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Colasurdo M, Chen H, Gandhi D. MR Imaging Techniques for Acute Ischemic Stroke and Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage. Neuroimaging Clin N Am 2024; 34:203-214. [PMID: 38604705 DOI: 10.1016/j.nic.2023.12.002] [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] [Indexed: 04/13/2024]
Abstract
Acute ischemic stroke (AIS) is a leading cause of death and disability worldwide, and its prevalence is expected to increase with global population aging and the burgeoning obesity epidemic. Clinical care for AIS has evolved during the past 3 decades, and it comprises of 3 major tenants: (1) timely recanalization of occluded vessels with intravenous thrombolysis or endovascular thrombectomy, (2) prompt initiation of antithrombotic agents to prevent stroke recurrences, and (3) poststroke supportive care and rehabilitation. In this article, we summarize commonly used MR sequences for AIS and DCI and highlight their clinical applications.
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Affiliation(s)
- Marco Colasurdo
- Division of Interventional Neuroradiology, Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201, USA; Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Huanwen Chen
- Division of Interventional Neuroradiology, Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201, USA; National Institute for Neurological Disorders and Stroke, National Institutes of Health, 10 center drive, Bethesda, MD 20892, USA; Department of Neurology, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Dheeraj Gandhi
- Division of Interventional Neuroradiology, Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201, USA; Department of Neurology, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201, USA; Department of Neurosurgery, University of Maryland School of Medicine, 22 South Green Street, Baltimore, MD 21201, USA.
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Yamaji K, Iwanaga Y, Kakehi K, Fujita K, Kawamura T, Hirase C, Ueno M, Nakazawa G. Prognostic Significance of Asymptomatic Cerebral Infarction in Patients After Cardiac Catheterization. Int Heart J 2024; 65:13-20. [PMID: 38296566 DOI: 10.1536/ihj.23-382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Recent studies have showed that asymptomatic cerebral infarction (ACI) developed in a reasonable number of patients after cardiac catheterization. However, no study has investigated the long-term prognostic impact of ACI after cardiac catheterization. We investigated whether ACI after cardiac catheterization affects long-term mortality and subsequent cardiovascular events.We retrospectively enrolled patients who underwent cardiac catheterization before cardiac surgery and cerebral diffusion-weighted magnetic resonance imaging (DWI). The incidence and clinical features of ACI were investigated. The long-term prognosis, including all-cause mortality and subsequent major cardiovascular events (MACE; all-cause mortality, stroke, acute myocardial infarction, fatal arrhythmia, and hospitalized heart failure), was also assessed.A total of 203 patients were enrolled. Of these, 10.3% had ACI diagnosed by DWI. There were no differences in baseline characteristics between patients with and without ACI, except more frequent history of symptomatic stroke in patients with ACI. In the Kaplan-Meier analysis during a median follow-up of 1009 days, the patients with ACI showed worse mortality and a slightly higher occurrence of MACE compared with those without ACI (P = 0.01 and P = 0.08, respectively). In addition, ACI was a prognostic marker independent of age, surgery type, and history of stroke.ACI after cardiac catheterization frequently developed and was also associated with long-term prognosis. It may be an independent prognostic marker in high-risk patients who underwent subsequent cardiac surgery.
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Affiliation(s)
- Kenji Yamaji
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
- Division of Cardiology, Pref Osaka Saiseikai Izuo Hospital
| | - Yoshitaka Iwanaga
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
- Department of Cardiology, Sakurabashi-Watanabe Hospital
| | - Kazuyoshi Kakehi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
| | - Kosuke Fujita
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
| | - Takayuki Kawamura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
| | | | - Masafumi Ueno
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
| | - Gaku Nakazawa
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine
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Abdullahi MZ, Mohammad HM, Lawal S, Ibrahim MZ, Bello N, Aliyu I, Muhammad RM. Evaluation of Pattern of Lesions Depicted on Brain Computed Tomography Scan of Patients Presenting with Stroke in Zaria, Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:16-21. [PMID: 37538210 PMCID: PMC10395855 DOI: 10.4103/jwas.jwas_256_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/18/2022] [Indexed: 08/05/2023]
Abstract
Introduction Stroke is a major public health problem worldwide and it is the third leading cause of death in industrialized countries and ranks among the five most common causes of hospital deaths in adults in Africa. Accurate stroke diagnosis has a high significance for patient's outcome. Computed tomography (CT) brain scan is the imaging of choice for patients presenting to the emergency department with stroke. Aim and Objectives The study aimed at evaluating the pattern of lesion depicted on CT brain of patients presenting with stroke in ABUTH, Zaria. Materials and Methods A prospective review of CT findings in 155 patients who presented in the Radiology Department of Ahmadu Bello University Teaching Hospital (ABUTH) with clinical diagnosis of stroke was undertaken over a period of six months (from October 2017 to April 2018).. Results Of the 155 patients seen within the period under review, 88 (56.8%) were males while 67 (43.2%) were females. Age range was 11-90 years (mean 56, standard deviation (SD) 16, 44(28.4%) of patients were in the age group of 61-70 years. Ninety six patients (61.9%) had ischaemic stroke, 27(17.4%) had hemorrhagic stroke, eight (5.2%) was stroke mimic, six patients (3.9%) mixed lesions (ie both ischaemic and haemorrhagic). Eighteen patients (11.6%) had normal brain CT findings. The region most affected by stroke was the parietal region 52(38%). Conclusion Ischaemic stroke is the most common form of stroke in this study.
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Affiliation(s)
| | - Halima Mono Mohammad
- Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Suleiman Lawal
- Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - Nafisa Bello
- Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Ibrahim Aliyu
- Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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Jansen van Vuuren JM, Pillay S, Naidoo A. The burden of suspected strokes in uMgungundlovu – Can biomarkers aid prognostication? Health SA 2022. [DOI: 10.4102/hsag.v27i0.1916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Peine B, Figueroa C, Robinette N. Neuro-Behcet's syndrome: Case report and literature review. Radiol Case Rep 2022; 17:3064-3070. [PMID: 35769120 PMCID: PMC9234539 DOI: 10.1016/j.radcr.2022.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Behcet's disease (BD) is a multisystem, autoimmune vasculitis disorder affecting small, medium, and large blood vessels, with poorly understood pathogenesis. It commonly presents with recurrent aphthous ulcers, genital ulcers, skin lesions, and bilateral uveitis. Neurological symptoms are present in less than 10% of cases and develop, on average, 5-6 years after the first non-neurological symptoms. This presentation, known as Neuro-Behcet's disease (NBD), is associated with a worse prognosis of BD. Treatment for NBD is dependent on the severity of symptoms and the presence of other systemic manifestations but often initially involves glucocorticoids and a disease-modifying agent. This case report presents a 44-year-old female patient, previously diagnosed with BD, who presented with neurological symptoms and MRI findings consistent with NBD.
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Affiliation(s)
- Brian Peine
- Central Michigan University College of Medicine, 1280 East Campus Dr, Mt Pleasant, MI 48858, USA
- Corresponding author.
| | | | - Natasha Robinette
- Department of Radiology, Detroit Medical Center, Detroit, MI, USA
- Karmanos Cancer Center, Detroit, MI, USA
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van Poppel LM, B.L.M. Majoie C, Marquering HA, Emmer BJ. Associations between Early Ischemic Signs on Non-Contrast CT and Time since Acute Ischemic Stroke Onset: A Scoping Review. Eur J Radiol 2022; 155:110455. [DOI: 10.1016/j.ejrad.2022.110455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 11/03/2022]
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Porta M, Moreno J, Werner M, Chirife Ó, López-Rueda A. Anomalous location of intracranial vessels in adults. RADIOLOGIA 2022; 64:41-53. [PMID: 35180986 DOI: 10.1016/j.rxeng.2021.11.001] [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] [Received: 01/22/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
Anomalous intracranial vessels are not uncommon, and this finding is not always associated with arteriovenous malformations. Other conditions such as anomalous connections between arteries or phlebitc patterns can also present as vessels with abnormal intracranial locations. Noninvasive diagnosis is important to determine whether to do more invasive tests such as cerebral digital subtraction angiography or to estimate the risk of bleeding in arteriovenous malformations and therefore to evaluate the need for endovascular/surgical treatment. In this paper, we present an algorithm for the differential diagnosis of anomalous intracranial vessels according to their location (intra/extra-axial) and function (whether the vessels are arterialized). Moreover, we analyze the important points of the angioarchitecture of the principal arteriovenous malformations with risk of intracranial bleeding, such as pial arteriovenous malformations and dural fistulas.
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Affiliation(s)
- M Porta
- Departamento de Radiología, Hospital Clínic de Barcelona, Universidad de Barcelona, Spain
| | - J Moreno
- Departamento de Radiología, Hospital Clínic de Barcelona, Universidad de Barcelona, Spain
| | - M Werner
- Departamento de Radiología, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Ó Chirife
- Departamento de Radiología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A López-Rueda
- Departamento de Radiología, Hospital Clínic de Barcelona, Universidad de Barcelona, Spain.
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Porta M, Moreno J, Werner M, Chirife Ó, López-Rueda A. Vasos intracraneales en localización anómala en adultos. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Greenberg K, Bykowski J. Modern Neuroimaging Techniques in Diagnosing Transient Ischemic Attack and Acute Ischemic Stroke. Emerg Med Clin North Am 2021; 39:29-46. [PMID: 33218661 DOI: 10.1016/j.emc.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Karen Greenberg
- Neurologic Emergency Department, Global Neurosciences Institute, Crozer Chester Medical Center, 3100 Princeton Pike, Building 3, Suite D, Lawrenceville, NJ 08648, USA
| | - Julie Bykowski
- Department of Radiology, UC San Diego Health, 200 West Arbor Drive, San Diego, CA 92013, USA.
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Gasco V, Cambria V, Bioletto F, Ghigo E, Grottoli S. Traumatic Brain Injury as Frequent Cause of Hypopituitarism and Growth Hormone Deficiency: Epidemiology, Diagnosis, and Treatment. Front Endocrinol (Lausanne) 2021; 12:634415. [PMID: 33790864 PMCID: PMC8005917 DOI: 10.3389/fendo.2021.634415] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury (TBI)-related hypopituitarism has been recognized as a clinical entity for more than a century, with the first case being reported in 1918. However, during the 20th century hypopituitarism was considered only a rare sequela of TBI. Since 2000 several studies strongly suggest that TBI-mediated pituitary hormones deficiency may be more frequent than previously thought. Growth hormone deficiency (GHD) is the most common abnormality, followed by hypogonadism, hypothyroidism, hypocortisolism, and diabetes insipidus. The pathophysiological mechanisms underlying pituitary damage in TBI patients include a primary injury that may lead to the direct trauma of the hypothalamus or pituitary gland; on the other hand, secondary injuries are mainly related to an interplay of a complex and ongoing cascade of specific molecular/biochemical events. The available data describe the importance of GHD after TBI and its influence in promoting neurocognitive and behavioral deficits. The poor outcomes that are seen with long standing GHD in post TBI patients could be improved by GH treatment, but to date literature data on the possible beneficial effects of GH replacement therapy in post-TBI GHD patients are currently scarce and fragmented. More studies are needed to further characterize this clinical syndrome with the purpose of establishing appropriate standards of care. The purpose of this review is to summarize the current state of knowledge about post-traumatic GH deficiency.
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Raffa GM, Agnello F, Occhipinti G, Miraglia R, Lo Re V, Marrone G, Tuzzolino F, Arcadipane A, Pilato M, Luca A. Neurological complications after cardiac surgery: a retrospective case-control study of risk factors and outcome. J Cardiothorac Surg 2019; 14:23. [PMID: 30683130 PMCID: PMC6347812 DOI: 10.1186/s13019-019-0844-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/14/2019] [Indexed: 11/14/2022] Open
Abstract
Background To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery. Methods A total of 2121 patients underwent cardiac surgery between August, 2008 and December, 2013; 91/2121 (4.3%) underwent brain computed tomography (70/91, 77%) or magnetic resonance imaging (21/91, 23%) scan because of major stroke (37/2121, 1.7%) and a spectrum of transient neurological episodes as well as transient ischemic attacks and delirium /psychosis/seizures (54/2121, 2.5%). The mean age was 65.3 ± 12.1 years and 60 (65.9%) were male. Variables were compared among study- and matched-patients (n = 113) without neurological deficits. Results A total of 37/2121 (1.7%) patients had imaging evidence of stroke. Radiological examinations were done 5.72 ± 3.6 days after surgery. Patients with and without imaging evidence of stroke had longer intensive care unit length of stay (LOS) (13.8 ± 14.7 and 12.9 ± 15 days vs. 5.7 ± 12.1 days, respectively (p < 0.001) and hospital LOS (53 ± 72.8 and 35.5 ± 29.8 days vs. 18.4 ± 29.2 days, respectively (p < 0.001) than the control group. The hospital mortality of patients with and without imaging evidence of stroke was higher than the control group (7/37 patients [19%], and 12/54 patients [22%] vs. 4/115 patients [3%], respectively (p < 0.001). Multivariate analysis showed that bilateral internal carotid artery stenosis of any grade (p < .001), and re-do operations (p = .013) increased the risk of postoperative neurological complications. Conclusions Neurological complications after cardiac surgery increase hospitalization and mortality even in patients without radiologic evidence of stroke. Bilateral internal carotid artery stenosis of any grade, suggesting a diffuse patient propensity toward atherosclerosis, and re-do operations increase the risk of postoperative neurological complications.
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Affiliation(s)
- Giuseppe Maria Raffa
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Via Tricomi 5, 90127, Palermo, Italy.
| | - Francesco Agnello
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), via Tricomi 5, Palermo, 90127, Italy
| | - Giovanna Occhipinti
- Department of Anesthesia and Critical Care, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), via Tricomi 5, Palermo, 90127, Italy
| | - Roberto Miraglia
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), via Tricomi 5, Palermo, 90127, Italy
| | - Vincenzina Lo Re
- Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, via Tricomi 5, Palermo, 90127, Italy
| | - Gianluca Marrone
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), via Tricomi 5, Palermo, 90127, Italy
| | - Fabio Tuzzolino
- Statistician, Research Office, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy
| | - Antonio Arcadipane
- Department of Anesthesia and Critical Care, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), via Tricomi 5, Palermo, 90127, Italy
| | - Michele Pilato
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Via Tricomi 5, 90127, Palermo, Italy
| | - Angelo Luca
- Diagnostic and Therapeutic Services, Radiology Unit, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), via Tricomi 5, Palermo, 90127, Italy
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Vogler J, Gariwala V, Trace A, Fong V, Plemmons J. Bilateral hyperdense middle cerebral arteries: Stroke sign or not? Radiol Case Rep 2018; 13:933-935. [PMID: 30093929 PMCID: PMC6072911 DOI: 10.1016/j.radcr.2018.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 11/18/2022] Open
Abstract
Hyperdense middle cerebral artery (MCA) is a classic sign of acute thromboembolic disease. Simultaneous bilateral occurrence is uncommon and traditionally attributed to physiological hemoconcentration or attributable to imaging artifact. We present the case of a 71-year-old man whose admission noncontrast computed tomography (CT) demonstrated bilateral hyperdense middle cerebral arteries without other radiographic evidence of acute stroke. CT angiography confirmed bilateral MCA, M1 segment vascular occlusion and follow-up noncontrast CT demonstrated MCA territory infarctions.
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Affiliation(s)
- James Vogler
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
- Corresponding author.
| | - Veer Gariwala
- Eastern Virginia Medical School, 825 Fairfax Ave, Norfolk, VA 23507, USA
| | - Anthony Trace
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
| | - Victor Fong
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
| | - John Plemmons
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
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Chu CM, Tong MMP. CT Quiz: An Old Lady with Sudden Onset of Right-Sided Weakness. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790801500410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - MMP Tong
- Prince of Wales Hospital, Department of Diagnostic Radiology and Organ Imaging, 30–32 Ngan Shing Street, Shatin, N.T., Hong Kong
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Ran YC, Zhu M, Zhang Y, Li TF, Cheng JL. Perfusion-weighted magnetic resonance imaging in the assessment of haemodynamics following stent angioplasty in patients with symptomatic middle cerebral artery plaque stenosis at the M1 segment. Exp Ther Med 2017; 14:1899-1904. [PMID: 28962101 PMCID: PMC5609125 DOI: 10.3892/etm.2017.4747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/06/2017] [Indexed: 11/10/2022] Open
Abstract
The most effective strategy to assess changes in the brain haemodynamics of stent angioplasty in patients with symptomatic ischemia of the M1 segment of the middle cerebral artery (MCA) remains unknown. The purpose of the present study was to use perfusion-weighted magnetic resonance imaging (PWI) to evaluate the effect of stent angioplasty in treating patients with symptomatic MCA plaque stenosis. Stent angioplasty was performed on 23 patients with reduplicative transient ischaemic attack who were refractory to medical therapy. All patients had MCA plaque stenosis at the M1 segment. Brain PWI was obtained from four major regions of interest (ROIs) at the frontal parietal, temporal, lateral ventricle and basal ganglia lobes prior to and following stent implantation. In addition, cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT) and time to peak (TTP) parameters derived from PWI were calculated. All patients underwent digital subtraction angiography following surgery to confirm the patency. Computed tomography angiography or PWI was performed 1 week and 3 months post-surgery. According to pre-operative PWI, there was significant hypoperfusion in the symptomatic frontal parietal, temporal, lateral ventricle and basal ganglia lobes. By contrast, the regional CBF and CBF increased in the ROIs of the affected cerebral hemisphere 3 months after stent implantation (P<0.05 vs. pre-operative data). Additionally, post-operative MTT and TTP in the ROIs on the operative side were significantly shorter than pre-operative MTT and TTP (P<0.05). During the follow-up period, the frequency of transient ischaemic attack was reduced or disappeared in all patients during the follow-up. In conclusion, PWI enables an effective and objective assessment of haemodynamics prior to and following stent angioplasty in patients with plaque stenosis of MCA at the M1 segment.
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Affiliation(s)
- Yun-Cai Ran
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Ming Zhu
- Department of Interventional Therapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Teng-Fei Li
- Department of Interventional Therapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Jing-Liang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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Abstract
Brain and vascular imaging are required components of the emergency assessment of patients with suspected stroke. Either CT or MRI may be used as the initial imaging test. MRI is more sensitive to the presence of acute and chronic ischemic lesions, and chronic microbleeds, but CT remains the most practical and used initial brain imaging test. Although, a non-enhanced CT or T2* MRI sequence showing no haemorrhage is sufficient for deciding intravenous treatment eligibility within the first 4.5h after stroke onset, a non-invasive intracranial vascular study is strongly recommended during the initial imaging evaluation of the acute stroke patient, particularly if mechanical thrombectomy is contemplated. Advanced imaging with multimodal MRI may facilitate accurate ischemic stroke diagnosis and characterization, and should be considered as an alternative to CT, especially for the selection of patients for acute reperfusion therapy in extended time windows, and in patients in which time of stroke onset is unknown. However, MRI should only be considered in the acute stroke workflow if centres are able to achieve speed and triaging efficiency similar to that which is currently available with CT-based imaging.
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Gomolka RS, Chrzan RM, Urbanik A, Kazmierski R, Grzanka AD, Nowinski WL. Quantification of image contrast of infarcts on computed tomography scans. Neuroradiol J 2017; 30:15-22. [PMID: 28059673 DOI: 10.1177/1971400916678226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Accurate identification of infarcts in non-contrast computed tomography (NC-CT) scans of the brain is fundamental in the diagnosis and management of patients with stroke. Quantification of image contrast properties at the boundaries of ischemic infarct regions in NC-CT can contribute to a more precise manual or automatic delineation of these regions. Here we explore these properties quantitatively. Methods We retrospectively investigated 519 NC-CT studies of 425 patients with clinically confirmed ischemic strokes. The average and standard deviation (SD) of patients' age was 67.5 ± 12.4 years and the average(median)±SD time from symptoms onset to NC-CT examination was 27.4(12)±35.7 h. For every scan with an ischemic lesion identified by experts, the image contrast of the lesion vs. normal surrounding parenchyma was calculated as a difference of mean Hounsfield Unit (HU) of 1-5 consecutive voxels (the contrast window width) belonging to the lesion and to the parenchyma. This contrast was calculated at each single voxel of ischemic lesion boundaries (previously delineated by the experts) in horizontal and vertical directions in each image. The distributions of obtained horizontal, vertical and both contrasts combined were calculated among all 519 NC-CTs. Results The highest applicative contrast window width was identified as 5 voxels. The ischemic infarcts were found to be characterized by 6.60 HU, 8.28 HU and 7.55 HU mean values for distributions of horizontal, vertical and combined contrasts. Approximately 40-50% of the infarct boundary voxels were found to refer to the image contrast below 5 HU. Conclusion Low image contrast of ischemic lesions prevents accurate delineation of the infarcts in NC-CT.
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Affiliation(s)
- R S Gomolka
- 1 The Faculty of Electronics and Information Technology, Warsaw University of Technology, Warsaw, Poland
| | - R M Chrzan
- 2 Department of Radiology, Jagiellonian University, The Cracow University Hospital, Krakow, Poland
| | - A Urbanik
- 2 Department of Radiology, Jagiellonian University, The Cracow University Hospital, Krakow, Poland
| | - R Kazmierski
- 3 Department of Neurology and Cerebrovascular Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - A D Grzanka
- 1 The Faculty of Electronics and Information Technology, Warsaw University of Technology, Warsaw, Poland
| | - W L Nowinski
- 4 John Paul II Center for Virtual Anatomy and Surgical Simulation, Cardinal Stefan Wyszynski, Warsaw, Poland
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Let thy left brain know what thy right brain doeth: Inter-hemispheric compensation of functional deficits after brain damage. Neuropsychologia 2016; 93:407-412. [DOI: 10.1016/j.neuropsychologia.2016.06.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 05/06/2016] [Accepted: 06/12/2016] [Indexed: 12/18/2022]
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Abd Elkhalek YI, Elia RZ. Qualitative and quantitative value of hyperdense MCA sign as a prognostic marker for infarction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gomolka RS, Chrzan RM, Urbanik A, Nowinski WL. A Quantitative Method Using Head Noncontrast CT Scans to Detect Hyperacute Nonvisible Ischemic Changes in Patients With Stroke. J Neuroimaging 2016; 26:581-587. [PMID: 27238914 DOI: 10.1111/jon.12363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Because clinical evaluation of noncontrast computed tomography (CT) has a poor sensitivity in the evaluation of acute ischemic stroke, computer-aided diagnosis may be able to facilitate the performance. Recently, we introduced a computational method for the detection and localization of visible infarcts. Herein, we aimed to evaluate and extend a previous method, the Stroke Imaging Marker (SIM), to localize nonvisible hyperacute ischemia. MATERIALS AND METHODS On the basis of the SIM and its components-the ratio of percentile differences in subranges of Hounsfield Unit (HU) distribution (P-ratio), ratio of voxels count in ranges of brain CT intensity, median HU attenuation value-the infarct localization was performed in 140 early and follow-up scans of 70 patients. In none of the early scans was the infarct visible to a radiologist or an experienced stroke neuroradiologist. The infarcted hemisphere detection rate (HDR) and sensitivity of infarct localization were measured by overlapping the region of detected tissue in the initial scan, with the gold standard set for the fully visible stroke in the follow-up scan. RESULTS The best performance of the algorithm was found for the P-ratio including seven percentile subranges within the range of 35th-75th percentile. The modified SIM provided a 76% ischemic HDR and 54% sensitivity in spatial localization of hyperacute ischemia (68% among properly detected infarct sides). CONCLUSION The improved SIM is a dedicated and potentially useful tool for hyperacute nonvisible brain infarct detection from CT scans and may contribute to reduction of image-to-needle time in patients eligible for revascularization therapy.
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Affiliation(s)
- Ryszard S Gomolka
- Faculty of Electronics and Information Technology, Warsaw University of Technology, Warsaw, Poland. .,Biomedical Imaging Lab, Agency for Science Technology and Research, Singapore.
| | - Robert M Chrzan
- Department of Radiology, Jagiellonian University, The Cracow University Hospital, Kraków, Poland
| | - Andrzej Urbanik
- Department of Radiology, Jagiellonian University, The Cracow University Hospital, Kraków, Poland
| | - Wieslaw L Nowinski
- Department of Radiology, University of Washington, University District Building, Seattle, WA.,John Paul II Center for Virtual Anatomy and Surgical Simulation, Cardinal Stefan Wyszyński University, Warsaw, Poland
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Abstract
Single-photon emission computed tomography (SPECT) is a functional nuclear imaging technique that allows visualization and quantification of different in vivo physiologic and pathologic features of brain neurobiology. It has been used for many years in diagnosis of several neurologic and psychiatric disorders. In this chapter, we discuss the current state-of-the-art of SPECT imaging of brain perfusion and dopamine transporter (DAT) imaging. Brain perfusion SPECT imaging plays an important role in the localization of the seizure onset zone in patients with refractory epilepsy. In cerebrovascular disease, it can be useful in determining the cerebrovascular reserve. After traumatic brain injury, SPECT has shown perfusion abnormalities despite normal morphology. In the context of organ donation, the diagnosis of brain death can be made with high accuracy. In neurodegeneration, while amyloid or (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) are the nuclear diagnostic tools of preference for early and differential diagnosis of dementia, perfusion SPECT imaging can be useful, albeit with slightly lower accuracy. SPECT imaging of the dopamine transporter system is widely available in Europe and Asia, but since recently also in the USA, and has been accepted as an important diagnostic tool in the early and differential diagnosis of parkinsonism in patients with unclear clinical features. The combination of perfusion SPECT (or FDG-PET) and DAT imaging provides differential diagnosis between idiopathic Parkinson's disease, Parkinson-plus syndromes, dementia with Lewy bodies, and essential tremor.
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Affiliation(s)
- Karolien Goffin
- Division of Nuclear Medicine, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - Koen van Laere
- Division of Nuclear Medicine, University Hospital Leuven and KU Leuven, Leuven, Belgium.
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Menzilcioglu MS, Mete A, Ünverdi Z. Effectiveness of CT Computed Tomography Perfusion in Diagnostics of Acute Ischemic Stroke. Pol J Radiol 2015; 80:549-54. [PMID: 26740827 PMCID: PMC4692568 DOI: 10.12659/pjr.895468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stroke is the third most common death reason after the cardiovascular disorders and cancer. Cerebral ischemia is a pathology that stems from a decrease in cerebral perfusion. Computed Tomography Perfusion (CTP) is an additional method to the conventional Computed Tomography (CT) that could be performed by using developed softwares, in a short period of time and with a low risk of complications. CTP not only allows early detection of cerebral ischemia but also gives valuable information on the ischemic penumbra which are very important in early diagnosis and treatment. Acute Ischemic Stroke (AIS) can be cured by trombolytic treapy within 3-6 hours after symptom onset. Since rapid screening and accurate diagnosis increase the success of the treatment, the role of neuroradiology in acute ischemia diagnostics and treatment has become more important. Our aim was to define CT skills in early diagnosis of AIS, to define its contribution to patient's diagnosis and treatment and to define its importance regarding patient's prognosis. MATERIAL/METHODS We included 42 patients that presented to the emergency service and neurology outpatient clinic with the symptoms of acute cerebral incidence. RESULTS In our study, we found that Cerebral Blood Flow (CBF) is 90.91% sensitive and 100% specific in examining ischemia. CONCLUSIONS Tissue hemodynamic data, especially sensitivity and specificity rates, which cannot be acquired by conventional CT and MRI methods, can be acquired by the CTP method.
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Affiliation(s)
| | - Ahmet Mete
- Department of Radiology, Gaziantep University, Gaziantep, Turkey
| | - Zeyni Ünverdi
- Department of Radiology, Gaziantep University, Gaziantep, Turkey
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Surgery of brain aneurysm in a BrainSuite® theater: A review of 105 cases. Clin Neurol Neurosurg 2015; 133:34-9. [DOI: 10.1016/j.clineuro.2015.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/28/2015] [Accepted: 03/07/2015] [Indexed: 02/07/2023]
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Garcia LHC, Ferreira BC. An ABC for decision making. Radiol Bras 2015; 48:101-10. [PMID: 25987751 PMCID: PMC4433301 DOI: 10.1590/0100-3984.2013.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 02/07/2014] [Indexed: 11/22/2022] Open
Abstract
The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw- Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters); Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations.
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Affiliation(s)
- Luiz Henrique Costa Garcia
- General Surgeon, Intensive Medicine Specialist, Associação
de Medicina Intensiva Brasileira (AMIB), and Irmandade da Santa Casa de
Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Bruna Cortez Ferreira
- MD, Resident of Medical Practice at Hospital de Base de São
José do Rio Preto, São José do Rio Preto, SP, Brazil
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[Vascular assessment in stroke codes: role of computed tomography angiography]. RADIOLOGIA 2014; 57:156-66. [PMID: 25060835 DOI: 10.1016/j.rx.2013.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 10/05/2013] [Accepted: 11/18/2013] [Indexed: 11/22/2022]
Abstract
Advances in imaging studies for acute ischemic stroke are largely due to the development of new efficacious treatments carried out in the acute phase. Together with computed tomography (CT) perfusion studies, CT angiography facilitates the selection of patients who are likely to benefit from appropriate early treatment. CT angiography plays an important role in the workup for acute ischemic stroke because it makes it possible to confirm vascular occlusion, assess the collateral circulation, and obtain an arterial map that is very useful for planning endovascular treatment. In this review about CT angiography, we discuss the main technical characteristics, emphasizing the usefulness of the technique in making the right diagnosis and improving treatment strategies.
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Abstract
Rapid diagnosis of stroke is necessary for the timely delivery of thrombolysis and evaluation of novel therapies such as neuroprotection. An accurate clinical history and competent examination are key to identifying which patients are likely to have had a stroke and arranging and interpreting neuroimaging. Stroke symptoms are typically acute in onset, but are highly variable depending on the vascular territory affected. Common presenting symptoms are limb weakness, and speech and visual disturbances. Common stroke mimics are seizures, space occupying lesions, syncope, somatization and delirium secondary to sepsis. Stroke recognition instruments can help nonspecialists in the early diagnosis of stroke, with studies reporting sensitivity of over 90% and specificity of approximately 85% for some instruments. In patients with a clinical diagnosis of stroke, brain computed tomography or MRI is required to exclude some stroke mimics and differentiate ischemic from hemorrhagic stroke, which is key to providing appropriate therapies such as thrombolysis. In the future, plasma biomarkers may improve clinical diagnosis of stroke, but prospective studies are required to establish their utility. Clinical trials of acute stroke therapies need to ensure rapid accurate diagnosis of stroke using structured clinical assessments and appropriate imaging to achieve early treatment and avoid entry of stroke mimics into trials.
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Effect of acupuncture on NSE and Hcy levels and magnetic resonance spectrum in cerebral infarction patients. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2013. [DOI: 10.1007/s11726-013-0693-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Abstract
Stroke and cerebrovascular diseases are major causes of mortality, morbidity, and disability. Nuclear Medicine, primarily via tomographic methods, has made significant contributions to the understanding of the hemodynamic and metabolic consequences of cerebrovascular diseases. In this review, the findings in acute, subacute, and chronic cerebrovascular diseases are described. Many of the pathophysiologic processes and consequences that follow stroke, including completed infarct core, adjacent penumbra, and diaschisis, have been investigated with Nuclear Medicine, and stroke outcome may be related to these phenomena. Additional topics included in this review are cerebrovascular reserve tests and multi-infarct dementia. Finally, Nuclear Medicine investigations of stroke recovery and cerebral plasticity appear to indicate that enhanced activity of preexisting networks, rather than substitution of function, represents the most important mechanism of improvement in chronic stroke rehabilitation.
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Affiliation(s)
- David H Lewis
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98104, USA.
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Abstract
Stroke is a heterogeneous syndrome caused by multiple mechanisms, all of which result in disruption of normal cerebral blood flow and thereby cause cerebral dysfunction. Its early diagnosis is important as its treatment is dependent on the time elapsed since ictus. Delay in diagnosis and treatment translates into increase neuronal loss and thereby increased morbidity. CT scan, and in particular perfusion CT, has helped greatly in the early diagnosis of stroke. This article is an endeavor to explain the pathophysiology of cerebral ischemia and the role of CT perfusion in detecting it.
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Affiliation(s)
- Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, PGIMER, Sector 12, Chandigarh, India
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31
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Paul AEH, Lenard Z, Mansfield CS. Computed tomography diagnosis of eight dogs with brain infarction. Aust Vet J 2010; 88:374-80. [PMID: 20854292 DOI: 10.1111/j.1751-0813.2010.00629.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Medical records of eight dogs presenting with acute onset of neurological signs and a diagnosis of brain infarction as determined by computed tomography (CT) imaging were reviewed. DESIGN Retrospective single-centre case review. RESULTS Ischaemic infarction in the territory of the rostral cerebellar artery was identified in three spaniel-breed dogs. All cerebellar infarcts were non-haemorrhagic. Telencephalic infarcts were identified in five dogs, in the territories of the middle cerebral artery (2/5) and rostral cerebral artery (3/5). One of these dogs had an ischaemic infarction, but all other infarctions appeared haemorrhagic. All dogs were geriatric (≥ 8 years old), with concurrent medical conditions identified in six dogs. One dog was euthanased after diagnosis because of the severity of its neurological signs and one dog was euthanased as a result of associated renal disease 2 months after diagnosis. Six dogs were alive at least 1 year after diagnosis. CONCLUSIONS CT is useful in the diagnosis of cerebrovascular accident in dogs, which can present as a spectrum of images with early changes in attenuation and subtle mass effects detected after infarction. CT is particularly sensitive for detecting haemorrhagic infarction, but under-represent ischaemic and lacunar infarctions when compared with MRI.
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Affiliation(s)
- A E H Paul
- Murdoch University Veterinary Hospital, Murdoch Dve., Murdoch, Western Australia, Australia.
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Tuftsin derivatives of FITC, Tb-DOTA or Gd-DOTA as potential macrophage-specific imaging biomarkers. CONTRAST MEDIA & MOLECULAR IMAGING 2010; 5:223-30. [DOI: 10.1002/cmmi.381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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CT emergencies. Emerg Radiol 2009. [DOI: 10.1017/cbo9780511691935.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ong RKC, Lenard ZM, Swindells KL, Raisis AL. Extradural haematoma secondary to brown snake (Pseudonajaspecies) envenomation. Aust Vet J 2009; 87:152-6. [DOI: 10.1111/j.1751-0813.2009.00410.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Blasel S, Hattingen E, Berkefeld J, Kurre W, Morawe G, Zanella F, de Rochemont RDM. Evaluation of Angiographic and Technical Aspects of Carotid Stenting with Diffusion-Weighted Magnetic Resonance Imaging. Cardiovasc Intervent Radiol 2009; 32:666-71. [DOI: 10.1007/s00270-009-9526-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 01/13/2009] [Accepted: 01/16/2009] [Indexed: 10/21/2022]
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Kang BT, Jang DP, Lee JH, Jung DI, Gu SH, Lim CY, Kim YB, Quan FS, Kim HJ, Woo EJ, Cho ZH, Park HM. Detection of cerebral metabolites in a canine model of ischemic stroke using 1H magnetic resonance spectroscopy. Res Vet Sci 2009; 87:300-6. [PMID: 19278700 DOI: 10.1016/j.rvsc.2009.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 11/26/2008] [Accepted: 01/22/2009] [Indexed: 11/15/2022]
Abstract
Proton magnetic resonance spectroscopy ((1)H MRS) provides in vivo biochemical information on tissue metabolites. The purpose of this study was to investigate the serial metabolic changes of (1)H MRS in the cerebrum of ischemic dogs. An ischemic stroke was induced in five health laboratory beagle dogs by permanent middle cerebral artery occlusion using a silicone plug. (1)H MRS was serially performed three times with a 1.5-T MR system: before, three days after and 10days after the stroke. Immunohistochemical staining was performed to determine the expression of neuronal nuclei (NeuN) and glial fibrillary acidic protein (GFAP) at both the ipsilateral and contralateral cerebral cortex. Reduced levels of N-acetyl-asparate (p<0.05), choline (Cho), creatine (Cr) and myo-inositol (mI), and a marked increase in the lactate (Lac) level (p<0.01) were found at three days after the stroke. At 10days after the stroke, the levels of Lac significantly increased (p<0.01); however, the other metabolites were partially elevated. The changes of Cr, Cho and mI were not statistically significant (p>0.05) when the before and after stroke values were compared. There was a significant loss of NeuN and GFAP immunoreactivity at the ischemic core. (1)H MRS may be to a useful diagnostic tool for the evaluation of ischemic stroke in dogs.
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Affiliation(s)
- Byeong-Teck Kang
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, #1 Hwayang-dong, Gwang-jin-gu, Seoul 143-701, South Korea
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Chu T, Li Z, Wang X. Synthesis and biological evaluation of radioiodinated 2NUBTA as a cerebral ischemia marker. Bioorg Med Chem Lett 2009; 19:658-61. [PMID: 19121583 DOI: 10.1016/j.bmcl.2008.12.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 12/08/2008] [Accepted: 12/11/2008] [Indexed: 10/21/2022]
Abstract
N-[4-(Benzothiazol-2-yl)phenyl]-11-(2-nitroimidazole-1-yl)undecanamide (2NUBTA) was synthesized and radiolabeled with iodine-131. In vitro evaluation of the [(131)I]2NUBTA using murine sarcoma S180 cells showed increase in radioactivity in hypoxic cells up to 4h, while it was not in aerobic cells. Its potential as a cerebral ischemia marker was evaluated using gerbil stroke models that had been subjected to right common carotid artery ligation to produce cerebral ischemia. The uptake in the right cerebral hemisphere decreased slowly than that of the left and the right/left hemisphere uptake ratios increased with time going on. It indicated that [(131)I]2NUBTA might be a possible cerebral ischemia marker.
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Affiliation(s)
- Taiwei Chu
- Bejing National Laboratory for Molecular Sciences, Department of Applied Chemistry, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, China.
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Niinimäki J, Korkiakoski A, Ojala O, Karppinen J, Ruohonen J, Haapea M, Korpelainen R, Natri A, Tervonen O. Association between visual degeneration of intervertebral discs and the apparent diffusion coefficient. Magn Reson Imaging 2008; 27:641-7. [PMID: 19106025 DOI: 10.1016/j.mri.2008.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 10/13/2008] [Accepted: 10/28/2008] [Indexed: 11/19/2022]
Abstract
The value of apparent diffusion coefficient (ADC) measurements in intervertebral disc has been studied because ADC provides an estimate of free diffusion of unbound water and could be used as a quantitative tool to estimate degenerative changes. However, the challenging nature of diffusion imaging of spine and limited numbers of subjects in earlier studies has produced contradictory findings. We aimed to determine the relation between ADC and visual degenerative changes in lumbar intervertebral discs in a sufficiently large homogeneous study group. Lumbar spines of 228 volunteer middle-aged men were MR imaged at 1.5 T including anatomic and diffusion-weighted imaging. ADC values, T2 signal intensity and height, and width of the three lowest lumbar intervertebral discs were measured and disc degeneration visually graded. The calculated average ADC of 530 measured discs was 2.01 x 10(-3) mm(2)/s+/-0.29 (+/-S.D.). The reduction in ADC between visually normal and moderately degenerated discs was 4%. Severely degenerated discs showed 5% larger ADC values than normal discs, presumably due to free water in cracks and fissures of those discs. T2 signal intensity of the disc was significantly correlated with the ADC values, whereas other measured parameters did not show correlation. There was no evident difference in ADC between the studied anatomic lumbar levels. Because there is considerable overlap between ADC values of normal and degenerated discs, we conclude that ADC measurements of intervertebral discs, at least with current technology, have limited clinical value.
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Affiliation(s)
- Jaakko Niinimäki
- Department of Diagnostic Radiology, Oulu University Hospital, 90029 Oulu, Finland.
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de Lange F, Dieleman JM, Blezer ELA, Houston RJF, Kalkman CJ, Nijsen JFW. Unilateral intracarotid injection of holmium microspheres to induce bilateral MRI-validated cerebral embolization in rats. J Neurosci Methods 2008; 176:152-6. [PMID: 18840466 DOI: 10.1016/j.jneumeth.2008.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 08/31/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cerebral embolization models have been hindered by the fact that delivery is predominantly one-sided and cannot be quantified easily. We have developed a model for bilateral cerebral micro-embolization. By using holmium microspheres, it is possible to quantify intracerebral delivery using MRI. METHODS To validate the quantification of holmium microspheres a phantom study was performed in which concentration of microspheres in solution was compared with the number of holmium-induced artifacts on MRI. After that identical microspheres were administered by unilateral injection in the carotid artery, while the opposite carotid artery was clamped. On post-injection MRI scans, intracerebral delivery and right/left distribution of the microspheres was determined. RESULTS In the phantom study it was shown that quantification by MRI is possible and that MRI artifacts represent single microspheres. In the rat brain, about one-third of the injected dose was consistently located on the contralateral side. The administration was reproducible regarding distribution and number of microspheres. CONCLUSIONS The use of holmium microspheres enables quantification of delivered dose as single microspheres induce artifacts on MRI. By clamping the contralateral carotid artery, one-third of the dose is diverted to the contralateral hemisphere.
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Affiliation(s)
- Fellery de Lange
- Division of Perioperative Care and Emergency Medicine, University Medical Center Utrecht, mail stop, 3508 GA Utrecht, The Netherlands.
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Doufekias E, Segal AZ, Kizer JR. Cardiogenic and Aortogenic Brain Embolism. J Am Coll Cardiol 2008; 51:1049-59. [DOI: 10.1016/j.jacc.2007.11.053] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 11/12/2007] [Accepted: 11/14/2007] [Indexed: 01/02/2023]
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Hendrikse J, Petersen ET, van Laar PJ, Golay X. Cerebral Border Zones between Distal End Branches of Intracranial Arteries: MR Imaging. Radiology 2008; 246:572-80. [DOI: 10.1148/radiol.2461062100] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kim SJ, Roh HG, Jeon P, Kim KH, Lee KH, Byun HS, Moon WJ, Kim GM, Kim YW, Kim DI. Cerebral ischemia detected with diffusion-weighted MR imaging after protected carotid artery stenting: comparison of distal balloon and filter device. Korean J Radiol 2007; 8:276-85. [PMID: 17673838 PMCID: PMC2627162 DOI: 10.3348/kjr.2007.8.4.276] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to examine the incidence of ischemia during protected carotid artery stenting (CAS) as well as to compare the protective efficacy of the balloon and filter devices on diffusion-weighted MR imaging (DWI). Materials and Methods Seventy-one consecutive protected CAS procedures in 70 patients with a severe (> 70%) or symptomatic moderate (> 50%) carotid artery stenosis were examined. A balloon device (PercuSurge GuardWire) and a filter device (FilterWire EX/EZ, Emboshield) was used in 33 cases (CAS-B group) and 38 cases (CAS-F group) to prevent distal embolization, respectively. All the patients underwent DWI within seven days before and after the procedures. The number of new cerebral ischemic lesions on the post-procedural DWI were counted and divided into ipsilateral and contralateral lesions according to the relationship with the stenting side. Results New cerebral ischemic lesions were detected in 13 (39.4%) out of the 33 CAS-Bs and in 15 (39.5%) out of the 38 CAS-Fs. The mean number of total, ipsilateral and contralateral new cerebral ischemic lesion was 2.39, 1.67 and 0.73 in the CAS-B group and 2.11, 1.32 and 0.79 in the CAS-F group, respectively. No statistical differences were found between the two groups (p = 0.96, 0.74 and 0.65, respectively). The embolic complications encountered included two retinal infarctions and one hemiparesis in the CAS-B group (9.09%), and one retinal infarction, one hemiparesis and one ataxia in the CAS-F group (7.89%). There was a similar incidence of embolic complications in the two groups (p = 1.00). Conclusion The type of distal protection device used such as a balloon and filter does not affect the incidence of cerebral embolization after protected CAS.
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Affiliation(s)
- Suk Jung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Hospital, Seoul, Korea
| | - Pyoung Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Ha Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Ho Lee
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Sik Byun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Hospital, Seoul, Korea
| | - Gyeong-Moon Kim
- Stroke and Neurovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Krishnananthan R, Minoshima S, Lewis D. Tc-99m ECD Neuro-SPECT and Diffusion Weighted MRI in the Detection of the Anatomical Extent of Subacute Stroke. Clin Nucl Med 2007; 32:700-2. [PMID: 17710022 DOI: 10.1097/rlu.0b013e318123f7e6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a case of subacute middle cerebral artery infarct, which demonstrates restricted diffusion on MRI and reperfusion hyperemia in the posterior half of the lesion on angiography. Tc-99m ethyl cysteinate dimer (ECD) SPECT obtained shortly after the MRI failed to demonstrate perfusion defects in the regions demonstrating reperfusion hyperemia on angiography, underestimating the true size of the infarct. Crossed cerebellar diaschisis is, however, present. SPECT studies obtained over the following weeks demonstrated gradual enlargement of the lesion to approximate the MRI signal changes over a 19-day period. The case presented demonstrates retention of ECD in the infarcted brain. Several studies have demonstrated that Tc-99m ECD uptake is dependent on preserved brain tissue function because tracer retention requires enzymatic esterase activity, rather than the passive, nonenergy dependent trapping of Tc-99m hexamethylpropyleneamine oxime. Hence, infarcted areas undergoing reperfusion hyperemia are unlikely to demonstrate ECD uptake. This report illustrates that MRI diffusion weighted imaging may be more accurate in demonstrating the full extent of reperfused infarcts earlier than Tc-99m ECD SPECT. SPECT in this case failed to demonstrate reduced uptake in reperfused regions of the infarct. Also, crossed cerebellar diaschisis may serve as an early marker of extensive neuronal dysfunction.
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Affiliation(s)
- Ruben Krishnananthan
- Division of Nuclear Medicine, University of Washington, Seattle, Washington 98195-7115, USA
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Canyigit M, Arat A, Cil BE, Turkbey B, Saatci I, Cekirge S, Balkanci F. Distal Embolization After Stenting of the Vertebral Artery: Diffusion-Weighted Magnetic Resonance Imaging Findings. Cardiovasc Intervent Radiol 2007; 30:189-95. [PMID: 17200903 DOI: 10.1007/s00270-005-0384-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We retrospectively evaluated our experience with stenting of the vertebral artery in an effort to determine the risk of distal embolization associated with the procedure. METHODS Between June 2000 and May 2005, 35 patients with 38 stenting procedures for atherosclerotic disease of the vertebral origin in our institution were identified. The average age of the patients was 60.3 years (range 32-76 years). Sixteen of these patients (with 18 stents) had MR imaging of the brain with diffusion-weighted imaging and an apparent diffusion coefficient map within 2 days before and after procedure. RESULTS On seven of the 16 postprocedural diffusion-weighted MR images, a total of 57 new hyperintensities were visible. All these lesions were focal in nature. One patient demonstrated a new diffusion-weighted imaging abnormality in the anterior circulation without MR evidence of posterior circulation ischemia. Six of 16 patients had a total of 25 new lesions in the vertebrobasilar circulation in postprocedural diffusion-weighted MR images. One patient in this group was excluded from the final analysis because the procedure was complicated by basilar rupture during tandem stent deployment in the basilar artery. Hence, new diffusion-weighted imaging abnormalities were noted in the vertebrobasilar territory in 5 of 15 patients after 17 stenting procedures, giving a 29% rate of diffusion-weighted imaging abnormalities per procedure. No patient with bilateral stenting had new diffusion-weighted imaging abnormalities. CONCLUSION Stenting of stenoses of the vertebral artery origin may be associated with a significant risk of asymptomatic distal embolization. Angiography, placement of the guiding catheter, inflation of the stent balloon, and crossing the lesion with guidewires or balloon catheters may potentially cause distal embolization. Further studies to evaluate measures to increase the safety of vertebral artery stenting, such as the use of distal protection devices or short-term postprocedural anticoagulation, should be considered for patients with clear indications for this procedure.
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Affiliation(s)
- Murat Canyigit
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06100 Ankara, Turkey
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In Vivo Evaluation of the Nitroimidazole-Based Thioflavin-T Derivatives as Cerebral Ischemia Markers. Int J Biomed Imaging 2007; 2007:49791. [PMID: 18350127 PMCID: PMC2267214 DOI: 10.1155/2007/49791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 07/05/2007] [Indexed: 11/17/2022] Open
Abstract
Timely imaging and accurate interpretation of cerebral ischemia are required to
identify patients who might benefit from more aggressive therapy, and nuclear medicine
offers a noninvasive method for demonstrating cerebral ischemia. Three
nitroimidazole-based thioflavin-T derivatives, N-[4-(benzothiazol-2-yl)phenyl]-3-(4-nitroimidazole-1-yl) propanamide (4NPBTA), N-[4-(benzothiazol-2-yl)phenyl]-3-(4-nitroimidazole-1-yl)-N-methylpropanamide (4NPBTA-1), and
N-[4-(benzothiazol-2-yl)phenyl]-3-(2-nitroimidazole-1-yl) propanamide (2NPBTA), were
radioiodinated and evaluated as possible cerebral ischemia markers. In normal mice,
these compounds showed good permeation of the intact blood-brain barrier (BBB), high
initial brain uptake, and rapid washout. In gerbil stroke models that had been subjected
to right common carotid artery ligation to produce cerebral ischemia, [131I]2NPBTA,
uptake in the right cerebral hemisphere decreased more slowly than that of the left, and
the right/left hemisphere uptake ratios increased with time. Also, the right/left
hemisphere uptake ratios correlated positively with the severity of the stroke. The results showed that
[131I]2NPBTA had a specific location in the cerebral ischemic tissue. This represented a first step in finding new drugs and might provide a possible cerebral
ischemic marker.
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Abstract
Stroke is a leading cause of mortality and morbidity in the developed world. The goals of an imaging evaluation for acute stroke are to establish a diagnosis as early as possible and to obtain accurate information about the intracranial vasculature and brain perfusion for guidance in selecting the appropriate therapy. A comprehensive evaluation may be performed with a combination of computed tomography (CT) or magnetic resonance (MR) imaging techniques. Unenhanced CT can be performed quickly, can help identify early signs of stroke, and can help rule out hemorrhage. CT angiography and CT perfusion imaging, respectively, can depict intravascular thrombi and salvageable tissue indicated by a penumbra. These examinations are easy to perform on most helical CT scanners and are increasingly used in stroke imaging protocols to decide whether intervention is necessary. While acute infarcts may be seen early on conventional MR images, diffusion-weighted MR imaging is more sensitive for detection of hyperacute ischemia. Gradient-echo MR sequences can be helpful for detecting a hemorrhage. The status of neck and intracranial vessels can be evaluated with MR angiography, and a mismatch between findings on diffusion and perfusion MR images may be used to predict the presence of a penumbra. The information obtained by combining various imaging techniques may help differentiate patients who do not need intravenous or intraarterial therapy from those who do, and may alter clinical outcomes.
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Affiliation(s)
- Ashok Srinivasan
- Department of Diagnostic Imaging, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada.
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Toyoda K, Kitai S, Ida M, Suga S, Aoyagi Y, Fukuda K. Usefulness of high-b-value diffusion-weighted imaging in acute cerebral infarction. Eur Radiol 2006; 17:1212-20. [PMID: 16969637 DOI: 10.1007/s00330-006-0397-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 06/20/2006] [Accepted: 07/07/2006] [Indexed: 12/21/2022]
Abstract
The aim of our study was to investigate the usefulness of high-b-value diffusion-weighted (DW) MR imaging in patients with acute cerebral infarction. DW images at b-values of 1,000, 2,000, and 3,000 s/mm(2) were performed for 32 patients 48 h after the onset of stroke using a 1.5 T clinical imager. The area of restricted diffusion became more distinct and extensive with increasing b-value in 19 of 32 patients, especially in patients with the atherothrombotic-type cerebral infarction. The visualized extent of infarction was almost the same among the area of restricted diffusion on the b=3,000 ADC map, b=3,000 DWI and final infarction in 12 of 15 patients. High-b-value DWI provided better identification of lesion extension in the cerebral ischemia. It is suggested that the size of the final infarction or irreversible cytotoxic edema is more predictable on high-b-value DWIs than on the usual b=1,000 DWI.
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Affiliation(s)
- Keiko Toyoda
- Department of Radiology, Kameda Medical Center, 929 Higashi-Cho, Kamogawa-Shi, Chiba, 296-8602, Japan.
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Graves MJ, U-King-Im J, Howarth S, Gillard JH. Ultrafast magnetic resonance imaging protocols in stroke. Expert Rev Neurother 2006; 6:921-30. [PMID: 16784414 DOI: 10.1586/14737175.6.6.921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke is the third leading cause of death and morbidity in the Western world. Ever since the publication of the major randomized trials showing the benefit of thrombolysis in early acute stroke, there has been growing impetus for the diagnosis of acute stroke to become a medical emergency. Currently, computed tomography (CT) remains the diagnostic method of choice in the assessment of acute strokes. It is practical, rapid, and widely available and, as used in these trials, can robustly exclude acute hemorrhage before potential thrombolysis. Although magnetic resonance imaging (MRI) has a number of advantages over unenhanced CT, the practicalities of performing MRI in the acute setting have hampered its widespread use. There are several reasons why speed of imaging is paramount in acute strokes. Firstly, such patients are often unwell and agitated and, as such, require close monitoring. Moreover, because of the short window within which intravenous thrombolysis can be given, time-consuming imaging studies decrease the therapeutic options available and likelihood of successful intervention. This review summarizes the latest developments in ultrafast imaging protocols that have the potential to improve practical feasibility, and thus propel MRI back to the forefront of acute stroke imaging.
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Affiliation(s)
- Martin J Graves
- University of Cambridge Hospitals NHS Foundation Trust, Departments of Radiology and Medical Physics, Hills Road, Cambridge, CB2 2QQ, UK.
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Tang L, Cianfoni A, Imbesi SG. Diffusion-Weighted Imaging Distinguishes Recurrent Epidermoid Neoplasm From Postoperative Arachnoid Cyst in the Lumbosacral Spine. J Comput Assist Tomogr 2006; 30:507-9. [PMID: 16778630 DOI: 10.1097/00004728-200605000-00026] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diffusion-weighted imaging can be used to distinguish epidermoid tumor from arachnoid cyst in the intracranial compartment. We report the use of diffusion-weighted imaging in a postoperative spine to successfully distinguish a recurrent epidermoid tumor from arachnoid cyst in a noninvasive manner. Our case illustrates the value of this readily available sequence presently not generally used in the clinical evaluation of spinal pathology.
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Affiliation(s)
- Lily Tang
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
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Chen PE, Simon JE, Hill MD, Sohn CH, Dickhoff P, Morrish WF, Sevick RJ, Frayne R. Acute Ischemic Stroke: Accuracy of Diffusion-weighted MR Imaging—Effects ofbValue and Cerebrospinal Fluid Suppression. Radiology 2006; 238:232-9. [PMID: 16373771 DOI: 10.1148/radiol.2381041113] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To prospectively determine which diffusion-weighted magnetic resonance (MR) imaging technique (ie, conventional diffusion-weighted MR imaging [b = 1000 or 1500 sec/mm2] or fluid-inversion prepared diffusion [FLIPD] MR imaging [b = 1500 sec/mm2]) is most accurate in depicting acute ischemic stroke at 3 T. MATERIALS AND METHODS The Health Research Ethics Board approved this study; written informed consent was provided by all participants or their surrogate. Diffusion-weighted MR imaging was performed in 75 consecutive patients (43 men, 32 women; mean age, 64.0 years) with acute ischemic stroke. Two experienced neuroradiologists determined the presence of hyperacute stroke lesions at diffusion-weighted MR imaging by locating areas of hyperintensity that corresponded to regions with a decreased diffusion coefficient. These findings were used as the reference standard. Four raters who were blinded to patient history assessed all images and apparent diffusion coefficient maps for the presence of changes that were consistent with acute ischemic stroke. Accuracy, sensitivity, specificity, negative predictive value, positive predictive value, and inter- and intrarater reliability scores were calculated for each technique. RESULTS Specificity, positive predictive value, and accuracy were not significantly different among the techniques. FLIPD MR images obtained with a b value of 1500 sec/mm2 had decreased sensitivity for acute ischemic stroke (mean, 61.8%; 95% confidence interval [CI]: 55.4%, 67.9%) compared with conventional diffusion-weighted MR images obtained with a b value of either 1000 sec/mm2 (mean, 82.5%; 95% CI: 77.1%, 87.0%) or 1500 sec/mm2 (mean, 84.5%; 95% CI: 79.3%, 88.9%). FLIPD MR images also had decreased negative predictive value (mean, 96.5%; 95% CI: 95.7%, 97.2%) compared with conventional diffusion-weighted MR images obtained with a b value of either 1000 sec/mm2 (mean, 98.4%; 95% CI: 97.8%, 98.8%) or 1500 sec/mm2 (mean, 98.6%; 95% CI: 98.1%, 99.0%). Intra- and interrater reliability scores were generally excellent for all three techniques. CONCLUSION FLIPD MR images obtained with a b value of 1500 sec/mm2 are less suitable for the detection of acute ischemic stroke owing to a decreased sensitivity and negative predictive value. The performance of the two conventional diffusion-weighted MR imaging techniques (b = 1000 and 1500 sec/mm2) was equivalent.
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Affiliation(s)
- Philip E Chen
- Seaman Family MR Research Centre, Foothills Medical Centre, Calgary Health Region, Calgary, AB, T2N 2T9, Canada
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