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Fournel J, Hermier M, Martin A, Gamondès D, Tommasino E, Broussolle T, Morgado A, Baassiri W, Cotton F, Berthezène Y, Bani-Sadr A. It Looks Like a Spinal Cord Tumor but It Is Not. Cancers (Basel) 2024; 16:1004. [PMID: 38473365 DOI: 10.3390/cancers16051004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Differentiating neoplastic from non-neoplastic spinal cord pathologies may be challenging due to overlapping clinical and radiological features. Spinal cord tumors, which comprise only 2-4% of central nervous system tumors, are rarer than non-tumoral myelopathies of inflammatory, vascular, or infectious origins. The risk of neurological deterioration and the high rate of false negatives or misdiagnoses associated with spinal cord biopsies require a cautious approach. Facing a spinal cord lesion, prioritizing more common non-surgical myelopathies in differential diagnoses is essential. A comprehensive radiological diagnostic approach is mandatory to identify spinal cord tumor mimics. The diagnostic process involves a multi-step approach: detecting lesions primarily using MRI techniques, precise localization of lesions, assessing lesion signal intensity characteristics, and searching for potentially associated anomalies at spinal cord and cerebral MRI. This review aims to delineate the radiological diagnostic approach for spinal cord lesions that may mimic tumors and briefly highlight the primary pathologies behind these lesions.
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Affiliation(s)
- Julien Fournel
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Anna Martin
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Delphine Gamondès
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Emanuele Tommasino
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Théo Broussolle
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Alexis Morgado
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Wassim Baassiri
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Francois Cotton
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
- Department of Radiology, South Lyon Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - Yves Berthezène
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
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Mechtouff L, Balanca B, Jung J, Bourgeois-Vionnet J, Dumot C, Guery D, Picart T, Bapteste L, Demarquay G, Bani-Sadr A, Rascle L, Berthezène Y, Jacquesson T, Amaz C, Macabrey J, Ramos I, Viprey M, Rode G, Cortet M. Interrater reliability in neurology objective structured clinical examination across specialties. Med Teach 2024; 46:239-244. [PMID: 37605843 DOI: 10.1080/0142159x.2023.2244146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
PURPOSE To assess interrater reliability and examiners' characteristics, especially specialty, associated with scoring of neurology objective structured clinical examination (OSCE). MATERIAL AND METHODS During a neurology mock OSCE, five randomly chosen students volunteers were filmed while performing 1 of the 5 stations. Video recordings were scored by physicians from the Lyon and Clermont-Ferrand university teaching hospitals to assess students performance using both a checklist scoring and a global rating scale. Interrater reliability between examiners were assessed using intraclass coefficient correlation. Multivariable linear regression models including video recording as random effect dependent variable were performed to detect factors associated with scoring. RESULTS Thirty examiners including 15 (50%) neurologists participated. The intraclass correlation coefficient of checklist scores and global ratings between examiners were 0.71 (CI95% [0.45-0.95]) and 0.54 (CI95% [0.28-0.91]), respectively. In multivariable analyses, no factor was associated with checklist scores, while male gender of examiner was associated with lower global rating (β coefficient = -0.37; CI 95% [-0.62-0.11]). CONCLUSIONS Our study demonstrated through a video-based scoring method that agreement among examiners was good using checklist scoring while moderate using global rating scale in neurology OSCE. Examiner's specialty did not affect scoring whereas gender was associated with global rating scale.
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Affiliation(s)
| | - Baptiste Balanca
- Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, Lyon, France
| | - Julien Jung
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | | | - Chloé Dumot
- Department of Vascular and Tumoral Neurosurgery, Hospices Civils de Lyon, Lyon, France
| | - Déborah Guery
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - Thiébaud Picart
- Department of Neurosurgery, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bapteste
- Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, Lyon, France
| | - Geneviève Demarquay
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | | | - Lucie Rascle
- Stroke Department, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | | | - Camille Amaz
- Clinical Investigation Center, Hospices Civils de Lyon, Lyon, France
| | - Juliette Macabrey
- RESearch on HealthcAre Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon, France
| | - Inès Ramos
- RESearch on HealthcAre Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon, France
| | - Marie Viprey
- RESearch on HealthcAre Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon, France
| | - Gilles Rode
- Physical Medicine and Rehabilitation Department, Henry Gabrielle Hospital, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Marion Cortet
- Gynecology and Obstetrics Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
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Baassiri W, Bani-Sadr A, Capo G, Brinzeu A, Barrey CY. Three-Dimensional Volumetric Magnetic Resonance Imaging Analysis of Syringomyelia Evolution After Posterior Fossa Decompression for Chiari Malformation Type1. World Neurosurg 2023; 178:e566-e577. [PMID: 37532020 DOI: 10.1016/j.wneu.2023.07.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE This study aims to introduce a method of three-dimensional (3D) volume magnetic resonance imaging (MRI) measurements to evaluate the evolution of syringomyelia (SM) in adults with Chiari malformation type 1 (CM-1) after posterior fossa decompression (PFD), to provide reproducible and accurate measurements. METHODS Radiologic and clinical data were obtained for 28 patients. MRI 3D syrinx volumes were evaluated by 2 observers using Philips Healthcare Tumor Tracking tool. RESULTS The mean SM preoperative volume was 9.1 ± 15.3 cm3 versus 4.6 ± 8.7 cm3 postoperatively, corresponding to a volume variation reduced by -50% ± 33.4%. A total of 21 patients (75%) showed >25% reduction in SM volume postoperatively and 25 patients (89.2%) showed good to excellent postoperative clinical outcomes. Very high interobserver and intraobserver agreement was noted for 3D volumetric analysis with Cohen weighted κ coefficients (0.899-0.991). A negative correlation was found between the number of involved metameres and the postoperative SM volume reduction (Pearson correlation coefficient = 0.378; P = 0.047). Patients with better clinical outcomes had fewer syrinx septae (F = 8.830; P = 0.001). Similarly, better syrinx volume reduction was associated with fewer septae (F = 1.554; P = 0.233). A positive relationship was observed between clinical outcomes and postoperative syrinx volume reduction (F = 1.554; P= 0.233), with data similar to the reported literature. CONCLUSIONS This study shows that 3D volume measurement of the syrinx cavity on MRI is a reproducible and accurate method to assess the postoperative evolution of SM in CM-1 after PFD. Most patients (75%) showed a reduction of SM volume, with a mean volume decrease of 50%. The reliability is yet to be validated in further larger studies.
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Affiliation(s)
- Wassim Baassiri
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France.
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France
| | - Gabriele Capo
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrei Brinzeu
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France; Department of Neurosciences, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Cédric Yves Barrey
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, Lyon, France; Laboratory of Biomechanics, École nationale supérieure d'Arts et Métiers, Arts et Metiers ParisTech, Paris, France
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Bani-Sadr A, Trintignac M, Mechtouff L, Hermier M, Cappucci M, Ameli R, de Bourguignon C, Derex L, Cho TH, Nighoghossian N, Eker OF, Berthezene Y. Is the optimal Tmax threshold identifying perfusion deficit volumes variable across MR perfusion software packages? A pilot study. MAGMA 2023; 36:815-822. [PMID: 36811716 DOI: 10.1007/s10334-023-01068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Accurate quantification of ischemic core and ischemic penumbra is mandatory for late-presenting acute ischemic stroke. Substantial differences between MR perfusion software packages have been reported, suggesting that the optimal Time-to-Maximum (Tmax) threshold may be variable. We performed a pilot study to assess the optimal Tmax threshold of two MR perfusion software packages (A: RAPID®; B: OleaSphere®) by comparing perfusion deficit volumes to final infarct volumes as ground truth. METHODS The HIBISCUS-STROKE cohort includes acute ischemic stroke patients treated by mechanical thrombectomy after MRI triage. Mechanical thrombectomy failure was defined as a modified thrombolysis in cerebral infarction score of 0. Admission MR perfusion were post-processed using two packages with increasing Tmax thresholds (≥ 6 s, ≥ 8 s and ≥ 10 s) and compared to final infarct volume evaluated with day-6 MRI. RESULTS Eighteen patients were included. Lengthening the threshold from ≥ 6 s to ≥ 10 s led to significantly smaller perfusion deficit volumes for both packages. For package A, Tmax ≥ 6 s and ≥ 8 s moderately overestimated final infarct volume (median absolute difference: - 9.5 mL, interquartile range (IQR) [- 17.5; 0.9] and 0.2 mL, IQR [- 8.1; 4.8], respectively). Bland-Altman analysis indicated that they were closer to final infarct volume and had narrower ranges of agreement compared with Tmax ≥ 10 s. For package B, Tmax ≥ 10 s was closer to final infarct volume (median absolute difference: - 10.1 mL, IQR: [- 17.7; - 2.9]) versus - 21.8 mL (IQR: [- 36.7; - 9.5]) for Tmax ≥ 6 s. Bland-Altman plots confirmed these findings (mean absolute difference: 2.2 mL versus 31.5 mL, respectively). CONCLUSIONS The optimal Tmax threshold for defining the ischemic penumbra appeared to be most accurate at ≥ 6 s for package A and ≥ 10 s for package B. This implies that the widely recommended Tmax threshold ≥ 6 s may not be optimal for all available MRP software package. Future validation studies are required to define the optimal Tmax threshold to use for each package.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France.
- CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 Avenue Jean Capelle O, 69100, Villeurbanne, France.
| | - Mathilde Trintignac
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
- CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | - Matteo Cappucci
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | - Roxana Ameli
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | | | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | - Tae-Hee Cho
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
- CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
- CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Omer Faruk Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
| | - Yves Berthezene
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
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Bani-Sadr A, Kuchcinski G. CT-based radiomics analysis of peri intracerebral hemorrhage edema: A new tool to predict functional outcome. Diagn Interv Imaging 2023; 104:387-388. [PMID: 37634933 DOI: 10.1016/j.diii.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS, CNRS UMR 5220 - INSERM U1294, 69100, Villeurbanne, France.
| | - Grégory Kuchcinski
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, 59000 Lille, France; Department of Clinical Sciences, Diagnostic Radiology, Lund University, Skåne University Hospital, 221 84, Lund, Sweden
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Bani-Sadr A, Escande R, Mechtouff L, Pavie D, Hermier M, Derex L, Choc TH, Eker OF, Nighoghossian N, Berthezène Y. Vascular hyperintensities on baseline FLAIR images are associated with functional outcome in stroke patients with successful recanalization after mechanical thrombectomy. Diagn Interv Imaging 2023; 104:337-342. [PMID: 37355301 DOI: 10.1016/j.diii.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The purpose of this study was to assess the prognostic value of vascular hyperintensities on FLAIR images (VHF) at admission MRI in patients with acute ischemic stroke (AIS) achieving successful recanalization after mechanical thrombectomy. MATERIALS AND METHODS Patients with AIS treated by mechanical thrombectomy following admission MRI from the single-center HIBISCUS-STROKE cohort were assessed for eligibility. VHF were categorized using a four-scale classification and were considered poor when grade < 3 (i.e., absence of distal VHF). Recanalization was considered successful when modified thrombolysis in cerebral infarction score was ≥ 2B Functional outcome was considered poor if modified Rankin scale (mRS) at three months was > 2. Univariable and multiple variable logistic regressions were performed to identify factors associated with poor functional outcome despite successful recanalization. RESULTS A total of 108 patients were included. There were 65 men and 43 women with a median age of 70.5 years (interquartile range: 55.0, 81.0; age range: 22.0-93.0 years). Among them, 39 subjects (36.1%) had poor functional outcome at three months. Univariable logistic regressions indicated that poorly extended VHF (VHF grade < 3) were associated with a poor functional outcome (P = 0.008) as well as age, hypertension and diabetes, baseline National Institute of Health Stroke Scale (NIHSS) score, pre-stroke mRS, lack of intravenous thrombolysis, cerebral microangiopathy and the presence of microbleeds. Multivariable analysis confirmed that poor VHF status was independently associated with a poor functional outcome (odds ratio [OR], 4.26; 95% confidence interval [CI]: 1.55-12.99; P = 0.007) in combination with hypertension (OR, 1.25; 95% CI: 0.87-1.85; P = 0.02), baseline NIHSS score (OR, 1.09; 95% CI: 1.04-1.20; P = 0.03), pre-stroke mRS (OR, 2.05; 95% CI: 1.07-4.61; P = 0.05) and lack of intravenous thrombolysis (OR, 0.23; 95% CI: 0.08-0.61; P = 0.004). CONCLUSION Poorly extended VHF (grade <3) at admission MRI are associated with a poor functional outcome at three months despite successful recanalization by mechanical thrombectomy.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France.
| | - Raphaël Escande
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Dylan Pavie
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; Research on Healthcare Performance (RESHAPE), INSERM U 1290, Claude Bernard Lyon I University, 69373, Lyon Cedex 08, France
| | - Tae-Hee Choc
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Omer F Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Yves Berthezène
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
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Bani-Sadr A, Eker OF, Cho TH, Ameli R, Berhouma M, Cappucci M, Derex L, Mechtouff L, Meyronet D, Nighoghossian N, Berthezène Y, Hermier M. Early Detection of Underlying Cavernomas in Patients with Spontaneous Acute Intracerebral Hematomas. AJNR Am J Neuroradiol 2023:ajnr.A7914. [PMID: 37385679 PMCID: PMC10337618 DOI: 10.3174/ajnr.a7914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/29/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Early identification of the etiology of spontaneous acute intracerebral hemorrhage is essential for appropriate management. This study aimed to develop an imaging model to identify cavernoma-related hematomas. MATERIALS AND METHODS Patients 1-55 years of age with acute (≤7 days) spontaneous intracerebral hemorrhage were included. Two neuroradiologists reviewed CT and MR imaging data and assessed the characteristics of hematomas, including their shape (spherical/ovoid or not), their regular or irregular margins, and associated abnormalities including extralesional hemorrhage and peripheral rim enhancement. Imaging findings were correlated with etiology. The study population was randomly split to provide a training sample (50%) and a validation sample (50%). From the training sample, univariate and multivariate logistic regression was performed to identify factors predictive of cavernomas, and a decision tree was built. Its performance was assessed using the validation sample. RESULTS Four hundred seventy-eight patients were included, of whom 85 had hemorrhagic cavernomas. In multivariate analysis, cavernoma-related hematomas were associated with spherical/ovoid shape (P < .001), regular margins (P = .009), absence of extralesional hemorrhage (P = .01), and absence of peripheral rim enhancement (P = .002). These criteria were included in the decision tree model. The validation sample (n = 239) had the following performance: diagnostic accuracy of 96.1% (95% CI, 92.2%-98.4%), sensitivity of 97.95% (95% CI, 95.8%-98.9%), specificity of 89.5% (95% CI, 75.2%-97.0%), positive predictive value of 97.7% (95% CI, 94.3%-99.1%), and negative predictive value of 94.4% (95% CI, 81.0%-98.5%). CONCLUSIONS An imaging model including ovoid/spherical shape, regular margins, absence of extralesional hemorrhage, and absence of peripheral rim enhancement accurately identifies cavernoma-related acute spontaneous cerebral hematomas in young patients.
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Affiliation(s)
- A Bani-Sadr
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
- Creatis Laboratory (A.B.-S., O.F.E., Y.B.), National Center for Scientific Research Unité Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U 5220, Claude Bernard Lyon I University, Villeurbanne, France
| | - O F Eker
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
- Creatis Laboratory (A.B.-S., O.F.E., Y.B.), National Center for Scientific Research Unité Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U 5220, Claude Bernard Lyon I University, Villeurbanne, France
| | - T-H Cho
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- CarMeN Laboratory (T.-H.C., L.M., N.N.), Institut National de la Santé et de la Recherche Médicale U1060, Claude Bernard Lyon I University, Bron, France
| | - R Ameli
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
| | | | - M Cappucci
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
| | - L Derex
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- Research on Healthcare Performance (L.D.), Institut National de la Santé et de la Recherche Médicale U 1290, Claude Bernard Lyon I University, Domaine Rockefeller, Lyon, France
| | - L Mechtouff
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- CarMeN Laboratory (T.-H.C., L.M., N.N.), Institut National de la Santé et de la Recherche Médicale U1060, Claude Bernard Lyon I University, Bron, France
| | - D Meyronet
- Department of Neurosurgery B Institute of Pathology East, Neuropathology (D.M.), East Group Hospital, Hospices Civils de Lyon, Bron, France
| | - N Nighoghossian
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- CarMeN Laboratory (T.-H.C., L.M., N.N.), Institut National de la Santé et de la Recherche Médicale U1060, Claude Bernard Lyon I University, Bron, France
| | - Y Berthezène
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
- Creatis Laboratory (A.B.-S., O.F.E., Y.B.), National Center for Scientific Research Unité Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U 5220, Claude Bernard Lyon I University, Villeurbanne, France
| | - M Hermier
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
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Bani-Sadr A, Mechtouff L, Bourguignon CDE, Mauffrey A, Boutelier T, Cho TH, Cappucci M, Ameli R, Hermier M, Derex L, Nighoghossian N, Berthezene Y. Brain-Blood Barrier Permeability and Kinetics of Inflammatory Markers in Acute Stroke Patients Treated by Thrombectomy. Neurology 2023:WNL.0000000000207460. [PMID: 37290975 PMCID: PMC10401692 DOI: 10.1212/wnl.0000000000207460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/13/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the relationship between baseline blood-brain barrier (BBB) permeability and the kinetics of circulating inflammatory markers in a cohort of acute ischemic stroke (AIS) patients treated with mechanical thrombectomy. METHODS The HIBISCUS-STROKE cohort includes AIS patients treated with mechanical thrombectomy following admission MRI, and undergoing a sequential assessment of circulating inflammatory markers. Baseline dynamic-susceptibility perfusion MRI was post-processed with arrival time correction to provide K2 maps reflecting BBB permeability. After co-registration of apparent-diffusion-coefficient and K2 maps, 90th percentile of K2 value was extracted within baseline ischemic core and expressed as a percentage change compared to contralateral normal appearing white matter. Population was dichotomized according to median K2 value. Uni- and multiple variable logistic regressions analyses were performed to investigate factors associated with increased pretreatment BBB permeability in the whole population and in patients with symptoms onset <6h. RESULTS In the whole population (n=105 patients, median K2=1.59), patients with increased BBB permeability had higher serum levels of MMP-9 at H48 (p=0.02), higher CRP serum level at H48 (p=0.01), poorer collateral status (p=0.01), and larger baseline ischemic core (p<0.001). They were more likely to have hemorrhagic transformation (p=0.008), larger final lesion volume (p=0.02), and worst neurologic outcome at 3-months (p=0.04). The multiple variable logistic regression indicated that increased BBB permeability was only associated with ischemic core volume (Odds Ratio (OR)= 1.04; 95% Confidence Interval (CI): [1.01; 1.06], p<0.0001).Restricting analysis to patients with symptoms onset < 6h (n=72, median K2=1.27), subjects with increased BBB permeability had higher serum levels of MMP-9 at both H0 (p=0.005), H6 (p=0.004), H24 (p=0.02) and H48 (p=0.01), higher CRP levels at H48 (p=0.02) and larger baseline ischemic core (p<0.0001). The multiple variable logistic analysis showed that increased BBB permeability was independently associated with higher H0 MMP-9 levels (OR=1.33; 95% CI: [1.12; 1.65]; p=0.01) and larger ischemic core (OR=1.27; 95% CI: [1.08; 1.59]; p=0.04). DISCUSSION In AIS patients, increased BBB permeability is associated with larger ischemic core. In the subgroup of patients with symptoms onset <6h, increased BBB permeability is independently associated with higher H0-MMP-9 levels and larger ischemic core.
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Bani-Sadr A, Cho TH, Cappucci M, Hermier M, Ameli R, Filip A, Riva R, Derex L, De Bourguignon C, Mechtouff L, Eker OF, Nighoghossian N, Berthezene Y. Assessment of three MR perfusion software packages in predicting final infarct volume after mechanical thrombectomy. J Neurointerv Surg 2023; 15:393-398. [PMID: 35318959 DOI: 10.1136/neurintsurg-2022-018674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the performance of three MR perfusion software packages (A: RAPID; B: OleaSphere; and C: Philips) in predicting final infarct volume (FIV). METHODS This cohort study included patients treated with mechanical thrombectomy following an admission MRI and undergoing a follow-up MRI. Admission MRIs were post-processed by three packages to quantify ischemic core and perfusion deficit volume (PDV). Automatic package outputs (uncorrected volumes) were collected and corrected by an expert. Successful revascularization was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2B. Uncorrected and corrected volumes were compared between each package and with FIV according to mTICI score. RESULTS Ninety-four patients were included, of whom 67 (71.28%) had a mTICI score ≥2B. In patients with successful revascularization, ischemic core volumes did not differ significantly from FIV regardless of the package used for uncorrected and corrected volumes (p>0.15). Conversely, assessment of PDV showed significant differences for uncorrected volumes. In patients with unsuccessful revascularization, the uncorrected PDV of packages A (median absolute difference -40.9 mL) and B (median absolute difference -67.0 mL) overestimated FIV to a lesser degree than package C (median absolute difference -118.7 mL; p=0.03 and p=0.12, respectively). After correction, PDV did not differ significantly from FIV for all three packages (p≥0.99). CONCLUSIONS Automated MRI perfusion software packages estimate FIV with high variability in measurement despite using the same dataset. This highlights the need for routine expert evaluation and correction of automated package output data for appropriate patient management.
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Affiliation(s)
- Alexandre Bani-Sadr
- Neuroradiology, Hospices Civils de Lyon, Bron, France .,MYRIAD, CREATIS, Villeurbanne, France
| | - Tae-Hee Cho
- Stroke Department, Hospices Civils de Lyon, Lyon, France
| | | | - Marc Hermier
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Roxana Ameli
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Andrea Filip
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Roberto Riva
- Neuroradiology, Hospices Civils de Lyon, Bron, France
| | - Laurent Derex
- Stroke Department, Hospices Civils de Lyon, Lyon, France
| | | | | | - Omer F Eker
- Neuroradiology, Hospices Civils de Lyon, Bron, France.,MYRIAD, CREATIS, Villeurbanne, France
| | | | - Yves Berthezene
- Neuroradiology, Hospices Civils de Lyon, Bron, France.,MYRIAD, CREATIS, Villeurbanne, France
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Bani-Sadr A, Mechtouff L, Bourguignon CD, Mauffrey A, Boutelier T, Cho TH, Cappucci M, Ameli R, Hermier M, Derex L, Nighoghossian N, Berthezene Y. Brain-blood barrier permeability and kinetics of inflammatory markers in acute stroke patients treated by thrombectomy. J Neuroradiol 2023. [DOI: 10.1016/j.neurad.2023.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Rossi J, Hermier M, Eker OF, Berthezene Y, Bani-Sadr A. Etiologies of spontaneous acute intracerebral hemorrhage: A pictorial review. Clin Imaging 2023; 95:10-23. [PMID: 36577316 DOI: 10.1016/j.clinimag.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/26/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Spontaneous acute intracerebral hemorrhage (SAIH) is a common and life-threatening condition that affects more than three million patients each year. Of these, one in three patients die within one month of onset and the remaining two in three patients have varying degrees of disability and neurological impairment. The role of radiology is paramount in optimizing patient outcomes by diagnosing SAIH, its potential complications, and the most likely etiology. While the positive diagnosis of SAIH is straightforward, the etiologic diagnosis is broad, covering primary SAIH (hypertension, cerebral amyloid angiopathy) and secondary SAIH (vascular malformations, nonatheromatous vasculopathies, neoplasia, coagulation disorders, toxicants). This pictorial review illustrates the imaging of spontaneous SAIH with an emphasis on etiologic workup.
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Affiliation(s)
- Julien Rossi
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Omer Faruk Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Yves Berthezene
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 avenue Jean Capelle O, 69100 Villeurbanne, France
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 avenue Jean Capelle O, 69100 Villeurbanne, France.
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Bani-Sadr A, Pavie D, Mechtouff L, Cappucci M, Hermier M, Ameli R, Derex L, De Bourguignon C, Cho TH, Eker O, Nighoghossian N, Berthezene Y. Brush sign and collateral supply as potential markers of large infarct growth after successful thrombectomy. Eur Radiol 2023; 33:4502-4509. [PMID: 36633674 DOI: 10.1007/s00330-022-09387-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate the relationships between brush sign and cerebral collateral status on infarct growth after successful thrombectomy. METHODS HIBISCUS-STROKE cohort includes acute ischemic stroke patients treated with thrombectomy after MRI triage and undergoing a day-6 MRI including FLAIR images to quantify final infarct volume (FIV). Successful reperfusion was defined as a modified thrombolysis in cerebral infarction score ≥ 2B. Infarct growth was calculated by subtracting FIV from baseline ischemic core after co-registration and considered large (LIG) when > 11.6 mL. Brush sign was assessed on T2*-weighted-imaging and collaterals were assessed using the hypoperfusion intensity ratio, which is the volume of Time-To-Tmax (Tmax) ≥ 10 s divided by the volume of Tmax ≥ 6 s. Good collaterals were defined by a hypoperfusion intensity ratio < 0.4. RESULTS One hundred and twenty-nine patients were included, of whom 45 (34.9%) had a brush sign and 63 (48.8%) good collaterals. Brush sign was associated with greater infarct growth (p = 0.01) and larger FIV (p = 0.02). Good collaterals were associated with a smaller baseline ischemic core (p < 0.001), larger penumbra (p = 0.04), and smaller FIV (p < 0.001). Collateral status was not significantly associated with brush sign (p = 0.20) or with infarct growth (p = 0.67). Twenty-eight (22.5%) patients experienced LIG. Univariate regressions indicated that brush sign (odds ratio (OR) = 4.8; 95% confidence interval (CI): [1.9;13.3]; p = 0.004) and hemorrhagic transformation (OR = 1.7; 95%CI: [1.2;2.6]; p = 0.04) were predictive of LIG. In multivariate regression, only the brush sign remained predictive of LIG (OR = 5.2; 95%CI: [1.8-16.6], p = 0.006). CONCLUSIONS Brush sign is a predictor of LIG after successful thrombectomy and cerebral collateral status is not. KEY POINTS • Few predictors of ischemic growth are known in ischemic stroke patients achieving successful mechanical thrombectomy. • Our results suggest that the brush sign-a surrogate marker of severe hypoperfusion-is independently associated with large ischemic growth (> 11.6 mL) after successful thrombectomy whereas cerebral collateral status does not.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France. .,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France.
| | - Dylan Pavie
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Matteo Cappucci
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Roxana Ameli
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France
| | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,Research On Healthcare Performance (RESHAPE), INSERM U 1290, Claude Bernard Lyon I University. Domaine Rockfeller, 8 Avenue Rockfeller, 69373 Cedex 08, Lyon, France
| | | | - Tae-Hee Cho
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Omer Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 59 Bd Pinel, 69500, Bron, France
| | - Yves Berthezene
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon. 59 Bd Pinel, 69500, Bron, France.,CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University. 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
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Mechtouff L, Debs N, Frindel C, Bani-Sadr A, Bochaton T, Paccalet A, Crola Da Silva C, Buisson M, Amaz C, Berthezene Y, Eker OF, Bouin M, de Bourguignon C, Mewton N, Ovize M, Bidaux G, Nighoghossian N, Cho TH. Association of Blood Biomarkers of Inflammation With Penumbra Consumption After Mechanical Thrombectomy in Patients With Acute Ischemic Stroke. Neurology 2022; 99:e2063-e2071. [PMID: 36316128 DOI: 10.1212/wnl.0000000000201038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to assess the relationship between blood biomarkers of inflammation and lesion growth within the penumbra in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT). METHODS The HIBISCUS-STROKE cohort enrolled patients admitted in the Lyon Stroke Center for an anterior circulation AIS treated with MT after brain MRI assessment. Lesion growth within the penumbra was assessed on day 6 MRI using a voxel-based nonlinear coregistration method and dichotomized into low and high according to the median value. C-reactive protein, interleukin (IL)-6, IL-8, IL-10, monocyte chemoattractant protein-1, soluble tumor necrosis factor receptor I, soluble form suppression of tumorigenicity 2 (sST2), soluble P-selectin, vascular cellular adhesion molecule-1, and matrix metalloproteinase-9 were measured in sera at 4 time points within the first 48 hours. Reperfusion was considered as successful if Thrombolysis in Cerebral Infarction score was 2b/2c/3. A multiple logistic regression model was performed to detect any association between area under the curve (AUC) of these biomarkers within the first 48 hours and a high lesion growth within the penumbra. RESULTS Ninety patients were included. The median lesion growth within the penumbra was 2.3 (0.7-6.2) mL. On multivariable analysis, a high sST2 AUC (OR 3.77, 95% CI 1.36-10.46), a high baseline DWI volume (OR 3.65, 95% CI 1.32-10.12), and a lack of successful reperfusion (OR 0.19, 95% CI 0.04-0.92) were associated with a high lesion growth within the penumbra. When restricting analyses to patients with successful reperfusion (n = 76), a high sST2 AUC (OR 5.03, 95% CI 1.64-15.40), a high baseline DWI volume (OR 3.74, 95% CI 1.22-11.53), and a high penumbra volume (OR 3.25, 95% CI 1.10-9.57) remained associated with a high lesion growth within the penumbra. DISCUSSION High sST2 levels within the first 48 hours are associated with a high lesion growth within the penumbra.
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Affiliation(s)
- Laura Mechtouff
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France.
| | - Noelie Debs
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Carole Frindel
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Alexandre Bani-Sadr
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Thomas Bochaton
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Alexandre Paccalet
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Claire Crola Da Silva
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Marielle Buisson
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Camille Amaz
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Yves Berthezene
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Omer Faruk Eker
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Morgane Bouin
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Charles de Bourguignon
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Nathan Mewton
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Michel Ovize
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Gabriel Bidaux
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Norbert Nighoghossian
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
| | - Tae-Hee Cho
- From the Stroke Department (L.M., N.N., T.-H.C.), Hospices Civils de Lyon; Univ Lyon (L.M., T.B., A.P., C.C.D.S., M.O., G.B., N.N., T.-H.C.), CarMeN Laboratory, INSERM, INRA, University Lyon 1; CREATIS (N.D., C.F., Y.B.), CNRS UMR 5220, INSERM U1044, University Lyon 1; Neuroradiology Department (A.B.-S., Y.B., O.F.E.), Hospices Civils de Lyon; Cardiac Intensive Care Unit (T.B.), Hospices Civils de Lyon; Clinical Investigation Center (M.B., C.A., C.d.B., N.M., M.O.), INSERM 1407, Hospices Civils de Lyon; and Cellule Recherche Imagerie (M.B.), Hospices Civils de Lyon, France
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14
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Mechtouff L, Sigovan M, Douek P, Costes N, Le Bars D, Mansuy A, Haesebaert J, Bani-Sadr A, Tordo J, Feugier P, Millon A, Luong S, Si-Mohamed S, Collet-Benzaquen D, Canet-Soulas E, Bochaton T, Crola Da Silva C, Paccalet A, Magne D, Berthezene Y, Nighoghossian N. Simultaneous assessment of microcalcifications and morphological criteria of vulnerability in carotid artery plaque using hybrid 18F-NaF PET/MRI. J Nucl Cardiol 2022; 29:1064-1074. [PMID: 33145738 DOI: 10.1007/s12350-020-02400-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies have suggested the role of microcalcifications in plaque vulnerability. This exploratory study sought to assess the potential of hybrid positron-emission tomography (PET)/magnetic resonance imaging (MRI) using 18F-sodium fluoride (18F-NaF) to check simultaneously 18F-NaF uptake, a marker of microcalcifications, and morphological criteria of vulnerability. METHODS AND RESULTS We included 12 patients with either recently symptomatic or asymptomatic carotid stenosis. All patients underwent 18F-NaF PET/MRI. 18F-NaF target-to-background ratio (TBR) was measured in culprit and nonculprit (including contralateral plaques of symptomatic patients) plaques as well as in other arterial walls. Morphological criteria of vulnerability were assessed on MRI. Mineral metabolism markers were also collected. 18F-NaF uptake was higher in culprit compared to nonculprit plaques (median TBR 2.6 [2.2-2.8] vs 1.7 [1.3-2.2]; P = 0.03) but was not associated with morphological criteria of vulnerability on MRI. We found a positive correlation between 18F-NaF uptake and calcium plaque volume and ratio but not with circulating tissue-nonspecific alkaline phosphatase (TNAP) activity and inorganic pyrophosphate (PPi) levels. 18F-NaF uptake in the other arterial walls did not differ between symptomatic and asymptomatic patients. CONCLUSIONS 18F-NaF PET/MRI may be a promising tool for providing additional insights into the plaque vulnerability.
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Affiliation(s)
- Laura Mechtouff
- Stroke Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France.
- INSERM U1060, CarMeN Laboratory, University Lyon 1, Lyon, France.
| | - Monica Sigovan
- CNRS, UMR 5220, CREATIS, University of Lyon, Lyon, France
- INSA-Lyon UCBL, Inserm U1206, UJM-Saint Etienne, Lyon, France
| | - Philippe Douek
- CNRS, UMR 5220, CREATIS, University of Lyon, Lyon, France
- INSA-Lyon UCBL, Inserm U1206, UJM-Saint Etienne, Lyon, France
- Department of Radiology, Louis Pradel University Hospital, Bron, France
| | | | - Didier Le Bars
- CERMEP - Imagerie du vivant, Lyon, France
- ICBMS, University C. Bernard Lyon 1 & Hospices Civils de Lyon, Lyon, France
| | - Adeline Mansuy
- Cellule Recherche Imagerie, Louis Pradel University Hospital, Bron, France
| | - Julie Haesebaert
- Clinical Research and Epidemiology Unit, Public Health Department Hospices Civils de Lyon & Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, 42023, Saint-Etienne, France
| | - Alexandre Bani-Sadr
- Department of Nuclear Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Tordo
- Department of Nuclear Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | - Patrick Feugier
- Vascular Surgery Department, Edouard Herriot University Hospital & Claude Bernard Lyon 1 University, Lyon, France
| | - Antoine Millon
- Vascular Surgery Department, Edouard Herriot University Hospital & Claude Bernard Lyon 1 University, Lyon, France
| | - Stéphane Luong
- Department of Radiology, Louis Pradel University Hospital, Bron, France
| | - Salim Si-Mohamed
- Department of Radiology, Louis Pradel University Hospital, Bron, France
| | | | | | - Thomas Bochaton
- INSERM U1060, CarMeN Laboratory, University Lyon 1, Lyon, France
| | | | | | - David Magne
- ICBMS, CNRS, UMR 5246, University Lyon 1, Lyon, France
| | - Yves Berthezene
- CNRS, UMR 5220, CREATIS, University of Lyon, Lyon, France
- Neuroradiology Department, Pierre Wertheimer Hospital, Bron, France
| | - Norbert Nighoghossian
- Stroke Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France
- INSERM U1060, CarMeN Laboratory, University Lyon 1, Lyon, France
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15
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Bani-Sadr A, Ruitton-Allinieu MC, Brisset JC, Ducray F, Joubert B, Picard G, Cotton F. Contribution of diffusion-weighted imaging to distinguish herpetic encephalitis from auto-immune encephalitis at an early stage. J Neuroradiol 2022; 50:288-292. [PMID: 35662572 DOI: 10.1016/j.neurad.2022.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine whether diffusion-weighted imaging (DWI) can help to distinguish early stage autoimmune (AI) and herpes simplex virus (HSV) encephalitides. METHODS This case-control study included patients from a multi-center cohort of AI encephalitides whose initial MRI including DWI was performed within ten days after symptoms onset. They were compared with patients with HSV encephalitis enrolled prospectively in a single-center from June, 2020 to December, 2020. The final diagnosis of AI encephalitis required a positive autoantibody assay, and that of HSV encephalitis required a positive HSV polymerase chain reaction based on cerebrospinal fluid. Brain MRI were evaluated for restricted diffusion, fluid-inversion recovery (FLAIR) abnormalities, lesion topography, hemorrhagic changes, and contrast enhancement. RESULTS Forty-nine patients were included of which, 19 (38.8%) had AI encephalitis. Twenty-seven patients (55.1%) were males and the median age was 46.0 years (interquartile range (IQR):[22.0; 65.0]). Brain MRI were performed after a median of 4 days (IQR:[2.0; 7.0]) of symptom onset and time between symptom onset and MRI was not significantly different (p=0.60). Twenty-six patients had restricted diffusion lesions in the medial temporal lobe, including 25/30 in the HSV encephalitis group (p<0.001). FLAIR abnormalities were observed in 36 patients, including 29/30 in the HSV encephalitis group (p<0.001). Lesion topography, hemorrhagic changes, and contrast enhancement did not differ significantly between the two groups. CONCLUSION Our results suggest that restricted diffusion lesions in the medial temporal lobe are a hallmark of HSV encephalitis and may help distinguish it from early-stage AI encephalitis.
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Affiliation(s)
- Alexandre Bani-Sadr
- Service de Radiologie, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Marie-Camille Ruitton-Allinieu
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69495, Pierre-Bénite, France
| | | | - François Ducray
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Bastien Joubert
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Géraldine Picard
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - François Cotton
- Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69495, Pierre-Bénite, France.
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16
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Guery D, Cousyn L, Navarro V, Picard G, Rogemond V, Bani-Sadr A, Shor N, Joubert B, Muñiz-Castrillo S, Honnorat J, Rheims S. Long-term evolution and prognostic factors of epilepsy in limbic encephalitis with LGI1 antibodies. J Neurol 2022; 269:5061-5069. [PMID: 35595970 DOI: 10.1007/s00415-022-11162-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/14/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To characterize the evolution of epilepsy in patients with leucine-rich glioma inactivated 1 antibody-associated (LGI1ab) limbic encephalitis, including factors associated with drug-resistant epilepsy (DRE). METHODS Retrospective analysis of patients with LGI1 encephalitis managed at two tertiary epilepsy centers between 2005 and 2019 and whose samples were confirmed by the French Reference Center of Paraneoplastic Neurological Syndromes. Raw clinical, biological, EEG, and MRI data were reviewed. Two endpoints were defined: (i) Epilepsy remission: patients seizure free and in whom anti-seizure medications (ASM) have been stopped for at least 1 year at the last follow-up visit (ii) DRE: patients with persistent seizures at the last follow-up despite at least two ASM used at efficacious daily dose. RESULTS 39 patients with LGI1 encephalitis were included with a median follow-up duration of 42 months (range 13-169). All of them reported seizures at the acute phase, with faciobrachial dystonic seizures (FBDS) in 23 (59%) and other focal seizures in 38 (97%), including 4 patients (10%) with de novo status epilepticus. At the last follow-up visit, 11 patients (28%) achieved epilepsy remission. Among the 28 patients with persistent epilepsy, eight (29%) fulfilled criteria of DRE. The only factor significantly associated with epilepsy remission was the time from clinical onset of the encephalitis to initiation of the first immunomodulatory treatment, with longer delay in patients with persistent epilepsy (7.5 ± 8.9 vs 2.4 ± 1.7 months, p = 0.006). Evolution to DRE was only driven by MRI evolution. Eight of the 15 patients (53%) who developed hippocampal atrophy (p = 0.007) also suffered from drug-resistant seizures at the last follow-up. SIGNIFICANCE In patients with LGI1 encephalitis, rapid initiation of immunomodulatory treatment favors long-term epilepsy remission. Evolution to DRE might primarily reflect the anatomical lesion of limbic structures. Determining what modalities of immune treatment may alter these outcomes requires prospective studies with long-term follow-up.
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Affiliation(s)
- Déborah Guery
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Louis Cousyn
- Epileptology Unit, Assistance Publique-Hôpitaux de Paris Groupe Hospitalier Pitié-Salpêtrière and Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC University Paris 06), Paris, France
| | - Vincent Navarro
- Epileptology Unit, Assistance Publique-Hôpitaux de Paris Groupe Hospitalier Pitié-Salpêtrière and Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC University Paris 06), Paris, France
| | - Géraldine Picard
- French Reference Center of Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France
| | - Véronique Rogemond
- French Reference Center of Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, Université de Lyon, Hospices Civils de Lyon, Lyon, France
| | - Natalia Shor
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Bastien Joubert
- French Reference Center of Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.,MELIS UMR Inserm 1314/ CNRS 5284, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Sergio Muñiz-Castrillo
- French Reference Center of Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.,MELIS UMR Inserm 1314/ CNRS 5284, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Jérome Honnorat
- French Reference Center of Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.,MELIS UMR Inserm 1314/ CNRS 5284, Lyon, France.,University Claude Bernard Lyon 1, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Lyon 1 University, Lyon, France. .,Lyon's Neurosciences Research Center, INSERM U1028CNRSUMR 5292, University Claude Bernard Lyon 1, Lyon, France. .,University Claude Bernard Lyon 1, Lyon, France.
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17
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Zumbihl L, Berthezene Y, Hermier M, Barrey C, Bani-Sadr A. Isolated atlas-duplication as a manifestation of persistent proatlas: a case report. Surg Radiol Anat 2022; 44:595-598. [DOI: 10.1007/s00276-022-02918-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
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18
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Bani-Sadr A, Cho TH, Cappucci M, Hermier M, Ameli R, Filip A, De Bourguignon C, Riva R, Derex L, Mechtouff L, Eker O, Nighoghossian N, Berthezène Y. Évaluation des logiciels de perfusion irm dans la prédiction du volume final de l'infarctus après thrombectomie mécanique. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Alhazmi H, Bani-Sadr A, Bochaton T, Paccalet A, Da Silva CC, Buisson M, Amaz C, Ameli R, Berthezene Y, Eker OF, Ovize M, Cho TH, Nighoghossian N, Mechtouff L. Large vessel cardioembolic stroke and embolic stroke of undetermined source share a common profile of matrix metalloproteinase-9 level and susceptibility vessel sign length. Eur J Neurol 2021; 28:1977-1983. [PMID: 33682255 DOI: 10.1111/ene.14806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Embolic stroke of undetermined source (ESUS) accounts for up to 25% of ischemic strokes. Identification of biomarkers that could improve the prediction of stroke subtype and subsequently of stroke prevention still remains a major issue. METHODS The HIBISCUS-STROKE cohort includes ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy following admission magnetic resonance imaging. Presence and length of susceptibility vessel sign (SVS) were assessed by gradient-recalled echo T2*-weighted imaging. Matrix metalloproteinase-9 (MMP-9) was measured on sera collected at admission. A multiple logistic regression model was performed to detect independent markers distinguishing cardioembolic (CE) from large-artery atherosclerosis (LAA) subtype. RESULTS A total of 147 patients were included, of them the etiology was distributed as follows: 86 (58.5%) CE, 26 (17.7%) LAA, and 35 (23.8%) ESUS. The optimal cutoff for differentiating CE from LAA subtype was 14.5 mm for SVS length (sensitivity, 79.7%; specificity, 72.7%) and 1110 ng/ml for admission MMP-9 level (sensitivity, 85.3%; specificity, 52.2%). Multivariate analysis revealed that current smoking (odds ratio [OR] 0.07, 95% confidence interval [CI] 0.01-0.93), tandem occlusion (OR 0.01, 95% CI 0.01-0.21), SVS length (OR 0.78, 95% CI 0.63-0.97), and admission MMP-9 level (OR 0.99, 95% CI 0.99-1.00) were inversely associated with CE subtype. SVS length and MMP-9 level did not differ between ESUS and CE subtypes. CONCLUSION SVS length and admission MMP-9 level may improve the prediction of CE subtype whose profile is close to ESUS, thus suggesting a common cardiac embolic source.
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Affiliation(s)
- Hanan Alhazmi
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Alexandre Bani-Sadr
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Thomas Bochaton
- Cardiac Intensive Care Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Alexandre Paccalet
- CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Claire Crola Da Silva
- CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Roxana Ameli
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
| | - Yves Berthezene
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Omer Faruk Eker
- Neuroradiology Department, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Michel Ovize
- CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France.,Clinical Investigation Center, INSERM 1407, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Tae-Hee Cho
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Norbert Nighoghossian
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Stroke Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France.,CarMeN, INSERM U.1060/Université Lyon1/INRA U.1397/INSA Lyon/Hospices Civils Lyon, University Lyon 1, Lyon, France
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20
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Bani-Sadr A, Eker OF, Berner LP, Ameli R, Hermier M, Barritault M, Meyronet D, Guyotat J, Jouanneau E, Honnorat J, Ducray F, Berthezene Y. Conventional MRI radiomics in patients with suspected early- or pseudo-progression. Neurooncol Adv 2019; 1:vdz019. [PMID: 32642655 PMCID: PMC7212855 DOI: 10.1093/noajnl/vdz019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background After radiochemotherapy, 30% of patients with early worsening MRI experience pseudoprogression (Psp) which is not distinguishable from early progression (EP). We aimed to assess the diagnostic value of radiomics in patients with suspected EP or Psp. Methods Radiomics features (RF) of 76 patients (53 EP and 23 Psp) retrospectively identified were extracted from conventional MRI based on four volumes-of-interest. Subjects were randomly assigned into training and validation groups. Classification model (EP versus Psp) consisted of a random forest algorithm after univariate filtering. Overall (OS) and progression-free survivals (PFS) were predicted using a semi-supervised principal component analysis, and forecasts were evaluated using C-index and integrated Brier scores (IBS). Results Using 11 RFs, radiomics classified patients with 75.0% and 76.0% accuracy, 81.6% and 94.1% sensitivity, 50.0% and 37.5% specificity, respectively, in training and validation phases. Addition of MGMT promoter status improved accuracy to 83% and 79.2%, and specificity to 63.6% and 75%. OS model included 14 RFs and stratified low- and high-risk patients both in the training (hazard ratio [HR], 3.63; P = .002) and the validation (HR, 3.76; P = .001) phases. Similarly, PFS model stratified patients during training (HR, 2.58; P = .005) and validation (HR, 3.58; P = .004) phases using 5 RF. OS and PFS forecasts had C-index of 0.65 and 0.69, and IBS of 0.122 and 0.147, respectively. Conclusions Conventional MRI radiomics has promising diagnostic value, especially when combined with MGMT promoter status, but with moderate specificity. In addition, our results suggest a potential for predicting OS and PFS.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France
| | - Omer Faruk Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France
| | - Lise-Prune Berner
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France
| | - Roxana Ameli
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France
| | - Marc Barritault
- Department of Molecular Biology, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France
| | - David Meyronet
- Department of Neuropathology, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France
| | - Jacques Guyotat
- Department of Neurosurgery, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Jerome Honnorat
- Université Claude Bernard Lyon 1, Villeurbanne, France.,Department of Neuro-Oncology, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France
| | - François Ducray
- Université Claude Bernard Lyon 1, Villeurbanne, France.,Department of Neuro-Oncology, East Group Hospital, Hospices Civils de Lyon, Lyon Cedex, France
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