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Li XM, Yao DQ, Quan XY, Li M, Chen W, Wáng YXJ. Perfusion of hepatocellular carcinomas measured by diffusion-derived vessel density biomarker: Higher hepatocellular carcinoma perfusion than earlier intravoxel incoherent motion reports. NMR Biomed 2024; 37:e5125. [PMID: 38361334 DOI: 10.1002/nbm.5125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
Diffusion-derived vessel density (DVDD) is a physiological surrogate of the area of microvessels per unit tissue area. DDVD is calculated according to DDVD(b0b2) = Sb0/ROIarea0 - Sb2/ROIarea2, where Sb0 and Sb2 refer to the liver signal when b is 0 or 2 s/mm2. Pathohistological studies and contrast-enhanced CT/MRI data showed higher blood volume in hepatocellular carcinoma (HCC) relative to native liver tissue. With intravoxel incoherent motion (IVIM) imaging, most authors paradoxically reported a decreased perfusion fraction of HCC relative to the adjacent liver. This study applied DDVD to assess the perfusion of HCC. MRI was performed with a 3.0-T magnet. Diffusion-weighted images with b-values of 0 and 2 s/mm2 were acquired in 72 HCC patients. Thirty-two patients had microvascular invasion (MVI(+)) and 40 patients did not have microvascular invasion (MVI(-)). Fifty-eight patients had Edmondson-Steiner grade I or II HCC, and 14 patients had Edmondson-Steiner grade III or IV HCC. DDVD measurement was conducted on the axial slice that showed the largest HCC size. DDVD(b0b2) T/L = HCC DDVD(b0b2)/liver DDVD(b0b2). DDVD(b0b2) T/L median (95% confidence interval) of all HCCs was 2.942 (2.419-3.522), of MVI(-) HCCs was 2.699 (2.030-3.522), of MVI(+) HCCs was 2.988 (2.423-3.990), of Edmondson-Steiner grade I/II HCCs was 2.873 (2.277-3.465), and of Edmondson-Steiner grade III/IV HCCs was 3.403 (2.008-4.485). DDVD(b0b2) T/L approximately agrees with contrast agent dynamically enhanced CT/MRI literature data, whereas it differs from earlier IVIM study results, where HCC perfusion fraction was paradoxically lower relative to native liver tissue. A weak trend was noted with MIV(+) HCCs had a higher DDVD(b0b2) T/L than that of MVI(-) HCCs, and a weak trend was noted with the poorly differentiated group of HCCs (Edmondson-Steiner grade III and IV) had a higher DDVD(b0b2) T/L than that of the better differentiated group of HCCs (Edmondson-Steiner grade I and II).
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Affiliation(s)
- Xin-Ming Li
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Dian-Qi Yao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xian-Yue Quan
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Min Li
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | | | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Fang T, Jiang Z, Zhou Y, Jia S, Zhao J, Nie S. Automatic assessment of DWI-ASPECTS for acute ischemic stroke based on deep learning. Med Phys 2024. [PMID: 38687043 DOI: 10.1002/mp.17101] [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: 09/15/2023] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a standardized semi-quantitative method for early ischemic changes in acute ischemic stroke. PURPOSE However, ASPECTS is still affected by expert experience and inconsistent results between readers in clinical. This study aims to propose an automatic ASPECTS scoring model based on diffusion-weighted imaging (DWI) mode to help clinicians make accurate treatment plans. METHODS Eighty-two patients with stroke were included in the study. First, we designed a new deep learning network for segmenting ASPECTS scoring brain regions. The network is improved based on U-net, which integrates multiple modules. Second, we proposed using hybrid classifiers to classify brain regions. For brain regions with larger areas, we used brain grayscale comparison algorithm to train machine learning classifiers, while using hybrid feature training for brain regions with smaller areas. RESULTS The average DICE coefficient of the segmented hindbrain area can reach 0.864. With the proposed hybrid classifier, our method performs significantly on both region-level ASPECTS and dichotomous ASPECTS. The sensitivity and accuracy on the test set are 95.51% and 93.43%, respectively. For dichotomous ASPECTS, the intraclass correlation coefficient (ICC) between our automated ASPECTS score and the expert reading was 0.87. CONCLUSIONS This study proposed an automated model for ASPECTS scoring of patients with acute ischemic stroke based on DWI images. Experimental results show that the method of segmentation first and then classification is feasible. Our method has the potential to assist physicians in the Alberta Stroke Program with early CT scoring and clinical stroke diagnosis.
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Affiliation(s)
- Ting Fang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhuoyun Jiang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yuxi Zhou
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Shouqiang Jia
- Department of Imaging, Jinan People's Hospital affiliated to Shandong First Medical University, Shandong, China
| | - Jiaqi Zhao
- Department of Ultrasound, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengdong Nie
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Muraoka H, Kaneda T, Kondo T, Hirahara N, Kohinata Y, Tokunaga S. Differentiation of submandibular sialadenitis based on apparent diffusion coefficient. Oral Dis 2024. [PMID: 38566274 DOI: 10.1111/odi.14953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/07/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES This study aimed to quantify the submandibular gland in suppurative sialadenitis, primary Sjögren's syndrome (pSS) and radiation-induced sialadenitis using the apparent diffusion coefficient (ADC) for differential diagnosis. SUBJECTS AND METHODS This retrospective study included 16 patients with suppurative sialadenitis (n = 9), pSS (n = 3) and radiation-induced sialadenitis (n = 4) who underwent magnetic resonance imaging between June 2006 and May 2022. The ADC of the submandibular glands in each state was calculated, and the differences were analysed using a one-way analysis of variance and Tukey's post hoc test. Receiver operating characteristic curves were used to assess the ability of the ADC to distinguish each condition. Statistical significance was set at p < 0.05. RESULTS The mean ADC value (×10-3 mm2/s) ± standard deviation in the control (non-affected side of the suppurative sialadenitis group), suppurative sialadenitis, pSS and radiation-induced groups were 0.94 ± 0.16, 1.24 ± 0.16, 1.33 ± 0.13 and 1.5 ± 0.12, respectively (p < 0.001). The diagnostic value for distinguishing each group was ≥0.75. CONCLUSION ADC values are useful for quantitatively assessing and distinguishing submandibular glands in suppurative sialadenitis, primary Sjögren's syndrome and radiation-induced sialadenitis.
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Affiliation(s)
- Hirotaka Muraoka
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Takashi Kaneda
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Takumi Kondo
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Naohisa Hirahara
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Yuta Kohinata
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Satoshi Tokunaga
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
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Radhakrishnan H, Zhao C, Sydnor VJ, Baller EB, Cook PA, Fair DA, Giesbrecht B, Larsen B, Murtha K, Roalf DR, Rush‐Goebel S, Shinohara RT, Shou H, Tisdall MD, Vettel JM, Grafton ST, Cieslak M, Satterthwaite TD. A practical evaluation of measures derived from compressed sensing diffusion spectrum imaging. Hum Brain Mapp 2024; 45:e26580. [PMID: 38520359 PMCID: PMC10960521 DOI: 10.1002/hbm.26580] [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: 03/22/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 03/25/2024] Open
Abstract
Diffusion Spectrum Imaging (DSI) using dense Cartesian sampling of q-space has been shown to provide important advantages for modeling complex white matter architecture. However, its adoption has been limited by the lengthy acquisition time required. Sparser sampling of q-space combined with compressed sensing (CS) reconstruction techniques has been proposed as a way to reduce the scan time of DSI acquisitions. However prior studies have mainly evaluated CS-DSI in post-mortem or non-human data. At present, the capacity for CS-DSI to provide accurate and reliable measures of white matter anatomy and microstructure in the living human brain remains unclear. We evaluated the accuracy and inter-scan reliability of 6 different CS-DSI schemes that provided up to 80% reductions in scan time compared to a full DSI scheme. We capitalized on a dataset of 26 participants who were scanned over eight independent sessions using a full DSI scheme. From this full DSI scheme, we subsampled images to create a range of CS-DSI images. This allowed us to compare the accuracy and inter-scan reliability of derived measures of white matter structure (bundle segmentation, voxel-wise scalar maps) produced by the CS-DSI and the full DSI schemes. We found that CS-DSI estimates of both bundle segmentations and voxel-wise scalars were nearly as accurate and reliable as those generated by the full DSI scheme. Moreover, we found that the accuracy and reliability of CS-DSI was higher in white matter bundles that were more reliably segmented by the full DSI scheme. As a final step, we replicated the accuracy of CS-DSI in a prospectively acquired dataset (n = 20, scanned once). Together, these results illustrate the utility of CS-DSI for reliably delineating in vivo white matter architecture in a fraction of the scan time, underscoring its promise for both clinical and research applications.
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Affiliation(s)
- Hamsanandini Radhakrishnan
- Lifespan Informatics and Neuroimaging CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Chenying Zhao
- Lifespan Informatics and Neuroimaging CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Lifespan Brain Institute, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Bioengineering, School of Engineering and Applied ScienceUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Valerie J. Sydnor
- Lifespan Informatics and Neuroimaging CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erica B. Baller
- Lifespan Informatics and Neuroimaging CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Philip A. Cook
- Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Damien A. Fair
- Masonic Institute for the Developing BrainUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Barry Giesbrecht
- Department of Psychological and Brain SciencesUniversity of CaliforniaSanta BarbaraCaliforniaUSA
| | - Bart Larsen
- Lifespan Informatics and Neuroimaging CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kristin Murtha
- Lifespan Informatics and Neuroimaging CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David R. Roalf
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Lifespan Brain Institute, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sage Rush‐Goebel
- Lifespan Informatics and Neuroimaging CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Biomedical Image Computing & AnalyticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Haochang Shou
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Biomedical Image Computing & AnalyticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - M. Dylan Tisdall
- Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jean M. Vettel
- Department of Psychological and Brain SciencesUniversity of CaliforniaSanta BarbaraCaliforniaUSA
- U.S. Army Research LaboratoryAberdeen Proving GroundAberdeenMarylandUSA
| | - Scott T. Grafton
- Department of Psychological and Brain SciencesUniversity of CaliforniaSanta BarbaraCaliforniaUSA
| | - Matthew Cieslak
- Lifespan Informatics and Neuroimaging CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Theodore D. Satterthwaite
- Lifespan Informatics and Neuroimaging CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Muraoka H, Kaneda T, Kondo T, Otsuka K, Tokunaga S. Visualising cervical lymph nodes in jaw osteonecrosis using diffusion-weighted imaging. Oral Dis 2024. [PMID: 38515001 DOI: 10.1111/odi.14938] [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: 12/20/2023] [Revised: 02/06/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This study aimed to apply diffusion-weighted imaging to the evaluation of cervical lymph nodes affected by medication-related osteonecrosis of the jaw (MRONJ). METHODS This retrospective study analysed the diffusion-weighted imaging data of 70 patients with or without MRONJ (Stages 0-3). The mean apparent diffusion coefficient (ADC) values of the submandibular (level IB) and superior internal jugular (level IIA) nodes in the control and MRONJ groups were calculated, and differences were analysed using the Mann-Whitney test. Moreover, receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of ADC values to predict lymph nodes that were affected by MRONJ. p < 0.05 was considered statistically significant. RESULTS The median [interquartile range] (×10-3 mm2/s) of level IB was 0.74 [0.7-0.81] and 0.93 [0.84-1.09] and that of level IIA was 0.79 [0.76-0.85] and 0.97 [0.84-1.06] in the control and MRONJ groups respectively. ROC analysis revealed that the ADC value had excellent ability to discriminate between the control and MRONJ groups. CONCLUSIONS The study findings indicate that diffusion-weighted imaging can contribute to differentiation of MRONJ from other cervical lymph node diseases and facilitate early detection of MRONJ.
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Affiliation(s)
- Hirotaka Muraoka
- Department of Radiology, Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho-Nishi, Matsudo, Japan
| | - Takashi Kaneda
- Department of Radiology, Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho-Nishi, Matsudo, Japan
| | - Takumi Kondo
- Department of Radiology, Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho-Nishi, Matsudo, Japan
| | - Kohei Otsuka
- Department of Radiology, Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho-Nishi, Matsudo, Japan
| | - Satoshi Tokunaga
- Department of Radiology, Nihon University School of Dentistry at Matsudo 2-870-1 Sakaecho-Nishi, Matsudo, Japan
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Lusk JB, Covington A, Liu L, Weikel DP, Li Y, Sekar P, Demel SL, Aziz YN, Kidwell CS, Woo D, James ML. Hyperglycemia, Ischemic Lesions, and Functional Outcomes After Intracerebral Hemorrhage. J Am Heart Assoc 2023; 12:e028632. [PMID: 37345809 PMCID: PMC10356065 DOI: 10.1161/jaha.122.028632] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/24/2023] [Indexed: 06/23/2023]
Abstract
Background Ischemic lesions observed on diffusion-weighted imaging (DWI) magnetic resonance imaging are associated with poor outcomes after intracerebral hemorrhage (ICH). We evaluated the association between hyperglycemia, ischemic lesions, and functional outcomes after ICH. Methods and Results This was a retrospective observational analysis of 1167 patients who received magnetic resonance imaging in the ERICH (Ethnic and Racial Variations in Intracerebral Hemorrhage) study. A machine learning strategy using the elastic net regularization and selection procedure was used to perform automated variable selection to identify final multivariable logistic regression models. Sensitivity analyses with alternative model development strategies were performed, and predictive performance was compared. After covariate adjustment, white matter hyperintensity score, leukocyte count on admission, and non-Hispanic Black race (compared with non-Hispanic White race) were associated with the presence of DWI lesions. History of ICH and ischemic stroke, presence of DWI lesions, deep ICH location (versus lobar), ICH volume, age, lower Glasgow Coma Score on admission, and medical history of diabetes were associated with poor 6-month modified Rankin Scale outcome (4-6) after covariate adjustment. Inclusion of interactions between race and ethnicity and variables included in the final multivariable model for functional outcome improved model performance; a significant interaction between race and ethnicity and medical history of diabetes and serum blood glucose on admission was observed. Conclusions No measure of hyperglycemia or diabetes was associated with presence of DWI lesions. However, both medical history of diabetes and presence of DWI lesions were independently associated with poor functional outcomes after ICH.
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Affiliation(s)
- Jay B. Lusk
- Department of Neurology, Duke University School of MedicineDurhamNCUSA
- Duke University Fuqua School of BusinessDurhamNCUSA
| | - Anna Covington
- Department of Neurology, Duke University School of MedicineDurhamNCUSA
| | - Li Liu
- Department of NeurologyPLA Strategic Support Force Characteristic Medical CenterBeijingP.R. China
| | - Daniel P. Weikel
- Department of AnesthesiologyDuke University School of MedicineDurhamNCUSA
| | - Yi‐Ju Li
- Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamNCUSA
- Duke Molecular Physiology Institute (DMPI)DurhamNCUSA
| | - Padmini Sekar
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Stacie L. Demel
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Yasmin N. Aziz
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Chelsea S. Kidwell
- Department of NeurologyUniversity of Arizona College of MedicineTucsonAZUSA
| | - Daniel Woo
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Michael L. James
- Departments of Neurology and AnesthesiologyDuke University School of MedicineDurhamNCUSA
- Duke Clinical Research InstituteDurhamNCUSA
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Joundi RA, Yu AYX, Smith EE, Zerna C, Penn AM, Balshaw RF, Votova K, Bibok MB, Penn M, Saly V, Hegedus J, Coutts SB, Yu AYX, Penn AM, Trivedi A, Cook J, Morrison J, Blackwood K, Richards K, Votova K, Nealis M, Bibok MB, Penn M, Beattyova P, Rosenberg P, Frost S, Grant C, Hedgedus J, Grant S, Watson T, Saly V, Sedgwick C, Lesperance ML, Croteau NS, Appireddy R, Balshaw RF, Field TS, Dubuc V, Demchuk AM, Jambula A, Le A, Menon BK, Calvert C, Kenney C, Zerna C, Nikneshan D, Smith EE, Klourfeld E, Wagner G, Klein G, Aram H, Desai J, Ryckborst K, Bilston L, Hill MD, Almekhlafi M, Godfrey N, Imoukheude O, Stys P, Barber PA, Couillard P, Eswaradas P, Rhandawa P, Coutts SB, Bal S, Peters S, Save S, Subramaniam S, Musuka T, Stewart T, Hong ZM. Association Between Duration of Transient Neurological Events and Diffusion-Weighted Brain Lesions. J Am Heart Assoc 2023; 12:e027861. [PMID: 36695298 PMCID: PMC9973650 DOI: 10.1161/jaha.122.027861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background The relationship between duration of transient neurological events and presence of diffusion-weighted lesions by symptom type is unclear. Methods and Results This was a substudy of SpecTRA (Spectrometry for Transient Ischemic Attack Rapid Assessment), a multicenter prospective cohort of patients with minor ischemic cerebrovascular events or stroke mimics at academic emergency departments in Canada. For this study we included patients with resolved symptoms and determined the presence of diffusion-weighted imaging (DWI) lesion on magnetic resonance imaging within 7 days. Using logistic regression, we evaluated the association between symptom duration and DWI lesion, assessing for interaction with symptom type (focal only versus nonfocal/mixed), and adjusting for age, sex, education, comorbidities, and systolic blood pressure. Of 658 patients included, a DWI lesion was present in 232 (35.1%). There was a significant interaction between symptom duration and symptom type. For those with focal-only symptoms, there was a continuous increase in DWI probability up to 24 hours in duration (ranging from ≈40% to 80% probability). In stratified analyses, the increase in probability of DWI lesion with increased duration of focal symptoms was seen in women but not men. For those with nonfocal or mixed symptoms, predicted probability of DWI lesion was ≈35% and was greater in men, but did not increase with longer duration. Conclusions Increased duration of neurological deficits is associated with greater probability of DWI lesion in those with focal symptoms only. For individuals with nonfocal or mixed symptoms, about one-third had DWI lesions, but the probability did not increase with duration. These results may be important to improve risk stratification of transient neurological events.
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Affiliation(s)
- Raed A. Joundi
- Division of Neurology, Hamilton Health SciencesMcMaster University & Population Health Research InstituteHamiltonOntarioCanada
| | - Amy Y. X. Yu
- Division of Neurology, Department of MedicineUniversity of Toronto, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Eric E. Smith
- Departments of Clinical Neurosciences and Community Health SciencesUniversity of CalgaryAlbertaCanada
| | - Charlotte Zerna
- Department of Clinical Neurosciences and Diagnostic ImagingUniversity of Calgary Cumming School of MedicineCalgaryAlbertaCanada
| | - Andrew M. Penn
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Robert F. Balshaw
- George & Fay Yee Centre for Healthcare InnovationUniversity of ManitobaWinnipegManitobaCanada
| | - Kristine Votova
- Island Health Regional Health Authority, Division of Medical SciencesUniversity of VictoriaVictoriaBritish ColumbiaCanada
| | - Maximilian B. Bibok
- Department of Research and Capacity Building, Island HealthVictoriaBritish ColumbiaCanada
| | - Melanie Penn
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Viera Saly
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Janka Hegedus
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Shelagh B. Coutts
- Departments of Clinical Neurosciences and Community Health SciencesUniversity of CalgaryAlbertaCanada
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Chi X, Zhao R, Pei H, Xing A, Hu S, Chen J, Mao Y, Zheng X. Diffusion-weighted imaging-documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature. Aging Med (Milton) 2020; 3:53-59. [PMID: 32232193 PMCID: PMC7099753 DOI: 10.1002/agm2.12105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/07/2020] [Accepted: 03/08/2020] [Indexed: 01/28/2023] Open
Abstract
Diffusion-weighted imaging (DWI) MRI is very sensitive for detecting small embolic brain infarctions. Stroke as the first manifestation of cancer is extremely rare. We performed a retrospective study to identify the clinical and DWI features of patients with acute ischemic stroke as the first manifestation of occult cancer. A total of five patients in our hospital from January 2017 to May 2019 were analyzed. We also reviewed the literature and seven case series (16 patients) were included. Most of these patients were aged in their sixties and lung cancer was the most common type of occult cancer. Patients showed various presentations of ischemic stroke. All of the patients showed small multiple lesions on DWI that involved mostly the anterior or both anterior and posterior territories. The lesions were mostly in both the supratentorium and infratentorium, with the mechanisms of embolic and watershed infarcts. These features were useful for identifying the causes of embolic stroke. Therefore, patients with small bilateral embolic stroke, especially those involved in multiple vascular territories, should be examined for concealed malignancy.
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Affiliation(s)
- Xiaosa Chi
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Renliang Zhao
- Department of NeurologyAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Haitao Pei
- Department of NeurologyAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Ang Xing
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Song Hu
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Jingjiao Chen
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Yongjun Mao
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Xueping Zheng
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
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Marebwa BK, Adams RJ, Magwood GS, Basilakos A, Mueller M, Rorden C, Fridriksson J, Bonilha L. Cardiovascular Risk Factors and Brain Health: Impact on Long-Range Cortical Connections and Cognitive Performance. J Am Heart Assoc 2019; 7:e010054. [PMID: 30520672 PMCID: PMC6405561 DOI: 10.1161/jaha.118.010054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Cardiovascular risk factor burden in the absence of clinical or radiological "events" is associated with mild cognitive impairment. Magnetic resonance imaging techniques exploring the integrity of neuronal fiber connectivity within white matter networks supporting cognitive processing could be used to measure the impact of cardiovascular disease on brain health and be used beyond bedside neuropsychological tests to detect subclinical changes and select or stratify participants for entry into clinical trials. Methods and Results We assessed the relationship between verbal IQ and brain network integrity and the effect of cardiovascular risk factors on network integrity by constructing whole-brain structural connectomes from magnetic resonance imaging diffusion images (N=60) from people with various degrees of cardiovascular risk factor burden. We measured axonal integrity by calculating network density and determined the effect of fiber loss on network topology and efficiency, using graph theory. Multivariate analyses were used to evaluate the relationship between cardiovascular risk factor burden, physical activity, age, education, white matter integrity, and verbal IQ . Reduced network density, resulting from a disproportionate loss of long-range white matter fibers, was associated with white matter network fragmentation ( r=-0.52, P<10-4), lower global efficiency ( r=0.91, P<10-20), and decreased verbal IQ (adjusted R2=0.23, P<10-4). Conclusions Cardiovascular risk factors may mediate negative effects on brain health via loss of energy-dependent long-range white matter fibers, which in turn leads to disruption of the topological organization of the white matter networks, lowered efficiency, and reduced cognitive function.
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Affiliation(s)
- Barbara K Marebwa
- 1 Department of Neurology Medical University of South Carolina Charleston SC
| | - Robert J Adams
- 1 Department of Neurology Medical University of South Carolina Charleston SC
| | - Gayenell S Magwood
- 2 Department of Nursing Medical University of South Carolina Charleston SC
| | - Alexandra Basilakos
- 3 Department of Communication Sciences and Disorders University of South Carolina Columbia SC
| | - Martina Mueller
- 2 Department of Nursing Medical University of South Carolina Charleston SC
| | - Chris Rorden
- 4 Department of Psychology University of South Carolina Columbia SC
| | - Julius Fridriksson
- 3 Department of Communication Sciences and Disorders University of South Carolina Columbia SC
| | - Leonardo Bonilha
- 1 Department of Neurology Medical University of South Carolina Charleston SC
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10
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Kuno Y, Baba T, Kuroda T, Teramoto M, Hirokawa N, Endo T, Saito T. Rare case of occult testosterone-producing ovarian tumor that was diagnosed by selective venous hormone sampling. Reprod Med Biol 2018; 17:504-508. [PMID: 30377407 PMCID: PMC6194242 DOI: 10.1002/rmb2.12213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/21/2018] [Indexed: 11/16/2022] Open
Abstract
CASE A 32 year old woman was referred because of secondary amenorrhea, hirsutism, and voice deepening. OUTCOME The blood testosterone level was markedly high. A transvaginal ultrasound revealed a small region in the left ovary, but whether or not it was a tumor was unclear. Therefore, selective ovarian venous sampling was performed. Consequently, the testosterone level was selectively increased in a blood sample that was taken from the left ovarian vein, the tumor was successfully localized, and a laparoscopic left oophorectomy was performed. Although the left ovary appeared to be normal at laparoscopy, the androgen-secreting tumor was located within it. The tumor was diagnosed as a Leydig cell tumor by histopathological analyses. CONCLUSION This report demonstrates that selective blood sampling from ovarian veins before an operation is effective in localizing an androgen-producing ovarian tumor that is difficult to diagnose by imaging studies.
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Affiliation(s)
- Yoshika Kuno
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
| | - Tsuyoshi Baba
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
| | - Takafumi Kuroda
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
| | - Mizue Teramoto
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
| | - Naoki Hirokawa
- Department of Radiology Sapporo Medical University School of Medicine Sapporo Japan
| | - Toshiaki Endo
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
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11
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Moore EE, Liu D, Pechman KR, Terry JG, Nair S, Cambronero FE, Bell SP, Gifford KA, Anderson AW, Hohman TJ, Carr JJ, Jefferson AL. Increased Left Ventricular Mass Index Is Associated With Compromised White Matter Microstructure Among Older Adults. J Am Heart Assoc 2018; 7:JAHA.118.009041. [PMID: 29945917 PMCID: PMC6064880 DOI: 10.1161/jaha.118.009041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Left ventricular (LV) hypertrophy is associated with cerebrovascular disease and cognitive decline. Increased LV mass index is a subclinical imaging marker that precedes overt LV hypertrophy. This study relates LV mass index to white matter microstructure and cognition among older adults with normal cognition and mild cognitive impairment. Methods and Results Vanderbilt Memory & Aging Project participants free of clinical stroke, dementia, and heart failure (n=318, 73±7 years, 58% male, 39% mild cognitive impairment) underwent brain magnetic resonance imaging, cardiac magnetic resonance, and neuropsychological assessment. Voxelwise analyses related LV mass index (g/m2) to diffusion tensor imaging metrics. Models adjusted for age, sex, education, race/ethnicity, Framingham Stroke Risk Profile, cognitive diagnosis, and apolipoprotein E–ε4 status. Secondary analyses included a LV mass index×diagnosis interaction term with follow‐up models stratified by diagnosis. With identical covariates, linear regression models related LV mass index to neuropsychological performances. Increased LV mass index related to altered white matter microstructure (P<0.05). In models stratified by diagnosis, associations between LV mass index and diffusion tensor imaging were present among mild cognitive impairment participants only (P<0.05). LV mass index was related only to worse visuospatial memory performance (β=−0.003, P=0.036), an observation that would not withstand correction for multiple testing. Conclusions In the absence of prevalent heart failure and clinical stroke, increased LV mass index corresponds to altered white matter microstructure, particularly among older adults with clinical symptoms of prodromal dementia. Findings highlight the potential link between subclinical LV remodeling and cerebral white matter microstructure vulnerability.
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Affiliation(s)
- Elizabeth E Moore
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Kimberly R Pechman
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
| | - James G Terry
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Sangeeta Nair
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Francis E Cambronero
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
| | - Susan P Bell
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN.,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine A Gifford
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
| | - Adam W Anderson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Timothy J Hohman
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
| | - John Jeffrey Carr
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Angela L Jefferson
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN .,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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12
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Meyer HJ, Emmer A, Kornhuber M, Surov A. Associations between apparent diffusion coefficient and electromyography parameters in myositis-A preliminary study. Brain Behav 2018; 8:e00958. [PMID: 29761011 PMCID: PMC5943752 DOI: 10.1002/brb3.958] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 02/05/2018] [Accepted: 02/21/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE MRI is widely used in several muscle disorders. Diffusion-weighted imaging (DWI) is an emergent imaging modality sensitive to microstructural alterations in tissue. The apparent diffusion coefficient (ADC) is used to quantify the random motion of water molecules. Electromyography (EMG) is a clinically used diagnostic tool in myositis. The aim of this study was to elucidate possible associations between ADC values and EMG findings in myositis patients. METHOD Seven patients (eight investigated muscles) with myositis (mean age 51.43 ± 19 years) were included in this study. The diagnosis was confirmed by histopathology in every case. DWI was obtained with a 1.5-T scanner using two b-values 0 and 1000 s/mm². In all patients, a needle electromyography (EMG) was performed within 3 days to the MRI. The following EMG parameters were studied: motor unit action potential (MUAP) amplitudes and durations, as well as pathological spontaneous activity. Spearman's correlation coefficient was used to analyze associations between investigated parameters. RESULTS The estimated mean ADC mean value was 1.51 ± 0.29 × 10-3 mm²/s, mean ADC min was 1.28 ± 0.27 × 10-3 mm²/s, and mean ADC max was 1.73 ± 0.28 × 10-3 mm²/s. Correlation analysis identified significant associations between ADC mean and duration of the MUAP (p = .78 P = .0279) and between ADC min and duration of the MUAP (p = .85, P = .01). There were no significant differences according to pathological spontaneous activity. CONCLUSION ADC mean and ADC min showed strong positive correlations with the duration of the MUAP in myositis patients. Both modalities might similarly reflect muscle fiber loss in myositis patients.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology University of Leipzig Leipzig Germany
| | - Alexander Emmer
- Department of Neurology Martin-Luther University Halle-Wittenberg Halle Germany
| | - Malte Kornhuber
- Department of Neurology Martin-Luther University Halle-Wittenberg Halle Germany
| | - Alexey Surov
- Department of Diagnostic and Interventional Radiology University of Leipzig Leipzig Germany
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13
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Mekkaoui C, Jackowski MP, Kostis WJ, Stoeck CT, Thiagalingam A, Reese TG, Reddy VY, Ruskin JN, Kozerke S, Sosnovik DE. Myocardial Scar Delineation Using Diffusion Tensor Magnetic Resonance Tractography. J Am Heart Assoc 2018; 7:JAHA.117.007834. [PMID: 29420216 PMCID: PMC5850260 DOI: 10.1161/jaha.117.007834] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Late gadolinium enhancement (LGE) is the current standard for myocardial scar delineation. In this study, we introduce the tractographic propagation angle (PA), a metric of myofiber curvature (degrees/unit distance) derived from diffusion tensor imaging (DTI), and compare its use to LGE and invasive scar assessment by endocardial voltage mapping. Methods and Results DTI was performed on 7 healthy human volunteers, 5 patients with myocardial infarction, 6 normal mice, and 7 mice with myocardial infarction. LGE to delineate the infarct and border zones was performed with a 2‐dimensional inversion recovery gradient‐echo sequence. Ex vivo DTI was performed on 5 normal human and 5 normal sheep hearts. Endocardial electroanatomic mapping and subsequent ex vivo DTI was performed on 5 infarcted sheep hearts. PA in the normal human hearts varied smoothly and was generally <4. The mean PA in the infarct zone was significantly elevated (10.34±1.02 versus 4.05±0.45, P<0.05). Regions with a PA ≤4 consistently had a bipolar voltage ≥1.5 mV, whereas those with PA values between 4 and 10 had voltages between 0.5 and 1.5 mV. A PA threshold >4 was the most accurate DTI‐derived measure of infarct size and demonstrated the greatest correlation with LGE (r=0.95). Conclusions We found a strong correlation between infarct size by PA and LGE in both mice and humans. There was also an inverse relationship between PA values and endocardial voltage. The use of PA may enable myocardial scar delineation and characterization of arrhythmogenic substrate without the need for exogenous contrast agents.
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Affiliation(s)
- Choukri Mekkaoui
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School, Boston, MA
| | - Marcel P Jackowski
- Department of Computer Science, Institute of Mathematics and Statistics, University of São Paulo, Brazil
| | - William J Kostis
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School, Boston, MA.,Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christian T Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | | | - Timothy G Reese
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School, Boston, MA
| | - Vivek Y Reddy
- Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital Harvard Medical School, Boston, MA
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - David E Sosnovik
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School, Boston, MA.,Cardiology Division, Cardiovascular Research Center, Massachusetts General Hospital Harvard Medical School, Boston, MA
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14
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Felfeli P, Wenz H, Al-Zghloul M, Groden C, Förster A. Combination of standard axial and thin-section coronal diffusion-weighted imaging facilitates the diagnosis of brainstem infarction. Brain Behav 2017; 7:e00666. [PMID: 28413710 PMCID: PMC5390842 DOI: 10.1002/brb3.666] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/25/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Although diffusion-weighted imaging (DWI) is a very sensitive technique for the detection of small ischemic lesions in the human brain, in particular in the brainstem it may fail to demonstrate acute ischemic infarction. In this study, we sought to evaluate the value of additional thin-section coronal DWI for the detection of brainstem infarction. METHODS In 155 consecutive patients (median age 69 [interquartile range, IQR 57-78] years, 95 [61.3%] males) with isolated brainstem infarction, MRI findings were analyzed, with emphasis on ischemic lesions on standard axial (5 mm) and thin-section coronal (3 mm) DWI. RESULTS On DWI, we identified ischemic lesions in the mesencephalon in 12 (7.7%), pons in 115 (74.2%), and medulla oblongata in 31 (20%) patients. In 3 (1.9%) cases-all of these with medulla oblongata infarction-the ischemic lesion was detected only on thin-section coronal DWI. Overall, in 35 (22.6%) patients the ischemic lesion was more easily identified on thin-section coronal DWI in comparison to standard axial DWI. In these, the ischemic lesions were significantly smaller (0.06 [IQR 0.05-0.11] cm3 vs. 0.25 [IQR 0.13-0.47] cm3; p < .001) in comparison to those patients whose ischemic lesion was more easily (6 [3.9%]) or at least similarly well identified (114 [73.5%]) on standard axial DWI. CONCLUSIONS Since thin-section coronal DWI may facilitate the diagnosis of brainstem infarction, we suggest its inclusion in standard stroke MRI protocols.
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Affiliation(s)
- Philippe Felfeli
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Holger Wenz
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Mansour Al-Zghloul
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Christoph Groden
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
| | - Alex Förster
- Department of Neuroradiology Universitätsmedizin Mannheim University of Heidelberg Mannheim Germany
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15
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Venkatasubramanian C, Kleinman JT, Fischbein NJ, Olivot JM, Gean AD, Eyngorn I, Snider RW, Mlynash M, Wijman CAC. Natural history and prognostic value of corticospinal tract Wallerian degeneration in intracerebral hemorrhage. J Am Heart Assoc 2013; 2:e000090. [PMID: 23913508 PMCID: PMC3828779 DOI: 10.1161/jaha.113.000090] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to define the incidence, imaging characteristics, natural history, and prognostic implication of corticospinal tract Wallerian degeneration (CST-WD) in spontaneous intracerebral hemorrhage (ICH) using serial MR imaging. METHODS AND RESULTS Consecutive ICH patients with supratentorial ICH prospectively underwent serial MRIs at 2, 7, 14, and 21 days. MRIs were analyzed by independent raters for the presence and topographical distribution of CST-WD on diffusion-weighted imaging (DWI). Baseline demographics, hematoma characteristics, ICH score, and admission National Institute of Health Stroke Score (NIHSS) were systematically recorded. Functional outcome at 3 months was assessed by the modified Rankin Scale (mRS) and the motor-NIHSS. Twenty-seven patients underwent 93 MRIs; 88 of these were serially obtained in the first month. In 13 patients (48%), all with deep ICH, CST-WD changes were observed after a median of 7 days (interquartile range, 7 to 8) as reduced diffusion on DWI and progressed rostrocaudally along the CST. CST-WD changes evolved into T2-hyperintense areas after a median of 11 days (interquartile range, 6 to 14) and became atrophic on MRIs obtained after 3 months. In univariate analyses, the presence of CST-WD was associated with poor functional outcome (ie, mRS 4 to 6; P=0.046) and worse motor-NIHSS (5 versus 1, P=0.001) at 3 months. CONCLUSIONS Wallerian degeneration along the CST is common in spontaneous supratentorial ICH, particularly in deep ICH. It can be detected 1 week after ICH on DWI and progresses rostrocaudally along the CST over time. The presence of CST-WD is associated with poor motor and functional recovery after ICH.
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