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EL-Adalany MA, Bilal MMZ, Rihan YAM, EL-Metwally D. Contrast enhanced FLAIR versus contrast enhanced T1W images in evaluation of intraparenchymal brain lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00817-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients with suspected brain lesions are usually evaluated by means of intravenous contrast materials. These lesions may demonstrate enhancement through different mechanisms. At most institutions, CE-T1WI is the preferred sequence. FLAIR is a sort of inversion recovery pulse sequence with a long TR, TE and T1 and hence effectually nulls signals from CSF. The long T1 causes mild T effect and this result in lesion enhancement on post-contrast study. Therefore, lesions demonstrating enhancement on CE-T1WI will also demonstrate enhancement on CE-FLAIR images. The purpose of this work was to assess the role of CE-FLAIR versus CE-T1WI in evaluation of different intraparenchymal brain lesions.
Results
Comparing CE-T1WI to CE-FLAIR in various brain pathologies, both observers found higher sensitivity and specificity for lesion to background contrast ratio on CE-FLAIR comparing to CE-T1WI. Observer 1 found that lesion to background contrast ratio on CE-FLAIR had sensitivity of 71.4%, specificity of 66.7% and AUC of 0.661 versus 63.3% sensitivity, 58.3% specificity and 0.634 AUC for CE-T1WI. Observer 2 found that lesion to background contrast ratio on CE-FLAIR had sensitivity of 77.6%, specificity of 66.7% and AUC of 0.719 versus 61.2% sensitivity, 50% specificity and 0.628 AUC for CE-T1WI.
Conclusion
On comparing CE-FLAIR to CE-T1WI, CE-FLAIR display better lesion detection and enhancement also better soft tissue contrast resolution.
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KARATAĞ O, KILINÇ A, GÜLTAÇ B, ÖZTOPRAK İ. Pseudosubarachnoid Hemorrhage on MRI: A potential pitfall. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2022. [DOI: 10.33706/jemcr.1160208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Fluid attenuated inversion recovery (FLAIR) is one of the most effective magnetic resonance imaging (MRI) sequences in the diagnosis of subarachnoid hemorrhage (SAH). However, sometimes false positive or false negative results can occur. One of the reasons that can lead to erroneous interpretation is artifacts. Especially when metallic artifact occurs, hyperintensity may be observed in the subarachnoid space, similar to SAH. Although FLAIR hyperintensities in the sulci can be detected in many serious diseases, they are not always pathological. Artifact related hyperintensities, especially in cases with severe headache, may be mistakenly evaluated as SAH by a clinician or radiologist who is not well-experienced in MRI. However, it is extremely important to recognise these artifact related hyperintensities, to make a correct diagnosis and to prevent unnecessary interventions. In order to achieve this, the evaluation of all radiological images, especially SWI and GRE, is critical. Both radiologists and clinicians evaluating neuroradiological examinations should be knowledgeable about this subject and show maximum attention.
In this report, we present the radiological images of 4 cases of pseudosubarachnoid hemorrhage, one of which was caused by conductive EEG gel and the other three due to braces artifacts, who were admitted to the hospital with headache.
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Affiliation(s)
- Ozan KARATAĞ
- CANAKKALE ONSEKIZ MART UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF RADIOLOGY
| | - Ali KILINÇ
- CANAKKALE ONSEKIZ MART UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF RADIOLOGY
| | - Bilge GÜLTAÇ
- CANAKKALE ONSEKIZ MART UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF RADIOLOGY
| | - İbrahim ÖZTOPRAK
- CANAKKALE ONSEKIZ MART UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF RADIOLOGY
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Zeng L, Chen J, Liao H, Wang Q, Xie M, Wu W. Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Cerebrovascular Disease: A Review for Radiologists and Clinicians. Front Aging Neurosci 2022; 13:790626. [PMID: 34975459 PMCID: PMC8716740 DOI: 10.3389/fnagi.2021.790626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022] Open
Abstract
Neuroradiological methods play important roles in neurology, especially in cerebrovascular diseases. Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is frequently encountered in patients with acute ischemic stroke and significant intracranial arterial stenosis or occlusion. The mechanisms underlying this phenomenon and the clinical implications of FVH have been a matter of debate. FVH is associated with large-vessel occlusion or severe stenosis, as well as impaired hemodynamics. Possible explanations suggested for its appearance include stationary blood and slow antegrade or retrograde filling of the leptomeningeal collateral circulation. However, the prognostic value of the presence of FVH has been controversial. FVH can also be observed in patients with transient ischemic attack (TIA), which may have different pathomechanisms. Its presence can help clinicians to identify patients who have a higher risk of stroke after TIA. In this review article, we aim to describe the mechanism and influencing factors of FVH, as well as its clinical significance in patients with cerebrovascular disease.
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Affiliation(s)
- Lichuan Zeng
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jinxin Chen
- Department of Geriatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huaqiang Liao
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qu Wang
- Department of Ultrasound, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingguo Xie
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenbin Wu
- Department of Geriatrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Zhang JF, Lim HF, Chappell FM, Clancy U, Wiseman S, Valdés-Hernández MC, Garcia DJ, Bastin ME, Doubal FN, Hewins W, Cox SR, Maniega SM, Thrippleton M, Stringer M, Jardine C, McIntyre D, Barclay G, Hamilton I, Kesseler L, Murphy M, Perri CD, Wu YC, Wardlaw JM. Relationship between inferior frontal sulcal hyperintensities on brain MRI, ageing and cerebral small vessel disease. Neurobiol Aging 2021; 106:130-138. [PMID: 34274698 DOI: 10.1016/j.neurobiolaging.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
Raised signal in cerebrospinal fluid (CSF) on fluid-attenuated inversion recovery (FLAIR) may indicate raised CSF protein or debris and is seen in inferior frontal sulci on routine MRI. To explore its clinical relevance, we assessed the association of inferior frontal sulcal hyperintensities (IFSH) on FLAIR with demographics, risk factors, and small vessel disease markers in three cohorts (healthy volunteers, n=44; mild stroke patients, n=105; older community-dwelling participants from Lothian birth cohort 1936, n=101). We collected detailed clinical data, scanned all subjects on the same 3T MRI scanner and 3-dimensional FLAIR sequence and developed a scale to rate IFSH. In adjusted analyses, the IFSH score increased with age (per 10-year increase; OR 1.69; 95% CI, 1.42-2.02), and perivascular spaces score in centrum semiovale in stroke patients (OR 1.73; 95% CI, 1.13-2.69). Since glymphatic CSF clearance declines with age and drains partially via the cribriform plate to the nasal lymphatics, IFSH on 3T MRI may be a non-invasive biomarker of altered CSF clearance and justifies further research in larger, more diverse samples.
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Affiliation(s)
- Jun-Fang Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Francesca M Chappell
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Una Clancy
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Stewart Wiseman
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Maria C Valdés-Hernández
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Daniela Jaime Garcia
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Will Hewins
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Susana Muñoz Maniega
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Michael Thrippleton
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Michael Stringer
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Donna McIntyre
- Edinburgh Imaging (RIE), University of Edinburgh, Edinburgh, UK
| | - Gayle Barclay
- Edinburgh Imaging (RIE), University of Edinburgh, Edinburgh, UK
| | - Iona Hamilton
- Edinburgh Imaging (RIE), University of Edinburgh, Edinburgh, UK
| | - Lucy Kesseler
- Edinburgh Imaging (RIE), University of Edinburgh, Edinburgh, UK
| | | | - Carol Di Perri
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Joanna M Wardlaw
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.
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Xu J, Chen X, Lin M. Significance of Magnetic Resonance Imaging (MRI) T2 Hyperintense Endo-Vessels Sign in Progressive Posterior Circulation Infarction. Med Sci Monit 2018; 24:3873-3881. [PMID: 29882523 PMCID: PMC6022782 DOI: 10.12659/msm.908300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background MRI FLAIR hyperintense vessels sign (FHVs) is a special imaging marker that plays a key role in acute infarction imaging and diagnosis. However, FHVs have not been studied in the context of progressive posterior circulation infarction (PPCI), and little is known about the association of hyperintense endo-vessels sign (HEVs) on transverse section MRI with infarction. Thus, our objective here was to investigate the clinical significance of transverse MRI T2 HEVs in patients with PPCI. Material/Methods In this retrospective, case-control study, we enrolled 100 consecutive posterior circulation infarction patients. All the patients underwent head MRI examinations on the onset day and the seventh day after admission. Neurologic deficits of the patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) scores upon admission and after 7 days. Infarction volume on DWI was compared. Results HEVs were detected in 25 of 37 patients in the PPCI group (67.6%) and 22 of 63 patients in the NPPCI group (34.9%). Logistic regression analysis showed that the proportion of HEVs in the PPCI group was higher than in the NPPCI group (P=0.007). Among all the patients, HEVs were detected in 15 of 18 patients (83.3%) with occlusion of the vertebral artery or basilar artery, and 17 of 23 (73.9%) showed severe stenosis. The proportion of vertebrobasilar artery occlusions in the PPCI group was higher than in the NPPCI group (P<0.05). MRI DWI showed that 20 patients had cerebellum infarction among 23 vertebral artery HEVs patients, and 14 patients had brainstem infarction among 15 basilar artery HEVs patients. All of the 9 vertebral and basilar artery HEVs patients had brainstem infarction. The increase in NIHSS scores from baseline to 7 days was significantly greater in patients with HEVs than in patients without HEVs in the PPCI group (P=0.002). The expansion of the infarction size from baseline to 7 days was significantly larger in patients with HEVs than in patients without HEVs in the PPCI group (P=0.037). Conclusions HEVs are frequently detected in patients with vertebrobasilar artery territory infarction, and they can be considered as a special imaging marker for vertebral artery and basilar artery occlusion and severe stenosis. HEVs can indicate whether or not posterior circulation infarction progresses and they may be an independent risk factor of PPCI.
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Affiliation(s)
- Jialiang Xu
- Seventh Department of Neurology, Liaoning Province People's Hospital, Shenyang, Liaoning, China (mainland)
| | - Xiaohong Chen
- Seventh Department of Neurology, Liaoning Province People's Hospital, Shenyang, Liaoning, China (mainland)
| | - Muhui Lin
- Seventh Department of Neurology, Liaoning Province People's Hospital, Shenyang, Liaoning, China (mainland)
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Wan CC, Chen DYT, Tseng YC, Yan FX, Lee KY, Chiang CH, Chen CJ. Fluid-attenuated inversion recovery vascular hyperintensities in predicting cerebral hyperperfusion after intracranial arterial stenting. Neuroradiology 2017; 59:791-796. [PMID: 28689257 DOI: 10.1007/s00234-017-1863-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE No reliable imaging sign predicting cerebral hyperperfusion after intracranial arterial stenting (IAS) had been described in the literature. This study evaluated the effect of fluid-attenuated inversion recovery vascular hyperintensities (FVHs), also called hyperintense vessel sign on T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) MR images, in predicting significant increase in cerebral blood flow (CBF) defined by arterial spin labeling (ASL) after IAS. METHODS We reviewed ASL CBF images and T2-FLAIR MR images before (D0), 1 day after (D1), and 3 days after (D3) IAS of 16 patients. T1-weighted MR images were used as cerebral maps for calculating CBF. The changes in CBF values after IAS were calculated in and compared among stenting and nonstenting vascular territories. An increase more than 50% of CBF was considered as hyperperfusion. The effect of FVHs in predicting hyperperfusion was calculated. RESULTS The D1 CBF value was significantly higher than the D0 CBF value in stenting vascular, contralateral anterior cerebral artery, contralateral middle cerebral artery, and contralateral posterior cerebral artery (PCA) territories (all P < .05). The D1 and D3 CBF values were significantly higher than the D0 CBF value in overall vascular (P < .001), overall nonstenting vascular (P < .001), and ipsilateral PCA (P < .05) territories. The rate of more than 50% increases in CBF was significantly higher in patients who exhibited asymmetric FVHs than in those who did not exhibit these findings. CONCLUSION FVHs could be a critical predictor of a significant increase in CBF after IAS.
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Affiliation(s)
- Chih-Cheng Wan
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, 110, Taiwan
| | - David Yen-Ting Chen
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, 110, Taiwan
| | - Ying-Chi Tseng
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, 110, Taiwan
| | - Feng-Xian Yan
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan
| | - Kun-Yu Lee
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, 110, Taiwan
| | - Chen-Hua Chiang
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, 110, Taiwan
| | - Chi-Jen Chen
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan. .,School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, 110, Taiwan.
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