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Tisserand M, Naggara O, Legrand L, Mellerio C, Edjlali M, Lion S, Rodriguez-Régent C, Souillard-Scemama R, Jbanca CF, Trystram D, Méder JF, Oppenheim C. Patient “candidate” for thrombolysis: MRI is essential. Diagn Interv Imaging 2014; 95:1135-44. [DOI: 10.1016/j.diii.2014.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Legrand L, Tisserand M, Turc G, Naggara O, Edjlali M, Mellerio C, Mas JL, Méder JF, Baron JC, Oppenheim C. Do FLAIR vascular hyperintensities beyond the DWI lesion represent the ischemic penumbra? AJNR Am J Neuroradiol 2014; 36:269-74. [PMID: 25190202 DOI: 10.3174/ajnr.a4088] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In acute stroke with proximal artery occlusion, FLAIR vascular hyperintensities observed beyond the boundaries of the cortical lesion on DWI (newly defined "FLAIR vascular hyperintensity-DWI mismatch") may be a marker of tissue at risk of infarction. Our aim was to compare the occurrence of FLAIR vascular hyperintensity-DWI mismatch relative to that of perfusion-weighted imaging-DWI mismatch in patients with proximal MCA occlusion before IV thrombolysis. MATERIALS AND METHODS In 141 consecutive patients with proximal MCA occlusion, 2 independent observers analyzed FLAIR images for the presence of FLAIR vascular hyperintensity-DWI mismatch before IV thrombolysis. PWI-DWI mismatch was defined as Volumehypoperfusion > 1.8 × VolumeDWI, with Volumehypoperfusion > 6 seconds on time to maximum value of the residue function maps in the 94 patients with available PWI. The presence of FLAIR vascular hyperintensity-DWI mismatch, PWI-DWI mismatch, and infarct growth on 24-hour follow-up DWI was compared. RESULTS A FLAIR vascular hyperintensity-DWI mismatch was present in 102/141 (72%) patients, with an excellent interobserver reliability (κ = 0.91), and a PWI-DWI mismatch, in 61 of the 94 (65%) patients with available PWI. FLAIR vascular hyperintensity-DWI mismatch predicted PWI-DWI mismatch with a sensitivity of 92% (95% CI, 85%-99%) and a specificity of 64% (95% CI, 47%-80%). Patients with FLAIR vascular hyperintensity-DWI mismatch had smaller initial DWI lesion and larger infarct growth (P < .001) than patients without FLAIR vascular hyperintensity-DWI mismatch, even though their final infarcts remained smaller (P < .001). CONCLUSIONS Albeit being moderately specific, probably due to inclusion of oligemic tissue, the FLAIR vascular hyperintensity-DWI mismatch identifies large PWI-DWI mismatch with high sensitivity.
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Badoual M, Gerin C, Deroulers C, Grammaticos B, Llitjos JF, Oppenheim C, Varlet P, Pallud J. Oedema-based model for diffuse low-grade gliomas: application to clinical cases under radiotherapy. Cell Prolif 2014; 47:369-80. [PMID: 24947764 DOI: 10.1111/cpr.12114] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 03/27/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Diffuse low-grade gliomas are characterized by slow growth. Despite appropriate treatment, they change inexorably into more aggressive forms, jeopardizing the patient's life. Optimizing treatments, for example with the use of mathematical modelling, could help to prevent tumour regrowth and anaplastic transformation. Here, we present a model of the effect of radiotherapy on such tumours. Our objective is to explain observed delay of tumour regrowth following radiotherapy and to predict its duration. MATERIALS AND METHODS We have used a migration-proliferation model complemented by an equation describing appearance and draining of oedema. The model has been applied to clinical data of tumour radius over time, for a population of 28 patients. RESULTS We were able to show that draining of oedema accounts for regrowth delay after radiotherapy and have been able to fit the clinical data in a robust way. The model predicts strong correlation between high proliferation coefficient and low progression-free gain of lifetime, due to radiotherapy among the patients, in agreement with clinical studies. We argue that, with reasonable assumptions, it is possible to predict (precision ~20%) regrowth delay after radiotherapy and the gain of lifetime due to radiotherapy. CONCLUSIONS Our oedema-based model provides an early estimation of individual duration of tumour response to radiotherapy and thus, opens the door to the possibility of personalized medicine.
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Edjlali M, Roca P, Gentric JC, Trystram D, Rodriguez-Régent C, Nataf F, Chrétien F, Wieben O, Turski P, Meder JF, Naggara O, Oppenheim C. Advanced technologies applied to physiopathological analysis of central nervous system aneurysms and vascular malformations. Diagn Interv Imaging 2014; 95:1187-93. [PMID: 24933269 DOI: 10.1016/j.diii.2014.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While depiction and definition of morphological and architectural characteristics of CNS vascular disorders remains the first step of an MR analysis, emerging imaging techniques offer new functional information that might help to characterize rupture risk of CNS vascular disorders. Two main orientations are suggested by recent studies: inflammation of the vessel wall and analysis of physical constraints of blood flow using 4D flow imaging (shear parietal). This paper will focus on radiological application of 4D flow imaging and inflammation imaging, in the characterization of potential prognostic markers of CNS vascular disorders. We will review the basic technical considerations of 4D flow MRA, inflammation imaging and discuss their applications in CNS vascular disorders: aneurysms, arteriovenous malformation, dural arteriovenous fistulas. We will illustrate their potential in the development of individual rupture risk criteria in brain vascular disorders.
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Tisserand M, Seners P, Turc G, Legrand L, Labeyrie M, Meder J, Mas J, Baron J, Oppenheim C. Détérioration neurologique précoce inexpliquée après thrombolyse : extension de l’infarctus au-delà de la pénombre ? J Neuroradiol 2014. [DOI: 10.1016/j.neurad.2014.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lamy C, Oppenheim C, Mas JL. Posterior reversible encephalopathy syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2014; 121:1687-701. [PMID: 24365441 DOI: 10.1016/b978-0-7020-4088-7.00109-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a recently proposed cliniconeuroradiologic entity with several well-known causes, such as hypertensive encephalopathy, eclampsia, and the use of cytotoxic and immunosuppressive drugs, as well as some causes more recently described. PRES is characterized by neuroimaging findings of reversible vasogenic subcortical edema without infarction. The pathogenesis is incompletely understood. Two opposing hypotheses are commonly cited, but the issue is controversial: (1) the current more popular theory suggests that severe hypertension exceeds the limits of autoregulation, leading to breakthrough brain edema; (2) the earlier original theory suggests that hypertension leads to cerebral autoregulatory vasoconstriction, ischemia, and subsequent brain edema. The clinical syndrome of PRES typically involves headache, encephalopathy, visual symptoms, and seizures. The clinical presentation is often nonspecific, and therefore the diagnosis of PRES has come to increasingly rely on magnetic resonance imaging (MRI) abnormalities consistent with PRES with documented recovery clinically and on repeated neuroimaging. The diagnosis has important therapeutic and prognostic implications because the reversibility of the clinical and radiologic abnormalities is contingent on the prompt control of blood pressure and/or discontinuing the offending drug.
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Oussous SA, Naggara O, Domigo V, Rodriguez C, Touze E, Meder JF, Mas JL, Oppenheim C. Extensive spinal epidural CSF collection after lumbar puncture. Neurol Clin Pract 2013; 3:361-362. [DOI: 10.1212/cpj.0b013e3182a1b9a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Turski P, Edjlali M, Oppenheim C. Fast 4D flow MRI re-emerges as a potential clinical tool for neuroradiology. AJNR Am J Neuroradiol 2013; 34:1929-30. [PMID: 23811970 DOI: 10.3174/ajnr.a3664] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Naggara O, Trystram D, Rodriguez Regent C, Souillard Scemama R, Edjlali Goujon M, Oppenheim C, Meder JF. Thromboses veineuses cérébrales (TVC) : diagnostic et suivi en neuro-imagerie. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oppenheim C, Tisserand M, Turc G, Naggara O, Calvet D, Mas JL, Meder JF. Accident vasculaire cérébral à la phase aiguë : place de l’IRM diagnostique. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Machet A, Fonseca A, Oppenheim C, Touzé E, Meder JF, Mas JL, Naggara O. Does Anticoagulation Promote Mural Hematoma Growth or Delayed Occlusion in Spontaneous Cervical Artery Dissections. Cerebrovasc Dis 2013; 35:175-81. [DOI: 10.1159/000346592] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/18/2012] [Indexed: 11/19/2022] Open
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Guérin C, Pallud J, Deroulers C, Varlet P, Oppenheim C, Grammaticos B, Badoual M, Roux FX. Quantification de la cellularité et de l’œdème de part et d’autre des limites des anomalies IRM des gliomes diffus de bas grade : implications pratiques. Neurochirurgie 2012. [DOI: 10.1016/j.neuchi.2012.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Oppenheim C, Souillard-Scemama R, Alemany C, Lion S, Edjlali-Goujon M, Labeyrie MA, Rodriguez-Régent C, Mellerio C, Trystram D, Naggara O, Meder JF. Tips and traps in brain MRI: applications to vascular disorders. Diagn Interv Imaging 2012; 93:935-48. [PMID: 23084073 DOI: 10.1016/j.diii.2012.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The French Society of Radiology's guide to good use of medical imaging examinations recommends MRI as the first-line examination for exploring cerebrovascular events or disorders. This paper will discuss the main traps in the images when stroke is suspected and provide the technical tips or knowledge necessary for an optimal radiological report.
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Edjlali M, Roca P, Rabrait C, Naggara O, Oppenheim C. 3D fast spin-echo T1 black-blood imaging for the diagnosis of cervical artery dissection. AJNR Am J Neuroradiol 2012; 34:E103-6. [PMID: 23064599 DOI: 10.3174/ajnr.a3261] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY We performed non-contrast-enhanced 3D fast spin-echo T1 imaging with variable flip angles (CUBE T1) at 3T in 11 patients with CAD. CUBE T1 allowed easy diagnosis of CAD, owing to its comprehensive neck coverage, high spatial resolution enabling multiplanar reformations, fat saturation, and BB effect, the latter also allowing lumen patency to be studied. This sequence may replace 2D axial T1WI for the diagnosis of CAD.
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Mellerio C, Labeyrie MA, Chassoux F, Daumas-Duport C, Landre E, Turak B, Roux FX, Meder JF, Devaux B, Oppenheim C. Optimizing MR imaging detection of type 2 focal cortical dysplasia: best criteria for clinical practice. AJNR Am J Neuroradiol 2012; 33:1932-8. [PMID: 22555587 DOI: 10.3174/ajnr.a3081] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Type 2 FCD is one of the main causes of drug-resistant partial epilepsy. Its detection by MR imaging has greatly improved surgical outcomes, but it often remains overlooked. Our objective was to determine the prevalence of typical MR imaging criteria for type 2 FCD, to provide a precise MR imaging pattern, and to optimize its detection. MATERIALS AND METHODS We retrospectively reviewed 1.5T MR imaging of 71 consecutive patients with histologically proved type 2 FCD. The protocol included millimetric 3D T1-weighted, 2D coronal and axial T2-weighted, and 2D or 3D FLAIR images. Two experienced neuroradiologists looked for 6 criteria: cortex thickening, cortical and subcortical signal changes, blurring of the GWM interface, the "transmantle" sign, and gyral abnormalities. The frequency of each sign and their combination were assessed. We compared the delay between epilepsy onset and surgery, taking into account the time of type 2 FCD detection by MR imaging. RESULTS Only 42 patients (59%) had positive MR imaging findings. In this group, a combination of at least 3 criteria was always found. Subcortical signal changes were constant. Three characteristic signs (cortical thickening, GWM blurring, and transmantle sign) were combined in 64% of patients, indicating that MR imaging can be highly suggestive. However, typical features of type 2 FCD were overlooked on initial imaging in 40% of patients, contributing to a delay in referral for surgical consideration (17 versus 11.5 years when initial MR imaging findings were positive). CONCLUSIONS A combination of 3 major MR imaging signs allows type 2 FCD to be recognized in clinical practice, thereby enabling early identification of candidates for surgery.
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van 't Klooster R, Naggara O, Marsico R, Reiber JHC, Meder JF, van der Geest RJ, Touzé E, Oppenheim C. Automated versus manual in vivo segmentation of carotid plaque MRI. AJNR Am J Neuroradiol 2012; 33:1621-7. [PMID: 22442043 DOI: 10.3174/ajnr.a3028] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Automatically identifying carotid plaque composition using MR imaging remains a challenging task in vivo. The purpose of our study was to compare the detection and quantification of carotid artery atherosclerotic plaque components based on in vivo MR imaging data using manual and automated segmentation. MATERIALS AND METHODS Sixty patients from a multicenter study were split into a training group (20 patients) and a study group (40 patients). Each MR imaging study consisted of 4 high-resolution carotid wall sequences (T1, T2, PDw, TOF). Manual segmentation was performed by delineation of the vessel wall and different plaque components. Automated segmentation was performed in the study group by a supervised classifier trained on images from the training group of patients. RESULTS For the detection of plaque components, the agreement between the visual and automated analysis was moderate for calcifications (κ = 0.59, CI 95% [0.36-0.82]) and good for hemorrhage (0.65 [0.42-0.88]) and lipids (0.65 [0.03-1.27]). For quantification of plaque volumes, the intraclass correlation was high for hemorrhage (0.80 [0.54-0.92]) and fibrous tissue (0.80 [0.65-0.89]), good for lipids (0.65 [0.43-0.80]), and poor for calcifications. CONCLUSIONS In 40 patients with carotid stenosis, our results indicated that it was possible to automatically detect carotid plaque components with substantial or good agreement with visual identification, and that the volumes obtained manually and automatically were reasonably consistent for hemorrhage and lipids but not for calcium.
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Edjlali-Goujon M, Roca P, Rabrait C, Trystram D, Al Shareef F, Godon-Hardy S, Rodriguez C, Naggara O, Oppenheim C, Meder JF. Tractographie de flux par IRM : application à l’étude des malformations vasculaires intracrâniennes. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lecler A, Naggara O, Trystram D, Al Shareef F, Rodriguez C, Oppenheim C, Meder JF, Raymond J. Anévrismes intracrâniens non rompus : revue systématique et analyse en sous-groupes de la morbimortalité du traitement endovasculaire. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rodriguez-Régent C, Naggara O, Trystram D, Godon-Hardy S, Alshareef F, Touzé E, Mas JL, Oppenheim C, Zuber M, Meder JF. Traitement des accidents ischémiques cérébraux avec occlusion artérielle à l’aide du stent Solitaire. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Souillard-Scemama R, Meary E, Mellerio C, Naggara O, Rodriguez-Régent C, Godon-Hardy S, Oppenheim C, Meder JF. Critères d’agressivité des méningiomes en IRM. J Neuroradiol 2012. [DOI: 10.1016/j.neurad.2012.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Llitjos J, Pallud J, Dezamis E, Devaux B, Page P, Koziak M, Dhermain F, Oppenheim C, Varlet P, Souillard-Scemama R, Schlienger M, Daumas-Duport C, Meder J, Roux F. Les modifications de la cinétique tumorale radiologique prédisent la survie globale et la durée de réponse après radiothérapie pour le traitement des gliomes diffus de bas grade. Neurochirurgie 2011. [DOI: 10.1016/j.neuchi.2011.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mouchet-Mages S, Rodrigo S, Cachia A, Mouaffak F, Olie JP, Meder JF, Oppenheim C, Krebs MO. Correlations of cerebello-thalamo-prefrontal structure and neurological soft signs in patients with first-episode psychosis. Acta Psychiatr Scand 2011; 123:451-8. [PMID: 21219267 DOI: 10.1111/j.1600-0447.2010.01667.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed at determining brain structural imaging correlates of neurological soft signs (NSS) in patients suffering from a first-episode psychosis. METHOD Fifty-two patients with a DSMIV diagnosis of first-episode psychosis (schizophrenia or schizophrenia spectrum disorder) were consecutively included. Subjects were assessed using a standardized neurological examination for motor coordination, motor integration and sensory integration. Anatomical magnetic resonance images (MRI) were analysed in the whole brain using optimized voxel-based morphometry. RESULTS Neurological soft signs (NSS) total score (P-corrected = 0.013) and motor integration subscore (P-corrected = 0.035) were found to negatively correlate with grey matter structure of the dorsolateral prefrontal cortices. Motor coordination subscore was positively correlated with grey matter structure of the thalami (P-corrected = 0.002) and negatively with white matter structure of the cerebellum (P-corrected = 0.034). The addition of age and gender as covariate yielded similar results. We did not find any correlation between neither sensory integration subscore and grey matter structure nor NSS total score, motor integration subscore and voxel-based morphometry (VBM) white matter structure. CONCLUSION Structural alteration in the cerebello-thalamo-prefrontal network is associated with neurological soft signs in schizophrenia, a candidate network for 'cognitive dysmetria'.
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Naggara O, Soares F, Touze E, Roy D, Leclerc X, Pruvo JP, Mas JL, Meder JF, Oppenheim C. Is it possible to recognize cervical artery dissection on stroke brain MR imaging? A matched case-control study. AJNR Am J Neuroradiol 2011; 32:869-73. [PMID: 21493767 DOI: 10.3174/ajnr.a2553] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Extracranial CAD accounts for nearly 20% of cases of stroke in young adults. The mural hematoma frequently extends cranially to the petrous carotid segment in cCAD or is distally located in vCAD. We hypothesized that standard brain MR imaging could allow the early detection of CAD of the upper portion of carotid and vertebral arteries. MATERIALS AND METHODS Our prospectively maintained stroke data base was retrospectively queried to identify all patients with the final diagnosis of CAD. In the 103 consecutive patients studied, analysis of cervical fat-suppressed T1-weighted sequences demonstrated that the mural hematoma was located in the FOV of brain MR imaging in 77 patients. Subsequent to enrollment of a patient, a control patient was extracted from the same data base, within a similar categories for sex, age, NIHSS score, and stroke on DWI. Two blinded observers independently reviewed the 5 brain MR sequences of each examination and determined whether a CAD was present. RESULTS Fifty-nine of the 77 patients with CAD (76.6%) and 73 of the 77 patients without CAD (94.8%) were correctly classified. Brain MR imaging demonstrated cCAD more frequently than vCAD in 54/58 (93.1%) and 5/19 (26.3%) patients, respectively, (P < .0001). CONCLUSIONS Initial brain MR imaging can correctly suggest CAD in more than two-thirds of patients. This may have practical implications in patients with stroke with delayed cervical MRA or in those who are not initially suspected of having CAD.
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Tisserand M, Le Guennec L, Touze E, Hess A, Charbonnier C, Devauchelle AD, Bracard S, Mas JL, Meder JF, Oppenheim C. Prevalence of MRI-defined recent silent ischemia and associated bleeding risk with thrombolysis. Neurology 2011; 76:1288-95. [DOI: 10.1212/wnl.0b013e3182152855] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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