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Lövblad KO, Bouchez L, Altrichter S, Ratib O, Machi P, Vargas MI, Sztajzel R. The role of advanced neuroimaging techniques in ischemic stroke prevention. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2019. [DOI: 10.1177/2514183x19881446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In great part due to recent advances in medical technology, ischemic cerebral stroke has become an increasingly treatable condition, which requires urgent measures and which rely on pharmacological and/or interventional measures. Due to its high prevalence, preventive measures should also be undertaken, and this is a situation where the use of advanced neuroimaging techniques could be helpful in certain underlying diseases. What is proposed here is to discuss how modern neuroimaging techniques (advanced magnetic resonance (MR) techniques and/or nuclear medicine techniques such as positron emission tomography (PET)) could help in situations that would otherwise lead to a stroke. Since both primary and secondary prevention measures are often required, we see that the techniques can be helpful in both situations. The diseases that cause stroke that can be investigated are, among others, carotid stenosis; transient ischemic attacks (TIAs) may also be followed by a major stroke if nothing is undertaken. It has been established that carotid stenosis is to be treated in the presence of a significant lesion that has neurological symptoms. The question of how to deal with these patients often arises when the relationship between the stenosis and symptoms is not significant or the symptomatology unclear. In such situations, either PET and/or fat-saturated T1 images of the carotids can help to demonstrate the embolic nature of the plaque. We have seen that carotid plaque vulnerability, which can cause embolism, can be associated with plaque inflammation (seen on PET) or plaque haemorrhage (seen on MR images). Also, while PET and MRI will demonstrate different stages of plaque vulnerability, they can both help to demonstrate vascular lesions that are at risk of causing significant ischemic events. Diffusion-weighted imaging (DWI) has shown that some TIAs may indeed be ischemic brain lesions with a transient symptomatology. The early use of DWI can thus help treat these patients more acutely. Based on this, we have seen that newer imaging techniques can provide additional knowledge about conditions that may lead to stroke and be treated. This should have a major impact on patient outcomes and ultimately on healthcare costs related to this condition.
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Affiliation(s)
- Karl-Olof Lövblad
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Laurie Bouchez
- Division of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Stephen Altrichter
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Osman Ratib
- Division of Nuclear Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Machi
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Maria Isabel Vargas
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Roman Sztajzel
- Division of Neurology, Geneva University Hospitals, Geneva, Switzerland
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Olof Lovblad K. Diagnostic and therapeutic neuroradiology of neurodegenerative diseases. J Neuroradiol 2019; 46:2. [DOI: 10.1016/j.neurad.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/30/2018] [Indexed: 11/27/2022]
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Luo S, Yang L, Luo Y. Susceptibility-weighted imaging predicts infarct size and early-stage clinical prognosis in acute ischemic stroke. Neurol Sci 2018; 39:1049-1055. [PMID: 29557515 DOI: 10.1007/s10072-018-3324-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/13/2018] [Indexed: 11/30/2022]
Abstract
Susceptibility-weighted imaging (SWI) is a non-invasive technique that can reveal venous structures and iron in the brain. This retrospective study evaluated SWI, relative to other imaging techniques, for determining cerebral infarct size and early-stage clinical prognosis in patients with acute ischemic stroke. Within 3 days after onset, 22 patients with acute ischemic stroke underwent SWI, diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), fluid-attenuated inversion recovery (FLAIR), and magnetic resonance angiography (MRA). At least 7 days after onset, the patients also underwent cranial FLAIR or computed tomography (CT). The severity of neurological damage was adjudged with NIHSS (National Institutes of Health Stroke Scale) scores. The imaged cranial lesions were evaluated according to ASPECTS (Alberta Stroke Program Early CT Score). The SWI-ASPECTS significantly correlated with mean transit time (MTT)-ASPECTS (Spearman's test, r = 0.662, P = 0.001) in evaluating ischemic penumbra and significantly correlated with the FLAIR and CT-ASPECTS (Spearman's test, r = 0.765, P < 0.001) in predicting infarct size. SWI is feasible for the early evaluation of cerebral infarct size and clinical prognosis of patients with acute cerebral infarction. SWI is a useful predictor of early infarct growth and early-stage outcome.
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Affiliation(s)
- Song Luo
- Department of Neurology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China.
| | - Lijuan Yang
- Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Yanfei Luo
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
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Neurointerventional staffing: The next frontier. J Neuroradiol 2017; 44:231-233. [DOI: 10.1016/j.neurad.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 01/31/2017] [Accepted: 03/06/2017] [Indexed: 11/20/2022]
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5
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Clinical assessment of cerebral hemodynamics in Moyamoya disease via multiple inversion time arterial spin labeling and dynamic susceptibility contrast-magnetic resonance imaging: A comparative study. J Neuroradiol 2017; 44:273-280. [DOI: 10.1016/j.neurad.2016.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/24/2016] [Accepted: 12/21/2016] [Indexed: 11/24/2022]
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Abdelgawad EA, Higazi MM, Abdelbaky AO, Abdelghany HS. Diagnostic performance of CT cerebral blood volume colour maps for evaluation of acute infarcts; comparison with diffusion-weighted MRI within 12hours of major stroke onset. J Neuroradiol 2017; 44:10-16. [DOI: 10.1016/j.neurad.2016.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 08/10/2016] [Accepted: 10/17/2016] [Indexed: 01/19/2023]
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Bouchez L, Sztajzel R, Vargas MI, Machi P, Kulcsar Z, Poletti PA, Pereira VM, Lövblad KO. CT imaging selection in acute stroke. Eur J Radiol 2016; 96:153-161. [PMID: 28277288 DOI: 10.1016/j.ejrad.2016.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/21/2016] [Accepted: 10/23/2016] [Indexed: 11/27/2022]
Abstract
Acute stroke has become an increasingly treatable cause of acute neurological deficits. Indeed, over the last two decades, the introduction of first thrombolysis, and now thrombectomy has improved patient outcomes and extended the therapeutic window. Computed tomography has been established as the most simple and readily available technique for the diagnosis and management of patients with acute stroke. Indeed, CT allows easy confirmation or exclusion of acute hemorrhage on the one hand, and on the other hand the early signs are quite reliable in the detection of ischemia. In the early phase the clot can be seen as well as exchanges related to early changes in water concentration in ischemia and the surrounding penumbra. Additional techniques such as angio-CT show the location of the clot and perfusion techniques reveal local hemodynamics as well as potential tissue viability. Newer techniques such as double energy CT and late phase CT should provide information on collateral flow as well as on the presence of early hemorrhagic transformation. All these techniques should thus make available new information on tissue viability,that is indispensable in the choice of revascularization technique. Thus CT techniques allow a quick and reliable triage as well as a finer characterization of the ischemic process. The use of all these CT techniques in an optimal way should help improve patient triage and selection of the most adequate treatment with further improvements in clinical outcomes as a result.
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Affiliation(s)
- Laurie Bouchez
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Roman Sztajzel
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Maria Isabel Vargas
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Paolo Machi
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Zsolt Kulcsar
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Pierre-Alexandre Poletti
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Vitor Mendes Pereira
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland
| | - Karl-Olof Lövblad
- Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals and Medical School, 1211, Geneva, Switzerland.
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Bouchez L, Lovblad KO, Kulcsar Z. Pretherapeutic characterization of the clot in acute stroke. J Neuroradiol 2016; 43:163-6. [DOI: 10.1016/j.neurad.2016.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
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Radiation dose reduction in perfusion CT imaging of the brain: A review of the literature. J Neuroradiol 2016; 43:1-5. [DOI: 10.1016/j.neurad.2015.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/04/2015] [Accepted: 06/10/2015] [Indexed: 11/30/2022]
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Emeriau S, Benaïssa A, Toubas O, Pombourcq F, Pierot L. Can MRI quantification help evaluate stroke age? J Neuroradiol 2016; 43:155-62. [PMID: 26783145 DOI: 10.1016/j.neurad.2015.11.002] [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] [Received: 11/04/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) fluid-attenuated inversion recovery (FLAIR) mismatch has a proven ability to estimate stroke-to-magnetic resonance imaging (MRI) delay. We evaluated the possibility of enhancing this estimation by quantifying MRI (DWI and FLAIR) signals, and compared this approach to the visual evaluation of DWI-FLAIR mismatch. MATERIALS AND METHODS This retrospective study included 194 patients presenting an ischemic stroke in the middle cerebral artery territory that had been explored with 3T MRI within 12h. According to the study design, written informed consent was waived and patient information was anonymized and de-identified prior to analysis. DWI-FLAIR mismatch was visually estimated by two radiologists and a quantification of MRI signals based on a manual segmentation of stroke lesion volume was performed. Using their receiver operating curve and area under the curve (AUC), we identified the variables of MRI quantification that were predictive of stroke-to-MRI delay, then compared their performance against visual classification. RESULTS The quantitative variables identified as predictive of stroke-to-MRI delay were: 1st quartile, 3rd quartile and median values of B0; 1st quartile, 3rd quartile, median and relative values of B1000; 1st quartile and relative values of the apparent diffusion coefficient. FLAIR was not found to be predictive. The AUC values of these variables ranged between 0618±0.053 and 0.683±0.048. The relative value of B1000 appeared to be the best predictive quantitative variable, with predictive values comparable to visual classification. CONCLUSIONS The quantification of MRI signal may be a helpful tool for stroke dating but cannot outperform the visual estimation of stroke lesion age.
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Affiliation(s)
- Samuel Emeriau
- CHU de Reims, Reims University, Hôpital Maison-Blanche, Department of Neuroradiology, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - Azzedine Benaïssa
- CHU de Reims, Reims University, Hôpital Maison-Blanche, Department of Neuroradiology, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Olivier Toubas
- CHU de Reims, Reims University, Hôpital Maison-Blanche, Department of Neuroradiology, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Francis Pombourcq
- CHU de Reims, Reims University, Hôpital Maison-Blanche, Department of Neuroradiology, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Laurent Pierot
- CHU de Reims, Reims University, Hôpital Maison-Blanche, Department of Neuroradiology, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Ono S, Niwa T, Yanagimachi N, Yamashita T, Okazaki T, Nomura T, Hashimoto J, Imai Y. Improved image quality of helical computed tomography of the head in children by iterative reconstruction. J Neuroradiol 2015; 43:31-6. [PMID: 26519982 DOI: 10.1016/j.neurad.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Iterative reconstruction (IR) offers noise reduction and improved image quality of computed tomography (CT). Our aim was to assess the imaging quality of non-contrast helical CT of the head in children using IR. MATERIALS AND METHODS This study recruited 78 consecutive children aged ≤5 years (range: from 3 months to 5 years; mean: 1.7 years) who underwent an emergent non-enhanced helical CT of the head with no abnormal findings. The acquired data were reconstructed using filtered back projection (FBP) and sinogram-affirmed IR (SAFIRE) with strength levels of 2 (IR2) and 4 (IR4). The imaging quality of FBP, IR2 and IR4 was scored by two experienced neuroradiologists in terms of the contrast between the gray-white matter junction and artifacts from the skull at the level of the semioval center, basal ganglia and fourth ventricle. FBP, IR2 and IR4 scores were compared at each slice level. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated for FBP, IR2 and IR4 and were compared among the three reconstruction algorithms. RESULTS The score of IR2 and IR4 was significantly higher than that of FBP in terms of both the contrast between the gray-white matter junction and artifacts from the skull at each slice level (P<0.001). SNR and CNR on IR4 were the highest followed by those on IR2 and FBP (P<0.001). CONCLUSIONS IR may improve the image quality of helical CT of the head in children.
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Affiliation(s)
- Shun Ono
- Department of Radiology, Tokai University School of Medicine, 143, Shimokasuya, Isehara 259-1193, Japan
| | - Tetsu Niwa
- Department of Radiology, Tokai University School of Medicine, 143, Shimokasuya, Isehara 259-1193, Japan.
| | - Noriharu Yanagimachi
- Department of Radiology, Tokai University School of Medicine, 143, Shimokasuya, Isehara 259-1193, Japan
| | - Tomohiro Yamashita
- Department of Radiology, Tokai University School of Medicine, 143, Shimokasuya, Isehara 259-1193, Japan; Department of Radiology, Isehara Kyodo Hospital, 345, Tanaka, Isehara 259-1132, Japan
| | - Takashi Okazaki
- Department of Radiology, Tokai University School of Medicine, 143, Shimokasuya, Isehara 259-1193, Japan
| | - Takakiyo Nomura
- Department of Radiology, Tokai University School of Medicine, 143, Shimokasuya, Isehara 259-1193, Japan
| | - Jun Hashimoto
- Department of Radiology, Tokai University School of Medicine, 143, Shimokasuya, Isehara 259-1193, Japan
| | - Yutaka Imai
- Department of Radiology, Tokai University School of Medicine, 143, Shimokasuya, Isehara 259-1193, Japan
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Luo S, Yang L, Wang L. Comparison of susceptibility-weighted and perfusion-weighted magnetic resonance imaging in the detection of penumbra in acute ischemic stroke. J Neuroradiol 2015; 42:255-60. [DOI: 10.1016/j.neurad.2014.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 10/23/2022]
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Gory B, Sivan-Hoffmann R, Riva R, Labeyrie PE, Eldesouky I, Sadeh-Gonike U, Signorelli F, Turjman F. DWI lesions reversal in posterior circulation stroke after reperfusion: Two illustrative cases and review of the literature. J Neuroradiol 2015; 42:184-7. [DOI: 10.1016/j.neurad.2015.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/23/2015] [Accepted: 02/26/2015] [Indexed: 11/29/2022]
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Lövblad KO, Altrichter S, Mendes Pereira V, Vargas M, Marcos Gonzalez A, Haller S, Sztajzel R. Imaging of acute stroke: CT and/or MRI. J Neuroradiol 2015; 42:55-64. [DOI: 10.1016/j.neurad.2014.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 11/28/2022]
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Sillanpää N, Saarinen JT, Rusanen H. Computed tomography angiography source images closely reflect the integrity of collateral circulation. J Neuroradiol 2014; 42:261-8. [PMID: 25454401 DOI: 10.1016/j.neurad.2014.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/01/2014] [Accepted: 06/11/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND We studied the interplay between collateral circulation, the location of the thrombus and infarct extent based on evaluation of CT angiography source images (CTA-SI) in predicting the clinical outcome of patients treated with intravenous thrombolytic therapy (<3h) in a retrospective cohort. METHODS Anterior circulation occlusion was detected with CTA in 105 patients. The site of the occlusion was recorded, collaterals were assessed with Collateral Score (CS) and Alberta Stroke Program Early CT Score (ASPECTS) was evaluated from CTA-SI, and entered into logistic regression analysis to predict favorable clinical outcome (three-month modified Rankin Scale 0-2). RESULTS CTA-SI ASPECTS was highly correlated with CS (Spearman's rho=0.63, P=0.01). Not a single patient with good collaterals (CS 2-4) had a poor CTA-SI scan (ASPECTS 0-7). The mean CTA-SI ASPECTS score became progressively lower when the status of the collateral circulation deteriorated (ANOVA P<0.001). In univariate analysis a good CTA-SI scan at the admission predicted favorable three-month outcome (P<0.001). In a multivariate model containing CTA-SI ASPECTS, CS and the site of the occlusion along with significant clinical parameters, CTA-SI ASPECTS was rendered non-significant (P=0.43) in the presence of CS. CONCLUSIONS CTA-SI and CS convey overlapping information. CTA-SI is not a significant predictor of the clinical outcome three months after intravenous thrombolysis when the other CTA-based parameters, CS and the clot location, are considered simultaneously. CTA-SI may have a role in the assessment of the extent of irreversible ischemic changes at admission if contrast injection and image acquisition protocols are designed suitably.
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Affiliation(s)
- Niko Sillanpää
- Medical Imaging Center, Tampere University Hospital, PL 2000, 33521 Tampere, Finland.
| | - Jukka Tapio Saarinen
- Department of Neurology, University of Tampere, Tampere and Vaasa Central Hospital, Vaasa, Finland
| | - Harri Rusanen
- Department of Neurology, Oulu University Hospital, Oulu, Finland
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MR screening of candidates for thrombolysis: How to identify stroke mimics? J Neuroradiol 2014; 41:283-95. [PMID: 25451670 DOI: 10.1016/j.neurad.2014.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 05/24/2014] [Accepted: 05/26/2014] [Indexed: 11/21/2022]
Abstract
Stroke mimics account for up to a third of suspected strokes. The main causes are epileptic deficit, migraine aura, hypoglycemia, and functional disorders. Accurate recognition of stroke mimics is important for adequate identification of candidates for thrombolysis. This decreases the number of unnecessary treatments and invasive vascular investigations. Correctly identifying the cause of symptoms also avoids delaying proper care. Therefore, this pictorial review focuses on what the radiologist should know about the most common MRI patterns of stroke mimics in the first hours after onset of symptoms. The issues linked to the accurate diagnosis of stroke mimics in the management of candidates for thrombolysis will be discussed.
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Affiliation(s)
- Karl-Olof Lövblad
- Service neuro-diagnostique et neuro-interventionnel, département DISIM, hôpitaux universitaires de Genève, 1211 Geneva, Switzerland.
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Amarteifio E, Essig M, Böckler D, Attigah N, Schuster L, Demirel S. Comparison of gadofosveset (Vasovist(®)) with gadobenate dimeglumine (Multihance(®))-enhanced MR angiography for high-grade carotid artery stenosis. J Neuroradiol 2014; 42:236-44. [PMID: 24996569 DOI: 10.1016/j.neurad.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/16/2014] [Accepted: 03/19/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To prove superiority of blood pool contrast agent gadofosveset over conventional contrast agent gadobenate dimeglumine for assessment of stenotic internal carotid artery (ICA). METHODS Eleven patients with high-grade ICA stenosis (≥75%), confirmed by duplex sonography, underwent MR angiography (MRA) with gadofosveset and gadobenate dimeglumine. RESULTS Agreement in stenosis grade was reached in 7 of 10 stenotic ICAs. In two ICAs, gadobenate dimeglumine led to underestimation of stenosis grade. There was a significant difference in signal intensity (pre-/post-stenotic segments), showing higher values for gadofosveset (P<0.01; P<0.05). Impression of contrast intensity with gadofosveset was better in 8 ICAs and only in 1 ICA with gadobenate dimeglumine (P<0.05). CONCLUSION Gadofosveset-enhanced MR angiography may be superior for assessment of high-grade ICA stenosis compared with gadobenate dimeglumine MR angiography.
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Affiliation(s)
- E Amarteifio
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - M Essig
- Department of Radiology, University of Manitoba, GA216-820 Sherbrook Street, MB R3T 2N2 Manitoba, Winnipeg, Canada
| | - D Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - N Attigah
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - L Schuster
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - S Demirel
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
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Laouchedi M, Galanaud D, Delmaire C, Fernandez-Vidal S, Messé A, Mesmoudi S, Oulebsir Boumghar F, Pélégrini-Issac M, Puybasset L, Benali H, Perlbarg V. Deafferentation in thalamic and pontine areas in severe traumatic brain injury. J Neuroradiol 2014; 42:202-11. [PMID: 24997478 DOI: 10.1016/j.neurad.2014.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Severe traumatic brain injury (TBI) is characterized mainly by diffuse axonal injuries (DAI). The cortico-subcortical disconnections induced by such fiber disruption play a central role in consciousness recovery. We hypothesized that these cortico-subcortical deafferentations inferred from diffusion MRI data could differentiate between TBI patients with favorable or unfavorable (death, vegetative state, or minimally conscious state) outcome one year after injury. METHODS Cortico-subcortical fiber density maps were derived by using probabilistic tractography from diffusion tensor imaging data acquired in 24 severe TBI patients and 9 healthy controls. These maps were compared between patients and controls as well as between patients with favorable (FO) and unfavorable (UFO) 1-year outcome to identify the thalamo-cortical and ponto-thalamo-cortical pathways involved in the maintenance of consciousness. RESULTS Thalamo-cortical and ponto-thalamo-cortical fiber density was significantly lower in TBI patients than in healthy controls. Comparing FO and UFO TBI patients showed thalamo-cortical deafferentation associated with unfavorable outcome for projections from ventral posterior and intermediate thalamic nuclei to the associative frontal, sensorimotor and associative temporal cortices. Specific ponto-thalamic deafferentation in projections from the upper dorsal pons (including the reticular formation) was also associated with unfavorable outcome. CONCLUSION Fiber density of cortico-subcortical pathways as measured from diffusion MRI tractography is a relevant candidate biomarker for early prediction of one-year favorable outcome in severe TBI.
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Affiliation(s)
- M Laouchedi
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France; ParIMed Team, LRPE, USTHB, Algiers, Algeria
| | - D Galanaud
- AP-HP, Pitié-Salpêtrière Hospital, Department of Neuroradiology, Paris, France
| | - C Delmaire
- CHRU de Lille, Department of Neuroradiology, Lille, France
| | - S Fernandez-Vidal
- Inserm and UPMC université Paris 06, UMR-S 975, CNRS, UMR 7225, centre de recherche de l'institut du cerveau et de la moelle épinière, Paris, France; Institut du cerveau et de la moelle épinière, centre de neuroimagerie de recherche, Paris, France
| | - A Messé
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France
| | - S Mesmoudi
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France; MATRICE Project University Paris 1 Panthéon-Sorbonne, Paris, France
| | | | - M Pélégrini-Issac
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France
| | - L Puybasset
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France; AP-HP, Pitié-Salpêtrière Hospital, Surgical Neuro-Intensive Care Unit, Paris, France
| | - H Benali
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France
| | - V Perlbarg
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France.
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Soize S, Naggara O, Desal H, Costalat V, Ricolfi F, Pierot L. Endovascular treatment of acute ischemic stroke in France: A nationwide survey. J Neuroradiol 2014; 41:71-9. [DOI: 10.1016/j.neurad.2013.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 01/19/2023]
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Simons N, Mitchell P, Dowling R, Gonzales M, Yan B. Thrombus composition in acute ischemic stroke: a histopathological study of thrombus extracted by endovascular retrieval. J Neuroradiol 2014; 42:86-92. [PMID: 24560545 DOI: 10.1016/j.neurad.2014.01.124] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 01/20/2014] [Accepted: 01/23/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE The composition of occlusive thrombus in acute ischemic stroke may affect treatment success. Neuroimaging characteristics may correlate with thrombus composition. In this study we aimed to investigate the relationship between the hyperdense artery sign (HAS) on imaging and thrombus composition. MATERIALS AND METHODS Acute ischemic stroke patients who underwent endovascular thrombus retrieval from 2010-2012 were prospectively recruited. One blinded pathologist prepared the histology sections of retrieved thrombi whereby staining with haematoxylin and eosin and CD34 immunostain were performed. Histology sections were categorised into 4 phases of thrombus formation: red blood cell (RBC) dominant, RBC proportion equal to fibrin, fibrin dominant and organised fibrin. Computed tomography (CT) brain scans were assessed for HAS. Fisher's exact test was performed to identify an association between HAS and thrombus composition. RESULTS Forty patients were included. The mean age was 65.6±12.9 years and 67.5% were male. Atrial fibrillation was detected in 19 (47.5%) patients, diabetes mellitus in 6 (15.0%), hypercholesterolaemia in 11 (27.5%), hypertension in 20 (50.0%) and previous stroke or transient ischemic attack in 8 (20.0%) patients. Of the retrieved thrombi, 11 (27.5%) were RBC dominant, 11 (27.5%) RBC proportion was equal to fibrin, 7 (17.5%) fibrin dominant and 11 (27.5%) organised fibrin pathology. HAS was present in 29 (72.5%) patients and was significantly associated with thrombus early phase pathology (P<0.05). CONCLUSION HAS was significantly associated with early phase thrombus composition. This may enable the prediction of thrombus composition and allow for targeted selection of therapeutic modality.
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Affiliation(s)
- Natasha Simons
- Melbourne Brain Centre, Level 4, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Peter Mitchell
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Richard Dowling
- Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Michael Gonzales
- Department of Histopathology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Bernard Yan
- Melbourne Brain Centre, Level 4, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia; Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
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Bivard A, Levi C, Krishnamurthy V, Hislop-Jambrich J, Salazar P, Jackson B, Davis S, Parsons M. Defining acute ischemic stroke tissue pathophysiology with whole brain CT perfusion. J Neuroradiol 2014; 41:307-15. [PMID: 24433950 DOI: 10.1016/j.neurad.2013.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to identify and validate whole brain perfusion computed tomography (CTP) thresholds for ischemic core and salvageable penumbra in acute stroke patients and develop a probability based model to increase the accuracy of tissue pathophysiology measurements. METHODS One hundred and eighty-three patients underwent multimodal stroke CT using a 320-slice scanner within 6hours of acute stroke onset, followed by 24hour MRI that included diffusion weighted imaging (DWI) and dynamic susceptibility weighted perfusion imaging (PWI). Coregistered acute CTP and 24hour DWI was used to identify the optimum single perfusion parameter thresholds to define penumbra (in patients without reperfusion), and ischemic core (in patients with reperfusion), using a pixel based receiver operator curve analysis. Then, these results were used to develop a sigma curve fitted probability based model incorporating multiple perfusion parameter thresholds. RESULTS For single perfusion thresholds, a time to peak (TTP) of +5seconds best defined the penumbra (area under the curve, AUC 0.79 CI 0.74-0.83) while a cerebral blood flow (CBF) of < 50% best defined the acute ischemic core (AUC 0.73, CI 0.69-0.77). The probability model was more accurate at detecting the ischemic core (AUC 0.80 SD 0.75-0.83) and penumbra (0.85 SD 0.83-0.87) and was significantly closer in volume to the corresponding reference DWI (P=0.031). CONCLUSIONS Whole brain CTP can accurately identify penumbra and ischemic core using similar thresholds to previously validated 16 or 64 slice CTP. Additionally, a novel probability based model was closer to defining the ischemic core and penumbra than single thresholds.
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Affiliation(s)
- A Bivard
- Melbourne Brain Centre, Flory Neuroscience Institute, University of Melbourne, Melbourne, Australia.
| | - C Levi
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
| | - V Krishnamurthy
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
| | | | - P Salazar
- Vital Images, Minneapolis, United States
| | - B Jackson
- Vital Images, Minneapolis, United States
| | - S Davis
- Melbourne Brain Centre, Flory Neuroscience Institute, University of Melbourne, Melbourne, Australia
| | - M Parsons
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
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Lovblad KO, Mendes-Pereira V, Garibotto V, Assal F, Willi JP, Stztajzel R, Ratib O, Vargas MI. Neuroimaging of the vulnerable plaque. Curr Vasc Pharmacol 2013; 13:182-91. [PMID: 24188487 PMCID: PMC4997941 DOI: 10.2174/15701611113116660164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/30/2012] [Accepted: 09/03/2012] [Indexed: 11/22/2022]
Abstract
Plaque vulnerability due to inflammation has been shown to be a participating factor in the degenerative process in the arterial wall that contributes to stenosis and embolism. This is believed to have an important role to play also in the genesis of stroke or cerebrovascular diseases. In order to appropriately screen patients for treatment, there is an absolute need to directly or indirectly visualize both the normal carotid and the suspected plaque. This can be done with a variety of techniques ranging from ultrasound to computed tomography (CT) and magnetic resonance imaging (MRI). In addition to angiographic techniques, direct imaging of the plaque can be done either by ultrasound or by the so-called molecular imaging techniques, i.e. positron emission tomography (PET). These findings, together with other clinical and paraclinical parameters should finally guide the therapeutic choice.
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Affiliation(s)
- Karl-Olof Lovblad
- Department of Interventional and Diagnostic Neuroradiology, Geneva University Hospitals, 4 rue Gabrielle- Perret-Gentil, 1211 Geneva 14, Switzerland.
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Bennett DA. Methodology of the global and regional burden of stroke study. Neuroepidemiology 2012; 38:30-40. [PMID: 22212892 DOI: 10.1159/000334744] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 11/01/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Setting priorities for the prevention of stroke requires an empirical understanding of the pattern of disease burden and exposure to major risk factors. In this manuscript we aim to report the methodology of a systematic review of the epidemiological literature on stroke and how this information will be synthesized to produce updated estimates of the global burden of stroke. METHODS We will use multi-state models implemented in the software program DisMod III to estimate age-specific prevalence, incidence, and early case-fatality (defined as either 28-day, 30-day or 1-month case fatality) for stroke by the 21 global burden of disease (GBD) regions as well as by gender and pathological stroke type based on information obtained from a systematic review. We conducted a two-stage search strategy in order to identify studies published between 1980 and 2011 for the GBD stroke review. Eligible studies: (a) distinguished between stroke and transient ischaemic attack (TIA); (b) distinguished between 1st ever and recurrent stroke; (c) reported on age-specific rates; (d) if reported, provided survival status within 28 days, 30 days or 1 month of onset for fatal and nonfatal events; (e) specified methods for ascertaining stroke cases, and (f) described imaging modalities to determine stroke subtypes. Details of included studies were recorded on a detailed data extraction form by trained reviewers. We will gather information on demographics, natural history and clinical outcomes (e.g. Rankin scale, Glasgow Coma Scale), after stroke which will be used to facilitate the estimation of epidemiological parameters. Reporting and methodological quality was rated. Populations were coded as urban, rural, or combined and studies classified as national, subnational, healthcare system-based, or community level. Studies published in non-English languages were translated and coded centrally. DISCUSSION In international health research, there is a crucial need for accurate assessment of global health patterns. A thorough GBD reassessment of stroke will ensure that global health policy decisions are based on the most up-to-date, valid and reliable epidemiological information available.
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Affiliation(s)
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- Clinical Trials Service Unit, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK. derrick.bennett @ ctsu.ox.ac.uk
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Wintermark P, Warfield SK. New insights in perinatal arterial ischemic stroke by assessing brain perfusion. Transl Stroke Res 2011; 3:255-62. [PMID: 24323781 DOI: 10.1007/s12975-011-0122-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 10/17/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
Abstract
Perinatal arterial ischemic stroke (AIS) is an important cause of long-term morbidity in children. Thus, there is an urgent need to better understand the mechanisms of stroke in newborns in order to develop effective treatment and prevention strategies. The purpose of this study was to assess brain perfusion within the first month of life in newborns with AIS. In this study, magnetic resonance imaging (MRI) and perfusion imaging by arterial spin labeling (ASL) were used to assess brain perfusion in four term newborns with AIS. One patient had a stroke within the territory of the right middle cerebral artery (MCA); the other three patients had a stroke within the territory of the left MCA. None of them displayed any hemorrhagic component. All four patients demonstrated abnormal brain perfusion in the stroke area. Cerebral blood flow (CBF) within the stroke area was increased in patient # 1. In all other three patients, CBF was decreased within the stroke center and increased in the periphery of the stroke area. These results show the feasibility of the ASL sequence in newborns with AIS and support its addition to the current MRI protocol used in these newborns as it provides useful information on brain hemodynamics. Its value for identifying salvageable tissue in newborns needs to be further assessed, as well as its potential role in stroke follow-up and for tissue-specific treatment screening.
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Affiliation(s)
- Pia Wintermark
- Division of Newborn Medicine, Montreal Children's Hospital, McGill University, 2300 rue Tupper, C-920, Montreal, QC, H3H 1P3, Canada,
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Chang JH, Lee DK, Kim BT, Ohn YH. Computed tomographic angiogram of an anterior communicating artery aneurysm causing acute retrobulbar optic neuropathy: a case report. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:366-8. [PMID: 21976949 PMCID: PMC3178776 DOI: 10.3341/kjo.2011.25.5.366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 06/08/2010] [Indexed: 11/23/2022] Open
Abstract
Three-dimensional computed tomographic (3D-CT) angiography is a widespread imaging modality for intracranial vascular lesions. However, 3D-CT angiograms of an anterior communicating artery aneurysm associated with acute retrobulbar optic neuropathy have not been previously described. We present 3D-CT angiograms of an aneurysm of the anterior communicating artery that caused subarachnoid hemorrhage and vision loss in a 39-year old man. The 3D-CT angiograms were consistent with findings identified directly during surgery.
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Affiliation(s)
- Jee Ho Chang
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Canale S, Rodrigo S, Tourdias T, Mellerio C, Perrin M, Souillard R, Oppenheim C, Meder JF. [Grading of adults primitive glial neoplasms using arterial spin-labeled perfusion MR imaging]. J Neuroradiol 2011; 38:207-13. [PMID: 21353707 DOI: 10.1016/j.neurad.2010.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 12/05/2010] [Accepted: 12/12/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE We investigated the relationship between tumor blood-flow measurement based on perfusion-imaging by arterial spin-labeling (ASL) and histopathologic findings in adults' primitive glial tumours. PATIENTS AND METHODS Thus, 40 primitive brain tumors (8 low-grade and 32 high-grade gliomas according to the Sainte-Anne classification) were imaged using pulsed (n=19) or continuous (n=21) ASL. Relative cerebral blood flow (rCBF=tumoral blood flow/normal cerebral blood flow) between high- and low-grade gliomas were compared. RESULTS Using pulsed ASL, differences in mean rCBF were observed in high- and low-grade gliomas although no significant (respectively 1.95 and 1.5). Using continuous ASL, mean rCBF were significantly higher for high-grade than for low-grade gliomas (P<0.05). High-grade gliomas could be discriminated using a CBF threshold of 1.18, with a sensitivity of 88%, specificity of 60%, predictive positive value of 88%, and predictive negative value of 60%. CONCLUSION ASL-based perfusion provides a quantitative, non-invasive alternative to dynamic susceptibility contrast perfusion MR methods for evaluating CBF. ASL is a suitable method for gliomas initial staging and could be useful to identify intermediate tumoral evolution.
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Affiliation(s)
- S Canale
- Service de neuroradiologie, centre hospitalier Sainte-Anne, université Paris Descartes, 1, rue Cabanis, 75014 Paris, France
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Roux A, Gauvrit JY, Carsin-Nicol B, Ronzière T, Ferré JC. Hypoglossal artery associated with homolateral internal carotid artery dissection. J Neuroradiol 2011; 38:258-60. [PMID: 21255842 DOI: 10.1016/j.neurad.2010.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 12/06/2010] [Accepted: 12/07/2010] [Indexed: 11/30/2022]
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Abstracts. Neuroradiol J 2010. [DOI: 10.1177/19714009100230s111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Masterson K, Vargas M, Delavelle J. Postictal deficit mimicking stroke: Role of perfusion CT. J Neuroradiol 2009; 36:48-51. [DOI: 10.1016/j.neurad.2008.08.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Altrichter S, Kulcsar Z, Sekoranja L, Rüfenacht D, Viallon M, Lovblad KO. Arterial spin labeling demonstrates early recanalization after stroke. J Neuroradiol 2008; 36:109-11. [PMID: 19056124 DOI: 10.1016/j.neurad.2008.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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