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Penckofer M, Kazmi KS, Thon J, Tonetti DA, Ries C, Rajagopalan S. Neuro-imaging in intracerebral hemorrhage: updates and knowledge gaps. Front Neurosci 2024; 18:1408288. [PMID: 38784090 PMCID: PMC11111865 DOI: 10.3389/fnins.2024.1408288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Intracerebral hemorrhage (ICH) is characterized by hematoma development within the brain's parenchyma, contributing significantly to the burden of stroke. While non-contrast head computed tomography (CT) remains the gold standard for initial diagnosis, this review underscores the pivotal role of magnetic resonance imaging (MRI) in ICH management. Beyond diagnosis, MRI offers invaluable insights into ICH etiology, prognosis, and treatment. Utilizing echo-planar gradient-echo or susceptibility-weighted sequences, MRI demonstrates exceptional sensitivity and specificity in identifying ICH, aiding in differentiation of primary and secondary causes. Moreover, MRI facilitates assessment of hemorrhage age, recognition of secondary lesions, and evaluation of perihematomal edema progression, thus guiding tailored therapeutic strategies. This comprehensive review discusses the multifaceted utility of MRI in ICH management, highlighting its indispensable role in enhancing diagnostic accuracy as well as aiding in prognostication. As MRI continues to evolve as a cornerstone of ICH assessment, future research should explore its nuanced applications in personalized care paradigms.
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Affiliation(s)
- Mary Penckofer
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Khuram S. Kazmi
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neuroradiology, Cooper University Health Care, Camden, NJ, United States
| | - Jesse Thon
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neurology, Cooper University Health Care, Camden, NJ, United States
| | - Daniel A. Tonetti
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neurosurgery, Cooper University Health Care, Camden, NJ, United States
| | - Casey Ries
- Department of Radiology, Cooper University Health Care, Camden, NJ, United States
| | - Swarna Rajagopalan
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neurology, Cooper University Health Care, Camden, NJ, United States
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2
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Kits A, Al-Saadi J, De Luca F, Janzon F, Mazya MV, Lundberg J, Sprenger T, Skare S, Delgado AF. 2.5-Minute Fast Brain MRI with Multiple Contrasts in Acute Ischemic Stroke. Neuroradiology 2024; 66:737-747. [PMID: 38462584 PMCID: PMC11031482 DOI: 10.1007/s00234-024-03331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE To assess the performance of a 2.5-minute multi-contrast brain MRI sequence (NeuroMix) in diagnosing acute cerebral infarctions. METHODS Adult patients with a clinical suspicion of acute ischemic stroke were retrospectively included. Brain MRI at 3 T included NeuroMix and routine clinical MRI (cMRI) sequences, with DWI/ADC, T2-FLAIR, T2-weighted, T2*, SWI-EPI, and T1-weighted contrasts. Three radiologists (R1-3) independently assessed NeuroMix and cMRI for the presence of acute infarcts (DWI ↑, ADC = or ↓) and infarct-associated abnormalities on other image contrasts. Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) were calculated and compared using DeLong's test. Inter- and intra-rater agreements were studied with kappa statistics. Relative DWI (rDWI) and T2-FLAIR (rT2-FLAIR) signal intensity for infarctions were semi-automatically rendered, and the correlation between methods was evaluated. RESULTS According to the reference standard, acute infarction was present in 34 out of 44 (77%) patients (63 ± 17 years, 31 men). Other infarct-associated signal abnormalities were reported in similar frequencies on NeuroMix and cMRI (p > .08). Sensitivity for infarction detection was 94%, 100%, and 94% evaluated by R1, R2, R3, for NeuroMix and 94%, 100%, and 100% for cMRI. Specificity was 100%, 90%, and 100% for NeuroMix and 100%, 100%, and 100% for cMRI. AUC for NeuroMix was .97, .95, and .97 and .97, 1, and 1 for cMRI (DeLong p = 1, .32, .15), respectively. Inter- and intra-rater agreement was κ = .88-1. The correlation between NeuroMix and cMRI was R = .73 for rDWI and R = .83 for rT2-FLAIR. CONCLUSION Fast multi-contrast MRI NeuroMix has high diagnostic performance for detecting acute cerebral infarctions.
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Affiliation(s)
- Annika Kits
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Neuroradiology, Karolinska University Hospital, Solna, 17176, Stockholm, Sweden.
| | - Jonathan Al-Saadi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Solna, 17176, Stockholm, Sweden
| | - Francesca De Luca
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Solna, 17176, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Janzon
- Department of Neuroradiology, Karolinska University Hospital, Solna, 17176, Stockholm, Sweden
- Department of Radiology, Danderyd Hospital, Stockholm, Sweden
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Lundberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Solna, 17176, Stockholm, Sweden
| | - Tim Sprenger
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- MR Applied Science Laboratory Europe, GE Healthcare, Stockholm, Sweden
| | - Stefan Skare
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Solna, 17176, Stockholm, Sweden
| | - Anna Falk Delgado
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Solna, 17176, Stockholm, Sweden
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Fan H, Bunker L, Wang Z, Durfee AZ, Lin DDM, Yedavalli V, Ge Y, Zhou XJ, Hillis AE, Lu H. Simultaneous perfusion, diffusion, T 2 *, and T 1 mapping with MR fingerprinting. Magn Reson Med 2024; 91:558-569. [PMID: 37749847 PMCID: PMC10872728 DOI: 10.1002/mrm.29880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/27/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Quantitative mapping of brain perfusion, diffusion, T2 *, and T1 has important applications in cerebrovascular diseases. At present, these sequences are performed separately. This study aims to develop a novel MRI technique to simultaneously estimate these parameters. METHODS This sequence to measure perfusion, diffusion, T2 *, and T1 mapping with magnetic resonance fingerprinting (MRF) was based on a previously reported MRF-arterial spin labeling (ASL) sequence, but the acquisition module was modified to include different TEs and presence/absence of bipolar diffusion-weighting gradients. We compared parameters derived from the proposed method to those derived from reference methods (i.e., separate sequences of MRF-ASL, conventional spin-echo DWI, and T2 * mapping). Test-retest repeatability and initial clinical application in two patients with stroke were evaluated. RESULTS The scan time of our proposed method was 24% shorter than the sum of the reference methods. Parametric maps obtained from the proposed method revealed excellent image quality. Their quantitative values were strongly correlated with those from reference methods and were generally in agreement with values reported in the literature. Repeatability assessment revealed that ADC, T2 *, T1 , and B1 + estimation was highly reliable, with voxelwise coefficient of variation (CoV) <5%. The CoV for arterial transit time and cerebral blood flow was 16% ± 3% and 25% ± 9%, respectively. The results from the two patients with stroke demonstrated that parametric maps derived from the proposed method can detect both ischemic and hemorrhagic stroke. CONCLUSION The proposed method is a promising technique for multi-parametric mapping and has potential use in patients with stroke.
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Affiliation(s)
- Hongli Fan
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lisa Bunker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zihan Wang
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alexandra Zezinka Durfee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Doris Da May Lin
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Vivek Yedavalli
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yulin Ge
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, Unites States
| | - Xiaohong Joe Zhou
- Center for Magnetic Resonance Research and Department of Radiology, University of Illinois at Chicago, Chicago, IL, United States
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hanzhang Lu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
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Ikram A, Sharma R, Selim M, Kim-Sun G, Shahraki T, Thomas AJ, Filippidis A, Wen Y, Spincemaille P, Wang Y, Soman S. mcTFI QSM MRI ABC/2 intracranial hemorrhage to noncontrast head CT volume measurement equivalence. J Neurol Sci 2024; 456:122859. [PMID: 38171071 PMCID: PMC10796171 DOI: 10.1016/j.jns.2023.122859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND/OBJECTIVES Intracranial hemorrhage (ICH) volume assessment is an important part of patient management and is routinely obtained by non-contrast head CT (NCHCT) using the validated ABC/2 measurement method. Because conventional MRI imaging sequences demonstrate variability in ICH appearance, volumetric analyses for MRI bleed volume in a standardized manner using ABC/2 is not possible. The recently introduced multiecho-complex total field inversion quantitative susceptibility mapping (mcTFI QSM) MRI technique, which maps brain tissue susceptibility to both depict brain tissue structures and quantify tissue susceptibility, may provide a viable alternative. In this study we evaluated mcTFI QSM ABC/2 ICH volume assessment relative to NCHCT. METHODS Patients with ICH who had undergone NCHCT and MRI brain scans within 48 h were recruited for this retrospective study. The ABC/2 method was applied to estimate the bleed volume for both NCHCT and MRI by a CAQ-certified neuroradiologist with 10 years of experience and a trained laboratory assistant. Results were analyzed via Bland-Altman (B-A) and linear regression. RESULTS 54 patients (27 females) who had undergone NCHCT and MRI within 48 h (<24 h., n = 31, 24-48 h, n = 10) were enrolled. mcTFI QSM ICH volume measurement method showed a positive correlation (99.5%) compared to NCHCT. B-A plot comparing ABC/2 ICH volume on NCHCT and mcTFI MRI done for patients within 24 h demonstrates a bias of -0.09%. CONCLUSIONS ICH volume calculation using ABC/2 on mcTFI QSM showed a high correlation with NCHCT measurement. These results suggest mcTFI QSM is a promising MRI method for ABC/2 for bleed volume measurement.
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Affiliation(s)
- Asad Ikram
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Ria Sharma
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Magdy Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | | | - Tamkin Shahraki
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ajith J Thomas
- Cooper University Healthcare/Cooper Medical School of Rowan University, Camden, NJ, United States.
| | - Aristotelis Filippidis
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Yan Wen
- GE Healthcare, Lincoln Medical Center, New York, NY, USA
| | | | - Yi Wang
- Weill Cornell Medicine, New York, NY, USA.
| | - Salil Soman
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Bae SB, Kim S. Imaging features of hyperacute intracerebral hemorrhage on multiple MRI sequences within 1 minute from onset during MRI examination: A case report. Medicine (Baltimore) 2023; 102:e33350. [PMID: 37000090 PMCID: PMC10063255 DOI: 10.1097/md.0000000000033350] [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] [Received: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 04/01/2023] Open
Abstract
RATIONALE Acute stroke requires accurate imaging to ensure appropriate treatment decisions and favorable clinical outcomes. Computed tomography has long been used as an exclusive imaging technique to assess intracerebral hemorrhage, owing to its rapid scanning time and widespread availability. Several recent studies have reported the reliable detection of hyperacute hemorrhage using magnetic resonance imaging (MRI). PATIENT CONCERNS An 88-year-old woman with a history of hypertension presented with mild, acute dysarthria. The National Institutes of Health Stroke Scale score was 1. DIAGNOSES Non contrast head computed tomography revealed the absence of acute cerebral hemorrhage. The patient underwent magnetic resonance, revealed hyperacute intracerebral hemorrhage within a few minutes of its occurrence on multiple MRI sequences. INTERVENTIONS AND OUTCOMES In this patient, hemorrhage developed during MRI for acute ischemic stroke. Hemorrhage was initially misdiagnosed, and inappropriate treatment severely affected the patient's health. LESSONS Clinicians in the Department of Neurological Emergency should be familiar with imaging findings of hyperacute hemorrhage on multiple MRI sequences.
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Affiliation(s)
- Sang Bin Bae
- Department of Radiology, Dong-A University College of Medicine, Seo-gu, Busan, Republic of Korea
| | - Sanghyeon Kim
- Department of Radiology, Dong-A University College of Medicine, Seo-gu, Busan, Republic of Korea
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Sullivan MN, Thakore P, Krishnan V, Alphonsa S, Li W, Feng Earley Y, Earley S. Endothelial cell TRPA1 activity exacerbates cerebral hemorrhage during severe hypertension. Front Mol Biosci 2023; 10:1129435. [PMID: 36793787 PMCID: PMC9922848 DOI: 10.3389/fmolb.2023.1129435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction: Hypoxia-induced dilation of cerebral arteries orchestrated by Ca2+-permeable transient receptor potential ankyrin 1 (TRPA1) cation channels on endothelial cells is neuroprotective during ischemic stroke, but it is unknown if the channel has a similar impact during hemorrhagic stroke. TRPA1 channels are endogenously activated by lipid peroxide metabolites generated by reactive oxygen species (ROS). Uncontrolled hypertension, a primary risk factor for the development of hemorrhagic stroke, is associated with increased ROS production and oxidative stress. Therefore, we hypothesized that TRPA1 channel activity is increased during hemorrhagic stroke. Methods: Severe, chronic hypertension was induced in control (Trpa1 fl/fl) and endothelial cell-specific TRPA1 knockout (Trpa1-ecKO) mice using a combination of chronic angiotensin II administration, a high-salt diet, and the addition of a nitric oxide synthase inhibitor to drinking water. Blood pressure was measured in awake, freely-moving mice using surgically placed radiotelemetry transmitters. TRPA1-dependent cerebral artery dilation was evaluated with pressure myography, and expression of TRPA1 and NADPH oxidase (NOX) isoforms in arteries from both groups was determined using PCR and Western blotting techniques. In addition, ROS generation capacity was evaluated using a lucigenin assay. Histology was performed to examine intracerebral hemorrhage lesion size and location. Results: All animals became hypertensive, and a majority developed intracerebral hemorrhages or died of unknown causes. Baseline blood pressure and responses to the hypertensive stimulus did not differ between groups. Expression of TRPA1 in cerebral arteries from control mice was not altered after 28 days of treatment, but expression of three NOX isoforms and the capacity for ROS generation was increased in hypertensive animals. NOX-dependent activation of TRPA1 channels dilated cerebral arteries from hypertensive animals to a greater extent compared with controls. The number of intracerebral hemorrhage lesions in hypertensive animals did not differ between control and Trpa1-ecKO animals but were significantly smaller in Trpa1-ecKO mice. Morbidity and mortality did not differ between groups. Discussion: We conclude that endothelial cell TRPA1 channel activity increases cerebral blood flow during hypertension resulting in increased extravasation of blood during intracerebral hemorrhage events; however, this effect does not impact overall survival. Our data suggest that blocking TRPA1 channels may not be helpful for treating hypertension-associated hemorrhagic stroke in a clinical setting.
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Affiliation(s)
- Michelle N. Sullivan
- Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, United States
| | - Pratish Thakore
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | - Vivek Krishnan
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | - Sushma Alphonsa
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | - Wencheng Li
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Yumei Feng Earley
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
- Department of Physiology and Cell Biology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
| | - Scott Earley
- Department of Pharmacology, Center for Molecular and Cellular Signaling in the Cardiovascular System, Reno School of Medicine, University of Nevada, Reno, NV, United States
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Boshra R, Eradath M, Dougherty K, Wu B, Morea BM, Harris M, Pinsk MA, Kastner S. Case studies in neuroscience: reversible signatures of edema following electric and piezoelectric craniotomy drilling in macaques. J Neurophysiol 2022; 128:919-926. [PMID: 36043799 PMCID: PMC9550573 DOI: 10.1152/jn.00108.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/28/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
In vivo electrophysiology requires direct access to brain tissue, necessitating the development and refinement of surgical procedures and techniques that promote the health and well-being of animal subjects. Here, we report a series of findings noted on structural magnetic resonance imaging (MRI) scans in monkeys with MRI-compatible implants following small craniotomies that provide access for intracranial electrophysiology. We found distinct brain regions exhibiting hyperintensities in T2-weighted scans that were prominent underneath the sites at which craniotomies had been performed. We interpreted these hyperintensities as edema of the neural tissue and found that they were predominantly present following electric and piezoelectric drilling, but not when manual, hand-operated drills were used. Furthermore, the anomalies subsided within 2-3 wk following surgery. Our report highlights the utility of MRI-compatible implants that promote clinical examination of the animal's brain, sometimes revealing findings that may go unnoticed when incompatible implants are used. We show replicable differences in outcome when using electric versus mechanical devices, both ubiquitous in the field. If electric drills are used, our report cautions against electrophysiological recordings from tissue directly underneath the craniotomy for the first 2-3 wk following the procedure due to putative edema.NEW & NOTEWORTHY Close examination of structural MRI in eight nonhuman primates following craniotomy surgeries for intracranial electrophysiology highlights a prevalence of hyperintensities on T2-weighted scans following surgeries conducted using electric and piezoelectric drills, but not when using mechanical, hand-operated drills. We interpret these anomalies as edema of neural tissue that resolved 2-3 wk postsurgery. This finding is especially of interest as electrophysiological recordings from compromised tissue may directly influence the integrity of collected data immediately following surgery.
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Affiliation(s)
- Rober Boshra
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Manoj Eradath
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Kacie Dougherty
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Bichan Wu
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Britney M Morea
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Michael Harris
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Mark A Pinsk
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Sabine Kastner
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
- Department of Psychology, Princeton University, Princeton, New Jersey
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Gil-Garcia CA, Alvarez EF, Garcia RC, Mendoza-Lopez AC, Gonzalez-Hermosillo LM, Garcia-Blanco MDC, Valadez ER. Essential topics about the imaging diagnosis and treatment of Hemorrhagic Stroke: a comprehensive review of the 2022 AHA guidelines. Curr Probl Cardiol 2022; 47:101328. [PMID: 35870549 DOI: 10.1016/j.cpcardiol.2022.101328] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
Intracerebral hemorrhage (ICH) is a severe stroke with a high death rate (40 % mortality). The prevalence of hemorrhagic stroke has increased globally, with changes in the underlying cause over time as anticoagulant use and hypertension treatment have improved. The fundamental etiology of ICH and the mechanisms of harm from ICH, particularly the complex interaction between edema, inflammation, and blood product toxicity, have been thoroughly revised by the American Heart Association (AHA) in 2022. Although numerous trials have investigated the best medicinal and surgical management of ICH, there is still no discernible improvement in survival and functional tests. Small vessel diseases, such as cerebral amyloid angiopathy (CAA) or deep perforator arteriopathy (hypertensive arteriopathy), are the most common causes of spontaneous non-traumatic intracerebral hemorrhage (ICH). Even though ICH only causes 10-15% of all strokes, it contributes significantly to morbidity and mortality, with few acute or preventive treatments proven effective. Current AHA guidelines acknowledge up to 89% sensitivity for unenhanced brain CT and 81% for brain MRI. The imaging findings of both methods are helpful for initial diagnosis and follow-up, sometimes necessary a few hours after admission, especially for detecting hemorrhagic transformation or hematoma expansion. This review summarized the essential topics on hemorrhagic stroke epidemiology, risk factors, physiopathology, mechanisms of injury, current management approaches, findings in neuroimaging, goals and outcomes, recommendations for lifestyle modifications, and future research directions ICH. A list of updated references is included for each topic.
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Affiliation(s)
| | | | | | | | | | | | - Ernesto-Roldan Valadez
- Directorado de investigación, Hospital General de Mexico "Dr. Eduardo Liceaga," 06720, CDMX, Mexico; I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, 119992, Moscow, Russia.
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9
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Weerink LBM, Appelman APA, Kloet RW, Van der Hoorn A. Susceptibility-weighted imaging in intracranial hemorrhage: not all bleeds are black. Br J Radiol 2022:20220304. [PMID: 35766940 PMCID: PMC10392652 DOI: 10.1259/bjr.20220304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
To correctly recognize intracranial hemorrhage (ICH) and differentiate it from other lesions, knowledge of the imaging characteristics of an ICH on susceptibility weighted imaging (SWI) is essential. It is a common misconception that blood is always black on SWI, and it is important to realize that hemorrhage has a variable appearance in different stages on SWI. Furthermore, the presence of a low signal on SWI does not equal the presence of blood products. In this review, the appearance of ICH on SWI during all its stages and common other causes of a low signal on SWI are further discussed and illustrated.
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Affiliation(s)
- Linda BM Weerink
- Department of Radiology, University Medical Center Groningen, Groningen, Netherlands
- Department of Radiology, Medisch Spectrum Twente, Enschede, Netherlands
| | - Auke PA Appelman
- Department of Radiology, University Medical Center Groningen, Groningen, Netherlands
| | - Reina W Kloet
- Department of Radiology, University Medical Center Groningen, Groningen, Netherlands
| | - Anouk Van der Hoorn
- Department of Radiology, University Medical Center Groningen, Groningen, Netherlands
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10
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A previous hemorrhagic stroke protects against a subsequent stroke via microglia alternative polarization. Commun Biol 2022; 5:654. [PMID: 35780249 PMCID: PMC9250506 DOI: 10.1038/s42003-022-03621-4] [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: 02/15/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
Microglia in hemorrhagic stroke contribute to both acute-phase exacerbation and late-phase attenuation of injury. Here, by using the mouse model, we reported that the shift in polarization of microglia from M1 to M2 phenotype could be altered by a past ‘mini’ stroke, resulting in better neurological function recovery, faster attenuation of lesion volume, and better survival. In mice with a previous stroke, M2 predominance appeared markedly in advance compared to mice without a previous stroke. Mechanistically, the RBC-mediated M2 polarization of microglia was synergistically enhanced by T cells: microglia cocultured with RBCs alone resulted in mild alterations to M2 markers, whereas in the presence of T cells, they expressed an early and sustained M2 response. These results suggest that by harnessing the microglia-mediated M2 polarization response, we could help mitigate devastating sequelae before a prospective hemorrhagic stroke even happens. Microglia shift in polarization from an M1 to a M2 phenotype following a past “mini” stroke, resulting in better neurological function recovery, faster attenuation of lesion volume, and better survival.
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Schlunk F, Kuthe J, Harmel P, Audebert H, Hanning U, Bohner G, Scheel M, Kleine J, Nawabi J. Volumetric accuracy of different imaging modalities in acute intracerebral hemorrhage. BMC Med Imaging 2022; 22:9. [PMID: 35033012 PMCID: PMC8760700 DOI: 10.1186/s12880-022-00735-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 01/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Follow-up imaging in intracerebral hemorrhage is not standardized and radiologists rely on different imaging modalities to determine hematoma growth. This study assesses the volumetric accuracy of different imaging modalities (MRI, CT angiography, postcontrast CT) to measure hematoma size. Methods 28 patients with acute spontaneous intracerebral hemorrhage referred to a tertiary stroke center were retrospectively included between 2018 and 2019. Inclusion criteria were (1) spontaneous intracerebral hemorrhage (supra- or infratentorial), (2) noncontrast CT imaging performed on admission, (3) follow-up imaging (CT angiography, postcontrast CT, MRI), and (4) absence of hematoma expansion confirmed by a third cranial image within 6 days. Two independent raters manually measured hematoma volume by drawing a region of interest on axial slices of admission noncontrast CT scans as well as on follow-up imaging (CT angiography, postcontrast CT, MRI) using a semi-automated segmentation tool (Visage image viewer; version 7.1.10). Results were compared using Bland–Altman plots. Results Mean admission hematoma volume was 18.79 ± 19.86 cc. All interrater and intrarater intraclass correlation coefficients were excellent (1; IQR 0.98–1.00). In comparison to hematoma volume on admission noncontrast CT volumetric measurements were most accurate in patients who received postcontrast CT (bias of − 2.47%, SD 4.67: n = 10), while CT angiography often underestimated hemorrhage volumes (bias of 31.91%, SD 45.54; n = 20). In MRI sequences intracerebral hemorrhage volumes were overestimated in T2* (bias of − 64.37%, SD 21.65; n = 10). FLAIR (bias of 6.05%, SD 35.45; n = 13) and DWI (bias of-14.6%, SD 31.93; n = 12) over- and underestimated hemorrhagic volumes. Conclusions Volumetric measurements were most accurate in postcontrast CT while CT angiography and MRI sequences often substantially over- or underestimated hemorrhage volumes. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-022-00735-3.
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Affiliation(s)
- Frieder Schlunk
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany.
| | - Johannes Kuthe
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Peter Harmel
- Department of Neurology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Heinrich Audebert
- Department of Neurology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Georg Bohner
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Scheel
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Justus Kleine
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Jawed Nawabi
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany.,Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
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12
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Lansberg MG, Wintermark M, Kidwell CS, Albers GW. Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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From Spot Sign to Bleeding on the Spot: Classic and Original Signs of Expanding Primary Spontaneous Intracerebral Hematoma. Case Rep Radiol 2021; 2021:9716952. [PMID: 34820144 PMCID: PMC8608540 DOI: 10.1155/2021/9716952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/28/2021] [Indexed: 12/02/2022] Open
Abstract
Expansion of a primary spontaneous intracranial hemorrhage (PSICH) has become lately of increasing interest, especially after the emergence of its early predictors. However, these signs lacked sensitivity and specificity. The flood phenomenon, defined as a drastic increase in the size of a PSICH during the same magnetic resonance study, was first described in this paper based on the data of a university medical center in Lebanon. Moreover, further review of this data resulted in 205 studies with presumed diagnosis of primary spontaneous intracranial hemorrhage within the last 10 years, of which 29 exams showed typical predictors of hematoma expansion on computed tomography. The intended benefit of this observation is to draw the radiologists' attention towards minimal variations in the volume of the hematoma between the two extreme sequences of the same MRI study, in order to detect inconspicuous flood phenomena—a direct sign of hematoma expansion.
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14
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Wang M, Xia F, Wan S, Hua Y, Keep RF, Xi G. Role of Complement Component 3 in Early Erythrolysis in the Hematoma After Experimental Intracerebral Hemorrhage. Stroke 2021; 52:2649-2660. [PMID: 34176310 DOI: 10.1161/strokeaha.121.034372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ming Wang
- Department of Neurosurgery, University of Michigan, Ann Arbor (M.W., F.X., S.W., Y.H., R.F.K., G.X.).,Brain Center, Zhejiang Hospital, Zhejiang University Medical School, Hangzhou, China (M.W., S.W.)
| | - Fan Xia
- Department of Neurosurgery, University of Michigan, Ann Arbor (M.W., F.X., S.W., Y.H., R.F.K., G.X.)
| | - Shu Wan
- Department of Neurosurgery, University of Michigan, Ann Arbor (M.W., F.X., S.W., Y.H., R.F.K., G.X.).,Brain Center, Zhejiang Hospital, Zhejiang University Medical School, Hangzhou, China (M.W., S.W.)
| | - Ya Hua
- Department of Neurosurgery, University of Michigan, Ann Arbor (M.W., F.X., S.W., Y.H., R.F.K., G.X.)
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor (M.W., F.X., S.W., Y.H., R.F.K., G.X.)
| | - Guohua Xi
- Department of Neurosurgery, University of Michigan, Ann Arbor (M.W., F.X., S.W., Y.H., R.F.K., G.X.)
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15
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Sato T, Nishiyama Y, Suda S, Shimoyama T, Takahashi S, Sakamoto Y, Aoki J, Suzuki K, Sekine T, Kumita SI, Kimura K. "Computed Tomography Perihematomal Rims": A Perihematomal Low-Density Area Is a Part of an Acute Brain Hemorrhage. Intern Med 2021; 60:2395-2403. [PMID: 34334590 PMCID: PMC8381191 DOI: 10.2169/internalmedicine.6653-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Computed tomography (CT) can be used for visualizing acute intracerebral hemorrhages (ICHs) as distinct hyperdense areas and cerebral edema as perihematomal low-density areas (LDAs). We observed a perihematomal LDA on CT, which appeared to be part of a hemorrhage on magnetic resonance imaging (MRI) in acute ICH. We named this "CT perihematomal rim" and evaluated its characteristics and clinical significance. Methods We stratified patients with acute ICH according to the presence or absence of a CT perihematomal rim and then compared their radiologic findings. Logistic regression analyses were performed to assess whether the CT findings can predict the presence of a CT perihematomal rim. Patients Patients within 24 hours of ICH onset who were admitted between September 1, 2014, and October 31, 2018, were registered. Results Overall, 139 patients (91 men; mean age, 66 years) were investigated. CT perihematomal rims were observed in 40 patients (29%). ICH volumes on CT were 30% smaller than those on MRI in patients with CT perihematomal rims. On a multivariate analysis, the presence of a CT perihematomal rim was independently associated with the maximum diameter of the perihematomal LDA. According to a receiver operating characteristic analysis, the maximum LDA diameter threshold was 7.5 mm (sensitivity, 85%; specificity, 83%). Conclusion CT perihematomal rims were observed in 29% of the patients with acute ICH. A perihematomal LDA (>7.5 mm) in acute ICH cases should be considered a CT perihematomal rim. Clinicians should be aware that the ICH volume on CT may be underestimated by 30%.
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Affiliation(s)
- Takahiro Sato
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yasuhiro Nishiyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Satoshi Suda
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takashi Shimoyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shiro Takahashi
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yuki Sakamoto
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Junya Aoki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kentaro Suzuki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Tetsuro Sekine
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
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16
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Trunz LM, Talekar KS, Stein A, Karambelkar A. Hyperacute intracranial hemorrhage with extensive contrast extravasation and rapid hematoma expansion imaged at onset with magnetic resonance imaging. Neuroradiol J 2020; 34:253-256. [PMID: 33307961 DOI: 10.1177/1971400920980151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Evaluation for intracranial hemorrhage is a common indication when performing imaging of the head in the emergency setting. We present a rare case of active, spontaneous extravasation of blood into the brain parenchyma, which evolved during a magnetic resonance imaging examination. A 70-year-old woman who had no previous history of hypertension or trauma underwent magnetic resonance imaging of the brain for confusion and dysarthria. Initial imaging sequences did not demonstrate an acute cerebral hemorrhage; however, subsequent fluid-attenuated inversion recovery, T2- and T1-weighted sequences demonstrated a progressively enlarging signal abnormality. Extravasation of contrast was noted after the administration of gadolinium-based contrast, indicating active intraparenchymal hemorrhage. A computed tomography scan was performed after magnetic resonance imaging to confirm the findings.
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Affiliation(s)
- Lukas M Trunz
- Department of Radiology, 23217Thomas Jefferson University Hospital, USA
| | - Kiran S Talekar
- Department of Radiology, 23217Thomas Jefferson University Hospital, USA
| | - Asher Stein
- Department of Radiology, 23217Thomas Jefferson University Hospital, USA
| | - Ajit Karambelkar
- Department of Radiology, 23217Thomas Jefferson University Hospital, USA
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17
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Oetelaar G, Heng HG, Lim CK, Cox A, Weng HY. Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues. J Forensic Sci 2020; 65:1524-1529. [PMID: 32525570 DOI: 10.1111/1556-4029.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
Intraosseous T1-weighted (T1W) and short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes-so-called bone marrow edema-may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2-weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board-certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI-particularly the T1W sequence-can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.
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Affiliation(s)
- Garrett Oetelaar
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Chee Kin Lim
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
| | - Hsin-Yi Weng
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN, 47907
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18
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Zhong H, Bianchi CM, Patel SJ, Wolfe AR, Visvikis GA. Intracranial migration of intraocular silicone oil following repetitive head trauma. Radiol Case Rep 2019; 14:1163-1166. [PMID: 31360280 PMCID: PMC6642226 DOI: 10.1016/j.radcr.2019.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/28/2019] [Accepted: 06/29/2019] [Indexed: 11/15/2022] Open
Abstract
Intraocular injection of silicone oil as a tamponade agent is a commonly used technique for the treatment of retinal detachment. An incompletely understood phenomenon which can occur after injection is the migration of silicone oil from the vitreous chamber to the intracranial space. Because the appearance of silicone oil can mimic hemorrhage or other pathologies on CT and MRI, careful comparison with prior studies is necessary to avoid unnecessary follow-up studies. We report a case of intracranial migration of intraocular silicone oil following repetitive head trauma.
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Affiliation(s)
- Han Zhong
- Richmond University Medical Center, Department of Radiology, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Christina M. Bianchi
- NYU Langone Hospital, Brooklyn, Department of Radiation Oncology, 150, 55th Street, Brooklyn, NY 11220, USA
| | - Soham J. Patel
- Richmond University Medical Center, Department of Radiology, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Allen R. Wolfe
- Richmond University Medical Center, Department of Radiology, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - George A. Visvikis
- Richmond University Medical Center, Department of Radiology, 355 Bard Avenue, Staten Island, NY 10310, USA
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19
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Reyes R, Viswanathan M, Aiyagari V. An update on neurocritical care for intracerebral hemorrhage. Expert Rev Neurother 2019; 19:557-578. [PMID: 31092052 DOI: 10.1080/14737175.2019.1618709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Intracerebral hemorrhage remains one of the leading causes of death and disability worldwide with few established interventions that improve neurologic outcome. Research dedicated to better understanding and treating hemorrhagic strokes has multiplied in the past decade. Areas Covered: This review aims to discuss the current landscape of management of intracerebral hemorrhage in a critical care setting and provide updates regarding developments in therapeutic interventions and targets. PubMed was utilized to review recent literature, with a focus on large trials and meta-analyses, which have shaped current practice. Published committee guidelines were also included. A focus was placed on research published after 2015 in an effort to supplement previous reviews included in this publication. Expert Opinion: Literature pertaining to ICH management has allowed for a greater understanding of ineffective strategies as opposed to those of benefit. Despite this, mortality has improved worldwide, which may be the result of growing research efforts. Areas of future research that will impact mortality and improve neurologic outcomes include prevention of hematoma expansion, optimization of blood pressure targets, effective coagulopathy reversal, and minimally invasive surgical techniques to reduce hematoma burden.
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Affiliation(s)
- Ranier Reyes
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Meera Viswanathan
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Venkatesh Aiyagari
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
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20
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Tóth A, Berente Z, Bogner P, Környei B, Balogh B, Czeiter E, Amrein K, Dóczi T, Büki A, Schwarcz A. Cerebral Microbleeds Temporarily Become Less Visible or Invisible in Acute Susceptibility Weighted Magnetic Resonance Imaging: A Rat Study. J Neurotrauma 2019; 36:1670-1677. [PMID: 30421664 PMCID: PMC6531906 DOI: 10.1089/neu.2018.6004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Previously, we reported human traumatic brain injury cases demonstrating acute to subacute microbleed appearance changes in susceptibility-weighted imaging (SWI—magnetic resonance imaging [MRI]). This study aims to confirm and characterize such temporal microbleed appearance alterations in an experimental model. To elicit microbleed formation, brains of male Sprague Dawley rats were pierced in a depth of 4 mm, in a parasagittal position bilaterally using 159 μm and 474 μm needles, without the injection of autologous blood or any agent. Rats underwent 4.7 T MRI immediately, then at multiple time points until 125 h. Volumes of hypointensities consistent with microbleeds in SWI were measured using an intensity threshold-based approach. Microbleed volumes across time points were compared using repeated measures analysis of variance. Microbleeds were assessed by Prussian blue histology at different time points. Hypointensity volumes referring to microbleeds were significantly decreased (corrected p < 0.05) at 24 h compared with the immediate or the 125 h time points. By visual inspection, microbleeds were similarly detectable at the immediate and 125 h imaging but were decreased in extent or completely absent at 24 h or 48 h. Histology confirmed the presence of microbleeds at all time points and in all animals. This study confirmed a general temporary reduction in visibility of microbleeds in the acute phase in SWI. Such short-term appearance dynamics of microbleeds should be considered when using SWI as a diagnostic tool for microbleeds in traumatic brain injury and various diseases.
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Affiliation(s)
- Arnold Tóth
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary.,2 Department of Radiology, Pécs Medical School, Pécs, Hungary.,3 MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Zoltán Berente
- 4 Department of Biochemistry and Medical Chemistry, Pécs Medical School, Pécs, Hungary.,5 János Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,6 Research Group for Experimental Diagnostic Imaging, Pécs Medical School, Pécs, Hungary
| | - Péter Bogner
- 2 Department of Radiology, Pécs Medical School, Pécs, Hungary
| | - Bálint Környei
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary
| | - Bendegúz Balogh
- 2 Department of Radiology, Pécs Medical School, Pécs, Hungary
| | - Endre Czeiter
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary.,3 MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary.,5 János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Krisztina Amrein
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary.,5 János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Tamás Dóczi
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary.,3 MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary.,7 Diagnostic Center of Pécs, Pécs, Hungary
| | - András Büki
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary.,5 János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Attila Schwarcz
- 1 Department of Neurosurgery, Pécs Medical School, Pécs, Hungary
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Abstract
PURPOSE OF REVIEW Here, we describe the four primary imaging modalities for identification of carotid artery dissection, advantages, limitations, and clinical considerations. In addition, imaging characteristics of carotid dissection associated with each modality will be described. RECENT FINDINGS Recent advances in etiopathogenesis describe the genetic factors implicated in cervical artery dissection. MRI/MRA (magnetic resonance angiography) with fat suppression is regarded as the best initial screening test to detect dissection. Advances in magnetic resonance imaging for the diagnosis of dissection include the use of susceptibility-weighted imaging (SWI) for the detection of intramural hematoma and multisection motion-sensitized driven equilibrium (MSDE), which causes phase dispersion of blood spin using a magnetic field to suppress blood flow signal and obtain 3D T1- or T2*-weighted images. Digital subtraction angiography (DSA) remains the gold standard for identifying and characterizing carotid artery dissections. Carotid artery dissection is the result of a tear in the intimal layer of the carotid artery. This leads to a "double lumen" sign comprised of the true vessel lumen and the false lumen created by the tear. The most common presentation of carotid artery dissection is cranial and/or cervical pain ipsilateral to the dissection. However, severe neurological sequelae such as embolic ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage can also result from carotid artery dissection. Carotid artery dissection can be identified by a variety of different imaging modalities including computed tomographic angiography (CTA), MRI, carotid duplex imaging (CDI), and digital subtraction angiography (DSA).
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Affiliation(s)
- Ryan Hakimi
- Department of Medicine, Neurology Division, Univ. of South Carolina School of Medicine-Greenville, Greenville Health System, 200 Patewood Dr., Suite #B350, Greenville, SC, 29615, USA.
| | - Sanjeev Sivakumar
- Department of Medicine, Neurology Division, Univ. of South Carolina School of Medicine-Greenville, Greenville Health System, 200 Patewood Dr., Suite #B350, Greenville, SC, 29615, USA
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22
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Morales H. Pitfalls in the Imaging Interpretation of Intracranial Hemorrhage. Semin Ultrasound CT MR 2018; 39:457-468. [DOI: 10.1053/j.sult.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Huang LC, Liew HK, Cheng HY, Kuo JS, Hsu WL, Pang CY. Brain Magnetic Resonance Imaging of Intracerebral Hemorrhagic Rats after Alcohol Consumption. J Stroke Cerebrovasc Dis 2018; 27:3493-3502. [PMID: 30205999 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/23/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Alcoholism is one of the risk factors for cerebrovascular diseases. Our previous study demonstrated that acute alcohol intoxication enhances brain injury and neurological impairment in rats suffering from intracerebral hemorrhage (ICH). We plan to investigate the effect of chronic alcohol consumption (CAC) in rats with ICH by magnetic resonance imaging (MRI). METHODS Sixteen Sprague-Dawley male rats were divided into 2 groups: CAC group (fed with 10% alcohol drinking water for 4 weeks, n = 8), and Control group (plain drinking water, n = 8). ICH was induced by collagenase infusion into the right striata of all rats. Coronal T1-weighted imaging, T2-weighted imaging, T2*-weighted imaging, and diffusion-weighted imaging were generated with a 3.0T MRI scanner to investigate the changes of hemorrhagic volume and edema throughout the injury and recovery stages of ICH in rats. RESULTS T2-weighted imaging is ideal for monitoring hematoma volume in rats. The hematoma volume was larger in the CAC group than in the control group (P < .001), however, did not correlate to post-ICH progressive edema formation (P > .7), and neurological impairment (P > .28) between the 2 groups, respectively. DISCUSSION Although our findings indicate that CAC induces larger hematoma in rats with ICH, the underlying mechanism should be studied in the future.
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Affiliation(s)
- Li-Chuan Huang
- Department of Radiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Hock-Kean Liew
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; Cardiovascular and Metabolomics Research Center, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hung-Yu Cheng
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jon-Son Kuo
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; Master Program and PhD Program in Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan
| | - Wen-Lin Hsu
- Department of Radiation Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Cheng-Yoong Pang
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan; Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; Cardiovascular and Metabolomics Research Center, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
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Liu R, Li H, Hua Y, Keep RF, Xiao J, Xi G, Huang Y. Early Hemolysis Within Human Intracerebral Hematomas: an MRI Study. Transl Stroke Res 2018; 10:52-56. [DOI: 10.1007/s12975-018-0630-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/13/2018] [Accepted: 04/04/2018] [Indexed: 10/16/2022]
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Goulay R, Drieu A, Di Palma C, Pro-Sistiaga P, Delcroix N, Chazalviel L, Saulnier R, Gakuba C, Goursaud S, Young AR, Gauberti M, Orset C, Emery E, Vivien D, Gaberel T. Modification of apparent intracerebral hematoma volume on T2 ∗-weighted images during normobaric oxygen therapy may contribute to false diagnosis. J Clin Neurosci 2018; 52:105-108. [PMID: 29571939 DOI: 10.1016/j.jocn.2018.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/08/2018] [Indexed: 10/17/2022]
Abstract
It was previously reported that normobaric oxygen therapy (NBO) significantly affected T2∗-weighted imaging in a mouse model of intracerebral hemorrhage (ICH). However, it is unclear whether a similar phenomenon exists in large volume ICH as seen in human pathology. We investigated the effects of NBO on T2∗-weighted images in a pig model of ICH. Our data show that NBO makes disappear a peripheral crown of the hematoma, which in turn decreases the apparent volume of ICH by 18%. We hypothesized that this result could be translated to ICH in human, and subsequently could lead to inaccurate diagnostic.
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Affiliation(s)
- Romain Goulay
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France
| | - Antoine Drieu
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France
| | - Camille Di Palma
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France; Department of Neurosurgery, Caen University Hospital, Avenue de la côte de Nacre, Caen, France
| | | | - Nicolas Delcroix
- UMS 3408, UNICAEN, CNRS, GIP Cyceron, Bd Henri Becquerel, Caen, France
| | - Laurent Chazalviel
- UMR6301-ISTCT, CNRS, CERVOxy Group, GIP Cyceron, Bd Henri Becquerel, Caen, France
| | - Romaric Saulnier
- UMS 3408, UNICAEN, CNRS, GIP Cyceron, Bd Henri Becquerel, Caen, France
| | - Clément Gakuba
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France; Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la côte de Nacre, Caen, France
| | - Suzanne Goursaud
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France; Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de la côte de Nacre, Caen, France
| | - Allan R Young
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France
| | - Maxime Gauberti
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France; Department of Radiology, Caen University Hospital, Avenue de la cote de Nacre, Caen, France
| | - Cyrille Orset
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France
| | - Evelyne Emery
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France; Department of Neurosurgery, Caen University Hospital, Avenue de la côte de Nacre, Caen, France
| | - Denis Vivien
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France; UMR6301-ISTCT, CNRS, CERVOxy Group, GIP Cyceron, Bd Henri Becquerel, Caen, France.
| | - Thomas Gaberel
- INSERM, UMR-S U1237, Pathophysiology and Imaging of Neurological Disorders, University Caen-Normandy, CHU Caen, GIP Cyceron, Bd Henri Becquerel, Caen, France; Department of Neurosurgery, Caen University Hospital, Avenue de la côte de Nacre, Caen, France
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Maekawa K, Shibata M, Nakajima H, Mizutani A, Kitano Y, Seguchi M, Yamasaki M, Kobayashi K, Sano T, Mori G, Yabana T, Naito Y, Shimizu S, Miya F. Erythrocyte-Rich Thrombus Is Associated with Reduced Number of Maneuvers and Procedure Time in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy. Cerebrovasc Dis Extra 2018; 8:39-49. [PMID: 29402828 PMCID: PMC5836222 DOI: 10.1159/000486042] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/28/2017] [Indexed: 02/01/2023] Open
Abstract
Background Only few studies have investigated the relationship between the histopathology of retrieved thrombi and clinical outcomes. This study aimed to evaluate thrombus composition and its association with clinical, laboratory, and neurointerventional findings in patients treated by mechanical thrombectomy due to acute large vessel occlusion. Methods At our institution, 79 patients were treated by mechanical thrombectomy using a stent retriever and/or aspiration catheter between August 2015 and August 2016. The retrieved thrombi were quantitatively analyzed to quantify red blood cells, white blood cells, and fibrin by area. We divided the patients into two groups – a fibrin-rich group and an erythrocyte-rich group – based on the predominant composition in the thrombus. The groups were compared for imaging, clinical, and neurointerventional data. Results The retrieved thrombi from 43 patients with acute stroke from internal carotid artery, middle cerebral artery, or basilar artery occlusion were histologically analyzed. Erythrocyte-rich thrombi were present in 18 cases, while fibrin-rich thrombi were present in 25 cases. A cardioembolic etiology was significantly more prevalent among the patients with fibrin-rich thrombi than among those with erythrocyte-rich thrombi. Attenuation of thrombus density as shown on computed tomography images was greater in patients with erythrocyte-rich thrombi than in those with fibrin-rich thrombi. All other clinical and laboratory characteristics remained the same. Patients with erythrocyte-rich thrombi had a smaller number of recanalization maneuvers, shorter procedure times, a shorter time interval between arrival and recanalization, and a higher percentage of stent retrievers in the final recanalization procedure. The occluded vessels did not differ significantly. Conclusions In this study, erythrocyte-rich thrombus was associated with noncardioembolic etiology, higher thrombus density, and reduced procedure time.
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Affiliation(s)
- Kota Maekawa
- Department of Neuroendovascular Therapy, Ise Red Cross Hospital, Ise City, Japan
| | - Masunari Shibata
- Department of Neuroendovascular Therapy, Ise Red Cross Hospital, Ise City, Japan
| | - Hideki Nakajima
- Department of Neurosurgery, Ise Red Cross Hospital, Ise City, Japan
| | - Akane Mizutani
- Department of Neurology, Ise Red Cross Hospital, Ise City, Japan
| | - Yotaro Kitano
- Department of Neurosurgery, Ise Red Cross Hospital, Ise City, Japan
| | - Masaru Seguchi
- Department of Neuroendovascular Therapy, Ise Red Cross Hospital, Ise City, Japan
| | | | - Kazuto Kobayashi
- Department of Neuroendovascular Therapy, Ise Red Cross Hospital, Ise City, Japan
| | - Takanori Sano
- Department of Neurosurgery, Ise Red Cross Hospital, Ise City, Japan
| | - Genshin Mori
- Department of Neurosurgery, Ise Red Cross Hospital, Ise City, Japan
| | - Tadashi Yabana
- Department of Pathology, Ise Red Cross Hospital, Ise City, Japan
| | - Yutaka Naito
- Department of Neurology, Ise Red Cross Hospital, Ise City, Japan
| | | | - Fumitaka Miya
- Department of Neurosurgery, Ise Red Cross Hospital, Ise City, Japan
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Xu J, Sisniega A, Zbijewski W, Dang H, Stayman JW, Mow M, Wang X, Foos DH, Koliatsos VE, Aygun N, Siewerdsen JH. Technical assessment of a prototype cone-beam CT system for imaging of acute intracranial hemorrhage. Med Phys 2017; 43:5745. [PMID: 27782694 DOI: 10.1118/1.4963220] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE A cone-beam CT scanner has been developed for detection and monitoring of traumatic brain injury and acute intracranial hemorrhage (ICH) at the point of care. This work presents a technical assessment of imaging performance and dose for the scanner in phantom and cadaver studies as a prerequisite to clinical translation. METHODS The scanner incorporates a compact, rotating-anode x-ray source and a flat-panel detector (43 × 43 cm2) on a mobile U-arm gantry with source-axis distance = 550 mm and source-detector distance = 1000 mm. Central and peripheral doses were measured in 16 cm diameter CTDI phantoms using a 0.6 cm3 Farmer ionization chamber for various scan techniques and as a function of longitudinal position, including out of field. Spatial resolution, contrast, noise, and image uniformity were assessed in quantitative and anthropomorphic head phantoms. Two reconstruction protocols were evaluated, including filtered backprojection (FBP) for high-resolution bone imaging and penalized weighted least squares (PWLS) reconstruction for low-contrast soft tissue (ICH) visualization. A fresh cadaver was imaged with and without simulated ICH using the scanner as well as a diagnostic multidetector CT (MDCT) scanner using a standard head protocol. Images were interpreted by a fellowship-trained neuroradiologist for imaging tasks of ICH detection, gray-white-CSF differentiation, detection of midline shift, and fracture detection. RESULTS The nominal scan protocol involved 720 projections acquired over a 360° orbit at 100 kV and 216 mAs, giving a dose (weighted CTDI) of 22.8 mGy (∼1.2 mSv effective dose). Out-of-field dose decreased to <10% within 6 cm of the field edge (approximate to the thyroid position). Image uniformity demonstrated <1% variation between the edge of the field (near the cranium) and center of the image. The high-resolution FBP reconstruction protocol showed ∼0.9 mm point spread function (PSF) full-width at half-maximum (FWHM). The smooth PWLS reconstruction protocol yielded ∼1.2 mm PSF FWHM and contrast-to-noise ratio exceeding 5.7 in ∼50 HU spherical ICH, resulting in conspicuous depiction of ICH down to ∼2 mm (the smallest diameter investigated). Cadaver images demonstrated good differentiation of brain and CSF (sufficient, but inferior to MDCT, recognizing that the CBCT dose was one-third that of MDCT), excellent visualization of cranial sutures and fracture (potentially superior to MDCT), clear detection of midline shift, and conspicuous detection of ICH. CONCLUSIONS Technical assessment of the prototype demonstrates dose characteristics and imaging performance consistent with point-of-care detection and monitoring of head injury-most notably, conspicuous detection of ICH-and supports translation of the system to clinical studies.
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Affiliation(s)
- Jennifer Xu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Alejandro Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Wojciech Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Hao Dang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - J Webster Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Michael Mow
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | | | | | | | - Nafi Aygun
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland 21205
| | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205; Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland 21205; Department of Computer Science, Johns Hopkins University, Baltimore, Maryland 21205; Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland 21205; and Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland 21205
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Ojaghihaghighi S, Vahdati SS, Mikaeilpour A, Ramouz A. Comparison of neurological clinical manifestation in patients with hemorrhagic and ischemic stroke. World J Emerg Med 2017; 8:34-38. [PMID: 28123618 DOI: 10.5847/wjem.j.1920-8642.2017.01.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cerebrovascular accident (CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment. The symptoms that follow a stroke aren't significant and depend on the area of the brain that has been affected and the amount of tissue damaged. Parameters for predicting long-term outcome in such patients have not been clearly delineated, therefore the aim of this study was to investigate this possibility and to test a system that might practicably be used routinely to aid management and predict outcomes of individual stroke patients. METHODS A descriptive hospital-based study of the neurological symptoms and signs of 503 patients with ischemic stroke, including severe headache, seizure, eye movement disorder, pupil size, Glasgow Coma Scale (GCS), agitation were analyzed in this study. RESULTS In the current study, dilated pupils, agitation, acute onset headache, lower GCS score, seizure, and eye gaze impairment had significantly higher prevalence in hemorrhagic stroke patients (P<0.001). However, the rate of gradual progressive headache is significantly higher in ischemic stroke patients (P<0.001). CONCLUSION Although this result provides reliable indicators for discrimination of stroke types, imaging studies are still the gold standard modality for diagnosis.
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Affiliation(s)
| | - Samad Shams Vahdati
- Road Traffic Injury Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | | | - Ali Ramouz
- Medicine Faculty and Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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Nevzati E, Berberat J, Soleman J, Coluccia D, Muroi C, Schöpf S, Lukes A, Fischer I, Remonda L, Fandino J, Marbacher S. Magnetic Resonance Imaging Signal Characteristics of Medishield: Early Postoperative Profile in a Rabbit Interlaminotomy Model. World Neurosurg 2016; 98:704-710.e3. [PMID: 27965076 DOI: 10.1016/j.wneu.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Application of Medishield to the nerve root is common during spinal surgery to create a mechanical barrier from pain mediators and reduce scar formation. However, Medishield's signal characteristics on magnetic resonance imaging (MRI) have not yet been examined. METHODS Microsurgical interlaminotomy was performed on 2 lower lumbar segments in 17 adult New Zealand white rabbits. After dural exposure, applications of 1 mL (autologous blood clot or Medishield) were randomized for each level. On postoperative days 1 through 3, various MRI sequences in 1.5T were performed including T1-weighted, T2-w, T1-gadolinium-weighted, susceptibility-weighted and turbo inversion recovery magnitude (TIRM) sequence. Signaling characteristics were analyzed by 3 blinded observers. Inter-rater agreement was calculated using Fleiss's kappa coefficient (κ). Positive and negative likelihood ratios in detecting Medishield by MRI were determined. RESULTS Of 24 MRIs performed, TIRM sequence identified Medishield with the highest likelihood ratio. Medishield's positive likelihood ratio was highest (5.8) on postoperative day 1 with interobserver agreement of 93% (κ = 0.75); these rates declined to 2.5 and 1.4 on postoperative days 2 and 3 with interobserver agreements of 71% (κ = 0.43) and 83% (κ = 0.67), respectively. Medishield adherence was confirmed in each rabbit by histologic examinations. CONCLUSION Understanding that radiologic detection of Medishield diminished over time as its signal characteristics became less distinguishable from a blood clot is essential in clinical practice. Medishield was detected on postoperative day 1 but not 2 days later after hemodynamic changes had occurred. These results may provide a guide for postoperative findings, such as differential diagnosis of hematoma.
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Affiliation(s)
- Edin Nevzati
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland.
| | - Jatta Berberat
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Carl Muroi
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Salome Schöpf
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Anton Lukes
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Ingeborg Fischer
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Luca Remonda
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aurau, Aarau, Switzerland
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Dang G, Yang Y, Wu G, Hua Y, Keep RF, Xi G. Early Erythrolysis in the Hematoma After Experimental Intracerebral Hemorrhage. Transl Stroke Res 2016; 8:174-182. [PMID: 27783383 DOI: 10.1007/s12975-016-0505-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 12/14/2022]
Abstract
Erythrolysis occurs in the clot after intracerebral hemorrhage (ICH), and the release of hemoglobin causes brain injury, but it is unclear when such lysis occurs. The present study examined early erythrolysis in rats. ICH rats had an intracaudate injection of 100 μl autologous blood, and sham rats had a needle insertion. All rats had T2 and T2* magnetic response imaging (MRI) scanning, and brains were used for histology and CD163 (a hemoglobin scavenger receptor) and DARPP-32 (a neuronal marker) immunohistochemistry. There was marked heterogeneity within the hematoma on T2* MRI, with a hyperintense or isointense core and a hypointense periphery. Hematoxylin and eosin staining in the same animals showed significant erythrolysis in the core with the formation of erythrocyte ghosts. The degree of erythrolysis correlated with the severity of perihematomal neuronal loss. Perihematomal CD163 was increased by day 1 after ICH and may be involved in clearing hemoglobin caused by early hemolysis. Furthermore, ICH resulted in more severe erythrolysis, neuronal loss, and perihematomal CD163 upregulation in spontaneously hypertensive rats compared to Wistar-Kyoto rats. In conclusion, T2*MRI-detectable early erythrolysis occurred in the clot after ICH and activated CD163. Hypertension is associated with enhanced erythrolysis in the hematoma.
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Affiliation(s)
- Ge Dang
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.,Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yuefan Yang
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.,Department of Neurosurgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Gang Wu
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Ya Hua
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Guohua Xi
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA. .,R5018 BSRB, University of Michigan, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA.
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De Reuck J, Cordonnier C, Deramecourt V, Auger F, Durieux N, Leys D, Pasquier F, Maurage CA, Bordet R. Lobar intracerebral haematomas: Neuropathological and 7.0-tesla magnetic resonance imaging evaluation. J Neurol Sci 2016; 369:121-125. [PMID: 27653876 DOI: 10.1016/j.jns.2016.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 07/29/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE The Boston criteria for cerebral amyloid angiopathy (CAA) need validation by neuropathological examination in patients with lobar cerebral haematomas (LCHs). In "vivo" 1.5-tesla magnetic resonance imaging (MRI) is unreliable to detect the age-related signal changes in LCHs. This post-mortem study investigates the validity of the Boston criteria in brains with LCHs and the signal changes during their time course with 7.0-tesla MRI. MATERIALS AND METHODS Seventeen CAA brains including 26 LCHs were compared to 13 non-CAA brains with 14 LCHs. The evolution of the signal changes with time was examined in 25 LCHs with T2 and T2* 7.0-tesla MRI. RESULTS In the CAA group LCHs were predominantly located in the parieto-occipital lobes. Also white matter changes were more severe with more cortical microinfarcts and cortical microbleeds. On MRI there was a progressive shift of the intensity of the hyposignal from the haematoma core in the acute stage to the boundaries later on. During the residual stage the hyposignal mildly decreased in the boundaries with an increase of the superficial siderosis and haematoma core collapse. CONCLUSIONS Our post-mortem study of LCHs confirms the validity of the Boston criteria for CAA. Also 7.0-tesla MRI allows staging the age of the LCHs.
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Affiliation(s)
- Jacques De Reuck
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France.
| | - Charlotte Cordonnier
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Vincent Deramecourt
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Florent Auger
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Nicolas Durieux
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Didier Leys
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Florence Pasquier
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Claude-Alain Maurage
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
| | - Regis Bordet
- Université Lille 2, INSERM U1171, Degenerative & vascular cognitive disorders, CHU Lille, F-59000 Li, France
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Eo T, Kim T, Jun Y, Lee H, Ahn SS, Kim DH, Hwang D. High-SNR multiple T 2 (*)-contrast magnetic resonance imaging using a robust denoising method based on tissue characteristics. J Magn Reson Imaging 2016; 45:1835-1845. [PMID: 27635526 DOI: 10.1002/jmri.25477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 08/30/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To develop an effective method that can suppress noise in successive multiecho T2 (*)-weighted magnetic resonance (MR) brain images while preventing filtering artifacts. MATERIALS AND METHODS For the simulation experiments, we used multiple T2 -weighted images of an anatomical brain phantom. For in vivo experiments, successive multiecho MR brain images were acquired from five healthy subjects using a multiecho gradient-recalled-echo (MGRE) sequence with a 3T MRI system. Our denoising method is a nonlinear filter whose filtering weights are determined by tissue characteristics among pixels. The similarity of the tissue characteristics is measured based on the l2 -difference between two temporal decay signals. Both numerical and subjective evaluations were performed in order to compare the effectiveness of our denoising method with those of conventional filters, including Gaussian low-pass filter (LPF), anisotropic diffusion filter (ADF), and bilateral filter. Root-mean-square error (RMSE), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were used in the numerical evaluation. Five observers, including one radiologist, assessed the image quality and rated subjective scores in the subjective evaluation. RESULTS Our denoising method significantly improves RMSE, SNR, and CNR of numerical phantom images, and CNR of in vivo brain images in comparison with conventional filters (P < 0.005). It also receives the highest scores for structure conspicuity (8.2 to 9.4 out of 10) and naturalness (9.2 to 9.8 out of 10) among the conventional filters in the subjective evaluation. CONCLUSION This study demonstrates that high-SNR multiple T2 (*)-contrast MR images can be obtained using our denoising method based on tissue characteristics without noticeable artifacts. Evidence level: 2 J. MAGN. RESON. IMAGING 2017;45:1835-1845.
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Affiliation(s)
- Taejoon Eo
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
| | - Taeseong Kim
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
| | - Yohan Jun
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
| | - Hongpyo Lee
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
| | - Sung Soo Ahn
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Hyun Kim
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
| | - Dosik Hwang
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
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Lövblad KO, Kiefer C, Oswald H, Arnold M, Nedeltchev K, Mattle H, Schroth G. Imaging the Ischemic Penumbra. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140090301600534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - M. Arnold
- Department of Neurology, Inselspital, Bern; Switzerland
| | - K. Nedeltchev
- Department of Neurology, Inselspital, Bern; Switzerland
| | - H. Mattle
- Department of Neurology, Inselspital, Bern; Switzerland
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Transient disappearance of microbleeds in the subacute period based on T2*-weighted gradient echo imaging in traumatic brain injury. Acta Neurochir (Wien) 2016; 158:1247-50. [PMID: 27106841 DOI: 10.1007/s00701-016-2805-5] [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: 03/01/2016] [Accepted: 04/06/2016] [Indexed: 12/16/2022]
Abstract
We report three cases of traumatic microbleeds evaluated by sequential observation. Hypo-intensities on T2* gradient echo imaging (T2*GEI) appeared just 2-3 h after the injury (the hyper-acute period). However, these hypo-intensities on T2*GEI disappeared or became obscure 2-6 days after the injury (the subacute period). A follow-up MRI again revealed clear hypo-intensities on T2*GEI 1-3 months after the injury (the chronic period). Our cases indicate that hypo-intensities on T2*GEI might change dynamically from the hyper-acute to the chronic period. The differences of susceptibility effects by hematoma age might be the cause of this dynamic change.
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Xu J, Sisniega A, Zbijewski W, Dang H, Stayman JW, Wang X, Foos DH, Aygun N, Koliatsos VE, Siewerdsen JH. Modeling and design of a cone-beam CT head scanner using task-based imaging performance optimization. Phys Med Biol 2016; 61:3180-207. [DOI: 10.1088/0031-9155/61/8/3180] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cora EA, White PM, Wardlaw JM. Stroke imaging in the age of thrombolysis. IMAGING 2016. [DOI: 10.1259/img.20120004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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38
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Abstract
Primary or nontraumatic spontaneous intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes, and has a poor prognosis. ICH has a mortality rate of almost 50% when associated with intraventricular hemorrhage within the first month, and 80% rate of dependency at 6 months from onset. Neuroimaging is critical in identifying the underlying etiology and thus assisting in the important therapeutic decisions. There are several imaging modalities available in the workup of patients who present with ICH, including computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA). A review of the current imaging approach, as well as a differential diagnosis of etiologies and imaging manifestations of primary versus secondary intraparenchymal hemorrhage, is presented. Active bleeding occurs in the first hours after symptom onset, with early neurologic deterioration. Identifying those patients who are more likely to have hematoma expansion is an active area of research, and there are many ongoing therapeutic trials targeting this specific patient population at risk.
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Affiliation(s)
- Javier M Romero
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jonathan Rosand
- Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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39
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Kase CS, Shoamanesh A, Greenberg SM, Caplan LR. Intracerebral Hemorrhage. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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40
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Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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41
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Do WJ, Kim KH, Choi SH, Park SH. Artifact-suppressed optimal three-dimensional T 1 - and T 2 *-weighted dual-echo imaging. Magn Reson Med 2015; 76:1504-1511. [PMID: 26536831 DOI: 10.1002/mrm.26033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/05/2022]
Abstract
PURPOSE To develop a new artifact-suppressed optimal three-dimensional (3D) T1 - and T2 *-weighted dual-echo imaging. METHODS We optimized flip angles for 3D T1 - and T2 *-weighted imaging by conventional dual-echo in vivo experiments and computer simulations, and then implemented a dual-echo sequence with an echo-specific k-space reordering scheme to satisfy the optimal flip angles for both T1 and T2 * contrast. We also proposed two strategies to suppress ringing artifacts induced by the abrupt flip angle jumps in the proposed dual echo sequence: (i) implementing smooth transition regions and (ii) discarding the k-space regions of the abrupt flip angle jumps as dummy phase-encoding steps. RESULTS The optimal flip angles measured from experiments were different between T1 - and T2 *-weighted contrast, in agreement with simulations. The echo-specific k-space reordered dual-echo sequence showed optimal T1 and T2 * contrast simultaneously, but also showed ringing artifacts because of high flip-angle changes between k-space regions. The two proposed strategies effectively suppressed the ringing artifacts. CONCLUSION The proposed 3D dual-echo sequence provided optimal T1 and T2 * contrast simultaneously with no artifacts and thus is potentially applicable to routine clinical applications for simultaneous high resolution T1 - and T2 *-weighted imaging. Magn Reson Med 76:1504-1511, 2016. © 2015 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Won-Joon Do
- MRI Laboratory, Department of Bio and Brian Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Ki Hwan Kim
- MRI Laboratory, Department of Bio and Brian Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea.,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hong Park
- MRI Laboratory, Department of Bio and Brian Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea.
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42
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Abstract
Cervical artery dissection (CAD) may affect the internal carotid and/or the vertebral arteries. CAD is the leading cause of ischemic stroke in patients younger than 45 years. Specific treatment (aspirin or anticoagulants) can be implemented once the diagnosis of CAD has been confirmed. This diagnosis is based on detection of a mural haematoma on ultrasound or on MRI. The diagnosis can be suspected on contrast-enhanced MRA (magnetic resonance angiography) or CT angiography, in case of long stenosis, sparing the internal carotid bulb, or suspended, at the junction of V2 and V3 segments of the vertebral artery, in patients with no signs of atheroma of the cervical arteries. MRI is recommended as the first line imaging screening tool, including a fat suppressed T1 weighted sequence, acquired in the axial or oblique plane at 1.5T, or 3D at 3T. Complete resolution of the lumen abnormality occurred in 80% of cases, and CAD recurrence is rare, encountered in less than 5% of cases. Interventional neuroradiology (angioplasty and/or stenting of the dissected vessel) may be envisaged in rare cases of haemodynamic effects with recurring clinical infarctions in the short-term.
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43
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MR image features predicting hemorrhagic transformation in acute cerebral infarction: a multimodal study. Neuroradiology 2015; 57:1145-52. [DOI: 10.1007/s00234-015-1575-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/07/2015] [Indexed: 11/27/2022]
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44
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Whang JS, Kolber M, Powell DK, Libfeld E. Diffusion-weighted signal patterns of intracranial haemorrhage. Clin Radiol 2015; 70:909-16. [PMID: 26050534 DOI: 10.1016/j.crad.2015.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 03/26/2015] [Accepted: 04/15/2015] [Indexed: 01/08/2023]
Abstract
The signal pattern of intracranial haemorrhage on diffusion-weighted imaging (DWI) as it evolves over time is rarely discussed due to the sensitivity of T2*-weighted sequences and the specificity of classic signal patterns on T1 and T2-weighted sequences. The DWI signal is strongly affected by the magnetic susceptibility of paramagnetic blood products and, therefore, is markedly hypointense in the same phases that demonstrate hypointensity on T2*-weighted sequences; however, hyperacute haemorrhage (oxyhaemoglobin-predominant clot) and late subacute haemorrhage (extracellular methaemoglobin) do not demonstrate T2* hypointensity. Moreover, T2*-weighted sequences are less sensitive to the presence of extra-axial haemorrhage than to intraparenchymal haemorrhage. At these stages of evolution, haemorrhage demonstrates high DWI signal in association with low ADC values, which may be more pronounced than even its corresponding fluid-attenuated inversion recovery (FLAIR) signal. DWI is useful for identifying hyperacute subarachnoid haemorrhage and as a problem-solving tool in challenging cases.
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Affiliation(s)
- J S Whang
- Department of Radiology Mount Sinai Beth Israel Medical Center, New York, NY, USA.
| | - M Kolber
- Department of Radiology Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - D K Powell
- Department of Radiology New York Presbyterian, Columbia Campus, New York, NY, USA
| | - E Libfeld
- Department of Radiology Mount Sinai Beth Israel Medical Center, New York, NY, USA
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45
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Hamirani YS, Wong A, Kramer CM, Salerno M. Effect of microvascular obstruction and intramyocardial hemorrhage by CMR on LV remodeling and outcomes after myocardial infarction: a systematic review and meta-analysis. JACC Cardiovasc Imaging 2015; 7:940-52. [PMID: 25212800 DOI: 10.1016/j.jcmg.2014.06.012] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/25/2014] [Accepted: 06/29/2014] [Indexed: 01/03/2023]
Abstract
The goal of this systematic analysis is to provide a comprehensive review of the current cardiac magnetic resonance data on microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH). Data related to the association of MVO and IMH in patients with acute myocardial infarction (MI) with left ventricular (LV) function, volumes, adverse LV remodeling, and major adverse cardiac events (MACE) were critically analyzed. MVO is associated with a lower ejection fraction, increased ventricular volumes and infarct size, and a greater risk of MACE. Late MVO is shown to be a stronger prognostic marker for MACE and cardiac death, recurrent MI, congestive heart failure/heart failure hospitalization, and follow-up LV end-systolic volumes than early MVO. IMH is associated with LV remodeling and MACE on pooled analysis, but because of limited data and heterogeneity in study methodology, the effects of IMH on remodeling require further investigation.
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Affiliation(s)
- Yasmin S Hamirani
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Andrew Wong
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Salerno
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
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46
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Adeli A, Behrouz R. The Role of Magnetic Resonance Imaging in Management of Patients With Nonlobar Hypertensive Intracerebral Hemorrhage. Neurohospitalist 2015; 5:59-62. [DOI: 10.1177/1941874414561030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose: Despite the increased use and availability of magnetic resonance imaging (MRI), its role in hypertensive intracerebral hemorrhage (ICH) remains uncertain. In this retrospective study, we assessed the utility of MRI in diagnosis and management of patients with hypertensive ICH. Methods: We retrospectively reviewed the charts of patients with ICH presenting to our hospital over an 18-month period. We included patients who presented with hypertensive ICH in typical locations and excluded lobar hemorrhages. We further isolated cases that had undergone MRI. Collected data included mean age, gender, location of hematoma, neuroradiologist’s interpretative report of the MRI, and management steps taken in response to the results of the MRI. Logistic regression was used to determine whether the overall yield of MRI in these patients was significant. Results: We found 222 patients with ICH in our database. Forty-eight patients met our inclusion criteria, of which 24 had brain MRI done as a part of their hospital workup. Brain MRI obtained in 2 (8%) of the 24 patients revealed abnormalities that led to a change in management. The diagnostic yield of MRI and the management decisions that followed were both insignificant. Conclusions: The diagnostic yield of brain MRI in patients with nonlobar hypertensive ICH is low and does not result in significant changes in management.
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Affiliation(s)
- Amir Adeli
- Division of Cerebrovascular Diseases, Department of Neurology, Ohio State University College of Medicine, Columbus, OH, USA
| | - Réza Behrouz
- Division of Cerebrovascular Diseases, Department of Neurology, Ohio State University College of Medicine, Columbus, OH, USA
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47
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Prediction of Reperfusion-Associated Hemorrhagic Transformation Using Dynamic Contrast-Enhanced Imaging in a Rat Stroke Model. J Comput Assist Tomogr 2015. [DOI: 10.1097/rct.0000000000000283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Abstract
Neuroimaging is essential to stroke diagnosis and management. To date, the non-contrast CT has served as our main diagnostic tool. Although brain parenchymal changes visible on CT do provide valuable prognostic information, they provide limited insight into the potential for tissue salvage in response to reperfusion therapy, such as thrombolysis. Newer advanced CT and MRI based imaging techniques have increased the detection sensitivity for hyperacute and chronic parenchymal changes, including ischemia and hemorrhage, permit visualization of blood vessels and cerebral blood flow. This review outlines the basic principles underlying acquisition and interpretation of these newer imaging modalities in the setting of acute stroke. The utility of advanced brain parenchymal and blood flow imaging in the context of acute stroke patient management is also discussed. Part II in this series is a discussion of how these techniques can be used to rationally select appropriate patients for thrombolysis based on pathophysiological data.
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49
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Neumayer B, Hassler E, Petrovic A, Widek T, Ogris K, Scheurer E. Age determination of soft tissue hematomas. NMR IN BIOMEDICINE 2014; 27:1397-1402. [PMID: 25208978 DOI: 10.1002/nbm.3202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 07/29/2014] [Accepted: 08/13/2014] [Indexed: 06/03/2023]
Abstract
In clinical forensic medicine, the estimation of the age of injuries such as externally visible subcutaneous hematomas is important for the reconstruction of violent events, particularly to include or exclude potential suspects. Since the estimation of the time of origin based on external inspection is unreliable, the aim of this study was to use contrast in MRI to develop an easy-to-use model for hematoma age estimation. In a longitudinal study, artificially created subcutaneous hematomas were repetitively imaged using MRI over a period of two weeks. The hemorrhages were created by injecting autologous blood into the subcutaneous tissue of the thigh in 20 healthy volunteers. For MRI, standard commercially available sequences, namely proton-density-weighted, T2 -weighted and inversion recovery sequences, were used. The hematomas' MRI data were analyzed regarding their contrast behavior using the most suitable sequences to derive a model allowing an objective estimation of the age of soft tissue hematomas. The Michelson contrast between hematoma and muscle in the proton-density-weighted sequence showed an exponentially decreasing behavior with a dynamic range of 0.6 and a maximum standard deviation of 0.1. The contrast of the inversion recovery sequences showed increasing characteristics and was hypointense for TI = 200ms and hyperintense for TI =1000ms. These sequences were used to create a contrast model. The cross-validation of the model finally yielded limits of agreement for hematoma age determination (corresponding to ±1.96 SD) of ±38.7h during the first three days and ±54 h for the entire investigation period. The developed model provides lookup tables which allow for the estimation of a hematoma's age given a single contrast measurement applicable by a radiologist or a forensic physician. This is a first step towards an accurate and objective dating method for subcutaneous hematomas, which will be particularly useful in child abuse.
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Affiliation(s)
- Bernhard Neumayer
- Ludwig Boltzmann Institute for Clinical Forensic Imaging, Universitätsplatz 4, A-8010, Graz, Austria
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50
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Kandler D, Lücke C, Grothoff M, Andres C, Lehmkuhl L, Nitzsche S, Riese F, Mende M, de Waha S, Desch S, Lurz P, Eitel I, Gutberlet M. The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging. Eur Radiol 2014; 24:3277-88. [PMID: 25097126 PMCID: PMC4231283 DOI: 10.1007/s00330-014-3318-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 06/19/2014] [Accepted: 07/04/2014] [Indexed: 01/08/2023]
Abstract
Background Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and “hypointense core” (HIC) appearance in T2-weighted images. We aimed to distinguish between IMH and MVO by using T2*-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development. Methods and results A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T2-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T2*-weighted sequences to detect IMH. IMH+/IMH− patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50 %) were IMH+, 82 (54 %) demonstrated HIC and 100 (66 %) MVO. IMH was detectable without HIC in 16 %, without MVO in 5 % and HIC without MVO in 6 %. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often. Conclusions IMH is associated with impaired left ventricular function and higher infarct size. T2 and HIC imaging showed moderate agreement for IMH detection. T2* imaging might be the preferred CMR imaging method for comprehensive IMH assessment. Key Points • Intramyocardial haemorrhage is a common finding in patients with acute reperfused myocardial-infarction. • T2*imaging should be the preferred CMR method for assessment of intramyocardial haemorrhage. • Intramyocardial haemorrhage can be considered as an important influencing factor on patient’s outcome.
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Affiliation(s)
- Diana Kandler
- Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Centre, Strümpellstraße 39, 04289, Leipzig, Germany
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