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Harvey-Jones K, Lange F, Verma V, Bale G, Meehan C, Avdic-Belltheus A, Hristova M, Sokolska M, Torrealdea F, Golay X, Parfentyeva V, Durduran T, Bainbridge A, Tachtsidis I, Robertson NJ, Mitra S. Early assessment of injury with optical markers in a piglet model of neonatal encephalopathy. Pediatr Res 2023; 94:1675-1683. [PMID: 37308684 PMCID: PMC10624614 DOI: 10.1038/s41390-023-02679-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Opportunities for adjunct therapies with cooling in neonatal encephalopathy are imminent; however, robust biomarkers of early assessment are lacking. Using an optical platform of broadband near-infrared spectroscopy and diffuse correlation spectroscopy to directly measure mitochondrial metabolism (oxCCO), oxygenation (HbD), cerebral blood flow (CBF), we hypothesised optical indices early (1-h post insult) after hypoxia-ischaemia (HI) predicts insult severity and outcome. METHODS Nineteen newborn large white piglets underwent continuous neuromonitoring as controls or following moderate or severe HI. Optical indices were expressed as mean semblance (phase difference) and coherence (spectral similarity) between signals using wavelet analysis. Outcome markers included the lactate/N-acetyl aspartate (Lac/NAA) ratio at 6 h on proton MRS and TUNEL cell count. RESULTS CBF-HbD semblance (cerebrovascular dysfunction) correlated with BGT and white matter (WM) Lac/NAA (r2 = 0.46, p = 0.004, r2 = 0.45, p = 0.004, respectively), TUNEL cell count (r2 = 0.34, p = 0.02) and predicted both initial insult (r2 = 0.62, p = 0.002) and outcome group (r2 = 0.65 p = 0.003). oxCCO-HbD semblance (cerebral metabolic dysfunction) correlated with BGT and WM Lac/NAA (r2 = 0.34, p = 0.01 and r2 = 0.46, p = 0.002, respectively) and differentiated between outcome groups (r2 = 0.43, p = 0.01). CONCLUSION Optical markers of both cerebral metabolic and vascular dysfunction 1 h after HI predicted injury severity and subsequent outcome in a pre-clinical model. IMPACT This study highlights the possibility of using non-invasive optical biomarkers for early assessment of injury severity following neonatal encephalopathy, relating to the outcome. Continuous cot-side monitoring of these optical markers can be useful for disease stratification in the clinical population and for identifying infants who might benefit from future adjunct neuroprotective therapies beyond cooling.
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Affiliation(s)
| | - Frederic Lange
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Vinita Verma
- Institute for Women's Health, University College London, London, UK
| | - Gemma Bale
- Department of Engineering and Department of Physics, University of Cambridge, Cambridge, UK
| | | | | | - Mariya Hristova
- Institute for Women's Health, University College London, London, UK
| | - Magdalena Sokolska
- Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Francisco Torrealdea
- Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Xavier Golay
- Institute of Neurology, University College London, London, UK
| | - Veronika Parfentyeva
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Alan Bainbridge
- Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | | | - Subhabrata Mitra
- Institute for Women's Health, University College London, London, UK.
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Kassem M, de Kam SS, van Velzen TJ, van der Geest R, Wagner B, Sokolska M, Pizzini FB, Nederkoorn PJ, Rolf Jäger H, Brown MM, van Oostenbrugge RJ, Bonati LH, Eline Kooi M. Application of mask images of contrast-enhanced MR angiography to detect carotid intraplaque hemorrhage in patients with moderate to severe symptomatic and asymptomatic carotid stenosis. Eur J Radiol 2023; 168:111145. [PMID: 37837923 DOI: 10.1016/j.ejrad.2023.111145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/21/2022] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Carotid intraplaque hemorrhage (IPH) on MRI predicts stroke. Magnetization-prepared rapid acquisition gradient (MP-RAGE) is widely used to detect IPH. CE-MRA is used routinely to assess stenosis. Initial studies indicated that IPH can be identified on mask images of CE-MRA, while Time-of-Flight (TOF) images were reported to have high specificity but lower sensitivity. We investigated the diagnostic accuracy of detecting IPH on mask images of CE-MRA and TOF. METHODS Thirty-six patients with ≥ 50% stenosis enrolled in the ongoing 2nd European Carotid Surgery Trial underwent carotid MRI. A 5-point quality score was used. Inter-observer agreement between two independent readers was determined. The sensitivity and specificity of IPH detection on mask MRA and TOF were calculated with MP-RAGE as a reference standard. RESULTS Of the 36 patients included in the current analysis, 66/72 carotid arteries could be scored. The inter-observer agreements for identifying IPH on MP-RAGE, mask, and TOF were outstanding (κ: 0.93, 0.96, and 0.85). The image quality of mask (1.42 ± 0.66) and TOF (2.42 ± 0.66) was significantly lower than MP-RAGE (3.47 ± 0.61). When T1w images were used to delineate the outer carotid wall, very high specificities (>95%) of IPH detection on mask and TOF images were found, while the sensitivity was high for mask images (>81%) and poor for TOF (50-60%). Without these images, the specificity was still high (>97%), while the sensitivity reduced to 62-71%. CONCLUSION Despite the lower image quality, routinely acquired mask images from CE-MRA, but not TOF, can be used as an alternative to MP-RAGE images to visualize IPH.
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Affiliation(s)
- Mohamed Kassem
- Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Soraya S de Kam
- Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Twan J van Velzen
- Department of Neurology, Amsterdam UMC: De Boelelaan 1108, 1081 HV Amsterdam, the Netherlands
| | - Rob van der Geest
- Department of Radiology, Leiden University Medical Centre: Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Benjamin Wagner
- Department of Neurology, University Hospital Basel: Universitätsspital CH, Petersgraben 4, 4031 Basel, Switzerland
| | - Magdalena Sokolska
- Department of Imaging, University College London Hospitals NHS Foundation Trust: 250 Euston Rd, London NW1 2PG, UK; Department of Medical Physics and Biomedical Engineering, University College London Hospitals NHS Foundation Trust: 250 Euston Rd, London NW1 2PG, UK
| | - Francesca B Pizzini
- Radiology, Department of Diagnostic and Public Health, University of Verona: Via S. Francesco, 22, 37129 Verona VR, Italy
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC: De Boelelaan 1108, 1081 HV Amsterdam, the Netherlands
| | - H Rolf Jäger
- Department of Imaging, University College London Hospitals NHS Foundation Trust: 250 Euston Rd, London NW1 2PG, UK
| | - Martin M Brown
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London: Queen Square, London WC1N 3BG, UK
| | - Robert J van Oostenbrugge
- Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Leo H Bonati
- Department of Neurology, University Hospital Basel: Universitätsspital CH, Petersgraben 4, 4031 Basel, Switzerland
| | - M Eline Kooi
- Cardiovascular Research Institute Maastrich (CARIM), Maastricht University: Universiteitssingel 50, PO Box 616, 6200 MD Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ (MUMC+): P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
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Ardellier FD, Baloglu S, Sokolska M, Noblet V, Lersy F, Collange O, Ferré JC, Maamar A, Carsin-Nicol B, Helms J, Schenck M, Khalil A, Gaudemer A, Caillard S, Pottecher J, Lefèbvre N, Zorn PE, Matthieu M, Brisset JC, Boulay C, Mutschler V, Hansmann Y, Mertes PM, Schneider F, Fafi-Kremer S, Ohana M, Meziani F, Meyer N, Yousry T, Anheim M, Cotton F, Jäger HR, Kremer S. Cerebral perfusion using ASL in patients with COVID-19 and neurological manifestations: A retrospective multicenter observational study. J Neuroradiol 2023; 50:470-481. [PMID: 36657613 PMCID: PMC9842391 DOI: 10.1016/j.neurad.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/15/2023] [Accepted: 01/15/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral hypoperfusion has been reported in patients with COVID-19 and neurological manifestations in small cohorts. We aimed to systematically assess changes in cerebral perfusion in a cohort of 59 of these patients, with or without abnormalities on morphological MRI sequences. METHODS Patients with biologically-confirmed COVID-19 and neurological manifestations undergoing a brain MRI with technically adequate arterial spin labeling (ASL) perfusion were included in this retrospective multicenter study. ASL maps were jointly reviewed by two readers blinded to clinical data. They assessed abnormal perfusion in four regions of interest in each brain hemisphere: frontal lobe, parietal lobe, posterior temporal lobe, and temporal pole extended to the amygdalo-hippocampal complex. RESULTS Fifty-nine patients (44 men (75%), mean age 61.2 years) were included. Most patients had a severe COVID-19, 57 (97%) needed oxygen therapy and 43 (73%) were hospitalized in intensive care unit at the time of MRI. Morphological brain MRI was abnormal in 44 (75%) patients. ASL perfusion was abnormal in 53 (90%) patients, and particularly in all patients with normal morphological MRI. Hypoperfusion occurred in 48 (81%) patients, mostly in temporal poles (52 (44%)) and frontal lobes (40 (34%)). Hyperperfusion occurred in 9 (15%) patients and was closely associated with post-contrast FLAIR leptomeningeal enhancement (100% [66.4%-100%] of hyperperfusion with enhancement versus 28.6% [16.6%-43.2%] without, p = 0.002). Studied clinical parameters (especially sedation) and other morphological MRI anomalies had no significant impact on perfusion anomalies. CONCLUSION Brain ASL perfusion showed hypoperfusion in more than 80% of patients with severe COVID-19, with or without visible lesion on conventional MRI abnormalities.
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Affiliation(s)
- François-Daniel Ardellier
- Service D'imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Engineering science, computer science and imaging laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France.
| | - Seyyid Baloglu
- Service D'imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, United Kingdom; Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Vincent Noblet
- Engineering science, computer science and imaging laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
| | - François Lersy
- Service D'imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Collange
- Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | | | - Adel Maamar
- Medical Intensive Care Unit, CHU Rennes, Rennes, France
| | | | - Julie Helms
- Service de Médecine Intensive Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Immuno-Rhumatologie Moléculaire, INSERM UMR S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Maleka Schenck
- Service de Médecine Intensive Réanimation, Hôpitaux universitaires de Strasbourg, Hautepierre, Strasbourg, France
| | - Antoine Khalil
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (APHP), Denis Diderot University and Medical School, Bichat University Hospital, Paris, France
| | - Augustin Gaudemer
- Neuroradiology Unit, Department of Radiology, Assistance Publique-Hôpitaux de Paris (APHP), Bichat University Hospital, Paris, France
| | - Sophie Caillard
- Immuno-Rhumatologie Moléculaire, INSERM UMR S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France; Nephrology and Transplantation department, Hôpitaux Universitaires de Strasbourg. Inserm UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Julien Pottecher
- Hôpital de Hautepierre, Service d'Anesthésie, Réanimation & Médecine Péri-Opératoire - Université de Strasbourg, Faculté de Médecine, FMTS, EA3072, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Lefèbvre
- Service de Maladies Infectieuses, NHC, CHU de Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Zorn
- Hôpitaux Universitaires de Strasbourg, UCIEC, Pôle d'Imagerie, Strasbourg, France
| | - Muriel Matthieu
- Hôpitaux Universitaires de Strasbourg, UCIEC, Pôle d'Imagerie, Strasbourg, France
| | | | - Clotilde Boulay
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Véronique Mutschler
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Yves Hansmann
- Service de Maladies Infectieuses, NHC, CHU de Strasbourg, Strasbourg, France
| | - Paul-Michel Mertes
- Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Francis Schneider
- Service de Médecine Intensive Réanimation, Hôpitaux universitaires de Strasbourg, Hautepierre, Strasbourg, France
| | - Samira Fafi-Kremer
- Laboratoire de Virologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mickael Ohana
- Radiology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Ferhat Meziani
- Service de Médecine Intensive Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; UMR 1260, Regenerative Nanomedicine (RNM), FMTS, INSERM (French National Institute of Health and Medical Research), Strasbourg, France
| | - Nicolas Meyer
- Service de Santé Publique, GMRC, CHU de Strasbourg, Strasbourg F-67091 , France
| | - Tarek Yousry
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch, France
| | - François Cotton
- MRI center, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Université Lyon 1, Villeurbanne, France
| | - Hans Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Stéphane Kremer
- Service D'imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Engineering science, computer science and imaging laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
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Gaunt T, Sokolska M. Physiological assessment of the fetal body using MRI: current uses and potential directions. Br J Radiol 2023:20221024. [PMID: 37310734 DOI: 10.1259/bjr.20221024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
MRI assessment of the fetus useing fast T2 weighted sequences is well established in defining alterations in fetal anatomy and structure, as a biomarker for disease and in some cases prognostication. To date, the physiological assessment of the fetus using advanced sequences to characterise tissue perfusion and microarchitecture has largely been unused. Current methods of assessing fetal organ function are invasive and carry inherent risk. Therefore the identification of imaging biomarkers of altered physiology in fetal disease, and their correlation with postnatal outcome, is therefore attractive. This review describes the techniques which show promise for such a task, and potential future directions.
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Affiliation(s)
- Trevor Gaunt
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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5
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Lindner T, Bolar DS, Achten E, Barkhof F, Bastos-Leite AJ, Detre JA, Golay X, Günther M, Wang DJJ, Haller S, Ingala S, Jäger HR, Jahng GH, Juttukonda MR, Keil VC, Kimura H, Ho ML, Lequin M, Lou X, Petr J, Pinter N, Pizzini FB, Smits M, Sokolska M, Zaharchuk G, Mutsaerts HJMM. Current state and guidance on arterial spin labeling perfusion MRI in clinical neuroimaging. Magn Reson Med 2023; 89:2024-2047. [PMID: 36695294 PMCID: PMC10914350 DOI: 10.1002/mrm.29572] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 11/01/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Abstract
This article focuses on clinical applications of arterial spin labeling (ASL) and is part of a wider effort from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group to update and expand on the recommendations provided in the 2015 ASL consensus paper. Although the 2015 consensus paper provided general guidelines for clinical applications of ASL MRI, there was a lack of guidance on disease-specific parameters. Since that time, the clinical availability and clinical demand for ASL MRI has increased. This position paper provides guidance on using ASL in specific clinical scenarios, including acute ischemic stroke and steno-occlusive disease, arteriovenous malformations and fistulas, brain tumors, neurodegenerative disease, seizures/epilepsy, and pediatric neuroradiology applications, focusing on disease-specific considerations for sequence optimization and interpretation. We present several neuroradiological applications in which ASL provides unique information essential for making the diagnosis. This guidance is intended for anyone interested in using ASL in a routine clinical setting (i.e., on a single-subject basis rather than in cohort studies) building on the previous ASL consensus review.
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Affiliation(s)
- Thomas Lindner
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Divya S. Bolar
- Center for Functional Magnetic Resonance Imaging, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Eric Achten
- Department of Radiology and Nuclear Medicine, Ghent University, Ghent, Belgium
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, UK
| | | | - John A. Detre
- Department of Neurology, University of Pennsylvania, Philadelphia PA USA
| | - Xavier Golay
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Matthias Günther
- (1) University Bremen, Germany; (2) Fraunhofer MEVIS, Bremen, Germany; (3) mediri GmbH, Heidelberg, Germany
| | - Danny JJ Wang
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles CA USA
| | - Sven Haller
- (1) CIMC - Centre d’Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Genève 1201 Genève (2) Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (3) Faculty of Medicine of the University of Geneva, Switzerland. Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hans R Jäger
- UCL Queen Square Institute of Neuroradiology, University College London, London, UK
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Meher R. Juttukonda
- (1) Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown MA USA (2) Department of Radiology, Harvard Medical School, Boston MA USA
| | - Vera C. Keil
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical sciences, University of Fukui, Fukui, JAPAN
| | - Mai-Lan Ho
- Nationwide Children’s Hospital and The Ohio State University, Columbus, OH, USA
| | - Maarten Lequin
- Division Imaging & Oncology, Department of Radiology & Nuclear Medicine | University Medical Center Utrecht & Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jan Petr
- (1) Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany (2) Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Nandor Pinter
- Dent Neurologic Institute, Buffalo, NY, USA. University at Buffalo Neurosurgery, Buffalo, NY, USA
| | - Francesca B. Pizzini
- Radiology Institute, Dept. of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Marion Smits
- (1) Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands (2) The Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering University College London Hospitals NHS Foundation Trust, UK
| | | | - Henk JMM Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Maguire A, Obasi E, Markus J, Gupta M, Kosmin M, Sokolska M, Hyare H. Early Post-treatment Pseudo-continuous Arterial Spin Labelling Stratifies 12 Month Survival in Gliomas. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.036] [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: 11/12/2022] Open
Abstract
Abstract
AIMS
Arterial spin labelling (ASL) is a non-invasive perfusion technique that uses endogenous contrast and is proving to be of value in paediatric neuro-oncology. ASL derived rCBV has been shown to correlate with Dynamic Susceptibility Contrast (DSC) -derived CBV and could be an alternative perfusion technique when DSC is not possible. The aim of the study was to investigate whether early post-treatment tumour ASL can stratify patient survival at 12 months.
METHOD
180 consecutive patients diagnosed with glioblastoma and undergoing treatment between 2017-2021 were imaged with an extended MRI protocol that included pseudo-continuous ASL (pCASL). Patients that were imaged with pCASL within 1-3 months of completing radiotherapy were identified retrospectively. Scanner generated Perfusion weighted images were inspected and regions of interest encompassing the tumour were generated and compared with a control region in the contra-lateral grey matter. Overall survival data was collated and a comparison of tumour ASL was assessed with t-test statistics between patients surviving < and >12 months.
RESULTS
43 patients were identified (23 male, median age 58 years, diagnoses: IDHwt-GBM 17, IDHmut-Astrocytoma 13, IDHmut 1p19q co-deleted Oligodendroglioma 13). Tumour ASL was 3.22 (± 2.1) in patients that survived less than 12 months compared to 1.64 (± 1.9) in patients that survived greater than 12 months, p=0.02).
CONCLUSION
Early post-treatment ASL can stratify patient survival at 12 months and show promise as an alternative to DSC perfusion in the prognostication of patients being treated for glioma.
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Affiliation(s)
| | | | | | - Meetakshi Gupta
- Cancer Division, University College London Hospitals NHS Foundation Trust , London , UK
| | - Michael Kosmin
- Cancer Division, University College London Hospitals NHS Foundation Trust , London , UK
| | | | - Harpreet Hyare
- Queen Square Institute of Neurology, University College London
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7
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Benjamin LA, Lim E, Sokolska M, Markus J, Zaletel T, Aggarwal V, Luder R, Sanchez E, Brown K, Sofat R, Singh A, Houlihan C, Nastouli E, Losseff N, Werring DJ, Brown MM, Mason JC, Simister RJ, Jäger HR. Vessel wall magnetic resonance and arterial spin labelling imaging in the management of presumed inflammatory intracranial arterial vasculopathy. Brain Commun 2022; 4:fcac157. [PMID: 35813881 PMCID: PMC9263889 DOI: 10.1093/braincomms/fcac157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/08/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
Optimal criteria for diagnosing and monitoring response to treatment for infectious and inflammatory medium–large vessel intracranial vasculitis presenting with stroke are lacking. We integrated intracranial vessel wall MRI with arterial spin labelling into our routine clinical stroke pathway to detect presumed inflammatory intracranial arterial vasculopathy, and monitor disease activity, in patients with clinical stroke syndromes. We used predefined standardized radiological criteria to define vessel wall enhancement, and all imaging findings were rated blinded to clinical details. Between 2017 and 2018, stroke or transient ischaemic attack patients were first screened in our vascular radiology meeting and followed up in a dedicated specialist stroke clinic if a diagnosis of medium–large inflammatory intracranial arterial vasculopathy was radiologically confirmed. Treatment was determined and monitored by a multi-disciplinary team. In this case series, 11 patients were managed in this period from the cohort of young stroke presenters (<55 years). The median age was 36 years (interquartile range: 33,50), of which 8 of 11 (73%) were female. Two of 11 (18%) had herpes virus infection confirmed by viral nucleic acid in the cerebrospinal fluid. We showed improvement in cerebral perfusion at 1 year using an arterial spin labelling sequence in patients taking immunosuppressive therapy for >4 weeks compared with those not receiving therapy [6 (100%) versus 2 (40%) P = 0.026]. Our findings demonstrate the potential utility of vessel wall magnetic resonance with arterial spin labelling imaging in detecting and monitoring medium–large inflammatory intracranial arterial vasculopathy activity for patients presenting with stroke symptoms, limiting the need to progress to brain biopsy. Further systematic studies in unselected populations of stroke patients are needed to confirm our findings and establish the prevalence of medium–large artery wall inflammation.
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Affiliation(s)
- L A Benjamin
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square , Box 16, London WC1N 3BG , UK
- Laboratory of Molecular and Cell Biology, UCL, Gower St, Kings Cross , London WC1E 6BT , UK
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London , London WC1B 5EH , UK
- University of Liverpool, Brain Infections Group, Liverpool , Merseyside, L69 7BE , UK
| | - E Lim
- Department of Imaging, University College London Hospitals NHS foundation trust , London, NW1 2PG , UK
| | - M Sokolska
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals NHS Foundation Trust , London, NW1 2PG , UK
| | - J Markus
- Department of Imaging, University College London Hospitals NHS foundation trust , London, NW1 2PG , UK
| | - T Zaletel
- Department of Medicine, University of Cambridge , Cambridge, CB2 1TN , UK
| | - V Aggarwal
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square , Box 16, London WC1N 3BG , UK
| | - R Luder
- Department of Medicine, North Middlesex University Hospital , London, N18 1QX , UK
| | - E Sanchez
- Department of clinical virology, University College London Hospitals NHS Foundation Trust , London, NW1 2PG , UK
| | - K Brown
- Department of Virology, UK Health Security Agency , London, NW9 5EQ , UK
| | - R Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool , Liverpool L69 7BE , UK
- Health Data Research , London, NW1 2BE , UK
| | - A Singh
- Department of Medicine, Royal Free Hospital Foundation Trust , London, NW3 2QG , UK
| | - C Houlihan
- Department of clinical virology, University College London Hospitals NHS Foundation Trust , London, NW1 2PG , UK
| | - E Nastouli
- Department of clinical virology, University College London Hospitals NHS Foundation Trust , London, NW1 2PG , UK
- Crick Institute , London, NW1 1AT , UK
| | - N Losseff
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square , Box 16, London WC1N 3BG , UK
| | - D J Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square , Box 16, London WC1N 3BG , UK
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London , London WC1B 5EH , UK
| | - M M Brown
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London , London WC1B 5EH , UK
| | - J C Mason
- Department of Medicine, Hammersmith Hospital , London, W12 0HS , UK
- National Heart and Lung Institute, Imperial College London , London, SW3 6LY , UK
| | - R J Simister
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square , Box 16, London WC1N 3BG , UK
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London , London WC1B 5EH , UK
| | - H R Jäger
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London , London WC1B 5EH , UK
- Department of Imaging, University College London Hospitals NHS foundation trust , London, NW1 2PG , UK
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London , London, WC1N 3BG , UK
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8
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Martinello KA, Meehan C, Avdic-Belltheus A, Lingam I, Mutshiya T, Yang Q, Akin MA, Price D, Sokolska M, Bainbridge A, Hristova M, Tachtsidis I, Tann CJ, Peebles D, Hagberg H, Wolfs TGAM, Klein N, Kramer BW, Fleiss B, Gressens P, Golay X, Robertson NJ. Hypothermia is not therapeutic in a neonatal piglet model of inflammation-sensitized hypoxia-ischemia. Pediatr Res 2022; 91:1416-1427. [PMID: 34050269 PMCID: PMC8160560 DOI: 10.1038/s41390-021-01584-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Perinatal inflammation combined with hypoxia-ischemia (HI) exacerbates injury in the developing brain. Therapeutic hypothermia (HT) is standard care for neonatal encephalopathy; however, its benefit in inflammation-sensitized HI (IS-HI) is unknown. METHODS Twelve newborn piglets received a 2 µg/kg bolus and 1 µg/kg/h infusion over 52 h of Escherichia coli lipopolysaccharide (LPS). HI was induced 4 h after LPS bolus. After HI, piglets were randomized to HT (33.5 °C 1-25 h after HI, n = 6) or normothermia (NT, n = 6). Amplitude-integrated electroencephalogram (aEEG) was recorded and magnetic resonance spectroscopy (MRS) was acquired at 24 and 48 h. At 48 h, terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL)-positive brain cell death, microglial activation/proliferation, astrogliosis, and cleaved caspase-3 (CC3) were quantified. Hematology and plasma cytokines were serially measured. RESULTS Two HT piglets died. aEEG recovery, thalamic and white matter MRS lactate/N-acetylaspartate, and TUNEL-positive cell death were similar between groups. HT increased microglial activation in the caudate, but had no other effect on glial activation/proliferation. HT reduced CC3 overall. HT suppressed platelet count and attenuated leukocytosis. Cytokine profile was unchanged by HT. CONCLUSIONS We did not observe protection with HT in this piglet IS-HI model based on aEEG, MRS, and immunohistochemistry. Immunosuppressive effects of HT and countering neuroinflammation by LPS may contribute to the observed lack of HT efficacy. Other immunomodulatory strategies may be more effective in IS-HI. IMPACT Acute infection/inflammation is known to exacerbate perinatal brain injury and can worsen the outcomes in neonatal encephalopathy. Therapeutic HT is the current standard of care for all infants with NE, but the benefit in infants with coinfection/inflammation is unknown. In a piglet model of inflammation (LPS)-sensitized HI, we observed no evidence of neuroprotection with cooling for 24 h, based on our primary outcome measures: aEEG, MRS Lac/NAA, and histological brain cell death. Additional neuroprotective agents, with beneficial immunomodulatory effects, require exploration in IS-HI models.
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Affiliation(s)
- Kathryn A Martinello
- Institute for Women's Health, University College London, London, UK
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | | | | | - Ingran Lingam
- Institute for Women's Health, University College London, London, UK
| | - Tatenda Mutshiya
- Institute for Women's Health, University College London, London, UK
| | - Qin Yang
- Institute for Women's Health, University College London, London, UK
| | - Mustafa Ali Akin
- Department of Paediatrics, Ondokuz Mayıs University, Samsun, Turkey
| | - David Price
- Medical Physics and Biomedical Engineering, University College London NHS Foundation Trust, London, UK
| | - Magdalena Sokolska
- Medical Physics and Biomedical Engineering, University College London NHS Foundation Trust, London, UK
| | - Alan Bainbridge
- Medical Physics and Biomedical Engineering, University College London NHS Foundation Trust, London, UK
| | - Mariya Hristova
- Institute for Women's Health, University College London, London, UK
| | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Cally J Tann
- Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Donald Peebles
- Institute for Women's Health, University College London, London, UK
| | - Henrik Hagberg
- Department of Clinical Sciences, Centre of Perinatal Medicine and Health, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre for the Developing Brain, Kings College London, London, UK
| | - Tim G A M Wolfs
- Department of Pediatrics, University of Maastricht, Maastricht, The Netherlands
| | - Nigel Klein
- Paediatric Infectious Diseases and Immunology, Institute of Child Health, University College London, London, UK
| | - Boris W Kramer
- Department of Pediatrics, University of Maastricht, Maastricht, The Netherlands
| | - Bobbi Fleiss
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- Université de Paris, NeuroDiderot, Inserm, Paris, France
| | | | - Xavier Golay
- Institute of Neurology, University College London, London, UK
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK.
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
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9
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Kosmin M, Gupta M, Sokolska M, Eiben B, Markus J, Hyare H. PD-0245 Changes in cortical blood flow >1 year after radiation for glioma using arterial spin labelling MRI. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02800-6] [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: 10/18/2022]
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10
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Rojas-Villabona A, Sokolska M, Solbach T, Grieve J, Rega M, Torrealdea F, Pizzini FB, De Vita E, Suzuki Y, Van Osch MJP, Biondetti E, Shmueli K, Atkinson D, Murphy M, Paddick I, Golay X, Kitchen N, Jäger HR. Planning of gamma knife radiosurgery (GKR) for brain arteriovenous malformations using triple magnetic resonance angiography (triple-MRA). Br J Neurosurg 2022; 36:217-227. [PMID: 33645357 DOI: 10.1080/02688697.2021.1884649] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Intra-arterial Digital Subtraction Angiography (DSA) is the gold standard technique for radiosurgery target delineation in brain Arterio-Venous Malformations (AVMs). This study aims to evaluate whether a combination of three Magnetic Resonance Angiography sequences (triple-MRA) could be used for delineation of brain AVMs for Gamma Knife Radiosurgery (GKR). METHODS Fifteen patients undergoing DSA for GKR targeting of brain AVMs also underwent triple-MRA: 4D Arterial Spin Labelling based angiography (ASL-MRA), Contrast-Enhanced Time-Resolved MRA (CE-MRA) and High Definition post-contrast Time-Of-Flight angiography (HD-TOF). The arterial phase of the AVM nidus was delineated on triple-MRA by an interventional neuroradiologist and a consultant neurosurgeon (triple-MRA volume). Triple-MRA volumes were compared to AVM targets delineated by the clinical team for delivery of GKR using the current planning paradigm, i.e., stereotactic DSA and volumetric MRI (DSA volume). Difference in size, degree of inclusion (DI) and concordance index (CcI) between DSA and triple-MRA volumes are reported. RESULTS AVM target volumes delineated on triple-MRA were on average 9.8% smaller than DSA volumes (95%CI:5.6-13.9%; SD:7.14%; p = .003). DI of DSA volume in triple-MRA volume was on average 73.5% (95%CI:71.2-76; range: 65-80%). The mean percentage of triple-MRA volume not included on DSA volume was 18% (95%CI:14.7-21.3; range: 7-30%). CONCLUSION The technical feasibility of using triple-MRA for visualisation and delineation of brain AVMs for GKR planning has been demonstrated. Tighter and more precise delineation of AVM target volumes could be achieved by using triple-MRA for radiosurgery targeting. However, further research is required to ascertain the impact this may have in obliteration rates and side effects.
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Affiliation(s)
- Alvaro Rojas-Villabona
- The Gamma Knife Centre at Queen Square, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Magdalena Sokolska
- Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Thomas Solbach
- The Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Joan Grieve
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Marilena Rega
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | | | | | - Enrico De Vita
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Yuriko Suzuki
- C. J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Matthias J P Van Osch
- C. J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Emma Biondetti
- MRI Group, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Karin Shmueli
- MRI Group, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, UK
| | - Mary Murphy
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ian Paddick
- The Gamma Knife Centre at Queen Square, National Hospital for Neurology and Neurosurgery, London, UK
| | - Xavier Golay
- Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Neil Kitchen
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Hans Rolf Jäger
- The Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
- Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
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11
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Mufti N, Ebner M, Patel P, Aertsen M, Gaunt T, Humphries PD, Bredaki FE, Hewitt R, Butler C, Sokolska M, Kendall GS, Atkinson D, Vercauteren T, Ourselin S, Pandya PP, Deprest J, Melbourne A, David AL. Super-resolution Reconstruction MRI Application in Fetal Neck Masses and Congenital High Airway Obstruction Syndrome. OTO Open 2021; 5:2473974X211055372. [PMID: 34723053 PMCID: PMC8549475 DOI: 10.1177/2473974x211055372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/06/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Reliable airway patency diagnosis in fetal tracheolaryngeal obstruction is crucial to select and plan ex utero intrapartum treatment (EXIT) surgery. We compared the clinical utility of magnetic resonance imaging (MRI) super-resolution reconstruction (SRR) of the trachea, which can mitigate unpredictable fetal motion effects, with standard 2-dimensional (2D) MRI for airway patency diagnosis and assessment of fetal neck mass anatomy. Study Design A single-center case series of 7 consecutive singleton pregnancies with complex upper airway obstruction (2013-2019). Setting A tertiary fetal medicine unit performing EXIT surgery. Methods MRI SRR of the trachea was performed involving rigid motion correction of acquired 2D MRI slices combined with robust outlier detection to reconstruct an isotropic high-resolution volume. SRR, 2D MRI, and paired data were blindly assessed by 3 radiologists in 3 experimental rounds. Results Airway patency was correctly diagnosed in 4 of 7 cases (57%) with 2D MRI as compared with 2 of 7 cases (29%) with SRR alone or paired 2D MRI and SRR. Radiologists were more confident (P = .026) in airway patency diagnosis when using 2D MRI than SRR. Anatomic clarity was higher with SRR (P = .027) or paired data (P = .041) in comparison with 2D MRI alone. Radiologists detected further anatomic details by using paired images versus 2D MRI alone (P < .001). Cognitive load, as assessed by the NASA Task Load Index, was increased with paired or SRR data in comparison with 2D MRI. Conclusion The addition of SRR to 2D MRI does not increase fetal airway patency diagnostic accuracy but does provide improved anatomic information, which may benefit surgical planning of EXIT procedures.
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Affiliation(s)
- Nada Mufti
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Michael Ebner
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Premal Patel
- Radiology Department, Great Ormond Street Hospital for Children, London, UK
| | - Michael Aertsen
- Department of Radiology, University Hospitals Katholieke Universiteit, Leuven, Belgium
| | - Trevor Gaunt
- Radiology Department, Great Ormond Street Hospital for Children, London, UK.,Women's Health Division, University College London Hospitals, London, UK
| | - Paul D Humphries
- Radiology Department, Great Ormond Street Hospital for Children, London, UK
| | | | - Richard Hewitt
- Ear, Nose and Throat Department, Great Ormond Street Hospital for Children, London, UK
| | - Colin Butler
- Ear, Nose and Throat Department, Great Ormond Street Hospital for Children, London, UK
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Giles S Kendall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Women's Health Division, University College London Hospitals, London, UK
| | - David Atkinson
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK.,Centre for Medical Imaging, University College London, London, UK
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Pranav P Pandya
- Women's Health Division, University College London Hospitals, London, UK
| | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Obstetrics and Gynaecology, University Hospitals Katholieke Universiteit, Leuven, Belgium
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Obstetrics and Gynaecology, University Hospitals Katholieke Universiteit, Leuven, Belgium
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12
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Kamourieh S, Sokolska M, Akram H, Patel J, Jäger HR, Arshad Q, Matharu M, Kaski D. Miners' Nystagmus Following Visual Deprivation: A Case Report. Ann Intern Med 2021; 174:1021-1022. [PMID: 33617724 DOI: 10.7326/l20-1261] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Salwa Kamourieh
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | - Harry Akram
- Royal National Ear Nose and Throat & Eastman Dental Hospital, London, United Kingdom
| | - Jay Patel
- Royal National Ear Nose and Throat & Eastman Dental Hospital, London, United Kingdom
| | - Hans Rolf Jäger
- UCL Queen Square Institute of Neurology, London, United Kingdom
| | | | - Manjit Matharu
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Diego Kaski
- National Hospital for Neurology and Neurosurgery, Royal National Ear Nose and Throat & Eastman Dental Hospital, and UCL Institute of Neurology, London, United Kingdom
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13
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Koskela T, Kendall GS, Memon S, Sokolska M, Mabuza T, Huertas-Ceballos A, Mitra S, Robertson NJ, Meek J, Whitehead K. Prognostic value of neonatal EEG following therapeutic hypothermia in survivors of hypoxic-ischemic encephalopathy. Clin Neurophysiol 2021; 132:2091-2100. [PMID: 34284244 PMCID: PMC8407358 DOI: 10.1016/j.clinph.2021.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/10/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Early prediction of neurological deficits following neonatal hypoxic-ischemic encephalopathy (HIE) may help to target support. Neonatal animal models suggest that recovery following hypoxia-ischemia depends upon cortical bursting. To test whether this holds in human neonates, we correlated the magnitude of cortical bursting during recovery (≥postnatal day 3) with neurodevelopmental outcomes. METHODS We identified 41 surviving infants who received therapeutic hypothermia for HIE (classification at hospital discharge: 19 mild, 18 moderate, 4 severe) and had 9-channel electroencephalography (EEG) recordings as part of their routine care. We correlated burst power with Bayley-III cognitive, motor and language scores at median 24 months. To examine whether EEG offered additional prognostic information, we controlled for structural MRI findings. RESULTS Higher power of central and occipital cortical bursts predicted worse cognitive and language outcomes, and higher power of central cortical bursts predicted worse motor outcome, all independently of structural MRI findings. CONCLUSIONS Clinical EEG after postnatal day 3 may provide additional prognostic information by indexing persistent active mechanisms that either support recovery or exacerbate brain damage, especially in infants with less severe encephalopathy. SIGNIFICANCE These findings could allow for the effect of clinical interventions in the neonatal period to be studied instantaneously in the future.
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Affiliation(s)
- Tuomas Koskela
- Research IT Services, University College London, London WC1E 7HB, UK.
| | - Giles S Kendall
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK; Academic Neonatology, Institute for Women's Health, University College London, London WC1E 6HU, UK.
| | - Sara Memon
- Department of Neuroscience, Physiology & Pharmacology, University College London, London WC1E 6BT, UK.
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK.
| | - Thalitha Mabuza
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK.
| | - Angela Huertas-Ceballos
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK.
| | - Subhabrata Mitra
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK; Academic Neonatology, Institute for Women's Health, University College London, London WC1E 6HU, UK.
| | - Nicola J Robertson
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK; Academic Neonatology, Institute for Women's Health, University College London, London WC1E 6HU, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
| | - Judith Meek
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK.
| | - Kimberley Whitehead
- Neonatal Intensive Care Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals, London WC1E 6DB, UK; Department of Neuroscience, Physiology & Pharmacology, University College London, London WC1E 6BT, UK.
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14
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Robertson NJ, Meehan C, Martinello KA, Avdic-Belltheus A, Boggini T, Mutshiya T, Lingam I, Yang Q, Sokolska M, Charalambous X, Bainbridge A, Hristova M, Kramer BW, Golay X, Weil B, Lowdell MW. Human umbilical cord mesenchymal stromal cells as an adjunct therapy with therapeutic hypothermia in a piglet model of perinatal asphyxia. Cytotherapy 2021; 23:521-535. [PMID: 33262073 PMCID: PMC8139415 DOI: 10.1016/j.jcyt.2020.10.005] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/12/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND With therapeutic hypothermia (HT) for neonatal encephalopathy, disability rates are reduced, but not all babies benefit. Pre-clinical rodent studies suggest mesenchymal stromal cells (MSCs) augment HT protection. AIMS The authors studied the efficacy of intravenous (IV) or intranasal (IN) human umbilical cord-derived MSCs (huMSCs) as adjunct therapy to HT in a piglet model. METHODS A total of 17 newborn piglets underwent transient cerebral hypoxia-ischemia (HI) and were then randomized to (i) HT at 33.5°C 1-13 h after HI (n = 7), (ii) HT+IV huMSCs (30 × 106 cells) at 24 h and 48 h after HI (n = 5) or (iii) HT+IN huMSCs (30 × 106 cells) at 24 h and 48 h after HI (n = 5). Phosphorus-31 and hydrogen-1 magnetic resonance spectroscopy (MRS) was performed at 30 h and 72 h and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-positive cells and oligodendrocytes quantified. In two further piglets, 30 × 106 IN PKH-labeled huMSCs were administered. RESULTS HI severity was similar between groups. Amplitude-integrated electroencephalogram (aEEG) recovery was more rapid for HT+IN huMSCs compared with HT from 25 h to 42 h and 49 h to 54 h (P ≤ 0.05). MRS phosphocreatine/inorganic phosphate was higher on day 2 in HT+IN huMSCs than HT (P = 0.035). Comparing HT+IN huMSCs with HT and HT+IV huMSCs, there were increased OLIG2 counts in hippocampus (P = 0.011 and 0.018, respectively), internal capsule (P = 0.013 and 0.037, respectively) and periventricular white matter (P = 0.15 for IN versus IV huMSCs). Reduced TUNEL-positive cells were seen in internal capsule with HT+IN huMSCs versus HT (P = 0.05). PKH-labeled huMSCs were detected in the brain 12 h after IN administration. CONCLUSIONS After global HI, compared with HT alone, the authors saw beneficial effects of HT+IN huMSCs administered at 24 h and 48 h (30 × 106 cells/kg total dose) based on more rapid aEEG recovery, improved 31P MRS brain energy metabolism and increased oligodendrocyte survival at 72 h.
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Affiliation(s)
| | | | | | | | - Tiziana Boggini
- Institute for Women's Health, University College London, London, UK
| | - Tatenda Mutshiya
- Institute for Women's Health, University College London, London, UK
| | - Ingran Lingam
- Institute for Women's Health, University College London, London, UK
| | - Qin Yang
- Institute for Women's Health, University College London, London, UK
| | | | | | - Alan Bainbridge
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Mariya Hristova
- Institute for Women's Health, University College London, London, UK
| | - Boris W Kramer
- Department of Pediatrics, University of Maastricht, Maastricht, the Netherlands
| | - Xavier Golay
- Institute for Women's Health, University College London, London, UK
| | - Ben Weil
- Royal Free London NHS Foundation Trust, London, UK
| | - Mark W Lowdell
- Institute for Women's Health, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
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15
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Rojas-Villabona A, Pizzini FB, Solbach T, Sokolska M, Ricciardi G, Lemonis C, DeVita E, Suzuki Y, van Osch MJP, Foroni RI, Longhi M, Montemezzi S, Atkinson D, Kitchen N, Nicolato A, Golay X, Jäger HR. Are Dynamic Arterial Spin-Labeling MRA and Time-Resolved Contrast-Enhanced MRA Suited for Confirmation of Obliteration following Gamma Knife Radiosurgery of Brain Arteriovenous Malformations? AJNR Am J Neuroradiol 2021; 42:671-678. [PMID: 33541896 DOI: 10.3174/ajnr.a6990] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 10/21/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intra-arterial DSA has been traditionally used for confirmation of cure following gamma knife radiosurgery for AVMs. Our aim was to evaluate whether 4D arterial spin-labeling MRA and contrast-enhanced time-resolved MRA in combination can be an alternative to DSA for confirmation of AVM obliteration following gamma knife radiosurgery. MATERIALS AND METHODS In this prospective study, 30 patients undergoing DSA for confirmation of obliteration following gamma knife radiosurgery for AVMs (criterion standard) also underwent MRA, including arterial spin-labeling MRA and contrast-enhanced time-resolved MRA. One dataset was technically unsatisfactory, and the case was excluded. The DSA and MRA datasets of 29 patients were independently and blindly evaluated by 2 observers regarding the presence/absence of residual AVMs. RESULTS The mean time between gamma knife radiosurgery and follow-up DSA/MRA was 53 months (95% CI, 42-64 months; range, 22-168 months). MRA total scanning time was 9 minutes and 17 seconds. Residual AVMs were detected on DSA in 9 subjects (obliteration rate = 69%). All residual AVMs were detected on at least 1 MRA sequence. Arterial spin-labeling MRA and contrast-enhanced time-resolved MRA showed excellent specificity and positive predictive values individually (100%). However, their sensitivity and negative predictive values were suboptimal due to 1 false-negative with arterial spin-labeling MRA and 2 with contrast-enhanced time-resolved MRA (sensitivity = 88% and 77%, negative predictive values = 95% and 90%, respectively). Both sensitivity and negative predictive values increased to 100% if a composite assessment of both MRA sequences was performed. Diagnostic accuracy (receiver operating characteristic) and agreement (κ) are maximized using arterial spin-labeling MRA and contrast-enhanced time-resolved MRA in combination (area under receiver operating characteristic curve = 1, P < .001; κ = 1, P < .001, respectively). CONCLUSIONS Combining arterial spin-labeling MRA with contrast-enhanced time-resolved MRA holds promise as an alternative to DSA for confirmation of obliteration following gamma knife radiosurgery for brain AVMs, having provided 100% sensitivity and specificity in the study. Their combined use also enables reliable characterization of residual lesions.
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Affiliation(s)
- A Rojas-Villabona
- From The Gamma Knife Centre at Queen Square (A.R.-V.) .,Department of Neurosurgery (A.R.-V.), Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - F B Pizzini
- Department of Radiology (F.B.P., R.I.F.), Department of Diagnostic and Public Health, Verona University, Verona, Italy
| | - T Solbach
- The Lysholm Department of Neuroradiology (T.S., H.R.J.)
| | - M Sokolska
- Department of Medical Physics and Bioengineering (M.S.).,Neuroradiological Academic Unit (M.S., X.G., H.R.J.)
| | - G Ricciardi
- Neuroradiology Unit (G.R., C.L.), Department of Diagnostic and Pathology, University Hospital of Verona, Verona, Italy
| | - C Lemonis
- Neuroradiology Unit (G.R., C.L.), Department of Diagnostic and Pathology, University Hospital of Verona, Verona, Italy
| | - E DeVita
- School of Biomedical Engineering and Imaging Sciences (E.D.V.), King's College London, London, UK
| | - Y Suzuki
- Wellcome Centre for Integrative Neuroimaging (Y.S.), FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M J P van Osch
- C.J. Gorter Center for High Field MRI (M.J.P.v.O.), Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - R I Foroni
- Department of Radiology (F.B.P., R.I.F.), Department of Diagnostic and Public Health, Verona University, Verona, Italy
| | - M Longhi
- Department of Neuroscience (M.L., A.N.)
| | | | - D Atkinson
- Department of Brain Repair and Rehabilitation, Institute of Neurology and Centre for Medical Imaging (D.A.), University College London, London, UK
| | - N Kitchen
- Department of Neurosurgery (N.K.), National Hospital for Neurology and Neurosurgery, London, UK
| | | | - X Golay
- Neuroradiological Academic Unit (M.S., X.G., H.R.J.)
| | - H R Jäger
- The Lysholm Department of Neuroradiology (T.S., H.R.J.).,Neuroradiological Academic Unit (M.S., X.G., H.R.J.)
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16
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Mckinnon K, Kendall GS, Tann CJ, Dyet L, Sokolska M, Baruteau KP, Marlow N, Robertson NJ, Peebles D, Srinivasan L. Biometric assessments of the posterior fossa by fetal MRI: A systematic review. Prenat Diagn 2020; 41:258-270. [PMID: 33251640 DOI: 10.1002/pd.5874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/07/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Posterior fossa abnormalities (PFAs) are commonly identified within routine screening and are a frequent indication for fetal magnetic resonance imaging (MRI). Although biometric measurements of the posterior fossa (PF) are established on fetal ultrasound and MRI, qualitative visual assessments are predominantly used to differentiate PFAs. OBJECTIVES This systematic review aimed to assess 2-dimensional (2D) biometric measurements currently in use for assessing the PF on fetal MRI to delineate different PFAs. METHODS The protocol was registered (PROSPERO ID CRD42019142162). Eligible studies included T2-weighted MRI PF measurements in fetuses with and without PFAs, including measurements of the PF, or other brain areas relevant to PFAs. RESULTS 59 studies were included - 6859 fetuses had 62 2D PF and related measurements. These included linear, area and angular measurements, representing measures of PF size, cerebellum/vermis, brainstem, and supratentorial measurements. 11 measurements were used in 10 or more studies and at least 1200 fetuses. These dimensions were used to characterise normal for gestational age, diagnose a range of pathologies, and predict outcome. CONCLUSION A selection of validated 2D biometric measurements of the PF on fetal MRI may be useful for identification of PFA in different clinical settings. Consistent use of these measures, both clinically and for research, is recommended.
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Affiliation(s)
- Katie Mckinnon
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Giles S Kendall
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Cally J Tann
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Leigh Dyet
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Magdalena Sokolska
- Institute for Women's Health, University College London, London, UK.,Medical Physics Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kelly Pegoretti Baruteau
- Institute for Women's Health, University College London, London, UK.,Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil Marlow
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Nicola J Robertson
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
| | - Donald Peebles
- Institute for Women's Health, University College London, London, UK.,Obstetric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Latha Srinivasan
- Neonatal Department, University College London Hospitals NHS Foundation Trust, London, UK.,Institute for Women's Health, University College London, London, UK
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17
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Pang R, Avdic-Belltheus A, Meehan C, Martinello K, Mutshiya T, Yang Q, Sokolska M, Torrealdea F, Hristova M, Bainbridge A, Golay X, Juul SE, Robertson NJ. Melatonin and/or erythropoietin combined with hypothermia in a piglet model of perinatal asphyxia. Brain Commun 2020; 3:fcaa211. [PMID: 33604569 PMCID: PMC7876304 DOI: 10.1093/braincomms/fcaa211] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022] Open
Abstract
As therapeutic hypothermia is only partially protective for neonatal encephalopathy, safe and effective adjunct therapies are urgently needed. Melatonin and erythropoietin show promise as safe and effective neuroprotective therapies. We hypothesized that melatonin and erythropoietin individually augment 12-h hypothermia (double therapies) and hypothermia + melatonin + erythropoietin (triple therapy) leads to optimal brain protection. Following carotid artery occlusion and hypoxia, 49 male piglets (<48 h old) were randomized to: (i) hypothermia + vehicle (n = 12), (ii) hypothermia + melatonin (20 mg/kg over 2 h) (n = 12), (iii) hypothermia + erythropoietin (3000 U/kg bolus) (n = 13) or (iv) tripletherapy (n = 12). Melatonin, erythropoietin or vehicle were given at 1, 24 and 48 h after hypoxia–ischaemia. Hypoxia–ischaemia severity was similar across groups. Therapeutic levels were achieved 3 hours after hypoxia–ischaemia for melatonin (15–30 mg/l) and within 30 min of erythropoietin administration (maximum concentration 10 000 mU/ml). Compared to hypothermia + vehicle, we observed faster amplitude-integrated EEG recovery from 25 to 30 h with hypothermia + melatonin (P = 0.02) and hypothermia + erythropoietin (P = 0.033) and from 55 to 60 h with tripletherapy (P = 0.042). Magnetic resonance spectroscopy lactate/N-acetyl aspartate peak ratio was lower at 66 h in hypothermia + melatonin (P = 0.012) and tripletherapy (P = 0.032). With hypothermia + melatonin, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labelled-positive cells were reduced in sensorimotor cortex (P = 0.017) and oligodendrocyte transcription factor 2 labelled-positive counts increased in hippocampus (P = 0.014) and periventricular white matter (P = 0.039). There was no reduction in terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labelled-positive cells with hypothermia + erythropoietin, but increased oligodendrocyte transcription factor 2 labelled-positive cells in 5 of 8 brain regions (P < 0.05). Overall, melatonin and erythropoietin were safe and effective adjunct therapies to hypothermia. Hypothermia + melatonin double therapy led to faster amplitude-integrated EEG recovery, amelioration of lactate/N-acetyl aspartate rise and reduction in terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labelled-positive cells in the sensorimotor cortex. Hypothermia + erythropoietin doubletherapy was in association with EEG recovery and was most effective in promoting oligodendrocyte survival. Tripletherapy provided no added benefit over the double therapies in this 72-h study. Melatonin and erythropoietin influenced cell death and oligodendrocyte survival differently, reflecting distinct neuroprotective mechanisms which may become more visible with longer-term studies. Staggering the administration of therapies with early melatonin and later erythropoietin (after hypothermia) may provide better protection; each therapy has complementary actions which may be time critical during the neurotoxic cascade after hypoxia–ischaemia.
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Affiliation(s)
- Raymand Pang
- Department of Neonatology, Institute for Women's Health, University College London, London, UK
| | - Adnan Avdic-Belltheus
- Department of Neonatology, Institute for Women's Health, University College London, London, UK
| | - Christopher Meehan
- Department of Neonatology, Institute for Women's Health, University College London, London, UK
| | - Kathryn Martinello
- Department of Neonatology, Institute for Women's Health, University College London, London, UK
| | - Tatenda Mutshiya
- Department of Neonatology, Institute for Women's Health, University College London, London, UK
| | - Qin Yang
- Department of Neonatology, Institute for Women's Health, University College London, London, UK
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Francisco Torrealdea
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Mariya Hristova
- Department of Neonatology, Institute for Women's Health, University College London, London, UK
| | - Alan Bainbridge
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals, London, UK
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, Institute of Neurology, Queen's Square, University College London, London, UK
| | - Sandra E Juul
- Department of Pediatrics, University of Washington, Seattle, Washington, DC, USA
| | - Nicola J Robertson
- Department of Neonatology, Institute for Women's Health, University College London, London, UK
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18
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Di Napoli A, Cheng SF, Gregson J, Atkinson D, Markus JE, Richards T, Brown MM, Sokolska M, Jäger HR. Arterial Spin Labeling MRI in Carotid Stenosis: Arterial Transit Artifacts May Predict Symptoms. Radiology 2020; 297:652-660. [PMID: 33048034 DOI: 10.1148/radiol.2020200225] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BackgroundStenosis of the internal carotid artery has a higher risk for stroke. Many investigations have focused on structure and plaque composition as signs of plaque vulnerability, but few studies have analyzed hemodynamic changes in the brain as a risk factor.PurposeTo use 3-T MRI methods including contrast material-enhanced MR angiography, carotid plaque imaging, and arterial spin labeling (ASL) to identify imaging parameters that best help distinguish between asymptomatic and symptomatic participants with carotid stenosis.Materials and MethodsParticipants with carotid stenosis from two ongoing prospective studies who underwent ASL and carotid plaque imaging with use of 3-T MRI in the same setting from 2014 to 2018 were studied. Participants were assessed clinically for recent symptoms (transient ischemic attack or stroke) and divided equally into symptomatic and nonsymptomatic groups. Reviewers were blinded to the symptomatic status and MRI scans were analyzed for the degree of stenosis, plaque surface structure, presence of intraplaque hemorrhage (IPH), circle of Willis collaterals, and the presence and severity of arterial transit artifacts (ATAs) at ASL imaging. MRI findings were correlated with symptomatic status by using t tests and the Fisher exact test.ResultsA total of 44 participants (mean age, 71 years ± 10 [standard deviation]; 31 men) were evaluated. ATAs were seen only in participants with greater than 70% stenosis (16 of 28 patients; P < .001) and were associated with absence of anterior communicating artery (13 of 16 patients; P = .003). There was no association between history of symptoms and degree of stenosis (27 patients with ≥70% stenosis and 17 patients with <70%; P = .54), IPH (12 patients with IPH and 32 patients without IPH; P = .31), and plaque surface structure (17 patients with irregular or ulcerated plaque and 27 with smooth plaque; P = .54). Participants with ATAs (n = 16) were more likely to be symptomatic than were those without ATAs (n = 28) (P = .004). Symptomatic status also was associated with the severity of ATAs (P = .002).ConclusionArterial transit artifacts were the only factor associated with recent ischemic symptoms in participants with carotid stenosis. The degree of stenosis, plaque ulceration, and intraplaque hemorrhage were not associated with symptomatic status.© RSNA, 2020Online supplemental material is available for this article.See also the editorial by Zaharchuk in this issue.
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Affiliation(s)
- Alberto Di Napoli
- From the Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, K 23 Queen Square, Holborn, London WC1N 3BG, England (A.D.N., H.R.J.); NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy (A.D.N.); Division of Surgery and Interventional Science (S.F.C., T.R., H.R.J.), Centre of Medical Imaging (D.A., J.E.M.), Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (M.M.B.), and Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (H.R.J.), University College London, London, England; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, England (J.G.); Department of Vascular Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, Australia (T.R.); and Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, England (M.S.)
| | - Suk Fun Cheng
- From the Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, K 23 Queen Square, Holborn, London WC1N 3BG, England (A.D.N., H.R.J.); NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy (A.D.N.); Division of Surgery and Interventional Science (S.F.C., T.R., H.R.J.), Centre of Medical Imaging (D.A., J.E.M.), Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (M.M.B.), and Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (H.R.J.), University College London, London, England; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, England (J.G.); Department of Vascular Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, Australia (T.R.); and Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, England (M.S.)
| | - John Gregson
- From the Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, K 23 Queen Square, Holborn, London WC1N 3BG, England (A.D.N., H.R.J.); NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy (A.D.N.); Division of Surgery and Interventional Science (S.F.C., T.R., H.R.J.), Centre of Medical Imaging (D.A., J.E.M.), Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (M.M.B.), and Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (H.R.J.), University College London, London, England; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, England (J.G.); Department of Vascular Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, Australia (T.R.); and Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, England (M.S.)
| | - David Atkinson
- From the Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, K 23 Queen Square, Holborn, London WC1N 3BG, England (A.D.N., H.R.J.); NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy (A.D.N.); Division of Surgery and Interventional Science (S.F.C., T.R., H.R.J.), Centre of Medical Imaging (D.A., J.E.M.), Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (M.M.B.), and Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (H.R.J.), University College London, London, England; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, England (J.G.); Department of Vascular Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, Australia (T.R.); and Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, England (M.S.)
| | - Julia Emily Markus
- From the Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, K 23 Queen Square, Holborn, London WC1N 3BG, England (A.D.N., H.R.J.); NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy (A.D.N.); Division of Surgery and Interventional Science (S.F.C., T.R., H.R.J.), Centre of Medical Imaging (D.A., J.E.M.), Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (M.M.B.), and Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (H.R.J.), University College London, London, England; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, England (J.G.); Department of Vascular Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, Australia (T.R.); and Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, England (M.S.)
| | - Toby Richards
- From the Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, K 23 Queen Square, Holborn, London WC1N 3BG, England (A.D.N., H.R.J.); NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy (A.D.N.); Division of Surgery and Interventional Science (S.F.C., T.R., H.R.J.), Centre of Medical Imaging (D.A., J.E.M.), Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (M.M.B.), and Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (H.R.J.), University College London, London, England; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, England (J.G.); Department of Vascular Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, Australia (T.R.); and Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, England (M.S.)
| | - Martin M Brown
- From the Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, K 23 Queen Square, Holborn, London WC1N 3BG, England (A.D.N., H.R.J.); NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy (A.D.N.); Division of Surgery and Interventional Science (S.F.C., T.R., H.R.J.), Centre of Medical Imaging (D.A., J.E.M.), Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (M.M.B.), and Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (H.R.J.), University College London, London, England; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, England (J.G.); Department of Vascular Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, Australia (T.R.); and Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, England (M.S.)
| | - Magdalena Sokolska
- From the Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, K 23 Queen Square, Holborn, London WC1N 3BG, England (A.D.N., H.R.J.); NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy (A.D.N.); Division of Surgery and Interventional Science (S.F.C., T.R., H.R.J.), Centre of Medical Imaging (D.A., J.E.M.), Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (M.M.B.), and Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (H.R.J.), University College London, London, England; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, England (J.G.); Department of Vascular Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, Australia (T.R.); and Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, England (M.S.)
| | - Hans Rolf Jäger
- From the Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, K 23 Queen Square, Holborn, London WC1N 3BG, England (A.D.N., H.R.J.); NESMOS (Neurosciences, Mental Health and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University, Rome, Italy (A.D.N.); Division of Surgery and Interventional Science (S.F.C., T.R., H.R.J.), Centre of Medical Imaging (D.A., J.E.M.), Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (M.M.B.), and Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology (H.R.J.), University College London, London, England; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, England (J.G.); Department of Vascular Surgery, University of Western Australia, Fiona Stanley Hospital, Perth, Australia (T.R.); and Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, England (M.S.)
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19
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Aughwane R, Mufti N, Flouri D, Maksym K, Spencer R, Sokolska M, Kendall G, Atkinson D, Bainbridge A, Deprest J, Vercauteren T, Ourselin S, David AL, Melbourne A. Magnetic resonance imaging measurement of placental perfusion and oxygen saturation in early-onset fetal growth restriction. BJOG 2020; 128:337-345. [PMID: 32603546 PMCID: PMC7613436 DOI: 10.1111/1471-0528.16387] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Accepted: 06/19/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We hypothesised that a multi-compartment magnetic resonance imaging (MRI) technique that is sensitive to fetal blood oxygenation would identify changes in placental blood volume and fetal blood oxygenation in pregnancies complicated by early-onset fetal growth restriction (FGR). DESIGN Case-control study. SETTING London, UK. POPULATION Women with uncomplicated pregnancies (estimated fetal weight [EFW] >10th centile for gestational age [GA] and normal maternal and fetal Doppler ultrasound, n = 12) or early-onset FGR (EFW <3rd centile with or without abnormal Doppler ultrasound <32 weeks GA, n = 12) were studied. METHODS All women underwent MRI examination. Using a multi-compartment MRI technique, we quantified fetal and maternal blood volume and feto-placental blood oxygenation. MAIN OUTCOME MEASURES Disease severity was stratified according to Doppler pulsatility index and the relationship to the MRI parameters was investigated, including the influence of GA at scan. RESULTS The FGR group (mean GA 27+5 weeks, range 24+2 to 33+6 weeks) had a significantly lower EFW compared with the control group (mean GA 29+1 weeks; -705 g, 95% CI -353 to -1057 g). MRI-derived feto-placental oxygen saturation was higher in controls compared with FGR (75 ± 9.6% versus 56 ± 16.2%, P = 0.02, 95% CI 7.8-30.3%). Feto-placental oxygen saturation estimation correlated strongly with GA at scan in controls (r = -0.83). CONCLUSION Using a novel multimodal MRI protocol we demonstrated reduced feto-placental blood oxygen saturation in pregnancies complicated by early-onset FGR. The degree of abnormality correlated with disease severity defined by ultrasound Doppler findings. Gestational age-dependent changes in oxygen saturation were also present in normal pregnancies. TWEETABLE ABSTRACT MRI reveals differences in feto-placental oxygen saturation between normal and FGR pregnancy that is associated with disease severity.
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Affiliation(s)
- R Aughwane
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - N Mufti
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - D Flouri
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,School of Biomedical Engineering and Imaging, Kings College London, London, UK
| | - K Maksym
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Spencer
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,University of Leeds, Leeds, UK
| | - M Sokolska
- Medical Physics, University College Hospital, London, UK
| | - G Kendall
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - D Atkinson
- Centre for Medical Imaging, University College London, London, UK
| | - A Bainbridge
- Medical Physics, University College Hospital, London, UK
| | - J Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,School of Biomedical Engineering and Imaging, Kings College London, London, UK.,University Hospital KU Leuven, Leuven, Belgium
| | - T Vercauteren
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,School of Biomedical Engineering and Imaging, Kings College London, London, UK
| | - S Ourselin
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,School of Biomedical Engineering and Imaging, Kings College London, London, UK
| | - A L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,University Hospital KU Leuven, Leuven, Belgium.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - A Melbourne
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,School of Biomedical Engineering and Imaging, Kings College London, London, UK
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20
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Haddow LJ, Godi C, Sokolska M, Cardoso MJ, Oliver R, Winston A, Stöhr W, Clarke A, Chen F, Williams IG, Johnson M, Paton N, Arenas-Pinto A, Golay X, Jäger HR. Brain Perfusion, Regional Volumes, and Cognitive Function in Human Immunodeficiency Virus-positive Patients Treated With Protease Inhibitor Monotherapy. Clin Infect Dis 2020; 68:1031-1040. [PMID: 30084882 DOI: 10.1093/cid/ciy617] [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: 02/06/2018] [Accepted: 07/30/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Protease inhibitor monotherapy (PIM) for human immunodeficiency virus (HIV) may exert suboptimal viral control in the central nervous system. We determined whether cerebral blood flow (CBF) and regional brain volumes were associated with PIM, and whether specific cognitive domains were associated with imaging biomarkers. METHODS Cognitive assessments and brain magnetic resonance imaging were performed after the final visit of a randomized HIV-treatment strategy trial. Participants were virologically suppressed on triple therapy at trial entry and followed for 3-5 years. We studied 37 patients randomized to ongoing triple therapy and 39 randomized to PIM. Resting CBF and normalized volumes were calculated for brain regions of interest, and correlated with treatment strategy and neuropsychological performance. RESULTS Mean age was 48.1 years (standard deviation 8.6 years), 63 male (83%), and 64 white (84%). Participants had median 8.1 years (interquartile range 6.4, 10.8) of antiretroviral therapy experience and CD4+ counts of median 640 cells/mm3 (interquartile range 490, 780). We found no difference between treatment arms in CBF or regional volumes. Regardless of treatment arm, poorer fine motor performance correlated with lower CBF in the caudate nucleus (P = .01), thalamus (P = .04), frontal cortex (P = .01), occipital cortex (P = .004), and cingulate cortex (P = .02), and was associated with smaller supratentorial white matter volume (decrease of 0.16 in Z-score per -1% of intracranial volume, 95% confidence interval 0.02-0.29; P = .023). CONCLUSIONS PIM does not confer an additional risk of neurological injury compared with triple therapy. There were correlations between fine motor impairment, grey matter hypoperfusion, and white matter volume loss. CLINICAL TRIALS REGISTRATION ISRCTN-04857074.
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Affiliation(s)
- Lewis J Haddow
- Institute of Global Health, University College London, United Kingdom
| | - Claudia Godi
- Institute of Neurology, University College London, United Kingdom.,Department of Neuroradiology, Ospedale San Raffaele, Milan, Italy
| | - Magdalena Sokolska
- Institute of Neurology, University College London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, United Kingdom
| | - M Jorge Cardoso
- Centre for Medical Image Computing, University College London, United Kingdom
| | - Ruth Oliver
- Institute of Neurology, University College London, United Kingdom.,Department of Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Alan Winston
- Department of Medicine, Imperial College London, United Kingdom
| | - Wolfgang Stöhr
- The Medical Research Council Clinical Trials Unit at University College London, United Kingdom
| | - Amanda Clarke
- Elton John Centre, Brighton and Sussex University Hospital, United Kingdom
| | - Fabian Chen
- The Florey Sexual Health Clinic, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Ian G Williams
- Institute of Global Health, University College London, United Kingdom
| | - Margaret Johnson
- Ian Charleson Day Centre, Royal Free London NHS Foundation Trust, United Kingdom
| | - Nick Paton
- The Medical Research Council Clinical Trials Unit at University College London, United Kingdom.,Department of Medicine, National University of Singapore
| | - Alejandro Arenas-Pinto
- Institute of Global Health, University College London, United Kingdom.,The Medical Research Council Clinical Trials Unit at University College London, United Kingdom
| | - Xavier Golay
- Institute of Neurology, University College London, United Kingdom
| | - Hans Rolf Jäger
- Institute of Neurology, University College London, United Kingdom.,Centre of Medical Imaging, University College London Hospitals NHS Foundation Trust, United Kingdom
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21
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Flouri D, Owen D, Aughwane R, Mufti N, Maksym K, Sokolska M, Kendall G, Bainbridge A, Atkinson D, Vercauteren T, Ourselin S, David AL, Melbourne A. Improved fetal blood oxygenation and placental estimated measurements of diffusion-weighted MRI using data-driven Bayesian modeling. Magn Reson Med 2019; 83:2160-2172. [PMID: 31742785 PMCID: PMC7064949 DOI: 10.1002/mrm.28075] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Motion correction in placental DW-MRI is challenging due to maternal breathing motion, maternal movements, and rapid intensity changes. Parameter estimates are usually obtained using least-squares methods for voxel-wise fitting; however, they typically give noisy estimates due to low signal-to-noise ratio. We introduce a model-driven registration (MDR) technique which incorporates a placenta-specific signal model into the registration process, and we present a Bayesian approach for Diffusion-rElaxation Combined Imaging for Detailed placental Evaluation model to obtain individual and population trends in estimated parameters. METHODS MDR exploits the fact that a placenta signal model is available and thus we incorporate it into the registration to generate a series of target images. The proposed registration method is compared to a pre-existing method used for DCE-MRI data making use of principal components analysis. The Bayesian shrinkage prior (BSP) method has no user-defined parameters and therefore measures of parameter variation in a region of interest are determined by the data alone. The MDR method and the Bayesian approach were evaluated on 10 control 4D DW-MRI singleton placental data. RESULTS MDR method improves the alignment of placenta data compared to the pre-existing method. It also shows a further reduction of the residual error between the data and the fit. BSP approach showed higher precision leading to more clearly apparent spatial features in the parameter maps. Placental fetal oxygen saturation (FO2 ) showed a negative linear correlation with gestational age. CONCLUSIONS The proposed pipeline provides a robust framework for registering DW-MRI data and analyzing longitudinal changes of placental function.
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Affiliation(s)
- Dimitra Flouri
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - David Owen
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Rosalind Aughwane
- Institute for Women's Health, University College Hospital, London, United Kingdom
| | - Nada Mufti
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Institute for Women's Health, University College Hospital, London, United Kingdom
| | - Kasia Maksym
- Institute for Women's Health, University College Hospital, London, United Kingdom
| | | | - Giles Kendall
- Institute for Women's Health, University College Hospital, London, United Kingdom
| | - Alan Bainbridge
- Medical Physics, University College Hospital, London, United Kingdom
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Anna L David
- Institute for Women's Health, University College Hospital, London, United Kingdom.,University Hospital KU Leuven, Leuven, Belgium.,NIHR Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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22
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Phellan R, Lindner T, Helle M, Falcao AX, Yasuda CL, Sokolska M, Jager RH, Forkert ND. Segmentation-Based Blood Flow Parameter Refinement in Cerebrovascular Structures Using 4-D Arterial Spin Labeling MRA. IEEE Trans Biomed Eng 2019; 67:1936-1946. [PMID: 31689181 DOI: 10.1109/tbme.2019.2951082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Cerebrovascular diseases are one of the main global causes of death and disability in the adult population. The preferred imaging modality for the diagnostic routine is digital subtraction angiography, an invasive modality. Time-resolved three-dimensional arterial spin labeling magnetic resonance angiography (4D ASL MRA) is an alternative non-invasive modality, which captures morphological and blood flow data of the cerebrovascular system, with high spatial and temporal resolution. This work proposes advanced medical image processing methods that extract the anatomical and hemodynamic information contained in 4D ASL MRA datasets. METHODS A previously published segmentation method, which uses blood flow data to improve its accuracy, is extended to estimate blood flow parameters by fitting a mathematical model to the measured vascular signal. The estimated values are then refined using regression techniques within the cerebrovascular segmentation. The proposed method was evaluated using fifteen 4D ASL MRA phantoms, with ground-truth morphological and hemodynamic data, fifteen 4D ASL MRA datasets acquired from healthy volunteers, and two 4D ASL MRA datasets from patients with a stenosis. RESULTS The proposed method reached an average Dice similarity coefficient of 0.957 and 0.938 in the phantom and real dataset segmentation evaluations, respectively. The estimated blood flow parameter values are more similar to the ground-truth values after the refinement step, when using phantoms. A qualitative analysis showed that the refined blood flow estimation is more realistic compared to the raw hemodynamic parameters. CONCLUSION The proposed method can provide accurate segmentations and blood flow parameter estimations in the cerebrovascular system using 4D ASL MRA datasets. SIGNIFICANCE The information obtained with the proposed method can help clinicians and researchers to study the cerebrovascular system non-invasively.
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23
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Bale G, Mitra S, de Roever I, Sokolska M, Price D, Bainbridge A, Gunny R, Uria-Avellanal C, Kendall GS, Meek J, Robertson NJ, Tachtsidis I. Oxygen dependency of mitochondrial metabolism indicates outcome of newborn brain injury. J Cereb Blood Flow Metab 2019; 39:2035-2047. [PMID: 29775114 PMCID: PMC6775592 DOI: 10.1177/0271678x18777928] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is a need for a method of real-time assessment of brain metabolism during neonatal hypoxic-ischaemic encephalopathy (HIE). We have used broadband near-infrared spectroscopy (NIRS) to monitor cerebral oxygenation and metabolic changes in 50 neonates with HIE undergoing therapeutic hypothermia treatment. In 24 neonates, 54 episodes of spontaneous decreases in peripheral oxygen saturation (desaturations) were recorded between 6 and 81 h after birth. We observed differences in the cerebral metabolic responses to these episodes that were related to the predicted outcome of the injury, as determined by subsequent magnetic resonance spectroscopy derived lactate/N-acetyl-aspartate. We demonstrated that a strong relationship between cerebral metabolism (broadband NIRS-measured cytochrome-c-oxidase (CCO)) and cerebral oxygenation was associated with unfavourable outcome; this is likely to be due to a lower cerebral metabolic rate and mitochondrial dysfunction in severe encephalopathy. Specifically, a decrease in the brain tissue oxidation state of CCO greater than 0.06 µM per 1 µM brain haemoglobin oxygenation drop was able to predict the outcome with 64% sensitivity and 79% specificity (receiver operating characteristic area under the curve = 0.73). With further work on the implementation of this methodology, broadband NIRS has the potential to provide an early, cotside, non-invasive, clinically relevant metabolic marker of perinatal hypoxic-ischaemic injury.
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Affiliation(s)
- Gemma Bale
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Subhabrata Mitra
- Institute of Women's Health, University College London, London, UK
| | - Isabel de Roever
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - David Price
- Department of Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Alan Bainbridge
- Department of Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Roxana Gunny
- Paediatric Neuroradiology, Great Ormond Street Hospital for Children, London, UK
| | | | - Giles S Kendall
- Neonatal Unit, University College London Hospital, London, UK
| | - Judith Meek
- Institute of Women's Health, University College London, London, UK
| | | | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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24
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Biondetti E, Rojas-Villabona A, Sokolska M, Pizzini FB, Jäger HR, Thomas DL, Shmueli K. Investigating the oxygenation of brain arteriovenous malformations using quantitative susceptibility mapping. Neuroimage 2019; 199:440-453. [DOI: 10.1016/j.neuroimage.2019.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/23/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023] Open
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25
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Mitra S, Kendall GS, Bainbridge A, Sokolska M, Dinan M, Uria-Avellanal C, Price D, Mckinnon K, Gunny R, Huertas-Ceballos A, Golay X, Robertson NJ. Proton magnetic resonance spectroscopy lactate/N-acetylaspartate within 2 weeks of birth accurately predicts 2-year motor, cognitive and language outcomes in neonatal encephalopathy after therapeutic hypothermia. Arch Dis Child Fetal Neonatal Ed 2019; 104:F424-F432. [PMID: 30322975 DOI: 10.1136/archdischild-2018-315478] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/13/2018] [Accepted: 09/07/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Brain proton (1H) magnetic resonance spectroscopy (MRS) lactate/N-acetylaspartate (Lac/NAA) peak area ratio is used for prognostication in neonatal encephalopathy (NE). At 3 Tesla in NE babies, the objectives were to assess: (1) sensitivity and specificity of basal ganglia and thalamus (BGT) 1H MRS Lac/NAA for the prediction of Bayley III outcomes at 2 years using optimised metabolite fitting (Tarquin) with threonine and total NAA; (2) prediction of motor outcome with diffusion-weighted MRI; (3) BGT Lac/NAA correlation with the National Institute of Child Health and Human Development (NICHD) MRI score. SUBJECTS AND METHODS 55 (16 inborn, 39 outborn) infants at 39w+5 d (35w+5d-42w+0d) with NE admitted between February 2012 and August 2014 to University College London Hospitals for therapeutic hypothermia underwent MRI and 1H MRS at 3T on day 2-14 (median day 5). MRIs were scored. Bayley III was assessed at 24 (22-26) months. RESULTS 16 babies died (1 inborn, 15 outborn); 20, 19 and 21 babies had poor motor, cognitive and language outcomes. Using a threshold of 0.39, sensitivity and specificity of BGT Lac/NAA for 2-year motor outcome was 100% and 97%, cognition 90% and 97% and language 81% and 97%, respectively. Sensitivity and specificity for motor outcome of mean diffusivity (threshold 0.001 mm2/s) up to day 9 was 72% and 100% and fractional anisotropy (threshold 0.198) was 39% and 94%, respectively. Lac/NAA correlated with BGT injury on NICHD scores (2A, 2B, 3). CONCLUSION BGT Lac/NAA on 1H MRS at 3T within 14 days accurately predicts 2-year motor, cognitive and language outcome and may be a marker directing decisions for therapies after cooling.
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Affiliation(s)
- Subhabrata Mitra
- Institute for Women's Health, University College London, London, UK
| | - Giles S Kendall
- Women and Children, University College London NHS Foundation Trust, London, UK
| | - Alan Bainbridge
- Medical Physics and Engineering, University College London NHS Foundation Trust, London, UK
| | - Magdalena Sokolska
- Medical Physics and Engineering, University College London NHS Foundation Trust, London, UK
| | - Mary Dinan
- Women and Children, University College London NHS Foundation Trust, London, UK
| | | | - David Price
- Medical Physics and Engineering, University College London NHS Foundation Trust, London, UK
| | - Katie Mckinnon
- Women and Children, University College London NHS Foundation Trust, London, UK
| | - Roxana Gunny
- Women and Children, University College London NHS Foundation Trust, London, UK
| | | | - Xavier Golay
- Institute of Neurology, Queen Square, University College London, London, UK
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK.,Division of Neonatology, Sidra Medicine, Doha, Qatar
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26
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Johnston EW, Latifoltojar A, Sidhu HS, Ramachandran N, Sokolska M, Bainbridge A, Moore C, Ahmed HU, Punwani S. Multiparametric whole-body 3.0-T MRI in newly diagnosed intermediate- and high-risk prostate cancer: diagnostic accuracy and interobserver agreement for nodal and metastatic staging. Eur Radiol 2019; 29:3159-3169. [PMID: 30519933 PMCID: PMC6510859 DOI: 10.1007/s00330-018-5813-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 04/12/2018] [Revised: 08/24/2018] [Accepted: 09/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy and interobserver concordance of whole-body (WB)-MRI, vs. 99mTc bone scintigraphy (BS) and 18fluoro-ethyl-choline (18F-choline) PET/CT for the primary staging of intermediate/high-risk prostate cancer. METHODS An institutional review board approved prospective cohort study carried out between July 2012 and November 2015, whereby 56 men prospectively underwent 3.0-T multiparametric (mp)-WB-MRI in addition to BS (all patients) ± 18F-choline PET/CT (33 patients). MRI comprised pre- and post-contrast modified Dixon (mDixon), T2-weighted (T2W) imaging, and diffusion-weighted imaging (DWI). Patients underwent follow-up mp-WB-MRI at 1 year to derive the reference standard. WB-MRIs were reviewed by two radiologists applying a 6-point scale and a locked sequential read (LSR) paradigm for the suspicion of nodal (N) and metastatic disease (M1a and M1b). RESULTS The mean sensitivity/specificity of WB-MRI for N1 disease was 1.00/0.96 respectively, compared with 1.00/0.82 for 18F-choline PET/CT. The mean sensitivity and specificity of WB-MRI, 18F-choline PET/CT, and BS were 0.90/0.88, 0.80/0.92, and 0.60/1.00 for M1b disease. ROC-AUC did not show statistically significant improvement for each component of the LSR; mean ROC-AUC 0.92, 0.94, and 0.93 (p < 0.05) for mDixon + DWI, + T2WI, and + contrast respectively. WB-MRI had an interobserver concordance (κ) of 0.79, 0.68, and 0.58 for N1, M1a, and M1b diseases respectively. CONCLUSIONS WB-MRI provides high levels of diagnostic accuracy for both nodal and metastatic bone disease, with higher levels of sensitivity than BS for metastatic disease, and similar performance to 18F-choline PET/CT. T2 and post-contrast mDixon had no significant additive value above a protocol comprising mDixon and DWI alone. KEY POINTS • A whole-body MRI protocol comprising unenhanced mDixon and diffusion-weighted imaging provides high levels of diagnostic accuracy for the primary staging of intermediate- and high-risk prostate cancer. • The diagnostic accuracy of whole-body MRI is much higher than that of bone scintigraphy, as currently recommended for clinical use. • Staging using WB-MRI, rather than bone scintigraphy, could result in better patient stratification and treatment delivery than is currently provided to patients worldwide.
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Affiliation(s)
- Edward William Johnston
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43 - 45 Foley Street, London, W1W 7TS, UK
| | - Arash Latifoltojar
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43 - 45 Foley Street, London, W1W 7TS, UK
| | - Harbir Singh Sidhu
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43 - 45 Foley Street, London, W1W 7TS, UK
| | - Navin Ramachandran
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43 - 45 Foley Street, London, W1W 7TS, UK
| | - Magdalena Sokolska
- Medical Physics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Alan Bainbridge
- Medical Physics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Caroline Moore
- Department of Urology, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Hashim Uddin Ahmed
- Department of Urology, Imperial College London, Fulham Palace Road, Hammersmith, London, W6 8RF, UK
| | - Shonit Punwani
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43 - 45 Foley Street, London, W1W 7TS, UK.
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27
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Haddow LJ, Sudre CH, Sokolska M, Gilson RC, Williams IG, Golay X, Ourselin S, Winston A, Sabin CA, Cardoso MJ, Jäger HR, Boffito M, Mallon P, Post F, Sabin C, Sachikonye M, Winston A, Anderson J, Asboe D, Boffito M, Garvey L, Mallon P, Post F, Pozniak A, Sabin C, Sachikonye M, Vera J, Williams I, Winston A, Post F, Campbell L, Yurdakul S, Okumu S, Pollard L, Williams I, Otiko D, Phillips L, Laverick R, Beynon M, Salz AL, Fisher M, Clarke A, Vera J, Bexley A, Richardson C, Mallon P, Macken A, Ghavani-Kia B, Maher J, Byrne M, Flaherty A, Babu S, Anderson J, Mguni S, Clark R, Nevin-Dolan R, Pelluri S, Johnson M, Ngwu N, Hemat N, Jones M, Carroll A, Whitehouse A, Burgess L, Babalis D, Winston A, Garvey L, Underwood J, Stott M, McDonald L, Boffito M, Asboe D, Pozniak A, Higgs C, Seah E, Fletcher S, Anthonipillai M, Moyes A, Deats K, Syed I, Matthews C, Fernando P, Sabin C, De Francesco D, Bagkeris E. Magnetic Resonance Imaging of Cerebral Small Vessel Disease in Men Living with HIV and HIV-Negative Men Aged 50 and Above. AIDS Res Hum Retroviruses 2019; 35:453-460. [PMID: 30667282 DOI: 10.1089/aid.2018.0249] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We assessed whether HIV status was associated with white matter hyperintensities (WMH), a neuroimaging correlate of cerebral small vessel disease (CSVD), in men aged ≥50 years. A cross-sectional substudy was nested within a larger cohort study. Virologically suppressed men living with HIV (MLWH) and demographically matched HIV-negative men aged ≥50 underwent magnetic resonance imaging (MRI) at 3 Tesla. Sequences included volumetric three-dimensional (3D) T1-weighted, fluid-attenuated inversion recovery and pseudocontinuous arterial spin labeling. Regional segmentation by automated image processing algorithms was used to extract WMH volume (WMHV) and resting cerebral blood flow (CBF). The association between HIV status and WMHV as a proportion of intracranial volume (ICV; log-transformed) was estimated using a multivariable linear regression model. Thirty-eight MLWH [median age 59 years (interquartile range, IQR 55-64)] and 37 HIV-negative [median 58 years (54-63)] men were analyzed. MLWH had median CD4+ count 570 (470-700) cells/μL and a median time since diagnosis of 20 (14-24) years. Framingham 10-year risk of cardiovascular disease was 6.5% in MLWH and 7.4% in controls. Two (5%) MLWH reported a history of stroke or transient ischemic attack and five (13%) reported coronary heart disease compared with none of the controls. The total WMHV in MLWH was 1,696 μL (IQR 1,229-3,268 μL) or 0.10% of ICV compared with 1,627 μL (IQR 1,032-3,077 μL), also 0.10% of ICV in the HIV-negative group (p = .43). In the multivariable model, WMHV/ICV was not associated with HIV status (p = .86). There was an age-dependent decline in cortical CBF [-3.9 mL/100 mL/min per decade of life (95% confidence interval 1.1-6.7 mL)] but no association between CBF and HIV status (p > .2 in all brain regions analyzed). In conclusion, we found no quantitative MRI evidence of an increased burden of CSVD in MLWH aged 50 years and older.
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Affiliation(s)
- Lewis J. Haddow
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, United Kingdom
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Carole H. Sudre
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Richard C. Gilson
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, United Kingdom
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Ian G. Williams
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, United Kingdom
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Xavier Golay
- Research Department of Brain Repair and Rehabilitation, University College London, London, United Kingdom
| | - Sebastien Ourselin
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Alan Winston
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Caroline A. Sabin
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, United Kingdom
| | - M. Jorge Cardoso
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - H. Rolf Jäger
- Research Department of Brain Repair and Rehabilitation, University College London, London, United Kingdom
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Smith LA, Melbourne A, Owen D, Cardoso MJ, Sudre CH, Tillin T, Sokolska M, Atkinson D, Chaturvedi N, Ourselin S, Hughes AD, Barkhof F, Jäger HR. Cortical cerebral blood flow in ageing: effects of haematocrit, sex, ethnicity and diabetes. Eur Radiol 2019; 29:5549-5558. [PMID: 30887200 PMCID: PMC6719435 DOI: 10.1007/s00330-019-06096-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/24/2018] [Accepted: 02/11/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Cerebral blood flow (CBF) estimates from arterial spin labelling (ASL) show unexplained variability in older populations. We studied the impact of variation of haematocrit (Hct) on CBF estimates in a tri-ethnic elderly population. MATERIALS AND METHODS Approval for the study was obtained from the Fulham Research Ethics Committee and participants gave written informed consent. Pseudo-continuous arterial spin labelling was performed on 493 subjects (age 55-90) from a tri-ethnic community-based cohort recruited in London. CBF was estimated using a simplified Buxton equation, with and without correction for Hct measured from blood samples. Differences in perfusion were compared, stratified by sex, ethnicity and diabetes. Results of Student's t tests were reported with effect size. RESULTS Hct adjustment decreased CBF estimates in all categories except white European men. The decrease for women was 2.7 (3.0, 2.4) mL/100 g/min) (mean (95% confidence interval (CI)), p < 0.001 d = 0.38. The effect size differed by ethnicity with estimated mean perfusion in South Asian and African Caribbean women found to be lower by 3.0 (3.6, 2.5) mL/100 g/min, p < 0.001 d = 0.56 and 3.1 (3.6, 2.5) mL/100 g/min), p < 0.001 d = 0.48, respectively. Estimates of perfusion in subjects with diabetes decreased by 1.8 (2.3, 1.4) mL/100 g/min, p < 0.001 d = 0.23) following Hct correction. Correction for individual Hct altered sample frequency distributions of CBF values, especially in women of non-European ethnicity. CONCLUSION ASL-derived CBF values in women, non-European ethnicities and individuals with diabetes are overestimated if calculations are not appropriately adjusted for individual Hct. KEY POINTS • CBF quantification from ASL using a fixed Hct of 43.5%, as recommended in the ISMRM white paper, may lead to erroneous CBF estimations particularly in non-European and female subjects. • Individually measured Hct values improve the accuracy of CBF estimation and, if these are not available, an adjusted value according to gender, ethnicity or diabetes status should be considered. • Hct-corrected ASL could be potentially important for CBF threshold decision making in the fields of neurodegenerative disease and neuro-oncology.
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Affiliation(s)
- Lorna A Smith
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, University College London, WC1E 6HX, London, UK. .,Centre for Medical Imaging, Division of Medicine, University College London, 2nd Floor, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, NW1 2BU, UK
| | - David Owen
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, NW1 2BU, UK
| | - M Jorge Cardoso
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.,Dementia Research Centre, UCL Institute of Neurology, London, Wc1N 3BG, UK
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, NW1 2BU, UK.,Dementia Research Centre, UCL Institute of Neurology, London, Wc1N 3BG, UK
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, University College London, WC1E 6HX, London, UK
| | - Magdalena Sokolska
- Institute of Healthcare Engineering, University College London, London, UK
| | - David Atkinson
- Centre for Medical Imaging, Division of Medicine, University College London, 2nd Floor, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, University College London, WC1E 6HX, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, University College London, WC1E 6HX, London, UK
| | - Frederik Barkhof
- Department of Medical Physics and Biomedical Engineering, University College London, London, NW1 2BU, UK.,Dementia Research Centre, UCL Institute of Neurology, London, Wc1N 3BG, UK.,Department of Radiology & Nuclear Medicine, VU University Medical Centre, Amsterdam, Netherlands
| | - H R Jäger
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, WC1N 3BG, UK.,Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London, London, WCN1 3BG, UK
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29
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Sokolska M, Bainbridge A, Rojas-Villabona A, Golay X, Thomas DL. Effect of labelling plane angulation and position on labelling efficiency and cerebral blood flow quantification in pseudo-continuous arterial spin labelling. Magn Reson Imaging 2019; 59:61-67. [PMID: 30802487 DOI: 10.1016/j.mri.2019.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/02/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
Pseudo-continuous arterial spin labelling (pCASL) is the MRI method of choice for non-invasive perfusion measurement in research and clinical practice. Knowledge of the labelling efficiency, α, is essential for accurate quantification of cerebral blood flow (CBF). Typically, a theoretical α value is used, based on an idealistic model and an assumption of spins flowing perpendicularly to the labelling plane. The aim of this work was to investigate the effect of violating this assumption, and to characterize the influence of labelling plane angulation with respect to the vessel direction on labelling efficiency and measured CBF. The effect of labelling plane angulation on labelling efficiency was demonstrated using a numerical simulation of spins at different velocities. Acquisitions from healthy volunteers were used to test the effect of a range of angulation offsets. Additional sub-optimal positions of the labelling plane with respect to the vertebral arteries, at locations where the direction of flow changes significantly from the head-foot direction, were also considered. No significant change in the measured CBF was seen when the labelling plane was angled up to 60° to the labelled vessel or when it was placed in sub-optimal positions. This study shows that in adult subjects, the efficiency of pCASL is robust to the angulation and positioning of the labelling plane beyond the range of potential operator error.
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Affiliation(s)
- Magdalena Sokolska
- Medical Physics and Biomedical Engineering, UCLH Foundation Trust, London, UK.
| | - Alan Bainbridge
- Medical Physics and Biomedical Engineering, UCLH Foundation Trust, London, UK
| | - Alvaro Rojas-Villabona
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, UK
| | - Xavier Golay
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, UK
| | - David L Thomas
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, 8-11 Queen Square, London, UK; Leonard Wolfson Experimental Neurology Centre, UCL Queen Square Institute of Neurology, Queen Square, London, UK
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30
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Mitra S, Bale G, Highton D, Gunny R, Uria-Avellanal C, Bainbridge A, Sokolska M, Price D, Huertas-Ceballos A, Kendall GS, Meek J, Tachtsidis I, Robertson NJ. Pressure passivity of cerebral mitochondrial metabolism is associated with poor outcome following perinatal hypoxic ischemic brain injury. J Cereb Blood Flow Metab 2019; 39:118-130. [PMID: 28949271 PMCID: PMC6311664 DOI: 10.1177/0271678x17733639] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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] [Indexed: 11/16/2022]
Abstract
Hypoxic ischemic encephalopathy (HIE) leads to significant morbidity and mortality. Impaired autoregulation after hypoxia-ischaemia has been suggested to contribute further to injury. Thalamic lactate/N-Acetylasperate (Lac/NAA) peak area ratio of > 0.3 on proton (1H) magnetic resonance spectroscopy (MRS) is associated with poor neurodevelopment outcome following HIE. Cytochrome-c-oxidase (CCO) plays a central role in mitochondrial oxidative metabolism and ATP synthesis. Using a novel broadband NIRS system, we investigated the impact of pressure passivity of cerebral metabolism (CCO), oxygenation (haemoglobin difference (HbD)) and cerebral blood volume (total haemoglobin (HbT)) in 23 term infants following HIE during therapeutic hypothermia (HT). Sixty-minute epochs of data from each infant were studied using wavelet analysis at a mean age of 48 h. Wavelet semblance (a measure of phase difference) was calculated to compare reactivity between mean arterial blood pressure (MABP) with oxCCO, HbD and HbT. OxCCO-MABP semblance correlated with thalamic Lac/NAA ( r = 0.48, p = 0.02). OxCCO-MABP semblance also differed between groups of infants with mild to moderate and severe injury measured using brain MRI score ( p = 0.04), thalamic Lac/NAA ( p = 0.04) and neurodevelopmental outcome at one year ( p = 0.04). Pressure passive changes in cerebral metabolism were associated with injury severity indicated by thalamic Lac/NAA, MRI scores and neurodevelopmental assessment at one year of age.
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Affiliation(s)
- Subhabrata Mitra
- 1 Institute for Women's Health, University College London, London, UK
| | - Gemma Bale
- 2 Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - David Highton
- 3 Neurocritical Care, National Hospital for Neurology & Neurosurgery, University College London, London, UK
| | - Roxanna Gunny
- 4 Paediatric Neuroradiology, Great Ormond Street Hospital for Children, London, UK
| | | | - Alan Bainbridge
- 5 Department of Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - Magdalena Sokolska
- 5 Department of Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | - David Price
- 5 Department of Medical Physics and Biomedical Engineering, University College London Hospital, London, UK
| | | | - Giles S Kendall
- 6 Neonatal Unit, University College London Hospital, London, UK
| | - Judith Meek
- 1 Institute for Women's Health, University College London, London, UK
| | - Ilias Tachtsidis
- 2 Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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31
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Robertson NJ, Martinello K, Lingam I, Avdic-Belltheus A, Meehan C, Alonso-Alconada D, Ragab S, Bainbridge A, Sokolska M, Tachrount M, Middleton B, Price D, Hristova M, Golay X, Soliani Raschini A, Aquino G, Pelizzi N, Facchinetti F. Melatonin as an adjunct to therapeutic hypothermia in a piglet model of neonatal encephalopathy: A translational study. Neurobiol Dis 2018; 121:240-251. [PMID: 30300675 DOI: 10.1016/j.nbd.2018.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/25/2018] [Accepted: 10/04/2018] [Indexed: 02/07/2023] Open
Abstract
Therapeutic hypothermia is only partially protective for neonatal encephalopathy; there is an urgent need to develop treatments that augment cooling. Our objective was to assess safety, efficacy and pharmacokinetics of 5 and 15 mg/kg/24 h melatonin (proprietary formulation) administered at 2 h and 26 h after hypoxia-ischemia (HI) with cooling in a piglet model. Following moderate cerebral HI, 30 piglets were eligible and randomized to: i) Hypothermia (33.5 °C, 2-26 h) and vehicle (HT + V;n = 13); b) HT and 5 mg/kg melatonin over 6 h at 2 h and 26 h after HI (HT + Mel-5;n = 4); c) HT and 15 mg/kg melatonin over 6 h at 2 h and 26 h after HI (HT + Mel-15;n = 13). Intensive care was maintained for 48 h; brain MRS was acquired and cell death (TUNEL) evaluated at 48 h. Comparing HT + V with HT + Mel-5 and HT + Mel-15, there was no difference in blood pressure or inotropic support needed, brain Lactate/N Acetylaspartate at 24 h and 48 h was similar, ATP/phosphate pool was higher for HT + Mel-15 versus HT + V at 24 h (p = 0.038) but not 48 h. A localized reduction in TUNEL positive cell death was observed in the sensorimotor cortex in the 15 mg/kg melatonin group (HT + Mel-15 versus HT + V; p < 0.003) but not in the 5 mg/kg melatonin group (HT + Mel-5 versus HT + V; p = 0.808). Putative therapeutic melatonin levels were reached 8 h after HI (104 increase from baseline; ~15-30 mg/l). Mean ± SD peak plasma melatonin levels after the first infusion were 0.0014 ± 0.0012 mg/l in the HT + V group, 3.97 ± 1.53 mg/l in the HT + Mel-5 group and 16.8 ± 8.3 mg/l in the HT + Mel-15 group. Protection was dose dependent; 15 mg/kg melatonin started 2 h after HI, given over 6 h, was well tolerated and augmented hypothermic protection in sensorimotor cortex. Earlier attainment of therapeutic plasma melatonin levels may optimize protection by targeting initial events of reperfusion injury. The time window for intervention with melatonin, as adjunct therapy with cooling, is likely to be narrow and should be considered in designing future clinical studies.
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Affiliation(s)
- Nicola J Robertson
- University College London, London WC1E 6HX, UK; Division of Neonatology, Department of Pediatrics, Sidra Medicine, Doha, Qatar.
| | | | | | | | | | | | - Sara Ragab
- University College London, London WC1E 6HX, UK
| | | | | | - Mohamed Tachrount
- Chronobiology Group, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Benita Middleton
- Chronobiology Group, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - David Price
- University College London Hospitals NHS Trust, UK
| | | | - Xavier Golay
- Institute of Neurology, Queen Square, University College London, London, UK
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32
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Melbourne A, Aughwane R, Sokolska M, Owen D, Kendall G, Flouri D, Bainbridge A, Atkinson D, Deprest J, Vercauteren T, David A, Ourselin S. Separating fetal and maternal placenta circulations using multiparametric MRI. Magn Reson Med 2018; 81:350-361. [PMID: 30239036 PMCID: PMC6282748 DOI: 10.1002/mrm.27406] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE The placenta is a vital organ for the exchange of oxygen, nutrients, and waste products between fetus and mother. The placenta may suffer from several pathologies, which affect this fetal-maternal exchange, thus the flow properties of the placenta are of interest in determining the course of pregnancy. In this work, we propose a new multiparametric model for placental tissue signal in MRI. METHODS We describe a method that separates fetal and maternal flow characteristics of the placenta using a 3-compartment model comprising fast and slowly circulating fluid pools, and a tissue pool is fitted to overlapping multiecho T2 relaxometry and diffusion MRI with low b-values. We implemented the combined model and acquisition on a standard 1.5 Tesla clinical system with acquisition taking less than 20 minutes. RESULTS We apply this combined acquisition in 6 control singleton placentas. Mean myometrial T2 relaxation time was 123.63 (±6.71) ms. Mean T2 relaxation time of maternal blood was 202.17 (±92.98) ms. In the placenta, mean T2 relaxation time of the fetal blood component was 144.89 (±54.42) ms. Mean ratio of maternal to fetal blood volume was 1.16 (±0.6), and mean fetal blood saturation was 72.93 (±20.11)% across all 6 cases. CONCLUSION The novel acquisition in this work allows the measurement of histologically relevant physical parameters, such as the relative proportions of vascular spaces. In the placenta, this may help us to better understand the physiological properties of the tissue in disease.
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Affiliation(s)
- Andrew Melbourne
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging, Kings College London, London, United Kingdom
| | - Rosalind Aughwane
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,Institute for Women's Health, University College Hospital,London, London, United Kingdom
| | | | - David Owen
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging, Kings College London, London, United Kingdom
| | - Giles Kendall
- Institute for Women's Health, University College Hospital,London, London, United Kingdom
| | - Dimitra Flouri
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging, Kings College London, London, United Kingdom
| | - Alan Bainbridge
- Medical Physics, University College Hospital, London, United Kingdom
| | - David Atkinson
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Jan Deprest
- Institute for Women's Health, University College Hospital,London, London, United Kingdom.,University Hospital KU Leuven, Leuven, Belgium
| | - Tom Vercauteren
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging, Kings College London, London, United Kingdom
| | - Anna David
- Institute for Women's Health, University College Hospital,London, London, United Kingdom.,University Hospital KU Leuven, Leuven, Belgium.,NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Sebastien Ourselin
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging, Kings College London, London, United Kingdom
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Leeuwis AE, Smith LA, Melbourne A, Hughes AD, Richards M, Prins ND, Sokolska M, Atkinson D, Tillin T, Jäger HR, Chaturvedi N, van der Flier WM, Barkhof F. Cerebral Blood Flow and Cognitive Functioning in a Community-Based, Multi-Ethnic Cohort: The SABRE Study. Front Aging Neurosci 2018; 10:279. [PMID: 30279656 PMCID: PMC6154257 DOI: 10.3389/fnagi.2018.00279] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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: 04/18/2018] [Accepted: 08/28/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Lower cerebral blood flow (CBF) is associated with cardiovascular disease and vascular risk factors, and is increasingly acknowledged as an important contributor to cognitive decline and dementia. In this cross-sectional study, we examined the association between CBF and cognitive functioning in a community-based, multi-ethnic cohort. Methods: From the SABRE (Southall and Brent Revisited) study, we included 214 European, 151 South Asian and 87 African Caribbean participants (71 ± 5 years; 39%F). We used 3T pseudo-continuous arterial spin labeling to estimate whole-brain, hematocrit corrected CBF. We measured global cognition and three cognitive domains (memory, executive functioning/attention and language) with a neuropsychological test battery. Associations were investigated using linear regression analyses, adjusted for demographic variables, vascular risk factors and MRI measures. Results: Across groups, we found an association between higher CBF and better performance on executive functioning/attention (standardized ß [stß] = 0.11, p < 0.05). Stratification for ethnicity showed associations between higher CBF and better performance on memory and executive functioning/attention in the white European group (stß = 0.14; p < 0.05 and stß = 0.18; p < 0.01 respectively), associations were weaker in the South Asian and African Caribbean groups. Conclusions: In a multi-ethnic community-based cohort we showed modest associations between CBF and cognitive functioning. In particular, we found an association between higher CBF and better performance on executive functioning/attention and memory in the white European group. The observations are consistent with the proposed role of cerebral hemodynamics in cognitive decline.
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Affiliation(s)
- Anna E Leeuwis
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam Amsterdam UMC, Amsterdam, Netherlands
| | - Lorna A Smith
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science University College London, London, United Kingdom
| | - Andrew Melbourne
- Translational Imaging Group, Department of Medical Physics and Biomedical Engineering University College London, London, United Kingdom
| | - Alun D Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science University College London, London, United Kingdom.,MRC Unit for Lifelong Health and Ageing University College London, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing University College London, London, United Kingdom
| | - Niels D Prins
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam Amsterdam UMC, Amsterdam, Netherlands
| | - Magdalena Sokolska
- Department of Medical Physics and Biomedical Engineering University College London, London, United Kingdom
| | - David Atkinson
- Centre for Medical Imaging University College London, London, United Kingdom
| | - Therese Tillin
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science University College London, London, United Kingdom
| | - Hans R Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation UCL Institute of Neurology, London, United Kingdom
| | - Nish Chaturvedi
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science University College London, London, United Kingdom.,MRC Unit for Lifelong Health and Ageing University College London, London, United Kingdom
| | - Wiesje M van der Flier
- Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam Amsterdam UMC, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam Amsterdam UMC, Amsterdam, Netherlands
| | - Frederik Barkhof
- Institutes of Neurology and Healthcare Engineering University College London, London, United Kingdom.,Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam Amsterdam UMC, Amsterdam, Netherlands
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Latifoltojar A, Hall-Craggs M, Bainbridge A, Rabin N, Popat R, Rismani A, D'Sa S, Dikaios N, Sokolska M, Antonelli M, Ourselin S, Yong K, Taylor SA, Halligan S, Punwani S. Whole-body MRI quantitative biomarkers are associated significantly with treatment response in patients with newly diagnosed symptomatic multiple myeloma following bortezomib induction. Eur Radiol 2017; 27:5325-5336. [PMID: 28656463 PMCID: PMC5674123 DOI: 10.1007/s00330-017-4907-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 11/07/2016] [Revised: 03/13/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate whole-body MRI (WB-MRI) parameters significantly associated with treatment response in multiple myeloma (MM). METHODS Twenty-one MM patients underwent WB-MRI at diagnosis and after two cycles of chemotherapy. Scans acquired at 3.0 T included T2, diffusion-weighted-imaging (DWI) and mDixon pre- and post-contrast. Twenty focal lesions (FLs) matched on DWI and post-contrast mDixon were selected for each time point. Estimated tumour volume (eTV), apparent diffusion coefficient (ADC), enhancement ratio (ER) and signal fat fraction (sFF) were derived. Clinical treatment response to chemotherapy was assessed using conventional criteria. Significance of temporal parameter change was assessed by the paired t test and receiver operating characteristics/area under the curve (AUC) analysis was performed. Parameter repeatability was assessed by interclass correlation (ICC) and Bland-Altman analysis of 10 healthy volunteers scanned at two time points. RESULTS Fifteen of 21 patients responded to treatment. Of 254 FLs analysed, sFF (p < 0.0001) and ADC (p = 0.001) significantly increased in responders but not non-responders. eTV significantly decreased in 19/21 cases. Focal lesion sFF was the best discriminator of treatment response (AUC 1.0). Bone sFF repeatability was excellent (ICC 0.98) and better than bone ADC (ICC 0.47). CONCLUSION WB-MRI derived focal lesion sFF shows promise as an imaging biomarker of treatment response in newly diagnosed MM. KEY POINTS • Bone signal fat fraction using mDixon is a robust quantifiable parameter • Fat fraction and ADC significantly increase in myeloma lesions responding to treatment • Bone lesion fat fraction is the best discriminator of myeloma treatment response.
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Affiliation(s)
- Arash Latifoltojar
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
| | - Margaret Hall-Craggs
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Alan Bainbridge
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Neil Rabin
- Department of Haematology, University College London Hospital, London, UK
| | - Rakesh Popat
- Department of Haematology, University College London Hospital, London, UK
| | - Ali Rismani
- Department of Haematology, University College London Hospital, London, UK
| | - Shirley D'Sa
- Department of Haematology, University College London Hospital, London, UK
| | - Nikolaos Dikaios
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
| | - Magdalena Sokolska
- Department of Medical Physics and Bioengineering, University College London Hospital, London, UK
| | - Michela Antonelli
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, UK
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, UK
| | - Kwee Yong
- Department of Haematology, University College London Hospital, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE
- Department of Radiology, University College London Hospital, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, 3rd Floor, Wolfson House, 4 Stephenson Way, London, UK, NW1 2HE.
- Department of Radiology, University College London Hospital, London, UK.
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35
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Melbourne A, Pratt R, Sokolska M, Owen D, Bainbridge A, Atkinson D, Kendall G, Deprest J, Vercauteren T, David A, Ourselin S. Separation of fetal and maternal circulations using multi-modal MRI. Placenta 2017. [DOI: 10.1016/j.placenta.2017.07.216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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36
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Latifoltojar A, Hall‐Craggs M, Rabin N, Popat R, Bainbridge A, Dikaios N, Sokolska M, Rismani A, D'Sa S, Punwani S, Yong K. Whole body magnetic resonance imaging in newly diagnosed multiple myeloma: early changes in lesional signal fat fraction predict disease response. Br J Haematol 2017; 176:222-233. [PMID: 27766627 PMCID: PMC5244686 DOI: 10.1111/bjh.14401] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 03/30/2016] [Accepted: 07/26/2016] [Indexed: 12/24/2022]
Abstract
Cross-sectional imaging techniques are being increasingly used for disease evaluation in patients with multiple myeloma. Whole body magnetic resonance imaging (WB-MRI) scanning is superior to plain radiography in baseline assessment of patients but changes following treatment have not been systematically explored. We carried out paired WB-MRI scans in 21 newly diagnosed patients prior to, and 8-weeks after, starting chemotherapy, and analysed stringently selected focal lesions (FLs) for parametric changes. A total of 323 FLs were evaluated, median 20 per patient. At 8 weeks, there was a reduction in estimated tumour volume (eTV), and an increase in signal fat fraction (sFF) and apparent diffusion coefficient (ADC) in the group as a whole (P < 0·001). Patients who achieved complete/very good partial response (CR/VGPR) to induction had a significantly greater increase in sFF compared to those achieving ≤ partial response (PR; P = 0·001). When analysed on a per-patient basis, all patients achieving CR/VGPR had a significant sFF increase in their FL's, in contrast to patients achieving ≤PR. sFF changes in patients reaching maximal response within 100 days (fast responders) were greater compared to slow responders (P = 0·001). Receiver Operator Characteristic analysis indicated that sFF changes at 8 weeks were the best biomarker (area under the Curve 0·95) for an inferior response (≤PR). We conclude that early lesional sFF changes may provide important information on depth of response, and are worthy of further prospective study.
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Affiliation(s)
| | - Margaret Hall‐Craggs
- Centre for Medical ImagingUniversity College LondonLondonUK
- Department of Clinical RadiologyUniversity College London HospitalsLondonUK
| | - Neil Rabin
- Department of HaematologyUniversity College London HospitalsLondonUK
| | - Rakesh Popat
- Department of HaematologyUniversity College London HospitalsLondonUK
| | - Alan Bainbridge
- Department of Medical PhysicsUniversity College London HospitalsLondonUK
| | | | - Magdalena Sokolska
- Department of Medical PhysicsUniversity College London HospitalsLondonUK
| | - Ali Rismani
- Department of HaematologyUniversity College London HospitalsLondonUK
| | - Shirley D'Sa
- Department of HaematologyUniversity College London HospitalsLondonUK
| | - Shonit Punwani
- Centre for Medical ImagingUniversity College LondonLondonUK
- Department of Clinical RadiologyUniversity College London HospitalsLondonUK
| | - Kwee Yong
- UCL Cancer Institute, HaematologyUniversity College LondonLondonUK
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37
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Proisy M, Mitra S, Uria-Avellana C, Sokolska M, Robertson NJ, Le Jeune F, Ferré JC. Brain Perfusion Imaging in Neonates: An Overview. AJNR Am J Neuroradiol 2016; 37:1766-1773. [PMID: 27079367 DOI: 10.3174/ajnr.a4778] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The development of cognitive function in children has been related to a regional metabolic increase and an increase in regional brain perfusion. Moreover, brain perfusion plays an important role in the pathogenesis of brain damage in high-risk neonates, both preterm and full-term asphyxiated infants. In this article, we will review and discuss several existing imaging techniques for assessing neonatal brain perfusion.
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Affiliation(s)
- M Proisy
- From the Department of Radiology (M.P., J.-C.F.), Rennes University Hospital, France .,Department of Neonatology (M.P., S.M., C.U.-A., N.J.R.), University College London Hospital, Institute for Women's Health, University College of London, London, UK.,Inserm VisAGeS Unit U746 (M.P., J.-C.F.), Inria, Rennes 1 University, Rennes, France
| | - S Mitra
- Department of Neonatology (M.P., S.M., C.U.-A., N.J.R.), University College London Hospital, Institute for Women's Health, University College of London, London, UK
| | - C Uria-Avellana
- Department of Neonatology (M.P., S.M., C.U.-A., N.J.R.), University College London Hospital, Institute for Women's Health, University College of London, London, UK
| | - M Sokolska
- Institute of Neurology (M.S.), University College of London, London, UK
| | - N J Robertson
- Department of Neonatology (M.P., S.M., C.U.-A., N.J.R.), University College London Hospital, Institute for Women's Health, University College of London, London, UK
| | - F Le Jeune
- Department of Nuclear Medicine (F.L.J.), Centre Eugène Marquis, Rennes, France
| | - J-C Ferré
- From the Department of Radiology (M.P., J.-C.F.), Rennes University Hospital, France.,Inserm VisAGeS Unit U746 (M.P., J.-C.F.), Inria, Rennes 1 University, Rennes, France
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38
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Kennedy J, Lehmann M, Crutch S, Fox N, Archer HA, Sokolska M. P1‐156: Visualising the emergence of posterior cortical atrophy. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.436] [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: 10/17/2022]
Affiliation(s)
| | | | | | - Nick Fox
- Dementia Research CentreUCL Institute of NeurologyLondon
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