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Wu C, Dong X, Li Q, Liu S, He Y, Zhang Y, Zhang S. Changes of serum MMP-9, NSE, MPO levels and prognostic influencing factors in patients with intracranial aneurysm undergoing interventional embolization at different treatment timing. J Med Biochem 2024; 43:144-152. [PMID: 38496021 PMCID: PMC10943457 DOI: 10.5937/jomb0-44364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/08/2023] [Indexed: 03/19/2024] Open
Abstract
Background To analyzes the changes in serum levels of matrix metalloproteinase-9 (MMP-9), neuroenolase (NSE), myeloperoxidase (MPO) and prognostic factors in patients with intracranial aneurysm (IA) undergoing interventional embolization at different treatment times. Methods A retrospective analysis was made of 200 IA patients admitted to our department from January 2018 to June 2021 was performed. All patients underwent interventional embolization. According to the timing of surgery, the patients were divided into an early group (n=120, onset to surgery ≤72 h) and a delayed group (n=80, onset to surgery >72 h). The effect of embolization, complications and neurological deficit scale (NDS) scores were compared between the two groups. Serum MMP-9, NSE and MPO levels were compared before and after surgery, and the prognosis of all patients within 2 years after surgery was assessed by the Glasgow outcome scale (GOS) and divided accordingly into the good prognosis group (n=147) and the poor prognosis group (n=53) accordingly, and the prognostic factors influencing the patients were analyzed univariately and multifactorially.
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Affiliation(s)
- Chunmiao Wu
- Chengdu Third Peopležs Hospital, Department of Neurosurgery, Chengdu, Sichuan, China
| | - Xingyu Dong
- Chengdu Third Peopležs Hospital, Department of Neurosurgery, Chengdu, Sichuan, China
| | - Qiang Li
- Chengdu Third Peopležs Hospital, Department of Neurosurgery, Chengdu, Sichuan, China
| | - Shengming Liu
- Chengdu Third Peopležs Hospital, Department of Neurosurgery, Chengdu, Sichuan, China
| | - Yuhao He
- Chengdu Third Peopležs Hospital, Department of Neurosurgery, Chengdu, Sichuan, China
| | - Yang Zhang
- Chengdu Third Peopležs Hospital, Department of Neurosurgery, Chengdu, Sichuan, China
| | - Sunfu Zhang
- Chengdu Third Peopležs Hospital, Department of Neurosurgery, Chengdu, Sichuan, China
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Fujiwara G, Oka H, Fujii A. In-hospital recurrence and functional outcome between ischemic stroke caused by intracranial arterial dissection and intracranial atherosclerosis: Retrospective cohort study of the nationwide multicenter registry. J Stroke Cerebrovasc Dis 2023; 32:107212. [PMID: 37331251 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Intracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) are often difficult to differentiate, and studies on their background factors and prognosis are scarce. Information on prognosis, including recurrence, is necessary for stroke care, and clarification of epidemiological and clinical differences between the two diseases is important for appropriately handling their heterogeneity. This study aimed to determine the association of ICAD and ICAS with in-hospital recurrence and prognosis and compare their background and clinical findings. METHODS In this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database. Adults with ischemic stroke caused by ICAD or ICAS were included in this study. Patients' backgrounds and clinical findings were compared between the ICAD and ICAS groups. The outcome showed an association of ICAD with in-hospital recurrence of ischemic stroke and poor functional outcome relative to ICAS. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (ORs) for ICAD with 95% confidence intervals (CIs) for each outcome. RESULTS Among 15,622 patients registered in the Saiseikai Stroke Database, 2,020 were enrolled (ICAD group: 89; ICAS group: 1,931). In the ICAD group, 65.2% of the patients were aged <64 years. Vascular lesion location was more common in ICAD with the vertebral artery [42 (47.2%)], anterior cerebral artery [20 (22.5%)], and middle cerebral artery (MCA) [16 (18.0%)], and in ICAS with MCA 1046 (52.3%). Multivariable logistic regression analyses of the association between ICAD and in-hospital recurrence and poor functional outcome yielded a crude OR (95% CI) of 3.26 (1.06-9.97) and 0.97 (0.54-1.74), respectively, relative to ICAS. CONCLUSION ICAD was associated with a higher in-hospital recurrence than ICAS; however, there was no significant difference in prognosis between the two groups. Differences in background characteristics and vessel lesions may be of interest in these two diseases.
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Affiliation(s)
- Gaku Fujiwara
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
| | - Akihiro Fujii
- Department of Neurology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
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Corrêa DG, Pacheco FT, da Cruz LCH, Nunes RH, Maia ACM, de Souza Godoy LF, Bisolo L, da Silva NA, Soldatelli MD, de Siqueira Campos CM, Vedolin LM, do Amaral LLF, da Rocha AJ. Intracranial vessel wall magnetic resonance imaging features of infectious vasculitis. Clin Imaging 2023; 98:26-35. [PMID: 36996597 DOI: 10.1016/j.clinimag.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/19/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
Vasculitis is a complication of several infectious diseases affecting the central nervous system, which may result in ischemic and/or hemorrhagic stroke, transient ischemic attack, and aneurysm formation. The infectious agent may directly infect the endothelium, causing vasculitis, or indirectly affect the vessel wall through an immunological mechanism. The clinical manifestations of these complications usually overlap with those of non-infectious vascular diseases, making diagnosis challenging. Intracranial vessel wall magnetic resonance imaging (VWI) enables the evaluation of the vessel wall and the diseases that affect it, providing diagnostic data beyond luminal changes and enabling the identification of inflammatory changes in cerebral vasculitis. This technique demonstrates concentric vessel wall thickening and gadolinium enhancement, associated or not with adjacent brain parenchymal enhancement, in patients with vasculitis of any origin. It permits the detection of early alterations, even before a stenosis occurs. In this article, we review the intracranial vessel wall imaging features of infectious vasculitis of bacterial, viral, and fungal etiologies.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil; Department of Radiology, Federal Fluminense University, Niterói, RJ, Brazil.
| | - Felipe Torres Pacheco
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | | | - Renato Hoffmann Nunes
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Antônio Carlos Martins Maia
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, Fleury, São Paulo, SP, Brazil
| | | | - Louise Bisolo
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Nivaldo Adolfo da Silva
- Department of Radiology, DASA, São Paulo, SP, Brazil; Department of Radiology, University of Campinas, Campinas, SP, Brazil
| | | | | | - Leonardo Modesti Vedolin
- Department of Radiology, DASA, São Paulo, SP, Brazil; Department of Radiology, Hospital de Clínicas de Porta Alegre, Porto Alegre, RS, Brazil
| | | | - Antônio José da Rocha
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
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Sun LR, Lynch JK. Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke. Neurotherapeutics 2023; 20:633-654. [PMID: 37072548 PMCID: PMC10112833 DOI: 10.1007/s13311-023-01373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
Though rare, stroke in infants and children is an important cause of mortality and chronic morbidity in the pediatric population. Neuroimaging advances and implementation of pediatric stroke care protocols have led to the ability to rapidly diagnose stroke and in many cases determine the stroke etiology. Though data on efficacy of hyperacute therapies, such as intravenous thrombolysis and mechanical thrombectomy, in pediatric stroke are limited, feasibility and safety data are mounting and support careful consideration of these treatments for childhood stroke. Recent therapeutic advances allow for targeted stroke prevention efforts in high-risk conditions, such as moyamoya, sickle cell disease, cardiac disease, and genetic disorders. Despite these exciting advances, important knowledge gaps persist, including optimal dosing and type of thrombolytic agents, inclusion criteria for mechanical thrombectomy, the role of immunomodulatory therapies for focal cerebral arteriopathy, optimal long-term antithrombotic strategies, the role of patent foramen ovale closure in pediatric stroke, and optimal rehabilitation strategies after stroke of the developing brain.
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Affiliation(s)
- Lisa R Sun
- Divisions of Pediatric Neurology and Cerebrovascular Neurology, Department of Neurology, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Ste 2158, Baltimore, MD, 21287, USA.
| | - John K Lynch
- Acute Stroke Research Section, Stroke Branch (SB), National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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Corrêa DG, de Souza SR, Freddi TDAL, Fonseca APA, Dos Santos RQ, Hygino da Cruz LC. Imaging features of neurosyphilis. J Neuroradiol 2023; 50:241-252. [PMID: 36641134 DOI: 10.1016/j.neurad.2023.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/09/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
Syphilis is an infectious disease caused by the spirochete Treponema pallidum, subspecies pallidum. Although its incidence has declined after the widespread availability of penicillin, it has recently re-emerged, especially in men who have sex with men and in people living with human immunodeficiency virus (HIV). The neurological manifestations of syphilis, generally known as neurosyphilis, may appear at any time during the infection, including the initial years after the primary infection. Neurosyphilis can be asymptomatic, only with cerebrospinal fluid abnormalities, or symptomatic, characterized by several different clinical syndromes, such as meningitis, gumma, meningovascular, brain parenchyma involvement, meningomyelitis, tabes dorsalis, and peripheral nervous system involvement. However, these syndromes may simulate several other diseases, making the diagnosis often a challenge. In addition, syphilis can also be vertically transmitted from mother to child during pregnancy, leading to neurological manifestations. Neuroimaging is essential to demonstrate abnormal brain or spinal cord findings in patients with neurosyphilis, aiding in the diagnosis, treatment, and follow-up of these patients. This article aims to review the imaging features of neurosyphilis, including the early and late stages of the infection.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil; Department of Radiology, Federal Fluminense University, Rua Marquês de Paraná, 303, Centro, Niterói, RJ 24070-035, Brazil.
| | - Simone Rachid de Souza
- Department of Pathology, Federal University of Rio de Janeiro, Cidade Universitária da Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, Rio de Janeiro, RJ 21941-617, Brazil
| | | | - Ana Paula Alves Fonseca
- Department of Radiology, UnitedHealth Group, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Roberto Queiroz Dos Santos
- Department of Radiology, Hospital dos Servidores do Estado, Rua Sacadura Cabral, 178, Saúde, Rio de Janeiro, RJ 20221-903, Brazil; Department of Radiology, Hospital das Américas, United Health Group, Avenida Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, RJ 22775-001, Brazil
| | - Luiz Celso Hygino da Cruz
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil
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6
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Wahed LA, Cho TA. Imaging of Central Nervous System Autoimmune, Paraneoplastic, and Neuro-rheumatologic Disorders. Continuum (Minneap Minn) 2023; 29:255-291. [PMID: 36795880 DOI: 10.1212/con.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This article provides an overview of the imaging modalities used in the evaluation of central nervous system (CNS) autoimmune, paraneoplastic, and neuro-rheumatologic disorders. An approach is outlined for interpreting imaging findings in this context, synthesizing a differential diagnosis based on certain imaging patterns, and choosing further imaging for specific diseases. LATEST DEVELOPMENTS The rapid discovery of new neuronal and glial autoantibodies has revolutionized the autoimmune neurology field and has elucidated imaging patterns characteristic of certain antibody-associated diseases. Many CNS inflammatory diseases, however, lack a definitive biomarker. Clinicians should recognize neuroimaging patterns suggestive of inflammatory disorders, as well as the limitations of imaging. CT, MRI, and positron emission tomography (PET) modalities all play a role in diagnosing autoimmune, paraneoplastic, and neuro-rheumatologic disorders. Additional imaging modalities such as conventional angiography and ultrasonography can be helpful for further evaluation in select situations. ESSENTIAL POINTS Knowledge of imaging modalities, both structural and functional, is critical in identifying CNS inflammatory diseases quickly and can help avoid invasive testing such as brain biopsy in certain clinical scenarios. Recognizing imaging patterns suggestive of CNS inflammatory diseases can also facilitate the early initiation of appropriate treatments to diminish morbidity and future disability.
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Rizzati F, Marie G, Chanez V, Ferry T, Natterer J, Longchamp D, Saliou G, Perez MH. Intra-arterial vasodilators infusion for management of reversible cerebral vasoconstriction syndrome in a 12-year-old girl: A case report. Front Pediatr 2023; 11:1042509. [PMID: 36937972 PMCID: PMC10020348 DOI: 10.3389/fped.2023.1042509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a vascular disease characterized by diffuse transient vasoconstriction and vasodilatation of the cerebral arteries. It is commonly associated with recurrent severe acute headaches with or without focal neurological deficits due to hemorrhages, infarcts, and even posterior reversible encephalopathy syndrome. The optimal management of acute neurologic deficits caused by RCVS is still uncertain. Calcium channel blockers (CCBs) such as nimodipine or verapamil have been reported to be effective in adult series. Intra-arterial injection of nimodipine, verapamil, and milrinone has recently been demonstrated to be safe and effective for treating severe segmental vasoconstriction in adults. CCBs are the most used treatment in the available pediatric literature. Intra-arterial vasodilators have been reported in some rare pediatric reports with more severe diseases, but their utility is still under investigation. We report a case of a 12-year-old girl who underwent a severe course of RCVS complicated by multiple cerebral infarcts, treated by several sessions of intra-arterial vasodilators infusion.
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Affiliation(s)
- Frida Rizzati
- Paediatric Intensive Care Unit, Woman, Mother and Child Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Guillaume Marie
- Department of Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Vivianne Chanez
- Paediatric Intensive Care Unit, Woman, Mother and Child Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Thomas Ferry
- Paediatric Intensive Care Unit, Woman, Mother and Child Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Julia Natterer
- Paediatric Intensive Care Unit, Woman, Mother and Child Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - David Longchamp
- Paediatric Intensive Care Unit, Woman, Mother and Child Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Guillaume Saliou
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Maria-Helena Perez
- Paediatric Intensive Care Unit, Woman, Mother and Child Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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Shrestha S, Bao H, Gu H, Gao C, Zeng Y, Xie K, Shi Y, Zhao L, He B, Zhao W, Tang Z, Li Z. Association of dissection features and primary collateral circulation with ischemic stroke in patients with spontaneous internal carotid artery dissection: evaluated using vessel wall-MRI and MRA. Br J Radiol 2022; 95:20210845. [PMID: 35816551 PMCID: PMC10996963 DOI: 10.1259/bjr.20210845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 05/15/2022] [Accepted: 07/01/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To study the ischemic stroke risk factors in spontaneous internal carotid artery dissection (ICAD) patients via analyzing the dissection features and primary collateral circulation using vessel wall-MRI and magnetic resonance angiography. METHODS ICAD patients who had undergone VW-MRI were included in this study. A total of 36 patients were included and divided into ICAD stroke (N = 23) and non-stroke (N = 13) group. Dissection imaging features [intramural hematoma (IMH), length of IMH, intimal flap, double lumen, intraluminal thrombus, degree of stenosis] and primary collateral status were analyzed. The primary collateral score (0-4) was evaluated based on presence of anterior communicating and ipsilateral anterior cerebral artery A1 segment (0-2) and ipsilateral posterior communicating artery (0-2). RESULTS There were no significant differences in dissection imaging features such as presence of double lumen, intimal flap, IMH, length of IMH and intraluminal thrombus between the two groups. Degree of stenosis and primary collateral score showed significant differences between the two groups. CONCLUSION Both the poor primary collateral circulation and severe stenosis may play an important role in occurrence of ischemic stroke for spontaneous ICAD patients and good primary collateral circulation can help to reduce the incidence of infarction. ADVANCES IN KNOWLEDGE ICAD is one of the major causes of ischemic stroke. Early evaluation of the status of the Circle of Willis in ICAD patients by MRI may help to make treatment strategies and improve clinical outcome.
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Affiliation(s)
- Srijana Shrestha
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Han Bao
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Heyi Gu
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Chao Gao
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Yizhen Zeng
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Kaipeng Xie
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Yixin Shi
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Lei Zhao
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Bo He
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Wei Zhao
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
| | - Zhiwei Tang
- Department of Neurosurgery, First Affiliated Hospital of
Kunming Medical University,
Kunming, China
| | - Zongfang Li
- Department of Radiology, First Affiliated Hospital of Kunming
Medical University, Kunming,
China
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Sundermann B, Billebaut B, Bauer J, Iacoban CG, Alykova O, Schülke C, Gerdes M, Kugel H, Neduvakkattu S, Bösenberg H, Mathys C. Practical Aspects of novel MRI Techniques in Neuroradiology: Part 1-3D Acquisitions, Dixon Techniques and Artefact Reduction. ROFO-FORTSCHR RONTG 2022; 194:1100-1108. [PMID: 35545104 DOI: 10.1055/a-1800-8692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recently introduced MRI techniques offer improved image quality and facilitate examinations of patients even when artefacts are expected. They pave the way for novel diagnostic imaging strategies in neuroradiology. These methods include improved 3D imaging, movement and metal artefact reduction techniques as well as Dixon techniques. METHODS Narrative review with an educational focus based on current literature research and practical experiences of different professions involved (physicians, MRI technologists/radiographers, physics/biomedical engineering). Different hardware manufacturers are considered. RESULTS AND CONCLUSIONS 3D FLAIR is an example of a versatile 3D Turbo Spin Echo sequence with broad applicability in routine brain protocols. It facilitates detection of smaller lesions and more precise measurements for follow-up imaging. It also offers high sensitivity for extracerebral lesions. 3D techniques are increasingly adopted for imaging arterial vessel walls, cerebrospinal fluid spaces and peripheral nerves. Improved hybrid-radial acquisitions are available for movement artefact reduction in a broad application spectrum. Novel susceptibility artefact reduction techniques for targeted application supplement previously established metal artefact reduction sequences. Most of these techniques can be further adapted to achieve the desired diagnostic performances. Dixon techniques allow for homogeneous fat suppression in transition areas and calculation of different image contrasts based on a single acquisition. KEY POINTS · 3D FLAIR can replace 2 D FLAIR for most brain imaging applications and can be a cornerstone of more precise and more widely applicable protocols.. · Further 3D TSE sequences are increasingly replacing 2D TSE sequences for specific applications.. · Improvement of artefact reduction techniques increase the potential for effective diagnostic MRI exams despite movement or near metal implants.. · Dixon techniques facilitate homogeneous fat suppression and simultaneous acquisition of multiple contrasts.. CITATION FORMAT · Sundermann B, Billebaut B, Bauer J et al. Practical Aspects of novel MRI Techniques in Neuroradiology: Part 1-3D Acquisitions, Dixon Techniques and Artefact Reduction. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1800-8692.
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Affiliation(s)
- Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Germany.,Clinic for Radiology, University Hospital Münster, Germany
| | - Benoit Billebaut
- Clinic for Radiology, University Hospital Münster, Germany.,School for Radiologic Technologists, University Hospital Münster, Germany
| | - Jochen Bauer
- Clinic for Radiology, University Hospital Münster, Germany
| | - Catalin George Iacoban
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Olga Alykova
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | | | - Maike Gerdes
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Harald Kugel
- Clinic for Radiology, University Hospital Münster, Germany
| | | | - Holger Bösenberg
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Christian Mathys
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Germany.,Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Germany
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10
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Maupu C, Lebas H, Boulaftali Y. Imaging Modalities for Intracranial Aneurysm: More Than Meets the Eye. Front Cardiovasc Med 2022; 9:793072. [PMID: 35242823 PMCID: PMC8885801 DOI: 10.3389/fcvm.2022.793072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Intracranial aneurysms (IA) are often asymptomatic and have a prevalence of 3 to 5% in the adult population. The risk of IA rupture is low, however when it occurs half of the patients dies from subarachnoid hemorrhage (SAH). To avoid this fatal evolution, the main treatment is an invasive surgical procedure, which is considered to be at high risk of rupture. This risk score of IA rupture is evaluated mainly according to its size and location. Therefore, angiography and anatomic imaging of the intracranial aneurysm are crucial for its diagnosis. Moreover, it has become obvious in recent years that several other factors are implied in this complication, such as the blood flow complexity or inflammation. These recent findings lead to the development of new IA imaging tools such as vessel wall imaging, 4D-MRI, or molecular MRI to visualize inflammation at the site of IA in human and animal models. In this review, we will summarize IA imaging techniques used for the patients and those currently in development.
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11
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Mazzacane F, Mazzoleni V, Scola E, Mancini S, Lombardo I, Busto G, Rognone E, Pichiecchio A, Padovani A, Morotti A, Fainardi E. Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases. Diagnostics (Basel) 2022; 12:diagnostics12020258. [PMID: 35204348 PMCID: PMC8871392 DOI: 10.3390/diagnostics12020258] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 01/27/2023] Open
Abstract
Cerebrovascular diseases are a leading cause of disability and death worldwide. The definition of stroke etiology is mandatory to predict outcome and guide therapeutic decisions. The diagnosis of pathological processes involving intracranial arteries is especially challenging, and the visualization of intracranial arteries’ vessel walls is not possible with routine imaging techniques. Vessel wall magnetic resonance imaging (VW-MRI) uses high-resolution, multiparametric MRI sequences to directly visualize intracranial arteries walls and their pathological alterations, allowing a better characterization of their pathology. VW-MRI demonstrated a wide range of clinical applications in acute cerebrovascular disease. Above all, it can be of great utility in the differential diagnosis of atherosclerotic and non-atherosclerotic intracranial vasculopathies. Additionally, it can be useful in the risk stratification of intracranial atherosclerotic lesions and to assess the risk of rupture of intracranial aneurysms. Recent advances in MRI technology made it more available, but larger studies are still needed to maximize its use in daily clinical practice.
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Affiliation(s)
- Federico Mazzacane
- Department of Emergency Neurology and Stroke Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Valentina Mazzoleni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (V.M.); (A.P.)
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Elisa Scola
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Sara Mancini
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Ivano Lombardo
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Giorgio Busto
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy; (E.S.); (S.M.); (I.L.); (G.B.)
| | - Elisa Rognone
- Department of Neuroradiology, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
- Department of Neuroradiology, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (V.M.); (A.P.)
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy;
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50121 Florence, Italy
- Correspondence:
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12
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Elsebaie N, Abdelzaher A, Gamaleldin O. Atypical intracranial aneurysms: spectrum of imaging findings in computed tomography and magnetic resonance imaging. Clin Imaging 2021; 83:1-10. [PMID: 34915276 DOI: 10.1016/j.clinimag.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
We aim to describe demographics, clinical presentation, and spectrum of CT and MRI features suggestive of atypical intracranial aneurysms. The imaging protocols used for the diagnosis of intracranial aneurysms were thoroughly reviewed, including different CT and MRI protocols. We classified atypical aneurysms according to their location, size, clinical presentation, and specific imaging features. Dissecting aneurysms are one of the causes of stroke in young adults that may show intimal flap and double lumen. Traumatic intracranial aneurysms are a rare but serious complication of head injuries. Mycotic aneurysms are small and multiple at distal branch points with a high risk of rupture. Aneurysms with vasculitis are fusiform with a wide neck at a non-branch point that may be associated with vessel wall enhancement. Atherosclerotic aneurysms are usually large fusiform that affect large arteries. Oncotic aneurysms are relatively rare. They were reported to occur in patients with left atrial myxoma. Our study represented a wide spectrum of atypical intracranial aneurysms with their detailed diagnostic imaging findings on MRI and CT including newly introduced MRI sequences, which greatly influenced early diagnosis and timely management.
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Affiliation(s)
- Nermeen Elsebaie
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion street, Alexandria 21131, Egypt.
| | - Ahmed Abdelzaher
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Omneya Gamaleldin
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion street, Alexandria 21131, Egypt
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13
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Boitet R, de Gaalon S, Ducros A. Sindrome da vasocostrizione cerebrale reversibile. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Pensato U, Matteo E, Cevoli S. The unforgivable curse of Harry Potter's thunderclap headaches. Headache 2021; 61:1287-1290. [PMID: 34510446 PMCID: PMC9293176 DOI: 10.1111/head.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Umberto Pensato
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Eleonora Matteo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- UOC Clinica Neurologica NEUROMET, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italia
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15
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Bathla G, Abdel-Wahed L, Agarwal A, Cho TA, Gupta S, Jones KA, Priya S, Soni N, Wasserman BA. Vascular Involvement in Neurosarcoidosis: Early Experiences From Intracranial Vessel Wall Imaging. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/6/e1063. [PMID: 34349028 PMCID: PMC8340434 DOI: 10.1212/nxi.0000000000001063] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Cerebrovascular manifestations in neurosarcoidosis (NS) were previously considered rare but are being increasingly recognized. We report our preliminary experience in patients with NS who underwent high-resolution vessel wall imaging (VWI). METHODS A total of 13 consecutive patients with NS underwent VWI. Images were analyzed by 2 neuroradiologists in consensus. The assessment included segment-wise evaluation of larger- and medium-sized vessels (internal carotid artery, M1-M3 middle cerebral artery; A1-A3 anterior cerebral artery; V4 segments of vertebral arteries; basilar artery; and P1-P3 posterior cerebral artery), lenticulostriate perforator vessels, and medullary and deep cerebral veins. Cortical veins were not assessed due to flow-related artifacts. Brain biopsy findings were available in 6 cases and were also reviewed. RESULTS Mean patient age was 54.9 years (33-71 years) with an M:F of 8:5. Mean duration between initial diagnosis and VWI study was 18 months. Overall, 9/13 (69%) patients had vascular abnormalities. Circumferential large vessel enhancement was seen in 3/13 (23%) patients, whereas perforator vessel involvement was seen in 6/13 (46%) patients. Medullary and deep vein involvement was also seen in 6/13 patients. In addition, 7/13 (54%) patients had microhemorrhages in susceptibility-weighted imaging, and 4/13 (31%) had chronic infarcts. On biopsy, 5/6 cases showed perivascular granulomas with vessel wall involvement in all 5 cases. DISCUSSION Our preliminary findings suggest that involvement of intracranial vascular structures may be a common finding in patients with NS and should be routinely looked for. These findings appear concordant with previously reported autopsy literature and need to be validated on a larger scale.
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Affiliation(s)
- Girish Bathla
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD.
| | - Lama Abdel-Wahed
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Amit Agarwal
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Tracey A Cho
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Sarika Gupta
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Karra A Jones
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Sarv Priya
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Neetu Soni
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Bruce A Wasserman
- From the Department of Radiology (G.B., S.P., N.S.), University of Iowa Hospitals and Clinics; Department of Neurology (L.A.-W., T.A.C.), University of Iowa Hospitals and Clinics, IA; Department of Radiology (A.A.), University of Texas Southwestern Medical Center; Department Pathology (S.G., K.A.J.), University of Iowa Hospitals and Clinics, IA; and Department of Radiology (B.A.W.), Johns Hopkins School of Medicine, Baltimore, MD
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16
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Abstract
Magnetic resonance (MR) imaging is a crucial tool for evaluation of the skull base, enabling characterization of complex anatomy by utilizing multiple image contrasts. Recent technical MR advances have greatly enhanced radiologists' capability to diagnose skull base pathology and help direct management. In this paper, we will summarize cutting-edge clinical and emerging research MR techniques for the skull base, including high-resolution, phase-contrast, diffusion, perfusion, vascular, zero echo-time, elastography, spectroscopy, chemical exchange saturation transfer, PET/MR, ultra-high-field, and 3D visualization. For each imaging technique, we provide a high-level summary of underlying technical principles accompanied by relevant literature review and clinical imaging examples.
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Affiliation(s)
- Claudia F Kirsch
- Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY
| | - Mai-Lan Ho
- Associate Professor of Radiology, Director of Research, Department of Radiology, Director, Advanced Neuroimaging Core, Chair, Asian Pacific American Network, Secretary, Association for Staff and Faculty Women, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY.
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17
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Yuan S, Jordan LC, Davis LT, Cogswell PM, Lee CA, Patel NJ, Waddle SL, Juttukonda M, Sky Jones R, Griffin A, Donahue MJ. A cross-sectional, case-control study of intracranial arterial wall thickness and complete blood count measures in sickle cell disease. Br J Haematol 2020; 192:769-777. [PMID: 33326595 DOI: 10.1111/bjh.17262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/25/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
In sickle cell disease (SCD), cerebral oxygen delivery is dependent on the cerebral vasculature's ability to increase blood flow and volume through relaxation of the smooth muscle that lines intracranial arteries. We hypothesised that anaemia extent and/or circulating markers of inflammation lead to concentric macrovascular arterial wall thickening, visible on intracranial vessel wall magnetic resonance imaging (VW-MRI). Adult and pediatric SCD (n = 69; age = 19.9 ± 8.6 years) participants and age- and sex-matched control participants (n = 38; age = 22.2 ± 8.9 years) underwent 3-Tesla VW-MRI; two raters measured basilar and bilateral supraclinoid internal carotid artery (ICA) wall thickness independently. Mean wall thickness was compared with demographic, cerebrovascular and haematological variables. Mean vessel wall thickness was elevated (P < 0·001) in SCD (1·07 ± 0·19 mm) compared to controls (0·97 ± 0·07 mm) after controlling for age and sex. Vessel wall thickness was higher in participants on chronic transfusions (P = 0·013). No significant relationship between vessel wall thickness and flow velocity, haematocrit, white blood cell count or platelet count was observed; however, trends (P < 0·10) for wall thickness increasing with decreasing haematocrit and increasing white blood cell count were noted. Findings are discussed in the context of how anaemia and circulating inflammatory markers may impact arterial wall morphology.
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Affiliation(s)
- Shuai Yuan
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori C Jordan
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Larry T Davis
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Petrice M Cogswell
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Chelsea A Lee
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J Patel
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Spencer L Waddle
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Meher Juttukonda
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - R Sky Jones
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Allison Griffin
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Fakih R, Roa JA, Bathla G, Olalde H, Varon A, Ortega-Gutierrez S, Derdeyn C, Adams HP, Hasan DM, Leira EC, Samaniego EA. Detection and Quantification of Symptomatic Atherosclerotic Plaques With High-Resolution Imaging in Cryptogenic Stroke. Stroke 2020; 51:3623-3631. [PMID: 32998652 DOI: 10.1161/strokeaha.120.031167] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution vessel wall imaging (HR-VWI) is a powerful tool in diagnosing intracranial vasculopathies not detected on routine imaging. We hypothesized that 7T HR-VWI may detect the presence of atherosclerotic plaques in patients with intracranial atherosclerosis disease initially misdiagnosed as cryptogenic strokes. METHODS Patients diagnosed as cryptogenic stroke but suspected of having an intracranial arteriopathy by routine imaging were prospectively imaged with HR-VWI. If intracranial atherosclerotic plaques were identified, they were classified as culprit or nonculprit based on the likelihood of causing the index stroke. Plaque characteristics, such as contrast enhancement, degree of stenosis, and morphology, were analyzed. Contrast enhancement was determined objectively after normalization with the pituitary stalk. A cutoff value for plaque-to-pituitary stalk contrast enhancement ratio (CR) was determined for optimal prediction of the presence of a culprit plaque. A revised stroke cause was adjudicated based on clinical and HR-VWI findings. RESULTS A total of 344 cryptogenic strokes were analyzed, and 38 eligible patients were imaged with 7T HR-VWI. Intracranial atherosclerosis disease was adjudicated as the final stroke cause in 25 patients. A total of 153 intracranial plaques in 374 arterial segments were identified. Culprit plaques (n=36) had higher CR and had concentric morphology when compared with nonculprit plaques (P≤0.001). CR ≥53 had 78% sensitivity for detecting culprit plaques and a 90% negative predictive value. CR ≥53 (P=0.008), stenosis ≥50% (P<0.001), and concentric morphology (P=0.030) were independent predictors of culprit plaques. CONCLUSIONS 7T HR-VWI allows identification of underlying intracranial atherosclerosis disease in a subset of stroke patients with suspected underlying vasculopathy but otherwise classified as cryptogenic. Plaque analysis in this population demonstrated that culprit plaques had more contrast enhancement (CR ≥53), caused a higher degree of stenosis, and had a concentric morphology.
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Affiliation(s)
- Rami Fakih
- Department of Neurology (R.F., J.A.R., H.O., A.V., S.O.-G., H.P.A., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
| | - Jorge A Roa
- Department of Neurology (R.F., J.A.R., H.O., A.V., S.O.-G., H.P.A., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
- Department of Neurosurgery (J.A.R., S.O.-G., D.M.H., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
| | - Girish Bathla
- Department of Radiology (G.B., S.O.-G., C.D., E.A.S.), University of Iowa Carver College of Medicine
| | - Heena Olalde
- Department of Neurology (R.F., J.A.R., H.O., A.V., S.O.-G., H.P.A., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
| | - Alberto Varon
- Department of Neurology (R.F., J.A.R., H.O., A.V., S.O.-G., H.P.A., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
| | - Santiago Ortega-Gutierrez
- Department of Neurology (R.F., J.A.R., H.O., A.V., S.O.-G., H.P.A., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
- Department of Neurosurgery (J.A.R., S.O.-G., D.M.H., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
- Department of Radiology (G.B., S.O.-G., C.D., E.A.S.), University of Iowa Carver College of Medicine
| | - Colin Derdeyn
- Department of Radiology (G.B., S.O.-G., C.D., E.A.S.), University of Iowa Carver College of Medicine
| | - Harold P Adams
- Department of Neurology (R.F., J.A.R., H.O., A.V., S.O.-G., H.P.A., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
| | - David M Hasan
- Department of Neurosurgery (J.A.R., S.O.-G., D.M.H., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
| | - Enrique C Leira
- Department of Neurology (R.F., J.A.R., H.O., A.V., S.O.-G., H.P.A., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
- Department of Neurosurgery (J.A.R., S.O.-G., D.M.H., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
- Department of Epidemiology, University of Iowa College of Public Health (E.C.L.)
| | - Edgar A Samaniego
- Department of Neurology (R.F., J.A.R., H.O., A.V., S.O.-G., H.P.A., E.C.L., E.A.S.), University of Iowa Carver College of Medicine
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19
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Pensato U, Cevoli S, Cirillo L. Vessel Wall Imaging in Thunderclap Headache: A Reversible Cerebral Vasoconstriction Syndrome (RCVS) Case. Headache 2020; 60:2633-2635. [PMID: 33112429 DOI: 10.1111/head.13992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Umberto Pensato
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luigi Cirillo
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
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