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Rivera-Rivera LA, Roberts GS, Peret A, Langhough RE, Jonaitis EM, Du L, Field A, Eisenmenger L, Johnson SC, Johnson KM. Unraveling diurnal and technical variability in cerebral hemodynamics from neurovascular 4D-Flow MRI. J Cereb Blood Flow Metab 2024:271678X241232190. [PMID: 38340787 DOI: 10.1177/0271678x241232190] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Neurovascular 4D-Flow MRI enables non-invasive evaluation of cerebral hemodynamics including measures of cerebral blood flow (CBF), vessel pulsatility index (PI), and cerebral pulse wave velocity (PWV). 4D-Flow measures have been linked to various neurovascular disorders including small vessel disease and Alzheimer's disease; however, physiological and technical sources of variability are not well established. Here, we characterized sources of diurnal physiological and technical variability in cerebral hemodynamics using 4D-Flow in a retrospective study of cognitively unimpaired older adults (N = 750) and a prospective study of younger adults (N = 10). Younger participants underwent repeated MRI sessions at 7am, 4 pm, and 10 pm. In the older cohort, having an MRI earlier on the day was significantly associated with higher CBF and lower PI. In prospective experiments, time of day significantly explained variability in CBF and PI; however, not in PWV. Test-retest experiments showed high CBF intra-session repeatability (repeatability coefficient (RPC) =7.2%), compared to lower diurnal repeatability (RPC = 40%). PI and PWV displayed similar intra-session and diurnal variability (PI intra-session RPC = 22%, RPC = 24% 7am vs 4 pm; PWV intra-session RPC = 17%, RPC = 21% 7am vs 4 pm). Overall, CBF measures showed low technical variability, supporting diurnal variability is from physiology. PI and PWV showed higher technical variability but less diurnal variability.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Anthony Peret
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rebecca E Langhough
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Erin M Jonaitis
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lianlian Du
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron Field
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kevin M Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Rivera-Rivera LA, Vikner T, Eisenmenger L, Johnson SC, Johnson KM. Four-dimensional flow MRI for quantitative assessment of cerebrospinal fluid dynamics: Status and opportunities. NMR Biomed 2023:e5082. [PMID: 38124351 DOI: 10.1002/nbm.5082] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023]
Abstract
Neurological disorders can manifest with altered neurofluid dynamics in different compartments of the central nervous system. These include alterations in cerebral blood flow, cerebrospinal fluid (CSF) flow, and tissue biomechanics. Noninvasive quantitative assessment of neurofluid flow and tissue motion is feasible with phase contrast magnetic resonance imaging (PC MRI). While two-dimensional (2D) PC MRI is routinely utilized in research and clinical settings to assess flow dynamics through a single imaging slice, comprehensive neurofluid dynamic assessment can be limited or impractical. Recently, four-dimensional (4D) flow MRI (or time-resolved three-dimensional PC with three-directional velocity encoding) has emerged as a powerful extension of 2D PC, allowing for large volumetric coverage of fluid velocities at high spatiotemporal resolution within clinically reasonable scan times. Yet, most 4D flow studies have focused on blood flow imaging. Characterizing CSF flow dynamics with 4D flow (i.e., 4D CSF flow) is of high interest to understand normal brain and spine physiology, but also to study neurological disorders such as dysfunctional brain metabolite waste clearance, where CSF dynamics appear to play an important role. However, 4D CSF flow imaging is challenged by the long T1 time of CSF and slower velocities compared with blood flow, which can result in longer scan times from low flip angles and extended motion-sensitive gradients, hindering clinical adoption. In this work, we review the state of 4D CSF flow MRI including challenges, novel solutions from current research and ongoing needs, examples of clinical and research applications, and discuss an outlook on the future of 4D CSF flow.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tomas Vikner
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Radiation Sciences, Radiation Physics and Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sterling C Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Du L, Hermann BP, Jonaitis EM, Cody KA, Rivera-Rivera L, Rowley H, Field A, Eisenmenger L, Christian BT, Betthauser TJ, Larget B, Chappell R, Janelidze S, Hansson O, Johnson SC, Langhough R. Harnessing cognitive trajectory clusterings to examine subclinical decline risk factors. Brain Commun 2023; 5:fcad333. [PMID: 38107504 PMCID: PMC10724051 DOI: 10.1093/braincomms/fcad333] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/23/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023] Open
Abstract
Cognitive decline in Alzheimer's disease and other dementias typically begins long before clinical impairment. Identifying people experiencing subclinical decline may facilitate earlier intervention. This study developed cognitive trajectory clusters using longitudinally based random slope and change point parameter estimates from a Preclinical Alzheimer's disease Cognitive Composite and examined how baseline and most recently available clinical/health-related characteristics, cognitive statuses and biomarkers for Alzheimer's disease and vascular disease varied across these cognitive clusters. Data were drawn from the Wisconsin Registry for Alzheimer's Prevention, a longitudinal cohort study of adults from late midlife, enriched for a parental history of Alzheimer's disease and without dementia at baseline. Participants who were cognitively unimpaired at the baseline visit with ≥3 cognitive visits were included in trajectory modelling (n = 1068). The following biomarker data were available for subsets: positron emission tomography amyloid (amyloid: n = 367; [11C]Pittsburgh compound B (PiB): global PiB distribution volume ratio); positron emission tomography tau (tau: n = 321; [18F]MK-6240: primary regions of interest meta-temporal composite); MRI neurodegeneration (neurodegeneration: n = 581; hippocampal volume and global brain atrophy); T2 fluid-attenuated inversion recovery MRI white matter ischaemic lesion volumes (vascular: white matter hyperintensities; n = 419); and plasma pTau217 (n = 165). Posterior median estimate person-level change points, slopes' pre- and post-change point and estimated outcome (intercepts) at change point for cognitive composite were extracted from Bayesian Bent-Line Regression modelling and used to characterize cognitive trajectory groups (K-means clustering). A common method was used to identify amyloid/tau/neurodegeneration/vascular biomarker thresholds. We compared demographics, last visit cognitive status, health-related factors and amyloid/tau/neurodegeneration/vascular biomarkers across the cognitive groups using ANOVA, Kruskal-Wallis, χ2, and Fisher's exact tests. Mean (standard deviation) baseline and last cognitive assessment ages were 58.4 (6.4) and 66.6 (6.6) years, respectively. Cluster analysis identified three cognitive trajectory groups representing steep, n = 77 (7.2%); intermediate, n = 446 (41.8%); and minimal, n = 545 (51.0%) cognitive decline. The steep decline group was older, had more females, APOE e4 carriers and mild cognitive impairment/dementia at last visit; it also showed worse self-reported general health-related and vascular risk factors and higher amyloid, tau, neurodegeneration and white matter hyperintensity positive proportions at last visit. Subtle cognitive decline was consistently evident in the steep decline group and was associated with generally worse health. In addition, cognitive trajectory groups differed on aetiology-informative biomarkers and risk factors, suggesting an intimate link between preclinical cognitive patterns and amyloid/tau/neurodegeneration/vascular biomarker differences in late middle-aged adults. The result explains some of the heterogeneity in cognitive performance within cognitively unimpaired late middle-aged adults.
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Affiliation(s)
- Lianlian Du
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Bruce P Hermann
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Neurology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53705, USA
| | - Erin M Jonaitis
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Karly Alex Cody
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Leonardo Rivera-Rivera
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53705, USA
| | - Howard Rowley
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Aaron Field
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Bradley T Christian
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53705, USA
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Bret Larget
- Department of Statistics, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Rick Chappell
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53726, USA
| | | | - Oskar Hansson
- Clinical Memory Research Unit, Lund University, Lund 205 02, Sweden
| | - Sterling C Johnson
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
| | - Rebecca Langhough
- Wisconsin Alzheimer’s Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA
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Sui B, Sannananja B, Zhu C, Balu N, Eisenmenger L, Baradaran H, Edjlali M, Romero JM, Rajiah PS, Li R, Mossa-Basha M. Report from the society of magnetic resonance angiography: clinical applications of 7T neurovascular MR in the assessment of intracranial vascular disease. J Neurointerv Surg 2023:jnis-2023-020668. [PMID: 37652689 PMCID: PMC10902184 DOI: 10.1136/jnis-2023-020668] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023]
Abstract
In recent years, ultra-high-field magnetic resonance imaging (MRI) applications have been rapidly increasing in both clinical research and practice. Indeed, 7-Tesla (7T) MRI allows improved depiction of smaller structures with high signal-to-noise ratio, and, therefore, may improve lesion visualization, diagnostic capabilities, and thus potentially affect treatment decision-making. Incremental evidence emerging from research over the past two decades has provided a promising prospect of 7T magnetic resonance angiography (MRA) in the evaluation of intracranial vasculature. The ultra-high resolution and excellent image quality of 7T MRA allow us to explore detailed morphological and hemodynamic information, detect subtle pathological changes in early stages, and provide new insights allowing for deeper understanding of pathological mechanisms of various cerebrovascular diseases. However, along with the benefits of ultra-high field strength, some challenges and concerns exist. Despite these, ongoing technical developments and clinical oriented research will facilitate the widespread clinical application of 7T MRA in the near future. In this review article, we summarize technical aspects, clinical applications, and recent advances of 7T MRA in the evaluation of intracranial vascular disease. The aim of this review is to provide a clinical perspective for the potential application of 7T MRA for the assessment of intracranial vascular disease, and to explore possible future research directions implementing this technique.
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Affiliation(s)
- Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bhagya Sannananja
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Vascular Imaging Lab, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Hediyeh Baradaran
- Department of Radiology & Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Javier M Romero
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rui Li
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Vascular Imaging Lab, University of Washington School of Medicine, Seattle, Washington, USA
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Dawkins D, Aagaard-Kienitz B, Capel K, Eisenmenger L, Samsonov A, Li Y, Sandoval-Garcia C, Iskandar B. In Reply: Wide Arterial Sparing Encephalo-Duro-Synangiosis for Moyamoya: Surgical Technique and Outcomes. Oper Neurosurg (Hagerstown) 2023; 24:e473. [PMID: 37039599 DOI: 10.1227/ons.0000000000000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 04/12/2023] Open
Affiliation(s)
- Demi Dawkins
- Department of Neurosurgery, University of Tennessee Health Sciences/Semmes-Murphey Clinic, Memphis , Tennessee , USA
| | - Beverly Aagaard-Kienitz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison , Wisconsin , USA
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison , Wisconsin , USA
| | - Kelly Capel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison , Wisconsin , USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison , Wisconsin , USA
| | - Alexey Samsonov
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison , Wisconsin , USA
| | - Yiping Li
- Inland Neurosurgery, Spokane , Washington , USA
| | | | - Bermans Iskandar
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison , Wisconsin , USA
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6
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Taylor J, Eisenmenger L, Lindroth H, Booth J, Mohanty R, Nair V, Parker M, Kunkel D, Rivera C, Casey C, Zetterberg H, Blennow K, Mrkobrada M, Devereaux PJ, Pearce RA, Lennertz R, Prabhakaran V, Sanders RD. Perioperative ischaemic brain injury and plasma neurofilament light: a secondary analysis of two prospective cohort studies. Br J Anaesth 2023; 130:e361-e369. [PMID: 36437124 PMCID: PMC9997085 DOI: 10.1016/j.bja.2022.10.018] [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: 05/19/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Ischaemic brain infarction can occur without acute neurological symptoms (covert strokes) or with symptoms (overt strokes), both associated with poor health outcomes. We conducted a pilot study of the incidence of preoperative and postoperative (intraoperative or postoperative) covert strokes, and explored the relationship of postoperative ischaemic brain injury to blood levels of neurofilament light, a biomarker of neuronal damage. METHODS We analysed 101 preoperative (within 2 weeks of surgery) and 58 postoperative research MRIs on postoperative days 2-9 from two prospective cohorts collected at the University of Wisconsin (NCT01980511 and NCT03124303). Participants were aged >65 yr and undergoing non-intracranial, non-carotid surgery. RESULTS Preoperative covert stroke was identified in 2/101 participants (2%; Bayesian 95% confidence interval [CI], 0.2-5.4). This rate was statistically different from the postoperative ischaemic brain injury rate of 7/58 (12%, 4.9-21.3%; P=0.01) based on postoperative imaging. However, in a smaller group of participants with paired imaging (n=30), we did not identify the same effect (P=0.67). Patients with postoperative brain injury had elevated peak neurofilament light levels (median [inter-quartile range], 2.34 [2.24-2.64] log10 pg ml-1) compared with those without (1.86 [1.48-2.21] log10 pg ml-1; P=0.025). Delirium severity scores were higher in those with postoperative brain injury (19 [17-21]) compared with those without (7 [4-12]; P=0.01). CONCLUSION Although limited by a small sample size, these data suggest that preoperative covert stroke occurs more commonly than previously anticipated. Plasma neurofilament light is a potential screening biomarker for postoperative ischaemic brain injury.
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Affiliation(s)
- Jennifer Taylor
- Specialty of Anaesthetics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW, Australia
| | - Laura Eisenmenger
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Heidi Lindroth
- Division of Nursing Research, Mayo Clinic, Rochester, MN, USA
| | - James Booth
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW, Australia
| | - Rosaleena Mohanty
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; Department of Neurobiology, Care, Sciences and Society, Karolinska Institute, Sweden
| | - Veena Nair
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Margaret Parker
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - David Kunkel
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Cameron Rivera
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Cameron Casey
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Marko Mrkobrada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Philip J Devereaux
- Department of Medicine and Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Perioperative and Surgery Research Group, Population Health Research Institute, Hamilton, ON, Canada; Outcomes Research Consortium, Cleveland, OH, USA
| | - Robert A Pearce
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Richard Lennertz
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Vivek Prabhakaran
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robert D Sanders
- Specialty of Anaesthetics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW, Australia.
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7
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Schroeder BE, Rivera LA, Romero MO, Johnson KM, Wieben O, Asthana S, Johnson SC, Eisenmenger L, Salamat S, Betthauser TJ. Antemortem‐postmortem correlates of 4D‐Flow MRI in cerebral vessels. Alzheimers Dement 2022. [DOI: 10.1002/alz.067214] [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: 12/24/2022]
Affiliation(s)
| | - Leonardo A Rivera
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | | | - Kevin M Johnson
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Oliver Wieben
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Laura Eisenmenger
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Shahriar Salamat
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health Madison WI USA
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8
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Rivera‐Rivera LA, Cody KA, Betthauser TJ, Koscik RL, Jonaitis EM, Cadman RV, Hermann BP, Rowley HA, Carlsson CM, Chin NA, Eisenmenger L, Johnson SC, Johnson KM. Examining cerebrovascular burden across the cognitive continuum in older adults with and without evidence of amyloidosis. Alzheimers Dement 2022. [DOI: 10.1002/alz.063350] [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: 12/24/2022]
Affiliation(s)
| | - Karly Alex Cody
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Tobey J Betthauser
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | | | - Erin M. Jonaitis
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
| | - Robert V. Cadman
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Bruce P Hermann
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
| | - Howard A. Rowley
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Cynthia M. Carlsson
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
| | - Nathaniel A. Chin
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
| | - Laura Eisenmenger
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Sterling C. Johnson
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
| | - Kevin M Johnson
- University of Wisconsin School of Medicine and Public Health Madison WI USA
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9
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Schroeder BE, Rivera LA, Romero MO, Johnson KM, Wieben O, Asthana S, Johnson SC, Eisenmenger L, Salamat S, Betthauser TJ. Antemortem‐postmortem correlates of 4D‐Flow MRI in cerebral vessels. Alzheimers Dement 2022. [DOI: 10.1002/alz.068168] [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: 12/24/2022]
Affiliation(s)
| | - Leonardo A Rivera
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | | | - Kevin M Johnson
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Laura Eisenmenger
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Shahriar Salamat
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Tobey J Betthauser
- Alzheimer's Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
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Rivera-Rivera LA, Kecskemeti S, Jen ML, Miller Z, Johnson SC, Eisenmenger L, Johnson KM. Motion-corrected 4D-Flow MRI for neurovascular applications. Neuroimage 2022; 264:119711. [PMID: 36307060 PMCID: PMC9801539 DOI: 10.1016/j.neuroimage.2022.119711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/08/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Neurovascular 4D-Flow MRI has emerged as a powerful tool for comprehensive cerebrovascular hemodynamic characterization. Clinical studies in at risk populations such as aging adults indicate hemodynamic markers can be confounded by motion-induced bias. This study develops and characterizes a high fidelity 3D self-navigation approach for retrospective rigid motion correction of neurovascular 4D-Flow data. A 3D radial trajectory with pseudorandom ordering was combined with a multi-resolution low rank regularization approach to enable high spatiotemporal resolution self-navigators from extremely undersampled data. Phantom and volunteer experiments were performed at 3.0T to evaluate the ability to correct for different amounts of induced motions. In addition, the approach was applied to clinical-research exams from ongoing aging studies to characterize performance in the clinical setting. Simulations, phantom and volunteer experiments with motion correction produced images with increased vessel conspicuity, reduced image blurring, and decreased variability in quantitative measures. Clinical exams revealed significant changes in hemodynamic parameters including blood flow rates, flow pulsatility index, and lumen areas after motion correction in probed cerebral arteries (Flow: P<0.001 Lt ICA, P=0.002 Rt ICA, P=0.004 Lt MCA, P=0.004 Rt MCA; Area: P<0.001 Lt ICA, P<0.001 Rt ICA, P=0.004 Lt MCA, P=0.004 Rt MCA; flow pulsatility index: P=0.042 Rt ICA, P=0.002 Lt MCA). Motion induced bias can lead to significant overestimation of hemodynamic markers in cerebral arteries. The proposed method reduces measurement bias from rigid motion in neurovascular 4D-Flow MRI in challenging populations such as aging adults.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
| | - Steve Kecskemeti
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States
| | - Mu-Lan Jen
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States
| | - Zachary Miller
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States
| | - Sterling C Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States.
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11
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Dawkins D, Aagaard-Kienitz B, Capel K, Eisenmenger L, Samsonov A, Li Y, Sandoval-Garcia C, Iskandar B. Wide Arterial Sparing Encephalo-Duro-Synangiosis for Moyamoya: Surgical Technique and Outcomes. Oper Neurosurg (Hagerstown) 2022; 23:489-498. [PMID: 36113163 PMCID: PMC10593263 DOI: 10.1227/ons.0000000000000376] [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: 01/05/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Moyamoya is managed by surgical revascularization, but no standardized method has yet been universally adopted. OBJECTIVE To describe a new indirect bypass technique for pediatric moyamoya, wide arterial sparing encephalo-duro-synangiosis (WASEDS), which provides a much wider area of revascularization with minimal compromise to the middle meningeal arterial tree compared with traditional procedures. Initially used as a salvage technique after failed encephalo-duro-arterio-synangiosis, its success later motivated its use as a first-line procedure. METHODS Clinical and radiographic records of patients who underwent WASEDS for moyamoya from 2009 to 2020 were reviewed. Brain perfusion relative cerebral blood volume on the side of the WASEDS procedure was calculated. Two-tailed paired t tests were performed to identify the statistically significant differences ( P ≤ .05). RESULTS WASEDS was successfully performed on 8 patients for a total of 14 cerebral hemispheres. Age ranged from 2 to 25 years. There were no mortalities. The average clinical and radiographic follow-up was 49.79 months (range 2-126 months), demonstrating improvement in neurological condition and no postoperative stroke and significant diminution or cessation of transient ischemic attacks in all patients. Relative cerebral blood volume increased 9.24% after the WASEDS procedure ( P = .012). There were no neurological complications. There were 2 pseudomeningoceles related to the extensive dural openings. CONCLUSION WASEDS is a safe and effective indirect revascularization technique for both primary and salvage techniques. It provides an extensive area of cortical revascularization with no compromise of the middle meningeal vasculature and subjective reports of early improvement in cognition and behavior. The main disadvantage is elevated risk of pseudomeningocele secondary to the large craniotomy.
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Affiliation(s)
- Demi Dawkins
- Department of Neurosurgery, University of Tennessee Health Sciences/Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Beverly Aagaard-Kienitz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kelly Capel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alexey Samsonov
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yiping Li
- Department of Neurosurgery, Inland Neurosurgery, Spokane, Washington, USA
| | | | - Bermans Iskandar
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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12
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Chang W, Eisenmenger L, Cerejo R, Li C, Goldberg MF. Abstract WP129: Artificial Intelligence For Automated Detection Of Intracranial Hemorrhage (RAPID ICH): Initial Clinical Experience. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp129] [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: 11/16/2022]
Abstract
Purpose:
Intracranial hemorrhage (ICH) has high morbidity and mortality, but early intervention has been shown to improve clinical outcomes. Several applications have emerged using artificial intelligence (AI) for automated detection of ICH, including RAPID ICH (RICH, iSchemaView, Menlo Park, CA). We present our initial clinical experience with RICH in a busy Level 1 trauma center.
Materials/Methods:
The study was supervised by the local IRB. Emergency department (ED) patients and inpatients (IP) receiving head CTs on the ED scanner at a level 1 trauma center were included. RICH output ("no ICH" or "suspected ICH") was recorded for each exam. Initial interpreting emergency radiologists or neuroradiologists had access to RICH output. Radiology reports reporting ICH were positive and those without ICH were negative. A board certified neuroradiologist reviewed each case with access to the initial report, RICH output, and prior exams. In cases with disagreement between readers, a third reader adjudicated the result and their decision was considered final. Expert reads were used as the gold standard and sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated.
Results:
1388 patients were included, 1251 from the ED and 137 IP. For the ED patients, 139 had ICH and 1112 did not, where as in the IP cohort, 100 had ICH and 37 did not. RICH demonstrated overall sensitivity of 79% (73% ED, 88% IP), overall specificity of 95% (96% ED, 84% IP), overall PPV of 76% (65% ED, 94% IP) and overall NPV of 96% (97% ED, 72% IP).
Conclusion:
RICH had relatively high sensitivity and very high specificity for ICH, with lower sensitivity/higher specificity in the ED, and higher sensitivity/lower specificity in IP. Active worklist reprioritization allows faster triage of potentially positive studies and earlier intervention potentially improving clinical outcomes, especially in IPs with longer average turnaround times for routine studies.
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Affiliation(s)
- Warren Chang
- Radiology, Allegheny Health Network, Pittsburgh, PA
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Chang W, Eisenmenger L, Cerejo R, Li C, Goldberg MF. Abstract WMP68: Artificial Intelligence For Automated Detection Of Large Vessel Occlusion Using Relative Vessel Density (RAPID LVO): One Year Experience In A Multihospital Integrated Delivery Network. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wmp68] [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: 11/16/2022]
Abstract
Purpose:
RAPID LVO (RLVO) automatically detects anterior circulation large vessel occlusion (LVO) by quantifying MCA territory relative vessel density (RVD) compared to the contralateral side, allowing early mobilization of treatment teams. We present our one year experience in a multihospital health system for LVO detection in patients with stroke symptoms, effect on treatment time and clinical outcomes.
Materials/Methods:
The study was supervised by the local IRB. 1203 patients presenting with stroke symptoms receiving CTAs with RLVO were included. RLVO exams were positive at RVD < 60% (red or yellow color) and negative at RVD >60%. Radiology exams were positive if LVO (ICA/M1or M2 occlusion) or high grade stenosis (HGS) was found. All positive cases were reviewed by a second reader with 100% concordance. Expert reads were used as the gold standard and sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) were calculated. Patients eligible for mechanical thrombectomy (MT) were transferred to a comprehensive stroke center for treatment. CTA to groin puncture time was calculated during one year time intervals before and after RLVO installation for patients undergoing MT. 90 day Modified Rankin Scores (mRS) were obtained.
Results:
126 patients had M1/ICA occlusion, 71 had M2 occlusion, and 134 had HGS of the ICA or MCA. RLVO had sensitivities of 90%, 82%, and 82%, specificities of 82%, 85%, and 95%, PPV of 37%, 52%, and 87% and NPV of 99%, 96%, and 93% in the detection of M1 occlusion, LVO, or HGS/LVO, respectively. CTA to groin puncture time was significantly lower after deployment of RLVO (93 minutes vs 68 minutes, p<0.05). Average 90 day mRS was lower with RLVO with a higher percentage of patients with functional independence (mRS ≤ 2) (p<0.05).
Conclusion:
RLVO detected HGS or LVO in patients presenting with stroke symptoms with high accuracy. After RLVO installation, time to treatment decreased and clinical outcomes were improved.
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Chang W, Yin D, Li C, Weston B, Sohn A, Wanamaker C, Kulzer M, Tragon T, Spearman M, Eisenmenger L, Goldberg M. Increased relative risk of delayed hemorrhage in patients taking anticoagulant/antiplatelet medications with concurrent aspirin therapy: implications for clinical practice based on 3-year retrospective analysis in a large health system. Emerg Radiol 2022; 29:353-358. [PMID: 34988752 DOI: 10.1007/s10140-021-02003-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The incidence of delayed posttraumatic intracranial hemorrhage (DH) in patients on anticoagulant (AC) and antiplatelet (AP) medications, especially with concurrent aspirin therapy, is not well established, with studies reporting disparate results with between 1-10% risk of DH and 0-3% mortality. The purpose of this 3-year retrospective study is to evaluate the true risk of DH in patients on AP/AC medications with or without concurrent aspirin therapy. METHODS One thousand forty-six patients taking AP and AC medications presenting to network emergency departments with head trauma who had repeat CT to evaluate for DH were included in the study. Repeat examinations were typically performed within 24 h (average follow-up time was 21 h and 99% were within 3 days). Mean time to DH was 20 h. All positive studies were reviewed by two board-certified neuroradiologists. Patients were excluded from the study if hemorrhage was retrospectively identified on the initial examination. Cases were reclassified as negative if hemorrhage on the follow-up examination was thought to be not present or artifactual. Cases were considered positive if the initial examination was negative and the follow-up examination demonstrated new hemorrhage. RESULTS Overall, there was 1.91% incidence (20 patients) of DH and 0.3% overall mortality (3 patients). The group of patients taking warfarin or AP agents demonstrated a significantly higher rate of DH (3.2% compared to 0.9%) and higher mortality (0.9% compared to 0.0%) compared to the DOAC group (p < 0.01). The risk of DH in patients taking AC or AP agents with aspirin (13/20 cases) was significantly higher (RR 3.8, p < 0.01) than that of patients taking AC or AP alone (7/20 cases). CONCLUSION The risk of DH was significantly higher in patients taking aspirin in addition to AC/AP medications. Repeat imaging should be obtained for trauma patients taking AC/AP agents with concurrent aspirin. The rate of DH was also significantly higher in patients taking warfarin or AP agents when compared to patients taking DOACs. Repeat examination should be strongly considered on patients taking warfarin or AP agents without aspirin. Given the relatively low risk of DH in patients taking DOACs alone, repeat imaging could be reserved for patients with external signs of trauma or dangerous mechanism of injury.
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Affiliation(s)
- Warren Chang
- Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA.
| | - Danielle Yin
- Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA
| | - Charles Li
- Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA
| | - Brian Weston
- Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA
| | - Albert Sohn
- Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA
| | - Christian Wanamaker
- Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA
| | - Matthew Kulzer
- Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA
| | - Tyson Tragon
- Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA
| | - Michael Spearman
- Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA
| | - Laura Eisenmenger
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Michael Goldberg
- Imaging Institute, Allegheny Health Network, 320 E. North Ave, Pittsburgh, PA, 15206, USA
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Rivera‐Rivera LA, Eisenmenger L, Cody KA, Reher T, Betthauser T, Cadman RV, Rowley HA, Carlsson CM, Chin NA, Johnson SC, Johnson KM. Cerebrovascular stiffness and flow dynamics in the presence of amyloid and tau biomarkers. Alzheimers Dement (Amst) 2021; 13:e12253. [PMID: 35005194 PMCID: PMC8719432 DOI: 10.1002/dad2.12253] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This work investigated the relationship between cerebrovascular disease (CVD) markers and Alzheimer's disease (AD) biomarkers of amyloid beta deposition, and neurofibrillary tau tangles in subjects spanning the AD clinical spectrum. METHODS A total of 136 subjects participated in this study. Four groups were established based on AD biomarker positivity from positron emission tomography (amyloid [A] and tau [T]) and clinical diagnosis (cognitively normal [CN] and impaired [IM]). CVD markers were derived from structural and quantitative magnetic resonance imaging data. RESULTS Transcapillary pulse wave delay was significantly longer in controls compared to AT biomarker-confirmed groups (A+/T-/CN P < .001, A+/T+/CN P < .001, A+/T+/IM P = .003). Intracranial low-frequency oscillations were diminished in AT biomarker-confirmed groups both CN and impaired (A+/T-/CN P = .039, A+/T+/CN P = .007, A+/T+/IM P = .011). A significantly higher presence of microhemorrhages was measured in A+/T+/CN compared to controls (P = .006). DISCUSSION Cerebrovascular markers indicate increased vessel stiffness and reduced vasomotion in AT biomarker-positive subjects during preclinical AD.
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Affiliation(s)
- Leonardo A. Rivera‐Rivera
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Laura Eisenmenger
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Karly A. Cody
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Thomas Reher
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Tobey Betthauser
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Robert V. Cadman
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Howard A. Rowley
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Cynthia M. Carlsson
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Nathaniel A. Chin
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Kevin M. Johnson
- Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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Rivera‐Rivera LA, Cody KA, Betthauser TJ, Cadman RV, Reher T, Rowley HA, Carlsson CM, Eisenmenger L, Johnson SC, Johnson KM. Associations in Alzheimer’s disease between intracranial vascular metrics from 4D‐flow MRI and β‐amyloid and tau PET. Alzheimers Dement 2021. [DOI: 10.1002/alz.056621] [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: 11/11/2022]
Affiliation(s)
- Leonardo A Rivera‐Rivera
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Karly Alex Cody
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Robert V Cadman
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Thomas Reher
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Howard A. Rowley
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital Madison WI USA
| | - Laura Eisenmenger
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
- University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital Madison WI USA
| | - Kevin M Johnson
- University of Wisconsin School of Medicine and Public Health Madison WI USA
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Wang R, Oh JM, Motovylyak A, Ma Y, Sager MA, Rowley HA, Johnson KM, Gallagher CL, Carlsson CM, Bendlin BB, Johnson SC, Asthana S, Eisenmenger L, Okonkwo OC. Impact of sex and APOE ε4 on age-related cerebral perfusion trajectories in cognitively asymptomatic middle-aged and older adults: A longitudinal study. J Cereb Blood Flow Metab 2021; 41:3016-3027. [PMID: 34102919 PMCID: PMC8545048 DOI: 10.1177/0271678x211021313] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 01/03/2023]
Abstract
Cerebral hypoperfusion is thought to contribute to cognitive decline in Alzheimer's disease, but the natural trajectory of cerebral perfusion in cognitively healthy adults has not been well-studied. This longitudinal study is consisted of 950 participants (40-89 years), who were cognitively unimpaired at their first visit. We investigated the age-related changes in cerebral perfusion, and their associations with APOE-genotype, biological sex, and cardiometabolic measurements. During the follow-up period (range 0.13-8.24 years), increasing age was significantly associated with decreasing cerebral perfusion, in total gray-matter (β=-1.43), hippocampus (-1.25), superior frontal gyrus (-1.70), middle frontal gyrus (-1.99), posterior cingulate (-2.46), and precuneus (-2.14), with all P-values < 0.01. Compared with male-ɛ4 carriers, female-ɛ4 carriers showed a faster decline in global and regional cerebral perfusion with increasing age, whereas the age-related decline in cerebral perfusion was similar between male- and female-ɛ4 non-carriers. Worse cardiometabolic profile (i.e., increased blood pressure, body mass index, total cholesterol, and blood glucose) was associated with lower cerebral perfusion at all the visits. When time-varying cardiometabolic measurements were adjusted in the model, the synergistic effect of sex and APOE-ɛ4 on age-related cerebral perfusion-trajectories became largely attenuated. Our findings demonstrate that APOE-genotype and sex interactively impact cerebral perfusion-trajectories in mid- to late-life. This effect may be partially explained by cardiometabolic alterations.
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Affiliation(s)
- Rui Wang
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- The Swedish School of Sport and Health Science, GIH, Stockholm, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Jennifer M Oh
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Alice Motovylyak
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yue Ma
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mark A Sager
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Howard A Rowley
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Catherine L Gallagher
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Barbara B Bendlin
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Laura Eisenmenger
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ozioma C Okonkwo
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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18
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Kim D, Eisenmenger L, Turski P, Johnson KM. Simultaneous 3D-TOF angiography and 4D-flow MRI with enhanced flow signal using multiple overlapping thin slab acquisition and magnetization transfer. Magn Reson Med 2021; 87:1401-1417. [PMID: 34708445 DOI: 10.1002/mrm.29060] [Citation(s) in RCA: 4] [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: 08/04/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the fusion of 3D time-of-flight principles into 4D-flow MRI to enhance vessel contrast and signal without an exogenous contrast agent, enabling simultaneous in-flow based angiograms. METHODS A 4D-flow MRI technique was developed consisting of multiple overlapping slabs with intermittent magnetization transfer preparation. The scan time penalty associated with multiple slab acquisitions was mitigated by using undersampled distributed spiral trajectories and compressed sensing reconstruction. A flow phantom was used to characterize in-flow enhancement, velocity noise improvement, and flow rate measurements against the single-slab 4D-flow MRI. In a patient-volunteer cohort (n = 15), magnitude-based angiograms were radiologically evaluated against 3D time-of-flight, and velocity measurements were compared pixel-wise against single-slab and contrast-enhanced 4D-flow MRI. RESULTS Multiple-slab acquisitions, together with magnetization transfer preparation, substantially improved vessel signal, contrast, and vessel conspicuity in magnitude angiograms. Both clinical 3D time-of-flight and the proposed technique produced equivalent vessel depictions with no statistically significant difference (p < .1). Both techniques also produced clear depictions of brain aneurysms in all patients; however, very small vessels tended to show reduced conspicuity in the proposed technique. Velocity measurements agreed with contrast-enhanced and single-slab scans with high correlations (R2 = 0.941-0.974) and agreements (slopes = 0.994-1.071). Slab boundary and magnetization transfer-related artifacts were not observed in velocity measurements, and velocity noise was reduced with in-flow enhancement over single-slab scans (phantom). CONCLUSION The vessel signal and contrast can be improved in 4D-flow MRI without exogenous contrast agents by utilizing in-flow enhancement, efficient sampling, and compressed sensing. The in-flow enhancement also enables simultaneous 3D time-of-flight angiograms useful for flow quantification and diagnosis.
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Affiliation(s)
- Dahan Kim
- Department of Physics, University of Wisconsin, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Patrick Turski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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19
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Adhya J, Li C, Eisenmenger L, Cerejo R, Tayal A, Goldberg M, Chang W. Positive predictive value and stroke workflow outcomes using automated vessel density (RAPID-CTA) in stroke patients: One year experience. Neuroradiol J 2021; 34:476-481. [PMID: 33906499 PMCID: PMC8559016 DOI: 10.1177/19714009211012353] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Several new techniques have emerged for detecting anterior circulation large vessel occlusion by quantifying relative vessel density including RAPID-CTA, potentially allowing for faster triage and decreased time to mechanical thrombectomy. We present our one-year experience on positive predictive value of RAPID-CTA for the detection of large vessel occlusion in patients presenting with stroke symptoms and its effect on treatment time and clinical outcomes. MATERIALS AND METHODS Three hundred and ten patients presenting with stroke symptoms with relative vessel density <60% on RAPID-CTA were included (average age 70 years, 145 male, 165 female). Examinations were considered positive if there was evidence of large vessel occlusion or high grade stenosis. Computed tomography angiography to groin puncture time was calculated during one-year time intervals before and after RAPID-CTA installation. Ninety-day Modified Rankin Scale scores were obtained for patients in each cohort. RESULTS Of the 310 patients, 270 had large vessel occlusion or high grade stenosis (87% positive predictive value), with 161 having large vessel occlusion. Using 45% relative vessel density threshold, 129/161 large vessel occlusion were detected (80% sensitivity) and 163/172 examinations were positive (95% positive predictive value). Computed tomography angiography to groin puncture time was significantly lower after deployment of RAPID-CTA (93 min vs 68 min, p<0.05). Average 90 day modified Rankin Scale score was lower in the RAPID-CTA group with a higher percentage of patients with functional independence, although the data was not statistically significant. CONCLUSION RAPID-CTA had high positive predictive value for large vessel occlusion with a 45% relative vessel density threshold, which could facilitate active worklist reprioritization. Time to treatment was significantly lower and clinical outcomes were improved after deployment of RAPID-CTA.
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Affiliation(s)
- Julie Adhya
- Department of Radiology, Allegheny Health Network, USA
| | - Charles Li
- Department of Radiology, Allegheny Health Network, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of
Medicine and Public Health, USA
| | | | - Ashis Tayal
- Department of Neurology, Allegheny Health Network, USA
| | | | - Warren Chang
- Department of Radiology, Allegheny Health Network, USA
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20
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Manunga J, Jordano L, Mirza AK, Teng X, Skeik N, Eisenmenger L. Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms. CVIR Endovasc 2021; 4:44. [PMID: 34061297 PMCID: PMC8167926 DOI: 10.1186/s42155-021-00233-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/28/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe technical details of modifying four different Cook Zenith devices to treat complex aortic aneurysms. Material In the first three cases, the modification process involved complete stent graft deployment on a sterile back table. Fenestrations were created using an ophthalmologic cautery and reinforced with a radiopaque snare using a double-armed 4–0 Ethibond locking suture based on measurements obtained on centerline of flow. In each instance, a nitinol wire was withdrawn and redirected through and through the fabric and used as a constraining wire. In the fourth patient, modification involved partial stent graft deployment and creation of additional two fenestrations to accommodate renal arteries. The devices are resheathed and implanted in the standard fashion. Results Four patients underwent exclusion of their aneurysms, including thoracoabdominal aneurysms (n = 2), a contained ruptured juxtarenal aneurysm (n = 1), and a ruptured failed previous endovascular repair (n = 1). Fifteen fenestrations were successfully bridged with Atrium iCAST stent grafts. Average graft modification time, operative time, contrast volume, radiation dose, estimated blood loss, and hospital length of stay were 89 min, 155.25 min, 58.8 mL, 2451 mGy, 175 mL, and 4.3 days, respectively. One patient required a secondary intervention to treat a type Ib endoleak. During an average follow-up of 25 months, aneurysm sacs progressively shrank without additional intervention. Conclusion Physician-modified fenestrated/branched endografts are a safe alternative to custom made devices, especially in urgent cases and should be part of the armamentarium of any complex aortic program.
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Affiliation(s)
- Jesse Manunga
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 E 28th Street, Ste 300, Minneapolis, MN, 55407, USA. .,Minneapolis Heart Institute foundation, University of Wisconsin at Madison, Minneapolis, MN, USA.
| | - Lia Jordano
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 E 28th Street, Ste 300, Minneapolis, MN, 55407, USA
| | - Aleem K Mirza
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 E 28th Street, Ste 300, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute foundation, University of Wisconsin at Madison, Minneapolis, MN, USA
| | - Xiaoyi Teng
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 E 28th Street, Ste 300, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute foundation, University of Wisconsin at Madison, Minneapolis, MN, USA
| | - Nedaa Skeik
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 E 28th Street, Ste 300, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute foundation, University of Wisconsin at Madison, Minneapolis, MN, USA
| | - Laura Eisenmenger
- Department of Radiology, Division of neuroradiology, University of Wisconsin at Madison, Madison, USA
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21
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Robinson E, Jordano L, Mirza AK, Eisenmenger L, Skeik N, Manunga J. Management of a contained ruptured infrarenal abdominal aortic pseudoaneurysm caused by inferior vena cava struts injury: A case report and literature review. J Vasc Surg Cases Innov Tech 2021; 7:438-442. [PMID: 34278079 PMCID: PMC8263528 DOI: 10.1016/j.jvscit.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/04/2021] [Indexed: 11/20/2022]
Abstract
Aortic pseudoaneurysms are rare entities caused by infection, trauma, atherosclerotic plaque rupture, or aortic instrumentation. Their natural course remains unknown; however, repair is invariably recommended. We present a case of a 71-year-old man with a history of recurrent deep venous thrombosis and pulmonary embolisms who underwent an inferior vena cava filter placement 8 years prior and was found to have a 3.6-cm contained ruptured infrarenal aortic pseudoaneurysm on imaging performed for abdominal pain. His pseudoaneurysm was excluded using a Gore Excluder Endoprosthesis. We further reviewed literature on the subject to highlight the various surgical approaches to this lethal condition.
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Affiliation(s)
- Emilie Robinson
- Section of vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Lia Jordano
- Section of vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Aleem K. Mirza
- Section of vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Laura Eisenmenger
- Division of Neuroradiology, Department of Radiology, University of Wisconsin at Madison, Madison, Wisc
| | - Nedaa Skeik
- Section of vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Jesse Manunga
- Section of vascular & Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn
- Correspondence: Jesse Manunga, MD, FACS, Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute @ Abbott Northwestern Hospital, 920 E 28th St, Ste 300, Minneapolis, MN 55407
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22
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Muster R, Ko N, Smith W, Su H, Dickey MA, Nelson J, McCulloch CE, Sneed PK, Clarke JL, Saloner DA, Eisenmenger L, Kim H, Cooke DL. Proof-of-concept single-arm trial of bevacizumab therapy for brain arteriovenous malformation. BMJ Neurol Open 2021; 3:e000114. [PMID: 34189463 PMCID: PMC8204171 DOI: 10.1136/bmjno-2020-000114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/04/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/13/2022] Open
Abstract
Brain arteriovenous malformations (bAVMs) are relatively rare, although their potential for secondary intracranial haemorrhage (ICH) makes their diagnosis and management essential to the community. Currently, invasive therapies (surgical resection, stereotactic radiosurgery and endovascular embolisation) are the only interventions that offer a reduction in ICH risk. There is no designated medical therapy for bAVM, although there is growing animal and human evidence supporting a role for bevacizumab to reduce the size of AVMs. In this single-arm pilot study, two patients with large bAVMs (deemed unresectable by an interdisciplinary team) received bevacizumab 5 mg/kg every 2 weeks for 12 weeks. Due to limitations of external funding, the intended sample size of 10 participants was not reached. Primary outcome measure was change in bAVM volume from baseline at 26 and 52 weeks. No change in bAVM volume was observed 26 or 52 weeks after bevacizumab treatment. No clinically important adverse events were observed during the 52-week study period. There were no observed instances of ICH. Sera vascular endothelial growth factor levels were reduced at 26 weeks and returned to baseline at 52 weeks. This pilot study is the first to test bevacizumab for patients with bAVMs. Bevacizumab therapy was well tolerated in both subjects. No radiographic changes were observed over the 52-week study period. Subsequent larger clinical trials are in order to assess for dose-dependent efficacy and rarer adverse drug effects. Trial registration number: NCT02314377.
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Affiliation(s)
- Rachel Muster
- School of Medicine, UCSF, San Francisco, California, USA
| | - Nerissa Ko
- Neurology, UCSF, San Francisco, California, USA
| | - Wade Smith
- Neurology, UCSF, San Francisco, California, USA
| | - Hua Su
- Anesthesia and Perioperative Care, UCSF, San Francisco, California, USA
| | - Melissa A Dickey
- Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Jeffrey Nelson
- Anesthesia and Perioperative Care, UCSF, San Francisco, California, USA
| | | | | | | | - David A Saloner
- Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | | | - Helen Kim
- Anesthesia and Perioperative Care, UCSF, San Francisco, California, USA
| | - Daniel L Cooke
- Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
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23
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Rivera-Rivera LA, Cody KA, Eisenmenger L, Cary P, Rowley HA, Carlsson CM, Johnson SC, Johnson KM. Assessment of vascular stiffness in the internal carotid artery proximal to the carotid canal in Alzheimer's disease using pulse wave velocity from low rank reconstructed 4D flow MRI. J Cereb Blood Flow Metab 2021; 41:298-311. [PMID: 32169012 PMCID: PMC8370001 DOI: 10.1177/0271678x20910302] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/27/2020] [Accepted: 02/07/2020] [Indexed: 12/19/2022]
Abstract
Clinical evidence shows vascular factors may co-occur and complicate the expression of Alzheimer's disease (AD); yet, the pathologic mechanisms and involvement of different compartments of the vascular network are not well understood. Diseases such as arteriosclerosis diminish vascular compliance and will lead to arterial stiffness, a well-established risk factor for cardiovascular morbidity. Arterial stiffness can be assessed using pulse wave velocity (PWV); however, this is usually done from carotid-to-femoral artery ratios. To probe the brain vasculature, intracranial PWV measures would be ideal. In this study, high temporal resolution 4D flow MRI was used to assess transcranial PWV in 160 subjects including AD, mild cognitive impairment (MCI), healthy controls, and healthy subjects with apolipoprotein ɛ4 positivity (APOE4+) and parental history of AD dementia (FH+). High temporal resolution imaging was achieved by high temporal binning of retrospectively gated data using a local-low rank approach. Significantly higher transcranial PWV in AD dementia and MCI subjects was found when compared to old-age-matched controls (AD vs. old-age-matched controls: P <0.001, AD vs. MCI: P = 0.029, MCI vs. old-age-matched controls P = 0.013). Furthermore, vascular changes were found in clinically healthy middle-age adults with APOE4+ and FH+ indicating significantly higher transcranial PWV compared to controls (P <0.001).
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of
Medicine and Public Health, Madison, WI, USA
| | - Karly A Cody
- Alzheimer’s Disease Research Center, University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
| | - Paul Cary
- Alzheimer’s Disease Research Center, University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA
| | - Howard A Rowley
- Alzheimer’s Disease Research Center, University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA
- Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
| | - Cynthia M Carlsson
- Alzheimer’s Disease Research Center, University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S.
Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sterling C Johnson
- Alzheimer’s Disease Research Center, University of Wisconsin School
of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S.
Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of
Medicine and Public Health, Madison, WI, USA
- Department of Radiology, University of Wisconsin School of Medicine
and Public Health, Madison, WI, USA
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24
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Wang R, Oh JM, Motovylyak A, Ma Y, Sager MA, Rowley HA, Johnson KM, Gallagher CL, Carlsson CM, Bendlin BB, Johnson SC, Asthana S, Eisenmenger L, Okonkwo OC. Impact of sex and
APOE
E4 on age‐related cerebral blood flow trajectories in cognitively asymptomatic middle‐aged and older adults: A longitudinal study. Alzheimers Dement 2020. [DOI: 10.1002/alz.042979] [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: 11/10/2022]
Affiliation(s)
- Rui Wang
- Wisconsin Alzheimer's Disease Research Center Madison WI USA
- Karolinska Institutet Stockholm Sweden
| | - Jennifer M. Oh
- Wisconsin Alzheimer's Disease Research Center Madison WI USA
| | | | - Yue Ma
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Mark A. Sager
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Howard A. Rowley
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Kevin M. Johnson
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Catherine L. Gallagher
- Geriatric Research Education and Clinical Center William S. Middleton Memorial Veterans Hospital Madison WI USA
| | | | | | | | - Sanjay Asthana
- The Wisconsin Alzheimer's Institute University of Wisconsin Madison WI USA
| | - Laura Eisenmenger
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Ozioma C. Okonkwo
- The Wisconsin Alzheimer's Institute University of Wisconsin Madison WI USA
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25
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Cody KA, Berman SE, Koscik RL, Rivera‐Rivera LA, Hoffman CA, Erickson CM, Mueller KD, Clark LR, Chin NA, Christian BT, Rowley HA, Wieben O, Johnson KM, Betthauser TJ, Johnson SC, Eisenmenger L. Association of cerebral white matter disease with cardiovascular risk factors, amyloid accumulation, and cognition. Alzheimers Dement 2020. [DOI: 10.1002/alz.046518] [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: 11/07/2022]
Affiliation(s)
- Karly Alex Cody
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Sara E Berman
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Rebecca L. Koscik
- Wisconsin Alzheimer’s Institute University of Wisconsin School of Medicine and Public Health Madison WI USA
| | | | - Carson A Hoffman
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Claire M Erickson
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Kimberly D Mueller
- University of Wisconsin School of Medicine and Public Health Madison WI USA
- Wisconsin Alzheimer’s Institute University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Lindsay R Clark
- University of Wisconsin School of Medicine and Public Health Madison WI USA
- VA Geriatric Research Education and Clinical Center William S. Middleton Memorial Veterans Hospital Madison WI USA
| | - Nathaniel A. Chin
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | | | - Howard A. Rowley
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Oliver Wieben
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Kevin M Johnson
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Tobey J Betthauser
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Sterling C. Johnson
- University of Wisconsin School of Medicine and Public Health Madison WI USA
- Wisconsin Alzheimer’s Institute University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Laura Eisenmenger
- University of Wisconsin School of Medicine and Public Health Madison WI USA
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26
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Rivera LA, Eisenmenger L, Cary P, Johnson SC, Johnson KM. Assessment of intracranial vascular flow oscillations in Alzheimer’s disease using real time 4D flow MRI. Alzheimers Dement 2020. [DOI: 10.1002/alz.044536] [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: 11/06/2022]
Affiliation(s)
- Leonardo A Rivera
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Laura Eisenmenger
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Paul Cary
- Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health Madison WI USA
| | | | - Kevin M Johnson
- University of Wisconsin School of Medicine and Public Health Madison WI USA
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27
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Drocton GT, Copelan A, Eisenmenger L, Villanueva-Meyer JE, Dillon WP, Shah VN, Meisel K, Amans M. Venous sinus stenting as a treatment approach in patients with idiopathic intracranial hypertension and encephaloceles. Interv Neuroradiol 2020; 27:129-136. [PMID: 32954924 DOI: 10.1177/1591019920956860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stenosis of a dural venous sinus is the most common cause of idiopathic intracranial hypertension (IIH) and can be classified as either intrinsic or extrinsic. Intrinsic stenoses are characterized by a focal filling defect within the sinus secondary to an enlarged arachnoid granulation or fibrous septa while extrinsic stenoses tend to be long and smooth-tapered and are most commonly secondary to external compression from the adjacent brain parenchyma. Brain herniations, or encephaloceles, into arachnoid granulations in dural venous sinuses have rarely been reported in the literature in patients with IIH. We propose that dural venous sinus stenting (VSS) may be a safe and effective treatment approach in patients with an encephalocele and IIH. METHODS We retrospectively analyze three cases of patients with encephalocele who underwent VSS for treatment of medically refractory IIH at our institution. RESULTS One patient underwent stenting ipsilateral and two patients underwent stenting contralateral to the side of their encephaloceles. No technical related issues or complications occurred during either of the three stenting procedures. Two out of the three patients had complete resolution in their IIH-related symptoms and normalization of cerebrospinal (CSF) pressures shortly after stenting. We await clinical follow-up in the third patient. CONCLUSIONS Our results suggest that VSS is a technically feasible and effective approach in treating patients with medically refractory IIH and encephaloceles.
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Affiliation(s)
- Gerald T Drocton
- Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, CA, USA
| | - Alexander Copelan
- Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, CA, USA
| | - Laura Eisenmenger
- Radiology and Biomedical Imaging, UW Health University Hospital, Madison, WI, USA
| | | | - William P Dillon
- Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, CA, USA
| | - Vinil N Shah
- Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, CA, USA
| | - Karl Meisel
- Department of Neurology, UCSF Medical Center, San Francisco, CA, USA
| | - Matthew Amans
- Radiology and Biomedical Imaging, UCSF Medical Center, San Francisco, CA, USA
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28
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Rivera-Rivera LA, Cody KA, Rutkowski D, Cary P, Eisenmenger L, Rowley HA, Carlsson CM, Johnson SC, Johnson KM. Intracranial vascular flow oscillations in Alzheimer's disease from 4D flow MRI. Neuroimage Clin 2020; 28:102379. [PMID: 32871386 PMCID: PMC7476069 DOI: 10.1016/j.nicl.2020.102379] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 04/16/2020] [Revised: 07/10/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022]
Abstract
Recent modeling and experimental evidence suggests clearance of soluble metabolites from the brain can be driven by low frequency flow oscillations (LFOs) through the intramural periarterial drainage (IPAD) pathway. This study investigates the use of 4D flow MRI to derive LFOs from arterial and venous measures of blood flow. 3D radial 4D flow MRI data were acquired on a 3.0 T scanner and reconstructed using a low-rank constraint to produce time resolved measurements of blood flow. Physical phantom experiments were performed to validate the time resolved 4D flow against a standard 2D phase contrast (PC) approach. To evaluate the ability of 4D flow to distinguish physiologic flow changes from noise, healthy volunteers were scanned during a breath-hold (BH) maneuver and compared against 2D PC measures. Finally, flow measures were performed in intracranial arteries and veins of 112 participants including subjects diagnosed with Alzheimer's disease (AD) clinical syndrome (n = 23), and healthy controls (n = 89) on whom apolipoprotein ɛ4 positivity (APOE4+) and parental history of AD dementia (FH+) was known. To assess LFOs, flow range, standard deviation, demeaned temporal flow changes, and power spectral density were quantified from the time series. Group differences were assessed using ANOVA followed by Tukey-Kramer method for pairwise comparison for adjusted means (P < 0.05). Significantly lower LFOs as measured from flow variation range and standard deviations were observed in the arteries of AD subjects when compared to age-matched controls (P = 0.005, P = 0.011). Results suggest altered vascular function in AD subjects. 4D flow based spontaneous LFO measures might hold potential for longitudinal studies aimed at predicting cognitive trajectories in AD and study disease mechanisms.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Karly A Cody
- Alzheimer's Disease Research Center, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - David Rutkowski
- Department of Radiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Paul Cary
- Alzheimer's Disease Research Center, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Howard A Rowley
- Alzheimer's Disease Research Center, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; Department of Radiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Cynthia M Carlsson
- Alzheimer's Disease Research Center, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sterling C Johnson
- Alzheimer's Disease Research Center, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; Department of Radiology, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
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29
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Cao L, Zhu C, Eisenmenger L, Du X, Liu J, Yang Q, Lu J, Li K, Saloner D. Wall enhancement characteristics of vertebrobasilar nonsaccular aneurysms and their relationship to symptoms. Eur J Radiol 2020; 129:109064. [DOI: 10.1016/j.ejrad.2020.109064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/18/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
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Zhu C, Wang X, Eisenmenger L, Shi Z, Degnan A, Tian B, Liu Q, Hess C, Saloner D, Lu J. Wall enhancement on black-blood MRI is independently associated with symptomatic status of unruptured intracranial saccular aneurysm. Eur Radiol 2020; 30:6413-6420. [PMID: 32666320 DOI: 10.1007/s00330-020-07063-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 01/02/2020] [Revised: 05/19/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aims to investigate whether aneurysm wall enhancement (AWE) is independently associated with symptomatic status of unruptured intracranial aneurysms (UIAs). METHODS One hundred thirty-nine consecutive patients (67 male, mean age 58 ± 11 years) with 79 symptomatic and 87 asymptomatic UIAs were imaged using black-blood MRI pre- and post-gadolinium contrast administration and 3D DSA. Symptoms related to aneurysms were identified including cranial nerve deficits and headache. AWE grade and area were characterized, and aneurysm size was measured on DSA. Multivariate binary logistic regression analysis was used to identify factors associated with symptoms. Further subgroup analysis was performed for aneurysms size < 10 mm. RESULTS Symptomatic UIAs had significantly larger aneurysm size (11.2 ± 6.2 mm vs. 6.4 ± 3.3 mm), enhancement grade (1.3 ± 0.6 vs. 0.4 ± 0.6), enhancement area (2.0 ± 0.9 vs. 0.4 ± 0.7), and higher prevalence of thick enhancement (39% vs. 3%) compared with asymptomatic UIAs, all p < 0.001. In multivariate analysis, only AWE area (odds ratio [OR] 6.9, 95% confidence interval [4.0, 11.7]) was independently associated with symptoms. AWE area had an area under curve (AUC) value of 0.888, with 72.2% sensitivity and 92.0% specificity for symptoms, which was superior to aneurysm size (AUC of 0.771, with 75.9% sensitivity and 65.5% specificity). In the subgroup analysis of aneurysms smaller than 10 mm (n = 118), AWE area (OR, 7.0, p < 0.001) remained the only independent risk factor associated with symptoms. CONCLUSIONS Larger AWE area is independently associated with symptomatic UIAs, which may provide additional value to guide UIA management and improve patient outcomes. KEY POINTS • Symptomatic intracranial aneurysms are larger and more often demonstrate significant wall enhancement than asymptomatic aneurysms. • Larger wall enhancement area is independently associated with symptomatic intracranial aneurysm.
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Affiliation(s)
- Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Xinrui Wang
- Department of Radiology, Changhai Hospital, Shanghai, China.,Department of Radiology, General Hospital of Northern Theatre Command, Shenyang, China
| | | | - Zhang Shi
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Andrew Degnan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bing Tian
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Christopher Hess
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Shanghai, China.
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Safaee MM, Carrera DA, Chin CT, Mashhood A, Eisenmenger L, Liang NE, Lewis KM, Chou D, Ames CP, Weinstein PR. Diagnostic Challenges in Primary Sacral Tumors and the Yield of Computed Tomography-Guided Needle Biopsy in the Modern Era. World Neurosurg 2020; 138:e806-e818. [PMID: 32222551 DOI: 10.1016/j.wneu.2020.03.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Primary sacral tumors pose unique challenges because of their complex radiographic appearances, diverse pathologic entities, and dramatically different treatment paradigms based on tumor type. Magnetic resonance imaging and computed tomography (CT) can provide valuable information; however, sacral lesions can possess unique radiographic features and pose diagnostic dilemmas. CT-guided percutaneous needle biopsy is a critical component of the diagnostic workup. However, limited data are available on its efficacy for primary sacral tumors. METHODS The data from patients with newly diagnosed primary sacral lesions during a 12-year period at our hospital were analyzed. The preoperative magnetic resonance imaging findings, biopsy results, and pathological data for patients who required surgery were analyzed. Unique cases in which the final pathologic result was unexpected from the preoperative imaging findings have been highlighted. RESULTS Of 38 patients who underwent percutaneous needle biopsy, diagnostic tissue was obtained on the first attempt for 31 (82%). Five of the remaining 7 obtained diagnostic tissue on the second attempt, yielding 95% diagnosis, with only two requiring open biopsies. In 2 patients with diagnostic tissue on CT-guided biopsy, an open biopsy was still recommended because of the clinical scenario. In both patients, the open biopsy results matched those of the CT-guided biopsy. For the 18 patients who required surgery, we found 100% correlation between the percutaneous needle biopsy findings and the final pathological diagnosis. No biopsy-induced complications or extraspinal tumor seeding occurred. CONCLUSIONS CT-guided biopsy is a safe and effective technique. It represents a critical component of the diagnostic algorithm, given the diverse pathological findings of primary sacral lesions and dramatic differences in treatment.
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Affiliation(s)
- Michael M Safaee
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Diego A Carrera
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Cynthia T Chin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Arian Mashhood
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Norah E Liang
- Department of Neurological Surgery, School of Medicine, San Francisco, California, USA
| | - Kristin M Lewis
- Department of Neurological Surgery, School of Medicine, San Francisco, California, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Philip R Weinstein
- Department of Neurological Surgery, University of California, San Francisco, California, USA.
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Eisenmenger L, Capel K, Garrett J, Li K, Li Y, Ahmed A, Niemann D, Griner D, Samaniego E, Ortega-Gutierrez S, Derdeyn C, Schafer S, Strother C, Chen GH, Aagaard Kienitz B. Abstract 55: Comparison of Sequential Multi-Detector CT and Cone-Beam CT Perfusion Maps in 54 Subjects With an Acute Ischemic Stroke. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.55] [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: 11/16/2022]
Abstract
Introduction:
Time from diagnostic imaging to groin puncture highly correlates with outcome and often accounts for delays between hospital arrival and EVT. Our study comparing image quality and information content of MDCTP and CBCTP provides feasibility data for selected AIS patients to go straight to the angio-suite for comprehensive imaging and treatment.
Methods:
AIS patients eligible for EVT underwent MDCTP, then a CBCTP study on arrival in angio-suite. Of 939 admitted June 2017-April 2019, 226 (24%) received EVT. Of these 54 (35%) were enrolled to receive additional CBCTP imaging. Inability to obtain consent and co-morbidities were major causes for non-enrollment. Times from the start of MDCTP to angio-suite and from angio-suite arrival to first arterial image were recorded. Acquired CBCTP data were reconstructed and processed with an in-house toolbox. MDCTP and CBCTP data were matched for slice thickness and angulation and were processed using RAPID CTP (iSchemaView, Inc.). The rCBF, rCBV, MTT, tMAX maps were randomized to generate 3 unique evaluation sets. 3 neuroradiologists scored diagnostic image quality, artifacts, mismatch pattern detection and EVT indication using 5-point Likert scales. Stroke laterality was compared with the clinical standard for diagnostic accuracy.
Results:
Accuracies for stroke diagnosis are 97% [95%, 97%] with MDCTP and 92% [90%, 95%] with CBCTP. Cohen’s Kappa between observers is 0.90 for MDCTP-based diagnosis and 0.89 for CBCTP-based diagnosis. Scores of CBCTP to make the stroke diagnosis, detect mismatch pattern, and make treatment decision were non-inferior to corresponding scores for MDCTP (alpha=0.05) within 10% of the whole score range. Subjective scores of MDCTP for image quality and artifacts were slightly superior to those of CBCTP (1.8 vs. 2.3, p<0.01).
Conclusions:
In this study, a direct to angio-suite workflow provided non-inferior perfusion imaging for AIS patient triage while saving nearly one hour per patient.
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Affiliation(s)
| | | | | | - Ke Li
- Univ of Wisconsin, Madison, WI
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Zhu C, Wang X, Eisenmenger L, Tian B, Liu Q, Degnan AJ, Hess C, Saloner D, Lu J. Surveillance of Unruptured Intracranial Saccular Aneurysms Using Noncontrast 3D-Black-Blood MRI: Comparison of 3D-TOF and Contrast-Enhanced MRA with 3D-DSA. AJNR Am J Neuroradiol 2019; 40:960-966. [PMID: 31122914 DOI: 10.3174/ajnr.a6080] [Citation(s) in RCA: 14] [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: 02/22/2019] [Accepted: 04/15/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Patients with unruptured intracranial aneurysms routinely undergo surveillance imaging to monitor growth. Angiography is the criterion standard for aneurysm diagnosis, but it is invasive. This study aimed to evaluate the accuracy and reproducibility of a 3D noncontrast black-blood MR imaging technique for unruptured intracranial aneurysm measurement in comparison with 3D-TOF and contrast-enhanced MRA, using 3D rotational angiography as a reference standard. MATERIALS AND METHODS Sixty-four patients (57.3 ± 10.9 years of age, 41 women) with 68 saccular unruptured intracranial aneurysms were recruited. Patients underwent 3T MR imaging with 3D-TOF-MRA, 3D black-blood MR imaging, and contrast-enhanced MRA, and they underwent 3D rotational angiography within 2 weeks. The neck, width, and height of the unruptured intracranial aneurysms were measured by 2 radiologists independently on 3D rotational angiography and 3 MR imaging sequences. The accuracy and reproducibility were evaluated by Bland-Altman plots, the coefficient of variance, and the intraclass correlation coefficient. RESULTS 3D black-blood MR imaging demonstrates the best agreement with DSA, with the smallest limits of agreement and measurement error (coefficients of variance range, 5.87%-7.04%). 3D-TOF-MRA had the largest limits of agreement and measurement error (coefficients of variance range, 12.73%-15.78%). The average coefficient of variance was 6.26% for 3D black-blood MR imaging, 7.03% for contrast-enhanced MRA, and 15.54% for TOF-MRA. No bias was found among 3 MR imaging sequences compared with 3D rotational angiography. All 3 MR imaging sequences had excellent interreader agreement (intraclass correlation coefficient, >0.95). 3D black-blood MR imaging performed the best for patients with intraluminal thrombus (n = 10). CONCLUSIONS 3D black-blood MR imaging achieves better accuracy for aneurysm size measurements compared with 3D-TOF, using 3D rotational angiography as a criterion standard. This noncontrast technique is promising for surveillance of unruptured intracranial aneurysms.
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Affiliation(s)
- C Zhu
- From the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
| | - X Wang
- Department of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China.,Department of Radiology (X.W.), General Hospital of Northern Military Command, Liaoning, China
| | - L Eisenmenger
- From the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
| | - B Tian
- Department of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China
| | - Q Liu
- Department of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China
| | - A J Degnan
- Department of Radiology (A.J.D.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - C Hess
- From the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
| | - D Saloner
- From the Department of Radiology and Biomedical Imaging (C.Z., L.E., C.H., D.S.), University of California, San Francisco, San Francisco, California
| | - J Lu
- Department of Radiology (X.W., B.T., Q.L., J.L.), Changhai Hospital, Shanghai, China
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Jensen M, Isaacson K, Steinhauff D, Barber Z, Eisenmenger L, Huo E, Taussky P, Cappello J, Ghandehari H. 03:18 PM Abstract No. 385 Radiopaque silk-elastinlike protein polymer-based embolic. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.460] [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: 10/27/2022] Open
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36
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Tian B, Toossi S, Eisenmenger L, Faraji F, Ballweber MK, Josephson SA, Haraldsson H, Zhu C, Ahn S, Laub G, Hess C, Saloner D. Visualizing wall enhancement over time in unruptured intracranial aneurysms using 3D vessel wall imaging. J Magn Reson Imaging 2018; 50:193-200. [DOI: 10.1002/jmri.26553] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Bing Tian
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California USA
- Department of RadiologyChanghai Hospital of Shanghai Shanghai P.R. China
| | - Shahed Toossi
- Department of NeurologyUniversity of California San Francisco California USA
| | - Laura Eisenmenger
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California USA
| | - Farshid Faraji
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California USA
| | - Megan K. Ballweber
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California USA
| | - S. Andrew Josephson
- Department of NeurologyUniversity of California San Francisco California USA
| | - Henrik Haraldsson
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California USA
| | - Chengcheng Zhu
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California USA
| | | | | | - Christopher Hess
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California USA
| | - David Saloner
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California USA
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Huo E, Eisenmenger L, Weinstein S. Imaging of the Postoperative Colon. Radiol Clin North Am 2018; 56:835-845. [PMID: 30119777 DOI: 10.1016/j.rcl.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recognition of postoperative complications is important for the immediate diagnosis and treatment needed for appropriate patient care. Identification of postoperative complications from colon surgery requires not only knowledge of the type of procedure, but also the expected normal postoperative appearance. The purpose of this article is to discuss and review the expected anatomic changes after colorectal surgery, and the appearance of the most common postoperative complications.
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Affiliation(s)
- Eugene Huo
- Department of Radiology, San Francisco VA Medical Center, 4150 Clement Street (114), San Francisco, CA 94121, USA.
| | - Laura Eisenmenger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Avenue, Room S-261, Box 0628, San Francisco, CA 94143, USA
| | - Stefanie Weinstein
- Department of Radiology, San Francisco VA Medical Center, 4150 Clement Street (114), San Francisco, CA 94121, USA
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38
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Zhu C, Tian B, Chen L, Eisenmenger L, Raithel E, Forman C, Ahn S, Laub G, Liu Q, Lu J, Liu J, Hess C, Saloner D. Accelerated whole brain intracranial vessel wall imaging using black blood fast spin echo with compressed sensing (CS-SPACE). MAGMA 2017; 31:457-467. [PMID: 29209856 DOI: 10.1007/s10334-017-0667-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Develop and optimize an accelerated, high-resolution (0.5 mm isotropic) 3D black blood MRI technique to reduce scan time for whole-brain intracranial vessel wall imaging. MATERIALS AND METHODS A 3D accelerated T1-weighted fast-spin-echo prototype sequence using compressed sensing (CS-SPACE) was developed at 3T. Both the acquisition [echo train length (ETL), under-sampling factor] and reconstruction parameters (regularization parameter, number of iterations) were first optimized in 5 healthy volunteers. Ten patients with a variety of intracranial vascular disease presentations (aneurysm, atherosclerosis, dissection, vasculitis) were imaged with SPACE and optimized CS-SPACE, pre and post Gd contrast. Lumen/wall area, wall-to-lumen contrast ratio (CR), enhancement ratio (ER), sharpness, and qualitative scores (1-4) by two radiologists were recorded. RESULTS The optimized CS-SPACE protocol has ETL 60, 20% k-space under-sampling, 0.002 regularization factor with 20 iterations. In patient studies, CS-SPACE and conventional SPACE had comparable image scores both pre- (3.35 ± 0.85 vs. 3.54 ± 0.65, p = 0.13) and post-contrast (3.72 ± 0.58 vs. 3.53 ± 0.57, p = 0.15), but the CS-SPACE acquisition was 37% faster (6:48 vs. 10:50). CS-SPACE agreed with SPACE for lumen/wall area, ER measurements and sharpness, but marginally reduced the CR. CONCLUSION In the evaluation of intracranial vascular disease, CS-SPACE provides a substantial reduction in scan time compared to conventional T1-weighted SPACE while maintaining good image quality.
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Affiliation(s)
- Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Bing Tian
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Luguang Chen
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Laura Eisenmenger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | | | | | | | | | - Qi Liu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Shanghai, China.
| | - Jing Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Christopher Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, USA
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Freer PE, Riegert J, Eisenmenger L, Ose D, Winkler N, Stein MA, Stoddard GJ, Hess R. Clinical implementation of synthesized mammography with digital breast tomosynthesis in a routine clinical practice. Breast Cancer Res Treat 2017; 166:501-509. [DOI: 10.1007/s10549-017-4431-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/29/2017] [Indexed: 11/24/2022]
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Abstract
Fluorodeoxyglucose PET and PET/computed tomography have gained acceptance in the evaluation of disease. Nontargeted tracers have been used in the diagnosis of certain malignancies but may not be sensitive or specific enough to become standard of care. Newer targeted PET tracers have been developed that target disease-specific biomarkers, and allow accurate and sensitive detection of disease. Combined with the capabilities of MR imaging to evaluate soft tissue, precision imaging with PET/MR imaging can change the diagnosis. This article discusses specific areas in which precision imaging with nontargeted and targeted diagnostic agents can change the diagnosis and treatment.
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Affiliation(s)
- Eugene Huo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - David M Wilson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Laura Eisenmenger
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Radiology, San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA.
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41
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De Havenon A, Lobo R, Eisenmenger L, Chauhan N, Dewitt D, Kim SE, Parker D, McNally JS. Abstract WP138: MRI Detection of Vessel Wall Inflammation and Contrast Leakage in Cerebral Amyloid Angiopathy. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Arterial wall enhancement detected on vessel wall MRI (vwMRI) has been associated with increased stroke risk in the setting of intracranial atherosclerosis. Other pathologies affect the vessel wall, including cerebral amyloid angiopathy (CAA). CAA is secondary to Aβ vessel wall deposition resulting in microvessel leakage, microbleeds and ischemic stroke. Our goal was to determine if vwMRI could detect vessel wall inflammation and leptomeningeal contrast leakage in CAA, and if these are associated with recent infarction.
Methods:
In this retrospective study, 28 vwMRI scans in 23 patients demonstrated probable CAA from 2015-16. Probable CAA was diagnosed by peripherally located microhemorrhages detected on susceptibility-weighted imaging. Vessel wall and leptomeningeal enhancement was determined using a validated pre and post contrast flow-suppressed T1-weighted sequence. Recent infarcts were detected by DTI trace (20 direction B2000). A mixed effects logistic regression model was used to determine the association of vessel wall or leptomeningeal enhancement with recent infarct in CAA patients, accounting for up to 3 scans per patient.
Results:
In the 28 vwMRI scans, ischemic stroke was detected in 17 (61%), leptomeningeal enhancement in 13 (46%), and vessel wall enhancement in 14 (50%). The figure shows a representative patient with a recent infarct and biopsy-proven CAA with vessel wall enhancement (arrow) detected on vwMRI. Vessel wall enhancement was associated with recent infarct with an odds ratio (OR) = 10.8, p= 0.012. Leptomeningeal enhancement was associated with recent infarct with an OR = 3.8, p= 0.11.
Conclusions:
Both vessel wall and leptomeningeal enhancement are present in CAA, though vessel wall enhancement is more associated with recent infarction. Larger, prospective studies may be needed to determine future stroke risk and additional risk factors predicting ischemic stroke in CAA.
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Affiliation(s)
| | - Remy Lobo
- Radiology, Univ of Utah, Salt Lake City, UT
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Eisenmenger L, Mead S, Hyare H. Use of Diffusion-Weighted Magnetic Resonance Imaging in Sporadic Creutzfeldt-Jakob Disease-Reply. JAMA Neurol 2016; 73:1154. [PMID: 27428820 DOI: 10.1001/jamaneurol.2016.2384] [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: 11/14/2022]
Affiliation(s)
| | - Simon Mead
- MRC Prion Unit, Department of Neurodegenerative Diseases, UCL Institute of Neurology, London, England
| | - Harpreet Hyare
- MRC Prion Unit, Department of Neurodegenerative Diseases, UCL Institute of Neurology, London, England
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Anzai Y, Eisenmenger L. Computed Tomography in Pediatric Traumatic Brain Injury: Who Needs It and How Is It Scored? J Pediatr Neuroradiol 2016. [DOI: 10.1055/s-0036-1584243] [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: 10/21/2022]
Affiliation(s)
- Yoshimi Anzai
- Department of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, United States
| | - Laura Eisenmenger
- Department of Radiology, Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, United States
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Eisenmenger L, Porter MC, Carswell CJ, Thompson A, Mead S, Rudge P, Collinge J, Brandner S, Jäger HR, Hyare H. Evolution of Diffusion-Weighted Magnetic Resonance Imaging Signal Abnormality in Sporadic Creutzfeldt-Jakob Disease, With Histopathological Correlation. JAMA Neurol 2016; 73:76-84. [PMID: 26569479 DOI: 10.1001/jamaneurol.2015.3159] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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]
Abstract
IMPORTANCE Prion diseases represent the archetype of brain diseases caused by protein misfolding, with the most common subtype being sporadic Creutzfeldt-Jakob disease (sCJD), a rapidly progressive dementia. Diffusion-weighted imaging (DWI) has emerged as the most sensitive magnetic resonance imaging (MRI) sequence for the diagnosis of sCJD, but few studies have assessed the evolution of MRI signal as the disease progresses. OBJECTIVES To assess the natural history of the MRI signal abnormalities on DWI in sCJD to improve our understanding of the pathogenesis and to investigate the potential of DWI as a biomarker of disease progression, with histopathological correlation. DESIGN, SETTING, AND PARTICIPANTS Gray matter involvement on DWI was assessed among 37 patients with sCJD in 26 cortical and 5 subcortical subdivisions per hemisphere using a semiquantitative scoring system of 0 to 2 at baseline and follow-up. A total brain score was calculated as the summed scores in the individual regions. In 7 patients, serial mean diffusivity measurements were obtained. Age at baseline MRI, disease duration, atrophy, codon 129 methionine valine polymorphism, Medical Research Council Rating Scale score, and histopathological findings were documented. The study setting was the National Prion Clinic, London, England. All participants had a probable or definite diagnosis of sCJD and had at least 2 MRI studies performed during the course of their illness. The study dates were October 1, 2008 to April 1, 2012. The dates of our analysis were January 19 to April 20, 2012. MAIN OUTCOMES AND MEASURES Correlation of regional and total brain scores with disease duration. RESULTS Among the 37 patients with sCJD in this study there was a significant increase in the number of regions demonstrating signal abnormality during the study period, with 59 of 62 regions showing increased signal intensity (SI) at follow-up, most substantially in the caudate and putamen (P < .001 for both). The increase in the mean (SD) total brain score from 30.2 (17.3) at baseline to 40.5 (20.6) at follow-up (P = .001) correlated with disease duration (r = 0.47, P = .003 at baseline and r = 0.35, P = .03 at follow-up), and the left frontal SI correlated with the degree of spongiosis (r = 0.64, P = .047). Decreased mean diffusivity in the left caudate at follow-up was seen (P < .001). Eight patients demonstrated decreased SI in cortical regions, including the left inferior temporal gyrus and the right lingual gyrus. CONCLUSIONS AND RELEVANCE Magnetic resonance images in sCJD show increased extent and degree of SI on DWI that correlates with disease duration and the degree of spongiosis. Although cortical SI may fluctuate, increased basal ganglia SI is a consistent finding and is due to restricted diffusion. Diffusion-weighted imaging in the basal ganglia may provide a noninvasive biomarker in future therapeutic trials.
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Affiliation(s)
| | - Marie-Claire Porter
- Medical Research Council Prion Unit, Department of Neurodegenerative Diseases, University College London Institute of Neurology, London, England
| | - Christopher J Carswell
- Medical Research Council Prion Unit, Department of Neurodegenerative Diseases, University College London Institute of Neurology, London, England
| | - Andrew Thompson
- Medical Research Council Prion Unit, Department of Neurodegenerative Diseases, University College London Institute of Neurology, London, England
| | - Simon Mead
- Medical Research Council Prion Unit, Department of Neurodegenerative Diseases, University College London Institute of Neurology, London, England
| | - Peter Rudge
- Medical Research Council Prion Unit, Department of Neurodegenerative Diseases, University College London Institute of Neurology, London, England
| | - John Collinge
- Medical Research Council Prion Unit, Department of Neurodegenerative Diseases, University College London Institute of Neurology, London, England
| | - Sebastian Brandner
- Medical Research Council Prion Unit, Department of Neurodegenerative Diseases, University College London Institute of Neurology, London, England
| | - Hans R Jäger
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, England
| | - Harpreet Hyare
- Medical Research Council Prion Unit, Department of Neurodegenerative Diseases, University College London Institute of Neurology, London, England
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Eisenmenger L, Kumpati G, Huo E. 3D printed patient specific aortic models for patient education and preoperative planning. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Eisenmenger L, Ghandehari H, Jensen M, Huo E. Novel creation of an angiographic training model for trainees from 3D printed patient data. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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