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Kumar S, Mondal S, Kumar R. Unusual Case Report of Headache in 10-Year-Old Female Child. Cureus 2024; 16:e53590. [PMID: 38449939 PMCID: PMC10915452 DOI: 10.7759/cureus.53590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/08/2024] Open
Abstract
According to the literature, transverse sinus hypoplasia is not a normal variant and has a serious potential effect on cerebral blood flow. We are presenting a rare case of chronic headache due to severe hypoplasia of the left transverse and sigmoidal sinus. A 12-year-old female girl was admitted with a complaint of gradual progressive severe headache, throbbing in nature, confined to a bitemporal and frontal region in the last 4-5 months. Headache is not associated with fever, vomiting, photophobia, or vision problems. The child had no history of recurrent running nose, refractory vision, ear discharge, head trauma, exanthemata rash, or any drug history. On examination, the child was conscious and oriented. Vital signs are normal. The child was neurologically normal and had no focal signs. Other systemic examinations were normal. Based on History and examination, differential diagnosis was made, like Pseudo tumor cerebri, migraine, deep vein sinus thrombosis, and functional and Posterior fossa tumor. The child had normal routine investigations like complete blood count, electrolyte, and D-dimer. The fundoscopy was normal. In MRI, brain hypoplasia of the left transverse and sinusoidal sinus was suspected and confirmed by MRI venography. Thus, for any patient in an emergency with a chronic headache without focal signs and normal fundoscopy, one deferential should be considered for transverse and sigmoid sinus hypoplasia.
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Affiliation(s)
- Sudesh Kumar
- Pediatrics, Mata Gujri Memorial Medical College, Kishanganj, IND
| | | | - Roshan Kumar
- Medicine, Mata Gujri Memorial Medical College, Kishanganj, IND
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Shang W, Zhong K, Shu L, Li Z, Hong H. Evaluation of extent vs velocity of cortical venous filing in stroke outcome after endovascular thrombectomy. Neuroradiology 2023:10.1007/s00234-023-03146-5. [PMID: 37022485 DOI: 10.1007/s00234-023-03146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Abnormal venous drainage may affect the prognosis of patients undergoing endovascular reperfusion therapy (ERT). Herein, time-resolved dynamic computed tomography arteriography (dCTA) was applied to evaluate the relationship between the velocity and extent of cortical venous filling (CVF), collateral status and outcomes. METHODS Thirty-five consecutive patients with acute anterior circulation occlusion who underwent ERT within 24 h of onset and successfully recanalized were enrolled. All patients underwent dCTA before ERT. Slow first or end of CVF was considered to occur when the time point of CVF appearance or disappearance on the affected side occurred after than that on the healthy side, whereas an equal CVF, a CVF reduced by ≤ 50%, or by > 50% on the affected side, were considered good, intermediate, and poor CVF extent, respectively. RESULTS Slow first CVF (29 patients, 82.8%), slow end of CVF (29, 85.7%), and intermediate extent of CVF (7, 20.0%) were not associated with collateral status or outcomes. Poor extent of CVF (6, 17.1%) was associated with poor collateral status, higher proportion of midline shift, larger final infarct volume, higher modified Rankin Scale (mRS) score at discharge, and higher proportion of in-hospital mortality. All patients with transtentorial herniation had poor extent of CVF, and those with poor CVF extent had an mRS score ≥ 3 at discharge. CONCLUSION Poor CVF extent, as assessed by dCTA, is a more accurate and specific marker than slow CVF to identify patients at high risk for poor outcomes after ERT.
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Affiliation(s)
- Wenjin Shang
- Department of Neurology, The First Affiliated Hospital, SunYat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Guangzhou, Guangdong Province, China
- National Key Clinical Department and Key Discipline of Neurology, Guangzhou, Guangdong Province, China
| | - Kaiyi Zhong
- Department of Neurology, The First Affiliated Hospital, SunYat-sen University, Guangzhou, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Guangzhou, Guangdong Province, China
- National Key Clinical Department and Key Discipline of Neurology, Guangzhou, Guangdong Province, China
| | - Liming Shu
- Department of Neurology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Zhuhao Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Hua Hong
- Department of Neurology, The First Affiliated Hospital, SunYat-sen University, Guangzhou, Guangdong Province, China.
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, Guangzhou, Guangdong Province, China.
- National Key Clinical Department and Key Discipline of Neurology, Guangzhou, Guangdong Province, China.
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
- Health Management Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
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Song X, Qiu H, Yang S, Liu Y, Cao Y, Wang S, Zhao J. Peri-therapeutic multi-modal hemodynamic assessment and detection of predictors for symptomatic in-stent restenosis after percutaneous transluminal angioplasty and stenting. Front Neurol 2023; 14:1136847. [PMID: 37144006 PMCID: PMC10151536 DOI: 10.3389/fneur.2023.1136847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 05/06/2023] Open
Abstract
Backgrounds This study performed multi-modal hemodynamic analysis including quantitative color-coded digital subtraction angiography (QDSA) and computational fluid dynamics (CFD) to delineate peri-therapeutic hemodynamic changes and explore the risk factors for in-stent restenosis (ISR) and symptomatic ISR (sISR). Methods Forty patients were retrospectively reviewed. Time to peak (TTP), full width at half maximum (FWHM), cerebral circulation time (CCT), angiographic mean transit time (aMTT), arterial stenosis index (ASI), wash-in gradient (WI), wash-out gradient (WO) and stasis index were calculated with QDSA and translesional pressure ratio (PR) and wall shear stress ratio (WSSR) were quantified from CFD analysis. These hemodynamic parameters were compared between before and after stent deployment and multivariate logistic regression model was established to detect predictors for ISR and sISR at follow-up. Results It was found that stenting generally reduced TTP, stasis index, CCT, aMTT and translesional WSSR while significantly increased translesional PR. ASI decreased after stenting, and during the mean follow-up time of 6.48 ± 2.86 months, lower ASI (<0.636) as well as larger stasis index were corroborated to be independently associated with sISR. aMTT showed a linear correlation with CCT before and after stenting. Conclusion PTAS not only improved cerebral circulation and blood flow perfusion but also changed local hemodynamics significantly. ASI and stasis index derived from QDSA were proved to play a prominent role in risk stratification for sISR. Multi-modal hemodynamic analysis could facilitate intraoperative real-time hemodynamic monitoring and help the determination of the end point of intervention.
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Affiliation(s)
- Xiaowen Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hancheng Qiu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Yang
- Department of Vascular Neurosurgery, New Era Stroke Care and Research Institute, The PLA Rocket Force General Hospital, Beijing, China
| | - Yuqi Liu
- Escope Innovation Academy, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- *Correspondence: Jizong Zhao,
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Zaid Al-Kaylani AHA, Schuurmann RCL, Maathuis WD, Slart RHJA, De Vries JPPM, Bokkers RPH. Clinical Applications of Quantitative Perfusion Imaging with a C-Arm Flat-Panel Detector-A Systematic Review. Diagnostics (Basel) 2022; 13:diagnostics13010128. [PMID: 36611421 PMCID: PMC9818280 DOI: 10.3390/diagnostics13010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
C-arm systems with digital flat-panel detectors are used in interventional radiology and hybrid operating rooms for visualizing and performing interventions on three-dimensional structures. Advances in C-arm technology have enabled intraoperative quantitative perfusion imaging with these scanners. This systematic review provides an overview of flat-panel detector C-arm techniques for quantifying perfusion, their clinical applications, and their validation. A systematic search was performed for articles published between January 2000 and October 2022 in which a flat-panel detector C-arm technique for quantifying perfusion was compared with a reference technique. Nine articles were retrieved describing two techniques: two-dimensional perfusion angiography (n = 5) and dual-phase cone beam computed tomography perfusion (n = 4). A quality assessment revealed no concerns about the applicability of the studies. The risk of bias was relatively high for the index and reference tests. Both techniques demonstrated potential for clinical application; however, weak-to-moderate correlations were reported between them and the reference techniques. In conclusion, both techniques could add new possibilities to treatment planning and follow-up; however, the available literature is relatively scarce and heterogeneous. Larger-scale randomized prospective studies focusing on clinical outcomes and standardization are required for the full understanding and clinical implementation of these techniques.
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Affiliation(s)
- Abdallah H. A. Zaid Al-Kaylani
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Richte C. L. Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Wouter D. Maathuis
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Riemer H. J. A. Slart
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Nuclear Medicine & Molecular Imaging, Medical Imaging Center, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Jean-Paul P. M. De Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Reinoud P. H. Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
- Correspondence: ; +31-50-3616161
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Shang W, Zhong K, Shu L, Li Z, Hong H. Poor Internal Jugular Venous Outflow Is Associated with Poor Cortical Venous Outflow and Outcomes after Successful Endovascular Reperfusion Therapy. Brain Sci 2022; 13:brainsci13010032. [PMID: 36672011 PMCID: PMC9856844 DOI: 10.3390/brainsci13010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
Many patients show poor outcomes following endovascular reperfusion therapy (ERT), and poor cortical venous outflow is a risk factor for these poor outcomes. We investigated the association between the outflow of the internal jugular vein (IJV) and baseline cortical venous outflow and the outcomes after ERT. We retrospectively enrolled 78 patients diagnosed with an acute anterior circulation stroke and successful ERT. Poor IJV outflow on the affected side was defined as stenosis ≥50% or occlusion of ipsilateral IJV, and poor outflow of bilateral IJVs was defined as stenosis ≥50% or occlusion of both IJVs. Poor cortical venous outflow was defined as a cortical vein opacification score (COVES) of 0 on admission. Multivariate analysis showed that poor outflow of IJV on the affected side was an independent predictor for hemorrhagic transformation. The poor outflow of bilateral IJVs was an independent risk factor for poor clinical outcomes. These patients also had numerical trends of a higher incidence of symptomatic intracranial hemorrhage, midline shift >10 mm, and in-hospital mortality; however, statistical significance was not observed. Additionally, poor IJV outflow was an independent determinant of poor cortical venous outflow. For acute large vessel occlusion patients, poor IJV outflow is associated with poor baseline cortical venous outflow and outcomes after successful ERT.
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Affiliation(s)
- Wenjin Shang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Kaiyi Zhong
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
| | - Liming Shu
- Department of Neurology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China
| | - Zhuhao Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Hua Hong
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Health Management Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Correspondence: ; Tel.: +86-13380007226
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Chen Z, Ding J, Wu X, Cao X, Liu H, Yin X, Ding Y, Ji X, Meng R. Anatomic Asymmetry of Transverse Sinus May Be Irrelevant to the Prognosis of Intracerebral Hemorrhage. Neurologist 2022; 27:235-239. [PMID: 34873112 PMCID: PMC9439688 DOI: 10.1097/nrl.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigate the probable effect of anatomic asymmetry of transverse sinus (TS) on the outcomes of acute intracerebral hemorrhage (ICH), to provide reference for customized treatment. METHODS Consecutive patients with imaging-confirmed acute ICH were enrolled from October 2015 through October 2019, and divided into 2 groups: symmetrical and unilateral (left or right) slender TS groups, based on the status of TS in imaging maps. Brain computed tomography (CT) maps of all patients at baseline and half-month post-ICH were obtained, and the volumes of hematoma and the perihematomal edemas (PHE), as well as the modified Rankin Scale (mRS) scores at the month-3 post-ICH between the 2 groups were assessed and analyzed. RESULTS A total of 46 eligible patients entered into final analysis, including 18 cases in the slender TS group (14 cases involved the left side while 4 cases involved the right side), and 28 cases in the symmetrical TS group. The mRS scores, hematoma absorption rates, and the residual volumes of PHE of all patients in the 2 groups at half-month post-ICH showed no statistical significance (all P >0.05), and all of the items mentioned above were related to the hematoma volume at baseline (all P <0.001). At the month-3 follow-up post-ICH, the mRS scores between the 2 groups showed no statistical significance as well ( P =0.551). CONCLUSIONS Anatomic asymmetry of TS may not affect the prognosis of PHE and clinical outcome after ICH.
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Affiliation(s)
- Zhiying Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Jiayue Ding
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqin Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University
| | - Xianming Cao
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Hao Liu
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Xiaoping Yin
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Yuchuan Ding
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
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Wang JQ, Wang YJ, Qiu J, Li W, Sun XH, Zhao YG, Liu X, Zhao ZA, Liu L, Nguyen TN, Chen HS. Cerebral Circulation Time After Thrombectomy: A Potential Predictor of Outcome After Recanalization in Acute Stroke. J Am Heart Assoc 2022; 11:e025853. [PMID: 35621204 PMCID: PMC9238696 DOI: 10.1161/jaha.122.025853] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Despite successful recanalization, up to half of patients with acute ischemic stroke caused by large‐vessel occlusion treated with endovascular treatment (EVT) do not recover to functional independence. We aim to evaluate the role of cerebral circulation time (CCT) as outcome predictor after EVT. Methods and Results We retrospectively enrolled consecutive patients with acute ischemic stroke–large‐vessel occlusion undergoing EVT. Three categories of CCT based on digital subtraction angiography were studied: CCT of the stroke side, CCT of the healthy side), and change of CCT of the stroke side versus CCT of the healthy side. Dramatic clinical recovery was defined as a 24‐hour National Institutes of Health Stroke Scale score ≤2 or ≥8 points drop. A modified Rankin Scale score ≤2 at 3 months was considered a favorable outcome. Logistic regression analysis was performed to evaluate the prediction of CCT on prognosis. One hundred patients were enrolled, of which 38 (38.0%) experienced a dramatic clinical recovery and 43 (43.0%) achieved a favorable outcome. Logistic regression analysis found that shorter change of CCT of the stroke side versus CCT of the healthy side and CCT of the stroke side were independent positive prognostic factors for dramatic clinical recovery (odds ratio [OR], 0.189; P=0.033; OR, 0.581; P=0.035) and favorable outcomes (OR, 0.142; P=0.020; OR, 0.581; P=0.046) after adjustment for potential confounders. A model including the change of CCT of the stroke side versus CCT of the healthy side also had significantly higher area under the curve values compared with the baseline model in patients with dramatic clinical recovery (0.780 versus 0.742) or favorable outcome (0.759 versus 0.713). Conclusions To our knowledge, this is the first report that CCT based on digital subtraction angiography data exhibits an independent predictive performance for clinical outcome in patients with acute ischemic stroke–large‐vessel occlusion after EVT. Given that this readily available CCT can provide alternative perfusion information during EVT, a prospective, multicenter trial is warranted.
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Affiliation(s)
- Jia-Qi Wang
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Ying-Jia Wang
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Jin Qiu
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Wei Li
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Xian-Hui Sun
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Yong-Gang Zhao
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Xin Liu
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Zi-Ai Zhao
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | - Liang Liu
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
| | | | - Hui-Sheng Chen
- Department of Neurology General Hospital of Northern Theater Command Shenyang China
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Naraoka M, Matsuda N, Shimamura N, Ohkuma H. Role of microcirculatory impairment in delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab 2022; 42:186-196. [PMID: 34496662 PMCID: PMC8721782 DOI: 10.1177/0271678x211045446] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early brain injury (EBI) is considered an important cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). As a factor in EBI, microcirculatory dysfunction has become a focus of interest, but whether microcirculatory dysfunction is more important than angiographic vasospasm (aVS) remains unclear. Using data from 128 cases, we measured the time to peak (TTP) in several regions of interest on digital subtraction angiography. The intracerebral circulation time (iCCT) was obtained between the TTP in the ultra-early phase (the baseline iCCT) and in the subacute phase and/or at delayed cerebral ischemia (DCI) onset (the follow-up iCCT). In addition, the difference in the iCCT was calculated by subtracting the baseline iCCT from the follow-up iCCT. Univariate analysis showed that DCI was significantly increased in those patients with a prolonged baseline iCCT, prolonged follow-up iCCT, increased differences in the iCCT, and with severe aVS. Poor outcome was significantly increased in patients with prolonged follow-up iCCT and increased differences in the iCCT. Multivariate analysis revealed that increased differences in the iCCT were a significant risk factor that increased DCI and poor outcome. The results suggest that the increasing microcirculatory dysfunction over time, not aVS, causes DCI and poor outcome after aneurysmal aSAH.
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Affiliation(s)
- Masato Naraoka
- Department of Neurosurgery, Hirosaki University School of Medicine & Hospital, Hirosaki, Japan
| | - Naoya Matsuda
- Department of Neurosurgery, Hirosaki University School of Medicine & Hospital, Hirosaki, Japan
| | - Norihito Shimamura
- Department of Neurosurgery, Hirosaki University School of Medicine & Hospital, Hirosaki, Japan
| | - Hiroki Ohkuma
- Department of Neurosurgery, Hirosaki University School of Medicine & Hospital, Hirosaki, Japan
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Quantitative Evaluation of Peripheral Arterial Blood Flow Using Peri-Interventional Fluoroscopic Parameters: An In Vivo Study Evaluating Feasibility and Clinical Utility. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9526790. [PMID: 32190691 PMCID: PMC7071793 DOI: 10.1155/2020/9526790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to evaluate various objective, quantitative, time-resolved fluoroscopic imaging parameters for use in the peri-interventional evaluation of stenotic peripheral arterial disease lesions. Material and Methods. Ten patients (median age, 64; age range, 52 to 79; 8 males, 2 females) with high-grade stenoses of either the superficial femoral or popliteal arteries who underwent endovascular treatment were included. During each intervention, two series of intraprocedural fluoroscopic images were collected, one preintervention and one postintervention. For each imaging series, four regions of interest (ROIs) were defined within the vessel lumen, with two ROIs being proximal (ROIs 1 and 2) and two being distal (ROIs 3 and 4) to the stenosis. The time-density curve (TDC) at each ROI was measured, and the resulting area under the curve (AUC), full width at half maximum (FWHM), and time-to-peak (TTP) were then calculated. Results The analysis of the TDC-derived parameters demonstrated significant differences between pre- and postinterventional flow rates in the ROI placed most distal to the stenosis, ROI 4. The AUC at ROI 4 (reported as a relative percentage of the AUC measured at ROI 1 proximal to the lesion) demonstrated a significant increase in the total flow (mean 67.84% vs. 128.68%, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s. Conclusion AUC, FWHM, and TTP are objective, reproducible, quantifiable tools for the peri-interventional fluoroscopic evaluation of vessel stenoses. When compared to the standard subjective interpretation of fluoroscopic imagery, AUC, FWHM, and TTP offer interventionalists the advantage of having an objective, complementary method of evaluating the success of a procedure, potentially allowing for more precisely targeted and quantitatively determined treatment goals and improved patient outcomes. This retrospective study was approved by the local ethics committee under the Number 372/2018BO2. The trial was registered at the German clinical trials register under the number DRKS00017813.
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Assessment of Flow after Lower Extremity Endovascular Revascularisation: A Feasibility Study Using Time Attenuation Curve Analysis of Digital Subtraction Angiography. EJVES Short Rep 2019; 45:1-6. [PMID: 31517074 PMCID: PMC6737305 DOI: 10.1016/j.ejvssr.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives Endovascular revascularisation is the mainstay of the treatment of lower extremity peripheral arterial disease. Improvement in perfusion after treatment is often quantified by a corresponding increment in ankle or toe brachial indices. These measurements are difficult to obtain in patients with foot wounds, and have to be performed at a separate time and setting after revascularisation. This preliminary study aimed to evaluate the use of parametric colour coding and analysis of time attenuation curves as a real time quantitative measure of perfusion after endovascular revascularisation. Methods Forty-seven consecutive patients with critical limb ischaemia were retrospectively enrolled and analysed. Parametric colour coding and generation of time attenuation curves in the main pedal vessel was performed for pre- and post-intervention digital subtraction angiograms of each patient. The change in time attenuation curve parameters was compared with the change in ankle or toe brachial indices before and after intervention. Results Comparing before and after lower extremity endovascular intervention, there were significant changes in the washout parameters derived from the time attenuation curve. The percentage of contrast decay 4 seconds after peak (I 4s) demonstrated the strongest correlation (R = .482) with the change in ankle or toe brachial indices. Conclusions Parametric colour coding and time attenuation curve analysis might be a helpful tool that can provide real time intra-procedural quantitative data on pedal perfusion which can improve clinical outcomes.
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Chu WF, Lee HJ, Lin CJ, Chang FC, Guo WY, Chen LW, Lin YY, Luo CB. Fluoroscopic angiography quantifies delay in cerebral circulation time and requires less radiation in carotid stenosis patients: A pilot study. J Chin Med Assoc 2019; 82:396-400. [PMID: 30893249 DOI: 10.1097/jcma.0000000000000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Quantitative digital subtraction angiography (DSA) facilitates in-room assessment of flow changes in various cerebrovascular diseases and improves patient safety. The purpose of this study was to compare the diagnostic accuracy of quantitative fluoroscopic angiography (FA) and DSA. METHODS Twenty-two patients with >70% carotid stenosis according to NASCET criteria were prospectively included in the study. All patients received DSA and FA (ArtisZee, Siemens Healthcare, Forchheim, Germany) before and after carotid stenting in the same angiosuite. The regions of interest (ROIs) included the extracranial internal carotid artery (eICA), first segment of the middle cerebral artery (MCA1), and sigmoid sinus in the anterior-posterior view; cavernous portion of the ICA (cICA), parietal vein, and jugular vein in the lateral views. The time-to-peak (TTP) for all ROIs and cerebral circulation time (CCT) were measured from FA and DSA scans. TTP, CCT, and radiation doses from DSA were compared with those from FA. RESULTS The mean age of the patients were 69 ± 9.5 years old. The average stenosis was 89.7% ± 7.8% before stenting and 31% ± 3.6% after stenting. No patient suffered from periprocedural stroke. The intermethod correlation for TTP for all ROIs except the eICA and cICA ranged from 0.46 to 0.65 before stenting and 0.57 to 0.73 after stenting, and that for CCT was 0.65 before stenting and 0.57 after stenting. The radiation doses were significantly lower for FA than for DSA regardless of views or periprocedural timing (p < 0.001). CONCLUSION Stenosis facilitated the creation of a bolus by manual injection and therefore increased the accuracy of cerebral flow quantification in FA. Cerebral hemodynamic assessment by FA is quicker and associated with less radiation.
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Affiliation(s)
- Wei-Fa Chu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Han-Jui Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Jung Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan-Yuo Guo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Liang-Wei Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Yang Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chao-Bao Luo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Andereggen L, Amin-Hanjani S, El-Koussy M, Verma RK, Yuki K, Schoeni D, Hsieh K, Gralla J, Schroth G, Beck J, Raabe A, Arnold M, Reinert M, Andres RH. Quantitative magnetic resonance angiography as a potential predictor for cerebral hyperperfusion syndrome: a preliminary study. J Neurosurg 2018; 128:1006-1014. [DOI: 10.3171/2016.11.jns161033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVECerebral hyperperfusion syndrome (CHS) is a rare but devastating complication of carotid endarterectomy (CEA). This study sought to determine whether quantitative hemodynamic assessment using MR angiography can stratify CHS risk.METHODSIn this prospective trial, patients with internal carotid artery (ICA) stenosis were randomly selected for pre- and postoperative quantitative phase-contrast MR angiography (QMRA). Assessment was standardized according to a protocol and included Doppler/duplex sonography, MRI, and/or CT angiography and QMRA of the intra- and extracranial supplying arteries of the brain. Clinical and radiological data were analyzed to identify CHS risk factors.RESULTSTwenty-five of 153 patients who underwent CEA for ICA stenosis were randomly selected for pre- and postoperative QMRA. QMRA data showed a 2.2-fold postoperative increase in blood flow in the operated ICA (p < 0.001) and a 1.3-fold increase in the ipsilateral middle cerebral artery (MCA) (p = 0.01). Four patients had clinically manifested CHS. The mean flow increases in the patients with CHS were significantly higher than in the patients without CHS, both in the ICA and MCA (p < 0.001). Female sex and a low preoperative diastolic blood pressure were the clearest clinical risk factors for CHS, whereas the flow differences and absolute postoperative flow values in the ipsilateral ICA and MCA were identified as potential radiological predictors for CHS.CONCLUSIONSCerebral blood flow in the ipsilateral ICA and MCA as assessed by QMRA significantly increased after CEA. Higher mean flow differences in ICA and MCA were associated with the development of CHS. QMRA might have the potential to become a noninvasive, operator-independent screening tool for identifying patients at risk for CHS.
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Affiliation(s)
- Lukas Andereggen
- Departments of 1Neurosurgery,
- 4Department of Neurosurgery and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Kenya Yuki
- 4Department of Neurosurgery and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Marcel Arnold
- 3Neurology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Michael Reinert
- Departments of 1Neurosurgery,
- 6Department of Neurosurgery, Neurocenter Lugano, Lugano, Switzerland
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Hu YS, Lin CJ, Wu HM, Guo WY, Luo CB, Wu CC, Chung WY, Liu KD, Yang HC, Lee CC. Lateral Sinus Dural Arteriovenous Fistulas: Sinovenous Outflow Restriction Outweighs Cortical Venous Reflux as a Parameter Associated with Hemorrhage. Radiology 2017; 285:528-535. [DOI: 10.1148/radiol.2017162594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yong-Sin Hu
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Chung-Jung Lin
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Hsiu-Mei Wu
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Wan-Yuo Guo
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Chao-Bao Luo
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Chih-Chun Wu
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Wen-Yuh Chung
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Kang-Du Liu
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Huai-Che Yang
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
| | - Cheng-Chia Lee
- From the Department of Radiology (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W.) and Neurologic Institute, Department of Neurosurgery (W.Y.C., K.D.L., H.C.Y., C.C.L.), Taipei Veterans General Hospital, 201 Shipai Rd, Sec 2, Beitou District, Taipei 112, Taiwan (ROC); and School of Medicine, National Yang Ming University, Taipei, Taiwan (ROC) (Y.S.H., C.J.L., H.M.W., W.Y.G., C.B.L., C.C.W., W.Y.C., K.D.L., H.C.Y., C.C.L.)
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14
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Lee HJ, Hong JS, Lin CJ, Kao YH, Chang FC, Luo CB, Chu WF. Automatic flow analysis of digital subtraction angiography using independent component analysis in patients with carotid stenosis. PLoS One 2017; 12:e0185330. [PMID: 28949999 PMCID: PMC5614569 DOI: 10.1371/journal.pone.0185330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/11/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Current time-density curve analysis of digital subtraction angiography (DSA) provides intravascular flow information but requires manual vasculature selection. We developed an angiographic marker that represents cerebral perfusion by using automatic independent component analysis. MATERIALS AND METHODS We retrospectively analyzed the data of 44 patients with unilateral carotid stenosis higher than 70% according to North American Symptomatic Carotid Endarterectomy Trial criteria. For all patients, magnetic resonance perfusion (MRP) was performed one day before DSA. Fixed contrast injection protocols and DSA acquisition parameters were used before stenting. The cerebral circulation time (CCT) was defined as the difference in the time to peak between the parietal vein and cavernous internal carotid artery in a lateral angiogram. Both anterior-posterior and lateral DSA views were processed using independent component analysis, and the capillary angiogram was extracted automatically. The full width at half maximum of the time-density curve in the capillary phase in the anterior-posterior and lateral DSA views was defined as the angiographic mean transient time (aMTT; i.e., aMTTAP and aMTTLat). The correlations between the degree of stenosis, CCT, aMTTAP and aMTTLat, and MRP parameters were evaluated. RESULTS The degree of stenosis showed no correlation with CCT, aMTTAP, aMTTLat, or any MRP parameter. CCT showed a strong correlation with aMTTAP (r = 0.67) and aMTTLat (r = 0.72). Among the MRP parameters, CCT showed only a moderate correlation with MTT (r = 0.67) and Tmax (r = 0.40). aMTTAP showed a moderate correlation with Tmax (r = 0.42) and a strong correlation with MTT (r = 0.77). aMTTLat also showed similar correlations with Tmax (r = 0.59) and MTT (r = 0.73). CONCLUSION Apart from vascular anatomy, aMTT estimates brain parenchyma hemodynamics from DSA and is concordant with MRP. This process is completely automatic and provides immediate measurement of quantitative peritherapeutic brain parenchyma changes during stenting.
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Affiliation(s)
- Han-Jui Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jia-Sheng Hong
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Hsuan Kao
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Fa Chu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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15
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Yamauchi K, Enomoto Y, Otani K, Egashira Y, Iwama T. Prediction of hyperperfusion phenomenon after carotid artery stenting and carotid angioplasty using quantitative DSA with cerebral circulation time imaging. J Neurointerv Surg 2017; 10:576-579. [DOI: 10.1136/neurintsurg-2017-013259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/08/2017] [Accepted: 08/16/2017] [Indexed: 11/04/2022]
Abstract
BackgroundHyperperfusion syndrome after carotid interventions has a low incidence but it can lead to morbidity and mortality.ObjectiveTo evaluate the usefulness of quantitative DSA for predicting hyperperfusion phenomenon (HPP) after carotid artery stenting and angioplasty.MethodsThirty-three consecutive patients with carotid stenosis treated with carotid artery stenting or angioplasty between February 2014 and August 2016 were included. Color-coded digital subtraction angiograms showing the time to maximum contrast intensity of each image pixel were obtained from conventional DSA before and after procedures. The cerebral circulation time (CCT) was defined as the difference in the relative time to maximum intensity between arterial and venous regions of interest set on the angiograms. HPP was diagnosed straight after the procedure with qualitative 123I-IMP single-photon emission CT (SPECT). Cut-off points for detecting HPP for preprocedural CCT and periprocedural change of CCT were assessed by receiver operating characteristic analysis using 123I-IMP SPECT as reference standard.Results123I-IMP SPECT showed HPP in 4 of 33 patients. In these 4 patients, preprocedural prolongation of CCT (13.0±6.1 vs 7.2±1.3 s; p<0.001) was seen compared with patients without HPP as well as larger periprocedural changes of CCT (5.9±5.7 vs 0.5±1.3 s; p<0.001). The optimal cut-off points of preprocedural CCT and change of CCT for predicting HPP were 8.0 s (100% sensitivity, 69% specificity) and 3.2 s (75% sensitivity, 100% specificity), respectively.ConclusionsPreprocedural prolongation and greater periprocedural change of CCT are associated with the occurrence of HPP. Periprocedural evaluation of CCT may be useful for predicting HPP.
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16
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Chao AC, Han K, Chang FC, Hsu HY, Chung CP, Sheng WY, Chan L, Wu J, Hu HH. Ultrasound diagnosis of transverse sinus hypoplasia using flow profiles of the internal jugular vein. PLoS One 2017; 12:e0181119. [PMID: 28704516 PMCID: PMC5509311 DOI: 10.1371/journal.pone.0181119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/25/2017] [Indexed: 11/19/2022] Open
Abstract
Accurate diagnosis of subtypes of transverse sinus (TS) hypoplasia requires more expensive methods like magnetic resonance (MR) imaging. We hypothesized ultrasound findings of the internal jugular vein (IJV) can be surrogate indicators for diagnosis of TS hypoplasia. MR images were reviewed in 131 subjects to evaluate TS diameter and the location and degree of venous flow stenosis and obstruction. Ultrasound parameters including the cross-sectional lumen area (CSA), time-average-mean velocity (TAMV), and flow volume (FV) at each IJV segment were also evaluated. Sixty-nine subjects had TS hypoplasia based on MRV criteria, of which 39 TS hypoplasia were considered a subtype of TS hypoplasia, which is secondary to the downstream venous compression/stenosis or left brachiocephalic vein. In the ultrasound study, the CSA of the IJV ipsilateral to TS hypoplasia was significantly smaller. Further, a contralateral/ipsilateral IJV CSA ratio >1.55 provided good sensitivity, specificity, and positive predictive value for discriminating TS hypoplasia.
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Affiliation(s)
- A-Ching Chao
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ke Han
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun, Jilin, China
- * E-mail: (HHH); (KH)
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Hung-Yi Hsu
- Department of Neurology, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
| | - Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Wen-Yung Sheng
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Lung Chan
- Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan
| | - Jiang Wu
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun, Jilin, China
| | - Han-Hwa Hu
- Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan
- Cerebrovascular Treatment and Research Center, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail: (HHH); (KH)
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17
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Difference in Cerebral Circulation Time between Subtypes of Moyamoya Disease and Moyamoya Syndrome. Sci Rep 2017; 7:2587. [PMID: 28566764 PMCID: PMC5451479 DOI: 10.1038/s41598-017-02588-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/12/2017] [Indexed: 11/16/2022] Open
Abstract
In this study, we evaluated the differences in hemodynamics between hemorrhagic and non-hemorrhagic moyamoya disease (MMD) and moyamoya syndrome (MMS) by measuring cerebral circulation time (CCT). This case-control study included 136 patients with MMD or MMS diagnosed between April 2015 and July 2016 at Beijing Tian Tan Hospital. Each hemisphere was analyzed separately. The difference in clinical, radiological characteristics and CCT between subtypes of MMD and MMS were analyzed statistically. The results showed that total CCT between hemorrhagic and non-hemorrhagic sides was not statistically different (16.55 s vs. 16.06 s, P = 0.562). The cerebral filling circulation time (CFCT) of hemorrhagic sides was significantly shorter than that of non-hemorrhagic sides (4.52 s vs. 5.41 s, P < 0.001), and the cerebral venous circulation time (CVCT) of hemorrhagic sides was significantly longer than that of non-hemorrhagic sides (12.02 s, vs. 10.64 s, P < 0.001). The ratio of CFCT to CVCT (F-V ratio) was inversely correlated with the possibility of hemorrhagic stroke. Therefore, we conclude that the rapid filling and poor venous drainage of cerebral circulation are likely risk factors of hemorrhagic stroke secondary to MMD or MMS. The F-V ratio can be used to identify individuals at high risk of hemorrhagic stroke.
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Guo WY, Lee CCJ, Lin CJ, Yang HC, Wu HM, Wu CC, Chung WY, Liu KD. Quantifying the Cerebral Hemodynamics of Dural Arteriovenous Fistula in Transverse Sigmoid Sinus Complicated by Sinus Stenosis: A Retrospective Cohort Study. AJNR Am J Neuroradiol 2017; 38:132-138. [PMID: 27765737 DOI: 10.3174/ajnr.a4960] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Sinus stenosis occasionally occurs in dural arteriovenous fistulas. Sinus stenosis impedes venous outflow and aggravates intracranial hypertension by reversing cortical venous drainage. This study aimed to analyze the likelihood of sinus stenosis and its impact on cerebral hemodynamics of various types of dural arteriovenous fistulas. MATERIALS AND METHODS Forty-three cases of dural arteriovenous fistula in the transverse-sigmoid sinus were reviewed and divided into 3 groups: Cognard type I, type IIa, and types with cortical venous drainage. Sinus stenosis and the double peak sign (occurrence of 2 peaks in the time-density curve of the ipsilateral drainage of the internal jugular vein) in dural arteriovenous fistula were evaluated. "TTP" was defined as the time at which a selected angiographic point reached maximum concentration. TTP of the vein of Labbé, TTP of the ipsilateral normal transverse sinus, trans-fistula time, and trans-stenotic time were compared across the 3 groups. RESULTS Thirty-six percent of type I, 100% of type IIa, and 84% of types with cortical venous drainage had sinus stenosis. All sinus stenosis cases demonstrated loss of the double peak sign that occurs in dural arteriovenous fistula. Trans-fistula time (2.09 seconds) and trans-stenotic time (0.67 seconds) in types with cortical venous drainage were the most prolonged, followed by those in type IIa and type I. TTP of the vein of Labbé was significantly shorter in types with cortical venous drainage. Six patients with types with cortical venous drainage underwent venoplasty and stent placement, and 4 were downgraded to type IIa. CONCLUSIONS Sinus stenosis indicated dysfunction of venous drainage and is more often encountered in dural arteriovenous fistula with more aggressive types. Venoplasty ameliorates cortical venous drainage in dural arteriovenous fistulas and serves as a bridge treatment to stereotactic radiosurgery in most cases.
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Affiliation(s)
- W-Y Guo
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-C J Lee
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-J Lin
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-C Yang
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - H-M Wu
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-C Wu
- From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.)
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Chung
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
| | - K-D Liu
- Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan
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Teng MMH, Chang FC, Lin CJ, Chiang L, Hong JS, Kao YH. Peritherapeutic Hemodynamic Changes of Carotid Stenting Evaluated with Quantitative DSA in Patients with Carotid Stenosis. AJNR Am J Neuroradiol 2016; 37:1883-1888. [PMID: 27173363 DOI: 10.3174/ajnr.a4813] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/20/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Quantitative data from DSA have become important tools for understanding hemodynamic changes of intracranial lesions. In this study, we evaluated 8 hemodynamic parameters in patients before and after carotid artery angioplasty. MATERIALS AND METHODS DSA images of 34 patients with carotid stenosis who underwent angioplasty and stent placement were retrospectively analyzed. Eleven ROIs (M1, M2, A1, A2, the parietal vein, superior sagittal sinus, internal jugular vein, and 4 in the ICA) were selected on color-coded DSA. Eight hemodynamic parameters (bolus arrival time, TTP, relative TTP, full width at half maximum, wash-in slope, washout slope, maximum enhancement, and area under the curve) were measured from the time-concentration curves of these ROIs. The dependent t test for paired samples was applied to these parameters before and after stent placement. RESULTS We found that the treatment significantly reduced TTP, relative TTP, bolus arrival time, and washout slope at all arterial ROIs and full width at half maximum and area under the curve at some arterial ROIs. Bolus arrival time was significantly reduced after treatment for all arterial ROIs, the parietal vein, and the superior sagittal sinus. The maximum enhancement and wash-in slope did not show significant changes after treatment. After treatment, the relative TTP from the ICA to M1, M2, and the parietal vein returned to normal values. CONCLUSIONS In addition to TTP and relative TTP, other parameters can be used to evaluate peritherapeutic cerebral hemodynamic changes. Bolus arrival time has the potential to evaluate brain circulation at arterial and venous sites, especially when TTP cannot be measured because of an incomplete time-concentration curve.
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Affiliation(s)
- M M H Teng
- From the Department of Medical Imaging (M.M.H.T.), Cheng Hsin General Hospital, Taipei, Taiwan
| | - F-C Chang
- Department of Radiology (F.-C.C., C.-J.L., L.C.), Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (F.-C.C., C.-J.L.)
| | - C-J Lin
- Department of Radiology (F.-C.C., C.-J.L., L.C.), Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine (F.-C.C., C.-J.L.)
| | - L Chiang
- Department of Radiology (F.-C.C., C.-J.L., L.C.), Taipei Veterans General Hospital, Taipei, Taiwan
| | - J-S Hong
- Department of Biomedical Imaging and Radiological Sciences (J.-S.H., Y.-H.K.), National Yang-Ming University, Taipei, Taiwan
| | - Y-H Kao
- Department of Biomedical Imaging and Radiological Sciences (J.-S.H., Y.-H.K.), National Yang-Ming University, Taipei, Taiwan.
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Lin CJ, Guo WY, Chang FC, Hung SC, Chen KK, Yu DZ, Wu CHF, Liou JKA. Using Flat-Panel Perfusion Imaging to Measure Cerebral Hemodynamics: A Pilot Feasibility Study in Patients With Carotid Stenosis. Medicine (Baltimore) 2016; 95:e3529. [PMID: 27196456 PMCID: PMC4902398 DOI: 10.1097/md.0000000000003529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Flat-detector CT perfusion (FD-CTP) imaging has demonstrated efficacy in qualitatively accessing the penumbra in acute stroke equivalent to that of magnetic resonance perfusion (MRP). The aim of our study was to evaluate the feasibility of quantifying oligemia in the brain in patients with carotid stenosis.Ten patients with unilateral carotid stenosis of >70% were included. All MRPs and FD-CTPs were performed before stenting. Region-of-interests (ROIs) including middle cerebral artery territory at basal ganglia level on both stenotic and contralateral sides were used for quantitative analysis. Relative time to peak (rTTP) was defined as TTP of the stenotic side divided by TTP of the contralateral side, and so as relative cerebral blood volume (rCBV), relative mean transit time (rMTT), and relative cerebral blood flow (rCBF). Absolute and relative TTP, CBV, MTT, CBF between two modalities were compared.For absolute quantitative analysis, the correlation of TTP was highest (r = 0.56), followed by CBV (r = 0.47), MTT (r = 0.47), and CBF (r = 0.43); for relative quantitative analysis, rCBF was the highest (r = 0.79), followed by rTTP (r = 0.75) and rCBV (r = 0.50).We confirmed that relative quantitative assessment of FD-CTP is feasible in chronic ischemic disease. Absolute quantitative measurements between MRP and FD-CTP only expressed moderate correlations. Optimization of acquisitions and algorithms is warranted to achieve better quantification.
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Affiliation(s)
- Chung-Jung Lin
- From the Department of Radiology (C-JL, W-YG, F-CC, S-CH, J-KAL), Taipei Veterans General Hospital; School of Medicine (C-JL, W-YG, F-CC, S-CH), National Yang-Ming University; Department of Biomedical Imaging and Radiological Sciences (S-CH, K-KC, J-KAL), School of Biomedical Science of Engineering, National Yang-Ming University; Siemens Healthcare GmbH (D-ZY), Advanced Therapies, Forchheim, Germany; Siemens Healthcare Ltd. (C-HFW), Advanced Therapies, Taipei, Taiwan
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21
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Lin CJ, Hung SC, Chang FC, Guo WY, Luo CB, Kowarschik M, Chu WF, Liou AJYK. Finding the optimal deconvolution algorithm for MR perfusion in carotid stenosis: Correlations with angiographic cerebral circulation time. J Neuroradiol 2016; 43:290-6. [PMID: 27038737 DOI: 10.1016/j.neurad.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of our study is to explore the impacts of different deconvolution algorithms on correlations between CBF, MTT, CBV, TTP, Tmax from MR perfusion (MRP) and angiography cerebral circulation time (CCT). METHODS Retrospectively, 30 patients with unilateral carotid stenosis, and available pre-stenting MRP and angiography were included for analysis. All MRPs were conducted in a 1.5-T MR scanner. Standard singular value decomposition, block-circulant, and two delay-corrected algorithms were used as the deconvolution methods. All angiographies were obtained in the same bi-plane flat-detector angiographic machine. A contrast bolus of 12mL was administrated via angiocatheter at a rate of 8mL/s. The acquisition protocols were the same for all cases. CCT was defined as the difference between time to peak from the cavernous ICA and the parietal vein in lateral view. Pearson correlations were calculated for CCT and CBF, MTT, CBV, TTP, Tmax. RESULTS The correlation between CCT and MTT was highest with Tmax (r=0.65), followed by MTT (r=0.60), CBF (r=-0.57), and TTP (r=0.33) when standard singular value decomposition was used. No correlation with CBV was noted. CONCLUSIONS MRP using a singular value decomposition algorithm confirmed the feasibility of quantifying cerebral blood flow deficit in steno-occlusive disease within the angio-room. This approach might further improve patient safety by providing immediate cerebral hemodynamics without extraradiation and iodine contrast.
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Affiliation(s)
- Chung-Jung Lin
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
| | - Sheng-Che Hung
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
| | - Wan-Yuo Guo
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan.
| | - Chao-Bao Luo
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
| | - Markus Kowarschik
- Siemens AG, healthcare sector, angiography and interventional X-Ray systems, Forchheim, Germany
| | - Wei-Fa Chu
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
| | - Adrian J Y Kang Liou
- Department of radiology, Taipei Veterans general hospital, 201, Shipai Road, Section 2, 11217 Taipei, Taiwan; School of medicine, National Yang Ming university, Taipei, Taiwan
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Lin CF, Hsu SPC, Lin CJ, Guo WY, Liao CH, Chu WF, Hung SC, Shih YS, Lin YT. Prolonged Cerebral Circulation Time Is the Best Parameter for Predicting Vasospasm during Initial CT Perfusion in Subarachnoid Hemorrhagic Patients. PLoS One 2016; 11:e0151772. [PMID: 26986626 PMCID: PMC4795708 DOI: 10.1371/journal.pone.0151772] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/03/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose We sought to imitate angiographic cerebral circulation time (CCT) and create a similar index from baseline CT perfusion (CTP) to better predict vasospasm in patients with subarachnoid hemorrhage (SAH). Methods Forty-one SAH patients with available DSA and CTP were retrospectively included. The vasospasm group was comprised of patients with deterioration in conscious functioning and newly developed luminal narrowing; remaining cases were classified as the control group. The angiography CCT (XA-CCT) was defined as the difference in TTP (time to peak) between the selected arterial ROIs and the superior sagittal sinus (SSS). Four arterial ROIs were selected to generate four corresponding XA-CCTs: the right and left anterior cerebral arteries (XA-CCTRA2 and XA-CCTLA2) and right- and left-middle cerebral arteries (XA-CCTRM2 and XA-CCTLM2). The CCTs from CTP (CT-CCT) were defined as the differences in TTP from the corresponding arterial ROIs and the SSS. Correlations of the different CCTs were calculated and diagnostic accuracy in predicting vasospasm was evaluated. Results Intra-class correlations ranged from 0.96 to 0.98. The correlations of XA-CCTRA2, XA-CCTRM2, XA-CCTLA2, and XA-CCTLM2 with the corresponding CT-CCTs were 0.64, 0.65, 0.53, and 0.68, respectively. All CCTs were significantly prolonged in the vasospasm group (5.8–6.4 s) except for XA-CCTLA2. CT-CCTA2 of 5.62 was the optimal cut-off value for detecting vasospasm with a sensitivity of 84.2% and specificity 82.4% Conclusion CT-CCTs can be used to interpret cerebral flow without deconvolution algorithms, and outperform both MTT and TTP in predicting vasospasm risk. This finding may help facilitate management of patients with SAH.
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Affiliation(s)
- Chun Fu Lin
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sanford P. C. Hsu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chung Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wan Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Chih Hsiang Liao
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei Fa Chu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng Che Hung
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yang Shin Shih
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen Tzu Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Han K, Chao AC, Chang FC, Hsu HY, Chung CP, Sheng WY, Chan L, Wu J, Hu HH. Diagnosis of Transverse Sinus Hypoplasia in Magnetic Resonance Venography: New Insights Based on Magnetic Resonance Imaging in Combined Dataset of Venous Outflow Impairment Case-Control Studies: Post Hoc Case-Control Study. Medicine (Baltimore) 2016; 95:e2862. [PMID: 26962781 PMCID: PMC4998862 DOI: 10.1097/md.0000000000002862] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In previous studies of transverse sinus (TS) hypoplasia, discrepancies between TS diameter measured by magnetic resonance venography (MRV) and contrast T1-weighted magnetic resonance (contrast T1) were observed. To investigate these discrepancies, and considering that TS hypoplasia is associated with neurological disorders, we performed a post hoc analysis of prospectively collected data from 3 case-control studies on transient global amnesia (TGA), transient monocular blindness (TMB), and panic disorders while retaining the original inclusion and exclusion criteria. Magnetic resonance (MR) imaging of 131 subjects was reviewed to evaluate TS diameter and the location and degree of venous flow stenosis and obstruction.MRV without contrast revealed that TS hypoplasia was observed in 69 subjects, whom we classified into 2 subgroups according to the concordance with contrast T1 observations: concordance indicated anatomically small TS (30 subjects), and discrepancy indicated that the MRV diagnosis is in fact flow-related and that TS is not anatomically small (39 subjects). The latter subgroup was associated with at least 1 site of venous compression/stenosis in the internal jugular vein (IJV) or the left brachiocephalic vein (BCV) (P < 0.001), which was significantly larger in patients than controls. Compensatory dilatation of contralateral TS diameter was only observed with MRV, not with contrast T1 imaging.The clinical implication of these results is that using MRV only, IJV/BCV compression/stenosis may be misdiagnosed as TS hypoplasia. And contralateral TS have no compensatory dilatation in its diameter in contrast T1 imaging, just compensatory increased flow volume.
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Affiliation(s)
- Ke Han
- From the Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun, Jilin, China (KH, JW), Department of Neurology, College of Medicine, Kaohsiung Medical University and Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung (A-CC), Department of Radiology (F-CC), Department of Neurology Veterans General Hospital and National Yang-Ming University (C-PC, W-YS), Department of Neurology, Tungs' Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung (H-YH), Department of Neurology, Taipei Medical University-Shaung Ho Hospital (LC), and Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University and Hospital (H-HH), Taipei, Taiwan
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Han K, Chao AC, Chang FC, Chung CP, Hsu HY, Sheng WY, Wu J, Hu HH. Obstruction of Venous Drainage Linked to Transient Global Amnesia. PLoS One 2015; 10:e0132893. [PMID: 26173146 PMCID: PMC4501814 DOI: 10.1371/journal.pone.0132893] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 06/22/2015] [Indexed: 11/19/2022] Open
Abstract
Abnormal extracranial venous drainage modality has been considered an etiology of transient global amnesia (TGA). Evidence suggests that the transmission of the intrathoracic/intraabdominal pressure during a Valsalva maneuver (VM) is mainly through the vertebral venous system, and patency of internal jugular vein (IJV) is essential for venous drainage and pressure releasing. We hypothesize that obstruction of IJV venous drainage is a contributing factor in TGA pathogenesis. A magnetic resonance (MR) imaging protocol was used in 45 TGA patients and 45 age- and sex-matched controls to assess the morphologies of IJV, brachiocephalic vein (BCV) and asymmetry of transverse sinus (TS). The IJV was divided into the upper- and middle-IJV segments. Compared to the controls, TGA patients had significantly higher rates of moderate and severe compression/stenosis at the bilateral upper-IJV segment (left: 37.8% vs. 17.8%, P = 0.0393; right: 57.8% vs.15.6%, P<0.0012), in left BCV (60% vs. 8.9%, P<0.0004), and in TS hypoplasia (53.3%% vs. 31.1%, P = 0.0405). The prevalence of at least one site of venous compression/stenosis in IJV or BCV was significantly higher in patients than in controls (91.1% vs. 33.3%, P<0.0004). The diameter of the left TS in MRV, but not in T1 contrast imaging, was significantly smaller in TGA patients than in controls (0.31±0.21 vs. 0.41±0.19, P = 0.0290), which was compatible with downstream venous stenosis/obstruction. TGA patients have a higher prevalence of compression/stenosis of the bilateral IJV and the left BCV and TS hypoplasia, which is new evidence that supports the role of extracranial veins in TGA pathogenesis.
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Affiliation(s)
- Ke Han
- Department of Neurology, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - A-Ching Chao
- Department of Neurology, College of Medicine, Kaohsiung Medical University and Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Hung-Yi Hsu
- Department of Neurology, Tungs’ Taichung Metro Harbor Hospital and Department of Neurology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Yung Sheng
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Jiang Wu
- Department of Neurology, First Hospital of Jilin University, Changchun, Jilin Province, China
- * E-mail: (HHH); (JW)
| | - Han-Hwa Hu
- Graduate Institute of Clinical Medicine and Department of Neurology, College of Medicine, Taipei Medical University and Hospital, Taipei, Taiwan
- * E-mail: (HHH); (JW)
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Abstract
PURPOSE This study aimed to define hyperperfusion in carotid stenting patients without excluding patients with stenosis on the contralateral side. MATERIALS AND METHODS A total of 32 patients were enrolled. Prestent computed tomography perfusions were performed within 1 week before stenting, poststent perfusions 3 days after stenting. Prestent relative cerebral blood volume, relative cerebral blood flow, and relative mean transient time (rMTT) were calculated by dividing measurements from ipsilateral stent sides to contralateral sides and prestent difference mean transit time (dMTT) by subtracting contralateral mean transient time (MTT) from ipsilateral MTT. Poststent values were calculated similarly. For differences between prestent and poststent values, independent t test was used between groups and paired sample t test within the groups. RESULTS Of the 31 patients, 4 showed poststent clinical hyperperfusion syndrome. Six showed poststent radiologic hyperperfusion with increased cerebral blood flow, increased or spared cerebral blood volume, and shortened MTT values, but only 1 demonstrated clinical hyperperfusion. Between normal and hyperperfused groups, only appreciable difference was noted in prestent and poststent dMTT without statistical significance. Within the groups, only statistical difference (P < 0.001) was noted in rMTT and dMTT in normal groups and no significant difference in the hyperperfused group. CONCLUSIONS Radiologic hyperperfusion does not match clinical hyperperfusion. Normal group responded to stenting with statistically significant changes of rMTT and dMTT. Hyperperfusion mostly occurred in the contralateral critically stenosed patients. The hyperperfused group, due to similar MTT of both hemispheres and ipsilateral internal carotid artery being the main feeder of both hemispheres, did not show significant changes in their rMTT and dMTT values after stenting. This shows that reduced hemodynamic reserve is the main reason behind the hyperperfusion after carotid stenting.
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Lin CJ, Chang FC, Guo WY, Hung SC, Luo CB, Beilner J, Kowarschik M, Chu WF. Changes of time-attenuation curve blood flow parameters in patients with and without carotid stenosis. AJNR Am J Neuroradiol 2015; 36:1176-81. [PMID: 25721077 DOI: 10.3174/ajnr.a4239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 12/01/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE From the time-attenuation curves of DSA flow parameters, maximal intensity, maximal slope, and full width at half maximum of selected vascular points are defined. The study explores the reliability of defining the flow parameters by the time-attenuation curves of DSA. MATERIALS AND METHODS Seventy patients with unilateral carotid artery stenosis (group A) and 56 healthy controls (group B) were retrospectively enrolled. Fixed contrast injection protocols and DSA acquisition parameters were used with all patients. The M1, sigmoid sinus, and internal jugular vein on anteroposterior view DSA and the M2, parietal vein, and superior sagittal sinus on lateral view DSA were chosen as ROI targets for measuring flow parameters. The difference of time of maximal intensity between 2 target points was defined as the circulation time between the target points. RESULTS The maximal intensity difference of 2 selected points from the ICA to the M1, sigmoid sinus, internal jugular vein, M2, parietal vein, and superior sagittal sinus was significantly longer in group A than in group B. The maximum slope of M1, M2, and the superior sagittal sinus was significantly lower in group A than in group B. The full width at half maximum of M1 and M2 was significantly larger in group A than in group B. The maximal slope of M1 demonstrated the best diagnostic performance. CONCLUSIONS The maximal intensity difference of 2 selected points derived from DSA can be used as a definitive alternative flow parameter for intracranial circulation time measurement. Maximal slope and full width at half maximum complement the maximal intensity difference of 2 selected points in defining flow characteristics of healthy subjects and patients with carotid stenosis.
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Affiliation(s)
- C-J Lin
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L.), National Yang-Ming University, Taipei, Taiwan
| | - F-C Chang
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L.), National Yang-Ming University, Taipei, Taiwan
| | - W-Y Guo
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L.), National Yang-Ming University, Taipei, Taiwan
| | - S-C Hung
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L.), National Yang-Ming University, Taipei, Taiwan
| | - C-B Luo
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L.), National Yang-Ming University, Taipei, Taiwan
| | - J Beilner
- Angiography and Interventional X-Ray Systems (J.B.), Siemens Ltd China, Healthcare Sector, Shanghai, P.R. China
| | - M Kowarschik
- Angiography and Interventional X-Ray Systems (M.K.), Siemens AG, Healthcare Sector, Erlangen, Germany
| | - W-F Chu
- From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-B.L., W.-F.C.), Taipei Veterans General Hospital, Taipei, Taiwan
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Lee KW, Tsai FY, Chen WL, Liu CK, Kuo CL. Intracranial venous hemodynamics and rupture of cerebral aneurysm. Neuroradiol J 2014; 27:703-9. [PMID: 25489894 DOI: 10.15274/nrj-2014-10091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/24/2014] [Indexed: 11/12/2022] Open
Abstract
Many uncertain and inconsistent etiologies of cerebral aneurysmal rupture including a wide spectrum of factors have been reported. Our recent observation discloses the potential new factor of cerebral aneurysm rupture with cerebral venous pressure gradient. We retrospectively reviewed 52 cases treated with coil embolization with or without cerebral aneurysmal rupture. Seventeen males and 30 females were recruited in this study. Quantitative color-coded cerebral angiography was performed during coil therapeutic procedures to measure cerebral venous circulation. Ruptured cases had shorter and symmetrical cerebral venous circulation time (P <0.05). In addition, an asymmetrical venous outflow pattern was critical for aneurysmal rupture. Non-ruptured cases tended to have slower and asymmetrical cerebral venous circulation compared with rupture cases. Symmetrical and shorter cerebral venous circulation in the dysplasia venous outlet may be a potential new factor for cerebral aneurysm rupture.
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Affiliation(s)
- Kwo-Whei Lee
- Department of Medical Imaging, Vascular and Genomic Research Center, Changhua Christian Hospital; Taipei, Taiwan - Imaging Research Center, Taipei Medical University; Taipei, Taiwan - -
| | - Fong-Y Tsai
- Department of Medical Imaging, Changhua Christian Hospital; Taipei, Taiwan - Imaging Research Center, Taipei Medical University; Taipei, Taiwan
| | - Wei-Liang Chen
- Department of Medical Imaging, Vascular and Genomic Research Center, Changhua Christian Hospital; Taipei, Taiwan
| | - Chi-Kuang Liu
- Department of Medical Imaging, Vascular and Genomic Research Center, Changhua Christian Hospital; Taipei, Taiwan
| | - Chen-Ling Kuo
- Vascular and Genomic Research Center, Changhua Christian Hospital; Taipei, Taiwan
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