|
1
|
Brenlla C, Sozzi C, Girona A, Muñoz-Moreno E, Laredo C, Rodríguez-Vázquez A, Amaro S, Renú A, Doncel-Moriano A, Llull L, Urra X, Rudilosso S, Chamorro Á. Deep Medullary Vein Integrity and Relationships with Small Vessel Disease and Interstitial Diffusivity Measures in Patients with a Recent Small Subcortical Infarct. AJNR Am J Neuroradiol 2025:ajnr.A8591. [PMID: 39572199 DOI: 10.3174/ajnr.a8591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 11/16/2024] [Indexed: 05/24/2025]
Abstract
BACKGROUND AND PURPOSE The role of the venous compartment in cerebral small vessel disease has yet to be fully understood. As such, we evaluated how deep medullary vein (DMV) integrity relates to MRI-based small vessel disease severity markers and glymphatic function assessed by DTI measures in patients with a recent small subcortical infarct. MATERIALS AND METHODS We gathered demographic, clinical, and 3T MRI imaging data from 50 patients with a recent small subcortical infarct. We evaluated the venular integrity by using 2 visual scales based on their appearance on SWI. We assessed the number of lacunes and microbleeds, white matter hyperintensities volume, perivascular spaces volume in basal ganglia and white matter, summary small vessel disease score, and brain volume. Diffusivity measures in normal-appearing white matter included free water fraction, mean diffusivity and fractional anisotropy with and without free water correction, and DTI along the perivascular spaces. After categorizing the cohort in quartiles according to both venular scores, we assessed their correlations with small vessel disease markers and diffusivity measures by using multivariable ordinal regression analyses adjusting for age, sex, smoking, and summary small vessel disease score. RESULTS In univariate analysis most of the imaging variables, except for microbleeds, perivascular spaces in white matter, and DTI along the perivascular spaces, were associated with 1 or both venular scores. In multivariate analysis, free water (OR, 1.33, 95% CI, 1.03-1.73), mean diffusivity (OR, 4.56, 95% CI, 1.32-15.81), fractional anisotropy (OR, 0.77, 95% CI, 0.63-0.93), free water-corrected mean diffusivity and fractional anisotropy (OR, 2.39, 95% CI, 1.06-5.39; OR 0.78, 95% CI, 0.65-0.94, respectively), associated with vein appearance, while only brain volume (OR, 0.48, 95% CI, 0.25-0.94), fractional anisotropy with and without free water correction (OR, 0.82, 95% CI, 0.86-0.99; OR, 0.83, 95% CI, 0.7-0.99, respectively) remained robust for vein count. CONCLUSIONS In patients with a recent small subcortical infarct, disruption of the DMVs, increased extracellular water, and white matter injury appear to be associated.
Collapse
Affiliation(s)
- Carla Brenlla
- From the Neurology Department (C.B., A.G.), Hospital Clinic, Barcelona, Spain
| | - Caterina Sozzi
- Neurology Department (C.S.), University of Milano Bicocca, Milano, Italy
| | - Andrés Girona
- From the Neurology Department (C.B., A.G.), Hospital Clinic, Barcelona, Spain
| | - Emma Muñoz-Moreno
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-M., C.L., S.R., A.C.), Barcelona, Spain
| | - Carlos Laredo
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-M., C.L., S.R., A.C.), Barcelona, Spain
| | - Alejandro Rodríguez-Vázquez
- Comprehensive Stroke Center, Department of Neuroscience (A.R.-V., S.A., A.R., A.D.-M., L.L., X.U., S.R., A.C.), Hospital Clinic. Barcelona, Spain
| | - Sergio Amaro
- Comprehensive Stroke Center, Department of Neuroscience (A.R.-V., S.A., A.R., A.D.-M., L.L., X.U., S.R., A.C.), Hospital Clinic. Barcelona, Spain
| | - Arturo Renú
- Comprehensive Stroke Center, Department of Neuroscience (A.R.-V., S.A., A.R., A.D.-M., L.L., X.U., S.R., A.C.), Hospital Clinic. Barcelona, Spain
| | - Antonio Doncel-Moriano
- Comprehensive Stroke Center, Department of Neuroscience (A.R.-V., S.A., A.R., A.D.-M., L.L., X.U., S.R., A.C.), Hospital Clinic. Barcelona, Spain
| | - Laura Llull
- Comprehensive Stroke Center, Department of Neuroscience (A.R.-V., S.A., A.R., A.D.-M., L.L., X.U., S.R., A.C.), Hospital Clinic. Barcelona, Spain
| | - Xabier Urra
- Comprehensive Stroke Center, Department of Neuroscience (A.R.-V., S.A., A.R., A.D.-M., L.L., X.U., S.R., A.C.), Hospital Clinic. Barcelona, Spain
| | - Salvatore Rudilosso
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-M., C.L., S.R., A.C.), Barcelona, Spain
- Comprehensive Stroke Center, Department of Neuroscience (A.R.-V., S.A., A.R., A.D.-M., L.L., X.U., S.R., A.C.), Hospital Clinic. Barcelona, Spain
| | - Ángel Chamorro
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS) (E.M.-M., C.L., S.R., A.C.), Barcelona, Spain
- Comprehensive Stroke Center, Department of Neuroscience (A.R.-V., S.A., A.R., A.D.-M., L.L., X.U., S.R., A.C.), Hospital Clinic. Barcelona, Spain
- Faculty of Medicine and Health Sciences (A.C.), University of Barcelona, Barcelona, Spain
| |
Collapse
|
|
2
|
Bosque Varela P, Machegger L, Crespo Pimentel B, Kuchukhidze G. Imaging of Status Epilepticus. J Clin Med 2025; 14:2922. [PMID: 40363954 PMCID: PMC12073066 DOI: 10.3390/jcm14092922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2025] [Revised: 04/14/2025] [Accepted: 04/17/2025] [Indexed: 05/15/2025] Open
Abstract
MRI plays an increasingly important role in the diagnosis of status epilepticus (SE). Approximately half of patients with SE do not have pre-existing epilepsy, and the cause of de novo SE is frequently unknown. The role of MRI in the identification of causes of SE is invaluable. MRI is often helpful as a diagnostic tool in cases of non-convulsive status epilepticus (NCSE) with ambiguous EEG findings. Thus, MRI is recommended for all patients presenting with de novo SE, patients with known epilepsy with the first episode of SE and NCSE with equivocal EEG. Different peri-ictal MRI (PMA) alterations may be seen during ongoing SE or briefly after its cessation. They commonly present as peri-ictal hyper-perfusion, diffusion restriction and/or FLAIR-hyperintensity affecting specific brain areas such as the cortex, hippocampus, pulvinar of the thalamus, splenium of the corpus callosum, claustrum or cerebellum, frequently in combination, suggesting the existence of a "status epilepticus network". MRI sequences, which are necessary for detecting PMA, include diffusion-weighted imaging, fluid attenuated inversion recovery, T1-weighted imaging with and without contrast application, as well as perfusion sequences such as arterial spin labeling. Recent research suggests that they may serve as biomarkers for predicting an outcome in SE. Patients with PMA seem to have a higher mortality rate compared to those without PMA. However, there is still a substantial knowledge gap and there are many open questions related to imaging in SE. Further prospective quantitative MRI studies with uniform protocols, timing and follow-up periods are needed to answer these important and clinically relevant questions.
Collapse
Affiliation(s)
- Pilar Bosque Varela
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (P.B.V.); (B.C.P.)
| | - Lukas Machegger
- Department of Neuroradiology, Christian Doppler University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Bernardo Crespo Pimentel
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (P.B.V.); (B.C.P.)
- Department of Neurology, Hietzing Hospital and Neurological Center Rosenhügel, 1130 Vienna, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Neurocritical Care and Neurorehabilitation, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (P.B.V.); (B.C.P.)
- Neuroscience Institute, Christian Doppler University Hospital, Centre for Cognitive Neuroscience, 5020 Salzburg, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
| |
Collapse
|
|
3
|
Vukmir RB. Amyloid-related imaging abnormalities (ARIA): diagnosis, management, and care in the setting of amyloid-modifying therapy. Ann Clin Transl Neurol 2024; 11:1669-1680. [PMID: 38939962 PMCID: PMC11251480 DOI: 10.1002/acn3.52042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 06/29/2024] Open
Abstract
Amyloid-related imaging abnormalities, were originally described by dementia care experts. The wider use of aducanumab and now lecanemab warrant broader understanding by the health care provider continuum. The optimal care approach for patients with Alzheimer's dementia, treated with amyloid-targeted therapy, includes proper clinical diagnosis, complication surveillance, specific imaging protocols, expert specialty consultation, integrated treatment strategies, and proper facility system planning. Improved awareness and understanding of amyloid-modifying therapy, both benefits and potential complications, among the health care provider continuum is paramount to the success of complex care programs. Specifically, recognition of treatment high risk, high benefit groups, and the interface of concurrent antiplatelet and anticoagulation. This integrated acute, specialty, and primary care approach should improve patient care quality and outcome.
Collapse
Affiliation(s)
- Rade B. Vukmir
- Emergency MedicineDrexel UniversityPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
|
4
|
Mattay RR, Kim K, Shah L, Shah B, Sugrue L, Safoora F, Ozhinsky E, Narsinh KH. MR Thermometry during Transcranial MR Imaging-Guided Focused Ultrasound Procedures: A Review. AJNR Am J Neuroradiol 2023; 45:1-8. [PMID: 38123912 PMCID: PMC10756580 DOI: 10.3174/ajnr.a8038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/04/2023] [Indexed: 12/23/2023]
Abstract
Interest in transcranial MR imaging-guided focused ultrasound procedures has recently grown. These incisionless procedures enable precise focal ablation of brain tissue using real-time monitoring by MR thermometry. This article will provide an updated review on clinically applicable technical underpinnings and considerations of proton resonance frequency MR thermometry, the most common clinically used MR thermometry sequence.
Collapse
Affiliation(s)
- Raghav R Mattay
- From the Department of Radiology and Biomedical Imaging (R.R.M., K.K., L. Sugrue, F.S., E.O., K.H.N.), University of California San Francisco, California
| | - Kisoo Kim
- From the Department of Radiology and Biomedical Imaging (R.R.M., K.K., L. Sugrue, F.S., E.O., K.H.N.), University of California San Francisco, California
| | - Lubdha Shah
- Department of Radiology and Neurosurgery (L. Shah), University of Utah, Salt Lake City, Utah
| | - Bhavya Shah
- Department of Radiology (B.S.), University of Texas Southwestern, Dallas, Texas
| | - Leo Sugrue
- From the Department of Radiology and Biomedical Imaging (R.R.M., K.K., L. Sugrue, F.S., E.O., K.H.N.), University of California San Francisco, California
- Department of Psychiatry (L. Sugrue), University of California San Francisco, California
| | - Fatima Safoora
- From the Department of Radiology and Biomedical Imaging (R.R.M., K.K., L. Sugrue, F.S., E.O., K.H.N.), University of California San Francisco, California
| | - Eugene Ozhinsky
- From the Department of Radiology and Biomedical Imaging (R.R.M., K.K., L. Sugrue, F.S., E.O., K.H.N.), University of California San Francisco, California
| | - Kazim H Narsinh
- From the Department of Radiology and Biomedical Imaging (R.R.M., K.K., L. Sugrue, F.S., E.O., K.H.N.), University of California San Francisco, California
- Department of Neurological Surgery (K.H.N.), University of California San Francisco, California
| |
Collapse
|
|
5
|
Ikawa H, Okamoto S, Shinohara N, Ozaki S, Kusuhara T. Usefulness of the Preoperative Images Supporting Mechanical Thrombectomy Based on Susceptibility-Weighted Image for Stroke. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:202-208. [PMID: 37731467 PMCID: PMC10508990 DOI: 10.5797/jnet.tn.2023-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/16/2023] [Indexed: 09/22/2023]
Abstract
Objective This is a report on the usefulness of 3D fusion imaging with susceptibility-weighted imaging (SWI) as preoperative imaging for mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Case Presentations Among 17 cases of patients who underwent MT in AIS between March 2021 and April 2022, 14 patients who underwent MRI with SWI (shortened SWI for stroke) and 3D T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolution were targeted in the study. Three cases with motion artifacts due to body movement were excluded from the images.After imaging, 3D fusion images were constructed to visualize thrombi and occluded vessels. SWI for stroke obtained thrombus information in 11 of the 14 cases (78.5%) and 3D images of the thrombi could be created in all 11 cases. 3D fusion images could be created in nine of the 14 cases (64.2%). Conclusion 3D fusion images, using SWI for stroke, can visualize thrombi and occluded vessels and may be effectively used as preoperative images for MT.
Collapse
Affiliation(s)
- Hiroshi Ikawa
- Department of Radiology, HITO Medical Center, Shikokuchuo, Ehime, Japan
| | - Shigetaka Okamoto
- Department of Neurovascular Medicine, HITO Medical Center, Shikokuchuo, Ehime, Japan
| | - Naoki Shinohara
- Department of Neurosurgery, HITO Medical Center, Shikokuchuo, Ehime, Japan
| | - Saya Ozaki
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Toshiaki Kusuhara
- Department of Radiology, HITO Medical Center, Shikokuchuo, Ehime, Japan
| |
Collapse
|
|
6
|
Salvalaggio S, Turolla A, Andò M, Barresi R, Burgio F, Busan P, Cortese AM, D’Imperio D, Danesin L, Ferrazzi G, Maistrello L, Mascotto E, Parrotta I, Pezzetta R, Rigon E, Vedovato A, Zago S, Zorzi M, Arcara G, Mantini D, Filippini N. Prediction of rehabilitation induced motor recovery after stroke using a multi-dimensional and multi-modal approach. Front Aging Neurosci 2023; 15:1205063. [PMID: 37469951 PMCID: PMC10352609 DOI: 10.3389/fnagi.2023.1205063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Background Stroke is a debilitating disease affecting millions of people worldwide. Despite the survival rate has significantly increased over the years, many stroke survivors are left with severe impairments impacting their quality of life. Rehabilitation programs have proved to be successful in improving the recovery process. However, a reliable model of sensorimotor recovery and a clear identification of predictive markers of rehabilitation-induced recovery are still needed. This article introduces the cross-modality protocols designed to investigate the rehabilitation treatment's effect in a group of stroke survivors. Methods/design A total of 75 stroke patients, admitted at the IRCCS San Camillo rehabilitation Hospital in Venice (Italy), will be included in this study. Here, we describe the rehabilitation programs, clinical, neuropsychological, and physiological/imaging [including electroencephalography (EEG), transcranial magnetic stimulation (TMS), and magnetic resonance imaging (MRI) techniques] protocols set up for this study. Blood collection for the characterization of predictive biological biomarkers will also be taken. Measures derived from data acquired will be used as candidate predictors of motor recovery. Discussion/summary The integration of cutting-edge physiological and imaging techniques, with clinical and cognitive assessment, dose of rehabilitation and biological variables will provide a unique opportunity to define a predictive model of recovery in stroke patients. Taken together, the data acquired in this project will help to define a model of rehabilitation induced sensorimotor recovery, with the final aim of developing personalized treatments promoting the greatest chance of recovery of the compromised functions.
Collapse
Affiliation(s)
- Silvia Salvalaggio
- IRCCS San Camillo Hospital, Venice, Italy
- Padova Neuroscience Center, Università degli Studi di Padova, Padua, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum – Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | | | | | - Anna Maria Cortese
- Department of Rehabilitation Medicine, AULSS 3 Serenissima, Venice, Italy
| | | | | | | | | | - Eleonora Mascotto
- Department of Physical Medicine and Rehabilitation, Venice Hospital, Venice, Italy
| | | | | | | | - Anna Vedovato
- General Hospital San Camillo of Treviso, Treviso, Italy
| | - Sara Zago
- IRCCS San Camillo Hospital, Venice, Italy
| | - Marco Zorzi
- IRCCS San Camillo Hospital, Venice, Italy
- Padova Neuroscience Center, Università degli Studi di Padova, Padua, Italy
- Department of General Psychology, University of Padova, Padua, Italy
| | | | - Dante Mantini
- IRCCS San Camillo Hospital, Venice, Italy
- Movement Control and Neuroplasticity Research Group, KU Leuven, Leuven, Belgium
| | | |
Collapse
|
|
7
|
Sotardi ST, Alves CAPF, Serai SD, Beslow LA, Schwartz ES, Magee R, Vossough A. Magnetic resonance imaging protocols in pediatric stroke. Pediatr Radiol 2023; 53:1324-1335. [PMID: 36604317 DOI: 10.1007/s00247-022-05576-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/30/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023]
Abstract
Neuroimaging protocols play an important role in the timely evaluation and treatment of pediatric stroke and its mimics. MRI protocols for stroke in the pediatric population should be guided by the clinical scenario and neurologic examination, with consideration of age, suspected infarct type and underlying risk factors. Acute stroke diagnosis and causes in pediatric age groups can differ significantly from those in adult populations, and delay in stroke diagnosis among children is a common problem. An awareness of pediatric stroke presentations and risk factors among pediatric emergency physicians, neurologists, pediatricians, subspecialists and radiologists is critical to ensuring timely diagnosis. Given special considerations related to unique pediatric stroke risk factors and the need for sedation in some children, expert consensus guidelines for the imaging of suspected pediatric infarct have been proposed. In this article the authors review standard and rapid MRI protocols for the diagnosis of pediatric stroke, as well as the key differences between pediatric and adult stroke imaging.
Collapse
Affiliation(s)
- Susan T Sotardi
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Cesar Augusto P F Alves
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Suraj D Serai
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Lauren A Beslow
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Erin Simon Schwartz
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ralph Magee
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Arastoo Vossough
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
|
8
|
Uchida Y, Kan H, Sakurai K, Oishi K, Matsukawa N. Quantitative susceptibility mapping as an imaging biomarker for Alzheimer’s disease: The expectations and limitations. Front Neurosci 2022; 16:938092. [PMID: 35992906 PMCID: PMC9389285 DOI: 10.3389/fnins.2022.938092] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common type of dementia and a distressing diagnosis for individuals and caregivers. Researchers and clinical trials have mainly focused on β-amyloid plaques, which are hypothesized to be one of the most important factors for neurodegeneration in AD. Meanwhile, recent clinicopathological and radiological studies have shown closer associations of tau pathology rather than β-amyloid pathology with the onset and progression of Alzheimer’s symptoms. Toward a biological definition of biomarker-based research framework for AD, the 2018 National Institute on Aging–Alzheimer’s Association working group has updated the ATN classification system for stratifying disease status in accordance with relevant pathological biomarker profiles, such as cerebral β-amyloid deposition, hyperphosphorylated tau, and neurodegeneration. In addition, altered iron metabolism has been considered to interact with abnormal proteins related to AD pathology thorough generating oxidative stress, as some prior histochemical and histopathological studies supported this iron-mediated pathomechanism. Quantitative susceptibility mapping (QSM) has recently become more popular as a non-invasive magnetic resonance technique to quantify local tissue susceptibility with high spatial resolution, which is sensitive to the presence of iron. The association of cerebral susceptibility values with other pathological biomarkers for AD has been investigated using various QSM techniques; however, direct evidence of these associations remains elusive. In this review, we first briefly describe the principles of QSM. Second, we focus on a large variety of QSM applications, ranging from common applications, such as cerebral iron deposition, to more recent applications, such as the assessment of impaired myelination, quantification of venous oxygen saturation, and measurement of blood– brain barrier function in clinical settings for AD. Third, we mention the relationships among QSM, established biomarkers, and cognitive performance in AD. Finally, we discuss the role of QSM as an imaging biomarker as well as the expectations and limitations of clinically useful diagnostic and therapeutic implications for AD.
Collapse
Affiliation(s)
- Yuto Uchida
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Yuto Uchida,
| | - Hirohito Kan
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Sakurai
- Department of Radiology, National Center for Geriatrics and Gerontology, Ōbu, Japan
| | - Kenichi Oishi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Noriyuki Matsukawa
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Noriyuki Matsukawa,
| |
Collapse
|
|
9
|
Khaladkar SM, Chanabasanavar V, Dhirawani S, Thakker V, Dilip D, Parripati VK. Susceptibility Weighted Imaging: An Effective Auxiliary Sequence That Enhances Insight Into the Imaging of Stroke. Cureus 2022; 14:e24918. [PMID: 35706758 PMCID: PMC9187257 DOI: 10.7759/cureus.24918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/05/2022] Open
|
|
10
|
Oh M, Lee M. Clinical Implications of Prominent Cortical Vessels on Susceptibility-Weighted Imaging in Acute Ischemic Stroke Patients Treated with Recanalization Therapy. Brain Sci 2022; 12:brainsci12020184. [PMID: 35203945 PMCID: PMC8869791 DOI: 10.3390/brainsci12020184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Prominent cortical vessels on susceptibility-weighted imaging (PCV–SWI) correlate with poor leptomeningeal collaterals. However, little is known about PCV–SWI in recanalization therapy-treated patients with anterior circulation large vessel occlusions (LVO). We investigated PCV–SWI-based assessment of leptomeningeal collaterals and outcome predictions in 100 such patients in an observational study. We assessed PCV–SWI using the Alberta Stroke Program Early CT Score and evaluated leptomeningeal collaterals on multiphase CT angiography (mCTA). Predictive abilities were analyzed using multivariable logistic regression and area of receiver operating curves (AUCs). The extent of PCV–SWI correlated with leptomeningeal collaterals on mCTA (Spearman test, r = 0.77; p < 0.001); their presence was associated with worse functional outcomes and a lower successful recanalization rate (adjusted odds ratios = 0.24 and 0.23, 95% CIs = 0.08–0.65 and 0.08–0.65, respectively). The presence of PCV–SWI predicted outcomes better than good collaterals on mCTA did (C-statistic = 0.84 vs. 0.80; 3-month modified Rankin Scale (mRS) 0–2 = 0.75 vs. 0.67 for successful recanalization). Comparison of AUCs showed that they had similar abilities for predicting outcomes (p = 0.68 for 3-month mRS 0–2; p = 0.23 for successful recanalization). These results suggest that PCV–SWI is a useful feature for assessing leptomeningeal collaterals in acute ischemic stroke patients with anterior circulation LVO and predicting outcomes after recanalization therapy.
Collapse
|
|
11
|
Aker L, Abandeh L, Abdelhady M, Aboughalia H, Vattoth S. Susceptibility-weighted Imaging in Neuroradiology: Practical Imaging Principles, Pearls and Pitfalls. Curr Probl Diagn Radiol 2021; 51:568-578. [PMID: 34210556 DOI: 10.1067/j.cpradiol.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/10/2021] [Indexed: 01/13/2023]
Abstract
Susceptibility-weighted imaging (SWI) was one of the recent and helpful advancement in magnetic resonance imaging. Its utilization -provided valuable information for the radiologists in multiple fields, including neuroradiology. SWI was able to demonstrate cerebral paramagnetic and diamagnetic substances. Therefore, the applications of this imaging technique were diverse in research and clinical neuroradiology. This article reviewed the basic technical steps, various clinical applications of SWI, and potential limitations. The practicing radiologist needs to be oriented about using SWI and phase images in the right- and left-handed MRI systems to demonstrate different brain pathologies, including neurovascular diseases, traumatic brain injuries, brain tumors, infectious and inflammatory, and neurodegenerative diseases.
Collapse
Affiliation(s)
- Loai Aker
- Department of Clinical Imaging, Hamad Medical Corporation,Doha,Qatar.
| | - Laith Abandeh
- Department of Radiology, University of Washington, Seattle,WA
| | | | - Hassan Aboughalia
- Radiology Department, Seattle Children's Hospital, University of Washington Medical Center,Seattle,WA
| | - Surjith Vattoth
- Neuroradiology Section, University of Arkansas for Medical Sciences (UAMS),Little Rock,AR
| |
Collapse
|
|
12
|
Kim YW, Choi YY, Park SY, Kim HJ, Kim YS. Prominent hypointense vessel on susceptibility-weighted images accompanying hyperacute and acute large infarction. Jpn J Radiol 2021; 39:681-689. [PMID: 33743148 DOI: 10.1007/s11604-021-01107-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple prominent hypointense vessels on susceptibility-weighted image (SWI) have been found in the ischemic territory of patients with acute ischemic stroke. SWI is suitable for venous imaging. PURPOSE To evaluate the conditions of prominent hypointense vessel (PHV) in hyperacute and acute cerebral infarctions using susceptibility-weighted image (SWI). MATERIALS AND METHODS Magnetic resonance images, including SWI, of 284 patients with acute infarction were evaluated. Based on lesion size, the infarction was classified as a small (< 3 cm) or a large (> 3 cm) infarction. Stage of infarction was classified as hyperacute (< 6 h) or acute (> 6 h, < 1 week) on the basis of the onset of stroke. The site of infarction was categorised as a deep grey matter or a mixed (cortical and/or deep grey matter) infarction. The venous structures were analysed qualitatively for the calibre difference between ipsilateral and contralateral hemispheres. We quantitatively analysed the relationship between the size of areas with PHV on SWI and the abnormalities on MR angiography, apparent diffusion coefficient value, and signal intensity on T2WI in the 271 patients. RESULTS PHV over the infarction site was observed in 54.1% (137/253) of the large infarctions, and 19.3% (6/31) of the small infarctions on SWI. PHV was demonstrated in 63.1% (118/187) of mixed infarctions and 25.8% (25/97) of deep grey matter infarctions, and 59.2% (58/98) in hyperacute and 45.7% (85/186) of acute infarctions. The presence of PHV was statistically significant in the size and region of cerebral infarction (p < 0.05), and was not significant in the stage of infarction (p = 0.137). Quantitative analysis revealed significant differences in the MRA abnormalities and ADC values in the PHV ( +) group (p < 0.05) and no significant difference in the T2WI SI ratio in the PHV ( +) group (p = 0.086), compared with PHV (-) group. CONCLUSION PHV on SWI was more prominent at the portions with the large and mixed infarctions. PHV was observed both in hyperacute and acute infarction.
Collapse
Affiliation(s)
- Yong-Woo Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yoon Young Choi
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Shin Young Park
- Department of Radiology, Medical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Pusan, South Korea
| | - Hak Jin Kim
- Department of Radiology, Medical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Pusan, South Korea.
| | - Yong Sun Kim
- Department of Radiology, College of Medicine, Kyungpook National University, Daeku, South Korea
| |
Collapse
|
|
13
|
Jiang HF, Zhang YQ, Pang JX, Shao PN, Qiu HC, Liu AF, Li C, Jin M, Man FY, Jiang WJ. Factors associated with prominent vessel sign on susceptibility-weighted imaging in acute ischemic stroke. Sci Rep 2021; 11:5641. [PMID: 33707446 PMCID: PMC7952411 DOI: 10.1038/s41598-021-84269-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/09/2021] [Indexed: 02/06/2023] Open
Abstract
The prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) is not displayed in all cases of acute ischemia. We aimed to investigate the factors associated with the presence of PVS in stroke patients. Consecutive ischemic stroke patients admitted within 24 h from symptom onset underwent emergency multimodal MRI at admission. Associated factors for the presence of PVS were analyzed using univariate analyses and multivariable logistic regression analyses. A total of 218 patients were enrolled. The occurrence rate of PVS was 55.5%. Univariate analyses showed significant differences between PVS-positive group and PVS-negative group in age, history of coronary heart disease, baseline NIHSS scores, total cholesterol, hemoglobin, anterior circulation infarct, large vessel occlusion, and cardioembolism. Multivariable logistic regression analyses revealed that the independent factors associated with PVS were anterior circulation infarct (odds ratio [OR] 13.7; 95% confidence interval [CI] 3.5–53.3), large vessel occlusion (OR 123.3; 95% CI 33.7–451.5), and cardioembolism (OR 5.6; 95% CI 2.1–15.3). Anterior circulation infarct, large vessel occlusion, and cardioembolism are independently associated with the presence of PVS on SWI.
Collapse
Affiliation(s)
- Hai-Fei Jiang
- Medical College of Soochow University, Suzhou, 215123, China.,Department of Neurology, Tongzhou People's Hospital, Nantong, 226300, China
| | - Yi-Qun Zhang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Jiang-Xia Pang
- Medical College of Soochow University, Suzhou, 215123, China
| | - Pei-Ning Shao
- Department of Neurology, Tongzhou People's Hospital, Nantong, 226300, China
| | - Han-Cheng Qiu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Ao-Fei Liu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Chen Li
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Min Jin
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Feng-Yuan Man
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China
| | - Wei-Jian Jiang
- Medical College of Soochow University, Suzhou, 215123, China. .,New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, 100088, China.
| |
Collapse
|
|
14
|
Jing L, Sui B, Shen M, Qin H, Gao P. Are prominent medullary veins better than prominent cortical veins as predictors of early clinical outcome in patients with acute ischemic stroke? Diagn Interv Radiol 2021; 27:285-292. [PMID: 33517255 DOI: 10.5152/dir.2021.19644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) can be dichotomized into prominent cortical veins (PCV) and prominent medullary veins (PMV). This study was designed to compare the predictive value of PCV and PMV in the evaluation of the severity of acute ischemic stroke (AIS) in patients within the reperfusion window. METHODS Forty-seven consecutive patients with AIS within the middle cerebral artery territory were recruited. Magnetic resonance imaging was performed within 8 hours of symptom onset and at 7 days after stroke onset. Infarct volume was measured, and the early clinical outcome at 7 days was assessed using the modified Rankin Scale. PVS was dichotomized into cases with both PCV and PMV and cases with only PCV according to location. RESULTS Patients with both PCV and PMV (n=32) had higher admission National Institutes of Health Stroke Scale scores (p = 0.020), larger infarct volumes at baseline (p = 0.026) and 7 days (p = 0.007), and larger infarct growth at 7 days (p = 0.050) than those with PCV only. Multivariate regression analysis showed that both the time of onset at baseline (p = 0.013) and infarct growth at 7 days (p = 0.014) could independently predict poor early clinical outcome. CONCLUSION PMV may predict poor early clinical outcome in AIS patients, and reperfusion therapy may, therefore, be required more urgently in patients with PMV.
Collapse
Affiliation(s)
- Lina Jing
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Mi Shen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | | | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China;Beijing Neurosurgical Institute, Beijing, China
| |
Collapse
|
|
15
|
Asymmetry of medullary veins on multiphase CT-angiography in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2020; 29:105064. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/06/2020] [Accepted: 06/14/2020] [Indexed: 11/20/2022] Open
|
|
16
|
Simultaneous feedback control for joint field and motion correction in brain MRI. Neuroimage 2020; 226:117286. [PMID: 32992003 DOI: 10.1016/j.neuroimage.2020.117286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/21/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022] Open
Abstract
T2*-weighted gradient-echo sequences count among the most widely used techniques in neuroimaging and offer rich magnitude and phase contrast. The susceptibility effects underlying this contrast scale with B0, making T2*-weighted imaging particularly interesting at high field. High field also benefits baseline sensitivity and thus facilitates high-resolution studies. However, enhanced susceptibility effects and high target resolution come with inherent challenges. Relying on long echo times, T2*-weighted imaging not only benefits from enhanced local susceptibility effects but also suffers from increased field fluctuations due to moving body parts and breathing. High resolution, in turn, renders neuroimaging particularly vulnerable to motion of the head. This work reports the implementation and characterization of a system that aims to jointly address these issues. It is based on the simultaneous operation of two control loops, one for field stabilization and one for motion correction. The key challenge with this approach is that the two loops both operate on the magnetic field in the imaging volume and are thus prone to mutual interference and potential instability. This issue is addressed at the levels of sensing, timing, and control parameters. Performance assessment shows the resulting system to be stable and exhibit adequate loop decoupling, precision, and bandwidth. Simultaneous field and motion control is then demonstrated in examples of T2*-weighted in vivo imaging at 7T.
Collapse
|
|
17
|
Kellner-Weldon F, Lehmann VF, Breiding PS, Grunder L, Muri R, Pastore-Wapp M, Bigi S, Wiest R, El-Koussy M, Slavova N. Findings in susceptibility weighted imaging in pediatric patients with migraine with aura. Eur J Paediatr Neurol 2020; 28:221-227. [PMID: 32723685 DOI: 10.1016/j.ejpn.2020.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/08/2020] [Accepted: 05/25/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Migraine with aura (MwA) in pediatric patients is clinically frequent. Clinically complex symptoms need to be differentiated to exclude mimicking conditions. PURPOSE We hypothesize that MwA in children induces abnormalities readily visible in perfusion time to peak (TTP) maps as well as non-enhanced susceptibility weighted magnetic resonance imaging (SWI). MATERIALS AND METHODS Between 2010 and 2018, we retrospectively evaluated symptoms and imaging of consecutive pediatric patients <18 years with MwA. We visually scored abnormalities on SWI and TTP maps in 12 regions of interest on both hemispheres on three axial slices, as normal, slightly, distinctly or severely abnormal. RESULTS 99 patients (69.7% female), mean age 14.07 y (±2.8) were included. Focally increased deoxygenation (FID) in SWI was present in 61.6%. FID on SWI was dominant for the left hemisphere (60.7% vs. 31.1%, (p < .001)), and in 8.2% symmetric. Side of aura symptoms and contralateral hemispheric imaging alterations in patients with FID correlated significantly (p = .002.). 61 of 99 patients had perfusion MR and 59% of these patients showed focal increase of TTP. Age correlated significantly with FID in SWI (r = -.248, p = .013) and increase of TTP in perfusion (r = -.252, p = .05). Focal abnormalities correlated significantly between SWI and TTP maps. Brain regions most often abnormal were the temporal superior, occipital and fronto-parietal regions. CONCLUSIONS This study provides confidence in recognizing FID, and linking FID in SWI to acute MwA in pediatric patients. FID phenomenon had a left hemispheric significant dominance, and can be found bilaterally.
Collapse
Affiliation(s)
- Frauke Kellner-Weldon
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Vera Franziska Lehmann
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Philipe Sebastian Breiding
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Lorenz Grunder
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Raphaela Muri
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Manuela Pastore-Wapp
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sandra Bigi
- Department of Pediatric Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Marwan El-Koussy
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Nedelina Slavova
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| |
Collapse
|
|
18
|
Darwish EAF, Abdelhameed-El-Nouby M, Geneidy E. Mapping the ischemic penumbra and predicting stroke progression in acute ischemic stroke: the overlooked role of susceptibility weighted imaging. Insights Imaging 2020; 11:6. [PMID: 31930428 PMCID: PMC6955386 DOI: 10.1186/s13244-019-0810-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives Asymmetrically prominent veins (APVs) detected on susceptibility weighted imaging (SWI) in acute stroke patients are assumed to signify compromised cerebral perfusion. We aimed to explore the role of APVs in identifying the ischemic penumbra and predicting stroke progression in acute stroke patients Methods Twenty patients with a middle cerebral artery ischemic infarction presenting within 24 h of symptoms onset underwent SWI following our standard MR stroke protocol imaging sequences which included diffusion-weighted imaging (DWI). Follow-up (FUP) FLAIR images were obtained at least 5 days after the initial MRI study. The Alberta Stroke Program Early CT Score (ASPECTS) was used to determine the initial infarct size, extent of APVs and final infarct size on initial DWI, SWI, and FUP images respectively. For each patient, SWI was compared with DWI images to determine match/mismatch of their respective ASPECTS values and calculate mismatch scores, whereas acute DWI findings were compared with follow-up images to identify infarct growth (IG) and calculate infarction growth scores (IGS). Results IG occurred in 6/10 patients with a positive DWI-SWI mismatch and in none of the patients without a positive DWI-SWI mismatch. A positive DWI/SWI mismatch was significantly associated with IG (χ2 = 8.57, p = 0.0138, Cramer’s V = 0.65). A significant inverse correlation was found between SWI ASPECTS and IGS (rs = − 0.702, p = 0.001). DWI-SWI mismatch scores were strongly correlated with IGS. (rs = 0.788, p = 0.000) Conclusion A positive DWI-SWI mismatch is an indicator of the ischemic penumbra and a predictor of infarct expansion if left untreated.
Collapse
Affiliation(s)
- Eman A F Darwish
- Department of Radiology, Faculty of Medicine, Ain Shams University, Abbassiya, Cairo, 11566, Egypt.
| | | | - Eman Geneidy
- Department of Radiology, Faculty of Medicine, Ain Shams University, Abbassiya, Cairo, 11566, Egypt
| |
Collapse
|
|
19
|
Elnekeidy AE, Yehia A, Elfatatry A. Importance of susceptibility weighted imaging (SWI) in management of cerebro-vascular strokes (CVS). ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Abd Elaziz Elnekeidy
- Department of Radio-Diagnosis, Faculty of Medicine, Alexandria University, Egypt
| | - Ahmed Yehia
- Department of Neurosurgery, Faculty of Medicine, Alexandria University, Egypt
| | - Amr Elfatatry
- Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
| |
Collapse
|
|
20
|
Rai SP, Sanyal P, Pai S, Achappa B, Madi D, Mr P. Synergistic role of susceptibility-weighted imaging with diffusion-weighted imaging and magnetic resonance angiography in the evaluation of acute arterial stroke. J Int Med Res 2019; 47:2166-2176. [PMID: 30971155 PMCID: PMC6567791 DOI: 10.1177/0300060519840909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study was performed to investigate whether diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) are more effective than conventional imaging modalities for evaluation of stroke and selection of candidates for thrombolytic therapy. Methods Eighty patients who presented within 12 hours of onset of symptoms of brain ischemia underwent 1.5T magnetic resonance imaging. DWI and SWI were compared with conventional sequences (T1, T2, and fluid-attenuated inversion recovery [FLAIR]) and time-of-flight magnetic resonance angiography (TOF-MRA) to assess factors that affect stroke management and prognosis. Results The volume of brain tissue showing hyperintensity was significantly greater than that showing diffusion restriction in patients with a >6-hour symptom onset. The hypointensity sign (susceptibility sign) on SWI showed a sensitivity of 66.7%, specificity of 87.5%, positive predictive value of 88.9, and negative predictive value of 63.6 compared with TOF-MRA. Micro-hemorrhagic foci were significantly associated with 27-mL infarcts on DWI (sensitivity, 71.4%; specificity, 85.0%). Patients with DWI–SWI mismatch showed better responses to thrombolytics. FLAIR–DWI mismatch helped to assess the time of stroke onset. Conclusion DWI and SWI should be part of the routine imaging protocol in patients with acute stroke and serve as a decision-making tool for selection of patients for thrombolytic therapy.
Collapse
Affiliation(s)
- Santosh Pv Rai
- 1 Department of Radiodiagnosis, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pulastya Sanyal
- 1 Department of Radiodiagnosis, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shivananda Pai
- 2 Department of Neurology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Basavaprabhu Achappa
- 3 Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Deepak Madi
- 3 Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pavan Mr
- 3 Department of Internal Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
|
21
|
Kim P, Langheinrich K, Cristiano B, Grigsby P, Oyoyo U, Kido D, Paul Jacobson J. Low thalamostriate venous quantitative susceptibility measurements correlate with higher presenting NIH stroke scale score in emergent large vessel occlusion stroke. J Int Med Res 2019; 48:300060519832462. [PMID: 30859887 PMCID: PMC7140206 DOI: 10.1177/0300060519832462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective Hyperacute stroke affects various patient subgroups who may benefit from
different management strategies. Magnetic resonance imaging (MRI)
quantitative susceptibility mapping (QSM) is a recent MRI technique for
measuring deoxyhemoglobin levels. The results of QSM thus have the potential
to act as a quantitative biomarker for predicting the success of
endovascular interventions. Methods Twenty-five patients with M1 occlusions were evaluated retrospectively. QSM
measurements were obtained based on susceptibility-weighted imaging
sequences from the most prominent veins in each of the four standard regions
of interest: the cortical and thalamostriate veins ipsilateral and
contralateral to the side of the stroke. The results were analyzed using
Wilcoxon’s signed rank test and compared with presenting National Institutes
of Health stroke scale (NIHSS) score. Results Cortical veins ipsilateral to the stroke showed the greatest elevation in
susceptibility compared with all other vein groups. Both ipsilateral and
contralateral thalamostriate vein susceptibilities showed strong inverse
correlation with presenting NIHSS score. Conclusion Thalamostriate vein susceptibility shows a strong inverse correlation with
presenting NIHSS in adult patients with hyperacute stroke who are selected
for endovascular intervention by advanced imaging.
Collapse
Affiliation(s)
- Paggie Kim
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Brian Cristiano
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Phillip Grigsby
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Udo Oyoyo
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Daniel Kido
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - J Paul Jacobson
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| |
Collapse
|
|
22
|
Weiqiang Q, Tikun S, Qiongqiong Q, Jinge Z, Chunchao X, Yi L, Chao Y. Asymmetric Cortical Vessel Sign Indicates Hemodynamic Deficits in Adult Patients with Moyamoya Disease. World Neurosurg 2019; 127:e137-e141. [PMID: 30862600 DOI: 10.1016/j.wneu.2019.02.187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 02/05/2023]
Abstract
BACKGOUND Asymmetric cortical vessel sign (ACVS) on susceptibility-weighted imaging (SWI) indicates elevated concentration of deoxyhemoglobin and elevated oxygen extraction fraction in patients with cerebral ischemia. This study aimed to clarify whether ACVS is associated with impaired hemodynamics and hyperperfusion syndrome in patients with moyamoya disease (MMD). METHODS Consecutive adult patients with MMD were enrolled. ACVS data on SWI and perfusion data using dynamic perfusion computed tomography were obtained and evaluated preoperatively and on postoperative days 2 and 180. RESULTS A total of 24 patients with MMD were enrolled. Of 11 (45.83%) patients showing positive ACVS before surgery, 8 turned negative on postoperative day 2 and 9 showed absence of ACVS 180 days after surgery. Regions of interest showing positive ACVS had lower cerebral blood flow (CBF, P<0.001), increased cerebral blood volume (P = 0.021), prolonged time to peak (P<0.001), and mean transit time (P = 0.009). No patients with hemorrhagic symptoms showed positive ACVS(P = 0.041) and patients with positive ACVS showed more increase in CBF (P<0.004). CONCLUSIONS In patients with MMD, ACVS on SWI indicates severe impairment in hemodynamics and is associated with more increase in CBF after bypass surgery. Hence, ACVS on SWI might be considered as a neuroimaging marker for the evaluation of hemodynamics in patients with MMD.
Collapse
Affiliation(s)
- Qian Weiqiang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, P.R. China
| | - Shan Tikun
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, P.R. China
| | - Qiu Qiongqiong
- Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhang Jinge
- Department of Radiology, West China Hospital of Sichuan University, Sichuan, P.R. China
| | - Xia Chunchao
- Department of Radiology, West China Hospital of Sichuan University, Sichuan, P.R. China
| | - Liu Yi
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, P.R. China.
| | - You Chao
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, P.R. China
| |
Collapse
|
|
23
|
Superficial Siderosis of the Central Nervous System: Neurotological Findings Related to Magnetic Resonance Imaging. Otol Neurotol 2018; 40:31-37. [PMID: 30516591 DOI: 10.1097/mao.0000000000002071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the neurotological results of five patients suffering from progressive hearing loss and ataxia due to superficial siderosis (SS) with the magnetic resonance imaging (MRI) findings. STUDY DESIGN Retrospective case review. SETTING Primary and hospital care center. PARTICIPANTS Five adult patients with neurotological symptoms of SS underwent MRI with acquisition of our temporal bone protocol including 3D-constructive interference in steady state (3D-CISS) and susceptibility-weighted imaging (SWI). All patients underwent a complete neurotological examination, the results of which were compared with the imaging findings. MAIN OUTCOME MEASURES Cochleovestibular deficits were present in all five patients as determined by uni- or bilateral bithermal caloric testing and/or video head impulse tests. Sacculocollic reflex was present with increased P1 and N1 latencies on both sides in all patients. MRI revealed an extensive hypointense SWI signal outlining the surface of the brain and the VIIIth cranial nerve in all five patients. Desynchronization of the brainstem auditory evoked potentials (BAEP) and partial or complete absence of the visual suppression of vestibulo-ocular reflex during the pendular rotatory test was particularly consistent with the lesions of the cochleovestibular nerves as well as the cerebellar atrophy seen on MRI. CONCLUSION The MRI results with SWI were related to neurotological findings in patients suffering from sensorineural deafness with ataxia due to SS. Our findings support the integration of the SWI and 3D-CISS sequences into the MRI protocol for all patients referred for evaluation of the extent of SS.
Collapse
|
|
24
|
Significance of hyperintense arteries on Gd-enhanced 3D T1W black-blood imaging in acute stroke. Eur Radiol 2018; 29:1329-1337. [PMID: 30088068 DOI: 10.1007/s00330-018-5669-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/18/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To elucidate the pathogenesis of hyperintense arteries on Gd-enhanced 3D T1W BB FSE and their clinical significance in acute middle cerebral artery (MCA) stroke. METHODS We retrospectively reviewed 20 patients with MCA infarction. We measured the contrast-to-noise ratio between hyperintense artery and adjacent grey matter on T2-FLAIR and Gd-enhanced 3D T1W BB FSE and compared them by using Student's t test. The agreement of positive hyperintense artery between T2 FLAIR and Gd-enhanced 3D T1WI BB FSE was estimated with intraclass correlation coefficient. Our cohort was dichotomised into two groups depending on hyperintense artery scores, and clinical data were compared between two groups by using Student's t test and chi-square test. RESULTS The contrast between hyperintense artery and grey matter on Gd-enhanced 3D T1W BB FSE was significantly higher than that on T2-FLAIR (2.27 ± 1.65 versus 0.94 ± 0.86, p = 0.01). Overall, agreement of hyperintense arteries on T2-FLAIR and Gd-enhanced 3D T1W BB FSE was excellent (ρ = 0.76, p < 0.01). Patients with higher hyperintense artery scores had higher perfusion deficits that those with lower hyperintense artery scores (196.7 ± 41.4 vs 100.1 ± 130.1, p = 0.03). CONCLUSION Hyperintense arteries on Gd-enhanced 3D T1W BB FSE in acute MCA stroke may be associated with slow collateral flows. Their territories corresponded to those of FLAIR, but had a better contrast. The patients with hyperintense arteries in a wider territory showed larger perfusion deficit than those with hyperintense arteries in a narrower territory. KEY POINTS • Hyperintense arteries on Gd-enhanced 3D T1W BB FSE are slow collateral flows. • Hyperintense arteries on Gd-enhanced 3D T1W BB FSE are well matched with FLAIR hyperintense vessels. • Hyperintense arteries are associated with perfusion deficit in stroke patients.
Collapse
|
|
25
|
Do WJ, Choi SH, Park SH. Simultaneous Variable-Slab Dual-Echo TOF MR Angiography and Susceptibility-Weighted Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:1632-1640. [PMID: 29969414 DOI: 10.1109/tmi.2018.2789923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this paper, we propose a new 3-D dual-echo method for simultaneous multislab time-of-flight MR angiography (TOF MRA) and single-slab susceptibility-weighted imaging (SWI). The previous echo-specific k-space reordering scheme for compatible dual-echo arteriovenography (CODEA) was advanced to applying excitation RF pulses for multiple thin slabs and a single thick slab to the first (TOF MRA) and second (SWI) echoes, respectively. Single-slab CODEA and multislab CODEA (fixed-slab CODEAs) were additionally acquired as comparison reference to the proposed variable-slab CODEA. Parallel imaging was also tested for feasibility of accelerating the proposed method. TOF MRA and SWI from the proposed variable-slab CODEA were visually and quantitatively comparable to multislab TOF MRA and single-slab SWI, respectively, separately acquired from the fixed-slab CODEAs. The parallel imaging reduced the scan time from 10.3 to 5.6 min. Furthermore, the proposed variable-slab approach improved the vessel continuities at slab boundaries of TOF MRA for CODEA as well as for the conventional single echo method. The proposed variable-slab CODEA provided multislab TOF MRA and single-slab SWI simultaneously in a clinically reasonable scan time of ~5 min with minimal impact on image qualities, while suppressing slab boundary artifacts in TOF MRA.
Collapse
|
|
26
|
Li L, Liu MS, Li GQ, Zheng Y, Guo TL, Kang X, Yuan MT. Susceptibility-weighted Imaging in Thrombolytic Therapy of Acute Ischemic Stroke. Chin Med J (Engl) 2018; 130:2489-2497. [PMID: 29052571 PMCID: PMC5684633 DOI: 10.4103/0366-6999.216401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: To provide a comprehensive and latest overview of susceptibility-weighted imaging (SWI) in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical value of SWI on identifying stroke patients suitable for thrombolytic therapy and possible benefits and risks followed. Data Sources: Literatures referred to this review were collected from PubMed, Medline, and EMBASE published till May 2017, using the search terms including susceptibility-weighted imaging, gradient-echo, T2*, thrombolysis, recombinant tissue plasminogen activator (rt-PA), thrombolytic therapy, and stroke. Study Selection: Papers in English or with available English abstracts were considered, with no limitation of study design. References were also identified from the bibliographies of identified articles and the authors’ files. Results: SWI is of guiding significance for thrombolytic therapy in stroke patients, it can predict the location and length of thrombus and ischemic penumbra. It is worthy of noting that susceptibility vessel sign (SVS) on SWI can be used to predict recanalization after thrombolytic therapy and whether it is better to implement endovascular thrombolectomy in combination or alone. SWI is sensitive in detecting cerebral microbleed (CMB), and CMB might not be a contraindication for thrombolytic therapy, yet CMBs in multiple foci could possibly be related to intracranial hemorrhage (ICH) after thrombolysis. SVS and CMB on SWI sequence are of instructive value in performing antiplatelet therapy after thrombolytic therapy. Cerebral venous change on SWI is related to lower recanalization rate and poor outcome after thrombolysis. Conclusions: It seems that SWI can be applied to guide individualized thrombolytic therapies and assist clinicians in making better decisions by weighing benefits and risks. However, there still exist controversies about the relationship between signs on SWI and thrombolytic therapy.
Collapse
Affiliation(s)
- Lin Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Ming-Su Liu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Guang-Qin Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Yang Zheng
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Tong-Li Guo
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Xin Kang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Mao-Ting Yuan
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| |
Collapse
|
|
27
|
Halefoglu AM, Yousem DM. Susceptibility weighted imaging: Clinical applications and future directions. World J Radiol 2018; 10:30-45. [PMID: 29849962 PMCID: PMC5971274 DOI: 10.4329/wjr.v10.i4.30] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 04/08/2018] [Accepted: 04/20/2018] [Indexed: 02/06/2023] Open
Abstract
Susceptibility weighted imaging (SWI) is a recently developed magnetic resonance imaging (MRI) technique that is increasingly being used to narrow the differential diagnosis of many neurologic disorders. It exploits the magnetic susceptibility differences of various compounds including deoxygenated blood, blood products, iron and calcium, thus enabling a new source of contrast in MR. In this review, we illustrate its basic clinical applications in neuroimaging. SWI is based on a fully velocity-compensated, high-resolution, three dimensional gradient-echo sequence using magnitude and phase images either separately or in combination with each other, in order to characterize brain tissue. SWI is particularly useful in the setting of trauma and acute neurologic presentations suggestive of stroke, but can also characterize occult low-flow vascular malformations, cerebral microbleeds, intracranial calcifications, neurodegenerative diseases and brain tumors. Furthermore, advanced MRI post-processing technique with quantitative susceptibility mapping, enables detailed anatomical differentiation based on quantification of brain iron from SWI raw data.
Collapse
Affiliation(s)
- Ahmet Mesrur Halefoglu
- Department of Radiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul 34371, Turkey
| | - David Mark Yousem
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Institution, Baltimore, MI 21287, United States
| |
Collapse
|
|
28
|
Luo S, Yang L, Luo Y. Susceptibility-weighted imaging predicts infarct size and early-stage clinical prognosis in acute ischemic stroke. Neurol Sci 2018; 39:1049-1055. [PMID: 29557515 DOI: 10.1007/s10072-018-3324-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/13/2018] [Indexed: 11/30/2022]
Abstract
Susceptibility-weighted imaging (SWI) is a non-invasive technique that can reveal venous structures and iron in the brain. This retrospective study evaluated SWI, relative to other imaging techniques, for determining cerebral infarct size and early-stage clinical prognosis in patients with acute ischemic stroke. Within 3 days after onset, 22 patients with acute ischemic stroke underwent SWI, diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), fluid-attenuated inversion recovery (FLAIR), and magnetic resonance angiography (MRA). At least 7 days after onset, the patients also underwent cranial FLAIR or computed tomography (CT). The severity of neurological damage was adjudged with NIHSS (National Institutes of Health Stroke Scale) scores. The imaged cranial lesions were evaluated according to ASPECTS (Alberta Stroke Program Early CT Score). The SWI-ASPECTS significantly correlated with mean transit time (MTT)-ASPECTS (Spearman's test, r = 0.662, P = 0.001) in evaluating ischemic penumbra and significantly correlated with the FLAIR and CT-ASPECTS (Spearman's test, r = 0.765, P < 0.001) in predicting infarct size. SWI is feasible for the early evaluation of cerebral infarct size and clinical prognosis of patients with acute cerebral infarction. SWI is a useful predictor of early infarct growth and early-stage outcome.
Collapse
Affiliation(s)
- Song Luo
- Department of Neurology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China.
| | - Lijuan Yang
- Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Yanfei Luo
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| |
Collapse
|
|
29
|
Jang W, Kwak HS, Chung GH, Hwang SB. Three-dimensional black-blood contrast-enhanced MRI improves detection of intraluminal thrombi in patients with acute ischaemic stroke. Eur Radiol 2018; 28:3840-3847. [DOI: 10.1007/s00330-018-5323-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 10/17/2022]
|
|
30
|
Abstract
OBJECTIVES The aim of this prospective study is to investigate the central nervous system involvement in Crimean-Congo haemorrhagic fever (CCHF) with magnetic resonance imaging (MRI) in conjunction with clinical and laboratory findings. METHODS Between July 2015 and August 2016, 36 patients with CCHF were undergone brain MRI including SWI. Two MRIs, one at the time of admission and the second in the convalescent period, were performed for each patient in order to see if there is any sign of central nervous system (CNS) involvement, especially in terms of intracranial haemorrhage or viral encephalitis. Clinical severity scoring was also done and laboratory findings were noted in order to correlate with clinical and imaging findings. RESULTS None of the 36 patients showed any MRI findings of an acute intracranial event during the course of the disease. There was a significant difference between mild cases and moderate cases in terms of some laboratory parameters (p < 0.05). CONCLUSIONS Although CCHF is a highly lethal disease which involves multiple organs and systems, CNS involvement seems to be extremely rare in mild and moderate cases. KEY POINTS • MRI is the imaging method of choice to diagnose microbleeds and encephalitis • Although CCHF causes multisystem bleeding, intracranial haemorrhage seems to be very rare • CNS complications are uncommon, even in the setting of suggestive symptoms • Death usually results from extracranial bleeding and multiorgan failure • Severity scoring is associated with some laboratory abnormalities in CCHF.
Collapse
|
|
31
|
Yuan T, Ren G, Quan G, Gao D. Fewer peripheral asymmetrical cortical veins is a predictor of favorable outcome in MCA infarctions with SWI-DWI mismatch. J Magn Reson Imaging 2018; 48:964-970. [PMID: 29424126 DOI: 10.1002/jmri.25965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/20/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Outcome prediction of asymmetrical prominent cortical veins (APCVs) on infarction is still debated and may help in selecting patients for reperfusion treatment. PURPOSE To explore the relationship between fewer peripheral APCVs and the outcome in the patients of acute/subacute middle cerebral artery (MCA) infarctions as well as the relationship between this sign and stenosis of ipsilateral MCA. STUDY TYPE Retrospective case-control study. POPULATION We enrolled 41 patients with MCA acute/subacute infarction. Compared to the low sign of cortical veins of contralateral hemisphere on susceptibility-weighted imaging (SWI), these patients were divided into fewer (n = 28) and prominent APCVs (n = 13) groups. FIELD STRENGTH/SEQUENCE 3.0T conventional stroke sequences, including T1 -weighted imaging, T2 -weighted imaging, fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI) (b = 0 and 1000 s/mm2 ), MR angiography (MRA), and SWI. ASSESSMENT We explored the relationships between fewer peripheral APCVs sign and clinical outcome, as well as the relationship between this sign and the degree of ipsilateral MCA stenosis. STATISTICAL TESTS Fisher's exact analysis, logistical regression, as well as Cohen's kappa coefficient were used for statistical analysis. RESULTS Fewer and prominent peripheral APCVs were detected in 28 (56.10%) and 13 (43.90%) patients. In 28 patients with fewer peripheral APCVs, 23 patients (82.14%) had a favorable outcome (modified Rankin Scale [mRS] ≤2), and five patients (17.76%) had an unfavorable outcome (mRS >2) (P = 0.010). In terms of MCA stenosis, the rate of normal and mild to moderate stenosis of MCA in the fewer APCVs group (82.14%) was higher than that in the prominent APCVs group (23.08%) (P < 0.001). More severe stenosis of ipsilateral MCA was found in patients with prominent APCVs group (76.92%) than that of fewer APCVs group (17.86%). The peripheral APCVs was positively correlated with the degree of MCA stenosis (r = 0.538, P < 0.001). DATA CONCLUSION Fewer peripheral APCVs may suggest a favorable outcome in unilateral MCA infarction. The patency of ipsilateral MCA may correlate to fewer APCVs and favorable outcome. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;48:964-970.
Collapse
Affiliation(s)
- Tao Yuan
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guoli Ren
- Department of Medical Imaging, Liaocheng Pepople's Hospital, Liaocheng, China
| | - Guanmin Quan
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Duo Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
|
32
|
Verma RK, Keller D, Grunt S, Bigi S, Weisstanner C, Wiest R, Gralla J, Hutter D, Wagner B. Decreased oxygen saturation levels in neonates with transposition of great arteries: Impact on appearance of cerebral veins in susceptibility-weighted imaging. Sci Rep 2017; 7:15471. [PMID: 29133891 PMCID: PMC5684390 DOI: 10.1038/s41598-017-15591-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/27/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose of this study was to investigate a potential correlation between the pattern of cerebral veins (CV) on susceptibility-weighted imaging (SWI) and blood oxygen saturation, as well as preoperative brain injury, in neonates with transposition of the great arteries (TGA). Eleven neonates with TGA underwent MRI preoperatively, including SWI, T1- and T2-weighted scans. Images were retrospectively evaluated and appearance of CV was graded from 0 (normal appearance) to 3 (severe prominent appearance). White matter injuries (WMI) and strokes were analysed. Results were correlated with preductal arterial oxygen saturation. As findings one subject showed a normal CV appearance (grade 0) whereas 10 showed pathological prominent CV (grades 1–3); median 2. Mean oxygen saturation ranged between 67.5% and 89.0% (median 81.0%). CV grade and mean oxygen saturation correlated significantly (p = 0.011). WMI were absent in 5 cases, mild in 4, and moderate in 2 cases. We conclude, that SWI has the potential to be used to estimate the current hypoxic burden on brain tissue in TGA newborns by assessing the prominence of the CV.
Collapse
Affiliation(s)
- Rajeev Kumar Verma
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland. .,Institute of Radiology and Neuroradiology, Tiefenau Hospital, Division Stadt, Inselgroup, Bern, Switzerland.
| | - Desislava Keller
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Sebastian Grunt
- University Department of Pediatrics, Division of Pediatric Neurology, Development and Rehabilitation, Inselspital, University of Bern, Bern, Switzerland
| | - Sandra Bigi
- University Department of Pediatrics, Division of Pediatric Neurology, Development and Rehabilitation, Inselspital, University of Bern, Bern, Switzerland
| | - Christian Weisstanner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Damian Hutter
- University Department of Pediatrics, Division of Pediatric Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Bendicht Wagner
- University Department of Pediatrics, Division of Pediatric Intensive Care Medicine, Inselspital Bern, University of Bern, Bern, Switzerland
| |
Collapse
|
|
33
|
Yedavalli V, Sammet S. Contrast Extravasation versus Hemorrhage after Thrombectomy in Patients with Acute Stroke. J Neuroimaging 2017; 27:570-576. [PMID: 28514045 PMCID: PMC5665701 DOI: 10.1111/jon.12446] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Intra-arterial recanalization postprocedural imaging in stroke patients can result in diagnostic complications due to hyperdensities on noncontrast computed tomography (CT), which may represent either contrast extravasation or intracranial hemorrhage. If these lesions are hemorrhage, then they are risk factors becoming symptomatic, which, if not distinguished, can alter clinical management. We investigate the effects of iodinated contrast on postprocedural magnetic resonance imaging (MRI) and prevalence of equivocal imaging interpretations of postprocedural extravasated contrast versus hemorrhage while identifying protocol pitfalls. METHODS We identified 10 patients diagnosed with ischemic stroke who underwent intra-arterial recanalization in a 5-year period. These patients demonstrated a hyperdensity on a postprocedural CT within 24 hours, underwent an MRI within 48 hours, and an additional confirmatory noncontrast CT at least 72 hours postprocedure. RESULTS Postprocedural MRI in all 10 stroke patients demonstrated T1 - and T2 -relaxation time changes due to residual iodine contrast agents. This lead to false positive postprocedural hemorrhage MRI interpretations in 2/10 patients, 3/10 false negative interpretations of contrast extravasation, and 5/10 equivocal interpretations suggesting extravasation or hemorrhage. Of these five cases, two were performed with gadolinium. CONCLUSION MRI done within 48 hours postprocedure can lead to false positive hemorrhage or false negative contrast extravasation interpretations in stroke patients possibly due to effects from the administered angiographic contrast. Additionally, MRI should be done both after 72 hours for confirmation and without gadolinium contrast as the effects of the gadolinium contrast and residual angiographic contrast could lead to misdiagnosis.
Collapse
Affiliation(s)
- Vivek Yedavalli
- Department of Diagnostic Radiology, Advocate Illinois Masonic Medical Center, Chicago, IL
- Department of Radiology, University of Chicago, Chicago, IL
| | - Steffen Sammet
- Department of Radiology, University of Chicago, Chicago, IL
| |
Collapse
|
|
34
|
Yu J, Wang L, Li Z, Wang S, Wang G. Related Factors of Asymmetrical Vein Sign in Acute Middle Cerebral Artery Stroke and Correlation with Clinical Outcome. J Stroke Cerebrovasc Dis 2017. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
|
35
|
Removal of Arterial Vessel Contributions in Susceptibility-Weighted Images for Quantification of Normalized Visible Venous Volume in Children with Sickle Cell Disease. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:5369385. [PMID: 29065618 PMCID: PMC5592388 DOI: 10.1155/2017/5369385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 07/25/2017] [Accepted: 08/13/2017] [Indexed: 11/26/2022]
Abstract
Purpose To evaluate a new postprocessing framework that eliminates arterial vessel signal contributions in the quantification of normalized visible venous volume (NVVV, a ratio between venous and brain volume) in susceptibility-weighted imaging (SWI) exams in patients with sickle cell disease (SCD). Materials and Methods We conducted a retrospective study and qualitatively reviewed for hypointense arterial vessel contamination in SWI exams from 21 children with SCD. We developed a postprocessing framework using magnetic resonance angiography in combination with SWI to provide a more accurate quantification of NVVV. NVVV was calculated before and after removing arterial vessel contributions to determine the error from hypointense arterial vessels in quantifying NVVV. Results Hypointense arterial vessel contamination was observed in 86% SWI exams and was successfully corrected by the proposed method. The contributions of hypointense arterial vessels in the original SWI were significant and accounted for approximately 33% of the NVVV [uncorrected NVVV = 0.012 ± 0.005 versus corrected NVVV = 0.008 ± 0.003 (mean ± SD), P < 0.01]. Conclusion Hypointense arterial vessel contamination occurred in the majority of SWI exams and led to a sizeable overestimation of the visible venous volume. A prospective longitudinal study is needed to evaluate if quantitation of NVVV was improved and to assess the role of NVVV as a biomarker of SCD severity or stroke risk.
Collapse
|
|
36
|
Payabvash S, Taleb S, Benson JC, Hoffman B, Oswood MC, McKinney AM, Rykken JB. Susceptibility-diffusion mismatch in middle cerebral artery territory acute ischemic stroke: clinical and imaging implications. Acta Radiol 2017; 58:876-882. [PMID: 27799573 DOI: 10.1177/0284185116675658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recent studies have suggested a correlation between susceptibility-diffusion mismatch and perfusion-diffusion mismatch in acute ischemic stroke patients. Purpose To determine the clinical and imaging associations of susceptibility-diffusion mismatch in patients with acute ischemic stroke in the middle cerebral artery (MCA) territory. Material and Methods Consecutive patients with MCA territory acute ischemic stroke, who had magnetic resonance imaging (MRI) performed with susceptibility-weighted imaging (SWI) and diffusion-weighted imaging (DWI) within 24 h of symptom onset or time last-seen-well, were included. Two neuroradiologists reviewed SWI scans for SWI-DWI mismatch defined by regionally increased vessel number or diameter on SWI extending beyond the DWI hyperintensity territory in the affected hemisphere. The stroke severity at admission was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Poor clinical outcome was defined by a 3-month modified Rankin Scale (mRS) score >2. Results The SWI-DWI mismatch was identified in 44 (29.3%) of 150 patients included in this study. Patients with SWI-DWI mismatch had smaller admission infarct volumes (31.2 ± 44.7 versus 55.9 ± 117.7 mL, P = 0.045) and were younger (60.4 ± 18.9 versus 67.1 ± 15.5, P = 0.026). After correction for age, admission NIHSS score, and infarct volume, the SWI-DWI mismatch was associated with a 22.6% lower rate of poor clinical outcome using propensity score matching ( P = 0.032). In our cohort, thrombolytic therapy showed no significant effect on outcome. Conclusion The presence of SWI-DWI mismatch in acute MCA territory ischemic infarct is associated with smaller infarct volume. Moreover, SWI-DWI mismatch was associated with better outcome after correction for infarct size, severity of admission symptoms, and age.
Collapse
Affiliation(s)
| | - Shayandokht Taleb
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - John C Benson
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Hoffman
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mark C Oswood
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Alexander M McKinney
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jeffrey B Rykken
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
|
37
|
Park MG, Yeom JA, Baik SK, Park KP. Total mismatch of diffusion-weighted imaging and susceptibility-weighted imaging in patients with acute cerebral ischemia. J Neuroradiol 2017; 44:308-312. [PMID: 28579039 DOI: 10.1016/j.neurad.2017.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/21/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Multiple hypointense vessels (MHV) on susceptibility-weighted imaging (SWI) is associated with an increased oxygen demand in acute cerebral ischemia. Occasionally, some patients exhibit extensive MHV on SWI despite of negative diffusion-weighted imaging (DWI), which is a phenomenon called total mismatch DWI-SWI. We analyzed the clinical characteristics and imaging findings in patients with the total DWI-SWI mismatch. MATERIALS AND METHODS We selected patients with total DWI-SWI mismatch who underwent MRI within 12hours from onset. To evaluate the degree of collateral flow, we graded vessels on post-contrast time-of-flight MR angiography as 3 groups. Perfusion lesion volume was measured using threshold of>6seconds of mean transit time on perfusion-weighted imaging. RESULTS Total DWI-SWI mismatch was found in 10 (2.7%) out of 370 patients. Four out of 10 patients were excluded due to lack of data on perfusion studies. Hence 6 patients were finally selected in the study. Two patients with internal carotid artery dissection were treated with emergent stenting, one patient with intravenous thrombolysis and mechanical thrombectomy, and two patients with drug-induced hypertension. All of the enrolled patients exhibited extensive MHV on SWI and good collateral flows. The mean perfusion lesion volume was 72.6±15.3ml (range 0-325.0ml). Clinical outcome was favorable in all of the patients (mRS at 3 months, 0). CONCLUSIONS Our results demonstrate that total mismatch of DWI-SWI is associated with good collateral flow and may be a predictor of good response to treatment in patients with acute cerebral ischemia.
Collapse
Affiliation(s)
- Min-Gyu Park
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, 20 Geumo-ro, Mulgeum, 50612 Yangsan, Republic of Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Seung Kug Baik
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Kyung-Pil Park
- Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, 20 Geumo-ro, Mulgeum, 50612 Yangsan, Republic of Korea.
| |
Collapse
|
|
38
|
Dempfle AK, Harloff A, Schuchardt F, Bäuerle J, Yang S, Urbach H, Egger K. Longitudinal Volume Quantification of Deep Medullary Veins in Patients with Cerebral Venous Sinus Thrombosis. Clin Neuroradiol 2017; 28:493-499. [DOI: 10.1007/s00062-017-0602-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/22/2017] [Indexed: 12/17/2022]
|
|
39
|
Ma X, Bai Y, Lin Y, Hong X, Liu T, Ma L, Haacke EM, Zhou J, Wang J, Wang M. Amide proton transfer magnetic resonance imaging in detecting intracranial hemorrhage at different stages: a comparative study with susceptibility weighted imaging. Sci Rep 2017; 7:45696. [PMID: 28374764 PMCID: PMC5379544 DOI: 10.1038/srep45696] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 03/03/2017] [Indexed: 02/08/2023] Open
Abstract
Amide proton transfer (APT) imaging is a noninvasive molecular magnetic resonance imaging (MRI) technique based on the chemical exchange-dependent saturation transfer mechanism. The purpose of this study was to investigate the diagnostic performance of APT MRI in detecting intracranial hemorrhage (ICH) at hyperacute, acute and subacute stages by comparing with susceptibility weighted imaging (SWI). APT MRI and SWI were performed on 33 included patients with ICH by using a 3-T MRI unit. A two-sided Mann-Whitney U test was used to detect differences in APT-weighted (APTw) and SWI signal intensities of ICH at hyperacute, acute and subacute stages. Receiver operating characteristic analysis was used to assess the diagnostic utilities of APT MRI and SWI. Our results showed that APT MRI could detect ICH at hyperacute, acute and subacute stages. Therefore, APTw signal intensity may serve as a reliable, noninvasive imaging biomarker for detecting ICH at hyperacute, acute and subacute stages. Moreover, APT MRI could provide additional information for the ICH compared with SWI.
Collapse
Affiliation(s)
- Xiaoyue Ma
- Department of Radiology, Zhengzhou University People's Hospital &Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yan Bai
- Department of Radiology, Zhengzhou University People's Hospital &Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yusong Lin
- Cooperative Innovation Center of Internet Healthcare &School of Software and Applied Technology, Zhengzhou, Henan, China
| | - Xiaohua Hong
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Taiyuan Liu
- Department of Radiology, Zhengzhou University People's Hospital &Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Lun Ma
- Department of Radiology, Zhengzhou University People's Hospital &Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - E Mark Haacke
- Department of Radiology, Wayne State University, Detroit, Michigan, USA
| | - Jinyuan Zhou
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jian Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meiyun Wang
- Department of Radiology, Zhengzhou University People's Hospital &Henan Provincial People's Hospital, Zhengzhou, Henan, China
| |
Collapse
|
|
40
|
Dlamini N, Wintermark M, Fullerton H, Strother S, Lee W, Bjornson B, Guilliams KP, Miller S, Kirton A, Filippi CG, Linds A, Askalan R, deVeber G. Harnessing Neuroimaging Capability in Pediatric Stroke: Proceedings of the Stroke Imaging Laboratory for Children Workshop. Pediatr Neurol 2017; 69:3-10. [PMID: 28259513 DOI: 10.1016/j.pediatrneurol.2017.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 12/22/2022]
Abstract
On June 5, 2015 the International Pediatric Stroke Study and the Stroke Imaging Laboratory for Children cohosted a unique workshop focused on developing neuroimaging research in pediatric stroke. Pediatric neurologists, neuroradiologists, interventional neuroradiologists, physicists, nurse practitioners, neuropsychologists, and imaging research scientists from around the world attended this one-day meeting. Our objectives were to (1) establish a group of experts to collaborate in advancing pediatric neuroimaging for stroke, (2) develop consensus clinical and research magnetic resonance imaging protocols for pediatric stroke patients, and (3) develop imaging-based research strategies in pediatric ischemic stroke. This article provides a summary of the meeting proceedings focusing on identified challenges and solutions and outcomes from the meeting. Further details on the workshop contents and outcomes are provided in three additional articles in the current issue of Pediatric Neurology.
Collapse
Affiliation(s)
- Nomazulu Dlamini
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Max Wintermark
- Division of Neuroradiology, Department of Radiology, Stanford University, Stanford, California
| | - Heather Fullerton
- Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Stephen Strother
- Department of Medical Biophysics, Rotman Research Institute at Baycrest, University of Toronto, Toronto, Ontario, Canada
| | - Wayne Lee
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Bjornson
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kristin P Guilliams
- Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri; Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Steven Miller
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Kirton
- Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher G Filippi
- Department of Radiology, Northwell Health, Manhasset, New York; Department of Neurology, University of Vermont Medical Center, Burlington, Vermont
| | - Alexandra Linds
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rand Askalan
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gabrielle deVeber
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
|
41
|
Liu S, Buch S, Chen Y, Choi HS, Dai Y, Habib C, Hu J, Jung JY, Luo Y, Utriainen D, Wang M, Wu D, Xia S, Haacke EM. Susceptibility-weighted imaging: current status and future directions. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3552. [PMID: 27192086 PMCID: PMC5116013 DOI: 10.1002/nbm.3552] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 05/14/2023]
Abstract
Susceptibility-weighted imaging (SWI) is a method that uses the intrinsic nature of local magnetic fields to enhance image contrast in order to improve the visibility of various susceptibility sources and to facilitate diagnostic interpretation. It is also the precursor to the concept of the use of phase for quantitative susceptibility mapping (QSM). Nowadays, SWI has become a widely used clinical tool to image deoxyhemoglobin in veins, iron deposition in the brain, hemorrhages, microbleeds and calcification. In this article, we review the basics of SWI, including data acquisition, data reconstruction and post-processing. In particular, the source of cusp artifacts in phase images is investigated in detail and an improved multi-channel phase data combination algorithm is provided. In addition, we show a few clinical applications of SWI for the imaging of stroke, traumatic brain injury, carotid vessel wall, siderotic nodules in cirrhotic liver, prostate cancer, prostatic calcification, spinal cord injury and intervertebral disc degeneration. As the clinical applications of SWI continue to expand both in and outside the brain, the improvement of SWI in conjunction with QSM is an important future direction of this technology. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Saifeng Liu
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
| | - Sagar Buch
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
| | - Yongsheng Chen
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Hyun-Seok Choi
- Department of Radiology, St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yongming Dai
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
| | - Charbel Habib
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Joon-Yong Jung
- Department of Radiology, St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yu Luo
- Department of Radiology, the Branch of Shanghai First Hospital, Shanghai, China
| | - David Utriainen
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - E. Mark Haacke
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
- Department of Radiology, Wayne State University, Detroit, MI, US
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
- Address correspondence to: E. Mark Haacke, Ph.D., 3990 John R Street, MRI Concourse, Detroit, MI 48201. 313-745-1395,
| |
Collapse
|
|
42
|
Wehrli FW, Fan AP, Rodgers ZB, Englund EK, Langham MC. Susceptibility-based time-resolved whole-organ and regional tissue oximetry. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3495. [PMID: 26918319 PMCID: PMC5001941 DOI: 10.1002/nbm.3495] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/18/2015] [Accepted: 01/06/2016] [Indexed: 05/15/2023]
Abstract
The magnetism of hemoglobin - being paramagnetic in its deoxy and diamagnetic in its oxy state - offers unique opportunities to probe oxygen metabolism in blood and tissues. The magnetic susceptibility χ of blood scales linearly with blood oxygen saturation, which can be obtained by measuring the magnetic field ΔB of the intravascular MR signal relative to tissue. In contrast to χ, the induced field ΔB is non-local. Therefore, to obtain the intravascular susceptibility Δχ relative to adjoining tissue from the measured ΔB demands solution of an inverse problem. Fortunately, for ellipsoidal structures, to which a straight, cylindrically shaped blood vessel segment conforms, the solution is trivial. The article reviews the principle of MR susceptometry-based blood oximetry. It then discusses applications for quantification of whole-brain oxygen extraction - typically on the basis of a measurement in the superior sagittal sinus - and, in conjunction with total cerebral blood flow, the cerebral metabolic rate of oxygen (CMRO2 ). By simultaneously measuring flow and venous oxygen saturation (SvO2 ) a temporal resolution of a few seconds can be achieved, allowing the study of the response to non-steady-state challenges such as volitional apnea. Extensions to regional measurements in smaller cerebral veins are also possible, as well as voxelwise quantification of venous blood saturation in cerebral veins accomplished by quantitative susceptibility mapping (QSM) techniques. Applications of susceptometry-based oximetry to studies of metabolic and degenerative disorders of the brain are reviewed. Lastly, the technique is shown to be applicable to other organ systems such as the extremities using SvO2 as a dynamic tracer to monitor the kinetics of the microvascular response to induced ischemia. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Felix W Wehrli
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania
| | - Audrey P Fan
- Lucas Center for Imaging, Department of Radiology, Stanford University, James H. Clark Center, 318 Campus Drive, Suite S170, Stanford, CA 94305
| | - Zachary B Rodgers
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania
| | - Erin K Englund
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania
| | - Michael C Langham
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania
| |
Collapse
|
|
43
|
Yeo LLL, Tan BYQ, Andersson T. Review of Post Ischemic Stroke Imaging and Its Clinical Relevance. Eur J Radiol 2017; 96:145-152. [PMID: 28237773 DOI: 10.1016/j.ejrad.2017.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
In this day and age, multiple imaging modalities are available to the stroke physician in the post-treatment phase.The practical challenge for physicians who treat stroke is to evaluate the pros and cons of each technique and select the best choice for the situation. The choice of imaging modality remains contentious at best and varies among different institutions and centres. This is no simple task an there are many factors to consider, including the differential diagnosis which need to be evaluated, the availability and reliability of the imaging technique and time and expertise required to perform and interpret the scanning. Other ancillary competing interest also come into play such as the financial cost of the modality, the requirement for patient monitoring during the imaging procedure and patient comfort. In an effort to clear some of the ambiguity surrounding this topic we present some of the current techniques in use and others, which are still in the realm of research and have not yet transitioned into clinical practice.
Collapse
Affiliation(s)
- Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| |
Collapse
|
|
44
|
Abstract
In this chapter we review the optimal imaging modalities for subacute and chronic stroke. We discuss the utility of computed tomography (CT) and multimodal CT imaging. Further, we analyze the importance of specific magnetic resonance imaging sequences, such as diffusion-weighted imaging for acute ischemic stroke, T2/fluid-attenuated inversion recovery for subacute and chronic stroke, and susceptibility imaging for detection of intracranial hemorrhages. Different ischemic stroke mechanisms are reviewed, and how these imaging modalities may aid in the determination of such. Further, we analyze how topographic patterns in ischemic stroke may provide important clues to the diagnosis, in addition to the temporal evolution of the stroke. Lastly, specific cerebrovascular occlusive diseases are reviewed, with emphasis on the optimal imaging modalities and their findings in each condition.
Collapse
|
|
45
|
Wu X, Luo S, Wang Y, Chen Y, Liu J, Bai J, Feng J, Zhang H. Use of susceptibility-weighted imaging in assessing ischemic penumbra: A case report. Medicine (Baltimore) 2017; 96:e6091. [PMID: 28178170 PMCID: PMC5313027 DOI: 10.1097/md.0000000000006091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE The ischemic penumbra assessment is essential for the subsequent therapy and prediction of evolution in patients with acute ischemic infraction. Although controversial as a perfect equivalence to penumbra, perfusion-weighted imaging (PWI)-diffusion-weighted imaging (DWI) mismatch may predict the response to thrombolysis. Due to the reliance of PWI on contrast agents, noninvasive alternatives remain an unmet need. PATIENT CONCERNS We reported a 65-year-old man complained of paroxysmal hemiplegia of his right limbs and anepia for 2 days, whereas the symptoms lasted for about 12 hours when he admitted to the hospital. DIAGNOSIS We diagnosed it as acute ischemic stroke caused by the left middle cerebral artery stenosis. INTERVENTIONS Susceptibility-weighted imaging (SWI), multimodal magnetic resonance imaging (MRI) work-up which includes conventional MRI sequences (T1WI, T2WI, and FLAIR), DWI, PWI. OUTCOMES His DWI-SWI mismatch was comparable to that of DWI-PWI at admission, suggesting that DWI-SWI could predict ischemic penumbra in patient with acute infarction. He refused the digital subtraction angiography examination or stenting, and he was treated with aspirin, atorvastain, and supportive treatment. The patient received a reexamination of the conventional MRI and SWI 11 days later. Expansion of the infarction in the affected MCA territory resulted from the penumbra indicated by the mismatch between DWI-SWI. LESSONS SWI can be used as a noninvasive alternative to evaluate the ischemic penumbra. Besides, SWI can provide perfusion information comparable to PWI and SWI is sufficient to identify occlusive arteries.
Collapse
Affiliation(s)
- Xiujuan Wu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Song Luo
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Ying Wang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Yang Chen
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Jun Liu
- Department of Neurosurgery, the Second Hospital of Jilin University, Jilin University, Changchun, China
| | - Jing Bai
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Jiachun Feng
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| | - Hongliang Zhang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University
| |
Collapse
|
|
46
|
Hsu CCT, Kwan GNC, Hapugoda S, Craigie M, Watkins TW, Haacke EM. Susceptibility weighted imaging in acute cerebral ischemia: review of emerging technical concepts and clinical applications. Neuroradiol J 2017; 30:109-119. [PMID: 28424015 DOI: 10.1177/1971400917690166] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Susceptibility weighted imaging (SWI) is an essential magnetic resonance imaging sequence in the assessment of acute ischemic stroke. In this article, we discuss the physics principals and clinical application of conventional SWI and multi-echo SWI sequences. We review the research evidence and practical approach of SWI in acute ischemic stroke by focusing on the detection and characterization of thromboembolism in the cerebral circulation. In addition, we discuss the role of SWI in the assessment of neuroparenchyma by depiction of asymmetric hypointense cortical veins in the ischemic territory (surrogate tissue perfusion), detection of existing microbleeds before stroke treatment and monitoring for hemorrhagic transformation post-treatment. In conclusion, the SWI sequence complements other parameters in the stroke magnetic resonance imaging protocol and understanding of the research evidence is vital for practising stroke neurologists and neuroradiologists.
Collapse
Affiliation(s)
- Charlie Chia-Tsong Hsu
- 1 Department of Medical Imaging, Princess Alexandra Hospital, Australia.,2 Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Gigi Nga Chi Kwan
- 1 Department of Medical Imaging, Princess Alexandra Hospital, Australia
| | | | - Michelle Craigie
- 1 Department of Medical Imaging, Princess Alexandra Hospital, Australia
| | | | - E Mark Haacke
- 3 Departments of Radiology and Biomedical Engineering, Wayne State University, USA
| |
Collapse
|
|
47
|
Prominent cerebral veins on susceptibility-weighted imaging (SWI) in pulmonary embolism. Eur Radiol 2016; 27:3004-3012. [DOI: 10.1007/s00330-016-4606-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/03/2016] [Accepted: 09/07/2016] [Indexed: 01/28/2023]
|
|
48
|
Luo Y, Gong Z, Zhou Y, Chang B, Chai C, Liu T, Han Y, Wang M, Qian T, Haacke EM, Xia S. Increased susceptibility of asymmetrically prominent cortical veins correlates with misery perfusion in patients with occlusion of the middle cerebral artery. Eur Radiol 2016; 27:2381-2390. [PMID: 27655300 DOI: 10.1007/s00330-016-4593-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/09/2016] [Accepted: 08/30/2016] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To evaluate tissue perfusion and venous susceptibility in ischaemic stroke patients as a means to predict clinical status and early prognosis. METHODS A retrospective study of 51 ischaemic stroke patients were enrolled in this study. Susceptibility, perfusion and National Institute of Health stroke scale (NIHSS) were compared between patients with and without asymmetrically prominent cortical veins (APCVs). The correlation between susceptibility, perfusion and NIHSS was performed. RESULTS Compared to patients without APCVs, the age of patients with APCVs was statistically older (p = 0.017). Patients with APCVs at discharge showed clinical deterioration in their NIHSS. Mean transit time (MTT), time to peak (TTP) and cerebral blood flow (CBF) in the stroke hemisphere were statistically delayed/decreased in patients with and without APCVs (all p < 0.05). In patients with APCVs, the changes in susceptibility positively correlated with increases in MTT and TTP (p < 0.05). Susceptibility and TTP positively correlated and CBF negatively correlated with NIHSS both at admission and discharge (p < 0.05). CONCLUSIONS Patients with APCVs have a tendency of deterioration. The presence of APCVs indicates the tissue has increased oxygen extraction fraction. Increased susceptibility from APCVs positively correlated with the delayed MTT and TTP, which reflects the clinical status at admission and predicts an early prognosis. KEY POINTS • Patients with and without APCVs have similar misery perfusion. • Patients with APCVs have a tendency of deterioration compared to those without. • The presence of APCVs indicated the tissue has increased oxygen extraction fraction. • Increased susceptibility from APCVs positively correlated with the MTT and TTP. • Increased susceptibility from APCVs reflected the clinical status at admission.
Collapse
Affiliation(s)
- Yu Luo
- Radiology Department, Branch of Shanghai First Hospital No.1878, North Sichuan Road, Shanghai, China, 200081
| | - Zhongying Gong
- Neurological Department, Tianjin First Central Hospital, Tianjin, China, 300192
| | - Yongming Zhou
- Radiology Department, Branch of Shanghai First Hospital No.1878, North Sichuan Road, Shanghai, China, 200081
| | - Binge Chang
- Neurosurgery Department, Tianjin First Central Hospital, Tianjin, China, 300192
| | - Chao Chai
- Radiology Department, Tianjin First Central Hospital, Tianjin, China, 300192
| | - Taiyuan Liu
- Radiology Department, Zhengzhou University People's Hospital, Zhengzhou, China, 450003
| | - Yanhong Han
- Radiology Department, Zhengzhou University People's Hospital, Zhengzhou, China, 450003
| | - Meiyun Wang
- Radiology Department, Zhengzhou University People's Hospital, Zhengzhou, China, 450003.
| | - Tianyi Qian
- Siemens Healthcare, MR collaboration, Northeast Asia, No.7, Wangjing Zhonghuan South Road, Beijing, China, 100102
| | - E Mark Haacke
- Radiology Department, Wayne State University, Detroit, MI, USA
| | - Shuang Xia
- Radiology Department, Tianjin First Central Hospital, Tianjin, China, 300192.
| |
Collapse
|
|
49
|
Evaluating the Role of Reduced Oxygen Saturation and Vascular Damage in Traumatic Brain Injury Using Magnetic Resonance Perfusion-Weighted Imaging and Susceptibility-Weighted Imaging and Mapping. Top Magn Reson Imaging 2016; 24:253-65. [PMID: 26502307 DOI: 10.1097/rmr.0000000000000064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The cerebral vasculature, along with neurons and axons, is vulnerable to biomechanical insult during traumatic brain injury (TBI). Trauma-induced vascular injury is still an underinvestigated area in TBI research. Cerebral blood flow and metabolism could be important future treatment targets in neural critical care. Magnetic resonance imaging offers a number of key methods to probe vascular injury and its relationship with traumatic hemorrhage, perfusion deficits, venous blood oxygen saturation changes, and resultant tissue damage. They make it possible to image the hemodynamics of the brain, monitor regional damage, and potentially show changes induced in the brain's function not only acutely but also longitudinally following treatment. These methods have recently been used to show that even mild TBI (mTBI) subjects can have vascular abnormalities, and thus they provide a major step forward in better diagnosing mTBI patients.
Collapse
|
|
50
|
Transient disappearance of microbleeds in the subacute period based on T2*-weighted gradient echo imaging in traumatic brain injury. Acta Neurochir (Wien) 2016; 158:1247-50. [PMID: 27106841 DOI: 10.1007/s00701-016-2805-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/06/2016] [Indexed: 12/16/2022]
Abstract
We report three cases of traumatic microbleeds evaluated by sequential observation. Hypo-intensities on T2* gradient echo imaging (T2*GEI) appeared just 2-3 h after the injury (the hyper-acute period). However, these hypo-intensities on T2*GEI disappeared or became obscure 2-6 days after the injury (the subacute period). A follow-up MRI again revealed clear hypo-intensities on T2*GEI 1-3 months after the injury (the chronic period). Our cases indicate that hypo-intensities on T2*GEI might change dynamically from the hyper-acute to the chronic period. The differences of susceptibility effects by hematoma age might be the cause of this dynamic change.
Collapse
|