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Lewén A, Fahlström M, Borota L, Larsson EM, Wikström J, Enblad P. ASL-MRI-guided evaluation of multiple burr hole revascularization surgery in Moyamoya disease. Acta Neurochir (Wien) 2023; 165:2057-2069. [PMID: 37326844 PMCID: PMC10409847 DOI: 10.1007/s00701-023-05641-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/25/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Moyamoya (MM) disease is characterized by progressive intracranial arterial stenosis. Patients commonly need revascularization surgery to optimize cerebral blood flow (CBF). Estimation of CBF and cerebrovascular reserve (CVR) is therefore necessary before and after surgery. However, assessment of CBF before and after indirect revascularization surgery with the multiple burr hole (MBH) technique in MM has not been studied extensively. In this study, we describe our initial experience using arterial spin labeling magnetic resonance perfusion imaging (ASL-MRI) for CBF and CVR assessment before and after indirect MBH revascularization surgery in MM patients. METHODS Eleven MM patients (initial age 6-50 years, 1 male/10 female) with 19 affected hemispheres were included. A total of 35 ASL-MRI examinations were performed using a 3D-pCASL acquisition before and after i.v. acetazolamide challenge (1000 mg in adults and 10 mg/kg in children). Twelve MBH procedures were performed in seven patients. The first follow-up ASL-MRI was performed 7-21 (mean 12) months after surgery. RESULTS Before surgery, CBF was 46 ± 16 (mean ± SD) ml/100 g/min and CVR after acetazolamide challenge was 38.5 ± 9.9 (mean ± SD)% in the most affected territory (middle cerebral artery). In cases in which surgery was not performed, CVR was 56 ± 12 (mean ± SD)% in affected hemispheres. After MBH surgery, there was a relative change in CVR compared to baseline (preop) of + 23.5 ± 23.3% (mean ± SD). There were no new ischemic events. CONCLUSION Using ASL-MRI we followed changes in CBF and CVR in patients with MM. The technique was encouraging for assessments before and after revascularization surgery.
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Affiliation(s)
- Anders Lewén
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala University Hospital, SE 751 85, Uppsala, Sweden.
| | - Markus Fahlström
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Ljubisa Borota
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Johan Wikström
- Department of Surgical Sciences, Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Per Enblad
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala University Hospital, SE 751 85, Uppsala, Sweden
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Vedung F, Fahlström M, Wall A, Antoni G, Lubberink M, Johansson J, Tegner Y, Stenson S, Haller S, Weis J, Larsson EM, Marklund N. Chronic cerebral blood flow alterations in traumatic brain injury and sports-related concussions. Brain Inj 2022; 36:948-960. [PMID: 35950271 DOI: 10.1080/02699052.2022.2109746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PRIMARY OBJECTIVE Traumatic brain injury (TBI) and sports-related concussion (SRC) may result in chronic functional and neuroanatomical changes. We tested the hypothesis that neuroimaging findings (cerebral blood flow (CBF), cortical thickness, and 1H-magnetic resonance (MR) spectroscopy (MRS)) were associated to cognitive function, TBI severity, and sex. RESEARCH DESIGN Eleven controls, 12 athletes symptomatic following ≥3SRCs and 6 patients with moderate-severe TBI underwent MR scanning for evaluation of cortical thickness, brain metabolites (MRS), and CBF using pseudo-continuous arterial spin labeling (ASL). Cognitive screening was performed using the RBANS cognitive test battery. MAIN OUTCOMES AND RESULTS RBANS-index was impaired in both injury groups and correlated with the injury severity, although not with any neuroimaging parameter. Cortical thickness correlated with injury severity (p = 0.02), while neuronal density, using the MRS marker ((NAA+NAAG)/Cr, did not. On multivariate analysis, injury severity (p = 0.0003) and sex (p = 0.002) were associated with CBF. Patients with TBI had decreased gray (p = 0.02) and white matter (p = 0.02) CBF compared to controls. CBF was significantly lower in total gray, white matter and in 16 of the 20 gray matter brain regions in female but not male athletes when compared to female and male controls, respectively. CONCLUSIONS Injury severity correlated with CBF, cognitive function, and cortical thickness. CBF also correlated with sex and was reduced in female, not male, athletes. Chronic CBF changes may contribute to the persistent injury mechanisms in TBI and rSRC.
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Affiliation(s)
- Fredrik Vedung
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | | | - Anders Wall
- PET Centre, Uppsala University Hospital, Uppsala, Sweden.,Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - Gunnar Antoni
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden.,PET Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Jakob Johansson
- Department of Surgical Sciences, Anesthesiology, Uppsala University, Uppsala, Sweden
| | - Yelverton Tegner
- Department of Health Sciences, Luleå University of Technology, Uppsala, Sweden
| | - Staffan Stenson
- Department of Neuroscience, Rehabilitation Medicine, Uppsala, Sweden
| | - Sven Haller
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.,Affidea CDRC Centre de Diagnostic Radiologique de Carouge SA, Geneva, Switzerland
| | - Jan Weis
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Niklas Marklund
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.,Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skåne University Hospital, Lund, Sweden
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Arvanitis P, Johansson AK, Frick M, Malmborg H, Gerovasileiou S, Larsson EM, Blomström-Lundqvist C. Recent-onset atrial fibrillation: a study exploring the elements of Virchow's triad after cardioversion. J Interv Card Electrophysiol 2021; 64:49-58. [PMID: 34689250 PMCID: PMC9236986 DOI: 10.1007/s10840-021-01078-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/10/2021] [Indexed: 12/11/2022]
Abstract
Purpose Atrial fibrillation (AF) imposes an inherent risk for stroke and silent cerebral emboli, partly related to left atrial (LA) remodeling and activation of inflammatory and coagulation systems. The aim was to explore the effects of cardioversion (CV) and short-lasting AF on left atrial hemodynamics, inflammatory, coagulative and cardiac biomarkers, and the association between LA functional recovery and the presence of a prior history of AF. Methods Patients referred for CV within 48 h after AF onset were prospectively included. Echocardiography and blood sampling were performed immediately prior, 1–3 h after, and at 7–10 days after CV. The presence of chronic white matter hyperintensities (WMH) on magnetic resonance imaging was related to biomarker levels. Results Forty-three patients (84% males), aged 55±9.6 years, with median CHA2DS2-VASc score 1 (IQR 0–1) were included. The LA emptying fraction (LAEF), LA peak longitudinal strain during reservoir, conduit, and contractile phases improved significantly after CV. Only LAEF normalized within 10 days. Interleukin-6, high-sensitivity cardiac-troponin-T (hs-cTNT), N-terminal-pro-brain-natriuretic peptide, prothrombin-fragment 1+2 (PTf1+2), and fibrinogen decreased significantly after CV. There was a trend towards higher C-reactive protein, hs-cTNT, and PTf1+2 levels in patients with WMH (n=21) compared to those without (n=22). At 7–10 days, the LAEF was significantly lower in patients with a prior history of AF versus those without. Conclusion Although LA stunning resolved within 10 days, LAEF remained significantly lower in patients with a prior history of AF versus those without. Inflammatory and coagulative biomarkers were higher before CV, but subsided after 7–10 days, which altogether might suggest an enhanced thrombogenicity, even in these low-risk patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01078-9.
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Affiliation(s)
- Panagiotis Arvanitis
- Department of Medical Science and Cardiology, Uppsala University, Sjukhusvägen 9, Ing 35, 75309, Uppsala, Sweden.
| | - Anna-Karin Johansson
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, South Hospital, Stockholm, Sweden
| | - Helena Malmborg
- Department of Medical Science and Cardiology, Uppsala University, Sjukhusvägen 9, Ing 35, 75309, Uppsala, Sweden
| | - Spyridon Gerovasileiou
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Science, Radiology, Uppsala University, Uppsala, Sweden
| | - Carina Blomström-Lundqvist
- Department of Medical Science and Cardiology, Uppsala University, Sjukhusvägen 9, Ing 35, 75309, Uppsala, Sweden
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Marklund N, Vedung F, Lubberink M, Tegner Y, Johansson J, Blennow K, Zetterberg H, Fahlström M, Haller S, Stenson S, Larsson EM, Wall A, Antoni G. Tau aggregation and increased neuroinflammation in athletes after sports-related concussions and in traumatic brain injury patients - A PET/MR study. Neuroimage Clin 2021; 30:102665. [PMID: 33894460 PMCID: PMC8091173 DOI: 10.1016/j.nicl.2021.102665] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/11/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023]
Abstract
Traumatic brain injury (TBI) leads to axonal injury and an inflammatory response. Repeated sports-related concussions (rSRC) are linked to neurodegeneration. We studied tau aggregation and neuroinflammation in rSRC and TBI using PET/MRI. In young rSRC and TBI patients, tau aggregation and neuroinflammation was increased. PET useful when studying the long-term consequences of rSRC and TBI.
Traumatic brain injury (TBI) and repeated sports-related concussions (rSRCs) are associated with an increased risk for neurodegeneration. Autopsy findings of selected cohorts of long-term TBI survivors and rSRC athletes reveal increased tau aggregation and a persistent neuroinflammation. To assess in vivo tau aggregation and neuroinflammation in young adult TBI and rSRC cohorts, we evaluated 9 healthy controls (mean age 26 ± 5 years; 4 males, 5 females), 12 symptomatic athletes (26 ± 7 years; 6 males, 6 females) attaining ≥3 previous SRCs, and 6 moderate-to severe TBI patients (27 ± 7 years; 4 males, 2 females) in a combined positron emission tomography (PET)/magnetic resonance (MR) scanner ≥6 months post-injury. Dual PET tracers, [18F]THK5317 for tau aggregation and [11C]PK11195 for neuroinflammation/microglial activation, were investigated on the same day. The Repeated Battery Assessment of Neurological Status (RBANS) scores, used for cognitive evaluation, were lower in both the rSRC and TBI groups (p < 0.05). Neurofilament-light (NF-L) levels were increased in plasma and cerebrospinal fluid (CSF; p < 0.05), and serum tau levels lower, in TBI although not in rSRC. In rSRC athletes, PET imaging showed increased neuroinflammation in the hippocampus and tau aggregation in the corpus callosum. In TBI patients, tau aggregation was observed in thalami, temporal white matter and midbrain; widespread neuroinflammation was found e.g. in temporal white matter, hippocampus and corpus callosum. In mixed-sex cohorts of young adult athletes with persistent post-concussion symptoms and in TBI patients, increased tau aggregation and neuroinflammation are observed at ≥6 months post-injury using PET. Studies with extended clinical follow-up, biomarker examinations and renewed PET imaging are needed to evaluate whether these findings progress to a neurodegenerative disorder or if spontaneous resolution is possible.
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Affiliation(s)
- Niklas Marklund
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund, Sweden.
| | - Fredrik Vedung
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Sweden
| | - Yelverton Tegner
- Department of Health Sciences, Luleå University of Technology, Sweden
| | - Jakob Johansson
- Department of Surgical Sciences, Anesthesiology, Uppsala University, Sweden
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at UCL, London, United Kingdom; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Markus Fahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Sven Haller
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden; CIMC - Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Genève, Switzerland
| | - Staffan Stenson
- Department of Neuroscience, Rehabilitation Medicine PET Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Anders Wall
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Sweden; Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Gunnar Antoni
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
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Arvanitis P, Johansson AK, Frick M, Malmborg H, Gerovasileiou S, Larsson EM, Blomström-Lundqvist C. Serial Magnetic Resonance Imaging after Electrical Cardioversion of Recent Onset Atrial Fibrillation in Anticoagulant-Naïve Patients - A Prospective Study Exploring Clinically Silent Cerebral Lesions. J Atr Fibrillation 2020; 13:2271. [PMID: 34950290 DOI: 10.4022/jafib.2271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/16/2019] [Revised: 12/27/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022]
Abstract
Background Patients with atrial fibrillation (AF) have a high incidence of cognitive impairment, which may be related to clinically silent microembolism causing cerebral infarctions. Objective To explore the occurrence and timing of silent brain lesions following electrical cardioversion (CV) of recent onset AF in anticoagulant-naïve patients and to study related effects on cognitive function and biomarkers of cerebral damage, S100b. Methods Patients with AF duration > 48 hours were prospectively included. Brain magnetic resonance imaging (MRI) and S100b, were obtained prior, after and 7-10 days following CV. Trail making tests (TMT-A and TMT-B) and their difference, ΔΤΜΤ, were assessed prior to CV, 7-10 days and 30 days after CV. Results Forty-three patients (84% males) with median CHA2DS2-VASc score 1 (interquartile range 0-1) were included. Sequential MRI, including diffusion weighted scans, showed no new brain lesions after CV. Chronic white matter hyperintensities were present at baseline in 21/43 (49%) patients. The S100b (µg/l) levels increased significantly from baseline, (mean ±SD) 0.0472±0.0182 to 0.0551±0.0185 after CV, p=0.001 and then decreased 7-10 days after CV to 0.0450±0.0186, p <.;0.001. Consecutive TMT scores improved successively after CV, being statistically and clinically significant for TMT-B (p<0.01) and ΔΤΜΤ (p=0.005) between 7-10 days and 30 days after CV (Reliable Change Index >1.96). Conclusions New brain lesions could not be detected on MRI after CV, but the high incidence of white matter hyperintensities and the transient increase in S100b may indicate transient or minor brain damage undetectable by MRI thus heightening the need to reevaluate thromboembolic risk prior to CV even in low risk patients.
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Affiliation(s)
- Panagiotis Arvanitis
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden.,Joint primary authors
| | - Anna-Karin Johansson
- Stockholm South General Hospital, Department of Cardiology, Stockholm, Sweden.,Joint primary authors
| | - Mats Frick
- Stockholm South General Hospital, Department of Cardiology, Stockholm, Sweden
| | - Helena Malmborg
- Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden
| | - Spyridon Gerovasileiou
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Science, Radiology, Uppsala University, Uppsala, Sweden
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Velickaite V, Ferreira D, Lind L, Ahlström H, Kilander L, Westman E, Larsson EM. Visual rating versus volumetry of regional brain atrophy and longitudinal changes over a 5-year period in an elderly population. Brain Behav 2020; 10:e01662. [PMID: 32436327 PMCID: PMC7375085 DOI: 10.1002/brb3.1662] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION The purpose of our study was to compare visual rating and volumetry of brain atrophy in an elderly population over a 5-year period and compare findings with cognitive test results. MATERIALS AND METHODS Two hundred and one subjects were examined with magnetic resonance imaging (MRI) of the brain. Visual rating and volumetry were performed in all subjects at ages 75 and 80. Cognitive function at both time points was assessed with the Mini-Mental State Examination (MMSE) and Trail Making Tests A and B (TMT-A and TMT-B). Changes in visual rating and volumetry were compared with changes in cognitive test. RESULTS A correlation was found between visual rating of medial temporal lobe atrophy (MTA) and hippocampal volumetry at both time points (rs = -.42 and rs = -.49, p < .001, respectively). The correlation between visual rating of posterior atrophy (PA); frontal atrophy (F-GCA) and volumetry of these brain regions was significant only at age 80 (rs = -.16, p = .02 for PA and rpb = .19, p = .006 for F-GCA). Visual rating showed only a minimal progression of regional atrophy at age 80, whereas volumetry showed 2%-5% decrease in volume depending on brain region. Performance in the MMSE, TMT-A, and TMT-B was virtually unchanged between ages 75 and 80. CONCLUSION We found a mild age-associated decrease in regional brain volumes in this healthy cohort with well-preserved cognitive functions. Visual assessment may not be sufficient for detecting mild progression of brain atrophy due to normal aging, whereas volumetry is more sensitive to capture these subtle changes.
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Affiliation(s)
- Vilma Velickaite
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Centre for Alzheimer's Research, Karolinska Institute, Huddinge, Sweden
| | - Lars Lind
- Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Erik Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Centre for Alzheimer's Research, Karolinska Institute, Huddinge, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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7
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Arvanitis P, Johansson AK, Frick M, Malmborg H, Larsson EM, Blomstrom Lundqvist C. P1080Magnetic resonance imaging after electrical cardioversion of recent-onset atrial fibrillation in anticoagulant-naive patients - a study exploring clinically silent cerebral lesions. Europace 2020. [DOI: 10.1093/europace/euaa162.377] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Unrestricted grants from the Swedish Heart-Lung Foundation, the Swedish Research Council, Correvio International Sárl (CH) and Selanders stiftelse
Background
Patients with atrial fibrillation (AF) have a high incidence of cognitive impairment, which may be related to clinically silent microembolism causing cerebral infarctions.
Purpose
To explore the occurrence and timing of silent brain lesions following electrical cardioversion (CV) of recent onset AF in anticoagulant-naïve patients and to further study related effects on cognitive function and biomarkers of cerebral damage, S100b.
Methods
Patients with AF duration < 48 hours were prospectively included. Brain magnetic resonance imaging (MRI) and S100b, were obtained prior, after and 7-10 days following CV. Trail making tests (TMT-A and TMT-B) and their difference, ΔΤΜΤ, were assessed prior to CV, 7-10 days and 30 days after CV.
Results
Forty-three patients (84% males) with mean CHA2DS2-VASc score 0.6 ± 0.7 were included. Sequential MRI, including diffusion weighted scans, showed no new brain lesions after CV.
Chronic white matter hyperintensities (WMH) were present at baseline in 21/43 (49%) patients. By partitioning the study population into four major groups according to the extend of WMH (Fazekas score 0 or ≥ 1) and the presence or absence of TE risk factors (CHA2DS2-VASc score 0 or ≥ 1), the TE risk as defined by CHA2DS2-VASc score ≥ 1, was associated with a higher incidence of WMH, Pearson χ2(1,N = 43)=3.95, p = 0.047.
The S100b (µg/l) levels increased significantly from baseline, (mean ± SD) 0.0472 ± 0.0182 to 0.0551 ± 0.0185 after CV, p = 0.001 and then decreased 7-10 days after CV to 0.0450 ± 0.0186, p < 0.001. Subgroup analysis according to the presence of at least one TE risk factor as defined by CHA2DS2-VASc score showed that statistical significance of repeated measures ANOVA was maintained; for patients with no risk factors F (2,30)=12.59, p < 0.001 and for patients with CHA2DS2-VASc score ≥1 F(2,36)=4.43, p < 0.019.
Consecutive TMT scores improved successively after CV, being statistically and clinically significant for TMT-B (p < 0.01) and ΔΤΜΤ (p = 0.005) between 7-10 days and 30 days after CV (Reliable Change Index >1.96).
Conclusion
New brain lesions could not be detected on MRI after CV, but the high incidence of white matter hyperintensities and the transient increase in S100b may indicate transient or minor brain damage undetectable by MRI thus heightening the need to reevaluate thromboembolic risk prior to CV even in low risk patients.
Abstract Figure. S100b_TMT
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Affiliation(s)
- P Arvanitis
- Uppsala University, Uppsala University Hospital, Dep. of Cardiology, Uppsala, Sweden
| | - A K Johansson
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - M Frick
- South Hospital Stockholm, Dep. of Cardiology, Stockholm, Sweden
| | - H Malmborg
- Uppsala University, Uppsala University Hospital, Dep. of Cardiology, Uppsala, Sweden
| | - E M Larsson
- Uppsala University, Uppsala University Hospital, Dep. of Radiology, Uppsala, Sweden
| | - C Blomstrom Lundqvist
- Uppsala University, Uppsala University Hospital, Dep. of Cardiology, Uppsala, Sweden
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8
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Virhammar J, Ahlgren A, Cesarini KG, Laurell K, Larsson EM. Cerebral Perfusion Does Not Increase after Shunt Surgery for Normal Pressure Hydrocephalus. J Neuroimaging 2020; 30:303-307. [PMID: 32374437 DOI: 10.1111/jon.12702] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/24/2020] [Accepted: 03/03/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Cerebral blood flow (CBF) has been reported to increase after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). The aims of this study were to investigate if CBF, measured using the noninvasive perfusion MRI method arterial spin labeling (ASL), increased after shunt surgery, if postoperative change in CBF correlated with improvement in symptoms, and if baseline CBF data correlated with postoperative outcome. METHODS Twenty-three patients with iNPH were prospectively included and examined with MRI of the brain and clinical tests of symptoms at baseline. Eighteen of the patients were treated with shunt implantation and were reexamined with clinical tests and MRI 3 months postoperatively. The MRI protocol included a pseudo-continuous ASL sequence for perfusion imaging. The perfusion was measured in 12 manually drawn regions of interest (ROIs). RESULTS In the whole sample, CBF did not increase after shunting in any ROI. Preoperative CBF in medial frontal cortex correlated with an improvement in urinary incontinence after shunt surgery, r = .53, P = .022. There were no correlations between change in CBF and change in clinical symptoms postoperatively. CONCLUSIONS The clinical value of ASL in the work-up of patients with iNPH is uncertain. In this study, ASL could not predict outcome after shunt surgery and there were no correlations between change in CBF and change in clinical symptoms after shunt surgery.
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Affiliation(s)
- Johan Virhammar
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - André Ahlgren
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | | | - Katarina Laurell
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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Kockum K, Virhammar J, Riklund K, Söderström L, Larsson EM, Laurell K. Diagnostic accuracy of the iNPH Radscale in idiopathic normal pressure hydrocephalus. PLoS One 2020; 15:e0232275. [PMID: 32330190 PMCID: PMC7182203 DOI: 10.1371/journal.pone.0232275] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/10/2020] [Indexed: 11/22/2022] Open
Abstract
Background and purpose The idiopathic normal pressure hydrocephalus (iNPH) Radscale was developed to standardize the evaluation of radiological signs in iNPH. The purpose of this study was to estimate the diagnostic accuracy of the iNPH Radscale in a sample of “true positive” and “true negative” cases. Methods Seventy-five patients with definite iNPH, i.e. who had improved at clinical follow-up one year after ventriculoperitoneal shunt surgery, were compared with 55 asymptomatic individuals from the general population. A radiologist assessed the seven radiological features of the iNPH Radscale in computed tomography of the brain in the patients (preoperatively) and controls. Results The iNPH Radscale score was significantly higher in the iNPH group (Median = 10, interquartile range 9–11) than in the control group (Median = 1, interquartile range 1–2) (p <0.001). Receiver operated characteristics analysis yielded an area under the curve of 99.7%, and an iNPH Radscale score ≤ 4 identified those without iNPH, with a sensitivity of 100%, specificity of 96% and overall accuracy of 98.5%. Conclusions In this study, iNPH Radscale could accurately discriminate between patients with definite iNPH and asymptomatic individuals over 65 years old. According to the results, a diagnosis of iNPH is very likely in patients with an iNPH Radscale score above 8 and corresponding clinical symptoms. On the other hand, the diagnosis should be questioned when the iNPH Radscale score is below the cut-off level of 4. We conclude that the iNPH Radscale could work as a diagnostic screening tool to detect iNPH. Whether the scale also can be used to predict shunt outcome needs further studies.
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Affiliation(s)
- Karin Kockum
- Department of Clinical Science, Neurosciences, Umeå university, Östersund, Sweden
- * E-mail:
| | - Johan Virhammar
- Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Lars Söderström
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Katarina Laurell
- Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala, Sweden
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10
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Frick A, Engman J, Alaie I, Björkstrand J, Gingnell M, Larsson EM, Eriksson E, Wahlstedt K, Fredrikson M, Furmark T. Neuroimaging, genetic, clinical, and demographic predictors of treatment response in patients with social anxiety disorder. J Affect Disord 2020; 261:230-237. [PMID: 31655378 DOI: 10.1016/j.jad.2019.10.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 04/06/2019] [Revised: 08/30/2019] [Accepted: 10/19/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Correct prediction of treatment response is a central goal of precision psychiatry. Here, we tested the predictive accuracy of a variety of pre-treatment patient characteristics, including clinical, demographic, molecular genetic, and neuroimaging markers, for treatment response in patients with social anxiety disorder (SAD). METHODS Forty-seven SAD patients (mean±SD age 33.9 ± 9.4 years, 24 women) were randomized and commenced 9 weeks' Internet-delivered cognitive behavior therapy (CBT) combined either with the selective serotonin reuptake inhibitor (SSRI) escitalopram (20 mg daily [10 mg first week], SSRI+CBT, n = 24) or placebo (placebo+CBT, n = 23). Treatment responders were defined from the Clinical Global Impression-Improvement scale (CGI-I ≤ 2). Before treatment, patients underwent functional magnetic resonance imaging and the Multi-Source Interference Task taxing cognitive interference. Support vector machines (SVMs) were trained to separate responders from nonresponders based on pre-treatment neural reactivity in the dorsal anterior cingulate cortex (dACC), amygdala, and occipital cortex, as well as molecular genetic, demographic, and clinical data. SVM models were tested using leave-one-subject-out cross-validation. RESULTS The best model separated treatment responders (n = 24) from nonresponders based on pre-treatment dACC reactivity (83% accuracy, P = 0.001). Responders had greater pre-treatment dACC reactivity than nonresponders especially in the SSRI+CBT group. No other variable was associated with clinical response or added predictive accuracy to the dACC SVM model. LIMITATIONS Small sample size, especially for genetic analyses. No replication or validation samples were available. CONCLUSIONS The findings demonstrate that treatment outcome predictions based on neural cingulate activity, at the individual level, outperform genetic, demographic, and clinical variables for medication-assisted Internet-delivered CBT, supporting the use of neuroimaging in precision psychiatry.
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Affiliation(s)
- Andreas Frick
- The Beijer Laboratory, Department of Neuroscience, Uppsala University, Uppsala, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Jonas Engman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Iman Alaie
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Johannes Björkstrand
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Psychology, Lund University, Lund, Sweden
| | - Malin Gingnell
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - Elias Eriksson
- Department of Pharmacology, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kurt Wahlstedt
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
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11
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Olivo G, Zhukovsky C, Salonen-Ros H, Larsson EM, Brooks S, Schiöth HB. Functional connectivity underlying hedonic response to food in female adolescents with atypical AN: the role of somatosensory and salience networks. Transl Psychiatry 2019; 9:276. [PMID: 31699967 PMCID: PMC6838122 DOI: 10.1038/s41398-019-0617-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/05/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
Atypical anorexia nervosa (AN) usually occurs during adolescence. Patients are often in the normal-weight range at diagnosis; however, they often present with signs of medical complications and severe restraint over eating, body dissatisfaction, and low self-esteem. We investigated functional circuitry underlying the hedonic response in 28 female adolescent patients diagnosed with atypical AN and 33 healthy controls. Participants were shown images of food with high (HC) or low (LC) caloric content in alternating blocks during functional MRI. The HC > LC contrast was calculated. Based on the previous literature on full-threshold AN, we hypothesized that patients would exhibit increased connectivity in areas involved in sensory processing and bottom-up responses, coupled to increased connectivity from areas related to top-down inhibitory control, compared with controls. Patients showed increased connectivity in pathways related to multimodal somatosensory processing and memory retrieval. The connectivity was on the other hand decreased in patients in salience and attentional networks, and in a wide cerebello-occipital network. Our study was the first investigation of food-related neural response in atypical AN. Our findings support higher somatosensory processing in patients in response to HC food images compared with controls, however HC food was less efficient than LC food in engaging patients' bottom-up salient responses, and was not associated with connectivity increases in inhibitory control regions. These findings suggest that the psychopathological mechanisms underlying food restriction in atypical AN differ from full-threshold AN. Elucidating the mechanisms underlying the development and maintenance of eating behavior in atypical AN might help designing specific treatment strategies.
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Affiliation(s)
- Gaia Olivo
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden.
| | - Christina Zhukovsky
- 0000 0004 1936 9457grid.8993.bDepartment of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Helena Salonen-Ros
- 0000 0004 1936 9457grid.8993.bDepartment of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- 0000 0004 1936 9457grid.8993.bDepartment of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Samantha Brooks
- 0000 0004 1936 9457grid.8993.bDepartment of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden ,0000 0004 1937 1151grid.7836.aDepartment of Human Biology, University of Cape Town, Cape Town, South Africa ,School of Natural Sciences and Psychology, Research Centre for Brain & Behaviour, Byrom Street, Liverpool, UK
| | - Helgi B. Schiöth
- 0000 0004 1936 9457grid.8993.bDepartment of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden ,0000 0001 2288 8774grid.448878.fInstitute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia
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12
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Falk Delgado A, Van Westen D, Nilsson M, Knutsson L, Sundgren PC, Larsson EM, Falk Delgado A. Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging-a comprehensive overview. Insights Imaging 2019; 10:84. [PMID: 31444580 PMCID: PMC6708018 DOI: 10.1186/s13244-019-0771-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/12/2019] [Indexed: 12/16/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) increase lesion detection and improve disease characterization for many cerebral pathologies investigated with MRI. These agents, introduced in the late 1980s, are in wide use today. However, some non-ionic linear GBCAs have been associated with the development of nephrogenic systemic fibrosis in patients with kidney failure. Gadolinium deposition has also been found in deep brain structures, although it is of unclear clinical relevance. Hence, new guidelines from the International Society for Magnetic Resonance in Medicine advocate cautious use of GBCA in clinical and research practice. Some linear GBCAs were restricted from use by the European Medicines Agency (EMA) in 2017. This review focuses on non-contrast-enhanced MRI techniques that can serve as alternatives for the use of GBCAs. Clinical studies on the diagnostic performance of non-contrast-enhanced as well as contrast-enhanced MRI methods, both well established and newly proposed, were included. Advantages and disadvantages together with the diagnostic performance of each method are detailed. Non-contrast-enhanced MRIs discussed in this review are arterial spin labeling (ASL), time of flight (TOF), phase contrast (PC), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), susceptibility weighted imaging (SWI), and amide proton transfer (APT) imaging. Ten common diseases were identified for which studies reported comparisons of non-contrast-enhanced and contrast-enhanced MRI. These specific diseases include primary brain tumors, metastases, abscess, multiple sclerosis, and vascular conditions such as aneurysm, arteriovenous malformation, arteriovenous fistula, intracranial carotid artery occlusive disease, hemorrhagic, and ischemic stroke. In general, non-contrast-enhanced techniques showed comparable diagnostic performance to contrast-enhanced MRI for specific diagnostic questions. However, some diagnoses still require contrast-enhanced imaging for a complete examination.
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Affiliation(s)
- Anna Falk Delgado
- Clinical neurosciences, Karolinska Institutet, Stockholm, Sweden. .,Department of Neuroradiology, Karolinska University Hospital, Eugeniavägen 3, Solna, Stockholm, Sweden.
| | - Danielle Van Westen
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Markus Nilsson
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden.,Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Pia C Sundgren
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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13
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Georgiopoulos C, Witt ST, Haller S, Dizdar N, Zachrisson H, Engström M, Larsson EM. A study of neural activity and functional connectivity within the olfactory brain network in Parkinson's disease. Neuroimage Clin 2019; 23:101946. [PMID: 31491835 PMCID: PMC6661283 DOI: 10.1016/j.nicl.2019.101946] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/23/2019] [Accepted: 07/17/2019] [Indexed: 01/16/2023]
Abstract
Olfactory dysfunction is an early manifestation of Parkinson's disease (PD). The present study aimed to illustrate potential differences between PD patients and healthy controls in terms of neural activity and functional connectivity within the olfactory brain network. Twenty PD patients and twenty healthy controls were examined with olfactory fMRI and resting-state fMRI. Data analysis of olfactory fMRI included data-driven tensorial independent component (ICA) and task-driven general linear model (GLM) analyses. Data analysis of resting-state fMRI included probabilistic ICA based on temporal concatenation and functional connectivity analysis within the olfactory network. ICA of olfactory fMRI identified an olfactory network consisting of the posterior piriform cortex, insula, right orbitofrontal cortex and thalamus. Recruitment of this network was less significant for PD patients. GLM analysis revealed significantly lower activity in the insula bilaterally and the right orbitofrontal cortex in PD compared to healthy controls but no significant differences in the olfactory cortex itself. Analysis of resting-state fMRI did not reveal any differences in the functional connectivity within the olfactory, default mode, salience or central executive networks between the two groups. In conclusion, olfactory dysfunction in PD is associated with less significant recruitment of the olfactory brain network. ICA could demonstrate differences in both the olfactory cortex and its main projections, compared to GLM that revealed differences only on the latter. Resting-state fMRI did not reveal any significant differences in functional connectivity within the olfactory, default mode, salience and central executive networks in this cohort. Less significant recruitment of the olfactory brain network was found in Parkinson's disease. Independent component analysis reveals differences in both olfactory cortex and its projections. Differences in functional connectivity within the olfactory network were not significant.
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Affiliation(s)
- Charalampos Georgiopoulos
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Suzanne T Witt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Sven Haller
- Centre Imagerie Rive Droite SA, Geneva, Switzerland; Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - Nil Dizdar
- Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Engström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
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14
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Georgiopoulos C, Witt ST, Haller S, Dizdar N, Zachrisson H, Engström M, Larsson EM. Olfactory fMRI: Implications of Stimulation Length and Repetition Time. Chem Senses 2019; 43:389-398. [PMID: 29726890 DOI: 10.1093/chemse/bjy025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Studying olfaction with functional magnetic resonance imaging (fMRI) poses various methodological challenges. This study aimed to investigate the effects of stimulation length and repetition time (TR) on the activation pattern of 4 olfactory brain regions: the anterior and the posterior piriform cortex, the orbitofrontal cortex, and the insula. Twenty-two healthy participants with normal olfaction were examined with fMRI, with 2 stimulation lengths (6 s and 15 s) and 2 TRs (0.901 s and 1.34 s). Data were analyzed using General Linear Model (GLM), Tensorial Independent Component Analysis (TICA), and by plotting the event-related time course of brain activation in the 4 olfactory regions of interest. The statistical analysis of the time courses revealed that short TR was associated with more pronounced signal increase and short stimulation was associated with shorter time to peak signal. Additionally, both long stimulation and short TR were associated with oscillatory time courses, whereas both short stimulation and short TR resulted in more typical time courses. GLM analysis showed that the combination of short stimulation and short TR could result in visually larger activation within these olfactory areas. TICA validated that the tested paradigm was spatially and temporally associated with a functionally connected network that included all 4 olfactory regions. In conclusion, the combination of short stimulation and short TR is associated with higher signal increase and shorter time to peak, making it more amenable to standard GLM-type analyses than long stimulation and long TR, and it should, thus, be preferable for olfactory fMRI.
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Affiliation(s)
- Charalampos Georgiopoulos
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Röntgenkliniken, Universitetssjukhuset, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, University Hospital, Linköping, Sweden
| | - Suzanne T Witt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, University Hospital, Linköping, Sweden
| | - Sven Haller
- Affidea CDRC Centre de Diagnostic Radiologique de Carouge SA, clos de la Fonderie, Geneva, Switzerland.,Department of Surgical Sciences/Radiology, Uppsala University, Akademiska sjukhuset Uppsala, Sweden
| | - Nil Dizdar
- Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Engström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, University Hospital, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Sandbäcksgatan, Linköping, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences/Radiology, Uppsala University, Akademiska sjukhuset Uppsala, Sweden
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15
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Latini F, Fahlström M, Berntsson SG, Larsson EM, Smits A, Ryttlefors M. A novel radiological classification system for cerebral gliomas: The Brain-Grid. PLoS One 2019; 14:e0211243. [PMID: 30677090 PMCID: PMC6345500 DOI: 10.1371/journal.pone.0211243] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/09/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Standard radiological/topographical classifications of gliomas often do not reflect the real extension of the tumor within the lobar-cortical anatomy. Furthermore, these systems do not provide information on the relationship between tumor growth and the subcortical white matter architecture. We propose the use of an anatomically standardized grid system (the Brain-Grid) to merge serial morphological magnetic resonance imaging (MRI) scans with a representative tractographic atlas. Two illustrative cases are presented to show the potential advantages of this classification system. Methods MRI scans of 39 patients (WHO grade II and III gliomas) were analyzed with a standardized grid created by intersecting longitudinal lines on the axial, sagittal, and coronal planes. The anatomical landmarks were chosen from an average brain, spatially normalized to the Montreal Neurological Institute (MNI) space and the Talairach space. Major white matter pathways were reconstructed with a deterministic tracking algorithm on a reference atlas and analyzed using the Brain-Grid system. Results In all, 48 brain grid voxels (areas defined by 3 coordinates, axial (A), coronal (C), sagittal (S) and numbers from 1 to 4) were delineated in each MRI sequence and on the tractographic atlas. The number of grid voxels infiltrated was consistent, also in the MNI space. The sub-cortical insula/basal ganglia (A3-C2-S2) and the fronto-insular region (A3-C2-S1) were most frequently involved. The inferior fronto-occipital fasciculus, anterior thalamic radiation, uncinate fasciculus, and external capsule were the most frequently associated pathways in both hemispheres. Conclusions The Brain-Grid based classification system provides an accurate observational tool in all patients with suspected gliomas, based on the comparison of grid voxels on a morphological MRI and segmented white matter atlas. Important biological information on tumor kinetics including extension, speed, and preferential direction of progression can be observed and even predicted with this system. This novel classification can easily be applied to both prospective and retrospective cohorts of patients and increase our comprehension of glioma behavior.
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Affiliation(s)
- Francesco Latini
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Markus Fahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Shala G. Berntsson
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Anja Smits
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Ryttlefors
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
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Fahlström M, Fransson S, Blomquist E, Nyholm T, Larsson EM. Dynamic contrast-enhanced magnetic resonance imaging may act as a biomarker for vascular damage in normal appearing brain tissue after radiotherapy in patients with glioblastoma. Acta Radiol Open 2018; 7:2058460118808811. [PMID: 30542625 PMCID: PMC6236579 DOI: 10.1177/2058460118808811] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022] Open
Abstract
Background Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a promising perfusion method and may be useful in evaluating radiation-induced changes in normal-appearing brain tissue. Purpose To assess whether radiotherapy induces changes in vascular permeability (Ktrans) and the fractional volume of the extravascular extracellular space (Ve) derived from DCE-MRI in normal-appearing brain tissue and possible relationships to radiation dose given. Material and Methods Seventeen patients with glioblastoma treated with radiotherapy and chemotherapy were included; five were excluded because of inconsistencies in the radiotherapy protocol or early drop-out. DCE-MRI, contrast-enhanced three-dimensional (3D) T1-weighted (T1W) images and T2-weighted fluid attenuated inversion recovery (T2-FLAIR) images were acquired before and on average 3.3, 30.6, 101.6, and 185.7 days after radiotherapy. Pre-radiotherapy CE T1W and T2-FLAIR images were segmented into white and gray matter, excluding all non-healthy tissue. Ktrans and Ve were calculated using the extended Kety model with the Parker population-based arterial input function. Six radiation dose regions were created for each tissue type, based on each patient’s computed tomography-based dose plan. Mean Ktrans and Ve were calculated over each dose region and tissue type. Results Global Ktrans and Ve demonstrated mostly non-significant changes with mean values higher for post-radiotherapy examinations in both gray and white matter compared to pre-radiotherapy. No relationship to radiation dose was found. Conclusion Additional studies are needed to validate if Ktrans and Ve derived from DCE-MRI may act as potential biomarkers for acute and early-delayed radiation-induced vascular damages. No dose-response relationship was found.
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Affiliation(s)
- Markus Fahlström
- Department of Radiology, Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Samuel Fransson
- Department of Radiology, Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Blomquist
- Department of Experimental and Clinical Oncology, Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tufve Nyholm
- Department of Radiation Physics, Radiation Sciences, Umeå University, Umeå, Sweden
| | - Elna-Marie Larsson
- Department of Radiology, Surgical Sciences, Uppsala University, Uppsala, Sweden
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17
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Sousa JM, Appel L, Engström M, Papadimitriou S, Nyholm D, Larsson EM, Ahlström H, Lubberink M. Evaluation of zero-echo-time attenuation correction for integrated PET/MR brain imaging-comparison to head atlas and 68Ge-transmission-based attenuation correction. EJNMMI Phys 2018; 5:20. [PMID: 30345471 PMCID: PMC6196145 DOI: 10.1186/s40658-018-0220-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/09/2018] [Accepted: 06/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND MRI does not offer a direct method to obtain attenuation correction maps as its predecessors (stand-alone PET and PET/CT), and bone visualisation is particularly challenging. Recently, zero-echo-time (ZTE) was suggested for MR-based attenuation correction (AC). The aim of this work was to evaluate ZTE- and atlas-AC by comparison to 68Ge-transmission scan-based AC. Nine patients underwent brain PET/MR and stand-alone PET scanning using the dopamine transporter ligand 11C-PE2I. For each of them, two AC maps were obtained from the MR images: an atlas-based, obtained from T1-weighted LAVA-FLEX imaging with cortical bone inserted using a CT-based atlas, and an AC map generated from proton-density-weighted ZTE images. Stand-alone PET 68Ge-transmission AC map was used as gold standard. PET images were reconstructed using the three AC methods and standardised uptake value (SUV) values for the striatal, limbic and cortical regions, as well as the cerebellum (VOIs) were compared. SUV ratio (SUVR) values normalised for the cerebellum were also assessed. Bias, precision and agreement were calculated; statistical significance was evaluated using Wilcoxon matched-pairs signed-rank test. RESULTS Both ZTE- and atlas-AC showed a similar bias of 6-8% in SUV values across the regions. Correlation coefficients with 68Ge-AC were consistently high for ZTE-AC (r 0.99 for all regions), whereas they were lower for atlas-AC, varying from 0.99 in the striatum to 0.88 in the posterior cortical regions. SUVR showed an overall bias of 2.9 and 0.5% for atlas-AC and ZTE-AC, respectively. Correlations with 68Ge-AC were higher for ZTE-AC, varying from 0.99 in the striatum to 0.96 in the limbic regions, compared to atlas-AC (0.99 striatum to 0.77 posterior cortex). CONCLUSIONS Absolute SUV values showed less variability for ZTE-AC than for atlas-AC when compared to 68Ge-AC, but bias was similar for both methods. This bias is largely caused by higher linear attenuation coefficients in atlas- and ZTE-AC image compared to 68Ge-images. For SUVR, bias was lower when using ZTE-AC than for atlas-AC. ZTE-AC shows to be a more robust technique than atlas-AC in terms of both intra- and inter-patient variability.
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Affiliation(s)
- João M Sousa
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
- PET Centre, Uppsala University Hospital, 75185, Uppsala, Sweden.
| | - Lieuwe Appel
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | | | - Stergios Papadimitriou
- Department of Neurosciences, Uppsala University, Uppsala, Sweden
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - Dag Nyholm
- Department of Neurosciences, Uppsala University, Uppsala, Sweden
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
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Leijonmarck C, Latini F, Libard S, Larsson EM, Hesselager G. P01.163 Impact of absolute postoperative tumor volume on survival in glioblastoma and significance of MGMT-methylation status for benefit of increasing surgical resection. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Leijonmarck
- Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| | - F Latini
- Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| | - S Libard
- Department of Immunology, Genetics and Pathology, Section of Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - E M Larsson
- Department of Surgical Sciences, Section of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - G Hesselager
- Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
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Clement P, Mutsaerts HJ, Václavů L, Ghariq E, Pizzini FB, Smits M, Acou M, Jovicich J, Vanninen R, Kononen M, Wiest R, Rostrup E, Bastos-Leite AJ, Larsson EM, Achten E. Variability of physiological brain perfusion in healthy subjects - A systematic review of modifiers. Considerations for multi-center ASL studies. J Cereb Blood Flow Metab 2018; 38:1418-1437. [PMID: 28393659 PMCID: PMC6120130 DOI: 10.1177/0271678x17702156] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Quantitative measurements of brain perfusion are influenced by perfusion-modifiers. Standardization of measurement conditions and correction for important modifiers is essential to improve accuracy and to facilitate the interpretation of perfusion-derived parameters. An extensive literature search was carried out for factors influencing quantitative measurements of perfusion in the human brain unrelated to medication use. A total of 58 perfusion modifiers were categorized into four groups. Several factors (e.g., caffeine, aging, and blood gases) were found to induce a considerable effect on brain perfusion that was consistent across different studies; for other factors, the modifying effect was found to be debatable, due to contradictory results or lack of evidence. Using the results of this review, we propose a standard operating procedure, based on practices already implemented in several research centers. Also, a theory of 'deep MRI physiotyping' is inferred from the combined knowledge of factors influencing brain perfusion as a strategy to reduce variance by taking both personal information and the presence or absence of perfusion modifiers into account. We hypothesize that this will allow to personalize the concept of normality, as well as to reach more rigorous and earlier diagnoses of brain disorders.
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Affiliation(s)
- Patricia Clement
- 1 Department of Radiology and nuclear medicine, Ghent University, Ghent, Belgium
| | - Henk-Jan Mutsaerts
- 2 Cognitive Neurology Research Unit, Sunnybrook Healthy Sciences Centre, Toronto, Canada.,3 Academic Medical Center, Amsterdam, the Netherlands
| | - Lena Václavů
- 3 Academic Medical Center, Amsterdam, the Netherlands
| | - Eidrees Ghariq
- 4 Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Marjan Acou
- 1 Department of Radiology and nuclear medicine, Ghent University, Ghent, Belgium
| | - Jorge Jovicich
- 7 Magnetic Resonance Imaging Laboratory Center for Mind/Brain Sciences, University of Trento, Mattarello, Italy
| | | | | | | | - Egill Rostrup
- 10 Department of Diagnostics, Glostrup Hospital, University of Copenhagen, Denmark
| | | | | | - Eric Achten
- 1 Department of Radiology and nuclear medicine, Ghent University, Ghent, Belgium
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Fällmar D, Lilja J, Danfors T, Kilander L, Iyer V, Lubberink M, Larsson EM, Sörensen J. Z-score maps from low-dose 18F-FDG PET of the brain in neurodegenerative dementia. Am J Nucl Med Mol Imaging 2018; 8:239-246. [PMID: 30245916 PMCID: PMC6146163] [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] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
Neuroimaging is a central part of diagnostic work-up of patients with suspected neurodegenerative disease. FDG-PET can reveal pathological changes earlier and more reliably than morphological imaging. Diagnostic accuracy can be improved by constructing 3D SSP Z-score maps, showing patterns of significant deficits. During FDG-PET, the subject receives a moderate but not insignificant dose of ionizing radiation, and a dose reduction with retained image quality is desirable. With lower dose, repeated examinations can become a useful tool for monitoring disease progress and potential effects of disease-modifying interventions. The aim of this study was to evaluate Z-maps created from low-dose and normal-dose FDG-PET of the brain, with quantitative and qualitative methods. Nine patients with neurodegenerative disorders were prospectively enrolled and nine age-matched controls were recruited through advertising. All subjects (n=18) underwent two FDG-PET scans on separate occasions; a routine and a low-dose scan. The routine dosage of FDG was 3 MBq/kg, and low dosage was 0.75 MBq/kg. 3D-SSP images showing Z-scores of < -1.96 were created from 10-minute summations. The study was comprised of a quantitative part comparing the Z-scores, and a qualitative part where experienced nuclear medicine specialists visually assessed the images. Regarding the quantitative part, Bland-Altman analysis showed a slight constant bias (0.206). Regarding qualitative discrimination between patients and controls, the performance between normal- and low-dose were equal, both showing 72% sensitivity, 83% specificity and 78% accuracy. In this study, visual assessment of 3D-SSP Z-score maps from low-dose FDG-PET provided diagnostic information highly comparable to normal-dose, with minor quantitative discrepancies.
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Affiliation(s)
- David Fällmar
- Department of Surgical Sciences, Radiology, Uppsala UniversityUppsala, Sweden
| | - Johan Lilja
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala UniversityUppsala, Sweden
- Hermes Medical SolutionsStockholm, Sweden
| | - Torsten Danfors
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala UniversityUppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala UniversityUppsala, Sweden
| | - Victor Iyer
- Department of Nuclear Medicine, Aalborg University HospitalAalborg, Denmark
| | - Mark Lubberink
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala UniversityUppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala UniversityUppsala, Sweden
| | - Jens Sörensen
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala UniversityUppsala, Sweden
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21
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Roodakker KR, Alhuseinalkhudhur A, Al-Jaff M, Georganaki M, Zetterling M, Berntsson SG, Danfors T, Strand R, Edqvist PH, Dimberg A, Larsson EM, Smits A. Region-by-region analysis of PET, MRI, and histology in en bloc-resected oligodendrogliomas reveals intra-tumoral heterogeneity. Eur J Nucl Med Mol Imaging 2018; 46:569-579. [PMID: 30109401 PMCID: PMC6351509 DOI: 10.1007/s00259-018-4107-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 06/04/2018] [Accepted: 07/20/2018] [Indexed: 12/21/2022]
Abstract
Purpose Oligodendrogliomas are heterogeneous tumors in terms of imaging appearance, and a deeper understanding of the histopathological tumor characteristics in correlation to imaging parameters is needed. We used PET-to-MRI-to-histology co-registration with the aim of studying intra-tumoral 11C-methionine (MET) uptake in relation to tumor perfusion and the protein expression of histological cell markers in corresponding areas. Methods Consecutive histological sections of four tumors covering the entire en bloc-removed tumor were immunostained with antibodies against IDH1-mutated protein (tumor cells), Ki67 (proliferating cells), and CD34 (blood vessels). Software was developed for anatomical landmarks-based co-registration of subsequent histological images, which were overlaid on corresponding MET PET scans and MRI perfusion maps. Regions of interest (ROIs) on PET were selected throughout the entire tumor volume, covering hot spot areas, areas adjacent to hot spots, and tumor borders with infiltrating zone. Tumor-to-normal tissue (T/N) ratios of MET uptake and mean relative cerebral blood volume (rCBV) were measured in the ROIs and protein expression of histological cell markers was quantified in corresponding regions. Statistical correlations were calculated between MET uptake, rCBV, and quantified protein expression. Results A total of 84 ROIs were selected in four oligodendrogliomas. A significant correlation (p < 0.05) between MET uptake and tumor cell density was demonstrated in all tumors separately. In two tumors, MET correlated with the density of proliferating cells and vessel cell density. There were no significant correlations between MET uptake and rCBV, and between rCBV and histological cell markers. Conclusions The MET uptake in hot spots, outside hotspots, and in infiltrating tumor edges unanimously reflects tumor cell density. The correlation between MET uptake and vessel density and density of proliferating cells is less stringent in infiltrating tumor edges and is probably more susceptible to artifacts caused by larger blood vessels surrounding the tumor. Although based on a limited number of samples, this study provides histological proof for MET as an indicator of tumor cell density and for the lack of statistically significant correlations between rCBV and histological cell markers in oligodendrogliomas. Electronic supplementary material The online version of this article (10.1007/s00259-018-4107-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kenney Roy Roodakker
- Department of Neuroscience, Neurology, Uppsala University, University Hospital, S-751 85, Uppsala, Sweden.
| | - Ali Alhuseinalkhudhur
- Department of Neuroscience, Neurology, Uppsala University, University Hospital, S-751 85, Uppsala, Sweden
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Mohammed Al-Jaff
- Department of Information Technology, Division of Visual Information and Interaction, Uppsala University, Uppsala, Sweden
| | - Maria Georganaki
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Maria Zetterling
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Shala G Berntsson
- Department of Neuroscience, Neurology, Uppsala University, University Hospital, S-751 85, Uppsala, Sweden
| | - Torsten Danfors
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Robin Strand
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Department of Information Technology, Division of Visual Information and Interaction, Uppsala University, Uppsala, Sweden
| | - Per-Henrik Edqvist
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Anna Dimberg
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Anja Smits
- Department of Neuroscience, Neurology, Uppsala University, University Hospital, S-751 85, Uppsala, Sweden
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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22
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Nylander R, Kilander L, Ahlström H, Lind L, Larsson EM. Small Vessel Disease on Neuroimaging in a 75-Year-Old Cohort (PIVUS): Comparison With Cognitive and Executive Tests. Front Aging Neurosci 2018; 10:217. [PMID: 30061827 PMCID: PMC6054972 DOI: 10.3389/fnagi.2018.00217] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/26/2018] [Indexed: 12/28/2022] Open
Abstract
Background and Purpose: Signs of small vessel disease (SVD) are commonly seen on magnetic resonance imaging (MRI) of the brain in cognitively healthy elderly individuals, and the clinical relevance of these are often unclear. We have previously described three different MRI manifestations of SVD as well as cerebral perfusion in a longitudinal study of non-demented 75-year-old subjects. The purpose of the present study was to evaluate the relationship of these findings to cognition and executive function at age 75 and changes after 5 years. Methods: In all, 406 subjects from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study were examined with MRI of the brain at age 75 years. Two-hundred and fifty of the subjects were re-examined 5 years later. White matter hyperintensities (WMHs) and lacunar infarcts (LIs) were assessed on both occasions, but microbleeds (MBs) and perfusion only at age 75. Cognitive function was screened by the Mini Mental State Examination (MMSE). Trail Making Test A and B (TMT-A and TMT-B) were performed at baseline and at follow-up at age 80. Results: At baseline, 93% performed >27 points in the MMSE. The TMT-B at age 75 was significantly related to WMH visual scoring after adjustment for sex, education and cerebrovascular disease risk factors (+80 s (95% CI 0.3-161 s), P < 0.05 for grade 2-3 vs. grade 0). Neither MMSE nor TMT-A was significantly related to WMH scoring. There was no relation between any test performance and WMH volume, white matter volume, number of MBs or brain perfusion at age 75. Subjects who had sustained a new LI (n = 26) showed a greater increase of the time to perform TMT-A at the 5-year follow-up (+25 s vs. +4 s in LI-free subjects, P = 0.003). Changes in MMSE or TMT-A and -B test performance between ages 75 and 80 were not related to changes in WMH scoring or volume during the 5 years follow-up, or to brain perfusion at age 75. Conclusion: In this cognitively healthy community-based population, moderate-severe WMHs and incident LIs on brain MRI in individuals aged 75-80 years were associated with a mild impairment of processing speed and executive function.
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Affiliation(s)
- Ruta Nylander
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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23
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Abstract
Cerebral microbleeds (CMBs), also referred to as microhemorrhages, appear on magnetic resonance (MR) images as hypointense foci notably at T2*-weighted or susceptibility-weighted (SW) imaging. CMBs are detected with increasing frequency because of the more widespread use of high magnetic field strength and of newer dedicated MR imaging techniques such as three-dimensional gradient-echo T2*-weighted and SW imaging. The imaging appearance of CMBs is mainly because of changes in local magnetic susceptibility and reflects the pathologic iron accumulation, most often in perivascular macrophages, because of vasculopathy. CMBs are depicted with a true-positive rate of 48%-89% at 1.5 T or 3.0 T and T2*-weighted or SW imaging across a wide range of diseases. False-positive "mimics" of CMBs occur at a rate of 11%-24% and include microdissections, microaneurysms, and microcalcifications; the latter can be differentiated by using phase images. Compared with postmortem histopathologic analysis, at least half of CMBs are missed with premortem clinical MR imaging. In general, CMB detection rate increases with field strength, with the use of three-dimensional sequences, and with postprocessing methods that use local perturbations of the MR phase to enhance T2* contrast. Because of the more widespread availability of high-field-strength MR imaging systems and growing use of SW imaging, CMBs are increasingly recognized in normal aging, and are even more common in various disorders such as Alzheimer dementia, cerebral amyloid angiopathy, stroke, and trauma. Rare causes include endocarditis, cerebral autosomal dominant arteriopathy with subcortical infarcts, leukoencephalopathy, and radiation therapy. The presence of CMBs in patients with stroke is increasingly recognized as a marker of worse outcome. Finally, guidelines for adjustment of anticoagulant therapy in patients with CMBs are under development. © RSNA, 2018.
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Affiliation(s)
- Sven Haller
- From the Affidea Centre de Diagnostic Radiologique de Carouge (CDRC), Geneva, Switzerland (S.H.); Faculty of Medicine, University of Geneva, Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H., E.M.L.); Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (S.H.); Department of Radiology and Nuclear Medicine and Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (M.W.V.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands (J.P.A.K., F.B.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, England (H.R.J., F.B.)
| | - Meike W Vernooij
- From the Affidea Centre de Diagnostic Radiologique de Carouge (CDRC), Geneva, Switzerland (S.H.); Faculty of Medicine, University of Geneva, Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H., E.M.L.); Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (S.H.); Department of Radiology and Nuclear Medicine and Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (M.W.V.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands (J.P.A.K., F.B.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, England (H.R.J., F.B.)
| | - Joost P A Kuijer
- From the Affidea Centre de Diagnostic Radiologique de Carouge (CDRC), Geneva, Switzerland (S.H.); Faculty of Medicine, University of Geneva, Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H., E.M.L.); Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (S.H.); Department of Radiology and Nuclear Medicine and Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (M.W.V.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands (J.P.A.K., F.B.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, England (H.R.J., F.B.)
| | - Elna-Marie Larsson
- From the Affidea Centre de Diagnostic Radiologique de Carouge (CDRC), Geneva, Switzerland (S.H.); Faculty of Medicine, University of Geneva, Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H., E.M.L.); Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (S.H.); Department of Radiology and Nuclear Medicine and Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (M.W.V.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands (J.P.A.K., F.B.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, England (H.R.J., F.B.)
| | - Hans Rolf Jäger
- From the Affidea Centre de Diagnostic Radiologique de Carouge (CDRC), Geneva, Switzerland (S.H.); Faculty of Medicine, University of Geneva, Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H., E.M.L.); Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (S.H.); Department of Radiology and Nuclear Medicine and Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (M.W.V.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands (J.P.A.K., F.B.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, England (H.R.J., F.B.)
| | - Frederik Barkhof
- From the Affidea Centre de Diagnostic Radiologique de Carouge (CDRC), Geneva, Switzerland (S.H.); Faculty of Medicine, University of Geneva, Geneva, Switzerland (S.H.); Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H., E.M.L.); Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (S.H.); Department of Radiology and Nuclear Medicine and Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (M.W.V.); Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands (J.P.A.K., F.B.); Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, England (H.R.J., F.B.)
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Nylander R, Fahlström M, Rostrup E, Kullberg J, Damangir S, Ahlström H, Lind L, Larsson EM. Quantitative and qualitative MRI evaluation of cerebral small vessel disease in an elderly population: a longitudinal study. Acta Radiol 2018; 59:612-618. [PMID: 28814098 DOI: 10.1177/0284185117727567] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Cerebral white matter hyperintensities (WMHs), lacunes, and microbleeds are seen on magnetic resonance imaging (MRI) in small vessel disease (SVD). Purpose To assess SVD on MRI and its evolution over five years in an elderly population and to investigate whether relative cerebral blood flow (rCBF) at baseline was related to the progression of white matter (WM) lesions. Material and Methods In a population-based study, 406 participants aged 75 years underwent morphological MRI of the brain and 252 of them again at age 80 years. At age 75 years, a perfusion scan was also done. WMHs were evaluated qualitatively (visual scoring) and quantitatively (CASCADE software). Lacunes and microbleeds were counted. Results A significant progression of the WMH score and WMH volume occurred over five years ( P < 0.0001). New lacunes were seen in 10%. Participants with new lacunes at age 80 years showed a more pronounced increase in WMHs (P < 0.0001). Microbleeds were present in 14% at age 75 years. The visual WMH score was significantly associated with the presence of microbleeds ( P < 0.0001). There was no relationship between total WM rCBF and WMH volume at age 75 years, and no significant associations between regional or total rCBF at age 75 years and changes in WMH volume over five years. The total WM and GM volume decreased significantly between the ages of 75 and 80 years ( P < 0.0001). Conclusion MRI manifestations of SVD progressed over five years in an elderly population (age range = 75-80 years). rCBF was not associated with WMH volume or progression of WMH volume.
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Affiliation(s)
- Ruta Nylander
- Department of Surgical Sciences, Radiology, Uppsala University, Sweden
| | - Markus Fahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Sweden
| | - Egill Rostrup
- Functional Imaging Unit, Department of Diagnostics, Glostrup hospital, University of Copenhagen, Denmark
| | - Joel Kullberg
- Department of Surgical Sciences, Radiology, Uppsala University, Sweden
| | - Soheil Damangir
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Sweden
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25
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Olivo G, Latini F, Wiemerslage L, Larsson EM, Schiöth HB. Disruption of Accumbens and Thalamic White Matter Connectivity Revealed by Diffusion Tensor Tractography in Young Men with Genetic Risk for Obesity. Front Hum Neurosci 2018. [PMID: 29520227 PMCID: PMC5826967 DOI: 10.3389/fnhum.2018.00075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/16/2022] Open
Abstract
Background: Neurovascular coupling is associated with white matter (WM) structural integrity, and it is regulated by specific subtypes of dopaminergic receptors. An altered activity of such receptors, highly expressed in reward-related regions, has been reported in carriers of obesity-risk alleles of the fat mass and obesity associated (FTO) gene. Among the reward-related regions, the thalamus and the nucleus accumbens are particularly vulnerable to blood pressure dysregulation due to their peculiar anatomo-vascular characteristics, and have been consistently reported to be altered in early-stage obesity. We have thus hypothesized that a disruption in thalamus and nucleus accumbens WM microstructure, possibly on neurovascular basis, could potentially be a predisposing factor underlying the enhanced risk for obesity in the risk-allele carriers. Methods: We have tested WM integrity in 21 male participants genotyped on the FTO risk single nucleotide polymorphisms (SNP) rs9939609, through a deterministic tractography analysis. Only homozygous participants (9 AA, 12 TT) were included. 11 tracts were selected and categorized as following according to our hypothesis: “risk tracts”, “obesity-associated tracts”, and a control tract (forcpes major). We investigated whether an association existed between genotype, body mass index (BMI) and WM microstructural integrity in the “risk-tracts” (anterior thalamic radiation and accumbofrontal fasciculus) compared to other tracts. Moreover, we explored whether WM diffusivity could be related to specific personality traits in terms of punishment and reward sensitivity, as measure by the BIS/BAS questionnaire. Results: An effect of the genotype and an interaction effect of genotype and BMI were detected on the fractional anisotropy (FA) of the “risk tracts”. Correlations between WM diffusivity parameters and measures of punishment and reward sensitivity were also detected in many WM tracts of both networks. Conclusions: A disruption of the structural connectivity from the nucleus accumbens and the thalamus might occur early in carriers of the FTO AA risk-allele, and possibly act as a predisposing factor to the development of obesity.
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Affiliation(s)
- Gaia Olivo
- Functional Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Francesco Latini
- Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Lyle Wiemerslage
- Functional Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Neuroradiology, Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Functional Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden
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26
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Georgiopoulos C, Warntjes M, Dizdar N, Zachrisson H, Engström M, Haller S, Larsson EM. Olfactory Impairment in Parkinson's Disease Studied with Diffusion Tensor and Magnetization Transfer Imaging. J Parkinsons Dis 2018; 7:301-311. [PMID: 28482644 PMCID: PMC5438470 DOI: 10.3233/jpd-161060] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Olfactory impairment is an early manifestation of Parkinson’s disease (PD). Diffusion Tensor Imaging (DTI) and Magnetization Transfer (MT) are two imaging techniques that allow noninvasive detection of microstructural changes in the cerebral white matter. Objective: To assess white matter alterations associated with olfactory impairment in PD, using a binary imaging approach with DTI and MT. Methods: 22 PD patients and 13 healthy controls were examined with DTI, MT and an odor discrimination test. DTI data were first analyzed with tract-based spatial statistics (TBSS) in order to detect differences in fractional anisotropy, mean, radial and axial diffusivity between PD patients and controls. Voxelwise randomized permutation was employed for the MT analysis, after spatial and intensity normalization. Additionally, ROI analysis was performed on both the DTI and MT data, focused on the white matter adjacent to olfactory brain regions. Results: Whole brain voxelwise analysis revealed decreased axial diffusivity in the left uncinate fasciculus and the white matter adjacent to the left olfactory sulcus of PD patients. ROI analysis demonstrated decreased axial diffusivity in the right orbitofrontal cortex, as well as decreased mean diffusivity and axial diffusivity in the white matter of the left entorhinal cortex of PD patients. There were no significant differences regarding fractional anisotropy, radial diffusivity or MT between patients and controls. Conclusions: ROI analysis of DTI could detect microstructural changes in the white matter adjacent to olfactory areas in PD patients, whereas MT imaging could not.
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Affiliation(s)
- Charalampos Georgiopoulos
- Department of Radiology and Department ofMedical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical ImageScience and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Marcel Warntjes
- Center for Medical ImageScience and Visualization (CMIV), Linköping University, Linköping, Sweden.,SyntheticMR AB, Linköping, Sweden
| | - Nil Dizdar
- Department of Neurologyand Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Helene Zachrisson
- Center for Medical ImageScience and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology and Departmentof Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Engström
- Center for Medical ImageScience and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Medical andHealth Sciences, Linköping University, Linköping, Sweden
| | - Sven Haller
- Affidea CDRC Centre de Diagnostic Radiologiquede Carouge SA, Geneva, Switzerland.,Departmentof Surgical Sciences/Radiology, Uppsala University, AkademiskaSjukhuset, Uppsala, Sweden
| | - Elna-Marie Larsson
- Departmentof Surgical Sciences/Radiology, Uppsala University, AkademiskaSjukhuset, Uppsala, Sweden
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Olivo G, Solstrand Dahlberg L, Wiemerslage L, Swenne I, Zhukovsky C, Salonen-Ros H, Larsson EM, Gaudio S, Brooks SJ, Schiöth HB. Atypical anorexia nervosa is not related to brain structural changes in newly diagnosed adolescent patients. Int J Eat Disord 2018; 51:39-45. [PMID: 29215777 DOI: 10.1002/eat.22805] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 07/18/2017] [Revised: 11/06/2017] [Accepted: 11/12/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Patients with atypical anorexia nervosa (AN) have many features overlapping with AN in terms of genetic risk, age of onset, psychopathology and prognosis of outcome, although the weight loss may not be a core factor. While brain structural alterations have been reported in AN, there are currently no data regarding atypical AN patients. METHOD We investigated brain structure through a voxel-based morphometry analysis in 22 adolescent females newly-diagnosed with atypical AN, and 38 age- and sex-matched healthy controls (HC). ED-related psychopathology, impulsiveness and obsessive-compulsive traits were assessed with the Eating Disorder Examination Questionnaire (EDE-Q), Barratt Impulsiveness Scale (BIS-11) and Obsessive-compulsive Inventory Revised (OCI-R), respectively. Body mass index (BMI) was also calculated. RESULTS Patients and HC differed significantly on BMI (p < .002), EDE-Q total score (p < .000) and OCI-R total score (p < .000). No differences could be detected in grey matter (GM) regional volume between groups. DISCUSSION The ED-related cognitions in atypical AN patients would suggest that atypical AN and AN could be part of the same spectrum of restrictive-ED. However, contrary to previous reports in AN, our atypical AN patients did not show any GM volume reduction. The different degree of weight loss might play a role in determining such discrepancy. Alternatively, the preservation of GM volume might indeed differentiate atypical AN from AN.
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Affiliation(s)
- Gaia Olivo
- Department of Neuroscience, Functional Pharmacology Uppsala University, Uppsala, Sweden
| | | | - Lyle Wiemerslage
- Department of Neuroscience, Functional Pharmacology Uppsala University, Uppsala, Sweden
| | - Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christina Zhukovsky
- Department of Neuroscience, Functional Pharmacology Uppsala University, Uppsala, Sweden
| | - Helena Salonen-Ros
- Department of Neuroscience Child and Adolescent Psychiatry, Uppsala University, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology Uppsala University, Uppsala, Sweden.,Centre for Integrated Research (CIR) Area of Diagnostic Imaging Università "Campus Bio-Medico di Roma", Rome, Italy
| | - Samantha J Brooks
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology Uppsala University, Uppsala, Sweden
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28
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Virhammar J, Laurell K, Cesarini KG, Larsson EM. Increase in callosal angle and decrease in ventricular volume after shunt surgery in patients with idiopathic normal pressure hydrocephalus. J Neurosurg 2018; 130:130-135. [DOI: 10.3171/2017.8.jns17547] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/01/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPostoperative decrease in ventricle size is usually not detectable either by visual assessment or by measuring the Evans index in patients with idiopathic normal pressure hydrocephalus (iNPH). The aim of the present study was to investigate whether the angle between the lateral ventricles (the callosal angle [CA]) increases and ventricular volume decreases after shunt surgery in patients with iNPH.METHODSMagnetic resonance imaging of the brain was performed before and 3 months after shunt surgery in 18 patients with iNPH. The CA and Evans index were measured on T1-weighted 3D MR images, and ventricular volume contralateral to the shunt valve was measured with quantitative MRI.RESULTSThe CA was larger postoperatively (mean 78°, 95% CI 69°–87°) than preoperatively (mean 67°, 95% CI 60°–73°; p < 0.001). The volume of the lateral ventricle contralateral to the shunt valve decreased from 73 ml (95% CI 66–80 ml) preoperatively to 63 ml (95% CI 54–72 ml) postoperatively (p < 0.001). The Evans index was 0.365 (95% CI 0.35–0.38) preoperatively and 0.358 (95% CI 0.34–0.38) postoperatively (p < 0.05). Postoperative change of CA showed a negative correlation with change of ventricular volume (r = −0.76, p < 0.01).CONCLUSIONSIn this sample of patients with iNPH, the CA increased and ventricular volume decreased after shunt surgery. The relative difference was most pronounced for the CA, indicating that this accessible, noninvasive radiological marker should be evaluated further as an indirect method to determine shunt function in patients with iNPH.
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Affiliation(s)
| | - Katarina Laurell
- 2Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Umeå University, Umeå, Sweden
| | | | - Elna-Marie Larsson
- 4Department of Surgical Sciences, Radiology, Uppsala University, Uppsala; and
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29
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Nordin K, Persson J, Stening E, Herlitz A, Larsson EM, Söderlund H. Structural whole-brain covariance of the anterior and posterior hippocampus: Associations with age and memory. Hippocampus 2017; 28:151-163. [DOI: 10.1002/hipo.22817] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Kristin Nordin
- Department of Psychology; Uppsala University; Uppsala Sweden
| | - Jonas Persson
- Department of Psychology; Uppsala University; Uppsala Sweden
| | - Eva Stening
- Department of Psychology; Uppsala University; Uppsala Sweden
| | - Agneta Herlitz
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology; Uppsala University; Uppsala Sweden
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30
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Faria V, Gingnell M, Hoppe JM, Hjorth O, Alaie I, Frick A, Hultberg S, Wahlstedt K, Engman J, Månsson KNT, Carlbring P, Andersson G, Reis M, Larsson EM, Fredrikson M, Furmark T. Do You Believe It? Verbal Suggestions Influence the Clinical and Neural Effects of Escitalopram in Social Anxiety Disorder: A Randomized Trial. EBioMedicine 2017; 24:179-188. [PMID: 29033138 PMCID: PMC5652281 DOI: 10.1016/j.ebiom.2017.09.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 07/19/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 11/27/2022] Open
Abstract
Background Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety, but their efficacy relative to placebo has been questioned. We aimed to test how manipulation of verbally induced expectancies, central for placebo, influences SSRI treatment outcome and brain activity in patients with social anxiety disorder (SAD). Methods We did a randomized clinical trial, within an academic medical center (Uppsala, Sweden), of individuals fulfilling the DSM-IV criteria for SAD, recruited through media advertising. Participants were 18 years or older and randomized in blocks, through a computer-generated sequence by an independent party, to nine weeks of overt or covert treatment with escitalopram (20 mg daily). The overt group received correct treatment information whereas the covert group was treated deceptively with the SSRI described, by the psychiatrist, as active placebo. The treating psychiatrist was necessarily unmasked while the research staff was masked from intervention assignment. Treatment efficacy was assessed primarily with the self-rated Liebowitz Social Anxiety Scale (LSAS-SR), administered at week 0, 1, 3, 6 and 9, also yielding a dichotomous estimate of responder status (clinically significant improvement). Before and at the last week of treatment, brain activity during an emotional face-matching task was assessed with functional magnetic resonance imaging (fMRI) and during fMRI sessions, anticipatory speech anxiety was also assessed with the Spielberger State-Trait Anxiety Inventory - State version (STAI-S). Analyses included all randomized patients with outcome data at posttreatment. This study is registered at ISRCTN, number 98890605. Findings Between March 17th 2014 and May 22nd 2015, 47 patients were recruited. One patient in the covert group dropped out after a few days of treatment and did not provide fMRI data, leaving 46 patients with complete outcome data. After nine weeks of treatment, overt (n = 24) as compared to covert (n = 22) SSRI administration yielded significantly better outcome on the LSAS-SR (adjusted difference 21.17, 95% CI 10.69–31.65, p < 0.0001) with more than three times higher response rate (50% vs. 14%; χ2(1) = 6.91, p = 0.009) and twice the effect size (d = 2.24 vs. d = 1.13) from pre-to posttreatment. There was no significant between-group difference on anticipatory speech anxiety (STAI-S), both groups improving with treatment. No serious adverse reactions were recorded. On fMRI outcomes, there was suggestive evidence for a differential neural response to treatment between groups in the posterior cingulate, superior temporal and inferior frontal gyri (all z thresholds exceeding 3.68, p ≤ 0.001). Reduced social anxiety with treatment correlated significantly with enhanced posterior cingulate (z threshold 3.24, p = 0.0006) and attenuated amygdala (z threshold 2.70, p = 0.003) activity. Interpretation The clinical and neural effects of escitalopram were markedly influenced by verbal suggestions. This points to a pronounced placebo component in SSRI-treatment of SAD and favors a biopsychosocial over a biomedical explanatory model for SSRI efficacy. Funding resources The Swedish Research Council for Working Life and Social Research (grant 2011-1368), the Swedish Research Council (grant 421-2013-1366), Riksbankens Jubileumsfond – the Swedish Foundation for Humanities and Social Sciences (grant P13-1270:1). Overt surpassed covert SSRI treatment with doubled effect size and tripled response rate on the main social anxiety outcome. Overt vs. covert SSRI treatment yielded different neural changes in brain areas involved in emotion-cognition interactions. This study suggests that the presentation of a treatment may be as important as the treatment itself.
Using truthful or deceiving verbal instructions, we tested how expectancies influence SSRI efficacy in social anxiety disorder. The number of responders was more than three times higher after open administration of escitalopram 20 mg compared to covert administration of the drug presented as “active placebo” in a cover story. Correct vs. incorrect information about the SSRI also yielded different neural changes in brain areas involved in emotion-cognition interactions. The benefit of SSRI medication seems to be highly affected by psychological factors like positive expectancies traditionally associated with placebo. Our results favor a biopsychosocial over a biomedical explanatory model for SSRI efficacy.
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Affiliation(s)
- Vanda Faria
- Department of Psychology, Uppsala University, Uppsala, Sweden; Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Malin Gingnell
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Johanna M Hoppe
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Olof Hjorth
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Iman Alaie
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Sweden
| | - Andreas Frick
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sara Hultberg
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kurt Wahlstedt
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Jonas Engman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kristoffer N T Månsson
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Margareta Reis
- Department of Medical and Health Sciences, Division of Drug Research, Linköping University, Linköping, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
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31
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Latini F, Mårtensson J, Larsson EM, Fredrikson M, Åhs F, Hjortberg M, Aldskogius H, Ryttlefors M. Segmentation of the inferior longitudinal fasciculus in the human brain: A white matter dissection and diffusion tensor tractography study. Brain Res 2017; 1675:102-115. [PMID: 28899757 DOI: 10.1016/j.brainres.2017.09.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/08/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
The inferior longitudinal fascicle (ILF) is one of the major occipital-temporal association pathways. Several studies have mapped its hierarchical segmentation to specific functions. There is, however, no consensus regarding a detailed description of ILF fibre organisation. The aim of this study was to establish whether the ILF has a constant number of subcomponents. A secondary aim was to determine the quantitative diffusion proprieties of each subcomponent and assess their anatomical trajectories and connectivity patterns. A white matter dissection of 14 post-mortem normal human hemispheres was conducted to define the course of the ILF and its subcomponents. These anatomical results were then investigated in 24 right-handed, healthy volunteers using in vivo diffusion tensor imaging (DTI) and streamline tractography. Fractional anisotropy (FA), volume, fibre length and the symmetry coefficient of each fibre group were analysed. In order to show the connectivity pattern of the ILF, we also conducted an analysis of the cortical terminations of each segment. We confirmed that the main structure of the ILF is composed of three constant components reflecting the occipital terminations: the fusiform, the lingual and the dorsolateral-occipital. ILF volume was significantly lateralised to the right. The examined indices of ILF subcomponents did not show any significant difference in lateralisation. The connectivity pattern and the quantitative distribution of ILF subcomponents suggest a pivotal role for this bundle in integrating information from highly specialised modular visual areas with activity in anterior temporal territory, which has been previously shown to be important for memory and emotions.
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Affiliation(s)
- Francesco Latini
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.
| | - Johanna Mårtensson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Fredrik Åhs
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Mats Hjortberg
- Department of Medical Cell Biology, Education, Uppsala University, Uppsala, Sweden
| | - Håkan Aldskogius
- Department of Neuroscience, Regenerative Neurobiology, Uppsala University, Uppsala, Sweden
| | - Mats Ryttlefors
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
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32
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Olivo G, Zhou W, Sundbom M, Zhukovsky C, Hogenkamp P, Nikontovic L, Stark J, Wiemerslage L, Larsson EM, Benedict C, Schiöth HB. Resting-state brain connectivity changes in obese women after Roux-en-Y gastric bypass surgery: A longitudinal study. Sci Rep 2017; 7:6616. [PMID: 28747648 PMCID: PMC5529553 DOI: 10.1038/s41598-017-06663-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/07/2017] [Indexed: 12/21/2022] Open
Abstract
Bariatric surgery is an effective method to rapidly induce weight loss in severely obese people, however its impact on brain functional connectivity after longer periods of follow-up is yet to be assessed. We investigated changes in connectivity in 16 severely obese women one month before, one month after and one year after Roux-en-Y gastric bypass surgery (RYGB). 12 lean controls were also enrolled. Resting-state fMRI was acquired for all participants following an overnight fast and after a 260 kcal load. Connectivity between regions involved in food-related saliency attribution and reward-driven eating behavior was stronger in presurgery patients compared to controls, but progressively weakened after follow-up. At one year, changes in networks related to cognitive control over eating and bodily perception also occurred. Connectivity between regions involved in emotional control and social cognition had a temporary reduction early after treatment but had increased again after one year of follow-up. Furthermore, we could predict the BMI loss by presurgery connectivity in areas linked to emotional control and social interaction. RYGBP seems to reshape brain functional connectivity, early affecting cognitive control over eating, and these changes could be an important part of the therapeutic effect of bariatric surgery.
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Affiliation(s)
- Gaia Olivo
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden.
| | - Wei Zhou
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University, Uppsala, Sweden
| | - Christina Zhukovsky
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Pleunie Hogenkamp
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Lamia Nikontovic
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Julia Stark
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Lyle Wiemerslage
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Christian Benedict
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
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Abstract
BACKGROUND Alzheimer's disease (AD) is the most common cause of dementia and early and accurate diagnosis is important. Olfactory dysfunction is an early sign of AD. The contribution by test of olfactory function has been surveyed in AD vs a line of conditions but remains to be settled in the workup of unselected patients referred with suspected dementia. METHODS We performed a two-step investigation: first, a comparative study of healthy controls and probable AD patients to test the applicability of the chosen scents (cuisine study); second, a study of consecutive patients referred to our geriatric outpatient clinic for suspected dementia with the investigating personnel blinded to the results of the Olfactory Test (blinded study). RESULTS The sum of scents detected discriminated patients with probable AD from controls in the cuisine study (n = 40; p < 0.001; area under ROC curve 0.94). In the blinded study (n = 50) the diagnosis was probable AD in 48%, minimal cognitive impairment in 24%, vascular dementia in 8%, alcohol induced impairment in 12%, depression in 4%, and Parkinson's disease and Lewy body dementia in 2%. Area under the ROC-curve was 0.67. The odds ratio for probable AD with 2+ smell errors was 12 (95%-CI: 1.3-101; p = 0.026 (reference 0-1 smell errors)) age adjusted. None in the AD group had zero smell errors (Negative Predictive Value 100%). CONCLUSION Olfactory testing may support to dismiss the diagnosis of probable AD in the workup of a mixed group of patients referred with cognitive impairment. Still, it had a low sensitivity for probable AD.
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Affiliation(s)
- Ib Thrane Christensen
- Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | | | - Ida E Holm
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole B F Nielsen
- Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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34
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Adam A, Robison J, Lu J, Jose R, Badran N, Vivas-Buitrago T, Rigamonti D, Sattar A, Omoush O, Hammad M, Dawood M, Maghaslah M, Belcher T, Carson K, Hoffberger J, Jusué Torres I, Foley S, Yasar S, Thai QA, Wemmer J, Klinge P, Al-Mutawa L, Al-Ghamdi H, Carson KA, Asgari M, de Zélicourt D, Kurtcuoglu V, Garnotel S, Salmon S, Balédent O, Lokossou A, Page G, Balardy L, Czosnyka Z, Payoux P, Schmidt EA, Zitoun M, Sevestre MA, Alperin N, Baudracco I, Craven C, Matloob S, Thompson S, Haylock Vize P, Thorne L, Watkins LD, Toma AK, Bechter K, Pong AC, Jugé L, Bilston LE, Cheng S, Bradley W, Hakim F, Ramón JF, Cárdenas MF, Davidson JS, García C, González D, Bermúdez S, Useche N, Mejía JA, Mayorga P, Cruz F, Martinez C, Matiz MC, Vallejo M, Ghotme K, Soto HA, Riveros D, Buitrago A, Mora M, Murcia L, Bermudez S, Cohen D, Dasgupta D, Curtis C, Domínguez L, Remolina AJ, Grijalba MA, Whitehouse KJ, Edwards RJ, Eleftheriou A, Lundin F, Fountas KN, Kapsalaki EZ, Smisson HF, Robinson JS, Fritsch MJ, Arouk W, Garzon M, Kang M, Sandhu K, Baghawatti D, Aquilina K, James G, Thompson D, Gehlen M, Schmid Daners M, Eklund A, Malm J, Gomez D, Guerra M, Jara M, Flores M, Vío K, Moreno I, Rodríguez S, Ortega E, Rodríguez EM, McAllister JP, Guerra MM, Morales DM, Sival D, Jimenez A, Limbrick DD, Ishikawa M, Yamada S, Yamamoto K, Junkkari A, Häyrinen A, Rauramaa T, Sintonen H, Nerg O, Koivisto AM, Roine RP, Viinamäki H, Soininen H, Luikku A, Jääskeläinen JE, Leinonen V, Kehler U, Lilja-Lund O, Kockum K, Larsson EM, Riklund K, Söderström L, Hellström P, Laurell K, Kojoukhova M, Sutela A, Vanninen R, Vanha KI, Timonen M, Rummukainen J, Korhonen V, Helisalmi S, Solje E, Remes AM, Huovinen J, Paananen J, Hiltunen M, Kurki M, Martin B, Loth F, Luciano M, Luikku AJ, Hall A, Herukka SK, Mattila J, Lötjönen J, Alafuzoff I, Jurjević I, Miyajima M, Nakajima M, Murai H, Shin T, Kawaguchi D, Akiba C, Ogino I, Karagiozov K, Arai H, Reis RC, Teixeira MJ, Valêncio CG, da Vigua D, Almeida-Lopes L, Mancini MW, Pinto FCG, Maykot RH, Calia G, Tornai J, Silvestre SSS, Mendes G, Sousa V, Bezerra B, Dutra P, Modesto P, Oliveira MF, Petitto CE, Pulhorn H, Chandran A, McMahon C, Rao AS, Jumaly M, Solomon D, Moghekar A, Relkin N, Hamilton M, Katzen H, Williams M, Bach T, Zuspan S, Holubkov R, Rigamonti A, Clemens G, Sharkey P, Sanyal A, Sankey E, Rigamonti K, Naqvi S, Hung A, Schmidt E, Ory-Magne F, Gantet P, Guenego A, Januel AC, Tall P, Fabre N, Mahieu L, Cognard C, Gray L, Buttner-Ennever JA, Takagi K, Onouchi K, Thompson SD, Thorne LD, Tully HM, Wenger TL, Kukull WA, Doherty D, Dobyns WB, Moran D, Vakili S, Patel MA, Elder B, Goodwin CR, Crawford JA, Pletnikov MV, Xu J, Blitz A, Herzka DA, Guerrero-Cazares H, Quiñones-Hinojosa A, Mori S, Saavedra P, Treviño H, Maitani K, Ziai WC, Eslami V, Nekoovaght-Tak S, Dlugash R, Yenokyan G, McBee N, Hanley DF. Abstracts from Hydrocephalus 2016. Fluids Barriers CNS 2017; 14:15. [PMID: 28929972 PMCID: PMC5471936 DOI: 10.1186/s12987-017-0054-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- A Adam
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Robison
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J Lu
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - R Jose
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - N Badran
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - T Vivas-Buitrago
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - D Rigamonti
- Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.,Johns Hopkins Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - A Sattar
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia.,Primary Care, Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - O Omoush
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia.,Primary Care, Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - M Hammad
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - M Dawood
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - M Maghaslah
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - T Belcher
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - K Carson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J Hoffberger
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - I Jusué Torres
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - S Foley
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - S Yasar
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Q A Thai
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - J Wemmer
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - P Klinge
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - L Al-Mutawa
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - H Al-Ghamdi
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - K A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Asgari
- The Interface Group, Institute of PhysiologyUniversity of Zurich, Zurich, Switzerland
| | - D de Zélicourt
- The Interface Group, Institute of PhysiologyUniversity of Zurich, Zurich, Switzerland
| | - V Kurtcuoglu
- The Interface Group, Institute of PhysiologyUniversity of Zurich, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich and the Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - S Garnotel
- BioFlowImage Laboratory, University of Picardie Jules Verne, Amiens, France.,Reims Mathematics Laboratory, University of Reims Champagne-Ardenne, Reims, France.,Image Processing Laboratory, University Hospital of Amiens-Picardie, Amiens, France.,BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - S Salmon
- Reims Mathematics Laboratory, University of Reims Champagne-Ardenne, Reims, France
| | - O Balédent
- BioFlowImage Laboratory, University of Picardie Jules Verne, Amiens, France.,Image Processing Laboratory, University Hospital of Amiens-Picardie, Amiens, France.,BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - A Lokossou
- BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - G Page
- BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - L Balardy
- Department of Geriatric, University Hospital of Toulouse, Toulouse, France.,Departments of Geriatric, University Hospital of Toulouse, Toulouse, France.,Department of Geriatry, University Hospital Toulouse, Toulouse, France
| | - Z Czosnyka
- Neurosciences department, University of Cambridge, Cambridge, UK.,Brain Physics Lab, Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - P Payoux
- Department of Nuclear Medicine, University Hospital of Toulouse, Toulouse, France.,Department of Nuclear Medicine, University Hospital Toulouse, Toulouse, France.,INSER TONIC 1014, Toulouse Neuroimaging Center, Toulouse, France
| | - E A Schmidt
- UMR 1214-INSERM/UPS-TONIC Toulouse Neuro-Imaging Center, Toulouse, France.,Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France.,Department of Neurosurgery, University Hospital Toulouse, Toulouse, France
| | - M Zitoun
- BioFlowImage, University Hospital of Picardie Jules Verne, Amiens, France
| | - M A Sevestre
- BioFlowImage, University Hospital of Picardie Jules Verne, Amiens, France
| | - N Alperin
- University of Miami Health System, Miami, FL, USA
| | - I Baudracco
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - C Craven
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - S Matloob
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - S Thompson
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - P Haylock Vize
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - L Thorne
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - L D Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.,The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - A K Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.,The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Karl Bechter
- Department Psychiatry II/Bezirkskliniken, Ulm University, Günzburg, Germany
| | - A C Pong
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - L Jugé
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - L E Bilston
- Neuroscience Research Australia, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - S Cheng
- Neuroscience Research Australia, Randwick, Australia.,Department of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - W Bradley
- Department of Radiology, University of California San Diego Health System, San Diego, CA, USA
| | - F Hakim
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Neurosurgery Department, Hospital Universitario, Fundación Santafe de Bogota, Bogota, Colombia
| | - J F Ramón
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Neurosurgery Department, Hospital Universitario, Fundación Santafe de Bogota, Bogota, Colombia
| | - M F Cárdenas
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J S Davidson
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - C García
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D González
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - S Bermúdez
- Department of Diagnostic Imaging, Section of Neuroradiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - N Useche
- Department of Diagnostic Imaging, Section of Neuroradiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J A Mejía
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - P Mayorga
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - F Cruz
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - C Martinez
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - M C Matiz
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - M Vallejo
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - K Ghotme
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - H A Soto
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D Riveros
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - A Buitrago
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - M Mora
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - L Murcia
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - S Bermudez
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D Cohen
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D Dasgupta
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - C Curtis
- Department of Microbiology, University College London Hospital NHS Foundation Trust, London, UK
| | - L Domínguez
- Neurosurgery Department, Cartagena University, Cartagena de Indias, Colombia
| | - A J Remolina
- Neurosurgery Department, Cartagena University, Cartagena de Indias, Colombia
| | - M A Grijalba
- Neurosurgery Department, Cartagena University, Cartagena de Indias, Colombia
| | - K J Whitehouse
- Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - R J Edwards
- Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - A Eleftheriou
- Department of Neurology, University Hospital, Linköping, Sweden
| | - F Lundin
- Division of Neuroscience, Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
| | - K N Fountas
- Department of Neurosurgery, School of Medicine, University of Thessaly, Larisa, Greece
| | - E Z Kapsalaki
- Department of Diagnostic Radiology, School of Medicine, University of Thessaly, Larisa, Greece
| | - H F Smisson
- Department of Neurosurgery, Georgia Neurosurgical Institute, Macon, GA, USA
| | - J S Robinson
- Department of Neurosurgery, Georgia Neurosurgical Institute, Macon, GA, USA
| | - M J Fritsch
- Klinik für Neurochirurgie, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - W Arouk
- Klinik für Neurochirurgie, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - M Garzon
- Great Ormond Street Hospital, London, UK
| | - M Kang
- Great Ormond Street Hospital, London, UK
| | - K Sandhu
- Great Ormond Street Hospital, London, UK
| | | | - K Aquilina
- Great Ormond Street Hospital, London, UK
| | - G James
- Great Ormond Street Hospital, London, UK
| | - D Thompson
- Great Ormond Street Hospital, London, UK
| | - M Gehlen
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - M Schmid Daners
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - A Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - J Malm
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - D Gomez
- Neurosurgery Department, Hospital Universitario, Fundación Santafe de Bogota, Bogota, Colombia
| | - M Guerra
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - M Jara
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - M Flores
- Laboratorio de Polímeros, Facultad de Ciencias, UACh, Valdivia, Chile
| | - K Vío
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - I Moreno
- Laboratorio de Polímeros, Facultad de Ciencias, UACh, Valdivia, Chile
| | - S Rodríguez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - E Ortega
- Instituto de Neurociencias Clínicas, Facultad de Medicina, UACh, Valdivia, Chile
| | - E M Rodríguez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile.,Instituto de Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - J P McAllister
- Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - M M Guerra
- Instituto de Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - D M Morales
- Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - D Sival
- Department of Pediatrics Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Jimenez
- Departamento de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain
| | - D D Limbrick
- Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA.,Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, USA
| | - M Ishikawa
- Rakuwa Villa Ilios, Kyoto, Japan.,Normal Pressure Hydrocephalus Center, Otowa Hospital, Kyoto, Japan
| | - S Yamada
- Normal Pressure Hydrocephalus Center, Otowa Hospital, Kyoto, Japan.,Department of Neurosurgery, Otowa Hospital, Kyoto, Japan
| | - K Yamamoto
- Department of Neurosurgery, Otowa Hospital, Kyoto, Japan
| | - A Junkkari
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - A Häyrinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - T Rauramaa
- Department of Pathology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Pathology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Pathology, University of Eastern Finland, Kuopio, Finland
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Nerg
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - A M Koivisto
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - R P Roine
- University of Eastern Finland, Kuopio Finland and Helsinki and Uusimaa Hospital DistrictGroup Administration, Helsinki, Finland
| | - H Viinamäki
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - H Soininen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - A Luikku
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - J E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - V Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - U Kehler
- Neurosurgical Department, Asklepios Klinik Hamburg Altona, Hamburg, Germany
| | - O Lilja-Lund
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - K Kockum
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - E M Larsson
- Department of Radiology, Uppsala University, Uppsala, Sweden
| | - K Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - L Söderström
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - P Hellström
- Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Laurell
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - M Kojoukhova
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - A Sutela
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - R Vanninen
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - K I Vanha
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - M Timonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - J Rummukainen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - V Korhonen
- Department of Neurosurgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - S Helisalmi
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - E Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - A M Remes
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - J Huovinen
- Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - J Paananen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - M Hiltunen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - M Kurki
- Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute for Harvard and MIT, Cambridge, MA, USA
| | - B Martin
- Biological Engineering, University of Idaho, Moscow, ID, USA
| | - F Loth
- Mechanical Engineering, University of Akron, Akron, Ohio, USA
| | - M Luciano
- Neurosurgery, Johns Hopkins University, Baltimore, MA, USA.,Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - A J Luikku
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - A Hall
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - S K Herukka
- Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - J Mattila
- VTT Technical Research Centre of Finland, Tampere, Finland.,Combinostics Ltd, Tampere, Finland
| | - J Lötjönen
- VTT Technical Research Centre of Finland, Tampere, Finland.,Combinostics Ltd, Tampere, Finland
| | - I Alafuzoff
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Pathology and Cytology, Uppsala University Hospital, Uppsala, Sweden
| | - I Jurjević
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Pharmacology and Department of Neurology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - M Miyajima
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - M Nakajima
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - H Murai
- Department of Neurosurgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - T Shin
- Department of Neurosurgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - D Kawaguchi
- Department of Neurosurgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - C Akiba
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - I Ogino
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - K Karagiozov
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - H Arai
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - R C Reis
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - M J Teixeira
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - C G Valêncio
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - D da Vigua
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - L Almeida-Lopes
- Núcleo de Pesquisa e Ensino de Fototerapia nas Ciências da Saúde (NUPEN), São Carlos, Brazil
| | - M W Mancini
- Núcleo de Pesquisa e Ensino de Fototerapia nas Ciências da Saúde (NUPEN), São Carlos, Brazil
| | - F C G Pinto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - R H Maykot
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - G Calia
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - J Tornai
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - S S S Silvestre
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - G Mendes
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - V Sousa
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - B Bezerra
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - P Dutra
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - P Modesto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - M F Oliveira
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - C E Petitto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - H Pulhorn
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
| | - A Chandran
- Department of Neuroradiology, The Walton Centre, Liverpool, UK
| | - C McMahon
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
| | - A S Rao
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - M Jumaly
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - D Solomon
- The Johns Hopkins Hospital, Baltimore, MD, USA.,Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - A Moghekar
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - N Relkin
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - M Hamilton
- Department of Neurosurgery, University of Calgary, Alberta, Canada
| | - H Katzen
- Department of Neurology, University of Miami, Miami, FL, USA
| | - M Williams
- Department of Neurosurgery, Washington University, Seattle, WA, USA
| | - T Bach
- Utah Data Collection Center (DCC), University of Utah, Salt Lake City, UT, USA
| | - S Zuspan
- Utah Data Collection Center (DCC), University of Utah, Salt Lake City, UT, USA
| | - R Holubkov
- Utah Data Collection Center (DCC), University of Utah, Salt Lake City, UT, USA
| | | | - G Clemens
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - P Sharkey
- School of Business, Loyola University Maryland, Baltimore, MD, USA
| | - A Sanyal
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - E Sankey
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - K Rigamonti
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - S Naqvi
- Primary Care, Johns Hopkins Aramco Healthcare, Abqaiq, Saudi Arabia
| | - A Hung
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - E Schmidt
- Department of Neurosurgery, University Hospital Toulouse, Toulouse, France
| | - F Ory-Magne
- Department of Neurology, University Hospital Toulouse, Toulouse, France.,INSER TONIC 1014, Toulouse Neuroimaging Center, Toulouse, France
| | - P Gantet
- Department of Nuclear Medicine, University Hospital Toulouse, Toulouse, France
| | - A Guenego
- Department of Neurosurgery, University Hospital Toulouse, Toulouse, France.,Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - A C Januel
- Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - P Tall
- Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - N Fabre
- Department of Neurology, University Hospital Toulouse, Toulouse, France
| | - L Mahieu
- Department of Ophtalmology, University Hospital Toulouse, Toulouse, France
| | - C Cognard
- Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - L Gray
- Department of Physiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | | | - K Takagi
- Normal Pressure Hydrocephalus Center, Kashiwa-Tanaka Hospital, Kashiwa, Japan
| | - K Onouchi
- Department of Neurology, Kashiwa-Tanaka Hospital, Kashiwa, Japan
| | - S D Thompson
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - L D Thorne
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - H M Tully
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - T L Wenger
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - W A Kukull
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - D Doherty
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - W B Dobyns
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - D Moran
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - S Vakili
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - M A Patel
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - B Elder
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - C R Goodwin
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J A Crawford
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - M V Pletnikov
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J Xu
- F. M. Kirby Research Center for Functional Brain Imaging at the Kennedy Krieger Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - A Blitz
- Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - D A Herzka
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - H Guerrero-Cazares
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - A Quiñones-Hinojosa
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - S Mori
- Department of Radiology-Magnetic Resonance Research, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - P Saavedra
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - H Treviño
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - K Maitani
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.,Tohoku University School of Medicine, Sendai, Japan
| | - W C Ziai
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V Eslami
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Nekoovaght-Tak
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Dlugash
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Yenokyan
- Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - N McBee
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D F Hanley
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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35
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Rylander C, Friberg H, Larsson EM, Liedholm LJ, Rubertsson S, Cronberg T. [Assessment of neurologic prognosis after cardiac arrest. Updated recommendations from the Swedish CPR Council Expert Group]. Lakartidningen 2017; 114:EIUH. [PMID: 28586081] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Assessment of neurologic prognosis after cardiac arrest. Updated recommendations from the Swedish CPR Council Expert Group European Resuscitation Council (ERC) issued updated guidelines for postresuscitation care in 2015. This paper provides updated Swedish recommendations for neurological prognostication of patients remaining unconscious after cardiac arrest (CA). The prognostication should be based on independent methods; clinical and neurophysiological examinations, imaging and biomarkers. It should not be performed earlier than three days after CA and any influence from sedatives must be negligible. Bilateral absence of both corneal and pupillary reflexes and bilaterally absent Somatosensory Evoked N20 Potentials (SSEP) at 72 hours are reliable predictors of poor outcome but the ocular reflexes have limited sensitivity and SSEP has limited availability. Hence, further delay of at least 24 hours and combinations of findings from multiple methods are often needed for reliable prognostication. If firm evidence of a poor prognosis is lacking four days after CA, further expectation with repeated examinations is recommended.
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Affiliation(s)
| | - Hans Friberg
- Lunds universitet Medicinska fakulteten - Lund, Sweden Lunds universitet Medicinska fakulteten - Lund, Sweden
| | - Elna-Marie Larsson
- Uppsala Universitet - Institutionen för radiologi, onkologi och strålningsvetenskap Uppsala, Sweden Institutionen för radiologi, onkologi och strålningsvetenskap - Uppsala Universitet Uppsala, Sweden
| | - Lars Johan Liedholm
- Norrlands universitetssjukhus - Umea, Sweden Norrlands universitetssjukhus - Umea, Sweden
| | - Sten Rubertsson
- Akademiska sjukhuset - Uppsala, Sweden Akademiska sjukhuset - Uppsala, Sweden
| | - Tobias Cronberg
- Skånes Universitetssjukhus - Neurologiska kliniken Lund, Sweden Skånes Universitetssjukhus - Neurologiska kliniken Lund, Sweden
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36
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Blystad I, Warntjes JBM, Smedby Ö, Lundberg P, Larsson EM, Tisell A. Quantitative MRI for analysis of peritumoral edema in malignant gliomas. PLoS One 2017; 12:e0177135. [PMID: 28542553 PMCID: PMC5441583 DOI: 10.1371/journal.pone.0177135] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/21/2017] [Indexed: 12/22/2022] Open
Abstract
Background and purpose Damage to the blood-brain barrier with subsequent contrast enhancement is a hallmark of glioblastoma. Non-enhancing tumor invasion into the peritumoral edema is, however, not usually visible on conventional magnetic resonance imaging. New quantitative techniques using relaxometry offer additional information about tissue properties. The aim of this study was to evaluate longitudinal relaxation R1, transverse relaxation R2, and proton density in the peritumoral edema in a group of patients with malignant glioma before surgery to assess whether relaxometry can detect changes not visible on conventional images. Methods In a prospective study, 24 patients with suspected malignant glioma were examined before surgery. A standard MRI protocol was used with the addition of a quantitative MR method (MAGIC), which measured R1, R2, and proton density. The diagnosis of malignant glioma was confirmed after biopsy/surgery. In 19 patients synthetic MR images were then created from the MAGIC scan, and ROIs were placed in the peritumoral edema to obtain the quantitative values. Dynamic susceptibility contrast perfusion was used to obtain cerebral blood volume (rCBV) data of the peritumoral edema. Voxel-based statistical analysis was performed using a mixed linear model. Results R1, R2, and rCBV decrease with increasing distance from the contrast-enhancing part of the tumor. There is a significant increase in R1 gradient after contrast agent injection (P < .0001). There is a heterogeneous pattern of relaxation values in the peritumoral edema adjacent to the contrast-enhancing part of the tumor. Conclusion Quantitative analysis with relaxometry of peritumoral edema in malignant gliomas detects tissue changes not visualized on conventional MR images. The finding of decreasing R1 and R2 means shorter relaxation times closer to the tumor, which could reflect tumor invasion into the peritumoral edema. However, these findings need to be validated in the future.
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Affiliation(s)
- Ida Blystad
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- * E-mail:
| | - J. B. Marcel Warntjes
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Örjan Smedby
- Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Peter Lundberg
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Elna-Marie Larsson
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Anders Tisell
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Ferreira D, Hansson O, Barroso J, Molina Y, Machado A, Hernández-Cabrera JA, Muehlboeck JS, Stomrud E, Nägga K, Lindberg O, Ames D, Kalpouzos G, Fratiglioni L, Bäckman L, Graff C, Mecocci P, Vellas B, Tsolaki M, Kłoszewska I, Soininen H, Lovestone S, Ahlström H, Lind L, Larsson EM, Wahlund LO, Simmons A, Westman E. The interactive effect of demographic and clinical factors on hippocampal volume: A multicohort study on 1958 cognitively normal individuals. Hippocampus 2017; 27:653-667. [DOI: 10.1002/hipo.22721] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Daniel Ferreira
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
| | - Oskar Hansson
- Department of Clinical Sciences; Clinical Memory Research Unit, Lund University; Malmö 20502 Sweden
| | - José Barroso
- Department of Clinical Psychology; Psychobiology and Methodology, University of La Laguna; La Laguna 38071 Spain
| | - Yaiza Molina
- Department of Clinical Psychology; Psychobiology and Methodology, University of La Laguna; La Laguna 38071 Spain
- Faculty of Health Sciences; University Fernando Pessoa Canarias, Las Palmas de Gran Canaria; Spain
| | - Alejandra Machado
- Department of Clinical Psychology; Psychobiology and Methodology, University of La Laguna; La Laguna 38071 Spain
| | | | - J-Sebastian Muehlboeck
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
| | - Erik Stomrud
- Department of Clinical Sciences; Clinical Memory Research Unit, Lund University; Malmö 20502 Sweden
| | - Katarina Nägga
- Department of Clinical Sciences; Clinical Memory Research Unit, Lund University; Malmö 20502 Sweden
| | - Olof Lindberg
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
- Department of Clinical Sciences; Clinical Memory Research Unit, Lund University; Malmö 20502 Sweden
| | - David Ames
- National Ageing Research Institute; Parkville; Victoria 3050 Australia
- University of Melbourne Academic Unit for Psychiatry of Old Age; St George's Hospital, Kew; Victoria 3101 Australia
| | - Grégoria Kalpouzos
- Aging Research Center (ARC); Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University; 113 30 Stockholm Sweden
| | - Laura Fratiglioni
- Aging Research Center (ARC); Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University; 113 30 Stockholm Sweden
- Stockholm Gerontology Research Centre; Stockholm 11330 Sweden
| | - Lars Bäckman
- Aging Research Center (ARC); Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University; 113 30 Stockholm Sweden
- Stockholm Gerontology Research Centre; Stockholm 11330 Sweden
| | - Caroline Graff
- Division of Neurogeriatrics; Department of Neurobiology Care Sciences and Society, Centre for Alzheimer Research, Karolinska Institutet; Stockholm 14157 Sweden
- Department of Geriatric Medicine; Karolinska University Hospital Huddinge; Stockholm 14186 Sweden
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics; University of Perugia; Perugia 06100 Italy
| | - Bruno Vellas
- INSERM U 558; University of Toulouse; Toulouse 31024 France
| | - Magda Tsolaki
- 3rd Department of Neurology; Aristoteleion Panepistimeion Thessalonikis; Thessaloniki 54124 Greece
| | | | - Hilkka Soininen
- University of Eastern Finland and Kuopio University Hospital; Kuopio 70211 Finland
| | - Simon Lovestone
- Department of Psychiatry; Warneford Hospital University of Oxford; Oxford OX37JX United Kingdom
| | - Håkan Ahlström
- Department of Surgical Sciences; Radiology, Uppsala University; Uppsala 75185 Sweden
| | - Lars Lind
- Department of Medical Sciences; Uppsala University; Uppsala 75185 Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences; Radiology, Uppsala University; Uppsala 75185 Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
| | - Andrew Simmons
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
- NIHR Biomedical Research Centre for Mental Health; London SE58AF United Kingdom
- NIHR Biomedical Research Unit for Dementia; London SE58AF United Kingdom
- Institute of Psychiatry; King's College London; London SE58AF United Kingdom
| | - Eric Westman
- Division of Clinical Geriatrics; Centre for Alzheimer Research, Department of Neurobiology Care Sciences and Society, Karolinska Institutet; Stockholm 14157 Sweden
- Institute of Psychiatry; King's College London; London SE58AF United Kingdom
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Fällmar D, Haller S, Lilja J, Danfors T, Kilander L, Tolboom N, Egger K, Kellner E, Croon PM, Verfaillie SCJ, van Berckel BNM, Ossenkoppele R, Barkhof F, Larsson EM. Arterial spin labeling-based Z-maps have high specificity and positive predictive value for neurodegenerative dementia compared to FDG-PET. Eur Radiol 2017; 27:4237-4246. [PMID: 28374078 PMCID: PMC5579184 DOI: 10.1007/s00330-017-4784-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 11/06/2016] [Revised: 01/23/2017] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
Objective Cerebral perfusion analysis based on arterial spin labeling (ASL) MRI has been proposed as an alternative to FDG-PET in patients with neurodegenerative disease. Z-maps show normal distribution values relating an image to a database of controls. They are routinely used for FDG-PET to demonstrate disease-specific patterns of hypometabolism at the individual level. This study aimed to compare the performance of Z-maps based on ASL to FDG-PET. Methods Data were combined from two separate sites, each cohort consisting of patients with Alzheimer’s disease (n = 18 + 7), frontotemporal dementia (n = 12 + 8) and controls (n = 9 + 29). Subjects underwent pseudocontinuous ASL and FDG-PET. Z-maps were created for each subject and modality. Four experienced physicians visually assessed the 166 Z-maps in random order, blinded to modality and diagnosis. Results Discrimination of patients versus controls using ASL-based Z-maps yielded high specificity (84%) and positive predictive value (80%), but significantly lower sensitivity compared to FDG-PET-based Z-maps (53% vs. 96%, p < 0.001). Among true-positive cases, correct diagnoses were made in 76% (ASL) and 84% (FDG-PET) (p = 0.168). Conclusion ASL-based Z-maps can be used for visual assessment of neurodegenerative dementia with high specificity and positive predictive value, but with inferior sensitivity compared to FDG-PET. Key points • ASL-based Z-maps yielded high specificity and positive predictive value in neurodegenerative dementia. • ASL-based Z-maps had significantly lower sensitivity compared to FDG-PET-based Z-maps. • FDG-PET might be reserved for ASL-negative cases where clinical suspicion persists. • Findings were similar at two study sites.
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Affiliation(s)
- David Fällmar
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.
| | - Sven Haller
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.,Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Affidea CDRC - Centre Diagnostique Radiologique de Carouge, Carouge, Switzerland
| | - Johan Lilja
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden.,Hermes Medical Solutions, Stockholm, Sweden
| | - Torsten Danfors
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Neuroscience Campus, Amsterdam, The Netherlands
| | - Karl Egger
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Elias Kellner
- Department of Radiology, Medical Physics, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany
| | - Philip M Croon
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Neuroscience Campus, Amsterdam, The Netherlands
| | - Sander C J Verfaillie
- Department of Neurology, Alzheimer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Neuroscience Campus, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Neuroscience Campus, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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Solstrand Dahlberg L, Wiemerslage L, Swenne I, Larsen A, Stark J, Rask-Andersen M, Salonen-Ros H, Larsson EM, Schiöth HB, Brooks SJ. Adolescents newly diagnosed with eating disorders have structural differences in brain regions linked with eating disorder symptoms. Nord J Psychiatry 2017; 71:188-196. [PMID: 27844498 DOI: 10.1080/08039488.2016.1250948] [Citation(s) in RCA: 9] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adults with eating disorders (ED) show brain volume reductions in the frontal, insular, cingulate, and parietal cortices, as well as differences in subcortical regions associated with reward processing. However, little is known about the structural differences in adolescents with behavioural indications of early stage ED. AIM This is the first study to investigate structural brain changes in adolescents newly diagnosed with ED compared to healthy controls (HC), and to study whether ED cognitions correlate with structural changes in adolescents with ED of short duration. METHODS Fifteen adolescent females recently diagnosed with ED, and 28 age-matched HC individuals, were scanned with structural magnetic resonance imaging (MRI). Whole-brain and region-of-interest analyses were conducted using voxel-based morphometry (VBM). ED cognitions were measured with self-report questionnaires and working memory performance was measured with a neuropsychological computerized test. RESULTS AND CONCLUSIONS The left superior temporal gyrus had a smaller volume in adolescents with ED than in HC, which correlated with ED cognitions (concerns about eating, weight, and shape). Working memory reaction time correlated positively with insula volumes in ED participants, but not HC. In ED, measurements of restraint and obsession was negatively correlated with temporal gyrus volumes, and positively correlated with cerebellar and striatal volumes. Thus, adolescents with a recent diagnosis of ED had volumetric variations in brain areas linked to ED cognitions, obsessions, and working memory. The findings emphasize the importance of early identification of illness, before potential long-term effects on structure and behaviour occur.
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Affiliation(s)
| | - Lyle Wiemerslage
- a Department of Neuroscience, Functional Pharmacology , Uppsala University , Uppsala , Sweden
| | - Ingemar Swenne
- b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Anna Larsen
- a Department of Neuroscience, Functional Pharmacology , Uppsala University , Uppsala , Sweden
| | - Julia Stark
- a Department of Neuroscience, Functional Pharmacology , Uppsala University , Uppsala , Sweden
| | - Mathias Rask-Andersen
- a Department of Neuroscience, Functional Pharmacology , Uppsala University , Uppsala , Sweden
| | - Helena Salonen-Ros
- c Department of Neuroscience, Child and Adolescent Psychiatry , Uppsala University , Sweden
| | - Elna-Marie Larsson
- d Department of Surgical Sciences , Uppsala University , Uppsala , Sweden
| | - Helgi B Schiöth
- a Department of Neuroscience, Functional Pharmacology , Uppsala University , Uppsala , Sweden
| | - Samantha J Brooks
- a Department of Neuroscience, Functional Pharmacology , Uppsala University , Uppsala , Sweden.,e Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
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Strandberg M, Mannfolk P, Stenberg L, Ljung H, Rorsman I, Larsson EM, van Westen D, Källén K. A Functional MRI-Based Model for Individual Memory Assessment in Patients Eligible for Anterior Temporal Lobe Resection. Open Neuroimag J 2017; 11:1-16. [PMID: 28567171 PMCID: PMC5420180 DOI: 10.2174/1874440001711010001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Received: 12/16/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 11/22/2022] Open
Abstract
Title: A functional (f) MRI-based model for individual memory assessment in patients eligible for temporal lobe resection. Aim: To investigate if pre-operative fMRI memory paradigms, add predictive information with regard to post-surgical memory deficits. Methods: Fourteen pharmacoresistant Temporal Lobe Epilepsy (TLE) patients accepted for Anterior Temporal Lobe Resection (ATLR) were included. A clinical risk assessment score (RAS 0-3) was constructed from structural MRI, neuropsychological testing and hemisphere dominance. fMRI lateralization indices (LIs) over frontal language and medial temporal regions were calculated. Predictive value from clinical risk scoring and added value from fMRI LIs were correlated to post-surgical memory change scores (significant decline -1 SD). Verbal memory outcome was classified either as expected (RAS 2-3 and post-operative decline; RAS 0-1 and intact post-operative verbal memory) or as unexpected (RAS 2-3 and intact post-operative verbal memory post-surgery; RAS 0-1 and post-operative decline). Results: RAS for verbal memory decline exhibited a specificity of 67% and a sensitivity of 75%. Significant correlations were found between frontal language LIs and post-operative verbal memory (r = -0.802; p = 0.017) for left (L) TLE and between medial temporal lobe LIs and visuospatial memory (r = 0.829; p = 0.021), as well as verbal memory (r = 0.714; p = 0.055) for right (R) TLE. Ten patients had expected outcome and four patients had an unexpected outcome. In two MRI-negative RTLE patients that suffered significant verbal memory decline post-operatively, fMRI identified bilateral language and right lateralized medial temporal verbal encoding. In two LTLE patients with MRI pathology and verbal memory dysfunction, neither RAS nor fMRI identified the risk for aggravated verbal memory decline following ATLR. Conclusion: fMRI visualization of temporal-frontal network activation may add value to the pre-surgical work-up in epilepsy patients eligible for ATLR. Frontal language patterns are important for prediction in both L and RTLE. Strong left lateralized language in LTLE, as well as bilateral language combined with right lateralized encoding in RTLE, seems to indicate an increased risk for post-operative verbal memory decline.
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Affiliation(s)
- Maria Strandberg
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Peter Mannfolk
- Diagnostic Radiology, Department of Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Lars Stenberg
- Diagnostic Radiology, Department of Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Hanna Ljung
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Ia Rorsman
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Elna-Marie Larsson
- Department of Radiology, Uppsala University Hospital, SE-75185, Uppsala, Sweden
| | - Danielle van Westen
- Diagnostic Radiology, Department of Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Kristina Källén
- Department of Neurology and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
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Fahlström M, Subasic I, Teder P, Åberg K, Larsson EM, Blomström-Lundqvist C. [Cardiac implantable electronic devices (CIED) not an absolute contraindication to MRI]. Lakartidningen 2017; 114:ECLR. [PMID: 28350417] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cardiac implantable electronic devices (CIED) not an absolute contraindication to MRI Conventional cardiac implantable electronic devices (CIED) are presently not an absolute contraindication to magnetic resonance imaging (MRI), which thus is accessible for device patients depending on risk/benefit assessments. While current literature suggests that MRI can be performed without risk if precautions are taken, adverse events have been reported. The number of MR conditional CIEDs is rapidly increasing, and depending on device and electrode combinations, patients can now undergo advanced MRI at 3.0 T without risk, possibly with restriction, e.g. anatomy coverage. This article describes published guidelines, recommendations and complications that may appear during MRI and precautions to avoid and manage them. The recommendations made are based on a thorough literature review and our own experiences reported with the aim to increase the awareness of healthcare professionals so that device patients no longer are excluded from the advantages of MRI as a diagnostic tool.
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Affiliation(s)
- Markus Fahlström
- Uppsala Universitet - Institutionen för Radiologi, Onkologi och Strålningsvetenskap Uppsala, Sweden Uppsala University - Department of Radiology, Oncology and Radiation Science Uppsala, Sweden
| | - Irfan Subasic
- Akademiska sjukhuset - Bild- och funktionsmedicinskt centrum Uppsala, Sweden Akademiska sjukhuset - Bild- och funktionsmedicinskt centrum Uppsala, Sweden
| | - Priit Teder
- Akademiska Sjukhuset - Arytmisektionen Uppsala, Sweden Uppsala Universitet Medicinska fakulteten - Arytmisektionen Uppsala, Sweden
| | - Karin Åberg
- Akademiska Sjukhuset - Sjukhusfysik Uppsala, Sweden Akademiska Sjukhuset - Sjukhusfysik Uppsala, Sweden
| | - Elna-Marie Larsson
- Uppsala Universitet - Institutionen för radiologi, onkologi och strålningsvetenskap Uppsala, Sweden Institutionen för radiologi, onkologi och strålningsvetenskap - Uppsala Universitet Uppsala, Sweden
| | - Carina Blomström-Lundqvist
- Akademiska Sjukhuset - Arytmisektionen Uppsala, Sweden Uppsala Universitet Medicinska fakulteten - Arytmisektionen Uppsala, Sweden
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Olivo G, Wiemerslage L, Swenne I, Zhukowsky C, Salonen-Ros H, Larsson EM, Gaudio S, Brooks SJ, Schiöth HB. Limbic-thalamo-cortical projections and reward-related circuitry integrity affects eating behavior: A longitudinal DTI study in adolescents with restrictive eating disorders. PLoS One 2017; 12:e0172129. [PMID: 28248991 PMCID: PMC5332028 DOI: 10.1371/journal.pone.0172129] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/31/2017] [Indexed: 12/20/2022] Open
Abstract
Few studies have used diffusion tensor imaging (DTI) to investigate the micro-structural alterations of WM in patients with restrictive eating disorders (rED), and longitudinal data are lacking. Twelve patients with rED were scanned at diagnosis and after one year of family-based treatment, and compared to twenty-four healthy controls (HCs) through DTI analysis. A tract-based spatial statistics procedure was used to investigate diffusivity parameters: fractional anisotropy (FA) and mean, radial and axial diffusivities (MD, RD and AD, respectively). Reduced FA and increased RD were found in patients at baseline in the corpus callosum, corona radiata and posterior thalamic radiation compared with controls. However, no differences were found between follow-up patients and controls, suggesting a partial normalization of the diffusivity parameters. In patients, trends for a negative correlation were found between the baseline FA of the right anterior corona radiata and the Eating Disorder Examination Questionnaire total score, while a positive trend was found between the baseline FA in the splenium of corpus callosum and the weight loss occurred between maximal documented weight and time of admission. A positive trend for correlation was also found between baseline FA in the right anterior corona radiata and the decrease in the Obsessive-Compulsive Inventory Revised total score over time. Our results suggest that the integrity of the limbic–thalamo–cortical projections and the reward-related circuitry are important for cognitive control processes and reward responsiveness in regulating eating behavior.
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Affiliation(s)
- Gaia Olivo
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Lyle Wiemerslage
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christina Zhukowsky
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Helena Salonen-Ros
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
- Centre for Integrated Research (CIR), Area of Diagnostic Imaging, Università “Campus Bio-Medico di Roma”, Rome, Italy
| | - Samantha J. Brooks
- Deptartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Helgi B. Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
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Delgado AF, Fahlström M, Nilsson M, Berntsson SG, Zetterling M, Libard S, Alafuzoff I, van Westen D, Lätt J, Smits A, Larsson EM. Diffusion Kurtosis Imaging of Gliomas Grades II and III - A Study of Perilesional Tumor Infiltration, Tumor Grades and Subtypes at Clinical Presentation. Radiol Oncol 2017; 51:121-129. [PMID: 28740446 PMCID: PMC5514651 DOI: 10.1515/raon-2017-0010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 08/15/2016] [Accepted: 01/08/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diffusion kurtosis imaging (DKI) allows for assessment of diffusion influenced by microcellular structures. We analyzed DKI in suspected low-grade gliomas prior to histopathological diagnosis. The aim was to investigate if diffusion parameters in the perilesional normal-appearing white matter (NAWM) differed from contralesional white matter, and to investigate differences between glioma malignancy grades II and III and glioma subtypes (astrocytomas and oligodendrogliomas). PATIENTS AND METHODS Forty-eight patients with suspected low-grade glioma were prospectively recruited to this institutional review board-approved study and investigated with preoperative DKI at 3T after written informed consent. Patients with histologically proven glioma grades II or III were further analyzed (n=35). Regions of interest (ROIs) were delineated on T2FLAIR images and co-registered to diffusion MRI parameter maps. Mean DKI data were compared between perilesional and contralesional NAWM (student's t-test for dependent samples, Wilcoxon matched pairs test). Histogram DKI data were compared between glioma types and glioma grades (multiple comparisons of mean ranks for all groups). The discriminating potential for DKI in assessing glioma type and grade was assessed with receiver operating characteristics (ROC) curves. RESULTS There were significant differences in all mean DKI variables between perilesional and contralesional NAWM (p=<0.000), except for axial kurtosis (p=0.099). Forty-four histogram variables differed significantly between glioma grades II (n=23) and III (n=12) (p=0.003-0.048) and 10 variables differed significantly between ACs (n=18) and ODs (n=17) (p=0.011-0.050). ROC curves of the best discriminating variables had an area under the curve (AUC) of 0.657-0.815. CONCLUSIONS Mean DKI variables in perilesional NAWM differ significantly from contralesional NAWM, suggesting altered microstructure by tumor infiltration not depicted on morphological MRI. Histogram analysis of DKI data identifies differences between glioma grades and subtypes.
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Affiliation(s)
- Anna F Delgado
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Markus Fahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | | | - Shala G Berntsson
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Maria Zetterling
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Sylwia Libard
- Department of Immunology, Genetics and Pathology, Section of pathology, Uppsala University Hospital and Uppsala University, Uppsala, Sweden
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Section of pathology, Uppsala University Hospital and Uppsala University, Uppsala, Sweden
| | | | - Jimmy Lätt
- Department of Imaging and Function, Skåne University Healthcare, Lund, Sweden
| | - Anja Smits
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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Fagius J, Feresiadou A, Larsson EM, Burman J. Discontinuation of disease modifying treatments in middle aged multiple sclerosis patients. First line drugs vs natalizumab. Mult Scler Relat Disord 2017; 12:82-87. [PMID: 28283113 DOI: 10.1016/j.msard.2017.01.009] [Citation(s) in RCA: 21] [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: 08/18/2016] [Revised: 11/29/2016] [Accepted: 01/13/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several disease-modifying drugs (DMD) are available for the treatment of MS, and most patients with relapsing-remitting disease are currently treated. Data on when and how DMD treatment can be safely discontinued are scarce. METHODS Fifteen MS patients, treated with natalizumab for >5 years without clinical and radiological signs of inflammatory disease activity, suspended treatment and were monitored with MRI examinations and clinical follow-up to determine recurrence of disease activity. This group was compared with a retrospectively analysed cohort comprising 55 MS patients treated with first-line DMDs discontinuing therapy in the time period of 1998-2015 after an analogous stable course. RESULTS Natalizumab discontinuers were followed for on average 19 months, and follow-up data for 56 months were available for first-line DMD quitters. Two-thirds of natalizumab treated patients experienced recurrent inflammatory disease activity, and one third had recurrence of rebound character. In contrast, 35% of first-line DMD quitters had mild recurrent disease activity, and no one exhibited rebound. CONCLUSIONS Withdrawal of a first-line DMD after prolonged treatment in middle-aged MS patients with stable disease appears to be relatively safe, while natalizumab withdrawal in a similar group of patients cannot be safely done without starting alternative therapy.
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Affiliation(s)
- Jan Fagius
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.
| | | | - Elna-Marie Larsson
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - Joachim Burman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Nordin K, Herlitz A, Larsson EM, Söderlund H. Overlapping effects of age on associative memory and the anterior hippocampus from middle to older age. Behav Brain Res 2017; 317:350-359. [DOI: 10.1016/j.bbr.2016.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/28/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
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Wahlund LO, Westman E, van Westen D, Wallin A, Shams S, Cavallin L, Larsson EM. Imaging biomarkers of dementia: recommended visual rating scales with teaching cases. Insights Imaging 2016; 8:79-90. [PMID: 28004274 PMCID: PMC5265189 DOI: 10.1007/s13244-016-0521-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 05/05/2016] [Revised: 09/01/2016] [Accepted: 09/19/2016] [Indexed: 11/04/2022] Open
Abstract
Abstract The diagnostic work up of dementia may benefit from structured reporting of CT and/or MRI and the use of standardised visual rating scales. We advocate a more widespread use of standardised scales as part of the workflow in clinical and research evaluation of dementia. We propose routine clinical use of rating scales for medial temporal atrophy (MTA), global cortical atrophy (GCA) and white matter hyperintensities (WMH). These scales can be used for evaluation of both CT and MRI and are efficient in routine imaging assessment in dementia, and may improve the accuracy of diagnosis. Our review provides detailed imaging examples of rating increments in each of these scales and a separate teaching file. The radiologist should relate visual ratings to the clinical assessment and other biomarkers to assist the clinician in the diagnostic decision. Teaching points • Clinical dementia diagnostics would benefit from structured radiological reporting. • Standardised rating scales should be used in dementia assessment. • It is important to relate imaging findings to the clinically suspected diagnosis. Electronic supplementary material The online version of this article (doi:10.1007/s13244-016-0521-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars-Olof Wahlund
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Danielle van Westen
- Diagnostic Radiology, Clinical Sciences, Lund University, Lund, Sweden.,Imaging and Function, Skåne University Hospital, Lund, Sweden
| | - Anders Wallin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Sara Shams
- Department of Clinical Science, Intervention, and Technology, Division of Medical Imaging and Technology, Karolinska Institutet, Stockholm, Sweden. .,Department of Radiology, Karolinska University Hospital, SE-14186, Stockholm, Sweden.
| | - Lena Cavallin
- Department of Clinical Science, Intervention, and Technology, Division of Medical Imaging and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, SE-14186, Stockholm, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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Wiemerslage L, Zhou W, Olivo G, Stark J, Hogenkamp PS, Larsson EM, Sundbom M, Schiöth HB. A resting-state fMRI study of obese females between pre- and postprandial states before and after bariatric surgery. Eur J Neurosci 2016; 45:333-341. [PMID: 27718507 DOI: 10.1111/ejn.13428] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 07/15/2016] [Revised: 09/26/2016] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Abstract
Past studies utilizing resting-state functional MRI (rsfMRI), have shown that obese humans exhibit altered activity in brain areas related to reward compared to normal-weight controls. However, to what extent bariatric surgery-induced weight loss alters resting-state brain activity in obese humans is less well-studied. Thus, we measured the fractional amplitude of low-frequency fluctuations from eyes-closed, rsfMRI in obese females (n = 11, mean age = 42 years, mean BMI = 41 kg/m2 ) in both a pre- and postprandial state at two time points: four weeks before, and four weeks after bariatric surgery. Several brain areas showed altered resting-state activity following bariatric surgery, including the putamen, insula, cingulate, thalamus and frontal regions. Activity augmented by surgery was also dependent on prandial state. For example, in the fasted state, activity in the middle frontal and pre- and postcentral gyri was found to be decreased after surgery. In the sated state, activity within the insula was increased before, but not after surgery. Collectively, our results suggest that resting-state neural functions are rapidly affected following bariatric surgery and the associated weight loss and change in diet.
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Affiliation(s)
- Lyle Wiemerslage
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Biomedicinska Centrum (BMC), Box 593, 751 24 Uppsala, Sweden
| | - Wei Zhou
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Biomedicinska Centrum (BMC), Box 593, 751 24 Uppsala, Sweden
| | - Gaia Olivo
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Biomedicinska Centrum (BMC), Box 593, 751 24 Uppsala, Sweden
| | - Julia Stark
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Biomedicinska Centrum (BMC), Box 593, 751 24 Uppsala, Sweden
| | - Pleunie S Hogenkamp
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Biomedicinska Centrum (BMC), Box 593, 751 24 Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Biomedicinska Centrum (BMC), Box 593, 751 24 Uppsala, Sweden
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Björkstrand J, Agren T, Åhs F, Frick A, Larsson EM, Hjorth O, Furmark T, Fredrikson M. Disrupting Reconsolidation Attenuates Long-Term Fear Memory in the Human Amygdala and Facilitates Approach Behavior. Curr Biol 2016; 26:2690-2695. [DOI: 10.1016/j.cub.2016.08.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/02/2016] [Accepted: 08/08/2016] [Indexed: 12/01/2022]
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49
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Fällmar D, Lilja J, Kilander L, Danfors T, Lubberink M, Larsson EM, Sörensen J. Validation of true low-dose 18F-FDG PET of the brain. Am J Nucl Med Mol Imaging 2016; 6:269-276. [PMID: 27766185 PMCID: PMC5069279] [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] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 07/26/2016] [Indexed: 06/06/2023]
Abstract
The dosage of 18F-FDG must be sufficient to ensure adequate PET image quality. For younger patients and research controls, the lowest possible radiation dose should be used. The purpose of this study was to find a protocol for FDG-PET of the brain with reduced radiation dose and preserved quantitative characteristics. Eight patients with neurodegenerative disorders and nine controls (n=17) underwent FDG-PET/CT twice on separate occasions, first with normal-dose (3 MBq/kg), and second with low-dose (0.75 MBq/kg, 25% of the original). Five additional controls (total n=22) underwent FDG-PET twice, using normal-dose and ultra-low-dose (0.3 MBq/kg, 10% of original). All subjects underwent MRI. Ten-minute summation images were spatially normalized and intensity normalized. Regional standard uptake value ratios (SUV-r) were calculated using an automated atlas. SUV-r values from the normal- and low-dose images were compared pairwise. No clinically significant bias was found in any of the three groups. The mean absolute difference in regional SUV-r values was 0.015 (1.32%) in controls and 0.019 (1.67%) in patients. The ultra-low-dose protocol produced a slightly higher mean difference of 0.023 (2.10%). The main conclusion is that 0.75 MBq/kg (56 MBq for a 75-kg subject) is a sufficient FDG dose for evaluating regional SUV-ratios in brain PET scans in adults with or without neurodegenerative disease, resulting in a reduction of total PET/CT effective dose from 4.54 to 1.15 mSv. The ultra-low-dose (0.5 mSv) could be useful in research studies requiring serial PET in healthy controls or children.
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Affiliation(s)
- David Fällmar
- Department of Surgical Sciences, Radiology, Uppsala UniversityUppsala, Sweden
| | - Johan Lilja
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala UniversityUppsala, Sweden
- Hermes Medical SolutionsStockholm, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala UniversityUppsala, Sweden
| | - Torsten Danfors
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala UniversityUppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala UniversityUppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala UniversityUppsala, Sweden
| | - Jens Sörensen
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala UniversityUppsala, Sweden
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50
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Latini F, Larsson EM, Ryttlefors M. Accurate MRI Segmentation of Skull Base Meningiomas. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1592562] [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: 10/21/2022]
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