1
|
Moreton FC, Cullen B, Dickie DA, Lopez Gonzalez R, Santosh C, Delles C, Muir KW. Brain imaging factors associated with progression of subcortical hyperintensities in CADASIL over 2-year follow-up. Eur J Neurol 2020; 28:220-228. [PMID: 32931073 DOI: 10.1111/ene.14534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/03/2020] [Revised: 08/03/2020] [Accepted: 09/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Mutations in the NOTCH3 gene cause cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a cerebral small vessel disease manifesting with stroke, migraine and dementia in adults. The disease displays significant phenotypic variability that is incompletely explained. Early abnormalities in vascular function have been shown in animal models. We postulated that studying changes in vascular function may offer insights into disease progression. METHODS Twenty-two subjects with CADASIL [50% female, 50 (±11) years] from 19 pedigrees were included in a longitudinal multimodality study using brain magnetic resonance imaging (MRI), clinical measures, neuropsychology and measures of peripheral vascular function. MRI studies included measurement of structural brain changes, cerebral blood flow (CBF) and cerebrovascular reactivity by arterial spin labelling and a CO2 respiratory challenge. RESULTS Over 2 years, new stroke or transient ischaemic attack (TIA) occurred in five (23%) subjects and new significant disability in one (5%). There were significant increases in number of lacunes, subcortical hyperintensity volume and microbleeds, and a decrease in brain volume. CBF declined by 3.2 (±4.5) ml/100 g/min over 2 years. CBF and carotid-femoral pulse wave velocity at baseline predicted change in subcortical hyperintensity volume at follow-up. Carotid intima-media thickness and age predicted brain atrophy. Baseline CBF was lower in subjects who showed a decline in attention and working memory. CONCLUSIONS Cerebral blood flow predicts radiological progression of hyperintensities and thus is a potential biomarker of disease progression in CADASIL. Over 2 years, there were changes in several relevant imaging biomarkers (CBF, brain volume, lacunes, microbleeds and hyperintensity volume). Future studies in CADASIL should consider assessment of CBF as prognostic factor.
Collapse
Affiliation(s)
- F C Moreton
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital Glasgow, University of Glasgow, Glasgow, UK
| | - B Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D A Dickie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - R Lopez Gonzalez
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital Glasgow, University of Glasgow, Glasgow, UK.,Department of Clinical Physics and Bioengineering, Glasgow Royal Infirmary, Glasgow, UK
| | - C Santosh
- Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - C Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - K W Muir
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital Glasgow, University of Glasgow, Glasgow, UK
| |
Collapse
|
2
|
Learmonth G, Benwell CSY, Märker G, Dascalu D, Checketts M, Santosh C, Barber M, Walters M, Muir KW, Harvey M. Non-invasive brain stimulation in Stroke patients (NIBS): A prospective randomized open blinded end-point (PROBE) feasibility trial using transcranial direct current stimulation (tDCS) in post-stroke hemispatial neglect. Neuropsychol Rehabil 2020; 31:1163-1189. [PMID: 32498606 PMCID: PMC8372288 DOI: 10.1080/09602011.2020.1767161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/27/2022]
Abstract
Up to 80% of people who experience a right-hemisphere stroke suffer from hemispatial neglect. This syndrome is debilitating and impedes rehabilitation. We carried out a clinical feasibility trial of transcranial direct current stimulation (tDCS) and a behavioural rehabilitation programme, alone or in combination, in patients with neglect. Patients >4 weeks post right hemisphere stroke were randomized to 10 sessions of tDCS, 10 sessions of a behavioural intervention, combined intervention, or a control task. Primary outcomes were recruitment and retention rates, with secondary outcomes effect sizes on measures of neglect and quality of life, assessed directly after the interventions, and at 6 months follow up. Of 288 confirmed stroke cases referred (representing 7% of confirmed strokes), we randomized 8% (0.6% of stroke cases overall). The largest number of exclusions (91/288 (34%)) were due to medical comorbidities that prevented patients from undergoing 10 intervention sessions. We recruited 24 patients over 29 months, with 87% completing immediate post-intervention and 67% 6 month evaluations. We established poor feasibility of a clinical trial requiring repeated hospital-based tDCS within a UK hospital healthcare setting, either with or without behavioural training, over a sustained time period. Future trials should consider intensity, duration and location of tDCS neglect interventions.Trial registration: ClinicalTrials.gov identifier: NCT02401724.
Collapse
Affiliation(s)
- Gemma Learmonth
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.,School of Psychology, University of Glasgow, Glasgow, UK
| | - Christopher S Y Benwell
- School of Psychology, University of Glasgow, Glasgow, UK.,Division of Psychology, School of Social Sciences, University of Dundee, Dundee, UK
| | - Gesine Märker
- School of Psychology, University of Glasgow, Glasgow, UK
| | - Diana Dascalu
- School of Psychology, University of Glasgow, Glasgow, UK
| | - Matthew Checketts
- School of Psychology, University of Glasgow, Glasgow, UK.,Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | | | - Mark Barber
- University Hospital Monklands, Lanarkshire, UK
| | - Matthew Walters
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Monika Harvey
- School of Psychology, University of Glasgow, Glasgow, UK
| |
Collapse
|
3
|
Darçot E, Colotti R, Brennan D, Deuchar GA, Santosh C, van Heeswijk RB. A characterization of ABL-101 as a potential tracer for clinical fluorine-19 MRI. NMR Biomed 2020; 33:e4212. [PMID: 31724252 DOI: 10.1002/nbm.4212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 10/10/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
The two main challenges that prevent the translation of fluorine-19 (19 F) MRI for inflammation monitoring or cell tracking into clinical practice are (i) the relatively low signal-to-noise ratio generated by the injected perfluorocarbon (PFC), which necessitates long scan times, and (ii) the need for regulatory approval and a high biocompatibility of PFCs that are also suitable for MRI. ABL-101, an emulsion of perfluoro(t-butylcyclohexane), is a third-generation PFC that is already used in clinical trials, but has not yet been used for 19 F MRI. The objective of this study was therefore to assess the performance of ABL-101 as a 19 F MRI tracer. At magnetic field strengths of 3, 9.4 and 14.1 T, the CF3 groups of ABL-101 generated a large well-separated singlet with T2 /T1 ratios of >0.27, >0.14 and > 0.05, respectively. All relaxation times decreased with the increase in magnetic field strength. The detection limit of ABL-101 in a 0.25 mm3 voxel at 3 T, 37°C and with a 3-minute acquisition time was 7.21mM. After intravenous injection, the clearance half-lives of the ABL-101 19 F MR signal in mouse (n = 3) spleen and liver were 6.85 ± 0.45 and 3.20 ± 0.35 days, respectively. These results demonstrate that ABL-101 has 19 F MR characteristics that are similar to those of PFCs developed specifically for MRI, while it has clearance half-lives similar to PFCs that have previously been used in large doses in non-MRI clinical trials. Overall, ABL-101 is thus a very promising candidate tracer for future clinical trials that use 19 F MRI for cell tracking or the monitoring of inflammation.
Collapse
Affiliation(s)
- Emeline Darçot
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Roberto Colotti
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - David Brennan
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
- Aurum Biosciences Ltd, Glasgow, UK
| | | | - Celestine Santosh
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
- Aurum Biosciences Ltd, Glasgow, UK
| | - Ruud B van Heeswijk
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne and Geneva, Switzerland
| |
Collapse
|
4
|
Deuchar GA, van Kralingen JC, Work LM, Santosh C, Muir KW, McCabe C, Macrae IM. Preclinical Validation of the Therapeutic Potential of Glasgow Oxygen Level Dependent (GOLD) Technology: a Theranostic for Acute Stroke. Transl Stroke Res 2018; 10:583-595. [PMID: 30506268 PMCID: PMC6733820 DOI: 10.1007/s12975-018-0679-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022]
Abstract
In acute stroke patients, penumbral tissue is non-functioning but potentially salvageable within a time window of variable duration and represents target tissue for rescue. Reperfusion by thrombolysis and/or thrombectomy can rescue penumbra and improve stroke outcomes, but these treatments are currently available to a minority of patients. In addition to the utility of Glasgow Oxygen Level Dependent (GOLD) as an MRI contrast capable of detecting penumbra, its constituent perfluorocarbon (PFC) oxygen carrier, combined with normobaric hyperoxia, also represents a potential acute stroke treatment through improved oxygen delivery to penumbra. Preclinical studies were designed to test the efficacy of an intravenous oxygen carrier, the perfluorocarbon emulsion Oxycyte® (O-PFC), combined with normobaric hyperoxia (50% O2) in both in vitro (neuronal cell culture) and in vivo rat models of ischaemic stroke. Outcome was assessed through the quantification of lipid peroxidation and oxidative stress levels, mortality, infarct volume, neurological scoring and sensorimotor tests of functional outcome in two in vivo models of stroke. Additionally, we investigated evidence for any positive or negative interactions with the thrombolytic recombinant tissue plasminogen activator (rt-PA) following embolus-induced stroke in rats. Treatment with intravenous O-PFC + normobaric hyperoxia (50% O2) provided evidence of reduced infarct size and improved functional recovery. It did not exacerbate oxidative stress and showed no adverse interactions with rt-PA. The positive results and lack of adverse effects support human trials of O-PFC + 50% O2 normobaric hyperoxia as a potential therapeutic approach. Combined with the diagnostic data presented in the preceding paper, O-PFC and normobaric hyperoxia is a potential theranostic for acute ischaemic stroke.
Collapse
Affiliation(s)
- Graeme A Deuchar
- Aurum Biosciences Ltd, 20-23 Woodside Place, Glasgow, Scotland, G3 7QL, UK.
- Institute of Neuroscience & Psychology, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK.
| | - Josie C van Kralingen
- Institute of Cardiovascular and Medical Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Lorraine M Work
- Institute of Cardiovascular and Medical Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Celestine Santosh
- Aurum Biosciences Ltd, 20-23 Woodside Place, Glasgow, Scotland, G3 7QL, UK
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland, G51 4TF, UK
| | - Keith W Muir
- Institute of Neuroscience & Psychology, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland, G51 4TF, UK
| | - Chris McCabe
- Institute of Neuroscience & Psychology, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - I Mhairi Macrae
- Institute of Neuroscience & Psychology, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| |
Collapse
|
5
|
Abstract
Impaired cerebrovascular reactivity precedes histological and clinical evidence of CADASIL in animal models. We aimed to more fully characterise peripheral and cerebral vascular function and reactivity in a cohort of adult CADASIL patients, and explore the associations of these with conventional clinical, imaging and neuropsychological measures. A total of 22 adults with CADASIL gave informed consent to participate in an exploratory study of vascular function in CADASIL. Clinical assessment, comprehensive vascular assessment, MRI and neuropsychological testing were conducted. We measured cerebral vasoreactivity with transcranial Doppler and arterial spin labelling MRI with hypercapnia challenge. Number and volume of lacunes, subcortical hyperintensity volume, microbleeds and normalised brain volume were assessed on MRI. Analysis was exploratory and examined the associations between different markers. Cerebrovascular reactivity measured by ASL correlated with peripheral vasoreactivity measured by flow mediated dilatation. Subjects with ≥5 lacunes were older, with higher carotid intima-media thickness and had impaired cerebral and peripheral vasoreactivity. Subjects with depressive symptoms, disability or delayed processing speed also showed a trend to impaired vasoreactivity. Impaired vasoreactivity and vascular dysfunction may play a significant role in the pathophysiology of CADASIL, and vascular assessments may be useful biomarkers of severity in both longitudinal and clinical trials.
Collapse
Affiliation(s)
- Fiona C Moreton
- 1 Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Breda Cullen
- 2 Institute of Health and Wellbeing, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Christian Delles
- 3 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Celestine Santosh
- 4 Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Rosario L Gonzalez
- 5 Department of Clinical Physics and Bioengineering, Glasgow Royal Infirmary, Glasgow, UK
| | - Krishna Dani
- 1 Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Keith W Muir
- 1 Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
6
|
Nazneen S, Mukta K, Santosh C, Borde A. Bacteriological trends and antibiotic susceptibility patterns of clinical isolates at Government Cancer Hospital, Marathwada. Indian J Cancer 2018; 53:583-586. [PMID: 28485357 DOI: 10.4103/ijc.ijc_34_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Preventing and starting early treatment of infections in patients whose immunity system is weak due to malignancies can reduce mortality. Since our hospital is a newly constructed one, this study aimed to determine microbial and antibiotic resistance patterns in clinical samples of patients with cancer at our center to start early treatment before the results of clinical tests are known. SUBJECTS AND METHODS The study was carried out in the Department of Microbiology, Government Cancer Hospital during the period from January 2016 to December 2016. A total 170 clinical samples (urine, blood, sputum, pus, etc.) were collected and processed for culture, identification as per standard recommended procedures and antibiotic susceptibility testing were carried out on isolates as per Clinical Laboratory Standard Institute guidelines. RESULTS A total of 170 specimens were cultured. Escherichia coli, Acinetobacter spp. , Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa were most commonly encountered. A high level of resistance to various antibiotics was noted among Gram-negative bacteria. Resistance among Gram-positive was not acute. CONCLUSION The present study reveals microbiological profile in patients attending our hospital. Regular surveillance helps in implementing better therapeutic strategies to reduce morbidity and mortality associated in patients in health-care facility.
Collapse
Affiliation(s)
- S Nazneen
- Department of Microbiology, Government Cancer Hospital, Aurangabad, Maharashtra, India
| | - K Mukta
- Department of Microbiology, Government Cancer Hospital, Aurangabad, Maharashtra, India
| | - C Santosh
- Department of Microbiology, Government Cancer Hospital, Aurangabad, Maharashtra, India
| | - A Borde
- Department of Microbiology, Government Cancer Hospital, Aurangabad, Maharashtra, India
| |
Collapse
|
7
|
Deuchar GA, Brennan D, Holmes WM, Shaw M, Macrae IM, Santosh C. Perfluorocarbon Enhanced Glasgow Oxygen Level Dependent (GOLD) Magnetic Resonance Metabolic Imaging Identifies the Penumbra Following Acute Ischemic Stroke. Am J Cancer Res 2018; 8:1706-1722. [PMID: 29556351 PMCID: PMC5858177 DOI: 10.7150/thno.21685] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/16/2017] [Indexed: 01/27/2023] Open
Abstract
The ability to identify metabolically active and potentially salvageable ischaemic penumbra is crucial for improving treatment decisions in acute stroke patients. Our solution involves two complementary novel MRI techniques (Glasgow Oxygen Level Dependant (GOLD) Metabolic Imaging), which when combined with a perfluorocarbon (PFC) based oxygen carrier and hyperoxia can identify penumbra due to dynamic changes related to continued metabolism within this tissue compartment. Our aims were (i) to investigate whether PFC offers similar enhancement of the second technique (Lactate Change) as previously demonstrated for the T2*OC technique (ii) to demonstrate both GOLD metabolic imaging techniques working concurrently to identify penumbra, following administration of Oxycyte® (O-PFC) with hyperoxia. Methods: An established rat stroke model was utilised. Part-1: Following either saline or PFC, magnetic resonance spectroscopy was applied to investigate the effect of hyperoxia on lactate change in presumed penumbra. Part-2; rats received O-PFC prior to T2*OC (technique 1) and MR spectroscopic imaging, which was used to identify regions of tissue lactate change (technique 2) in response to hyperoxia. In order to validate the techniques, imaging was followed by [14C]2-deoxyglucose autoradiography to correlate tissue metabolic status to areas identified as penumbra. Results: Part-1: PFC+hyperoxia resulted in an enhanced reduction of lactate in the penumbra when compared to saline+hyperoxia. Part-2: Regions of brain tissue identified as potential penumbra by both GOLD metabolic imaging techniques utilising O-PFC, demonstrated maintained glucose metabolism as compared to adjacent core tissue. Conclusion: For the first time in vivo, enhancement of both GOLD metabolic imaging techniques has been demonstrated following intravenous O-PFC+hyperoxia to identify ischaemic penumbra. We have also presented preliminary evidence of the potential therapeutic benefit offered by O-PFC. These unique theranostic applications would enable treatment based on metabolic status of the brain tissue, independent of time from stroke onset, leading to increased uptake and safer use of currently available treatment options.
Collapse
|
8
|
Dani KA, Moreton FC, Santosh C, Lopez R, Brennan D, Schwarzbauer C, Goutcher C, O'Hare K, Macrae IM, Muir KW. Oxygen challenge magnetic resonance imaging in healthy human volunteers. J Cereb Blood Flow Metab 2017; 37:366-376. [PMID: 26787107 PMCID: PMC5363753 DOI: 10.1177/0271678x15627827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/12/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022]
Abstract
Oxygen challenge imaging involves transient hyperoxia applied during deoxyhaemoglobin sensitive (T2*-weighted) magnetic resonance imaging and has the potential to detect changes in brain oxygen extraction. In order to develop optimal practical protocols for oxygen challenge imaging, we investigated the influence of oxygen concentration, cerebral blood flow change, pattern of oxygen administration and field strength on T2*-weighted signal. Eight healthy volunteers underwent multi-parametric magnetic resonance imaging including oxygen challenge imaging and arterial spin labelling using two oxygen concentrations (target FiO2 of 100 and 60%) administered consecutively (two-stage challenge) at both 1.5T and 3T. There was a greater signal increase in grey matter compared to white matter during oxygen challenge (p < 0.002 at 3T, P < 0.0001 at 1.5T) and at FiO2 = 100% compared to FiO2 = 60% in grey matter at both field strengths (p < 0.02) and in white matter at 3T only (p = 0.0314). Differences in the magnitude of signal change between 1.5T and 3T did not reach statistical significance. Reduction of T2*-weighted signal to below baseline, after hyperoxia withdrawal, confounded interpretation of two-stage oxygen challenge imaging. Reductions in cerebral blood flow did not obscure the T2*-weighted signal increases. In conclusion, the optimal protocol for further study should utilise target FiO2 = 100% during a single oxygen challenge. Imaging at both 1.5T and 3T is clinically feasible.
Collapse
Affiliation(s)
- Krishna A Dani
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Fiona C Moreton
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Celestine Santosh
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Rosario Lopez
- Department of Clinical Physics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - David Brennan
- Department of Clinical Physics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Christian Schwarzbauer
- University of Applied Sciences Munich, School of Applied Sciences and Mechatronics, München
| | - Colin Goutcher
- Department of Anaesthetics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - Kevin O'Hare
- Department of Anaesthetics, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow
| | - I Mhairi Macrae
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow
| | - Keith W Muir
- Institute of Neuroscience and Psychology, College of Medical Veterinary and Life Sciences, University of Glasgow, Queen Elizabeth University Hospital Glasgow, Glasgow
| |
Collapse
|
9
|
Kalladka D, Sinden J, Pollock K, Haig C, McLean J, Smith W, McConnachie A, Santosh C, Bath PM, Dunn L, Muir KW. Human neural stem cells in patients with chronic ischaemic stroke (PISCES): a phase 1, first-in-man study. Lancet 2016; 388:787-96. [PMID: 27497862 DOI: 10.1016/s0140-6736(16)30513-x] [Citation(s) in RCA: 274] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND CTX0E03 is an immortalised human neural stem-cell line from which a drug product (CTX-DP) was developed for allogeneic therapy. Dose-dependent improvement in sensorimotor function in rats implanted with CTX-DP 4 weeks after middle cerebral artery occlusion stroke prompted investigation of the safety and tolerability of this treatment in stroke patients. METHODS We did an open-label, single-site, dose-escalation study. Men aged 60 years or older with stable disability (National Institutes of Health Stroke Scale [NIHSS] score ≥6 and modified Rankin Scale score 2-4) 6-60 months after ischaemic stroke were implanted with single doses of 2 million, 5 million, 10 million, or 20 million cells by stereotactic ipsilateral putamen injection. Clinical and brain imaging data were collected over 2 years. The primary endpoint was safety (adverse events and neurological change). This trial is registered with ClinicalTrials.gov, number NCT01151124. FINDINGS 13 men were recruited between September, 2010, and January, 2013, of whom 11 (mean age 69 years, range 60-82) received CTX-DP. Median NIHSS score before implantation was 7 (IQR 6-8) and the mean time from stroke was 29 (SD 14) months. Three men had subcortical infarcts only and seven had right-hemisphere infarcts. No immunological or cell-related adverse events were seen. Other adverse events were related to the procedure or comorbidities. Hyperintensity around the injection tracts on T2-weighted fluid-attenuation inversion recovery MRI was seen in five patients. At 2 years, improvement in NIHSS score ranged from 0 to 5 (median 2) points. INTERPRETATION Single intracerebral doses of CTX-DP up to 20 million cells induced no adverse events and were associated with improved neurological function. Our observations support further investigation of CTX-DP in stroke patients. FUNDING ReNeuron Limited.
Collapse
Affiliation(s)
- Dheeraj Kalladka
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - John Sinden
- ReNeuron Ltd, Surrey Research Park, Guildford, Surrey, UK
| | | | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - John McLean
- Department of Neuroradiology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Wilma Smith
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Celestine Santosh
- Department of Neuroradiology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Laurence Dunn
- Neurosurgery, Institute of Neurological Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.
| |
Collapse
|
10
|
Cullen B, Moreton FC, Stringer MS, Krishnadas R, Kalladka D, López-González MR, Santosh C, Schwarzbauer C, Muir KW. Resting state connectivity and cognitive performance in adults with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy. J Cereb Blood Flow Metab 2016; 36:981-91. [PMID: 26929239 PMCID: PMC4853844 DOI: 10.1177/0271678x16636395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/14/2016] [Indexed: 11/15/2022]
Abstract
Cognitive impairment is an inevitable feature of cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), affecting executive function, attention and processing speed from an early stage. Impairment is associated with structural markers such as lacunes, but associations with functional connectivity have not yet been reported. Twenty-two adults with genetically-confirmed CADASIL (11 male; aged 49.8 ± 11.2 years) underwent functional magnetic resonance imaging at rest. Intrinsic attentional/executive networks were identified using group independent components analysis. A linear regression model tested voxel-wise associations between cognitive measures and component spatial maps, and Pearson correlations were performed with mean intra-component connectivity z-scores. Two frontoparietal components were associated with cognitive performance. Voxel-wise analyses showed an association between one component cluster and processing speed (left middle temporal gyrus; peak -48, -18, -14; ZE = 5.65, pFWE corr = 0.001). Mean connectivity in both components correlated with processing speed (r = 0.45, p = 0.043; r = 0.56, p = 0.008). Mean connectivity in one component correlated with faster Trailmaking B minus A time (r = -0.77, p < 0.001) and better executive performance (r = 0.56, p = 0.011). This preliminary study provides evidence for associations between cognitive performance and attentional network connectivity in CADASIL. Functional connectivity may be a useful biomarker of cognitive performance in this population.
Collapse
Affiliation(s)
- Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fiona C Moreton
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Michael S Stringer
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK
| | - Rajeev Krishnadas
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dheeraj Kalladka
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | | | | | - Christian Schwarzbauer
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK Faculty of Applied Science and Mechatronics, University of Applied Sciences, Munich, Germany
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| |
Collapse
|
11
|
Moreton FC, Santosh C, McArthur K, Muir KW. Cerebral hyperperfusion on arterial spin labeling MRI during CADASIL migrainous encephalopathy. Neurology 2015; 85:2177-9. [DOI: 10.1212/wnl.0000000000002214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/13/2015] [Indexed: 11/15/2022] Open
|
12
|
Robertson CA, McCabe C, Lopez-Gonzalez MR, Deuchar GA, Dani K, Holmes WM, Muir KW, Santosh C, Macrae IM. Detection of ischemic penumbra using combined perfusion and T2* oxygen challenge imaging. Int J Stroke 2014; 10:42-50. [PMID: 25042078 PMCID: PMC4283703 DOI: 10.1111/ijs.12327] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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] [Received: 01/29/2014] [Accepted: 05/27/2014] [Indexed: 01/28/2023]
Abstract
Background Acute ischemic stroke is common and disabling, but there remains a paucity of acute treatment options and available treatment (thrombolysis) is underutilized. Advanced brain imaging, designed to identify viable hypoperfused tissue (penumbra), could target treatment to a wider population. Existing magnetic resonance imaging and computed tomography-based technologies are not widely used pending validation in ongoing clinical trials. T2* oxygen challenge magnetic resonance imaging, by providing a more direct readout of tissue viability, has the potential to identify more patients likely to benefit from thrombolysis – irrespective of time from stroke onset – and patients within and beyond the 4·5 h thrombolysis treatment window who are unlikely to benefit and are at an increased risk of hemorrhage. Aims This study employs serial multimodal imaging and voxel-based analysis to develop optimal data processing for T2* oxygen challenge penumbra assessment. Tissue in the ischemic hemisphere is compartmentalized into penumbra, ischemic core, or normal using T2* oxygen challenge (single threshold) or T2* oxygen challenge plus cerebral blood flow (dual threshold) data. Penumbra defined by perfusion imaging/apparent diffusion coefficient mismatch (dual threshold) is included for comparison. Methods Permanent middle cerebral artery occlusion was induced in male Sprague-Dawley rats (n = 6) prior to serial multimodal imaging: T2* oxygen challenge, diffusion-weighted and perfusion imaging (cerebral blood flow using arterial spin labeling). Results Across the different methods evaluated, T2* oxygen challenge combined with perfusion imaging most closely predicted 24 h infarct volume. Penumbra volume declined from one to four-hours post-stroke: mean ± SD, 77 ± 44 to 49 ± 37 mm3 (single T2* oxygen challenge-based threshold); 55 ± 41 to 37 ± 12 mm3 (dual T2* oxygen challenge/cerebral blood flow); 84 ± 64 to 42 ± 18 mm3 (dual cerebral blood flow/apparent diffusion coefficient), as ischemic core grew: 155 ± 37 to 211 ± 36 mm3 (single apparent diffusion coefficient threshold); 178 ± 56 to 205 ± 33 mm3 (dual T2* oxygen challenge/cerebral blood flow); 139 ± 30 to 168 ± 38 mm3 (dual cerebral blood flow/apparent diffusion coefficient). There was evidence of further lesion growth beyond four-hours (T2-defined edema-corrected infarct, 231 ± 19 mm3). Conclusions In conclusion, T2* oxygen challenge combined with perfusion imaging has advantages over alternative magnetic resonance imaging techniques for penumbra detection by providing serial assessment of available penumbra based on tissue viability.
Collapse
Affiliation(s)
- Craig A Robertson
- Centre for Stroke and Brain Imaging Research, Institute of Neuroscience and Psychology, College of Medicine, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Deuchar GA, Brennan D, Griffiths H, Macrae I M, Santosh C. Perfluorocarbons enhance a T2*-based MRI technique for identifying the penumbra in a rat model of acute ischemic stroke. J Cereb Blood Flow Metab 2013; 33:1422-8. [PMID: 23801243 PMCID: PMC3764387 DOI: 10.1038/jcbfm.2013.86] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/22/2013] [Accepted: 05/01/2013] [Indexed: 02/05/2023]
Abstract
Accurate imaging of ischemic penumbra is crucial for improving the management of acute stroke patients. T2* magnetic resonance imaging (MRI) combined with a T2*oxygen challenge (T2*OC) is being developed to detect penumbra based on changes in blood deoxyhemoglobin. Using 100% O2, T2*OC-defined penumbra exhibits ongoing glucose metabolism and tissue recovery on reperfusion. However, potential limitations in translating this technique include a sinus artefact in human scans with delivery of 100% OC and relatively small signal changes. Here we investigate whether an oxygen-carrying perfluorocarbon (PFC) emulsion can enhance the sensitivity of the technique, enabling penumbra detection with lower levels of inspired oxygen. Stroke was induced in male Sprague-Dawley rats (n=17) with ischemic injury and perfusion deficit determined by diffusion and perfusion MRI, respectively. T2* signal change was measured in regions of interest (ROIs) located within ischemic core, T2*OC-defined penumbra and equivalent contralateral areas during 40% O2±prior PFC injection. Region of interest analyses between groups showed that PFC significantly enhanced the T2* response to 40% O2 in T2*-defined penumbra (mean increase of 10.6±2.3% compared to 5.6±1.5% with 40% O2, P<0.001). This enhancement was specific to the penumbra ROI. Perfluorocarbon emulsions therefore enhances the translational potential of the T2*OC technique for identifying penumbra in acute stroke patients.
Collapse
Affiliation(s)
- Graeme A Deuchar
- Wellcome Surgical Institute, Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David Brennan
- Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
| | - Hugh Griffiths
- Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
| | - I Mhairi Macrae
- Wellcome Surgical Institute, Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Celestine Santosh
- Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
| |
Collapse
|
14
|
Abstract
Hyperoxia during T2*-weighted magnetic resonance imaging (oxygen challenge imaging (OCI)) causes T2*-weighted signal change that is dependent on cerebral blood volume (CBV) and oxygen extraction fraction (OEF). Crossed cerebellar diaschisis (CCD), where CBV is reduced but OEF is maintained, may be used to understand the relative contributions of OEF and CBV to OCI results. In subjects with large hemispheric strokes, OCI showed reduced signal change in the contralesional cerebellum (P=0.027, n=12). This was associated with reduced CBV in contralesional cerebellum (P=0.039, n=9). CCD may be a useful model to determine the relative contribution of CBV to signal change measured by OCI.
Collapse
Affiliation(s)
- Krishna A Dani
- Institute of Neurosciences and Psychology, School of Medicine, University of Glasgow, Glasgow, UK
| | | | | | | | | |
Collapse
|
15
|
Macleod A, Dani KA, Santosh C, Leach JP. 093 Extensive persistent post-ictal MRI changes: unusual imaging findings in autoimmune encephalitis: Abstract 093 Figure 1. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
16
|
Goodfellow JA, Dani K, Stewart W, Santosh C, McLean J, Mulhern S, Razvi S. Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes: an important cause of stroke in young people. Postgrad Med J 2012; 88:326-34. [DOI: 10.1136/postgradmedj-2011-130326] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
17
|
Holmes WM, Lopez-Gonzalez MR, Gallagher L, Deuchar GA, Macrae IM, Santosh C. Novel MRI detection of the ischemic penumbra: direct assessment of metabolic integrity. NMR Biomed 2012; 25:295-304. [PMID: 21751274 DOI: 10.1002/nbm.1748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 04/12/2011] [Accepted: 04/17/2011] [Indexed: 05/31/2023]
Abstract
We describe a novel magnetic resonance imaging technique to directly assess the metabolic integrity of penumbral tissue following stroke. For ischemically stressed tissue to be salvageable, it has to be capable of recovering aerobic metabolism (in place of anaerobic metabolism) on reperfusion. We probed ischemic brain tissue by altering the rate of oxygen delivery using a challenge of 100% oxygen ventilation. Any change from anaerobic to aerobic metabolism should alter the rate of lactate production and hence, levels of tissue lactate. Stroke was induced by permanent middle cerebral artery occlusion in rats. In Series 1 (n = 6), changes in tissue lactate during and following 100% oxygen challenge were monitored using (1)H magnetic resonance spectroscopy (MRS). Diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) were used to locate MRS voxels within the ischemic core, the homotopic contralateral striatum and within PWI/DWI mismatch (i.e. presumed penumbra). After 20 min of oxygen, lactate signal change was -16.1 ± 8.8% (mean ± SD) in PWI/DWI mismatch, +2.8 ± 5.1% in the ischemic core, and -0.6 ± 7.6% in the contralateral striatum. Return to air ventilation for 20 min resulted in a reversal, with lactate increasing by 46 ± 25.3% in the PWI/DWI mismatch, 6.6 ± 6.2% in the ischemic core, and -5 ± 11.4% in the contralateral striatum. In Series 2 (n = 6), a novel form of spectroscopic imaging was used to acquire lactate change maps to spatially identify regions of lactate change within the ischemic brain. This technique has potential clinical utility by identifying tissue that displays anaerobic metabolism capable of recovering aerobic metabolism when oxygen delivery is increased, which could provide a more precise assessment of penumbra.
Collapse
Affiliation(s)
- William M Holmes
- Glasgow Experimental MRI Centre, Division of Clinical Neuroscience, Faculty of Medicine, University of Glasgow, G61 1QH, Scotland, UK.
| | | | | | | | | | | |
Collapse
|
18
|
Hunter MA, Santosh C, Teasdale E, Forbes KP. High-resolution double inversion recovery black-blood imaging of cervical artery dissection using 3T MR imaging. AJNR Am J Neuroradiol 2011; 33:E133-7. [PMID: 21852374 DOI: 10.3174/ajnr.a2599] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY We performed high-resolution DIR-BBI of the cervical arteries at 3T in 19 subjects with cervical dissection. It offered excellent visualization of both the lumen and arterial wall, allowing detection of the primary and secondary features of dissection. We suggest that this is a highly useful technique for diagnosis of cervical dissection, either routinely or in equivocal cases of suspected dissection. It also offers further insight into the pathogenesis of this disorder.
Collapse
Affiliation(s)
- M A Hunter
- Department of Radiology, Royal Alexander Hospital, Paisley, United Kingdom.
| | | | | | | |
Collapse
|
19
|
Robertson CA, McCabe C, Gallagher L, Lopez-Gonzalez MDR, Holmes WM, Condon B, Muir KW, Santosh C, Macrae IM. Stroke penumbra defined by an MRI-based oxygen challenge technique: 1. Validation using [14C]2-deoxyglucose autoradiography. J Cereb Blood Flow Metab 2011; 31:1778-87. [PMID: 21559032 PMCID: PMC3154682 DOI: 10.1038/jcbfm.2011.66] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Accurate identification of ischemic penumbra will improve stroke patient selection for reperfusion therapies and clinical trials. Current magnetic resonance imaging (MRI) techniques have limitations and lack validation. Oxygen challenge T(2)(*) MRI (T(2)(*) OC) uses oxygen as a biotracer to detect tissue metabolism, with penumbra displaying the greatest T(2)(*) signal change during OC. [(14)C]2-deoxyglucose (2-DG) autoradiography was combined with T(2)(*) OC to determine metabolic status of T(2)(*)-defined penumbra. Permanent middle cerebral artery occlusion was induced in anesthetized male Sprague-Dawley rats (n=6). Ischemic injury and perfusion deficit were determined by diffusion- and perfusion-weighted imaging, respectively. At 147 ± 32 minutes after stroke, T(2)(*) signal change was measured during a 5-minute 100% OC, immediately followed by 125 μCi/kg 2-DG, intravenously. Magnetic resonance images were coregistered with the corresponding autoradiograms. Regions of interest were located within ischemic core, T(2)(*)-defined penumbra, equivalent contralateral structures, and a region of hyperglycolysis. A T(2)(*) signal increase of 9.22% ± 3.9% (mean ± s.d.) was recorded in presumed penumbra, which displayed local cerebral glucose utilization values equivalent to contralateral cortex. T(2)(*) signal change was negligible in ischemic core, 3.2% ± 0.78% in contralateral regions, and 1.41% ± 0.62% in hyperglycolytic tissue, located outside OC-defined penumbra and within the diffusion abnormality. The results support the utility of OC-MRI to detect viable penumbral tissue following stroke.
Collapse
Affiliation(s)
- Craig A Robertson
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Teasdale E, Zampakis P, Santosh C, Razvi S. Multidetector computed tomography angiography: Application in vertebral artery dissection. Ann Indian Acad Neurol 2011; 14:35-41. [PMID: 21633613 PMCID: PMC3098522 DOI: 10.4103/0972-2327.78048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [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] [Received: 08/20/2010] [Revised: 10/12/2010] [Accepted: 12/29/2010] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE Multidetector computed tomography angiography (MDCTA) is a minimally invasive radiological technique providing high-resolution images of the arterial wall and angiographic images of the lumen. We studied the radiological features of vertebral artery dissection (VAD) in a consecutive series of patients investigated for acute stroke and subarachnoid hemorrhage (SAH) in order to confirm and define the diagnostic features of VAD on MDCTA. PATIENTS AND METHODS Review of patients identified prospectively over a 4-year period with VAD assessed by MDCTA was conducted. Radiological features of VAD on MDCTA were reanalyzed utilising previously reported criteria for VAD. RESULTS Thirty-five patients (25 males, mean age 49.6 years) with a total of 45 dissected vertebral arteries were reviewed. MDCTA features of VAD included increased wall thickness in 44/45 (97.7%) arteries and increased total vessel diameter in 42/45 arteries (93.3%). All dissected arteries had either lumen stenosis (21/45) or associated segmental occlusion (24/45). An intimal flap was detected in 6/45 (13.3 %) vessels. Twenty-five patients had follow-up imaging, 14/32 vessels returned to normal, 4 showed improvement in stenosis but did not return to normal and 14 demonstrated no change. The majority of non-occluded vessels became normal or displayed improved patency. Only 4/17 occluded arteries demonstrated re-establishment of flow. No adverse effects were recorded. CONCLUSIONS MDCTA is a safe and reliable technique for the diagnosis of VAD. Increased wall thickness (97.7%) and increased vessel wall diameter (93.3%) were the most frequently observed features.
Collapse
Affiliation(s)
- Evelyn Teasdale
- Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, United Kingdom
| | | | | | | |
Collapse
|
21
|
Awadh M, MacDougall N, Santosh C, Teasdale E, Baird T, Muir KW. Early Recurrent Ischemic Stroke Complicating Intravenous Thrombolysis for Stroke. Stroke 2010; 41:1990-5. [DOI: 10.1161/strokeaha.109.569459] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mostafa Awadh
- From the Division of Clinical Neurosciences (M.A., N.M., K.W.M.), University of Glasgow, and the Departments of Neuroradiology (C.S., E.T.) and Neurology (T.B.), Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland
| | - Niall MacDougall
- From the Division of Clinical Neurosciences (M.A., N.M., K.W.M.), University of Glasgow, and the Departments of Neuroradiology (C.S., E.T.) and Neurology (T.B.), Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland
| | - Celestine Santosh
- From the Division of Clinical Neurosciences (M.A., N.M., K.W.M.), University of Glasgow, and the Departments of Neuroradiology (C.S., E.T.) and Neurology (T.B.), Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland
| | - Evelyn Teasdale
- From the Division of Clinical Neurosciences (M.A., N.M., K.W.M.), University of Glasgow, and the Departments of Neuroradiology (C.S., E.T.) and Neurology (T.B.), Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland
| | - Tracey Baird
- From the Division of Clinical Neurosciences (M.A., N.M., K.W.M.), University of Glasgow, and the Departments of Neuroradiology (C.S., E.T.) and Neurology (T.B.), Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland
| | - Keith W. Muir
- From the Division of Clinical Neurosciences (M.A., N.M., K.W.M.), University of Glasgow, and the Departments of Neuroradiology (C.S., E.T.) and Neurology (T.B.), Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland
| |
Collapse
|
22
|
Dani KA, Santosh C, Brennan D, McCabe C, Holmes WM, Condon B, Hadley DM, Macrae IM, Shaw M, Muir KW. T2*-weighted magnetic resonance imaging with hyperoxia in acute ischemic stroke. Ann Neurol 2010; 68:37-47. [PMID: 20582987 DOI: 10.1002/ana.22032] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE We describe the first clinical application of transient hyperoxia ("oxygen challenge") during T2*-weighted magnetic resonance imaging (MRI), to detect differences in vascular deoxyhemoglobin between tissue compartments following stroke. METHODS Subjects with acute ischemic stroke were scanned with T2*-weighted MRI and oxygen challenge. For regions defined as infarct core (diffusion-weighted imaging lesion) and presumed penumbra (perfusion-diffusion mismatch [threshold = T(max) > or =4 seconds], or regions exhibiting diffusion lesion expansion at day 3), T2*-weighted signal intensity-time curves corresponding to the duration of oxygen challenge were generated. From these, the area under the curve, gradient of incline of the signal increase, time to maximum signal, and percentage signal change after oxygen challenge were measured. RESULTS We identified 25 subjects with stroke lesions >1ml. Eighteen subjects with good quality T2*-weighted signal intensity-time curves in the contralateral hemisphere were analyzed. Curves from the diffusion lesion had a smaller area under the curve, percentage signal change, and gradient of incline, and longer time to maximum signal (p < 0.05, n = 17) compared to normal tissue, which consistently showed signal increase during oxygen challenge. Curves in the presumed penumbral regions (n = 8) showed varied morphology, but at hyperacute time points (<8 hours) showed a tendency to greater percentage signal change. INTERPRETATION Differences in T2*-weighted signal intensity-time curves during oxygen challenge in brain regions with different pathophysiological states after stroke are likely to reflect differences in deoxyhemoglobin concentration, and therefore differences in metabolic activity. Despite its underlying complexities, this technique offers a possible novel mode of metabolic imaging in acute stroke.
Collapse
Affiliation(s)
- Krishna A Dani
- Division of Clinical Neurosciences, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Zampakis P, Santosh C, Taylor W, Teasdale E. The role of non-invasive computed tomography in patients with suspected dural fistulas with spinal drainage. Neurosurgery 2006; 58:686-94; discussion 686-94. [PMID: 16575332 DOI: 10.1227/01.neu00199163.10539.56] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Accurate diagnosis and demonstration of the angioarchitecture and localization of a spinal dural arteriovenous fistula is of crucial importance before treatment. Selective spinal angiography (DSA) has been considered the standard technique, but is invasive, time-consuming, and may be falsely negative. This report evaluates the use of noninvasive vascular imaging (computed tomographic and magnetic resonance angiography [MRA]) in patients suspected to have a dural fistula with spinal drainage. METHOD Ten consecutive patients had DSA and multidetector computed tomographic angiography (MDCTA), eight also had MRA. Nine were men with an average age of 67 years. In nine patients, the diagnosis was confirmed at surgery or intravascular treatment. Eight were proven to have a spinal dural fistula. In two, the fistula was within the cervical cranial dura. In all patients, the venous drainage involved only the spinal venous plexus. RESULTS MDCTA identified the level of the feeding artery in nine patients. In two cases, selective DSA failed to show the abnormality found on MDCTA, but both were confirmed at surgery. MRA was diagnostic in a case in which the lesion was not accurately depicted by either MDCTA or DSA. MRA was less accurate than MDCTA in determining the level of the feeding artery. CONCLUSION MDCTA and MRA can direct and focus DSA. MDCTA gives additional useful three-dimensional bone detail and localization information for the surgeon. It may replace DSA if surgery is the planned treatment.
Collapse
Affiliation(s)
- Peter Zampakis
- Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland
| | | | | | | |
Collapse
|
24
|
MESH Headings
- Acute Disease
- Brain Damage, Chronic/diagnosis
- Brain Damage, Chronic/etiology
- Cerebral Angiography/methods
- Cerebral Hemorrhage/diagnosis
- Cerebral Hemorrhage/etiology
- Cerebral Infarction/diagnosis
- Cerebral Infarction/etiology
- Diagnosis, Differential
- Humans
- Image Enhancement
- Image Processing, Computer-Assisted
- Imaging, Three-Dimensional
- Ischemic Attack, Transient/diagnosis
- Ischemic Attack, Transient/etiology
- Positron-Emission Tomography/methods
- Prognosis
- Syndrome
- Tomography, Emission-Computed, Single-Photon/methods
- Tomography, X-Ray Computed/methods
Collapse
Affiliation(s)
- K W Muir
- Division of Clinical Neurosciences, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, UK.
| | | |
Collapse
|
25
|
|
26
|
Abstract
STUDY DESIGN Case report. OBJECTIVE To report a case of spinal cord infarction after a self-inflicted needle stick injury, following an injection of heroin into the cord. SETTING National spinal injury unit in a Scottish University teaching hospital, Glasgow, UK. CASE REPORT A 20-year-old male, injected street heroin accidentally into the cord through the left side of the neck, leading to sudden loss of power to all four limbs. Initial magnetic resonance imaging scans showed extensive cord oedema and follow-up scans showed signal changes within the anterior horns of the spinal cord in keeping with a cord infarct. CONCLUSION Self-inflicted spinal cord injury with a small needle is difficult, but not impossible. Cord infarct as a result of a self-inflicted injury has not been previously reported. The mechanism of the injury resulting in cord infarction is explained by the vascular anatomy of the spinal cord circulation, and this may also explain the residual neurological status of the patient.
Collapse
Affiliation(s)
- G Joseph
- The Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK
| | | | | | | | | |
Collapse
|
27
|
Blanch RJ, Brennan D, Condon B, Santosh C, Hadley D. Are There Gender-specific Neural Substrates of Route Learning from Different Perspectives? Cereb Cortex 2004; 14:1207-13. [PMID: 15142964 DOI: 10.1093/cercor/bhh081] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Psychological studies have demonstrated sex differences in performance and tactics for route learning. Route information can be encoded in different ways, such as the survey perspective (as in maps) and the route perspective (as we experience the world). Here we show, using functional magnetic resonance imaging, that men and women use the same brain areas to learn routes from both perspectives, and that the observed sex differences in route learning are not due to differences in the parts of the brain being used. We also show that many of the same brain areas are used in route learning from both perspectives, such as the parahippocampus, precuneus, posterior cingulate gyrus and middle frontal gyrus. However, paired comparisons of route learning from both perspectives shows that the survey perspective activates the superior and middle temporal gyri and the angular gyrus, which are not activated in the route perspective.
Collapse
Affiliation(s)
- Richard J Blanch
- Department of Clinical Physics, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, UK.
| | | | | | | | | |
Collapse
|
28
|
Affiliation(s)
- C Santosh
- Department of Neuroradiology Southern General Hospital Glasgow, UK.
| |
Collapse
|
29
|
Abstract
OBJECTIVE To assess the suitability and accuracy of magnetic resonance imaging (MRI) in measuring the swelling of the face and lingual tissues after removal of third molar teeth. DESIGN Prospective open study. SETTING Teaching hospital, Scotland. SUBJECTS 5 patients 19-22 years old with bilateral mesioangular impacted wisdom teeth. INTERVENTIONS Magnetic resonance imaging scans taken before, and 1 and 7 days after, removal of bilateral lower wisdom teeth under general anaesthesia. MAIN OUTCOME MEASURES Amount of swelling measured postoperatively compared with preoperatively. Coefficient of analytical variation calculated for the main observer, and between him and a second observer to assess accuracy and reproducibility for each examiner and between examiners. RESULTS Buccal swelling on the first postoperative day was significantly greater than preoperative (P < 0.01). There was no significant difference in lingual swelling. The mean coefficient of variation for the first examiner was 1.92 and there was no significant difference between the two examiners. CONCLUSIONS Measurements on MRI scans are both recordable and reproducible for buccal swelling, but lingual swelling is more difficult to measure because of problems in defining the lateral border of the tongue. MRI scans provide an objective measurement of swelling after extraction of wisdom teeth and could be used to evaluate the efficacy of drug regimens.
Collapse
Affiliation(s)
- J Llewelyn
- Department of Maxillofacial and Oral Surgery, Royal Gwent Hospital, Newport, UK
| | | | | |
Collapse
|
30
|
Egan V, Chiswick A, Santosh C, Naidu K, Rimmington J, Best JJ. Size isn't everything: A study of brain volume, intelligence and auditory evoked potentials. Personality and Individual Differences 1994. [DOI: 10.1016/0191-8869(94)90283-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
31
|
De Silva R, Santosh C. Interpreting fluoroscein angiograms. BMJ 1993; 306:795. [PMID: 8490361 PMCID: PMC1677255 DOI: 10.1136/bmj.306.6880.795-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
32
|
Abstract
This case report concerns the spontaneous closure of a middle cerebral arteriovenous fistula, lesions which are normally treated by surgery or interventional therapy. We have been unable to find any previous report of spontaneous closure of a similar fistula.
Collapse
Affiliation(s)
- C Santosh
- Department of Neuroradiology, Southern General Hospital, Glasgow, UK
| | | | | |
Collapse
|