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Abstract
Advanced neuroimaging techniques are increasingly being implemented in clinical practice as complementary tools to conventional imaging because they can provide crucial functional information about the pathophysiology of a variety of disorders. Therefore, it is important to understand the basic principles underlying them and their role in diagnosis and management. In this review, we will primarily focus on the basic principles and clinical applications of perfusion imaging, diffusion imaging, magnetic resonance spectroscopy, functional MRI, and dual-energy computerized tomography. Our goal is to provide the reader with a basic understanding of these imaging techniques and when they should be used in clinical practice.
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102
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Shankar JJS, Hodgson L, Sinha N. Diffusion weighted imaging may help differentiate intracranial hemangiopericytoma from meningioma. J Neuroradiol 2019; 46:263-267. [DOI: 10.1016/j.neurad.2018.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 11/25/2022]
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103
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Tu Z, Xiao Z, Zheng Y, Huang H, Yang L, Cao D. Benign and malignant skull-involved lesions: discriminative value of conventional CT and MRI combined with diffusion-weighted MRI. Acta Radiol 2019; 60:880-886. [PMID: 29742920 DOI: 10.1177/0284185118773541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about the value of computed tomography (CT) and magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) in distinguishing malignant from benign skull-involved lesions. PURPOSE To evaluate the discriminative value of DWI combined with conventional CT and MRI for differentiating between benign and malignant skull-involved lesions. MATERIAL AND METHODS CT and MRI findings of 58 patients with pathologically proven skull-involved lesions (43 benign and 15 malignant) were retrospectively reviewed. Conventional CT and MRI characteristics and apparent diffusion coefficient (ADC) value of the two groups were evaluated and compared. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the differential performance of each parameter separately and together. RESULTS The presence of cortical defects or break-through and ill-defined margins were associated with malignant skull-involved lesions (both P < 0.05). Malignant skull-involved lesions demonstrated a significantly lower ADC (P = 0.016) than benign lesions. ROC curve analyses indicated that a combination of CT, MRI, and DWI with an ADC ≤ 0.703 × 10-3 mm2/s showed optimal sensitivity, while DWI along showed optimal specificity of 88.4% in differentiating between benign and malignant skull-involved lesions. CONCLUSION The combination of CT, MRI, and DWI can help to differentiate malignant from benign skull-involved lesions. CT + MRI + DWI offers optimal sensitivity, while DWI offers optimal specificity.
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Affiliation(s)
- Zhanhai Tu
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Zebin Xiao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Yingyan Zheng
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Hongjie Huang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Libin Yang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
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104
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de Amorim JC, Torricelli AK, Frittoli RB, Lapa AT, Dertkigil SSJ, Reis F, Costallat LT, França Junior MC, Appenzeller S. Mimickers of neuropsychiatric manifestations in systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2019; 32:623-639. [PMID: 31203921 DOI: 10.1016/j.berh.2019.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Systemic lupus erythematosus (SLE), presenting with new onset or worsening neuropsychiatric (NP) symptoms, is a challenge in clinical practice. Mimickers such as infections, drug-induced side effects, metabolic abnormalities, malignancies, and alcohol-related disorders have to be excluded, before attributing the manifestations to disease activity. Proper diagnosis is essential to guide adequate management and reduce morbidity and mortality. In this review article, we will highlight clinical, laboratorial, and neuroradiological features that are helpful to assist in the differential diagnosis.
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Affiliation(s)
- Jaqueline Cristina de Amorim
- Graduate Program of Child and Adolescent Health, School of Medical Science, University of Campinas, Brazil; Laboratory of Autoimmune Diseases, School of Medical Science, University of Campinas, Brazil
| | | | - Renan Bazuco Frittoli
- Laboratory of Autoimmune Diseases, School of Medical Science, University of Campinas, Brazil; Graduate Program of Physiopathology, School of Medical Science, University of Campinas, Brazil
| | - Aline Tamires Lapa
- Graduate Program of Child and Adolescent Health, School of Medical Science, University of Campinas, Brazil; Laboratory of Autoimmune Diseases, School of Medical Science, University of Campinas, Brazil
| | | | - Fabiano Reis
- Department of Radiology, School of Medical Science, University of Campinas, Brazil
| | - Lilian Tl Costallat
- Rheumatology Unit, Department of Medicine, School of Medical Science, University of Campinas, Brazil
| | | | - Simone Appenzeller
- Laboratory of Autoimmune Diseases, School of Medical Science, University of Campinas, Brazil; Rheumatology Unit, Department of Medicine, School of Medical Science, University of Campinas, Brazil.
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105
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Yokoi S, Kidokoro H, Yamamoto H, Ohno A, Nakata T, Kubota T, Tsuji T, Morishita M, Kawabe T, Naiki M, Maruyama K, Itomi K, Kato T, Ito K, Natsume J. Hippocampal diffusion abnormality after febrile status epilepticus is related to subsequent epilepsy. Epilepsia 2019; 60:1306-1316. [DOI: 10.1111/epi.16059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Setsuri Yokoi
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
- Brain and Mind Research Center Nagoya University Nagoya Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
| | - Atsuko Ohno
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
| | - Tomohiko Nakata
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
| | - Tetsuo Kubota
- Department of Pediatrics Anjo Kosei Hospital Anjo Japan
| | - Takeshi Tsuji
- Department of Pediatrics Okazaki City Hospital Okazaki Japan
| | | | - Takashi Kawabe
- Department of Pediatrics Kasugai Municipal Hospital Kasugai Japan
| | - Misako Naiki
- Department of Pediatrics Kasugai Municipal Hospital Kasugai Japan
| | - Koichi Maruyama
- Department of Pediatric Neurology Aichi Prefectural Colony Central Hospital Kasugai Japan
| | - Kazuya Itomi
- Department of Neurology Aichi Children's Health and Medical Center Obu Japan
| | - Toru Kato
- Department of Pediatrics Okazaki City Hospital Okazaki Japan
| | - Komei Ito
- Department of Allergology Aichi Children's Health and Medical Center Obu Japan
| | - Jun Natsume
- Department of Pediatrics Nagoya University Graduate School of Medicine Nagoya Japan
- Brain and Mind Research Center Nagoya University Nagoya Japan
- Department of Pediatrics Japanese Red Cross Nagoya First Hospital Nagoya Japan
- Department of Developmental Disability Medicine Nagoya University Graduate School of Medicine Nagoya Japan
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106
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Poddar R, Rajagopal S, Winter L, Allan AM, Paul S. A peptide mimetic of tyrosine phosphatase STEP as a potential therapeutic agent for treatment of cerebral ischemic stroke. J Cereb Blood Flow Metab 2019; 39:1069-1084. [PMID: 29215306 PMCID: PMC6547188 DOI: 10.1177/0271678x17747193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Extensive research over the last two decades has advanced our understanding of the pathophysiology of ischemic stroke. However, current pharmacologic therapies are still limited to rapid reperfusion using thrombolytic agents, and neuroprotective approaches that can reduce the consequences of ischemic and reperfusion injury, are still not available. To bridge this gap, we have evaluated the long-term efficacy and therapeutic time window of a novel peptide-based neuroprotectant TAT-STEP, derived from the brain-enriched and neuron-specific tyrosine phosphatase STEP. Using a rat model of transient middle cerebral artery occlusion (90 min), we show that a single intravenous administration of the peptide at the onset of reperfusion (early) or 6 h after the onset of the insult (delayed) reduces mortality rate. In the surviving rats, MRI scans of the brain at days 1, 14 and 28 after the insult show significant reduction in infarct size and improvement of structural integrity within the infarcted area following peptide treatment, regardless of the time of administration. Behavioral assessments show significant improvement in normal gait, motor coordination, sensory motor function and spatial memory following early or delayed peptide treatment. The study establishes for the first time the therapeutic potential of a tyrosine phosphatase in ischemic brain injury.
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Affiliation(s)
- Ranjana Poddar
- 1 Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Lucas Winter
- 1 Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Andrea M Allan
- 2 Department of Neurosciences, 1 University of New Mexico, Albuquerque, NM, USA
| | - Surojit Paul
- 1 Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.,2 Department of Neurosciences, 1 University of New Mexico, Albuquerque, NM, USA
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107
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Hwang EJ, Ryu DW, Lee JE, Park SH, Choi HS, Kim JS. Magnetic resonance imaging assessment of the substrate for hyposmia in patients with Parkinson's disease. Clin Radiol 2019; 74:489.e9-489.e15. [DOI: 10.1016/j.crad.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 02/06/2019] [Indexed: 01/12/2023]
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108
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Siddiqui H, Vakil S, Hassan M. Diagnostic Accuracy of Echo-planar Diffusion-weighted Imaging in the Diagnosis of Intra-cerebral Abscess by Taking Histopathological Findings as the Gold Standard. Cureus 2019; 11:e4677. [PMID: 31328068 PMCID: PMC6634348 DOI: 10.7759/cureus.4677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/16/2019] [Indexed: 11/05/2022] Open
Abstract
Objective To determine the diagnostic accuracy of echo-planar diffusion-weighted imaging (DWI) in the diagnosis of intra-cerebral abscesses by taking histopathological findings as the gold standard. Subject and methods A retrospective cross-sectional study was performed from July 2014 to June 2015 at a tertiary care hospital in Karachi. A total of 462 patients, who were referred for magnetic resonance imaging (MRI) brain, presenting with clinical suspicion of an intra-cerebral abscess on the basis of clinical signs and symptoms, were included in this study. MR imaging was performed. All patients subsequently underwent surgery. The histopathological findings of these patients were collected and compared with echo-planar diffusion-weighted MRI findings. A proforma was used to record the findings. Results The mean age of the patients was 47.39±13.54 years. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of echo-planar diffusion-weighted MRI in the diagnosis of intra-cerebral abscesses was 85.64%, 95.88%, 93.82%, 90.14%, and 91.56%, respectively. Conclusion Brain abscesses and necrotic tumors are, most of the time, difficult to differentiate on routine conventional imaging, and prompt diagnosis is important, as an untreated brain abscess could be lethal. Diffusion imaging can aid in the diagnosis and further management plan so as to help in improved patient care. Although this sequence has high sensitivity and specificity, it should be used in addition to conventional imaging and not as a replacement of histopathology.
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Affiliation(s)
- Hina Siddiqui
- Radiology, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Sameera Vakil
- Radiology, Dow University of Health Sciences (DUHS), Karachi, PAK
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109
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Chiang CW, Lin SY, Cho KH, Wu KJ, Wang Y, Kuo LW. Effects of signal averaging, gradient encoding scheme, and spatial resolution on diffusion kurtosis imaging: An empirical study using 7T MRI. J Magn Reson Imaging 2019; 50:1593-1603. [PMID: 30990956 DOI: 10.1002/jmri.26755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/04/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Although diffusion gradient directions and b-values have been optimized for diffusion kurtosis imaging (DKI), little is known about the effect of signal averaging on DKI reliability. PURPOSE To evaluate how signal averaging influences the reliability of DKI indices using two gradient encoding schemes with three spatial resolutions. STUDY TYPE Prospective. ANIMAL MODEL Fifteen naïve Sprague-Dawley rats. FIELD STRENGTH/SEQUENCE DKI was performed at 7T using two schemes (30 directions with three b-values [30d-3b] and six directions with 15 b-values [6d-15b]), three resolutions, and eight repetitions. ASSESSMENT DKI reliability was assessed using voxelwise relative error (σ) and test-retest error of fractional anisotropy (FA), mean diffusivity (MD), and mean kurtosis (MK) within gray matter (GM) and white matter (WM). The number of excitations (NEX) was optimized by considering DKI reliability. The influence of the partial volume effect (PVE) was also assessed. STATISTICAL TEST One-way analysis of variance. RESULTS The 30d-3b scheme, compared with the 6d-15b scheme, exhibited apparently smaller σFA and σMK (eg, at NEX 1, in GM, for three resolutions, σFA : 19.9-38.2% vs. 34.2-61.4%, σMK : 6.9-11.4% vs. 14.1-15.4%) and similar σMD (all differences between two schemes <1.6%). The optimal NEX was determined as 2 for enabling a reliable measurement of DKI-derived indices. The PVE at the lowest resolution apparently increased σFA for both schemes (19.9% for 30d-3b and 34.2% for 6d-15b) and σMK for the 6d-15b scheme (14.7%) in GM, and exerted lower effects on MK values for the 30d-3b scheme (P > 0.05). DATA CONCLUSION A higher number of diffusion directions would benefit FA and MK estimation. A higher spatial resolution helps to reduce PVE. By using the 30d-3b scheme, MK is considered a robust index to reflect microstructural changes in GM and WM. We propose a systematic approach to determine the optimal DKI protocols for appropriate preclinical settings. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1593-1603.
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Affiliation(s)
- Chia-Wen Chiang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes (NHRI), Miaoli, Taiwan
| | - Shih-Yen Lin
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes (NHRI), Miaoli, Taiwan.,Department of Computer Science, National Chiao Tung University, Hsinchu, Taiwan
| | - Kuan-Hung Cho
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes (NHRI), Miaoli, Taiwan
| | - Kuo-Jen Wu
- Center for Neuropsychiatric Research, NHRI, Miaoli, Taiwan
| | - Yun Wang
- Center for Neuropsychiatric Research, NHRI, Miaoli, Taiwan
| | - Li-Wei Kuo
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes (NHRI), Miaoli, Taiwan.,Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
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110
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Hyperhomocysteinemia leads to exacerbation of ischemic brain damage: Role of GluN2A NMDA receptors. Neurobiol Dis 2019; 127:287-302. [PMID: 30885791 DOI: 10.1016/j.nbd.2019.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/19/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022] Open
Abstract
Hyperhomocysteinemia has been implicated in several neurodegenerative disorders including ischemic stroke. However, the pathological consequences of ischemic insult in individuals predisposed to hyperhomocysteinemia and the associated etiology are unknown. In this study, we evaluated the outcome of transient ischemic stroke in a rodent model of hyperhomocysteinemia, developed by subcutaneous implantation of osmotic pumps containing L-homocysteine into male Wistar rats. Our findings show a 42.3% mortality rate in hyperhomocysteinemic rats as compared to 7.7% in control rats. Magnetic resonance imaging of the brain in the surviving rats shows that mild hyperhomocysteinemia leads to exacerbation of ischemic injury within 24 h, which remains elevated over time. Behavioral studies further demonstrate significant deficit in sensorimotor functions in hyperhomocysteinemic rats compared to control rats. Using pharmacological inhibitors targeting the NMDAR subtypes, the study further demonstrates that inhibition of GluN2A-containing NMDARs significantly reduces ischemic brain damage in hyperhomocysteinemic rats but not in control rats, indicating that hyperhomocysteinemia-mediated exacerbation of ischemic brain injury involves GluN2A-NMDAR signaling. Complementary studies in GluN2A-knockout mice show that in the absence of GluN2A-NMDARs, hyperhomocysteinemia-associated exacerbation of ischemic brain injury is blocked, confirming that GluN2A-NMDAR activation is a critical determinant of the severity of ischemic damage under hyperhomocysteinemic conditions. Furthermore, at the molecular level we observe GluN2A-NMDAR dependent sustained increase in ERK MAPK phosphorylation under hyperhomocysteinemic condition that has been shown to be involved in homocysteine-induced neurotoxicity. Taken together, the findings show that hyperhomocysteinemia triggers a unique signaling pathway that in conjunction with ischemia-induced pathways enhance the pathology of stroke under hyperhomocysteinemic conditions.
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111
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Natural language processing and machine learning algorithm to identify brain MRI reports with acute ischemic stroke. PLoS One 2019; 14:e0212778. [PMID: 30818342 PMCID: PMC6394972 DOI: 10.1371/journal.pone.0212778] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/08/2019] [Indexed: 12/31/2022] Open
Abstract
Background and purpose This project assessed performance of natural language processing (NLP) and machine learning (ML) algorithms for classification of brain MRI radiology reports into acute ischemic stroke (AIS) and non-AIS phenotypes. Materials and methods All brain MRI reports from a single academic institution over a two year period were randomly divided into 2 groups for ML: training (70%) and testing (30%). Using “quanteda” NLP package, all text data were parsed into tokens to create the data frequency matrix. Ten-fold cross-validation was applied for bias correction of the training set. Labeling for AIS was performed manually, identifying clinical notes. We applied binary logistic regression, naïve Bayesian classification, single decision tree, and support vector machine for the binary classifiers, and we assessed performance of the algorithms by F1-measure. We also assessed how n-grams or term frequency-inverse document frequency weighting affected the performance of the algorithms. Results Of all 3,204 brain MRI documents, 432 (14.3%) were labeled as AIS. AIS documents were longer in character length than those of non-AIS (median [interquartile range]; 551 [377–681] vs. 309 [164–396]). Of all ML algorithms, single decision tree had the highest F1-measure (93.2) and accuracy (98.0%). Adding bigrams to the ML model improved F1-mesaure of naïve Bayesian classification, but not in others, and term frequency-inverse document frequency weighting to data frequency matrix did not show any additional performance improvements. Conclusions Supervised ML based NLP algorithms are useful for automatic classification of brain MRI reports for identification of AIS patients. Single decision tree was the best classifier to identify brain MRI reports with AIS.
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112
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Głowniak A, Janczarek M, Tarkowski A, Wysocka A, Szczerbo-Trojanowska M, Wysokiński A. Silent Cerebral Infarcts Following Left-Sided Accessory Pathway Ablation in Wolff-Parkinson-White (WPW) Syndrome: A Preliminary Report. Med Sci Monit 2019; 25:1336-1341. [PMID: 30778023 PMCID: PMC6391861 DOI: 10.12659/msm.914652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Catheter ablation is a routine procedure in patients with WPW syndrome. Silent cerebral infarcts (SCI) detected in magnetic resonance imaging may be a complication of the ablation procedure, but it is well documented only in atrial fibrillation ablation. Ablation of left-sided accessory pathways (L-AP) has a similar target area, but WPW patients differ from those with atrial fibrillation, due to lower initial risk of cerebral embolic events. The aim of this study was to determine whether the ablation of left-sided accessory pathways carries the risk of SCI. Material/Methods Twenty consecutive patients with overt L-AP referred for RF ablation in our center were included in the study. An irrigated ablation catheter was used in 8 patients, and a non-irrigated ablation catheter was used in 12 patients. Diffusion-weighted magnetic resonance imaging was performed pre-procedurally and on the next day after the ablation in all patients. Results Ablation procedures were completed without complications and there were no neurological symptoms following the procedure, although in 2 patients (10%), post-procedural diffusion-weighted magnetic resonance revealed new acute silent cerebral infarcts. Both patients with new cerebral lesions were female, and a non-irrigated catheter was used in both cases. Conclusions This is the first study documenting the presence of silent cerebral infarcts after WPW ablation. Further investigations are needed to evaluate the risk of silent cerebral infarcts associated with L-AP ablation.
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Affiliation(s)
- Andrzej Głowniak
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Marzena Janczarek
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Adam Tarkowski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Anna Wysocka
- Department of Cardiology, Medical University of Lublin, Lublin, Poland.,Department of Internal Medicine in Nursing, Medical University of Lublin, Lublin, Poland
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113
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Ravi D, Ghavami N, Alexander DC, Ianus A. Current Applications and Future Promises of Machine Learning in Diffusion MRI. COMPUTATIONAL DIFFUSION MRI 2019. [DOI: 10.1007/978-3-030-05831-9_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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114
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Sayal NR, Boyd S, Zach White G, Farrugia M. Incidental mastoid effusion diagnosed on imaging: Are we doing right by our patients? Laryngoscope 2018; 129:852-857. [PMID: 30570749 DOI: 10.1002/lary.27452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES/HYPOTHESIS To investigate whether radiologist-produced imaging reports containing the terms mastoiditis or mastoid opacification clinically correlate with physical examination findings of mastoiditis. Additionally, to investigate whether and how often otolaryngology was unnecessarily consulted and inappropriate antibiotic therapy was initiated. STUDY DESIGN Retrospective chart review within a large community hospital setting. METHODS A retrospective review of 160 patients who had imaging tests performed for nonotolaryngology indications from January 2011 to March 2017 at our facility. Indications, patient demographics, otolaryngology consultations, and new antibiotics started were recorded. Physical examinations were documented. RESULTS Physical examination revealed that only 14 of 160 patients (8.8%) had clinical evidence of otologic disease. However, of the 160 patients meeting the inclusion criteria, 18 (11.3%) received an otolaryngology consultation, and 18 (11.3%) had antibiotics started. Eleven of the 18 patients in each group (61.1%) had a normal physical examination, two (11.1%) had serous otitis media, one (5.6%) had chronic otitis media, and four (22.2%) had acute otitis media. No patients were found to have clinical mastoiditis. χ2 analysis revealed no significance in the radiologic diagnosis of mastoiditis versus mastoid opacification in relation to physicians requesting otolaryngology consultations (P = .241) or starting patients on antibiotics (P = .951). CONCLUSIONS This study highlights the prevalence of incidental but clinically insignificant opacification of the mastoid cavity. We believe that nonotolaryngology physicians are, overall, competent to correlate such radiologic findings clinically and to prevent unnecessary consultations and inappropriate treatment, which add significant costs to our overstretched healthcare system. LEVEL OF EVIDENCE 4 Laryngoscope, 129:852-857, 2019.
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Affiliation(s)
- Navdeep R Sayal
- Department of Otolaryngology/Facial Plastic Surgery, Beaumont Health System, Farmington Hills, Michigan, U.S.A
| | - Sara Boyd
- Department of Otolaryngology/Facial Plastic Surgery, Beaumont Health System, Farmington Hills, Michigan, U.S.A
| | - G Zach White
- Department of Otolaryngology/Facial Plastic Surgery, Beaumont Health System, Farmington Hills, Michigan, U.S.A
| | - Matthew Farrugia
- Department of Otolaryngology/Facial Plastic Surgery, Beaumont Health System, Farmington Hills, Michigan, U.S.A
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115
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Changes in brain white matter structure are associated with urine proteins in urologic chronic pelvic pain syndrome (UCPPS): A MAPP Network study. PLoS One 2018; 13:e0206807. [PMID: 30517112 PMCID: PMC6281196 DOI: 10.1371/journal.pone.0206807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/21/2018] [Indexed: 12/11/2022] Open
Abstract
The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network has yielded neuroimaging and urinary biomarker findings that highlight unique alterations in brain structure and in urinary proteins related to tissue remodeling and vascular structure in patients with Urological Chronic Pelvic Pain Syndrome (UCPPS). We hypothesized that localized changes in diffusion tensor imaging (DTI) measurements might be associated with corresponding changes in urinary protein levels in UCPPS. To test this hypothesis, we created statistical parameter maps depicting the linear correlation between DTI measurements (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) and urinary protein quantification (MMP2, MMP9, NGAL, MMP9/NGAL complex, and VEGF) in 30 UCPPS patients from the MAPP Research Network, after accounting for clinical covariates. Results identified a brainstem region that showed a strong correlation between both ADC (R2 = 0.49, P<0.0001) and FA (R2 = 0.39, P = 0.0002) with urinary MMP9 levels as well as a correlation between both ADC (R2 = 0.42, P = 0.0001) and FA (R2 = 0.29, P = 0.0020) and urinary MMP9/NGAL complex. Results also identified significant correlations between FA and urinary MMP9 in white matter adjacent to sensorimotor regions (R2 = 0.30, P = 0.002; R2 = 0.36, P = 0.0005, respectively), as well as a correlation in similar sensorimotor regions when examining ADC and urinary MMP2 levels (R2 = 0.42, P<0.0001) as well as FA and urinary MMP9/NGAL complex (R2 = 0.33, P = 0.0008). A large, diffuse cluster of white matter was identified as having a strong correlation between both ADC (R2 = 0.35, P = 0.0006) and FA (R2 = 0.43, P<0.0001) with urinary NGAL levels. In contrast, no significant association between DTI measurements and VEGF was observed. Results suggest that elevated MMP9 or MMP9/NGAL in UCPPS may be related to degenerative neuronal changes in brainstem nuclei through excitotoxicity, while also facilitating synaptic plasticity in sensorimotor regions.
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116
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Carney O, Falzon A, MacKinnon A. Diffusion-weighted MRI in paediatric neuroimaging. Clin Radiol 2018; 73:999-1013. [DOI: 10.1016/j.crad.2018.07.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
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117
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Craig PG, Zhan X, Aly N, Policeni B. Nontraumatic emergencies of inflammatory paranasal sinus disease. Semin Ultrasound CT MR 2018; 40:125-138. [PMID: 31030736 DOI: 10.1053/j.sult.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Inflammatory disease of the paranasal sinuses is extremely common and the course is often innocuous. However, when extrasinus spread of disease occurs life-threatening complications can arise. Intraorbital and intracranial involvement can progress rapidly either by hematogenous spread or in the case of fungal sinusitis via angioinvasion. An understanding of anatomy and appropriate imaging protocols is critical when these complications arise. The knowledge of imaging features of the different disease processes and prompt diagnosis is essential to improve patient outcomes and positively impact patient care.
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Affiliation(s)
- Patrick G Craig
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Xin Zhan
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Nour Aly
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Bruno Policeni
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
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Mono-exponential and bi-exponential model-based diffusion-weighted MR imaging and IDEAL-IQ sequence for quantitative evaluation of sacroiliitis in patients with ankylosing spondylitis. Clin Rheumatol 2018; 37:3069-3076. [DOI: 10.1007/s10067-018-4321-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/13/2018] [Accepted: 10/01/2018] [Indexed: 01/02/2023]
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Mahammedi A, Bachir S, Purdy J, Larvie M, Buehler M. Pyogenic brain abscess, ventriculitis and diffuse meningitis with fatal outcome in an adult: Radiologic-pathologic correlation ☆,. Radiol Case Rep 2018; 13:1063-1068. [PMID: 30228844 PMCID: PMC6137902 DOI: 10.1016/j.radcr.2018.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 10/25/2022] Open
Abstract
Rupture of brain abscesses with evolution into ventriculitis with meningitis may result in sudden and dramatic worsening of the clinical situation. We present a 57-year-old man with such an event and fatal outcome. Multiple imaging modalities including computed tomography and advanced magnetic resonance imaging were correlated with gross specimen and histologic images. The differential diagnosis of multiple lesions with ring enhancement and prominent perifocal edema includes mainly infectious and neoplastic processes, such as brain abscess, metastasis, and multicentric glioblastoma. Pyogenic ventriculitis is an uncommon manifestation of severe intracranial infection that might be clinically obscure. We discuss the characteristic magnetic resonance findings of brain abscess and its complications, including meningitis and ventriculitis with emphasis on the role of diffusion-weighted and fluid-attenuated inversion recovery imaging.
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Affiliation(s)
- Abdelkader Mahammedi
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Suha Bachir
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Jenna Purdy
- University of Toledo, Department of Pathology and Neuroradiology, Toledo, OH, USA
| | - Mykol Larvie
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Mark Buehler
- University of Toledo, Department of Pathology and Neuroradiology, Toledo, OH, USA
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120
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Leslie-Mazwi TM, Lev MH, Schaefer PW, Hirsch JA, González RG. MR Imaging Selection of Acute Stroke Patients with Emergent Large Vessel Occlusions for Thrombectomy. Neuroimaging Clin N Am 2018; 28:573-584. [PMID: 30322594 DOI: 10.1016/j.nic.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Acute stroke caused by large vessel occlusions (LVOs) are common. The time window to treat is up to 24 hours, and the most important factor is the size of the ischemic core. If the core is small (<70-100 mL), the penumbra must be large; penumbral imaging is unnecessary. MR imaging is precise in measuring the core, and superior to alternatives. The necessary sequences are obtainable rapidly, comparable to computed tomography scans. Available evidence suggests that most patients with LVOs are slow progressors defined as having a small core 6 hours or more after ictus onset.
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Affiliation(s)
- Thabele M Leslie-Mazwi
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, WAC-7-745, MGH, 15 Parkman Street, Boston, MA 02114-3117, USA; Neurocritical Care, Massachusetts General Hospital, Harvard Medical School, WAC-7-745, MGH, 15 Parkman Street, Boston, MA 02114-3117, USA; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, WAC-7-745, MGH, 15 Parkman Street, Boston, MA 02114-3117, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, WAC-7-745, MGH, 15 Parkman Street, Boston, MA 02114-3117, USA
| | - Michael H Lev
- Emergency Radiology, Massachusetts General Hospital, Harvard Medical School, BLK-SB-0038 MGH, 55 Fruit Street, Boston, MA 02114, USA
| | - Pamela W Schaefer
- Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Founders 228 MGH, 55 Fruit Street, Boston, MA 02114, USA; Radiology, Massachusetts General Hospital, Harvard Medical School, Founders 228 MGH, 55 Fruit Street, Boston, MA 02114, USA
| | - Joshua A Hirsch
- NeuroInterventional Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 241 MGH, 55 Fruit Street, Boston, MA 02114, USA; Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Gray 241 MGH, 55 Fruit Street, Boston, MA 02114, USA
| | - R Gilberto González
- Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Gray 241 MGH, 55 Fruit Street, Boston, MA 02114, USA.
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Discrimination between malignant and bland portal vein thrombosis: Could diffusion weighted MRI help. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Higaki T, Nakamura Y, Tatsugami F, Kaichi Y, Akagi M, Akiyama Y, Baba Y, Iida M, Awai K. Introduction to the Technical Aspects of Computed Diffusion-weighted Imaging for Radiologists. Radiographics 2018; 38:1131-1144. [DOI: 10.1148/rg.2018170115] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Toru Higaki
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Yuko Nakamura
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Fuminari Tatsugami
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Yoko Kaichi
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Motonori Akagi
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Yuij Akiyama
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Yasutaka Baba
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Makoto Iida
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
| | - Kazuo Awai
- From the Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan (T.H., Y.N., F.T., Y.K, M.A., Y.B., M.I., K.A.); and Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan (Y.A.)
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Sartoretti T, Sartoretti E, Binkert C, Gutzeit A, Reischauer C, Czell D, Wyss M, Brüllmann E, Sartoretti-Schefer S. Diffusion-Weighted Zonal Oblique Multislice-EPI Enhances the Detection of Small Lesions with Diffusion Restriction in the Brain Stem and Hippocampus: A Clinical Report of Selected Cases. AJNR Am J Neuroradiol 2018; 39:1255-1259. [PMID: 29700045 DOI: 10.3174/ajnr.a5635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/05/2018] [Indexed: 12/30/2022]
Abstract
Diffusion restriction is the morphologic hallmark of acute ischemic infarcts and excitotoxic brain injury in various cerebral pathologies. Diffusion restriction is visible as hyperintensity on DWI and as hypointensity on ADC maps. Due to the vicinity of multiple anatomic structures in the brain stem and hippocampus, very small lesions with diffusion restriction may result in severe clinical symptomatology, but these small lesions easily go undetected on standard cerebral DWI due to insufficient spatial resolution, T2* blurring, and image artifacts caused by susceptibility-related image distortions. Diffusion-weighted zonal oblique multislice-EPI with reduced FOV acquisition permits a considerable increase in spatial resolution and enhances the visualization of very small pathologic lesions in the brain stem and hippocampus. Improved performance in the depiction of different pathologic lesions with diffusion restriction in the brain stem and hippocampus using this sequence compared with standard DWI in selected cases is presented.
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Affiliation(s)
- T Sartoretti
- From the Institut für Radiologie (T.S., E.S., C.B., M.W., S.S.-S.), Kantonsspital Winterthur, Winterthur, Switzerland
| | - E Sartoretti
- From the Institut für Radiologie (T.S., E.S., C.B., M.W., S.S.-S.), Kantonsspital Winterthur, Winterthur, Switzerland
| | - C Binkert
- From the Institut für Radiologie (T.S., E.S., C.B., M.W., S.S.-S.), Kantonsspital Winterthur, Winterthur, Switzerland
| | - A Gutzeit
- Institut für Radiologie und Nuklearmedizin (A.G., C.R.), Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - C Reischauer
- Institut für Radiologie und Nuklearmedizin (A.G., C.R.), Hirslanden Klinik St. Anna, Luzern, Switzerland
| | - D Czell
- Medizinische Klinik (D.C.), Abteilung für Neurologie, Uznach, Switzerland
| | - M Wyss
- From the Institut für Radiologie (T.S., E.S., C.B., M.W., S.S.-S.), Kantonsspital Winterthur, Winterthur, Switzerland
- Philips HealthSystems (M.W., E.B.), Zürich, Switzerland
| | - E Brüllmann
- Philips HealthSystems (M.W., E.B.), Zürich, Switzerland
| | - S Sartoretti-Schefer
- From the Institut für Radiologie (T.S., E.S., C.B., M.W., S.S.-S.), Kantonsspital Winterthur, Winterthur, Switzerland
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Ackman JB. Invited Commentary on "Mediastinal and Pleural MR Imaging: Practical Approach for Daily Practice". Radiographics 2018; 38:55-57. [PMID: 29320318 DOI: 10.1148/rg.2018170198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jeanne B Ackman
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital Boston, Massachusetts
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126
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Comparison of DWI Methods in the Pediatric Brain: PROPELLER Turbo Spin-Echo Imaging Versus Readout-Segmented Echo-Planar Imaging Versus Single-Shot Echo-Planar Imaging. AJR Am J Roentgenol 2018; 210:1352-1358. [PMID: 29570373 DOI: 10.2214/ajr.17.18796] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study is to compare DWI for pediatric brain evaluation using single-shot echo-planar imaging (EPI), periodically rotated overlapping parallel lines with enhanced reconstruction (Blade), and readout-segmented EPI (Resolve). MATERIALS AND METHODS Blade, Resolve, and single-shot EPI were performed for 27 pediatric patients (median age, 9 years), and three datasets were independently reviewed by two radiologists. Qualitative analyses were performed for perceptive coarseness, image distortion, susceptibility-related changes, motion artifacts, and lesion conspicuity using a 5-point Likert scale. Quantitative analyses were conducted for spatial distortion and signal uniformity of each sequence. RESULTS Mean scores were 2.13, 3.17, and 3.76 for perceptive coarseness; 4.85, 3.96, and 2.19 for image distortion; 4.76, 3.96, and 2.30 for susceptibility-related change; 4.96, 3.83, and 4.69 for motion artifacts; and 2.71, 3.75, and 1.92 for lesion conspicuity, for Blade, Resolve, and single-shot EPI, respectively. Blade and Resolve showed better quality than did single-shot EPI for image distortion, susceptibility-related changes, and lesion conspicuity. Blade showed less image distortion, fewer susceptibility-related changes, and fewer motion artifacts than did Resolve, whereas lesion conspicuity was better with Resolve. Blade showed increased signal variation compared with Resolve and single-shot EPI (coefficients of variation were 0.10, 0.08, and 0.05 for lateral ventricle; 0.13, 0.09, and 0.05 for centrum semiovale; and 0.16, 0.09, and 0.06 for pons in Blade, Resolve, and single-shot EPI, respectively). CONCLUSION DWI with Resolve or Blade yields better quality regarding distortion, susceptibility-related changes, and lesion conspicuity, compared with single-shot EPI. Blade is less susceptible to motion artifacts than is Resolve, whereas Resolve yields less noise and better lesion conspicuity than does Blade.
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127
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Sowa P, Harbo HF, White NS, Celius EG, Bartsch H, Berg-Hansen P, Moen SM, Bjørnerud A, Westlye LT, Andreassen OA, Dale AM, Beyer MK. Restriction spectrum imaging of white matter and its relation to neurological disability in multiple sclerosis. Mult Scler 2018. [PMID: 29542336 DOI: 10.1177/1352458518765671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Restriction spectrum imaging (RSI) is a recently introduced magnetic resonance imaging diffusion technique. The utility of RSI in multiple sclerosis (MS) is unknown. OBJECTIVE To investigate the association between RSI-derived parameters and neurological disability in MS. METHODS Seventy-seven relapsing-remitting MS patients were scanned with RSI on a 3-T scanner. RSI-derived parameters: fast and slow apparent diffusion coefficient (sADC), fractional anisotropy, restricted fractional anisotropy, neurite density (ND), cellularity, extracellular water fraction, and free water fraction, were obtained in white matter lesions (WML) and normal appearing white matter (NAWM). Patients were divided into three groups according to their expanded disability status scale (EDSS): with minimal, low, and substantial disability (<2.5, 2.5-3, and >3, respectively). Group comparisons and correlation analyses were performed. RESULTS All tested RSI-derived parameters differed between WML and NAWM ( p < 0.001 for all pairwise comparisons). The sADC in WML showed largest difference across disability subgroups (analysis of variance (ANOVA): F = 5.1, η2 = 0.12, p = 0.008). ND in NAWM showed strongest correlation with disability (ϱ = -0.39, p < 0.001). CONCLUSION The strongest correlation with EDSS of ND obtained in NAWM indicates that processes outside lesions are important for disability in MS. Our study suggests that RSI-derived parameters may help understand the "clinico-radiological paradox" and improve disease monitoring in MS.
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Affiliation(s)
- Piotr Sowa
- Division of Radiology & Nuclear Medicine, Oslo University Hospital, Oslo, Norway/Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway/Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Nathan S White
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Elisabeth G Celius
- Department of Neurology, Oslo University Hospital, Oslo, Norway/Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hauke Bartsch
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Pål Berg-Hansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway/Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Stine M Moen
- Department of Neurology, Oslo University Hospital, Oslo, Norway/MS Centre Hakadal, Hakadal, Norway
| | - Atle Bjørnerud
- Division of Radiology & Nuclear Medicine, Oslo University Hospital, Oslo, Norway/Department of Physics, University of Oslo, Oslo, Norway
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway/NORMENT K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA/Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Mona K Beyer
- Division of Radiology & Nuclear Medicine, Oslo University Hospital, Oslo, Norway/Department of Life Sciences and Health, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Ni Y, Alwell K, Moomaw CJ, Woo D, Adeoye O, Flaherty ML, Ferioli S, Mackey J, De Los Rios La Rosa F, Martini S, Khatri P, Kleindorfer D, Kissela BM. Towards phenotyping stroke: Leveraging data from a large-scale epidemiological study to detect stroke diagnosis. PLoS One 2018; 13:e0192586. [PMID: 29444182 PMCID: PMC5812624 DOI: 10.1371/journal.pone.0192586] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/26/2018] [Indexed: 01/30/2023] Open
Abstract
Objective 1) To develop a machine learning approach for detecting stroke cases and subtypes from hospitalization data, 2) to assess algorithm performance and predictors on real-world data collected by a large-scale epidemiology study in the US; and 3) to identify directions for future development of high-precision stroke phenotypic signatures. Materials and methods We utilized 8,131 hospitalization events (ICD-9 codes 430–438) collected from the Greater Cincinnati/Northern Kentucky Stroke Study in 2005 and 2010. Detailed information from patients’ medical records was abstracted for each event by trained research nurses. By analyzing the broad list of demographic and clinical variables, the machine learning algorithms predicted whether an event was a stroke case and, if so, the stroke subtype. The performance was validated on gold-standard labels adjudicated by stroke physicians, and results were compared with stroke classifications based on ICD-9 discharge codes, as well as labels determined by study nurses. Results The best performing machine learning algorithm achieved a performance of 88.57%/93.81%/92.80%/93.30%/89.84%/98.01% (accuracy/precision/recall/F-measure/area under ROC curve/area under precision-recall curve) on stroke case detection. For detecting stroke subtypes, the algorithm yielded an overall accuracy of 87.39% and greater than 85% precision on individual subtypes. The machine learning algorithms significantly outperformed the ICD-9 method on all measures (P value<0.001). Their performance was comparable to that of study nurses, with better tradeoff between precision and recall. The feature selection uncovered a subset of predictive variables that could facilitate future development of effective stroke phenotyping algorithms. Discussion and conclusions By analyzing a broad array of patient data, the machine learning technologies held promise for improving detection of stroke diagnosis, thus unlocking high statistical power for subsequent genetic and genomic studies.
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Affiliation(s)
- Yizhao Ni
- Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Kathleen Alwell
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Charles J. Moomaw
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Opeolu Adeoye
- Department of Emergency Medicine and Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Matthew L. Flaherty
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Simona Ferioli
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Jason Mackey
- Department of Neurology, Indiana University, Indianapolis, Indiana, United States of America
| | | | - Sharyl Martini
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Dawn Kleindorfer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Brett M. Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
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Qin L, Li A, Qu J, Reinshagen K, Li X, Cheng SC, Bryant A, Young GS. Normalization of ADC does not improve correlation with overall survival in patients with high-grade glioma (HGG). J Neurooncol 2018; 137:313-319. [PMID: 29383647 DOI: 10.1007/s11060-017-2719-y] [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: 09/29/2017] [Accepted: 12/13/2017] [Indexed: 12/29/2022]
Abstract
Mixed reports leave uncertainty about whether normalization of apparent diffusion coefficient (ADC) to a within-subject white matter reference is necessary for assessment of tumor cellularity. We tested whether normalization improves the previously reported correlation of resection margin ADC with 15-month overall survival (OS) in HGG patients. Spin-echo echo-planar DWI was retrieved from 3 T MRI acquired between maximal resection and radiation in 37 adults with new-onset HGG (25 glioblastoma; 12 anaplastic astrocytoma). ADC maps were produced with the FSL DTIFIT tool (Oxford Centre for Functional MRI). 3 neuroradiologists manually selected regions of interest (ROI) in normal appearing white matter (NAWM) and in non-enhancing tumor (NT) < 2 cm from the margin of residual enhancing tumor or resection cavity. Normalized ADC (nADC) was computed as the ratio of absolute NT ADC to NAWM ADC. Reproducibility of nADC and absolute ADC among the readers' ROI was assessed using intra-class correlation coefficient (ICC) and within-subject coefficient of variation (wCV). Correlations of ADC and nADC with OS were compared using receiver operating characteristics (ROC) analysis. A p value 0.05 was considered statistically significant. Both mean ADC and nADC differed significantly between patients subgrouped by 15-month OS (p = 0.0014 and 0.0073 respectively). wCV and ICC among the readers were similar for absolute and normalized ADC. In ROC analysis of correlation with OS, nADC did not perform significantly better than absolute ADC. Normalization does not significantly improve the correlation of absolute ADC with OS in HGG, suggesting that normalization is not necessary for clinical or research ADC analysis in HGG patients.
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Affiliation(s)
- Lei Qin
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Angie Li
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jinrong Qu
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Katherine Reinshagen
- Department of Radiology, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Xiang Li
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Su-Chun Cheng
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Annie Bryant
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Behavioral Neuroscience, Northeastern University, Boston, MA, USA
| | - Geoffrey S Young
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Radiology, Harvard Medical School, Boston, MA, USA. .,Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Havsteen I, Ovesen C, Willer L, Nybing JD, Ægidius K, Marstrand J, Meden P, Rosenbaum S, Folke MN, Christensen H, Christensen A. Small cortical grey matter lesions show no persistent infarction in transient ischaemic attack? A prospective cohort study. BMJ Open 2018; 8:e018160. [PMID: 29358426 PMCID: PMC5780721 DOI: 10.1136/bmjopen-2017-018160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To find determining factors for persistent infarction signs in patients with transient ischaemic attack (TIA), herein initial diffusion lesion size, visibility on apparent diffusion coefficient (ADC) or fluid-attenuated inversion recovery (FLAIR) and location. DESIGN Prospective cohort study of patients with clinical TIA receiving 3T-MRI within 72 hours of symptom onset and at 8-week follow-up. SETTING Clinical workflow in a single tertiary stroke centre between February 2012 and June 2014. PARTICIPANTS 199 candidate patients were recruited, 64 patients were excluded due to non-TIA discharge diagnosis or no 8-week MRI. 122 patients completed the study. PRIMARY OUTCOME MEASURES The primary outcome was visible persistent infarction defined as 8-week FLAIR hyperintensity or atrophy corresponding to the initial diffusion-weighted imaging (DWI) lesion. RESULTS 50 patients showed 84 initial DWI lesions. 29 (35%) DWI lesions did not result in infarction signs on 8-week FLAIR. 26 (90%, P<0.0001) reversing lesions were located in the cortical grey matter (cGM). cGM location (vs any other location) strongly predicted no 8-week infarction sign development (OR 0.02, 95% CI 0.001 to 0.17) or partial lesion area decrease (>30% of initial DWI-area, OR 14.10, 95% CI 3.61 to 54.72), adjusted for FLAIR-visibility, DWI-area, ADC-confirmation and time to scan (TTS) from symptom onset to baseline MRI. Acute FLAIR-visibility was a strong associated factor for persistent infarction signs (OR 33.06, 95% CI 2.94 to 1432.34). For cGM lesions area size was sole associated factor for persistent infarction signs with a 0.31 cm2 (area under the curve (AUC), 0.97) threshold. In eight (16%) DWI-positive patients, all lesions reversed fully. CONCLUSIONS 16% of DWI-positive patients and one-third of acute DWI lesions caused no persistent infarction signs, especially small cGM lesions were not followed by development of persistent infarction signs. Late MRI after TIA is likely to be less useful in the clinical setting, and it is dubious if the absence of old vascular lesions can be taken as evidence of no prior ischaemic attacks. TRIAL REGISTRATION NUMBER NCT01531946; Results.
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Affiliation(s)
- Inger Havsteen
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Christian Ovesen
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Lasse Willer
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Janus Damm Nybing
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Karen Ægidius
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Jacob Marstrand
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Per Meden
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Marie Norsker Folke
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Anders Christensen
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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131
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Diffusion-Weighted Magnetic Resonance Imaging. Methods Mol Biol 2018; 1718:89-101. [PMID: 29341004 DOI: 10.1007/978-1-4939-7531-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Magnetic resonance imaging (MRI) is a technique based on the contents and relaxation features of water in tissues. In basic MRI sequences, diffusion phenomenon of water molecules is not taken into account although it has a notable influence in the relaxation times, and therefore in the signal intensity of images. In fact, MRI techniques that take advantage of water diffusion have experienced a huge development in last years. Diffusion-weighted imaging (DWI) has spectacularly evolved reaching nowadays a great impact both in clinical and preclinical imaging-especially in the neuroimaging field-and in basic research. We present here a protocol to perform DWI studies in a high-field preclinical setup.
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132
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Ewe R, White OB, Burke A. Isolated Horizontal Gaze Palsy: Observations and Explanations. Front Neurol 2017; 8:611. [PMID: 29187832 PMCID: PMC5694745 DOI: 10.3389/fneur.2017.00611] [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: 08/05/2017] [Accepted: 11/02/2017] [Indexed: 12/30/2022] Open
Abstract
We present three cases that we suggest require a novel diagnosis and a reconsideration of current understandings of pontine anatomy. In this case series, we highlight a series of patients with monophasic, fully recovering inflammatory lesions in the pontine tegmentum not due to any of the currently recognized causes of this syndrome. We highlight other similar cases in the literature and suggest there may be a particular epitope for an as-yet-undiscovered antibody underlying the tropism for this area. We highlight the potential harm of misdiagnosis with relapsing inflammatory or other serious diagnoses with significant adverse impact on the patient. In addition, we propose that this would support a reinterpretation of the currently accepted anatomy of the pontine gaze inputs to the median longitudinal fasciculus and paramedian pontine reticular formation.
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Affiliation(s)
- Renee Ewe
- Whittington Hospital, London, United Kingdom
| | - Owen B White
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Ailbhe Burke
- The National Hospital for Nervous Diseases, London, United Kingdom
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133
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Afzali M, Fatemizadeh E, Soltanian-Zadeh H. Sparse registration of diffusion weighted images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 151:33-43. [PMID: 28947004 DOI: 10.1016/j.cmpb.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/21/2017] [Accepted: 08/07/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Registration is a critical step in group analysis of diffusion weighted images (DWI). Image registration is also necessary for construction of white matter atlases that can be used to identify white matter changes. A challenge in the registration of DWI is that the orientation of the fiber bundles should be considered in the process, making their registration more challenging than that of the scalar images. Most of the current registration methods use a model of diffusion profile, limiting the method to the used model. METHODS We propose a model-independent method for DWI registration. The proposed method uses a multi-level free-form deformation (FFD), a sparse similarity measure, and a dictionary. We also propose a synthesis K-SVD algorithm for sparse interpolation of images during the registration process. We utilize two dictionaries: analysis dictionary is learned based on diffusion signals while synthesis dictionary is generated based on image patches. The proposed multi-level approach registers anatomical structures at different scales. T-test is used to determine the significance of the differences between different methods. RESULTS We have shown the efficiency of the proposed approach using real data. The method results in smaller generalized fractional anisotropy (GFA) root mean square (RMS) error (0.05 improvements, p = 0.0237) and angular error (0.37 ° improvement, p = 0.0330) compared to the large deformation diffeomorphic metric mapping (LDDMM) method and advanced normalization tools (ANTs). CONCLUSION Sparse registration of diffusion signals enables registration of diffusion weighted images without using a diffusion model.
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Affiliation(s)
- Maryam Afzali
- Department of Electrical Engineering, Biomedical Signal and Image Processing Laboratory (BiSIPL), Sharif University of Technology, Tehran, Iran.
| | - Emad Fatemizadeh
- Department of Electrical Engineering, Biomedical Signal and Image Processing Laboratory (BiSIPL), Sharif University of Technology, Tehran, Iran.
| | - Hamid Soltanian-Zadeh
- Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran; Image Analysis Laboratory, Departments of Radiology and Research Administration, Henry Ford Health System, Detroit, Michigan, USA.
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134
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Mormina E, Petracca M, Bommarito G, Piaggio N, Cocozza S, Inglese M. Cerebellum and neurodegenerative diseases: Beyond conventional magnetic resonance imaging. World J Radiol 2017; 9:371-388. [PMID: 29104740 PMCID: PMC5661166 DOI: 10.4329/wjr.v9.i10.371] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/18/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
The cerebellum plays a key role in movement control and in cognition and cerebellar involvement is described in several neurodegenerative diseases. While conventional magnetic resonance imaging (MRI) is widely used for brain and cerebellar morphologic evaluation, advanced MRI techniques allow the investigation of cerebellar microstructural and functional characteristics. Volumetry, voxel-based morphometry, diffusion MRI based fiber tractography, resting state and task related functional MRI, perfusion, and proton MR spectroscopy are among the most common techniques applied to the study of cerebellum. In the present review, after providing a brief description of each technique’s advantages and limitations, we focus on their application to the study of cerebellar injury in major neurodegenerative diseases, such as multiple sclerosis, Parkinson’s and Alzheimer’s disease and hereditary ataxia. A brief introduction to the pathological substrate of cerebellar involvement is provided for each disease, followed by the review of MRI studies exploring structural and functional cerebellar abnormalities and by a discussion of the clinical relevance of MRI measures of cerebellar damage in terms of both clinical status and cognitive performance.
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Affiliation(s)
- Enricomaria Mormina
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy
| | - Giulia Bommarito
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
| | - Niccolò Piaggio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- Department of Neuroradiology, San Martino Hospital, 16132 Genoa, Italy
| | - Sirio Cocozza
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
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135
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Nabavizadeh SA, Chawla S, Agarwal M, Mohan S. Chapter 8 On the Horizon: Advanced Imaging Techniques to Improve Noninvasive Assessment of Cervical Lymph Nodes. Semin Ultrasound CT MR 2017; 38:542-556. [PMID: 29031370 DOI: 10.1053/j.sult.2017.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Conventional imaging modalities are limited in the evaluation of lymph nodes as they predominantly rely on size and morphology, which have suboptimal sensitivity and specificity for malignancy. In this review we will explore the role of "on the horizon" advanced imaging modalities that can look beyond the size and morphologic features of a cervical lymph node and explore its molecular nature and can aid in personalizing therapy rather than use the "one-size-fits-all" approach.
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Affiliation(s)
- Seyed Ali Nabavizadeh
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sanjeev Chawla
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mohit Agarwal
- Division of Neuroradiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Suyash Mohan
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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136
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Yuan Y, Dong Y, Hu S, Zheng T, Du D, Du J, Liu L. Reduced Apparent Diffusion Coefficient in Various Brain Areas following Low-Intensity Transcranial Ultrasound Stimulation. Front Neurosci 2017; 11:562. [PMID: 29062269 PMCID: PMC5640877 DOI: 10.3389/fnins.2017.00562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/25/2017] [Indexed: 01/30/2023] Open
Abstract
Diffusion of water molecules closely related to physiological and pathological information of brain tissue. Low-intensity transcranial ultrasound stimulation (TUS) has advantages of noninvasive, high spatial resolution and penetration depth. Previous studies have demonstrate that TUS can modulate neuronal activity and alter cortical hemodynamic. However, how TUS affect diffusion of water molecules remain unclear. In this paper, in order to evaluate the effect of low-intensity TUS on the diffusion of water molecules in brain tissue, diffusion-weighted magnetic resonance (MR) imaging was performed in 19 healthy Sprague-Dawley rats in sham surgery group (six rats) and TUS group (thirteen rats) Subsequently, rats were stimulated by low-intensity transcranial ultrasound for 5 min in TUS group. Finally, rats of sham surgery group and TUS group were imaged again by diffusion-weighted MR imaging. The apparent diffusion coefficient (ADC) was measured in caudate putamen region and middle brain motor-related region of each rat in sham surgery group and TUS group. Surgery-related and TUS-related changes were calculated using a statistical analysis. The mean ADC values of marked regions of six rats in sham surgery group were 0.743 ± 0.031 (pre-surgery) and 0.745 ± 0.029 (post-surgery). The mean ADC values of marked regions of 13 rats in TUS group were 0.749 ± 0.032 (pre-TUS) and 0.712 ± 0.033 (post-TUS) Compared to the pre-TUS values, the mean ADC values of the rats decreased 4.9% (*P < 0.05) post-TUS. These results of this study demonstrate that low-intensity TUS can restrict the diffusion of water molecules in brain tissue.
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Affiliation(s)
- Yi Yuan
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Yanchao Dong
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Shuo Hu
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Tao Zheng
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Dan Du
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Juan Du
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
| | - Lanxiang Liu
- Department of Magnetic Resonance Imaging, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, China
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137
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Abstract
MRI techniques and systems have evolved dramatically over recent years. These advances include higher field strengths, new techniques, faster gradients, improved coil technology, and more robust sequence protocols. This article reviews the most commonly used advanced MRI techniques, including diffusion-weighted imaging, magnetic resonance spectrography, diffusion tensor imaging, and cerebrospinal fluid flow tracking.
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138
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Villanueva-Meyer JE, Mabray MC, Cha S. Current Clinical Brain Tumor Imaging. Neurosurgery 2017; 81:397-415. [PMID: 28486641 PMCID: PMC5581219 DOI: 10.1093/neuros/nyx103] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/23/2017] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors. This review provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, we focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse.
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Affiliation(s)
- Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Marc C. Mabray
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
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Kim J, Hong CK, Suh SH, Jung WS, Ahn SJ. The added value of the CSF cleft on ADC in distinguishing extra-axial from intra-axial tumors. Clin Imaging 2017. [DOI: 10.1016/j.clinimag.2017.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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140
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Comparison of intravoxel incoherent motion diffusion-weighted imaging between turbo spin-echo and echo-planar imaging of the head and neck. Eur Radiol 2017; 28:316-324. [DOI: 10.1007/s00330-017-4990-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/25/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
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141
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Paediatric Multiple Sclerosis: Update on Diagnostic Criteria, Imaging, Histopathology and Treatment Choices. Curr Neurol Neurosci Rep 2017; 16:68. [PMID: 27271748 PMCID: PMC4894922 DOI: 10.1007/s11910-016-0663-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Paediatric multiple sclerosis (MS) represents less than 5 % of the MS population, but patients with paediatric-onset disease reach permanent disability at a younger age than adult-onset patients. Accurate diagnosis at presentation and optimal long-term treatment are vital to mitigate ongoing neuroinflammation and irreversible neurodegeneration. However, it may be difficult to early differentiate paediatric MS from acute disseminated encephalomyelitis (ADEM) and neuromyelitis optica spectrum disorders (NMOSD), as they often have atypical presentation that differs from that of adult-onset MS. The purpose of this review is to summarize the updated views on diagnostic criteria, imaging, histopathology and treatment choices.
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142
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Nakamura M, Yanagihara M, Matsui K, Kobayashi M, Inoue Y. Brain microstructural alterations in patients with severe obstructive sleep apnea: a preliminary diffusion tensor imaging study. Sleep Biol Rhythms 2017. [DOI: 10.1007/s41105-017-0113-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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143
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Cicuendez M, Castaño-León A, Ramos A, Hilario A, Gómez PA, Lagares A. [Magnetic resonance in traumatic brain injury: A comparative study of the different conventional magnetic resonance imaging sequences and their diagnostic value in diffuse axonal injury]. Neurocirugia (Astur) 2017; 28:266-275. [PMID: 28728755 DOI: 10.1016/j.neucir.2017.06.001] [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: 03/09/2017] [Revised: 05/29/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the identification capability of traumatic axonal injury (TAI) by different sequences on conventional magnetic resonance (MR) studies in traumatic brain injury (TBI) patients. MATERIAL AND METHODS We retropectevely analyzed 264 TBI patients to whom a MR had been performed in the first 60 days after trauma. All clinical variables related to prognosis were registered, as well as the data from the initial computed tomography. The MR imaging protocol consisted of a 3-plane localizer sequence T1-weighted and T2-weighted fast spin-echo, FLAIR and gradient-echo images (GRET2*). TAI lesions were classified according to Gentry and Firsching classifications. We calculated weighted kappa coefficients and the area under the ROC curve for each MR sequence. A multivariable analyses was performed to correlate MR findings in each sequence with the final outcome of the patients. RESULTS TAI lesions were adequately visualized on T2, FLAIR and GRET2* sequences in more than 80% of the studies. Subcortical TAI lesions were well on FLAIR and GRET2* sequences visualized hemorrhagic TAI lesions. We saw that these MR sequences had a high inter-rater agreement for TAI diagnosis (0.8). T2 sequence presented the highest value on ROC curve in Gentry (0.68, 95%CI: 0.61-0.76, p<0.001, Nagerlkerke-R2 0.26) and Firsching classifications (0.64, 95%CI 0.57-0.72, p<0.001, Nagerlkerke-R2 0.19), followed by FLAIR and GRET2* sequences. Both classifications determined by each of these sequences were associated with poor outcome after performing a multivariable analyses adjusted for prognostic factors (p<0.02). CONCLUSIONS We recommend to perform conventional MR study in subacute phase including T2, FLAIR and GRET2* sequences for visualize TAI lesions. These MR findings added prognostic information in TBI patients.
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Affiliation(s)
- Marta Cicuendez
- Departamento de Neurocirugía, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - Ana Castaño-León
- Departamento de Neurocirugía, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre. Universidad Complutense de Madrid, Madrid, España
| | - Ana Ramos
- Departamento de Neurorradiología, Hospital Universitario 12 de Octubre. Universidad Complutense de Madrid, Madrid, Spain
| | - Amaya Hilario
- Departamento de Neurorradiología, Hospital Universitario 12 de Octubre. Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro A Gómez
- Departamento de Neurocirugía, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre. Universidad Complutense de Madrid, Madrid, España
| | - Alfonso Lagares
- Departamento de Neurocirugía, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre. Universidad Complutense de Madrid, Madrid, España
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Nemeth CL, Drummond GT, Mishra MK, Zhang F, Carr P, Garcia MS, Doman S, Fatemi A, Johnston MV, Kannan RM, Kannan S, Wilson MA. Uptake of dendrimer-drug by different cell types in the hippocampus after hypoxic-ischemic insult in neonatal mice: Effects of injury, microglial activation and hypothermia. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 13:2359-2369. [PMID: 28669854 DOI: 10.1016/j.nano.2017.06.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/15/2017] [Accepted: 06/22/2017] [Indexed: 12/13/2022]
Abstract
Perinatal hypoxic-ischemic encephalopathy (HIE) can result in neurodevelopmental disability, including cerebral palsy. The only treatment, hypothermia, provides incomplete neuroprotection. Hydroxyl polyamidoamine (PAMAM) dendrimers are being explored for targeted delivery of therapy for HIE. Understanding the biodistribution of dendrimer-conjugated drugs into microglia, neurons and astrocytes after brain injury is essential for optimizing drug delivery. We conjugated N-acetyl-L-cysteine to Cy5-labeled PAMAM dendrimer (Cy5-D-NAC) and used a mouse model of perinatal HIE to study effects of timing of administration, hypothermia, brain injury, and microglial activation on uptake. Dendrimer conjugation delivered therapy most effectively to activated microglia but also targeted some astrocytes and injured neurons. Cy5-D-NAC uptake was correlated with brain injury in all cell types and with activated morphology in microglia. Uptake was not inhibited by hypothermia, except in CD68+ microglia. Thus, dendrimer-conjugated drug delivery can target microglia, astrocytes and neurons and can be used in combination with hypothermia for treatment of HIE.
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Affiliation(s)
- Christina L Nemeth
- Hugo W. Moser Research Institute at Kennedy Krieger, 707 N Broadway, Baltimore, MD 21205, USA; Department of Neurology, The Johns Hopkins University School of Medicine, 1800 Orleans St., Baltimore, MD 21287, USA
| | - Gabrielle T Drummond
- Hugo W. Moser Research Institute at Kennedy Krieger, 707 N Broadway, Baltimore, MD 21205, USA
| | - Manoj K Mishra
- Center for Nanomedicine at the Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 400 N Broadway, Baltimore, MD 21287, USA
| | - Fan Zhang
- Center for Nanomedicine at the Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 400 N Broadway, Baltimore, MD 21287, USA
| | - Patrice Carr
- Hugo W. Moser Research Institute at Kennedy Krieger, 707 N Broadway, Baltimore, MD 21205, USA
| | - Maxine S Garcia
- Hugo W. Moser Research Institute at Kennedy Krieger, 707 N Broadway, Baltimore, MD 21205, USA
| | - Sydney Doman
- Hugo W. Moser Research Institute at Kennedy Krieger, 707 N Broadway, Baltimore, MD 21205, USA
| | - Ali Fatemi
- Hugo W. Moser Research Institute at Kennedy Krieger, 707 N Broadway, Baltimore, MD 21205, USA; Department of Neurology, The Johns Hopkins University School of Medicine, 1800 Orleans St., Baltimore, MD 21287, USA
| | - Michael V Johnston
- Hugo W. Moser Research Institute at Kennedy Krieger, 707 N Broadway, Baltimore, MD 21205, USA; Department of Neurology, The Johns Hopkins University School of Medicine, 1800 Orleans St., Baltimore, MD 21287, USA
| | - Rangaramanujam M Kannan
- Hugo W. Moser Research Institute at Kennedy Krieger, 707 N Broadway, Baltimore, MD 21205, USA; Center for Nanomedicine at the Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 400 N Broadway, Baltimore, MD 21287, USA
| | - Sujatha Kannan
- Hugo W. Moser Research Institute at Kennedy Krieger, 707 N Broadway, Baltimore, MD 21205, USA; Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, The Charlotte R. Bloomberg Children's Center, 1800 Orleans Street, Suite 6318D, Baltimore, MD 21287, USA.
| | - Mary Ann Wilson
- Hugo W. Moser Research Institute at Kennedy Krieger, 707 N Broadway, Baltimore, MD 21205, USA; Department of Neurology, The Johns Hopkins University School of Medicine, 1800 Orleans St., Baltimore, MD 21287, USA; Department of Neuroscience, The Johns Hopkins University School of Medicine, 725 N. Wolfe St., Baltimore, MD 21205, USA.
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145
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Abstract
Although an essential nutrient, manganese (Mn) can be toxic at high doses. There is, however, uncertainty regarding the effects of chronic low-level Mn-exposure. This review provides an overview of Mn-related brain and functional changes based on studies of a cohort of asymptomatic welders who had lower Mn-exposure than in most previous work. In welders with low-level Mn-exposure, we found: 1) Mn may accumulate in the brain in a non-linear fashion: MRI R1 (1/T1) signals significantly increased only after a critical level of exposure was reached (e.g., ≥300 welding hours in the past 90days prior to MRI). Moreover, R1 may be a more sensitive marker to capture short-term dynamic changes in Mn accumulation than the pallidal index [T1-weighted intensity ratio of the globus pallidus vs. frontal white matter], a traditional marker for Mn accumulation; 2) Chronic Mn-exposure may lead to microstructural changes as indicated by lower diffusion tensor fractional anisotropy values in the basal ganglia (BG), especially when welding years exceeded more than 30 years; 3) Mn-related subtle motor dysfunctions can be captured sensitively by synergy metrics (indices for movement stability), whereas traditional fine motor tasks failed to detect any significant differences; and 4) Iron (Fe) also may play a role in welding-related neurotoxicity, especially at low-level Mn-exposure, evidenced by higher R2* values (an estimate for brain Fe accumulation) in the BG. Moreover, higher R2* values were associated with lower phonemic fluency performance. These findings may guide future studies and the development of occupation- and public health-related polices involving Mn-exposure.
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146
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Edlow BL, Hurwitz S, Edlow JA. Diagnosis of DWI-negative acute ischemic stroke: A meta-analysis. Neurology 2017; 89:256-262. [PMID: 28615423 DOI: 10.1212/wnl.0000000000004120] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 04/20/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence of diffusion-weighted imaging (DWI)-negative acute ischemic stroke (AIS) and to identify clinical characteristics of patients with DWI-negative AIS. METHODS We systematically searched PubMed and Ovid/MEDLINE for relevant studies between 1992, the year that the DWI sequence entered clinical practice, and 2016. Studies were included based upon enrollment of consecutive patients presenting with a clinical diagnosis of AIS prior to imaging. Meta-analysis was performed to synthesize study-level data, estimate DWI-negative stroke prevalence, and estimate the odds ratios (ORs) for clinical characteristics associated with DWI-negative stroke. RESULTS Twelve articles including 3,236 AIS patients were included. The meta-analytic synthesis yielded a pooled prevalence of DWI-negative AIS of 6.8%, 95% confidence interval (CI) 4.9-9.3. In the 5 studies that reported proportion data for DWI-negative and DWI-positive AIS based on the ischemic vascular territory (n = 1,023 AIS patients), DWI-negative stroke was strongly associated with posterior circulation ischemia, as determined by clinical diagnosis at hospital discharge or repeat imaging (OR 5.1, 95% CI 2.3-11.6, p < 0.001). CONCLUSIONS A small but significant percentage of patients with AIS have a negative DWI scan. Patients with neurologic deficits consistent with posterior circulation ischemia have 5 times the odds of having a negative DWI scan compared to patients with anterior circulation ischemia. AIS remains a clinical diagnosis and urgent reperfusion therapy should be considered even when an initial DWI scan is negative.
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Affiliation(s)
- Brian L Edlow
- From the Department of Neurology (B.L.E.) and Athinoula A. Martinos Center for Biomedical Imaging (B.L.E.), Massachusetts General Hospital, Department of Medicine (S.H.), Brigham and Women's Hospital, and Department of Emergency Medicine (J.A.E.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Shelley Hurwitz
- From the Department of Neurology (B.L.E.) and Athinoula A. Martinos Center for Biomedical Imaging (B.L.E.), Massachusetts General Hospital, Department of Medicine (S.H.), Brigham and Women's Hospital, and Department of Emergency Medicine (J.A.E.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jonathan A Edlow
- From the Department of Neurology (B.L.E.) and Athinoula A. Martinos Center for Biomedical Imaging (B.L.E.), Massachusetts General Hospital, Department of Medicine (S.H.), Brigham and Women's Hospital, and Department of Emergency Medicine (J.A.E.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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147
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Abstract
The Alberta Stroke Program Early CT score (ASPECTS) is a 10-point semiquantitative topographic scoring system developed for the assessment of early ischemic changes (EICs) on noncontrast-enhanced computed tomography (NCCT) in patients with acute ischemic stroke involving the middle cerebral artery (MCA) territory. One point is subtracted from a total score of 10, if an EIC is present in any part of each of the ASPECTS regions. Higher ASPECTS has been associated with better outcomes and a lower risk of symptomatic intracerebral hemorrhage. To date, there are still controversies regarding the utility of ASPECTS for selecting patients for intravenous and intra-arterial therapies. This article provides a comprehensive review regarding methodology, limitations, and interobserver reproducibility of ASPECTS, as well as application of ASPECTS in clinical care. The focus of this review is ASPECTS evaluation on NCCT. The application of ASPECTS on multimodal computed tomography and magnetic resonance imaging (MRI) is briefly described.
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Affiliation(s)
- Supada Prakkamakul
- *Department of Radiology, King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Bangkok, Thailand †Division of Neurointervention, Texas Stroke Institute, Plano, TX
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148
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Lee SJ, Kim M, Lagman C, Bui TT, Yong WH, Yang I. Corpora amylacea mimicking low-grade glioma and manifesting as a seizure: Case report. Surg Neurol Int 2017; 8:64. [PMID: 28540130 PMCID: PMC5421196 DOI: 10.4103/sni.sni_423_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/12/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Corpora amylacea (CA) are accumulations of polyglucosan bodies typically found in astrocytic foot processes, and rarely, can mimic neoplasm. CA accumulation has also been associated with seizure disorders. We report the first case of a histologically confirmed intracranial, intraparenchymal CA lesion mimicking a low-grade glioma and manifesting as a seizure. CASE DESCRIPTION A 43-year-old man presented after a general tonic-clonic (GTC) seizure. Brain magnetic resonance imaging (MRI) revealed a small lesion in the right mesial temporal lobe with radiologic features of a low-grade glioma. The patient underwent a right pteronial craniotomy for resection of the lesion. Histology demonstrated abundant polyglucosan bodies without neoplastic features. The patient tolerated the procedure well, was free from seizures without antiepileptic drugs at 2-week follow-up, and is undergoing serial surveillance. CONCLUSION The clinical manifestation of CA as a seizure in the context of an identified brain mass is extraordinarily rare. Nevertheless, CA should be considered in the differential diagnosis for patients with seizures and a radiologically identifiable low-grade lesion. Symptomatic CA lesions Mimicking a low-grade glioma should be surgically pursued with a goal of safe, maximal resection to confirm the diagnosis and to provide the patient with prognosis, which can significantly impact patient quality of life.
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Affiliation(s)
- Seung J Lee
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Minsu Kim
- Department of Neurosurgery, Yeungnam University College of Medicine, Daemyung-dong, Nam-gu, Daegu, Korea
| | - Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Timothy T Bui
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - William H Yong
- Department of Pathology, University of California, Los Angeles, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, USA
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149
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Shaharir SS, Osman SS, Md Rani SA, Sakthiswary R, Said MSM. Factors associated with increased white matter hyperintense lesion (WMHI) load in patients with systemic lupus erythematosus (SLE). Lupus 2017; 27:25-32. [PMID: 28467290 DOI: 10.1177/0961203317707062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction White matter hyperintense (WMHI) lesions are the most common finding in magnetic resonance imaging (MRI) of the brain in patients with systemic lupus erythematosus (SLE). Objective The objective of this article is to determine the clinical factors associated with an increase in WMHI lesion load among SLE patients. Method A total of 83 SLE patients with MRI of the brain from National University of Malaysia Medical Centre were included. The WMHI lesion load was determined using the Scheltens score and Fazekas scale, and their distribution was divided into the deep white matter (DWMHI) and periventricular (PVH) regions. The clinical correlates of WMHI lesions were initially determined using univariate analyses and subsequently multivariable regression analyses were performed to determine the independent factors of increased WMHI lesion load. Results MRI of the brain of 46 patients who had WMHI lesions were compared with 37 patients with normal MRI. We found significant association between the presence of WMHI lesions and age, presence of cerebral infarcts, positive antiphospholipid antibody (aPL), active disease, neuropsychiatric lupus (NPSLE) and disease damage. Age, SLEDAI scores, cerebral infarcts and disease damage were significantly associated with higher DWMHI and PVH Scheltens scores. Meanwhile, patients with active lupus nephritis (LN), lower serum albumin and more severe proteinuria were associated with larger Fazekas WMHI lesions. Multivariable regression analysis revealed that the independent factors associated with presence of WMHI lesions were positive aPL and SLEDAI scores ( p < 0.05). Higher WMHI Scheltens scores in both DWMHI and PVH were associated with presence of cerebral infarct but higher PVH lesion load was significantly associated with active SLE disease. Conclusion Presence of WMHI lesions in SLE was significantly associated with cerebral infarcts, aPL and high general SLE activity, suggesting both inflammation and ischaemia as the underlying pathology of these lesions.
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Affiliation(s)
- S S Shaharir
- 1 Department of Internal Medicine/Rheumatology, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - S S Osman
- 2 Department of Radiology, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - S A Md Rani
- 3 Department of Internal Medicine/Neurology, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - R Sakthiswary
- 1 Department of Internal Medicine/Rheumatology, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - M S M Said
- 1 Department of Internal Medicine/Rheumatology, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
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150
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Conventional and ZOOMit DWI for Evaluation of Testis in Patients With Ipsilateral Varicocele. AJR Am J Roentgenol 2017; 208:1045-1050. [DOI: 10.2214/ajr.16.17292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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