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Kwa VIH, Algra A, Brundel M, Bouvy W, Kappelle LJ. Microbleeds as a predictor of intracerebral haemorrhage and ischaemic stroke after a TIA or minor ischaemic stroke: a cohort study. BMJ Open 2013; 3:bmjopen-2013-002575. [PMID: 23793658 PMCID: PMC4401818 DOI: 10.1136/bmjopen-2013-002575] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES We examined whether patients with cerebral microbleeds on MRI, who started and continued antithrombotic medication for years, have an increased risk of symptomatic intracerebral haemorrhage (ICH). DESIGN Prospective cohort study. SETTINGS Multicentre outpatient clinics in the Netherlands. PARTICIPANTS We followed 397 patients with newly diagnosed transient ischaemic attack (TIA) or minor ischaemic stroke receiving anticoagulants or antiplatelet drugs. 58% were men. The mean age was 65.3 years. 395 (99%) patients were white Europeans. MRI including a T2*-weighted gradient echo was performed within 3 months after start of medication. 48 (12%) patients had one or more microbleeds. They were followed every 6 months by telephone for a mean of 3.8 years. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was a symptomatic ICH. Secondary outcome were all strokes, ischaemic stroke, myocardial infarct, death from all vascular causes, death from non-vascular causes and death from all causes. RESULTS Five patients (1%) suffered from a symptomatic ICH. One ICH occurred in a patient with microbleeds at baseline (adjusted HR 2.6, 95% CI 0.3 to 27). The incidence of all strokes during follow-up was higher in patients with than without microbleeds (adjusted HR 2.3, 95% CI 1.0 to 5.3), with a dose-response relationship. The incidences of ischaemic stroke, vascular death, non-vascular death and death of all causes were higher in patients with microbleeds, but not statistically significant. CONCLUSIONS In our cohort of patients using antithrombotic drugs after a TIA or minor ischaemic stroke, we found that microbleeds on MRI are associated with an increased risk of future stroke in general, but we did not find an increased risk of symptomatic ICH.
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Affiliation(s)
- Vincent I H Kwa
- Department of Neurology, Onze Lieve Vrouwe Gasthuis,Slotervaart Hospital, Amsterdam, The Netherlands
| | - Ale Algra
- Department of Neurology and Neurosurgery, UMC Utrecht Stroke Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
- Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Manon Brundel
- Department of Neurology and Neurosurgery, UMC Utrecht Stroke Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Willem Bouvy
- Department of Neurology and Neurosurgery, UMC Utrecht Stroke Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, UMC Utrecht Stroke Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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102
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Joint effect of hypertension and lifestyle-related risk factors on the risk of brain microbleeds in healthy individuals. Hypertens Res 2013; 36:789-94. [PMID: 23575379 DOI: 10.1038/hr.2013.26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/27/2013] [Accepted: 01/31/2013] [Indexed: 11/08/2022]
Abstract
Brain microbleeds (MBs) are potential risk factors for future stroke, and hypertension is an established risk factor for MBs. However, data on other lifestyle-related risk factors and their joint effects with hypertension are limited. We enrolled 860 adults who underwent 1.5-T brain magnetic resonance imaging and had no history of stroke. Information on clinical risk factors was obtained from health-screening tests, and dietary history was assessed using a validated, brief, self-administered dietary questionnaire. Subjects were divided into three groups (no MBs, deep MBs and lobar MBs), which were compared for the potential risk factors; their joint effects with hypertension were assessed by logistic regression. Biologic interaction was estimated with the synergy index. After adjustment for possible confounders, age and systolic and diastolic blood pressures were found to be associated with the presence of MBs in a dose-dependent manner, especially in the case of deep MBs. With regard to lifestyle-related factors, current smoking status was significantly associated with deep MBs, and the odds ratio was 2.73 (95% confidence interval (CI) 1.15-6.48). We found that hypertension and current smoking status, higher alcohol consumption or lower calcium intake had joint effects on the risk of MBs and that hypertension and current smoking status had synergistic additive action (synergy index, 6.30; 95% CI 1.07-37.13). These results suggest that approaches combining lowering blood pressure and smoking cessation may greatly reduce the risk of MBs and contribute to preventing stroke.
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Affiliation(s)
- Andreas Charidimou
- From the Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK (A.C., D.J.W.); Department of Stroke Medicine, Imperial College Healthcare, NHS Trust, London, UK (P.K.); and Education Unit, UCL Institute of Neurology, Queen Square, London, UK (Z.F.)
| | - Puneet Kakar
- From the Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK (A.C., D.J.W.); Department of Stroke Medicine, Imperial College Healthcare, NHS Trust, London, UK (P.K.); and Education Unit, UCL Institute of Neurology, Queen Square, London, UK (Z.F.)
| | - Zoe Fox
- From the Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK (A.C., D.J.W.); Department of Stroke Medicine, Imperial College Healthcare, NHS Trust, London, UK (P.K.); and Education Unit, UCL Institute of Neurology, Queen Square, London, UK (Z.F.)
| | - David J. Werring
- From the Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK (A.C., D.J.W.); Department of Stroke Medicine, Imperial College Healthcare, NHS Trust, London, UK (P.K.); and Education Unit, UCL Institute of Neurology, Queen Square, London, UK (Z.F.)
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104
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Klarenbeek P, van Oostenbrugge RJ, Rouhl RPW, Knottnerus ILH, Staals J. Higher ambulatory blood pressure relates to new cerebral microbleeds: 2-year follow-up study in lacunar stroke patients. Stroke 2013; 44:978-83. [PMID: 23449261 DOI: 10.1161/strokeaha.111.676619] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Elevated blood pressure (BP) is associated with the presence of cerebral microbleeds (CMBs) in cross-sectional studies. However, longitudinal studies did not show a convincing relationship. We aimed to determine the association between elevated BP levels and the occurrence of new CMBs after a 2-year follow-up in first-ever lacunar stroke patients using ambulatory BP monitoring. METHODS Ninety-six first-ever lacunar stroke patients underwent brain MRI and ambulatory BP monitoring at baseline and after 2-year follow-up. We used logistic regression analyses to assess the association of BP levels with new CMBs. RESULTS We found new CMBs in 17 patients (18%). Higher 24-hour, day and night systolic BP (odds ratio, 2.69; 95% confidence interval, 1.40-5.21 per SD increase for 24-hour BP) and diastolic BP (odds ratio, 2.13; 95% confidence interval, 1.15-3.90 per SD increase for 24-hour BP) at baseline were associated with the development of new CMBs independent of age and sex. BP levels decreased during follow-up in both patients with and without new CMBs. Unlike BP levels at baseline, there was no difference in BP levels at follow-up between patients with and without new CMBs. CONCLUSIONS Both higher systolic and diastolic BP levels were associated with the development of new CMBs in a population of lacunar stroke patients. Decrease of BP levels during follow-up did not halt progression of CMBs; however, it remains to be determined whether (early) intervention with antihypertensive drugs can slow down progression of CMBs.
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Affiliation(s)
- Pim Klarenbeek
- Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands.
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105
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Anderson CD, Biffi A, Nalls MA, Devan WJ, Schwab K, Ayres AM, Valant V, Ross OA, Rost NS, Saxena R, Viswanathan A, Worrall BB, Brott TG, Goldstein JN, Brown D, Broderick JP, Norrving B, Greenberg SM, Silliman SL, Hansen BM, Tirschwell DL, Lindgren A, Slowik A, Schmidt R, Selim M, Roquer J, Montaner J, Singleton AB, Kidwell CS, Woo D, Furie KL, Meschia JF, Rosand J. Common variants within oxidative phosphorylation genes influence risk of ischemic stroke and intracerebral hemorrhage. Stroke 2013; 44:612-9. [PMID: 23362085 DOI: 10.1161/strokeaha.112.672089] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Previous studies demonstrated association between mitochondrial DNA variants and ischemic stroke (IS). We investigated whether variants within a larger set of oxidative phosphorylation (OXPHOS) genes encoded by both autosomal and mitochondrial DNA were associated with risk of IS and, based on our results, extended our investigation to intracerebral hemorrhage (ICH). METHODS This association study used a discovery cohort of 1643 individuals, a validation cohort of 2432 individuals for IS, and an extension cohort of 1476 individuals for ICH. Gene-set enrichment analysis was performed on all structural OXPHOS genes, as well as genes contributing to individual respiratory complexes. Gene-sets passing gene-set enrichment analysis were tested by constructing genetic scores using common variants residing within each gene. Associations between each variant and IS that emerged in the discovery cohort were examined in validation and extension cohorts. RESULTS IS was associated with genetic risk scores in OXPHOS as a whole (odds ratio [OR], 1.17; P=0.008) and complex I (OR, 1.06; P=0.050). Among IS subtypes, small vessel stroke showed association with OXPHOS (OR, 1.16; P=0.007), complex I (OR, 1.13; P=0.027), and complex IV (OR, 1.14; P=0.018). To further explore this small vessel association, we extended our analysis to ICH, revealing association between deep hemispheric ICH and complex IV (OR, 1.08; P=0.008). CONCLUSIONS This pathway analysis demonstrates association between common genetic variants within OXPHOS genes and stroke. The associations for small vessel stroke and deep ICH suggest that genetic variation in OXPHOS influences small vessel pathobiology. Further studies are needed to identify culprit genetic variants and assess their functional consequences.
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106
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Guo LF, Geng J, Qiu MH, Mao CH, Liu C, Cui L. Quantification of Phase Values of Cerebral Microbleeds in Hypertensive Patients Using ESWAN MRI. Clin Neuroradiol 2013; 23:197-205. [PMID: 23334227 DOI: 10.1007/s00062-012-0196-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 12/31/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The presence of cerebral microbleeds (CMBs) may have predictive and diagnostic value for cerebrovascular diseases. The purpose of our study was to measure the phase values (PVs) of CMBs by phase maps. METHODS We retrospectively analyzed 75 patients with hypertension who had CMBs using enhanced T2*-weighted angiography (ESWAN). The PVs of CMBs were measured and documented. The mean PVs of CMBs were correlated with demographic features and the grade of white matter lesions for seven brain regions. RESULTS A total of 275 CMBs were found. Their mean PV was - 1.39 ± 0.29 radians. The mean PV of CMBs in seven brain regions was significantly lower than that of red nucleus and substantia nigra of healthy controls (P < .05). The mean PV of CMBs in the basal ganglia gray matter was significantly lower than that of the brainstem, subcortical white matter, and cerebellum (P < 0.05). In subcortical white matter, the PVs were significantly lower in patients with hypertension < 10 years than for those patients with hypertension ≥ 10 years (P < 0.05). In basal ganglia gray matter, the PVs were significantly lower in men than in women (P < 0.05). There was no significant correlation between the PVs of CMBs and the demographic features addressed or the grade of white matter lesions. CONCLUSIONS Measurement of the PV of phase maps using ESWAN sequence provides quantitative information for detection of CMBs. The measurement data reported herein will provide a reference for a longitudinal study of CMBs in the future.
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Affiliation(s)
- L F Guo
- Shandong Medical Imaging Research Institute, Shandong University, Jing-wu Road No. 324, 250021, Jinan, Shandong, P.R. China,
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107
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Alberts MJ, Eikelboom JW, Hankey GJ. Antithrombotic therapy for stroke prevention in non-valvular atrial fibrillation. Lancet Neurol 2013; 11:1066-81. [PMID: 23153406 DOI: 10.1016/s1474-4422(12)70258-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The world faces an epidemic of atrial fibrillation and atrial fibrillation-related stroke. An individual's risk of atrial fibrillation-related stroke can be estimated with the CHADS(2) or CHA(2)DS(2)VASc scores, and reduced by two-thirds with effective anticoagulation. Vitamin K antagonists, such as warfarin, are underused and often poorly managed. The direct thrombin inhibitor dabigatran etexilate and factor Xa inhibitors rivaroxaban and apixaban are new oral anticoagulants that are at least as efficacious and safe as warfarin. Their advantages are predictable anticoagulant effects, low propensity for drug interactions, and lower rates of intracranial haemorrhage than with warfarin. A disadvantage is the continuing need to develop and validate rapidly effective antidotes for major bleeding and standardised tests that accurately measure plasma concentrations and anticoagulant effects, together with the disadvantage of possible higher rates of gastrointestinal haemorrhage and greater expense than with warfarin. The new oral anticoagulants should increase the number of patients with atrial fibrillation at risk of stroke who are optimally anticoagulated, and reduce the burden of atrial fibrillation-related stroke.
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Affiliation(s)
- Mark J Alberts
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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108
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Sun W, Yuan C, Liu W, Li Y, Huang Z, Zhu W, Li M, Xu G, Liu X. Asymptomatic Cerebral Microbleeds in Adult Patients with Moyamoya Disease: A Prospective Cohort Study with 2 Years of Follow-Up. Cerebrovasc Dis 2013; 35:469-75. [DOI: 10.1159/000350203] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/20/2013] [Indexed: 11/19/2022] Open
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Comparison of ESWAN, SWI-SPGR, and 2D T2*-Weighted GRE Sequence for Depicting Cerebral Microbleeds. Clin Neuroradiol 2012; 23:121-7. [DOI: 10.1007/s00062-012-0185-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
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Kakar P, Charidimou A, Werring DJ. Cerebral microbleeds: a new dilemma in stroke medicine. JRSM Cardiovasc Dis 2012; 1:2048004012474754. [PMID: 24175079 PMCID: PMC3738371 DOI: 10.1177/2048004012474754] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cerebral microbleeds (CMBs) are an increasingly common neuroimaging finding in the context of ageing, cerebrovascular disease and dementia, with potentially important clinical relevance. Perhaps the most pressing clinical question is whether CMBs are associated with a clinically important increase in the risk of intracerebral haemorrhage (ICH), the most feared complication in patients treated with thrombolytic or antithrombotic (antiplatelet and anticoagulant) drugs. This review will summarize the evidence available regarding CMBs as an indicator of future ICH risk in stroke medicine clinical practice.
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Affiliation(s)
- Puneet Kakar
- Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Andreas Charidimou
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - David J Werring
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
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111
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Charidimou A, Shakeshaft C, Werring DJ. Cerebral microbleeds on magnetic resonance imaging and anticoagulant-associated intracerebral hemorrhage risk. Front Neurol 2012; 3:133. [PMID: 23015806 PMCID: PMC3446731 DOI: 10.3389/fneur.2012.00133] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/27/2012] [Indexed: 01/12/2023] Open
Abstract
The increasing use of antithrombotic drugs in an aging population [including anticoagulants to prevent future ischemic stroke in individuals with atrial fibrillation (AF)] has been associated with a dramatic increase in the incidence of intracerebral hemorrhage (ICH) in users of antithrombotic drugs. Several lines of evidence suggest that cerebral small vessel disease (particularly sporadic cerebral amyloid angiopathy) is a risk factor for this rare but devastating complication of these commonly used treatments. Cerebral microbleeds (CMBs) have emerged as a key MRI marker of small vessel disease and a potentially powerful marker of future ICH risk, but adequately powered, high quality prospective studies of CMBs and ICH risk on anticoagulation are not available. Further data are urgently needed to determine how neuroimaging and other biomarkers may contribute to individualized risk prediction to make anticoagulation as safe and effective as possible. In this review we discuss the available evidence on cerebral small vessel disease and CMBs in the context of antithrombotic treatments, especially regarding their role as a predictor of future ICH risk after ischemic stroke, where risk-benefit judgments can be a major challenge for physicians. We will focus on patients with AF because these are frequently treated with anticoagulation. We briefly describe the rationale and design of a new prospective observational inception cohort study (Clinical Relevance of Microbleeds in Stroke; CROMIS-2) which investigates the value of MRI markers of small vessel disease (including CMBs) and genetic factors in assessing the risk of oral anticoagulation-associated ICH.
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Affiliation(s)
- Andreas Charidimou
- Stroke Research Group, Department of Brain Repair and Rehabilitation, The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology Queen Square, London, UK
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112
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Madai VI, von Samson-Himmelstjerna FC, Bauer M, Stengl KL, Mutke MA, Tovar-Martinez E, Wuerfel J, Endres M, Niendorf T, Sobesky J. Ultrahigh-field MRI in human ischemic stroke--a 7 tesla study. PLoS One 2012; 7:e37631. [PMID: 22701525 PMCID: PMC3365122 DOI: 10.1371/journal.pone.0037631] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 04/27/2012] [Indexed: 11/27/2022] Open
Abstract
Introduction Magnetic resonance imaging (MRI) using field strengths up to 3 Tesla (T) has proven to be a powerful tool for stroke diagnosis. Recently, ultrahigh-field (UHF) MRI at 7 T has shown relevant diagnostic benefits in imaging of neurological diseases, but its value for stroke imaging has not been investigated yet. We present the first evaluation of a clinically feasible stroke imaging protocol at 7 T. For comparison an established stroke imaging protocol was applied at 3 T. Methods In a prospective imaging study seven patients with subacute and chronic stroke were included. Imaging at 3 T was immediately followed by 7 T imaging. Both protocols included T1-weighted 3D Magnetization-Prepared Rapid-Acquired Gradient-Echo (3D-MPRAGE), T2-weighted 2D Fluid Attenuated Inversion Recovery (2D-FLAIR), T2-weighted 2D Fluid Attenuated Inversion Recovery (2D-T2-TSE), T2* weighted 2D Fast Low Angle Shot Gradient Echo (2D-HemoFLASH) and 3D Time-of-Flight angiography (3D-TOF). Results The diagnostic information relevant for clinical stroke imaging obtained at 3 T was equally available at 7 T. Higher spatial resolution at 7 T revealed more anatomical details precisely depicting ischemic lesions and periinfarct alterations. A clear benefit in anatomical resolution was also demonstrated for vessel imaging at 7 T. RF power deposition constraints induced scan time prolongation and reduced brain coverage for 2D-FLAIR, 2D-T2-TSE and 3D-TOF at 7 T versus 3 T. Conclusions The potential of 7 T MRI for human stroke imaging is shown. Our pilot study encourages a further evaluation of the diagnostic benefit of stroke imaging at 7 T in a larger study.
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Affiliation(s)
- Vince I. Madai
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Federico C. von Samson-Himmelstjerna
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Berlin Ultra-High Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
| | - Miriam Bauer
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Katharina L. Stengl
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Matthias A. Mutke
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Elena Tovar-Martinez
- Berlin Ultra-High Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
| | - Jens Wuerfel
- Berlin Ultra-High Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany
- Institute of Neuroradiology, University Luebeck, Luebeck, Germany
| | - Matthias Endres
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Excellence Cluster Neurocure, Charité-Universitätsmedizin, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultra-High Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin and Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
| | - Jan Sobesky
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin and Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- * E-mail:
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Poels MMF, Ikram MA, Vernooij MW. Improved MR imaging detection of cerebral microbleeds more accurately identifies persons with vasculopathy. AJNR Am J Neuroradiol 2012; 33:1553-6. [PMID: 22492574 DOI: 10.3174/ajnr.a3108] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The clinical relevance of improved detection of cerebral microbleeds by using advanced-versus-conventional MR imaging techniques remains uncertain. As part of the population-based Rotterdam Scan Study, we compared whether participants whose microbleeds were only demonstrated on a high-resolution MR imaging sequence differed with respect to risk profile and risk of new microbleeds from participants whose microbleeds were also depicted on a conventional MR imaging sequence. MATERIALS AND METHODS Two hundred participants (mean age, 79.2 years) underwent both conventional 2D T2*-weighted MR imaging and high-resolution 3D T2*-weighted MR imaging at 1.5T. Vascular risk factors, APOE allele status, and markers of small vessel disease and risk of incident microbleeds were compared for microbleed status by using logistic regression models adjusted for age and sex. RESULTS There were no significant associations between any of the factors and microbleed presence in participants whose microbleeds were only demonstrated on a high-resolution MR imaging sequence. However, the estimates in these participants were more similar to those in participants whose microbleeds were also depicted on a conventional MR imaging sequence than to those in participants without microbleeds. Moreover, significantly more participants whose microbleeds were only demonstrated on high-resolution MR imaging developed new CMBs during follow-up compared with participants without CMBs (25.0% versus 5.9%; OR, 5.98; 95% CI, 1.35-26.49). CONCLUSIONS Improved detection of microbleeds may contribute to more accurate identification of persons with underlying small-vessel pathology in the general elderly population. Further studies are needed to replicate these findings and firmly establish the role of improved detection of CMBs in the identification of persons with vasculopathy.
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Affiliation(s)
- M M F Poels
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Affiliation(s)
- Chelsea S Kidwell
- Department of Neurology, Georgetown University, 4000 Reservoir Road, Suite 150, Washington, DC 20007, USA.
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115
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Fluri F, Jax F, Amort M, Wetzel SG, Lyrer PA, Katan M, Hatz F, Engelter ST. Significance of microbleeds in patients with transient ischaemic attack. Eur J Neurol 2011; 19:522-4. [PMID: 21951303 DOI: 10.1111/j.1468-1331.2011.03522.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to determine the prognostic significance of microbleeds in TIA-patients. In patients with a transient ischaemic attack (TIA), the prognostic value of microbleeds is unknown. METHODS In 176 consecutive TIA patients, the number, size, and location of microbleeds with or without acute ischaemic lesions were assessed. We compared microbleed-positive and microbleed-negative patients with regard to the end-point stroke within 3 months. RESULTS Four of the seven patients with subsequent stroke had microbleeds. Microbleed-positive patients had a higher risk for stroke [odds ratios (OR) 8.91, 95% CI 1.87-42.51, P<0.01] than those without microbleeds. Microbleed-positive patients with accompanying acute ischaemic lesions had a higher stroke risk than those with neither an acute ischaemia nor a microbleed (OR 6.20, 95% CI 1.10-35.12; P=0.04). CONCLUSION Microbleeds alone or in combination with acute ischaemic lesions may increase the risk for subsequent ischaemic stroke after TIA within 3 months.
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Affiliation(s)
- F Fluri
- Departments of Clinical Neurology Neuroradiology, University Hospital Basel, Basel, Switzerland
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116
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Charidimou A, Werring DJ. Cerebral microbleeds: detection, mechanisms and clinical challenges. FUTURE NEUROLOGY 2011. [DOI: 10.2217/fnl.11.42] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In the last decade or so, cerebral microbleeds (CMBs) – tiny perivascular hemorrhages seen as small, well-demarcated, hypointense, rounded lesions on MRI sequences that are sensitive to magnetic susceptibility – have generated increasing interest among neurologists and clinical stroke researchers. As MRI techniques become more sophisticated, CMBs are increasingly detected in various patient populations (including all types of stroke, Alzheimer’s disease and vascular cognitive impairment) and healthy community-dwelling older people. Their presence raises many clinical dilemmas and intriguing pathophysiological questions. CMBs are emerging as an important new manifestation and diagnostic marker of cerebral small-vessel disease. They are a potential predictor of future intracerebral hemorrhage risk, a possible contributor to cognitive impairment and dementia and a potential key link between vascular and degenerative pathologies. In this article, we discuss the available pathological, neuroimaging and clinical studies in the field, and we provide a modern overview of the clinical and pathophysiological implications of CMBs in different disease settings.
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Affiliation(s)
- Andreas Charidimou
- Stroke Research Group, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology & The National Hospital for Neurology & Neurosurgery, Queen Square, London WC1N 3BG, UK
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