Manisha Koneru, Meisam Hoseinyazdi, Dhairya A. Lakhani, Cynthia Greene, Karen Copeland, Richard Wang, Risheng Xu, Licia Luna, Justin M. Caplan, Adam A. Dmytriw, Adrien Guenego, Jeremy J. Heit, Gregory W. Albers, Max Wintermark, Luis F. Gonzalez, Victor C. Urrutia, Judy Huang, Kambiz Nael, Richard Leigh, Elisabeth B. Marsh, Argye E. Hillis, Rafael H. Llinas, Vivek S. Yedavalli
Background and Purpose
In large vessel occlusion (LVO) stroke patients, relative cerebral blood flow (rCBF)<30% volume thresholds are commonly used in treatment decisions. In the early time window, nearly infarcted but salvageable tissue volumes may lead to pretreatment overestimates of infarct volume, and thus potentially exclude patients who may otherwise benefit from intervention. Our multisite analysis aims to explore the strength of relationships between widely used pretreatment CT parameters and clinical outcomes for early window stroke patients.
Methods
Patients from two sites in a prospective registry were analyzed. Patients with LVOs, presenting within 3 hours of last known well, and who were successfully reperfused were included. Primary short-term neurological outcome was percent National Institutes of Health Stroke Scale (NIHSS) change from admission to discharge. Secondary long-term outcome was 90-day modified Rankin score. Spearman's correlations were performed. Significance was attributed to p-value ≤.05.
Results
Among 73 patients, median age was 66 (interquartile range 54-76) years. Among all pretreatment imaging parameters, rCBF<30%, rCBF<34%, and rCBF<38% volumes were significantly, inversely correlated with percentage NIHSS change (p<.048). No other parameters significantly correlated with outcomes.
Conclusions
Our multisite analysis shows that favorable short-term neurological recovery was significantly correlated with rCBF volumes in the early time window. However, modest strength of correlations provides supportive evidence that the applicability of general ischemic core estimate thresholds in this subpopulation is limited. Our results support future larger-scale efforts to liberalize or reevaluate current rCBF parameter thresholds guiding treatment decisions for early time window stroke patients.
{"title":"Redefining CT perfusion-based ischemic core estimates for the ghost core in early time window stroke","authors":"Manisha Koneru, Meisam Hoseinyazdi, Dhairya A. Lakhani, Cynthia Greene, Karen Copeland, Richard Wang, Risheng Xu, Licia Luna, Justin M. Caplan, Adam A. Dmytriw, Adrien Guenego, Jeremy J. Heit, Gregory W. Albers, Max Wintermark, Luis F. Gonzalez, Victor C. Urrutia, Judy Huang, Kambiz Nael, Richard Leigh, Elisabeth B. Marsh, Argye E. Hillis, Rafael H. Llinas, Vivek S. Yedavalli","doi":"10.1111/jon.13180","DOIUrl":"10.1111/jon.13180","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>In large vessel occlusion (LVO) stroke patients, relative cerebral blood flow (rCBF)<30% volume thresholds are commonly used in treatment decisions. In the early time window, nearly infarcted but salvageable tissue volumes may lead to pretreatment overestimates of infarct volume, and thus potentially exclude patients who may otherwise benefit from intervention. Our multisite analysis aims to explore the strength of relationships between widely used pretreatment CT parameters and clinical outcomes for early window stroke patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients from two sites in a prospective registry were analyzed. Patients with LVOs, presenting within 3 hours of last known well, and who were successfully reperfused were included. Primary short-term neurological outcome was percent National Institutes of Health Stroke Scale (NIHSS) change from admission to discharge. Secondary long-term outcome was 90-day modified Rankin score. Spearman's correlations were performed. Significance was attributed to <i>p</i>-value ≤.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 73 patients, median age was 66 (interquartile range 54-76) years. Among all pretreatment imaging parameters, rCBF<30%, rCBF<34%, and rCBF<38% volumes were significantly, inversely correlated with percentage NIHSS change (<i>p</i><.048). No other parameters significantly correlated with outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our multisite analysis shows that favorable short-term neurological recovery was significantly correlated with rCBF volumes in the early time window. However, modest strength of correlations provides supportive evidence that the applicability of general ischemic core estimate thresholds in this subpopulation is limited. Our results support future larger-scale efforts to liberalize or reevaluate current rCBF parameter thresholds guiding treatment decisions for early time window stroke patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 2","pages":"249-256"},"PeriodicalIF":2.4,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139037821","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}
Daniel A. Schwartz, Jason Talbott, Andrew Callen, Benjamin Laguna, Jared Narvid, Judy H. Ch'ang, Vineeta Singh
Background and Purpose
Cerebral venous sinus thrombosis (CVST) is an underrecognized cause of morbidity in acute traumatic brain injury (TBI). Radiologic diagnosis is challenging in the setting of concurrent extra-axial injury and a lack of standardized diagnostic criteria. The prevalence of traumatic thrombosis versus compression is unknown. Treatment with anticoagulation is often determined by the appropriate classification of the type of traumatic venous injury.
Methods
We developed a two-part radiologic grading method for standardized assessment of traumatic CVST based on (1) the degree of flow limitation through the affected sinus and (2) the location of venous pathology (ie, external compression vs. intrinsic thrombosis) based on computed tomography venography. We applied this grading method to a retrospective cohort of TBI patients presenting to a Level 1 Trauma center. Chart review was performed to identify potential clinical correlates. A senior neuroradiologist graded the entire cohort and a random subsample was selected for blinded rating by two independent neuroradiologists.
Results
Seventy-six of 221 patients were identified for inclusion after excluding nontraumatic mechanisms. Seven unique grades were employed to characterize the full extent of venous injuries. The plurality of patients from the cohort (43/76 = 43.4%) suffered compressive injuries. Inter-rater reliability was moderate for the combined grade, kappa = 0.48, p<.05, and substantial for the flow limitation component, kappa = 0.69, p<.05.
Conclusions
We introduce a standardized two-part classification system for traumatic venous sinus injury with moderate-substantial inter-rater reliability. Compressive injuries were more common than thrombotic injuries. Further prospective work is needed to validate the clinical significance of this classification system.
{"title":"Classification of traumatic injury to the dural venous sinus using CT venography","authors":"Daniel A. Schwartz, Jason Talbott, Andrew Callen, Benjamin Laguna, Jared Narvid, Judy H. Ch'ang, Vineeta Singh","doi":"10.1111/jon.13182","DOIUrl":"10.1111/jon.13182","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Cerebral venous sinus thrombosis (CVST) is an underrecognized cause of morbidity in acute traumatic brain injury (TBI). Radiologic diagnosis is challenging in the setting of concurrent extra-axial injury and a lack of standardized diagnostic criteria. The prevalence of traumatic thrombosis versus compression is unknown. Treatment with anticoagulation is often determined by the appropriate classification of the type of traumatic venous injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed a two-part radiologic grading method for standardized assessment of traumatic CVST based on (1) the degree of flow limitation through the affected sinus and (2) the location of venous pathology (ie, external compression vs. intrinsic thrombosis) based on computed tomography venography. We applied this grading method to a retrospective cohort of TBI patients presenting to a Level 1 Trauma center. Chart review was performed to identify potential clinical correlates. A senior neuroradiologist graded the entire cohort and a random subsample was selected for blinded rating by two independent neuroradiologists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-six of 221 patients were identified for inclusion after excluding nontraumatic mechanisms. Seven unique grades were employed to characterize the full extent of venous injuries. The plurality of patients from the cohort (43/76 = 43.4%) suffered compressive injuries. Inter-rater reliability was moderate for the combined grade, kappa = 0.48, <i>p</i><.05, and substantial for the flow limitation component, kappa = 0.69, <i>p</i><.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We introduce a standardized two-part classification system for traumatic venous sinus injury with moderate-substantial inter-rater reliability. Compressive injuries were more common than thrombotic injuries. Further prospective work is needed to validate the clinical significance of this classification system.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 2","pages":"205-210"},"PeriodicalIF":2.4,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.13182","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139037820","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}
Syed A. Ahsan, Nicholas B. Dadario, Jasneet Dhaliwal, Robert G. Briggs, Karol Osipowicz, Syed M. Ahsan, Kassem Chendeb, Andrew K. Conner, Christen M. O'Neal, Chad A. Glenn, Michael E. Sughrue
Background and Purpose
Hemispatial neglect is characterized by a reduced awareness to stimuli on the contralateral side. Current literature suggesting that damage to the right parietal lobe and attention networks may cause hemispatial neglect is conflicting and can be improved by investigating a connectomic model of the “neglect system” and the anatomical specificity of regions involved in it.
Methods
A meta-analysis of voxel-based morphometry magnetic resonance imaging (MRI) studies of hemispatial neglect was used to identify regions associated with neglect. We applied parcellation schemes to these regions and performed diffusion spectrum imaging (DSI) tractography to determine their connectivity. By overlaying neglect areas and maps of the attention networks, we studied the relationship between them.
Results
The meta-analysis generated a list of 13 right hemisphere parcellations. These 13 neglect-related parcellations were predominantly linked by the superior longitudinal fasciculus (SLF) throughout a fronto-parietal-temporal network. We found that the dorsal and ventral attention networks showed partial overlap with the neglect system and included various other higher-order networks.
Conclusions
We provide an anatomically specific connectomic model of the neurobehavioral substrates underlying hemispatial neglect. Our model suggests a fronto-parietal-temporal network linked via the SLF supports the functions impaired in neglect and implicates various higher-order networks which are not limited to the attention networks.
{"title":"A parcellation-based connectomic model of hemispatial neglect","authors":"Syed A. Ahsan, Nicholas B. Dadario, Jasneet Dhaliwal, Robert G. Briggs, Karol Osipowicz, Syed M. Ahsan, Kassem Chendeb, Andrew K. Conner, Christen M. O'Neal, Chad A. Glenn, Michael E. Sughrue","doi":"10.1111/jon.13176","DOIUrl":"10.1111/jon.13176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Hemispatial neglect is characterized by a reduced awareness to stimuli on the contralateral side. Current literature suggesting that damage to the right parietal lobe and attention networks may cause hemispatial neglect is conflicting and can be improved by investigating a connectomic model of the “neglect system” and the anatomical specificity of regions involved in it.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A meta-analysis of voxel-based morphometry magnetic resonance imaging (MRI) studies of hemispatial neglect was used to identify regions associated with neglect. We applied parcellation schemes to these regions and performed diffusion spectrum imaging (DSI) tractography to determine their connectivity. By overlaying neglect areas and maps of the attention networks, we studied the relationship between them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The meta-analysis generated a list of 13 right hemisphere parcellations. These 13 neglect-related parcellations were predominantly linked by the superior longitudinal fasciculus (SLF) throughout a fronto-parietal-temporal network. We found that the dorsal and ventral attention networks showed partial overlap with the neglect system and included various other higher-order networks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We provide an anatomically specific connectomic model of the neurobehavioral substrates underlying hemispatial neglect. Our model suggests a fronto-parietal-temporal network linked via the SLF supports the functions impaired in neglect and implicates various higher-order networks which are not limited to the attention networks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 2","pages":"267-279"},"PeriodicalIF":2.4,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138800538","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}
Livja Mertiri, John T. Freiling, Nilesh K. Desai, Stephen F. Kralik, Thierry A. G. M. Huisman
Neurotuberculosis is defined as a tuberculous infection of the meninges, brain parenchyma, vessels, cranial and spinal nerves, spinal cord, skull, and spine that can occur either in a localized or in a diffuse form.
It is a heterogeneous disease characterized by many imaging appearances and it has been defined as “the great mimicker” due to similarities with many other conditions.
The diagnosis of central nervous system (CNS) tuberculosis (TB) is based on clinical presentation, neuroimaging findings, laboratory and microbiological findings, and comprehensive evaluation of the response to anti-TB drug treatment.
However, the absence of specific symptoms, the wide spectrum of neurological manifestations, the myriad of imaging findings, possible inconclusive laboratory results, and the paradoxical reaction to treatment make the diagnosis often challenging and difficult, potentially delaying adequate treatment with possible devastating short-term and long-term neurologic sequelae.
Familiarity with the imaging characteristics helps in accurate diagnosis and may prevent or limit significantly morbidity and mortality. The goal of this review is to provide a comprehensive up-to-date overview of the conventional and advanced imaging features of CNS TB for radiologists, neuroradiologists, and pediatric radiologists. We discuss the most typical neurotuberculosis imaging findings and their differential diagnosis in children and adults with the goal to provide a global overview of this entity.
{"title":"Pediatric and adult meningeal, parenchymal, and spinal tuberculosis: A neuroimaging review","authors":"Livja Mertiri, John T. Freiling, Nilesh K. Desai, Stephen F. Kralik, Thierry A. G. M. Huisman","doi":"10.1111/jon.13177","DOIUrl":"10.1111/jon.13177","url":null,"abstract":"<p>Neurotuberculosis is defined as a tuberculous infection of the meninges, brain parenchyma, vessels, cranial and spinal nerves, spinal cord, skull, and spine that can occur either in a localized or in a diffuse form.</p><p>It is a heterogeneous disease characterized by many imaging appearances and it has been defined as “the great mimicker” due to similarities with many other conditions.</p><p>The diagnosis of central nervous system (CNS) tuberculosis (TB) is based on clinical presentation, neuroimaging findings, laboratory and microbiological findings, and comprehensive evaluation of the response to anti-TB drug treatment.</p><p>However, the absence of specific symptoms, the wide spectrum of neurological manifestations, the myriad of imaging findings, possible inconclusive laboratory results, and the paradoxical reaction to treatment make the diagnosis often challenging and difficult, potentially delaying adequate treatment with possible devastating short-term and long-term neurologic sequelae.</p><p>Familiarity with the imaging characteristics helps in accurate diagnosis and may prevent or limit significantly morbidity and mortality. The goal of this review is to provide a comprehensive up-to-date overview of the conventional and advanced imaging features of CNS TB for radiologists, neuroradiologists, and pediatric radiologists. We discuss the most typical neurotuberculosis imaging findings and their differential diagnosis in children and adults with the goal to provide a global overview of this entity.</p>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 2","pages":"179-194"},"PeriodicalIF":2.4,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138680453","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}
Dhairya A. Lakhani, Aneri B. Balar, Manisha Koneru, Meisam Hoseinyazdi, Nathan Hyson, Andrew Cho, Cynthia Greene, Risheng Xu, Licia Luna, Justin Caplan, Adam Dmytriw, Adrien Guenego, Max Wintermark, Fernando Gonzalez, Victor Urrutia, Judy Huang, Kambiz Nael, Ansaar T. Rai, Gregory W. Albers, Jeremy J. Heit, Vivek Yedavalli
Background and Purpose
Acute ischemic stroke due to large vessel occlusion (AIS-LVO) is a major cause of functional dependence. Collateral status (CS) is an important determinant of functional outcomes. Pretreatment CT perfusion (CTP) parameters serve as reliable surrogates of CS. Penumbra Salvage Index (PSI) is another parameter predictive of functional outcomes in AIS-LVO. The aim of this study is to assess the relationship of pretreatment CTP parameters with PSI.
Methods
In this prospectively collected, retrospectively reviewed multicenter analysis, inclusion criteria were as follows: (1) CT angiography confirmed middle cerebral artery (MCA) M1-segment and proximal M2-segment occlusion from 9/1/2017 to 9/22/2022; (2) diagnostic CTP; and (3) available diagnostic Magnetic resonance Imaging (MRI) diffusion-weighted images. Pearson correlation analysis was performed to assess the association between cerebral blood volume (CBV) index and hypoperfusion intensity ratio (HIR) with PSI. p value ≤.05 was considered statistically significant.
Results
In total, 131 patients (n = 86, M1 and n = 45, proximal M2 occlusion) met our inclusion criteria. CBV index showed a modest positive correlation with PSI (r = 0.34, p<.001) in patients with proximal MCA occlusion. Similar trends were noted in subgroup analysis of patients with M1 occlusion, and proximal M2 occlusion. Whereas, HIR did not have a strong trend or correlation with PSI.
Conclusion
CBV index correlates with PSI, whereas HIR does not. Future studies are needed to expand our understanding of the adjunct role of CBV index with other similar pretreatment CTP-based markers in clinical evaluation and decision-making in patients with MCA occlusion.
{"title":"Pretreatment CT perfusion collateral parameters correlate with penumbra salvage in middle cerebral artery occlusion","authors":"Dhairya A. Lakhani, Aneri B. Balar, Manisha Koneru, Meisam Hoseinyazdi, Nathan Hyson, Andrew Cho, Cynthia Greene, Risheng Xu, Licia Luna, Justin Caplan, Adam Dmytriw, Adrien Guenego, Max Wintermark, Fernando Gonzalez, Victor Urrutia, Judy Huang, Kambiz Nael, Ansaar T. Rai, Gregory W. Albers, Jeremy J. Heit, Vivek Yedavalli","doi":"10.1111/jon.13178","DOIUrl":"10.1111/jon.13178","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Acute ischemic stroke due to large vessel occlusion (AIS-LVO) is a major cause of functional dependence. Collateral status (CS) is an important determinant of functional outcomes. Pretreatment CT perfusion (CTP) parameters serve as reliable surrogates of CS. Penumbra Salvage Index (PSI) is another parameter predictive of functional outcomes in AIS-LVO. The aim of this study is to assess the relationship of pretreatment CTP parameters with PSI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospectively collected, retrospectively reviewed multicenter analysis, inclusion criteria were as follows: (1) CT angiography confirmed middle cerebral artery (MCA) M1-segment and proximal M2-segment occlusion from 9/1/2017 to 9/22/2022; (2) diagnostic CTP; and (3) available diagnostic Magnetic resonance Imaging (MRI) diffusion-weighted images. Pearson correlation analysis was performed to assess the association between cerebral blood volume (CBV) index and hypoperfusion intensity ratio (HIR) with PSI. <i>p</i> value ≤.05 was considered statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 131 patients (<i>n</i> = 86, M1 and <i>n</i> = 45, proximal M2 occlusion) met our inclusion criteria. CBV index showed a modest positive correlation with PSI (<i>r</i> = 0.34, <i>p</i><.001) in patients with proximal MCA occlusion. Similar trends were noted in subgroup analysis of patients with M1 occlusion, and proximal M2 occlusion. Whereas, HIR did not have a strong trend or correlation with PSI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CBV index correlates with PSI, whereas HIR does not. Future studies are needed to expand our understanding of the adjunct role of CBV index with other similar pretreatment CTP-based markers in clinical evaluation and decision-making in patients with MCA occlusion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 1","pages":"44-49"},"PeriodicalIF":2.4,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.13178","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138498634","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}
Margareta A. Clarke, Rachael Cheek, Habeeb F. Kazimuddin, Bryan Hernandez, Reece Clarke, Colin D. McKnight, Joy Derwenskus, James Eaton, Rebecca Irlmeier, Fei Ye, Kristin P. O'Grady, Baxter Rogers, Seth A. Smith, Francesca Bagnato
Background and Purpose
Paramagnetic rims and the central vein sign (CVS) are proposed imaging markers of multiple sclerosis (MS) lesions. Using 7 tesla magnetic resonance imaging, we aimed to: (1) characterize the appearance of paramagnetic rim lesions (PRLs); (2) assess whether PRLs and the CVS are associated with higher levels of MS pathology; and (3) compare the characteristics between subjects with and without PRLs in early MS.
Methods
Prospective study of 32 treatment-naïve subjects around the time of diagnosis who were assessed for the presence of PRLs and the CVS. Comparisons of lesion volume and macromolecular pool size ratio (PSR) index, a proxy of myelin integrity, between PRLs and non-PRLs, and CVS-positive and CVS-negative lesions were carried out. Differences in clinical/demographic characteristics between patients with PRLs and those without were tested.
Results
Fifteen subjects had ≥1 PRL for a total of 36 PRLs, of which two-thirds had a full rim. PRLs predicted a larger lesion size and decreased PSR signal. Lesion volume and presence of cervical spine lesions were significantly different between subjects with PRLs and those without, although neither remained significant after adjusting for multiple comparisons. One hundred and eighty-one lesions with CVS were identified with no differences between CVS-positive and CVS-negative lesions in volume (p = .27) and PSR values (p = .62).
Conclusions
PRLs, but not CVS-positive lesions, are larger and have lower myelin integrity. Our findings indicate that PRLs are associated with higher levels of lesion-specific pathology prior to the start of disease-modifying therapy.
{"title":"Paramagnetic rim lesions and the central vein sign: Characterizing multiple sclerosis imaging markers","authors":"Margareta A. Clarke, Rachael Cheek, Habeeb F. Kazimuddin, Bryan Hernandez, Reece Clarke, Colin D. McKnight, Joy Derwenskus, James Eaton, Rebecca Irlmeier, Fei Ye, Kristin P. O'Grady, Baxter Rogers, Seth A. Smith, Francesca Bagnato","doi":"10.1111/jon.13173","DOIUrl":"10.1111/jon.13173","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Paramagnetic rims and the central vein sign (CVS) are proposed imaging markers of multiple sclerosis (MS) lesions. Using 7 tesla magnetic resonance imaging, we aimed to: (1) characterize the appearance of paramagnetic rim lesions (PRLs); (2) assess whether PRLs and the CVS are associated with higher levels of MS pathology; and (3) compare the characteristics between subjects with and without PRLs in early MS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective study of 32 treatment-naïve subjects around the time of diagnosis who were assessed for the presence of PRLs and the CVS. Comparisons of lesion volume and macromolecular pool size ratio (PSR) index, a proxy of myelin integrity, between PRLs and non-PRLs, and CVS-positive and CVS-negative lesions were carried out. Differences in clinical/demographic characteristics between patients with PRLs and those without were tested.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen subjects had ≥1 PRL for a total of 36 PRLs, of which two-thirds had a full rim. PRLs predicted a larger lesion size and decreased PSR signal. Lesion volume and presence of cervical spine lesions were significantly different between subjects with PRLs and those without, although neither remained significant after adjusting for multiple comparisons. One hundred and eighty-one lesions with CVS were identified with no differences between CVS-positive and CVS-negative lesions in volume (<i>p</i> = .27) and PSR values (<i>p</i> = .62).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PRLs, but not CVS-positive lesions, are larger and have lower myelin integrity. Our findings indicate that PRLs are associated with higher levels of lesion-specific pathology prior to the start of disease-modifying therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 1","pages":"86-94"},"PeriodicalIF":2.4,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.13173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451616","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}
Mohammad Amin, Oun Al-iedani, Rodney A. Lea, Fabienne Brilot, Vicki E. Maltby, Jeannette Lechner-Scott
Background and Purpose
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a relapsing demyelinating condition. There are several cross-sectional studies showing evidence of brain atrophy in people with MOGAD (pwMOGAD), but longitudinal brain volumetric assessment is still an unmet need. Current recommendations do not include monitoring with MRI and assume distinct attacks. Evidence of ongoing axon loss will have diagnostic and therapeutic implications. In this study, we assessed brain volume changes in pwMOGAD over a mean follow-up period of 2 years and compared this to changes in people with multiple sclerosis (pwMS).
Methods
This is a retrospective single-center study over a 7-year period from 2014 to 2021. MRI brain scans at the time of diagnosis and follow-up in remission were collected from 14 Caucasian pwMOGAD, confirmed by serum myelin oligodendrocyte glycoprotein immunoglobulin G antibody presence, detected by live cell-based assays. Total brain volume (TBV), white matter (WM), gray matter (GM), and demyelinating lesion volumes were assessed automatically using the Statistical Parametric Mapping and FMRIB automated segmentation tools. MRI brain scans at diagnosis and follow-up on remission were collected from 32-matched pwMS for comparison. Statistical analysis was done using analysis of variance.
Results
There is evidence of TBV loss, affecting particularly GM, over an approximately 2-year follow-up period in pwMOGAD (p < .05), comparable to pwMS. WM and lesion volume change over the same period were not statistically significant (p > .1).
Conclusion
We found evidence of loss of GM and TBV over time in pwMOGAD, similar to pwMS, although the WM and lesion volumes were unchanged.
{"title":"A longitudinal analysis of brain volume changes in myelin oligodendrocyte glycoprotein antibody-associated disease","authors":"Mohammad Amin, Oun Al-iedani, Rodney A. Lea, Fabienne Brilot, Vicki E. Maltby, Jeannette Lechner-Scott","doi":"10.1111/jon.13175","DOIUrl":"10.1111/jon.13175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a relapsing demyelinating condition. There are several cross-sectional studies showing evidence of brain atrophy in people with MOGAD (pwMOGAD), but longitudinal brain volumetric assessment is still an unmet need. Current recommendations do not include monitoring with MRI and assume distinct attacks. Evidence of ongoing axon loss will have diagnostic and therapeutic implications. In this study, we assessed brain volume changes in pwMOGAD over a mean follow-up period of 2 years and compared this to changes in people with multiple sclerosis (pwMS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective single-center study over a 7-year period from 2014 to 2021. MRI brain scans at the time of diagnosis and follow-up in remission were collected from 14 Caucasian pwMOGAD, confirmed by serum myelin oligodendrocyte glycoprotein immunoglobulin G antibody presence, detected by live cell-based assays. Total brain volume (TBV), white matter (WM), gray matter (GM), and demyelinating lesion volumes were assessed automatically using the Statistical Parametric Mapping and FMRIB automated segmentation tools. MRI brain scans at diagnosis and follow-up on remission were collected from 32-matched pwMS for comparison. Statistical analysis was done using analysis of variance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There is evidence of TBV loss, affecting particularly GM, over an approximately 2-year follow-up period in pwMOGAD (<i>p</i> < .05), comparable to pwMS. WM and lesion volume change over the same period were not statistically significant (<i>p</i> > .1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found evidence of loss of GM and TBV over time in pwMOGAD, similar to pwMS, although the WM and lesion volumes were unchanged.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 1","pages":"78-85"},"PeriodicalIF":2.4,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.13175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451614","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}
Parenchymal hematoma is a dreaded complication of mechanical thrombectomy after acute ischemic stroke. This study evaluated whether blood-brain barrier permeability measurements based on CT perfusion could be used as predictors of parenchymal hematoma after successful recanalization and compared the predictive value of various permeability parameters in patients with acute ischemic stroke.
Methods
We enrolled 53 patients with acute ischemic stroke who underwent mechanical thrombectomy and achieved successful recanalization. Each patient underwent CT, CT angiography, and CT perfusion imaging before treatment. We used relative volume transfer constant (rKtrans) values, relative permeability–surface area product (rP·S), and relative extraction fraction (rE) to evaluate preoperative blood-brain barrier permeability in the delayed perfusion area.
Results
Overall, 22 patients (37.7%) developed hemorrhagic transformation after surgery, including 10 patients (16.9%) with hemorrhagic infarction and 11 patients (20.8%) with parenchymal hematoma. The rP·S, rKtrans, and rE of the hypoperfusion area in the parenchymal hematoma group were significantly higher than those in the hemorrhagic infarction and no-hemorrhage transformation groups (p < .01). We found that rE and rP·S were superior to rKtrans in predicting parenchymal hematoma transformation after thrombectomy (P·S area under the curve [AUC] .844 vs. rKtrans AUC .753, z = 2.064, p = .039; rE AUC .907 vs. rKtrans AUC .753, z = 2.399, p = .017).
Conclusions
Patients with parenchymal hematoma after mechanical thrombectomy had higher blood-brain barrier permeability in hypoperfusion areas. Among blood-brain barrier permeability measurement parameters, rP·S and rE showed better accuracy for parenchymal hematoma prediction.
背景与目的:脑实质血肿是急性缺血性脑卒中机械取栓术中一种可怕的并发症。本研究评估了基于CT灌注的血脑屏障通透性测量是否可以作为脑实质血肿再通成功后的预测指标，并比较了各种通透性参数在急性缺血性脑卒中患者中的预测价值。方法:我们招募了53例急性缺血性脑卒中患者，他们接受了机械取栓术并成功地实现了再通。治疗前均行CT、CT血管造影、CT灌注成像。我们使用相对体积传递常数(rKtrans)值、相对透性-表面积积(rP·S)和相对提取分数(rE)来评估延迟灌注区术前血脑屏障透性。结果:术后发生出血转化22例(37.7%)，其中出血性梗死10例(16.9%)，实质血肿11例(20.8%)。脑实质血肿组低灌注区rP·S、rKtrans、rE均显著高于出血性梗死组和无出血转化组(p trans预测取栓后脑实质血肿转化的曲线下p·S面积[AUC] .844 vs. rKtrans AUC .753, z = 2.064, p = 0.039;rE AUC为0.907,rKtrans AUC为0.753,z = 2.399, p = 0.017)。结论:机械取栓后脑实质血肿患者在低灌注区具有较高的血脑屏障通透性。在血脑屏障通透性测量参数中，rP·S和rE对脑实质血肿的预测精度较高。
{"title":"Blood-brain barrier permeability by CT perfusion predicts parenchymal hematoma after recanalization with thrombectomy","authors":"Xinyi Chen, Jie Xu, Shunyuan Guo, Sheng Zhang, Huiyuan Wang, Panpan Shen, Yafei Shang, Mingming Tan, Yu Geng","doi":"10.1111/jon.13172","DOIUrl":"10.1111/jon.13172","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Parenchymal hematoma is a dreaded complication of mechanical thrombectomy after acute ischemic stroke. This study evaluated whether blood-brain barrier permeability measurements based on CT perfusion could be used as predictors of parenchymal hematoma after successful recanalization and compared the predictive value of various permeability parameters in patients with acute ischemic stroke.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 53 patients with acute ischemic stroke who underwent mechanical thrombectomy and achieved successful recanalization. Each patient underwent CT, CT angiography, and CT perfusion imaging before treatment. We used relative volume transfer constant (r<i>K</i><sub>trans</sub>) values, relative permeability–surface area product (r<i>P</i>·<i>S</i>), and relative extraction fraction (r<i>E</i>) to evaluate preoperative blood-brain barrier permeability in the delayed perfusion area.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 22 patients (37.7%) developed hemorrhagic transformation after surgery, including 10 patients (16.9%) with hemorrhagic infarction and 11 patients (20.8%) with parenchymal hematoma. The r<i>P</i>·<i>S</i>, r<i>K</i><sub>trans</sub>, and r<i>E</i> of the hypoperfusion area in the parenchymal hematoma group were significantly higher than those in the hemorrhagic infarction and no-hemorrhage transformation groups (<i>p</i> < .01). We found that r<i>E</i> and r<i>P</i>·<i>S</i> were superior to r<i>K</i><sub>trans</sub> in predicting parenchymal hematoma transformation after thrombectomy (<i>P</i>·<i>S</i> area under the curve [AUC] .844 vs. r<i>K</i><sub>trans</sub> AUC .753, <i>z</i> = 2.064, <i>p</i> = .039; r<i>E</i> AUC .907 vs. r<i>K</i><sub>trans</sub> AUC .753, <i>z</i> = 2.399, <i>p</i> = .017).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with parenchymal hematoma after mechanical thrombectomy had higher blood-brain barrier permeability in hypoperfusion areas. Among blood-brain barrier permeability measurement parameters, r<i>P</i>·<i>S</i> and r<i>E</i> showed better accuracy for parenchymal hematoma prediction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 2","pages":"241-248"},"PeriodicalIF":2.4,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451615","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}
Many studies have shown that exposure to life events can have a negative impact on mental health. Life events like the death of a spouse or the birth of a child pose a challenge and require temporal or permanent adjustments. Meta-analyses on brain stress responses found bilateral anterior insula activation in response to acute stress. Fear conditioning is assumed a crucial mechanism for the development of anxiety disorders associated with increased activation in the bilateral amygdala. Empirical evidence is lacking regarding the relationship of exposure to recent life events and past childhood adversity with neural processing during fear conditioning.
Methods
In the present study, we analyzed data from 103 young, healthy participants. Multiple linear regressions were performed on functional magnetic resonance imaging activation during fear conditioning with the Life Events Scale for Students and the Childhood Trauma questionnaire included as covariates in two separate models.
Results
We found a positive relationship between the number of life events in the last year and left amygdala activation to the conditioned stimulus. A second finding was a positive relationship between childhood adversity and right anterior insula response to the unconditioned stimulus.
Conclusions
Many studies have shown increased amygdala activity after stressful life events. In addition, the anterior insula is activated during acute stress. The present study points to stressor-induced increased salience processing during fear conditioning. We suggest that this could be a potential mechanism for resilience versus mental illness.
{"title":"The impact of past childhood adversity and recent life events on neural responses during fear conditioning","authors":"Miriam Kampa, Rudolf Stark, Tim Klucken","doi":"10.1111/jon.13174","DOIUrl":"10.1111/jon.13174","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and purpose</h3>\u0000 \u0000 <p>Many studies have shown that exposure to life events can have a negative impact on mental health. Life events like the death of a spouse or the birth of a child pose a challenge and require temporal or permanent adjustments. Meta-analyses on brain stress responses found bilateral anterior insula activation in response to acute stress. Fear conditioning is assumed a crucial mechanism for the development of anxiety disorders associated with increased activation in the bilateral amygdala. Empirical evidence is lacking regarding the relationship of exposure to recent life events and past childhood adversity with neural processing during fear conditioning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the present study, we analyzed data from 103 young, healthy participants. Multiple linear regressions were performed on functional magnetic resonance imaging activation during fear conditioning with the Life Events Scale for Students and the Childhood Trauma questionnaire included as covariates in two separate models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found a positive relationship between the number of life events in the last year and left amygdala activation to the conditioned stimulus. A second finding was a positive relationship between childhood adversity and right anterior insula response to the unconditioned stimulus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many studies have shown increased amygdala activity after stressful life events. In addition, the anterior insula is activated during acute stress. The present study points to stressor-induced increased salience processing during fear conditioning. We suggest that this could be a potential mechanism for resilience versus mental illness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 2","pages":"217-223"},"PeriodicalIF":2.4,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.13174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138444972","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}
This work investigates verbal memory functional MRI (fMRI) versus language fMRI in terms of lateralization, and assesses the validity of performing word recognition during the functional scan.
Methods
Thirty patients with a diagnosis of epilepsy underwent verbal memory, visuospatial memory, and language fMRI. We used word encoding, word recognition, image encoding, and image recognition memory tasks, and semantic description, reading comprehension, and listening comprehension language tasks. We used three common lateralization metrics: network spatial distribution, maximum statistical value, and laterality index (LI).
Results
Lateralization of signal spatial distribution resulted in poor similarity between verbal memory and language fMRI tasks. Signal maximum lateralization showed significant (>.8) but not perfect (1) similarity. Word encoding LI showed significant correlation only with listening comprehension LI (p = .016). Word recognition LI was significantly correlated with expressive language semantic description LI (p = .024) and receptive language reading and listening comprehension LIs (p = .015 and p = .019, respectively). There was no correlation between LIs of the visuospatial tasks and LIs of the language tasks.
Conclusions
Our results support the association between language and verbal memory lateralization, optimally determined by LI quantification, and the introduction of quantitative means for language fMRI interpretation in clinical settings where verbal memory lateralization is imperative.
{"title":"Concordance of verbal memory and language fMRI lateralization in people with epilepsy","authors":"Vasileios Kokkinos, Ioannis Seimenis","doi":"10.1111/jon.13171","DOIUrl":"10.1111/jon.13171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>This work investigates verbal memory functional MRI (fMRI) versus language fMRI in terms of lateralization, and assesses the validity of performing word recognition during the functional scan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty patients with a diagnosis of epilepsy underwent verbal memory, visuospatial memory, and language fMRI. We used word encoding, word recognition, image encoding, and image recognition memory tasks, and semantic description, reading comprehension, and listening comprehension language tasks. We used three common lateralization metrics: network spatial distribution, maximum statistical value, and laterality index (LI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Lateralization of signal spatial distribution resulted in poor similarity between verbal memory and language fMRI tasks. Signal maximum lateralization showed significant (>.8) but not perfect (1) similarity. Word encoding LI showed significant correlation only with listening comprehension LI (<i>p</i> = .016). Word recognition LI was significantly correlated with expressive language semantic description LI (<i>p</i> = .024) and receptive language reading and listening comprehension LIs (<i>p</i> = .015 and <i>p</i> = .019, respectively). There was no correlation between LIs of the visuospatial tasks and LIs of the language tasks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results support the association between language and verbal memory lateralization, optimally determined by LI quantification, and the introduction of quantitative means for language fMRI interpretation in clinical settings where verbal memory lateralization is imperative.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 1","pages":"95-107"},"PeriodicalIF":2.4,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.13171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134649155","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}
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