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Combined MR quantitative susceptibility mapping and multi-shell diffusion in Parkinson's disease 帕金森病中的磁共振定量易感性图谱和多壳扩散相结合。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-07-14 DOI: 10.1111/jon.13222
Oscar Andersson Forsman, Henrik Sjöström, Per Svenningsson, Tobias Granberg

Background and Purpose

Quantitative susceptibility mapping (QSM), neurite orientation dispersion and density imaging (NODDI), and the g-ratio have separately shown differences between Parkinson's disease (PD) and healthy controls. The g-ratio has, however, not been studied in PD in the substantia nigra (SN) and the putamen. A combination of these methods could also potentially be a complementary imaging biomarker for PD. This study aimed to assess the diagnostic performance of QSM, NODDI, the g-ratio, and a combined QSM-NODDI imaging marker in the SN and putamen of PD patients.

Methods

In this prospective study, the diagnostic performance of median region of interest values was compared in a cohort of 15 participants with PD and 14 healthy controls after manual segmentation. The diagnostic performance was assessed using the area under curve (AUC) for the receiving operator characteristic.

Results

Median QSM in the contralateral SN identified PD with AUC 0.77, and median isotropic volume fraction identified PD in the ipsilateral SN with AUC 0.68. A combined NODDI-QSM marker improved diagnostic performance (AUC 0.80). No significant differences were found in the g-ratio.

Conclusion

A combination of median QSM and median isotropic volume fraction improves the differentiation of PD from healthy controls and is a potential biomarker in the diagnostics of PD. This confirms previously reported results indicating that combining QSM and NODDI modestly improves differentiation of PD.

背景和目的:定量易感图(QSM)、神经元定向分散和密度成像(NODDI)以及g比率已分别显示出帕金森病(PD)与健康对照组之间的差异。然而,尚未对帕金森病黑质(SN)和普鲁士门的 g 比率进行研究。这些方法的结合也有可能成为帕金森病的补充成像生物标志物。本研究旨在评估 QSM、NODDI、g 比值以及 QSM-NODDI 联合成像标记物在帕金森病患者的黑质和视丘中的诊断性能:在这项前瞻性研究中,对 15 名帕金森病患者和 14 名健康对照者进行手动分割后,比较了感兴趣区中值的诊断性能。诊断性能使用接收操作者特征曲线下面积(AUC)进行评估:结果:对侧SN的QSM中位数识别出了PD,AUC为0.77;同侧SN的各向同性体积分数中位数识别出了PD,AUC为0.68。联合 NODDI-QSM 标记提高了诊断性能(AUC 0.80)。结论:结论:QSM中位数和各向同性体积分数中位数的组合提高了PD与健康对照组的区分度,是诊断PD的潜在生物标志物。这证实了之前报道的结果,即结合QSM和NODDI可适度改善PD的分化。
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引用次数: 0
Lesion phenotyping based on magnetic susceptibility in pediatric multiple sclerosis 基于小儿多发性硬化症磁感应强度的病变表型。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-07-14 DOI: 10.1111/jon.13221
Vincenzo Daniele Boccia, Giacomo Boffa, Caterina Lapucci, Mauro Costagli, Luca Bosisio, Maria Margherita Mancardi, Matilde Inglese, Maria Cellerino

Background and purpose

Pediatric multiple sclerosis (MS) displays different pathological features compared to adult MS, which can be studied in vivo by assessing tissue magnetic susceptibility with 3T-MRI. We aimed to assess different white matter lesions (WMLs) phenotypes in pediatric MS patients using quantitative susceptibility mapping (QSM) and susceptibility mapping weighted imaging (SMWI) over 12 months.

Methods

Eleven pediatric MS patients [female: 63.6%; mean ± standard deviation (SD) age and disease duration: 16.3 ± 2.2 and 2.4 ± 1.5; median (range) Expanded Disability Status Scale (EDSS) 1 (0-2)] underwent 3 Tesla-MRI exams and EDSS assessments at baseline and after 1 year. QSM and SMWI were obtained using 3-dimensional (3D)-segmented echo-planar-imaging with submillimetric spatial resolution. WMLs were classified according to their QSM appearance and SMWI was used to identify QSM hyperintensities ascribable to veins. Total brain volumes at baseline and follow-up were computed using high-resolution 3D T1-weighted images.

Results

Mean ± SD paramagnetic rim lesions (PRLs) prevalence was 7.0% ± 9.0. Fifty-four percent (6/11) of patients exhibited at least one PRL, with one patient exhibiting ≥ 4 PRLs. All patients showed QSM-iso-/hypo-intense lesions, which represented a mean ± SD of 65.8% ± 22.7 of total WMLs. QSM-hyperintense WMLs showed a positive correlation with total brain volume reduction at follow-up (r = 0.705; p =  .02). No lesion was classified as different between baseline and follow-up.

Conclusion

Chronic compartmentalized inflammation seems to occur early in pediatric MS patients with short disease duration. A high prevalence of iso-/hypo-intense lesions was found, which could account for the higher remyelination potential in pediatric MS.

背景和目的:与成人多发性硬化症相比,小儿多发性硬化症(MS)显示出不同的病理特征,这可以通过3T-MRI评估组织磁感应强度进行体内研究。我们旨在使用定量磁感应强度图谱(QSM)和磁感应强度图谱加权成像(SMWI)评估小儿多发性硬化症患者12个月内不同的白质病变(WMLs)表型:11名小儿多发性硬化症患者(女性:63.6%;平均±标准差(SD)年龄和病程:16.3±2.2和16.3±2.216.3±2.2和2.4±1.5;中位数(范围)残疾状况扩展量表(EDSS)1(0-2)]在基线和1年后接受了3特斯拉-MRI检查和EDSS评估。QSM和SMWI是通过具有亚毫米空间分辨率的三维(3D)分割回声平面成像获得的。WML根据其QSM外观进行分类,SMWI用于识别可归因于静脉的QSM高密度。使用高分辨率三维T1加权图像计算基线和随访时的脑总体积:结果:顺磁性边缘病变(PRLs)发生率的平均值(± SD)为 7.0% ± 9.0。54%的患者(6/11)表现出至少一个PRL,其中一名患者表现出≥4个PRL。所有患者都出现了 QSM 异/低密度病变,平均(±SD)占 WML 总数的 65.8% ± 22.7。QSM-hyperintense WMLs与随访时脑总体积缩小呈正相关(r = 0.705; p = .02)。没有任何病变被归类为基线与随访期间的差异:结论:在病程较短的儿童多发性硬化症患者中,慢性分区炎症似乎发生得较早。结论:在病程较短的小儿多发性硬化症患者中,慢性室间隔炎症似乎发生较早,等/低强度病变的发生率较高,这可能是小儿多发性硬化症患者再髓鞘化潜力较高的原因。
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引用次数: 0
Pial collaterals limit stroke progression and metabolic stress in hypoperfused tissue: An MRI perfusion and mq-BOLD study 在低灌注组织中,静脉瓣限制了中风的进展和代谢压力:磁共振成像灌注和 mq-BOLD 研究。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-06-26 DOI: 10.1111/jon.13220
Franziska Frank, Stephan Kaczmarz, Christine Preibisch, Ralf Deichmann, Ulrike Nöth, Marlies Wagner, Alexander Seiler

Background and Purpose

In acute ischemic stroke (AIS) due to large-vessel occlusion (LVO), the relationship between cerebral oxygen extraction fraction (OEF) as the hallmark of the ischemic penumbra and leptomeningeal collateral supply is not well established. We aimed to investigate the relationship between pial collateralization and tissue oxygen extraction in patients with LVO using magnetic resonance imaging (MRI).

Methods

Data from 14 patients with anterior circulation LVO who underwent MRI before acute stroke treatment were analyzed. In addition to diffusion-weighted imaging and perfusion-weighted imaging (PWI), the protocol comprised sequences for multiparametric quantitative blood-oxygen-level-dependent imaging for the calculation of relative OEF (rOEF). Pial collateral supply was quantitatively assessed by analyzing the signal variance in T2*-weighted PWI time series. Relationships between collateral supply, infarct volume, rOEF in peri-infarct hypoperfused tissue, and clinical stroke severity were assessed.

Results

The PWI-based parameter quantifying collateral supply was negatively correlated with baseline ischemic core volume and rOEF in the hypoperfused peri-infarct area (p < .01). Both reduced collateral supply and increased rOEF correlated significantly with higher scores on the National Institutes of Health Stroke Scale (p < .05). Increased rOEF within hypoperfused tissue was associated with higher baseline (p = .043) and follow-up infarct volume (p = .009).

Conclusions

Signal variance-based mapping of collaterals with PWI depicts pial collateral supply, which is closely tied to tissue pathophysiology and clinical and imaging outcomes. Magnetic-resonance-derived mapping of cerebral rOEF reveals penumbral characteristics of hypoperfused tissue and might provide a promising imaging biomarker in AIS.

背景和目的:在大血管闭塞(LVO)导致的急性缺血性卒中(AIS)中,作为缺血半影标志的脑氧萃取率(OEF)与脑侧膜侧供之间的关系尚未明确。我们的目的是利用磁共振成像(MRI)研究 LVO 患者的静脉侧支与组织氧萃取之间的关系:方法:分析了 14 名前循环 LVO 患者的数据,这些患者在急性卒中治疗前接受了 MRI 检查。除了弥散加权成像和灌注加权成像(PWI)外,方案还包括用于计算相对 OEF(rOEF)的多参数定量血氧水平依赖性成像序列。通过分析 T2* 加权 PWI 时间序列中的信号方差,对皮质侧支供应进行定量评估。评估了侧支供应、梗死容积、梗死周围低灌注组织的 rOEF 和临床卒中严重程度之间的关系:结果:基于脉搏波成像的侧支供应量化参数与基线缺血核心容积和梗死周围低灌注区的 rOEF 呈负相关(p 结论:基于脉搏波成像的侧支供应量化参数与基线缺血核心容积和梗死周围低灌注区的 rOEF 呈负相关(p 结论):基于信号方差的脉搏波成像侧支映射描述了与组织病理生理学、临床和成像结果密切相关的侧支供应。磁共振衍生的大脑 rOEF 映射揭示了低灌注组织的半影特征,可能为 AIS 提供一种有前景的成像生物标志物。
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引用次数: 0
Biological variation in cervical spinal cord MRI morphometry in healthy individuals and people with multiple sclerosis 健康人和多发性硬化症患者颈椎脊髓核磁共振成像形态测量的生物变异。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-06-10 DOI: 10.1111/jon.13219
Sarah R. Cook, Kritin Vasamreddy, Anna Combes, Simon Vandekar, Mereze Visagie, Delaney Houston, Lily Wald, Ashwin Kumar, Megan McGrath, Colin D. McKnight, Francesca Bagnato, Seth A. Smith, Kristin P. O'Grady

Background and Purpose

Conclusions from prior literature regarding the impact of sex, age, and height on spinal cord (SC) MRI morphometrics are conflicting, while the effect of body weight on SC morphometrics has been found to be nonsignificant. The purpose of this case-control study is to assess the associations between cervical SC MRI morphometric parameters and age, sex, height, and weight to establish their potential role as confounding variables in a clinical study of people with multiple sclerosis (MS) compared to a cohort of healthy volunteers.

Methods

Sixty-nine healthy volunteers and 31 people with MS underwent cervical SC MRI at 3 Tesla field strength. Images were centered at the C3/C4 intervertebral disc and processed using Spinal Cord Toolbox v.4.0.2. Mixed-effects linear regression models were used to evaluate the effects of biological variables and disease status on morphometric parameters.

Results

Sex, age, and height had significant effects on cord and gray matter (GM) cross-sectional area (CSA) as well as the GM:cord CSA ratio. There were no significant effects of body weight on morphometric parameters. The effect of MS disease duration on cord CSA in the C4 level was significant when controlling for all other variables.

Conclusions

Studies of disease-related changes in SC morphometry should control for sex, age, and height to account for physiological variation.

背景和目的:关于性别、年龄和身高对脊髓(SC)MRI 形态测量的影响,以往文献的结论相互矛盾,而体重对脊髓形态测量的影响则不明显。本病例对照研究的目的是评估颈椎 SC MRI 形态测量参数与年龄、性别、身高和体重之间的关系,以确定它们在多发性硬化症(MS)患者的临床研究中与健康志愿者队列相比作为混杂变量的潜在作用:69 名健康志愿者和 31 名多发性硬化症患者在 3 特斯拉场强下接受了颈椎 SC MRI 检查。图像以 C3/C4 椎间盘为中心,使用脊髓工具箱 v.4.0.2 进行处理。混合效应线性回归模型用于评估生物变量和疾病状态对形态测量参数的影响:结果:性别、年龄和身高对脊髓和灰质(GM)横截面积(CSA)以及GM:脊髓CSA比率有显著影响。体重对形态测量参数没有明显影响。在控制所有其他变量的情况下,多发性硬化症病程对C4水平脊髓CSA的影响是显著的:对与疾病相关的SC形态测量变化的研究应控制性别、年龄和身高,以考虑生理变化。
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引用次数: 0
Brain lesion microstructure in neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein disease 神经脊髓炎视网膜谱系障碍和髓鞘少突胶质细胞糖蛋白病的脑损伤微结构。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-06-03 DOI: 10.1111/jon.13218
Caterina Lapucci, Vincenzo Daniele Boccia, Thoma Dario Clementi, Simona Schiavi, Luana Benedetti, Antonio Uccelli, Giovanni Novi, Maria Cellerino, Matilde Inglese

Background and purpose

Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) diagnosis are based on the presence of serological and magnetic resonance imaging (MRI) biomarkers. Diffusion tensor imaging (DTI), neurites orientation dispersion and density imaging (NODDI), and the Spherical Mean Technique (SMT) may be helpful to provide a microstructural characterization of the different types of white matter lesions and give an insight about their different pathological mechanisms. The aim of the study was to characterize microstructural differences between brain typical lesions (TLs) and nontypical lesions (nTLs).

Methods

A total of 17 NMOSD and MOGAD patients [9 Aquaporin4 (AQP4) + NMO, 2 seronegative-NMO, 6 MOGAD] underwent MRI scans on a 3 Tesla MAGNETON PRISMA. Diffusion parameters (fractional anisotropy; mean diffusivity [MD]; intracellular volume fraction [ICVF]; extra-neurite transverse diffusivity; and extra-neurite MD; neurite signal fraction) were obtained using DTI, NODDI, and SMT. Microstructural parameters within lesions were compared through a generalized linear model using age, sex, and total lesion volume as covariates.

Results

In NMOSD/MOGAD whole cohort (total lesions = 477), TLs showed increased MD and decreased ICVF compared to nTLs (p < .05), indicating higher inflammation and axonal loss. Similar results were found also in the AQP4 + NMO subgroup (decreased ICVF, p < .05). Furthermore, in NMOSD/MOGAD whole cohort and in AQP4 + NMO subgroup, TLs showed a trend toward higher EXRATRANS than nTLs, suggesting a more severe degree of demyelination within TLs.

Conclusions

TLs and nTLs in NMOSD/MOGAD showed different diffusion MRI-derived microstructural features, with TLs showing a more severe degree of inflammation and fiber disruption with respect to nTLs.

背景和目的:神经脊髓炎视谱系障碍(NMOSD)和髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)的诊断基于血清学和磁共振成像(MRI)生物标志物的存在。弥散张量成像(DTI)、神经元取向弥散和密度成像(NODDI)以及球形均值技术(SMT)可能有助于提供不同类型白质病变的微观结构特征,并有助于了解其不同的病理机制。本研究旨在描述脑部典型病变(TLs)和非典型病变(nTLs)之间的微观结构差异:共有 17 名 NMOSD 和 MOGAD 患者(9 名 Aquaporin4 (AQP4) + NMO,2 名血清阴性 NMO,6 名 MOGAD)在 3 特斯拉 MAGNETON PRISMA 上接受了 MRI 扫描。利用 DTI、NODDI 和 SMT 获得了扩散参数(分数各向异性;平均扩散率 [MD];细胞内体积分数 [ICVF];神经元外横向扩散率;神经元外 MD;神经元信号分数)。以年龄、性别和病变总体积为协变量,通过广义线性模型对病变内的微结构参数进行比较:在整个 NMOSD/MOGAD 队列(病变总数 = 477)中,与 nTLs 相比,TLs 的 MD 增加,ICVF 减少(p 结论:在 NMOSD/MOGAD 队列中,TLs 和 nTLs 的 MD 增加,ICVF 减少:NMOSD/MOGAD中的TLs和nTLs显示出不同的弥散MRI衍生微结构特征,与nTLs相比,TLs显示出更严重的炎症和纤维破坏。
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引用次数: 0
Validation of bedside manual versus automated measurements of brain arterial diameters from MR angiography 核磁共振血管造影床旁手动与自动脑动脉直径测量的验证。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-29 DOI: 10.1111/jon.13217
Nicolas D. Garzon-Mancera, Farid Khasiyev, Victor J. Del Brutto, Antonio J. Spagnolo Allende, Clinton B. Wright, Mitchell Elkind, Tatjana Rundek, Oscar H. Del Brutto, Jose Gutierrez

Background and Purpose

Brain arterial luminal diameters are reliably measured with automated imaging software. Nonautomated imaging software alternatives such as a Picture Archiving Communication System are more common bedside tools used for manual measurement. This study is aimed at validating manual measurements against automated methods.

Methods

We randomly selected 600 participants from the Northern Manhattan Study (NOMAS) and 260 participants from the Atahualpa Project studied with 1.5 Tesla MR angiography. Using the Radiant measuring tool, three independent readers (general practitioner, neurology resident, and vascular neurologist) measured manually the diameter of arterial brain vessels. The same vessels were also measured by LKEB Automated Vessel Analysis (LAVA). We calculated the intraclass correlation coefficient (ICC) of each rater's diameters versus those obtained with LAVA.

Results

The ICC between diameters obtained by the general practitioner or the neurology resident compared to LAVA was excellent for both internal carotid arteries (ICA) and Basilar Arteries (BA) (ICC > .80 in all comparisons) in NOMAS. In the Atahualpa Project, ICC between diameters obtained by a vascular neurologist and LAVA was good for both ICA and BA (ICC > .60 in all comparisons). The ICCs for the measurements of the remaining arteries were moderate to poor.

Conclusion

Results suggest that manual measurements of ICA and BA diameters, but not MCA or ACA, are valid and could be used to identify dilated brain arteries at the bedside and for eventual selection of patients with dolichoectasia into clinical trials.

背景和目的:使用自动成像软件可以可靠地测量脑动脉管腔直径。图片存档通信系统等非自动成像软件是更常用的床边手动测量工具。本研究旨在验证手动测量与自动方法之间的差异:我们从曼哈顿北部研究(NOMAS)中随机选取了 600 名参与者,从阿塔瓦尔帕项目中随机选取了 260 名参与者,对他们进行了 1.5 特斯拉磁共振血管造影研究。三名独立读者(全科医生、神经科住院医生和血管神经科医生)使用 Radiant 测量工具手动测量了脑动脉血管的直径。同样的血管也通过 LKEB 自动血管分析仪(LAVA)进行测量。我们计算了每位测量者的直径与 LAVA 所获直径的类内相关系数 (ICC):结果:在 NOMAS 中,全科医生或神经科住院医师获得的颈内动脉 (ICA) 和基底动脉 (BA) 直径与 LAVA 获得的直径之间的 ICC 非常接近(所有比较中 ICC 均大于 0.80)。在阿塔瓦尔帕项目中,由血管神经科医生和 LAVA 获得的颈内动脉和基底动脉直径的 ICC 均为良好(所有比较中 ICC 均大于 0.60)。其余动脉测量的 ICC 值为中等至较差:结果表明,人工测量 ICA 和 BA 直径(而非 MCA 或 ACA)是有效的,可用于在床旁识别扩张的脑动脉,并最终选择脑动脉硬化症患者进行临床试验。
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引用次数: 0
Sodium signal intensity of CSF using 1H-guided 23Na-MRI as a potential noninvasive biomarker in Alzheimer's disease 利用 1H-guided 23Na-MRI 测量 CSF 的钠信号强度,作为阿尔茨海默病的潜在无创生物标记物。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-28 DOI: 10.1111/jon.13216
Hans-Ulrich Kerl, Hakim Baazaoui, Katrin Herrmann, Anne Adlung, Nadia K. Ludwig, Lucrezia Hausner, Lutz Frölich, Lothar Schad, Christoph Groden, Sherif A. Mohamed

Background and Purpose

Alzheimer's disease (AD) is characterized by cognitive decline and mnestic deficits. The pathophysiology of AD is not fully understood, which renders the development of accurate tools for early diagnosis and effective therapies exceedingly difficult. In this study, we investigated the use of 23Na-MRI to measure the relative sodium signal intensities (rSSIs) in CSF in patients with AD and healthy controls.

Methods

We prospectively recruited 11 patients with biomarker-diagnosed early-stage AD, as well as 12 cognitively healthy age-matched controls. All participants underwent 23Na-MRI to measure rSSI. Statistical analyses were performed to compare CSF sodium signal intensities between groups and to evaluate the specificity and sensitivity of the rSSI in the diagnosis of AD.

Results

RSSIs in CSF were significantly higher in AD patients (mean = 68.6% ± 7.7%) compared to healthy controls (mean = 56.9% ± 5.5%) (p < .001). There was also a significant negative correlation between rSSI in CSF and hippocampus and amygdala volumes (r = −.54 and −.49, p < .05) as well as a positive correlation with total CSF volumes (r = .81, p < .05). Receiver operating characteristic analysis showed high diagnostic accuracy for rSSI in discriminating between AD patients and healthy controls (area under the curve = .94).

Conclusion

Our study provides evidence that rSSI in CSF is increased in AD patients in comparison to healthy controls. rSSI may serve as a potential marker for early detection and monitoring of disease progression. Larger, longitudinal studies are needed to confirm our findings and to investigate the association between rSSI in CSF and the severity of cognitive impairment.

背景和目的:阿尔茨海默病(AD)的特征是认知能力下降和运动障碍。由于人们对阿尔茨海默病的病理生理学尚不完全了解,因此很难开发出用于早期诊断和有效治疗的准确工具。在这项研究中,我们探讨了使用 23Na-MRI 测量 AD 患者和健康对照组 CSF 中相对钠信号强度(rSSIs)的方法:我们前瞻性地招募了 11 名经生物标记物确诊的早期 AD 患者和 12 名认知健康的年龄匹配对照者。所有参与者都接受了 23Na-MRI 测量 rSSI。研究人员进行了统计分析,以比较不同组间的脑脊液钠信号强度,并评估rSSI在诊断AD方面的特异性和敏感性:结果:与健康对照组(平均值为 56.9% ± 5.5%)相比,AD 患者脑脊液中的 RSSIs 明显较高(平均值为 68.6% ± 7.7%)(p 结论:我们的研究为 rSSI 在 AD 诊断中的特异性和敏感性提供了证据:我们的研究提供了证据,表明与健康对照组相比,AD 患者 CSF 中的 rSSI 有所增加。需要进行更大规模的纵向研究来证实我们的发现,并调查 CSF 中 rSSI 与认知障碍严重程度之间的关联。
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引用次数: 0
Lower admission stroke severity is associated with good collateral status in distal medium vessel occlusion stroke 在远端中血管闭塞性卒中中,较低的入院卒中严重程度与良好的侧支状态相关。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-26 DOI: 10.1111/jon.13208
Janet Mei, Hamza A. Salim, Dhairya A. Lakhani, Aneri Balar, Basel Musmar, Nimer Adeeb, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z. Hyson, Adam A. Dmytriw, Adrien Guenego, Tobias D. Faizy, Jeremy J. Heit, Gregory W. Albers, Victor C. Urrutia, Raf Llinas, Elisabeth B. Marsh, Argye E. Hillis, Kambiz Nael, Vivek S. Yedavalli

Background and Purpose

Distal medium vessel occlusions (DMVOs) are a significant contributor to acute ischemic stroke (AIS), with collateral status (CS) playing a pivotal role in modulating ischemic damage progression. We aimed to explore baseline characteristics associated with CS in AIS-DMVO.

Methods

This retrospective analysis of a prospectively collected database enrolled 130 AIS-DMVO patients from two comprehensive stroke centers. Baseline characteristics, including patient demographics, admission National Institutes of Health Stroke Scale (NIHSS) score, admission Los Angeles Motor Scale (LAMS) score, and co-morbidities, including hypertension, hyperlipidemia, diabetes, coronary artery disease, atrial fibrillation, and history of transient ischemic attack or stroke, were collected. The analysis was dichotomized to good CS, reflected by hypoperfusion index ratio (HIR) <.3, versus poor CS, reflected by HIR ≥.3.

Results

Good CS was observed in 34% of the patients. As to the occluded location, 43.8% occurred in proximal M2, 16.9% in mid M2, 35.4% in more distal middle cerebral artery, and 3.8% in distal anterior cerebral artery. In multivariate logistic analysis, a lower NIHSS score and a lower LAMS score were both independently associated with a good CS (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.82-0.95, p < .001 and OR: 0.77, 95% CI: 0.62-0.96, p = .018, respectively). Patients with poor CS were more likely to manifest as moderate to severe stroke (29.1% vs. 4.5%, p < .001), while patients with good CS had a significantly higher chance of having a minor stroke clinically (40.9% vs. 12.8%, p < .001).

Conclusions

CS remains an important determinant in the severity of AIS-DMVO. Collateral enhancement strategies may be a worthwhile pursuit in AIS-DMVO patients with more severe initial stroke presentation, which can be swiftly identified by the concise LAMS and serves as a proxy for underlying poor CS.

背景和目的:远端中血管闭塞(DMVO)是急性缺血性卒中(AIS)的重要诱因,而侧支状态(CS)在调节缺血性损伤进展中起着关键作用。我们旨在探讨与 AIS-DMVO 中 CS 相关的基线特征:本研究对前瞻性收集的数据库进行了回顾性分析,纳入了来自两家综合卒中中心的 130 名 AIS-DMVO 患者。收集了基线特征,包括患者人口统计学特征、入院时美国国立卫生研究院卒中量表(NIHSS)评分、入院时洛杉矶运动量表(LAMS)评分以及合并疾病,包括高血压、高脂血症、糖尿病、冠心病、心房颤动以及短暂性脑缺血发作或卒中病史。分析结果以低灌注指数比值(HIR)反映的良好 CS 为二分法:34%的患者CS良好。就闭塞位置而言,43.8%发生在M2近端,16.9%发生在M2中段,35.4%发生在更远端大脑中动脉,3.8%发生在远端大脑前动脉。在多变量逻辑分析中,较低的 NIHSS 评分和较低的 LAMS 评分均与良好的 CS 独立相关(比值比 [OR]:0.88,95% 置信区间 [CI]:0.82-0.95, p 结论:CS仍是决定AIS-DMVO严重程度的重要因素。对于初始卒中表现较严重的 AIS-DMVO 患者,侧支增强策略可能是一个值得追求的目标,简明的 LAMS 可以迅速识别侧支增强策略,并可作为潜在不良 CS 的替代指标。
{"title":"Lower admission stroke severity is associated with good collateral status in distal medium vessel occlusion stroke","authors":"Janet Mei,&nbsp;Hamza A. Salim,&nbsp;Dhairya A. Lakhani,&nbsp;Aneri Balar,&nbsp;Basel Musmar,&nbsp;Nimer Adeeb,&nbsp;Meisam Hoseinyazdi,&nbsp;Licia Luna,&nbsp;Francis Deng,&nbsp;Nathan Z. Hyson,&nbsp;Adam A. Dmytriw,&nbsp;Adrien Guenego,&nbsp;Tobias D. Faizy,&nbsp;Jeremy J. Heit,&nbsp;Gregory W. Albers,&nbsp;Victor C. Urrutia,&nbsp;Raf Llinas,&nbsp;Elisabeth B. Marsh,&nbsp;Argye E. Hillis,&nbsp;Kambiz Nael,&nbsp;Vivek S. Yedavalli","doi":"10.1111/jon.13208","DOIUrl":"10.1111/jon.13208","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Distal medium vessel occlusions (DMVOs) are a significant contributor to acute ischemic stroke (AIS), with collateral status (CS) playing a pivotal role in modulating ischemic damage progression. We aimed to explore baseline characteristics associated with CS in AIS-DMVO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective analysis of a prospectively collected database enrolled 130 AIS-DMVO patients from two comprehensive stroke centers. Baseline characteristics, including patient demographics, admission National Institutes of Health Stroke Scale (NIHSS) score, admission Los Angeles Motor Scale (LAMS) score, and co-morbidities, including hypertension, hyperlipidemia, diabetes, coronary artery disease, atrial fibrillation, and history of transient ischemic attack or stroke, were collected. The analysis was dichotomized to good CS, reflected by hypoperfusion index ratio (HIR) &lt;.3, versus poor CS, reflected by HIR ≥.3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Good CS was observed in 34% of the patients. As to the occluded location, 43.8% occurred in proximal M2, 16.9% in mid M2, 35.4% in more distal middle cerebral artery, and 3.8% in distal anterior cerebral artery. In multivariate logistic analysis, a lower NIHSS score and a lower LAMS score were both independently associated with a good CS (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.82-0.95, <i>p</i> &lt; .001 and OR: 0.77, 95% CI: 0.62-0.96, <i>p</i> = .018, respectively). Patients with poor CS were more likely to manifest as moderate to severe stroke (29.1% vs. 4.5%, <i>p</i> &lt; .001), while patients with good CS had a significantly higher chance of having a minor stroke clinically (40.9% vs. 12.8%, <i>p</i> &lt; .001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CS remains an important determinant in the severity of AIS-DMVO. Collateral enhancement strategies may be a worthwhile pursuit in AIS-DMVO patients with more severe initial stroke presentation, which can be swiftly identified by the concise LAMS and serves as a proxy for underlying poor CS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 4","pages":"424-429"},"PeriodicalIF":2.3,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Validation of the transcranial Doppler rescue criteria for mechanical thrombectomy 验证机械血栓切除术的经颅多普勒抢救标准。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-25 DOI: 10.1111/jon.13207
Adnan Khan, Maher Saqqur, Ashfaq Shuaib, Khurshid Khan, Vijay K. Sharma, Alejandro Brunser, Jürgen Eggers, Robert Mikulik, Aristeidis H. Katsanos, Theodore N. Sergentanis, Konstantinos Vadikolias, Marta Rubiera, Reza Bavarsad Shahripour, Huy Thang Nguyen, Patricia Martínez-Sánchez, Apostolos Safouris, Ioannis Heliopoulos, Abdul Salam, Carol Derksen, Konstantinos Voumvourakis, Theodora Psaltopoulou, Anne W. Alexandrov, Andrei V. Alexandrov, Georgios Tsivgoulis, CLOTBUST-PRO Investigators

Background and Purpose

Transcranial Doppler (TCD) identifies acute stroke patients with arterial occlusion where treatment may not effectively open the blocked vessel. This study aimed to examine the clinical utility and prognostic value of TCD flow findings in patients enrolled in a multicenter prospective study (CLOTBUST-PRO).

Methods

Patients enrolled with intracranial occlusion on computed tomography angiography (CTA) who underwent urgent TCD evaluation before intravenous thrombolysis was included in this analysis. TCD findings were assessed using the mean flow velocity (MFV) ratio, comparing the reciprocal ratios of the middle cerebral artery (MCA) depths bilaterally (affected MCA-to-contralateral MCA MFV [aMCA/cMCA MFV ratio]).

Results

A total of 222 patients with intracranial occlusion on CTA were included in the study (mean age: 64 ± 14 years, 62% men). Eighty-eight patients had M1 MCA occlusions; baseline mean National Institutes of Health Stroke Scale (NIHSS) score was 16, and a 24-hour mean NIHSS score was 10 points. An aMCA/cMCA MFV ratio of <.6 had a sensitivity of 99%, specificity of 16%, positive predictive value (PV) of 60%, and negative PV of 94% for identifying large vessel occlusion (LVO) including M1 MCA, terminal internal carotid artery, or tandem ICA/MCA. Thrombolysis in Brain Ischemia scale, with (grade ≥1) compared to without flow (grade 0), showed a sensitivity of 17.1%, specificity of 86.9%, positive PV of 62%, and negative PV of 46% for identifying LVO.

Conclusions

TCD is a valuable modality for evaluating arterial circulation in acute ischemic stroke patients, demonstrating significant potential as a screening tool for intravenous/intra-arterial lysis protocols.

背景和目的:经颅多普勒(TCD)可识别动脉闭塞的急性卒中患者,在这种情况下,治疗可能无法有效打通阻塞的血管。本研究旨在对参加多中心前瞻性研究(CLOTBUST-PRO)的患者的 TCD 血流检查结果的临床实用性和预后价值进行研究:分析对象包括计算机断层扫描血管造影(CTA)显示颅内闭塞的入组患者,这些患者在静脉溶栓前接受了紧急TCD评估。通过比较双侧大脑中动脉(MCA)深度的倒数比值(受累 MCA 与对侧 MCA MFV [aMCA/cMCA MFV 比值]),使用平均流速(MFV)比值对 TCD 结果进行评估:研究共纳入了 222 名 CTA 检查显示颅内闭塞的患者(平均年龄:64 ± 14 岁,62% 为男性)。88名患者为M1 MCA闭塞;美国国立卫生研究院卒中量表(NIHSS)基线平均评分为16分,24小时NIHSS平均评分为10分。aMCA/cMCA MFV 比值为结论:TCD 是评估急性缺血性卒中患者动脉循环的一种重要方式,作为静脉/动脉内溶栓方案的筛选工具具有巨大潜力。
{"title":"Validation of the transcranial Doppler rescue criteria for mechanical thrombectomy","authors":"Adnan Khan,&nbsp;Maher Saqqur,&nbsp;Ashfaq Shuaib,&nbsp;Khurshid Khan,&nbsp;Vijay K. Sharma,&nbsp;Alejandro Brunser,&nbsp;Jürgen Eggers,&nbsp;Robert Mikulik,&nbsp;Aristeidis H. Katsanos,&nbsp;Theodore N. Sergentanis,&nbsp;Konstantinos Vadikolias,&nbsp;Marta Rubiera,&nbsp;Reza Bavarsad Shahripour,&nbsp;Huy Thang Nguyen,&nbsp;Patricia Martínez-Sánchez,&nbsp;Apostolos Safouris,&nbsp;Ioannis Heliopoulos,&nbsp;Abdul Salam,&nbsp;Carol Derksen,&nbsp;Konstantinos Voumvourakis,&nbsp;Theodora Psaltopoulou,&nbsp;Anne W. Alexandrov,&nbsp;Andrei V. Alexandrov,&nbsp;Georgios Tsivgoulis,&nbsp;CLOTBUST-PRO Investigators","doi":"10.1111/jon.13207","DOIUrl":"10.1111/jon.13207","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Transcranial Doppler (TCD) identifies acute stroke patients with arterial occlusion where treatment may not effectively open the blocked vessel. This study aimed to examine the clinical utility and prognostic value of TCD flow findings in patients enrolled in a multicenter prospective study (CLOTBUST-PRO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients enrolled with intracranial occlusion on computed tomography angiography (CTA) who underwent urgent TCD evaluation before intravenous thrombolysis was included in this analysis. TCD findings were assessed using the mean flow velocity (MFV) ratio, comparing the reciprocal ratios of the middle cerebral artery (MCA) depths bilaterally (affected MCA-to-contralateral MCA MFV [aMCA/cMCA MFV ratio]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 222 patients with intracranial occlusion on CTA were included in the study (mean age: 64 ± 14 years, 62% men). Eighty-eight patients had M1 MCA occlusions; baseline mean National Institutes of Health Stroke Scale (NIHSS) score was 16, and a 24-hour mean NIHSS score was 10 points. An aMCA/cMCA MFV ratio of &lt;.6 had a sensitivity of 99%, specificity of 16%, positive predictive value (PV) of 60%, and negative PV of 94% for identifying large vessel occlusion (LVO) including M1 MCA, terminal internal carotid artery, or tandem ICA/MCA. Thrombolysis in Brain Ischemia scale, with (grade ≥1) compared to without flow (grade 0), showed a sensitivity of 17.1%, specificity of 86.9%, positive PV of 62%, and negative PV of 46% for identifying LVO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TCD is a valuable modality for evaluating arterial circulation in acute ischemic stroke patients, demonstrating significant potential as a screening tool for intravenous/intra-arterial lysis protocols.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 4","pages":"430-437"},"PeriodicalIF":2.3,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.13207","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141097144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Longitudinal myelin content measures of slowly expanding lesions using 7T MRI in multiple sclerosis 利用 7T 磁共振成像测量多发性硬化症缓慢扩展病灶的纵向髓鞘含量。
IF 2.3 4区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-22 DOI: 10.1111/jon.13209
Mina M. Huerta, Devon S. Conway, Sarah M. Planchon, Bhaskar Thoomukuntla, Oh Se-Hong, Ken E. Sakaie, Daniel Ontaneda, Kunio Nakamura

Background and Purpose

Slowly expanding lesions (SELs) are thought to represent a subset of chronic active lesions and have been associated with clinical disability, severity, and disease progression. The purpose of this study was to characterize SELs using advanced magnetic resonance imaging (MRI) measures related to myelin and neurite density on 7 Tesla (T) MRI.

Methods

The study design was retrospective, longitudinal, observational cohort with multiple sclerosis (n = 15). Magnetom 7T scanner was used to acquire magnetization-prepared 2 rapid acquisition gradient echo and advanced MRI including visualization of short transverse relaxation time component (ViSTa) for myelin, quantitative magnetization transfer (qMT) for myelin, and neurite orientation dispersion density imaging (NODDI). SELs were defined as lesions showing ≥12% of growth over 12 months on serial MRI. Comparisons of quantitative measures in SELs and non-SELs were performed at baseline and over time. Statistical analyses included two-sample t-test, analysis of variance, and mixed-effects linear model for MRI metrics between lesion types.

Results

A total of 1075 lesions were evaluated. Two hundred twenty-four lesions (21%) were SELs, and 216 (96%) of the SELs were black holes. At baseline, compared to non-SELs, SELs showed significantly lower ViSTa (1.38 vs. 1.53, p < .001) and qMT (2.47 vs. 2.97, p < .001) but not in NODDI measures (p > .27). Longitudinally, only ViSTa showed a greater loss when comparing SEL and non-SEL (p = .03).

Conclusions

SELs have a lower myelin content relative to non-SELs without a difference in neurite measures. SELs showed a longitudinal decrease in apparent myelin water fraction reflecting greater tissue injury.

背景和目的:缓慢扩展病变(SELs)被认为是慢性活动性病变的一个子集,与临床残疾、严重程度和疾病进展有关。本研究的目的是利用先进的磁共振成像(MRI)技术,通过7特斯拉(T)磁共振成像检查与髓鞘和神经元密度相关的指标来描述SEL的特征:研究设计为多发性硬化症患者(n = 15)的回顾性纵向观察队列。使用 Magnetom 7 T 扫描仪采集磁化准备 2 快速采集梯度回波和高级 MRI,包括髓鞘短横向弛豫时间分量可视化(ViSTa)、髓鞘定量磁化转移(qMT)和神经元定向弥散密度成像(NODDI)。SEL的定义是在连续核磁共振成像上显示12个月内增长≥12%的病变。对SEL和非SEL的定量指标进行基线和随时间变化的比较。统计分析包括双样本 t 检验、方差分析和病变类型间 MRI 指标的混合效应线性模型:共评估了 1075 个病灶。其中 224 个病灶(21%)为 SEL,216 个病灶(96%)为黑洞。基线时,与非 SEL 相比,SEL 的 ViSTa 明显较低(1.38 对 1.53,P.27)。纵向比较,SEL 与非 SEL 相比,只有 ViSTa 的损失更大(p = .03):结论:SEL 相对于非 SEL 的髓鞘含量较低,但神经元测量结果没有差异。SEL的表观髓鞘水分率呈纵向下降趋势,反映出组织损伤更严重。
{"title":"Longitudinal myelin content measures of slowly expanding lesions using 7T MRI in multiple sclerosis","authors":"Mina M. Huerta,&nbsp;Devon S. Conway,&nbsp;Sarah M. Planchon,&nbsp;Bhaskar Thoomukuntla,&nbsp;Oh Se-Hong,&nbsp;Ken E. Sakaie,&nbsp;Daniel Ontaneda,&nbsp;Kunio Nakamura","doi":"10.1111/jon.13209","DOIUrl":"10.1111/jon.13209","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Slowly expanding lesions (SELs) are thought to represent a subset of chronic active lesions and have been associated with clinical disability, severity, and disease progression. The purpose of this study was to characterize SELs using advanced magnetic resonance imaging (MRI) measures related to myelin and neurite density on 7 Tesla (T) MRI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study design was retrospective, longitudinal, observational cohort with multiple sclerosis (<i>n</i> = 15). Magnetom 7T scanner was used to acquire magnetization-prepared 2 rapid acquisition gradient echo and advanced MRI including visualization of short transverse relaxation time component (ViSTa) for myelin, quantitative magnetization transfer (qMT) for myelin, and neurite orientation dispersion density imaging (NODDI). SELs were defined as lesions showing ≥12% of growth over 12 months on serial MRI. Comparisons of quantitative measures in SELs and non-SELs were performed at baseline and over time. Statistical analyses included two-sample <i>t</i>-test, analysis of variance, and mixed-effects linear model for MRI metrics between lesion types.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1075 lesions were evaluated. Two hundred twenty-four lesions (21%) were SELs, and 216 (96%) of the SELs were black holes. At baseline, compared to non-SELs, SELs showed significantly lower ViSTa (1.38 vs. 1.53, <i>p</i> &lt; .001) and qMT (2.47 vs. 2.97, <i>p</i> &lt; .001) but not in NODDI measures (<i>p</i> &gt; .27). Longitudinally, only ViSTa showed a greater loss when comparing SEL and non-SEL (<i>p</i> = .03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SELs have a lower myelin content relative to non-SELs without a difference in neurite measures. SELs showed a longitudinal decrease in apparent myelin water fraction reflecting greater tissue injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 4","pages":"451-458"},"PeriodicalIF":2.3,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.13209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Neuroimaging
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