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Safety and efficacy of balloon angioplasty in symptomatic intracranial stenosis: A systematic review and meta-analysis. J Neuroradiol 2020; 47:27-32. [DOI: 10.1016/j.neurad.2019.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/16/2019] [Accepted: 02/27/2019] [Indexed: 11/18/2022]
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Liu Z, Han C, Wang H, Zhang Q, Li S, Bao X, Zhang Z, Duan L. Clinical characteristics and leptomeningeal collateral status in pediatric and adult patients with ischemic moyamoya disease. CNS Neurosci Ther 2020; 26:14-20. [PMID: 31875482 PMCID: PMC6930821 DOI: 10.1111/cns.13130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/28/2022] Open
Abstract
AIM Previous studies have found significant differences in clinical characteristics between pediatric and adult moyamoya disease (MMD) patients, but few studies have focused on the factors underlying these differences. We aimed to investigate the differences in leptomeningeal collateral (LMC) status between pediatric and adult MMD patients and to analyze the effects of LMCs on clinical characteristics and therapeutic prognosis. METHODS We retrospectively analyzed 214 MMD patients from January 2014 to January 2016. Clinical characteristics and LMC status were compared between the pediatric and adult patients. LMC status was graded as good or poor depending on the retrograde flow from the posterior cerebral artery (PCA) on digital subtraction angiography (DSA). RESULTS A total of 83 pediatric and 131 adult (1:1.6) MMD patients were analyzed. Pediatric patients were more likely to experience a transient ischemic attack (81%), whereas adult patients were more likely to experience infarction (51%). Regarding the different MMD stages (the early, medium, and advanced stages corresponded to Suzuki stages 1-2, 3-4, and 5-6, respectively), the prevalence of good LMC status was higher for pediatric patients than for adult patients in the early stage (P = 0.047) and the medium stage (P = 0.001), but there were no differences between these patient groups in the advanced stage (P = 0.547). Worse postoperative angiographic outcomes (P = 0.017) were found in adult patients than in pediatric patients in the medium stage. Poor LMC status had strong correlations with infarction (P < 0.001 and P = 0.017) and poor postoperative outcomes (P = 0.003 and P = 0.043) in both pediatric and adult patients. CONCLUSIONS Pediatric MMD patients have greater patency and a greater ability to establish good LMC status than adult patients, and poor LMC status has a strong correlation with severe clinical symptoms and poor postoperative outcomes. LMC status may be an important factor in the differences in clinical characteristics and prognosis between pediatric and adult MMD patients.
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Affiliation(s)
- Zhi‐Wen Liu
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Cong Han
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Hui Wang
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Qian Zhang
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Si‐Jie Li
- Departments of Neurology and Neurosurgery, Xuanwu Hospital, Center of Stroke, Beijing Institute for Brain DisordersCapital Medical UniversityBeijingChina
| | - Xiang‐yang Bao
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Zheng‐Shan Zhang
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
| | - Lian Duan
- Department of Neurosurgery, The Fifth Medical Center of Chinese PLA General HospitalThe 307th Hospital of the Chinese People's Liberation ArmyAcademy of Military Medical ScienceBeijingChina
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Yao Q, Zhang L, Zhou J, Li M, Jing W, Li X, Han J, He L, Zhang Y. Imaging Diagnosis of Transient Ischemic Attack in Clinic and Traditional Chinese Medicine. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5094842. [PMID: 30906774 PMCID: PMC6398052 DOI: 10.1155/2019/5094842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/04/2019] [Accepted: 02/02/2019] [Indexed: 11/18/2022]
Abstract
Neuroimaging plays a pivotal role in Transient Ischemic Attack (TIA). Generally, clinicians focus on the specific changes in morphology and function, but the diagnosis of TIA often depends on imaging evidence. Whereas Traditional Chinese Medicine (TCM) is concerned with the performance of clinical symptoms, they began to use imaging methods to diagnose TIA. CT and MRI are the recommended modality to diagnose TIA and image ischemic lesions. In addition, Transcranial Doppler sonography (TCD) and Digital Subtraction Angiography (DSA) are two acceptable alternatives for diagnosing TIA patients. This article elaborates the update of imaging modalities in clinic and the development of imaging modalities in TCM. Besides, multiple joint imaging technologies also will be evaluated whether enhanced diagnostic yields availably.
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Affiliation(s)
- Qigu Yao
- Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Lincheng Zhang
- Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Jing Zhou
- College of Life Sciences of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Min Li
- College of Life Sciences of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Weifeng Jing
- College of Pharmaceutical Science of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Xiaohong Li
- College of Pharmaceutical Science of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Jin Han
- Basic Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Lan He
- Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yuyan Zhang
- College of Life Sciences of Zhejiang Chinese Medical University, Hangzhou 310053, China
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Mutsaerts HJ, Petr J, Václavů L, van Dalen JW, Robertson AD, Caan MW, Masellis M, Nederveen AJ, Richard E, MacIntosh BJ. The spatial coefficient of variation in arterial spin labeling cerebral blood flow images. J Cereb Blood Flow Metab 2017; 37:3184-3192. [PMID: 28058975 PMCID: PMC5584689 DOI: 10.1177/0271678x16683690] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Macro-vascular artifacts are a common arterial spin labeling (ASL) finding in populations with prolonged arterial transit time (ATT) and result in vascular regions with spuriously increased cerebral blood flow (CBF) and tissue regions with spuriously decreased CBF. This study investigates whether there is an association between the spatial signal distribution of a single post-label delay ASL CBF image and ATT. In 186 elderly with hypertension (46% male, 77.4 ± 2.5 years), we evaluated associations between the spatial coefficient of variation (CoV) of a CBF image and ATT. The spatial CoV and ATT metrics were subsequently evaluated with respect to their associations with age and sex - two demographics known to influence perfusion. Bland-Altman plots showed that spatial CoV predicted ATT with a maximum relative error of 7.6%. Spatial CoV was associated with age (β = 0.163, p = 0.028) and sex (β = -0.204, p = 0.004). The spatial distribution of the ASL signal on a standard CBF image can be used to infer between-participant ATT differences. In the absence of ATT mapping, the spatial CoV may be useful for the clinical interpretation of ASL in patients with cerebrovascular pathology that leads to prolonged transit of the ASL signal to tissue.
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Affiliation(s)
- Henri Jmm Mutsaerts
- 1 Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.,2 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Jan Petr
- 3 PET Center, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Lena Václavů
- 2 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Jan W van Dalen
- 2 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Andrew D Robertson
- 1 Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Matthan W Caan
- 2 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Mario Masellis
- 1 Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Aart J Nederveen
- 2 Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Edo Richard
- 4 Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands.,5 Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bradley J MacIntosh
- 1 Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
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5
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Ginsberg MD. The cerebral collateral circulation: Relevance to pathophysiology and treatment of stroke. Neuropharmacology 2017; 134:280-292. [PMID: 28801174 DOI: 10.1016/j.neuropharm.2017.08.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/28/2017] [Accepted: 08/06/2017] [Indexed: 12/29/2022]
Abstract
The brain's collateral circulation consists of arterial anastomotic channels capable of providing nutrient perfusion to brain regions whose normal sources of flow have become compromised, as occurs in acute ischemic stroke. Modern CT-based neuroimaging is capable of providing detailed information as to collateral extent and sufficiency and is complemented by magnetic resonance-based methods. In the present era of standard-of-care IV thrombolysis for acute ischemic stroke, and following the recent therapeutic successes of randomized clinical trials of acute endovascular intervention, the sufficiency of the collateral circulation has been convincingly established as a key factor influencing the likelihood of successful reperfusion and favorable clinical outcome. This article reviews the features of the brain's collateral circulation; methods for its evaluation in the acute clinical setting; the relevance of collateral circulation to prognosis in acute ischemic stroke; the specific insights into the collateral circulation learned from recent trials of endovascular intervention; and the major influence of genetic factors. Finally, we emphasize the need to develop therapeutic approaches to augment collateral perfusion as an adjunctive strategy to be employed along with, or prior to, thrombolysis and endovascular interventions, and we highlight the possible potential of inhaled nitric oxide, albumin, and other approaches. This article is part of the Special Issue entitled 'Cerebral Ischemia'.
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Affiliation(s)
- Myron D Ginsberg
- Department of Neurology, University of Miami Miller School of Medicine, Clinical Research Center, Room 1331, 1120 NW 14th Street, Miami, FL 33136, USA.
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Douvas I, Moris D, Karaolanis G, Bakoyiannis C, Georgopoulos S. Evaluation of cerebrovascular reserve capacity in symptomatic and asymptomatic internal carotid stenosis with transcranial Doppler. Physiol Res 2016; 65:917-925. [PMID: 27539111 DOI: 10.33549/physiolres.933303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cerebrovascular reserve capacity (CVRC) is a hemodynamic parameter indicating the brain's capacity to overcome ischemia. Transcranial Doppler (TCD) is a useful device to measure CVRC, with high availability and low cost. The aim of the study is to investigate asymptomatic patients with affected CVRC, who could benefit from CEA. One hundred and forty five consecutive patients (60 symptomatic and 65 asymptomatic), with internal carotid artery (ICA) stenosis >70 % and 20 healthy individuals without internal carotid stenosis underwent TCD-inhalation CO(2) tests in order to measure the CVRC in both hemispheres of each patient. CVRC between asymptomatic and symptomatic patients were significantly different in the 95 % confidence interval (CI) as well as the mean CVRC value in contralateral carotid artery. The correlation between CVRC in the carotid artery with stenosis and the existence of symptoms is significant at the 0.01 level. Additionally, symptoms and CVRC of the contralateral carotid artery are also significant at the 0.05 level and CVRC values in asymptomatic patients and the control group at the 0.01 level. None of the covariant factors, except the age, are significantly correlated with CRVC. CVRC could be an early mark-index to evaluate the risk of stroke in this group of patients and to design their therapeutic approach.
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Affiliation(s)
- I Douvas
- First Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, School of Medicine, Athens, Greece.
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Bouchez L, Sztajzel R, Vargas MI, Machi P, Kulcsar Z, Poletti PA, Pereira VM, Lövblad KO. CT imaging selection in acute stroke. Eur J Radiol 2016; 96:153-161. [PMID: 28277288 DOI: 10.1016/j.ejrad.2016.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/21/2016] [Accepted: 10/23/2016] [Indexed: 11/27/2022]
Abstract
Acute stroke has become an increasingly treatable cause of acute neurological deficits. Indeed, over the last two decades, the introduction of first thrombolysis, and now thrombectomy has improved patient outcomes and extended the therapeutic window. Computed tomography has been established as the most simple and readily available technique for the diagnosis and management of patients with acute stroke. Indeed, CT allows easy confirmation or exclusion of acute hemorrhage on the one hand, and on the other hand the early signs are quite reliable in the detection of ischemia. In the early phase the clot can be seen as well as exchanges related to early changes in water concentration in ischemia and the surrounding penumbra. Additional techniques such as angio-CT show the location of the clot and perfusion techniques reveal local hemodynamics as well as potential tissue viability. Newer techniques such as double energy CT and late phase CT should provide information on collateral flow as well as on the presence of early hemorrhagic transformation. All these techniques should thus make available new information on tissue viability,that is indispensable in the choice of revascularization technique. Thus CT techniques allow a quick and reliable triage as well as a finer characterization of the ischemic process. The use of all these CT techniques in an optimal way should help improve patient triage and selection of the most adequate treatment with further improvements in clinical outcomes as a result.
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Affiliation(s)
- Laurie Bouchez
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Roman Sztajzel
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Maria Isabel Vargas
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Paolo Machi
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Zsolt Kulcsar
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Pierre-Alexandre Poletti
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Vitor Mendes Pereira
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Karl-Olof Lövblad
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland.
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Ginsberg MD. Expanding the concept of neuroprotection for acute ischemic stroke: The pivotal roles of reperfusion and the collateral circulation. Prog Neurobiol 2016; 145-146:46-77. [PMID: 27637159 DOI: 10.1016/j.pneurobio.2016.09.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/22/2016] [Accepted: 09/10/2016] [Indexed: 12/27/2022]
Abstract
This review surveys the efforts taken to achieve clinically efficacious protection of the ischemic brain and underscores the necessity of expanding our purview to include the essential role of cerebral perfusion and the collateral circulation. We consider the development of quantitative strategies to measure cerebral perfusion at the regional and local levels and the application of these methods to elucidate flow-related thresholds of ischemic viability and to characterize the ischemic penumbra. We stress that the modern concept of neuroprotection must consider perfusion, the necessary substrate upon which ischemic brain survival depends. We survey the major mechanistic approaches to neuroprotection and review clinical neuroprotection trials, focusing on those phase 3 multicenter clinical trials for acute ischemic stroke that have been completed or terminated. We review the evolution of thrombolytic therapies; consider the lessons learned from the initial, negative multicenter trials of endovascular therapy; and emphasize the highly successful positive trials that have finally established a clinical role for endovascular clot removal. As these studies point to the brain's collateral circulation as key to successful reperfusion, we next review the anatomy and pathophysiology of collateral perfusion as it relates to ischemic infarction, as well as the molecular and genetic influences on collateral development. We discuss the current MR and CT-based diagnostic methods for assessing the collateral circulation and the prognostic significance of collaterals in ischemic stroke, and we consider past and possible future therapeutic directions.
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Affiliation(s)
- Myron D Ginsberg
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States.
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das Neves MF, Dos Reis MCR, de Andrade EAF, Lima FPS, Nicolau RA, Arisawa EÂL, Andrade AO, Lima MO. Effects of low-level laser therapy (LLLT 808 nm) on lower limb spastic muscle activity in chronic stroke patients. Lasers Med Sci 2016; 31:1293-300. [PMID: 27299571 DOI: 10.1007/s10103-016-1968-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
A cerebrovascular accident (CVA) may affect basic motor functions, including spasticity that may be present in the upper extremity and/or the lower extremity, post-stroke. Spasticity causes pain, muscle force reduction, and decreases the time to onset of muscle fatigue. Several therapeutic resources have been employed to treat CVA to promote functional recovery. The clinical use of low-level laser therapy (LLLT) for rehabilitation of muscular disorders has provided better muscle responses. Thus, the aim of this study was to evaluate the effect of the application of LLLT in spastic muscles in patients with spasticity post-CVA. A double-blind clinical trial was conducted with 15 volunteer stroke patients who presented with post-stroke spasticity. Both males and females were treated; the average age was 51.5 ± 11.8 years old; the participants entered the study ranging from 11 to 48 months post-stroke onset. The patients participated in three consecutive phases (control, placebo, and real LLLT), in which all tests of isometric endurance of their hemiparetic lower limb were performed. LLLT (diode laser, 100 mW 808 nm, beam spot area 0.0314 cm(2), 127.39 J/cm(2)/point, 40 s) was applied before isometric endurance. After the real LLLT intervention, we observed significant reduction in the visual analogue scale for pain intensity (p = 0.0038), increased time to onset of muscle fatigue (p = 0.0063), and increased torque peak (p = 0.0076), but no significant change in the root mean square (RMS) value (electric signal in the motor unit during contraction, as obtained with surface electromyography). Our results suggest that the application of LLLT may contribute to increased recruitment of muscle fibers and, hence, to increase the onset time of the spastic muscle fatigue, reducing pain intensity in stroke patients with spasticity, as has been observed in healthy subjects and athletes.
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Affiliation(s)
- Marcele Florêncio das Neves
- Universidade do Vale do Paraíba - Laboratório de Engenharia de Reabilotação Sensório Motora, Instituto de Pesquisa e Desenvolvimento, Av. Shishima Hifumi, 2911, Urbanova, São José dos Campos, SP, Brasil.
| | - Mariana César Ribeiro Dos Reis
- Universidade do Vale do Paraíba - Laboratório de Engenharia de Reabilotação Sensório Motora, Instituto de Pesquisa e Desenvolvimento, Av. Shishima Hifumi, 2911, Urbanova, São José dos Campos, SP, Brasil
| | - Eliana Aparecida Fonseca de Andrade
- Universidade do Vale do Paraíba - Laboratório de Engenharia de Reabilotação Sensório Motora, Instituto de Pesquisa e Desenvolvimento, Av. Shishima Hifumi, 2911, Urbanova, São José dos Campos, SP, Brasil
| | - Fernanda Pupio Silva Lima
- Universidade do Vale do Paraíba - Laboratório de Engenharia de Reabilotação Sensório Motora, Instituto de Pesquisa e Desenvolvimento, Av. Shishima Hifumi, 2911, Urbanova, São José dos Campos, SP, Brasil
| | - Renata Amadei Nicolau
- Universidade do Vale do Paraíba, Centro de Laserterapia e Fotobiologia, Instituto de Pesquisa e Desenvolvimento, São José dos Campos, SP, Brasil
| | - Emília Ângela Loschiavo Arisawa
- Universidade do Vale do Paraíba, Laboratório de Espectroscopia Vibracional Biomédica, Instituto de Pesquisa e Desenvolvimento, São José dos Campos, SP, Brasil
| | | | - Mário Oliveira Lima
- Universidade do Vale do Paraíba - Laboratório de Engenharia de Reabilotação Sensório Motora, Instituto de Pesquisa e Desenvolvimento, Av. Shishima Hifumi, 2911, Urbanova, São José dos Campos, SP, Brasil
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Labriffe M, Ter Minassian A, Pasco-Papon A, N’Guyen S, Aubé C. Feasibility and validity of monitoring subarachnoid hemorrhage by a noninvasive MRI imaging perfusion technique: Pulsed Arterial Spin Labeling (PASL). J Neuroradiol 2015; 42:358-67. [DOI: 10.1016/j.neurad.2015.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 03/17/2015] [Accepted: 04/01/2015] [Indexed: 02/03/2023]
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Mutsaerts HJMM, van Dalen JW, Heijtel DFR, Groot PFC, Majoie CBLM, Petersen ET, Richard E, Nederveen AJ. Cerebral Perfusion Measurements in Elderly with Hypertension Using Arterial Spin Labeling. PLoS One 2015; 10:e0133717. [PMID: 26241897 PMCID: PMC4524722 DOI: 10.1371/journal.pone.0133717] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 07/01/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose The current study assesses the feasibility and value of crushed cerebral blood flow (CBFcrushed) and arterial transit time (ATT) estimations for large clinical imaging studies in elderly with hypertension. Material and Methods Two pseudo-continuous arterial spin labeling (ASL) scans with (CBFcrushed) and without flow crushers (CBFnon-crushed) were performed in 186 elderly with hypertension, from which CBF and ATT maps were calculated. Standard flow territory maps were subdivided into proximal, intermediate and distal flow territories, based on the measured ATT. The coefficient of variation (CV) and physiological correlations with age and gender were compared between the three perfusion parameters. Results There was no difference in CV between CBFcrushed and CBFnon-crushed (15–24%, p>0.4) but the CV of ATT (4–9%) was much smaller. The total gray matter correlations with age and gender were most significant with ATT (p = .016 and p<.001 respectively), in between for CBFcrushed (p = .206 and p = .019) and least significant for CBFnon-crushed (p = .236 and p = .100). Conclusion These data show the feasibility and added value of combined measurements of both crushed CBF and ATT for group analyses in elderly with hypertension. The obtained flow territories provide knowledge on vascular anatomy of elderly with hypertension and can be used in future studies to investigate regional vascular effects.
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Affiliation(s)
- H. J. M. M. Mutsaerts
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - J. W. van Dalen
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - D. F. R. Heijtel
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - P. F. C. Groot
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - C. B. L. M. Majoie
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - E. T. Petersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - E. Richard
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A. J. Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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12
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Eryurt B, Oner AY, Ucar M, Capraz I, Kurt G, Bilir E, Tali ET. Presurgical evaluation of mesial temporal lobe epilepsy with multiple advanced MR techniques at 3T. J Neuroradiol 2015; 42:283-90. [PMID: 26024772 DOI: 10.1016/j.neurad.2015.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Accurate localization of the epileptogenic zone is essential for successful surgical treatment of mesial temporal lobe epilepsy (MTLE). The aim of this study was to analyze and compare the hippocampal volumetry (HV), MR spectroscopy (MRS), Dynamic susceptibility contrast (DSC) and pulsed arterial spin labeling (pASL) perfusion techniques in a large sample size of refractory MTLE patients. MATERIALS AND METHODS Forty-two patients with medically refractory MTLE who underwent preoperative evaluation and eleven normal controls were studied. Pathologic and control hippocampi were compared in terms of hippocampal volume, metabolite ratios and relative hippocampal perfusion values. By using cut-off points and asymmetry indexes, percentages of performance indicators for each technique were calculated in groups of MR (+), MR (-) and bilateral MTLE. RESULTS For all techniques, a statistically significant difference was found between the pathologic and control hippocampus groups (P<0.001). Also, all of them except HV had diagnostic value in groups of MR (-) and bilateral MTLE. CONCLUSION HV, MRS, DSC and pASL have achieved comparable performance and each of them provides important information about the lateralization of epileptogenic focus. Among those, pASL and MRS may easily be used as an adjunct to conventional MR.
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Affiliation(s)
- Bulent Eryurt
- Department of Radiology, Gazi University School of Medicine, 06560 Ankara, Turkey.
| | - A Yusuf Oner
- Department of Radiology, Gazi University School of Medicine, 06560 Ankara, Turkey
| | - Murat Ucar
- Department of Radiology, Gazi University School of Medicine, 06560 Ankara, Turkey
| | - Irem Capraz
- Department of Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Gokhan Kurt
- Department of Neurosurgery, Gazi University School of Medicine, Ankara, Turkey
| | - Erhan Bilir
- Department of Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - E Turgut Tali
- Department of Radiology, Gazi University School of Medicine, 06560 Ankara, Turkey
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Perfusion CT and acute stroke imaging: Foundations, applications, and literature review. J Neuroradiol 2015; 42:21-9. [DOI: 10.1016/j.neurad.2014.11.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022]
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15
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Future directions for endovascular management of patients with acute ischemic stroke. J Neuroradiol 2014; 41:151-2. [DOI: 10.1016/j.neurad.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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