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Yamauchi H, Kagawa S, Takahashi M, Higashi T. Long-term hemodynamic changes and blood pressure in atherosclerotic major cerebral artery disease. J Cereb Blood Flow Metab 2019; 39:324-331. [PMID: 28820296 PMCID: PMC6365607 DOI: 10.1177/0271678x17727385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In patients with major cerebral artery disease, lower blood pressure might reduce blood flow in the collateral pathways, thereby impairing the growth of cerebral collaterals, inhibiting hemodynamic improvement. We evaluated the hemodynamic status twice using positron emission tomography and 15O-gas, over time, in 89 medically treated patients with atherosclerotic internal carotid artery or middle cerebral artery disease that had no ischemic episodes during follow-up (mean, 28 ± 23 months). Changes in the mean hemispheric values of hemodynamic parameters in the territory of the diseased artery at follow-up were correlated with the mean blood pressure values at the baseline and follow-up examinations. There was a positive linear relationship between the degree of hemodynamic improvement and systolic blood pressure. Patients with low systolic blood pressure (<130 mmHg) ( n = 18) showed hemodynamic deterioration as indicated by significant decreases in cerebral blood flow, cerebral blood flow/cerebral blood volume ratio, and increases in oxygen extraction fraction during follow-up. In contrast, there were no significant changes in patients without low systolic blood pressure. In patients with atherosclerotic internal carotid artery or middle cerebral artery disease and no ischemic episodes of stroke during follow-up, lower systolic blood pressure was associated with lesser hemodynamic improvement.
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Affiliation(s)
- Hiroshi Yamauchi
- 1 Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan
| | - Shinya Kagawa
- 1 Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan
| | - Masaaki Takahashi
- 1 Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan
| | - Tatsuya Higashi
- 1 Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan.,2 National Institute of Radiological Sciences, National Institutes of Quantum and Radiological Science and Technology, Chiba, Japan
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Imasaka KI, Tayama E, Morita S, Tomita Y. Neurological outcome and efficacy of intensive craniocervical screening for elective cardiac surgery. Interact Cardiovasc Thorac Surg 2019; 26:216-223. [PMID: 29049799 DOI: 10.1093/icvts/ivx307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/13/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of intensive craniocervical screening before elective cardiovascular surgery. METHODS A retrospective analysis of 1134 consecutive patients who underwent routine screening before cardiovascular surgery between November 2004 and December 2014 was conducted. The study was divided into 2 distinct cohorts of patients undergoing surgery: before (n = 500) and after (n = 634) the introduction of intensive screening in January 2009. In 2009, preoperative screening underwent a transition from the evaluation of carotid atherosclerosis alone to that of craniocervical atherosclerosis. Additionally, patients with moderate or greater stenosis on intensive screening underwent single-photon emission computed tomography with acetazolamide. Craniocervical atherosclerosis was classified as no or mild [0-49%: n = 836 (before/after: 370/466)], moderate [50-69%: n = 118 (56/62)] or severe [70-100%: n = 141 (36/105)]. One of 166 (0.6%) patients with moderate or greater stenosis undergoing single-photon emission computed tomography with acetazolamide after the introduction of intensive screening was diagnosed as having impaired cerebral autoregulation. RESULTS The occurrences of perioperative stroke were 2.8% before the introduction of intensive screening and 0.9% after that (P = 0.033). Notably, intraoperative stroke significantly decreased from 1.4% to 0.2% (P = 0.034). Specifically, the occurrence of perioperative stroke in patients with no or mild stenosis decreased significantly after the introduction of intensive screening, from 2.7% to 0.4% (P = 0.007). CONCLUSIONS The incidence of perioperative stroke decreased following the introduction of intensive screening. Intensive screening may be able to detect patients with a greater risk of perioperative stroke.
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Affiliation(s)
- Ken-Ichi Imasaka
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shigeki Morita
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yukihiro Tomita
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Hwang YH, Kwon YS, Lee YH. STA-Distal ACA Bypass Using a Contralateral STA Interposition Graft for Symptomatic ACA Stenosis. J Cerebrovasc Endovasc Neurosurg 2018; 20:191-197. [PMID: 30397592 PMCID: PMC6199401 DOI: 10.7461/jcen.2018.20.3.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/05/2018] [Accepted: 09/21/2018] [Indexed: 11/23/2022] Open
Abstract
Intracranial arterial stenosis usually occurs due to atherosclerosis and is considered the most common cause of stroke worldwide. Although the effectiveness of bypass surgery for ischemic stroke is controversial, the superficial temporal artery to the middle cerebral artery bypass for ischemic stroke is a common procedure. In our report, a 50-year-old man presented with sudden-onset left side weakness and dysarthria. An angiogram showed significant stenosis in the junction of the right cavernous-supraclinoid internal carotid artery and right pericallosal artery. Symptoms altered between improvement and deterioration. Magnetic resonance imaging showed a repeated progression of anterior cerebral artery (ACA) infarction despite maximal medical therapy. We performed a STA-ACA bypass with contralateral STA interposition. Postoperative course was uneventful with no further progression of symptoms. Thus, bypass surgery may be considered in patients with symptomatic stenosis or occlusion of the ACA, especially when patients present progressive symptoms despite maximal medical therapy.
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Affiliation(s)
- Yoon Ha Hwang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sub Kwon
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yun Ho Lee
- Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Derdeyn CP. Hemodynamics and oxygen extraction in chronic large artery steno-occlusive disease: Clinical applications for predicting stroke risk. J Cereb Blood Flow Metab 2018; 38:1584-1597. [PMID: 28925313 PMCID: PMC6125965 DOI: 10.1177/0271678x17732884] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depending on the adequacy of collateral sources of blood flow, arterial stenosis or occlusion may lead to reduced perfusion pressure and ultimately reduced blood flow in the distal territory supplied by that vessel. There are two well-defined compensatory mechanisms to reduced pressure or flow - autoregulatory vasodilation and increased oxygen extraction fraction. Other changes, such as metabolic downregulation, are likely. The positive identification of autoregulatory vasodilation and increased oxygen extraction fraction in humans is an established risk factor for future ischemic stroke in some disease states such as atherosclerotic carotid stenosis and occlusion. The mechanisms by which ischemic stroke may occur are not clear, and may include an increased vulnerability to embolic events. The use of hemodynamic assessment to identify patients with occlusive vasculopathy at an increased risk for stroke is very appealing for several different patient populations, such as those with symptomatic intracranial atherosclerotic disease, moyamoya phenomenon, complete internal carotid artery occlusion, and asymptomatic cervical carotid artery stenosis. While there is very good data for stroke risk prediction in some of these groups, no intervention based on these tools has been proven effective yet. In this manuscript, we will review these topics above and identify areas for future research.
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Affiliation(s)
- Colin P Derdeyn
- Departments of Radiology and Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Leigh R, Knutsson L, Zhou J, van Zijl PC. Imaging the physiological evolution of the ischemic penumbra in acute ischemic stroke. J Cereb Blood Flow Metab 2018; 38:1500-1516. [PMID: 28345479 PMCID: PMC6125975 DOI: 10.1177/0271678x17700913] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We review the hemodynamic, metabolic and cellular parameters affected during early ischemia and their changes as a function of approximate cerebral blood flow ( CBF) thresholds. These parameters underlie the current practical definition of an ischemic penumbra, namely metabolically affected but still viable brain tissue. Such tissue is at risk of infarction under continuing conditions of reduced CBF, but can be rescued through timely intervention. This definition will be useful in clinical diagnosis only if imaging techniques exist that can rapidly, and with sufficient accuracy, visualize the existence of a mismatch between such a metabolically affected area and regions that have suffered cell depolarization. Unfortunately, clinical data show that defining the outer boundary of the penumbra based solely on perfusion-related thresholds may not be sufficiently accurate. Also, thresholds for CBF and cerebral blood volume ( CBV) differ for white and gray matter and evolve with time for both inner and outer penumbral boundaries. As such, practical penumbral imaging would involve parameters in which the physiology is immediately displayed in a manner independent of baseline CBF or CBF threshold, namely pH, oxygen extraction fraction ( OEF), diffusion constant and mean transit time ( MTT). Suitable imaging technologies will need to meet this requirement in a 10-20 min exam.
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Affiliation(s)
- Richard Leigh
- 1 National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, USA
| | - Linda Knutsson
- 2 Department of Medical Radiation Physics, Lund University, Lund, Sweden.,3 Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jinyuan Zhou
- 3 Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.,4 F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Peter Cm van Zijl
- 3 Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.,4 F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
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Setta K, Kojima D, Shimada Y, Yoshida J, Oshida S, Fujimoto K, Tsutsui S, Chiba T, Fujiwara S, Terasaki K, Ogasawara K. Accuracy of brain perfusion single-photon emission computed tomography for detecting misery perfusion in adult patients with symptomatic ischemic moyamoya disease. Ann Nucl Med 2018; 32:611-619. [PMID: 30030783 DOI: 10.1007/s12149-018-1283-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of the present study was to determine how accurately relative cerebral blood flow (RCBF) and relative cerebrovascular reactivity (RCVR) to acetazolamide assessed using brain perfusion single-photon emission computed tomography (SPECT) detected misery perfusion identified on positron emission tomography (PET) in adult patients with ischemic moyamoya disease (MMD). METHODS Oxygen extraction fraction (OEF), RCBF, and RCVR were assessed using 15O gas PET and N-isopropyl-p-[123I]-iodoamphetamine SPECT without and with acetazolamide challenge, respectively, in 45 patients. Regions of interest (ROIs) were automatically placed in the five middle cerebral artery (MCA) territories in the symptomatic cerebral hemisphere and in the ipsilateral cerebellar hemisphere using a three-dimensional stereotaxic ROI template. For RCBF and RCVR to acetazolamide, the ratio of the MCA ROI to cerebellar ROI was calculated. Of the five MCA ROIs in the symptomatic cerebral hemisphere in each patient, the ROI with the highest and lowest OEF value (two ROIs per patient) was selected for analyses. RESULTS A significant square or linear correlation was observed between the OEF and RCBF (correlation coefficient, 0.780) or RCVR (correlation coefficient, - 0.345), respectively. The area under the receiver operating characteristic curve for detecting misery perfusion (OEF > 51.3%) was significantly greater for the RCBF than for the RCVR (difference between areas, 0.221; p < 0.0001). Sensitivity, specificity, and positive- and negative-predictive values for the RCBF for detecting misery perfusion were 100, 91, 67, and 100%, respectively. The specificity and positive-predictive value did not differ between the combination of the RCBF and RCVR and the CBF ratio alone. CONCLUSIONS RCBF assessed using brain perfusion SPECT detects misery perfusion with high sensitivity, a high negative-predictive value, and a low positive-predictive value in adult patients with ischemic MMD. The accuracy of RCVR to acetazolamide assessed using brain perfusion SPECT is lower than that of RCBF.
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Affiliation(s)
- Kengo Setta
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan.,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Daigo Kojima
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan.,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Yasuyoshi Shimada
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan.,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Jun Yoshida
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan.,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Sotaro Oshida
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan
| | - Kentaro Fujimoto
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan
| | - Shouta Tsutsui
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan
| | - Takayuki Chiba
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan
| | | | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan. .,Cyclotron Research Center, Iwate Medical University, Morioka, Japan.
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Li C, Cao X, Ma Z, Sun X, Hu F, Wang L. Effect of pre-surgery assessments on the prognosis of patients received extracranial-intracranial bypass surgery. Restor Neurol Neurosci 2018; 36:593-604. [PMID: 30010157 DOI: 10.3233/rnn-180848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Extracranial-intracranial (EC-IC) bypass surgery has been used to improve the conditions of cerebral ischemia symptoms for selected patients resulting from diverse complications such as stroke and atherosclerotic disease. However, several clinical trials showed EC-IC bypass surgery failed to prevent recurrent ischemic stroke in certain patients. OBJECTIVE Our clinical trial aimed to investigate whether there is a correlation between pre-surgery assessments and prognosis of patients received EC-IC bypass operation. METHODS We divided all patients into 4 groups according to their compensatory stages of cerebral ischemia. The values of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and oxygen extraction fraction (OEF) were obtained by computed tomography perfusion (CTP), single photon emission computed tomography (SPECT), and positron emission tomography (PET) at different time points before and after EC-IC bypass surgery. We assessed the correlations between the compensatory stage with modified Rankin scale (mRS) scores, survival rates, stroke and TIA incidences over the 12 months after surgery. RESULTS Patients with normal CBF, normal or increased CBV, and normal OEF tended to have a better prognosis after the EI-CI bypass operation than patients with abnormal CBF, CBV and OEF. However, patients with abnormal CBF and CBV, and increased OEF showed elevated mRS, less survival rates, and higher stroke and TIA incidences over the 12 months after surgery, compared to the groups with normal CBF, CBV and OEF. CONCLUSIONS Our results suggest that a defined compensatory stage of cerebral ischemia might be useful for the prognosis of patients receiving EI-CI bypass surgery.
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Affiliation(s)
- Chen Li
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China
| | - Xuhua Cao
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China
| | - Zhizhao Ma
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China
| | - Xiaofeng Sun
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China
| | - Fuguang Hu
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China
| | - Liqun Wang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China
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Peng JW, Liu Y, Meng G, Zhang JY, Yu LF. Effects of salvianolic acid on cerebral perfusion in patients after acute stroke: A single-center randomized controlled trial. Exp Ther Med 2018; 16:2600-2614. [PMID: 30186492 DOI: 10.3892/etm.2018.6444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/02/2018] [Indexed: 01/01/2023] Open
Abstract
Hypoperfusion following acute stroke is common in the infarct core and periphery tissues. The present study evaluated the efficacy of salvianolic acid (SA) on the cerebral perfusion of patients who had suffered from acute stroke using perfusion-weighted magnetic resonance imaging (PWI) to examine the blood perfusion of the affected brain tissue prior to and following treatment. Patients who were admitted to PLA 153 Central Hospital within 72 h of acute stroke symptom onset and had a Glasgow coma scale ≥5 were randomized into two groups: SA and control groups. Patients in the SA group were administered SA 0.13 g/day for 14 days. PWI was performed for all patients at admission and post-treatment. The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were applied to assess neurological function at admission and 3 months post treatment. A total of 159 patients were enrolled (85 patients in the SA group and 74 patients in the control group). A total of 62 patients in the SA group and 51 patients in the control group exhibited hypoperfusion in the ipsihemisphere of the diffusion-weighted magnetic resonance imaging (DWI) lesion. In addition, relative cerebral blood volume (rCBV), a ratio of the signal value of the region of interest in the same hemisphere of the DWI lesion to that of its mirror in the PWI CBV map, decreased significantly following treatment with SA compared with the control group in patients with hypoperfusion (P=0.02), which were indicated by PWI images at admission, in the DWI lesions or the surrounding areas. Additionally, there was no significant difference in patients with normal perfusion at admission in rCBV in DWI lesions or its surrounding area between the two groups at day 15. However, a significant improvement in NIHSS (P=0.001) and mRS (P=0.005) was indicated in the SA group compared with the control at day 90. The present study indicated that SA may improve the neurological dysfunction of patients with acute stroke, which may be explained by the increased perfusion of hypoperfused brain tissues.
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Affiliation(s)
- Jian-Wei Peng
- Department of Neurology, People's Liberation Army 153 Central Hospital, Zhengzhou, Henan 450041, P.R. China
| | - Yuan Liu
- Postgraduate Department, Xinxiang Medical College, Xinxiang, Henan 453003, P.R. China
| | - Gai Meng
- Department of Neurology, People's Liberation Army 153 Central Hospital, Zhengzhou, Henan 450041, P.R. China
| | - Jin-Yan Zhang
- Department of Neurology, People's Liberation Army 153 Central Hospital, Zhengzhou, Henan 450041, P.R. China
| | - Lian-Fang Yu
- Department of Radiology, People's Liberation Army 153 Central Hospital, Zhengzhou, Henan 450041, P.R. China
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Validation of scatter limitation correction to eliminate scatter correction error in oxygen-15 gas-inhalation positron emission tomography images. Nucl Med Commun 2018; 39:936-944. [PMID: 29985832 DOI: 10.1097/mnm.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE High levels of radioactivity inside a facemask cause scatter correction (SC) errors that appear as photopenic artifacts on quantitative oxygen-15 (O) gas-inhalation positron emission tomography (PET) images. The present study aimed to validate the ability of scatter limitation correction (SLC) to eliminate SC errors in O gas-inhalation PET images acquired from patients and a phantom. MATERIALS AND METHODS We analyzed the SC errors in phantom images and calculated parametric images of the cerebral blood flow (CBF), cerebral blood volume, oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2). Phantoms comprised a cylinder and paper with radioactivity to simulate a facemask during (O)O2 gas inhalation. Parametric images were calculated from O gas-inhalation PET images of ten participants. All PET data were reconstructed using conventional SC as model-based SC and SLC. Images acquired from the phantoms and parametric images were assessed visually and quantitatively in the presence and absence of SC error. RESULTS SC error was evident in images derived from the paper phantom and at the slice level of the cerebellum in CBF, OEF, and CMRO2 images. The radioactivity concentration in the cylindrical phantom with the paper phantom significantly improved with SLC. The SLC also increased the quantitative indices of CBF, OEF, and CMRO2 by 23.8, 42.2, and 44.4%, respectively. CONCLUSION SLC visually eliminated the SC error and increased the quantitative parameters on O gas-inhalation images derived from a phantom and from patients.
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Abstract
Electroconvulsive therapy (ECT) is a safe and effective treatment for major depressive disorder, but cerebrovascular and cardiovascular complications, although rare, remain the most concerning. This is particularly notable in those with preexisting cerebrovascular disease, which impacts dynamic cerebral autoregulation. In these patients, the increased blood flow to the seizing portions of the brain induced by ECT potentially can reduce cerebral blood flow to ischemic areas, possibly causing adverse neurological events. The authors describe a patient with chronic cerebral ischemic disease, chronic anemia, and major depressive disorder undergoing ECT to achieve remission. The patient developed recurrent focal neurological deficits after each ECT procedure, with neurological recovery within 48 hours post-ECT. Clinical guidelines may need to be updated for the management of ECT patients with cerebrovascular disease who may be at an increased risk of intraictal and possibly postictal regional ischemia, especially in areas already compromised by a prior stroke and/or by reduced cerebral oxygenation caused by symptomatic anemia at risk of ischemia. Research is needed to assess changes in regional cerebral blood flow during and after ECT in patients with cerebrovascular disease, including small-vessel cerebral ischemia, and to evaluate these changes in relation to the location, intensity, and duration of induced seizure.
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Shoji F, Takeo S, Yamazaki K, Miura N, Katsura M, Oku Y, Shimokawa M. Impact of Preoperative Ultrasonography Screening for Carotid Artery Stenosis in Lung Cancer Patients. Ann Thorac Surg 2018; 106:1047-1054. [PMID: 29852144 DOI: 10.1016/j.athoracsur.2018.04.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 03/05/2018] [Accepted: 04/23/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Stroke is a major cause of morbidity or death after lung operations. Carotid artery screening (CAS) is useful for detecting carotid artery stenosis, which is one of the causes of stroke. This study investigated the frequency of and risk factors for preoperative carotid artery stenosis to determine whether CAS with ultrasonography contributes to preventing postoperative stroke or cardiovascular comorbidities in lung cancer patients. METHODS This retrospective study included 1,676 consecutive lung cancer patients who underwent surgical resection. RESULTS Of the 1,342 patients who underwent CAS, 173 (12.9%) had carotid artery stenosis. Significant associations with carotid artery stenosis were found for older patients (p < 0.0001), men (p < 0.0001), smoking history (p < 0.0001), history of stroke (p = 0.0037), cardiovascular diseases (p < 0.0001), hypertension (p = 0.0353), diabetes mellitus (p = 0.0037), and peripheral vascular diseases (p < 0.0001). Patients with the three independent risk factors of age, male sex, and history of cardiovascular diseases had a 6.43-fold higher prevalence of carotid artery stenosis (odds ratio, 6.43; 95% confidence interval, 3.80 to 10.89) than those with none of these factors. Propensity score-matched analysis showed that incidences of postoperative stroke and cardiovascular comorbidities were both lower in patients who underwent CAS and received appropriate anticoagulant therapy than in those who did not (p = 0.0619 and p = 0.0319, respectively). CONCLUSIONS Preoperative CAS is a simple and useful tool for detecting carotid artery stenosis. Administration of perioperative anticoagulant therapy to preoperative patients with lung cancer and carotid artery stenosis identified by CAS may prevent postoperative stroke and cardiovascular events.
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Affiliation(s)
- Fumihiro Shoji
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan.
| | - Sadanori Takeo
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan
| | - Koji Yamazaki
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan
| | - Naoko Miura
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan
| | - Masakazu Katsura
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan
| | - Yuka Oku
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Chuo-ku, Fukuoka, Japan
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Yamaguchi S, Horie N, Morikawa M, Tateishi Y, Hiu T, Morofuji Y, Izumo T, Hayashi K, Matsuo T. Assessment of veins in T2*-weighted MR angiography predicts infarct growth in hyperacute ischemic stroke. PLoS One 2018; 13:e0195554. [PMID: 29617449 PMCID: PMC5884555 DOI: 10.1371/journal.pone.0195554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/23/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE T2*-weighted magnetic resonance angiography (SWAN) detects hemodynamic insufficiency as hypointense areas in medullary or cortical veins. We therefore investigated whether SWAN can help predict ischemic penumbra-like lesions in patients with acute ischemic stroke (AIS). MATERIALS AND METHODS Magnetic resonance imaging (MRI) records-including SWAN, diffusion-weighted imaging (DWI), and magnetic resonance angiography (MRA)-of consecutive patients with major vessel occlusion within 6 h from AIS onset were analyzed. Acute recanalization was defined as an arterial occlusive lesion score of 2-3. A modified Alberta Stroke Program Early CT Score (mASPECTS) was used to evaluate ischemic areas revealed by SWAN and DWI. SWAN- and DWI-based mASPECTSs were calculated, and correlations between DWI-SWAN mismatches with final infarct lesions or clinical outcomes were evaluated. RESULTS Among the 35 patients included in this study, we confirmed cardioembolic stroke in 26, atherothrombotic stroke in 4, and unknown stroke etiology in 5. Overall, recanalization was achieved in 23 patients, who showed a higher follow-up DWI-based mASPECTS and lower modified Rankin Scale (mRS) score at 90 days than patients without recanalization. Initial SWAN- and follow-up DWI-based mASPECTSs were significantly higher for atherothrombotic stroke than for cardioembolic stroke. Of 12 patients without recanalization, DWI-SWAN mismatch was significantly correlated with infarct growth. Patients with recanalization showed no such correlation. In the assessment of clinical outcome, follow-up DWI-based mASPECTS and patient's age were significantly correlated with mRS at 90 days after stroke. A multivariate logistic regression analysis revealed that the follow-up DWI-based mASPECTS was independently associated with a favorable outcome 90 days after stroke. CONCLUSIONS For patients with AIS, DWI-SWAN mismatch might show penumbra-like lesions that would predict infarct growth without acute recanalization. Assessment of ischemic lesions from the venous side appears to be useful for considering the etiology and revascularization therapy.
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Affiliation(s)
- Susumu Yamaguchi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- * E-mail:
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Minoru Morikawa
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takeshi Hiu
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yoichi Morofuji
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kentaro Hayashi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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[Revascularization experience and results in ischaemic cerebrovascular disease: Moyamoya disease and carotid occlusion]. Neurocirugia (Astur) 2018; 29:170-186. [PMID: 29550248 DOI: 10.1016/j.neucir.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/24/2018] [Accepted: 01/31/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cerebral revascularization techniques are an indispensable tool in the current armamentarium of vascular neurosurgeons. We present revascularization surgery experience and results in both moyamoya disease and occlusive cerebral ischaemia. PATIENTS AND METHODS Patients with ischaemic occlusive disease and moyamoya disease who underwent microsurgical revascularization between October 2014 and September 2017 were analysed. RESULTS In the study period, 23 patients with occlusive ischaemic disease underwent microsurgical revascularization. Three patients presented with serious postoperative complications (2 intraparenchymal haemorrhages in the immediate postoperative period and one thrombosis of the femoral artery). All patients, except one, achieved normalization of the cerebral hemodynamic reserve (CHR) in the SPECT study. Twenty patients had a good neurological result, with no ischaemic recurrence of the revascularized territory. Among patients with moyamoya, 20 had moyamoya disease and 5 had moyamoya syndrome with unilateral involvement. Five patients were treated at paediatric age. Haemorrhagic onset occurred in 2 patients. The CHR study showed hemodynamic compromise in all patients. Cerebral SPECT at one year showed resolution of the hemodynamic failure in all patients. There have been 4 postoperative complications (acute subdural hematoma, two subdural collections and one dehiscence of the surgical wound). No patient presented with neurological worsening at 6 and 12months of follow-up. CONCLUSIONS Cerebral revascularization through end-to-side anastomosis between the superficial temporal artery and a cortical branch of the middle cerebral artery is an indisputable technique in the treatment of moyamoya disease and possibly in a subgroup of patients with symptomatic occlusive ischaemic cerebrovascular disease.
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Saito H, Ishikawa T, Tanabe J, Kobayashi S, Moroi J. Bedside assessment of regional cerebral perfusion using near-infrared spectroscopy and indocyanine green in patients with atherosclerotic occlusive disease. Sci Rep 2018; 8:1242. [PMID: 29352217 PMCID: PMC5775286 DOI: 10.1038/s41598-018-19668-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/05/2018] [Indexed: 01/13/2023] Open
Abstract
This pilot study aimed to investigate the utility of near-infrared spectroscopy/indocyanine green (NIRS/ICG) for examining patients with occlusive cerebrovascular disease. Twenty-nine patients with chronic-stage atherosclerotic occlusive cerebrovascular disease were included. The patients were monitored using NIRS at the bedside. Using ICG time-intensity curves, the affected-to-unaffected side ratios were calculated for several parameters, including the maximum ICG concentration (ΔICGmax), time to peak (TTP), rise time (RT), and blood flow index (BFI = ΔICGmax/RT), and were compared to the affected-to-unaffected side ratios of the regional cerebral blood flow (rCBF) and regional oxygen extraction fraction (rOEF) obtained using positron emission tomography with 15O-labeled gas. The BFI ratio showed the best correlation with the rCBF ratio among these parameters (r = 0.618; P = 0.0004), and the RT ratio showed the best correlation with the rOEF ratio (r = 0.593; P = 0.0007). The patients were further divided into reduced rCBF or elevated rOEF groups, and the analysis revealed significant related differences. The present results advance the measurement of ICG kinetics using NIRS as a useful tool for the detection of severely impaired perfusion with reduced rCBF or elevated rOEF. This method may be applicable as a monitoring tool for patients with acute ischemic stroke.
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Affiliation(s)
- Hiroshi Saito
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan. .,Department of Neurosurgery, Kameda medical center, Chiba, Japan.
| | - Tatsuya Ishikawa
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan
| | - Jun Tanabe
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan
| | - Shinya Kobayashi
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan
| | - Junta Moroi
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan
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Nomura JI, Uwano I, Sasaki M, Kudo K, Yamashita F, Ito K, Fujiwara S, Kobayashi M, Ogasawara K. Preoperative Cerebral Oxygen Extraction Fraction Imaging Generated from 7T MR Quantitative Susceptibility Mapping Predicts Development of Cerebral Hyperperfusion following Carotid Endarterectomy. AJNR Am J Neuroradiol 2017; 38:2327-2333. [PMID: 28982786 DOI: 10.3174/ajnr.a5390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 07/18/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Preoperative hemodynamic impairment in the affected cerebral hemisphere is associated with the development of cerebral hyperperfusion following carotid endarterectomy. Cerebral oxygen extraction fraction images generated from 7T MR quantitative susceptibility mapping correlate with oxygen extraction fraction images on positron-emission tomography. The present study aimed to determine whether preoperative oxygen extraction fraction imaging generated from 7T MR quantitative susceptibility mapping could identify patients at risk for cerebral hyperperfusion following carotid endarterectomy. MATERIALS AND METHODS Seventy-seven patients with unilateral internal carotid artery stenosis (≥70%) underwent preoperative 3D T2*-weighted imaging using a multiple dipole-inversion algorithm with a 7T MR imager. Quantitative susceptibility mapping images were then obtained, and oxygen extraction fraction maps were generated. Quantitative brain perfusion single-photon emission CT was also performed before and immediately after carotid endarterectomy. ROIs were automatically placed in the bilateral middle cerebral artery territories in all images using a 3D stereotactic ROI template, and affected-to-contralateral ratios in the ROIs were calculated on quantitative susceptibility mapping-oxygen extraction fraction images. RESULTS Ten patients (13%) showed post-carotid endarterectomy hyperperfusion (cerebral blood flow increases of ≥100% compared with preoperative values in the ROIs on brain perfusion SPECT). Multivariate analysis showed that a high quantitative susceptibility mapping-oxygen extraction fraction ratio was significantly associated with the development of post-carotid endarterectomy hyperperfusion (95% confidence interval, 33.5-249.7; P = .002). Sensitivity, specificity, and positive- and negative-predictive values of the quantitative susceptibility mapping-oxygen extraction fraction ratio for the prediction of the development of post-carotid endarterectomy hyperperfusion were 90%, 84%, 45%, and 98%, respectively. CONCLUSIONS Preoperative oxygen extraction fraction imaging generated from 7T MR quantitative susceptibility mapping identifies patients at risk for cerebral hyperperfusion following carotid endarterectomy.
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Affiliation(s)
- J-I Nomura
- From the Department of Neurosurgery (J.-i.N., S.F., M.K., K.O.)
| | - I Uwano
- Division of Ultrahigh Field MRI (I.U., M.S., F.Y., K.I), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Morioka, Japan
| | - M Sasaki
- Division of Ultrahigh Field MRI (I.U., M.S., F.Y., K.I), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Morioka, Japan
| | - K Kudo
- Department of Diagnostic and Interventional Radiology (K.K.), Hokkaido University School of Medicine, Sappro, Japan
| | - F Yamashita
- Division of Ultrahigh Field MRI (I.U., M.S., F.Y., K.I), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Morioka, Japan
| | - K Ito
- Division of Ultrahigh Field MRI (I.U., M.S., F.Y., K.I), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Morioka, Japan
| | - S Fujiwara
- From the Department of Neurosurgery (J.-i.N., S.F., M.K., K.O.)
| | - M Kobayashi
- From the Department of Neurosurgery (J.-i.N., S.F., M.K., K.O.)
| | - K Ogasawara
- From the Department of Neurosurgery (J.-i.N., S.F., M.K., K.O.)
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Abstract
Advanced imaging techniques including computed tomography (CT) angiography, CT perfusion, magnetic resonance (MR) angiography, MR with diffusion- and perfusion-weighted imaging, and, more recently, resting-state BOLD (Blood Oxygen Level Dependent) functional MRI (rs-fMRI) are increasingly used to evaluate patients with acute ischemic stroke. Advanced imaging allows for identification of patients with ischemic stroke and determination of the size of infarcted and potentially salvageable tissue, all of which yield crucial information for proper stroke management. The addition of rs-fMRI for ischemia adds information at the microvascular level, thereby improving the understanding of pathophysiologic mechanisms of impaired cerebral perfusion and tissue oxygenation beyond the known concepts at the macrovascular level. As such, it may further delineate functional and dysfunctional neuronal networks, guide stroke interventions, and improve prognosis and monitoring of patient outcomes.
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Nanba T, Nishimoto H, Yoshioka Y, Murakami T, Sasaki M, Uwano I, Fujiwara S, Terasaki K, Ogasawara K. Apparent brain temperature imaging with multi-voxel proton magnetic resonance spectroscopy compared with cerebral blood flow and metabolism imaging on positron emission tomography in patients with unilateral chronic major cerebral artery steno-occlusive disease. Neuroradiology 2017; 59:923-935. [PMID: 28776269 DOI: 10.1007/s00234-017-1890-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/20/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the present study was to determine whether apparent brain temperature imaging using multi-voxel proton magnetic resonance (MR) spectroscopy correlates with cerebral blood flow (CBF) and metabolism imaging in the deep white matter of patients with unilateral chronic major cerebral artery steno-occlusive disease. METHODS Apparent brain temperature and CBF and metabolism imaging were measured using proton MR spectroscopy and 15O-positron emission tomography (PET), respectively, in 35 patients. A set of regions of interest (ROIs) of 5 × 5 voxels was placed on an MR image so that the voxel row at each edge was located in the deep white matter of the centrum semiovale in each cerebral hemisphere. PET images were co-registered with MR images with these ROIs and were re-sliced automatically using image analysis software. RESULTS In 175 voxel pairs located in the deep white matter, the brain temperature difference (affected hemisphere - contralateral hemisphere: ΔBT) was correlated with cerebral blood volume (CBV) (r = 0.570) and oxygen extraction fraction (OEF) ratios (affected hemisphere/contralateral hemisphere) (r = 0.641). We excluded voxels that contained ischemic lesions or cerebrospinal fluid and calculated the mean values of voxel pairs in each patient. The mean ΔBT was correlated with the mean CBF (r = - 0.376), mean CBV (r = 0.702), and mean OEF ratio (r = 0.774). CONCLUSIONS Apparent brain temperature imaging using multi-voxel proton MR spectroscopy was correlated with CBF and metabolism imaging in the deep white matter of patients with unilateral major cerebral artery steno-occlusive disease.
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Affiliation(s)
- Takamasa Nanba
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Hideaki Nishimoto
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yoshichika Yoshioka
- Open and Transdisciplinary Research Initiatives, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toshiyuki Murakami
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Makoto Sasaki
- Institute for Biomedical Science, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Ikuko Uwano
- Institute for Biomedical Science, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Kazunori Terasaki
- Cyclotron Research Center, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
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Uwano I, Kudo K, Sato R, Ogasawara K, Kameda H, Nomura JI, Mori F, Yamashita F, Ito K, Yoshioka K, Sasaki M. Noninvasive Assessment of Oxygen Extraction Fraction in Chronic Ischemia Using Quantitative Susceptibility Mapping at 7 Tesla. Stroke 2017; 48:2136-2141. [DOI: 10.1161/strokeaha.117.017166] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/18/2017] [Accepted: 05/30/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Ikuko Uwano
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
| | - Kohsuke Kudo
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
| | - Ryota Sato
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
| | - Kuniaki Ogasawara
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
| | - Hiroyuki Kameda
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
| | - Jun-ichi Nomura
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
| | - Futoshi Mori
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
| | - Fumio Yamashita
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
| | - Kenji Ito
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
| | - Kunihiro Yoshioka
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
| | - Makoto Sasaki
- From the Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., K.K., H.K., F.M., F.Y., K.I., M.S.), Department of Neurosurgery (K.O., J.N.), and Department of Radiology (K.Y.), Iwate Medical University, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (K.K., H.K.); and Research and Development Group, Hitachi Ltd, Tokyo, Japan (R.S.)
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Payabvash S, Taleb S, Benson JC, Hoffman B, Oswood MC, McKinney AM, Rykken JB. Susceptibility-diffusion mismatch in middle cerebral artery territory acute ischemic stroke: clinical and imaging implications. Acta Radiol 2017; 58:876-882. [PMID: 27799573 DOI: 10.1177/0284185116675658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recent studies have suggested a correlation between susceptibility-diffusion mismatch and perfusion-diffusion mismatch in acute ischemic stroke patients. Purpose To determine the clinical and imaging associations of susceptibility-diffusion mismatch in patients with acute ischemic stroke in the middle cerebral artery (MCA) territory. Material and Methods Consecutive patients with MCA territory acute ischemic stroke, who had magnetic resonance imaging (MRI) performed with susceptibility-weighted imaging (SWI) and diffusion-weighted imaging (DWI) within 24 h of symptom onset or time last-seen-well, were included. Two neuroradiologists reviewed SWI scans for SWI-DWI mismatch defined by regionally increased vessel number or diameter on SWI extending beyond the DWI hyperintensity territory in the affected hemisphere. The stroke severity at admission was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Poor clinical outcome was defined by a 3-month modified Rankin Scale (mRS) score >2. Results The SWI-DWI mismatch was identified in 44 (29.3%) of 150 patients included in this study. Patients with SWI-DWI mismatch had smaller admission infarct volumes (31.2 ± 44.7 versus 55.9 ± 117.7 mL, P = 0.045) and were younger (60.4 ± 18.9 versus 67.1 ± 15.5, P = 0.026). After correction for age, admission NIHSS score, and infarct volume, the SWI-DWI mismatch was associated with a 22.6% lower rate of poor clinical outcome using propensity score matching ( P = 0.032). In our cohort, thrombolytic therapy showed no significant effect on outcome. Conclusion The presence of SWI-DWI mismatch in acute MCA territory ischemic infarct is associated with smaller infarct volume. Moreover, SWI-DWI mismatch was associated with better outcome after correction for infarct size, severity of admission symptoms, and age.
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Affiliation(s)
| | - Shayandokht Taleb
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - John C Benson
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Hoffman
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mark C Oswood
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Alexander M McKinney
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jeffrey B Rykken
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Kurzhunov D, Borowiak R, Reisert M, Joachim Krafft A, Caglar Özen A, Bock M. 3D CMRO 2 mapping in human brain with direct 17O MRI: Comparison of conventional and proton-constrained reconstructions. Neuroimage 2017; 155:612-624. [PMID: 28527792 DOI: 10.1016/j.neuroimage.2017.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022] Open
Abstract
Oxygen metabolism is altered in brain tumor regions and is quantified by the cerebral metabolic rate of oxygen consumption (CMRO2). Direct dynamic 17O MRI with inhalation of isotopically enriched 17O2 gas can be used to quantify CMRO2; however, pixel-wise CMRO2 quantification in human brain is challenging due to low natural abundance of 17O isotope and, thus, the low signal-to-noise ratio (SNR) of 17O MR images. To test the feasibility CMRO2 mapping at a clinical 3 T MRI system, a new iterative reconstruction was proposed, which uses the edge information contained in a co-registered 1H gradient image to construct a non-homogeneous anisotropic diffusion (AD) filter. AD-constrained reconstruction of 17O MR images was compared to conventional Kaiser-Bessel gridding without and with Hanning filtering, and to iterative reconstruction with a total variation (TV) constraint. For numerical brain phantom and in two in vivo data sets of one healthy volunteer, AD-constrained reconstruction provided 17O images with improved resolution of fine brain structures and resulted in higher SNR. CMRO2 values of 0.78 - 1.55µmol/gtissue/min (white brain matter) and 1.03 - 2.01µmol/gtissue/min (gray brain matter) as well as the CMRO2 maps are in a good agreement with the results of 15O-PET and 17O MRI at 7 T and at 9.4 T. In conclusion, the proposed AD-constrained reconstruction enabled calculation of 3D CMRO2 maps at 3 T MRI system, which is an essential step towards clinical translation of 17O MRI for non-invasive CMRO2 quantification in tumor patients.
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Affiliation(s)
- Dmitry Kurzhunov
- Dept. of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Robert Borowiak
- Dept. of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marco Reisert
- Dept. of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Axel Joachim Krafft
- Dept. of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ali Caglar Özen
- Dept. of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Bock
- Dept. of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Optimal Brain 99mTc-Ethyl Cysteinate Dimer SPECT Imaging and Analysis to Detect Misery Perfusion on 15O PET Imaging in Patients With Chronic Occlusive Disease of Unilateral Major Cerebral Artery. Clin Nucl Med 2017; 42:499-505. [PMID: 28481786 PMCID: PMC5464751 DOI: 10.1097/rlu.0000000000001670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Misery perfusion is defined as marginally sufficient cerebral blood supply relative to cerebral metabolic demand. The aim of the present study was to determine the optimal brain Tc-ethyl cysteinate dimer (ECD) SPECT imaging and analysis to detect misery perfusion on O PET imaging in patients with chronic occlusive disease of unilateral internal carotid or middle cerebral artery (MCA). METHODS For 97 patients, cerebral blood flow, cerebral metabolic rate of oxygen, and oxygen extraction fraction were measured using O PET; Tc-ECD SPECT was performed using dynamic scanning with a scan duration of 10 minutes each for 50 minutes after tracer administration. A region of interest was placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres in all standardized images using a 3-dimensional stereotaxic region-of-interest template and affected-to-contralateral asymmetry ratio in the MCA territory (ARMCA) and contralateral-to-affected asymmetry ratio in the cerebellar hemisphere (ARcbl) were calculated. RESULTS The ARMCA or ARcbl on Tc-ECD SPECT with a scan time of 20 to 30 minutes after tracer administration (ARMCA20-30 or ARcbl20-30) was correlated with ARMCA on PET cerebral blood flow (r = 0.654) or ARMCA on PET cerebral metabolic rate of oxygen (r = 0.576), respectively, more strongly than with other scan times. The area under the receiver operating characteristic curve for detecting abnormally elevated ARMCA on PET oxygen extraction fraction was significantly greater for ARcbl20-30/ARMCA20-30 (0.947) than for ARMCA20-30 alone (0.780) (difference between areas, 0.167; P = 0.0001) on Tc-ECD SPECT. CONCLUSIONS Combination of asymmetries in the cerebellar and cerebral hemispheres on Tc-ECD SPECT in a scan time of 20 to 30 minutes after tracer administration optimally detects misery perfusion in unilateral internal carotid artery or MCA occlusive disease.
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Faulkner J, Stoner L, Grigg R, Fryer S, Stone K, Lambrick D. Acute effects of exercise posture on executive function in transient ischemic attack patients. Psychophysiology 2017; 54:1239-1248. [DOI: 10.1111/psyp.12868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- James Faulkner
- Department of Sport and Exercise; University of Winchester; Winchester United Kingdom
| | - Lee Stoner
- School of Sport and Exercise; Massey University; Wellington New Zealand
- Department of Exercise and Sport Science; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Rebecca Grigg
- School of Sport and Exercise; Massey University; Wellington New Zealand
| | - Simon Fryer
- School of Sport and Exercise; University of Gloucestershire; Gloucester United Kingdom
| | - Keeron Stone
- School of Sport and Exercise; University of Gloucestershire; Gloucester United Kingdom
| | - Danielle Lambrick
- School of Health and Life Sciences; University of Southampton; Southampton United Kingdom
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Derdeyn CP, Zipfel GJ, Zazulia AR, Davis PH, Prabhakaran S, Ivan CS, Aiyagari V, Sagar JR, Hantler N, Shinawi L, Lee JJ, Jafri H, Grubb RL, Miller JP, Dacey RG. Baseline Hemodynamic Impairment and Future Stroke Risk in Adult Idiopathic Moyamoya Phenomenon: Results of a Prospective Natural History Study. Stroke 2017; 48:894-899. [PMID: 28283605 PMCID: PMC8204377 DOI: 10.1161/strokeaha.116.014538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/09/2017] [Accepted: 01/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose was to test the hypothesis that increased oxygen extraction fraction (OEF), a marker of severe hemodynamic impairment measured by positron emission tomography, is an independent risk factor for subsequent ischemic stroke in this population. METHODS Adults with idiopathic moyamoya phenomena were recruited between 2005 and 2012 for a prospective, multicenter, blindly adjudicated, longitudinal cohort study. Measurements of OEF were obtained on enrollment. Subjects were followed up for the occurrence of ipsilateral ischemic stroke at 6-month intervals. Patients were censored at the time of surgical revascularization or at last follow-up. The primary analysis was time to ischemic stroke in the territory of the occlusive vasculopathy. RESULTS Forty-nine subjects were followed up during a median of 3.7 years. One of 16 patients with increased OEF on enrollment had an ischemic stroke and another had an intraparenchymal hemorrhage. Three of 33 patients with normal OEF had an ischemic stroke. On a per-hemisphere basis, 21 of 79 hemispheres with moyamoya vasculopathy had increased OEF at baseline. No ischemic strokes and one hemorrhage occurred in a hemisphere with increased OEF (n=21). Sixteen patients (20 hemispheres), including 5 with increased OEF at enrollment, were censored at a mean of 5.3 months after enrollment for revascularization surgery. CONCLUSIONS The risk of new or recurrent stroke was lower than expected. The low event rate, low prevalence of increased OEF, and potential selection bias introduced by revascularization surgery limit strong conclusions about the association of increased OEF and future stroke risk. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00629915.
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Affiliation(s)
- Colin P Derdeyn
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.).
| | - Gregory J Zipfel
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - Allyson R Zazulia
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - Patricia H Davis
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - Shyam Prabhakaran
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - Cristina S Ivan
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - Venkatesh Aiyagari
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - James R Sagar
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - Nancy Hantler
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - Lina Shinawi
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - John J Lee
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - Hussain Jafri
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - Robert L Grubb
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - J Philip Miller
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
| | - Ralph G Dacey
- From the Department of Radiology (C.P.D.), Department of Neurology (C.P.D., P.H.D.), and Department of Neurosurgery (C.P.D.), University of Iowa Hospitals and Clinics, Iowa City; Department of Neurological Surgery (G.J.Z., R.L.G., R.G.D.), Department of Neurology (A.R.Z.), Department of Radiology (J.R.S., N.H., L.S., J.J.L., H.J.), and Division of Biostatistics (J.P.M.), Washington University School of Medicine, St Louis, MO; Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.P.); Department of Neurology, University of Indiana Medical School, Indianapolis (C.S.I.); and Department of Neurology, University of Texas Southwestern Medical School, Dallas (V.A.)
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Yamauchi H, Kagawa S, Kishibe Y, Takahashi M, Higashi T. Progressive Cortical Neuronal Damage and Extracranial-Intracranial Bypass Surgery in Patients with Misery Perfusion. AJNR Am J Neuroradiol 2017; 38:935-941. [PMID: 28255031 DOI: 10.3174/ajnr.a5110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/17/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Misery perfusion may cause selective neuronal damage in atherosclerotic ICA or MCA disease. Bypass surgery can improve misery perfusion and may prevent neuronal damage. On the other hand, surgery conveys a risk for neuronal damage. The purpose of this retrospective study was to determine whether progression of cortical neuronal damage in surgically treated patients with misery perfusion is larger than that in surgically treated patients without misery perfusion or medically treated patients with misery perfusion. MATERIALS AND METHODS We evaluated the distribution of benzodiazepine receptors twice by using PET and 11C-labeled flumazenil in 18 surgically treated patients with atherosclerotic ICA or MCA disease (9 with misery perfusion and 9 without) and no perioperative stroke before and after bypass surgery; in 8 medically treated patients with misery perfusion and no intervening ischemic event; and in 7 healthy controls. We quantified abnormal decreases in the benzodiazepine receptors of the cerebral cortex within the MCA distribution and compared changes in the benzodiazepine receptor index among the 3 groups. RESULTS The change in the benzodiazepine receptor index in surgically treated patients with misery perfusion (27.5 ± 15.6) during 7 ± 5 months was significantly larger than that in surgically treated patients without misery perfusion (-5.2 ± 9.4) during 6 ± 4 months (P < .001) and in medically treated patients with misery perfusion (3.2 ± 15.4) during 16 ± 6 months (P < .01). CONCLUSIONS Progression of cortical neuronal damage in surgically treated patients with misery perfusion and no perioperative stroke may occur and may be larger than that in medically treated patients with misery perfusion and no intervening ischemic event.
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Affiliation(s)
- H Yamauchi
- From the Division of PET Imaging (H.Y., S.K., Y.K., M.T., T.H.), Shiga Medical Center Research Institute, Moriyama, Japan
| | - S Kagawa
- From the Division of PET Imaging (H.Y., S.K., Y.K., M.T., T.H.), Shiga Medical Center Research Institute, Moriyama, Japan
| | - Y Kishibe
- From the Division of PET Imaging (H.Y., S.K., Y.K., M.T., T.H.), Shiga Medical Center Research Institute, Moriyama, Japan
| | - M Takahashi
- From the Division of PET Imaging (H.Y., S.K., Y.K., M.T., T.H.), Shiga Medical Center Research Institute, Moriyama, Japan
| | - T Higashi
- From the Division of PET Imaging (H.Y., S.K., Y.K., M.T., T.H.), Shiga Medical Center Research Institute, Moriyama, Japan.,National Institute of Radiological Sciences (T.H.), National Institutes of Quantum and Radiological Science and Technology, Chiba, Japan
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76
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Ward PGD, Fan AP, Raniga P, Barnes DG, Dowe DL, Ng ACL, Egan GF. Improved Quantification of Cerebral Vein Oxygenation Using Partial Volume Correction. Front Neurosci 2017; 11:89. [PMID: 28289372 PMCID: PMC5326785 DOI: 10.3389/fnins.2017.00089] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/10/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose: Quantitative susceptibility mapping (QSM) enables cerebral venous characterization and physiological measurements, such as oxygen extraction fraction (OEF). The exquisite sensitivity of QSM to deoxygenated blood makes it possible to image small veins; however partial volume effects must be addressed for accurate quantification. We present a new method, Iterative Cylindrical Fitting (ICF), to estimate voxel-based partial volume effects for susceptibility maps and use it to improve OEF quantification of small veins with diameters between 1.5 and 4 voxels. Materials and Methods: Simulated QSM maps were generated to assess the performance of the ICF method over a range of vein geometries with varying echo times and noise levels. The ICF method was also applied to in vivo human brain data to assess the feasibility and behavior of OEF measurements compared to the maximum intensity voxel (MIV) method. Results: Improved quantification of OEF measurements was achieved for vessels with contrast to noise greater than 3.0 and vein radii greater than 0.75 voxels. The ICF method produced improved quantitative accuracy of OEF measurement compared to the MIV approach (mean OEF error 7.7 vs. 12.4%). The ICF method provided estimates of vein radius (mean error <27%) and partial volume maps (root mean-squared error <13%). In vivo results demonstrated consistent estimates of OEF along vein segments. Conclusion: OEF quantification in small veins (1.5–4 voxels in diameter) had lower error when using partial volume estimates from the ICF method.
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Affiliation(s)
- Phillip G D Ward
- Monash Biomedical Imaging, Monash UniversityClayton, VIC, Australia; Faculty of Information Technology, Monash UniversityClayton, VIC, Australia
| | - Audrey P Fan
- Department of Radiology, Lucas Center for Imaging, Stanford University Stanford, CA, USA
| | - Parnesh Raniga
- Monash Biomedical Imaging, Monash UniversityClayton, VIC, Australia; The Australian eHealth Research Centre, CSIRO Health and BiosecurityHerston, QLD, Australia
| | - David G Barnes
- Faculty of Information Technology, Monash UniversityClayton, VIC, Australia; Monash eResearch Centre, Monash UniversityClayton, VIC, Australia
| | - David L Dowe
- Faculty of Information Technology, Monash University Clayton, VIC, Australia
| | - Amanda C L Ng
- Department of Anatomy and Neuroscience, The University of Melbourne Melbourne, VIC, Australia
| | - Gary F Egan
- Monash Biomedical Imaging, Monash UniversityClayton, VIC, Australia; ARC Centre of Excellence for Integrative Brain FunctionMelbourne, VIC, Australia
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77
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Imasaka KI, Tayama E, Tomita Y. The impact of carotid or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery. J Thorac Cardiovasc Surg 2017; 153:1045-1053. [PMID: 28411747 DOI: 10.1016/j.jtcvs.2016.12.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/09/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to clarify the impact of carotid or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery. METHODS Between 2008 and 2015, 200 consecutive patients underwent elective aortic arch surgery with selective antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Nonselective screening for carotid or intracranial atherosclerosis was performed using carotid ultrasonography or magnetic resonance angiography. Carotid or intracranial atherosclerosis was classified as below moderate (0%-49% stenosis), moderate (50%-69%), or severe (70%-100%). In patients with moderate or severe stenosis, cerebral hemodynamics were evaluated using single-photon emission computed tomography with acetazolamide. RESULTS None of the 37 patients undergoing preoperative single-photon emission computed tomography with acetazolamide had impaired cerebral hemodynamics. In-hospital mortality rate was 3.5% (7/200). Postoperative neurologic morbidity included permanent stroke in 8 patients (4.0%) and transient neurologic deficits in 27 patients (14%). Permanent stroke occurred in 3 of 159 patients (1.9%) with below moderate stenosis and 5 of 41 patients (12.2%) with moderate or severe stenosis (P = .008). Seven of 8 patients (87.5%) with stroke experienced multiple atherothrombotic embolizations, and 1 patient experienced a stroke of unknown cause. In multivariate analysis, previous cerebrovascular accident (odds ratio, 5.0; 95% confidence interval, 2.07-12.42; P = .0004) and shaggy aorta (odds ratio, 4.2; 95% confidence interval, 1.58-10.98; P = .0045) were significant determinants of neurologic morbidity. CONCLUSIONS Embolism was the major cause of permanent stroke in our patient population. Preoperative craniocervical and aortic screening may aid in modifying the operative strategy to reduce the occurrence of stroke.
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Affiliation(s)
- Ken-Ichi Imasaka
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yukihiro Tomita
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
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78
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Munuera J, Blasco G, Hernández-Pérez M, Daunis-I-Estadella P, Dávalos A, Liebeskind DS, Wintermark M, Demchuk A, Menon BK, Thomalla G, Nael K, Pedraza S, Puig J. Venous imaging-based biomarkers in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2017; 88:62-69. [PMID: 27807197 DOI: 10.1136/jnnp-2016-314814] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 11/04/2022]
Abstract
Vascular neuroimaging plays a decisive role in selecting the best therapy in patients with acute ischaemic stroke. However, compared with the arterial system, the role of veins has not been thoroughly studied. In this review, we present the major venous imaging-based biomarkers in ischaemic stroke. First, the presence of hypodense veins in the monophasic CT angiography ipsilateral to the arterial occlusion. Second, the asymmetry of venous drainage in the pathological cerebral hemisphere on CT and MRI dynamic angiography. Finally, the presence of hypodense veins on T2* -based MRI. From the physiological point of view, the venous imaging-based biomarkers would detect the alteration of brain perfusion (flow), as well as the optimisation of extraction oxygen mechanisms (misery perfusion). Several studies have correlated the venous imaging-based biomarkers with grade of collateral circulation, the ischaemic penumbra and clinical functional outcome. Although venous imaging-based biomarkers still have to be validated, growing evidence highlights a potential complementary role in the acute stroke clinical decision-making process.
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Affiliation(s)
- Josep Munuera
- Diagnostic Imaging Institute (IDI), Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Gerard Blasco
- Institute of Diagnostic Imaging (IDI)-Research Unit (IDIR), Girona, Spain.,Girona Biomedical Research Institute (IDIBGI)-Medical Imaging, Girona, Spain
| | | | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Antoni Dávalos
- Stroke Unit, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Los Angeles, California, USA
| | - Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California, USA
| | - Andrew Demchuk
- Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bijoy K Menon
- Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kambiz Nael
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Salvador Pedraza
- Girona Biomedical Research Institute (IDIBGI)-Medical Imaging, Girona, Spain.,Institute of Diagnostic Imaging (IDI)-Dr. Josep Trueta University Hospital, Girona, Spain
| | - Josep Puig
- Institute of Diagnostic Imaging (IDI)-Research Unit (IDIR), Girona, Spain.,Girona Biomedical Research Institute (IDIBGI)-Medical Imaging, Girona, Spain
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79
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Dani KA, Moreton FC, Santosh C, Lopez R, Brennan D, Schwarzbauer C, Goutcher C, O'Hare K, Macrae IM, Muir KW. Oxygen challenge magnetic resonance imaging in healthy human volunteers. J Cereb Blood Flow Metab 2017; 37:366-376. [PMID: 26787107 PMCID: PMC5363753 DOI: 10.1177/0271678x15627827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/12/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022]
Abstract
Oxygen challenge imaging involves transient hyperoxia applied during deoxyhaemoglobin sensitive (T2*-weighted) magnetic resonance imaging and has the potential to detect changes in brain oxygen extraction. In order to develop optimal practical protocols for oxygen challenge imaging, we investigated the influence of oxygen concentration, cerebral blood flow change, pattern of oxygen administration and field strength on T2*-weighted signal. Eight healthy volunteers underwent multi-parametric magnetic resonance imaging including oxygen challenge imaging and arterial spin labelling using two oxygen concentrations (target FiO2 of 100 and 60%) administered consecutively (two-stage challenge) at both 1.5T and 3T. There was a greater signal increase in grey matter compared to white matter during oxygen challenge (p < 0.002 at 3T, P < 0.0001 at 1.5T) and at FiO2 = 100% compared to FiO2 = 60% in grey matter at both field strengths (p < 0.02) and in white matter at 3T only (p = 0.0314). Differences in the magnitude of signal change between 1.5T and 3T did not reach statistical significance. Reduction of T2*-weighted signal to below baseline, after hyperoxia withdrawal, confounded interpretation of two-stage oxygen challenge imaging. Reductions in cerebral blood flow did not obscure the T2*-weighted signal increases. In conclusion, the optimal protocol for further study should utilise target FiO2 = 100% during a single oxygen challenge. Imaging at both 1.5T and 3T is clinically feasible.
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Affiliation(s)
- Krishna A Dani
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Fiona C Moreton
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Celestine Santosh
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Rosario Lopez
- Department of Clinical Physics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - David Brennan
- Department of Clinical Physics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Christian Schwarzbauer
- University of Applied Sciences Munich, School of Applied Sciences and Mechatronics, München
| | - Colin Goutcher
- Department of Anaesthetics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Kevin O'Hare
- Department of Anaesthetics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - I Mhairi Macrae
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow
| | - Keith W Muir
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital Glasgow, Glasgow
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80
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Sakamoto S, Ikeda H, Tsuyuguchi N, Uda T, Okumura E, Asakawa T, Haruta Y, Nishiyama H, Okada T, Kamada H, Ohata K, Miki Y. MEG Frequency Analysis Depicts the Impaired Neurophysiological Condition of Ischemic Brain. PLoS One 2016; 11:e0168588. [PMID: 27992543 PMCID: PMC5161380 DOI: 10.1371/journal.pone.0168588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/02/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Quantitative imaging of neuromagnetic fields based on automated region of interest (ROI) setting was analyzed to determine the characteristics of cerebral neural activity in ischemic areas. METHODS Magnetoencephalography (MEG) was used to evaluate spontaneous neuromagnetic fields in the ischemic areas of 37 patients with unilateral internal carotid artery (ICA) occlusive disease. Voxel-based time-averaged intensity of slow waves was obtained in two frequency bands (0.3-4 Hz and 4-8 Hz) using standardized low-resolution brain electromagnetic tomography (sLORETA) modified for a quantifiable method (sLORETA-qm). ROIs were automatically applied to the anterior cerebral artery (ACA), anterior middle cerebral artery (MCAa), posterior middle cerebral artery (MCAp), and posterior cerebral artery (PCA) using statistical parametric mapping (SPM). Positron emission tomography with 15O-gas inhalation (15O-PET) was also performed to evaluate cerebral blood flow (CBF) and oxygen extraction fraction (OEF). Statistical analyses were performed using laterality index of MEG and 15O-PET in each ROI with respect to distribution and intensity. RESULTS MEG revealed statistically significant laterality in affected MCA regions, including 4-8 Hz waves in MCAa, and 0.3-4 Hz and 4-8 Hz waves in MCAp (95% confidence interval: 0.020-0.190, 0.030-0.207, and 0.034-0.213), respectively. We found that 0.3-4 Hz waves in MCAp were highly correlated with CBF in MCAa and MCAp (r = 0.74, r = 0.68, respectively), whereas 4-8 Hz waves were moderately correlated with CBF in both the MCAa and MCAp (r = 0.60, r = 0.63, respectively). We also found that 4-8 Hz waves in MCAp were statistically significant for misery perfusion identified on 15O-PET (p<0.05). CONCLUSIONS Quantitatively imaged spontaneous neuromagnetic fields using the automated ROI setting enabled clear depiction of cerebral ischemic areas. Frequency analysis may reveal unique neural activity that is distributed in the impaired vascular metabolic territory, in which the cerebral infarction has not yet been completed.
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Affiliation(s)
- Shinichi Sakamoto
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
- * E-mail:
| | - Hidetoshi Ikeda
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Naohiro Tsuyuguchi
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takehiro Uda
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Okumura
- Medical Imaging Business Department, Ricoh Company, Ltd., Kanazawa, Japan
| | - Takashi Asakawa
- Medical Imaging Business Department, Ricoh Company, Ltd., Kanazawa, Japan
| | - Yasuhiro Haruta
- Applied Electronics Laboratory, Kanazawa Institute of Technology, Kanazawa, Japan
| | | | - Toyoji Okada
- Department of Clinical Laboratory, Hokuto Hospital, Obihiro, Japan
| | - Hajime Kamada
- Department of Neurosurgery, Hokuto Hospital, Obihiro, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
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81
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Nas ÖF, Demir AB, Bakar M, Özkaya G, Kaçar E, Hakyemez B. Impact of Stent-Assisted Recanalization of Carotid Artery Stenosis on Brain Volume Changes. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2016. [DOI: 10.5799/jcei.328500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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82
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Heiss WD, Zaro Weber O. Validation of MRI Determination of the Penumbra by PET Measurements in Ischemic Stroke. J Nucl Med 2016; 58:187-193. [PMID: 27879370 DOI: 10.2967/jnumed.116.185975] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 11/16/2022] Open
Abstract
The concept of the ischemic penumbra was formulated on the basis of animal experiments showing functional impairment and electrophysiologic disturbances with decreasing flow to the brain below defined values (the threshold for function) and irreversible tissue damage with blood supply further decreased (the threshold for infarction). The perfusion range between these thresholds was termed the "penumbra," and restitution of flow above the functional threshold was able to reverse the deficits without permanent damage. In further experiments, the dependency of the development of irreversible lesions on the interaction of the severity and the duration of critically reduced blood flow was established, proving that the lower the flow, the shorter the time for efficient reperfusion. As a consequence, infarction develops from the core of ischemia to the areas of less severe hypoperfusion. The translation of this experimental concept as the basis for the efficient treatment of stroke requires noninvasive methods with which regional flow and energy metabolism can be repeatedly investigated to demonstrate penumbra tissue, which can benefit from therapeutic interventions. PET allows the quantification of regional cerebral blood flow, the regional oxygen extraction fraction, and the regional metabolic rate for oxygen. With these variables, clear definitions of irreversible tissue damage and of critically hypoperfused but potentially salvageable tissue (i.e., the penumbra) in stroke patients can be achieved. However, PET is a research tool, and its complex logistics limit clinical routine applications. Perfusion-weighted or diffusion-weighted MRI is a widely applicable clinical tool, and the "mismatch" between perfusion-weighted and diffusion-weighted abnormalities serves as an indicator of the penumbra. However, comparative studies of perfusion-weighted or diffusion-weighted MRI and PET have indicated overestimation of the core of irreversible infarction as well as of the penumbra by the MRI modalities. Some of these discrepancies can be explained by the nonselective application of relative perfusion thresholds, which might be improved by more complex analytic procedures. The heterogeneity of the MRI signatures used for the definition of the mismatch are also responsible for disappointing results in the application of perfusion-weighted or diffusion-weighted MRI to the selection of patients for clinical trials. As long as validation of the mismatch selection paradigm is lacking, the use of this paradigm as a surrogate marker of outcome is limited.
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83
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Relation between brain temperature and white matter damage in subacute carbon monoxide poisoning. Sci Rep 2016; 6:36523. [PMID: 27819312 PMCID: PMC5098147 DOI: 10.1038/srep36523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 10/18/2016] [Indexed: 12/29/2022] Open
Abstract
In the previous studies, carbon monoxide (CO) poisoning showed an imbalance between cerebral perfusion and metabolism in the acute phase and the brain temperature (BT) in these patients remained abnormally high from the acute to the subacute phase. As observed in chronic ischemic patients, BT can continuously remain high depending on impairments of cerebral blood flow and metabolism; this is because heat removal and production system in the brain may mainly be maintained by the balance of these two factors; thus, cerebral white matter damage (WMD) affecting normal metabolism may affect the BT in patients with CO poisoning. Here, we investigated whether the BT correlates with the degree of WMD in patients with subacute CO-poisoning. In 16 patients with subacute CO-poisoning, the BT and degree of WMD were quantitatively measured by using magnetic resonance spectroscopy and the fractional anisotropy (FA) value from diffusion tensor imaging dataset. Consequently, the BT significantly correlated with the degree of WMD. In particular, BT observed in patients with delayed neuropsychiatric sequelae, a crucial symptom with sudden-onset in the chronic phase after CO exposure, might indicate cerebral hypo-metabolism and abnormal hemodynamics like “matched perfusion,” in which the reduced perfusion matches the reduced metabolism.
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84
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Abstract
Disorders of the brain manifest in a variety of manners ranging from feeling or thought abnormalities to total paralysis. Until recently, most imaging methods of the brain have been limited to anatomic considerations, with little information about actual function of the brain except that deduced from clinical examination and physical and cognitive assessment testing. With the advent of positron emission tomography (PET) and enhanced computer and scintigraphic image detection systems, there is keen interest in applying this imaging technique to better understand brain physiology and pathophysiology. Potential applications of PET in CNS assessment is expanding avenues for improved diagnosis and staging of disease, as well as monitoring therapeutic interventions. A general review of the radiopharmaceuticals used for neuro-PET imaging, as well as their application in situations such as cerebrovascular disease, brain activation studies, various movement disorders and dementias, depression, epilepsy, obsessive-compulsive disorder, schizophrenia, and neuropharmacology (including cerebral receptor studies) will be presented.
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Affiliation(s)
- David L. Laven
- Gammascan Consultants, 633 Sabal Lake Drive (Unit 103), Longwood, Florida 32779,
| | - Edward M. Bednarczyk
- Department of Nuclear Medicine, University at Buffalo-State University of New York, Parker Hall (Rm 105), 3435 Main Street, Buffalo, New York 14214-3007
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85
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Lövblad KO, Kiefer C, Oswald H, Arnold M, Nedeltchev K, Mattle H, Schroth G. Imaging the Ischemic Penumbra. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140090301600534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - M. Arnold
- Department of Neurology, Inselspital, Bern; Switzerland
| | - K. Nedeltchev
- Department of Neurology, Inselspital, Bern; Switzerland
| | - H. Mattle
- Department of Neurology, Inselspital, Bern; Switzerland
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86
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Kudo K, Liu T, Murakami T, Goodwin J, Uwano I, Yamashita F, Higuchi S, Wang Y, Ogasawara K, Ogawa A, Sasaki M. Oxygen extraction fraction measurement using quantitative susceptibility mapping: Comparison with positron emission tomography. J Cereb Blood Flow Metab 2016; 36:1424-33. [PMID: 26661168 PMCID: PMC4976745 DOI: 10.1177/0271678x15606713] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 08/03/2015] [Indexed: 11/15/2022]
Abstract
The purposes of this study are to establish oxygen extraction fraction (OEF) measurements using quantitative susceptibility mapping (QSM) of magnetic resonance imaging (MRI), and to compare QSM-OEF data with the gold standard (15)O positron emission tomography (PET). Twenty-six patients with chronic unilateral internal carotid artery or middle cerebral artery stenosis or occlusion, and 15 normal subjects were included. MRI scans were conducted using a 3.0 Tesla scanner with a three-dimensional spoiled gradient recalled sequence. QSM images were created using the morphology-enabled dipole inversion method, and OEF maps were generated from QSM images using extraction of venous susceptibility induced by deoxygenated hemoglobin. Significant correlation of relative OEF ratio to contra-lateral hemisphere between QSM-OEF and PET-OEF was observed (r = 0.62, p < 0.001). The local (intra-section) correlation was also significant (r = 0.52, p < 0.001) in patients with increased PET-OEF. The sensitivity and specificity of OEF increase in QSM was 0.63 (5/8) and 0.89 (16/18), respectively, in comparison with PET. In conclusion, good correlation was achieved between QSM-OEF and PET-OEF in the identification of elevated OEF in affected hemispheres of patients with unilateral chronic steno-occlusive disease.
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Affiliation(s)
- Kohsuke Kudo
- Division of Ultra-High Field MRI, Iwate Medical University, Japan Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Japan
| | - Tian Liu
- Departments of Radiology, Weill Cornell Medical College, New York, NY, USA MedImageMetric LLC, New York, NY, USA
| | | | - Jonathan Goodwin
- Division of Ultra-High Field MRI, Iwate Medical University, Japan
| | - Ikuko Uwano
- Division of Ultra-High Field MRI, Iwate Medical University, Japan
| | - Fumio Yamashita
- Division of Ultra-High Field MRI, Iwate Medical University, Japan
| | - Satomi Higuchi
- Division of Ultra-High Field MRI, Iwate Medical University, Japan
| | - Yi Wang
- Departments of Radiology, Weill Cornell Medical College, New York, NY, USA
| | | | - Akira Ogawa
- Department of Neurosurgery, Iwate Medical University, Japan
| | - Makoto Sasaki
- Division of Ultra-High Field MRI, Iwate Medical University, Japan
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87
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Rodgers ZB, Detre JA, Wehrli FW. MRI-based methods for quantification of the cerebral metabolic rate of oxygen. J Cereb Blood Flow Metab 2016; 36:1165-85. [PMID: 27089912 PMCID: PMC4929705 DOI: 10.1177/0271678x16643090] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Abstract
The brain depends almost entirely on oxidative metabolism to meet its significant energy requirements. As such, the cerebral metabolic rate of oxygen (CMRO2) represents a key measure of brain function. Quantification of CMRO2 has helped elucidate brain functional physiology and holds potential as a clinical tool for evaluating neurological disorders including stroke, brain tumors, Alzheimer's disease, and obstructive sleep apnea. In recent years, a variety of magnetic resonance imaging (MRI)-based CMRO2 quantification methods have emerged. Unlike positron emission tomography - the current "gold standard" for measurement and mapping of CMRO2 - MRI is non-invasive, relatively inexpensive, and ubiquitously available in modern medical centers. All MRI-based CMRO2 methods are based on modeling the effect of paramagnetic deoxyhemoglobin on the magnetic resonance signal. The various methods can be classified in terms of the MRI contrast mechanism used to quantify CMRO2: T2*, T2', T2, or magnetic susceptibility. This review article provides an overview of MRI-based CMRO2 quantification techniques. After a brief historical discussion motivating the need for improved CMRO2 methodology, current state-of-the-art MRI-based methods are critically appraised in terms of their respective tradeoffs between spatial resolution, temporal resolution, and robustness, all of critical importance given the spatially heterogeneous and temporally dynamic nature of brain energy requirements.
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Affiliation(s)
- Zachary B Rodgers
- University of Pennsylvania Medical Center, Philadelphia, PA, USA Laboratory for Structural, Physiologic, and Functional Imaging, Department of Radiology, Philadelphia, PA, USA
| | - John A Detre
- University of Pennsylvania Medical Center, Philadelphia, PA, USA Center for Functional Neuroimaging, Department of Neurology, Philadelphia, PA, USA
| | - Felix W Wehrli
- University of Pennsylvania Medical Center, Philadelphia, PA, USA
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88
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Yamauchi H, Kagawa S, Kishibe Y, Takahashi M, Higashi T. Progressive Cortical Neuronal Damage and Chronic Hemodynamic Impairment in Atherosclerotic Major Cerebral Artery Disease. Stroke 2016; 47:1534-41. [DOI: 10.1161/strokeaha.116.013093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/29/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Cross-sectional studies suggest that chronic hemodynamic impairment may cause selective cortical neuronal damage in patients with atherosclerotic internal carotid artery or middle cerebral artery occlusive disease. The purpose of this longitudinal study was to determine whether the progression of cortical neuronal damage, evaluated as a decrease in central benzodiazepine receptors (BZRs), is associated with hemodynamic impairment at baseline or hemodynamic deterioration during follow-up.
Methods—
We evaluated the distribution of BZRs twice using positron emission tomography and
11
C-flumazenil over time in 80 medically treated patients with atherosclerotic internal carotid artery or middle cerebral artery occlusive disease that had no ischemic episodes during follow-up. Using 3D stereotactic surface projections, we quantified abnormal decreases in the BZRs in the cerebral cortex within the middle cerebral artery distribution and correlated changes in the BZR index with the mean hemispheric values of hemodynamic parameters obtained from
15
O gas positron emission tomography.
Results—
In the hemisphere affected by arterial disease, the BZR index in 40 patients (50%) was increased during follow-up (mean 26±20 months). In multivariable logistic regression analyses, increases in the BZR index were associated with the decreased cerebral blood flow at baseline and an increased oxygen extraction fraction during follow-up. Increases in the oxygen extraction fraction during follow-up were associated with a lack of statin use.
Conclusions—
In patients with atherosclerotic internal carotid artery or middle cerebral artery disease, the progression of cortical neuronal damage was associated with hemodynamic impairment at baseline and hemodynamic deterioration during follow-up. Statin use may be beneficial against hemodynamic deterioration and therefore neuroprotective.
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Affiliation(s)
- Hiroshi Yamauchi
- From the Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan
| | - Shinya Kagawa
- From the Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan
| | - Yoshihiko Kishibe
- From the Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan
| | - Masaaki Takahashi
- From the Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan
| | - Tatsuya Higashi
- From the Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan
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89
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The masaryk hospital extracranial–intracranial bypass study. Neurosurg Rev 2016; 40:53-57. [DOI: 10.1007/s10143-016-0746-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/31/2016] [Accepted: 04/09/2016] [Indexed: 11/25/2022]
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90
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Nishino A, Tajima Y, Takuwa H, Masamoto K, Taniguchi J, Wakizaka H, Kokuryo D, Urushihata T, Aoki I, Kanno I, Tomita Y, Suzuki N, Ikoma Y, Ito H. Long-term effects of cerebral hypoperfusion on neural density and function using misery perfusion animal model. Sci Rep 2016; 6:25072. [PMID: 27116932 PMCID: PMC4846861 DOI: 10.1038/srep25072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 03/23/2016] [Indexed: 11/09/2022] Open
Abstract
We investigated the chronic effects of cerebral hypoperfusion on neuronal density and functional hyperemia using our misery perfusion mouse model under unilateral common carotid artery occlusion (UCCAO). Neuronal density evaluated 28 days after UCCAO using [(11)C]flumazenil-PET and histology indicated no neurologic deficit in the hippocampus and neocortex. CBF response to sensory stimulation was assessed using laser-Doppler flowmetry. Percentage changes in CBF response of the ipsilateral hemisphere to UCCAO were 18.4 ± 3.0%, 6.9 ± 2.8%, 6.8 ± 2.3% and 4.9 ± 2.4% before, and 7, 14 and 28 days after UCCAO, respectively. Statistical significance was found at 7, 14 and 28 days after UCCAO (P < 0.01). Contrary to our previous finding (Tajima et al. 2014) showing recovered CBF response to hypercapnia on 28 days after UCCAO using the same model, functional hyperemia was sustained and became worse 28 days after UCCAO.
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Affiliation(s)
- Asuka Nishino
- Biophysics Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Yosuke Tajima
- Biophysics Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba 263-8555, Japan.,Department of Neurosurgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-8535, Japan
| | - Hiroyuki Takuwa
- Biophysics Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Kazuto Masamoto
- Biophysics Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba 263-8555, Japan.,Brain Science Inspired Life Support Research Center, University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, Tokyo 182-8585, Japan
| | - Junko Taniguchi
- Biophysics Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Hidekatsu Wakizaka
- Biophysics Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Daisuke Kokuryo
- Diagnostic Imaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Takuya Urushihata
- Biophysics Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Ichio Aoki
- Diagnostic Imaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Iwao Kanno
- Biophysics Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Yutaka Tomita
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan
| | - Norihiro Suzuki
- Department of Neurology, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yoko Ikoma
- Biophysics Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Hiroshi Ito
- Biophysics Program, Molecular Imaging Center, National Institute of Radiological Sciences, 4-9-1 Anagawa, Chiba 263-8555, Japan.,Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, 1 Hikariga-oka, Fukushima 960-1295, Japan
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91
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Hossmann KA, Heiss WD. History of the Letzte Wiese/Last Meadow Concept of Brain Ischemia. Stroke 2016; 47:e46-50. [DOI: 10.1161/strokeaha.115.010976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Konstantin-Alexander Hossmann
- From the Max Planck Institute for Metabolism Research (formerly Max Planck Institute of Neurological Research), Cologne, Germany
| | - Wolf-Dieter Heiss
- From the Max Planck Institute for Metabolism Research (formerly Max Planck Institute of Neurological Research), Cologne, Germany
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92
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Park CS, Payne SJ. Modelling the effects of cerebral microvasculature morphology on oxygen transport. Med Eng Phys 2016; 38:41-7. [PMID: 26499366 PMCID: PMC4751405 DOI: 10.1016/j.medengphy.2015.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 07/29/2015] [Accepted: 09/10/2015] [Indexed: 12/28/2022]
Abstract
The cerebral microvasculature plays a vital role in adequately supplying blood to the brain. Determining the health of the cerebral microvasculature is important during pathological conditions, such as stroke and dementia. Recent studies have shown the complex relationship between cerebral metabolic rate and transit time distribution, the transit times of all the possible pathways available dependent on network topology. In this paper, we extend a recently developed technique to solve for residue function, the amount of tracer left in the vasculature at any time, and transit time distribution in an existing model of the cerebral microvasculature to calculate cerebral metabolism. We present the mathematical theory needed to solve for oxygen concentration followed by results of the simulations. It is found that oxygen extraction fraction, the fraction of oxygen removed from the blood in the capillary network by the tissue, and cerebral metabolic rate are dependent on both mean and heterogeneity of the transit time distribution. For changes in cerebral blood flow, a positive correlation can be observed between mean transit time and oxygen extraction fraction, and a negative correlation between mean transit time and metabolic rate of oxygen. A negative correlation can also be observed between transit time heterogeneity and the metabolic rate of oxygen for a constant cerebral blood flow. A sensitivity analysis on the mean and heterogeneity of the transit time distribution was able to quantify their respective contributions to oxygen extraction fraction and metabolic rate of oxygen. Mean transit time has a greater contribution than the heterogeneity for oxygen extraction fraction. This is found to be opposite for metabolic rate of oxygen. These results provide information on the role of the cerebral microvasculature and its effects on flow and metabolism. They thus open up the possibility of obtaining additional valuable clinical information for diagnosing and treating cerebrovascular diseases.
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Affiliation(s)
- Chang Sub Park
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom.
| | - Stephen J Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom
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93
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94
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Lukshin VA, Usachev DY, Pronin IN, Akhmedov AD, Schultz EI. [Perfusion criteria of the EICMA efficacy in patients with symptomatic occlusion of the internal carotid artery]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2016; 80:67-77. [PMID: 27801401 DOI: 10.17116/neiro201680567-77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM To investigate changes in cerebral perfusion in patients with unilateral internal carotid artery occlusion before and after surgical revascularization of the brain, depending on the clinical efficacy of surgical treatment. MATERIAL AND METHODS The study included 60 patients with unilateral ICA occlusions who underwent placement of an extra-intracranial microvascular anastomosis (EICMA). All patients underwent a CT perfusion study before and after cerebral revascularization. In addition, the degree of neurological deficit was evaluated before surgery and during follow-up (3 and 8-10 months) using the NIHSS score. RESULTS All patients were divided into 3 groups, depending on the results of surgical treatment: objective improvement (43 patients), no changes (14 patients), and worsening of clinical symptoms (3 patients). In each group, the absolute and relative perfusion parameters (MTT, CBV, and CBF) were analyzed to identify the perfusion criteria for the EICMA efficacy. A significant relationship between the clinical efficacy of EICMA and a baseline perfusion deficit and its change after anastomosis placement was found. CONCLUSION Placement of EICMA is effective treatment for patients with symptomatic ICA occlusions and an increase in the blood transit time in the hemisphere ipsilateral to occlusion by more than 40% compared to that in the opposite side provided that perfusion is recovered in more than one area of the MCA territory (in accordance with the ASPECTS scale).
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Affiliation(s)
- V A Lukshin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - D Yu Usachev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A D Akhmedov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - E I Schultz
- Burdenko Neurosurgical Institute, Moscow, Russia
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95
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Cerebral Blood Flow and Metabolism. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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96
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Duarte JV, Pereira JMS, Quendera B, Raimundo M, Moreno C, Gomes L, Carrilho F, Castelo-Branco M. Early disrupted neurovascular coupling and changed event level hemodynamic response function in type 2 diabetes: an fMRI study. J Cereb Blood Flow Metab 2015; 35:1671-80. [PMID: 26058698 PMCID: PMC4640307 DOI: 10.1038/jcbfm.2015.106] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/19/2015] [Accepted: 04/24/2015] [Indexed: 11/09/2022]
Abstract
Type 2 diabetes (T2DM) patients develop vascular complications and have increased risk for neurophysiological impairment. Vascular pathophysiology may alter the blood flow regulation in cerebral microvasculature, affecting neurovascular coupling. Reduced fMRI signal can result from decreased neuronal activation or disrupted neurovascular coupling. The uncertainty about pathophysiological mechanisms (neurodegenerative, vascular, or both) underlying brain function impairments remains. In this cross-sectional study, we investigated if the hemodynamic response function (HRF) in lesion-free brains of patients is altered by measuring BOLD (Blood Oxygenation Level-Dependent) response to visual motion stimuli. We used a standard block design to examine the BOLD response and an event-related deconvolution approach. Importantly, the latter allowed for the first time to directly extract the true shape of HRF without any assumption and probe neurovascular coupling, using performance-matched stimuli. We discovered a change in HRF in early stages of diabetes. T2DM patients show significantly different fMRI response profiles. Our visual paradigm therefore demonstrated impaired neurovascular coupling in intact brain tissue. This implies that functional studies in T2DM require the definition of HRF, only achievable with deconvolution in event-related experiments. Further investigation of the mechanisms underlying impaired neurovascular coupling is needed to understand and potentially prevent the progression of brain function decrements in diabetes.
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Affiliation(s)
- João V Duarte
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ICNAS, University of Coimbra, Coimbra, Portugal
| | - João M S Pereira
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ICNAS, University of Coimbra, Coimbra, Portugal.,Laboratory of Biostatistics and Medical Informatics, Institute for Biomedical Imaging in Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Bruno Quendera
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ICNAS, University of Coimbra, Coimbra, Portugal
| | - Miguel Raimundo
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Carolina Moreno
- Department of Endocrinology, University Hospital of Coimbra (CHUC), Coimbra, Portugal
| | - Leonor Gomes
- Department of Endocrinology, University Hospital of Coimbra (CHUC), Coimbra, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, University Hospital of Coimbra (CHUC), Coimbra, Portugal
| | - Miguel Castelo-Branco
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,ICNAS, University of Coimbra, Coimbra, Portugal.,Laboratory of Biostatistics and Medical Informatics, Institute for Biomedical Imaging in Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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97
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Yamauchi H, Kagawa S, Kishibe Y, Takahashi M, Nishii R, Mizuma H, Takahashi K, Onoe H, Higashi T. Increase in [18F]-Fluoroacetate Uptake in Patients With Chronic Hemodynamic Cerebral Ischemia. Stroke 2015; 46:2669-72. [DOI: 10.1161/strokeaha.115.010080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/02/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
[18F]-fluoroacetate (
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F-FACE) can be used for evaluating glial cell metabolism. Experimental studies have shown an increase in
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F-FACE uptake in rodent models of cerebral ischemia. The aim of this study was to determine whether
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F-FACE uptake is increased in the noninfarcted cerebral cortex in patients with hemodynamic ischemia owing to atherosclerotic internal carotid artery or middle cerebral artery disease.
Methods—
We evaluated 9 symptomatic patients with unilateral atherosclerotic internal carotid artery or middle cerebral artery disease and no cortical infarction using positron emission tomography with
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F-FACE and
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O-gases.
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F-FACE uptake during 40 to 60 minutes after injection was compared with the cerebral blood flow, cerebral metabolic rate of oxygen, oxygen extraction fraction, and cerebral blood volume in the middle cerebral artery distributions.
Results—
Significant decreases of cerebral blood flow and cerebral metabolic rate of oxygen and increases of oxygen extraction fraction and cerebral blood volume were found in the hemisphere ipsilateral to the arterial lesion, and
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F-FACE uptake in this region was greater than that in the contralateral hemisphere. The relative
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F-FACE uptake (ipsilateral/contralateral ratio) was negatively correlated with cerebral blood flow or cerebral metabolic rate of oxygen values and was positively correlated with oxygen extraction fraction values. Multivariate analysis showed that the ipsilateral/contralateral
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F-FACE uptake ratio was independently correlated with the cerebral blood flow (or oxygen extraction fraction) and cerebral metabolic rate of oxygen values.
Conclusions—
In patients with atherosclerotic internal carotid artery or middle cerebral artery disease,
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F-FACE uptake is increased in the noninfarcted cerebral cortex with chronic hemodynamic ischemia characterized by misery perfusion with decreased oxygen metabolism. Increased
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F-FACE uptake may indicate the cortical regions that are at particular risk for ischemic damage.
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Affiliation(s)
- Hiroshi Yamauchi
- From the Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (H.Y., S.K., Y.K., M.T., T.H.); Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan (R.N.); and Bio-Function Imaging Team (H.M., H.O.) and Clinical Application Unit (K.T.), RIKEN Center for Life Science Technologies, Kobe, Japan
| | - Shinya Kagawa
- From the Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (H.Y., S.K., Y.K., M.T., T.H.); Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan (R.N.); and Bio-Function Imaging Team (H.M., H.O.) and Clinical Application Unit (K.T.), RIKEN Center for Life Science Technologies, Kobe, Japan
| | - Yoshihiko Kishibe
- From the Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (H.Y., S.K., Y.K., M.T., T.H.); Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan (R.N.); and Bio-Function Imaging Team (H.M., H.O.) and Clinical Application Unit (K.T.), RIKEN Center for Life Science Technologies, Kobe, Japan
| | - Masaaki Takahashi
- From the Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (H.Y., S.K., Y.K., M.T., T.H.); Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan (R.N.); and Bio-Function Imaging Team (H.M., H.O.) and Clinical Application Unit (K.T.), RIKEN Center for Life Science Technologies, Kobe, Japan
| | - Ryuichi Nishii
- From the Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (H.Y., S.K., Y.K., M.T., T.H.); Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan (R.N.); and Bio-Function Imaging Team (H.M., H.O.) and Clinical Application Unit (K.T.), RIKEN Center for Life Science Technologies, Kobe, Japan
| | - Hiroshi Mizuma
- From the Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (H.Y., S.K., Y.K., M.T., T.H.); Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan (R.N.); and Bio-Function Imaging Team (H.M., H.O.) and Clinical Application Unit (K.T.), RIKEN Center for Life Science Technologies, Kobe, Japan
| | - Kazuhiro Takahashi
- From the Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (H.Y., S.K., Y.K., M.T., T.H.); Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan (R.N.); and Bio-Function Imaging Team (H.M., H.O.) and Clinical Application Unit (K.T.), RIKEN Center for Life Science Technologies, Kobe, Japan
| | - Hirotaka Onoe
- From the Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (H.Y., S.K., Y.K., M.T., T.H.); Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan (R.N.); and Bio-Function Imaging Team (H.M., H.O.) and Clinical Application Unit (K.T.), RIKEN Center for Life Science Technologies, Kobe, Japan
| | - Tatsuya Higashi
- From the Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (H.Y., S.K., Y.K., M.T., T.H.); Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan (R.N.); and Bio-Function Imaging Team (H.M., H.O.) and Clinical Application Unit (K.T.), RIKEN Center for Life Science Technologies, Kobe, Japan
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98
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Abstract
Carotid occlusion is a disease that presents a difficult decision for the treating provider. Traditionally, many providers would opt for expectant management with risk factor reduction and supportive therapy. There is a growing body of literature however pointing to possible improved outcomes of more aggressive treatments, including reopening of the occluded carotid. In this review, we discuss the difficulties involved in diagnosing a patient presenting with symptomatic carotid occlusion, the natural history of the disease, and the emerging treatment options and paradigms of different institutions based on recent literature.
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99
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Roussakis E, Li Z, Nichols AJ, Evans CL. Sauerstoffmessung in der Biomedizin - von der Makro- zur Mikroebene. Angew Chem Int Ed Engl 2015. [DOI: 10.1002/ange.201410646] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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100
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Roussakis E, Li Z, Nichols AJ, Evans CL. Oxygen-Sensing Methods in Biomedicine from the Macroscale to the Microscale. Angew Chem Int Ed Engl 2015; 54:8340-62. [DOI: 10.1002/anie.201410646] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/05/2015] [Indexed: 12/15/2022]
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