Patient Radiation Exposure During Diagnostic and Therapeutic Procedures for Intracranial Aneurysms: A Multicenter Study.

PURPOSE: To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms across multi-centers and propose a diagnostic reference level (DRL). MATERIALS AND METHODS: We studied a sample of 490 diagnostic and 371 therapeutic procedures for intracranial aneurysms, which were performed at 23 hospitals in Korea in 2015. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time and total angiographic image frames were obtained and analyzed. RESULTS: Total mean DAP, CAK, fluoroscopy time, and total angiographic image frames were 106.2 ± 66.4 Gy-cm(2), 697.1 ± 473.7 mGy, 9.7 ± 6.5 minutes, 241.5 ± 116.6 frames for diagnostic procedures, 218.8 ± 164.3 Gy-cm(2), 3365.7 ± 2205.8 mGy, 51.5 ± 31.1 minutes, 443.5 ± 270.7 frames for therapeutic procedures, respectively. For diagnostic procedure, the third quartiles for DRLs were 144.2 Gy-cm(2) for DAP, 921.1 mGy for CAK, 12.2 minutes for fluoroscopy times and 286.5 for number of image frames, respectively. For therapeutic procedures, the third quartiles for DRLs were 271.0 Gy-cm(2) for DAP, 4471.3 mGy for CAK, 64.7 minutes for fluoroscopy times and 567.3 for number of image frames, respectively. On average, rotational angiography was used 1.5 ± 0.7 times/session (range, 0-4; n=490) for diagnostic procedures and 1.6 ± 1.2 times/session (range, 0-4; n=368) for therapeutic procedures, respectively. CONCLUSION: Radiation dose as measured by DAP, fluoroscopy time and image frames were lower in our patients compared to another study regarding cerebral angiography, and DAP was lower with fewer angiographic image frames for therapeutic procedures. Proposed DRLs can be used for quality assurance and patient safety in diagnostic and therapeutic procedures.

A neurometabolite study of chronic daily headache in patients with systemic lupus erythematosus using magnetic resonance spectroscopy: comparison with fibromyalgia patients and healthy controls.

BACKGROUND/AIMS: Neuropsychiatric systemic lupus erythematosus (SLE) includes a broad spectrum of neurologic and psychiatric manifestations. One of the most commonly observed neuropsychiatric symptoms is headache. However, the lack of specific clinical distinctions for headache in SLE has made it difficult to elucidate its pathophysiology. The aim of this study is to evaluate the neurometabolic changes using Proton Magnetic Resonance Spectroscopy (1H-MRS) in patients with SLE who suffer from chronic daily headache (CDH). METHODS: SLE and fibromyalgia patients with CDH and healthy controls were recruited (n = 9, n = 5, and n = 6, respectively). 1H-MRS metabolite ratios were evaluated in bilateral basal ganglia (BG) and bilateral peritrigonal white matter (PWM). RESULTS: 1H-MRS showed a significantly decreased N-acetylaspartate (NAA)/creatine (Cr) ratio in right BG in SLE patients with CDH compared to fibromyalgia patients with CDH and normal controls (p = 0.029 and p = 0.020, respectively). Left PWM NAA/Cr and choline/Cr ratios in SLE patients with CDH were lower than those in fibromyalgia patients with CDH (p = 0.019 and p = 0.029, respectively). CONCLUSIONS: This study suggests the possibility that CDH in patients with SLE might be associated with neuronal dysfunction and neurometabolic changes.

A comparison of MRI tissue relaxometry and ROI methods used to determine regional brain iron concentrations in restless legs syndrome.

PURPOSE: Magnetic resonance imaging relaxometry studies differed on the relaxometry methods and their approaches to determining the regions of interest (ROIs) in restless legs syndrome (RLS) patients. These differences could account for the variable and inconsistent results found across these studies. The aim of this study was to assess the relationship between the different relaxometry methods and different ROI approaches using each of these methods on a single population of controls and RLS subjects. METHODS: A 3.0-T magnetic resonance imaging with the gradient-echo sampling of free induction decay and echo pulse sequence was used. The regional brain "iron concentrations" were determined using three relaxometry metrics (R2, R2*, and R2') through two different ROI methods. The substantia nigra (SN) was the primary ROI with red nucleus, caudate, putamen, and globus pallidus as the secondary ROIs. RESULTS: Thirty-seven RLS patients and 40 controls were enrolled. The iron concentration as determined by R2 did not correlate with either of the other two methods, while R2* and R2' showed strong correlations, particularly for the substantia nigra and red nucleus. In the fixed-shape ROI method, the RLS group showed a lower iron index compared to the control group in the substantia nigra and several other regions. With the semi-automated ROI method, however, only the red nucleus showed a significant difference between the two groups. CONCLUSION: Both the relaxometry and ROI determination methods significantly influenced the outcome of studies that used these methods to estimate regional brain iron concentrations.

Aneurysmal bone cyst in the temporal bone and complete resection with preoperative embolization. A case report.

We describe a rare case of aneurysmal bone cysts (ABCs) that occurred in the petrous portion of the temporal bone. The ABCs were treated with preoperative embolization and complete removal of the mass from the adjacent tissue. The technical details suggest that preoperative embolization is a good treatment option for ABCs.

The management of traumatic scalp pseudoaneurysms with manual or US-guided compression.

There are many reports dealing with the treatment of traumatic pseudoaneurysms of the scalp. But, there is no consistent standard of treatment for such lesions, to our knowledge. We reviewed our cases and evaluated the use of manual or ultrasonography (US)-guided compression as a treatment option for patients with traumatic scalp pseudoaneurysm. Four patients with traumatic pseudoaneurysm were enrolled in this study. Among them, three patients underwent manual or US-guided compression (mean size = 5.67 mm) and all the lesions were resolved. In one case, a residual lesion (size = 10 mm) remained after surgical operation (initial size = 20 mm). The lesion regressed after the patient was treated with US-guided compression. Overall, in this study population, four patients (mean = 6.75 mm) were treated with manual or US-guided compression. Although there were only a small number of patients in this study, all the traumatic scalp pseudoaneurysms were treated successfully. We recommend manual or US-guided compression for the treatment of these lesions. Further studies involving a larger number of patients and comparisons with surgical and endovascular data are needed.

Pulmonary and cerebral fat embolism syndrome after total knee replacement.

Fat embolism occurs after long bone fracture or orthopedic surgery and usually shows mild symptom. But it rarely results in fat embolism syndrome, presenting as multiorgan dysfunction such as lung, brain and skin. Although the diagnosis of fat embolism syndrome is mostly based on clinical features, we experienced fat embolism syndrome involving lung and brain, showing typical imaging findings in pulmonary computed tomography and brain magnetic resonance image. So we present interesting case about fat embolism syndrome after total knee replacement with reviewing associated literatures including imaging findings.

Anthocyanins from black soybean seed coat enhance wound healing.

Anthocyanins are known to have antioxidant and antiinflammatory effects. We hypothesized that anthocyanins would enhance wound healing in Sprague-Dawley rats. The purpose of this study was to evaluate our hypothesis and investigate the mechanism of wound healing enhancement. The cytoprotective effect of an immortalized epidermal keratinocyte cell line (HaCaT) and human neonatal dermal fibroblasts in response to various concentrations of anthocyanins was determined. Vascular endothelial growth factor (VEGF) and thrombospondin 1 (TSP1) of HaCaT were measured by Western blot analysis. Anthocyanins were applied to the wounds in rats, and the healing ratio was calculated. Tissue VEGF, TSP1, CD31, nuclear factor-κB, and phosphorylation of IκBα were measured. The viability of the HaCaT cell line and human neonatal dermal fibroblasts increased under cytotoxicity by H2O2 in the anthocyanin-treated groups. The VEGF in the anthocyanin-treated groups increased, whereas TSP1 decreased. Wounds in the experimental groups healed faster, and VEGF and CD31 increased in the experimental groups, whereas TSP1 decreased. Anthocyanins inhibited the translocation of nuclear factor-κB (p65) from cytosol to nucleus and also prevented the phosphorylation of IκBα. Anthocyanins enhance wound healing through a cytoprotective effect, enhancement of angiogenesis, and an antiinflammatory effect.

Cribriform neuroepithelial tumor in the third ventricle: a case report and literature review.

Cribriform neuroepithelial tumor (CRINET) is a very rare and recently described entity of INI1-deficient intraventricular neuroepithelial tumor of primitive non-rhabdoid cells with distinct cribriform formation and has a relatively favorable prognosis. A 14-month-old boy had presented with gait imbalance and was crawling for the last 2 weeks. MRI revealed a large, complex solid and cystic mass with dimensions of 55 × 55 × 50 mm in the vicinity of the third ventricle. Histopathologically, the tumor was composed of relatively small undifferentiated neuroepithelial cells arranged in a cribriform pattern and intervening solid sheets with true rosettes. Immunohistochemically, the tumor cells showed complete loss of nuclear INI1 expression and distinct expression of epithelial membrane antigen (EMA) along the luminal borders of the tubules or glands. The typical rhabdoid feature of tumor cells was absent. Ultrastructurally, the tumor cells were neuroepithelial cells that contained short linear rough endoplasmic reticula and distinct intercellular junctions. Here, we describe a new case of CRINET and also discuss its clinicopathological, immunohistochemical, and ultrastructural features.

Anti-inflammatory effect of quetiapine on collagen-induced arthritis of mouse.

Quetiapine is an atypical antipsychotic and has also been used in the treatment of depression. Since anti-inflammatory effects of antidepressants are well established, we hypothesized that quetiapine may also exert anti-inflammatory effects. Thus this study was designed to examine the anti-inflammatory effect of quetiapine in murine collagen-induced arthritis. Mice were immunized with collagen type II for the induction of arthritis and treated with quetiapine (10mg/kg) daily for 2weeks. Mice were divided into 3 groups: control, CIA, and CIA+quetiapine treatment. Arthritic index and paw thickness were used to compare severity of arthritis. In additions, radiological and histological assessments were employed. Anti-type II collagen-specific antibody, interleukin-6 (IL-6), interleukin-17 (IL-17), and prostaglandin E(2) (PGE(2)) were evaluated at the end of the treatment period. Both arthritic index and paw thickness were markedly improved in CIA+quetiapine treatment group compared with those in CIA groups (arthritic index; P<0.01, paw thickness; P<0.05). Radiologic assessment revealed decreased cartilage damage and bone erosion in CIA+quetiapine treatment group compared with those in CIA groups. Articular cartilage destruction observed in CIA group was not found in CIA+quetiapine group. The concentrations of anti-type II collagen-specific antibody, IL-6, IL-17, and PGE(2) in CIA+quetiapine group were significantly lower than those in CIA groups (P<0.05). Weight gain which is commonly observed with the treatment of antipsychotics was not observed. Taken together, these results suggest that quetiapine shows anti-inflammatory effects in murine collagen-induced arthritis.

Cilostazol effectively reduces the decrease of flow volume in a thrombotic anastomosis model in a rat: a novel application of ultrasonography for evaluation.

The purpose of this study was to investigate the efficacy of cilostazol for prevention of thrombosis in microsurgical anastomosis. We used not only a patency test, but also ultrasonography to evaluate the blood flow volume (FV) more accurately and objectivity. In addition, we evaluated the accuracy and sensitivity of the patency test. Thrombogenic anastomoses were performed on rat external iliac arteries. Forty-six rats were randomly allocated into the following 5 experimental groups: negative control, without any surgery and medication; control, received distilled water orally; group A, received aspirin orally; group B, received cilostazol orally; and group C, received aspirin and cilostazol orally 3 hours before a thrombogenic artery anastomosis. The artery was evaluated by FV using ultrasonography and a patency test 10, 30, and 120 minutes after clamp removal. The FV in group C was significantly larger than the control group 30 minutes after clamp removal. The FVs in groups A, B, and C were significantly larger than the control group 120 minutes after clamp removal. The FV decreased in all groups with time. The patency rate between the control group and group C 120 minutes after clamp removal was significantly different. There were 8 false negatives in a total of 114 patency tests. The total accuracy and sensitivity of the patency test were 93.0% and 92.7%, respectively. Cilostazol plus aspirin therapy is recommended for reducing thrombosis and increasing FV without increasing the risk of bleeding during microsurgery. The patency test cannot evaluate the state of the anastomotic vessels accurately and objectively.

Intracranial aneurysm perforation during endosaccular coiling: impact on clinical outcome, initial occlusion, and recanalization rates.

OBJECTIVE: The aim of this study was to evaluate the acute and follow-up outcomes of cerebral aneurysms that perforated during endovascular treatment. METHODS: Nine hundred ten patients harboring 1056 intracranial aneurysms received 1164 endovascular treatments over 11 years at our institution. Intraprocedural aneurysm perforation occurred in 20 cases (1.7%). Thirteen cases (mean size, 6.2 mm) demonstrated contrast leakage, whereas the other 7 cases (mean size, 5.3 mm) showed only nonleak coil extrusion from the aneurysms. Results of follow-up magnetic resonance angiography or catheter angiography at least 6 months after embolization were available in 11 contrast leak and 6 nonleak cases. Acute and follow-up results were reviewed. RESULTS: New neurological deficits directly associated with aneurysm perforation were identified at discharge in only 4 contrast leak patients (20%). Their respective modified Rankin Scale scores were 1, 2, 3, and 5. Respective acute results in the contrast leak and nonleak groups were as follows: complete occlusion in 7 (54%) and 3 (43%), neck remnant in 3 (23%) and 4 (57%), and incomplete occlusion in 3 (23%) and 0. Respective follow-up results were as follows: major recanalization in 3 (27%) and 1 (17%), minor recanalization in 3 (27%) and 1 (17%), and stable occlusion in 5 (46%) and 4 (67%). CONCLUSION: Intraprocedural aneurysm perforation with leakage of contrast appears to be associated with relatively high rates of incomplete acute results and major recanalizations during follow-up, although perforation frequently occurs in small aneurysms. Nonleak perforation may also lead to major recanalization through the potentially weak point of initial coil extrusion.