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Fragata I, Alves M, Papoila AL, Diogo M, Canhão P, Canto-Moreira N. Temporal evolution of cerebral computed tomography perfusion after acute subarachnoid hemorrhage: a prospective cohort study. Acta Radiol 2020; 61:376-385. [PMID: 31265319 DOI: 10.1177/0284185119858701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Changes in cerebral perfusion occur in subarachnoid hemorrhage that possibly relate to clinical presentation and complications. Purpose To evaluate changes in computed tomography perfusion (CTP) parameters between the acute and subacute stage of subarachnoid hemorrhage. To analyze correlation of these parameters to SAH severity and delayed cerebral ischemia. Material and Methods Cerebral CT perfusion was assessed in a prospective cohort of 44 patients with acute subarachnoid hemorrhage at < 72 h (CTP1) and 8–10 days (CTP2), using the mean of all regions of interest. Regions of interest were located at arterial territories of the anterior, middle, and posterior cerebral artery and basal ganglia and midpons cerebellar hemispheres. Linear regression models (univariable and multivariable) were used to explore the association between changes in perfusion parameters (absolute and relative differences) and relevant clinical data. Results Worse perfusion parameters on the first 72 h were correlated with poor admission clinical scores: cerebral blood flow positively correlated with Glasgow Coma Scale (rS = 0.398, P = 0.008), and negatively correlated with Hunt & Hess scale (rS = −0.348, P = 0.020) and World Federation of Neurosurgeons scale (rS = −0.384, P = 0.010). Cerebral blood volume positively correlated with Glasgow Coma Scale (rS = 0.332, P = 0.028) and negatively correlated with World Federation of Neurosurgeons scale (rS = −0.353, P = 0.019). Mean transit time negatively correlated with Glasgow Coma Scale (rS = −0.415, P = 0.005) and positively correlated with Hunt & Hess scale (rS = 0.471, P = 0.001) and World Federation of Neurosurgeons scale (rS = 0.386, P = 0.010) scores. There were no differences between absolute CTP1/CTP2 parameters. Patients with delayed cerebral ischemia had ΔTmax mean decrease of 2.08 s (95% CI = −4.04–−0.12; P = 0.038). Conclusion Early cerebral hypoperfusion correlates with poor clinical grade at admission in subarachnoid hemorrhage and with higher amounts of blood. Tmax was decreased at 8–10 days, in patients with delayed cerebral ischemia, which may favor the application value of Tmax in signaling delayed cerebral ischemia.
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Affiliation(s)
- Isabel Fragata
- Neuroradiology Department Hospital São José, Centro Hospitalar Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Marta Alves
- Epidemiology and Statistics Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Ana Luísa Papoila
- Epidemiology and Statistics Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Mariana Diogo
- Neuroradiology Department Hospital São José, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Patrícia Canhão
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHLN, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Portugal
| | - Nuno Canto-Moreira
- Department of Neuroradiology, Karolinska University Hospital; Department of Pediatric Radiology, Astrid Lindgren Children's Hospital Stockholm, Sweden
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Magnetic Resonance Imaging in Aneurysmal Subarachnoid Hemorrhage: Current Evidence and Future Directions. Neurocrit Care 2019; 29:241-252. [PMID: 29633155 DOI: 10.1007/s12028-018-0534-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is associated with an unacceptably high mortality and chronic disability in survivors, underscoring a need to validate new approaches for treatment and prognosis. The use of advanced imaging, magnetic resonance imaging (MRI) in particular, could help address this gap given its versatile capacity to quantitatively evaluate and map changes in brain anatomy, physiology and functional activation. Yet there is uncertainty about the real value of brain MRI in the clinical setting of aSAH. METHODS In this review, we discuss current and emerging MRI research in aSAH. PubMed was searched from inception to June 2017, and additional studies were then chosen on the basis of relevance to the topics covered in this review. RESULTS Available studies suggest that brain MRI is a feasible, safe, and valuable testing modality. MRI detects brain abnormalities associated with neurologic examination, outcomes, and aneurysm treatment and thus has the potential to increase knowledge of aSAH pathophysiology as well as to guide management and outcome prediction. Newer pulse sequences have the potential to reveal structural and physiological changes that could also improve management of aSAH. CONCLUSION Research is needed to confirm the value of MRI-based biomarkers in clinical practice and as endpoints in clinical trials, with the goal of improving outcome for patients with aSAH.
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Nelson S, Edlow BL, Wu O, Rosenthal ES, Westover MB, Rordorf G. Default Mode Network Perfusion in Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2017; 25:237-42. [PMID: 26800697 DOI: 10.1007/s12028-016-0244-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The etiology of altered consciousness in patients with high-grade aneurysmal subarachnoid hemorrhage (SAH) is not thoroughly understood. We hypothesized that decreased cerebral blood flow (CBF) in brain regions critical to consciousness may contribute. METHODS We retrospectively evaluated arterial-spin labeled (ASL) perfusion magnetic resonance imaging (MRI) measurements of CBF in 12 patients with aneurysmal SAH admitted to our neurocritical care unit. CBF values were analyzed within gray matter nodes of the default mode network (DMN), whose functional integrity has been shown to be necessary for consciousness. DMN nodes studied were the bilateral medial prefrontal cortices, thalami, and posterior cingulate cortices. Correlations between nodal CBF and admission Glasgow Coma Scale (GCS) score, admission Hunt and Hess (HH) class, and GCS score at the time of MRI (MRI GCS) were tested. RESULTS Spearman's correlation coefficients were not significant when comparing admission GCS, admission HH, and MRI GCS versus nodal CBF (p > 0.05). However, inter-rater reliability for nodal CBF was high (r = 0.71, p = 0.01). CONCLUSIONS In this retrospective pilot study, we did not identify significant correlations between CBF and admission GCS, admission HH class, or MRI GCS for any DMN node. Potential explanations for these findings include small sample size, ASL data acquisition at variable times after SAH onset, and CBF analysis in DMN nodes that may not reflect the functional integrity of the entire network. High inter-rater reliability suggests ASL measurements of CBF within DMN nodes are reproducible. Larger prospective studies are needed to elucidate whether decreased cerebral perfusion contributes to altered consciousness in SAH.
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Affiliation(s)
- Sarah Nelson
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
| | - Brian L Edlow
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Eric S Rosenthal
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
| | - Guy Rordorf
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
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Chen Z, Zhang X, Yuan C, Zhao X, van Osch MJ. Measuring the labeling efficiency of pseudocontinuous arterial spin labeling. Magn Reson Med 2016; 77:1841-1852. [DOI: 10.1002/mrm.26266] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Zhensen Chen
- Center for Biomedical Imaging Research, Department of Biomedical EngineeringTsinghua UniversityBeijing China
| | - Xingxing Zhang
- C.J. Gorter Center for High Field MRI, Department of RadiologyLeiden University Medical CenterLeiden Netherlands
- Leiden Institute for Brain and CognitionLeiden Netherlands
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical EngineeringTsinghua UniversityBeijing China
- Department of RadiologyUniversity of WashingtonSeattle Washington USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical EngineeringTsinghua UniversityBeijing China
| | - Matthias J.P. van Osch
- C.J. Gorter Center for High Field MRI, Department of RadiologyLeiden University Medical CenterLeiden Netherlands
- Leiden Institute for Brain and CognitionLeiden Netherlands
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Sun Y, Shen Q, Watts LT, Muir ER, Huang S, Yang GY, Suarez JI, Duong TQ. Multimodal MRI characterization of experimental subarachnoid hemorrhage. Neuroscience 2016; 316:53-62. [PMID: 26708744 PMCID: PMC4724533 DOI: 10.1016/j.neuroscience.2015.12.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 01/01/2023]
Abstract
Subarachnoid hemorrhage (SAH) is associated with significant morbidity and mortality. We implemented an in-scanner rat model of mild SAH in which blood or vehicle was injected into the cistern magna, and applied multimodal MRI to study the brain prior to, immediately after (5min to 4h), and upto 7days after SAH. Vehicle injection did not change arterial lumen diameter, apparent diffusion coefficient (ADC), T2, venous signal, vascular reactivity to hypercapnia, or foot-fault scores, but mildly reduce cerebral blood flow (CBF) up to 4h, and open-field activity up to 7days post injection. By contrast, blood injection caused: (i) vasospasm 30min after SAH but not thereafter, (ii) venous abnormalities at 3h and 2days, delayed relative to vasospasm, (iii) reduced basal CBF and to hypercapnia 1-4h but not thereafter, (iv) reduced ADC immediately after SAH but no ADC and T2 changes on days 2 and 7, and (v) reduced open-field activities in both SAH and vehicle animals, but no significant differences in open-field activities and foot-fault tests between groups. Mild SAH exhibited transient and mild hemodynamic disturbances and diffusion changes, but did not show apparent ischemic brain injury nor functional deficits.
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Affiliation(s)
- Y Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Research Imaging Institute, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Q Shen
- Research Imaging Institute, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - L T Watts
- Research Imaging Institute, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; Department of Cellular and Structural Biology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; Department of Neurology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - E R Muir
- Research Imaging Institute, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - S Huang
- Research Imaging Institute, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - G-Y Yang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Neuroscience and Neuroengineering Research Center, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China
| | - J I Suarez
- Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Baylor College of Medicine, Baylor St Luke's Medical Center, Houston, TX 77027, USA
| | - T Q Duong
- Research Imaging Institute, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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Segerdahl AR, Mezue M, Okell TW, Farrar JT, Tracey I. The dorsal posterior insula is not an island in pain but subserves a fundamental role - Response to: "Evidence against pain specificity in the dorsal posterior insula" by Davis et al. F1000Res 2015; 4:1207. [PMID: 26834997 PMCID: PMC4706052 DOI: 10.12688/f1000research.7287.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/24/2022] Open
Abstract
An interesting and valuable discussion has arisen from our recent article (Segerdahl, Mezue
et al., 2015) and we are pleased here to have the opportunity to expand on the various points we made. Equally important, we wish to correct several important misunderstandings that were made by Davis and colleagues that possibly contributed to their concerns about power when assessing our paper (e.g. actual subject numbers used in control experiment and the reality of the signal-to-noise and sampling of the multi-TI technique we employed). Here, we clarify the methods and analysis plus discuss how we interpret the data in the Brief Communication noting that the extrapolation and inferences made by Davis and colleagues are not consistent with our report or necessarily, in our opinion, what the data supports. We trust this reassures the
F1000Research readership regarding the robustness of our results and what we actually concluded in the paper regarding their possible meaning. We are pleased, though, that Davis and colleagues have used our article to raise an important discussion around pain perception, and here offer some further insights towards that broader discussion.
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Affiliation(s)
- Andrew R Segerdahl
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK; Nuffield Division of Anesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK
| | - Melvin Mezue
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK; Nuffield Division of Anesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK
| | - Thomas W Okell
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK
| | - John T Farrar
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104-6291, USA
| | - Irene Tracey
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK; Nuffield Division of Anesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX1 4BH, UK
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