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Zhang W, Yin Y, Zhang Y, Yang F, Shi W, Chen D, Song C, Shi H, Zhao X, Shi J. Influence of cerebrovascular reactivity on outcome of the patients with ≥50% symptomatic unilateral middle cerebral artery stenosis. Int J Neurosci 2017; 128:42-47. [PMID: 28724339 DOI: 10.1080/00207454.2017.1357552] [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]
Affiliation(s)
- Weiqing Zhang
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Yanwei Yin
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Yingqian Zhang
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Fen Yang
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Wenqian Shi
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Dawei Chen
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Chen Song
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Huiping Shi
- Department of CT and MRI, Chinese PLA Air Force General Hospital, Beijing, China
| | - Xuanzhu Zhao
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
| | - Jin Shi
- Department of Neurology, Chinese PLA Air Force General Hospital, Beijing, China
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Yeh BM, FitzGerald PF, Edic PM, Lambert JW, Colborn RE, Marino ME, Evans PM, Roberts JC, Wang ZJ, Wong MJ, Bonitatibus PJ. Opportunities for new CT contrast agents to maximize the diagnostic potential of emerging spectral CT technologies. Adv Drug Deliv Rev 2017; 113:201-222. [PMID: 27620496 PMCID: PMC5344792 DOI: 10.1016/j.addr.2016.09.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/15/2022]
Abstract
The introduction of spectral CT imaging in the form of fast clinical dual-energy CT enabled contrast material to be differentiated from other radiodense materials, improved lesion detection in contrast-enhanced scans, and changed the way that existing iodine and barium contrast materials are used in clinical practice. More profoundly, spectral CT can differentiate between individual contrast materials that have different reporter elements such that high-resolution CT imaging of multiple contrast agents can be obtained in a single pass of the CT scanner. These spectral CT capabilities would be even more impactful with the development of contrast materials designed to complement the existing clinical iodine- and barium-based agents. New biocompatible high-atomic number contrast materials with different biodistribution and X-ray attenuation properties than existing agents will expand the diagnostic power of spectral CT imaging without penalties in radiation dose or scan time.
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Affiliation(s)
- Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States.
| | - Paul F FitzGerald
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Peter M Edic
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Jack W Lambert
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Robert E Colborn
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Michael E Marino
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Paul M Evans
- GE Healthcare Life Sciences, The Grove Centre, White Lion Road, Amersham, Buckinghamshire HP7 9LL, United Kingdom
| | - Jeannette C Roberts
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Margaret J Wong
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Peter J Bonitatibus
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
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Yang F, Shi W, Shi J, Zhang Y, Yin Y, Shi H, Chen D. Assessment of cerebrovascular reserve in unilateral middle cerebral artery stenosis using perfusion CT and CO 2 inhalation tests. Int J Neurosci 2016; 127:320-325. [PMID: 27619639 DOI: 10.1080/00207454.2016.1235044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose/Aim of the study: Cerebrovascular reactivity (CVR) is an important marker for assessing cerebrovascular disease. This study assessed the CVR by perfusion computed tomography (CT) and CO2 inhalation tests in patients with unilateral middle cerebral artery (MCA) stenosis disease. MATERIALS AND METHODS Thirty-one patients with unilateral MCA stenosis disease diagnosed by digital subtraction angiography were studied. Patients were divided into two groups according to the degree of stenosis: severe and moderate. The regional cerebral blood flow (CBF) before and after CO2 inhalation was determined by perfusion CT. Regional CVR values were obtained by the following formula: increase (%) = (post-CBF) - (pre-CBF)/(pre-CBF) × 100%. RESULTS No significant differences in the mean CBF in the MCA stenosis region were found between the affected and contralateral sides before the CO2 inhalation test; after the test, CBF was more significantly decreased on the affected side than on the contralateral side. The changes in CBF on the affected side were categorized into three types: increased CBF (17 cases), decreased CBF (12 cases) and no change in CBF (2 cases). The rate of CVR impairment among severe stenosis patients (13/19) was higher than that among moderate stenosis patients (3/12). CVR was significantly correlated with the degree of stenosis (r = 0.423, P = 0.018). CONCLUSION CVR impairment was found in approximately half of patients with unilateral MCA stenosis. Along with an increase in the degree of stenosis, patients with unilateral MCA stenosis were more likely to exhibit CVR impairment. It is important to assess the CVR in patients with unilateral MCA stenosis, especially those with severe stenosis.
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Affiliation(s)
- Fen Yang
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Wenqian Shi
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Jin Shi
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Yingqian Zhang
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Yanwei Yin
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Huiping Shi
- b Department of CT and MRI , Air Force General Hospital of the Chinese PLA , Beijing , China
| | - Dawei Chen
- a Department of Neurology , Air Force General Hospital of the Chinese PLA , Beijing , China
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Bivard A, Cheng X, Lin LT, Levi C, Spratt N, Kleinig T, O'Brien B, Butcher K, Lou M, Zhang JF, Sylaja PN, Cao WJ, Jannes J, Dong Q, Parsons M. Global White Matter Hypoperfusion on CT Predicts Larger Infarcts and Hemorrhagic Transformation after Acute Ischemia. CNS Neurosci Ther 2016; 22:238-43. [PMID: 26775830 DOI: 10.1111/cns.12491] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/03/2015] [Accepted: 11/09/2015] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Presence of white matter hyperintensity (WMH) on MRI is a marker of cerebral small vessel disease and is associated with increased small vessel stroke and increased risk of hemorrhagic transformation (HT) after thrombolysis. AIM We sought to determine whether white matter hypoperfusion (WMHP) on perfusion CT (CTP) was related to WMH, and if WMHP predisposed to acute lacunar stroke subtype and HT after thrombolysis. METHODS Acute ischemic stroke patients within 12 h of symptom onset at 2 centers were prospectively recruited between 2011 and 2013 for the International Stroke Perfusion Imaging Registry. Participants routinely underwent baseline CT imaging, including CTP, and follow-up imaging with MRI at 24 h. RESULTS Of 229 ischemic stroke patients, 108 were Caucasians and 121 Chinese. In the contralateral white matter, patients with acute lacunar stroke had lower cerebral blood flow (CBF) and cerebral blood volume (CBV), compared to those with other stroke subtypes (P = 0.041). There were 46 patients with HT, and WMHP was associated with increased risk of HT (R(2) = 0.417, P = 0.002). Compared to previously reported predictors of HT, WMHP performed better than infarct core volume (R(2) = 0.341, P = 0.034), very low CBV volume (R(2) = 0.249, P = 0.026), and severely delayed perfusion (Tmax>14 second R(2) = 0.372, P = 0.011). Patients with WMHP also had larger acute infarcts and increased infarct growth compared to those without WMHP (mean 28 mL vs. 13 mL P < 0.001). CONCLUSION White matter hypoperfusion remote to the acutely ischemic region on CTP is a marker of small vessel disease and was associated with increased HT, larger acute infarct cores, and greater infarct growth.
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Affiliation(s)
- Andrew Bivard
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Xin Cheng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Long-Ting Lin
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Christopher Levi
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Neil Spratt
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Tim Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, NSW, Australia
| | - Billy O'Brien
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - Kenneth Butcher
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jing-Fen Zhang
- Department of Neurology, Baotou Central Hospital, Baotou, China
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Wen-Jie Cao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jim Jannes
- Department of Neurology, The Queen Elizabeth Hospital, Adelaide, NSW, Australia
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mark Parsons
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
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