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Chen Zhou ZH, Hilario A, Salvador Álvarez E, Cárdenas Del Carre AM, Romero Coronado J, Lechuga Vázquez C, Martínez de Aragón A, Ramos González A. The "Hypointense Focal Brain" on susceptibility-weighted imaging as a sign of venous congestion in cranial dural arteriovenous fistulas. Neuroradiol J 2024:19714009241269522. [PMID: 39075737 DOI: 10.1177/19714009241269522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Cranial dural arteriovenous fistulas (dAVFs) are complex neurovascular malformations accounting for approximately 10%-15% of all intracranial arteriovenous malformations. The objective is to investigate the utility of susceptibility-weighted imaging (SWI) in identifying "hypointense focal brain" as an additional helpful sign of venous congestion in cranial dAVFs. MATERIALS AND METHODS A retrospective review of patients diagnosed with cranial dAVFs between January 2015 and June 2023 was conducted, and SWI was used to identify the "hypointense focal brain" sign within the venous drainage region of the dAVF. The "hypointense focal brain" on SWI was identified as a low-intensity signal within the venous drainage region, indicative of venous congestion. The presence of this imaging sign was assessed by two neuroradiologists and signal intensity measurements were performed to support the presence of the sign. RESULTS The study included six patients with cranial dAVFs exhibiting cortical venous retrograde drainage and the "hypointense focal brain" on SWI. Follow-up imaging post-treatment revealed resolution or improvement of the hypointense signal, confirming its association with venous congestion. Signal intensity measurements further supported the presence of this imaging sign in pre-treatment scans. CONCLUSION The study's findings demonstrate the presence of a reversible "hypointense focal brain" sign on SWI in patients with cranial dAVFs and CVR, which can be useful as an additional imaging sign for venous congestion.
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Affiliation(s)
- Zhao Hui Chen Zhou
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | - Amaya Hilario
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | - Elena Salvador Álvarez
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | | | - Juan Romero Coronado
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | - Carmen Lechuga Vázquez
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | - Ana Martínez de Aragón
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
| | - Ana Ramos González
- Neuroradiology Section, Department of Radiology, Hospital Universitario 12 de Octubre, Spain
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Alyafaie A, Han W, Li Y, Vydro SA, Vella M, Truong TL, Park L, Langston D, Kim H, Conrad MB, Hetts SW. Arterial Spin-Labeling MR Imaging in the Detection of Intracranial Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia. AJNR Am J Neuroradiol 2024:ajnr.A8281. [PMID: 38991769 DOI: 10.3174/ajnr.a8281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/07/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND AND PURPOSE Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease that causes vascular malformations in a variety of organs and tissues, including brain AVMs. Because brain AVMs have the potential to cause disabling or fatal intracranial hemorrhage, detection of these lesions before rupture is the goal of screening MR imaging/MRA examinations in patients with HHT. Prior studies have demonstrated superior sensitivity for HHT-related brain AVMs by using postcontrast MR imaging sequences as compared with MRA alone. We now present data regarding the incremental benefit of including arterial spin-labeling (ASL) perfusion sequences as part of MR imaging/MRA screening in patients with this condition. MATERIALS AND METHODS We retrospectively analyzed 831 patients at the UCSF Hereditary Hemorrhagic Telangiectasia Center of Excellence. Of these, 42 patients had complete MR imaging/MRA, ASL perfusion scans, and criterion-standard DSA data. Two neuroradiologists reviewed imaging studies and a third provided adjudication when needed. RESULTS Eight patients had no brain AVMs detected on DSA. The remaining 34 patients had 57 brain AVMs on DSA. Of the 57 identified AVMs, 51 (89.5%) were detected on ASL and 43 (75.4%) were detected on conventional MR imaging/MRA sequences (P = .049), with 8 lesions detected on ASL perfusion but not on conventional MR imaging. CONCLUSIONS ASL provides increased sensitivity for brain AVMs in patients with HHT. Inclusion of ASL should be considered as part of comprehensive MR imaging/MRA screening protocols for institutions taking care of patients with HHT.
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Affiliation(s)
- Adam Alyafaie
- From the School of Medicine (A.A., S.A.V.), University of California, San Francisco, San Francisco, California
| | - Woody Han
- Department of Radiology and Biomedical Imaging (W.H., Y.L., M.V.), University of California, San Francisco, San Francisco, California
| | - Yi Li
- Department of Radiology and Biomedical Imaging (W.H., Y.L., M.V.), University of California, San Francisco, San Francisco, California
| | - Samuel A Vydro
- From the School of Medicine (A.A., S.A.V.), University of California, San Francisco, San Francisco, California
| | - Maya Vella
- Department of Radiology and Biomedical Imaging (W.H., Y.L., M.V.), University of California, San Francisco, San Francisco, California
| | - Torianna L Truong
- HHT Center of Excellence, Department of Radiology and Biomedical Imaging (T.L.T., L.P., D.L., M.B.C.), University of California, San Francisco, San Francisco, California
| | - Lindsay Park
- HHT Center of Excellence, Department of Radiology and Biomedical Imaging (T.L.T., L.P., D.L., M.B.C.), University of California, San Francisco, San Francisco, California
| | - Daniel Langston
- HHT Center of Excellence, Department of Radiology and Biomedical Imaging (T.L.T., L.P., D.L., M.B.C.), University of California, San Francisco, San Francisco, California
| | - Helen Kim
- Department of Anesthesia, and Perioperative Care (H.K.), University of California, San Francisco, San Francisco, California
| | - Miles B Conrad
- HHT Center of Excellence, Department of Radiology and Biomedical Imaging (T.L.T., L.P., D.L., M.B.C.), University of California, San Francisco, San Francisco, California
| | - Steven W Hetts
- HHT Center of Excellence, Departments of Radiology, Biomedical Imaging, and Neurological Surgery (S.W.H.), University of California, San Francisco, San Francisco, California
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Yoo DH, Sohn CH, Kang HS, Cho YD, Kim KM. Arterial Spin-Labeling MR Imaging for the Differential Diagnosis of Venous-Predominant AVMs and Developmental Venous Anomalies. AJNR Am J Neuroradiol 2023; 44:916-921. [PMID: 37385682 PMCID: PMC10411836 DOI: 10.3174/ajnr.a7922] [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: 03/06/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Venous-predominant AVMs are almost identical in appearance to developmental venous anomalies on conventional MR imaging. Herein, we compared and analyzed arterial spin-labeling findings in patients with developmental venous anomalies or venous-predominant AVMs, using DSA as the criterion standard. MATERIALS AND METHODS We retrospectively collected patients with either DVAs or venous-predominant AVMs, each available on both DSA and arterial spin-labeling images. Arterial spin-labeling imaging was visually assessed for the presence of hyperintense signal. CBF measured at the most representative section was normalized to the contralateral gray matter. The temporal phase of developmental venous anomalies or venous-predominant AVMs was measured on DSA as a delay between the first appearance of the intracranial artery and the lesion. Correlation between the normalized CBF and the temporal phase was evaluated. RESULTS Analysis of 15 lesions (13 patients) resulted in categorization into 3 groups: typical venous-predominant AVMs (temporal phase, <2 seconds), intermediate group (temporal phase between 2.5 and 5 seconds), and classic developmental venous anomalies (temporal phase, >10 seconds). Arterial spin-labeling signal was markedly increased in the typical venous-predominant AVM group, while there was no discernible signal in the classic developmental venous anomaly group. In the intermediate group, however, 3 of 6 lesions showed mildly increased arterial spin-labeling signal. The normalized CBF on arterial spin-labeling and the temporal phase on DSA were moderately negatively correlated: r(13) = 0.66, P = .008. CONCLUSIONS Arterial spin-labeling may predict the presence and amount of arteriovenous shunting in venous-predominant AVMs, and using arterial spin-labeling enables confirmation of typical venous-predominant AVMs without DSA. However, lesions with an intermediate amount of shunting suggest a spectrum of vascular malformations ranging from purely vein-draining developmental venous anomalies to venous-predominant AVMs with overt arteriovenous shunting.
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Affiliation(s)
- D H Yoo
- From the Departments of Radiology (D.H.Y., C.-H.S., Y.D.C.)
| | - C-H Sohn
- From the Departments of Radiology (D.H.Y., C.-H.S., Y.D.C.)
| | - H-S Kang
- Neurosurgery (H.-S.K., K.M.K.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Y D Cho
- From the Departments of Radiology (D.H.Y., C.-H.S., Y.D.C.)
| | - K M Kim
- Neurosurgery (H.-S.K., K.M.K.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Lindner T, Bolar DS, Achten E, Barkhof F, Bastos-Leite AJ, Detre JA, Golay X, Günther M, Wang DJJ, Haller S, Ingala S, Jäger HR, Jahng GH, Juttukonda MR, Keil VC, Kimura H, Ho ML, Lequin M, Lou X, Petr J, Pinter N, Pizzini FB, Smits M, Sokolska M, Zaharchuk G, Mutsaerts HJMM. Current state and guidance on arterial spin labeling perfusion MRI in clinical neuroimaging. Magn Reson Med 2023; 89:2024-2047. [PMID: 36695294 PMCID: PMC10914350 DOI: 10.1002/mrm.29572] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Abstract
This article focuses on clinical applications of arterial spin labeling (ASL) and is part of a wider effort from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group to update and expand on the recommendations provided in the 2015 ASL consensus paper. Although the 2015 consensus paper provided general guidelines for clinical applications of ASL MRI, there was a lack of guidance on disease-specific parameters. Since that time, the clinical availability and clinical demand for ASL MRI has increased. This position paper provides guidance on using ASL in specific clinical scenarios, including acute ischemic stroke and steno-occlusive disease, arteriovenous malformations and fistulas, brain tumors, neurodegenerative disease, seizures/epilepsy, and pediatric neuroradiology applications, focusing on disease-specific considerations for sequence optimization and interpretation. We present several neuroradiological applications in which ASL provides unique information essential for making the diagnosis. This guidance is intended for anyone interested in using ASL in a routine clinical setting (i.e., on a single-subject basis rather than in cohort studies) building on the previous ASL consensus review.
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Affiliation(s)
- Thomas Lindner
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Divya S. Bolar
- Center for Functional Magnetic Resonance Imaging, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Eric Achten
- Department of Radiology and Nuclear Medicine, Ghent University, Ghent, Belgium
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, UK
| | | | - John A. Detre
- Department of Neurology, University of Pennsylvania, Philadelphia PA USA
| | - Xavier Golay
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Matthias Günther
- (1) University Bremen, Germany; (2) Fraunhofer MEVIS, Bremen, Germany; (3) mediri GmbH, Heidelberg, Germany
| | - Danny JJ Wang
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles CA USA
| | - Sven Haller
- (1) CIMC - Centre d’Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Genève 1201 Genève (2) Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (3) Faculty of Medicine of the University of Geneva, Switzerland. Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hans R Jäger
- UCL Queen Square Institute of Neuroradiology, University College London, London, UK
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Meher R. Juttukonda
- (1) Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown MA USA (2) Department of Radiology, Harvard Medical School, Boston MA USA
| | - Vera C. Keil
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical sciences, University of Fukui, Fukui, JAPAN
| | - Mai-Lan Ho
- Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Maarten Lequin
- Division Imaging & Oncology, Department of Radiology & Nuclear Medicine | University Medical Center Utrecht & Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jan Petr
- (1) Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany (2) Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Nandor Pinter
- Dent Neurologic Institute, Buffalo, NY, USA. University at Buffalo Neurosurgery, Buffalo, NY, USA
| | - Francesca B. Pizzini
- Radiology Institute, Dept. of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Marion Smits
- (1) Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands (2) The Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering University College London Hospitals NHS Foundation Trust, UK
| | | | - Henk JMM Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Kochi R, Suzuki Y, Yamazaki H, Aikawa T, Endo H, Tominaga T. Efficacy of repeat arterial spin labeling for angiogram-negative ruptured micro-arteriovenous malformation: A case report. Surg Neurol Int 2023; 14:119. [PMID: 37151432 PMCID: PMC10159299 DOI: 10.25259/sni_200_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Background:
Diagnosing ruptured micro-arteriovenous malformation (AVM) could be difficult using digital subtraction angiography (DSA) in the acute stage, and a repeat DSA is recommended in DSA-negative cases. Arterial spin labeling (ASL) is a useful noninvasive tool for detecting AVM, but the efficacy of a repeat ASL for DSA and ASL-negative ruptured micro-AVM in the acute stage is unclear. Here, we report a case of ruptured micro-AVM that was not detected in the acute stage by ASL but in the chronic stage by ASL.
Case Description:
A 43-year-old man developed right upper-extremity paralysis, and computed tomography (CT) revealed a left frontal lobe hemorrhage. Magnetic resonance imaging, including ASL, CT angiography, and DSA, showed no abnormal findings associated with hemorrhage in the acute stage. The second ASL 93 days after the hemorrhage showed a high signal on the cortical vein of the left frontal lobe and superior sagittal sinus, and subsequent DSA detected a micro-AVM in the left precentral gyrus.
Conclusion:
Repeat ASL is less invasive and useful for detecting micro-AVMs which showed no findings on ASL and DSA in the acute stage.
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Tritanon O, Khunvutthidee S, Kobkitsuksakul C, Jindahra P, Panyaping T. Differentiation between aggressive and benign intracranial non-cavernous dural arteriovenous fistulas using cortical venous reflux on susceptibility weighted images. Eur J Radiol 2023; 162:110800. [PMID: 36990052 DOI: 10.1016/j.ejrad.2023.110800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/24/2023] [Accepted: 03/22/2023] [Indexed: 03/28/2023]
Abstract
PURPOSE This study aimed to evaluate the ability of susceptibility-weighted imaging (SWI) to detect cortical venous reflux (CVR) in patients with intracranial non-cavernous dural arteriovenous fistulas (DAVFs), which can be helpful to differentiate benign and aggressive DAVFs. MATERIAL AND METHODS Twenty-seven patients (8 women and 19 men) with 33 non-cavernous DAVFs were divided into benign and aggressive groups. Presence of CVR and pseudophlebitic pattern (PPP) and location of fistula on SWI were determined. Digital subtraction angiography was used as the reference standard. Interobserver agreement for the presence of CVR and PPP and location of DAVF on SWI was evaluated using the kappa statistic. Statistical comparisons between the benign and aggressive DAVFs were performed. RESULTS Sensitivity, specificity, positive predictive value, and negative predictive value of SWI for detecting CVR was 73.7%, 85.7%, 87.5%, and 70.6%, respectively. Corresponding values for detecting PPP were 95.2%, 83.3%, 95.2%, and 83.3%, respectively. SWI correctly identified DAVF location in 78.9%. Prevalence rates of CVR and PPP on SWI were significantly higher in aggressive DAVFs than benign ones. CONCLUSION SWI exhibited high sensitivity and specificity for detection of CVR, a characteristic used to differentiate benign and aggressive lesions. CVR and PPP on SWI are signs of aggressive DAVFs that guide to perform angiography confirmation and prompt treatment to avoid serious complication.
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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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Han SW, Shin JH, Ihn YK, Yang SH, Sung JH. Comparison of Single- and Multi-Echo Susceptibility-Weighted Imaging in Detecting Cerebral Arteriovenous Shunts: A Preliminary Study. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:226-239. [PMID: 36818708 PMCID: PMC9935958 DOI: 10.3348/jksr.2022.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 02/10/2023]
Abstract
Purpose To compare the sensitivities of T2-weighted image (T2WI) and susceptibility-weighted imaging (SWI) in detecting cerebral arteriovenous fistula (AVF), cerebral arteriovenous malformation (AVM), and carotid-cavernous sinus fistula (CCF), and to qualitatively evaluate single-echo SWI (s-SWI) and multi-echo SWI (m-SWI) in characterizing vascular lesions. Materials and Methods From January 2016 to December 2021, cerebral angiography-proven lesions were recruited. The sensitivities of T2WI and SWI in detecting vascular lesions were compared using McNemar's test. Qualitative evaluations of s-SWI and m-SWI were categorized to be of poor, average, or good quality and compared using Fisher's exact test. Results A total of 24 patients (mean age: 61 years, 12 female, and 12 male) were enrolled. Twenty patients underwent s-SWI or m-SWI, and four patients underwent both. AVF, AVM, and CCF were diagnosed in 10, 11, and 3 patients, respectively. SWI demonstrated higher sensitivity compared to that of T2WI (82.1% vs. 53.6%, p = 0.013). m-SWI showed better image quality compared to that of s-SWI (good quality, 83.3% vs. 25.0%, p = 0.009). Conclusion SWI demonstrated a higher sensitivity for detecting cerebral arteriovenous shunts compared to that of T2WI. m-SWI exhibited better image quality compared to that of s-SWI in characterizing vascular lesions.
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Affiliation(s)
- Seung Wan Han
- Department of Radiology, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae Ho Shin
- Department of Radiology, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Yon Kwon Ihn
- Department of Radiology, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Seung Ho Yang
- Department of Neurosurgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
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Role of MRI and CT in the Evaluation of Headache in Pregnancy and the Postpartum Period. Neurol Clin 2022; 40:661-677. [PMID: 35871790 DOI: 10.1016/j.ncl.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Approximately 35% of acute headaches in pregnant women are secondary to an underlying condition. Headaches are also common in the postpartum period where they occur in 30% to 40% of patients. The majority of secondary headaches are due to hypertensive disorders: preeclampsia-eclampsia, posterior reversible encephalopathy syndrome, and acute arterial hypertension. Other causes include reversible cerebral vasoconstriction syndrome and pituitary apoplexy, as well as life-threatening conditions such as cerebral venous thrombosis. In this article, we review general recommendations for imaging the pregnant patients and discuss the imaging findings of common causes of headaches in pregnancy and the postpartum period.
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Cummins DD, Caton MT, Shah V, Meisel K, Glastonbury C, Amans MR. MRI and MR angiography evaluation of pulsatile tinnitus: A focused, physiology-based protocol. J Neuroimaging 2022; 32:253-263. [PMID: 34910345 PMCID: PMC8917066 DOI: 10.1111/jon.12955] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Pulsatile tinnitus (PT) is the subjective sensation of a pulse-synchronous sound, most often due to a cerebrovascular etiology. PT can severely impact quality of life and may indicate a life-threatening process, yet a timely and accurate diagnosis can often lead to effective treatment. Clinical assessment with a history and physical examination can often suggest a diagnosis for PT, but is rarely definitive. Therefore, PT should be evaluated with a comprehensive and targeted radiographic imaging protocol. MR imaging provides a safe and effective means to evaluate PT. Specific MR sequences may be used to highlight different elements of cerebrovascular anatomy and physiology. However, routine MR evaluation of PT must comply with economic and practical constraints, while effectively capturing both common and rarer, life-threatening etiologies of PT. METHODS In this state-of-the-art review, we describe our institutional MR protocol for evaluating PT. RESULTS This protocol includes the following dedicated sequences: time-of-flight magnetic resonance angiography; arterial spin labeling; spoiled gradient recalled acquisition in the steady state; time-resolved imaging of contrast kinetics; diffusion weighted imaging, and 3-dimensional fluid-attenuated inversion recovery. CONCLUSIONS We describe the physiologic and clinical rationale for including each MR sequence in a comprehensive PT imaging protocol, and detail the role of MR within the broader evaluation of PT, from clinical presentation to treatment.
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Affiliation(s)
- Daniel D. Cummins
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael T. Caton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Vinil Shah
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Karl Meisel
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Christine Glastonbury
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Matthew R. Amans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA,Corresponding author: Matthew R. Amans, Address: 505 Parnassus Ave, Room L349, San Francisco, CA 94143, Telephone: 415-353-1863, Fax: 415-353-8606,
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11
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Kochi R, Endo H, Uchida H, Kawaguchi T, Omodaka S, Matsumoto Y, Tominaga T. Efficacy of arterial spin labeling for detection of the ruptured micro-arteriovenous malformation: illustrative cases. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 3:CASE21597. [PMID: 36131567 PMCID: PMC9379700 DOI: 10.3171/case21597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/18/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Diagnosis of a microarteriovenous malformation (micro-AVM) is difficult, especially in the acute stage of rupture because of the small size of the nidus and the existence of hematoma. We report two cases of ruptured micro-AVMs detected by arterial spin labeling (ASL). OBSERVATIONS In one case, a 45-year-old male was transported with a complaint of right hemiparesis. Computed tomography (CT) revealed a right parietal lobar hemorrhage. Standard magnetic resonance imaging (MRI) showed no abnormal findings as the cause of the hemorrhage. ASL 23 days after the onset demonstrated high signals on the medial wall of the hematoma. Digital subtraction angiography (DSA) showed a micro-AVM in accordance with the site of high signals on ASL. In another case, a 38-year-old female was transported with a complaint of left hemianopsia. CT on admission revealed a right parietal lobar hemorrhage. Standard MRI showed no abnormal findings as the cause of the hemorrhage. ASL 15 days after the onset demonstrated high signals on the internal wall of the hematoma. DSA showed micro-AVM in accordance with the site of high signaling on ASL. Both cases were successfully treated with open surgery. LESSONS ASL can manifest micro-AVMs as high signals within the hematoma. ASL is a useful less-invasive screening tool for the detection of ruptured micro-AVMs.
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Affiliation(s)
| | - Hidenori Endo
- Departments of Neurosurgery and
- Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan
| | | | | | - Shunsuke Omodaka
- Division of Advanced Cerebrovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; and
| | - Yasushi Matsumoto
- Division of Advanced Cerebrovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; and
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Hak JF, Boulouis G, Kerleroux B, Benichi S, Stricker S, Gariel F, Garzelli L, Meyer P, Kossorotoff M, Boddaert N, Vidal V, Girard N, Dangouloff Ros V, Brunelle F, Blauwblomme T, Naggara O. Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children. Stroke 2021; 53:185-193. [PMID: 34517772 DOI: 10.1161/strokeaha.120.032690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Pediatric nontraumatic intracerebral hemorrhage accounts for half of stroke in children. Early diagnostic of the causative underlying lesion is the first step toward prevention of hemorrhagic recurrence. We aimed to investigate the performance of arterial spin labeling sequence (ASL) in the acute phase etiological workup for the detection of an arteriovenous shunt (AVS: including malformation and fistula), the most frequent cause of pediatric nontraumatic intracerebral hemorrhage. METHODS Children with a pediatric nontraumatic intracerebral hemorrhage between 2011 and 2019 enrolled in a prospective registry were retrospectively included if they had undergone ASL-magnetic resonance imaging before any etiological treatment. ASL sequences were reviewed using cerebral blood flow maps by 2 raters for the presence of an AVS. The diagnostic performance of ASL was compared with admission computed tomography angiography, other magnetic resonance imaging sequences including contrast-enhanced sequences and subsequent digital subtraction angiography. RESULTS A total of 121 patients with pediatric nontraumatic intracerebral hemorrhage were included (median age, 9.9 [interquartile range, 5.8-13]; male sex 48.8%) of whom 76 (63%) had a final diagnosis of AVS. Using digital subtraction angiography as an intermediate reference, visual ASL inspection had a sensitivity and a specificity of, respectively, 95.9% (95% CI, 88.5%-99.1%) and 79.0% (95% CI, 54.4%-94.0%). ASL had a sensitivity, specificity, and accuracy of 90.2%, 97.2%, and 92.5%, respectively for the detection of the presence of an AVS, with near perfect interrater agreement (κ=0.963 [95% CI, 0.912-1.0]). The performance of ASL alone was higher than that of other magnetic resonance imaging sequences, individually or combined, and higher than that of computed tomography angiography. CONCLUSIONS ASL has strong diagnostic performance for the detection of AVS in the initial workup of intracerebral hemorrhage in children. If our findings are confirmed in other settings, ASL may be a helpful diagnostic imaging modality for patients with pediatric nontraumatic intracerebral hemorrhage. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: 3618210420, 2217698.
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Affiliation(s)
- Jean François Hak
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
| | - Grégoire Boulouis
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
| | - Basile Kerleroux
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
| | - Sandro Benichi
- The Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163 (S.B., S.S., T.B.), University hospital Necker-Enfants-malades, Paris, France
| | - Sarah Stricker
- The Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163 (S.B., S.S., T.B.), University hospital Necker-Enfants-malades, Paris, France
| | - Florent Gariel
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Department of Neuroradiology, University Hospital of Bordeaux, France (F.G.)
| | - Lorenzo Garzelli
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Philippe Meyer
- Pediatric Neuro ICU (P.M.), University hospital Necker-Enfants-malades, Paris, France
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, INSERM U894 (M.K., T.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Department of Pediatric Neurology (M.K.), AP-HP, University hospital Necker-Enfants-malades, Paris, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Vincent Vidal
- Department of Radiology (V.V.), University Hospital La Timone Hospital, AP-HM, Marseille, France
| | - Nadine Girard
- the Department of Neuroradiology (N.G.), University Hospital La Timone Hospital, AP-HM, Marseille, France
| | - Volodia Dangouloff Ros
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Francis Brunelle
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Thomas Blauwblomme
- The Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163 (S.B., S.S., T.B.), University hospital Necker-Enfants-malades, Paris, France.,French Center for Pediatric Stroke, INSERM U894 (M.K., T.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Olivier Naggara
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,French Center for Pediatric Stroke, INSERM U894 (M.K., T.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
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Song Y, Kwon B, Al-Abdulwahhab AH, Nam YK, Ahn Y, Jeong SY, Seo EJ, Lee JK, Suh DC. Rare Neurovascular Diseases in Korea: Classification and Related Genetic Variants. Korean J Radiol 2021; 22:1379-1396. [PMID: 34047503 PMCID: PMC8316781 DOI: 10.3348/kjr.2020.1171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/07/2020] [Accepted: 01/23/2021] [Indexed: 01/19/2023] Open
Abstract
Rare neurovascular diseases (RNVDs) have not been well-recognized in Korea. They involve the central nervous system and greatly affect the patients' lives. However, these diseases are difficult to diagnose and treat due to their rarity and incurability. We established a list of RNVDs by referring to the previous literature and databases worldwide to better understand the diseases and their current management status. We categorized 68 RNVDs based on their pathophysiology and clinical manifestations and estimated the prevalence of each disease in Korea. Recent advances in genetic, molecular, and developmental research have enabled further understanding of these RNVDs. Herein, we review each disease, while considering its classification based on updated pathologic mechanisms, and discuss the management status of RNVD in Korea.
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Affiliation(s)
- Yunsun Song
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boseong Kwon
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Abdulrahman Hamed Al-Abdulwahhab
- Department of Diagnostic and Interventional Radiology, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al-Khobar City, Eastern Province, Saudi Arabia
| | - Yeo Kyoung Nam
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yura Ahn
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeong Jeong
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eul Ju Seo
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Keuk Lee
- Asan Institute of Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Chul Suh
- Division of Neurointervention Clinic, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Evaluation of cerebral arteriovenous shunts: a comparison of parallel imaging time-of-flight magnetic resonance angiography (TOF-MRA) and compressed sensing TOF-MRA to digital subtraction angiography. Neuroradiology 2020; 63:879-887. [PMID: 33063222 DOI: 10.1007/s00234-020-02581-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Time-of-flight (TOF)-MR angiography (MRA) is an important imaging sequence for the surveillance and analysis of cerebral arteriovenous shunt (AVS), including arteriovenous malformation (AVM) and arteriovenous fistula (AVF). However, this technique has the disadvantage of a relatively long scan time. The aim of this study was to compare diagnostic accuracy between compressed sensing (CS)-TOF and conventional parallel imaging (PI)-TOF-MRA for detecting and characterizing AVS. METHODS This study was approved by the institutional review board for human studies. Participants comprised 56 patients who underwent both CS-TOF-MRA and PI-TOF-MRA on a 3-T MR unit with or without cerebral AVS between June 2016 and September 2018. Imaging parameters for both sequences were almost identical, except the acceleration factor of 3× for PI-TOF-MRA and 6.5× for CS-TOF-MRA, and the scan time of 5 min 19 s for PI-TOF-MRA and 2 min 26 s for CS-TOF-MRA. Two neuroradiologists assessed the accuracy of AVS detection on each sequence and analyzed AVS angioarchitecture. Concordance between CS-TOF, PI-TOF, and digital subtraction angiography was calculated using unweighted and weighted kappa statistics. RESULTS Both CS-TOF-MRA and PI-TOF-MRA yielded excellent sensitivity and specificity for detecting intracranial AVS (reviewer 1, 97.3%, 94.7%; reviewer 2, 100%, 100%, respectively). Interrater agreement on the angioarchitectural features of intracranial AVS on CS-MRA and PI-MRA was moderate to good. CONCLUSION The diagnostic performance of CS-TOF-MRA is comparable to that of PI-TOF-MRA in detecting and classifying AVS with a reduced scan time under 2.5 min.
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15
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Arterial spin-labeling perfusion MR images with dual postlabeling delay reveals hemodynamic changes in dural arteriovenous fistulas following endovascular surgery. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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Ramachandran S, Mukherjee D, Delf J, Bown MJ, Kandiyil N. A comparison of arterial spin labelling with catheter angiography in evaluating arteriovenous malformations: a systematic review. Br J Radiol 2020; 93:20190830. [PMID: 32208976 PMCID: PMC10993222 DOI: 10.1259/bjr.20190830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the performance of arterial spin labelling (ASL) in evaluating arteriovenous malformations (AVMs) against the current gold standard of catheter angiography. METHODS We systematically reviewed the published literature using EMBASE and Medline. We included studies that compared ASL to catheter angiography in the assessment of AVMs in three outcome domains: detection, angioarchitectural and haemodynamic features. RESULTS From 314 unique citations, 19 studies representing 289 patients with intracranial AVMs met our inclusion criteria. We did not pool data due to marked heterogeneity in study outcome measures. Seven studies showed high diagnostic performance of ASL in identifying arterial feeders, with sensitivity ranging from 84.6 to 100% and specificity ranging from 93.3 to 100%. Six studies showed strong ability in detecting arteriovenous shunting, with sensitivity ranging from 91.7 to 100% and specificity ranging from 90 to 100%. Seven studies demonstrated that ASL could identify nidal location and size as well as catheter angiography, while five studies showed relatively poorer performance in delineating venous drainage. Two studies showed 100% sensitivity of ASL in the identification of residual or obliterated AVMs following stereotactic radiosurgery. CONCLUSIONS Despite limitations in the current evidence base and technical challenges, this review suggests that ASL has a promising role in the work-up and post-treatment follow-up of AVMs. Larger scale prospective studies assessing the diagnostic performance of ASL are warranted. ADVANCES IN KNOWLEDGE ASL demonstrates overall validity in the evaluation of intracranial AVMs.
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Affiliation(s)
- Sanjeev Ramachandran
- University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
- University of Leicester,
Leicester, United Kingdom
| | - Deyashini Mukherjee
- University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
- University of Leicester,
Leicester, United Kingdom
| | - Jonathan Delf
- University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
| | - Matthew James Bown
- University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
- University of Leicester,
Leicester, United Kingdom
| | - Neghal Kandiyil
- University Hospitals of Leicester NHS Trust,
Leicester, United Kingdom
- University of Leicester,
Leicester, United Kingdom
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17
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Leclerc X, Guillaud O, Reyns N, Hodel J, Outteryck O, Bala F, Bricout N, Bretzner M, Ramdane N, Pruvo JP, Hacein-Bey L, Kuchcinski G. Follow-Up MRI for Small Brain AVMs Treated by Radiosurgery: Is Gadolinium Really Necessary? AJNR Am J Neuroradiol 2020; 41:437-445. [PMID: 32029465 DOI: 10.3174/ajnr.a6404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/17/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Follow-up MR imaging of brain AVMs currently relies on contrast-enhanced sequences. Noncontrast techniques, including arterial spin-labeling and TOF, may have value in detecting a residual nidus after radiosurgery. The aim of this study was to compare noncontrast with contrast-enhanced MR imaging for the differentiation of residual-versus-obliterated brain AVMs in radiosurgically treated patients. MATERIALS AND METHODS Twenty-eight consecutive patients with small brain AVMs (<20 mm) treated by radiosurgery were followed with the same MR imaging protocol. Three neuroradiologists, blinded to the results, independently reviewed the following: 1) postcontrast images alone (4D contrast-enhanced MRA and postcontrast 3D T1 gradient recalled-echo), 2) arterial spin-labeling and TOF images alone, and 3) all MR images combined. The primary end point was the detection of residual brain AVMs using a 5-point scale, with DSA as the reference standard. RESULTS The highest interobserver agreement was for arterial spin-labeling/TOF (κ = 0.81; 95% confidence interval, 0.66-0.93). Regarding brain AVM detection, arterial spin-labeling/TOF had higher sensitivity (sensitivity, 85%; specificity, 100%; 95% CI, 62-97) than contrast-enhanced MR imaging (sensitivity, 55%; specificity, 100%; 95% CI, 27-73) and all MR images combined (sensitivity, 75%; specificity, 100%; 95% CI, 51-91) (P = .008). All nidus obliterations on DSA were detected on MR imaging. In 6 patients, a residual brain AVM present on DSA was only detected with arterial spin-labeling/TOF, including 3 based solely on arterial spin-labeling images. CONCLUSIONS In this study of radiosurgically treated patients with small brain AVMs, arterial spin-labeling/TOF was found to be superior to gadolinium-enhanced MR imaging in detecting residual AVMs.
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Affiliation(s)
- X Leclerc
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France .,Inserm U1171, Degenerative and Vascular Cognitive Disorders (X.L., O.O., J.-P.P., G.K.), University of Lille, Lille, France
| | - O Guillaud
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France
| | - N Reyns
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France.,Inserm U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology (N. Reyns), University of Lille, Lille, France
| | - J Hodel
- Department of Neuroradiology (J.H.), Hôpital Henri Mondor, Créteil, France; EA 2694-Public Health: Epidemiology and Quality of Care (N. Ramdane), University of Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - O Outteryck
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France.,Inserm U1171, Degenerative and Vascular Cognitive Disorders (X.L., O.O., J.-P.P., G.K.), University of Lille, Lille, France
| | - F Bala
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France
| | - N Bricout
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France
| | - M Bretzner
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France
| | - N Ramdane
- Department of Neuroradiology (J.H.), Hôpital Henri Mondor, Créteil, France; EA 2694-Public Health: Epidemiology and Quality of Care (N. Ramdane), University of Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - J-P Pruvo
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France.,Inserm U1171, Degenerative and Vascular Cognitive Disorders (X.L., O.O., J.-P.P., G.K.), University of Lille, Lille, France
| | - L Hacein-Bey
- Neuroradiology, Radiology Department (L.H.-B.), University of California Davis School of Medicine, Sacramento, California
| | - G Kuchcinski
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France.,Inserm U1171, Degenerative and Vascular Cognitive Disorders (X.L., O.O., J.-P.P., G.K.), University of Lille, Lille, France
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Jugular venous reflux may mimic type I dural arterio-venous fistula on arterial spin labeling magnetic resonance images. Neuroradiology 2020; 62:447-454. [PMID: 31898766 DOI: 10.1007/s00234-019-02346-2] [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: 09/24/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Previous studies have shown that arterial spin-labeling (ASL) has high sensitivity and specificity for detecting dural arteriovenous fistulas (DAVFs). However, in case of jugular venous reflux (JVR), the labeled protons in the jugular vein may lead to a venous hypersignal in the jugular vein, sigmoid, and transverse sinus on ASL images and mimic DAVF. METHODS To ascertain this hypothesis, two blinded senior neuroradiologists independently and retrospectively reviewed randomized ASL images and graded the likelihood of DAVF on a 5-point Likert scale in 2 groups of patients: (i) 13 patients with angiographically proven type I DAVF; and (ii) 11 patients with typical JVR diagnosed on the basis of clinical and MR imaging data, first using ASL alone, and second using ASL together with all of the sequences including 4D CE MRA. RESULT A dural venous ASL signal was seen in 11 patients with type I DAVF and in all the 11 patients with JVR, with no distinctive pattern between the two. The mean Likert score was "very likely" in DAVF and JVR patients when using ASL alone (k = 0.71), and "very unlikely" for JVR versus "very likely" for DAVF when using all the sequences available (k = 0.92). CONCLUSION Our study shows that JVR can mimic DAVF on ASL images with potential implications for patient care. The detection of DAVFs should be based on additional MR sequences such as TOF-MRA and 4D CE MRA to exclude JVR and to avoid unnecessary DSAs.
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Falk Delgado A, Van Westen D, Nilsson M, Knutsson L, Sundgren PC, Larsson EM, Falk Delgado A. Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging-a comprehensive overview. Insights Imaging 2019; 10:84. [PMID: 31444580 PMCID: PMC6708018 DOI: 10.1186/s13244-019-0771-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/12/2019] [Indexed: 12/16/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) increase lesion detection and improve disease characterization for many cerebral pathologies investigated with MRI. These agents, introduced in the late 1980s, are in wide use today. However, some non-ionic linear GBCAs have been associated with the development of nephrogenic systemic fibrosis in patients with kidney failure. Gadolinium deposition has also been found in deep brain structures, although it is of unclear clinical relevance. Hence, new guidelines from the International Society for Magnetic Resonance in Medicine advocate cautious use of GBCA in clinical and research practice. Some linear GBCAs were restricted from use by the European Medicines Agency (EMA) in 2017. This review focuses on non-contrast-enhanced MRI techniques that can serve as alternatives for the use of GBCAs. Clinical studies on the diagnostic performance of non-contrast-enhanced as well as contrast-enhanced MRI methods, both well established and newly proposed, were included. Advantages and disadvantages together with the diagnostic performance of each method are detailed. Non-contrast-enhanced MRIs discussed in this review are arterial spin labeling (ASL), time of flight (TOF), phase contrast (PC), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), susceptibility weighted imaging (SWI), and amide proton transfer (APT) imaging. Ten common diseases were identified for which studies reported comparisons of non-contrast-enhanced and contrast-enhanced MRI. These specific diseases include primary brain tumors, metastases, abscess, multiple sclerosis, and vascular conditions such as aneurysm, arteriovenous malformation, arteriovenous fistula, intracranial carotid artery occlusive disease, hemorrhagic, and ischemic stroke. In general, non-contrast-enhanced techniques showed comparable diagnostic performance to contrast-enhanced MRI for specific diagnostic questions. However, some diagnoses still require contrast-enhanced imaging for a complete examination.
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Affiliation(s)
- Anna Falk Delgado
- Clinical neurosciences, Karolinska Institutet, Stockholm, Sweden. .,Department of Neuroradiology, Karolinska University Hospital, Eugeniavägen 3, Solna, Stockholm, Sweden.
| | - Danielle Van Westen
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Markus Nilsson
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden.,Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Pia C Sundgren
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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Padilha IG, Pacheco FT, Araujo AIR, Nunes RH, Baccin CE, Conti MLM, Maia ACM, Rocha AJD. Tips and tricks in the diagnosis of intracranial dural arteriovenous fistulas: A pictorial review. J Neuroradiol 2019; 47:369-381. [PMID: 31279838 DOI: 10.1016/j.neurad.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/25/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) are complex vascular abnormalities that account for 10-15% of intracranial vascular malformations. DAVFs are typically encountered in middle-aged adults, with a slightly female predominance. The causative factors are still uncertain; however, abnormal local hemodynamics and neoangiogenesis related to dural sinus or venous thrombosis can contribute to DAVF occurrence. The diagnosis is dependent on a high level of clinical suspicion and high-resolution imaging techniques. Computed tomography and/or magnetic resonance imaging aid in the diagnosis, but conventional angiography remains the most accurate method for the complete characterization and classification of DAVFs. The therapeutic approach can be conservative or more aggressive, based on symptom severity, sequelae risk and patient characteristics. This article is a pictorial review of adult intracranial DAVFs that highlights some tips and tricks for recognizing useful red flags in the suspicion of DAVFs.
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Affiliation(s)
- Igor Gomes Padilha
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil.
| | - Felipe Torres Pacheco
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
| | - Alan Iuno Rios Araujo
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
| | - Renato Hoffmann Nunes
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
| | - Carlos Eduardo Baccin
- Division of Interventional Neuroradiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, 05652-900 Sao Paulo SP, Brazil
| | - Mario Luiz Marques Conti
- Division of Interventional Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil
| | - Antônio Carlos Martins Maia
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Fleury Medicina e Saúde, Rua Cincinato Braga, 282 - Bela Vista, 01333-910 Sao Paulo SP, Brazil
| | - Antônio José da Rocha
- Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, Rua Dr. Cesario Motta Jr. 112, Vila Buarque, 01221-020 Sao Paulo SP, Brazil; Division of Neuroradiology, Diagnosticos da America SA, São Paulo, Brazil; Department of Medical Imaging, R. João Cachoeira, 743 - Itaim Bibi, 04535-012 Sao Paulo SP, Brazil
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21
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Arterial Spin Labeling and Dynamic Susceptibility Contrast-enhanced MR Imaging for evaluation of arteriovenous shunting and tumor hypoxia in glioblastoma. Sci Rep 2019; 9:8747. [PMID: 31217496 PMCID: PMC6584644 DOI: 10.1038/s41598-019-45312-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/05/2019] [Indexed: 12/24/2022] Open
Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumor in adults and carries a dismal prognosis. Significant challenges in the care of patients with GBM include marked vascular heterogeneity and arteriovenous (AV) shunting, which results in tumor hypoxia and inadequate delivery of systemic treatments to reach tumor cells. In this study, we investigated the utility of different MR perfusion techniques to detect and quantify arteriovenous (AV) shunting and tumor hypoxia in patients with GBM. Macrovascular shunting was present in 33% of subjects, with the degree of shunting ranging from (37–60%) using arterial spin labeling perfusion. Among the dynamic susceptibility contrast-enhanced perfusion curve features, there were a strong negative correlation between hypoxia score, DSC perfusion curve recovery slope (r = −0.72, P = 0.018) and angle (r = −0.73, P = 0.015). The results of this study support the possibility of using arterial spin labeling and pattern analysis of dynamic susceptibility contrast-enhanced MR Imaging for evaluation of arteriovenous shunting and tumor hypoxia in glioblastoma.
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22
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Juttukonda MR, Donahue MJ, Davis LT, Gindville MC, Lee CA, Patel NJ, Kassim AA, Pruthi S, Hendrikse J, Jordan LC. Preliminary evidence for cerebral capillary shunting in adults with sickle cell anemia. J Cereb Blood Flow Metab 2019; 39:1099-1110. [PMID: 29260615 PMCID: PMC6547194 DOI: 10.1177/0271678x17746808] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Elevated flow velocities in adults with sickle cell anemia (SCA) may cause rapid erythrocyte transit through capillaries. This phenomenon could present as dural venous sinus hyperintensity on arterial spin labeling (ASL)-MRI and could be indicative of capillary shunting. Here, the prevalence of ASL venous hyperintensities and association with relevant physiology in adults with SCA was investigated. SCA ( n = 46) and age-matched control ( n = 16) volunteers were recruited for 3.0 T MRI. Pseudo-continuous ASL-MRI was acquired for cerebral blood flow (CBF) calculation and venous hyperintensity determination; venous signal intensity and a categorical venous score (three raters; 0 = no hyperintensity, 1 = focal hyperintensity, and 2 = diffuse hyperintensity) were recorded. Flow velocity in cervical internal carotid artery segments was determined from phase contrast data (venc = 40 cm/s) and whole-brain oxygen extraction fraction (OEF) was determined from T2-relaxation-under-spin-tagging MRI. Cerebral metabolic rate of oxygen was calculated as the product of OEF, CBF, and blood oxygen content. ASL venous hyperintensities were significantly ( p < 0.001) more prevalent in SCA (65%) relative to control (6%) participants and were associated with elevated flow velocities ( p = 0.03). CBF ( p < 0.001), but not OEF, increased with increasing hyperintensity score. Prospective trials that evaluate this construct as a possible marker of impaired oxygen delivery and stroke risk may be warranted.
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Affiliation(s)
- Meher R Juttukonda
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,2 Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,3 Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA.,4 Department of Physics and Astronomy, Vanderbilt University, Nashville, TN, USA
| | - Larry T Davis
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa C Gindville
- 5 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea A Lee
- 5 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J Patel
- 5 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adetola A Kassim
- 6 Department of Medicine, Division of Hematology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumit Pruthi
- 1 Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeroen Hendrikse
- 7 Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lori C Jordan
- 2 Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,5 Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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23
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Pacheco FT, Allegro BB, Padilha IG, Nunes RH, Rocha AJD. Added value of arterial spin-labeling (ASL) and susceptibility weighted-images (SWI) in detecting a mild symptomatic intracranial arteriovenous fistula. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:568. [PMID: 30231132 DOI: 10.1590/0004-282x20180056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/31/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Felipe T Pacheco
- Faculdade de Medicina da Santa Casa de São Paulo, Divisão de Neurorradiologia, São Paulo SP, Brasil.,Diagnósticos da América, São Paulo SP, Brasil
| | - Bruna Bianca Allegro
- Faculdade de Medicina da Santa Casa de São Paulo, Divisão de Neurorradiologia, São Paulo SP, Brasil.,Diagnósticos da América, São Paulo SP, Brasil
| | - Igor Gomes Padilha
- Faculdade de Medicina da Santa Casa de São Paulo, Divisão de Neurorradiologia, São Paulo SP, Brasil.,Diagnósticos da América, São Paulo SP, Brasil
| | - Renato Hoffmann Nunes
- Faculdade de Medicina da Santa Casa de São Paulo, Divisão de Neurorradiologia, São Paulo SP, Brasil.,Diagnósticos da América, São Paulo SP, Brasil
| | - Antônio José da Rocha
- Faculdade de Medicina da Santa Casa de São Paulo, Divisão de Neurorradiologia, São Paulo SP, Brasil.,Diagnósticos da América, São Paulo SP, Brasil
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24
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Donahue MJ, Achten E, Cogswell PM, De Leeuw FE, Derdeyn CP, Dijkhuizen RM, Fan AP, Ghaznawi R, Heit JJ, Ikram MA, Jezzard P, Jordan LC, Jouvent E, Knutsson L, Leigh R, Liebeskind DS, Lin W, Okell TW, Qureshi AI, Stagg CJ, van Osch MJP, van Zijl PCM, Watchmaker JM, Wintermark M, Wu O, Zaharchuk G, Zhou J, Hendrikse J. Consensus statement on current and emerging methods for the diagnosis and evaluation of cerebrovascular disease. J Cereb Blood Flow Metab 2018; 38:1391-1417. [PMID: 28816594 PMCID: PMC6125970 DOI: 10.1177/0271678x17721830] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/26/2017] [Accepted: 06/10/2017] [Indexed: 01/04/2023]
Abstract
Cerebrovascular disease (CVD) remains a leading cause of death and the leading cause of adult disability in most developed countries. This work summarizes state-of-the-art, and possible future, diagnostic and evaluation approaches in multiple stages of CVD, including (i) visualization of sub-clinical disease processes, (ii) acute stroke theranostics, and (iii) characterization of post-stroke recovery mechanisms. Underlying pathophysiology as it relates to large vessel steno-occlusive disease and the impact of this macrovascular disease on tissue-level viability, hemodynamics (cerebral blood flow, cerebral blood volume, and mean transit time), and metabolism (cerebral metabolic rate of oxygen consumption and pH) are also discussed in the context of emerging neuroimaging protocols with sensitivity to these factors. The overall purpose is to highlight advancements in stroke care and diagnostics and to provide a general overview of emerging research topics that have potential for reducing morbidity in multiple areas of CVD.
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Affiliation(s)
- Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physics and Astronomy, Vanderbilt University, Nashville, TN, USA
| | - Eric Achten
- Department of Radiology and Nuclear Medicine, Universiteit Gent, Gent, Belgium
| | - Petrice M Cogswell
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frank-Erik De Leeuw
- Radboud University, Nijmegen Medical Center, Donders Institute Brain Cognition & Behaviour, Center for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | - Colin P Derdeyn
- Department of Radiology and Neurology, University of Iowa, Iowa City, IA, USA
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Audrey P Fan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Rashid Ghaznawi
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeremy J Heit
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Peter Jezzard
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric Jouvent
- Department of Neurology, AP-HP, Lariboisière Hospital, Paris, France
| | - Linda Knutsson
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Richard Leigh
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | | | - Weili Lin
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas W Okell
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Adnan I Qureshi
- Department of Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA
| | - Charlotte J Stagg
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
| | | | - Peter CM van Zijl
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jennifer M Watchmaker
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Max Wintermark
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Greg Zaharchuk
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - Jinyuan Zhou
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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25
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Zhang M, Telischak NA, Fischbein NJ, Steinberg GK, Marks M, Zaharchuk G, Heit JJ, Iv M. Clinical and Arterial Spin Labeling Brain MRI Features of Transitional Venous Anomalies. J Neuroimaging 2017; 28:289-300. [PMID: 29205641 DOI: 10.1111/jon.12487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/03/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE Transitional venous anomalies (TVAs) are rare cerebrovascular lesions that resemble developmental venous anomalies (DVAs), but demonstrate early arteriovenous shunting on digital subtraction angiography (DSA) without the parenchymal nidus of arteriovenous malformations (AVMs). We investigate whether arterial spin labeling (ASL) magnetic resonance imaging (MRI) can distinguish brain TVAs from DVAs and guide their clinical management. METHODS We conducted a single-center retrospective review of patients with brain parenchymal DVA-like lesions with increased ASL signal on MRI. Clinical histories and follow-up information were obtained. Two readers assessed ASL signal location relative to the vascular lesion on MRI and, if available, the presence of arteriovenous shunting on DSA. RESULTS Thirty patients with DVA-like lesions with increased ASL signal were identified. Clinical symptoms prompted MRI evaluation in 83%. Symptoms did not localize to the venous anomaly in 90%. Ten percent presented with acute symptoms, only one of whom presented with hemorrhage. ASL signal in relation to the venous anomaly was identified in: 50% in the adjacent parenchyma, 33% in the lesion, 7% in a distal draining vein/sinus, and 10% in at least two of these sites. Follow-up DSA confirmed arteriovenous shunting in 71% of ASL-positive venous anomalies. Interrater agreement was very good (κ = .81-1.0, P < .001). CONCLUSION A DVA-like lesion with increased ASL signal likely represents a TVA with arteriovenous shunting. Our study indicates that these lesions are usually incidentally detected and have a lower risk of hemorrhage than AVMs. ASL-MRI may be a useful tool to identify TVAs and guide further management of patients with TVAs.
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Affiliation(s)
- Michael Zhang
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA
| | - Nicholas A Telischak
- Department of Radiology, Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, CA
| | - Nancy J Fischbein
- Department of Radiology, Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, CA
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA
| | - Michael Marks
- Department of Radiology, Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, CA
| | - Greg Zaharchuk
- Department of Radiology, Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, CA
| | - Jeremy J Heit
- Department of Radiology, Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, CA
| | - Michael Iv
- Department of Radiology, Neuroimaging and Neurointervention, Stanford University Medical Center, Stanford, CA
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26
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Hodel J, Blanc R, Kalsoum E, Zins M, Leclerc X. Reply. AJNR Am J Neuroradiol 2017; 38:E33. [PMID: 28232498 DOI: 10.3174/ajnr.a5131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- J Hodel
- Department of Radiology Hôpital Saint Joseph Paris, France
- Department of Neuroradiology AP-HP Hôpitaux Universitaires Henri Mondor Créteil, France
- Faculty of Medicine Université Paris Est Créteil Créteil, France
| | - R Blanc
- Department of Interventional Neuroradiology Fondation Rothschild Paris, France
| | - E Kalsoum
- Department of Neuroradiology AP-HP Hôpitaux Universitaires Henri Mondor Créteil, France
| | - M Zins
- Department of Radiology Hôpital Saint Joseph Paris, France
| | - X Leclerc
- Department of Neuroradiology Hôpital Roger Salengro Lille, France
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27
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Nabavizadeh SA. Intracranial Arteriovenous Shunting Detection with Arterial Spin-Labeling and Susceptibility-Weighted Imaging: Potential Pitfall of a Venous Predominant Parenchymal Arteriovenous Malformation. AJNR Am J Neuroradiol 2017; 38:E32. [PMID: 28232499 DOI: 10.3174/ajnr.a5108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S A Nabavizadeh
- Department of Radiology Hospital of University of Pennsylvania Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania
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