MRI study of the relationship between the cerebral small vessel disease total burden and imaging markers and degree of middle cerebral artery stenosis / 中华放射学杂志

Objective:To investigate the relationship between the cerebral small vascular disease (CSVD) total burden and the imaging markers and the degree of unilateral middle cerebral artery (MCA) stenosis.Methods:The study was a cross-sectional study. Clinical and imaging data of patients with chronic unilateral MCA stenosis who underwent multimodal MRI from October 2015 to January 2019 in the First Medical Center of PLA General Hospital were retrospectively analyzed. A total of 261 patients were included, 187 males and 74 females. According to the degree of MCA stenosis, the patients were divided into 102 cases in severe stenosis-occlusion group (stenosis degree ≥70%) and 159 cases in mild-moderate stenosis group (stenosis degree <70%). CSVD imaging marker scores (including white matter hyperintensity, perivascular space, cerebral microbleed, and lacune of presumed vascular origin) were assessed according to the ?standards for reporting vascular changes on neuroimaging 1 in the 2 groups, and the CSVD total burden score was calculated. Mann-Whitney U test was used to compare the indicators between the two groups, and the CSVD total burden score and imaging marker scores were ultimately included in a multifactorial binary logistic regression to assess the association of CSVD imaging markers with severe stenosis-occlusion of the MCA after adjusting for vascular risk factors (age, gender, drinking, smoking, hypertension, hyperlipidemia, atrial fibrillation and coronary heart disease). Results:There were significant differences in the CSVD total burden, centrum semiovale perivascular space and lacune of presumed vascular origin score between the mild-to-moderate stenosis group and the severe stenosis-occlusion group (all P<0.05), and none of the differences in the remaining imaging marker scores were statistically significant (all P>0.05). Multivariate binary logistics regression analysis showed CSVD total burden score ( OR=1.300, 95% CI 1.047-1.613, P=0.017), centrum semiovale perivascular space score ( OR=2.099, 95% CI 1.540-2.860, P<0.001) and lacune of presumed vascular origin score ( OR=2.609, 95% CI 1.294-5.261, P=0.007) were independent associated with severe stenosis-occlusion of MCA. Conclusion:The higher CSVD total burden score, centrum semiovale perivascular space score and lacune of presumed vascular origin score are associated with severe stenosis-occlusion of MCA.

Embolic stroke of undetermined source: knowledge validated and refuted in the past 10 years / 中华神经科杂志

Embolic stroke of undetermined source (ESUS) is a concept proposed by an international working group in 2014 to define a class of stroke patients and explore the rationality of secondary prevention by anticoagulation in them. During the decade since the concept was proposed, numerous studies have been conducted on the pathogenesis and prevention strategies of ESUS. However, the research results are not quite consistent with the speculations and assumptions when the concept was proposed. Based on the review of the findings of related studies over the past decade, this article discusses the inherent defects in the ESUS concept, the new idea derived from the research results, the future role of ESUS, and trends in etiological diagnosis of ischemic stroke.

Application of fast susceptibility weighted imaging based on deep learning in assessment of acute ischemic stroke / 中华放射学杂志

Objective:To explore the value of fast susceptibility weighted imaging (SWI) generated by a deep learning model in assessment of acute ischemic stroke (AIS).Methods:From January 2019 to January 2021, 118 AIS patients [75 males and 43 females, aged 23-100 (66±14) years] who underwent MR examination and SWI sequence scanning within 24 h of symptom onset in the First Medical Center of PLA General Hospital were retrospectively analyzed. MATLAB ′s randperm function was used to divide 118 patients into a training set of 96 cases and a test set of 22 cases at a ratio of 8∶2. Fourty-seven AIS patients [38 males and 9 females, aged 16-75 (58±12) years] from one center of a multicenter study were selected to build the external validation set. SWI image and filtered phase image were combined into complex value image as full sampling reference image. Undersampled SWI images were obtained by retrospective undersampling of reference fully sampled images, and the undersampling multiple was five times which could save 80% of the scanning time, then the complex-valued convolutional neural network (ComplexNet) was used to develop reconstruct fast SWI. Interclass correlation coefficient (ICC) or Kappa tests were used to compare the consistency of image quality and the diagnostic consistency for the presence of susceptibility vessel sign (SVS), cerebral microbleeds and asymmetry of cerebral deep medullary veins (DMVs) in AIS patient on fully sampled SWI and fast SWI based on ComplexNet.Results:In test set, score of image quality was 4.5±0.6 for fully sampled SWI image and 4.6±0.7 for fast SWI based on ComplexNet, and coefficient was excellent (ICC=0.86, P<0.05). Full sampling SWI had good agreement with fast SWI based on ComplexNet in detecting SVS (Kappa=0.79, P<0.05), microbleeds (Kappa=0.86, P<0.05), and DMVs asymmetry (Kappa=0.82, P<0.05) in AIS patients. In the external validation set, score of image quality was 4.1±1.0 for fully sampled SWI image and 4.0±0.9 for fast SWI based on ComplexNet, and coefficient was excellent (ICC=0.97, P<0.05). Full sampling SWI had good agreement with fast SWI based on ComplexNet in detecting SVS (Kappa=0.74, P<0.05), microbleeds (Kappa=0.83, P<0.05), and DMVs asymmetry (Kappa=0.74, P<0.05) in AIS patients. Conclusions:Deep learning techniques can significantly accelerate the speed of SWI, and the consistency of image quality and detected AIS signs between fast SWI based on ComplexNet and fully sampled SWI is good. The fast SWI based on ComplexNet can be applied to the radiographic assessment of clinical AIS patients

Measurement of tumor markers in cerebrospinal fluid: an important role in the diagnosis of leptomeningeal carcinomatosis / 中华神经科杂志

Tumor markers (TMs) in blood are important tools for the diagnosis, prognosis prediction and monitoring therapeutic efficacy of malignant tumor. Measurement of TMs in pleural and peritoneal fluid has been widely used. However, the significance of common TMs associated with systemic solid tumors in cerebrospinal fluid (CSF) has been overlooked to some extent. TMs in CSF are within extremely low limits in patients without intracranial malignant diseases. Slightly elevated TMs in CSF usually indicate abnormal intrathecal synthesis. Measurement of TMs in CSF is a useful and feasible ancillary diagnostic tool for intracranial metastasis, especially for leptomeningeal metastasis.

Cerebral amyloid angiopathy / 中华神经科杂志

Cerebral amyloid angiopathy is a special type of cerebrovascular diseases. The etiologic mechanism, pathological changes, imaging characteristics, biological markers, clinical presentation, diagnostic criteria and therapeutic issues needing caution were reviewed in this article. Special attention was paid to clinically related progress in this field.

Application of Vaso CT in the recanalization of vertebrobasilar junction occlusion / 中国脑血管病杂志

Objective To investigate the risk assessment,guiding role,and clinical value of Vaso CT image features for recanalization of vertebrobasilar junction occlusion. Methods From January 2016 to May 2017,14 patients with vertebrobasilar junction occlusion admitted to the Department of Neurology, Chinese PLA General Hospital were analyzed retrospectively. Preoperative cerebral angiography confirmed vertebrobasilar junction occlusion. Vaso CT was used to measure the length of the occluded vessels and vascular direction at both ends. According to these results, the operative risks were evaluated and the recanalization of vertebrobasilar junction occlusion were guided. Results The length of vertebrobasilar junction occlusion was 2. 56-19. 09 mm (mean 4. 5 ± 2. 1 mm) in 14 patients,and 13 of them were treated with the recanalization of vertebrobasilar artery occlusion,the blood vessels of 12 cases were successfully recanalized and stent placement was performed after the recanalization,among them,8 Solitaire stents and 4 Wingspan stents were implanted;One patient did not perform recanalization because of longer length of occlusion (19. 09 mm). All patients operated did not have any perioperative complications, and the neurological symptoms were significantly improved after procedure. Conclusion Vaso CT can accurately determine the surgical risk of the recanalization of vertebrobasilar junction occlusion,and can guide the surgical pathways,reduce the incidence of perioperative complications,and improve the success rate of the operation.

Application of Vaso CT in the recanalization of vertebrobasilar junction occlusion / 中国脑血管病杂志

Objective To investigate the risk assessment,guiding role,and clinical value of Vaso CT image features for recanalization of vertebrobasilar junction occlusion. Methods From January 2016 to May 2017,14 patients with vertebrobasilar junction occlusion admitted to the Department of Neurology, Chinese PLA General Hospital were analyzed retrospectively. Preoperative cerebral angiography confirmed vertebrobasilar junction occlusion. Vaso CT was used to measure the length of the occluded vessels and vascular direction at both ends. According to these results, the operative risks were evaluated and the recanalization of vertebrobasilar junction occlusion were guided. Results The length of vertebrobasilar junction occlusion was 2. 56-19. 09 mm (mean 4. 5 ± 2. 1 mm) in 14 patients,and 13 of them were treated with the recanalization of vertebrobasilar artery occlusion,the blood vessels of 12 cases were successfully recanalized and stent placement was performed after the recanalization,among them,8 Solitaire stents and 4 Wingspan stents were implanted;One patient did not perform recanalization because of longer length of occlusion (19. 09 mm). All patients operated did not have any perioperative complications, and the neurological symptoms were significantly improved after procedure. Conclusion Vaso CT can accurately determine the surgical risk of the recanalization of vertebrobasilar junction occlusion,and can guide the surgical pathways,reduce the incidence of perioperative complications,and improve the success rate of the operation.

Diagnostic value of biomarkers in cerebrospinal fluid in differentiating meningeal carcinomatosis and tubercular meningitis / 中华神经医学杂志

Objective To investigate the diagnostic value ofbiomarkers in cerebrospinal fluid in differentiating meningeal carcinomatosis (MC) and tubercular meningitis (TBM).Methods The clinical features and cerebrospinal fluid (CSF) test results of 34 patients with MC and 44 patients with TBM,admitted to our hospital from January 1994 to August 2014,were retrospectively analyzed and compared.Results The main clinical manifestations of MC included headache and bowel and bladder dysfunction,and those of TBM were fever and headache.The cell population of MC and TBM patients increased and the number of leucocyte of TBM patients was significantly larger than that of MC patients (P＜0.05);the CSF of all the patients presented with decreased levels of glucose and chloride,and increased protein level,and higher protein in MC patients was noted than that in TBM patients (P＜0.05).The biomarkers in CSF of MC and TBM patients increased to varying degrees,and the biomarkers,including carcinoembryonic antigen (CEA),cancer antigen (CA) 125,CA 199,CA 153 and CYFRA21-1,in MC group were significantly higher than those in TBM group (P＜0.05).The neuron-specific enolase level in the TBM patients of Ⅲ grade was significantly higher than that in the MC patients (P＜ 0.05).Conclusion The detections of tumor biomarkers in cerebrospinal fluid is a tool in differentiating MC and all stages of TBM,especially with the combined detections of CEA,CA125,CA199 and CYFRA21-1.

Role of enhancement features of cerebral venous sinus in the diagnosis of cerebral venous sinus thrombosis: a MRI study / 中华神经科杂志

Objective To describe the changes of thrombosed venous sinus on MRI after administration of contrast material and evaluate the sensitivity and specificity of thread-like enhancement around sinus to diagnose thrombosis in the corresponding sinus.Methods Patients with cerebral venous sinus thrombosis (CVST) admitted to our department from January 2005 to December 2014 and undergone a MRI scan with administration of contrast material were included in this study.The enhancement features of venous sinus were studied in the plane parallel to the interested sinus.The features of enhancement were classified as peripheral thread-like enhancement, partial enhancement and complete enhancement.The proportion of these three type of enhancement in thrombosed sinuses and normal sinuses were described and compared.The sensitivity and specificity of peripheral thread-like enhancement to diagnose thrombosis in corresponding sinus were calculated.The proportion of each type of enhancement was also described and compared in acute (≤ 7 d), subacute (8-30 d) and chronic (≥ 31 d) stage after onset of symptoms.Results Peripheral thread-like enhancement, partial enhancement and complete enhancement were all found in both thrombosed and normal sinuses.There was a significant difference of enhancement features between normal and thrombosed sinus in superior sagittal sinus (100％ (30/30) vs 60％ (27/45), x2 =13.789, P =0.001), left trans verse sinus, and right sigrnoid sinus.The sensitivity and specificity of peripheral thread-like enhancement to diagnose thrombosis in the corresponding sinus were 10.5％-44.4％ and 53.3％-76.7％ respectively.There was no significant difference of contrast features at different stage after onset.Conclusion The value of peripheral thread-like enhancement to diagnose CVST is limited because of low sensitivity and specificity.

Clinical value of CereTom mobile CT scanner for patients in neurological ICU / 医疗卫生装备

Objective To explore the clinical value of cranial CT for the patients in neurological ICU by analyzing the application of mobile CT scanner CereTom in some hospital.Methods Retrospective analysis was carried out for the patients being hospitalized and undergoing cranial CT examination in some hospital from March 2012 to August 2014.Results Totally 261 patients and 325 times of examination were involved in, and two ones failed in the examination, with the success rate of 99.23%. There were 218 patients (83.52%) had the examination completed in one time and 43 ones (16.48%) in several times. It's proved that bedside CT could be applied clinically with high successful rate. The mean time of bedside CT examination was (18.3±3.8)min, significantly less that then of common examination.Conclusion Mobile CT may decrease moving-related risk of the patient and the time, manpower consumed for examination, and thus is worth popularizing clinically.

Study on the length of hypertension history and its related factors in patients with both ischemic cerebral vascular disease and hypertension / 中国实用内科杂志

Objective To study the length of hypertension history and its related factors in patients with both ischemic cerebral vascular disease(ICVD) and hypertension.Methods The profile of hypertension history in ICVD patients from our hospital between 1990 and 1999 was summarized.Hypertension history meant the time interval between onset of first symptomatic ICVD and establishment of diagnosis of hypertension.The related factors' influence on the length of hypertension history was analyzed by means of multiple linear regression model.Results In ICVD patients with hypertension,the mean length of hypertension history was 14.29?10.63 years,the median was 11 years.In multiple linear regression model,increased age when hypertension was diagnosed,diabetes mellitus,smoking,peasant(army man as control group) were independent factors that shortened hypertension history.Antihypertensive treatment independently lengthened hypertension history.Conclusion The length of hypertension history varies greatly,50% of patients developed the first ICVD in 11 years after the diagnosis of hypertension was established .Coexisting smoking and diabetes mellitus hasten while control of arterial blood pressure postpone onset of ICVD in patients with hypertension.

Analysis of cause and correlative factors of death within short-term in initially lucid patients with intracerebral hemorrhage / 临床神经病学杂志

Objective To analyze the correlative factors and cause of death within short-term in initially lucid patients with intracerebral hemorrhage (ICH).Methods 441 patients with spontaneous ICH admitted within 24 hours of onset and with Glasgow Coma Scale (GCS) score more than 9 on admission were enrolled. The demographic characteristics, clinical features at onset, CT, electrocardiograph (ECG) and laboratory findings, medical complications and 27 days outcome were recorded. Univariate and multivariate analysis were performed.Results 24 (5.4%) patients died winthin 27 days after onset, 14 (58.3%) died of brain herniation and central respiratory failure, another 10 (41.7%) of systemic complications. Multivariate analysis demonstrated that age was 75 years old or more, urinary incontinence at onset, peripheral white blood cell count more than 10.0?10 9/L on admission, blood glucose more than 7.0 mmol/L and abnormal ECG were independent correlative factors of death.Conclusions The short-term outcome of initially lucid patients with ICH is favorable in general, albeit with a relatively low mortality. Brain herniation and central respiratory failure were main cause of death, and they have independent correlative risk factors.