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Miranda Bautista J, Garrido Morro I, Fernández García P, Herrera Herrera I. FLAIR hyperintensity in the subarachnoid space: Main differentials. Radiologia (Engl Ed) 2024; 66:78-89. [PMID: 38365357 DOI: 10.1016/j.rxeng.2022.01.003] [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: 09/28/2021] [Accepted: 01/21/2022] [Indexed: 02/18/2024]
Abstract
The fluid-attenuated inversion recovery (FLAIR) sequence forms part of the vast majority of current diagnostic protocols for brain MRI. This sequence enables the suppression of the signal from cerebrospinal fluid, facilitating the detection of disease involving the subarachnoid space. The causes of hyperintensity in the arachnoid space in this sequence can be divided into two main categories: hyperintensity due to disease and hyperintensity due to artifacts. Hyperintensity due to tumors, inflammation, vascular disease, or hypercellularity of the cerebrospinal fluid or hematic contents is well known. However, numerous other non-pathological conditions, mainly due to artifacts, that are also associated with this finding are a potential source of diagnostic errors.
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Affiliation(s)
| | - I Garrido Morro
- Servicio de Radiodiagnóstico, HGU Gregorio Marañón, Madrid, Spain
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Beach TG, Sue LI, Scott S, Intorcia AJ, Walker JE, Arce RA, Glass MJ, Borja CI, Cline MP, Hemmingsen SJ, Qiji S, Stewart A, Martinez KN, Krupp A, McHattie R, Mariner M, Lorenzini I, Kuramoto A, Long KE, Tremblay C, Caselli RJ, Woodruff BK, Rapscak SZ, Belden CM, Goldfarb D, Choudhury P, Driver-Dunckley ED, Mehta SH, Sabbagh MN, Shill HA, Atri A, Adler CH, Serrano GE. Cerebral white matter rarefaction has both neurodegenerative and vascular causes and may primarily be a distal axonopathy. J Neuropathol Exp Neurol 2023; 82:457-466. [PMID: 37071794 PMCID: PMC10209646 DOI: 10.1093/jnen/nlad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Cerebral white matter rarefaction (CWMR) was considered by Binswanger and Alzheimer to be due to cerebral arteriolosclerosis. Renewed attention came with CT and MR brain imaging, and neuropathological studies finding a high rate of CWMR in Alzheimer disease (AD). The relative contributions of cerebrovascular disease and AD to CWMR are still uncertain. In 1181 autopsies by the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND), large-format brain sections were used to grade CWMR and determine its vascular and neurodegenerative correlates. Almost all neurodegenerative diseases had more severe CWMR than the normal control group. Multivariable logistic regression models indicated that Braak neurofibrillary stage was the strongest predictor of CWMR, with additional independently significant predictors including age, cortical and diencephalic lacunar and microinfarcts, body mass index, and female sex. It appears that while AD and cerebrovascular pathology may be additive in causing CWMR, both may be solely capable of this. The typical periventricular pattern suggests that CWMR is primarily a distal axonopathy caused by dysfunction of the cell bodies of long-association corticocortical projection neurons. A consequence of these findings is that CWMR should not be viewed simply as "small vessel disease" or as a pathognomonic indicator of vascular cognitive impairment or vascular dementia.
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Affiliation(s)
- Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Lucia I Sue
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Sarah Scott
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | | | - Richard A Arce
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Michael J Glass
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Madison P Cline
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Sanaria Qiji
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Analisa Stewart
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Addison Krupp
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Rylee McHattie
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Monica Mariner
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - Angela Kuramoto
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Kathy E Long
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | | | | | | | | | | | | | | | - Shyamal H Mehta
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Holly A Shill
- Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Alireza Atri
- Banner Sun Health Research Institute, Sun City, Arizona, USA
- Harvard Medical School & Brigham & Women’s Hospital, Boston, Massachusetts, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Geidy E Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, USA
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Shima A, Sakai K, Yamashita F, Hamaguchi T, Kitamoto T, Sasaki M, Yamada M, Ono K. Vacuoles related to tissue neuron-astrocyte ratio and infiltration of macrophages/monocytes contribute to hyperintense brain signals on diffusion-weighted magnetic resonance imaging in sporadic Creutzfeldt-Jakob disease. J Neurol Sci 2023; 447:120612. [PMID: 36913815 DOI: 10.1016/j.jns.2023.120612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Radiological features in patients with sporadic Creutzfeldt-Jakob disease (sCJD) are hyperintensity of the cerebral cortex and the basal ganglia displayed by diffusion-weighted magnetic resonance imaging (DW-MRI). We performed a quantitative study on neuropathological and radiological findings. METHODS Patient 1 received a definite diagnosis of MM1-type sCJD, while patient 2 received a definite diagnosis of MM1 + 2-type sCJD. Two DW-MRI scans were performed on each patient. DW-MRI was either taken the day before or on the day of the patient's death, and several hyperintense or isointense areas were marked as a region of interest (ROI). Mean signal intensity of the ROI was measured. Pathological quantitative assessments of the vacuoles, astrocytosis, infiltration of monocytes/macrophages, and proliferation of microglia was performed. Vacuole load (% area vacuole), glial fibrillary acidic protein (GFAP), CD68, and Iba-1 load were calculated. We defined spongiform change index (SCI) to indicate vacuoles related to a tissue neuron-astrocyte ratio. We assessed the correlation of intensity of the last DW-MRI and the pathological findings as well as association of changes of the signal intensity on the sequential images and the pathological findings. RESULT We observed a strong positive correlation between SCI and DW-MRI intensity. In the analysis using serial DW-MRI and pathological findings, we found that CD68 load was significantly larger in areas where signal intensity decreased, as compared to those areas where hyperintensity remained unchanged. CONCLUSION DW-MRI intensity in sCJD is associated with the ratio of neuron to astrocyte in the vacuoles and the infiltration of macrophages and/or monocytes.
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Affiliation(s)
- Ayano Shima
- Department of Neurology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-Machi, Kanazawa 920-8640, Japan
| | - Kenji Sakai
- Department of Neurology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-Machi, Kanazawa 920-8640, Japan; Department of Neurology, Joetsu General Hospital, 616 Daidofukuda, Joetsu, Niigata 943-8507, Japan.
| | - Fumio Yamashita
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan
| | - Tsuyoshi Hamaguchi
- Department of Neurology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-Machi, Kanazawa 920-8640, Japan; Department of Neurology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan
| | - Tetsuyuki Kitamoto
- Department of Neurological Science, Tohoku University Graduate School of Medicine, 2-1 Seiyo-machi, Aoba-ku, Sendai 980-8565, Japan
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan
| | - Masahito Yamada
- Department of Neurology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-Machi, Kanazawa 920-8640, Japan; Department of Internal Medicine, Division of Neurology, Kudanzaka Hospital, 1-6-12 Kudanzakaminami, Chiyoda-ku, Tokyo 102-0074, Japan
| | - Kenjiro Ono
- Department of Neurology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-Machi, Kanazawa 920-8640, Japan.
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Garg P, Kaur B, Yagnik VD, Dawka S, Menon GR. Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula: Experience from 2404 scans. World J Gastroenterol 2021; 27:5460-5473. [PMID: 34588745 PMCID: PMC8433608 DOI: 10.3748/wjg.v27.i33.5460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/12/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance imaging (MRI) is considered the gold standard for the evaluation of anal fistulas. There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery. However, the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken. Incidentally, there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period. In this article, we discuss the challenges faced while interpreting the postoperative MRI, the timing of the postoperative MRI, the utility of MRI in the postoperative period for the management of anal fistulas, the importance of the active involvement and experience of the treating clinician in interpreting MRI scans, and the latest advancements in the field.
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Affiliation(s)
- Pankaj Garg
- Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula 134113, Haryana, India
- Department of Colorectal Surgery, Indus International Hospital, Mohali 140201, Punjab, India
| | - Baljit Kaur
- Department of Radiology, SSRD Magnetic Resonance Imaging Institute, Chandigarh 160011, Chandigarh, India
| | - Vipul D Yagnik
- Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Center, Patan 384265, Gujarat, India
| | - Sushil Dawka
- Department of Surgery, SSR Medical College, Belle Rive, Mauritius
| | - Geetha R Menon
- Department of Statistics, Indian Council of Medical Research, New Delhi 110029, New Delhi, India
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Moscoso A, Grothe MJ, Schöll M; Alzheimer’s Disease Neuroimaging Initiative. Reduced [ 18F]flortaucipir retention in white matter hyperintensities compared to normal-appearing white matter. Eur J Nucl Med Mol Imaging 2021; 48:2283-94. [PMID: 33475761 DOI: 10.1007/s00259-021-05195-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/04/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE Recent research has suggested the use of white matter (WM) reference regions for longitudinal tau-PET imaging. However, tau tracers display affinity for the β-sheet structure formed by myelin, and thus WM lesions might influence tracer retention. Here, we explored whether the tau-sensitive tracer [18F]flortaucipir shows reduced retention in WM hyperintensities (WMH) and how this retention changes over time. METHODS We included 707 participants from the Alzheimer's Disease Neuroimaging Initiative with available [18F]flortaucipir-PET and structural and FLAIR MRI scans. WM segments and WMH were automatically delineated in the structural MRI and FLAIR scans, respectively. [18F]flortaucipir standardized uptake value ratios (SUVR) of WMH and normal-appearing WM (NAWM) were calculated using the inferior cerebellar grey matter as reference region, and a 3-mm erosion was applied to the combined NAWM and WMH masks to avoid partial volume effects. Longitudinal [18F]flortaucipir SUVR changes in NAWM and WMH were estimated using linear mixed models. The percent variance of WM-referenced cortical [18F]flortaucipir SUVRs explained by longitudinal changes in the WM reference region was estimated with the R2 coefficient. RESULTS Compared to NAWM, WMH areas displayed significantly reduced [18F]flortaucipir SUVR, independent of cognitive impairment or Aβ status (mean difference = 0.14 SUVR, p < 0.001). Older age was associated with lower [18F]flortaucipir SUVR in both NAWM (- 0.002 SUVR/year, p = 0.005) and WMH (- 0.004 SUVR/year, p < 0.001). Longitudinally, [18F]flortaucipir SUVR decreased in NAWM (- 0.008 SUVR/year, p = 0.03) and even more so in WMH (- 0.02 SUVR/year, p < 0.001). Between 17% and 66% of the variance of longitudinal changes in cortical WM-referenced [18F]flortaucipir SUVRs were explained by longitudinal changes in the reference region. CONCLUSIONS [18F]flortaucipir retention in the WM decreases over time and is influenced by the presence of WMH, supporting the hypothesis that [18F]flortaucipir retention in the WM is partially myelin-dependent. These findings have implications for the use of WM reference regions for [18F]flortaucipir-PET imaging.
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Aydın K, Havali C, Kartal A, Serdaroğlu A, Haspolat Ş. MRI in CLN2 disease patients: Subtle features that support an early diagnosis. Eur J Paediatr Neurol 2020; 28:228-236. [PMID: 32855042 DOI: 10.1016/j.ejpn.2020.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/11/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022]
Abstract
Neuronal ceroid lipofuscinosis type 2 (CLN2) disease is a rare, paediatric-onset, neurodegenerative disorder characterised in its early stages by language delay, seizures and loss of motor function. It is rapidly progressive and ultimately results in the premature death of patients. We aim to highlight common magnetic resonance imaging (MRI) features seen in early CLN2 disease and increase disease awareness among clinicians in order to facilitate early diagnosis and treatment of patients with disease-modifying enzyme replacement therapy. We obtained MRI scans from 12 Turkish children with CLN2 disease, at symptom onset or time of diagnosis, and at various times during disease progression. Patient details including age at onset of symptoms, age at diagnosis and clinical presentation were collected. MRIs were analysed to identify common features present in patients with CLN2 disease. The median diagnostic delay in this cohort was 2 years, highlighting the need for increased disease awareness among clinicians. Key MRI features suggestive of CLN2 disease that were identified included cerebellar atrophy in 11 patients, linear hyperintensity of central white matter in 10 patients, cerebral atrophy in 8 patients and thinning of the corpus callosum in 6 patients. Thalamic hypointensity was seen in 1 patient and may also indicate CLN2 disease. It is important to consider the presenting symptoms alongside clinical test results in order to support early diagnosis of CLN2 disease. Clinical suspicion of CLN2 disease accompanied by the detection of any of the above-mentioned features on MRI should encourage healthcare professionals to test for CLN2 disease.
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Affiliation(s)
- Kürşad Aydın
- Medipol University, Faculty of Medicine, Istanbul, Turkey.
| | - Cengiz Havali
- High Specialty Training and Research Hospital, Bursa, Turkey.
| | - Ayşe Kartal
- Selçuk University, Faculty of Medicine, Konya, Turkey.
| | | | - Şenay Haspolat
- Akdeniz University, Faculty of Medicine, Antalya, Turkey.
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Griessenauer CJ, McPherson D, Berger A, Cuiper P, Sofoluke N, Adams MD, Kunaprayoon S, Zand R, Li J, Abedi V, Goren O, Schirmer CM, Donahue K, Nardin M, Giese AK, Schirmer MD, Rost NS, Hendrix P. Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke. Cerebrovasc Dis 2020; 49:419-426. [PMID: 32694259 DOI: 10.1159/000509071] [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: 03/18/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION White matter hyperintensity (WMH) burden is a critically important cerebrovascular phenotype related to the diagnosis and prognosis of acute ischemic stroke. The effect of WMH burden on functional outcome in large vessel occlusion (LVO) stroke has only been sparsely assessed, and direct LVO and non-LVO comparisons are currently lacking. MATERIAL AND METHODS We reviewed acute ischemic stroke patients admitted between 2009 and 2017 at a large healthcare system in the USA. Patients with LVO were identified and clinical characteristics, including 90-day functional outcomes, were assessed. Clinical brain MRIs obtained at the time of the stroke underwent quantification of WMH using a fully automated algorithm. The pipeline incorporated automated brain extraction, intensity normalization, and WMH segmentation. RESULTS A total of 1,601 acute ischemic strokes with documented 90-day mRS were identified, including 353 (22%) with LVO. Among those strokes, WMH volume was available in 1,285 (80.3%) who had a brain MRI suitable for WMH quantification. Increasing WMH volume from 0 to 4 mL, age, female gender, a number of stroke risk factors, presence of LVO, and higher NIHSS at presentation all decreased the odds for a favorable outcome. Increasing WMH above 4 mL, however, was not associated with decreasing odds of favorable outcome. While WMH volume was associated with functional outcome in non-LVO stroke (p = 0.0009), this association between WMH and functional status was not statistically significant in the complete case multivariable model of LVO stroke (p = 0.0637). CONCLUSION The burden of WMH has effects on 90-day functional outcome after LVO and non-LVO strokes. Particularly, increases from no measurable WMH to 4 mL of WMH correlate strongly with the outcome. Whether this relationship of increasing WMH to worse outcome is more pronounced in non-LVO than LVO strokes deserves additional investigation.
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Affiliation(s)
- Christoph Johannes Griessenauer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA, .,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria,
| | - David McPherson
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Andrea Berger
- Biostatistics Core, Geisinger, Danville, Pennsylvania, USA
| | - Ping Cuiper
- Biostatistics Core, Geisinger, Danville, Pennsylvania, USA
| | - Nelson Sofoluke
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Matthew D Adams
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Saran Kunaprayoon
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Ramin Zand
- Department of Neurology, Geisinger, Danville, Pennsylvania, USA
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger, Danville, Pennsylvania, USA
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger, Danville, Pennsylvania, USA.,Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia, USA
| | - Oded Goren
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | | | - Kathleen Donahue
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco Nardin
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne-Karin Giese
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Markus D Schirmer
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philipp Hendrix
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.,Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
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Ko SB, Kim TJ, Sohn CH. Focal hyperemia in Wernicke's encephalopathy: a preliminary arterial spin labeling MRI study. Neuroradiology 2019; 62:105-108. [PMID: 31732755 DOI: 10.1007/s00234-019-02298-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/01/2019] [Indexed: 11/25/2022]
Abstract
Although a perturbed cerebral blood flow (CBF) has been reported in patients with Wernicke's encephalopathy (WE), its clinical meaning is still elusive. A retrospective analysis of 10 patients (male, 6; mean age, 57.7 years) with WE between October 2012 and May 2018 was performed. Brain imaging was performed using fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), arterial spin labeling (ASL) perfusion-weighted imaging (PWI), and contrasted enhanced T1-weighted imaging. All patients had symmetric high signal intensity lesions in the vulnerable areas on FLAIR or DWI with focal hyperintensity on ASL-PWI (100% sensitivity). CBFlesion was variable (from 70 mL/100 g/min to 190.0 mL/100 g/min). CBFlesion/CBFwhite matter was elevated, ranging from 2.5 to 5.5. Focal hyperintensity on ASL in the vulnerable areas can be a diagnostic clue for WE.
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Affiliation(s)
- Sang-Bae Ko
- Department of Neurology, College of Medicine, Seoul National University Hospital, Daehak-ro 101, Jongno-gu, Seoul, 03086, South Korea.
| | - Tae Jung Kim
- Department of Neurology, College of Medicine, Seoul National University Hospital, Daehak-ro 101, Jongno-gu, Seoul, 03086, South Korea
| | - Chul-Ho Sohn
- Department of Radiology, College of Medicine, Seoul National University Hospital, Daehak-ro 101, Jongno-gu, Seoul, 03086, South Korea
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Hayashi Y, Sasagawa Y, Oishi M, Misaki K, Kozaka K, Tachibana O, Nakada M. Radiological and endocrinological evaluations with grading of hypothalamic perifocal edema caused by craniopharyngiomas. Pituitary 2019; 22:146-155. [PMID: 30847775 DOI: 10.1007/s11102-019-00945-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Hypophysial and hypothalamic dysfunction caused by craniopharyngioma is a serious problem despite the progress of surgical approaches and techniques. Perifocal edema induced by craniopharyngioma could be speculated as a potential factor resulting in pre- and post-operative hypophysial and hypothalamic dysfunction, as well as, their anatomical involvement. METHODS Medical records of 54 patients with craniopharyngioma were retrospectively reviewed. The edema was characterized by a hyperintense area in magnetic resonance imaging, being classified into no edema (group A), only adjacent to the tumor (group B), and extending to the internal capsule or the optic tract (group C). Age, sex, tumor diameter, presence of cyst, hydrocephalus, intracranial pressure (ICP) elevation, visual function impairment, hypopituitarism, diabetes insipidus, memory disturbance, and obesity were investigated. RESULTS The occurrence rate of edema was found more frequently in adults (73.7%) than in children (25.0%). The peritumoral edema grading system had an excellent correlation with the degree of hypothalamic involvement graded by the Puget's system. Pre-operative ICP elevation was significantly detected in group C when compared with the other groups. In adults patients, group C was significantly associated with the occurrence of hydrocephalus both in pre- and post-operatively. Pre- and post-operative hypothalamic dysfunction, including diabetes insipidus, memory disturbance, and obesity, were highest in group C. CONCLUSION Hypothalamic dysfunctions greatly influence the quality of daily living following craniopharyngioma surgery. The grading of perifocal edema's extension could be a new index suggesting pre- and post-operative hypothalamic dysfunction caused by craniopharyngioma in addition to their anatomical involvement.
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Affiliation(s)
- Yasuhiko Hayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yasuo Sasagawa
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masahiro Oishi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kouichi Misaki
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuto Kozaka
- Department of Radiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Osamu Tachibana
- Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Sano K, Ichikawa T, Motosugi U, Ichikawa S, Morisaka H, Enomoto N, Matsuda M, Fujii H. Outcome of hypovascular hepatic nodules with positive uptake of gadoxetic acid in patients with cirrhosis. Eur Radiol. 2017;27:518-525. [PMID: 27255397 DOI: 10.1007/s00330-016-4423-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 05/08/2016] [Accepted: 05/19/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the longitudinal risk to patients with cirrhosis of hypervascular hepatocellular carcinoma (HCC) developing from hypovascular hepatic nodules that show positive uptake of gadoxetic acid (hyperintensity) on hepatocyte phase images. METHODS In 69 patients, we evaluated findings from serial follow-up examinations of 633 hepatic nodules that appeared hypovascular and hyperintense on initial gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) until the nodules demonstrated hypervascularity and were diagnosed as hypervascular HCC. Cox analyses were performed to identify risk factors for the development of hypervascular HCCs from the nodules. RESULTS The median follow-up was 663 days (range, 110 to 1215 days). Hypervascular HCCs developed in six of the 633 nodules (0.9 %) in five of the 69 patients. The only independent risk factor, the nodule's initial maximum diameter of 10 mm or larger, demonstrated a hazard ratio of 1.25. The one-year risk of hypervascular HCC developing from a nodule was 0.44 %. The risk was significantly higher for nodules of larger diameter (1.31 %) than those smaller than 10 mm (0.10 %, p < 0.01). CONCLUSIONS Hypervascular HCC rarely develops from hypovascular, hyperintense hepatic nodules. We observed low risk even for nodules of 10 mm and larger diameter at initial examination. KEY POINTS • Hypervascularization was rare on follow-up examination of hypovascular, hyperintense nodules • The risk of hypervascularization in a nodule increased with large size • Hypovascular, hyperintense nodules require neither treatment nor more intense follow-up.
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Cervo A, Cocozza S, Saccà F, Giorgio SMDA, Morra VB, Tedeschi E, Marsili A, Vacca G, Palma V, Brunetti A, Quarantelli M. The combined use of conventional MRI and MR spectroscopic imaging increases the diagnostic accuracy in amyotrophic lateral sclerosis. Eur J Radiol 2014; 84:151-157. [PMID: 25466774 DOI: 10.1016/j.ejrad.2014.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/21/2014] [Accepted: 10/28/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE We aimed to assess, in amyotrophic lateral sclerosis (ALS), the diagnostic accuracy of the combined use of conventional MRI signal changes (namely, hypointensity of the precentral cortex and hyperintensity of the corticospinal tracts on T2-weighted images), and N-Acetyl-Aspartate (NAA) reduction in the motor cortex at Magnetic Resonance Spectroscopy (MRS), which are affected by limited diagnostic accuracy when used separately. METHODS T2-hypointensity and NAA/(Choline+Creatine) ratio of the precentral gyrus and T2-hyperintensity of the corticospinal tracts were measured in 84 ALS patients and 28 healthy controls, using a Region-of-Interest approach. Sensitivity and specificity values were calculated using Fisher stepwise discriminant analysis, and cross-validated using the leave-one-out method. RESULTS Precentral gyrus T2 signal intensity (p<10(-4)) and NAA peak (p<10(-6)) were significantly reduced in patients, and their values did not correlate significantly to each other both in patients and controls, while no significant differences were obtained in terms of T2-hyperintensity of the corticospinal tract. Sensitivity and specificity of the two discriminant variables, taken alone, were 71.4% and 75.0%, for NAA peak, and 63.1% and 71.4% for T2-hypointensity, respectively. When using these two variables in combination, a significant increase in sensitivity (78.6%) and specificity (82.1%) was achieved. CONCLUSIONS Precentral gyrus T2-hypointensity and NAA peak are not significantly correlated in ALS patients, suggesting that they reflect relatively independent phenomena. The combined use of these measures improves the diagnostic accuracy of MRI in ALS diagnosis.
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Affiliation(s)
- Amedeo Cervo
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
| | - Francesco Saccà
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Sara M D A Giorgio
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Enrico Tedeschi
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Angela Marsili
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Giovanni Vacca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Vincenzo Palma
- U.O.C. Neurofisiopatologia, PO S. Gennaro ASL Napoli 1, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Mario Quarantelli
- Biostructure and Bioimaging Institute, National Research Council, Naples, Italy
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