Time-to-Maximum of the Tissue Residue Function Improves Diagnostic Performance for Detecting Distal Vessel Occlusions on CT Angiography.

BACKGROUND AND PURPOSE: Detecting intracranial distal arterial occlusions on CTA is challenging but increasingly relevant to clinical decision-making. Our purpose was to determine whether the use of CTP-derived time-to-maximum of the tissue residue function maps improves diagnostic performance for detecting these occlusions. MATERIALS AND METHODS: Seventy consecutive patients with a distal arterial occlusion and 70 randomly selected controls who underwent multimodal CT with CTA and CTP for a suspected acute ischemic stroke were included in this retrospective study. Four readers with different levels of experience independently read the CTAs in 2 separate sessions, with and without time-to-maximum of the tissue residue function maps, recording the presence or absence of an occlusion, diagnostic confidence, and interpretation time. Accuracy for detecting distal occlusions was assessed using receiver operating characteristic analysis, and areas under curves were compared to assess whether accuracy improved with use of time-to-maximum of the tissue residue function. Changes in diagnostic confidence and interpretation time were assessed using the Wilcoxon signed rank test. RESULTS: Mean sensitivity for detecting occlusions on CTA increased from 70.7% to 90.4% with use of time-to-maximum of the tissue residue function maps. Diagnostic accuracy improved significantly for the 4 readers (P < .001), with areas under the receiver operating characteristic curves increasing by 0.186, 0.136, 0.114, and 0.121, respectively. Diagnostic confidence and speed also significantly increased. CONCLUSIONS: All assessed metrics of diagnostic performance for detecting distal arterial occlusions improved with the use of time-to-maximum of the tissue residue function maps, encouraging their use to aid in interpretation of CTA by both experienced and inexperienced readers. These findings show the added diagnostic value of including CTP in the acute stroke imaging protocol.

Magnetic resonance imaging of meningiomas: a pictorial review.

UNLABELLED: Meningiomas are the most common non-glial tumour of the central nervous system (CNS). There are a number of characteristic imaging features of meningiomas on magnetic resonance imaging (MRI) that allow an accurate diagnosis, however there are a number of atypical features that may be diagnostically challenging. Furthermore, a number of other neoplastic and non-neoplastic conditions may mimic meningiomas. This pictorial review discusses the typical and atypical MRI features of meningiomas and their mimics. TEACHING POINTS: There are several characteristic features of meningiomas on MRI that allow an accurate diagnosis Some meningiomas may display atypical imaging characteristics that may be diagnostically challenging Routine MRI sequences do not reliably distinguish between benign and malignant meningiomas Spectroscopy and diffusion tensor imaging may be useful in the diagnosis of malignant meningiomas A number of conditions may mimic meningiomas; however, they may have additional differentiating features.

Evidence for, and a spectrum of, neurological involvement in carriers of the fragile X pre-mutation: FXTAS and beyond.

A neurodegenerative disorder, fragile X-associated tremor/ataxia syndrome (FXTAS), occurs in some older men carrying a small CGG repeat expansion (pre-mutation) in the FMR1 gene. We surveyed a sample of older pre-mutation males to estimate the prevalence and spectrum of neurological involvement. Twelve pre-mutation males aged 50-82 years and 11 age-matched normal controls ascertained in an unbiased manner were included in a neurological assessment that also used standard scales for tremor (Clinical Rating Scale for Tremor), ataxia (International Cooperative Ataxia Rating Scale, ICARS) and parkinsonian signs (Unified Parkinson's Disease Rating Scale). Axial FLAIR images of the brain, and neuropsychological and molecular tests were also conducted in pre-mutation carriers. The neurological disorder meeting all the criteria for diagnosis of 'definite' to 'possible' FXTAS occurred in five of 12 pre-mutation carriers (41.7%), and this prevalence was significantly higher compared with normal controls (0%). The ataxia (ICARS) score and the sum of all three tremor/ataxia scores were significantly higher in pre-mutation carriers than in controls, and mRNA was elevated in all but one carrier, but did not correlate with the degree of neurological involvement. In conclusion, the findings provide further evidence that the pre-mutation allele of FMR1 is a significant cause of late-onset neurodegeneration, presenting with a broad spectrum of clinical manifestations.

Separate body- and world-referenced representations of visual space in parietal cortex.

In order to direct a movement towards a visual stimulus, visual spatial information must be combined with postural information. For example, directing gaze (eye plus head) towards a visible target requires the combination of retinal image location with eye and head position to determine the location of the target relative to the body. Similarly, world-referenced postural information is required to determine where something lies in the world. Posterior parietal neurons recorded in monkeys combine visual information with eye and head position. A population of such cells could make up a distributed representation of target location in an extraretinal frame of reference. However, previous studies have not distinguished between world-referenced and body-referenced signals. Here we report that modulations of visual signals (gain fields) in two adjacent cortical fields, LIP and 7a, are referenced to the body and to the world, respectively. This segregation of spatial information is consistent with a streaming of information, with one path carrying body-referenced information for the control of gaze, and the other carrying world-referenced information for navigation and other tasks that require an absolute frame of reference.

Head position signals used by parietal neurons to encode locations of visual stimuli.

The mechanism for object location in the environment, and the perception of the external world as stable when eyes, head and body are moved, have long been thought to be centred on the posterior parietal cortex. However, head position signals, and their integration with visual and eye position signals to form a representation of space referenced to the body, have never been examined in any area of the cortex. Here we show that the visual and saccadic activities of parietal neurons are strongly affected by head position. The eye and head position effects are equivalent for individual neurons, indicating that the modulation is a function of gaze direction, regardless of whether the eyes or head are used to direct gaze. These data are consistent with the idea that the posterior parietal cortex contains a distributed representation of space in body-centred coordinates.

Evidence for the lateral intraparietal area as the parietal eye field.

It has long been appreciated that the posterior parietal cortex plays a role in the processing of saccadic eye movements. Only recently has it been discovered that a small cortical area, the lateral intraparietal area, within this much larger area appears to be specialized for saccadic eye movements. Unlike other cortical areas in the posterior parietal cortex, the lateral intraparietal area has strong anatomical connections to other saccade centers, and its cells have saccade-related responses that begin before the saccades. The lateral intraparietal area appears to be neither a strictly visual nor strictly motor structure; rather it performs visuomotor integration functions including determining the spatial location of saccade targets and forming plans to make eye movements.

A neural network model of neural activity in the monkey globus pallidus.

A 3-layer neural network model was constructed to determine the discharge patterns of neurons within the globus pallidus (GP) which would be required to run a sequence of movements at the motor cortical level. The model was based on the presence of tonic and phasic neuronal activity within the motor cortical region; that positive feedback was required to maintain tonic neuronal activity and that phasic neuronal activity was required to initiate and terminate the tonic neuronal activity. The model predicted the presence of both phasic and tonic activity within the middle layer (layer 2; GP) of the model in order for the motor cortical regions (layers 1 and 3) to be able to run and to maintain the movement sequence. This prediction was in keeping with our electrophysiological findings within GP.

Motor function of the monkey globus pallidus. 1. Neuronal discharge and parameters of movement.

In order to examine the role of the basal ganglia (BG) in the regulation of basic movement parameters, we recorded extracellularly from pallidal neurons in conscious monkeys during the performance of a sequential wrist movement task which was composed of a series of holds and ballistic jumps. The movement sequence was predictable and had to be performed within specified time restraints. We recorded the activity of 297 neurons whose discharges were related to the movement task. We included only neurons whose discharges were related to movements at or about the wrist joint by prior examination outside the behavioural paradigm. Each neuron discharged preferentially to one direction of movement at or about the wrist joint. No consistent correlation was found between neuronal discharge and initial joint position, static load application, amplitude of movement or velocity of movement. The mean onset of neuronal discharge was 2 ms after the onset of EMG activity. The findings implied little contribution from the pallidal neurons in the execution of the current movement or to the movement's parameters. The implications are that the basal ganglia are likely to be concerned with other aspects of movement control.

Motor function of the monkey globus pallidus. 2. Cognitive aspects of movement and phasic neuronal activity.

In order to study the role of the basal ganglia (BG) in cognitive aspects of movement, we recorded extracellularly from pallidal neurons in conscious monkeys while they performed a sequential wrist movement task consisting of a series of holds and ballistic jumps. The movement sequence had to be performed within specified time restraints and was predictable. We recorded the activity of 297 neurons whose discharges were related to the movement task. The movement-related response was found to be influenced by the contextual setting and by the degree of difficulty of the task in a subgroup of 82 neurons with a clear response to the first ballistic movement. Predictable and easy movements were usually represented by more prominent movement-related responses in 46% of these neurons; 35% of neurons from a different subset of 105 neurons also demonstrated a second phasic response just before the end of the final hold period of the task. This response was also found to be influenced by the predictability of the final hold period, both in its time duration and also by the direction of the following ballistic movement in double jump tasks. These findings were in keeping with a cognitive role for the BG in movement performance. In particular we suggest that the phasic neuronal activity was an internal cue generated by the BG for predictable movements of a subconscious nature which signals the end of a component of movement in a movement sequence. This cue is appropriately timed to terminate sustained neuronal activity in the SMA and to allow the next movement in the sequence to be executed.