increase with worsening disease severity. Although abnormalities in brain structure have been widely documented, few studies to date have examined the functioning of brain areas associated with the specific cognitive domains affected by CKD (namely, attention and executive functions). Furthermore, few studies have examined functional connectivity among CKD youth who are relatively early in the course of the disease. The present study used functional magnetic resonance imaging to examine the resting state connectivity in 67 youth with CKD (mean age, 17 y) and 58 age-matched healthy controls. Using seed-based multiple regression, decreased connectivity was observed within the anterior cingulate portion of the default mode network. In addition, decreased connectivity within the dorsolateral prefrontal cortex, paracingulate gyrus, and frontal pole were correlated significantly with disease severity. These data indicate that connectivity deficits in circuits implementing attentional processes may represent an early marker for cognitive decline in CKD.
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Affiliation(s)
- John D Herrington
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Child Psychiatry and Behavioral Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nina C Laney
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Stephen R Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina School-Chapel Hill, Chapel Hill, NC
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Kurt A, Firat A, Aildere A, Aytekin C, Benli S, Özmen I, Özdemir N, Haberal M. Evaluation of MRI-detected White Matter Changes in Relation to Hemodialysis Duration and Renal Transplantation. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140090301600207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Compared to the normal population, renal transplant recipients and end-stage renal disease (ESRD) patients on hemodialysis have a higher incidence of white matter changes (WMC) on brain magnetic resonance imaging (MRI). The lesions appear as focal or patchy areas in the periventricular white matter. Both these patient groups are known to be affected by accelerated atherosclerosis, which produces small-vessel disease. This may lead to thromboembolic complications that cause these white matter lesions. This study retrospectively assessed the frequency of MRI-detected WMC in ESRD patients on hemodialysis and kidney recipients, and correlated the rates with hemodialysis duration and post-transplantation interval. Focal and patchy type lesions were distinguished, and the frequencies of these were studied. Also, in the respective groups, comparisons were made among patients with different hemodialysis durations and post-transplantation intervals. The results showed that specifically focal lesions increase in parallel with hemodialysis duration, but there was no statistical relationship between WMC and post-transplantation interval.
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Affiliation(s)
- A Kurt
- Department of Radiology, Baskent University Medical Faculty, Fevzi Çakmak Cad. 10.Sok. No: 45 Bahçelievler-Ankara, 06490, Turkey
| | | | - Am Aildere
- Department of Radiology, Baskent University Medical Faculty, Fevzi Çakmak Cad. 10.Sok. No: 45 Bahçelievler-Ankara, 06490, Turkey
| | - C Aytekin
- Department of Radiology, Baskent University Medical Faculty, Fevzi Çakmak Cad. 10.Sok. No: 45 Bahçelievler-Ankara, 06490, Turkey
| | - S Benli
- Department of Neurology, Baskent University Medical Faculty, Fevzi Çakmak Cad. 10.Sok. No: 45 Bahçelievler-Ankara, 06490, Turkey
| | - I Özmen
- Department of Statistics, Baskent University Medical Faculty, Fevzi Çakmak Cad. 10.Sok. No: 45 Bahçelievler-Ankara, 06490, Turkey
| | - N Özdemir
- Department of Nephrology, Baskent University Medical Faculty, Fevzi Çakmak Cad. 10.Sok. No: 45 Bahçelievler-Ankara, 06490, Turkey
| | - M Haberal
- Department of General Surgery, Baskent University Medical Faculty, Fevzi Çakmak Cad. 10.Sok. No: 45 Bahçelievler-Ankara, 06490, Turkey
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Ma X, Tian J, Wu Z, Zong X, Dong J, Zhan W, Xu Y, Li Z, Jiang G. Spatial Disassociation of Disrupted Functional Connectivity for the Default Mode Network in Patients with End-Stage Renal Disease. PLoS One 2016; 11:e0161392. [PMID: 27560146 PMCID: PMC4999135 DOI: 10.1371/journal.pone.0161392] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the aberrant functional connectivity of the default mode network (DMN) in patients with end-stage renal disease (ESRD) and their clinical relevance. MATERIALS AND METHODS Resting-state functional MRI data were collected from 31 patients with ESRD (24 men, 24-61 years) and 31 age- and gender-matched healthy controls (HCs, 21 men, 26-61years). A whole-brain seed-based functional connectivity analysis of these collected R-fMRI data was performed by locating the seeds in the posterior cingulate cortex (PCC) and ventromedial prefrontal cortex (vmPFC) to investigate the functional connectivity of the posterior and anterior DMN over the whole brain, respectively. RESULTS Compared to the HCs, the patients exhibited significantly decreased functional connectivity with the PCC in the left middle temporal gyrus, the right anterior cingulate gyrus, and the bilateral medial superior frontal gyrus. For the vmPFC seed, only the right thalamus showed significantly decreased functional connectivity in the patients with ESRD compared to HCs. Interestingly, functional connectivity between the PCC and right medial superior frontal gyrus exhibited a significantly positive correlation with the hemoglobin level in the patients. CONCLUSION Our findings suggest a spatially specific disruption of functional connectivity in the DMN in patients with ESRD, thereby providing novel insights into our understanding of the neurophysiology mechanism that underlies the disease.
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Affiliation(s)
- Xiaofen Ma
- Department of Medical Imaging, Guangdong Provincial No.2 People’s Hospital, Guangzhou City, Guangdong province, PR China
| | - Junzhang Tian
- Department of Medical Imaging, Guangdong Provincial No.2 People’s Hospital, Guangzhou City, Guangdong province, PR China
| | - Zhanhong Wu
- Biomedical Research Imaging Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Xiaopeng Zong
- Biomedical Research Imaging Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jianwei Dong
- Department of Mathematics, Guangdong Pharmaceutical University, Guangzhou City, Guangdong province, PR China
| | - Wenfeng Zhan
- Department of Medical Imaging, Guangdong Provincial No.2 People’s Hospital, Guangzhou City, Guangdong province, PR China
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong province, PR China
| | - Zibo Li
- Biomedical Research Imaging Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail: (GJ); (ZL)
| | - Guihua Jiang
- Department of Medical Imaging, Guangdong Provincial No.2 People’s Hospital, Guangzhou City, Guangdong province, PR China
- * E-mail: (GJ); (ZL)
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Abstract
Cognitive impairment is very common in chronic kidney disease (CKD) and is strongly associated with increased mortality. This review article will discuss the pathophysiology of cognitive impairment in CKD, as well as the effect of dialysis and transplantation on cognitive function. In CKD, uremic toxins, hyperparathyroidism and Klotho deficiency lead to chronic inflammation, endothelial dysfunction and vascular calcifications. This results in an increased burden of cerebrovascular disease in CKD patients, who consistently have more white matter hyperintensities, microbleeds, microinfarctions and cerebral atrophy on magnetic resonance imaging scans. Hemodialysis, although beneficial in terms of uremic toxin clearance, also contributes to cognitive decline by causing rapid fluid and osmotic shifts. Decreasing the dialysate temperature and increasing total dialysis time limits these shifts and helps maintain cognitive function in hemodialysis patients. For many patients, kidney transplantation is the preferred treatment modality, because it reverses the underlying mechanisms causing cognitive impairment in CKD. These positive effects have to be balanced against the possible neurotoxicity of infections and immunosuppressive medications, especially glucocorticosteroids and calcineurin inhibitors. A limited number of studies have addressed the overall effect of transplantation on cognitive function. These have mostly found an improvement after transplantation, but have a limited applicability to daily practice because they have only included relatively young patients.
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Meurs M, Roest AM, Groenewold NA, Franssen CFM, Westerhuis R, Kloppenburg WD, Doornbos B, Beukema L, Lindmäe H, de Groot JC, van Tol MJ, de Jonge P. Gray matter volume and white matter lesions in chronic kidney disease: exploring the association with depressive symptoms. Gen Hosp Psychiatry 2016; 40:18-24. [PMID: 27040607 DOI: 10.1016/j.genhosppsych.2016.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 02/09/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Chronic kidney disease (CKD) is associated with structural brain damage and with a high prevalence of depression. We therefore investigated structural brain alterations in both gray and white matter in CKD patients, focusing on depression-related (frontal-subcortical) regions. METHOD This cross-sectional MRI study in 24 CKD patients and 24 age- and sex-matched controls first tested whether CKD was associated with regionally lower gray matter (GM) volumes and more severe white matter lesions (WMLs). In exploratory subanalyses, we examined whether differences were more pronounced in CKD patients with depressive symptoms. RESULTS CKD patients showed lower global GM volume (P=.04) and more severe WMLs (P=.04) compared to controls. In addition, we found substantial clusters of lower GM in the bilateral orbitofrontal-cortex for CKD patients, which were however nonsignificant after proper multiple-comparison correction. In exploratory analyses for depressed CKD patients, reduced GM clusters were mainly detected within the frontal lobe. WML severity was unrelated to depression. CONCLUSION CKD was characterized by differences in brain structure. Although subthreshold, lower GM volumes were observed in depression-related brain areas and were more pronounced for depressed patients. There is a need for replication in larger and longitudinal studies to investigate whether WMLs and regional GM reductions may render CKD patients more susceptible for depression.
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Affiliation(s)
- Maaike Meurs
- University of Groningen/University Medical Center Groningen, Department of psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
| | - Annelieke M Roest
- University of Groningen/University Medical Center Groningen, Department of psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
| | - Nynke A Groenewold
- University of Groningen/University Medical Center Groningen, Department of psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
| | - Casper F M Franssen
- University of Groningen/University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, The Netherlands.
| | | | | | - Bennard Doornbos
- University Medical Center Groningen, department of Psychiatry, the Netherlands, GGZ Drenthe, Assen, the Netherlands.
| | - Lindy Beukema
- University of Groningen/University Medical Center Groningen, Department of psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
| | - Hanna Lindmäe
- University of Groningen/University Medical Center Groningen, department of Radiology, The Netherlands.
| | - Jan Cees de Groot
- University of Groningen/University Medical Center Groningen, department of Radiology, The Netherlands.
| | - Marie-José van Tol
- University of Groningen/University Medical Center Groningen, Neuroimaging Center, department of Neuroscience, section Cognitive NeuroPsychiatry, The Netherlands.
| | - Peter de Jonge
- University of Groningen/University Medical Center Groningen, Department of psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
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Chai C, Zhang M, Long M, Chu Z, Wang T, Wang L, Guo Y, Yan S, Haacke EM, Shen W, Xia S. Increased brain iron deposition is a risk factor for brain atrophy in patients with haemodialysis: a combined study of quantitative susceptibility mapping and whole brain volume analysis. Metab Brain Dis 2015; 30:1009-16. [PMID: 25796223 DOI: 10.1007/s11011-015-9664-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/04/2015] [Indexed: 12/11/2022]
Abstract
To explore the correlation between increased brain iron deposition and brain atrophy in patients with haemodialysis and their correlation with clinical biomarkers and neuropsychological test. Forty two patients with haemodialysis and forty one age- and gender-matched healthy controls were recruited in this prospective study. 3D whole brain high resolution T1WI and susceptibility weighted imaging were scanned on a 3 T MRI system. The brain volume was analyzed using voxel-based morphometry (VBM) in patients and to compare with that of healthy controls. Quantitative susceptibility mapping was used to measure and compare the susceptibility of different structures between patients and healthy controls. Correlation analysis was used to investigate the relationship between the brain volume, iron deposition and neuropsychological scores. Stepwise multiple regression analysis was used to explore the effect of clinical biomarkers on the brain volumes in patients. Compared with healthy controls, patients with haemodialysis showed decreased volume of bilateral putamen and left insular lobe (All P < 0.05). Susceptibilities of bilateral caudate head, putamen, substantia nigra, red nucleus and dentate nucleus were significantly higher (All P < 0.05). The increased brain iron deposition is negatively correlated with the decreased volume of bilateral putamen (P < 0.01). Neuropsychological scores positively correlated with decreased volume of left insular lobe (P < 0.05). Dialysis duration was negatively associated with decreased volume of bilateral putamen (P < 0.05). Our study indicated increased brain iron deposition and dialysis duration was risk factors for brain atrophy in patients with haemodialysis. The decreased gray matter volume of the left insular lobe was correlated with neurocognitive impairment.
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Affiliation(s)
- Chao Chai
- Department of Medical Imaging, Tianjin First Central Hospital, Tianjin, 300192, China
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Multimodality MRI Findings in Patients with End-Stage Renal Disease. BIOMED RESEARCH INTERNATIONAL 2015; 2015:697402. [PMID: 26064943 PMCID: PMC4434172 DOI: 10.1155/2015/697402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/15/2015] [Indexed: 01/17/2023]
Abstract
Patients with end-stage renal disease (ESRD) suffer from a number of complex neurological complications including vascular damage and cognitive dysfunction. It is of great significance to detect the neurological complications and improve the prognosis of ESRD patients. Many new noninvasive MRI techniques have been steadily used for the diagnosis of occult central nervous system complications in ESRD patients. This gives an opportunity to understand the pathophysiological mechanisms of these neurological disorders. This paper is a review that presents the MRI findings of occult brain damage in ESRD patients, outlines the applications of advanced MRI techniques, and introduces a brief perspective in this study field.
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Li C, Su HH, Qiu YW, Lv XF, Shen S, Zhan WF, Tian JZ, Jiang GH. Regional homogeneity changes in hemodialysis patients with end stage renal disease: in vivo resting-state functional MRI study. PLoS One 2014; 9:e87114. [PMID: 24516545 PMCID: PMC3916321 DOI: 10.1371/journal.pone.0087114] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 12/22/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To prospectively investigate and detect early cerebral regional homogeneity (ReHo) changes in neurologically asymptomatic patients with end stage renal disease (ESRD) using in vivo resting-state functional MR imaging (Rs-fMRI). METHODS We enrolled 20 patients (15 men, 5 women; meanage, 37.1 years; range, 19-49 years) with ESRD and 20 healthy controls (15 men, 5 women; mean age, 38.3 years; range, 28-49 years). The mean duration of hemodialysis for the patient group was 10.7±6.4 monthes. There was no significant sex or age difference between the ESRD and control groups. Rs-fMRI was performed using a gradient-echo echo-planar imaging sequence. ReHo was calculated using software (DPARSF). Voxel-based analysis of the ReHo maps between ESRD and control groups was performed with a two-samples t test. Statistical maps were set at P value less than 0.05 and were corrected for multiple comparisons. The Mini-Mental State Examination (MMSE) was administered to all participants at imaging. RESULTS ReHo values were increased in the bilateral superior temporal gyrus and left medial frontal gyrus in the ERSD group compared with controls, but a significantly decreased ReHo value was found in the right middle temporal gyrus. There was no significant correlation between ReHo values and the duration of hemodialysis in the ESRD group. Both the patients and control subjects had normal MMSE scores (≥28). CONCLUSIONS Our finding revealed that abnormal brain activity was distributed mainly in the memory and cognition related cotices in patients with ESRD. The abnormal spontaneous neuronal activity in those areas provide information on the neural mechanisms underlying cognitive impairment in patients with ESRD, and demonstrate that Rs-fMRI with ReHo analysis is a useful non-invasive imaging tool for the detection of early cerebral ReHo changes in hemodialysis patients with ESRD.
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Affiliation(s)
- Cheng Li
- Department of Renal Transplantation, Guangdong No.2 Provincial People's Hospital, Guangzhou, People's Republic of China
| | - Huan-Huan Su
- Department of Medical Imaging, Guangdong No.2 Provincial People's Hospital, Guangzhou, People's Republic of China
| | - Ying-Wei Qiu
- Department of Medical Imaging, Guangdong No.2 Provincial People's Hospital, Guangzhou, People's Republic of China
| | - Xiao-Fei Lv
- State Key Laboratory of Oncology in South China and Department of Medical Imaging and Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Sheng Shen
- Department of Renal Transplantation, Guangdong No.2 Provincial People's Hospital, Guangzhou, People's Republic of China
| | - Wen-Feng Zhan
- Department of Medical Imaging, Guangdong No.2 Provincial People's Hospital, Guangzhou, People's Republic of China
| | - Jun-Zhang Tian
- Department of Medical Imaging, Guangdong No.2 Provincial People's Hospital, Guangzhou, People's Republic of China
| | - Gui-Hua Jiang
- Department of Medical Imaging, Guangdong No.2 Provincial People's Hospital, Guangzhou, People's Republic of China
- * E-mail:
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12
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Zhang LJ, Wen J, Ni L, Zhong J, Liang X, Zheng G, Lu GM. Predominant gray matter volume loss in patients with end-stage renal disease: a voxel-based morphometry study. Metab Brain Dis 2013; 28:647-54. [PMID: 24065440 DOI: 10.1007/s11011-013-9438-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 09/16/2013] [Indexed: 01/26/2023]
Abstract
To investigate the pattern of brain volume changes in patients with end-stage renal disease (ESRD) using voxel-based morphometry (VBM) and correlation with clinical and neuropsychological (NP) tests. Fifty seven ESRD patients with no anatomical abnormalities in conventional magnetic resonance imaging [24 patients with abnormal NP scores, 16 male, 39 ± 12 years; 33 patients with normal NP scores, 23 male, 35 ± 9.7 years] and 22 age- and gender-matched healthy controls (14 male, 36 ± 10.1 years) were recruited in this study. Results from VBM analysis were analyzed with ANOVA test among 3 groups (controls, minimal nephro-encephalopathy group, non-nephro-encephalopathy group). Multiple linear regression analysis was used to investigate the effect of serum urea and creatinine, and dialysis duration on the brain volumes in ESRD patients. Correlation analysis was performed to investigate the association between NP scores with the brain volumes in ESRD patients. Compared with healthy controls, ESRD patients showed diffusely decreased gray matter volume that further decreased in the presence of encephalopathy. Multiple linear regression results showed that serum urea was negatively associated with changes in gray matter volume in many regions, while dialysis duration was negatively associated with some white matter volume changes (All P < 0.05, AlphaSim correction). NP scores correlated with some decreased gray matter volume in ESRD patients (All P < 0.05, AlphaSim correction). No correlation was found between white matter volume and any NP test scores in ESRD patients. This study found predominantly decreased gray matter volume in ESRD patients, which was associated with neurocognitive dysfunction. Serum urea level may be a risk factor for decreased gray matter in ESRD patients.
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Affiliation(s)
- Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province, 210002, China,
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Moodalbail DG, Reiser KA, Detre JA, Schultz RT, Herrington JD, Davatzikos C, Doshi JJ, Erus G, Liu HS, Radcliffe J, Furth SL, Hooper SR. Systematic review of structural and functional neuroimaging findings in children and adults with CKD. Clin J Am Soc Nephrol 2013; 8:1429-48. [PMID: 23723341 DOI: 10.2215/cjn.11601112] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
CKD has been linked with cognitive deficits and affective disorders in multiple studies. Analysis of structural and functional neuroimaging in adults and children with kidney disease may provide additional important insights into the pathobiology of this relationship. This paper comprehensively reviews neuroimaging studies in both children and adults. Major databases (PsychLit, MEDLINE, WorldCat, ArticleFirst, PubMed, Ovid MEDLINE) were searched using consistent search terms, and studies published between 1975 and 2012 were included if their samples focused on CKD as the primary disease process. Exclusion criteria included case reports, chapters, and review articles. This systematic process yielded 43 studies for inclusion (30 in adults, 13 in children). Findings from this review identified several clear trends: (1) presence of cerebral atrophy and cerebral density changes in patients with CKD; (2) cerebral vascular disease, including deep white matter hyperintensities, white matter lesions, cerebral microbleeds, silent cerebral infarction, and cortical infarction, in patients with CKD; and (3) similarities in regional cerebral blood flow between patients with CKD and those with affective disorders. These findings document the importance of neuroimaging procedures in understanding the effect of CKD on brain structure, function, and associated behaviors. Results provide a developmental linkage between childhood and adulthood, with respect to the effect of CKD on brain functioning across the lifespan, with strong implications for a cerebrovascular mechanism contributing to this developmental linkage. Use of neuroimaging methods to corroborate manifest neuropsychological deficits or perhaps to indicate preventive actions may prove useful to individuals with CKD.
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Affiliation(s)
- Divya G Moodalbail
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Cerebral metabolic changes in neurologically presymptomatic patients undergoing haemodialysis: in vivo proton MR spectroscopic findings. Eur Radiol 2009; 20:1502-7. [PMID: 19997847 DOI: 10.1007/s00330-009-1673-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 09/09/2009] [Accepted: 10/10/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To prospectively investigate and detect early cerebral metabolic changes in patients with end-stage renal disease (ESRD) by using in vivo proton MR spectroscopy (MRS). METHODS We enrolled 32 patients with ESRD and 32 healthy controls between the ages of 26 and 50 years. Short echo time single-voxel proton MRS was acquired from volumes of interest (VOIs) located in the frontal grey and white matter, temporal white matter and basal ganglia. The choline/phospatidylcholine (Cho), myo-inositol (mI), N-acetylaspartate (NAA) and total creatine (tCr) peaks were measured and the metabolic ratios with respect to tCr were calculated. RESULTS In the ESRD group, significant elevations of the Cho/tCr and mI/tCr ratios were observed for the frontal grey matter, frontal white matter, temporal white matter and basal ganglia as compared with controls. There was no significant difference in the NAA/tCr ratios at all VOIs between the ESRD patients and the healthy controls. CONCLUSIONS Proton MRS is a useful and non-invasive imaging tool for the detection of early cerebral metabolic changes in neurologically presymptomatic ESRD patients.
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Hsieh TJ, Chang JM, Chuang HY, Ko CH, Hsieh ML, Liu GC, Hsu JS. End-stage renal disease: in vivo diffusion-tensor imaging of silent white matter damage. Radiology 2009; 252:518-25. [PMID: 19528357 DOI: 10.1148/radiol.2523080484] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To characterize and compare regional differences in anisotropy in patients with end-stage renal disease (ESRD) and in control subjects to understand the effect of ESRD and hemodialysis on the microstructures of white matter. MATERIALS AND METHODS This study was approved by an institutional review board; written informed consent was obtained. From March 2007 to December 2007, 34 patients (16 men, 18 women; mean age, 40.0 years; range, 26-50 years) with ESRD who were undergoing dialysis and 35 control subjects (16 men, 19 women; mean age, 38.3 years; range, 25-49 years) were enrolled. There was no significant sex or age difference between the ESRD and control groups. By using a 1.5-T imager, fractional anisotropy (FA) data obtained at diffusion-tensor magnetic resonance (MR) imaging (echo-planar imaging, 33 directions; b value, 1000 sec/mm(2)) and at T2-weighted fluid-attenuated inversion recovery (FLAIR) MR imaging of the bilateral parietal, frontal, occipital, and temporal lobe white matter, as well as the genu and splenium of the corpus callosum, were compared. The Cognitive Abilities Screening Instrument (CASI) was administered to all participants at imaging. RESULTS The ESRD group had significantly lower FA values in all regions than the control group. FA values were generally lower in older patients and in those who had been undergoing dialysis for a longer duration. Duration of dialysis was more often than age found to be correlated with differences in FA values. In areas in which there was a significant correlation between age, duration, and FA values, the regression coefficients were greater for those who had been undergoing dialysis longer than for those who were older. Patients with ESRD had significantly lower CASI scores than control subjects (P = .03). There were no significant group differences in FLAIR values (P = .25-.89). CONCLUSION Changes in FA values may be used to follow-up white matter changes in patients with ESRD who are undergoing maintenance dialysis. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/2523080484/DC1.
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Affiliation(s)
- Tsyh-Jyi Hsieh
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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JUNG EY, CHO HS, SEO JW, KIM DW, KIM HJ, CHANG SH, PARK DJ. Metformin-induced encephalopathy without lactic acidosis in a patient with contraindication for metformin. Hemodial Int 2009; 13:172-5. [DOI: 10.1111/j.1542-4758.2009.00358.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kuncova J, Sviglerova J, Kummer W, Rajdl D, Chottova-Dvorakova M, Tonar Z, Nalos L, Stengl M. Parasympathetic regulation of heart rate in rats after 5/6 nephrectomy is impaired despite functionally intact cardiac vagal innervation. Nephrol Dial Transplant 2009; 24:2362-70. [DOI: 10.1093/ndt/gfp123] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Murray AM. Cognitive impairment in the aging dialysis and chronic kidney disease populations: an occult burden. Adv Chronic Kidney Dis 2008; 15:123-32. [PMID: 18334236 DOI: 10.1053/j.ackd.2008.01.010] [Citation(s) in RCA: 268] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The high burden of cognitive impairment in hemodialysis and chronic kidney disease (CKD) patients has only recently become recognized. Up to 70% of hemodialysis patients aged 55 years and older have moderate to severe chronic cognitive impairment, yet it is largely undiagnosed. Recent studies describe the strong graded relation between estimated glomerular filtration rate and cognitive function in CKD patients. The process of conventional hemodialysis may induce recurrent episodes of acute cerebral ischemia, which, in turn, may contribute to acute decline in cognitive function during dialysis. Thus, the worst time to communicate with dialysis patients may be during the hemodialysis session. Both symptomatic and occult, subclinical ischemic cerebrovascular disease appears to play a large role in a proposed model of accelerated vascular cognitive impairment in these populations. Severe cognitive impairment or dementia among hemodialysis patients is associated with an approximately 2-fold increased risk of both mortality and dialysis withdrawal. Predialysis cognitive screening and adding dementia to the list of comorbidities on Form 2728 would provide critical information regarding the benefit versus risks of receiving dialysis. It could also improve quality of care and outcomes by raising clinicians' awareness of the potential effects of cognitive impairment on medication, fluid, and dietary compliance and the ability to make advance directive decisions among dialysis patients. Although much remains to be learned regarding the pathophysiology of cognitive impairment in kidney disease, the public health implications of this substantial burden are immediate.
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da Silva CJ, da Rocha AJ, Jeronymo S, Mendes MF, Milani FT, Maia ACM, Braga FT, Sens YAS, Miorin LA. A preliminary study revealing a new association in patients undergoing maintenance hemodialysis: manganism symptoms and T1 hyperintense changes in the basal ganglia. AJNR Am J Neuroradiol 2007; 28:1474-9. [PMID: 17846194 PMCID: PMC8134392 DOI: 10.3174/ajnr.a0600] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients undergoing parenteral nutrition and those with portosystemic encephalopathy secondary to chronic liver disease and acquired and congenital portosystemic venous shunts frequently present manganese deposition in the basal ganglia, detected by MR imaging as hyperintense areas on T1-weighted sequences. We also observed similar abnormalities in the basal ganglia of patients with chronic renal failure undergoing maintenance hemodialysis. Our aim was to evaluate the pallidal signal intensity on T1-weighted images in a series of patients undergoing hemodialysis, with further evaluation of serum manganese levels and neurologic correlation, comparing them with patients with chronic renal failure without dialytic treatment. MATERIALS AND METHODS We performed MR imaging examinations in 9 patients with chronic renal failure, 5 of whom were undergoing hemodialysis. An experienced neuroradiologist scrutinized the presence of symmetric hyperintensities in the basal ganglia on T1-weighted sequences. We also determined the serum manganese levels and performed the neurologic evaluations in all patients. RESULTS All patients undergoing hemodialysis presented elevated serum manganese levels and symmetric hyperintensities within the globus pallidus. In this group, 4 patients presented with parkinsonian symptoms, myoclonus, and syndromes with vestibular and vestibular-auditory symptoms. The patients without dialytic treatment presented with neither bilaterally increased T1 MR imaging signal intensity within the globus pallidus nor symptoms of manganism. CONCLUSION Our preliminary results demonstrated the occurrence of bilateral pallidal hyperintensity on T1-weighted images in all patients undergoing hemodialysis associated with high serum manganese levels, revealing a new association.
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Affiliation(s)
- C J da Silva
- Section of Radiology, Laboratório Fleury-Centro de Medicina Diagnóstica, São Paulo-SP, Brazil.
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Antoine V, Souid M, Bodenan L. La population âgée hémodialysée : évaluer et prendre en charge le risque de déclin cognitif. Nephrol Ther 2007; 3:11-26. [PMID: 17383587 DOI: 10.1016/j.nephro.2006.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 04/14/2006] [Accepted: 11/14/2006] [Indexed: 12/25/2022]
Abstract
Epidemiological data suggest a large prevalence of cognitive impairment in elderly patients on haemodialysis. They are frequently exposed to pathologies that affect the brain, and hold a plurality of risk factors for neurodegenerative and vascular dementia. Cognitive dysfunctions, because of their medical and socio-economical consequences, may led to discuss the indication for haemodialysis and its profit for the elderly patient. These facts highlight the advantage of a regular assessment of cognitive functions in this population. They also suggest the need in the future of a multidisciplinary intervention for these patients, for a better evaluation of interventions aimed on primary and secondary prevention of cognitive decline in the elderly group.
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Affiliation(s)
- Valéry Antoine
- Consultation de la mémoire, unité mobile de gériatrie, hôpital de Poissy, CHI de Poissy-Saint-Germain-en-Laye, Les Maisonnées, Poissy, France.
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Agildere AM, Başaran C, Cakir B, Ozgül E, Kural F, Haberal M. Evaluation of neurologic complications by brain MRI in kidney and liver transplant recipients. Transplant Proc 2006; 38:611-8. [PMID: 16549189 DOI: 10.1016/j.transproceed.2005.12.113] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to retrospectively analyze brain magnetic resonance imaging (MRI) findings in patients who developed neurologic complications after liver and kidney transplantation. The results in 216 organ transplant recipients, who had brain MRI were evaluated retrospectively. We performed 187 brain MRI on kidney recipients and 29 liver recipients. Neuroradiologic findings were classified in three groups: group 1 findings were related to transplantation; group 2 findings, to chronic parenchymal disease; and group 3 to neither transplantation nor chronic parenchymal disease. In group 1, six patients (20.6%) after liver and three (1.6%) after kidney transplantation had posterior reversible encephalopathy syndrome; two patients (1.1%) after renal and one (3.4%) after liver transplantation had tuberculosis granulomas; one patient (0.5%) after renal transplantation had osmotic demyelination syndrome; one patient (0.5%) had a Nocardia abcess and one (0.5%) focal cerebritis after renal transplantation. Among group 2, 38 patients (20.3%) had brain atrophy; 37 (20%), white matter changes; 3 (1.6%), sinus thrombosis; 8 (4.3%), lacunar infarct; 1 (0.5%), had renal osteodystrophy in the cranial bones; and 4 (2.2%), had intracranial hemorrhage secondary to end-stage renal disease. Brain atrophy in nine patients (31%), hyperintensity in the globus pallidus on T1-weighted MR images owing to manganese deposits in nine patients (31%), hyperintensity in basal ganglia on T2-weighted MR images owing to copper depositions in one patient (3.4%) were seen secondary to chronic liver disease. In group 3, three patients (1.6%) had intracranial lipomas; one (0.5%), mesial temporal sclerosis; and one (0.5%), an anterior cerebral artery aneurysm in renal transplant patients. Periventricular and subcortical white matter hyperintensities were observed on T2-weighted MR images in six liver transplant patients (20.7%). Neurologic complications after organ transplantation may be secondary to transplantation itself, to chronic parenchymal disease, or to neither transplantation nor chronic parenchymal disease.
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Affiliation(s)
- A M Agildere
- Başkent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
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Tarhan NC, Agildere AM, Benli US, Ozdemir FN, Aytekin C, Can U. Osmotic Demyelination Syndrome in End-Stage Renal Disease After Recent Hemodialysis:MRI of the Brain. AJR Am J Roentgenol 2004; 182:809-16. [PMID: 14975990 DOI: 10.2214/ajr.182.3.1820809] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Osmotic demyelination syndrome has been reported in patients with end-stage renal disease, but the specific MRI findings in this patient group have not been documented in detail. Our aims were to present the brain MRI findings during an episode after hemodialysis and at follow-up, and to identify possible factors that may contribute to lesion development. MATERIALS AND METHODS Seventeen patients with osmotic demyelination syndrome who had undergone hemodialysis at least once and had brain MRI examinations were retrospectively reviewed. Neurologic and MRI examinations were performed during a clinical episode. Serum levels of sodium, creatinine, blood urea nitrogen, and glucose were assessed, and serum osmolality and the ratio of blood urea nitrogen to creatinine (BUN:Cr) were calculated. Follow-up MRI was performed in nine cases. Laboratory and imaging findings were evaluated. RESULTS An altered level of consciousness and convulsions were the most common neurologic symptoms. The pons was involved in 11 patients (65%) and extrapontine sites in 12 (71%). Four patients had dysequilibrium syndrome. Follow-up MRI showed complete resolution in six patients and lesion reduction in three within a short time. The most common biochemical changes at the time of MRI were hyponatremia and low BUN:Cr in the blood. Only one patient showed rapid correction of hyponatremia and a rapid change in osmolality during the acute stage. CONCLUSION In patients who develop osmotic demyelination syndrome after hemodialysis, the lesions may involve the pons or the pons and extrapontine sites. Most lesions that were followed up resolved rapidly and almost completely, favoring transient edema rather than demyelination. Blood chemistries suggested underlying changes in osmolality, particularly as a result of urea shift from the extracellular fluid.
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Affiliation(s)
- N Cagla Tarhan
- Department of Radiology, Baskent University Faculty of Medicine, Fevzi Cakmak Cad. 10. Sok No. 45, 06490 Bahçelievler, Ankara, Turkey
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Verrees M, Fernandes Filho JA, Suarez JI, Ratcheson RA. Primary hypertension-induced cerebellar encephalopathy causing obstructive hydrocephalus. Case report. J Neurosurg 2003; 98:1307-11. [PMID: 12816279 DOI: 10.3171/jns.2003.98.6.1307] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hypertension-induced encephalopathy is a recognized pathological process commonly focused in the parietal and occipital lobes of the cerebral hemispheres. The parenchyma of the posterior fossa is infrequently involved. The authors report on two cases of isolated edema of the cerebellar hemispheres, which occurred in the setting of hypertensive crisis and led to complete obstruction of or significant impingement on the fourth ventricle and potentially lethal hydrocephalus. To the best of the authors' knowledge, these are the first reported cases of hypertensive encephalopathy centered in the posterior fossa. Two patients presented with profound decreases in neurological status subsequent to development of malignant hypertension. Imaging studies revealed diffusely edematous cerebellar hemispheres with effacement of the fourth ventricle, causing dilation of the lateral and third ventricles. Following emergency placement of external ventricular drains, control of systemic blood pressure was accomplished, and neurological functioning returned to baseline. Although neurological deterioration resolved swiftly following placement of ventricular catheters and administration of diuretic agents, systemic blood pressure did not fluctuate with the release of cerebrospinal fluid and resolution of increased intracranial pressure. Decrease in systemic blood pressure lagged well behind improvement in neurological status; the patients remained morbidly hypertensive until systemic blood pressure was controlled with multiple parenteral medications. The authors hypothesize that the development of hypertension beyond the limits of cerebral autoregulation led to breakdown of the blood-brain barrier in the cerebellum and development of posterior fossa edema secondary to the focal transudation of protein and fluid. Correction of the elevated blood pressure led to amelioration of cerebellar edema. In the appropriate clinical setting, hypertension as the inciting cause of cerebellar encephalopathy should be considered.
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Affiliation(s)
- Meg Verrees
- Department of Neurosurgery, Case Western Reserve University, University Hospitals of Cleveland, Ohio 44106, USA.
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