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Tuerxun R, Kamagata K, Saito Y, Andica C, Takabayashi K, Uchida W, Yoshida S, Kikuta J, Tabata H, Naito H, Someya Y, Kaga H, Miyata M, Akashi T, Wada A, Taoka T, Naganawa S, Tamura Y, Watada H, Kawamori R, Aoki S. Assessing interstitial fluid dynamics in type 2 diabetes mellitus and prediabetes cases through diffusion tensor imaging analysis along the perivascular space. Front Aging Neurosci 2024; 16:1362457. [PMID: 38515515 PMCID: PMC10954820 DOI: 10.3389/fnagi.2024.1362457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Background and purpose Glymphatic system in type 2 diabetes mellitus (T2DM) but not in the prodrome, prediabetes (Pre-DM) was investigated using diffusion tensor image analysis along the perivascular space (DTI-ALPS). Association between glymphatic system and insulin resistance of prominent characteristic in T2DM and Pre-DM between is yet elucidated. Therefore, this study delves into the interstitial fluid dynamics using the DTI-ALPS in both Pre-DM and T2DM and association with insulin resistance. Materials and methods In our cross-sectional study, we assessed 70 elderly individuals from the Bunkyo Health Study, which included 22 with Pre-DM, 18 with T2DM, and 33 healthy controls with normal glucose metabolism (NGM). We utilized the general linear model (GLM) to evaluate the ALPS index based on DTI-ALPS across these groups, considering variables like sex, age, intracranial volume, years of education, anamnesis of hypertension and hyperlipidemia, and the total Fazekas scale. Furthermore, we have explored the relationship between the ALPS index and insulin resistance, as measured by the homeostasis model assessment of insulin resistance (HOMA-IR) using GLM and the same set of covariates. Results In the T2DM group, the ALPS index demonstrated a reduction compared with the NGM group [family-wise error (FWE)-corrected p < 0.001; Cohen's d = -1.32]. Similarly, the Pre-DM group had a lower ALPS index than the NGM group (FWE-corrected p < 0.001; Cohen's d = -1.04). However, there was no significant disparity between the T2DM and Pre-DM groups (FWE-corrected p = 1.00; Cohen's d = -0.63). A negative correlation was observed between the ALPS index and HOMA-IR in the combined T2DM and Pre-DM groups (partial correlation coefficient r = -0.35, p < 0.005). Conclusion The ALPS index significantly decreased in both the pre-DM and T2DM groups and showed a correlated with insulin resistance. This indicated that changes in interstitial fluid dynamics are associated with insulin resistance.
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Affiliation(s)
- Rukeye Tuerxun
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Saito
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Faculty of Health Data Science, Juntendo University, Chiba, Japan
| | - Kaito Takabayashi
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Wataru Uchida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Seina Yoshida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Junko Kikuta
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Tabata
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hitoshi Naito
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Someya
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Hideyoshi Kaga
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mari Miyata
- Department of Functional Brain Imaging, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Toshiaki Akashi
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akihiko Wada
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Taoka
- Department of Innovative Biomedical Visualization, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshifumi Tamura
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryuzo Kawamori
- Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Shah MJ, Beck J, Meckel S, Urbach H, Duman IE, Ketterer MC, Hildenbrand T. Reliability of High-resolution Gadolinium-enhanced MR Cisternography and Gasket-seal Technique for Management of Anterior Skull Base Defects. Clin Neuroradiol 2024; 34:115-123. [PMID: 37656200 PMCID: PMC10881784 DOI: 10.1007/s00062-023-01339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Precise preoperative localization of anterior skull base defects is important to plan surgical access, increase the success rate and reduce complications. A stable closure of the defect is vital to prevent recurrence of cerebrospinal fluid (CSF) rhinorrhea. The purpose of this retrospective case series was to evaluate the reliability of a new high-resolution gadolinium-enhanced compressed-sensing SPACE technique (CS T1 SPACE) for magnetic resonance (MR) cisternography to detect cerebrospinal fluid leaks of the anterior skull base and to assess the long-term success rate of the gasket-seal technique for closure of skull base defects. METHOD All patients with spontaneous or postoperative cerebrospinal fluid rhinorrhea and defects of the anterior skull base presenting to the Departments of Otorhinolaryngology and Neurosurgery between 2019 and 2020, receiving a computed tomography (CT) cisternography and MR cisternography (on a 3T whole-body MR scanner using a 64-channel head and neck coil) with CS T1 SPACE sequence and closure of the defect with the gasket-seal technique, were enrolled in the study. For the cisternography, iodinated contrast agent (15 ml Solutrast 250 M®), saline (4 mL) mixed with a 0.5 mL of gadoteridol was injected into the lumbar subarachnoid space. RESULTS A total of four patients were included in the study and MR cisternography with CS T1 SPACE sequence was able to precisely localize CSF leaks in all patients. The imaging results correlated with intraoperative findings. All defects could be successfully closed with the gasket-seal technique. The mean follow-up was 35.25 months (range 33-37 months). CONCLUSION MR cisternography with CS T1 SPACE sequence could be a promising technique for precise localization of CSF leaks and the gasket-seal technique resulted in good closure of the CSF fistula in this case series.
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Affiliation(s)
- Mukesch Johannes Shah
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Stephan Meckel
- Institute for Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Ikram Eda Duman
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - Manuel Christoph Ketterer
- Department of Oto-Rhino-Laryngology, Medical Center, University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Tanja Hildenbrand
- Department of Oto-Rhino-Laryngology, Medical Center, University of Freiburg, Killianstr. 5, 79106, Freiburg, Germany.
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Yu Z, Zhang HFZ, Wang YJ. Surgical treatment of mixed cervical spondylosis with spontaneous cerebrospinal fluid leakage: A case report. World J Clin Cases 2023; 11:7242-7247. [PMID: 37946769 PMCID: PMC10631428 DOI: 10.12998/wjcc.v11.i29.7242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Spontaneous cerebrospinal fluid (CSF) leaks associated with cervical spondylosis are rare. To our knowledge, only a few cases have been reported in which treatment is challenging and varies from case to case. Here, we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur. CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction, presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton. The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago. Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae, and computed tomography showed a "sickle-shaped" disc prolapse with calcification in C4/5. We chose to perform an anterior cervical discectomy. When the prolapsed C4/5 disc was scraped, clear fluid leakage was observed, and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater, which was compressed continuously with cotton patties, with no significant cerebrospinal fluid leakage after 1 h. CONCLUSION Three months after surgery, the patient was asymptomatic and follow-up imaging demonstrated complete resolution.
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Affiliation(s)
- Zhong Yu
- Department of Emergency, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710032, Shaanxi Province, China
| | - Hao-Fu-Zi Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
| | - Yan-Jun Wang
- Department of Emergency, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710032, Shaanxi Province, China
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Greiser J, Groeber S, Weisheit T, Niksch T, Schwab M, Senft C, Kuehnel C, Drescher R, Freesmeyer M. Radionuclide Cisternography with [ 64Cu]Cu-DOTA. Pharmaceuticals (Basel) 2023; 16:1269. [PMID: 37765077 PMCID: PMC10537886 DOI: 10.3390/ph16091269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Radionuclide cisternography (RNC) is a method for conducting imaging of the cerebrospinal system and can be used to identify cerebrospinal fluid leaks. So far, RNC has commonly employed radiopharmaceutical agents suitable only for single-photon emission tomography techniques, which are thus lacking in terms of image resolution and can potentially lead to false-negative results. Therefore, [64Cu]Cu-DOTA was investigated as an alternative radiopharmaceutical for RNC, employing positron emission tomography (PET) instead of single-photon emission tomography. A formulation of [64Cu]Cu-DOTA was produced according to the guidelines for good manufacturing practice. The product met the requirements of agents suitable for intrathecal application. [64Cu]Cu-DOTA was administered to a patient and compared to the approved scintigraphic RNC agent, [111In]In-DTPA. While no cerebrospinal fluid leak was detected with [111In]In-DTPA, [64Cu]Cu-DOTA RNC exhibited a posterolateral leak between the vertebral bodies C1 and C2. Thus, in this patient, PET RNC with [64Cu]Cu-DOTA was superior to RNC with [111In]In-DTPA. Since radiopharmaceuticals have a very good safety profile regarding the occurrence of adverse events, PET RNC with [64Cu]Cu-DOTA may become an attractive alternative to scintigraphic methods, and also to computed tomography or magnetic resonance imaging, which often require contrast agents, causing adverse events to occur much more frequently.
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Affiliation(s)
- Julia Greiser
- Working Group for Translational Nuclear Medicine and Radiopharmacy, Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany;
| | - Sebastian Groeber
- Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany (C.K.)
| | - Thomas Weisheit
- Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany (C.K.)
| | - Tobias Niksch
- Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany (C.K.)
| | | | - Christian Senft
- Neurosurgery, Jena University Hospital, 07747 Jena, Germany;
| | - Christian Kuehnel
- Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany (C.K.)
| | - Robert Drescher
- Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany (C.K.)
| | - Martin Freesmeyer
- Nuclear Medicine, Jena University Hospital, 07747 Jena, Germany (C.K.)
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Lee SJ, Kim D, Suh CH, Shim WH, Heo H, Jo S, Chung SJ, Kim HS, Kim SJ. Detection rate of MR myelography without intrathecal gadolinium in patients with newly diagnosed spontaneous intracranial hypotension. Clin Radiol 2022; 77:848-854. [PMID: 35985843 DOI: 10.1016/j.crad.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the detection rate of magnetic resonance (MR) myelography without intrathecal gadolinium for cerebrospinal fluid (CSF) leakage in patients with newly diagnosed spontaneous intracranial hypotension (SIH) and to validate a published scoring system for predicting CSF leakage. MATERIALS AND METHODS This retrospective, observational, single-institution study included patients with newly diagnosed SIH between March 2015 and April 2021. Patients were included if they (a) had newly diagnosed SIH and (b) underwent initial brain MR imaging and preprocedural MR myelography with two- and three-dimensional turbo spin-echo sequences. Patients who underwent spine surgery or procedures including epidural injection and acupuncture were excluded. The detection rate was defined as the proportion of patients with a true-positive MR myelography result among all patients with confirmed CSF leakage. The interobserver agreement for the MR myelography results between two radiologists was analysed using weighted kappa statistics. RESULTS A total of 136 patients (mean age, 48 years; 70 women) with suspected SIH were included. Of these patients, 120 (88%, 120/136) were confirmed to have CSF leakage. Of the patients with confirmed CSF leakage, 90 (75%, 90/120) had epidural fluid collection. The detection rate of MR myelography for CSF leakage was 88% (105/120). The interobserver agreement between the two readers for detecting CSF leakage (κ = 0.76) or epidural fluid collection (κ = 0.76) on MR myelography was high. Among 24 patients with normal brain MR imaging results, 16 had CSF leakage (67%, 16/24). CONCLUSIONS Non-invasive MR myelography without intrathecal gadolinium should be considered to detect CSF leakage in patients with suspected SIH.
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Affiliation(s)
- S J Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Kim
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - C H Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - W H Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H Heo
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H S Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S J Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Diagnostic yield of MR myelography in patients with newly diagnosed spontaneous intracranial hypotension: a systematic review and meta-analysis. Eur Radiol 2022; 32:7843-7853. [PMID: 35538263 DOI: 10.1007/s00330-022-08845-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To investigate the pooled diagnostic yield of MR myelography in patients with newly diagnosed spontaneous intracranial hypotension (SIH). METHODS A literature search of the MEDLINE/PubMed and Embase databases was conducted until July 25, 2021, including studies with the following inclusion criteria: (a) population: patients with newly diagnosed SIH; (b) diagnostic modality: MR myelography or MR myelography with intrathecal gadolinium for evaluation of CSF leakage; (c) outcomes: diagnostic yield of MR myelography or MR myelography with intrathecal gadolinium. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. DerSimonian-Laird random-effects modeling was used to calculate the pooled estimates. Subgroup analysis regarding epidural fluid collection and meta-regression were additionally performed. RESULTS Fifteen studies with 643 patients were included. Eight studies used MR myelography with intrathecal gadolinium, and 11 used MR myelography. The overall quality of the included studies was moderate. The pooled diagnostic yield of MR myelography was 86% (95% CI, 80-91%) and that of MR myelography with intrathecal gadolinium was 83% (95% CI, 51-96%). There was no significant difference in pooled diagnostic yield between MR myelography and MR myelography with intrathecal gadolinium (p = 0.512). In subgroup analysis, the pooled diagnostic yield of the epidural fluid collection was 91% (95% CI, 84-94%). In meta-regression, the diagnostic yield was unaffected regardless of consecutive enrollment, magnet strength, or 2D/3D. CONCLUSIONS MR myelography had a high diagnostic yield in patients with SIH. MR myelography is non-invasive and not inferior to MR myelography with intrathecal gadolinium. KEY POINTS • The pooled diagnostic yield of MR myelography was 86% (95% CI, 80-91%) in patients with spontaneous intracranial hypotension. • There was no significant difference in pooled diagnostic yield between MR myelography and MR myelography with intrathecal gadolinium. • MR myelography is non-invasive and not inferior to MR myelography with intrathecal gadolinium.
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Kohan L, Pellis Z, Provenzano DA, Pearson ACS, Narouze S, Benzon HT. American Society of Regional Anesthesia and Pain Medicine contrast shortage position statement. Reg Anesth Pain Med 2022; 47:511-518. [DOI: 10.1136/rapm-2022-103830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/03/2022] [Indexed: 11/03/2022]
Abstract
The medical field has been experiencing numerous drug shortages in recent years. The most recent shortage to impact the field of interventional pain medicine is that of iodinated contrast medium. Pain physicians must adapt to these changes while maintaining quality of care. This position statement offers guidance on adapting to the shortage.
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Moradian M, Tekmyster G, Wei JJ, Avetisian H, Acharya JN, Furman MB. Encephalopathy after unintentional intrathecal gadolinium: A letter to the editor. INTERVENTIONAL PAIN MEDICINE 2022; 1:100105. [PMID: 39238511 PMCID: PMC11373013 DOI: 10.1016/j.inpm.2022.100105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 09/07/2024]
Abstract
Objective Raise awareness of gadolinium encephalopathy, a rare cause of neurological symptoms. Setting An L5-S1 interlaminar epidural steroid injection (IL-ESI) was performed with a gadolinium-based contrast agent (GBCA) due to the patient's history of allergic reaction to iodine-based contrast agents. Discussion Several hours after administration of GBCA, the patient had nausea and vomiting with altered mental status. Patient was treated with dexamethasone IV, and was discharged on day 2. Patient had no residual deficits at follow-up two weeks later. Current literature shows that caution should be used to prevent inadvertent intrathecal GBCA, and doses >2.0 mmols are associated with serious adverse effects, including death. Conclusions Intrathecal administration of GBCAs should be limited to less than 0.5 mmol. If adverse effects are experienced, IV steroids should be administered as soon as possible, and a CSF drain should be considered.
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Affiliation(s)
- Maxim Moradian
- Interventional Spine and Orthopedic Regenerative Experts, PC (iSCORE). California Sports and Spine Institute, PC (CSSI), 51 N. 5 Ave, Suite 301, Arcadia, CA, 91006, USA
| | - Gene Tekmyster
- Assistant Professor of Clinical Orthopaedic Surgery, Keck Medicine of USC, Toyota Sports Performance Center, 555 N. Nash Street, El Segundo, CA, USA
| | - Jason J Wei
- UCLA Spine Center, 1131 Wilshire Blvd, Suite 100, Santa Monica, CA, 90401, USA
| | - Henry Avetisian
- Interventional Spine and Orthopedic Regenerative Experts, PC (iSCORE). California Sports and Spine Institute, PC (CSSI), 51 N. 5 Ave, Suite 301, Arcadia, CA, 91006, USA
| | - Jayant N Acharya
- Department of Neurology, EC037. Penn State Hershey Medical Center, 30 Hope Drive, Hershey, PA, 17033, USA
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Kikuta J, Kamagata K, Taoka T, Takabayashi K, Uchida W, Saito Y, Andica C, Wada A, Kawamura K, Akiba C, Nakajima M, Miyajima M, Naganawa S, Aoki S. Water Diffusivity Changes Along the Perivascular Space After Lumboperitoneal Shunt Surgery in Idiopathic Normal Pressure Hydrocephalus. Front Neurol 2022; 13:843883. [PMID: 35295837 PMCID: PMC8918529 DOI: 10.3389/fneur.2022.843883] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/27/2022] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this study was to evaluate the water diffusivity changes along the perivascular space after lumboperitoneal shunt (LPS) surgery in idiopathic normal pressure hydrocephalus. Methods Nine patients diagnosed with idiopathic normal pressure hydrocephalus (iNPH; three men and six women, mean age ± SD = 75.22 ± 5.12 years) according to the guidelines for iNPH in Japan were included in the study. Post-LPS surgery, six patients with iNPH who exhibited improvement in symptoms were defined as responder subjects, while three patients with iNPH who did not were defined as non-responder subjects. We calculated the mean analysis along the perivascular space (ALPS) index of the left and right hemispheres and compared the differences between pre- and post-LPS surgery mean ALPS indices in iNPH patients. In the responder or non-responder subjects, the mean ALPS indices in the pre- and post-operative iNPH groups were compared using Wilcoxon signed-rank tests. Next, correlation analyses between pre- and post-operation changes in the mean ALPS index and clinical characteristics were conducted. Results The mean ALPS index of the post-operative iNPH group was significantly higher than that of the pre-operative iNPH group (p = 0.021). In responder subjects, the mean ALPS index of the post-operative iNPH group was significantly higher than that of the pre-operative iNPH group (p = 0.046). On the other hand, in the non-responder subjects, the mean ALPS index of the post-operative iNPH group was not significantly different compared to the pre-operative iNPH group (p = 0.285). The mean ALPS index change was not significantly correlated with changes in the Mini-Mental State Examination (MMSE) score (r = −0.218, p = 0.574), Frontal Assessment Battery (FAB) score (r = 0.185, p = 0.634), Trail Making Test A (TMTA) score (r = 0.250, p = 0.516), and Evans' index (r = 0.109, p = 0.780). In responder subjects, the mean ALPS index change was significantly correlated with Evans' index in pre-operative patients with iNPH (r = 0.841, p = 0.036). Conclusion This study demonstrates the improved water diffusivity along perivascular space in patients with iNPH after LPS surgery. This could be indicative of glymphatic function recovery following LPS surgery.
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Affiliation(s)
- Junko Kikuta
- Department of Radiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
- *Correspondence: Junko Kikuta
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Toshiaki Taoka
- Department of Innovative Biomedical Visualization, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kaito Takabayashi
- Department of Radiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Wataru Uchida
- Department of Radiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Yuya Saito
- Department of Radiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Akihiko Wada
- Department of Radiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Kaito Kawamura
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Japan
| | - Chihiro Akiba
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Koto-ku, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Koto-ku, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
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Lauer M, Lauer A, You SJ, Kluge S, Hattingen E, Harter PN, Senft C, Wagner M, Voss M. Neurotoxicity of subarachnoid Gd-based contrast agent accumulation: a potential complication of intraoperative MRI? Neurosurg Focus 2021; 50:E12. [PMID: 33386012 DOI: 10.3171/2020.10.focus20402] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative MRI with Gd-based contrast agent (GBCA) improves the extent of resection of contrast-enhancing brain tumors. Signal changes of CSF due to perioperative GBCA leakage in the subarachnoid space have been reported. However, although GBCA potentially exhibits neurotoxic effects, so far no associated complications have been described. In this case series, the authors report a single-center cohort of patients with subarachnoid GBCA extravasation after intraoperative MRI and discuss potential neurotoxic complications and potential ways of avoiding them. METHODS All patients with CSF signal increase on unenhanced T1-weighted and FLAIR images on postoperative MRI, who had previously undergone tumor resection with use of intraoperative MRI, were retrospectively included and compared with a control cohort. The control group was matched in age, tumor characteristics, and extent of resection; comparisons were made regarding postoperative seizures and ICU stay. A subgroup with initially diagnosed malignant glioma was additionally analyzed for potential delay of initiation of adjuvant treatment and overall survival. RESULTS Seven patients with postoperative GBCA accumulation in the subarachnoid space were identified; 5 presented with focal seizures and altered mental status postoperatively. Poor patient condition led to extended ICU stay and prolonged delay of the initiation of adjuvant treatment in patients with newly diagnosed malignant glioma. Overall survival was reduced compared to the matched control group. CONCLUSIONS The results suggest that there might be a risk of neurotoxic complications if GBCA that is intravenously applied during neurosurgery leaks into the subarachnoid space. Patients with highly vascularized tumors with intraoperative bleeding seem to be especially at risk for GBCA accumulation and neurotoxic complications. Therefore, awareness of the potential risk of complicating GBCA leakage is mandatory in the application of intraoperative GBCA.
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Affiliation(s)
- Monika Lauer
- 1Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main
| | - Arne Lauer
- 1Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main
| | - Se-Jong You
- 1Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main
| | - Sara Kluge
- 1Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main
| | - Elke Hattingen
- 1Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main
| | - Patrick N Harter
- 2Edinger Institute (Institute of Neurology), Goethe University, Frankfurt am Main.,3German Cancer Research Center (DKFZ) Heidelberg, and German Cancer Consortium (DKTK) Frankfurt/Mainz
| | - Christian Senft
- 4Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main; and
| | - Marlies Wagner
- 1Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main
| | - Martin Voss
- 5Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Malalur P, Rajacic PC. Neurotoxic manifestations of high-dose intrathecal gadolinium administration for CT myelogram. Radiol Case Rep 2020; 15:1992-1995. [PMID: 32874398 PMCID: PMC7452073 DOI: 10.1016/j.radcr.2020.07.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022] Open
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Halvorsen M, Edeklev CS, Fraser-Green J, Løvland G, Vatnehol SAS, Gjertsen Ø, Nedregaard B, Sletteberg R, Ringstad G, Eide PK. Off-label intrathecal use of gadobutrol: safety study and comparison of administration protocols. Neuroradiology 2020; 63:51-61. [PMID: 32803338 PMCID: PMC7803712 DOI: 10.1007/s00234-020-02519-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/08/2020] [Indexed: 12/23/2022]
Abstract
Purpose Magnetic resonance imaging (MRI) contrast agents have been used off-label for diagnosis of cerebrospinal fluid (CSF) leaks and lately also for assessment of the glymphatic system and meningeal lymphatic drainage. The purpose of this study was to further evaluate the short- and long-term safety profile of intrathecal MRI contrast agents. Methods In this prospective study, we compared the safety profile of different administration protocols of intrathecal gadobutrol (GadovistTM; 1.0 mmol/ml). Gadobutrol was administered intrathecal in a dose of 0.5 mmol, with or without iodixanol (VisipaqueTM 270 mg I/ml; 3 ml). In addition, a subgroup was given intrathecal gadobutrol in a dose of 0.25 mmol. Adverse events were assessed at 1 to 3 days, 4 weeks, and after 12 months. Results Among the 149 patients, no serious adverse events were seen in patients without history of prior adverse events. The combination of gadobutrol with iodixanol did not increase the occurrence of non-serious adverse events after days 1–3. Intrathecal gadobutrol in a dose of 0.25 mmol caused less severity of nausea, as compared with the dose of 0.5 mmol. The clinical diagnosis was the major determinant for occurrence of non-serious adverse events after intrathecal gadobutrol. Conclusion This prospective study showed that intrathecal administration of gadobutrol in a dose of 0.5 mmol is safe. Non-serious adverse events were to a lesser degree affected by the administration protocols, though preliminary data are given that side effects of intrathecal gadobutrol are dose-dependent.
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Affiliation(s)
- Merete Halvorsen
- Department. of Neurosurgery, Oslo University Hospital - Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway
| | - Camilla Sæthre Edeklev
- Department. of Neurosurgery, Oslo University Hospital - Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway
| | - Jorunn Fraser-Green
- The Interventional Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Grethe Løvland
- The Interventional Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | | | - Øivind Gjertsen
- Dept. of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Bård Nedregaard
- Dept. of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ruth Sletteberg
- Dept. of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Geir Ringstad
- Dept. of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Per Kristian Eide
- Department. of Neurosurgery, Oslo University Hospital - Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway. .,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Yang G, Deng N, Liu Y, Gu Y, Yao X. Evaluation of Glymphatic System Using Diffusion MR Technique in T2DM Cases. Front Hum Neurosci 2020; 14:300. [PMID: 32922272 PMCID: PMC7456821 DOI: 10.3389/fnhum.2020.00300] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/06/2020] [Indexed: 01/10/2023] Open
Abstract
Objective: We aimed to evaluate the activity of the human glymphatic system in type 2 diabetes mellitus (T2DM) using diffusion tensor image analysis along with the perivascular space (DTI-ALPS). Methods: Diffusion tensor images were acquired to calculate the diffusivities in the direction of the x-axis (right-to-left; Dx), y-axis (anterior-to-posterior; Dy), and z-axis (inferior-to-superior; Dz) of the plane of the lateral ventricle body in 20 patients with type 2 diabetes and 10 people in a control group. We evaluated the diffusivity along with the perivascular spaces, as well as the projection fibers and association fibers, separately. The analysis along the perivascular space (ALPS-index) was defined as the mean (Dxpro, Dypro)/mean (Dypro, Dzasc), where the Dxpro and Dxasc were the Dx values in the projection and association fiber areas, respectively. Results: There were significant differences in diffusivity along the projection fibers and the association fibers among the groups. The significant differences among the groups along the perivascular spaces, shown as the ALPS-index and medical history of T2DM, indicating lower water diffusivity along the perivascular space concerning type 2 diabetes severity, was also observed. Conclusion: Lower diffusivity along the perivascular space on DTI-APLS can reflect impairment of the glymphatic system in T2DM. This study showed that the activity of the glymphatic system could be evaluated by diffusion tensor image analysis.
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Affiliation(s)
- Guangwei Yang
- Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, China
| | - Nan Deng
- Luzhou People's Hospital, Luzhou, China
| | - Yi Liu
- Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, China
| | - Yingjiang Gu
- Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, China
| | - Xiang Yao
- Department of Radiology, Xiang'an Hospital of Xiamen University, Xiamen, China
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Patel M, Atyani A, Salameh JP, McInnes M, Chakraborty S. Safety of Intrathecal Administration of Gadolinium-based Contrast Agents: A Systematic Review and Meta-Analysis. Radiology 2020; 297:75-83. [PMID: 32720867 DOI: 10.1148/radiol.2020191373] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The use of MR cisternography with intrathecal administration of gadolinium-based contrast agents (GBCAs) is limited by a lack of understanding of the relationship between intrathecal GBCA exposure and dose-related adverse events. Purpose To perform a systematic review to establish an understanding of the dose-response relationship of intrathecal GBCAs and to characterize related adverse events, particularly at higher doses. Materials and Methods Medline, Embase, CINAHL, and Central databases were searched for studies reporting intrathecal GBCA use. Data extraction included studies focused on rates and types of adverse events after intrathecal GBCA exposure. A two-tailed independent sample t test statistic was used to evaluate the relationship between GBCA dose and the presence of serious versus nonserious adverse events. Meta-analysis was used to determine the overall incidence of adverse events. Study quality and publication bias were assessed using the modified Newcastle-Ottawa scale and a funnel plot (effect size measured using Hedges' g followed by the Egger test), respectively. Results Fifty-three studies with a total of 1036 patients were included for analysis. The overall rate of adverse events after intrathecal administration of GBCA was 13% (95% confidence interval [CI]: 9.3%, 18%). Meta-analysis revealed moderate heterogeneity (I2 = 62%). Serious adverse event rates could not be determined with meta-analysis. They were reported in 10 studies and were primarily neurologic in nature, with two cases of coma-one resulting in death. Serious adverse events were associated with significantly higher GBCA doses when compared with nonserious adverse events (mean difference, 4.5 mmol; 95% CI: 2.3 mmol, 6.6 mmol; P = .008). For serious adverse events, there was no clear dose-dependent increase in severity above 2.0 mmol. Conclusion Overall, intrathecal administration of GBCAs at doses greater than 1.0 mmol are associated with serious neurotoxic complications with relative clinical safety at lower doses. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Kanal in this issue.
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Affiliation(s)
- Mihilkumar Patel
- From the Department of Medical Imaging, Division of Neuroradiology, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
| | - Almohannad Atyani
- From the Department of Medical Imaging, Division of Neuroradiology, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
| | - Jean-Paul Salameh
- From the Department of Medical Imaging, Division of Neuroradiology, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
| | - Matthew McInnes
- From the Department of Medical Imaging, Division of Neuroradiology, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
| | - Santanu Chakraborty
- From the Department of Medical Imaging, Division of Neuroradiology, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
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Dobrocky T, Winklehner A, Breiding PS, Grunder L, Peschi G, Häni L, Mosimann PJ, Branca M, Kaesmacher J, Mordasini P, Raabe A, Ulrich CT, Beck J, Gralla J, Piechowiak EI. Spine MRI in Spontaneous Intracranial Hypotension for CSF Leak Detection: Nonsuperiority of Intrathecal Gadolinium to Heavily T2-Weighted Fat-Saturated Sequences. AJNR Am J Neuroradiol 2020; 41:1309-1315. [PMID: 32554417 DOI: 10.3174/ajnr.a6592] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/06/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spine MR imaging plays a pivotal role in the diagnostic work-up of spontaneous intracranial hypotension. The aim of this study was to compare the diagnostic accuracy of unenhanced spine MR imaging and intrathecal gadolinium-enhanced spine MR imaging for identification and localization of CSF leaks in patients with spontaneous intracranial hypotension. MATERIALS AND METHODS A retrospective study of patients with spontaneous intracranial hypotension examined from February 2013 to October 2017 was conducted. Their spine MR imaging was reviewed by 3 blinded readers for the presence of epidural CSF using 3 different sequences (T2WI, 3D T2WI fat-saturated, T1WI gadolinium). In patients with leaks, the presumed level of the leak was reported. RESULTS In total, 103 patients with spontaneous intracranial hypotension (63/103 [61%] women; mean age, 50 years) were evaluated. Seventy had a confirmed CSF leak (57/70 [81%] proved intraoperatively), and 33 showed no epidural CSF on multimodal imaging. Intrathecal gadolinium-enhanced spine MR imaging was nonsuperior to unenhanced spine MR imaging for the detection of epidural CSF (P = .24 and .97). All MR imaging sequences had a low accuracy for leak localization. In all patients, only 1 leakage point was present, albeit multiple suspicious lesions were reported in all sequences (mean, 5.0). CONCLUSIONS Intrathecal gadolinium-enhanced spine MR imaging does not improve the diagnostic accuracy for the detection of epidural CSF. Thus, it lacks a rationale to be included in the routine spontaneous intracranial hypotension work-up. Heavily T2-weighted images with fat saturation provide high accuracy for the detection of an epidural CSF collection. Low accuracy for leak localization is due to an extensive CSF collection spanning several vertebrae (false localizing sign), lack of temporal resolution, and a multiplicity of suspicious lesions, albeit only a single leakage site is present. Thus, dynamic examination is mandatory before targeted treatment is initiated.
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Affiliation(s)
- T Dobrocky
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - A Winklehner
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - P S Breiding
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - L Grunder
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - G Peschi
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
- Department of Interventional, Pediatric, and Diagnostic Radiology (G.P., J.K.)
| | - L Häni
- Neurosurgery (L.H., A.R., C.T.U., J.B.), University of Bern, Inselspital, Bern, Switzerland
| | - P J Mosimann
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - M Branca
- Clinical Trials Unit (M.B.), University of Bern, Bern, Switzerland
| | - J Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
- Department of Interventional, Pediatric, and Diagnostic Radiology (G.P., J.K.)
| | - P Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - A Raabe
- Neurosurgery (L.H., A.R., C.T.U., J.B.), University of Bern, Inselspital, Bern, Switzerland
| | - C T Ulrich
- Neurosurgery (L.H., A.R., C.T.U., J.B.), University of Bern, Inselspital, Bern, Switzerland
| | - J Beck
- Neurosurgery (L.H., A.R., C.T.U., J.B.), University of Bern, Inselspital, Bern, Switzerland
- Department of Neurosurgery (J.B.), Medical Center, University of Freiburg, Freiburg, Germany
| | - J Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - E I Piechowiak
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
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Dogan SN, Salt V, Korkmazer B, Arslan S, Islak C, Kocer N, Kizilkilic O. Intrathecal use of gadobutrol for gadolinium-enhanced MR cisternography in the evaluation of patients with otorhinorrhea. Neuroradiology 2020; 62:1381-1387. [PMID: 32535661 DOI: 10.1007/s00234-020-02463-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/20/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Intrathecal gadolinium-enhanced MR cisternography (IGE-MRC) has a high sensitivity to detect accurate localization of cerebrospinal fluid (CSF) leakage in otorhinorrhea patients. Our purpose in this study was to describe our experience in analyzing clinically suspected CSF leakage by IGE-MRC by using gadobutrol with emphasis on its safety and diagnostic performance. METHODS We retrospectively reviewed our imaging and clinical database for the evaluation of patients admitted to our clinic with complaints of otorhinorrhea between 2017 and 2019. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the follow-up. RESULTS Of the 85 patients included in the retrospective analysis, 82 (96.5%) had rhinorrhea and 3 (3.5%) had otorrhea. Overall, 29 patients (34.1% of all patients) underwent operation for repair of the CSF leakage site. Beta-transferrin test was available and positive in 33 patients (38.8%). Five (5.9%) patients complained headaches after the procedure and complaints were resolved with increased water intake. Postprocedurally, 3 patients (3.5%) had vertigo and 1 patient (1.2%) complained nausea but spontaneous regression were observed in a few hours. None of the patients experienced a significant complication or adverse reaction during follow-up period. Sixty-seven patients (78.8%) had medical record and telephone follow-up. Mean follow-up duration with call was 14.2 months. CONCLUSION IGE-MRC is a minimally invasive and highly sensitive imaging technique. The current results during our follow-up demonstrate the relative safety and feasibility of IGE-MRC by using gadobutrol to evaluate CSF leakage.
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Affiliation(s)
- Sebahat Nacar Dogan
- Gaziosmanpaşa Training and Research Hospital, Department of Radiology, University of Health Sciences Turkey, 34098, Istanbul, Turkey
| | - Vefa Salt
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Bora Korkmazer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Serdar Arslan
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey.
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Calvo N, Jamil M, Feldman S, Shah A, Nauman F, Ferrara J. Neurotoxicity from intrathecal gadolinium administration. Neurol Clin Pract 2020; 10:e7-e10. [DOI: 10.1212/cpj.0000000000000696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/19/2019] [Indexed: 11/15/2022]
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Acute Encephalopathy and Cardiac Arrest Induced by Intrathecal Gadolinium Administration. Clin Neuroradiol 2019; 30:629-631. [DOI: 10.1007/s00062-019-00845-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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19
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Hagedorn JM, Bendel MA, Moeschler SM, Lamer TJ, Pope JE, Deer TR. Intrathecal Gadolinium Use for the Chronic Pain Physician. Neuromodulation 2019; 22:769-774. [DOI: 10.1111/ner.13043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Jonathan M. Hagedorn
- Division of Pain Medicine, Department of Anesthesiology and Perioperative MedicineMayo Clinic Rochester MN USA
| | - Markus A. Bendel
- Division of Pain Medicine, Department of Anesthesiology and Perioperative MedicineMayo Clinic Rochester MN USA
| | - Susan M. Moeschler
- Division of Pain Medicine, Department of Anesthesiology and Perioperative MedicineMayo Clinic Rochester MN USA
| | - Tim J. Lamer
- Division of Pain Medicine, Department of Anesthesiology and Perioperative MedicineMayo Clinic Rochester MN USA
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Edeklev CS, Halvorsen M, Løvland G, Vatnehol SAS, Gjertsen Ø, Nedregaard B, Sletteberg R, Ringstad G, Eide PK. Intrathecal Use of Gadobutrol for Glymphatic MR Imaging: Prospective Safety Study of 100 Patients. AJNR Am J Neuroradiol 2019; 40:1257-1264. [PMID: 31320462 DOI: 10.3174/ajnr.a6136] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/15/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intrathecal contrast-enhanced glymphatic MR imaging has shown promise in assessing glymphatic function in patients with dementia. The purpose of this study was to determine the safety profile and feasibility of this new MR imaging technique. MATERIALS AND METHODS A prospective safety and feasibility study was performed in 100 consecutive patients (58 women and 42 men, 51 ± 19 years of age) undergoing glymphatic MR imaging from September 2015 to August 2018. Short- and long-term serious and nonserious adverse events were registered clinically and by interview after intrathecal administration of 0.5 mL of gadobutrol (1.0 mmol/mL) along with 3 mL of iodixanol (270 mg I/mL). Adverse events are presented as numbers and percentages. RESULTS One serious adverse event (anaphylaxis) occurred in a patient with known allergy to iodine-containing contrast agents (1%). The main nonserious adverse events during the first 1-3 days after contrast injection included severe headache (28%) and severe nausea (34%), though the frequency depended heavily on the diagnosis. After 4 weeks, adverse events had resolved. CONCLUSIONS Intrathecal administration of gadobutrol in conjunction with iodixanol for glymphatic MR imaging is safe and feasible. We cannot conclude whether short-duration symptoms such as headache and nausea were caused by gadobutrol, iodixanol, the lumbar puncture, or the diagnosis. The safety profile closely resembles that of iodixanol alone.
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Affiliation(s)
- C S Edeklev
- From the Department of Neurosurgery (C.S.E., M.H., P.K.E.)
| | - M Halvorsen
- From the Department of Neurosurgery (C.S.E., M.H., P.K.E.)
| | - G Løvland
- Interventional Centre (G.L., S.A.S.V.)
| | | | - Ø Gjertsen
- Department of Radiology and Nuclear Medicine (Ø.G., B.N. R.S., G.R.), Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - B Nedregaard
- Department of Radiology and Nuclear Medicine (Ø.G., B.N. R.S., G.R.), Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - R Sletteberg
- Department of Radiology and Nuclear Medicine (Ø.G., B.N. R.S., G.R.), Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - G Ringstad
- Department of Radiology and Nuclear Medicine (Ø.G., B.N. R.S., G.R.), Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - P K Eide
- From the Department of Neurosurgery (C.S.E., M.H., P.K.E.) .,Institute of Clinical Medicine (P.K.E.), Faculty of Medicine, University of Oslo, Oslo, Norway
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Provenzano DA, Pellis Z, DeRiggi L. Fatal gadolinium-induced encephalopathy following accidental intrathecal administration: a case report and a comprehensive evidence-based review. Reg Anesth Pain Med 2019; 44:rapm-2019-100422. [PMID: 31023932 DOI: 10.1136/rapm-2019-100422] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 12/13/2022]
Abstract
Gadolinium-based contrast agents (GBCAs) have been suggested as off-label alternatives to iodine-based contrast agents for fluoroscopic imaging during interventional pain procedures. We report a case of accidental intrathecal administration of a GBCA during a neuraxial interventional pain procedure leading to acute gadolinium neurotoxicity, which resulted in encephalopathy and ultimately death. To our knowledge, it is the first published case of fatal intrathecal gadolinium-induced encephalopathy and the first published case of intrathecal gadoteridol causing serious neurologic complications. In addition, the case presented here is placed in context with an associated comprehensive, evidence-based review of the use of gadolinium in interventional pain procedures, addressing gadolinium chemistry and pharmacologic properties, neurotoxicity and radiology. Physicians must be aware that gadolinium poses a significant risk of acute neurotoxicity even in small doses. Until further safety research is performed, GBCAs should not be considered a safe alternative for use in neuraxial interventional spine procedures when there is a risk of inadvertent intrathecal administration.
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Affiliation(s)
| | - Zachary Pellis
- Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA
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Caro-Osorio E, Espino-Ojeda A, Guevara-Maldonado L, Herrera-Castro JC. Utility of magnetic resonance cisternography with intrathecal gadolinium in detection of cerebrospinal fluid fistula associated with Mondini dysplasia in a patient with recurrent meningitis: Case report and literature review. Surg Neurol Int 2018; 9:92. [PMID: 29770252 PMCID: PMC5938894 DOI: 10.4103/sni.sni_449_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/20/2018] [Indexed: 11/04/2022] Open
Abstract
Background The intrathecal contrast-enhanced magnetic resonance cisternography (MRC) is a diagnostic method that has been proven effective in selected patients with various disorders of the cerebrospinal system, including the detection of cerebrospinal fluid (CSF) leaks. The Mondini dysplasia is a malformation of the inner ear characterized by an incomplete cochlear development. The cerebrospinal fistula associated with Mondini dysplasia usually occurs in the first 5-10 years. Case Description The case of a 34-year-old woman with CSF rhinorrhea and recurrent meningitis associated with CSF fistula into the right inner ear, which was detected by MRC with intrathecal gadolinium, is presented. The computed tomography (CT) cisternography failed to detect the exact location of the leak. The right Mondini dysplasia was identified on CT of the temporal bone. A subtotal right-sided petrosectomy and fistula closure into the bony labyrinth were performed. After the procedure the patient no longer presented meningitis or CSF leak. Conclusions The radiological identification of the site of CSF leak through sensitive imaging studies such as MRC with intrathecal gadolinium is crucial for surgical approach.
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Affiliation(s)
- Enrique Caro-Osorio
- Department of Neurosurgery, Tecnologico de Monterrey, Monterrey, Nuevo León, México
| | - Alba Espino-Ojeda
- Department of Neurology, Tecnologico de Monterrey, Monterrey, Nuevo León, México
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Nacar Dogan S, Kizilkilic O, Kocak B, Isler C, Islak C, Kocer N. Intrathecal gadolinium-enhanced MR cisternography in patients with otorhinorrhea: 10-year experience of a tertiary referral center. Neuroradiology 2018; 60:471-477. [PMID: 29572604 DOI: 10.1007/s00234-018-2014-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/13/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Despite a considerable amount of literature that has been published about the use of intrathecal gadolinium-enhanced MR cisternography (IGE-MRC), there is still relatively lack of evidence as to its long-term effects. Our purpose in this study was twofold: firstly, to assess the long-term safety of the IGE-MRC; secondly, to evaluate the diagnostic performance of IGE-MRC for detecting cerebrospinal fluid (CSF) leak in otorhinorrhea patients. METHODS We retrospectively reviewed our imaging and clinical database for the patients admitted to our department for the evaluation of their otorhinorrhea between 2008 and 2017. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the long-term follow-up. RESULTS The retrospective review yielded 166 patients. Rhinorrhea was present in 150 (90.4%) patients and otorrhea in 16 (9.6%) patients. Overall, 67 patients (40.5% of all patients) underwent operation for repair of the CSF leak site. Beta-transferrin test was available and positive in 57 (34.3%) patients. Overall sensitivity of IGE-MRC and paranasal high-resolution CT (HRCT) was 89.3 and 72%, respectively. Within the first 24 h after the procedure, none of the patients experienced a significant complication or adverse reaction. Ninety-nine patients (59.6%) had medical record and telephone follow-up. The mean follow-up duration with call was 37.1 months. Three (3%) patients complained about severe headache 3-4 weeks after the procedure. CONCLUSIONS IGE-MRC is a minimally invasive and highly sensitive imaging technique. No adverse side effect during our long-term follow-up might strengthen and support the safety of IGE-MRC.
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Affiliation(s)
- Sebahat Nacar Dogan
- Department of Radiology, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Division of Neuroradiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
| | - Burak Kocak
- Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cihan Isler
- Department of Neurosurgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Division of Neuroradiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Division of Neuroradiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Mishra RK, Pruthi N, Bharath RD, Malla BR. Role of intraoperative dynamic magnetic resonance myelogram in management of giant dorsolumbar spinal extradural arachnoid cyst: case report. J Neurosurg Spine 2017; 27:185-188. [PMID: 28574330 DOI: 10.3171/2017.2.spine16637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Giant dorsolumbar spinal arachnoid cysts are a complex, poorly understood, and difficult to manage clinical entity. Traditional CT myelography is technically difficult to use in these cases to detect the site of leakage preoperatively. The authors report a novel technique for detecting the site of the leak by using sequential, dynamic intraoperative MR myelography. To the authors' knowledge, there is no other similar report in the literature.
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Affiliation(s)
| | | | - Rose Dawn Bharath
- Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Taoka T, Masutani Y, Kawai H, Nakane T, Matsuoka K, Yasuno F, Kishimoto T, Naganawa S. Evaluation of glymphatic system activity with the diffusion MR technique: diffusion tensor image analysis along the perivascular space (DTI-ALPS) in Alzheimer's disease cases. Jpn J Radiol 2017; 35:172-178. [PMID: 28197821 DOI: 10.1007/s11604-017-0617-z] [Citation(s) in RCA: 345] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The activity of the glymphatic system is impaired in animal models of Alzheimer's disease (AD). We evaluated the activity of the human glymphatic system in cases of AD with a diffusion-based technique called diffusion tensor image analysis along the perivascular space (DTI-ALPS). MATERIALS AND METHODS Diffusion tensor images were acquired to calculate diffusivities in the x, y, and z axes of the plane of the lateral ventricle body in 31 patients. We evaluated the diffusivity along the perivascular spaces as well as projection fibers and association fibers separately, to acquire an index for diffusivity along the perivascular space (ALPS-index) and correlated them with the mini mental state examinations (MMSE) score. RESULTS We found a significant negative correlation between diffusivity along the projection fibers and association fibers. We also observed a significant positive correlation between diffusivity along perivascular spaces shown as ALPS-index and the MMSE score, indicating lower water diffusivity along the perivascular space in relation to AD severity. CONCLUSION Activity of the glymphatic system may be evaluated with diffusion images. Lower diffusivity along the perivascular space on DTI-APLS seems to reflect impairment of the glymphatic system. This method may be useful for evaluating the activity of the glymphatic system.
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Affiliation(s)
- Toshiaki Taoka
- Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Yoshitaka Masutani
- Department of Biomedical Information Sciences, Graduate School of Information Sciences, Hiroshima City University, 3-4-1, Ozuka-Higashi, Asa-Minami-Ku, Hiroshima, 731-3194, Japan
| | - Hisashi Kawai
- Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Toshiki Nakane
- Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kiwamu Matsuoka
- Department of Psychiatry, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Fumihiko Yasuno
- Department of Psychiatry, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Intrathecal Contrast-Enhanced Magnetic Resonance Imaging–Related Brain Signal Changes. Invest Radiol 2017; 52:195-197. [DOI: 10.1097/rli.0000000000000327] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Misconnections in the Critically Ill: Injection of High-Dose Gadolinium into an External Ventricular Drain. ACTA ACUST UNITED AC 2016; 6:121-3. [PMID: 26462163 DOI: 10.1213/xaa.0000000000000230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report an unfortunate case of accidental administration of intrathecal gadolinium through an external ventricular drain in a postcraniotomy patient during magnetic resonance imaging of the brain. The incident occurred after the venous contrast line was connected mistakenly to the ventricular drainage catheter. The patient subsequently developed confusion, aphasia, and right facial droop with new computed tomography evidence of diffuse cerebral edema and stroke. Review of the magnetic resonance image revealed the inappropriate presence of subarachnoid gadolinium. Despite all interventions, the patient developed irreversible neurologic disability. We address the clinical sequelae, management strategies, and factors contributing to the catheter misconnection that led to this event.
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Mavioglu H, Tuglu I, Temiz C, Ozbilgin K, Cilaker S, Selcuki D, Selcuki M. Clinical and Histological Changes of Intrathecally Administered Gadopentate Dimeglumine (Gd-DTPA) in Normal Rats. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140090501800501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: This study is carried out to explore clinical and histological changes induced in rats by intrathecal administration of Gd-DTPA via suboccipital spinal injection. 2.5, 5, 10 μmol/g-brain of Gd-DTPA were injected intrathecally to 43 adult male rats and sucrose as control solution with same volume and osmolarity were injected to 18 rats. Animals were sacrificed on day 4 and 14. Sections from the cortex, brain stem, cerebellum and medulla spinalis were obtained to examine for cell loss and apoptosis. In this study, no clinical abnormalities were observed in 69.8 % of rats of Gd-DTPA group and in 83.3 % of rats of sucrose group. Transient neurological signs such as ataxia and paresis were seen in 11.6 % of rats in the Gd-DTPA group and in 5.5 % of rats in the sucrose group. They were seen more frequently in the Gd-DTPA group especially in the highest dose and volume. Histological examination did not revealed necrosis or apoptosis in both groups. This study suggests that intrathecally administered Gd-DTPA may be safe in humans when lower doses per gram of brain are used than rats.
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Affiliation(s)
- H. Mavioglu
- Celal Bayar University, Faculty of Medicine, Department of Neurology; Manisa
| | - I. Tuglu
- Department of Histology & Embryology; Manisa
| | - C. Temiz
- Celal Bayar University, Faculty of Medicine, Department of Neurosurgery; Manisa, Turkey
| | - K. Ozbilgin
- Department of Histology & Embryology; Manisa
| | - S. Cilaker
- Department of Histology & Embryology; Manisa
| | - D. Selcuki
- Celal Bayar University, Faculty of Medicine, Department of Neurology; Manisa
| | - M. Selcuki
- Celal Bayar University, Faculty of Medicine, Department of Neurosurgery; Manisa, Turkey
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Kartamihardja AAP, Nakajima T, Kameo S, Koyama H, Tsushima Y. Distribution and clearance of retained gadolinium in the brain: differences between linear and macrocyclic gadolinium based contrast agents in a mouse model. Br J Radiol 2016; 89:20160509. [PMID: 27459250 DOI: 10.1259/bjr.20160509] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To investigate the distribution and clearance of retained gadolinium (Gd) in various parts of the brain after intravenously administering a Gd-based contrast agent (GBCA) in normal and renal failure mouse models. METHODS Two different mouse models: normal (n = 12) and renal failure (n = 12) were used. Clinical GBCAs (Gd-DTPA-BMA, 5 mmol kg(-1), or Gd-DOTA, 5 mmol kg(-1)) were intravenously administered five times per week for 4 weeks. Both groups were divided into two subgroups based on the time point for sample collection: 3 days (3d) and 45 days (45d) after the last injection. Normal saline (5 ml kg(-1)) was intravenously administered to mice of the control groups in the same manner. Samples of the following parts of the mouse brain were obtained on dissection: olfactory bulb, cerebral cortex, hippocampus, thalamus, mid-brain, cerebellum, pons and medulla. (158)Gd concentrations in each sample were quantified using inductively coupled plasma mass spectrometry. RESULTS The olfactory bulb had the highest Gd concentration in both Gd-DTPA-BMA and Gd-DOTA groups. Gd retention was higher in the Gd-DTPA-BMA group than in the Gd-DOTA group (p < 0.01). In the Gd-DTPA-BMA group, Gd retention in the 3d subgroups of normal and renal failure models were similar (p = 0.4). At 45d, Gd in the Gd-DTPA-BMA group was not eliminated from the renal failure model (p = 0.1), while that in the Gd-DOTA group was eliminated from both the normal and renal failure mouse models (p < 0.01). CONCLUSION Gd distributions in the brain for both groups were similar, regardless of the renal function and GBCA type. The Gd concentration was highest in the olfactory bulb of both groups. In the Gd-DOTA group, Gd was eliminated from the brain in both mouse models, while in the Gd-DTPA-BMA group, Gd clearance was limited. ADVANCES IN KNOWLEDGE Gd concentration in the brain was not affected by renal function. The clearance of Gd from linear GBCA was limited in both the normal and impaired renal function mouse models.
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Affiliation(s)
- A Adhipatria P Kartamihardja
- 1 Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.,2 Nuclear Medicine and Molecular Imaging Department, Universitas Padjadjaran, Bandung, Indonesia
| | - Takahito Nakajima
- 1 Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Satomi Kameo
- 3 Department of Public Health, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Koyama
- 3 Department of Public Health, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- 1 Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.,4 Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Japan
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Abstract
Two patients with cerebrospinal fluid (CSF) leak, one at the level of fourth thoracic spine and another with undetermined level of leak, presented with paradoxical postural headaches in that the headaches were present when in a horizontal position and resolved if the patients were upright. One patient improved spontaneously and the other responded to a targeted epidural blood patch. Paradoxical postural headache is yet another headache type that can be associated with CSF leak and CSF volume depletion. Its mechanism is uncertain, but it could be related to congestion and dilatation of cerebral venous sinuses and large veins.
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Affiliation(s)
- B Mokri
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
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31
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Santin MD, Vandenberghe ME, Herard AS, Pradier L, Cohen C, Debeir T, Delzescaux T, Rooney T, Dhenain M. In Vivo Detection of Amyloid Plaques by Gadolinium-Stained MRI Can Be Used to Demonstrate the Efficacy of an Anti-amyloid Immunotherapy. Front Aging Neurosci 2016; 8:55. [PMID: 27047372 PMCID: PMC4802995 DOI: 10.3389/fnagi.2016.00055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/08/2016] [Indexed: 01/05/2023] Open
Abstract
Extracellular deposition of β amyloid plaques is an early event associated to Alzheimer’s disease. Here, we have used in vivo gadolinium-stained high resolution (29∗29∗117 μm3) magnetic resonance imaging (MRI) to follow-up in a longitudinal way individual amyloid plaques in APP/PS1 mice and evaluate the efficacy of a new immunotherapy (SAR255952) directed against protofibrillar and fibrillary forms of Aβ. APP/PS1 mice were treated for 5 months between the age of 3.5 and 8.5 months. SAR255952 reduced amyloid load in 8.5-months-old animals, but not in 5.5-months animals compared to mice treated with a control antibody (DM4). Histological evaluation confirmed the reduction of amyloid load and revealed a lower density of amyloid plaques in 8.5-months SAR255952-treated animals. The longitudinal follow-up of individual amyloid plaques by MRI revealed that plaques that were visible at 5.5 months were still visible at 8.5 months in both SAR255952 and DM4-treated mice. This suggests that the amyloid load reduction induced by SAR255952 is related to a slowing down in the formation of new plaques rather than to the clearance of already formed plaques.
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Affiliation(s)
- Mathieu D Santin
- Centre National de la Recherche Scientifique, Université Paris-Sud, Université Paris-Saclay, UMR 9199, Neurodegenerative Diseases LaboratoryFontenay-aux-Roses, France; Commissariat à l'Energie Atomique et aux Energies Alternatives, Direction de la Recherche Fondamentale, Institut d'Imagerie Biomédicale, MIRCenFontenay-aux-Roses, France
| | - Michel E Vandenberghe
- Centre National de la Recherche Scientifique, Université Paris-Sud, Université Paris-Saclay, UMR 9199, Neurodegenerative Diseases LaboratoryFontenay-aux-Roses, France; Commissariat à l'Energie Atomique et aux Energies Alternatives, Direction de la Recherche Fondamentale, Institut d'Imagerie Biomédicale, MIRCenFontenay-aux-Roses, France
| | - Anne-Sophie Herard
- Centre National de la Recherche Scientifique, Université Paris-Sud, Université Paris-Saclay, UMR 9199, Neurodegenerative Diseases LaboratoryFontenay-aux-Roses, France; Commissariat à l'Energie Atomique et aux Energies Alternatives, Direction de la Recherche Fondamentale, Institut d'Imagerie Biomédicale, MIRCenFontenay-aux-Roses, France
| | - Laurent Pradier
- Sanofi, Neurodegeneration and Pain Unit Chilly-Mazarin, France
| | - Caroline Cohen
- Sanofi, Neurodegeneration and Pain Unit Chilly-Mazarin, France
| | | | - Thierry Delzescaux
- Centre National de la Recherche Scientifique, Université Paris-Sud, Université Paris-Saclay, UMR 9199, Neurodegenerative Diseases LaboratoryFontenay-aux-Roses, France; Commissariat à l'Energie Atomique et aux Energies Alternatives, Direction de la Recherche Fondamentale, Institut d'Imagerie Biomédicale, MIRCenFontenay-aux-Roses, France
| | - Thomas Rooney
- Sanofi, Neurodegeneration and Pain Unit Chilly-Mazarin, France
| | - Marc Dhenain
- Centre National de la Recherche Scientifique, Université Paris-Sud, Université Paris-Saclay, UMR 9199, Neurodegenerative Diseases LaboratoryFontenay-aux-Roses, France; Commissariat à l'Energie Atomique et aux Energies Alternatives, Direction de la Recherche Fondamentale, Institut d'Imagerie Biomédicale, MIRCenFontenay-aux-Roses, France
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Watanabe T, Frahm J, Michaelis T. In Vivo Brain MR Imaging at Subnanoliter Resolution: Contrast and Histology. Magn Reson Med Sci 2015; 15:11-25. [PMID: 26346405 DOI: 10.2463/mrms.2015-0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This article provides an overview of in vivo magnetic resonance (MR) imaging contrasts obtained for mammalian brain in relation to histological knowledge. Emphasis is paid to the (1) significance of high spatial resolution for the optimization of T1, T2, and magnetization transfer contrast, (2) use of exogenous extra- and intracellular contrast agents for validating endogenous contrast sources, and (3) histological structures and biochemical compounds underlying these contrasts and (4) their relevance to neuroradiology. Comparisons between MR imaging at subnanoliter resolution and histological data indicate that (a) myelin sheaths, (b) nerve cells, and (c) the neuropil are most responsible for observed MR imaging contrasts, while (a) diamagnetic macromolecules, (b) intracellular paramagnetic ions, and (c) extracellular free water, respectively, emerge as the dominant factors. Enhanced relaxation rates due to paramagnetic ions, such as iron and manganese, have been observed for oligodendrocytes, astrocytes, microglia, and blood cells in the brain as well as for nerve cells. Taken together, a plethora of observations suggests that the delineation of specific structures in high-resolution MR imaging of mammalian brain and the absence of corresponding contrasts in MR imaging of the human brain do not necessarily indicate differences between species but may be explained by partial volume effects. Second, paramagnetic ions are required in active cells in vivo which may reduce the magnetization transfer ratio in the brain through accelerated T1 recovery. Third, reductions of the magnetization transfer ratio may be more sensitive to a particular pathological condition, such as astrocytosis, microglial activation, inflammation, and demyelination, than changes in relaxation. This is because the simultaneous occurrence of increased paramagnetic ions (i.e., shorter relaxation times) and increased free water (i.e., longer relaxation times) may cancel T1 or T2 effects, whereas both processes reduce the magnetization transfer ratio.
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Affiliation(s)
- Takashi Watanabe
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie
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Griauzde J, Gemmete JJ, Pandey AS, Chaudhary N. Intrathecal preservative-free normal saline challenge magnetic resonance myelography for the identification of cerebrospinal fluid leaks in spontaneous intracranial hypotension. J Neurosurg 2015; 123:732-6. [DOI: 10.3171/2014.12.jns142057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
A CSF leak can be difficult to locate in patients who present with spontaneous intracranial hypotension (SIH). The purpose of this case series was to describe the authors’ experience with intrathecal preservative-free normal saline challenge coupled with contrast-enhanced MR myelography (CEMRM), which was used to provoke and detect a CSF leakage site in patients with SIH.
METHODS
The authors performed a retrospective review of the records of patients who underwent preservative-free normal saline challenge followed by intrathecal gadolinium (Gd) contrast infusion and MR myelography from 2010 to 2012.
RESULTS
The records survey identified 5 patients who underwent 6 procedures. Intrathecal preservative-free normal saline challenge followed by CEMRM identified a CSF leak during 5 of the 6 procedures. Previous CT myelograms were available from 4 patients, which did not reveal a leakage site. A CT myelogram of 1 patient showed a single leak, but the authors’ saline challenge-CEMRM technique identified multiple additional leakage sites. Three patients exhibited transient postprocedural symptoms related to the saline infusion, but no long-term or permanent adverse effects related to the procedure were observed.
CONCLUSIONS
Instillation of preservative-free normal saline into the thecal sac followed by intrathecal Gd infusion is a safe technique that may increase the detection of a CSF leak on MR myelography images in patients with SIH.
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Higuera-Calleja J, Góngora-Rivera F, Soto-Hernández JL, Del-Brutto OH, Moreno-Andrade T, Gutiérrez-Alvarado R, Rodríguez-Carbajal J. Intrathecal gadodiamide for identifying subarachnoid and ventricular neurocysticercosis. Trop Med Int Health 2015; 20:930-3. [PMID: 25726723 DOI: 10.1111/tmi.12495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Some neurocysticercosis cysts may remain hidden despite novel MRI sequences. This study evaluates the diagnostic value of gadodiamide (GDD)-contrasted MRI cisternography in selected cases of neurocysticercosis. METHODS We included patients aged 18-65 years with a probable diagnosis of subarachnoid cysticercosis in whom previous neuroimaging studies failed to demonstrate the presence of cysts. One millilitre of GDD was administered intrathecally as a contrast agent with subsequent performance of MRI. RESULTS Fourteen patients were included. Optimal contrast diffusion was achieved in nine patients, and partial diffusion was achieved in 4. Intracranial vesicles were identified in 10 patients, with the presence of more than 60 basal subarachnoid vesicles being revealed in all, with five cysts in the fourth ventricle in four patients and a floating cyst in the lateral ventricle in one. In one case, intrathecal GDD demonstrated spinal cysticercosis. No adverse events were reported after intrathecal GDD administration. CONCLUSIONS Intrathecal GDD administration is useful for the diagnosis of subarachnoid and intraventricular neurocysticercosis and can be used to improve diagnostic accuracy in selected cases.
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Affiliation(s)
- Jesús Higuera-Calleja
- Department of Neuroradiology, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Distrito Federal, México
| | - Fernando Góngora-Rivera
- Department of Neurology, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Distrito Federal, México.,Department of Neurology, Hospital Universitario José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - José Luis Soto-Hernández
- Department of Infectious Diseases, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Distrito Federal, México
| | - Oscar H Del-Brutto
- School of Medicine, Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
| | - Talía Moreno-Andrade
- Department of Neuroradiology, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Distrito Federal, México
| | - Ramón Gutiérrez-Alvarado
- Department of Neuroradiology, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Distrito Federal, México
| | - Jesús Rodríguez-Carbajal
- Department of Neuroradiology, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Distrito Federal, México
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Abstract
Spontaneous intracranial hypotension (SIH) is a condition caused by spontaneous spinal cerebrospinal fluid (CSF) leaks. Clinically, it is characterized by orthostatic headache and may respond well to epidural blood patch. Other neurological presentations of SIH include diplopia, memory loss, hearing deficits, Parkinsonism, ataxia, obtundation and even coma.Magnetic resonance imaging (MRI) is crucial in the diagnosis of this condition. Typical radiological features include diffuse pachymeningeal enhancement, descent of the cerebellar tonsil, a decrease in the size of prepontine and perichiasmatic cisterns, and subdural fluid collections. However, radiological imaging such as radionuclide cisternography or spinal MRI are not reliable in detecting the site of leakage. Myelography with iodinated contrast followed by thin-cut computed tomography (CT) or MRI of the entire spine has been shown as the technique of choice in defining the location of the CSF leak.
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Mehdi E, Alkan A, Yetis H, Aralasmak A, Ozdemir H. CSF otorhinorrhea in a child with inner ear dysplasia: diagnosis with T2-weighted and intrathecal contrast-enhanced MR cisternography. Jpn J Radiol 2014; 32:437-40. [DOI: 10.1007/s11604-014-0316-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/02/2014] [Indexed: 12/01/2022]
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Watanabe T, Frahm J, Michaelis T. Cell layers and neuropil: contrast-enhanced MRI of mouse brain in vivo. NMR IN BIOMEDICINE 2013; 26:1870-1878. [PMID: 24142688 DOI: 10.1002/nbm.3042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 06/02/2023]
Abstract
Contrast-enhanced T₁- and T₂-weighted MRI at 9.4 T and in-plane resolutions of 25 and 30 µm has been demonstrated to differentiate between neural tissues in mouse brain in vivo, including granule cell layers, principal cell layers, general neuropil, specialized neuropil and white matter. In T₁-weighted MRI of the olfactory bulb, hippocampus and cerebellum, contrast obtained by the intracranial administration of gadopentetate dimeglumine (Gd-DTPA) reflects the extra- and intracellular spaces of gray matter in agreement with histological data. General neuropil areas are highlighted, whereas other tissues present with lower signal intensities. The induced contrast is similar to that in plain T₂-weighted MRI, but offers a 16-30-fold higher contrast-to-noise ratio. Systemic administration of manganese chloride increases the signal-to-noise ratio in T₁-weighted MRI to a significantly greater extent in principal cell layers and specialized neuropil than in granule cell layers, whereas gadolinium-enhanced MRI indicates no larger intracellular spaces in these tissues. Granule cell layers are enhanced no more than general neuropil by manganese, whereas gadolinium-enhanced MRI indicates significantly larger intracellular spaces in the cell layers. These discrepancies suggest that the signal increase after manganese administration reflects cellular activity which is disproportionate to the intracellular space. As a result, principal cell layers and specialized neuropil become highlighted, whereas granule cell layers, general neuropil and white matter present with lower signal intensities.
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Samardzic D, Thamburaj K. Magnetic Resonance Characteristics and Susceptibility Weighted Imaging of the Brain in Gadolinium Encephalopathy. J Neuroimaging 2013; 25:136-9. [DOI: 10.1111/jon.12067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 05/16/2013] [Accepted: 06/30/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Dejan Samardzic
- Department of Radiology; Penn State Milton S Hershey Medical Center; Penn State College of Medicine; Hershey PA 17033
| | - Krishnamoorthy Thamburaj
- Department of Radiology; Penn State Milton S Hershey Medical Center; Penn State College of Medicine; Hershey PA 17033
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Tabakow P, Czyz M, Szewczyk P, Weiser A, Jarmundowicz W. Usefulness of intraoperative magnetic resonance ventriculography during endoscopic third ventriculostomy. Neurosurgery 2013; 73:730-8; discussion 738. [PMID: 23839517 DOI: 10.1227/neu.0000000000000063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic third ventriculostomy (ETV) is the preferred method for the treatment of noncommunicating hydrocephalus. The different success rates of ETV indicate the difficulties in predicting the success of this procedure. OBJECTIVE To show the usefulness of intraoperative ventriculography performed by the low-field 0.15-T magnetic resonance imager Polestar N20 during ETV. METHODS The study was conducted in 11 patients with noncommunicating hydrocephalus caused by tumors or cysts of the third ventricle (n = 5), nontumoral stenosis of the sylvian aqueduct (n = 3), and fourth ventricle outlet obstruction (n = 3). Intraoperative magnetic resonance (iMR) ventriculography was performed before and after the ETV. RESULTS In each case, iMR-ventriculography was a safe procedure and determined the exact site of obstruction of cerebrospinal fluid flow. In all cases, iMR-ventriculography performed after ETV showed with the greatest accuracy the patency of the performed fenestrations, demonstrating in 9 patients good flow of the contrast from the third ventricle to the basal cisterns, restricted flow in 1 patient, and no flow in 1 patient. The results of ventriculography were consistent with the postoperative neurological status of operated-on patients. In 3 patients, the opinion of the surgeons about the patency of endoscopic fenestration, based on intraoperative observation of the third ventricle floor, was inconsistent with the results from iMR-ventriculography. CONCLUSION Low-field iMR-ventriculography is a safe procedure that can be successfully applied during ETV to determine the site of obstruction in hydrocephalus and the patency of performed ventricle fenestration.
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Affiliation(s)
- Pawel Tabakow
- Departments of †Neurosurgery and ‡General Radiology, Interventional Radiology, and Neuroradiology, Wrocław Medical University, Wrocław, Poland
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Mokri B. Spontaneous Low Pressure, Low CSF Volume Headaches: Spontaneous CSF Leaks. Headache 2013; 53:1034-53. [DOI: 10.1111/head.12149] [Citation(s) in RCA: 196] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Bahram Mokri
- Department of Neurology; Mayo Clinic; Rochester; MN; USA
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Muñoz A, Mateo I, Lorenzo V, Martinez J, Crespo J. MR cisternography/myelography of post-traumatic spinal CSF fistulae and meningeal lesions in small animals. Acta Radiol 2013; 54:569-75. [PMID: 23550181 DOI: 10.1258/ar.2012.120264] [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] [Indexed: 11/18/2022]
Abstract
BACKGROUND The diagnosis of post-traumatic spinal cerebrospinal fluid (CSF) fistulae due to dural tears or lesions remains a challenge. Thus far, CT myelography is the standard test used to diagnose these complications. PURPOSE To evaluate the diagnostic ability of gadolinium-enhanced MR cisternography/myelography (intrathecal gadopentate dimeglumine or Gd-DTPA) in small animals that had experienced accidental spinal trauma. MATERIAL AND METHODS Four dogs and one cat suffered traumatic accidents resulting in neurological deficits underwent spinal MRI with intrathecal Gd-DTPA after routine plain films and MR images. RESULTS T2-weighted SE images showed high water content in the epidural space or in the surroundings of the vertebrae in four animals. MR myelography revealed CSF leakage in all of them. In two animals CSF leaks were observed exuding from the spinal canal and tracking towards adjacent loose fat and interfascial planes. In two other animals Gd-DTPA extravasation was diffusely collected in paraspinal tissues around the vertebral arch. In the fifth animal a focal pseudomeningocele was observed adjacent to the traumatized region. CONCLUSION Intrathecal administration of Gd-DTPA is an effective method to reveal and confirm post-traumatic spinal CSF fistulae or other dural lesions in animals with potential application in humans.
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Affiliation(s)
- Alberto Muñoz
- Facultad de Medicina, Universidad Complutense de Madrid - Radiology, Madrid, Spain
| | - Isidro Mateo
- Facultad de Medicina, Universidad Complutense de Madrid - Radiology, Madrid, Spain
| | - Valentina Lorenzo
- Facultad de Medicina, Universidad Complutense de Madrid - Radiology, Madrid, Spain
| | - Jeronimo Martinez
- Facultad de Medicina, Universidad Complutense de Madrid - Radiology, Madrid, Spain
| | - Jose Crespo
- Facultad de Medicina, Universidad Complutense de Madrid - Radiology, Madrid, Spain
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Ziu M, Savage JG, Jimenez DF. Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures. Neurosurg Focus 2013; 32:E3. [PMID: 22655692 DOI: 10.3171/2012.4.focus1244] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebrospinal fluid rhinorrhea is a serious and potentially fatal condition because of an increased risk of meningitis and brain abscess. Approximately 80% of all cases occur in patients with head injuries and craniofacial fractures. Despite technical advances in the diagnosis and management of CSF rhinorrhea caused by craniofacial injury through the introduction of MRI and endoscopic extracranial surgical approaches, difficulties remain. The authors review here the pathophysiology, diagnosis, and management of CSF rhinorrhea relevant exclusively to traumatic anterior skull base injuries and attempt to identify areas in which further work is needed.
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Affiliation(s)
- Mateo Ziu
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA.
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Watanabe T, Frahm J, Michaelis T. Myelin mapping in the central nervous system of living mice using contrast-enhanced magnetization transfer MRI. Neuroimage 2012; 63:812-7. [PMID: 22796983 DOI: 10.1016/j.neuroimage.2012.06.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/13/2012] [Accepted: 06/15/2012] [Indexed: 11/17/2022] Open
Abstract
This work compares magnetization transfer (MT) MRI of living mice with contrast-enhanced MT MRI using intraventricular administration of gadopentetate dimeglumine (Gd-DTPA), systemic administration of MnCl2, and both. In MT MRI at 9.4 T, the contrast-to-noise ratio (CNR) between white matter (WM) and gray matter (GM) increased by 85% after Gd-DTPA injection into the lateral ventricle. When applied in conjunction with manganese-enhanced MT MRI (117 μm isotropic resolution, 6 min measuring time), Gd-DTPA boosted the CNR increase from +56% to +117%. Additional T1 measurements at 2.35 T revealed that intraventricular Gd-DTPA shortens the T1 of GM much more than that of WM, which corresponds to estimated extracellular spaces of 26% in GM and only 15% in WM. These results explain the additional MT contrast enhancement by Gd-DTPA and demonstrate that the T1 shortening by intracellular Mn2+ is well complemented by extracellular Gd-DTPA. The data suggest a high myelin and low water content to hinder access of hydrophilic paramagnetic agents, so that the resulting differential accumulation effectively reduces the MT saturation in water-rich tissues and thereby facilitates the mapping of myelin-rich tissues. Finally, a 156% CNR increase between GM and WM for contrast-enhanced MT MRI at 9.4T using both Gd-DTPA and manganese allowed for 60μm isotropic resolution (102 min measuring time), which delineated myelinated fibers and layers even within GM areas such as the thalamus and cerebellar cortex. Improved MT contrasts were also seen in the cervical spinal cord.
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Affiliation(s)
- Takashi Watanabe
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.
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Albes G, Weng H, Horvath D, Musahl C, Bäzner H, Henkes H. Detection and treatment of spinal CSF leaks in idiopathic intracranial hypotension. Neuroradiology 2012; 54:1367-73. [PMID: 22766975 DOI: 10.1007/s00234-012-1055-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
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Algin O, Turkbey B. Intrathecal gadolinium-enhanced MR cisternography: a comprehensive review. AJNR Am J Neuroradiol 2012; 34:14-22. [PMID: 22268089 DOI: 10.3174/ajnr.a2899] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CE-MRC has been in use for the past 15 years and was reported to be a useful method in the evaluation of CSF disorders and hydrocephalus. The use of CE-MRC in conjunction with other MR imaging techniques has been shown to be effective in selected cases for the evaluation of several disorders of cerebrospinal system. CE-MRC has certain advantages over other cisternographic studies with fewer side effects if performed properly. Although intrathecal Gd administration is not widely accepted yet, several recent studies have reported the safety of small-dose intrathecal gadolinium injection. In this review, we describe CE-MRC and review recent applications in several clinical conditions.
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Affiliation(s)
- O Algin
- Department of Radiology, Atatürk Training and Research Hospital, Bilkent, Ankara, Turkey.
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Akbar JJ, Luetmer PH, Schwartz KM, Hunt CH, Diehn FE, Eckel LJ. The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2011; 33:535-40. [PMID: 22173753 DOI: 10.3174/ajnr.a2815] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Localization of spinal CSF leaks in CSF hypovolemia is critical in directing focal therapy. In this retrospective review, our aim was to determine whether GdM was helpful in confirming and localizing spinal CSF leaks in patients in whom no leak was identified on a prior CTM. MATERIALS AND METHODS Forty-one symptomatic patients with clinical suspicion of SIH were referred for GdM after undergoing at least 1 CTM between February 2002 and August 2010. A retrospective review of the imaging and electronic medical records was performed on each patient. RESULTS In 17 of the 41 patients (41%), GdM was performed for follow-up of a previously documented leak at CTM. In the remaining 24 patients (59%), in whom GdM was performed for a suspected CSF leak, which was not identified on CTM, GdM localized the CSF leak in 5 of 24 patients (21%). In 1 of these 5 patients, GdM detected the site of leak despite negative findings on brain MR imaging, spine MR imaging, and CTM of the entire spine. Sixteen of 17 patients with previously identified leaks underwent interval treatment, and leaks were again identified in 12 of 17 (71%). CONCLUSIONS GdM is a useful technique in the highly select group of patients who have debilitating symptoms of SIH, a high clinical index of suspicion of spinal CSF leak, and no demonstrated leak on conventional CTM. Intrathecal injection of gadolinium contrast remains an off-label use and should be reserved for those patients who fail conventional CTM.
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Affiliation(s)
- J J Akbar
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Tosun O, Kilic Ozmen E, Akgunduz G, Karaoglanoglu M, Stachura K. Which is the best radiological technique to demonstrate spontaneous or endoscopic third ventriculostomy? Neurol Neurochir Pol 2011; 45:309-10; author reply 310. [PMID: 21866489 DOI: 10.1016/s0028-3843(14)60085-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Algin O, Hakyemez B, Parlak M. Phase-contrast MRI and 3D-CISS versus contrast-enhanced MR cisternography for the detection of spontaneous third ventriculostomy. J Neuroradiol 2010; 38:98-104. [PMID: 20627312 DOI: 10.1016/j.neurad.2010.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 02/24/2010] [Accepted: 03/25/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the diagnostic efficacies of phase-contrast MRI (PC-MRI) and three-dimensional constructive interference in steady-state (3D-CISS) sequence for the detection of spontaneous third ventriculostomy (STV) on the basis of contrast-enhanced MR cisternography (MRC). PATIENTS AND METHODS Eleven obstructive hydrocephalus patients with clinically-radiologically suspected STV and ten controls were examined by PC-MRI, 3D-CISS and MRC. PC-MRI and 3D-CISS sequence were applied to view the third ventricle and basal cisterns. Following injection of 0.5-1ml intrathecal Gd-DTPA injection, postcontrast MRC images were obtained in three planes. Presence of STV was scored as follows: grade 0, no existence of STV; grade 1, STV present. Results of PC-MRI and 3D-CISS were compared with the MRC findings. RESULTS In PC-MRI, five patients were assessed as grade 0 and six cases grade 1. As a result of 3D-CISS sequence, eight cases were evaluated as grade 0 and three cases grade 1. Based on MRC, nine cases were assessed as grade 0 and two cases grade 1. False positivity was found in four cases by PC-MRI and in one case by 3D-CISS. The sensitivity, specificity and accuracy of PC-MRI and 3D-CISS sequence regarding demonstration of STV, were 100, 100, 56, 89, 64, and 91% respectively. DISCUSSION PC-MRI and 3D-CISS are helpful in confirming the STV. PC-MRI and 3D-CISS should be the first preference. If PC-MRI and 3D-CISS give negative results, then MRC is not required. MRC should be performed on patients who demonstrate suspected STV findings on PC-MRI and 3D-CISS sequences. MRC may prevent false positive results.
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Affiliation(s)
- O Algin
- Department of Radiology, Atatürk Training and Research Hospital, Bilkent, Ankara, Turkey.
| | - B Hakyemez
- Department of Neuroradiology, Uludag University Medical Faculty, Gorukle, Bursa, Turkey
| | - M Parlak
- Department of Neuroradiology, Uludag University Medical Faculty, Gorukle, Bursa, Turkey
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Park KW, Im SB, Kim BT, Hwang SC, Park JS, Shin WH. Neurotoxic manifestations of an overdose intrathecal injection of gadopentetate dimeglumine. J Korean Med Sci 2010; 25:505-8. [PMID: 20191058 PMCID: PMC2826734 DOI: 10.3346/jkms.2010.25.3.505] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 01/31/2009] [Indexed: 12/04/2022] Open
Abstract
The intravenous administration of gadopentetate dimeglumine (GD) is relatively safe and rarely causes systemic toxicity in the course of routine imaging studies. However, the general safety of intrathecal GD has not been established. We report a very rare case of an overdose intrathecal GD injection presenting with neurotoxic manifestations, including a decreased level of consciousness, global aphasia, rigidity, and visual disturbance.
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Affiliation(s)
- Kwan-Woong Park
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Soo-Bin Im
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun-Chul Hwang
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jong-Sun Park
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Won-Han Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Diener HC, Johansson U, Dodick DW. Headache attributed to non-vascular intracranial disorder. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:547-587. [PMID: 20816456 DOI: 10.1016/s0072-9752(10)97050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This chapter deals with non-vascular intracranial disorders resulting in headache. Headache attributed to high or low cerebrospinal fluid pressure is separated into headache attributed to idiopathic intracranial hypertension (IIH), headache attributed to intracranial hypertension secondary to metabolic, toxic, or hormonal causes, headache attributed to intracranial hypertension secondary to hydrocephalus, post-dural puncture headache, cerebrospinal fluid (CSF) fistula headache, headache attributed to spontaneous (or idiopathic) low CSF pressure. Headache attributed to non-infectious inflammatory disease can be caused by neurosarcoidosis, aseptic (non-infectious) meningitis or lymphocytic hypophysitis. Headache attributed to intracranial neoplasm can be caused by increased intracranial pressure or hydrocephalus caused by neoplasm or attributed directly to neoplasm or carcinomatous meningitis. Other causes of headache include hypothalamic or pituitary hyper- or hyposecretion and intrathecal injection. Headache attributed to epileptic seizure is separated into hemicrania epileptica and post-seizure headache. Finally headache attributed to Chiari malformation type I (CM1) and the syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) are described.
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