Initial microbleeds at MR imaging can predict recurrent intracerebral hemorrhage.

BACKGROUND: Intracerebral microbleeds (MBs) are frequently observed in intracerebral hemorrhage (ICH) patients. Although MBs have been shown to be pathogenetically related with ICH, it is not known whether MBs are predictors of recurrent ICHs. METHODS: Among 220 acute symptomatic primary ICH patients, 112 patients who underwent gradient-echo T2*-weighted MR imaging (GRE) within 10 days after symptom onset were considered for this study. Among them, the final 63 patients who consented to follow-up clinical, laboratory and GRE studies were included. The presence and number of ICHs (mean diameter >5 mm) and MBs on baseline and follow-up GRE were evaluated. The relationship of recurrent ICHs with initial and follow-up clinical and laboratory data as well as the MBs was assessed. RESULTS: Among 63 patients, 43 (68.3%) had MBs (median, 2; range, 1 to 17) on baseline GRE. Seven (11.1%) patients (6 with initial MBs; 1 without initial MBs) developed recurrent ICHs, and 19 (30.2%) had new MBs during a median 23.3 months (range, 8.3 to 33.0) of follow-up. The number of initial MBs on baseline GRE was significantly (p < 0.0001) associated with development of recurrent ICHs whereas other clinical and laboratory data were not. CONCLUSIONS: Recurrent ICHs and MBs are common after long-term follow-up of primary ICH. The number of MBs on baseline GRE may predict the recurrence of the ICH.

Factors affecting the angiographic recanalization and early clinical improvement in middle cerebral artery territory infarction after thrombolysis.

BACKGROUND: Factors affecting the angiographic recanalization (AR) and clinical improvement (CI) still remain unclear in patients receiving thrombolytic therapy. OBJECTIVES: To elucidate factors related to AR and early CI in patients with middle cerebral artery (MCA) or internal carotid artery (ICA) occlusion. DESIGNS: Retrospective study. SETTING: Department of Neurology, Asan Medical Center, Seoul, South Korea. PATIENTS: We studied 42 patients who (1) underwent diffusion-weighted magnetic resonance (MR) imaging and MR angiography within 6 hours after onset, (2) had MCA territory infarction, (3) had nonvisualization of the MCA or the ICA on initial MR angiography, (4) were treated with thrombolytics, and (5) underwent follow-up MR imaging and MR angiography at day 2 or 3. RESULTS: Successful AR and CI were achieved in 31 and 16 patients, respectively. Angiographic recanalization was related to CI (P<.01), lower follow-up National Institutes of Health Stroke Scale scores (P<.05), the absence of a dominant ipsilateral posterior cerebral artery (P<.01) on initial MR angiography, and the sparing of the internal capsule on both initial (P<.05) and follow-up (P<.01) MR imaging. Clinical improvement was associated with the absence of ICA (vs MCA) flow signals (P<.05), the sparing of the internal capsule (P<.01), and marginally, with the infarct volume change (P = .06). CONCLUSIONS: In patients with MCA or ICA occlusion, CI after thrombolysis is related to the AR and the sparing of the critical motor pathway. The presence of a dominant ipsilateral posterior cerebral artery may predict poor AR after thrombolysis.

Comparison of brain MRI and 18F-FDG PET in the differential diagnosis of multiple system atrophy from Parkinson's disease.

To investigate the diagnostic value of brain magnetic resonance image (MRI) and (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) in the differentiation of multiple system atrophy (MSA) from Parkinson's disease (PD). Thirty-five patients with MSA (23 MSA-P and 12 MSA-C) and 17 patients with PD were included in this study. Overall correct diagnosis rates between clinical and imaging diagnosis among MSA-P, MSA-C, and PD patients were 80% for visual MRI analysis, 88.5% for visual (18)F-FDG PET analysis, and 84.3% for SPM-supported analysis of (18)F-FDG PET. The sensitivity of brain MRI, and visual and SPM analysis of (18)F-FDG PET in differentiating MSA from PD was 72.7%, 90.9%, and 95.5%, respectively, the specificity was 100% for each imaging analysis, the positive predictive value was 100% for each imaging analysis, and the negative predictive value was 60%, 81.8%, and 90%, respectively. Our results suggest that brain MRI and (18)F-FDG PET are diagnostically useful in differentiating MSA (MSA-P and MSA-C) from PD, and indicate that (18)F-FDG PET has a tendency toward higher sensitivity compared to brain MRI, but a larger longitudinal study including pathological data will be required to confirm our findings.

Large cerebral artery involvement in CADASIL.

The authors evaluated the involvement of large cerebral artery in 13 patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) with angiography (12 MR and one conventional). Five patients (38%) showed stenosis: at the middle cerebral artery in three, vertebral artery in one, and the internal carotid artery in one. The stenosis persisted on follow-up angiogram in two patients. There were no differences in risk factors between patients with angiographic abnormality and those without, suggesting occasional involvement of large vessels in CADASIL.