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DENEKE THOMAS, JAIS PIERRE, SCAGLIONE MARCO, SCHMITT RAINER, DI BIASE LUIGI, CHRISTOPOULOS GEORGIOS, SCHADE ANJA, MÜGGE ANDREAS, BANSMANN MARTIN, NENTWICH KARIN, MÜLLER PATRICK, KRUG JOACHIM, ROOS MARKUS, HALBFASS PHILLIP, NATALE ANDREA, GAITA FIORENZO, HAINES DAVID. Silent Cerebral Events/Lesions Related to Atrial Fibrillation Ablation: A Clinical Review. J Cardiovasc Electrophysiol 2015; 26:455-463. [DOI: 10.1111/jce.12608] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- THOMAS DENEKE
- Heart Center Bad Neustadt; Bad Neustadt Germany
- Ruhr-University Bochum; Bochum Germany
| | | | - MARCO SCAGLIONE
- Cardiology Division; Cardinal Guglielmo Massaia Hospital; Asti Italy
| | - RAINER SCHMITT
- Department of Radiology; Heart Center Bad Neustadt; Bad Neustadt Germany
| | - LUIGI DI BIASE
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
- Department of Biomedical Engineering; University of Texas; Austin Texas USA
- Department of Cardiology; University of Foggia; Foggia Italy
- Albert Einstein College of Medicine at Montefiore Hospital New York; New York USA
| | | | - ANJA SCHADE
- Heart Center Bad Neustadt; Bad Neustadt Germany
| | | | - MARTIN BANSMANN
- Institute for Diagnostic and Interventional Radiology; Hospital Cologne-Porz; Germany
| | | | - PATRICK MÜLLER
- Heart Center Bad Neustadt; Bad Neustadt Germany
- Ruhr-University Bochum; Bochum Germany
| | | | - MARKUS ROOS
- Heart Center Bad Neustadt; Bad Neustadt Germany
| | | | - ANDREA NATALE
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
- Ruhr-University Bochum; Bochum Germany
| | - FIORENZO GAITA
- Division of Cardiology; Department of Medical Sciences; University of Turin; Italy
| | - DAVID HAINES
- Department of Cardiovascular Medicine; Oakland University William Beaumont School of Medicine; Royal Oak Michigan USA
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Deneke T, Nentwich K, Krug J, Müller P, Grewe PH, Mügge A, Schade A. Silent Cerebral Events after Atrial Fibrillation Ablation - Overview and Current Data. J Atr Fibrillation 2014; 6:996. [PMID: 27957043 DOI: 10.4022/jafib.996] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 12/30/2014] [Accepted: 01/05/2014] [Indexed: 11/10/2022]
Abstract
Silent cerebral lesions (SCL) have been identified on brain magnetic resonance imaging (MRI) in apparently asymptomatic patients after cardiovascular procedures. After atrial fibrillation (AF) ablation incidences range from 1 to over 40% depending upon different factors. MRI definition should include diffusion weighted imaging (DWI) to detect hyperintensities (bright spots) due to acute brain ischemia correlated with a hypointensity in the apparent diffusion coefficient mapping (ADC-map) to rule out artifacts. The genesis of SCL appears to be multifactorial and appears to be a result of embolic events either from gaseous or solid particles. The MRI pattern appears to be comparable not hinting towards a specific mechanism. One may distinguish two different MRI definition: one, more sensitive, for silent ischemic events (SCE) not proven to be related to cell death (DWI positive but FLAIR negative); and one for SCL that are due to edema caused by cell death which will lead to glial cell scar formation (DWI positive and FLAIR positive). For ease of data interpretation, future studies should ensure both definitions, and that DWI and FLAIR data is acquired using identical slice thickness and orientation. Risk factors associated with increased SCL-incidences involve patient-specific, technology-associated and procedural determinants. When using a high-sensitive MRI definition differences in SCE-rates in between technologies appear to be less prominent. Further studies on the effects of different periprocedural anticoagulation regimen, different steps of the ablation procedure and new technologies are needed. For now, SCL incidence may determine the thrombogenic potential of an ablation technology and further studies to reduce or avoid SCL generation are desirable. It appears reasonable, that any SCE should be avoided.
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Affiliation(s)
- Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt,Germany; Ruhr-University Bochum, Bochum, Germany
| | - Karin Nentwich
- Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt,Germany
| | - Joachim Krug
- Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt,Germany
| | - Patrick Müller
- Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt,Germany; Ruhr-University Bochum, Bochum, Germany
| | | | | | - Anja Schade
- Clinic for Interventional Electrophysiology, Heart Center Bad Neustadt, Bad Neustadt,Germany
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Boada FE, Qian Y, Nemoto E, Jovin T, Jungreis C, Jones SC, Weimer J, Lee V. Sodium MRI and the assessment of irreversible tissue damage during hyper-acute stroke. Transl Stroke Res 2012; 3:236-45. [PMID: 24323779 DOI: 10.1007/s12975-012-0168-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 03/29/2012] [Indexed: 12/24/2022]
Abstract
Sodium MRI (sMRI) has undergone a tremendous amount of technical development during the last two decades that makes it a suitable tool for the study of human pathology in the acute setting within the constraints of a clinical environment. The salient role of the sodium ion during impaired ATP production during the course of brain ischemia makes sMRI an ideal tool for the study of ischemic tissue viability during stroke. In this paper, the current limitations of conventional MRI for the determination of tissue viability during evolving brain ischemia are discussed. This discussion is followed by a summary of the known findings about the dynamics of tissue sodium changes during brain ischemia. A mechanistic model for the explanation of these findings is presented together with the technical requirements for its investigation using clinical MRI scanners. An illustration of the salient features of the technique is also presented using a nonhuman primate model of reversible middle cerebral artery occlusion.
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Affiliation(s)
- Fernando E Boada
- MR Research Center, Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA,
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Yamatogi S, Furukawa M, Iida E, Takahashi S, Ishihara H, Kato S, Suzuki M, Matsunaga N. Evaluation of small ischemic lesions after carotid artery stenting: the usefulness of thin-slice diffusion-weighted MR imaging. Neuroradiology 2010; 53:255-60. [PMID: 20585767 DOI: 10.1007/s00234-010-0730-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/08/2010] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There has been concern regarding the usefulness of diffusion-weighted imaging (DWI) to evaluate the ischemic lesions associated with carotid artery stent placement (CAS). Some small lesions may be detected not by standard DWI but by thin-slice DWI alone, since most of the cerebral lesions are very small in size and clinically silent. The purpose of this study is to compare the detectability of the small ischemic lesions after CAS by standard and thin-slice DWI. METHODS Both standard DWI with slice thickness of 6 mm and thin-slice DWI with slice thickness of 2 mm were obtained at the same MR examination within 2 to 7 days after 20 procedures of CAS in 17 patients. Number and measured diameter size of the detected lesions on both DWI were compared. RESULTS All CAS procedures in 17 patients were successfully completed. The focal ischemic lesions were detected in 14 of 20 on thin-slice DWI and seven examinations on standard DWI. The total numbers of hyperintense lesions were 31 on thin-slice DWI and ten on standard DWI (p < 0.001). The sizes of these ten lesions on thin-slice DWI were larger than those of standard DWI, and the mean size of the thin-slice DWI and that of standard DWI were significantly different (p < 0.005). CONCLUSION Thin-slice DWI was able to detect small cortical lesions better than standard DWI. Thin-slice DWI may be useful to evaluate small silent ischemic lesions after CAS.
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Affiliation(s)
- Shigenari Yamatogi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
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Influence of fluid-attenuated inversion-recovery on stroke apparent diffusion coefficient measurements and its clinical application. Eur J Radiol 2010; 75:e76-81. [PMID: 20047810 DOI: 10.1016/j.ejrad.2009.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 11/29/2009] [Accepted: 11/30/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE The application of a fluid-attenuated inversion-recovery pulse with a conventional diffusion-weighted MRI sequence (FLAIR DWI) decreases the partial volume effects from cerebrospinal fluid on apparent diffusion coefficient (ADC) measurements. For this reason, FLAIR DWI may be more useful in the evaluation of ischemic stroke, but few studies have looked at the effect of FLAIR on ADC measurements in this setting. This study quantitatively compares FLAIR DWI and conventional DWI in ischemic stroke of varying ages to assess the potential advantages of this technique. METHODS We respectively analyzed 139 DWI studies in patients with ischemic stroke with and without FLAIR at varying time points ranging from hyperacute to chronic. ADC values were measured in each lesion, as well as in the contralateral normal side. Comparisons were made between the ADC values obtained from the DWI sequences with and without FLAIR for both the lesion and the normal contralateral side. RESULTS The ADC measurements within the ischemic lesion were very similar on FLAIR DWI and conventional DWI for lesions less than 14 days old (p>0.05), but were significantly decreased on FLAIR DWI for lesions between 15 and 30 days old and in lesions >31 days old (chronic stage) (p<0.01). The contralateral ADC values were all significantly decreased on the FLAIR DWI sequence compared with conventional DWI (p<0.01). CONCLUSIONS The application of an inversion pulse does not significantly affect the ADC values for early stage ischemic stroke (less than 14 days from symptom onset), but results in a more accurate relative ADC measurement by reducing the cerebrospinal fluid partial volume effects of the normal contralateral side. In addition, combined with the conventional DWI, FLAIR DWI may be helpful in determining the age of ischemic lesions.
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Duckworth JL, Hawley JS, Riedy G, Landau ME. Magnetic resonance restricted diffusion resolution correlates with clinical improvement and response to treatment in herpes simplex encephalitis. Neurocrit Care 2006; 3:251-3. [PMID: 16377839 DOI: 10.1385/ncc:3:3:251] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION A 34-year-old man presented with herpes simplex encephalitis (HSE), with magnetic resonance imaging (MRI) showing dense foci of restricted diffusion in the temporal lobe. CASE REPORT With treatment and clinical improvement, follow-up MRI done 8 days later showed complete resolution of the restricted diffusion abnormalities, whereas other MRI sequences suggested interval progression. DISCUSSION Restricted diffusion abnormalities on MRI in patients with HSE may be more sensitive to and correlate better with disease activity in HSE.
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Affiliation(s)
- Joshua L Duckworth
- Department of Neurology, Walter Reed Army Medical Center, Washington, DC 20307, USA
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Bammer R, Skare S, Newbould R, Liu C, Thijs V, Ropele S, Clayton DB, Krueger G, Moseley ME, Glover GH. Foundations of advanced magnetic resonance imaging. NeuroRx 2005; 2:167-96. [PMID: 15897944 PMCID: PMC1064985 DOI: 10.1602/neurorx.2.2.167] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
During the past decade, major breakthroughs in magnetic resonance imaging (MRI) quality were made by means of quantum leaps in scanner hardware and pulse sequences. Some advanced MRI techniques have truly revolutionized the detection of disease states and MRI can now-within a few minutes-acquire important quantitative information noninvasively from an individual in any plane or volume at comparatively high resolution. This article provides an overview of the most common advanced MRI methods including diffusion MRI, perfusion MRI, functional MRI, and the strengths and weaknesses of MRI at high magnetic field strengths.
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Affiliation(s)
- Roland Bammer
- Lucas MRS/I Center, Department of Radiology, Stanford University, California, USA.
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Satoh T, Omi M, Ohsako C, Ekino C. Transparent color-coded three-dimensional diffusion-weighted magnetic resonance imaging for the numerical analysis of reversible and irreversible hyperacute ischemic stroke--case report. Neuroradiology 2005; 47:245-50. [PMID: 15806432 DOI: 10.1007/s00234-004-1315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Accepted: 11/01/2004] [Indexed: 11/29/2022]
Abstract
Although diffusion-weighted (DW) magnetic resonance (MR) imaging can detect hyperacute ischemic parenchyma with high sensitivity, the ability of DW images to reveal subtle change in abnormal diffusion may be limited by the conventional visual evaluation. To overcome the limitation, we have developed a method of transparent color-coded three-dimensional (3D) DW MR imaging for the computer-aided numerical analysis of hyperacute ischemic stroke. The 3D images were reconstructed from volume data of source DW images by using a parallel volume-rendering algorithm with transluminal imaging technique. By selecting a threshold range from a signal intensity opacity chart of volume-rendering data set, several high signal intensity areas were depicted and assigned to different colors, transparently through contours of the brain. This imaging was applied in a case of a recanalized middle cerebral artery (M2) occlusion with partially reversible ischemic parenchyma accompanied by partial recovery from ischemic neurological deficit. Complex and dynamic change in hyperacute ischemic parenchyma, with regression of subtle high signal intensity areas and progression of ischemic parenchyma, was depicted three-dimensionally. Transparent color-coded 3D DW MR imaging may provide computer-aided numerical analysis of hyperacute ischemic stroke appearing as a high signal intensity area on the source DW images.
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Affiliation(s)
- T Satoh
- Department of Neurological Surgery, Ryofukai Satoh Neurosurgical Hospital, 5-23-23 Matsunaga, Fukuyama, Hiroshima 729-0104, Japan.
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Bammer R, Skare S, Newbould R, Liu C, Thijs V, Ropele S, Clayton DB, Krueger G, Moseley ME, Glover GH. Foundations of advanced magnetic resonance imaging. Neurotherapeutics 2005. [DOI: 10.1007/bf03206665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Boada FE, LaVerde G, Jungreis C, Nemoto E, Tanase C, Hancu I. Loss of cell ion homeostasis and cell viability in the brain: what sodium MRI can tell us. Curr Top Dev Biol 2005; 70:77-101. [PMID: 16338338 DOI: 10.1016/s0070-2153(05)70004-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
This chapter demonstrates the use of sodium magnetic resonance imaging (MRI) as a noninvasive, in vivo means to assess metabolic changes that ensue from loss of cell ion homeostasis due to cell death in the brain. The chapter is organized in two sections. In the first section, the constraints imposed on the imaging methods by the nuclear magnetic resonance (NMR) properties of the sodium ion are discussed and strategies for avoiding their potential limitations are addressed. The second section illustrates the use of sodium MRI for monitoring focal brain ischemia in permanent and temporary primate models of endovascular middle cerebral artery occlusion.
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Affiliation(s)
- Fernando E Boada
- Magnetic Resonance Research Center, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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