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Lang M, Clifford B, Lo WC, Applewhite BP, Tabari A, Filho ALMG, Hosseini Z, Longo MGF, Cauley SF, Setsompop K, Bilgic B, Feiweier T, Lev MH, Schaefer PW, Rapalino O, Huang SY, Conklin J. Clinical Evaluation of a 2-Minute Ultrafast Brain MR Protocol for Evaluation of Acute Pathology in the Emergency and Inpatient Settings. AJNR Am J Neuroradiol 2024; 45:379-385. [PMID: 38453413 DOI: 10.3174/ajnr.a8143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/07/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE The use of MR imaging in emergency settings has been limited by availability, long scan times, and sensitivity to motion. This study assessed the diagnostic performance of an ultrafast brain MR imaging protocol for evaluation of acute intracranial pathology in the emergency department and inpatient settings. MATERIALS AND METHODS Sixty-six adult patients who underwent brain MR imaging in the emergency department and inpatient settings were included in the study. All patients underwent both the reference and the ultrafast brain MR protocols. Both brain MR imaging protocols consisted of T1-weighted, T2/T2*-weighted, FLAIR, and DWI sequences. The ultrafast MR images were reconstructed by using a machine-learning assisted framework. All images were reviewed by 2 blinded neuroradiologists. RESULTS The average acquisition time was 2.1 minutes for the ultrafast brain MR protocol and 10 minutes for the reference brain MR protocol. There was 98.5% agreement on the main clinical diagnosis between the 2 protocols. In head-to-head comparison, the reference protocol was preferred in terms of image noise and geometric distortion (P < .05 for both). The ultrafast ms-EPI protocol was preferred over the reference protocol in terms of reduced motion artifacts (P < .01). Overall diagnostic quality was not significantly different between the 2 protocols (P > .05). CONCLUSIONS The ultrafast brain MR imaging protocol provides high accuracy for evaluating acute pathology while only requiring a fraction of the scan time. Although there was greater image noise and geometric distortion on the ultrafast brain MR protocol images, there was significant reduction in motion artifacts with similar overall diagnostic quality between the 2 protocols.
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Affiliation(s)
- Min Lang
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Bryan Clifford
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Wei-Ching Lo
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Brooks P Applewhite
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Azadeh Tabari
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | | | - Zahra Hosseini
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Maria Gabriela Figueiro Longo
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Stephen F Cauley
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kawin Setsompop
- Departments of Radiology and Electrical Engineering (K.S.), Stanford University, Stanford, California
| | - Berkin Bilgic
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Michael H Lev
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Pamela W Schaefer
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Otto Rapalino
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Susie Y Huang
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - John Conklin
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
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Ji X, Zhou Y, Gao Q, He H, Wu Z, Feng B, Mei Y, Cheng Y, Zhou W, Chen Y, Xiong M. Functional reconstruction of the basal ganglia neural circuit by human striatal neurons in hypoxic-ischaemic injured brain. Brain 2022; 146:612-628. [PMID: 36516880 PMCID: PMC9924911 DOI: 10.1093/brain/awac358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/16/2022] [Accepted: 09/09/2022] [Indexed: 12/16/2022] Open
Abstract
Perinatal hypoxic-ischaemic encephalopathy is the leading cause of neonatal death and permanent neurological deficits, while the basal ganglia is one of the major nuclei that is selectively and greatly affected in the brains of hypoxic-ischaemic encephalopathy patients, especially in severe cases. Human embryonic stem cell-derived neurons have shown great potential in different types of brain disorders in adults. However, it remains unknown whether and how grafted human embryonic stem cell-derived neurons can repair immature brains with hypoxic-ischaemic encephalopathy. Here, by administrating genetically labelled human embryonic stem cell-derived striatal neural progenitors into the ipsilateral striatum of hypoxic-ischaemic encephalopathy-injured mice, we found that the grafted cells gradually matured into GABA spiny projection neurons morphologically and electrophysiologically, and significantly rescued the area loss of hypoxic-ischaemic encephalopathy-injured brains. Intriguingly, using immunohistochemical staining combined with enhanced ascorbate peroxidase-based immunoelectron microscopy and rabies virus-mediated trans-synaptic tracing, we show that the grafts start to extend axonal projections to the endogenous target areas (globus pallidus externa, globus pallidus internus, substantia nigra), form synapses with host striatal, globus pallidus and nigra neurons, and receive extensive and stable synaptic inputs as early as 2 months post-transplantation. Importantly, we further demonstrated functional neural circuits re-established between the grafted neurons and host cortical, striatal and substantial nigra neurons at 3-6 months post-transplantation in the hypoxic-ischaemic encephalopathy-injured brain by optogenetics combined with electrophysiological recording. Finally, the transplanted striatal spiny projection neurons but not spinal GABA neurons restored the motor defects of hypoxic-ischaemic encephalopathy, which were reversed by clozapine-N-oxide-based inhibition of graft function. These findings demonstrate anatomical and functional reconstruction of the basal ganglia neural circuit including multiple loops by striatal spiny projection neurons in hypoxic-ischaemic encephalopathy-injured immature brains, which raises the possibility of such a cell replacement therapeutic strategy for hypoxic-ischaemic encephalopathy in neonates.
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Affiliation(s)
| | | | - Qinqin Gao
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Hui He
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China,University of Chinese Academy of Sciences, Beijing, China
| | - Ziyan Wu
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Ban Feng
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Yuting Mei
- Stem Cell Center, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Yan Cheng
- Stem Cell Center, Children’s Hospital of Fudan University, Shanghai 201102, China
| | - Wenhao Zhou
- Wenhao Zhou 399 Wanyuan Road, Children’s Hospital of Fudan University, Shanghai, China E-mail:
| | - Yuejun Chen
- Correspondence may also be addressed to: Yuejun Chen 320 Yueyang Road, Chinese Academy of Sciences, Shanghai, China E-mail:
| | - Man Xiong
- Correspondence to: Man Xiong 138 Medical College Road, Shanghai, Fudan University, China E-mail:
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Management of Hydrocephalus in Children: Anatomic Imaging Appearances of CSF Shunts and Their Complications. AJR Am J Roentgenol 2020; 216:187-199. [PMID: 33112667 DOI: 10.2214/ajr.20.22888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This article addresses the management of hydrocephalus and the CSF shunts used to treat this entity. CONCLUSION. CSF shunts have a high failure rate. Imaging plays a pivotal role in assessing CSF shunt failure and determining the need for surgical revision. An in-depth knowledge of CSF shunt components, their failure modes, and the corresponding findings on anatomic imaging studies is necessary to ensure timely diagnosis and prevent permanent neurologic damage.
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4
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Jabarkheel R, Tong E, Lee EH, Cullen TM, Yousaf U, Loening AM, Taviani V, Iv M, Grant GA, Holdsworth SJ, Vasanawala SS, Yeom KW. Variable Refocusing Flip Angle Single-Shot Imaging for Sedation-Free Fast Brain MRI. AJNR Am J Neuroradiol 2020; 41:1256-1262. [PMID: 32586967 DOI: 10.3174/ajnr.a6616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/18/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional single-shot FSE commonly used for fast MRI may be suboptimal for brain evaluation due to poor image contrast, SNR, or image blurring. We investigated the clinical performance of variable refocusing flip angle single-shot FSE, a variation of single-shot FSE with lower radiofrequency energy deposition and potentially faster acquisition time, as an alternative approach to fast brain MR imaging. MATERIALS AND METHODS We retrospectively compared half-Fourier single-shot FSE with half- and full-Fourier variable refocusing flip angle single-shot FSE in 30 children. Three readers reviewed images for motion artifacts, image sharpness at the brain-fluid interface, and image sharpness/tissue contrast at gray-white differentiation on a modified 5-point Likert scale. Two readers also evaluated full-Fourier variable refocusing flip angle single-shot FSE against T2-FSE for brain lesion detectability in 38 children. RESULTS Variable refocusing flip angle single-shot FSE sequences showed more motion artifacts (P < .001). Variable refocusing flip angle single-shot FSE sequences scored higher regarding image sharpness at brain-fluid interfaces (P < .001) and gray-white differentiation (P < .001). Acquisition times for half- and full-Fourier variable refocusing flip angle single-shot FSE were faster than for single-shot FSE (P < .001) with a 53% and 47% reduction, respectively. Intermodality agreement between full-Fourier variable refocusing flip angle single-shot FSE and T2-FSE findings was near-perfect (κ = 0.90, κ = 0.95), with an 8% discordance rate for ground truth lesion detection. CONCLUSIONS Variable refocusing flip angle single-shot FSE achieved 2× faster scan times than single-shot FSE with improved image sharpness at brain-fluid interfaces and gray-white differentiation. Such improvements are likely attributed to a combination of improved contrast, spatial resolution, SNR, and reduced T2-decay associated with blurring. While variable refocusing flip angle single-shot FSE may be a useful alternative to single-shot FSE and, potentially, T2-FSE when faster scan times are desired, motion artifacts were more common in variable refocusing flip angle single-shot FSE, and, thus, they remain an important consideration before clinical implementation.
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Affiliation(s)
- R Jabarkheel
- From the Stanford University School of Medicine (R.J.)
| | - E Tong
- Departments of Radiology (E.T., A.M.L., V.T., M.I.)
| | - E H Lee
- Electrical Engineering (E.H.L.)
| | - T M Cullen
- Department of Radiology (T.M.C., U.Y., S.S.V., K.W.Y.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - U Yousaf
- Department of Radiology (T.M.C., U.Y., S.S.V., K.W.Y.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - A M Loening
- Departments of Radiology (E.T., A.M.L., V.T., M.I.)
| | - V Taviani
- Departments of Radiology (E.T., A.M.L., V.T., M.I.)
| | - M Iv
- Departments of Radiology (E.T., A.M.L., V.T., M.I.)
| | - G A Grant
- Neurosurgery (G.A.G.), Stanford University, Stanford, California
| | - S J Holdsworth
- Department of Anatomy and Medical Imaging and Centre for Brain Research (S.J.H.), Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S S Vasanawala
- Department of Radiology (T.M.C., U.Y., S.S.V., K.W.Y.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - K W Yeom
- Department of Radiology (T.M.C., U.Y., S.S.V., K.W.Y.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
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5
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Ryu KH, Baek HJ, Skare S, Moon JI, Choi BH, Park SE, Ha JY, Kim TB, Hwang MJ, Sprenger T. Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment. AJNR Am J Neuroradiol 2020; 41:424-429. [PMID: 32029473 DOI: 10.3174/ajnr.a6427] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The long scan time of MR imaging is a major drawback limiting its clinical use in neuroimaging; therefore, we aimed to investigate the clinical feasibility of a 1-minute full-brain MR imaging using a multicontrast EPI sequence on a different MR imaging scanner than the ones previously reported. MATERIALS AND METHODS We retrospectively reviewed the records of 146 patients who underwent a multicontrast EPI sequence, including T1-FLAIR, T2-FLAIR, T2WI, DWI, and T2*WI sequences. Two attending neuroradiologists assessed the image quality of each sequence to compare the multicontrast EPI sequence with routine MR imaging protocols. We used the Wilcoxon signed rank test and McNemar test to compare the 2 MR imaging protocols. RESULTS The multicontrast EPI sequence generally showed sufficient image quality of >2 points using a 4-point assessment scale. Regarding image quality and susceptibility artifacts, there was no significant difference between the multicontrast EPI sequence DWI and routine DWI (P > .05), attesting to noninferiority of the multicontrast EPI, whereas there were significant differences in the other 4 sequences between the 2 MR imaging protocols. CONCLUSIONS The multicontrast EPI sequence showed sufficient image quality for clinical use with a shorter scan time; however, it was limited by inferior image quality and frequent susceptibility artifacts compared with routine brain MR imaging. Therefore, the multicontrast EPI sequence cannot completely replace the routine MR imaging protocol at present; however, it may be a feasible option in specific clinical situations such as screening, time-critical diseases or for use with patients prone to motion.
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Affiliation(s)
- K H Ryu
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - H J Baek
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea .,Department of Radiology (H.J.B.), Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - S Skare
- Department of Clinical Neuroscience (S.S., T.S.), Karolinska Institute, Stockholm, Sweden.,Department of Neuroradiology (S.S.), Karolinska University Hospital, Stockholm, Sweden
| | - J I Moon
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - B H Choi
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - S E Park
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - J Y Ha
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - T B Kim
- From the Department of Radiology (K.H.R., H.J.B., J.I.M., B.H.C., S.E.P., J.Y.H., T.B.K.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - M J Hwang
- MR Applications and Workflow, GE Healthcare (M.J.H.), Seoul, Republic of Korea
| | - T Sprenger
- Department of Clinical Neuroscience (S.S., T.S.), Karolinska Institute, Stockholm, Sweden.,MR Applied Science Laboratory Europe (T.S.), GE Healthcare Stockholm, Sweden
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Nguyen JC, Yi PH, Woo KM, Rosas HG. Detection of pediatric musculoskeletal pathology using the fluid-sensitive sequence. Pediatr Radiol 2019; 49:114-121. [PMID: 30232532 DOI: 10.1007/s00247-018-4256-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/18/2018] [Accepted: 08/31/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Musculoskeletal complaints are common among children, and magnetic resonance (MR) is increasingly used to supplement the clinical assessment. The validation of a short triage protocol could reduce the number of unnecessary contrast-enhanced MR studies that sometimes also require the need for sedation. OBJECTIVE To compare the diagnostic accuracy between fluid-sensitive sequence and contrast-enhanced MR study in the detection of musculoskeletal pathology in the pelvis and the appendicular skeleton in children older than 2 years. MATERIALS AND METHODS We performed a retrospective review between Feb. 1, 2016, and Oct. 31, 2016, and identified 99 studies from 96 patients (48 boys and 48 girls; mean age ± standard deviation, 11.1±4.6 years) without syndromic deformity, recent trauma, a history of infectious or inflammatory arthropathy, prior instrumentation or incomplete records. Two radiologists reviewed each study twice, at least 1 month apart, first using only the fluid-sensitive sequences (triage study) and later using the contrast-enhanced study. Readers rated the presence or absence of pathology independently and generated final impressions in consensus. We used Cohen's kappa (κ) and percentage agreement to compare agreement between readers and between studies, respectively. RESULTS Inter-reader agreement was overall higher for the contrast-enhanced studies (κ range = 0.91-1) than for the triage studies (κ range = 0.49-1). Percentage agreement between studies was high for the detection of pathology (97-100%) and for the impressions (93%). Clinical diagnoses were stress reaction or overuse in 31%, infection in 21%, space-occupying process in 17%, normal in 15%, inflammatory in 14%, and both inflammatory and overuse in 1%. The full study increased diagnostic confidence in five studies and accuracy in two but did not alter management. CONCLUSION The fluid-sensitive sequence had a near-perfect percentage of agreement with the contrast-enhanced study in the detection of musculoskeletal pathology and could possibly be used to screen children who need a contrast-enhanced MR study.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, 3NW39, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Paul H Yi
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Kaitlin M Woo
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Humberto G Rosas
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Tekes A, Senglaub SS, Ahn ES, Huisman TAGM, Jackson EM. Ultrafast Brain MRI Can Be Used for Indications beyond Shunted Hydrocephalus in Pediatric Patients. AJNR Am J Neuroradiol 2018; 39:1515-1518. [PMID: 30002051 DOI: 10.3174/ajnr.a5724] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Evaluation of shunted hydrocephalus is the most common indication for ultrafast brain MRI. Radiation-/sedation-free imaging capabilities make this protocol more desirable over CT and standard brain MRI. We hypothesized that ultrafast brain MRI can be used for selected indications beyond shunted hydrocephalus without adverse outcomes. MATERIALS AND METHODS Ultrafast brain MRI was performed with axial, sagittal, and coronal HASTE. The radiology information system was used to identify pediatric patients (0-18 years of age) who underwent ultrafast brain MRI between March 2014 and May 2016. A retrospective chart review was completed to identify indications other than shunted hydrocephalus, such as ventriculomegaly, macrocephaly, or intracranial cyst. All ultrafast brain MRIs were evaluated by a certified neuroradiologist and a neurosurgeon. Ultrafast brain MRI was deemed of sufficient diagnostic value for these indications if no further standard brain MRI was required for the study indication or if additional imaging was performed for an alternate indication. RESULTS The radiology information system identified 800 patients who had undergone an ultrafast brain MRI during the study period. One hundred twenty-two of these patients had ventriculomegaly, macrocephaly, or intracranial cyst as the study indication. Twenty-one of the 122 patients were excluded due to insufficient follow-up. Of the remaining 101 patients, only 5 had a standard brain MRI for the same indication, with no additional clinically significant information identified on those studies. CONCLUSIONS These results suggest that ultrafast brain MRI is sufficient to evaluate ventriculomegaly, macrocephaly, or intracranial cyst. Ultrafast brain MRI is radiation- and sedation-free; therefore, we recommend its use as the primary screening neuroimaging study for these indications.
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Affiliation(s)
- A Tekes
- From the Department of Radiology (A.T., T.A.G.M.H.), Division of Pediatric Radiology and Pediatric Neuroradiology
| | - S S Senglaub
- Department of Neurosurgery (S.S.S., E.S.A., E.M.J.), Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - E S Ahn
- Department of Neurosurgery (S.S.S., E.S.A., E.M.J.), Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - T A G M Huisman
- From the Department of Radiology (A.T., T.A.G.M.H.), Division of Pediatric Radiology and Pediatric Neuroradiology
| | - E M Jackson
- Department of Neurosurgery (S.S.S., E.S.A., E.M.J.), Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Vadivelu S, Xu K, Tolj V, Rege R, Darkins L, Vishwanath K. Neurovascular toxicity of N-methyl-d-aspartate is markedly enhanced in the developing mouse central nervous system. Neurosci Lett 2017. [PMID: 28636928 DOI: 10.1016/j.neulet.2017.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Penumbral perfusion is critical to brain viability. Proximal arterial occlusion and deep brain stroke has variable effect on cortical dysfunction. Cortical microvessel collaterals may be recruited and at times sufficient for partial parenchymal perfusion. Postnatal neural and endothelial cells are markedly vulnerable to glutamate excitotoxicity. Early vascular cell stress may promote partial protective neural preconditioning though postnatally a developmental window of the cerebral microvasculature may be particularly vulnerable to injury. We tested the hypothesis that postnatal NMDA excitotoxic injury, when cerebral endothelial cells' central energy source is via glycolysis, is age specific. Neurovascular responses of cortical viability were directly identified with diffuse reflectance patterns of perfusion properties in a non-invasive manner, over time. Histological evaluation for neural and vascular cytoarchitectonic abnormalities were evaluated 4- 7days post injury. Optical diffuse reflectance recordings were obtained at the injection site prior to, immediately after and 48h post injury. Extent of neurovascular injury at the infarct zone was greatest at PND 5 and cortical perfusion responses identified with recordings of pattern change. These data further suggest excitotoxic injury to both neural and vascular cells, in vivo, can enhance CNS injury in the young and neuroprotective strategies may benefit from vascular directed therapies.
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Affiliation(s)
- Sudhakar Vadivelu
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Kui Xu
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Vanja Tolj
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Rahul Rege
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lindsay Darkins
- Department of Physics, Miami University, Oxford, OH, United States
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Kralik SF, Yasrebi M, Supakul N, Lin C, Netter LG, Hicks RA, Hibbard RA, Ackerman LL, Harris ML, Ho CY. Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma. AJNR Am J Neuroradiol 2017; 38:807-813. [PMID: 28183837 DOI: 10.3174/ajnr.a5093] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging with sedation is commonly used to detect intracranial traumatic pathology in the pediatric population. Our purpose was to compare nonsedated ultrafast MR imaging, noncontrast head CT, and standard MR imaging for the detection of intracranial trauma in patients with potential abusive head trauma. MATERIALS AND METHODS A prospective study was performed in 24 pediatric patients who were evaluated for potential abusive head trauma. All patients received noncontrast head CT, ultrafast brain MR imaging without sedation, and standard MR imaging with general anesthesia or an immobilizer, sequentially. Two pediatric neuroradiologists independently reviewed each technique blinded to other modalities for intracranial trauma. We performed interreader agreement and consensus interpretation for standard MR imaging as the criterion standard. Diagnostic accuracy was calculated for ultrafast MR imaging, noncontrast head CT, and combined ultrafast MR imaging and noncontrast head CT. RESULTS Interreader agreement was moderate for ultrafast MR imaging (κ = 0.42), substantial for noncontrast head CT (κ = 0.63), and nearly perfect for standard MR imaging (κ = 0.86). Forty-two percent of patients had discrepancies between ultrafast MR imaging and standard MR imaging, which included detection of subarachnoid hemorrhage and subdural hemorrhage. Sensitivity, specificity, and positive and negative predictive values were obtained for any traumatic pathology for each examination: ultrafast MR imaging (50%, 100%, 100%, 31%), noncontrast head CT (25%, 100%, 100%, 21%), and a combination of ultrafast MR imaging and noncontrast head CT (60%, 100%, 100%, 33%). Ultrafast MR imaging was more sensitive than noncontrast head CT for the detection of intraparenchymal hemorrhage (P = .03), and the combination of ultrafast MR imaging and noncontrast head CT was more sensitive than noncontrast head CT alone for intracranial trauma (P = .02). CONCLUSIONS In abusive head trauma, ultrafast MR imaging, even combined with noncontrast head CT, demonstrated low sensitivity compared with standard MR imaging for intracranial traumatic pathology, which may limit its utility in this patient population.
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Affiliation(s)
- S F Kralik
- From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.)
| | - M Yasrebi
- From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.)
| | - N Supakul
- From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.)
| | - C Lin
- From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.)
| | - L G Netter
- From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.)
| | - R A Hicks
- Child Protective Program (R.A. Hicks, R.A. Hibbard)
| | - R A Hibbard
- Child Protective Program (R.A. Hicks, R.A. Hibbard)
| | | | - M L Harris
- Neurology (M.L.H.), Indiana University School of Medicine, Indianapolis, Indiana
| | - C Y Ho
- From the Department of Radiology and Imaging Sciences (S.F.K., M.Y., N.S., C.L., L.G.N., C.Y.H.)
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Neuroimaging of Children With Surgically Treated Hydrocephalus: A Practical Approach. AJR Am J Roentgenol 2017; 208:413-419. [DOI: 10.2214/ajr.16.16870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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Aldrink JH, Adler B, Haines J, Watkins D, Matthews M, Lubeley L, Wang W, King DR. Patients exposed to diagnostic head and neck radiation for the management of shunted hydrocephalus have a significant risk of developing thyroid nodules. Pediatr Surg Int 2016; 32:565-9. [PMID: 27083898 DOI: 10.1007/s00383-016-3894-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE External radiation to the head and neck can lead to an increased incidence of thyroid nodules. We investigated whether patients requiring repeated head and neck imaging for the management of shunted hydrocephalus had a higher incidence of ultrasound-detected thyroid nodules compared to reports of comparable age. METHODS Patients treated at our institution for shunted hydrocephalus from 1990 to 2003 were contacted. Enroled patients underwent a thyroid ultrasound. Demographic data and radiation exposure history were obtained retrospectively. RESULTS Thyroid nodules were identified sonographically in 15/112 patients (13.6 %). Patients with thyroid nodules were older (mean 24.3 ± 7.6 years) than those without (mean 18.4 ± 8.0 years) (p = 0.005). Those with a detectable thyroid nodule had a longer follow up time compared to those who did not (mean 21.9 ± 5.5 vs. 15.1 ± 7 years, respectively) (p = 0.018). CONCLUSION Patients with shunted hydrocephalus are exposed to substantial head and neck radiation from diagnostic imaging and have a higher incidence of thyroid nodules detected by ultrasonography. These patients should be provided ongoing surveillance for detection of thyroid nodules and the possibility of malignancy.
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Affiliation(s)
- Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA.
| | - Brent Adler
- Department of Radiology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jesse Haines
- The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel Watkins
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA
| | - Mika Matthews
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA
| | - Lacey Lubeley
- Department of Radiology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Wei Wang
- Department of Biostatistics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Denis R King
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA
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Tekes A, Jackson EM, Ogborn J, Liang S, Bledsoe M, Durand DJ, Jallo G, Huisman TAGM. How to Reduce Head CT Orders in Children with Hydrocephalus Using the Lean Six Sigma Methodology: Experience at a Major Quaternary Care Academic Children's Center. AJNR Am J Neuroradiol 2016; 37:990-6. [PMID: 26797143 DOI: 10.3174/ajnr.a4658] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/12/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Lean Six Sigma methodology is increasingly used to drive improvement in patient safety, quality of care, and cost-effectiveness throughout the US health care delivery system. To demonstrate our value as specialists, radiologists can combine lean methodologies along with imaging expertise to optimize imaging elements-of-care pathways. In this article, we describe a Lean Six Sigma project with the goal of reducing the relative use of pediatric head CTs in our population of patients with hydrocephalus by 50% within 6 months. MATERIALS AND METHODS We applied a Lean Six Sigma methodology using a multidisciplinary team at a quaternary care academic children's center. The existing baseline imaging practice for hydrocephalus was outlined in a Kaizen session, and potential interventions were discussed. An improved radiation-free workflow with ultrafast MR imaging was created. Baseline data were collected for 3 months by using the departmental radiology information system. Data collection continued postintervention and during the control phase (each for 3 months). The percentage of neuroimaging per technique (head CT, head ultrasound, ultrafast brain MR imaging, and routine brain MR imaging) was recorded during each phase. RESULTS The improved workflow resulted in a 75% relative reduction in the percentage of hydrocephalus imaging performed by CT between the pre- and postintervention/control phases (Z-test, P = .0001). CONCLUSIONS Our lean interventions in the pediatric hydrocephalus care pathway resulted in a significant reduction in head CT orders and increased use of ultrafast brain MR imaging.
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Affiliation(s)
- A Tekes
- From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., D.J.D., T.A.G.M.H.)
| | - E M Jackson
- Division of Pediatric Neurosurgery, Department of Neurosurgery (E.M.J., G.J.)
| | - J Ogborn
- Department of Pediatrics (J.O.), The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - S Liang
- Department of Radiology (S.L., M.B.), Russell H. Morgan Department of Radiology and Radiological Science
| | - M Bledsoe
- Department of Radiology (S.L., M.B.), Russell H. Morgan Department of Radiology and Radiological Science
| | - D J Durand
- From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., D.J.D., T.A.G.M.H.)
| | - G Jallo
- Division of Pediatric Neurosurgery, Department of Neurosurgery (E.M.J., G.J.)
| | - T A G M Huisman
- From the Division of Pediatric Radiology and Pediatric Neuroradiology (A.T., D.J.D., T.A.G.M.H.)
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13
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Young JY, Duhaime AC, Caruso PA, Rincon SP. Comparison of non-sedated brain MRI and CT for the detection of acute traumatic injury in children 6 years of age or less. Emerg Radiol 2016; 23:325-31. [DOI: 10.1007/s10140-016-1392-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/18/2016] [Indexed: 11/25/2022]
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Mehta H, Acharya J, Mohan AL, Tobias ME, LeCompte L, Jeevan D. Minimizing Radiation Exposure in Evaluation of Pediatric Head Trauma: Use of Rapid MR Imaging. AJNR Am J Neuroradiol 2015; 37:11-8. [PMID: 26381555 DOI: 10.3174/ajnr.a4464] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/20/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE With >473,000 annual emergency department visits for children with traumatic brain injuries in the United States, the risk of ionizing radiation exposure during CT examinations is a real concern. The purpose of this study was to assess the validity of rapid MR imaging to replace CT in the follow-up imaging of patients with head trauma. MATERIALS AND METHODS A retrospective review of 103 pediatric patients who underwent initial head CT and subsequent follow-up rapid MR imaging between January 2010 and July 2013 was performed. Patients had minor head injuries (Glasgow Coma Scale, >13) that required imaging. Initial head CT was performed, with follow-up rapid MR imaging completed within 48 hours. A board-certified neuroradiologist, blinded to patient information and scan parameters, then independently interpreted the randomized cases. RESULTS There was almost perfect agreement in the ability to detect extra-axial hemorrhage on rapid MR imaging and CT (κ = 0.84, P < .001). Evaluation of hemorrhagic contusion/intraparenchymal hemorrhage demonstrated a moderate level of agreement between MR imaging and CT (κ = 0.61, P < .001). The ability of MR imaging to detect a skull fracture also showed a substantial level of agreement with CT (κ = 0.71, P < .001). Detection of diffuse axonal injury demonstrated a slight level of agreement between MR imaging and CT (κ = 0.154, P = .04). However, the overall predictive agreement for the detection of an axonal injury was 91%. CONCLUSIONS Rapid MR imaging is a valid technique for detecting traumatic cranial injuries and an adequate examination for follow-up imaging in lieu of repeat CT.
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Affiliation(s)
- H Mehta
- From the Departments of Radiology (H.M., J.A., L.L.)
| | - J Acharya
- From the Departments of Radiology (H.M., J.A., L.L.)
| | - A L Mohan
- Neurosurgery (A.L.M., M.E.T., D.J.), New York Medical College, Valhalla, New York
| | - M E Tobias
- Neurosurgery (A.L.M., M.E.T., D.J.), New York Medical College, Valhalla, New York
| | - L LeCompte
- From the Departments of Radiology (H.M., J.A., L.L.)
| | - D Jeevan
- Neurosurgery (A.L.M., M.E.T., D.J.), New York Medical College, Valhalla, New York
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15
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Magnetic resonance imaging acquisition techniques intended to decrease movement artefact in paediatric brain imaging: a systematic review. Pediatr Radiol 2015; 45:1271-81. [PMID: 25820342 DOI: 10.1007/s00247-015-3333-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 02/03/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
Attaining paediatric brain images of diagnostic quality can be difficult because of young age or neurological impairment. The use of anaesthesia to reduce movement in MRI increases clinical risk and cost, while CT, though faster, exposes children to potentially harmful ionising radiation. MRI acquisition techniques that aim to decrease movement artefact may allow diagnostic paediatric brain imaging without sedation or anaesthesia. We conducted a systematic review to establish the evidence base for ultra-fast sequences and sequences using oversampling of k-space in paediatric brain MR imaging. Techniques were assessed for imaging time, occurrence of movement artefact, the need for sedation, and either image quality or diagnostic accuracy. We identified 24 relevant studies. We found that ultra-fast techniques had shorter imaging acquisition times compared to standard MRI. Techniques using oversampling of k-space required equal or longer imaging times than standard MRI. Both ultra-fast sequences and those using oversampling of k-space reduced movement artefact compared with standard MRI in unsedated children. Assessment of overall diagnostic accuracy was difficult because of the heterogeneous patient populations, imaging indications, and reporting methods of the studies. In children with shunt-treated hydrocephalus there is evidence that ultra-fast MRI is sufficient for the assessment of ventricular size.
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16
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Vadivelu S, Stewart TJ, Qu Y, Horn K, Liu S, Li Q, Silver J, McDonald JW. NG2+ progenitors derived from embryonic stem cells penetrate glial scar and promote axonal outgrowth into white matter after spinal cord injury. Stem Cells Transl Med 2015; 4:401-11. [PMID: 25713464 DOI: 10.5966/sctm.2014-0107] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The glial scar resulting from spinal cord injury is rich in chondroitin sulfate proteoglycan (CSPG), a formidable barrier to axonal regeneration. We explored the possibility of breaching that barrier by first examining the scar in a functional in vitro model. We found that embryonic stem cell-derived neural lineage cells (ESNLCs) with prominent expression of nerve glial antigen 2 (NG2) survived, passed through an increasingly inhibitory gradient of CSPG, and expressed matrix metalloproteinase 9 (MMP-9) at the appropriate stage of their development. Outgrowth of axons from ESNLCs followed because the migrating cells sculpted pathways in which CSPG was degraded. The degradative mechanism involved MMP-9 but not MMP-2. To confirm these results in vivo, we transplanted ESNLCs directly into the cavity of a contused spinal cord 9 days after injury. A week later, ESNLCs survived and were expressing both NG2 and MMP-9. Their axons had grown through long distances (>10 mm), although they preferred to traverse white rather than gray matter. These data are consistent with the concept that expression of inhibitory CSPG within the injury scar is an important impediment to regeneration but that NG2+ progenitors derived from ESNLCs can modify the microenvironment to allow axons to grow through the barrier. This beneficial action may be partly due to developmental expression of MMP-9. We conclude that it might eventually be possible to encourage axonal regeneration in the human spinal cord by transplanting ESNLCs or other cells that express NG2.
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Affiliation(s)
- Sudhakar Vadivelu
- The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at the Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Todd J Stewart
- The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at the Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yun Qu
- The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at the Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin Horn
- The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at the Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Su Liu
- The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at the Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Qun Li
- The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at the Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jerry Silver
- The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at the Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John W McDonald
- The International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at the Kennedy Krieger Institute, Baltimore, Maryland, USA; Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gabriel S, Eckel LJ, DeLone DR, Krecke KN, Luetmer PH, McCollough CH, Fletcher JG, Yu L. Pilot study of radiation dose reduction for pediatric head CT in evaluation of ventricular size. AJNR Am J Neuroradiol 2014; 35:2237-42. [PMID: 25082822 DOI: 10.3174/ajnr.a4056] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE CT is a ubiquitous, efficient, and cost-effective method to evaluate pediatric ventricular size, particularly in patients with CSF shunt diversion who often need emergent imaging. We therefore sought to determine the minimum dose output or CT dose index required to produce clinically acceptable examinations. MATERIALS AND METHODS Using a validated noise insertion method and CT projection data from 22 patients, standard pediatric head CT images were reconstructed with weighted filtered back-projection and sinogram-affirmed iterative reconstruction corresponding to routine, 25%, and 10% dose. Reconstructed images were then evaluated by 3 neuroradiologists (blinded to dose and reconstruction method) for ventricular size, diagnostic confidence, image quality, evidence of hemorrhage, and shunt tip location, and compared with the reference standard. RESULTS There was no significant difference in the ventricular size ranking, and the sensitivity for moderate to severe hydrocephalus was 100%. There was no significant difference between the full-dose level and the ventricular size rankings at the 25% or the 10% dose level for either reconstruction kernel (P > .979). Diagnostic confidence was maintained across doses and kernel. Hemorrhage was more difficult to identify as image quality degraded as dose decreased but was still seen in a majority of cases. Shunts were identified by all readers across all doses and reconstruction methods. CONCLUSIONS CT images having dose reductions of 90% relative to routine head CT examinations provide acceptable image quality to address the specific clinical task of evaluating ventricular size.
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Affiliation(s)
- S Gabriel
- From the Department of Radiology (S.G.), University of California Los Angeles, Los Angeles, California
| | - L J Eckel
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota.
| | - D R DeLone
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - K N Krecke
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - P H Luetmer
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - C H McCollough
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - J G Fletcher
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - L Yu
- Department of Radiology (L.J.E., D.R.D., K.N.K., P.H.L., C.H.M., J.G.F., L.Y.), Mayo Clinic, Rochester, Minnesota
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Yeom KW, Lober RM, Alexander A, Cheshier SH, Edwards MSB. Hydrocephalus decreases arterial spin-labeled cerebral perfusion. AJNR Am J Neuroradiol 2014; 35:1433-9. [PMID: 24651817 DOI: 10.3174/ajnr.a3891] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Reduced cerebral perfusion has been observed with elevated intracranial pressure. We hypothesized that arterial spin-labeled CBF can be used as a marker for symptomatic hydrocephalus. MATERIALS AND METHODS We compared baseline arterial spin-labeled CBF in 19 children (median age, 6.5 years; range, 1-17 years) with new posterior fossa brain tumors and clinical signs of intracranial hypertension with arterial spin-labeled CBF in 16 age-matched controls and 4 patients with posterior fossa tumors without ventriculomegaly or signs of intracranial hypertension. Measurements were recorded in the cerebrum at the vertex, deep gray nuclei, and periventricular white matter and were assessed for a relationship to ventricular size. In 16 symptomatic patients, we compared cerebral perfusion before and after alleviation of hydrocephalus. RESULTS Patients with uncompensated hydrocephalus had lower arterial spin-labeled CBF than healthy controls for all brain regions interrogated (P < .001). No perfusion difference was seen between asymptomatic patients with posterior fossa tumors and healthy controls (P = 1.000). The median arterial spin-labeled CBF increased after alleviation of obstructive hydrocephalus (P < .002). The distance between the frontal horns inversely correlated with arterial spin-labeled CBF of the cerebrum (P = .036) but not the putamen (P = .156), thalamus (P = .111), or periventricular white matter (P = .121). CONCLUSIONS Arterial spin-labeled-CBF was reduced in children with uncompensated hydrocephalus and restored after its alleviation. Arterial spin-labeled-CBF perfusion MR imaging may serve a future role in the neurosurgical evaluation of hydrocephalus, as a potential noninvasive method to follow changes of intracranial pressure with time.
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Affiliation(s)
- K W Yeom
- From the Departments of Radiology (K.W.Y.)
| | - R M Lober
- Neurosurgery (R.M.L., A.A., S.H.C., M.S.B.E.)
| | - A Alexander
- Neurosurgery (R.M.L., A.A., S.H.C., M.S.B.E.)
| | - S H Cheshier
- Neurosurgery (R.M.L., A.A., S.H.C., M.S.B.E.)Division of Pediatric Neurosurgery (S.H.C., M.S.B.E.), Lucile Packard Children's Hospital at Stanford University, Palo Alto, California
| | - M S B Edwards
- Neurosurgery (R.M.L., A.A., S.H.C., M.S.B.E.)Division of Pediatric Neurosurgery (S.H.C., M.S.B.E.), Lucile Packard Children's Hospital at Stanford University, Palo Alto, California
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Evaluation of a Limited Three-Slice Head CT Protocol for Monitoring Patients With Ventriculoperitoneal Shunts. AJR Am J Roentgenol 2013; 201:400-5. [DOI: 10.2214/ajr.12.9110] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Niederhauser BD, McDonald RJ, Eckel LJ, Keating GF, Broomall EM, Wetjen NM, Diehn FE, Schwartz KM, Hunt CH, Welker KM, Kallmes DF. Retrospective review of rapid pediatric brain MR imaging at an academic institution including practice trends and factors affecting scan times. AJNR Am J Neuroradiol 2013; 34:1836-40. [PMID: 23557956 DOI: 10.3174/ajnr.a3510] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In an effort to reduce radiation exposure in children requiring regular follow up for shunted hydrocephalus, our institution implemented a rapid brain MR imaging protocol. The purpose of this study was to review an academic practice experience with pediatric rapid brain MR imaging without patient sedation in the evaluation of hydrocephalus and a limited group of other conditions. MATERIALS AND METHODS We retrospectively analyzed limited-sequence, rapid brain MR imaging scans performed in nonsedated patients younger than 14 years between April 2009 and December 2011. So-called failed examinations were determined by consensus of 2 authors as insufficiently diagnostic for evaluation of ventricular size. CT and MR imaging quarterly volumes for hydrocephalus-related indications were determined from 2005-2012. Multivariable logistic regression analysis was performed to elucidate factors potentially affecting scan durations including examination indication and patient age, sex, inpatient status, and clinical conditions. RESULTS A total of 398 examinations were performed on 168 patients (103 boys, 65 girls; median age, 13 months). None were deemed to be failed examinations. Median scan duration was 4.43 minutes (interquartile range, 4.42 minutes-5.88 minutes; SD, 2.42 minutes). Examination indication of altered mental status was the only factor associated with increased scan duration (+1.77 minutes; P = .0021). Hydrocephalus-related imaging volumes approximately doubled in the 7 years reviewed, but rapid MR imaging introduced in 2009 is quickly replacing CT scanning for these indications, accounting for nearly 7 of every 8 examinations at the end of the study period. CONCLUSIONS In every case of initial work-up and follow-up, rapid brain MR imaging effectively evaluated ventricular size and/or intracranial fluid and represents a viable alternative to CT scanning, irrespective of a child's age or clinical condition. For this indication and patient group, MR imaging is now the predominant imaging method in our practice.
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Krishnamurthy S, Schmidt B, Tichenor MD. Radiation risk due to shunted hydrocephalus and the role of MR imaging-safe programmable valves. AJNR Am J Neuroradiol 2013; 34:695-7. [PMID: 23124639 PMCID: PMC7964487 DOI: 10.3174/ajnr.a3334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Koral K, Blackburn T, Bailey AA, Koral KM, Anderson J. Strengthening the argument for rapid brain MR imaging: estimation of reduction in lifetime attributable risk of developing fatal cancer in children with shunted hydrocephalus by instituting a rapid brain MR imaging protocol in lieu of Head CT. AJNR Am J Neuroradiol 2012; 33:1851-4. [PMID: 22555583 PMCID: PMC7964620 DOI: 10.3174/ajnr.a3076] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 01/26/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Children with shunted hydrocephalus have been undergoing surveillance neuroimaging, generally in the form of head CT, for evaluation of ventricular size. As the life expectancy of these children has improved due to better shunt technology and medical care, risks related to the ionizing radiation incurred during multiple head CT examinations that they are expected to undergo throughout their lifetime have become a concern. The purpose of this study is to estimate the LAR of developing fatal cancer due to head CT for ventricular size assessment in children with shunted hydrocephalus and to assess the impact of instituting a rapid brain MR imaging protocol in reducing radiation exposure. MATERIALS AND METHODS Retrospective review of medical records yielded 182 patients who underwent neuroimaging for assessment of ventricular size. Available neuroimaging studies (head CT and rapid brain MR) were counted and annual neuroimaging frequency was calculated. It was assumed that these patients undergo a similar number of neuroimaging studies annually through 20 years of age. A risk estimate was calculated based on the BEIR VII report and effective doses obtained using the International Commission on Radiologic Protection Report 103 organ weighting factors. RESULTS The mean annual neuroimaging study frequency was 2.1. Based on the average age of 1.89 years, it was assumed neuroimaging surveillance commences in the second year of life. LAR was calculated assuming that a patient undergoes neuroimaging in the form of head CT at this frequency (2/year) through 20 years of age. Assuming 2 scans are performed per year and the low-dose head CT protocol is used, approximately 1 excess lifetime fatal cancer would be generated per 230 patients; with standard head CT, there would be 1 excess lifetime fatal cancer per 97 patients. CONCLUSIONS Children with shunted hydrocephalus are at increased risk of developing fatal cancer if they are to undergo surveillance using head CT. Implementation of a rapid brain MR imaging protocol with no radiation detriment will reduce this risk.
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Affiliation(s)
- K Koral
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas 75235, USA.
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Eight-second MRI scan for evaluation of shunted hydrocephalus. Childs Nerv Syst 2012; 28:1237-41. [PMID: 22729572 DOI: 10.1007/s00381-012-1769-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 04/11/2012] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Pediatric patients harboring shunts placed early in life are subjected to numerous radiographic studies during development of their central nervous system. Radiation is detrimental to these young patients. MRI avoids the risk of radiation but is thought more difficult due to the increased time a young patient must lie motionless during scan acquisition. Optimal radiographic interrogation would be quick, radiation-free, and allow adequate ventricular evaluation. METHODS We queried the electronic medical records system of the senior author (SE) for the terms "hydrocephalus" and "shunt malfunction." All patients currently younger than 18 years were included. In the last 5 years, pediatric patients have been evaluated in an office setting with a limited MRI sequence (T1 sagittal, T2 axial, T1 axial, and DWI) lasting a total of 178 s. In the event of significant motion artifact, the total sequence is abandoned and an 8-s T2 diffusion-weighted scan is performed. RESULTS Forty-four patients were included in the study (20 males, average age 10.4 yrs). Eighty-eight rapid acquisition scans were obtained. Adequate ventricular evaluation was performed without sedation in every case. In each instance where there was motion, the 8-s scan provided adequate ventricular evaluation. CONCLUSION Rapid acquisition MRI scanning avoids the deleterious cumulative effects of radiation in pediatric patients and allows adequate evaluation of the ventricles without the need for sedation.
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Stem Cells and Spinal Cord Injury Repair. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 760:53-73. [DOI: 10.1007/978-1-4614-4090-1_4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Becker D, McDonald JW. Approaches to repairing the damaged spinal cord: overview. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:445-61. [PMID: 23098730 DOI: 10.1016/b978-0-444-52137-8.00028-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Affecting young people during the most productive period of their lives, spinal cord injury (SCI) is a devastating problem for modern society. In the past, treating SCI seemed frustrating and hopeless because of the tremendous morbidity and mortality, life-shattering impact, and limited therapeutic options associated with the condition. Today, however, an understanding of the underlying pathophysiological mechanisms, the development of neuroprotective interventions, and progress toward regenerative interventions are increasing hope for functional restoration. In this chapter, we provide an overview of various repair strategies for the injured spinal cord. Special attention will be paid to strategies that promote spontaneous regeneration, including functional electrical stimulation, cell replacement, neuroprotection, and remyelination. The concept that limited rebuilding can provide a disproportionate improvement in quality of life is emphasized throughout. New surgical procedures, pharmacological treatments, and functional neuromuscular stimulation methods have evolved over the last decades and can improve functional outcomes after spinal cord injury; however, limiting secondary injury remains the primary goal. Tissue replacement strategies, including the use of embryonic stem cells, become an important tool and can restore function in animal models. Controlled clinical trials are now required to confirm these observations. The ultimate goal is to harness the body's own potential to replace lost central nervous system cells by activation of endogenous progenitor cell repair mechanisms.
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Affiliation(s)
- Daniel Becker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Miller JH, Walkiewicz T, Towbin RB, Curran JG. Improved delineation of ventricular shunt catheters using fast steady-state gradient recalled-echo sequences in a rapid brain MR imaging protocol in nonsedated pediatric patients. AJNR Am J Neuroradiol 2009; 31:430-5. [PMID: 19942705 DOI: 10.3174/ajnr.a1866] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Rapid brain MR imaging is often substituted for head CT in multiply imaged patients with shunted hydrocephalus. Fast TSE-T2 sequences are commonly used in these protocols. One limitation of TSE-T2 sequences is the decreased catheter delineation compared with CT. The aim of this study was to compare fast TSE-T2 with rapid SS-GRE sequences in the evaluation of intracranial shunt catheter delineation as part of a rapid nonsedated pediatric brain MR imaging protocol. MATERIALS AND METHODS We evaluated the findings from 179 consecutive patients who underwent routine clinical imaging according to the rapid nonsedated pediatric brain MR imaging protocol. Comparison of the quality of intracranial shunt catheter localization on SS-GRE versus TSE-T2 was performed. RESULTS Of the total of 179 rapid nonsedated pediatric brain MR images that were reviewed, 62 (35%) had an intracranial shunt catheter. The shunt catheter tip was better localized on the SS-GRE than on the TSE-T2 images in 49/62 (79%) of these patients. Of the remaining 13/62 (21%), the TSE-T2 was either better or equivalent in localizing the shunt catheter tip. CONCLUSIONS Our study shows that rapid SS-GRE sequences can provide better delineation of standard intracranial shunt catheters than standard rapid MR imaging protocols containing only fast TSE-T2 sequences.
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Affiliation(s)
- J H Miller
- Department of Radiology, Neuroradiology Section, Phoenix Children's Hospital, Phoenix, Arizona 85016, USA.
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Eftekharpour E, Karimi-Abdolrezaee S, Fehlings MG. Current status of experimental cell replacement approaches to spinal cord injury. Neurosurg Focus 2008; 24:E19. [PMID: 18341395 DOI: 10.3171/foc/2008/24/3-4/e18] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite advances in medical and surgical care, the current clinical therapies for spinal cord injury (SCI) are largely ineffective. During the last 2 decades, the search for new therapies has been revolutionized by the discovery of stem cells, which has inspired scientists and clinicians to search for a stem cell-based reparative approaches to many diseases, including neurotrauma. In the present study, the authors briefly summarize current knowledge related to the pathophysiology of SCI, including the concepts of primary and secondary injury and the importance of posttraumatic demyelination. Key inhibitory obstacles that impede axonal regeneration include the glial scar and a number of myelin inhibitory molecules including Nogo. Recent advancements in cell replacement therapy as a therapeutic strategy for SCI are summarized. The strategies include the use of pluripotent human stem cells, embryonic stem cells, and a number of adult-derived stem and progenitor cells such as mesenchymal stem cells, Schwann cells, olfactory ensheathing cells, and adult-derived neural precursor cells. Although current strategies to repair the subacutely injured cord appear promising, many obstacles continue to render the treatment of chronic injuries challenging. Nonetheless, the future for stem cell-based reparative strategies for treating SCI appears bright.
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Affiliation(s)
- Eftekhar Eftekharpour
- Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital and Division of Genetics and Development, Toronto Western Research Institute, Canada
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Comi AM, Cho E, Mulholland JD, Hooper A, Li Q, Qu Y, Gary DS, McDonald JW, Johnston MV. Neural stem cells reduce brain injury after unilateral carotid ligation. Pediatr Neurol 2008; 38:86-92. [PMID: 18206788 DOI: 10.1016/j.pediatrneurol.2007.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 09/06/2007] [Accepted: 10/08/2007] [Indexed: 12/17/2022]
Abstract
Neonatal stroke presents with seizures and results in neurologic morbidity, including epilepsy, hemiparesis, and cognitive deficits. Stem cell-based therapy offers a possible therapeutic strategy for neonatal stroke. We developed an immature mouse model of stroke with acute seizures and ischemic brain injury. Postnatal day 12 CD1 mice received right-sided carotid ligation. Two or 7 days after ligation, mice received an intrastriatal injection of B5 embryonic stem cell-derived neural stem cells. Four weeks after ligation, hemispheric brain atrophy was measured. Pups receiving stem cells 2 days after ligation had less severe hemispheric brain atrophy compared with either noninjected or vehicle-injected ligated controls. Transplanted cells survived, but 3 out of 10 pups injected with stem cells developed local tumors. No difference in hemispheric brain atrophy was seen in mice injected with stem cells 7 days after ligation. Neural stem cells have the potential to ameliorate ischemic injury in the immature brain, although tumor development is a serious concern.
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Affiliation(s)
- Anne M Comi
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, and Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA.
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Belegu V, Oudega M, Gary DS, McDonald JW. Restoring function after spinal cord injury: promoting spontaneous regeneration with stem cells and activity-based therapies. Neurosurg Clin N Am 2007; 18:143-68, xi. [PMID: 17244561 DOI: 10.1016/j.nec.2006.10.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although neural regeneration is an active research field today, no current treatments can aid regeneration after spinal cord injury. This article reviews the feasibility of spinal cord repair and provides an overview of the range of strategies scientists are taking toward regeneration. The major focus of this article is the future role of stem cell transplantation and similar rehabilitative restorative approaches designed to optimize spontaneous regeneration by mobilizing endogenous stem cells and facilitating other cellular mechanisms of regeneration, such as axonal growth and myelination.
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Affiliation(s)
- Visar Belegu
- The International Center for Spinal Cord Injury, Kennedy Krieger Institute, Department of Neurology, Johns Hopkins University School of Medicine, 707 North Broadway, Room 518, Baltimore, MD 21205, USA
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Vadivelu S, Becker D, McDonald JW. Generating chimeric spinal cord: a novel model for transplantable oligodendrocyte progenitors derived from embryonic stem cells. Neurosurg Focus 2005; 19:E3. [PMID: 16190602 DOI: 10.3171/foc.2005.19.3.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
ObjectTo identify and evaluate stem cell–derived oligodendrocytes obtained for cell transplantation therapies, the authors developed a novel model to examine single, adult oligodendrocytes in situ.MethodsGreen fluorescent protein–expressing, mouse embryonic stem cells (ESCs) were neural induced and additionally staged in an oligosphere preparatory step for high-yield derivation of oligodendrocyte progenitors. These transplantable, induced progenitors were injected into postnatal Day 2 rat pups, in which spinal cord sections were then examined at 3 and 9 weeks posttransplantation.ConclusionsTransplanted oligosphere ESCs survived and integrated anatomically into postnatal and adult white matter, generating targeted regions of chimeric spinal cord. A simple model for identifying adult oligodendrocytes in situ is presented, which is suitable for use in further studies examining functional myelination and derivation of oligodendrocytes from genetically engineered ESC lines, including human ESCs. Results from the model presented here demonstrate a unique method for examining transplantable oligodendrocyte progenitors derived from ESCs for repair of white matter disease.
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Affiliation(s)
- Sudhakar Vadivelu
- The International Center for Spinal Cord Injury, Kennedy Krieger Institute, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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