RESUMEN
BACKGROUND: Cerebral microbleeds (CMBs) are microscopic brain hemorrhages with implications for various diseases. Automated detection of CMBs is a challenging task due to their wide distribution throughout the brain, small size, and visual similarity to their mimics. For this reason, most of the previously proposed methods have been accomplished through two distinct stages, which may lead to difficulties in integrating them into clinical workflows. PURPOSE: To develop a clinically feasible end-to-end CMBs detection network with a single-stage structure utilizing 3D information. This study proposes triplanar ensemble detection network (TPE-Det), ensembling 2D convolutional neural networks (CNNs) based detection networks on axial, sagittal, and coronal planes. STUDY TYPE: Retrospective. SUBJECTS: Two datasets (DS1 and DS2) were used: 1) 116 patients with 367 CMBs and 12 patients without CMBs for training, validation, and testing (70.39 ± 9.30 years, 68 women, 60 men, DS1); 2) 58 subjects with 148 microbleeds and 21 subjects without CMBs only for testing (76.13 ± 7.89 years, 47 women, 32 men, DS2). FIELD STRENGTH/SEQUENCE: A 3 T field strength and 3D GRE sequence scan for SWI reconstructions. ASSESSMENT: The sensitivity, FPavg (false-positive per subject), and precision measures were computed and analyzed with statistical analysis. STATISTICAL TESTS: A paired t-test was performed to investigate the improvement of detection performance by the suggested ensembling technique in this study. A P value < 0.05 was considered significant. RESULTS: The proposed TPE-Det detected CMBs on the DS1 testing set with a sensitivity of 96.05% and an FPavg of 0.88, presenting statistically significant improvement. Even when the testing on DS2 was performed without retraining, the proposed model provided a sensitivity of 85.03% and an FPavg of 0.55. The precision was significantly higher than the other models. DATA CONCLUSION: The ensembling of multidimensional networks significantly improves precision, suggesting that this new approach could increase the benefits of detecting lesions in the clinic. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.
Asunto(s)
Hemorragia Cerebral , Imagen por Resonancia Magnética , Masculino , Humanos , Femenino , Imagen por Resonancia Magnética/métodos , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/patología , Estudios Retrospectivos , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Redes Neurales de la ComputaciónRESUMEN
AIM: The neurobiological substrates underlying the relationship of circadian rest-activity rhythm (RAR) alteration with accelerated late-life cognitive decline are not clearly understood. In the present study, the longitudinal relationship of objectively measured circadian RAR with in vivo Alzheimer disease (AD) pathologies and cerebrovascular injury was investigated in older adults without dementia. METHODS: The present study included 129 participants without dementia who participated in the KBASE (Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer's Disease) cohort. All participants underwent actigraphy at baseline and two consecutive [11 C] Pittsburgh compound-B positron emission tomography (PET), [18 F] fluorodeoxyglucose-PET, magnetic resonance imaging, and Mini-Mental State Examination (MMSE) at baseline and at a 2-year follow-up assessment. The associations of circadian RAR with annualized change in neuroimaging measures including global amyloid-beta retention, AD-signature region cerebral glucose metabolism (AD-CM), and white matter hyperintensity volume were examined. RESULTS: Delayed acrophase at baseline was significantly associated with greater annualized decline of AD-CM over a 2-year period, but not with that of other neuroimaging measures. In contrast, other circadian RAR parameters at baseline had no association with annualized change of any neuroimaging measures. Annualized decline of AD-CM was also significantly positively associated with the annual change in MMSE scores. Furthermore, a mediation analysis showed that greater reduction in AD-CM mediated the effect of delayed acrophase at baseline on faster decline of MMSE score. CONCLUSION: The findings indicate that delayed acrophase in late life may cause or predict hypometabolism at AD-signature brain regions, which underlies cognitive decline in the near future.
Asunto(s)
Enfermedad de Alzheimer , Disfunción Cognitiva , Humanos , Anciano , Encéfalo/patología , Enfermedad de Alzheimer/metabolismo , Péptidos beta-Amiloides/metabolismo , Neuroimagen , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/etiología , Disfunción Cognitiva/metabolismo , Tomografía de Emisión de Positrones , Imagen por Resonancia Magnética , Estudios LongitudinalesRESUMEN
OBJECTIVE: Although computed tomography perfusion (CTP) is used to select and guide decision-making processes in patients with acute ischemic stroke, there is no clear standardization of the optimal threshold to predict ischemic core volume accurately. The infarct core volume with a relative cerebral blood flow(rCBF) threshold of < 30% is commonly used. We aimed to assess the volumetric agreement of the infarct core volume with different CTP parameters and thresholds using CTP software (RAPID, VITREA) and the infarct volume on diffusion-weighted imaging (DWI), with a short interval time (within 60 min) between CTP and follow-up DWI. MATERIALS AND METHODS: This retrospective study included 42 acute ischemic stroke patients with occlusion of the large artery in the anterior circulation between April 2017-November 2020. RAPID identified infarct core as tissue rCBF < 20-38%. VITREA defined the infarct core as cerebral blood volume (CBV) < 26-56%. Olea Sphere was used to measure infarct core volume on DWI. The CTP-infarct core volume with different thresholds of perfusion parameters (CBF threshold vs CBV threshold) were compared with DWI-infarct core volumes. RESULTS: The median time between CTP and DWI was 37.5min. The commonly used threshold of CBV< 41% (4.3 mL) resulted in lower median infarct core volume difference compared to the commonly used thresholds of rCBF < 30% (8.2mL). On the other hand, the optimal thresholds of CBV < 26% (-1.0mL; 95% CI, -53.9 to 58.1 mL; 0.945) resulted in the lowest median infarct core volume difference, narrowest limits of agreement, and largest interclass correlation coefficient compared with the optimal thresholds of rCBF < 38% (4.9 mL; 95% CI, -36.4 to 62.9 mL; 0.939). CONCLUSION: Our study found that the both optimal and commonly used thresholds of CBV provided a more accurate prediction of the infarct core volume in patients with AIS than rCBF.
Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/terapia , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Perfusión , Circulación Cerebrovascular , Infarto , Imagen de Perfusión/métodos , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/terapiaRESUMEN
OBJECTIVES: Traumatic neuromas (TNs) mimic recurrent tumors in US after total thyroidectomy (TT) and lateral neck dissection (LND) for thyroid cancer. We aimed to evaluate whether CT could complement US in the differential diagnosis of TNs from recurrent thyroid cancer in the dissected neck. MATERIAL AND METHODS: We retrospectively included a total of 97 consecutive US-detected lesions (28 TNs and 69 recurrent tumors) in patients with a previous history of TT and LND for thyroid cancer. The lesions were classified as benign, indeterminate, or suspicious according to the presence of benign or suspicious features on US and CT. Imaging features and categories on US and CT were compared between TNs and recurrent tumors. The diagnostic performances of US and CT for differentiating between TNs and recurrent tumors were calculated. RESULTS: On US, most TNs and recurrent tumors showed internal hyperechogenicity without hilar echogenicity or hilar vascularity and were categorized as suspicious lesions (23/28, 82.1% vs. 53/69, 76.8%). On CT, all TNs lacked strong enhancement without hilar fat or hilar vessel enhancement and were categorized as indeterminate lesions (28/28, 100%). In contrast, most recurrent tumors showed strong enhancement and were categorized as suspicious lesions (63/69, 91.3%). The addition of CT to US corrected 23 false-positive diagnoses in 28 TNs and 10 false-negative diagnoses in 69 recurrent tumors. CONCLUSIONS: CT complements US for the correct differentiation of TNs from recurrent tumors in postoperative thyroid cancer patients. The addition of CT to US may prevent unnecessary painful biopsy or surgery. KEY POINTS: ⢠In the dissected neck, traumatic neuromas could mimic US suspicious LNs owing to its internal hyperechogenicity. ⢠CT effectively differentiated traumatic neuromas from recurrent thyroid cancers by demonstrating significantly different enhancement patterns. ⢠CT could complement US and may prevent unnecessary painful biopsy or surgery for US-detected lesions after thyroidectomy and neck dissection.
Asunto(s)
Neuroma , Neoplasias de la Tiroides , Diagnóstico Diferencial , Humanos , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/cirugía , Neuroma/diagnóstico por imagen , Neuroma/patología , Neuroma/cirugía , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tomografía Computarizada por Rayos X , Ultrasonografía/métodosRESUMEN
OBJECTIVES: Hemorrhage occasionally occurs after ultrasound (US)-guided biopsy of the thyroid and neck and sometimes leads to serious complications. We aimed to identify predictors of hemorrhagic complications after US-guided biopsy of the thyroid and neck. MATERIAL AND METHODS: In this retrospective study, we analyzed consecutive patients who underwent US-guided biopsy from April 2020 to November 2020. Procedure characteristics, US features, and peri- and post-procedural patient symptoms and signs were compared between patients with and without post-biopsy hemorrhage. Associations between clinical and imaging variables and post-biopsy hemorrhage were analyzed using univariate and multivariate regression analyses. RESULTS: A total of 305 patients who underwent US-guided biopsy of the thyroid and neck were included (219 women, 86 men; age range, 20-89 years). Seventeen (5.7%) cases of post-biopsy hemorrhage were detected 30 min after biopsy and manual compression. Among them, 10 developed hemorrhage at 30 min without immediate hemorrhage. In the multivariate analysis, a high tenderness score on the visual analog scale (VAS) at 30 min after biopsy (odds ratio [OR] 5.05, p < .001) was identified as an independent predictor of post-biopsy hemorrhage. In patients with hemorrhage at 30 min, tenderness scores significantly increased over 30 min of observation. CONCLUSIONS: High tenderness scores at 30 min after biopsy and manual compression were independent predictors of hemorrhage after US-guided biopsy of the thyroid and neck. The tenderness score could serve as a valuable marker to triage patients who require further observation and management after a US-guided biopsy of the thyroid and neck. KEY POINTS: ⢠High tenderness scores at 30 min after compression were associated with the presence of delayed post-biopsy hemorrhage at 30 min. ⢠Patients with hemorrhage at 30 min demonstrated a significant increase in tenderness scores over time. ⢠High tenderness scores after biopsy site compression predicted the presence of delayed post-biopsy hemorrhage in the thyroid and neck.
Asunto(s)
Nódulo Tiroideo , Adulto , Anciano , Anciano de 80 o más Años , Dolor en el Pecho , Femenino , Hemorragia/epidemiología , Hemorragia/etiología , Humanos , Biopsia Guiada por Imagen/efectos adversos , Biopsia Guiada por Imagen/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología , Ultrasonografía Intervencional/métodos , Adulto JovenRESUMEN
OBJECTIVES: There are few known predictive factors for response to gamma-knife radiosurgery (GKRS) in vestibular schwannoma (VS). We investigated the predictive role of pretreatment dynamic contrast-enhanced (DCE)-MRI parameters regarding the tumor response after GKRS in sporadic VS. METHODS: This single-center prospective study enrolled participants between April 2017 and February 2019. We performed a volumetric measurement of DCE-MRI-derived parameters before GKRS. The tumor volume was measured in a follow-up MRI. The pharmacokinetic parameters were compared between responders and nonresponders according to 20% or more tumor volume reduction. Stepwise multivariable logistic regression analyses were performed, and the diagnostic performance of DCE-MRI parameters for the prediction of tumor response was evaluated by receiver operating characteristic curve analysis. RESULTS: Ultimately, 35 participants (21 women, 52 ± 12 years) were included. There were 22 (62.9%) responders with a mean follow-up interval of 30.2 ± 5.7 months. Ktrans (0.036 min-1 vs. 0.057 min-1, p = .008) and initial area under the time-concentration curve within 90 s (IAUC90) (84.4 vs. 143.6, p = .003) showed significant differences between responders and nonresponders. Ktrans (OR = 0.96, p = .021) and IAUC90 (OR = 0.97, p = .004) were significant differentiating variables in each multivariable model with clinical variables for tumor response prediction. Ktrans showed a sensitivity of 81.8% and a specificity of 69.2%, and IAUC90 showed a sensitivity of 100% and a specificity of 53.8% for tumor response prediction. CONCLUSION: DCE-MRI (particularly Ktrans and IAUC90) has the potential to be a predictive factor for tumor response in VS after GKRS. KEY POINTS: â¢Pretreatment prediction of gamma-knife radiosurgery response in vestibular schwannoma is still challenging. â¢Dynamic contrast-enhanced MRI could have predictive value for the response of vestibular schwannoma after gamma-knife radiosurgery.
Asunto(s)
Neuroma Acústico , Radiocirugia , Femenino , Humanos , Imagen por Resonancia Magnética , Neuroma Acústico/diagnóstico por imagen , Neuroma Acústico/radioterapia , Neuroma Acústico/cirugía , Estudios Prospectivos , Resultado del TratamientoRESUMEN
AIM: Spouse bereavement is one of life's greatest stresses and has been suggested to trigger or accelerate cognitive decline and dementia. However, little information is available about the potential brain pathologies underlying the association between spouse bereavement and cognitive decline. We aimed to investigate that lifetime spouse bereavement is associated with in vivo human brain pathologies underlying cognitive decline. METHODS: A total of 319 ever-married older adults between the ages of 61 and 90 years underwent comprehensive clinical assessments and multimodal brain imaging including [11 C] Pittsburgh compound B-positron emission tomography (PET), AV-1451 PET, [18 F] fluorodeoxyglucose-PET, and magnetic resonance imaging. Participants were classified as experiencing no spouse bereavement or spouse bereavement, and comparisons using propensity score matching (59 cases and 59 controls) were performed. RESULTS: Spouse bereavement was significantly associated with higher cerebral white matter hyperintensity (WMH) volume compared with no spouse bereavement. Interaction and subsequent subgroup analyses showed that spouse bereavement was significantly associated with higher WMH in the older (>75 years) subgroup and among those with no- or low-skill occupations. In addition, spouse bereavement at 60 years or older affects WMH volume compared with no spouse bereavement, whereas spouse bereavement at younger than 60 years did not. No group differences were observed in other brain pathologies between spouse bereavement categories. CONCLUSIONS: The findings suggest that the spouse bereavement may contribute to dementia or cognitive decline by increasing cerebrovascular injury, particularly in older individuals and those with no- or low-skill occupations.
Asunto(s)
Aflicción , Disfunción Cognitiva , Demencia , Sustancia Blanca , Anciano , Anciano de 80 o más Años , Péptidos beta-Amiloides/metabolismo , Encéfalo/patología , Disfunción Cognitiva/complicaciones , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Puntaje de Propensión , Sustancia Blanca/patologíaRESUMEN
Parkinson disease is characterized by dopaminergic cell loss in the substantia nigra of the midbrain. There are various imaging markers for Parkinson disease. Recent advances in MRI have enabled elucidation of the underlying pathophysiologic changes in the nigral structure. This has contributed to accurate and early diagnosis and has improved disease progression monitoring. This article aims to review recent developments in nigral imaging for Parkinson disease and other parkinsonian syndromes, including nigrosome imaging, neuromelanin imaging, quantitative iron mapping, and diffusion-tensor imaging. In particular, this article examines nigrosome imaging using 7-T MRI and 3-T susceptibility-weighted imaging. Finally, this article discusses volumetry and its clinical importance related to symptom manifestation. This review will improve understanding of recent advancements in nigral imaging of Parkinson disease. Published under a CC BY 4.0 license.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Enfermedad de Parkinson/diagnóstico por imagen , Trastornos Parkinsonianos/diagnóstico por imagen , Sustancia Negra/diagnóstico por imagen , HumanosRESUMEN
Background Evaluation of the glymphatic system with intrathecal contrast material injection has limited clinical use. Purpose To investigate the feasibility of using serial intravenous contrast-enhanced T1 mapping in the quantitative evaluation of putative dynamic glymphatic activity in various brain regions and to demonstrate the effect of sleep on glymphatic activity in humans. Materials and Methods In this prospective study from May 2019 to February 2020, 25 healthy participants (mean age, 25 years ± 2 [standard deviation]; 15 men) underwent two cycles of MRI (day and night cycles). For each cycle, T1 maps were acquired at baseline and 0.5, 1, 1.5, 2, and 12 hours after intravenous contrast material injection. For the night cycle, participants had a normal night of sleep between 2 and 12 hours. The time (tmin) to reach the minimum T1 value (T1min), the absolute difference between baseline T1 and T1min (peak ΔT1), and the slope between two measurements at 2 and 12 hours (slope[2h-12h]) were determined from T1 value-time curves in cerebral gray matter (GM), cerebral white matter (WM), cerebellar GM, cerebellar WM, and putamen. Mixed-model analysis of variance (ANOVA), Friedman test, and repeated-measures ANOVA were used to assess the effect of sleep on slope(2h-12h) and to compare tmin and peak ΔT1 among different regions. Results The slope(2h-12h) increased from the day to night cycles in cerebral GM, cerebellar GM, and putamen (geometric mean ratio [night/day] = 1.4 [95% CI: 1.2, 1.7], 1.3 [95% CI: 1.1, 1.4], and 2.4 [95% CI: 1.6, 3.6], respectively; P = .001, P < .001, and P < .001, respectively). Median tmin values were 0.5 hour in cerebral and cerebellar GM and putamen for both cycles. Cerebellar GM had the highest mean peak ΔT1, followed by cerebral GM and putamen in both day (159 msec ± 6, 99 msec ± 4, and 62 msec ± 5, respectively) and night (152 msec ± 6, 104 msec ± 6, and 58 msec ± 4, respectively) cycles. Conclusion Clearance of a gadolinium-based contrast agent was greater after sleep compared with daytime wakefulness. These results suggest that sleep was associated with greater glymphatic clearance compared with wakefulness. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Anzai and Minoshima in this issue.
Asunto(s)
Encéfalo/diagnóstico por imagen , Sistema Glinfático/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Sueño/fisiología , Vigilia/fisiología , Adulto , Medios de Contraste , Estudios de Factibilidad , Voluntarios Sanos , Humanos , Aumento de la Imagen/métodos , Masculino , Estudios ProspectivosRESUMEN
PURPOSE: To make clinically feasible whole-brain chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) by enhancing imaging efficiency. METHODS: A novel, whole-brain three-dimensional (3D) steady-state CEST MRI method was introduced by utilizing a time-efficient, fat-suppressed excitation followed by rapid, segmented 3D echo-planar-imaging with incoherent undersampling in k-ω space. Missing signals and CEST-specific spectral images were then jointly estimated directly from incomplete measurements using model-based reconstruction and robust spectral analysis. In vivo studies were performed at 3T both retrospectively (using a fully sampled reference) and prospectively to validate the effectiveness of the proposed method in patients with brain cancer. RESULTS: In retrospective studies, the proposed method exhibits superior accuracies to existing methods in estimating images, z-spectra, and APTw relative to the reference. In prospective patient studies, compared with existing methods, the proposed method is statistically significantly different in contrast-to-noise ratio of the APTw contrast between tumor and normal appearing white matter (NAWM) and amide proton transfer weighted contrast (p < 0.05) while not being significantly different in signal-to-noise ratio in an NAWM region. CONCLUSIONS: We successfully demonstrated that it is feasible to perform whole-brain CEST MRI roughly within 4 minutes for patients with brain cancer. It is expected that the proposed method widens clinical utilities of CEST MRI.
Asunto(s)
Neoplasias Encefálicas , Imagen por Resonancia Magnética , Encéfalo/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Humanos , Fantasmas de Imagen , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
OBJECTIVE: This study aimed to evaluate whether arterial input functions (AIFs) obtained from dynamic susceptibility contrast (DSC)-MRI (AIFDSC) improve the reliability and diagnostic accuracy of dynamic contrast-enhanced (DCE)-derived pharmacokinetic (PK) parameters for differentiating glioblastoma from primary CNS lymphoma (PCNSL) compared with AIFs derived from DCE-MRI (AIFDCE). METHODS: This retrospective study included 172 patients with glioblastoma (n = 147) and PCNSL (n = 25). All patients had undergone preoperative DSC- and DCE-MRI. The volume transfer constant (Ktrans), volume of the vascular plasma space (vp), and volume of the extravascular extracellular space (ve) were acquired using AIFDSC and AIFDCE. The relative cerebral blood volume (rCBV) was obtained from DSC-MRI. Intraclass correlation coefficients (ICC) and ROC curves were used to assess the reliability and diagnostic accuracy of individual parameters. RESULTS: The mean Ktrans, vp, and ve values revealed better ICCs with AIFDSC than with AIFDCE (Ktrans, 0.911 vs 0.355; vp, 0.766 vs 0.503; ve, 0.758 vs 0.657, respectively). For differentiating all glioblastomas from PCNSL, the mean rCBV (AUC = 0.856) was more accurate than the AIFDSC-driven mean Ktrans, which had the largest AUC (0.711) among the DCE-derived parameters (p = 0.02). However, for glioblastomas with low rCBV (≤ 75th percentile of PCNSL; n = 30), the AIFDSC-driven mean Ktrans and vp were more accurate than rCBV (AUC: Ktrans, 0.807 vs rCBV, 0.515, p = 0.004; vp, 0.715 vs rCBV, p = 0.045). CONCLUSION: DCE-derived PK parameters using the AIFDSC showed improved reliability and diagnostic accuracy for differentiating glioblastoma with low rCBV from PCNSL. KEY POINTS: ⢠An accurate differential diagnosis of glioblastoma and PCNSL is crucial because of different therapeutic strategies. ⢠In contrast to the rCBV from DSC-MRI, another perfusion imaging technique, the DCE parameters for the differential diagnosis have been limited because of the low reliability of AIFs from DCE-MRI. ⢠When we analyzed DCE-MRI data using AIFs from DSC-MRI (AIFDSC), AIFDSC-driven DCE parameters showed improved reliability and better diagnostic accuracy than rCBV for differentiating glioblastoma with low rCBV from PCNSL.
Asunto(s)
Neoplasias Encefálicas , Glioblastoma , Linfoma no Hodgkin , Neoplasias Encefálicas/diagnóstico por imagen , Medios de Contraste , Glioblastoma/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
Background and Purpose- In unilateral moyamoya disease, altered endothelial shear stress on the intact-side terminal internal carotid artery might trigger the progression to bilateral disease. We analyzed the endothelial shear stress parameters of the normally appearing terminal internal carotid artery in unilateral moyamoya disease and its association with the progression to bilateral disease. Methods- This retrospective cohort study included patients diagnosed with unilateral moyamoya disease by cerebral angiography and followed-up with regular magnetic resonance imaging/magnetic resonance angiography evaluations for >1 year. Endothelial shear stress parameters acquired were mean and maximum signal intensity gradients (SIG) and SIG SD at the vessel boundary in time-of-flight sequences in initial brain magnetic resonance imaging/magnetic resonance angiography. Contralateral disease progression defined as the detection of newly developed vessel steno-occlusion with an magnetic resonance angiography steno-occlusive stage of ≥2, in the previously intact side of the brain on follow-up magnetic resonance imaging/magnetic resonance angiography evaluation. Results- Among 146 patients (66 males [45.2%] and 80 females [54.8%]; 76 pediatric [52.1%]), contralateral disease progression was detected in 43 patients (29.5%) after a mean follow-up of 4.3±2.4 years. Multivariate analysis showed that SIG SD was significantly associated with this progression (odds ratio, 13.001 [95% CI, 1.764-95.794], P=0.012). In receiver operating characteristic curve analysis, SIG SD predicted the contralateral progression with area under the curve values of 0.803 (95% CI, 0.726-0.880, P<0.001). The regression model was reproduced in the external cohort of 31 patients. Conclusions- Increased spatial variability of the endothelial shear stress around the normally appearing terminal internal carotid artery, as measured by SIG SD in time-of-flight sequences, may predict the contralateral progression of unilateral moyamoya disease.
Asunto(s)
Endotelio Vascular/diagnóstico por imagen , Enfermedad de Moyamoya/diagnóstico por imagen , Adolescente , Adulto , Encéfalo/diagnóstico por imagen , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/fisiopatología , Niño , Preescolar , Estudios de Cohortes , Progresión de la Enfermedad , Endotelio Vascular/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Lactante , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedad de Moyamoya/fisiopatología , Curva ROC , Estudios Retrospectivos , Estrés Mecánico , Tomografía Computarizada de Emisión de Fotón Único , Adulto JovenRESUMEN
Background and Purpose- With the lack of confirmatory examinations, the distinction of a transient ischemic attack (TIA) from various TIA-mimicking diseases is difficult, particularly in diffusion-weighted imaging (DWI)-negative TIAs. In this study, we aimed to evaluate the relationship between arterial spin labeling (ASL) perfusion defects and early ischemic recurrence (FU-DWI [+]) in patients with DWI-negative TIAs. Methods- We assessed consecutive patients with a DWI-negative TIA within 24 hours of symptom onset, who underwent both ASL images and follow-up magnetic resonance imaging during the acute period. As markers of the ASL images, we evaluated the ASL perfusion defects in each hemisphere. Arterial transit artifact (ATA) and intraarterial high-intensity signal (IAS) were also rated as markers of collateral status and blood stagnation due to large vessel occlusion, respectively. Results- Among the 136 patients with a DWI-negative TIA, 33 patients had FU-DWI (+) lesions in 36 hemispheres. In the multivariable analysis, ASL defects remained an independent predictor of FU-DWI (+) (adjusted odds ratio, 13.94 [95% CI, 5.77-33.70], P<0.001). In the evaluation of the interactive relationship between ASL defects and ATA/IAS, the (ASL [+] ATA [-]) group showed the highest frequencies of FU-DWI (+) events (55.6%) with the highest adjusted odds ratio values (adjusted odds ratio, 14.86 [95% CI, 5.63-39.24], P<0.001), indicating a negative synergistic effect between the ASL defects and ATA. Meanwhile, the (ASL [+] IAS [+]) group showed higher frequencies of FU-DWI (+) and higher adjusted odds ratio values than those of the (ASL [+] IAS [-]) and (ASL [-] IAS [-]) groups, indicating a positive synergistic effect. Conclusions- We demonstrated that ASL perfusion defects were associated with ipsilateral FU-DWI (+) in patients with a DWI-negative TIA. Furthermore, this association was enhanced with IASs and attenuated with ATAs.
Asunto(s)
Imagen de Difusión por Resonancia Magnética , Ataque Isquémico Transitorio , Imagen de Perfusión , Sistema de Registros , Marcadores de Spin , Anciano , Femenino , Humanos , Ataque Isquémico Transitorio/diagnóstico por imagen , Ataque Isquémico Transitorio/epidemiología , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: An emerging body of literature has indicated that moderate alcohol intake may be protective against Alzheimer disease (AD) dementia. However, little information is available regarding whether moderate alcohol intake is related to reductions in amyloid-beta (Aß) deposition, or is protective via amyloid-independent mechanisms in the living human brain. Here we examined the associations of moderate alcohol intake with in vivo AD pathologies, including cerebral Aß deposition, neurodegeneration of AD-signature regions, and cerebral white matter hyperintensities (WMHs) in the living human brain. METHODS AND FINDINGS: The present study was part of the Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer's Disease (KBASE), an ongoing prospective cohort study that started in 2014. As of November 2016, 414 community-dwelling individuals with neither dementia nor alcohol-related disorders (280 cognitively normal [CN] individuals and 134 individuals with mild cognitive impairment [MCI]) between 56 and 90 years of age (mean age 70.9 years ± standard deviation 7.8; male, n [%] = 180 [43.5]) were recruited from 4 sites (i.e., 2 university hospitals and 2 public centers for dementia prevention and management) around Seoul, South Korea. All the participants underwent comprehensive clinical assessments comprising lifetime and current histories of alcohol intake and multimodal brain imaging, including [11C] Pittsburgh compound B positron emission tomography (PET), [18F] fluorodeoxyglucose (FDG) PET, and magnetic resonance imaging (MRI) scans. Lifetime and current alcohol intake were categorized as follows: no drinking, <1 standard drink (SD)/week, 1-13 SDs/week, and 14+ SDs/week. A moderate lifetime alcohol intake (1-13 SDs/week) was significantly associated with a lower Aß positivity rate compared to the no drinking group, even after controlling for potential confounders (odds ratio 0.341, 95% confidence interval 0.163-0.714, p = 0.004). In contrast, current alcohol intake was not associated with amyloid deposition. Additionally, alcohol intake was not related to neurodegeneration of AD-signature regions or cerebral WMH volume. The present study had some limitations in that it had a cross-sectional design and depended on retrospective recall for alcohol drinking history. CONCLUSIONS: In this study, we observed in middle- and old-aged individuals with neither dementia nor alcohol-related disorders that moderate lifetime alcohol intake was associated with lower cerebral Aß deposition compared to a lifetime history of not drinking. Moderate lifetime alcohol intake may have a beneficial influence on AD by reducing pathological amyloid deposition rather than amyloid-independent neurodegeneration or cerebrovascular injury.
Asunto(s)
Consumo de Bebidas Alcohólicas/metabolismo , Péptidos beta-Amiloides/metabolismo , Encéfalo/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/epidemiología , Compuestos de Anilina , Encéfalo/metabolismo , Estudios de Casos y Controles , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/metabolismo , Estudios Transversales , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Factores Protectores , República de Corea/epidemiología , TiazolesRESUMEN
Background A superselective (SS) arterial spin labeling (ASL) MRI technique can be used to monitor the revascularization area as a supplementary or alternative modality to digital subtraction angiography (DSA), with the advantage of being noninvasive. Purpose To evaluate whether SS-ASL perfusion MRI could be used to visualize the revascularization area after combined direct and indirect bypass surgery in adults with moyamoya disease compared with DSA. Materials and Methods Patients diagnosed with moyamoya disease who underwent DSA and SS-ASL 6 months after surgery between June 2017 and November 2019 in a single institution were retrospectively evaluated. Subjective grading of the revascularization area and collateral grading in 10 Alberta Stroke Program Early CT Score (ASPECTS) locations were performed. The change in perfusion status in a subgroup that underwent both preoperative and postoperative SS-ASL studies was evaluated. Intermodality agreement was analyzed by using weighted κ statistics. Results Thirty-seven hemispheres from 33 patients (mean age, 39 years ± 12 [standard deviation]; 20 women) were evaluated. The intermodality agreement of the revascularization area grading was substantial (weighted κ = 0.70; 95% confidence interval [CI]: 0.37, 1.00). The overall intermodality agreement of the postoperative collateral grading in the 10 ASPECTS locations for all vessels was substantial (weighted κ = 0.77; 95% CI: 0.74, 0.80). For the presence of postoperative collateral supplied by the ipsilateral external carotid artery in 10 ASPECTS locations (a total of 370 locations) using DSA as a reference test, the SS-ASL showed a sensitivity of 92% (183 of 199 locations; 95% CI: 87%, 95%) and a specificity of 83% (142 of 171 locations; 95% CI: 77%, 88%). The overall intermodality agreement of the changes in perfusion status was moderate (weighted κ = 0.59; 95% CI: 0.54, 0.65). Conclusion Superselective arterial spin labeling imaging precisely depicted the revascularization territory in patients with moyamoya disease who underwent bypass surgery, and it showed the changes in the vascular supplying territories before and after bypass surgery. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Hendrikse in this issue.
Asunto(s)
Angiografía de Substracción Digital , Revascularización Cerebral/métodos , Angiografía por Resonancia Magnética/métodos , Enfermedad de Moyamoya/diagnóstico por imagen , Enfermedad de Moyamoya/cirugía , Marcadores de Spin , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: Prediction of progression-free survival (PFS) and overall survival (OS) and early identification of molecular biomarkers with prognostic information are clinically important in glioblastoma (GBM) patients. We aimed to explore the utility of arterial spin labeling perfusion-weighted imaging (ASL-PWI) in the prediction of molecular biomarkers and survival in GBM patients. METHODS: We retrospectively analyzed 149 consecutive GBM patients, who had undergone maximal surgical resection or biopsy followed by concurrent chemoradiotherapy and adjuvant chemotherapy using temozolomide between November 2010 and June 2016. On preoperative ASL-PWI, cerebral blood flow (CBF) within contrast-enhancing (CE) and nonenhancing (NE) portions were evaluated both qualitatively (perfusion pattern[CE] and perfusion pattern[NE]) and quantitatively (nCBFCE and nCBFNE). ASL-PWI findings were correlated with molecular biomarkers, including isocitrate dehydrogenase (IDH) and O6-methylguanine-DNA methyltransferase (MGMT) methylation statuses, and survival, using the Mann-Whitney U-test, Spearman rank correlation, Kaplan-Meier analysis, and receiver operating characteristics analysis. RESULTS: nCBFCE was significantly higher in the IDH wild-type group than in the IDH mutant group (p = .013) and in the MGMT unmethylated group than in the methylated group (p = .047). Areas under the receiver operating characteristic curve were 0.678 for IDH mutation (p = .022) and 0.601 for MGMT promoter methylation (p = .043). Hyperperfusion was associated with the shortest median PFS for both perfusion pattern[CE] (7.6 months) and perfusion pattern[NE] (4.0 months). The perfusion pattern[NE] remained an independent predictor for PFS and OS even after adjusting for clinical and molecular predictors, unlike perfusion pattern[CE]. CONCLUSIONS: ASL-PWI can aid to predict survival and molecular biomarkers including IDH mutation and MGMT promoter methylation statuses in GBM patients. KEY POINTS: ⢠ASL-PWI can aid to predict survival in GBM patients. ⢠ASL-PWI can aid to predict IDH and MGMT promoter methylation statuses in GBM.
Asunto(s)
Biomarcadores de Tumor/genética , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/mortalidad , Glioblastoma/diagnóstico por imagen , Glioblastoma/mortalidad , Imagen de Perfusión/métodos , Adulto , Anciano , Antineoplásicos Alquilantes/uso terapéutico , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/terapia , Circulación Cerebrovascular , Quimioradioterapia , Quimioterapia Adyuvante , Metilación de ADN , Metilasas de Modificación del ADN/genética , Enzimas Reparadoras del ADN/genética , Femenino , Glioblastoma/genética , Glioblastoma/terapia , Humanos , Isocitrato Deshidrogenasa/genética , Masculino , Persona de Mediana Edad , Mutación , Pronóstico , Regiones Promotoras Genéticas , Estudios Retrospectivos , Temozolomida/uso terapéutico , Proteínas Supresoras de Tumor/genéticaRESUMEN
Although a perturbed cerebral blood flow (CBF) has been reported in patients with Wernicke's encephalopathy (WE), its clinical meaning is still elusive. A retrospective analysis of 10 patients (male, 6; mean age, 57.7 years) with WE between October 2012 and May 2018 was performed. Brain imaging was performed using fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), arterial spin labeling (ASL) perfusion-weighted imaging (PWI), and contrasted enhanced T1-weighted imaging. All patients had symmetric high signal intensity lesions in the vulnerable areas on FLAIR or DWI with focal hyperintensity on ASL-PWI (100% sensitivity). CBFlesion was variable (from 70 mL/100 g/min to 190.0 mL/100 g/min). CBFlesion/CBFwhite matter was elevated, ranging from 2.5 to 5.5. Focal hyperintensity on ASL in the vulnerable areas can be a diagnostic clue for WE.
Asunto(s)
Hiperemia/etiología , Encefalopatía de Wernicke/diagnóstico por imagen , Adulto , Anciano , Circulación Cerebrovascular/fisiología , Femenino , Humanos , Hiperemia/diagnóstico por imagen , Hiperemia/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Marcadores de Spin , Encefalopatía de Wernicke/complicaciones , Encefalopatía de Wernicke/fisiopatología , Adulto JovenRESUMEN
AIM: It has been suggested that personality traits, particularly neuroticism and conscientiousness, are risk factors for Alzheimer's disease (AD) and related cognitive decline. However, the underlying pathological links between personality traits and AD-related cognitive impairments remain unclear. Thus, the present study investigated associations of neuroticism and conscientiousness with in vivo cerebral amyloid-beta (Aß) burden, AD-signature regional neurodegeneration, and white matter hyperintensities (WMH) in non-demented middle- and old-aged adults. METHODS: A total of 397 non-demented participants underwent comprehensive clinical and neuropsychological assessments, 11 C-labeled Pittsburgh Compound B positron emission tomography, and magnetic resonance imaging. Additionally, the NEO Five-Factor Inventory was administered to both the participants and their informants to measure neuroticism and conscientiousness. RESULTS: Neither neuroticism nor conscientiousness was associated with cerebral Aß deposition or WMH. In contrast, higher neuroticism and lower conscientiousness, reported by informants in particular, were significantly associated with reduced AD-signature region cortical thickness. In regards to the direct and indirect effect of each personality on AD-signature region cortical thickness, only the direct effects were found, whereas indirect effects via Aß deposition or WMH were not. CONCLUSION: The present findings suggest that amyloid-independent regional neurodegeneration might underlie relations of neuroticism and conscientiousness with AD.
Asunto(s)
Envejecimiento , Enfermedad de Alzheimer , Péptidos beta-Amiloides/metabolismo , Corteza Cerebral/patología , Disfunción Cognitiva , Personalidad/fisiología , Sustancia Blanca/patología , Anciano , Anciano de 80 o más Años , Envejecimiento/metabolismo , Envejecimiento/patología , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/metabolismo , Enfermedad de Alzheimer/patología , Compuestos de Anilina , Corteza Cerebral/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/metabolismo , Disfunción Cognitiva/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroticismo , Inventario de Personalidad , Tomografía de Emisión de Positrones , Factores de Riesgo , Tiazoles , Sustancia Blanca/diagnóstico por imagenRESUMEN
OBJECTIVES: To explore the utility of dynamic contrast-enhanced (DCE) MR imaging for quantitative analysis of blood-brain barrier disruption in mild traumatic brain injury (mTBI) patients with post-concussion syndrome (PCS). METHODS: Forty-four consecutive patients with PCS after mTBI and 32 controls were included in this retrospective study. Ktrans and ve from DCE MR imaging were analyzed at contrast-enhancing lesions, T2 hyperintense white matter (WM) lesions, normal-appearing white matter (NAWM), and predilection sites for diffuse axonal injury (LocationDAI). The Mann-Whitney U-test was performed to compare the parameters between mTBI patients and controls and the parameters were correlated with neuropsychological tests using Mann-Whitney U-test and Spearman rank correlation. RESULTS: The median ve of the T2 hyperintense WM lesions in mTBI patients (n=21) was higher than that of NAWM in controls (p=.027). Both median Ktrans and ve at NAWM were also significantly higher in mTBI patients than in controls (p=.023 and p=.029, respectively). In addition, mTBI patients had higher Ktrans and ve at LocationDAI than controls (p=.008 and p=.015, respectively). VLT (delayed recall) scores were significantly correlated with ve values at T2 hyperintense WM lesions (p=-0.767, p=.044). The median ve at LocationDAI was significantly higher in patients with atypical performance in the digit span test (forward) than in those with average or good performance (p=.043). CONCLUSIONS: mTBI patients with PCS had higher Ktrans and ve values than controls not only at T2 hyperintense WM lesions but also at NAWM and LocationDAI. BBB disruption may be implicated in development of PCS in mTBI patients. KEY POINTS: ⢠mTBI patients with PCS had higher permeability than controls at T2 hyperintense WM lesions on DCE MR imaging. ⢠mTBI patients with PCS had higher permeability than controls also at NAWM and predilection sites for DAI. ⢠BBB disruption may be implicated in the development of PCS in mTBI patients.
Asunto(s)
Barrera Hematoencefálica/fisiología , Lesiones Traumáticas del Encéfalo/diagnóstico , Imagen por Resonancia Magnética/métodos , Síndrome Posconmocional/diagnóstico , Sustancia Blanca/patología , Adulto , Anciano , Anciano de 80 o más Años , Lesiones Traumáticas del Encéfalo/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Síndrome Posconmocional/fisiopatología , Estudios Retrospectivos , Adulto JovenRESUMEN
Purpose To determine the association between the administration of the macrocyclic contrast medium gadobutrol and T1 relaxation time in the brains of patients with normal renal function by using multidynamic multiecho (MDME) magnetic resonance (MR) imaging sequences. Materials and Methods The institutional review board approved this retrospective study, and the need to obtain written informed consent was waived. This study included 46 patients (revealed by an electronic medical record search) who had received one or more gadobutrol injections and a maximum of one MR imaging contrast medium injection other than gadobutrol before MDME sequence acquisition. One radiologist performed quantitative analyses of regions of interest on quantitative T1 maps twice to cover the normal-appearing globus pallidus (GP), frontal white matter, frontal cortex, and thalamus. The number of administrations and the cumulative dose of gadobutrol, age, intervals between administrations, sex, and treatment were investigated. Univariable and multivariable linear regression analyses of the T1 values in four brain regions and the GP-to-thalamus signal intensity (SI) ratio were performed. P values of less than the Bonferroni-corrected value of .01 were considered to indicate significant differences. Results Intraobserver reproducibility was good to excellent (intraclass correlation coefficients, 0.62-0.81). Because of high multicollinearity between the number of gadobutrol administrations and accumulated dose (r = 0.96, P < .001), the number of gadobutrol administrations was considered in the regression analyses. T1 shortening in the GP was independently associated with the number of gadobutrol administrations (P = .002). T1 in the other brain regions and the GP-to-thalamus SI ratio were not significantly associated with the number of gadobutrol administrations (P > .01). Conclusion Multiple exposures to gadobutrol are associated with T1 shortening in the GP. © RSNA, 2017 Online supplemental material is available for this article.