MRI to detect and localize the area postrema in multiple sclerosis: The role of 3D-DIR and 3D-FLAIR

Unmasking the Area Postrema on MRI: Utility of 3D FLAIR, 3D-T2, and 3D-DIR Sequences in a Case-Control Study

The area postrema (AP) is a key circumventricular organ involved in the regulation of autonomic functions. Accurate identification of the AP via MRI is essential in neuroimaging but it is challenging. This study evaluated 3D FSE Cube T2WI, 3D FSE Cube FLAIR, and 3D DIR sequences to improve AP detection in patients with and without multiple sclerosis (MS). A case-control study included 35 patients with MS and 35 with other non-demyelinating central nervous system diseases (ND-CNSD). MRI images were acquired employing 3D DIR, 3D FSE Cube FLAIR, and 3D FSE Cube T2WI sequences. The evaluation of AP was conducted using a 3-point scale. Statistical analysis was performed with the chi-square test used to assess group homogeneity and differences between sequences. No significant differences were found in the visualization of the AP between the MS and ND-CNSD groups across the sequences or planes. The AP was not visible in 27.6% of the 3D FSE Cube T2WI sequences, while it was visualized in 99% of the 3D FSE Cube FLAIR sequences and 100% of the 3D DIR sequences. The 3D DIR sequence showed superior performance in identifying the AP.

Isolated transient vertigo due to TIA: challenge for diagnosis and therapy

As a prevalent vertigo disease in the clinic, isolated transient vertigo can present as a vertigo episode without focal signs and always free of symptoms on presentation. Previous studies showed a part of isolated transient vertigo events had a high risk of stroke during follow-up. However, how to discern posterior circulation ischemia become a great challenge for clinicians, especially in emergency, neurology, and ENT departments. Routine besides, hematological, and imaging examinations are often difficult provide a clear etiological diagnosis. Hence, this article reviews current knowledge about the epidemiology, risk factors, offending lesions, and clinical manifestation of transient ischemic attack (TIA) presenting as isolated transient vertigo. In addition, we summarize several advances in besides examinations, serum biomarkers, and imaging technologies to better identify stroke events. Finally, the current situation of therapy was briefly retrospected. Here we present a critical clinical puzzle that needs to be solved in the future. Of note, there is a still lack of high-quality studies in this field. The article reviews the keys to the diagnosis of isolated transient vertigo due to TIA and provides us with more methods to screen for high-risk stroke populations.