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Frisoni GB, Festari C, Massa F, Cotta Ramusino M, Orini S, Aarsland D, Agosta F, Babiloni C, Borroni B, Cappa SF, Frederiksen KS, Froelich L, Garibotto V, Haliassos A, Jessen F, Kamondi A, Kessels RP, Morbelli SD, O'Brien JT, Otto M, Perret-Liaudet A, Pizzini FB, Vandenbulcke M, Vanninen R, Verhey F, Vernooij MW, Yousry T, Boada Rovira M, Dubois B, Georges J, Hansson O, Ritchie CW, Scheltens P, van der Flier WM, Nobili F. European intersocietal recommendations for the biomarker-based diagnosis of neurocognitive disorders. Lancet Neurol 2024; 23:302-312. [PMID: 38365381 DOI: 10.1016/s1474-4422(23)00447-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 02/18/2024]
Abstract
The recent commercialisation of the first disease-modifying drugs for Alzheimer's disease emphasises the need for consensus recommendations on the rational use of biomarkers to diagnose people with suspected neurocognitive disorders in memory clinics. Most available recommendations and guidelines are either disease-centred or biomarker-centred. A European multidisciplinary taskforce consisting of 22 experts from 11 European scientific societies set out to define the first patient-centred diagnostic workflow that aims to prioritise testing for available biomarkers in individuals attending memory clinics. After an extensive literature review, we used a Delphi consensus procedure to identify 11 clinical syndromes, based on clinical history and examination, neuropsychology, blood tests, structural imaging, and, in some cases, EEG. We recommend first-line and, if needed, second-line testing for biomarkers according to the patient's clinical profile and the results of previous biomarker findings. This diagnostic workflow will promote consistency in the diagnosis of neurocognitive disorders across European countries.
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Affiliation(s)
- Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland; Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
| | - Cristina Festari
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Cotta Ramusino
- Unit of Behavioral Neurology and Dementia Research Center (DRC), IRCCS Mondino Foundation, Pavia, Italy
| | - Stefania Orini
- Alzheimer's Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway; UK Dementia Research Institute, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "V Erspamer", Sapienza University of Rome, Rome, Italy; Hospital San Raffaele of Cassino, Cassino, Italy
| | - Barbara Borroni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Continuity of Care and Frailty, ASST Spedali Civili, Brescia, Italy
| | - Stefano F Cappa
- Centro Ricerca sulle Demenze, IRCCS Mondino Foundation, Pavia, Italy; University Institute for Advanced Studies (IUSS), Pavia, Italy
| | - Kristian S Frederiksen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lutz Froelich
- Department of Geriatric Psychiatry, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Valentina Garibotto
- Laboratory of Neuroimaging and Innovative Molecular Tracers (NIMTlab), Geneva University Neurocenter and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland; CIBM Center for Biomedical Imaging, Geneva, Switzerland
| | | | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany; Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Anita Kamondi
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary; Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Roy Pc Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands; Radboud UMC Alzheimer Center and Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands; Vincent van Gogh Institute for Psychiatry, Venray, Netherlands
| | - Silvia D Morbelli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Markus Otto
- Department of Neurology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | | | - Francesca B Pizzini
- Department of Diagnostic and Public Health, Verona University Hospital, Verona University, Verona, Italy
| | - Mathieu Vandenbulcke
- Department of Neurosciences, KU Leuven, Leuven, Belgium; Department of Geriatric Psychiatry, University Psychiatric Centre KU Leuven, Leuven-Kortenberg, Belgium
| | - Ritva Vanninen
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology-Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Meike W Vernooij
- Department of Epidemiology and Department of Radiology and Nuclear Medicine Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Tarek Yousry
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
| | - Mercè Boada Rovira
- Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Bruno Dubois
- Institut de La Mémoire et de La Maladie d'Alzheimer, Neurology Department, Salpêtrière Hospital, Assistance Publique-Hôpital de Paris, Paris, France; Sorbonne University, Paris, France
| | | | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Western General Hospital, University of Edinburgh, Edinburgh, UK; Brain Health Scotland, Edinburgh, UK
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam Neuroscience-Neurodegeneration, Amsterdam, Netherlands; Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Järvinen I, Launes J, Lipsanen J, Lehto E, Schiavone N, Virta M, Vanninen R, Tuulio-Henriksson A, Hokkanen L. Motor difficulties from childhood to midlife: A 40-year cohort study. Res Dev Disabil 2024; 146:104670. [PMID: 38237252 DOI: 10.1016/j.ridd.2024.104670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/26/2023] [Accepted: 01/04/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND There are few studies of the persistence of childhood motor difficulties (MD) into adulthood. AIMS To investigate the association of childhood MD with motor skills and body mass index (BMI) in midlife. METHODS AND PROCEDURES We studied 324 adults aged 40 from a cohort born in 1971-1974. At age 9, they had undergone the Test of Motor Impairment, used to classify them into groups: childhood MD (cMD), borderline cMD (bcMD), or no cMD. At age 40, participants comprised 23 with cMD, 47 with bcMD, and 254 with no cMD. Participants completed motor tests of balance, manual dexterity, and visuomotor speed, followed by recording of their BMI. OUTCOMES AND RESULTS At age 40, the cMD group performed worse than the no-cMD group on all motor tests (p < .001-.008). The bcMD group had slower visuomotor speed than the no-cMD group (p = .025). The groups differed in BMI (p = .002). Having cMD was associated with obesity in midlife (p < .001). After adjusting for sex, childhood socioeconomic status, and BMI at age 9, both cMD and bcMD were associated with obesity in midlife (p = .015). CONCLUSIONS AND IMPLICATIONS Childhood MD are associated with poor motor skills, overweight, and obesity in midlife. This emphasises the importance of early intervention and follow-up when a child exhibits MD. WHAT THIS PAPER ADDS This prospective longitudinal study presents novel evidence that individuals with a history of comprehensively and objectively assessed childhood motor difficulties (MD) have worse motor skills and a higher risk of obesity in midlife than do those with no childhood MD. There is a growing literature on adults with developmental coordination disorder or a history of MD. There is, however, a scarcity of longitudinal studies of childhood MD that continue beyond early adulthood, into midlife. In a systematic search, we could identify only one longitudinal study of objectively measured childhood MD with a reassessment of motor skills in those same participants in adulthood, and no study with a reassessment after age 20. Furthermore, longitudinal studies of the association of comprehensively and objectively assessed childhood MD with BMI in midlife have been lacking.
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Affiliation(s)
- Ilkka Järvinen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
| | - Jyrki Launes
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jari Lipsanen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Eliisa Lehto
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Nella Schiavone
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Maarit Virta
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Ritva Vanninen
- University of Eastern Finland, Institute of Clinical Medicine, Radiology, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Finland
| | | | - Laura Hokkanen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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Almasarweh S, Sudah M, Okuma H, Joukainen S, Vanninen R, Masarwah A. Specimen tomosynthesis provides no additional value to specimen ultrasound in ultrasound-visible malignant breast lesions. Scand J Surg 2024:14574969241233435. [PMID: 38414158 DOI: 10.1177/14574969241233435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the accuracy and added value of specimen tomosynthesis (ST) to specimen ultrasound (SUS) in margin assessment of excised breast specimens in breast-conserving therapy for non-palpable US-visible breast lesions. MATERIALS Between January 2018 and August 2019, all consecutive patients diagnosed with non-palpable breast cancer visible by ultrasound (US), treated with breast-conserving surgery (BCS) and requiring radiological intraoperative breast specimen assessment, were included in this study. Excised breast specimens were examined with SUS by radiologists blinded to the ST results, and margins smaller than 10 mm were recorded. STs were evaluated retrospectively by experienced radiologists. RESULTS A total of 120 specimens were included. SUS showed a statistically significant correlation with pathological margin measurements, while ST did not and provided no additional information. The odds ratios (ORs) for SUS to predict a positive margin was 3.429 (confidence interval (CI) = 0.548-21.432) using a 10-mm cut-off point and 14.182 (CI = 2.134-94.254) using a 5-mm cut-off point, while the OR for ST were 2.528 (CI = 0.400-15.994) and 3.188 (CI = 0.318-31.998), respectively. CONCLUSIONS SUS was superior in evaluating intraoperative resection margins of US-visible breast resection specimens when compared to ST. Therefore, ST could be considered redundant in applicable situations.
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Affiliation(s)
- Sa'ed Almasarweh
- Department of Obstetrics and Gynaecology
- Essen University Hospital Hufelandstraße 55 45147 Essen Germany
- Diagnostic Imaging Center and Department of Clinical Radiology Kuopio University Hospital Kuopio Finland
- Cancer Center of Eastern Finland University of Eastern Finland Kuopio Finland
| | - Mazen Sudah
- Diagnostic Imaging Center and Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Hidemi Okuma
- Diagnostic Imaging Center and Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Sarianna Joukainen
- Division of Surgery, Department of Plastic Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Diagnostic Imaging Center and Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Amro Masarwah
- Diagnostic Imaging Center and Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
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Hyppönen J, Paanila V, Äikiä M, Koskenkorva P, Könönen M, Vanninen R, Mervaala E, Kälviäinen R, Hakumäki J. Progressive myoclonic epilepsy type 1 (EPM1) patients present with abnormal 1H MRS brain metabolic profiles associated with cognitive function. Neuroimage Clin 2023; 39:103459. [PMID: 37541097 PMCID: PMC10412857 DOI: 10.1016/j.nicl.2023.103459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE Progressive myoclonic epilepsy, type 1A (EPM1, Unverricht-Lundborg disease), is a rare neurodegenerative autosomal recessive disorder characterized by stimulus-sensitive and action myoclonus and tonic-clonic epileptic seizures. Patients develop neurological symptoms, including ataxia, intention tremor, and dysarthria, over time, with relatively limited and nonspecific MRI atrophy findings. The effects of the disease on brain metabolism are largely unknown. METHOD Eighteen EPM1 patients (9 M, 9F) underwent clinical evaluation and neuropsychological testing, which included the assessment of intellectual ability, verbal memory, and psychomotor and executive functions. Magnetic resonance spectroscopy (MRS) and imaging (MRI) were performed on a 1.5 T MRI system. 2D MRS chemical shift imaging (CSI) maps (TE = 270) were obtained from the following regions of the brain: basal ganglia, thalamus, insula, splenium, and occipital white and gray matter, and N-acetyl-aspartate (NAA)-, choline (Cho)-, and lactate (Lac)-to-creatine (Cr) ratios were analyzed. Ten healthy age-and sex-matched subjects (5M, 5F) were used as controls for MRS. RESULTS We found significant brain metabolic changes involving lactate, NAA, and choline, which are widespread in the basal ganglia, thalamic nuclei, insula, and occipital areas of EPM1 patients. Changes, especially in the right insula, basal ganglia, and thalamus, were associated with intellectual abilities and impairment of the psychomotor and executive functions of EPM1 patients. CONCLUSION Multiple brain metabolic alterations suggest the presence of neurodegeneration associated with EPM1 progression. The changes in metabolite ratios are associated with the neurocognitive dysfunction caused by the disease. However, the role of MRS findings in understanding pathophysiology of EPM1 warrants further studies.
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Affiliation(s)
- Jelena Hyppönen
- Department of Clinical Neurophysiology, Epilepsy Center, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Vili Paanila
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Marja Äikiä
- Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Päivi Koskenkorva
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Epilepsy Center, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Reetta Kälviäinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland
| | - Juhana Hakumäki
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland.
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Juntunen A, Määttä S, Könönen M, Kallioniemi E, Niskanen E, Kaarre O, Kivimäki P, Vanninen R, Tolmunen T, Ferreri F, Kekkonen V. Cortical thickness is inversely associated with transcranial magnetic stimulation-evoked N45 potential among young adults whose heavy drinking began in adolescence. Alcohol Clin Exp Res 2023; 47:1341-1351. [PMID: 37526579 DOI: 10.1111/acer.15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Adolescence is a particularly vulnerable stage of development in terms of the deleterious effects of alcohol. Both lower gray matter (GM) volume and greater GABAergic activity have been associated with chronic alcohol consumption during adolescence. However, the association between these measures has not been investigated. METHODS In this exploratory study, we compared 26 young adults with a 10year history of heavy alcohol consumption with 21 controls who used little or no alcohol. Simultaneous transcranial magnetic stimulation and electroencephalography were used to assess transcranial magnetic stimulation-evoked N45 potentials, reflecting a balance between GABAergic inhibition and N-methyl-D-aspartate (NMDA) receptor-mediated glutaminergic excitation in the brain. GM thickness was measured from magnetic resonance images and GM and N45 potentials were then correlated. RESULTS Cortical thickness was significantly lower in several brain regions in the heavy-drinking group than the light-drinking group. The N45 amplitude was significantly larger frontally in the heavy-drinking group. Among heavy drinkers, there were several statistically significant correlations between thinner GM and larger frontal N45 amplitudes that were not detectable in the light-drinking group. The strongest correlations were detected in the frontal and parietal lobes, especially in the left superior frontal gyrus and the left supramarginal gyrus, and in both hemispheres in the superior parietal lobes. CONCLUSIONS These findings show that a thinner cortex and greater inhibitory neurotransmission are correlated in certain brain regions among young, long-term heavy alcohol users. Studies are needed to explore the possible causal mechanisms underlying these effects.
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Affiliation(s)
- Anna Juntunen
- School of Medicine, Faculty of Health, University of Eastern Finland, Kuopio, Finland
| | - Sara Määttä
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Elisa Kallioniemi
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Eini Niskanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Outi Kaarre
- School of Medicine, Faculty of Health, University of Eastern Finland, Kuopio, Finland
- Forensic Psychiatry Clinic of the University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Petri Kivimäki
- School of Medicine, Faculty of Health, University of Eastern Finland, Kuopio, Finland
- Vuosaari Psychiatric Outpatient Clinic, Vuosaari Health and Well-being Centre, City of Helsinki, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Tommi Tolmunen
- School of Medicine, Faculty of Health, University of Eastern Finland, Kuopio, Finland
- Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Florinda Ferreri
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Unit of Clinical Neurophysiology and Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Virve Kekkonen
- School of Medicine, Faculty of Health, University of Eastern Finland, Kuopio, Finland
- Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland
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Lindgren A, Anttila M, Arponen O, Hämäläinen K, Könönen M, Vanninen R, Sallinen H. Dynamic contrast-enhanced MRI to characterize angiogenesis in primary epithelial ovarian cancer: An exploratory study. Eur J Radiol 2023; 165:110925. [PMID: 37320880 DOI: 10.1016/j.ejrad.2023.110925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/02/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Angiogenesis is essential for tumor growth. Currently, there are no established imaging biomarkers to show angiogenesis in tumor tissue. The aim of this prospective study was to evaluate whether semiquantitative and pharmacokinetic DCE-MRI perfusion parameters could be used to assess angiogenesis in epithelial ovarian cancer (EOC). METHOD We enrolled 38 patients with primary EOC treated in 2011-2014. DCE-MRI was performed with a 3.0 T imaging system before the surgical treatment. Two different sizes of ROI were used to evaluate semiquantitative and pharmacokinetic DCE perfusion parameters: a large ROI (L-ROI) covering the whole primary lesion on one plane and a small ROI (S-ROI) covering a small solid, highly enhancing focus. Tissue samples from tumors were collected during the surgery. Immunohistochemistry was used to measure the expression of vascular endothelial growth factor (VEGF), its receptors (VEGFRs) and to analyse microvascular density (MVD) and the number of microvessels. RESULTS VEGF expression correlated inversely with Ktrans (L-ROI, r = -0.395 (p = 0.009), S-ROI, r = -0.390, (p = 0.010)), Ve (L-ROI, r = -0.395 (p = 0.009), S-ROI, r = -0.412 (p = 0.006)) and Vp (L-ROI, r = -0.388 (p = 0.011), S-ROI, r = -0.339 (p = 0.028)) values in EOC. Higher VEGFR-2 correlated with lower DCE parameters Ktrans (L-ROI, r = -0.311 (p = 0.040), S-ROI, r = -0.337 (p = 0.025)) and Ve (L-ROI, r = -0.305 (p = 0.044), S-ROI, r = -0.355 (p = 0.018)). We also found that MVD and the number of microvessels correlated positively with AUC, Peak and WashIn values. CONCLUSIONS We observed that several DCE-MRI parameters correlated with VEGF and VEGFR-2 expression and MVD. Thus, both semiquantitative and pharmacokinetic perfusion parameters of DCE-MRI represent promising tools for the assessment of angiogenesis in EOC.
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Affiliation(s)
- Auni Lindgren
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Obstetrics and Gynaecology, Kuopio, Finland.
| | - Maarit Anttila
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Obstetrics and Gynaecology, Kuopio, Finland
| | - Otso Arponen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Kirsi Hämäläinen
- Department of Pathology and Forensic Medicine, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Clinical Radiology, Kuopio, Finland; Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Hanna Sallinen
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland
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Rydström A, Stephen R, Kåreholt I, Darin Mattsson A, Ngandu T, Lehtisalo J, Bäckman L, Kemppainen N, Rinne J, Sindi S, Soininen H, Vanninen R, Solomon A, Mangialasche F. The Role of Brain Integrity in the Association between Occupational Complexity and Cognitive Performance in Subjects with Increased Risk of Dementia. Gerontology 2023; 69:972-985. [PMID: 37071974 DOI: 10.1159/000530688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/24/2023] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION Mechanisms underlying the positive association between occupational mental demands and late-life cognition are poorly understood. The objective of this study was to assess whether the association between occupational complexity and cognition is related to and moderated by brain integrity in individuals at risk for dementia. Brain integrity was appraised throughout structural measures (magnetic resonance imaging, MRI) and amyloid accumulation (Pittsburgh compound B (PiB)-positron emission tomography, PiB-PET). METHODS Participants from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) neuroimaging sample - MRI (N = 126), PiB-PET (N = 41) - were included in a post hoc cross-sectional analysis. Neuroimaging parameters comprised the Alzheimer's disease signature (ADS) cortical thickness (FreeSurfer 5.3), medial temporal atrophy (MTA), and amyloid accumulation (PiB-PET). Cognition was assessed using the neuropsychological test battery. Occupational complexity with data, people, and substantive complexity were classified through the Dictionary of Occupational Titles. Linear regression models included cognition as dependent variable, and occupational complexity, measures of brain integrity, and their interaction terms as predictors. RESULTS Occupational complexity with data and substantive complexity were associated with better cognition (overall cognition, executive function) when adjusting for ADS and MTA (independent association). Significant interaction effects between occupational complexity and brain integrity were also found, indicating that, for some indicators of brain integrity and cognition (e.g., overall cognition, processing speed), the positive association between occupational complexity and cognition occurred only among persons with higher brain integrity (moderated association). CONCLUSIONS Among individuals at risk for dementia, occupational complexity does not seem to contribute toward resilience against neuropathology. These exploratory findings require validation in larger populations.
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Affiliation(s)
- Anders Rydström
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Department of Neurobiology, Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Ruth Stephen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ingemar Kåreholt
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Department of Neurobiology, Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Institute of Gerontology, School of Health and Welfare, Aging Research Network-Jönköping, Jönköping University, Jönköping, Sweden
| | - Alexander Darin Mattsson
- Aging Research Center, Department of Neurobiology, Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Tiia Ngandu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Welfare, Population Health, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jenni Lehtisalo
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Public Health and Welfare, Population Health, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lars Bäckman
- Aging Research Center, Department of Neurobiology, Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Nina Kemppainen
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Juha Rinne
- Turku PET Centre, Turku University Hospital, Turku, Finland
- InFLAMES Research Flagship Center, University of Turku, Turku, Finland
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neurocenter/Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Department of Neurobiology, Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Reijonen M, Holopainen E, Arponen O, Könönen M, Vanninen R, Anttila M, Sallinen H, Rinta-Kiikka I, Lindgren A. Neoadjuvant chemotherapy induces an elevation of tumour apparent diffusion coefficient values in patients with ovarian cancer. BMC Cancer 2023; 23:299. [PMID: 37005578 PMCID: PMC10068179 DOI: 10.1186/s12885-023-10760-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVES Multiparametric magnetic resonance imaging (mMRI) is the modality of choice in the imaging of ovarian cancer (OC). We aimed to investigate the feasibility of different types of regions of interest (ROIs) in the measurement of apparent diffusion coefficient (ADC) values of diffusion-weighted imaging in OC patients treated with neoadjuvant chemotherapy (NACT). METHODS We retrospectively enrolled 23 consecutive patients with advanced OC who had undergone NACT and mMRI. Seventeen of them had been imaged before and after NACT. Two observers independently measured the ADC values in both ovaries and in the metastatic mass by drawing on a single slice of (1) freehand large ROIs (L-ROIs) covering the solid parts of the whole tumour and (2) three small round ROIs (S-ROIs). The side of the primary ovarian tumour was defined. We evaluated the interobserver reproducibility and statistical significance of the change in tumoural pre- and post-NACT ADC values. Each patient's disease was defined as platinum-sensitive, semi-sensitive, or resistant. The patients were deemed either responders or non-responders. RESULTS The interobserver reproducibility of the L-ROI and S-ROI measurements ranged from good to excellent (ICC range: 0.71-0.99). The mean ADC values were significantly higher after NACT in the primary tumour (L-ROI p < 0.001, S-ROIs p < 0.01), and the increase after NACT was associated with sensitivity to platinum-based chemotherapy. The changes in the ADC values of the omental mass were associated with a response to NACT. CONCLUSION The mean ADC values of the primary tumour increased significantly after NACT in the OC patients, and the amount of increase in omental mass was associated with the response to platinum-based NACT. Our study indicates that quantitative analysis of ADC values with a single slice and a whole tumour ROI placement is a reproducible method that has a potential role in the evaluation of NACT response in patients with OC. TRIAL REGISTRATION Retrospectively registered (institutional permission code: 5302501; date of the permission: 31.7.2020).
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Affiliation(s)
- Milja Reijonen
- Department of Radiology, Tampere University Hospital, Tampere, Finland.
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.
| | - Erikka Holopainen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Otso Arponen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Mervi Könönen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Maarit Anttila
- Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Obstetrics and Gynaecology, University of Eastern Finland, Kuopio, Finland
| | - Hanna Sallinen
- Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland
| | - Irina Rinta-Kiikka
- Department of Radiology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Auni Lindgren
- Department of Gynaecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Obstetrics and Gynaecology, University of Eastern Finland, Kuopio, Finland
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9
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Hannula O, Hällberg V, Meuronen A, Suominen O, Rautiainen S, Palomäki A, Hyppölä H, Vanninen R, Mattila K. Self-reported skills and self-confidence in point-of-care ultrasound: a cross-sectional nationwide survey amongst Finnish emergency physicians. BMC Emerg Med 2023; 23:23. [PMID: 36859177 PMCID: PMC9979460 DOI: 10.1186/s12873-023-00795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The use of point-of-care ultrasound (POCUS) is increasing. Numerous investigators have evaluated the learning curves in POCUS, but there are no published studies on how emergency physicians perceive their own competence level with this skill. METHODS A nationwide survey amongst Finnish emergency physicians was conducted. The respondents reported their use of POCUS and how it has affected their clinical decision-making. The number of POCUS examinations performed was compared to the self-assessed skill level with different applications. Cut-off values were determined for the number of examinations required to acquire a good self-assessed skill level in each POCUS application. The correlation between self-confidence and the self-estimated skill level was analyzed. Several different statistical methods were used, such as Student's t-test, Pearson's correlation test, Loess method and ROC curve analysis. RESULTS A total of 134 out of 253 Finnish emergency medicine specialists and residents (52%) responded to the survey. The most commonly used POCUS applications were POCUS-assisted procedures, pleural effusion and pneumothorax, inferior vena cava and lower extremity deep venous thrombosis. The initial rate of perceived skill acquisition was very steep with the curve flattening with greater skill and more experience. The number of examinations performed to reach a self-assessed good competence varied from seven to 75 with different applications. The lowest cut-off point for self-assessed good competence was obtained for rapid ultrasound for the shock and hypotension-protocol and the highest for focused cardiac examinations. There was an excellent correlation between self-confidence and the self-assessed skill level. CONCLUSIONS The Finnish emergency practitioners' self-assessed development of POCUS skills parallels the previously published learning curves of POCUS. The correlation of self-confidence and the self-assessed skill level was found to be excellent. These findings add information on the development of perceived POCUS skills amongst emergency physicians and could complement a formal performance assessment.
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Affiliation(s)
- Ossi Hannula
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland. .,Emergency Department, Päijät-Häme Social and Health Care District, Lahti, Finland.
| | - Ville Hällberg
- Emergency Department, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Anna Meuronen
- Emergency Department, Helsinki University Hospital, Porvoo, Finland
| | - Olli Suominen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Suvi Rautiainen
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Pihlajalinna Medical Centre Eastern Finland, Kuopio, Finland
| | - Ari Palomäki
- Emergency Department, Kanta-Häme Central Hospital, Hämeenlinna, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Harri Hyppölä
- Emergency Department, South Savo Central Hospital, Mikkeli, Finland
| | - Ritva Vanninen
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Kalle Mattila
- Emergency Department, Turku University Hospital, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
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Holopainen E, Lahtinen O, Könönen M, Anttila M, Vanninen R, Lindgren A. Greater increases in intratumoral apparent diffusion coefficients after chemoradiotherapy predict better overall survival of patients with cervical cancer. PLoS One 2023; 18:e0285786. [PMID: 37167301 PMCID: PMC10174495 DOI: 10.1371/journal.pone.0285786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/28/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE To evaluate whether 1) the intratumoral apparent diffusion coefficients (ADCs) change during cervical cancer treatment and 2) the pretreatment ADC values or their change after treatment predict the treatment outcome or overall survival of patients with cervical cancer. METHODS We retrospectively enrolled 52 patients with inoperable cervical cancer treated with chemoradiotherapy, who had undergone diffusion weighted MRI before treatment and post external beam radiotherapy (EBRT) and concurrent chemotherapy. A subgroup of patients (n = 28) underwent altogether six consecutive diffusion weighted MRIs; 1) pretreatment, 2) post-EBRT and concurrent chemotherapy; 3-5) during image-guided brachytherapy (IGBT) and 6) after completing the whole treatment course. To assess interobserver and intertechnique reproducibility two observers independently measured the ADCs by drawing freehand a large region of interest (L-ROI) covering the whole tumor and three small ROIs (S-ROIs) in areas with most restricted diffusion. RESULTS Reproducibility was equally good for L-ROIs and S-ROIs. The pretreatment ADCs were higher in L-ROIs (883 mm2/s) than in S-ROIs (687 mm2/s, P < 0.001). The ADCs increased significantly between the pretreatment and post-EBRT scans (L-ROI: P < 0.001; S-ROI: P = 0.001). The ADCs remained significantly higher than pretreatment values during the whole IGBT. Using S-ROIs, greater increases in ADCs between pretreatment and post-EBRT MRI predicted better overall survival (P = 0.018). CONCLUSION ADC values significantly increase during cervical cancer treatment. Greater increases in ADC values between pretreatment and post-EBRT predicted better overall survival using S-ROIs. Standardized methods for timing and delineation of ADC measurements are advocated in future studies.
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Affiliation(s)
- Erikka Holopainen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Olli Lahtinen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Mervi Könönen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Maarit Anttila
- Department of Gynecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Obstetrics and Gynecology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Auni Lindgren
- Department of Gynecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Obstetrics and Gynecology, University of Eastern Finland, Kuopio, Finland
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11
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Festari C, Massa F, Cotta Ramusino M, Gandolfo F, Nicolosi V, Orini S, Aarsland D, Agosta F, Babiloni C, Boada M, Borroni B, Cappa S, Dubois B, Frederiksen KS, Froelich L, Garibotto V, Georges J, Haliassos A, Hansson O, Jessen F, Kamondi A, Kessels RPC, Morbelli S, O'Brien JT, Otto M, Perret-Liaudet A, Pizzini FB, Ritchie CW, Scheltens P, Vandenbulcke M, Vanninen R, Verhey F, Vernooij MW, Yousry T, Van Der Flier WM, Nobili F, Frisoni GB. European consensus for the diagnosis of MCI and mild dementia: Preparatory phase. Alzheimers Dement 2022; 19:1729-1741. [PMID: 36209379 DOI: 10.1002/alz.12798] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Etiological diagnosis of neurocognitive disorders of middle-old age relies on biomarkers, although evidence for their rational use is incomplete. A European task force is defining a diagnostic workflow where expert experience fills evidence gaps for biomarker validity and prioritization. We report methodology and preliminary results. METHODS Using a Delphi consensus method supported by a systematic literature review, 22 delegates from 11 relevant scientific societies defined workflow assumptions. RESULTS We extracted diagnostic accuracy figures from literature on the use of biomarkers in the diagnosis of main forms of neurocognitive disorders. Supported by this evidence, panelists defined clinical setting (specialist outpatient service), application stage (MCI-mild dementia), and detailed pre-assessment screening (clinical-neuropsychological evaluations, brain imaging, and blood tests). DISCUSSION The Delphi consensus on these assumptions set the stage for the development of the first pan-European workflow for biomarkers' use in the etiological diagnosis of middle-old age neurocognitive disorders at MCI-mild dementia stages. HIGHLIGHTS Rational use of biomarkers in neurocognitive disorders lacks consensus in Europe. A consensus of experts will define a workflow for the rational use of biomarkers. The diagnostic workflow will be patient-centered and based on clinical presentation. The workflow will be updated as new evidence accrues.
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Affiliation(s)
- Cristina Festari
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matteo Cotta Ramusino
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Federica Gandolfo
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Valentina Nicolosi
- UOC Neurologia, Ospedale Magalini (ULSS 9 - Veneto), Villafranca di Verona (VR), Italy
| | - Stefania Orini
- Alzheimer's Unit - Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
- European DLB Consortium
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- European Academy of Neurology
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
- Hospital San Raffaele of Cassino, Cassino (FR), Italy
- Europe, Middle East and Africa Chapter of the International Federation of Clinical Neurophysiology
| | - Mercè Boada
- Ace Alzheimer Center Barcelona - Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
- European FTLD network
| | - Stefano Cappa
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
- Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- Federation of the European Societies of Neuropsychology
| | - Bruno Dubois
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), ICM, Salpetriere Hospital, AP-HP, University Paris 6, Paris, France
| | - Kristian S Frederiksen
- European Academy of Neurology
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lutz Froelich
- Department of Geriatric Psychiatry, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
- European Alzheimer Disease Consortium
| | - Valentina Garibotto
- NIMTLab, Faculty of Medicine, University of Geneva, Switzerland
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
- Center for Biomedical Imaging, CIBM, Geneva, Switzerland
- European Association of Nuclear Medicine
| | | | - Alexander Haliassos
- ESEAP-Proficiency Testing Scheme for Clinical Laboratories, Athens, Greece
- International Federation of Clinical Chemistry
| | - Oskar Hansson
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmo, Sweden
| | - Frank Jessen
- European Alzheimer Disease Consortium
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Anita Kamondi
- Europe, Middle East and Africa Chapter of the International Federation of Clinical Neurophysiology
- Department of Neurology, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Roy P C Kessels
- Federation of the European Societies of Neuropsychology
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Dept of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - John T O'Brien
- European DLB Consortium
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Markus Otto
- European FTLD network
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Armand Perret-Liaudet
- International Federation of Clinical Chemistry
- Laboratory of Neurobiology, Department of Biochemistry and Molecular Biology, Hospices civils de Lyon; Research and Resources Memory Centre, Lyon, France
- BioRan Team, Centre de Recherche en Neurosciences de Lyon, CNRS UMR5292, INSERM U1028, Lyon, France
| | - Francesca B Pizzini
- Verona University Hospital, Verona University, Dept. of Diagnostic and Public Health, Verona, Italy
- European Union of Medical Specialists
| | - Craig W Ritchie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Brain Health Scotland, Edinburgh, UK
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mathieu Vandenbulcke
- Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Centre KU Leuven, Leuven, Belgium
- European Association of Geriatric Psychiatry
| | - Ritva Vanninen
- European Union of Medical Specialists
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Frans Verhey
- European Association of Geriatric Psychiatry
- Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- European Society of Neuroradiology
| | - Tarek Yousry
- European Society of Neuroradiology
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK
| | - Wiesje M Van Der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
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12
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Joukainen S, Laaksonen E, Vanninen R, Kaarela O, Sudah M. ASO Visual Abstract: Dual-Layer Rotation: A Versatile Therapeutic Mammoplasty Technique. Ann Surg Oncol 2022; 29:6728. [PMID: 35816245 DOI: 10.1245/s10434-022-12113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Sarianna Joukainen
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
| | - Elina Laaksonen
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Outi Kaarela
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Mazen Sudah
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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13
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Kiema M, Sarin JK, Kauhanen SP, Torniainen J, Matikka H, Luoto ES, Jaakkola P, Saari P, Liimatainen T, Vanninen R, Ylä-Herttuala S, Hedman M, Laakkonen JP. Wall Shear Stress Predicts Media Degeneration and Biomechanical Changes in Thoracic Aorta. Front Physiol 2022; 13:934941. [PMID: 35874533 PMCID: PMC9301078 DOI: 10.3389/fphys.2022.934941] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/15/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives: In thoracic aortic aneurysm (TAA) of the ascending aorta (AA), AA is progressively dilating due to the weakening of the aortic wall. Predicting and preventing aortic dissections and ruptures in TAA continues to be challenging, and more accurate assessment of the AA dilatation, identification of high-risk patients, and timing of repair surgery are required. We investigated whether wall shear stress (WSS) predicts pathological and biomechanical changes in the aortic wall in TAA. Methods: The study included 12 patients with bicuspid (BAV) and 20 patients with the tricuspid aortic valve (TAV). 4D flow magnetic resonance imaging (MRI) was performed a day before aortic replacement surgery. Biomechanical and histological parameters, including assessing of wall strength, media degeneration, elastin, and cell content were analyzed from the resected AA samples. Results: WSSs were greater in the outer curves of the AA compared to the inner curves in all TAA patients. WSSs correlated with media degeneration of the aortic wall (ρ = -0.48, p < 0.01), elastin content (ρ = 0.47, p < 0.01), and aortic wall strength (ρ = -0.49, p = 0.029). Subsequently, the media of the outer curves was thinner, more rigid, and tolerated lower failure strains. Failure values were shown to correlate with smooth muscle cell (SMC) density (ρ = -0.45, p < 0.02), and indicated the more MYH10+ SMCs the lower the strength of the aortic wall structure. More macrophages were detected in patients with severe media degeneration and the areas with lower WSSs. Conclusion: The findings indicate that MRI-derived WSS predicts pathological and biomechanical changes in the aortic wall in patients with TAA and could be used for identification of high-risk patients.
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Affiliation(s)
- Miika Kiema
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jaakko K. Sarin
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Medical Physics, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
| | - S. Petteri Kauhanen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Jari Torniainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Hanna Matikka
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Emma-Sofia Luoto
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Pekka Jaakkola
- Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Kuopio, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Timo Liimatainen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Research Unit of Medical Imaging, Physics and Technology, Oulu University Hospital, Oulu, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
- Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Johanna P. Laakkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
- *Correspondence: Johanna P. Laakkonen,
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14
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Niiranen M, Koikkalainen J, Lötjönen J, Selander T, Cajanus A, Hartikainen P, Simula S, Vanninen R, Remes AM. Grey matter atrophy in patients with benign multiple sclerosis. Brain Behav 2022; 12:e2679. [PMID: 35765699 PMCID: PMC9304852 DOI: 10.1002/brb3.2679] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/22/2022] [Accepted: 06/03/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Brain atrophy appears during the progression of multiple sclerosis (MS) and is associated with the disability caused by the disease. METHODS We investigated global and regional grey matter (GM) and white matter (WM) volumes, WM lesion load, and corpus callosum index (CCI), in benign relapsing-remitting MS (BRRMS, n = 35) with and without any treatment and compared those to aggressive relapsing-remitting MS (ARRMS, n = 46). Structures were analyzed by using an automated MRI quantification tool (cNeuro®). RESULTS The total brain and cerebral WM volumes were larger in BRRMS than in ARRMS (p = .014, p = .017 respectively). In BRRMS, total brain volumes, regional GM volumes, and CCI were found similar whether or not disease-modifying treatment (DMT) was used. The total (p = .033), as well as subcortical (p = .046) and deep WM (p = .041) lesion load volumes were larger in BRRMS patients without DMT. Cortical GM volumes did not differ between BRRMS and ARRMS, but the volumes of total brain tissue (p = .014) and thalami (p = .003) were larger in patients with BRRMS compared to ARRMS. A positive correlation was found between CCI and whole-brain volume in both BRRMS (r = .73, p < .001) and ARRMS (r = .80, p < .01). CONCLUSIONS Thalamic volume is the most prominent measure to differentiate BRRMS and ARRMS. Validation of automated quantification of CCI provides an additional applicable MRI biomarker to detect brain atrophy in MS.
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Affiliation(s)
- Marja Niiranen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Cajanus
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Sakari Simula
- Department of Neurology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine - Radiology, University of Eastern Finland, Kuopio, Finland.,Department of Radiology, Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
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15
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Järvinen I, Launes J, Lipsanen J, Virta M, Vanninen R, Lehto E, Schiavone N, Tuulio-Henriksson A, Hokkanen L. No Clinically Relevant Memory Effects in Perinatal Hyperglycemia and Hypoglycemia: A 40-Year Follow-Up of a Small Cohort. Front Public Health 2022; 10:858210. [PMID: 35844845 PMCID: PMC9283869 DOI: 10.3389/fpubh.2022.858210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Maternal diabetes mellitus in pregnancy is associated with impairments in memory functions of the offspring in childhood and adolescence but has not been studied in adulthood. The association of perinatal hypoglycemia with memory has not been studied in adulthood either. The combined sequelae of these two risk factors have not been directly compared. We studied general cognitive ability and memory functions in a prospective follow-up of a cohort born in 1971 to 1974. The sample included participants exposed to prenatal hyperglycemia (n = 24), perinatal hypoglycemia (n = 19), or both (n = 7). It also included controls with no early risks (n = 82). We assessed the participants' Intelligence quotient (IQ), working memory, and immediate and delayed recall of both verbal and visual material at the age of 40. We did not find significant differences in IQ or the memory tests between the groups. We did identify an interaction (p = 0.03) of the early risk with the type of digit span task: compared to the controls, the participants exposed to perinatal hypoglycemia had a larger difference between the forward digit span, a measure of attention, and the backward digit span, a measure of working memory processing (p = 0.022). The interaction remained significant when birth weight was controlled for (p = 0.026). Thus, in this small cohort, prenatal hyperglycemia, perinatal hypoglycemia, and their combination appeared relatively benign disorders. The association of these conditions with neurocognitive impairments in adulthood remains unconfirmed. The significance of the working memory difference needs to be verified with a larger sample.
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Affiliation(s)
- Ilkka Järvinen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jyrki Launes
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jari Lipsanen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Maarit Virta
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Ritva Vanninen
- University of Eastern Finland, Institute of Clinical Medicine, Radiology, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Eliisa Lehto
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Nella Schiavone
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | | | - Laura Hokkanen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- *Correspondence: Laura Hokkanen
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16
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Joukainen S, Laaksonen E, Vanninen R, Kaarela O, Sudah M. Dual-Layer Rotation: A Versatile Therapeutic Mammoplasty Technique. Ann Surg Oncol 2022; 29:6716-6727. [PMID: 35711016 PMCID: PMC9492593 DOI: 10.1245/s10434-022-11977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
Abstract
Background Multifocal or complex breast lesions are a challenge for breast-conserving surgery, particularly surgery in small breasts or those located in the upper inner quadrant. The dual-layer rotation technique exploits the idea of manipulating the skin and glandular tissue in separate layers to fill the resection cavity via vertical mammoplasty if skin excision is not required, except in the central area. Methods The authors performed a retrospective review of consecutive breast cancer patients who underwent DLR mammoplasty between 2017 and 2019 at a single institution. Clinical data, reoperations, surgical complications, delays in adjuvant treatments, and the need for late revisional surgery were evaluated. Aesthetic outcomes were evaluated objectively and subjectively from photographs. Results The study included 46 breasts of 40 patients. Tumors were located in the UIQ (30%, 14/46) or in multiple quadrants (22%, 10/46). One third (33%, 13/40) of the patients had a small breast cup size (A–B). Negative margins were primarily achieved in 45 of the 46 breasts. Major complications occurred in three patients, who needed reoperation, and adjuvant therapy was delayed for one of these patients. Late refinement surgery was needed for two patients. The objective and subjective aesthetic outcomes were good or excellent regardless of the tumor position. Conclusion As a novel oncoplastic approach, DLR mammoplasty offers a one-step procedure to treat selected breast cancer patients with challenging resection defects due to different breast sizes or lesion locations. The technique preserves the breast’s natural appearance.
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Affiliation(s)
- Sarianna Joukainen
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
| | - Elina Laaksonen
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Outi Kaarela
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Mazen Sudah
- Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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17
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Schiavone N, Virta M, Leppämäki S, Launes J, Vanninen R, Tuulio-Henriksson A, Järvinen I, Lehto E, Michelsson K, Hokkanen L. Mortality in individuals with childhood ADHD or subthreshold symptoms - a prospective perinatal risk cohort study over 40 years. BMC Psychiatry 2022; 22:325. [PMID: 35534804 PMCID: PMC9082906 DOI: 10.1186/s12888-022-03967-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is associated with negative life outcomes and recent studies have linked it to increased mortality. These studies have examined nationwide registers or clinic-referred samples and mostly included participants up until the age of 30. No studies have investigated mortality associated with subthreshold levels of ADHD symptoms. Our aim was to analyze mortality in a perinatal risk cohort of 46-year-old adults with childhood ADHD (cADHD) and milder childhood attention problems (including hyperactivity and inattention; cAP) compared with a group with similar birth risks but no or low levels of childhood ADHD symptoms (Non-cAP). Causes of death obtained from a national register were examined. METHODS Mortality was analyzed with Cox proportional hazard models for all-cause mortality, cause-specific mortality (natural and unnatural causes), and age-specific mortality (under and over age 30). All models were adjusted with gender. The total n in the study was 839 (cADHD n = 115; cAP n = 216; Non-cAP n = 508). RESULTS By the age of 46, 11 (9.6%) deaths occurred in the cADHD group, 7 (3.2%) in the cAP group, and 20 (3.9%) in the Non-cAP group. The cADHD group had the highest mortality risk (adjusted hazard ratio = 2.15; 95% CI 1.02, 4.54). Mortality was not elevated in the cAP group (adjusted hazard ratio = 0.72; 95% CI .30, 1.72). Mortality in the cADHD group was mainly attributed to unnatural causes of death (adjusted hazard ratio = 2.82; 95% CI 1.12, 7.12). The mortality risk in the cADHD group was sixfold before age 30 (adjusted hazard ratio = 6.20; 95% CI 1.78, 21.57). CONCLUSIONS Childhood ADHD was associated with a twofold risk of premature death by the age of 46 in this prospective longitudinal cohort study. Our results corroborate previous findings and the morbidity of ADHD. Subthreshold levels of childhood ADHD symptoms were not linked to increased mortality. Our results suggest that mortality risk is higher in young than middle adulthood. Future studies should examine mortality associated with ADHD in different ages in adulthood to identify those in greatest risk of premature death.
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Affiliation(s)
- Nella Schiavone
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
| | - Maarit Virta
- grid.7737.40000 0004 0410 2071Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Sami Leppämäki
- grid.15485.3d0000 0000 9950 5666Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Jyrki Launes
- grid.7737.40000 0004 0410 2071Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Ritva Vanninen
- grid.9668.10000 0001 0726 2490Department of Clinical Radiology, Kuopio University Hospital and School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Annamari Tuulio-Henriksson
- grid.7737.40000 0004 0410 2071Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Ilkka Järvinen
- grid.7737.40000 0004 0410 2071Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Eliisa Lehto
- grid.7737.40000 0004 0410 2071Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Katarina Michelsson
- grid.424592.c0000 0004 0632 3062Children’s Hospital, Helsinki University Hospital, Retired, Helsinki, Finland
| | - Laura Hokkanen
- grid.7737.40000 0004 0410 2071Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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18
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Heikkinen S, Cajanus A, Katisko K, Hartikainen P, Vanninen R, Haapasalo A, Krüger J, Remes AM, Solje E. Brainstem atrophy is linked to extrapyramidal symptoms in frontotemporal dementia. J Neurol 2022; 269:4488-4497. [PMID: 35377014 PMCID: PMC9294011 DOI: 10.1007/s00415-022-11095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022]
Abstract
AbstractExtrapyramidal (EP) symptoms are a known feature in a subpopulation of patients with behavioral variant frontotemporal dementia (bvFTD). Concomitant EP symptoms with FTD-like neuropsychiatric symptoms are also core features in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). This complicates the early diagnosis of these disorders. Our retrospective register study aimed to discover imaging (MRI and FDG-PET) biomarkers to differentiate PSP, CBD, and bvFTD patients with extrapyramidal symptoms (EP +) from bvFTD patients without EP symptoms (EP-). The records of 2751 patients were screened for the diagnoses and presence of EP symptoms. A total of 222 patients were submitted to imaging analysis and applicable imaging data were recovered from 139 patients. Neuroimaging data were analyzed using Freesurfer software. In the whole cohort, EP + patients showed lower volumes of gray matter compared to EP- patients in the putamen (p = 0.002), bilateral globus pallidum (p = 0.002, p = 0.042), ventral diencephalon (p = 0.002) and brain stem (p < 0.001). In the bvFTD subgroup, there was volumetric difference between EP + and EP− patients in the brain stem. FDG-PET scans in the bvFTD patient subgroup showed that EP + patients had comparative hypometabolism of the superior cerebellar peduncle (SCP) and the frontal lobes. We discovered that EP symptoms are linked to brainstem atrophy in bvFTD patients and the whole cohort. Also, evident hypometabolism in the SCP of bvFTD EP + patients was detected as compared to bvFTD EP− patients. This could indicate that the EP symptoms in these diseases have a more caudal origin in the brainstem than in Parkinson’s disease.
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Affiliation(s)
- Sami Heikkinen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), 70211, Kuopio, Finland
| | - Antti Cajanus
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), 70211, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), 70211, Kuopio, Finland
| | | | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine - Radiology, University of Eastern Finland, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, P.O. Box 1627 (Yliopistonranta 1C), 70211, Kuopio, Finland.
- Neuro Center, Kuopio University Hospital, Kuopio, Finland.
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19
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Lepola A, Arponen O, Okuma H, Holli-Helenius K, Junkkari H, Könönen M, Auvinen P, Sudah M, Sutela A, Vanninen R. Association between breast cancer's prognostic factors and 3D textural features of non-contrast-enhanced T1 weighted breast MRI. Br J Radiol 2022; 95:20210702. [PMID: 34826254 PMCID: PMC8822552 DOI: 10.1259/bjr.20210702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The aim of this exploratory study was to evaluate whether three-dimensional texture analysis (3D-TA) features of non-contrast-enhanced T1 weighted MRI associate with traditional prognostic factors and disease-free survival (DFS) of breast cancer. METHODS 3D-T1 weighted images from 78 patients with 81 malignant histopathologically verified breast lesions were retrospectively analysed using standard-size volumes of interest. Grey-level co-occurrence matrix (GLCM)-based features were selected for statistical analysis. In statistics the Mann-Whitney U and the Kruskal-Wallis tests, the Cox proportional hazards model and the Kaplan-Meier method were used. RESULTS Tumours with higher histological grade were significantly associated with higher contrast (1 voxel: p = 0.033, 2 voxels: p = 0.036). All the entropy parameters showed significant correlation with tumour grade (p = 0.015-0.050) but there were no statistically significant associations between other TA parameters and tumour grade. The Nottingham Prognostic Index (NPI) was correlated with contrast and sum entropy parameters. A higher sum variance TA parameter was a significant predictor of shorter DFS. CONCLUSION Texture parameters, assessed by 3D-TA from non-enhanced T1 weighted images, indicate tumour heterogeneity but have limited independent prognostic value. However, they are associated with tumour grade, NPI, and DFS. These parameters could be used as an adjunct to contrast-enhanced TA parameters. ADVANCES IN KNOWLEDGE 3D-TA of non-contrast enhanced T1 weighted breast MRI associates with tumour grade, NPI, and DFS. The use of non-contrast 3D-TA parameters in adjunct with contrast-enhanced 3D-TA parameters warrants further research.
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Affiliation(s)
| | | | | | | | | | - Mervi Könönen
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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20
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Hänninen JJ, Nakajima M, Vanninen A, Hytönen S, Rummukainen J, Koivisto AM, Jääskeläinen JE, Soininen H, Sutela A, Vanninen R, Hiltunen M, Leinonen V, Rauramaa T. Neuropathological findings in possible normal pressure hydro-cephalus: A post-mortem study of 29 cases with lifelines. Free Neuropathol 2022; 3:3-2. [PMID: 37284164 PMCID: PMC10210004 DOI: 10.17879/freeneuropathology-2022-3331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 01/19/2022] [Indexed: 06/08/2023]
Abstract
Aims: There are very few detailed post-mortem studies on idiopathic normal-pressure hydrocephalus (iNPH) and there is a lack of proper neuropathological criteria for iNPH. This study aims to update the knowledge on the neuropathology of iNPH and to develop the neuropathological diagnostic criteria of iNPH. Methods: We evaluated the clinical lifelines and post-mortem findings of 29 patients with possible NPH. Pre-mortem cortical brain biopsies were taken from all patients during an intracranial pressure measurement or a cerebrospinal fluid (CSF) shunt surgery. Results: The mean age at the time of the biopsy was 70±8 SD years and 74±7 SD years at the time of death. At the time of death, 11/29 patients (38%) displayed normal cognition or mild cognitive impairment (MCI), 9/29 (31%) moderate dementia and 9/29 (31%) severe dementia. Two of the demented patients had only scarce neuropathological findings indicating a probable hydrocephalic origin for the dementia. Amyloid-β (Aβ) and hyperphosphorylated τ (HPτ) in the biopsies predicted the neurodegenerative diseases so that there were 4 Aβ positive/low Alzheimer's disease neuropathological change (ADNC) cases, 4 Aβ positive/intermediate ADNC cases, 1 Aβ positive case with both low ADNC and progressive supranuclear palsy (PSP), 1 HPτ/PSP and primary age-related tauopathy (PART) case, 1 Aβ/HPτ and low ADNC/synucleinopathy case and 1 case with Aβ/HPτ and high ADNC. The most common cause of death was due to cardiovascular diseases (10/29, 34%), followed by cerebrovascular diseases or subdural hematoma (SDH) (8/29, 28%). Three patients died of a postoperative intracerebral hematoma (ICH). Vascular lesions were common (19/29, 65%). Conclusions: We update the suggested neuropathological diagnostic criteria of iNPH, which emphasize the rigorous exclusion of all other known possible neuropathological causes of dementia. Despite the first 2 probable cases reported here, the issue of "hydrocephalic dementia" as an independent entity still requires further confirmation. Extensive sampling (with fresh frozen tissue including meninges) with age-matched neurologically healthy controls is highly encouraged.
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Affiliation(s)
- Joni J. Hänninen
- The Department of Pathology, Kuopio University Hospital and the Institute of Clinical Medicine – Pathology, University of Eastern Finland, KuopioFinland
- The Department of Neurosurgery, Kuopio University Hospital and the Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland, KuopioFinland
| | - Madoka Nakajima
- The Department of Neurosurgery, Juntendo University Faculty of Medicine, TokyoJapan
| | - Aleksi Vanninen
- The Department of Pathology, Kuopio University Hospital and the Institute of Clinical Medicine – Pathology, University of Eastern Finland, KuopioFinland
- The Department of Neurosurgery, Kuopio University Hospital and the Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland, KuopioFinland
| | - Santtu Hytönen
- The National Institute for Health and Welfare, Forensic Medicine, KuopioFinland
| | - Jaana Rummukainen
- The Department of Pathology, Kuopio University Hospital, KuopioFinland
| | - Anne Maria Koivisto
- The Department of Neurology, Kuopio University Hospital and the Institute of Clinical Medicine – Neurology, University of Eastern Finland, KuopioFinland
- The Department of Neurosciences, Medical Faculty, University of Helsinki, HelsinkiFinland
- The Department of Geriatrics/Rehabilitation and Internal Medicine, Helsinki University Hospital, HelsinkiFinland
| | - Juha E. Jääskeläinen
- The Department of Neurosurgery, Kuopio University Hospital and the Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland, KuopioFinland
| | - Hilkka Soininen
- The Department of Neurology, Kuopio University Hospital, KuopioFinland
| | - Anna Sutela
- The Department of Radiology, Kuopio University Hospital and the Institute of Clinical Medicine – Radiology, University of Eastern Finland, KuopioFinland
| | - Ritva Vanninen
- The Department of Radiology, Kuopio University Hospital and the Institute of Clinical Medicine – Radiology, University of Eastern Finland, KuopioFinland
| | - Mikko Hiltunen
- The Institute of Biomedicine, University of Eastern Finland, KuopioFinland
| | - Ville Leinonen
- The Department of Neurosurgery, Kuopio University Hospital and the Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland, KuopioFinland
| | - Tuomas Rauramaa
- The Department of Pathology, Kuopio University Hospital and the Institute of Clinical Medicine – Pathology, University of Eastern Finland, KuopioFinland
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21
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Ylä-Herttuala S, Hakulinen M, Poutiainen P, Lötjönen J, Könönen M, Gröhn H, Vanninen R, Mussalo H, Laitinen T, Mervaala E. Decreased Gray-White Matter Contrast of [11C]-PiB Uptake in Cognitively Unimpaired Subjects with Severe Obstructive Sleep Apnea. J Prev Alzheimers Dis 2022; 9:499-506. [PMID: 35841251 DOI: 10.14283/jpad.2022.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Very recently, cognitively normal, middle-aged adults with severe obstructive sleep apnea (OSA) were shown to have regional cortical amyloid-β deposits. In the normal brain, amyloid tracer (e.g., [11C]-PiB) uptake is observed in white matter (WM) but not in cortical gray matter (GM), resulting in clear GM-WM contrast. There are no reports on possible changes in this contrast in severe OSA. OBJECTIVES Evaluate changes in the global [11C]-PiB GM-WM contrast and study if factors reflecting clinical and imaging characteristics are associated with them. DESIGN AND SETTING Cross-sectional imaging study. PARTICIPANTS 19 cognitively intact middle-aged (mean 44 years) patients with severe OSA (Apnea-Hypopnea Index >30/h), carefully selected to exclude any other possible factors that could alter brain health. MEASUREMENTS Detailed neuroimaging (amyloid PET, MRI). Signs of possible alterations in amyloid tracer GM-WM contrast and kinetics were studied with static and dynamic [11C]-PiB PET and WM structures with detailed 3.0T MRI. RESULTS Static [11C]-PiB PET uptake showed significantly decreased GM-WM contrast in 5 out of 19 patients. This was already clearly seen in visual evaluation and also detected quantitatively using retention indexes. Dynamic imaging revealed decreased contrast due to alterations in trace accumulation in the late phase of [11C]-PiB kinetics. Decreased GM-WM contrast in the late phase was global in nature. MRI revealed no corresponding alterations in WM structures. Importantly, decreased GM-WM contrast was associated with smoking (p = 0.007) and higher Apnea-Hypopnea Index (p = 0.001). CONCLUSIONS Severe OSA was associated with decreased GM-WM contrast in amyloid tracer uptake, with significant correlation with clinical parameters of smoking and AHI. The results support and further extend the current understanding of the deleterious effect of severe OSA on proper amyloid clearance, possibly reflecting dysfunction of the brain glymphatic system.
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Affiliation(s)
- S Ylä-Herttuala
- Professor Esa Mervaala, M.D., Ph.D. Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, 70029 KYS, Finland, ORCID ID: 0000-0001-5682-5747, Mobile: +358-44-7113245, , Fax: +358-17-173244
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22
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Korpela T, Kauhanen SP, Kariniemi E, Saari P, Liimatainen T, Jaakkola P, Vanninen R, Hedman M. Flow displacement and decreased wall shear stress might be associated with the growth rate of an ascending aortic dilatation. Eur J Cardiothorac Surg 2021; 61:395-402. [PMID: 34791134 PMCID: PMC8788001 DOI: 10.1093/ejcts/ezab483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Our goal was to evaluate whether four-dimensional (4D) flow magnetic resonance imaging (MRI) can predict the growth rate of dilatation of the ascending aorta (AA) in patients with a tricuspid, normally functioning aortic valve. METHODS In this prospective clinical study, aortic 4D flow MRI was performed at the Kuopio University Hospital on 30 patients diagnosed with AA dilatation (maximum diameter >40 mm) between August 2017 and July 2020. The MRI was repeated after a 1-year follow-up, with AA dimensions and 4D flow parameters analysed retrospectively at both time points. The standard error of measurement was used to assess the statistical significance of the growth rate of AA dilatation. Flow displacement (FD) was transformed to a class-scaled parameter using FD ≥5% as a threshold. RESULTS Statistically significant growth [median 2.1 mm (1.5–2.2 mm); P = 0.03] was detected in 6 male patients (20%); the AA diameter remained unchanged [0.2 mm (−0.3 to 0.9 mm)] in 24 patients (80%). An increased FD at the baseline was associated with significant growth during the 1-year follow-up in the proximal AA. An association was detected between decreased total wall shear stress and significant aortic growth in the inner curve of the sinotubular junction [529 mPa (449–664 mPa) vs 775 mPa (609–944 mPa); P = 0.03] and the anterior side of the proximal aortic arch [356 mPa (305–367 mPa) vs 493 mPa (390–586 mPa); P < 0.001]. CONCLUSIONS FD and decreased wall shear stress seem to be associated with significant growth of AA dilatation at the 1-year follow-up. Thus, 4D flow MRI might be useful in assessing risk for AA diameter growth in patients with a tricuspid aortic valve.
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Affiliation(s)
- Tarmo Korpela
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Finland.,Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Finland
| | - S Petteri Kauhanen
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Elina Kariniemi
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Timo Liimatainen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Pekka Jaakkola
- Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Marja Hedman
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Finland.,Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Finland
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23
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Niukkanen A, Okuma H, Sudah M, Auvinen P, Mannermaa A, Liimatainen T, Vanninen R. Quantitative Three-Dimensional Assessment of the Pharmacokinetic Parameters of Intra- and Peri-tumoural Tissues on Breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging. J Digit Imaging 2021; 34:1110-1119. [PMID: 34508299 PMCID: PMC8555007 DOI: 10.1007/s10278-021-00509-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 07/02/2021] [Accepted: 08/17/2021] [Indexed: 12/27/2022] Open
Abstract
We aimed to assess the feasibility of three-dimensional (3D) segmentation and to investigate whether semi-quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters are associated with traditional prognostic factors for breast cancer. In addition, we evaluated whether both intra-tumoural and peri-tumoural DCE parameters can differentiate the breast cancers that are more aggressive from those that are less aggressive. Consecutive patients with newly diagnosed invasive breast cancer and structural breast MRI (3.0 T) were included after informed consent. Fifty-six patients (mean age, 57 years) with mass lesions of > 7 mm in diameter were included. A semi-automatic image post-processing algorithm was developed to measure 3D pharmacokinetic information from the DCE-MRI images. The kinetic parameters were extracted from time-signal curves, and the absolute tissue contrast agent concentrations were calculated with a reference tissue model. Markedly, higher intra-tumoural and peri-tumoural tissue concentrations of contrast agent were found in high-grade tumours (n = 44) compared to low-grade tumours (n = 12) at every time point (P = 0.006-0.040), providing positive predictive values of 90.6-92.6% in the classification of high-grade tumours. The intra-tumoural and peri-tumoural signal enhancement ratios correlated with tumour grade, size, and Ki67 activity. The intra-observer reproducibility was excellent. We developed a model to measure the 3D intensity data of breast cancers. Low- and high-grade tumours differed in their intra-tumoural and peri-tumoural enhancement characteristics. We anticipate that pharmacokinetic parameters will be increasingly used as imaging biomarkers to model and predict tumour behavior, prognoses, and responses to treatment.
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Affiliation(s)
- A. Niukkanen
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, PO BOX 100, 70029 KYS, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - H. Okuma
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, PO BOX 100, 70029 KYS, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - M. Sudah
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, PO BOX 100, 70029 KYS, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - P. Auvinen
- Institute of Clinical Medicine, School of Medicine, Oncology, University of Eastern Finland, Kuopio, Finland
| | - A. Mannermaa
- Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland
| | - T. Liimatainen
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, PO BOX 100, 70029 KYS, Kuopio, Finland
- Physics and Technology, Research Unit of Medical Imaging, University of Oulu, Oulu, Finland
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - R. Vanninen
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, PO BOX 100, 70029 KYS, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
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24
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Kaipainen AL, Pitkänen J, Haapalinna F, Jääskeläinen O, Jokinen H, Melkas S, Erkinjuntti T, Vanninen R, Koivisto AM, Lötjönen J, Koikkalainen J, Herukka SK, Julkunen V. A novel CT-based automated analysis method provides comparable results with MRI in measuring brain atrophy and white matter lesions. Neuroradiology 2021; 63:2035-2046. [PMID: 34389887 PMCID: PMC8589740 DOI: 10.1007/s00234-021-02761-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
Purpose Automated analysis of neuroimaging data is commonly based on magnetic resonance imaging (MRI), but sometimes the availability is limited or a patient might have contradictions to MRI. Therefore, automated analyses of computed tomography (CT) images would be beneficial. Methods We developed an automated method to evaluate medial temporal lobe atrophy (MTA), global cortical atrophy (GCA), and the severity of white matter lesions (WMLs) from a CT scan and compared the results to those obtained from MRI in a cohort of 214 subjects gathered from Kuopio and Helsinki University Hospital registers from 2005 - 2016. Results The correlation coefficients of computational measures between CT and MRI were 0.9 (MTA), 0.82 (GCA), and 0.86 (Fazekas). CT-based measures were identical to MRI-based measures in 60% (MTA), 62% (GCA) and 60% (Fazekas) of cases when the measures were rounded to the nearest full grade variable. However, the difference in measures was 1 or less in 97–98% of cases. Similar results were obtained for cortical atrophy ratings, especially in the frontal and temporal lobes, when assessing the brain lobes separately. Bland–Altman plots and weighted kappa values demonstrated high agreement regarding measures based on CT and MRI. Conclusions MTA, GCA, and Fazekas grades can also be assessed reliably from a CT scan with our method. Even though the measures obtained with the different imaging modalities were not identical in a relatively extensive cohort, the differences were minor. This expands the possibility of using this automated analysis method when MRI is inaccessible or contraindicated. Supplementary Information The online version contains supplementary material available at 10.1007/s00234-021-02761-4.
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Affiliation(s)
- Aku L Kaipainen
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland.
- Neurosurgery of NeuroCenter, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland.
| | - Johanna Pitkänen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Fanni Haapalinna
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
| | - Olli Jääskeläinen
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
| | - Hanna Jokinen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Timo Erkinjuntti
- Department of Neurology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
- University of Eastern Finland, Institute of Clinical Medicine / Radiology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
| | - Anne M Koivisto
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
- Department of Neurosciences, Department of Geriatrics / Rehabilitation and Internal Medicine, University of Helsinki, Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Jyrki Lötjönen
- Combinostics Oy, Hatanpään valtatie 24, 33100, Tampere, Finland
| | | | - Sanna-Kaisa Herukka
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
| | - Valtteri Julkunen
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
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Kauhanen SP, Saari P, Korpela T, Liimatainen T, Vanninen R, Hedman M. Excess of visceral adipose tissue with or without aortic elongation leads to a steeper heart position. Acta Radiol 2021; 63:1157-1165. [PMID: 34304632 DOI: 10.1177/02841851211034053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The heart's position determined as the heart-aorta angle (HAA) has been demonstrated to associate with ascending aortic (AA) dilatation. Visceral adipose tissue (VAT) and aortic elongation may shift the heart to the steeper position. PURPOSE To investigate whether VAT and aortic length influence the HAA. MATERIAL AND METHODS We examined 346 consecutive patients (58.4% men; mean age = 67.0 ± 14.1 years) who underwent aortic computed tomography angiography (CTA). HAA was measured as the angle between the long axis of the heart and AA midline. The amount of VAT was measured at the level of middle L4 vertebra from a single axial CT slice. Aortic length was measured by combining four anatomical segments in different CTA images. The amount of VAT and aortic length were determined as mild with values in the lowest quartile and as excessive with values in the other three quartiles. RESULTS A total of 191 patients (55.2%) had no history of aortic diseases, 134 (38.7%) displayed AA dilatation, 8 (2.3%) had abdominal aortic aneurysm (AAA), and 13 (3.8%) had both AA dilatation and AAA. There was a strong nonlinear regression between smaller HAA and VAT/height, and HAA and aortic length/height. Median HAA was 124.2° (interquartile range 119.0°-130.8°) in patients with a mild amount of VAT versus 120.5° (interquartile range 115.4°-124.7°) in patients with excessive VAT (P < 0.001). CONCLUSION An excessive amount of VAT and aortic elongation led to a steeper heart position. These aspects may possess clinical value when evaluating aortic diseases in obese patients.
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Affiliation(s)
- S Petteri Kauhanen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Tarmo Korpela
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Timo Liimatainen
- Research Unit of Medical Imaging, University of Oulu, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu University Hospital, Oulu, Finland
| | - Ritva Vanninen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
- Department of Cardiothoracic Surgery, Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland
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Gudhe NR, Behravan H, Sudah M, Okuma H, Vanninen R, Kosma VM, Mannermaa A. Multi-level dilated residual network for biomedical image segmentation. Sci Rep 2021; 11:14105. [PMID: 34238940 PMCID: PMC8266898 DOI: 10.1038/s41598-021-93169-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/22/2021] [Indexed: 11/08/2022] Open
Abstract
We propose a novel multi-level dilated residual neural network, an extension of the classical U-Net architecture, for biomedical image segmentation. U-Net is the most popular deep neural architecture for biomedical image segmentation, however, despite being state-of-the-art, the model has a few limitations. In this study, we suggest replacing convolutional blocks of the classical U-Net with multi-level dilated residual blocks, resulting in enhanced learning capability. We also propose to incorporate a non-linear multi-level residual blocks into skip connections to reduce the semantic gap and to restore the information lost when concatenating features from encoder to decoder units. We evaluate the proposed approach on five publicly available biomedical datasets with different imaging modalities, including electron microscopy, magnetic resonance imaging, histopathology, and dermoscopy, each with its own segmentation challenges. The proposed approach consistently outperforms the classical U-Net by 2%, 3%, 6%, 8%, and 14% relative improvements in dice coefficient, respectively for magnetic resonance imaging, dermoscopy, histopathology, cell nuclei microscopy, and electron microscopy modalities. The visual assessments of the segmentation results further show that the proposed approach is robust against outliers and preserves better continuity in boundaries compared to the classical U-Net and its variant, MultiResUNet.
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Affiliation(s)
- Naga Raju Gudhe
- Institute of Clinical Medicine, Pathology and Forensic Medicine, Translational Cancer Research Area, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Hamid Behravan
- Institute of Clinical Medicine, Pathology and Forensic Medicine, Translational Cancer Research Area, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Mazen Sudah
- Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland
| | - Hidemi Okuma
- Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland
- Institute of Clinical Medicine, Radiology, Translational Cancer Research Area, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Veli-Matti Kosma
- Institute of Clinical Medicine, Pathology and Forensic Medicine, Translational Cancer Research Area, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Biobank of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Arto Mannermaa
- Institute of Clinical Medicine, Pathology and Forensic Medicine, Translational Cancer Research Area, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Biobank of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
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27
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Kauhanen SP, Liimatainen T, Korhonen M, Parkkonen J, Vienonen J, Vanninen R, Hedman M. Pulmonary Artery Dilatation Is a Common Finding in a Coronary Artery CT Angiography Population. In Vivo 2021; 35:2177-2185. [PMID: 34182495 DOI: 10.21873/invivo.12489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIM Dilatation of the main pulmonary artery (mPA) is a common incidental finding in chest imaging and often leads to consultation. The aim of this study was to determine the prevalence of mPA dilatation in a coronary artery CT angiography (CCTA) population. PATIENTS AND METHODS The study investigated 985 consecutive patients scheduled for diagnostic CCTA. The transverse axial diameter of the mPA was measured. The prevalence of mPA dilatation was estimated using different reference values (Framingham Heart Study: 28.9 mm for males and 26.9 mm for females, Bozlar: 29.5 mm for both genders and Karazincir: 32.6 mm for males and 31.9 mm for females). RESULTS The patient mean age was 53.0±9.7 years (66.5% were women). Body surface area (BSA) correlated moderately with the mPA diameter (r=0.423, p<0.001). The prevalence of mPA dilatation varied from 5.9% (Karazincir) to 33.7% (Framingham Heart Study) in the overall study population. CONCLUSION The prevalence of mPA dilatation is high in a CCTA patient population when using a cut-off value from the Framingham Heart Study.
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Affiliation(s)
- S Petteri Kauhanen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland; .,Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Kuopio, Finland
| | - Timo Liimatainen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Miika Korhonen
- Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Kuopio, Finland
| | - Johannes Parkkonen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Juska Vienonen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Clinical Imaging Center, Kuopio, Finland.,Department of Cardiothoracic Surgery, Heart Center, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Tuominen H, Taina M, Puranen M, Onatsu J, Huumonen S, Vanninen R. Serum High-Sensitive C-reactive Protein May Reflect Periodontitis in Patients With Stroke. In Vivo 2021; 34:2829-2835. [PMID: 32871821 DOI: 10.21873/invivo.12109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM Chronic infectious diseases are believed to increase the risk of stroke. We aimed to evaluate the prevalence of periodontal disease and its association with systemic inflammatory processes in patients suffering an acute stroke/transient ischemic attack (TIA). PATIENTS AND METHODS Altogether 36 acute stroke/TIA patients underwent clinical, laboratory and radiological examinations. The level of systemic inflammation was analyzed both with routine measurements of plasma C-reactive protein (p-CRP) and serum high-sensitivity CRP (s-hsCRP) to analyze their associations with periodontitis. The diagnostic criteria for periodontitis included increased probing depth (>4 mm) measured from four different sites, bleeding on probing, and horizontal (>1 mm), vertical (>1 mm) or apical bone loss observed on orthopantomography. RESULTS Twenty-six (72.2%) patients were diagnosed with periodontitis. Only five of the patients with periodontitis (19.2%) had elevated p-CRP values whereas the majority, (17/26; 65.4%) had elevated s-hsCRP values (p<0.01). Absolute s-hsCRP values in patients with periodontitis (8.9±12.5 mg/l) were significantly higher than in patients without periodontitis (2.3±3.0 mg/l; p<0.05). Absolute p-CRP concentrations did not differ (2.3±5.8 vs. 2.4±5.1 mg/l; p=not significant). The total number of periodontitis findings was significantly associated with s-hsCRP values (r=1.83) but not with p-CRP values. Conversely, seventeen of the nineteen patients with elevated s-hsCRP (89.5%) indicative of systemic inflammation had periodontitis. CONCLUSION Periodontitis is a common finding among patients with acute stroke/TIA as over 80% of patients with cryptogenic stroke/TIA had periodontitis. S-hsCRP is a useful tool for detecting subclinical systemic inflammation.
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Affiliation(s)
- Hanna Tuominen
- The Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Mikko Taina
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Mirja Puranen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland.,Oral and Maxillofacial Department, Kuopio University Hospital, Kuopio, Finland
| | - Juha Onatsu
- NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Sisko Huumonen
- The Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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Onatsu J, Vanninen R, JÄkÄlÄ P, Mustonen P, Pulkki K, Korhonen M, Hedman M, HÖglund K, Blennow K, Zetterberg H, Herukka SK, Taina M. Tau, S100B and NSE as Blood Biomarkers in Acute Cerebrovascular Events. In Vivo 2021; 34:2577-2586. [PMID: 32871787 DOI: 10.21873/invivo.12075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We aimed to analyze the diagnostic value of total tau (T-tau), S-100 calcium-binding protein B (S100B) and neuron-specific enolase (NSE) as blood-based biomarkers in acute ischemic stroke (AIS) or transient ischemic attack (TIA), and their correlation with symptom severity, infarct size, etiology and outcome. PATIENTS AND METHODS A total of 102 patients with stroke and 35 with TIA were analyzed. Subacute (63.8±50.1 h) plasma T-tau was measured with the single-molecule array (Simoa) method and NSE and S100B were evaluated for comparison. We evaluated biomarkers associations with: (i) diagnosis of AIS or TIA, (ii) cerebral infarction volume in the brain computed tomography, (iii) stroke etiology, (iv) clinical stroke severity and (iv) functional outcome after three months. RESULTS T-tau was higher in patients with stroke [1.0 pg/ml (IQR=0.3-2.2)] than with TIA [0.5 pg/ml (IQR=0.2-1.0), p=0.02]. The levels of S100B were also increased in stroke [0.082 μg/l (IQR=0.049-0.157)] patients compared to TIA patients [0.045 μg/l (IQR=0.03-0.073), p<0.001]. However, when the results were adjusted for confounders, significance was lost. Serum levels of NSE among patients with AIS [11.85 μg/l (IQR=9.30-16.14)] compared to those with TIA [10.96 μg/l (IQR=7.98-15.33), p=0.30] were equal. T-tau and S100B concentrations significantly correlated with cerebral infarction volume (r=0.412, p<0.001) and (r=0.597, p<0.001), also after corrections (p<0.001). mRS scores at three-month follow-up correlated with T-tau (r=0.248, p=0.016) and S100B concentrations (r=0.205, p=0.045). CONCLUSION For the diagnosis of TIA vs. AIS, blood T-tau and S100B concentrations discriminated only modestly. Additionally, groups were not separable after measuring of T-tau and S100B levels in the blood. T-tau and S100B concentrations correlated with the infarct size, but were not alone predictive for functional outcome at 3 months.
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Affiliation(s)
- Juha Onatsu
- Department of Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland .,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Pekka JÄkÄlÄ
- Department of Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pirjo Mustonen
- Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland.,Eastern Finland Laboratory Centre, Kuopio, Finland
| | - Miika Korhonen
- Department of Clinical Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Kina HÖglund
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, U.K.,UK Dementia Research Institute, London, U.K
| | - Sanna-Kaisa Herukka
- Department of Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, University of Eastern Finland, Kuopio, Finland
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30
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Hannula O, Mustonen A, Rautiainen S, Vanninen R, Hyppölä H. Cost-minimization modeling of venous thromboembolism diagnostics: performing limited compression ultrasound in primary health care reduces costs compared to referring patients to a hospital. Ultrasound J 2021; 13:26. [PMID: 34046805 PMCID: PMC8160047 DOI: 10.1186/s13089-021-00227-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this retrospective study was to determine whether diagnosing a deep venous thrombosis (DVT) in primary health care using limited compression ultrasound (LCUS) can save resources compared to referring these patients to hospital. According to the current literature, LCUS is as safe as a standard protocol based on a whole-leg ultrasound (US). Methods We created a standardized patient for this cost-analysis model based on 76 patients that were referred to hospital for a suspected DVT. Travel distance to the health care centre and hospital was calculated based on the home address. Hospital costs were acquired from the hospital price list and Finnish legislation. Time spent in the hospital was retrieved from hospital statistics. Time spent in the health care centre and travelling were estimated and monetized based on average salary. The cost of participating physicians attending a US training course was estimated based on the national average salary of a general practitioner as well as the course participation fee. A cost-minimization modeling was performed for this standardized patient comparing the total costs, including private and public costs, of standard and LCUS strategies. Results The total costs per patient of standard and LCUS pathways were 1151.52€ and 301.94€ [difference 849.59€ (95% CI 800.21€–898.97€, p < 0.001)], respectively. The real-life costs of these strategies, considering that some patients are probably referred to hospital every year and including training costs, are 1151.53€ and 508.69€ [difference 642.84€ (95% CI 541.85€–743.82€)], respectively. Conclusion Using LCUS in diagnosing DVT in primary health care instead of referring these patients to the hospital is shown to save a significant amount of public and private resources. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-021-00227-5.
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Affiliation(s)
| | | | - Suvi Rautiainen
- University of Eastern Finland, Kuopio, Finland.,Pihlajalinna Medical Centre Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Harri Hyppölä
- Emergency Department, South Savo Central Hospital, Mikkeli, Finland
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Stephen R, Ngandu T, Liu Y, Peltonen M, Antikainen R, Kemppainen N, Laatikainen T, Lötjönen J, Rinne J, Strandberg T, Tuomilehto J, Vanninen R, Soininen H, Kivipelto M, Solomon A. Change in CAIDE Dementia Risk Score and Neuroimaging Biomarkers During a 2-Year Multidomain Lifestyle Randomized Controlled Trial: Results of a Post-Hoc Subgroup Analysis. J Gerontol A Biol Sci Med Sci 2021; 76:1407-1414. [PMID: 33970268 PMCID: PMC8277089 DOI: 10.1093/gerona/glab130] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 11/29/2022] Open
Abstract
The CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Risk Score is a validated tool estimating dementia risk. It was previously associated with imaging biomarkers. However, associations between dementia risk scores (including CAIDE) and dementia-related biomarkers have not been studied in the context of an intervention. This study investigated associations between change in CAIDE score and change in neuroimaging biomarkers (brain magnetic resonance imaging [MRI] and Pittsburgh Compound B-positron emission tomography [PiB-PET] measures) during the 2-year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) (post-hoc analyses). FINGER targeted at-risk older adults, aged 60–77 years, from the general population. Participants were randomized to either multidomain intervention (diet, exercise, cognitive training, and vascular risk management) or control group (general health advice). Neuroimaging (MRI and PiB-PET) data from baseline and 2-year visits were used. A toal of 112 participants had repeated brain MRI measures (hippocampal, total gray matter, and white matter lesion volumes, and Alzheimer’s disease signature cortical thickness). Repeated PiB-PET scans were available for 39 participants. Reduction in CAIDE score (indicating lower dementia risk) during the intervention was associated with less decline in hippocampus volume in the intervention group, but not the control group (Randomization group × CAIDE change interaction β coefficient = −0.40, p = .02). Associations for other neuroimaging measures were not significant. The intervention may have benefits on hippocampal volume in individuals who succeed in improving their overall risk level as indicated by a reduction in CAIDE score. This exploratory finding requires further testing and validation in larger studies.
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Affiliation(s)
- Ruth Stephen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tiia Ngandu
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Yawu Liu
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Finland
| | - Markku Peltonen
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Antikainen
- Center for Life Course Health Research/Geriatrics, University of Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and Oulu City Hospital, Finland
| | - Nina Kemppainen
- Division of Clinical Neurosciences, Turku University Hospital, Finland.,Turku PET Centre, University of Turku, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland.,Department of Public Health Solutions, National Institute for Health and Welfare Helsinki, Finland
| | | | - Juha Rinne
- Division of Clinical Neurosciences, Turku University Hospital, Finland.,Turku PET Centre, University of Turku, Finland
| | - Timo Strandberg
- Center for Life Course Health Research/Geriatrics, University of Oulu, Finland.,University of Helsinki, Clinicum, and Helsinki University Hospital, Finland
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, University of Helsinki, Finland.,South Ostrobothnia Central Hospital, Seinäjoki, Finland.,Department of Neurosciences and Preventive Medicine, Danube-University Krems, Austria.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ritva Vanninen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Neurology, Kuopio University Hospital, Finland
| | - Miia Kivipelto
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, UK
| | - Alina Solomon
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden.,Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, UK
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Alanko J, Tanner M, Vanninen R, Auvinen A, Isola J. Triple-negative and HER2-positive breast cancers found by mammography screening show excellent prognosis. Breast Cancer Res Treat 2021; 187:267-274. [PMID: 33420595 PMCID: PMC8062374 DOI: 10.1007/s10549-020-06060-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/15/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Our purpose was to explore the prognosis of aggressive breast cancers of the HER2 oncogene amplification (HER2 +) and triple-negative (TN) subtypes detected by screening, as well as the prognosis of interval cancers (clinically due to symptoms between screening rounds) and cancers in screening nonparticipants. METHODS The study population comprised of 823 breast cancers in women aged 50-69 years from 2006-2014. Of these, 572 were found by screening mammography (69%), 170 were diagnosed between the screening rounds (21%), and 81 were diagnosed in women who did not participate in the screening program (10%). RESULTS The majority of all HER2 + (59%) and TN cancers (57%) in this age group were detected by screening. Screen-detected HER2 + tumors were small (median 12 mm), and node-negative (84%). During a median follow-up of eight years, the distant disease-free survival of screen-detected HER2 + and TN cancers was better than that of interval and nonparticipant cancers (age-adjusted HR = 0.16, 95% CI 0.03-0.81 and HR = 0.09, 95% CI 0.01-0.79, respectively). In nonparticipants, the distant disease-free survival of these cancers was worse than in participants (age-adjusted HR = 2.52, 95% CI 0.63-10.11 and HR = 5.30, 95% 1.16-24.29, respectively). CONCLUSION In the 50-69 age group, the majority of HER2 + and TN cancers can be found by a quality assured population-based mammography screening. Despite their generally aggressive behavior, after a median follow-up of 8 years, distant disease-free survival was over 90% of these cancers detected by screening. The worst prognosis of these cancers was in women who did not participate in screening.
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Affiliation(s)
- Johanna Alanko
- Laboratory of Cancer Biology, Faculty of Medicine and Health Technology, Screening Clinic of Terveystalo, Tampere University, Tampere, Finland.
| | - Minna Tanner
- Department of Oncology, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Centre, Tampere, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, School of Medicine, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
| | - Jorma Isola
- Laboratory of Cancer Biology, Faculty of Medicine and Health Technology, Jilab Inc., Tampere University, Tampere, Finland
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33
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Karhi S, Tähtinen O, Aherto J, Matikka H, Manninen H, Nerg O, Taina M, Jäkälä P, Vanninen R. Effect of different thresholds for CT perfusion volumetric analysis on estimated ischemic core and penumbral volumes. PLoS One 2021; 16:e0249772. [PMID: 33882098 PMCID: PMC8059822 DOI: 10.1371/journal.pone.0249772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/24/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose This single-center study compared three threshold settings for automated analysis of the ischemic core (IC) and penumbral volumes using computed tomographic perfusion, and their accuracy for predicting final infarct volume (FIV) in patients with anterior circulation acute ischemic stroke (AIS). Methods Fifty-two consecutive AIS patients undergoing mechanical thrombectomy (November 2015–March 2018) were included. Perfusion images were retrospectively analyzed using a single CT Neuro perfusion application (syngo.via 4.1, Siemens Healthcare GmbH). Three threshold values (S1–S3) were derived from another commercial package (RAPID; iSchema View) (S1), up-to-date syngo.via default values (S2), and adapted values for syngo.via from a reference study (S3). The results were compared with FIV determined by non-contrast CT. Results The median IC volume (mL) was 24.6 (interquartile range: 13.7–58.1) with S1 and 30.1 (20.1–53.1) with S2/S3. After removing the contralateral hemisphere from the analysis, the median IC volume decreased by 1.33(0–3.14) with S1 versus 9.13 (6.24–14.82) with S2/S3. The median penumbral volume (mL) was 74.52 (49.64–131.91), 77.86 (46.56–99.23), and 173.23 (125.86–200.64) for S1, S2, and S3, respectively. Limiting analysis to the affected hemisphere, the penumbral volume decreased by 1.6 (0.13–9.02), 19.29 (12.59–26.52), and 58.33 mL (45.53–74.84) for S1, S2, and S3, respectively. The correlation between IC and FIV was highest in patients with successful recanalization (n = 34, r = 0.784 for S1; r = 0.797 for S2/S3). Conclusion Optimizing thresholds significantly improves the accuracy of estimated IC and penumbral volumes. Current recommended values produce diversified results. International guidelines based on larger multicenter studies should be established to support the standardization of volumetric analysis in clinical decision-making.
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Affiliation(s)
- Simo Karhi
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- * E-mail:
| | - Olli Tähtinen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Joona Aherto
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Hanna Matikka
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Manninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ossi Nerg
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neuro Center, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pekka Jäkälä
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neuro Center, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Istomin A, Masarwah A, Vanninen R, Okuma H, Sudah M. Diagnostic performance of the Kaiser score for characterizing lesions on breast MRI with comparison to a multiparametric classification system. Eur J Radiol 2021; 138:109659. [PMID: 33752000 DOI: 10.1016/j.ejrad.2021.109659] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the diagnostic performance of the Kaiser score and to compare it with the BI-RADS-based multiparametric classification system (MCS). METHOD Two breast radiologists, blinded to the clinical and pathological information, separately evaluated a database of 499 consecutive patients with structural 3.0 T breast MRI and 697 histopathologically verified lesions. The Kaiser scores and corresponding MCS categories were recorded. The sensitivity and specificity of the Kaiser score and the MCS categories to differentiate benign from malignant lesions were calculated. The interobserver reproducibility and receiver operating characteristic (ROC) parameters were analysed. RESULTS The sensitivity and specificity of the MCS were 100 % and 12 %, respectively, and those of the Kaiser score were 98.5 % and 34.8 % for reader 1 and 98.7 % and 47.5 % for reader 2. The area under the ROC-curve was 85.9 and 87.6 for readers 1 and 2. The interobserver intraclass correlation coefficient was excellent at 0.882. Reader 1 upgraded six lesions from BI-RADS 3 to a Kaiser score of >4, and reader 2 upgraded seven lesions. When applying the Kaiser score to 158 benign lesions readers 1 and 2 would have reduced the biopsy rate by 22.8 % and 35.4 %, respectively. CONCLUSIONS The Kaiser score showed high diagnostic accuracy with excellent interobserver reproducibility. The MCS had perfect sensitivity but low specificity. Although the Kaiser score had slightly lower sensitivity, its specificity was 3-4 times greater than that of the MCS. Thus, the Kaiser score has the potential to considerably reduce the biopsy rate for true negative lesions.
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Affiliation(s)
- Aleksandr Istomin
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
| | - Amro Masarwah
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
| | - Ritva Vanninen
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland; University of Eastern Finland, Cancer Center of Eastern Finland, Kuopio, Finland; University of Eastern Finland, Institute of Clinical Medicine, School of Medicine, Kuopio, Finland
| | - Hidemi Okuma
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
| | - Mazen Sudah
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland; University of Eastern Finland, Cancer Center of Eastern Finland, Kuopio, Finland.
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35
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Nykänen A, Okuma H, Sutela A, Masarwah A, Vanninen R, Sudah M. The mammographic breast density distribution of Finnish women with breast cancer and comparison of breast density reporting using the 4 th and 5 th editions of the Breast Imaging-Reporting and Data System. Eur J Radiol 2021; 137:109585. [PMID: 33607373 DOI: 10.1016/j.ejrad.2021.109585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine the breast density distribution in patients diagnosed with breast cancer in an eastern Finnish population and to examine the changes in breast density reporting patterns between the 4th and 5th editions of the Breast Imaging-Reporting and Data System (BI-RADS). METHOD 821 women (mean age 62.8 ± 12.2 years, range 28-94 years) with breast cancer were included in this retrospective study and their digital mammographic examinations were assessed semi-automatically and then visually by two radiologists in accordance with the 4th and 5th editions of the BI-RADS. Intraclass correlation coefficients (ICCs) were used to evaluate interobserver reproducibility. Chi-square tests were used to examine the associations between the breast density distribution and age or body mass index (BMI). RESULTS Interobserver reproducibility of the visual assessment was excellent, with an ICCr = 0.93. The majority of breast cancers occurred in fatty breasts (93.8 %) when density was assessed according to the 4th edition of the BI-RADS. The distributions remained constant after correction for age and BMI. Using the 5th edition, there was an overall 50.2 % decrease in almost entirely fatty (p < 0.001), 19.4 % increase in scattered fibroglandular (p < 0.001), 28.7 % increase in heterogeneously dense (p < 0.001), and 2.1 % increase in extremely dense (p < 0.001) categories. CONCLUSIONS Most breast cancers in eastern Finland occur in fatty breasts with an area density of < 50 %. Assessing breast density using the 5th edition of the BI-RADS greatly increased denser assessments.
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Affiliation(s)
- Aki Nykänen
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Puijonlaaksontie 2, 70210 Kuopio, Finland; University of Eastern Finland, Institute of Clinical Medicine, School of Medicine, Yliopistonranta 1, 70210 Kuopio, Finland.
| | - Hidemi Okuma
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Anna Sutela
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Amro Masarwah
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Ritva Vanninen
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Puijonlaaksontie 2, 70210 Kuopio, Finland; University of Eastern Finland, Institute of Clinical Medicine, School of Medicine, Yliopistonranta 1, 70210 Kuopio, Finland; University of Eastern Finland, Cancer Center of Eastern Finland, Yliopistonranta 1, 70210 Kuopio, Finland
| | - Mazen Sudah
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Puijonlaaksontie 2, 70210 Kuopio, Finland
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36
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Hannula O, Vanninen R, Rautiainen S, Mattila K, Hyppölä H. Teaching limited compression ultrasound to general practitioners reduces referrals of suspected DVT to a hospital: a retrospective cross-sectional study. Ultrasound J 2021; 13:1. [PMID: 33527170 PMCID: PMC7851247 DOI: 10.1186/s13089-021-00204-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study was to retrospectively determine whether teaching limited compression ultrasound (LCUS) to general practitioners (GP) would reduce the number of patients with a suspected lower extremity DVT referred to a hospital for ultrasound (US) examination. According to the current literature, an LCUS protocol is a safe way to diagnose or exclude lower extremity deep venous thrombosis (DVT) and a good option to radiologist-performed whole-leg ultrasound (US), especially in remote health care units where there may be a limited availability of radiological services. METHODS Between 2015 and 2016, altogether 13 GPs working in the same primary care unit were trained in LCUS for DVT diagnostics. The number of annual referrals due to a suspected DVT from Saarikka primary care unit to the closest hospital was evaluated before and after training. The incidence of DVT was considered to be constant. Thus, the reduction of referrals was attributed to the fact that these patients were diagnosed and treated in primary health care. Incidence rate ratio of hospital referrals was calculated. As a measure of safety, all patients diagnosed with a pulmonary embolism in the nearest hospital were evaluated to determine if they had undergone LCUS by a GP in primary care. RESULTS Before training in 2014, there were 60 annual referrals due to a suspected DVT; in 2017, after training, the number was reduced to 16, i.e., a 73.3% decrease. The incidence of referrals decreased from 3.21 to 0.89 per 1000 person-years. (IRR 3.58, 95% CI 2.04-6.66, p < 0.001). No patient with a pulmonary embolism diagnosis had LCUS performed previously, indicating that there were no false negatives, resulting in pulmonary embolism. CONCLUSIONS Teaching LCUS to GPs can safely reduce the number of patients with a suspected DVT referred to a hospital substantially.
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Affiliation(s)
- Ossi Hannula
- Central Finland Central Hospital, Jyväskylä, Finland. .,University of Eastern Finland, Kuopio, Finland.
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Suvi Rautiainen
- University of Eastern Finland, Kuopio, Finland.,Pihlajalinna Medical Centre Eastern, Kuopio, Finland
| | - Kalle Mattila
- Emergency Department, Turku University Hospital, Turku, Finland.,University of Turku, Turku, Finland
| | - Harri Hyppölä
- Emergency Department, South Savo Central Hospital, Mikkeli, Finland
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37
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Ylä-Herttuala S, Hakulinen M, Poutiainen P, Laitinen TM, Koivisto AM, Remes AM, Hallikainen M, Lehtola JM, Saari T, Korhonen V, Könönen M, Vanninen R, Mussalo H, Laitinen T, Mervaala E. Severe Obstructive Sleep Apnea and Increased Cortical Amyloid-β Deposition. J Alzheimers Dis 2021; 79:153-161. [PMID: 33216027 DOI: 10.3233/jad-200736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The suggested association between severe obstructive sleep apnea (OSA) and risk of Alzheimer's disease (AD) needs further study. Only few recent reports exist on associations between brain amyloid-β (Aβ) burden and severe OSA in middle-aged patients. OBJECTIVE Examine the possible presence of cortical Aβ accumulation in middle-aged patients with severe OSA. METHODS We performed detailed multimodal neuroimaging in 19 cognitive intact patients (mean 44.2 years) with severe OSA (Apnea-Hypopnea Index >30 h-1). Known etiological factors for possible Aβ accumulation were used as exclusion criteria. Aβ uptake was studied with [11C]-PiB-PET, glucose metabolism with [18F]-FDG-PET, and structural imaging with 3.0T MRI. RESULTS When analyzed individually, in [11C]-PiB-PET a substantial number (∼32%) of the patients exhibited statistically significant evidence of increased cortical Aβ uptake based on elevated regional Z-score values, mostly seen bilaterally in the precuneus and posterior cingulum regions. Cortical glucose hypometabolism in [18F]-FDG-PET was seen in two patients. MRI did not show structural changes suggestive of AD-related pathology. CONCLUSION Increased [11C]-PiB uptake was seen in middle-aged cognitively intact patients with severe OSA. These findings are similar to those described in cognitive unimpaired older OSA patients. The changes in cortical Aβ uptake suggest that severe OSA itself may predispose to alterations related to AD already in middle-age. Aβ clearance may be compromised without simultaneous evidence of metabolic or structural alterations. The results emphasize the importance of early diagnostics and proper treatment of severe OSA in cognitively intact middle-aged subjects, possibly diminishing the individual risk for later cognitive dysfunction.
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Affiliation(s)
- Salla Ylä-Herttuala
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hakulinen
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Pekka Poutiainen
- Department of Cyclotron and Radiopharmacy, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Anne M Koivisto
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Neurosciences, University of Helsinki, Helsinki, Finland.,Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
| | - Anne M Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Merja Hallikainen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha-Matti Lehtola
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Toni Saari
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Educational Sciences and Psychology, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Ville Korhonen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Hanna Mussalo
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Neurophysiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Säisänen L, Könönen M, Niskanen E, Lakka T, Lintu N, Vanninen R, Julkunen P, Määttä S. Primary hand motor representation areas in healthy children, preadolescents, adolescents, and adults. Neuroimage 2020; 228:117702. [PMID: 33385558 DOI: 10.1016/j.neuroimage.2020.117702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 01/28/2023] Open
Abstract
The development of the organization of the motor representation areas in children and adolescents is not well-known. This cross-sectional study aimed to provide an understanding for the development of the functional motor areas of the upper extremity muscles by studying healthy right-handed children (6-9 years, n = 10), preadolescents (10-12 years, n = 13), adolescents (15-17 years, n = 12), and adults (22-34 years, n = 12). The optimal representation site and resting motor threshold (rMT) for the abductor pollicis brevis (APB) were assessed in both hemispheres using navigated transcranial magnetic stimulation (nTMS). Motor mapping was performed at 110% of the rMT while recording the EMG of six upper limb muscles in the hand and forearm. The association between the motor map and manual dexterity (box and block test, BBT) was examined. The mapping was well-tolerated and feasible in all but the youngest participant whose rMT exceeded the maximum stimulator output. The centers-of-gravity (CoG) for individual muscles were scattered to the greatest extent in the group of preadolescents and centered and became more focused with age. In preadolescents, the CoGs in the left hemisphere were located more laterally, and they shifted medially with age. The proportion of hand compared to arm representation increased with age (p = 0.001); in the right hemisphere, this was associated with greater fine motor ability. Similarly, there was less overlap between hand and forearm muscles representations in children compared to adults (p<0.001). There was a posterior-anterior shift in the APB hotspot coordinate with age, and the APB coordinate in the left hemisphere exhibited a lateral to medial shift with age from adolescence to adulthood (p = 0.006). Our results contribute to the elucidation of the developmental course in the organization of the motor cortex and its associations with fine motor skills. It was shown that nTMS motor mapping in relaxed muscles is feasible in developmental studies in children older than seven years of age.
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Affiliation(s)
- Laura Säisänen
- Department of Clinical Neurophysiology, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - Mervi Könönen
- Department of Clinical Neurophysiology, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Eini Niskanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Timo Lakka
- Institute of Biomedicine, Faculty of Health Sciences, University of Eastern Finland, Finland; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Niina Lintu
- Institute of Biomedicine, Faculty of Health Sciences, University of Eastern Finland, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine, University of Eastern Finland, Finland; Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Petro Julkunen
- Department of Clinical Neurophysiology, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Sara Määttä
- Department of Clinical Neurophysiology, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland
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Stephen R, Ngandu T, Liu Y, Peltonen M, Antikainen R, Kemppainen N, Laatikainen T, Lötjönen J, Rinne JO, Strandberg T, Tuomilehto J, Vanninen R, Soininen H, Kivipelto M, Solomon A. Change in CAIDE dementia risk score and neuroimaging biomarkers during a 2‐year multidomain lifestyle randomized controlled trial. Alzheimers Dement 2020. [DOI: 10.1002/alz.040879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Tiia Ngandu
- Finnish Institute for Health and Welfare Helsinki Finland
| | - Yawu Liu
- Kuopio University Hospital Kuopio Finland
| | | | | | | | | | - Jyrki Lötjönen
- VTT Technical Research Centre of Finland Ltd Tampere Finland
| | | | | | | | | | - Hilkka Soininen
- Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
| | - Miia Kivipelto
- Karolinska Institutet Center for Alzheimer Research Stockholm Sweden
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Istomin A, Masarwah A, Okuma H, Sutela A, Vanninen R, Sudah M. A multiparametric classification system for lesions detected by breast magnetic resonance imaging. Eur J Radiol 2020; 132:109322. [DOI: 10.1016/j.ejrad.2020.109322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 12/18/2022]
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Almasarweh S, Sudah M, Joukainen S, Okuma H, Vanninen R, Masarwah A. The feasibility of ultrasound-guided vacuum-assisted evacuation of large breast hematomas. Radiol Oncol 2020; 54:311-316. [PMID: 32598321 PMCID: PMC7409600 DOI: 10.2478/raon-2020-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/27/2020] [Indexed: 12/02/2022] Open
Abstract
Background Breast hematoma is an often underrated and disregarded post-procedural complication in the literature. Current treatment modalities are comprised of either surgical or expectant therapy, while percutaneous procedures play a smaller role in their treatment. We aimed to examine the efficacy of vacuum-assisted evacuation (VAE) in the treatment of clinically significant large breast hematomas as an alternative to surgery. Patients and methods We retrospectively analysed patients that underwent breast interventions (surgical and percutaneous), who later developed clinically significant large hematomas and underwent a trial of VAE of hematoma in our hospital within the period of four years. Patient and procedure characteristics were acquired before and after VAE. Success of intervention was based on ≥ 50% clearance of hematoma volume and patients' subjective resolution of symptoms. All patients were followed clinically and by ultrasound if needed at different intervals depending on the severity of presenting symptoms. Results Eleven patients were included in the study. The mean largest diameter of hematomas was 7.9 cm and mean surface area was 32.4 cm2. The mean duration of the procedure was 40.5 min. In all patients VAE of hematoma was implemented successfully with no complications. Control visits showed no major residual hematoma or seroma formation. Conclusions Our results show that VAE of hematoma can be implemented as a safe alternative to surgery in large, clinically significant hematomas, regardless of aetiology or duration. The procedure carries less risk, stress and cost with the added benefit of outpatient treatment when compared to surgical treatment.
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Affiliation(s)
- Sa'ed Almasarweh
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
| | - Mazen Sudah
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
| | - Sarianna Joukainen
- Kuopio University Hospital, Department of Plastic Surgery, Division Surgery, Kuopio, Finland
| | - Hidemi Okuma
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
| | - Ritva Vanninen
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
- University of Eastern Finland, Cancer Center of Eastern Finland, Kuopio, Finland
| | - Amro Masarwah
- Kuopio University Hospital, Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio, Finland
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Okuma H, Sudah M, Kettunen T, Niukkanen A, Sutela A, Masarwah A, Kosma VM, Auvinen P, Mannermaa A, Vanninen R. Peritumor to tumor apparent diffusion coefficient ratio is associated with biologically more aggressive breast cancer features and correlates with the prognostication tools. PLoS One 2020; 15:e0235278. [PMID: 32584887 PMCID: PMC7316248 DOI: 10.1371/journal.pone.0235278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The apparent diffusion coefficient (ADC) is increasingly used to characterize breast cancer. The peritumor/tumor ADC ratio is suggested to be a reliable and generally applicable index. However, its overall prognostication value remains unclear. We aimed to evaluate the associations between the peritumor/tumor ADC ratio and histopathological biomarkers and published prognostic tools in patients with invasive breast cancer. MATERIALS AND METHODS This prospective study included 88 lesions (five bilateral) in 83 patients with primary invasive breast cancer who underwent preoperative 3.0-T magnetic resonance imaging. The lowest intratumoral mean ADC value on the slice with the largest tumor cross-sectional area was designated the tumor ADC, and the highest mean ADC value on the peritumoral breast parenchymal tissue adjacent to the tumor border was designated the peritumor ADC. The peritumor/tumor ADC ratio was then calculated. The tumor and peritumor ADC values and peritumor/tumor ADC ratios were compared with histopathological parameters using an unpaired t test, and their correlations with published prognostic tools were evaluated with Pearson's correlation coefficient. RESULTS The peritumor/tumor ADC ratio was significantly associated with tumor size (p<0.001), histological grade (p = 0.005), Ki-67 index (p = 0.006), axillary-lymph-node metastasis (p = 0.001), and lymphovascular invasion (p = 0.006), but was not associated with estrogen receptor status (p = 0.931), progesterone receptor status (p = 0.160), or human epidermal growth factor receptor 2 status (p = 0.259). The peritumor/tumor ADC ratio showed moderate positive correlations with the Nottingham Prognostic Index (r = 0.498, p<0.001) and mortality predicted using PREDICT (r = 0.436, p<0.001). CONCLUSION The peritumor/tumor ADC ratio was correlated with histopathological biomarkers in patients with invasive breast cancer, showed significant correlations with published prognostic indexes, and may provide an easily applicable imaging index for the preoperative prognostic evaluation of breast cancer.
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Affiliation(s)
- Hidemi Okuma
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- * E-mail:
| | - Mazen Sudah
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Tiia Kettunen
- Institute of Clinical Medicine, School of Medicine, Oncology, University of Eastern Finland, Kuopio, Finland
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Anton Niukkanen
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Anna Sutela
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Amro Masarwah
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Veli-Matti Kosma
- Institute of Clinical Medicine, School of Medicine, Pathology and Forensic Medicine, and Translational Cancer Research Area, University of Eastern Finland, Kuopio, Finland
- Biobank of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Päivi Auvinen
- Institute of Clinical Medicine, School of Medicine, Oncology, University of Eastern Finland, Kuopio, Finland
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Arto Mannermaa
- Institute of Clinical Medicine, School of Medicine, Pathology and Forensic Medicine, and Translational Cancer Research Area, University of Eastern Finland, Kuopio, Finland
- Biobank of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Institute of Clinical Medicine, School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Cajanus A, Katisko K, Kontkanen A, Jääskeläinen O, Hartikainen P, Haapasalo A, Herukka SK, Vanninen R, Solje E, Hall A, Remes AM. Serum neurofilament light chain in FTLD: association with C9orf72, clinical phenotype, and prognosis. Ann Clin Transl Neurol 2020; 7:903-910. [PMID: 32441885 PMCID: PMC7318100 DOI: 10.1002/acn3.51041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The aim of the present study was to compare the levels of serum neurofilament light chain (sNfL) in frontotemporal lobar degeneration (FTLD) patients of different clinical subtypes (bvFTD, PPA, and FTLD‐MND) and with or without the C9orf72 repeat expansion, and to correlate sNfL levels to disease progression, assessed by the brain atrophy rate and survival time. Methods The sNfL levels were determined from 78 FTLD patients (C9orf72 repeat expansion carriers [n = 26] and non‐carriers [n = 52]) with Single Molecule Array (SIMOA). The progression of brain atrophy was evaluated using repeated T1‐weighted MRI scans and the survival time from medical records. Results In the total FTLD cohort, sNfL levels were significantly higher in C9orf72 repeat expansion carriers compared to non‐carriers. Considering clinical phenotypes, sNfL levels were higher in the C9orf72 repeat expansion carriers than in the non‐carriers in bvFTD and PPA groups. Furthermore, sNfL levels were the highest in the FTLD‐MND group (median 105 pg/mL) and the lowest in the bvFTD group (median 27 pg/mL). Higher sNfL levels significantly correlated with frontal cortical atrophy rate and subcortical grey matter atrophy rate. The higher sNfL levels also associated with shorter survival time. Interpretation Our results indicate that the C9orf72 repeat expansion carriers show elevated sNFL levels compared to non‐carriers and that the levels differ among different clinical phenotypes of FTLD. Higher sNfL levels correlated with a shorter survival time and cortical and subcortical atrophy rates. Thus, sNfL could prove as a potential prognostic biomarker in FTLD.
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Affiliation(s)
- Antti Cajanus
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Aleksi Kontkanen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Olli Jääskeläinen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Päivi Hartikainen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anette Hall
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
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Kauhanen SP, Liimatainen T, Kariniemi E, Korhonen M, Parkkonen J, Vienonen J, Vanninen R, Hedman M. A smaller heart-aorta-angle associates with ascending aortic dilatation and increases wall shear stress. Eur Radiol 2020; 30:5149-5157. [PMID: 32323010 PMCID: PMC7431431 DOI: 10.1007/s00330-020-06852-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/10/2020] [Accepted: 03/31/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether the orientation of the heart, measured as an angle between the long axis of the heart and ascending aorta midline (heart-aorta-angle, HAA), associates with ascending aortic (AA) dilatation. Furthermore, the association between HAA and wall shear stress (WSS) was studied. METHODS HAA was retrospectively measured in 1000 consecutive coronary artery computed tomographic angiography (CCTA) images in patients with low-to-moderate pretest probability for coronary artery disease (CAD). To evaluate the effects of HAA on AA flow, 4D flow MRI was performed for 28 patients with AA dilatation (> 40 mm) and WSS was analyzed. RESULTS The mean age of patients undergoing CCTA was 52.9 ± 9.8 years; 66.5% were women. Their median HAA was 128.7° and interquartile range 123.3-134.1°. HAA was significantly smaller in patients with dilated AA (median 126.7° [121.3-130.8°]) compared with the patients with normal AA (median 129.5° [124.3-135.3°], p < 0.001). HAA was smaller in males (p < 0.001) and in patients with diabetes (p = 0.016), hypertension (p = 0.001), CAD (p = 0.003), hypercholesterolemia (p < 0.001), and bicuspid aortic valve (p = 0.025) than without these factors. In a subpopulation without any of these underlying diseases (n = 233), HAA was still significantly smaller in the patients with dilated AA (median 127.9° [124.3-134.3°]) compared with patients with normal AA (median 131.9° [127.6-136.9°], p = 0.013). In 4D flow MRI, a smaller HAA correlated with increased total WSS in the outer curvature of the proximal AA (r = - 0.510, p = 0.006). CONCLUSION A smaller HAA associates with AA dilatation and affects the blood flow in the proximal AA. KEY POINTS • A smaller angle between the long axis of the heart and ascending aorta midline associated with ascending aortic dilatation. • A smaller heart-aorta-angle correlated with increased total wall shear stress in the outer curvature of the proximal ascending aorta.
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Affiliation(s)
- S Petteri Kauhanen
- Doctoral Programme of Clinical Research, University of Eastern Finland, Kuopio, Finland.
- Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Timo Liimatainen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Elina Kariniemi
- Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Miika Korhonen
- Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Johannes Parkkonen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Juska Vienonen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Department of Cardiothoracic Surgery, Heart Center, Kuopio University Hospital, Kuopio, Finland
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Kaipainen A, Jääskeläinen O, Liu Y, Haapalinna F, Nykänen N, Vanninen R, Koivisto AM, Julkunen V, Remes AM, Herukka SK. Cerebrospinal Fluid and MRI Biomarkers in Neurodegenerative Diseases: A Retrospective Memory Clinic-Based Study. J Alzheimers Dis 2020; 75:751-765. [PMID: 32310181 PMCID: PMC7369056 DOI: 10.3233/jad-200175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) biomarkers of neurodegenerative diseases are relatively sensitive and specific in highly curated research cohorts, but proper validation for clinical use is mostly missing. OBJECTIVE We studied these biomarkers in a novel memory clinic cohort with a variety of different neurodegenerative diseases. METHODS This study consisted of 191 patients with subjective or objective cognitive impairment who underwent neurological, CSF biomarker (Aβ42, p-tau, and tau) and T1-weighted MRI examinations at Kuopio University Hospital. We assessed CSF and imaging biomarkers, including structural MRI focused on volumetric and cortical thickness analyses, across groups stratified based on different clinical diagnoses, including Alzheimer's disease (AD), frontotemporal dementia, dementia with Lewy bodies, Parkinson's disease, vascular dementia, and mild cognitive impairment (MCI), and subjects with no evidence of neurodegenerative disease underlying the cognitive symptoms. Imaging biomarkers were also studied by profiling subjects according to the novel amyloid, tau, and, neurodegeneration (AT(N)) classification. RESULTS Numerous imaging variables differed by clinical diagnosis, including hippocampal, amygdalar and inferior lateral ventricular volumes and entorhinal, lingual, inferior parietal and isthmus cingulate cortical thicknesses, at a false discovery rate (FDR)-corrected threshold for significance (analysis of covariance; p < 0.005). In volumetric comparisons by AT(N) profile, hippocampal volume significantly differed (p < 0.001) between patients with normal AD biomarkers and patients with amyloid pathology. CONCLUSION Our analysis suggests that CSF and MRI biomarkers function well also in clinical practice across multiple clinical diagnostic groups in addition to AD, MCI, and cognitively normal groups.
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Affiliation(s)
- Aku Kaipainen
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
| | - Olli Jääskeläinen
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
| | - Yawu Liu
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Fanni Haapalinna
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
| | - Niko Nykänen
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M. Koivisto
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Valtteri Julkunen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M. Remes
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | - Sanna-Kaisa Herukka
- University of Eastern Finland, Institute of Clinical Medicine/Neurology, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
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Shen Q, Heikkinen N, Kärkkäinen O, Gröhn H, Könönen M, Liu Y, Kaarre O, Zhang Z, Tan C, Tolmunen T, Vanninen R. Effects of long-term adolescent alcohol consumption on white matter integrity and their correlations with metabolic alterations. Psychiatry Res Neuroimaging 2019; 294:111003. [PMID: 31726326 DOI: 10.1016/j.pscychresns.2019.111003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/28/2022]
Abstract
Alcohol-related white matter (WM) microstructural changes have not been fully elucidated in adolescents. We aimed to investigate influences of subclinical alcohol use during adolescence on WM microstructure and to characterize those with serum metabolic alterations. 35 moderate-to-heavy drinkers (15 males, 20 females) and 27 controls (12 males, 15 females) were selected based on their ten-year Alcohol Use Disorders Identification Test scores measured at three time points. Magnetic resonance imaging was conducted at endpoint time. Whole brain analysis of fractional anisotropy (FA) was performed. Diffusivity indices in the significant regions were computed for between-group comparisons and correlation analyses with serum metabolite concentrations. Decreased FA was found in moderate-to-heavy drinking men in anterior corpus callosum, superior/anterior corona radiata and right inferior fronto-occipital fasciculus, accompanied by increased radial diffusivity and a smaller area of reduced axial diffusivity, which correlated with serum metabolites playing roles in energy metabolism, myelination and axonal degeneration. No significant difference in FA was detected between female or mixed-gender moderate-to-heavy drinking subjects and controls, supporting gender differences in the relationship between adolescent alcohol use and neurodevelopmental trajectories. Future researches with longitudinal imaging data are warranted for comprehensive evaluation on potentially reversible effects of alcohol use over adolescent brain.
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Affiliation(s)
- Qin Shen
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, China; Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Noora Heikkinen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Doctoral Programme of Clinical Research, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Olli Kärkkäinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Heidi Gröhn
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
| | - Yawu Liu
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Department of Neurology, University of Kuopio, Kuopio, Finland
| | - Outi Kaarre
- Doctoral Programme of Clinical Research, School of Medicine, University of Eastern Finland, Kuopio, Finland; Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Zishu Zhang
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Changlian Tan
- Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Tommi Tolmunen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Department of Psychiatry, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Radiology, School of Medicine, University of Eastern Finland, Kuopio, Finland.
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47
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Korhonen VE, Remes AM, Helisalmi S, Rauramaa T, Sutela A, Vanninen R, Suhonen NM, Haapasalo A, Hiltunen M, Jääskeläinen JE, Soininen H, Koivisto AM, Leinonen V. Prevalence of C9ORF72 Expansion in a Large Series of Patients with Idiopathic Normal-Pressure Hydrocephalus. Dement Geriatr Cogn Disord 2019; 47:91-103. [PMID: 30861516 DOI: 10.1159/000497306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The C9ORF72 expansion is known to cause frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS). We aim to identify the prevalence of the C9ORF72 expansion in idiopathic normal pressure hydrocephalus (iNPH). METHODS We analysed the C9ORF72 expansion in a large cohort of patients with possible iNPH (n = 487) and cognitively intact elderly controls (n = 432; age > 65 years). RESULTS While the C9ORF72 expansion was detected in 1.6% (n = 8/487) of cases with possible iNPH, no control subject was found to carry the mutation. The mean age at onset of symptoms of C9ORF72 expansion carriers was 59 years (range: 52-67 years), 11 years less than non-carriers (p = 0.0002). The most frequent initial/main symptom pertained to gait difficulties. Despite identified mutation, only 3 of the patients fulfilled the criteria for the FTLD-ALS spectrum. Clinically significant shunt response was detected in 6 out of 7 shunted C9ORF72 expansion carriers. CONCLUSION This is the first study cohort identifying the underlying C9ORF72 expansion in patients with iNPH providing evidence for the potential comorbidity between iNPH and the FTLD-ALS spectrum. Analysis of the C9ORF72 expansion should be considered for patients with probable iNPH presenting with frontal atrophy and personality changes or other severe psychiatric symptoms.
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Affiliation(s)
- Ville E Korhonen
- Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland,
| | - Anne M Remes
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Seppo Helisalmi
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Rauramaa
- Institute of Clinical Medicine - Pathology, School of Medicine, University of Eastern Finland and Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Anna Sutela
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Noora-Maria Suhonen
- Medical Research Center, Oulu University Hospital, Oulu, Finland.,Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Annakaisa Haapasalo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anne M Koivisto
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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48
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Tiainen S, Masarwah A, Oikari S, Rilla K, Hämäläinen K, Sudah M, Sutela A, Vanninen R, Ikonen J, Tammi R, Tammi M, Auvinen P. Tumor microenvironment and breast cancer survival: combined effects of breast fat, M2 macrophages and hyaluronan create a dismal prognosis. Breast Cancer Res Treat 2019; 179:565-575. [PMID: 31720917 PMCID: PMC6997252 DOI: 10.1007/s10549-019-05491-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 11/05/2019] [Indexed: 12/30/2022]
Abstract
Purpose Tumor microenvironment, including inflammatory cells, adipocytes and extracellular matrix constituents such as hyaluronan (HA), impacts on cancer progression. Systemic metabolism also influences tumor growth e.g. obesity and type 2 diabetes (T2D) are risk factors for breast cancer. Here, in 262 breast cancer cases, we explored the combined impacts on survival of M2-like tumor associated macrophages (TAMs), the abundance of breast fat visualized as low density in mammograms, and tumor HA, and their associations with T2D. Methods Mammographic densities were assessed visually from the diagnostic images and dichotomized into very low density (VLD, density ≤ 10%, “fatty breast”) and mixed density (MID, density > 10%). The amounts of TAMs (CD163+ and CD68+) and tumor HA were determined by immunohistochemistry. The data of T2D was collected from the patient records. Statistical differences between the parameters were calculated with Chi square or Mann–Whitney test and survival analyses with Cox’s model. Results A combination of fatty breasts (VLD), abundance of M2-like TAMs (CD163+) and tumor HA associated with poor survival, as survival was 88–89% in the absence of these factors but only 40–47% when all three factors were present (p < 0.001). Also, an association between T2D and fatty breasts was found (p < 0.01). Furthermore, tumors in fatty breasts contained more frequently high levels of M2-like TAMs than tumors in MID breasts (p = 0.01). Conclusions Our results demonstrate a dramatic effect of the tumor microenvironment on breast cancer progression. We hypothesize that T2D as well as obesity increase the fat content of the breasts, subsequently enhancing local pro-tumoral inflammation. Electronic supplementary material The online version of this article (10.1007/s10549-019-05491-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Satu Tiainen
- Cancer Center, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland. .,Institute of Clinical Medicine, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Amro Masarwah
- Imaging Center, Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland
| | - Sanna Oikari
- Institute of Biomedicine, University of Eastern Finland, P.O.Box 1627, 70211, Kuopio, Finland
| | - Kirsi Rilla
- Institute of Biomedicine, University of Eastern Finland, P.O.Box 1627, 70211, Kuopio, Finland
| | - Kirsi Hämäläinen
- Imaging Center, Clinical Pathology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland.,Institute of Clinical Medicine, Clinical Pathology and Forensic Medicine, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Biocenter Kuopio and Cancer Center of Eastern Finland, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Mazen Sudah
- Imaging Center, Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland
| | - Anna Sutela
- Imaging Center, Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland
| | - Ritva Vanninen
- Imaging Center, Clinical Radiology, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland.,Institute of Clinical Medicine, Clinical Radiology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Juho Ikonen
- Cancer Center, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Raija Tammi
- Institute of Biomedicine, University of Eastern Finland, P.O.Box 1627, 70211, Kuopio, Finland
| | - Markku Tammi
- Institute of Biomedicine, University of Eastern Finland, P.O.Box 1627, 70211, Kuopio, Finland
| | - Päivi Auvinen
- Cancer Center, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
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49
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Schiavone N, Virta M, Leppämäki S, Launes J, Vanninen R, Tuulio-Henriksson A, Immonen S, Järvinen I, Lehto E, Michelsson K, Hokkanen L. ADHD and subthreshold symptoms in childhood and life outcomes at 40 years in a prospective birth-risk cohort. Psychiatry Res 2019; 281:112574. [PMID: 31590105 DOI: 10.1016/j.psychres.2019.112574] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 12/27/2022]
Abstract
We investigated ADHD symptoms and life outcomes in adulthood and their association with childhood ADHD and subthreshold symptoms in a prospectively followed cohort with perinatal risks. We identified participants with childhood ADHD (cADHD, n = 37), subthreshold symptoms defined as attention problems (cAP, n = 64), and no ADHD or cAP (Non-cAP, n = 217). We compared the groups and a control group with no perinatal risks (n = 64) on self-reported ADHD symptoms, executive dysfunction, and life outcomes in adulthood. At age 40, 21.6% of the cADHD, 6.3% of the cAP, 6.0% of the Non-cAP group, and 1.6% of the controls reached a screener cutoff for possible ADHD. The cADHD group had lower educational level, more ADHD symptoms and executive dysfunction, and higher rates of drug use than the other groups. Childhood ADHD associated with perinatal risks persists into midlife whereas childhood subthreshold ADHD symptoms in this cohort were not associated with negative outcomes in adulthood.
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Affiliation(s)
- Nella Schiavone
- Department of Psychology and Logopedics, University of Helsinki, P.O. Box 21, Helsinki 00014, Finland.
| | - Maarit Virta
- Department of Psychology and Logopedics, University of Helsinki, P.O. Box 21, Helsinki 00014, Finland
| | - Sami Leppämäki
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Jyrki Launes
- Department of Psychology and Logopedics, University of Helsinki, P.O. Box 21, Helsinki 00014, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital and School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | | | - Satu Immonen
- Department of Psychology and Logopedics, University of Helsinki, P.O. Box 21, Helsinki 00014, Finland
| | - Ilkka Järvinen
- Department of Psychology and Logopedics, University of Helsinki, P.O. Box 21, Helsinki 00014, Finland
| | - Eliisa Lehto
- Department of Psychology and Logopedics, University of Helsinki, P.O. Box 21, Helsinki 00014, Finland
| | - Katarina Michelsson
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland, Retired
| | - Laura Hokkanen
- Department of Psychology and Logopedics, University of Helsinki, P.O. Box 21, Helsinki 00014, Finland
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50
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Cajanus A, Solje E, Koikkalainen J, Lötjönen J, Suhonen NM, Hallikainen I, Vanninen R, Hartikainen P, de Marco M, Venneri A, Soininen H, Remes AM, Hall A. The Association Between Distinct Frontal Brain Volumes and Behavioral Symptoms in Mild Cognitive Impairment, Alzheimer's Disease, and Frontotemporal Dementia. Front Neurol 2019; 10:1059. [PMID: 31632342 PMCID: PMC6786130 DOI: 10.3389/fneur.2019.01059] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/19/2019] [Indexed: 11/28/2022] Open
Abstract
Our aim was to investigate the association between behavioral symptoms of agitation, disinhibition, irritability, elation, and aberrant motor behavior to frontal brain volumes in a cohort with various neurodegenerative diseases. A total of 121 patients with mild cognitive impairment (MCI, n = 58), Alzheimer's disease (AD, n = 45) and behavioral variant frontotemporal dementia (bvFTD, n = 18) were evaluated with a Neuropsychiatric Inventory (NPI). A T1-weighted MRI scan was acquired for each participant and quantified with a multi-atlas segmentation method. The volumetric MRI measures of the frontal lobes were associated with neuropsychiatric symptom scores with a linear model. In the regression model, we included CDR score and TMT B time as covariates to account for cognitive and executive functions. The brain volumes were corrected for age, gender and head size. The total behavioral symptom score of the five symptoms of interest was negatively associated with the volume of the subcallosal area (β = −0.32, p = 0.002). High disinhibition scores were associated with reduced volume in the gyrus rectus (β = −0.30, p = 0.002), medial frontal cortex (β = −0.30, p = 0.002), superior frontal gyrus (β = −0.28, p = 0.003), inferior frontal gyrus (β = −0.28, p = 0.005) and subcallosal area (β = −0.28, p = 0.005). Elation scores were associated with reduced volumes of the medial orbital gyrus (β = −0.30, p = 0.002) and inferior frontal gyrus (β = −0.28, p = 0.004). Aberrant motor behavior was associated with atrophy of frontal pole (β = −0.29, p = 0.005) and the subcallosal area (β = −0.39, p < 0.001). No significant associations with frontal brain volumes were found for agitation and irritability. We conclude that the subcallosal area may be common neuroanatomical area for behavioral symptoms in neurodegenerative diseases, and it appears to be independent of disease etiology.
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Affiliation(s)
- Antti Cajanus
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Eino Solje
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | | | | | | | - Ilona Hallikainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | | | - Matteo de Marco
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Anne M Remes
- MRC Oulu, Oulu University Hospital, Oulu, Finland.,Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Anette Hall
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
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