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Kavak RP, Kavak N, Koca S, Balcı N, Turhan B, Kaymak SD. Measurement of optic nerve sheath diameter on computed tomography for the differentiation of transient ischemic attacks. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231001. [PMID: 38422321 PMCID: PMC10903272 DOI: 10.1590/1806-9282.20231001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The objective of this study was to investigate whether the measurement of mean optic nerve sheath diameter in patients with transient ischemic attack could be used to distinguish between control groups, the acute ischemic stroke group, and subgroups within the acute ischemic stroke category. METHODS Retrospectively, the mean optic nerve sheath diameters of patients aged 18 years and older belonging to control, transient ischemic attack, acute ischemic stroke, and subgroups within the acute ischemic stroke category were measured with initial computed tomography conducted in the emergency department. RESULTS Out of the 773 patients included in the study, 318 (41.1%) were in the control group, 77 (10%) had transient ischemic attack, and 378 (49%) were categorized as stroke patients. The average mean optic nerve sheath diameter was significantly higher in both the stroke and transient ischemic attack groups compared with the control group (p<0.001 for both comparisons). Furthermore, the mean optic nerve sheath diameter in the stroke subgroups was significantly higher than in both the transient ischemic attack and control groups (p<0.001 for all comparisons). In transient ischemic attack patients, the mean optic nerve sheath diameter showed a significant ability to predict transient ischemic attack (AUC=0.913, p<0.001), with a calculated optimal cutoff value of 4.72, sensitivity of 94.8%, and specificity of 73.9%. CONCLUSION The mean optic nerve sheath diameter of patients in the transient ischemic attack group was lower compared with those in the stroke subgroups but higher compared with the control group.
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Affiliation(s)
| | - Nezih Kavak
- Etlik City Hospital, Department of Emergency - Ankara, Turkey
| | - Senem Koca
- Etlik City Hospital, Department of Emergency - Ankara, Turkey
| | - Nurgül Balcı
- The Republic of Türkiye Ministry of Health, General Directorate of Public Hospitals - Ankara, Turkey
| | - Berna Turhan
- Etlik City Hospital, Department of Radiology - Ankara, Turkey
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Altered Effective Connectivity of the Primary Motor Cortex in Transient Ischemic Attack. Neural Plast 2022; 2022:2219993. [PMID: 36437903 PMCID: PMC9699783 DOI: 10.1155/2022/2219993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 11/19/2022] Open
Abstract
Objective This study is aimed at exploring alteration in motor-related effective connectivity in individuals with transient ischemic attack (TIA). Methods A total of 48 individuals with TIA and 41 age-matched and sex-matched healthy controls (HCs) were recruited for this study. The participants were scanned using MRI, and their clinical characteristics were collected. To investigate motor-related effective connectivity differences between individuals with TIA and HCs, the bilateral primary motor cortex (M1) was used as the regions of interest (ROIs) to perform a whole-brain Granger causality analysis (GCA). Furthermore, partial correlation was used to evaluate the relationship between GCA values and the clinical characteristics of individuals with TIA. Results Compared with HCs, individuals with TIA demonstrated alterations in the effective connectivity between M1 and widely distributed brain regions involved in motor, visual, auditory, and sensory integration. In addition, GCA values were significantly correlated with high- and low-density lipoprotein cholesterols in individuals with TIA. Conclusion This study provides important evidence for the alteration of motor-related effective connectivity in TIA, which reflects the abnormal information flow between different brain regions. This could help further elucidate the pathological mechanisms of motor impairment in individuals with TIA and provide a new perspective for future early diagnosis and intervention for TIA.
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RP-Rs-fMRIomics as a Novel Imaging Analysis Strategy to Empower Diagnosis of Brain Gliomas. Cancers (Basel) 2022; 14:cancers14122818. [PMID: 35740484 PMCID: PMC9220978 DOI: 10.3390/cancers14122818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 12/07/2022] Open
Abstract
Rs-fMRI can provide rich information about functional processes in the brain with a large array of imaging parameters and is also suitable for investigating the biological processes in cerebral gliomas. We aimed to propose an imaging analysis method of RP-Rs-fMRIomics by adopting omics analysis on rs-fMRI with exhaustive regional parameters and subsequently estimating its feasibility on the prediction diagnosis of gliomas. In this retrospective study, preoperative rs-fMRI data were acquired from patients confirmed with diffuse gliomas (n = 176). A total of 420 features were extracted through measuring 14 regional parameters of rs-fMRI as much as available currently in 10 specific narrow frequency bins and three parts of gliomas. With a randomly split training and testing dataset (ratio 7:3), four classifiers were implemented to construct and optimize RP-Rs-fMRIomics models for predicting glioma grade, IDH status and Karnofsky Performance Status scores. The RP-Rs-fMRIomics models (AUROC 0.988, 0.905, 0.801) were superior to the corresponding traditional single rs-fMRI index (AUROC 0.803, 0.731, 0.632) in predicting glioma grade, IDH and survival. The RP-Rs-fMRIomics analysis, featuring high interpretability, was competitive for prediction of glioma grading, IDH genotype and prognosis. The method expanded the clinical application of rs-fMRI and also contributed a new imaging analysis for brain tumor research.
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Hu JY, Kirilina E, Nierhaus T, Ovadia-Caro S, Livne M, Villringer K, Margulies D, Fiebach JB, Villringer A, Khalil AA. A novel approach for assessing hypoperfusion in stroke using spatial independent component analysis of resting-state fMRI. Hum Brain Mapp 2021; 42:5204-5216. [PMID: 34323339 PMCID: PMC8519861 DOI: 10.1002/hbm.25610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 01/03/2023] Open
Abstract
Individualized treatment of acute stroke depends on the timely detection of ischemia and potentially salvageable tissue in the brain. Using functional MRI (fMRI), it is possible to characterize cerebral blood flow from blood‐oxygen‐level‐dependent (BOLD) signals without the administration of exogenous contrast agents. In this study, we applied spatial independent component analysis to resting‐state fMRI data of 37 stroke patients scanned within 24 hr of symptom onset, 17 of whom received follow‐up scans the next day. Our analysis revealed “Hypoperfusion spatially‐Independent Components” (HICs) whose spatial patterns of BOLD signal resembled regions of delayed perfusion depicted by dynamic susceptibility contrast MRI. These HICs were detected even in the presence of excessive patient motion, and disappeared following successful tissue reperfusion. The unique spatial and temporal features of HICs allowed them to be distinguished with high accuracy from other components in a user‐independent manner (area under the curve = 0.93, balanced accuracy = 0.90, sensitivity = 1.00, and specificity = 0.85). Our study therefore presents a new, noninvasive method for assessing blood flow in acute stroke that minimizes interpretative subjectivity and is robust to severe patient motion.
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Affiliation(s)
- Jiun-Yiing Hu
- Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Evgeniya Kirilina
- Department of Neurophysics, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Neurocomputation and Neuroimaging Unit, Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Till Nierhaus
- Neurocomputation and Neuroimaging Unit, Center for Cognitive Neuroscience Berlin (CCNB), Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.,Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Michelle Livne
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Margulies
- Centre National de la Recherche Scientifique (CNRS) UMR 7225, Frontlab, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Arno Villringer
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany
| | - Ahmed A Khalil
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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Xu M, Lin R, Luo J, Tang C, Wang S, Wong J, Wu M, Huang J, Shi P, Gao A, Bai Y, Xie Y, Luo J, Yang Y, Cui S. Using brain functional magnetic resonance imaging to evaluate the effectiveness of acupuncture combined with mirror therapy on upper limb function in patients with cerebral ischemic stroke: a study protocol for a randomized, controlled trial. Trials 2021; 22:53. [PMID: 33436053 PMCID: PMC7805106 DOI: 10.1186/s13063-020-04955-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Upper limb and hand motor dysfunction is one of the challenges in rehabilitation after cerebral ischemic stroke (CIS), and the clinical efficacy of rehabilitation needs to be improved. This study aims to combine Jin's three-needle acupuncture (JTN) therapy with mirror therapy (MT) for hemiplegia after CIS, objectively evaluate the clinical effects and safety of JTN to treat upper limb dysfunction, and use functional magnetic resonance imaging (fMRI) of the brain to investigate the central mechanisms of the effects, which would provide a powerful evidence-based medical basis for further supporting the application of JTN combined with MT. METHODS/DESIGN This trial will be a single-blind, randomized controlled study. Patients who meet the study criteria will be recruited and randomly assigned to either the combined treatment group (JTN+MT) or the JTN group. Both interventions will be conducted for 6 days per week and last for 4 weeks. The primary outcome will be the effective rate based on the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Other outcome measures will include scores on the motor assessment scale (MAS), action research arm test (ARAT), activities of daily living (ADL) scale, and fMRI analyses. For safety evaluation, adverse events will be observed and recorded. DISCUSSION This study may help to identify the efficacy and safety of acupuncture combined with MT for upper limb dysfunction after CIS and explore the central mechanisms with brain fMRI. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-IOR-17012174 . Registered on 5 April 2017.
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Affiliation(s)
- Mingzhu Xu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, 518034, Guangdong, China.,Shenzhen Hospital, Southern Medical University, Shenzhen, 518100, Guangdong, China.,Shenzhen Hospital, Peking University, Shenzhen, 518034, Guangdong, China
| | - Run Lin
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, 518034, Guangdong, China
| | - Jing Luo
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, 518034, Guangdong, China.
| | - Chunzhi Tang
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Shuhui Wang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, 518034, Guangdong, China
| | - John Wong
- MGH Institute of Health Professions, Boston, MA, USA
| | - Meng Wu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, 518034, Guangdong, China
| | - Jianting Huang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, 518034, Guangdong, China
| | - Peng Shi
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Ang Gao
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Beijing, China
| | - Yuqian Bai
- Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, 518001, China
| | - Ying Xie
- Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, 518001, China
| | - Jun Luo
- Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen, 518001, China
| | - Yunqiu Yang
- Macau University of Science and Technology, Macau, 519020, China
| | - Shaoyang Cui
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, 518034, Guangdong, China.
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Tanrıtanır AC, Villringer K, Galinovic I, Grittner U, Kirilina E, Fiebach JB, Villringer A, Khalil AA. The Effect of Scan Length on the Assessment of BOLD Delay in Ischemic Stroke. Front Neurol 2020; 11:381. [PMID: 32431665 PMCID: PMC7214917 DOI: 10.3389/fneur.2020.00381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/15/2020] [Indexed: 01/21/2023] Open
Abstract
Objectives: To evaluate the impact of resting-state functional MRI scan length on the diagnostic accuracy, image quality and lesion volume estimation of BOLD delay maps used for brain perfusion assessment in acute ischemic stroke. Methods: Sixty-three acute ischemic stroke patients received a 340 s resting-state functional MRI within 24 h of stroke symptom onset. BOLD delay maps were calculated from the full scan and four shortened versions (68 s, 136 s, 204 s, 272 s). The BOLD delay lesions on these maps were compared in terms of spatial overlap and volumetric agreement with the lesions derived from the full scans and with time-to-maximum (Tmax) lesions derived from DSC-MRI in a subset of patients (n = 10). In addition, the interpretability and quality of these maps were compared across different scan lengths using mixed models. Results: Shortened BOLD delay scans showed a small volumetric bias (ranging from 0.05 to 5.3 mL; between a 0.13% volumetric underestimation and a 7.7% overestimation relative to the mean of the volumes, depending on scan length) compared to the full scan. Decreased scan length was associated with decreased spatial overlap with both the BOLD delay lesions derived from the full scans and with Tmax lesions. Only the two shortest scan lengths (68 and 136 s) were associated with substantially decreased interpretability, decreased structure clarity, and increased noisiness of BOLD delay maps. Conclusions: BOLD delay maps derived from resting-state fMRI scans lasting 272 and 204 s provide sufficient diagnostic quality and adequate assessment of perfusion lesion volumes. Such shortened scans may be helpful in situations where quick clinical decisions need to be made.
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Affiliation(s)
| | - Kersten Villringer
- Center for Stroke Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ivana Galinovic
- Center for Stroke Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Evgeniya Kirilina
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Center for Cognitive Neuroscience Berlin, Free University, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Arno Villringer
- Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Ahmed A Khalil
- Center for Stroke Research, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Lv Y, Han X, Song Y, Han Y, Zhou C, Zhou D, Zhang F, Xue Q, Liu J, Zhao L, Zhang C, Li L, Wang J. Toward neuroimaging-based network biomarkers for transient ischemic attack. Hum Brain Mapp 2019; 40:3347-3361. [PMID: 31004388 DOI: 10.1002/hbm.24602] [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] [Received: 02/11/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 12/23/2022] Open
Abstract
Stroke is associated with topological disruptions of large-scale functional brain networks. However, whether these disruptions occur in transient ischemic attack (TIA), an important risk factor for stroke, remains largely unknown. Combining multimodal MRI techniques, we systematically examined TIA-related topological alterations of functional brain networks, and tested their reproducibility, structural, and metabolic substrates, associations with clinical risk factors and abilities as diagnostic and prognostic biomarkers. We found that functional networks in patients with TIA exhibited decreased whole-brain network efficiency, reduced nodal centralities in the bilateral insula and basal ganglia, and impaired connectivity of inter-hemispheric communication. These alterations remained largely unchanged when using different brain parcellation schemes or correcting for micro head motion or for regional gray matter volume, cerebral blood flow or hemodynamic lag of BOLD signals in the patients. Moreover, some alterations correlated with the levels of high-density lipoprotein cholesterol (an index related to ischemic attacks via modulation of atherosclerosis) in the patients, distinguished the patients from healthy individuals, and predicted future ischemic attacks in the patients. Collectively, these findings highlight the emergence of characteristic network dysfunctions in TIA, which may aid in elucidating pathological mechanisms and establishing diagnostic and prognostic biomarkers for the disease.
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Affiliation(s)
- Yating Lv
- Institutes of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China.,Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Xiujie Han
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Yulin Song
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Yu Han
- Department of Neurology, the First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China
| | - Chengshu Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Dan Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Fuding Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Qiming Xue
- Department of Image, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Jinling Liu
- Department of Ultrasonics, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Lijuan Zhao
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Cairong Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Lingyu Li
- Institutes of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China.,Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Jinhui Wang
- Institute for Brain Research and Rehabilitation, Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
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