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He Y, Guo J, Ding Y, Zhou L, Jiang X, Zhen C, Wu Q. Application value of 3D pCASL in early assessment of potential radiation encephalopathy in nasopharyngeal carcinoma patients undergoing radiotherapy. Br J Radiol 2023; 96:20200448. [PMID: 37393533 PMCID: PMC10461280 DOI: 10.1259/bjr.20200448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 04/26/2023] [Accepted: 05/22/2023] [Indexed: 07/03/2023] Open
Abstract
OBJECTIVE The study explores the application value of three-dimensional arterial spin labeling magnetic resonance imaging (3D pCASL) in early assessment of radiation encephalopathy (REP) in patients with nasopharyngeal carcinoma (NPC). METHODS A retrospective analysis of 39 cases of NPC was performed. Routine enhanced MRI scan and 3D pCASL imaging were used to examine the apparent diffusion coefficient (ADC) and brain blood flow (CBF) before and after treatment with intensity-modulated radiotherapy (IMRT). Dosimetric analysis of irradiation was performed. Receiver operating characteristic curve (ROC) was used to analyze diagnostic performance of two imaging methods. RESULTS There was no statistically significant difference between the two methods for the measurement of temporal white matter ADC, but statistically significant difference was found in CBF. 3D pCASL imaging showed more sensitivity, specificity and higher accuracy than conventional MRI enhanced scan in showing REP. The maximum dose of the temporal lobe was at the enhanced area. CONCLUSION The present study demonstrates that 3D pCASL scan at month 3 can reflect blood flow perfusion differences in NPC patients after IMRT and can accurately assess the possibility of REP at early stage. Enhanced areas have a higher probability of REP than the surrounding areas. ADVANCES IN KNOWLEDGE There is few magnetic resonance angiography studies used to evaluate arterial circulation on its application on potential REP after radiotherapy for NPC. In our study, we evaluate the application value of 3D pCASL in the early assessment of potential REP in patients with NPC after radiotherapy. The study was to provide an improved understanding of the early specific characteristics on MRI imaging and evolution of potential radiation encephalopathy using 3D pCASL technique, which can quantitatively evaluate the changes of blood flow in tissues at early stage and help to diagnose and treat potential radiation encephalopathy as early as possible.
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Affiliation(s)
- Yujie He
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Jingjing Guo
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yongjun Ding
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Leyuan Zhou
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Xinyu Jiang
- Department of Radiology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi Children’s Hospital, Wuxi, Jiangsu, China
| | - Chendao Zhen
- Department of Clinical Laboratory, Affiliated Wuxi Matemity and Child Health Care Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Qinghua Wu
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Iutaka T, de Freitas MB, Omar SS, Scortegagna FA, Nael K, Nunes RH, Pacheco FT, Maia Júnior ACM, do Amaral LLF, da Rocha AJ. Arterial Spin Labeling: Techniques, Clinical Applications, and Interpretation. Radiographics 2023; 43:e220088. [DOI: 10.1148/rg.220088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mizowaki T, Hosoda K, Inoue S, Kuroda R, Kurihara E. Pseudo-continuous arterial spin labeling with short post-labeling delay time sensitively reflects the hemodynamics of symptomatic patients with permanent large vessel occlusion before and after revascularization. Neuroradiol J 2022; 35:706-712. [PMID: 35499089 PMCID: PMC9626846 DOI: 10.1177/19714009221096826] [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] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND AND PURPOSE This study evaluated the feasibility of arterial spin labeling (ASL) for diagnosing hemodynamic stroke due to permanent anterior circulation large vessel occlusion. METHODS Three-dimensional pseudo-continuous ASL data at two post-labeling delay (PLD) times (1.5 and 2.5 s) in patients with unilateral permanent middle cerebral artery (MCA) segment 1 (M1) or internal cerebral artery (ICA) occlusion were acquired during routine magnetic resonance angiography. Sixty-one patients with symptomatic occlusion (M1, 24; ICA, 37) and 69 patients with asymptomatic occlusion (M1, 21; ICA, 48) were enrolled. Regions of interest were automatically placed in the MCA region using a template. The respective scans were compared with asymptomatic M1 or ICA occlusion scans. The ratio of signal intensity (occlusion side/non-occlusion side) in the perfusion area of MCA (asymmetry index [AI]) was compared between both groups. RESULTS In both PLD groups, AI was significantly lower in symptomatic patients than in asymptomatic patients. The receiver operating characteristic curve showed moderate capacity for the prediction of symptomatic AI in both groups (area under the curve, 0.739 and 0.712, respectively). As a result of extracranial-intracranial bypass operation in 28 symptomatic (M1, eight; ICA, 20) patients, AI was significantly higher postoperatively in the PLD 1.5 s group than in the PLD 2.5 s group. CONCLUSION In symptomatic patients with permanent large vessel occlusion, the signal intensity ratio of pseudo-continuous ASL with short PLD sensitively reflects the hemodynamics before and after revascularization; therefore, this technique may be an alternative method in situations where PET or SPECT cannot be performed.
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Affiliation(s)
| | - Kohkichi Hosoda
- Department of Neurosurgery, Kobe City Nishi-Kobe Medical
Center, Kobe, Japan
| | - Satoshi Inoue
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Japan
| | - Ryuichi Kuroda
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Japan
| | - Eiji Kurihara
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Japan
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Buch K, Hakimelahi R, Locascio JJ, Bolar DS, Gonzalez RG, Schaefer PW. Clinical utility of arterial spin labeling perfusion images in the emergency department for the work-up of stroke-like symptoms. Neuroradiology 2021; 64:925-934. [PMID: 34664110 DOI: 10.1007/s00234-021-02835-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the utility of ASL in evaluating patients presenting to the ED with stroke-like symptoms. METHODS ASL and DWI images from 526 consecutive patients presenting to the ED with acute stroke symptoms were retrospectively reviewed. DWI images were evaluated for volume of restricted diffusion using ABC/2. ASL maps were evaluated for decreased, normal, or increased signal. The volume of decreased ASL signal was calculated using the same ABC/2 technique. The volume of decreased ASL signal was correlated with the volume of DWI signal abnormality to identify cases of mismatch (DWI:ASL ratio > 1.8) and to correlate this mismatch with infarct growth on imaging follow-up. NIHSS, length of hospital stay, mRS, and future admission for acute stroke-like symptoms were recorded. Correlations between ASL abnormalities and clinical parameters were evaluated using a two-tailed t-test. RESULTS Of the 526 patients presenting with acute stroke symptoms, 136 patients had an abnormal ASL scan and 388 patients had a normal ASL scan. Of the 136 patients with abnormal ASL, 84 patients had low ASL signal with 79 of these being related to acute infarcts. Elevated ASL signal was seen in 52 patients, of which 30 of these patients had reperfusion hyperemia related to acute infarctions. ASL had a negative predictive value of 94% for evaluating patients with acute ischemic stroke. A subset of patients with abnormal ASL scans with a discharge diagnosis of acute infarction were found to have an ASL:DWI mismatch (ratio > 1.8) and demonstrated significant lesion growth on follow-up imaging (57%). This included some patients who exhibited low ASL signal before development of diffusion restriction (infarction). CONCLUSION In patients presenting to the ED with acute stroke symptoms, ASL provides information not available with DWI alone. The NPV of ASL for evaluating patients with acute ischemia was 94%.
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Affiliation(s)
- Karen Buch
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Gray 241 G, Boston, MA, 02114, USA.
| | - Reza Hakimelahi
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Gray 241 G, Boston, MA, 02114, USA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Divya S Bolar
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - R Giliberto Gonzalez
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Gray 241 G, Boston, MA, 02114, USA
| | - Pamela W Schaefer
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Gray 241 G, Boston, MA, 02114, USA
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Wang J, Li Y, Yu H, Li G, Bai S, Chen S, Zhang P, Tang Z. Dl-3-N-Butylphthalide Promotes Angiogenesis in an Optimized Model of Transient Ischemic Attack in C57BL/6 Mice. Front Pharmacol 2021; 12:751397. [PMID: 34658892 PMCID: PMC8513739 DOI: 10.3389/fphar.2021.751397] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022] Open
Abstract
Transient ischemic attack (TIA) has been widely regarded as a clinical entity. Even though magnetic resonance imaging (MRI) results of TIA patients are negative, potential neurovascular damage might be present, and may account for long-term cognitive impairment. Animal models that simulate human diseases are essential tools for in-depth study of TIA. Previous studies have clarified that Dl-3-N-butylphthalide (NBP) promotes angiogenesis after stroke. However, the effects of NBP on TIA remain unknown. This study aims to develop an optimized TIA model in C57BL/6 mice to explore the microscopic evidence of ischemic injury after TIA, and investigate the therapeutic effects of NBP on TIA. C57BL/6 mice underwent varying durations (7, 8, 9 or 10 min) of middle cerebral artery occlusion (MCAO). Cerebral artery occlusion and reperfusion were assessed by laser speckle contrast imaging. TIA and ischemic stroke were distinguished by neurological testing and MRI examination at 24 h post-operation. Neuronal apoptosis was examined by TUNEL staining. Images of submicron cerebrovascular networks were obtained via micro-optical sectioning tomography. Subsequently, the mice were randomly assigned to a sham-operated group, a vehicle-treated TIA group or an NBP-treated TIA group. Vascular density was determined by immunofluorescent staining and fluorescein isothiocyanate method, and the expression of angiogenic growth factors were detected by western blot analysis. We found that an 8-min or shorter period of ischemia induced neither permanent neurological deficits nor MRI detectable brain lesions in C57BL/6 mice, but histologically caused neuronal apoptosis and cerebral vasculature abnormalities. NBP treatment increased the number of CD31+ microvessels and perfused microvessels after TIA. NBP also up-regulated the expression of VEGF, Ang-1 and Ang-2 and improved the cerebrovascular network. In conclusion, 8 min or shorter cerebral ischemia induced by the suture MCAO method is an appropriate TIA model in C57BL/6 mice, which conforms to the definition of human TIA, but causes microscopic neurovascular impairment. NBP treatment increased the expression of angiogenic growth factors, promoted angiogenesis and improved cerebral microvessels after TIA. Our study provides new insights on the pathogenesis and potential treatments of TIA.
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Affiliation(s)
| | | | | | | | | | | | - Ping Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Antonucci MU, Yazdani M. A Helpful Tool in Diagnosing Stroke Mimics: Arterial Spin Labeled Perfusion Magnetic Resonance Imaging. J Emerg Med 2020; 58:439-443. [PMID: 32197894 DOI: 10.1016/j.jemermed.2019.12.019] [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: 04/05/2018] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prompt and effective management of acute ischemic stroke in the emergency setting requires a high level of suspicion and accurate diagnosis. Conversely, identifying stroke mimics can be challenging, given the similarity of their clinical symptomatology, the necessary rapid assessment and triage, and the overall frenetic pace inherent in the goal of rapid thrombolysis ("time is brain"). CASE REPORT We describe a case that involves an elderly patient with acute hemiplegia and dysarthria. Given these concerning symptoms, and multiple preexisting cerebrovascular risk factors (including paroxysmal atrial fibrillation), a "stroke alert" was issued. Imaging was negative for infarct and she was ultimately diagnosed with hemiplegic migraine based on her symptoms and impressive findings on a novel magnetic resonance sequence called arterial spin labeled (ASL) perfusion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Identifying a nonischemic etiology in a presumed stroke patient, while often difficult, can obviate unnecessary treatment, improve patient care, and promote appropriate resource allocation. As imaging and treatment of cerebrovascular disease advances, the optimization of multidisciplinary care should incorporate neuroradiologists informing and availing their clinical colleagues of applications of an ever-expanding imaging armamentarium. This case is an excellent example of both a common challenging stroke mimic and the potential benefits of ASL perfusion imaging in refining and expediting accurate diagnosis. In addition, it serves as a more general introduction to the particular strengths of this noninvasive, noncontrast magnetic resonance technique, which can be employed to assess varied emergent neuropathology.
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Affiliation(s)
- Michael U Antonucci
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Milad Yazdani
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
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7
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Suman G, Rusin JA, Lebel RM, Hu HH. Multidelay Arterial Spin Labeling MRI in the Assessment of Cerebral Blood Flow: Preliminary Clinical Experience in Pediatrics. Pediatr Neurol 2020; 103:79-83. [PMID: 31570299 DOI: 10.1016/j.pediatrneurol.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We attempted to demonstrate the clinical applicability and utility of a three-dimensional multidelay arterial spin labeling magnetic resonance imaging technique in pediatric neuroimaging through a series of case studies. METHODS Whole-brain three-dimensional multidelay arterial spin labeling data were acquired in five pediatric patients with different neurological conditions using 3 mm to 4 mm slices and a scan time of six to seven minutes. RESULTS Three-dimensional multidelay arterial spin labeling provided complementary diagnostic information via quantitative cerebral blood flow and arterial transit time maps. CONCLUSIONS Three-dimensional multidelay arterial spin labeling sequence provides simultaneous quantification of cerebral blood flow and arterial transit time and is feasible for pediatric patients.
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Affiliation(s)
- Garima Suman
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Jerome A Rusin
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Houchun H Hu
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio.
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Nam KW, Kim CK, Ko SB, Yoon BW, Yoo RE, Sohn CH. Regional Arterial Spin Labeling Perfusion Defect Is Associated With Early Ischemic Recurrence in Patients With a Transient Ischemic Attack. Stroke 2019; 51:186-192. [PMID: 31718505 DOI: 10.1161/strokeaha.119.026556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- With the lack of confirmatory examinations, the distinction of a transient ischemic attack (TIA) from various TIA-mimicking diseases is difficult, particularly in diffusion-weighted imaging (DWI)-negative TIAs. In this study, we aimed to evaluate the relationship between arterial spin labeling (ASL) perfusion defects and early ischemic recurrence (FU-DWI [+]) in patients with DWI-negative TIAs. Methods- We assessed consecutive patients with a DWI-negative TIA within 24 hours of symptom onset, who underwent both ASL images and follow-up magnetic resonance imaging during the acute period. As markers of the ASL images, we evaluated the ASL perfusion defects in each hemisphere. Arterial transit artifact (ATA) and intraarterial high-intensity signal (IAS) were also rated as markers of collateral status and blood stagnation due to large vessel occlusion, respectively. Results- Among the 136 patients with a DWI-negative TIA, 33 patients had FU-DWI (+) lesions in 36 hemispheres. In the multivariable analysis, ASL defects remained an independent predictor of FU-DWI (+) (adjusted odds ratio, 13.94 [95% CI, 5.77-33.70], P<0.001). In the evaluation of the interactive relationship between ASL defects and ATA/IAS, the (ASL [+] ATA [-]) group showed the highest frequencies of FU-DWI (+) events (55.6%) with the highest adjusted odds ratio values (adjusted odds ratio, 14.86 [95% CI, 5.63-39.24], P<0.001), indicating a negative synergistic effect between the ASL defects and ATA. Meanwhile, the (ASL [+] IAS [+]) group showed higher frequencies of FU-DWI (+) and higher adjusted odds ratio values than those of the (ASL [+] IAS [-]) and (ASL [-] IAS [-]) groups, indicating a positive synergistic effect. Conclusions- We demonstrated that ASL perfusion defects were associated with ipsilateral FU-DWI (+) in patients with a DWI-negative TIA. Furthermore, this association was enhanced with IASs and attenuated with ATAs.
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Affiliation(s)
- Ki-Woong Nam
- From the Department of Neurology (K.-W.N., S.-B.K., B.-W.Y.), Seoul National University Hospital, Korea.,Seoul National University College of Medicine, Korea (K.-W.N., S.-B.K., B.-W.Y., C.-H.S.)
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul (C.K.K.).,Korea University College of Medicine, Seoul (C.K.K.)
| | - Sang-Bae Ko
- From the Department of Neurology (K.-W.N., S.-B.K., B.-W.Y.), Seoul National University Hospital, Korea.,Seoul National University College of Medicine, Korea (K.-W.N., S.-B.K., B.-W.Y., C.-H.S.)
| | - Byung-Woo Yoon
- From the Department of Neurology (K.-W.N., S.-B.K., B.-W.Y.), Seoul National University Hospital, Korea.,Seoul National University College of Medicine, Korea (K.-W.N., S.-B.K., B.-W.Y., C.-H.S.)
| | - Roh-Eul Yoo
- Department of Radiology (R.-E.Y., C.-H.S.), Seoul National University Hospital, Korea
| | - Chul-Ho Sohn
- Department of Radiology (R.-E.Y., C.-H.S.), Seoul National University Hospital, Korea.,Seoul National University College of Medicine, Korea (K.-W.N., S.-B.K., B.-W.Y., C.-H.S.)
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9
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Mora Álvarez MG, Stobbe RW, Beaulieu C. High resolution continuous arterial spin labeling of human cerebral perfusion using a separate neck tagging RF coil. PLoS One 2019; 14:e0215998. [PMID: 31022257 PMCID: PMC6483248 DOI: 10.1371/journal.pone.0215998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/11/2019] [Indexed: 02/07/2023] Open
Abstract
For standard clinical applications, ASL images are typically acquired with 4–8 mm thick slices and 3–4 mm in-plane resolution. However, in this paper we demonstrate that high-resolution continuous arterial spin labeling (CASL) perfusion images can be acquired in a clinically relevant scan time using current MRI technology. CASL was implemented with a separate neck coil for labeling the arterial blood on a 4.7T MRI using standard axial 2D GE-EPI. Typical-resolution to high-resolution (voxels of 95, 60, 45, 27, or 7 mm3) images were compared for qualitative and quantitative cerebral blood flow analysis (CBF) in nine healthy volunteers (ages: 24–32 years). The highest resolution (1.5x1.5x3 = 7 mm3) CASL implementation yielded perfusion images with improved cortex depiction and increased cortical CBF measurements (53 ± 8 ml/100g/min), consistent with reduced partial volume averaging. The 7 mm3 voxel images were acquired with 6 cm brain coverage in a clinically relevant scan of 6 minutes. Improved spatial resolution facilitates CBF measurement with reduced partial volume averaging and may be valuable for the detection of perfusion deficits in small lesions and perfusion measurement in small brain regions.
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Affiliation(s)
- María Guadalupe Mora Álvarez
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Wayne Stobbe
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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10
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Lv Y, Han X, Song Y, Han Y, Zhou C, Zhou D, Zhang F, Xue Q, Liu J, Zhao L, Zhang C, Li L, Wang J. Toward neuroimaging-based network biomarkers for transient ischemic attack. Hum Brain Mapp 2019; 40:3347-3361. [PMID: 31004388 DOI: 10.1002/hbm.24602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 12/23/2022] Open
Abstract
Stroke is associated with topological disruptions of large-scale functional brain networks. However, whether these disruptions occur in transient ischemic attack (TIA), an important risk factor for stroke, remains largely unknown. Combining multimodal MRI techniques, we systematically examined TIA-related topological alterations of functional brain networks, and tested their reproducibility, structural, and metabolic substrates, associations with clinical risk factors and abilities as diagnostic and prognostic biomarkers. We found that functional networks in patients with TIA exhibited decreased whole-brain network efficiency, reduced nodal centralities in the bilateral insula and basal ganglia, and impaired connectivity of inter-hemispheric communication. These alterations remained largely unchanged when using different brain parcellation schemes or correcting for micro head motion or for regional gray matter volume, cerebral blood flow or hemodynamic lag of BOLD signals in the patients. Moreover, some alterations correlated with the levels of high-density lipoprotein cholesterol (an index related to ischemic attacks via modulation of atherosclerosis) in the patients, distinguished the patients from healthy individuals, and predicted future ischemic attacks in the patients. Collectively, these findings highlight the emergence of characteristic network dysfunctions in TIA, which may aid in elucidating pathological mechanisms and establishing diagnostic and prognostic biomarkers for the disease.
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Affiliation(s)
- Yating Lv
- Institutes of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China.,Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Xiujie Han
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Yulin Song
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Yu Han
- Department of Neurology, the First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China
| | - Chengshu Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Dan Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Fuding Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Qiming Xue
- Department of Image, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Jinling Liu
- Department of Ultrasonics, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Lijuan Zhao
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Cairong Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Lingyu Li
- Institutes of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China.,Department of Neurology, Anshan Changda Hospital, Anshan, Liaoning, China
| | - Jinhui Wang
- Institute for Brain Research and Rehabilitation, Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
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11
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Lv Y, Li L, Song Y, Han Y, Zhou C, Zhou D, Zhang F, Xue Q, Liu J, Zhao L, Zhang C, Han X. The Local Brain Abnormalities in Patients With Transient Ischemic Attack: A Resting-State fMRI Study. Front Neurosci 2019; 13:24. [PMID: 30804735 PMCID: PMC6371034 DOI: 10.3389/fnins.2019.00024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/11/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Transient ischemic attack (TIA) is an important risk factor for stroke. Despite the transient episodes of clinical symptoms, brain alterations are still observed in patients with TIA. However, the functional mechanism of transient ischemia is still unclear. Here, we employed resting-state functional magnetic resonance imaging (rs-fMRI) to explore the functional abnormalities in patients with TIA. Methods: 48 TIA patients and 41 age- and sex-matched healthy controls (HCs) were enrolled in the study. For each participant, we collected rs-fMRI data and clinical/physiological/biochemical data. Amplitude of low frequency fluctuation (ALFF), regional homogeneity (ReHo), and degree centrality (DC) were then calculated. Two sample t-tests were performed to compare the ALFF, ReHo, and DC maps between the two groups. Furthermore, a correlation analysis was performed to explore the relationship between local brain abnormalities and clinical/physiological/biochemical characteristics tests in TIA patients. Results: Compared with the HCs, the TIA patients exhibited decreased ALFF in the left middle temporal gyrus, decreased DC in the triangular part of right inferior frontal gyrus, and no significant statistical difference in ReHo. No correlation was found between local abnormalities and clinical/physiological/biochemical scores in the patients with TIA. Conclusion: Collectively, we found decreased ALFF and DC in patients with TIA which provide evidence for local brain dysfunctions and may help to understand the pathological mechanism for the disease.
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Affiliation(s)
- Yating Lv
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.,Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Lingyu Li
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.,Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Yulin Song
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Yu Han
- Department of Neurology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Chengshu Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Dan Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Fuding Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Qiming Xue
- Department of Image, Anshan Changda Hospital, Anshan, China
| | - Jinling Liu
- Department of Ultrasonics, Anshan Changda Hospital, Anshan, China
| | - Lijuan Zhao
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Cairong Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Xiujie Han
- Department of Neurology, Anshan Changda Hospital, Anshan, China
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12
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Non-invasive evaluation of cerebral perfusion in patients with transient ischemic attack: an fMRI study. J Neurol 2018; 266:157-164. [PMID: 30446964 DOI: 10.1007/s00415-018-9113-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
Detection of hypoperfused tissue due to the ischemia is considered to be important in understanding the cerebral perfusion status and may be helpful in guiding therapeutic decisions for patients with transient ischemic attack (TIA). We hypothesized that the combination of two non-invasive fMRI techniques: resting-state BOLD-fMRI time-shift analysis (TSA) approach and 3D ASL, could detect the cerebral hemodynamic status in TIA patients noninvasively. From April 2015 to June 2016, 51 TIA patients were recruited in this study. We calculated the time delay between the resting-state BOLD signal at each voxel and the whole-brain signal using TSA approach and compared the results to CBF map derived from ASL. Out of the 51 patients, 24 patients with normal arrival time and CBF were in Stage 0; 14 patients who showed delayed arrival time and normal CBF which indicated elevated CBV were in Stage I; the other 13 patients who had both delayed arrival time and decreased CBF were in Stage II, the group average spatial overlap, i.e., Dice coefficient, of the two measurements was 0.55. Four patients in Stage 0 (17.4%), three patients in Stage I (23.1%) and five patients in Stage II (45.5%) suffered ischemic stroke or TIA symptoms in 1 year after MRI scan. The patients in Stage II was at highest risk of subsequent events when compared to other two stages. The combination of resting-state BOLD-fMRI and ASL hold the potential to noninvasively identify the hemodynamic status in TIA patients and help predict the risk of subsequent events.
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Havsteen I, Damm Nybing J, Christensen H, Christensen AF. Arterial spin labeling: a technical overview. Acta Radiol 2018; 59:1232-1238. [PMID: 29313361 DOI: 10.1177/0284185117752552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Arterial spin labeling (ASL) is a non-invasive magnetic resonance imaging perfusion method based on changes in net-magnetization of blood water. The absence of contrast use and ionizing radiation, renders ASL valuable in hyper-acute settings as a monitoring tool for repeated dynamical measurements during and after intervention, and for patients with known co-morbidities. This text provides a short methodological introduction to ASL and contrasts it with traditional contrast-enhanced perfusion imaging. The review focused on sequence usefulness in the clinical setting of acute cerebral ischemia investigation.
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Affiliation(s)
- Inger Havsteen
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Janus Damm Nybing
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Anders F Christensen
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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14
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Havsteen I, Willer L, Ovesen C, Nybing JD, Ægidius K, Marstrand J, Meden P, Rosenbaum S, Folke MN, Christensen H, Christensen A. Significance of arterial spin labeling perfusion and susceptibility weighted imaging changes in patients with transient ischemic attack: a prospective cohort study. BMC Med Imaging 2018; 18:24. [PMID: 30126352 PMCID: PMC6102826 DOI: 10.1186/s12880-018-0264-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 07/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background In a prospective cohort of patients with transient ischemic attack (TIA), we investigated usefulness and feasibility of arterial spin labeling (ASL) perfusion and susceptibility weighted imaging (SWI) alone and in combination with standard diffusion weighted (DWI) imaging in subacute diagnostic work-up. We investigated rates of ASL and SWI changes and their potential correlation to lasting infarction 8 weeks after ictus. Methods Patients with TIA underwent 3T-MRI including DWI, ASL and SWI within 72 h of symptom onset. We defined lasting infarction as presence of 8-week MRI T2-fluid attenuated inversion recovery (FLAIR) hyperintensity or atrophy in the area of initial DWI-lesion. Results We included 116 patients. Diffusion and perfusion together identified more patients with ischemia than either alone (59% vs. 40%, p < 0.0001). The presence of both diffusion and perfusion lesions had the highest rate of 8-week gliosis scars, 65% (p < 0.0001). In white matter, DWI-restriction was the determinant factor for scar development. However, in cortical gray matter half of lesions with perfusion deficit left a scar, while lesions without perfusion change rarely resulted in scars (56% versus 21%, p = 0.03). SWI lesions were rare (6%) and a subset of perfusion lesions. SWI-lesions with DWI-lesions were all located in cortical gray matter and showed high scar rate. Conclusions ASL perfusion increased ischemia detection in patients with TIA, and was most useful in conjunction with DWI. ASL was fast, robust and useful in a subacute clinical diagnostic setting. SWI had few positive findings and did not add information. Trial Registration. http://www.clinicaltrials.gov. Unique Identifier NCT01531946, prospectively registered February 9, 2012. Electronic supplementary material The online version of this article (10.1186/s12880-018-0264-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Inger Havsteen
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - Lasse Willer
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Christian Ovesen
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Janus Damm Nybing
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Karen Ægidius
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Jacob Marstrand
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Per Meden
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Marie Norsker Folke
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Anders Christensen
- Department of Radiology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
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Lee JS, Lee KM, Kim HG. A case of recurrent transient ischemic attacks: carotid stump syndrome or posterior cerebral artery syndrome? Neurol Sci 2018; 39:1993-1995. [DOI: 10.1007/s10072-018-3509-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
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16
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Arteaga DF, Strother MK, Davis LT, Fusco MR, Faraco CC, Roach BA, Scott AO, Donahue MJ. Planning-free cerebral blood flow territory mapping in patients with intracranial arterial stenosis. J Cereb Blood Flow Metab 2017; 37:1944-1958. [PMID: 27389177 PMCID: PMC5464691 DOI: 10.1177/0271678x16657573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 11/15/2022]
Abstract
A noninvasive method for quantifying cerebral blood flow and simultaneously visualizing cerebral blood flow territories is vessel-encoded pseudocontinuous arterial spin labeling MRI. However, obstacles to acquiring such information include limited access to the methodology in clinical centers and limited work on how clinically acquired vessel-encoded pseudocontinuous arterial spin labeling data correlate with gold-standard methods. The purpose of this work is to develop and validate a semiautomated pipeline for the online quantification of cerebral blood flow maps and cerebral blood flow territories from planning-free vessel-encoded pseudocontinuous arterial spin labeling MRI with gold-standard digital subtraction angiography. Healthy controls (n = 10) and intracranial atherosclerotic disease patients (n = 34) underwent 3.0 T MRI imaging including vascular (MR angiography) and hemodynamic (cerebral blood flow-weighted arterial spin labeling) MRI. Patients additionally underwent catheter and/or CT angiography. Variations in cross-territorial filling were grouped according to diameters of circle of Willis vessels in controls. In patients, Cohen's k-statistics were computed to quantify agreement in perfusion patterns between vessel-encoded pseudocontinuous arterial spin labeling and angiography. Cross-territorial filling patterns were consistent with circle of Willis anatomy. The intraobserver Cohen's k-statistics for cerebral blood flow territory and digital subtraction angiography perfusion agreement were 0.730 (95% CI = 0.593-0.867; reader one) and 0.708 (95% CI = 0.561-0.855; reader two). These results support the feasibility of a semiautomated pipeline for evaluating major neurovascular cerebral blood flow territories in patients with intracranial atherosclerotic disease.
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Affiliation(s)
| | | | - L Taylor Davis
- Radiology, Vanderbilt University Medical Center, Nashville, USA
| | - Matthew R Fusco
- Neurosurgery, Vanderbilt University Medical Center, Nashville, USA
| | - Carlos C Faraco
- Radiology, Vanderbilt University Medical Center, Nashville, USA
| | - Brent A Roach
- Radiology, Vanderbilt University Medical Center, Nashville, USA
| | - Allison O Scott
- Radiology, Vanderbilt University Medical Center, Nashville, USA
| | - Manus J Donahue
- Radiology, Vanderbilt University Medical Center, Nashville, USA
- Psychiatry, Vanderbilt University Medical Center, Nashville, USA
- Physics and Astronomy, Vanderbilt University, Nashville, USA
- Neurology, Vanderbilt University Medical Center, Nashville, USA
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Burns R, De Malherbe M, Chadenat ML, Pico F, Buch D. Arterial Spin-Labeled MR Imaging Detecting Biphasic Neurovascular Changes in Migraine With Persistent Aura. Headache 2017; 57:1627-1628. [DOI: 10.1111/head.13119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Robert Burns
- Neurology Department and Stroke Centre; Mignot Hospital; Le Chesnay France
| | - Maxine De Malherbe
- Radiology Department; Centre Hospitalier de Versailles; Le Chesnay France
| | | | - Fernando Pico
- Neurology Department and Stroke Centre; Mignot Hospital; Le Chesnay France
- Université de Versailles Saint-Quentin-en-Yvelines; Versailles France
- INSERM LVTS (Laboratory for Vascular Translational Science) 1148; Paris France
| | - Dan Buch
- Neurology Department and Stroke Centre; Mignot Hospital; Le Chesnay France
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18
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Tong E, Sugrue L, Wintermark M. Understanding the Neurophysiology and Quantification of Brain Perfusion. Top Magn Reson Imaging 2017; 26:57-65. [PMID: 28277465 DOI: 10.1097/rmr.0000000000000128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Newer neuroimaging technology has moved beyond pure anatomical imaging and ventured into functional and physiological imaging. Perfusion magnetic resonance imaging (PWI), which depicts hemodynamic conditions of the brain at the microvascular level, has an increasingly important role in clinical central nervous system applications. This review provides an overview of the established role of PWI in brain tumor and cerebrovascular imaging, as well as some emerging applications in neuroimaging. PWI allows better characterization of brain tumors, grading, and monitoring. In acute stroke imaging, PWI is utilized to distinguish penumbra from infarcted tissue. PWI is a promising tool in the assessment of neurodegenerative and neuropsychiatric diseases, although its clinical role is not yet defined.
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Affiliation(s)
- Elizabeth Tong
- *Department of Radiology & Biomedical Imaging, University of California, San Francisco †Department of Neuroradiology, Stanford University Medical Center, Palo Alto, CA
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Lee SH, Nah HW, Kim BJ, Ahn SH, Kim JS, Kang DW, Kwon SU. Role of Perfusion-Weighted Imaging in a Diffusion-Weighted-Imaging-Negative Transient Ischemic Attack. J Clin Neurol 2017; 13:129-137. [PMID: 28176500 PMCID: PMC5392454 DOI: 10.3988/jcn.2017.13.2.129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/08/2016] [Accepted: 10/10/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The absence of acute ischemic lesions in diffusion-weighted imaging (DWI) in transient ischemic attack (TIA) patients makes it difficult to diagnose the true vascular etiologies. Among patients with DWI-negative TIA, we investigated whether the presence of a perfusion-weighted imaging (PWI) abnormality implied a true vascular event by identifying new acute ischemic lesions in follow-up magnetic resonance imaging (MRI) in areas corresponding to the initial PWI abnormality. METHODS The included patients underwent DWI and PWI within 72 hours of TIA and also follow-up DWI at 3 days after the initial MRI. These patients had visited the emergency room between July 2009 and May 2015. Patients who demonstrated initial DWI lesions were excluded. The initial PWI abnormalities in the corresponding vascular territory were visually classified into three patterns: no abnormality, focal abnormality, and territorial abnormality. RESULTS No DWI lesions were evident in initial MRI in 345 of the 443 TIA patients. Follow-up DWI was applied to 87 of these 345 DWI-negative TIA patients. Initial PWI abnormalities were significantly associated with follow-up DWI abnormalities: 8 of 43 patients with no PWI abnormalities (18.6%) had new ischemic lesions, whereas 13 of 16 patients with focal perfusion abnormalities (81.2%) had new ischemic lesions in the areas of initial PWI abnormalities [odds ratio (OR)=15.1, 95% confidence interval (CI)=3.6-62.9], and 14 of 28 patients with territorial perfusion abnormalities (50%) had new lesions (OR=3.7, 95% CI=1.2-11.5). CONCLUSIONS PWI is useful in defining whether or not the transient neurological symptoms in DWI-negative TIA are true vascular events, and will help to improve the understanding of the pathomechanism of TIA.
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Affiliation(s)
- Sang Hun Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Wook Nah
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Ho Ahn
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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20
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Agrawal K, Raman R, Ernstrom K, Claycomb RJ, Meyer DM, Hemmen TM, Modir RF, Kachhi P, Meyer BC. Accuracy of Stroke Diagnosis in Telestroke-Guided Tissue Plasminogen Activator Patients. J Stroke Cerebrovasc Dis 2016; 25:2942-2946. [PMID: 27599906 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 07/30/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The objective of the study is to assess the accuracy of final diagnosis in telestroke-guided tissue plasminogen activator (rt-PA) patients compared with bedside evaluation using computed tomography (CT) or magnetic resonance imaging (MRI) as a surrogate for final stroke diagnosis. The overall goal was to determine if telestroke had similar diagnostic accuracy as bedside evaluations in diagnosing rt-PA-treated patients. MATERIALS AND METHODS We analyzed all acute stroke code calls who received intravenous rt-PA at our center from October 2013 to June 2015. Calls were grouped into patients who were initially evaluated by telestroke at a spoke partner site (spoke) and patients evaluated in person at the hub. Patients receiving additional neurointervention were excluded to avoid confounding. Relevant variables included severity of stroke (National Institutes of Health Stroke Scale [NIHSS]), rt-PA times, presence of intracranial hemorrhage (ICH), and primary outcome of CT or MRI evidence of stroke after rt-PA administration. Post-rt-PA imaging used included CT or MRI within 72 hours after treatment. RESULTS Overall, 80 patients received intravenous rt-PA (spoke [n = 23] and hub [n = 57]). There was no difference in mean NIHSS score prior to treatment (10.3 ± 9.2 and 9.8 ± 8.4; P = .936), "onset-to-treatment" time (143.6 ± 53.5 minutes and 141.0 ± 54.1 minutes; P = .915), and ICH rate (13% and 8.8%; adjusted P = .898). The presence of radiographic evidence of stroke at spoke versus hub was not different (78.3% and 66.7%; adjusted P = .338). The most commonly used radiographic modality was MRI (MRI: 80%, CT: 20%). CONCLUSIONS Using imaging as a surrogate for final diagnosis resulted in no difference in final stroke diagnosis rate between the groups, reinforcing that telestroke evaluations are as accurate as bedside evaluations in diagnosing acute stroke.
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Affiliation(s)
| | - Rema Raman
- University of Southern California, Los Angeles, California
| | - Karin Ernstrom
- University of Southern California, Los Angeles, California
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A neuroradiologist's guide to arterial spin labeling MRI in clinical practice. Neuroradiology 2015; 57:1181-202. [PMID: 26351201 PMCID: PMC4648972 DOI: 10.1007/s00234-015-1571-z] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/05/2015] [Indexed: 01/01/2023]
Abstract
Arterial spin labeling (ASL) is a non-invasive MRI technique to measure cerebral blood flow (CBF). This review provides a practical guide and overview of the clinical applications of ASL of the brain, as well its potential pitfalls. The technical and physiological background is also addressed. At present, main areas of interest are cerebrovascular disease, dementia and neuro-oncology. In cerebrovascular disease, ASL is of particular interest owing to its quantitative nature and its capability to determine cerebral arterial territories. In acute stroke, the source of the collateral blood supply in the penumbra may be visualised. In chronic cerebrovascular disease, the extent and severity of compromised cerebral perfusion can be visualised, which may be used to guide therapeutic or preventative intervention. ASL has potential for the detection and follow-up of arteriovenous malformations. In the workup of dementia patients, ASL is proposed as a diagnostic alternative to PET. It can easily be added to the routinely performed structural MRI examination. In patients with established Alzheimer’s disease and frontotemporal dementia, hypoperfusion patterns are seen that are similar to hypometabolism patterns seen with PET. Studies on ASL in brain tumour imaging indicate a high correlation between areas of increased CBF as measured with ASL and increased cerebral blood volume as measured with dynamic susceptibility contrast-enhanced perfusion imaging. Major advantages of ASL for brain tumour imaging are the fact that CBF measurements are not influenced by breakdown of the blood–brain barrier, as well as its quantitative nature, facilitating multicentre and longitudinal studies.
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22
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Li JL, Li CS, Fu JH, Zhang K, Xu R, Xu WJ. Evaluation of Cranial and Cervical Arteries and Brain Tissue in Transient Ischemic Attack Patients with Magnetic Resonance Angiography and Diffusion-Weighted Imaging. Med Sci Monit 2015; 21:1726-31. [PMID: 26073092 PMCID: PMC4473803 DOI: 10.12659/msm.894388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Magnetic resonance angiography (MRA) and diffusion-weighted imaging (DWI) have been widely used in the prediction of ischemic stroke; however, the differences of the 2 methods in detection the artery lesion differences between transient ischemic attack (TIA) and infarction patients have been long neglected. We performed the present study to investigate the differences between vessel characteristics detected by MRA and DWI in acute stroke and TIA patients. Material/Methods We classified 110 subjects into 2 groups and all the patients underwent both MRA and DWI. The degree of stenosis of cranial and cervical arteries, the distribution of the stenosis, the development and changes of the vessels, and the DWI scanning results of the brain tissue were all analyzed. Results We detected a significant difference in the number and the degree of stenosis of cranial and cervical arteries among the 3 groups (P=0.006). Compared with health controls, patients with TIA and cerebral infraction had much more severe stenosis and occlusive arteries (P<0.05). However, no significant difference was detected between TIA and cerebral infraction patients (P=0.148). Moreover, a higher rate of unilateral vertebral artery dysplasia was found in the vertebrobasilar TIA patients. Higher lesion signals were also observed by DWI in TIA patients of internal carotid artery system (4/8, 50%). Conclusions Vessel characteristics were not significantly different between TIA and infarction patients. Unilateral vertebral artery hypoplasia was a predisposing factor for vertebrobasilar TIA and ischemic focus in DWI detection was always caused by severe artery lesions.
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Affiliation(s)
- Jian-Long Li
- Rizhao City People's Hospital, Rizhao, Shandong, China (mainland)
| | - Chang-Shan Li
- Rizhao City People's Hospital, Rizhao, Shandong, China (mainland)
| | - Jun-Hua Fu
- Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Ke Zhang
- Rizhao City People's Hospital, Rizhao, Shandong, China (mainland)
| | - Rui Xu
- Rizhao City People's Hospital, Rizhao, Shandong, China (mainland)
| | - Wen-Jian Xu
- Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
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Chen J, Zhao B, Bai M, Bu C. Multiphase arterial spin labeling assessment of cerebral perfusion changes associated with middle cerebral artery stenosis. Acad Radiol 2015; 22:610-8. [PMID: 25636975 DOI: 10.1016/j.acra.2014.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the sensitivity and utility of multiphase pulsed arterial spin labeling (PASL) in detecting dynamic changes of cerebral perfusion in the presence of a middle cerebral artery (MCA) severe stenosis. MATERIALS AND METHODS Seventeen patients with severe stenoses in unilateral M1 segment of MCA were involved in this study. All patients underwent multiphase PASL imaging. Bilateral basal ganglia were drawn by hand as regions of interest (ROIs) on eight-phase images of each patient. The signal intensities of ROIs were measured and the time-intensity curves (TICs) were acquired through postprocessing on a magnetic resonance workstation. Whether there was a significant difference in the peak signal intensities of ROIs between the narrowed and normal sides was determined by the paired samples t test. RESULTS Three types of TICs were observed: eight cases with platform type, five cases with two-peak type, and four cases with single-peak type. There was a significant difference in the peak signal intensities of ROIs between the narrowed and normal sides. CONCLUSIONS Different types of TICs represent different cerebral hemodynamic changes. Multiphase PASL can sensitively detect the dynamic characteristics of cerebral perfusion and provide important dynamic perfusion information for clinical treatment of arterial stenosis.
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Affiliation(s)
- Jun Chen
- Shandong Medical Imaging Research Institute, Shandong University, Jingwu Rd No. 324, Jinan, Shandong Province 250021, China; Department of Radiology, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Bin Zhao
- Shandong Medical Imaging Research Institute, Shandong University, Jingwu Rd No. 324, Jinan, Shandong Province 250021, China.
| | - Min Bai
- Department of Radiology, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Chunqing Bu
- Department of Radiology, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
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A retrospective analysis of negative diffusion-weighted image results in patients with acute cerebral infarction. Sci Rep 2015; 5:8910. [PMID: 25777182 PMCID: PMC4361873 DOI: 10.1038/srep08910] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 02/10/2015] [Indexed: 11/09/2022] Open
Abstract
We aimed to investigate the clinicoradiologic determinants of negative diffusion-weighted image (DWI) results in patients with acute cerebral infarction (ACI). The medical records were reviewed of ACI patients. Patients were divided to the DWI positive and negative group. Positive DWI was used as independent variable and patients' clinicoradiologic factors were used as co-variables for multivariate logistic regression analysis. 349 patients received initial cerebral MRI within 72 hours of admission. Lacunar infarction was most common (42.1%) followed by posterior circulation infarction (30.1%) and partial anterior circulation infarction (18.1%). The majority of the patients (72.2%) had an NIHSS score of less than 5 at admission. 316 patients (90.54%) were positive on initial DWI. Patients with smoking, initial SBP ≥ 140 or DBP ≥ 90 mmHg, initial fasting plasma glucose (FPG) ≥ 7.0 mmol/L, initial MRI from onset of disease >1 d and anterior circulation infarction were liable to show positive DWI. Furthermore, DWI negative patients had significantly lower NIHSS scores (IQR 0,1,2) than DWI positive patients (IQR 1,2,4) (P = 0.000) at two weeks post onset of acute cerebral infarction. In conclusion, multiple clinicoradiologic factors are associated with negative and positive DWI and further delineation of these factors is required in future prospective studies.
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Souillard-Scemama R, Tisserand M, Calvet D, Jumadilova D, Lion S, Turc G, Edjlali M, Mellerio C, Lamy C, Naggara O, Meder JF, Oppenheim C. An update on brain imaging in transient ischemic attack. J Neuroradiol 2015; 42:3-11. [DOI: 10.1016/j.neurad.2014.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022]
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Yger M, Villain N, Belkacem S, Bertrand A, Rosso C, Crozier S, Samson Y, Dormont D. [Contribution of arterial spin labeling to the diagnosis of sudden and transient neurological deficit]. Rev Neurol (Paris) 2014; 171:161-5. [PMID: 25555846 DOI: 10.1016/j.neurol.2014.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 08/31/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
MRI is the gold standard exploration for sudden transient neurological events. If diffusion MRI is negative, there may be a diagnostic doubt between transient ischemic attack and other causes of transient neurological deficit. We illustrate how sequence arterial spin labeling (ASL), which evaluates cerebral perfusion, contributes to the exploration of transient neurological events. An ASL sequence was performed in seven patients with a normal diffusion MRI explored for a transient deficit. Cortical hyperperfusion not systematized to an arterial territory was found in three and hypoperfusion systematized to an arterial territory in four. ASL helped guide early management of these patients.
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Affiliation(s)
- M Yger
- Service d'urgences cérébrovasculaires, groupe hospitalier Pitié-Salpétrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - N Villain
- Service d'urgences cérébrovasculaires, groupe hospitalier Pitié-Salpétrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - S Belkacem
- Service de neuroradiologie diagnostique et fonctionnelle, groupe hospitalier Pitié-Salpétrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - A Bertrand
- Service de neuroradiologie diagnostique et fonctionnelle, groupe hospitalier Pitié-Salpétrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - C Rosso
- Service d'urgences cérébrovasculaires, groupe hospitalier Pitié-Salpétrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - S Crozier
- Service d'urgences cérébrovasculaires, groupe hospitalier Pitié-Salpétrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - Y Samson
- Service d'urgences cérébrovasculaires, groupe hospitalier Pitié-Salpétrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - D Dormont
- Service de neuroradiologie diagnostique et fonctionnelle, groupe hospitalier Pitié-Salpétrière, 47, boulevard de l'Hôpital, 75013 Paris, France
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