Traumatic Cerebral Microbleeds in the Subacute Phase Are Practical and Early Predictors of Abnormality of the Normal-Appearing White Matter in the Chronic Phase.

BACKGROUND AND PURPOSE: In the chronic phase after traumatic brain injury, DTI findings reflect WM integrity. DTI interpretation in the subacute phase is less straightforward. Microbleed evaluation with SWI is straightforward in both phases. We evaluated whether the microbleed concentration in the subacute phase is associated with the integrity of normal-appearing WM in the chronic phase. MATERIALS AND METHODS: Sixty of 211 consecutive patients 18 years of age or older admitted to our emergency department ≤24 hours after moderate to severe traumatic brain injury matched the selection criteria. Standardized 3T SWI, DTI, and T1WI were obtained 3 and 26 weeks after traumatic brain injury in 31 patients and 24 healthy volunteers. At baseline, microbleed concentrations were calculated. At follow-up, mean diffusivity (MD) was calculated in the normal-appearing WM in reference to the healthy volunteers (MDz). Through linear regression, we evaluated the relation between microbleed concentration and MDz in predefined structures. RESULTS: In the cerebral hemispheres, MDz at follow-up was independently associated with the microbleed concentration at baseline (left: B = 38.4 [95% CI 7.5-69.3], P = .017; right: B = 26.3 [95% CI 5.7-47.0], P = .014). No such relation was demonstrated in the central brain. MDz in the corpus callosum was independently associated with the microbleed concentration in the structures connected by WM tracts running through the corpus callosum (B = 20.0 [95% CI 24.8-75.2], P < .000). MDz in the central brain was independently associated with the microbleed concentration in the cerebral hemispheres (B = 25.7 [95% CI 3.9-47.5], P = .023). CONCLUSIONS: SWI-assessed microbleeds in the subacute phase are associated with DTI-based WM integrity in the chronic phase. These associations are found both within regions and between functionally connected regions.

Automated detection of cerebral microbleeds in patients with Traumatic Brain Injury.

In this paper a Computer Aided Detection (CAD) system is presented to automatically detect Cerebral Microbleeds (CMBs) in patients with Traumatic Brain Injury (TBI). It is believed that the presence of CMBs has clinical prognostic value in TBI patients. To study the contribution of CMBs in patient outcome, accurate detection of CMBs is required. Manual detection of CMBs in TBI patients is a time consuming task that is prone to errors, because CMBs are easily overlooked and are difficult to distinguish from blood vessels. This study included 33 TBI patients. Because of the laborious nature of manually annotating CMBs, only one trained expert manually annotated the CMBs in all 33 patients. A subset of ten TBI patients was annotated by six experts. Our CAD system makes use of both Susceptibility Weighted Imaging (SWI) and T1 weighted magnetic resonance images to detect CMBs. After pre-processing these images, a two-step approach was used for automated detection of CMBs. In the first step, each voxel was characterized by twelve features based on the dark and spherical nature of CMBs and a random forest classifier was used to identify CMB candidate locations. In the second step, segmentations were made from each identified candidate location. Subsequently an object-based classifier was used to remove false positive detections of the voxel classifier, by considering seven object-based features that discriminate between spherical objects (CMBs) and elongated objects (blood vessels). A guided user interface was designed for fast evaluation of the CAD system result. During this process, an expert checked each CMB detected by the CAD system. A Fleiss' kappa value of only 0.24 showed that the inter-observer variability for the TBI patients in this study was very large. An expert using the guided user interface reached an average sensitivity of 93%, which was significantly higher (p = 0.03) than the average sensitivity of 77% (sd 12.4%) that the six experts manually detected. Furthermore, with the use of this CAD system the reading time was substantially reduced from one hour to 13 minutes per patient, because the CAD system only detects on average 25.9 false positives per TBI patient, resulting in 0.29 false positives per definite CMB finding.

Susceptibility-weighted imaging improves the diagnostic accuracy of 3T brain MRI in the work-up of parkinsonism.

BACKGROUND AND PURPOSE: The differentiation between Parkinson disease and atypical parkinsonian syndromes can be challenging in clinical practice, especially in early disease stages. Brain MR imaging can help to increase certainty about the diagnosis. Our goal was to evaluate the added value of SWI in relation to conventional 3T brain MR imaging for the diagnostic work-up of early-stage parkinsonism. MATERIALS AND METHODS: This was a prospective observational cohort study of 65 patients presenting with parkinsonism but with an uncertain initial clinical diagnosis. At baseline, 3T brain MR imaging with conventional and SWI sequences was performed. After clinical follow-up, probable diagnoses could be made in 56 patients, 38 patients diagnosed with Parkinson disease and 18 patients diagnosed with atypical parkinsonian syndromes, including 12 patients diagnosed with multiple system atrophy-parkinsonian form. In addition, 13 healthy controls were evaluated with SWI. Abnormal findings on conventional brain MR imaging were grouped into disease-specific scores. SWI was analyzed by a region-of-interest method of different brain structures. One-way ANOVA was performed to analyze group differences. Receiver operating characteristic analyses were performed to evaluate the diagnostic accuracy of conventional brain MR imaging separately and combined with SWI. RESULTS: Disease-specific scores of conventional brain MR imaging had a high specificity for atypical parkinsonian syndromes (80%-90%), but sensitivity was limited (50%-80%). The mean SWI signal intensity of the putamen was significantly lower for multiple system atrophy-parkinsonian form than for Parkinson disease and controls (P < .001). The presence of severe dorsal putaminal hypointensity improved the accuracy of brain MR imaging: The area under the curve was increased from 0.75 to 0.83 for identifying multiple system atrophy-parkinsonian form, and it was increased from 0.76 to 0.82 for identifying atypical parkinsonian syndromes as a group. CONCLUSIONS: SWI improves the diagnostic accuracy of 3T brain MR imaging in the work-up of parkinsonism by identifying severe putaminal hypointensity as a sign indicative of multiple system atrophy-parkinsonian form.

Discrimination between metastasis and glioblastoma multiforme based on morphometric analysis of MR images.

BACKGROUND AND PURPOSE: Solitary MET and GBM are difficult to distinguish by using MR imaging. Differentiation is useful before any metastatic work-up or biopsy. Our hypothesis was that MET and GBM tumors differ in morphology. Shape analysis was proposed as an indicator for discriminating these 2 types of brain pathologies. The purpose of this study was to evaluate the accuracy of this approach in the discrimination of GBMs and brain METs. MATERIALS AND METHODS: The dataset consisted of 33 brain MR imaging sets of untreated patients, of which 18 patients were diagnosed as having a GBM and 15 patients, as having solitary metastatic brain tumor. The MR imaging was segmented by using the K-means algorithm. The resulting set of classes (also called "clusters") represented the variety of tissues observed. A morphology-based approach allowed discrimination of the 2 types of tumors. This approach was validated by a leave-1-patient-out procedure. RESULTS: A method was developed for the discrimination of GBMs and solitary METs. Two masses out of 33 were wrongly classified; the overall results were accurate in 93.9% of the observed cases. CONCLUSIONS: A semiautomated method based on a morphologic analysis was developed. Its application was found to be useful in the discrimination of GBM from solitary MET.

[Virtual bronchoscopy: a new tool of non-invasive imaging of airway inner surface based on standard spiral computed tomography of the chest]. / Wirtualna bronchoskopia--nowe narzedzie nieinwazyjnego obrazowania wnetrza dróg oddechowych, uzyskane ze standardowego badania klatki piersiowej spiralna tomografia komputerowa.

The aim of the study is to assess the new method of radiological imaging of the inner surface of a tracheobronchial tree in order to determine to what extend it can replace the standard bronchoscopy. The spiral CT examinations of 43 patients with hilar lung tumor in virtual mode had been reconstructed retrospectively and compared to the results of fiberoptic bronchoscopy. There was a significant correlation between both methods to reveal stenoses or occlusions of airway lumen. Virtual endoscopy turned out to be an unsatisfactory method in the visualisation of mucosal changes.

[Use of three-dimensional reconstruction of the biliary tree in spiral computed tomography without using hepatotropic contrast media]. / Uzyskiwanie trójwymiarowych rekonstrukcji obrazu dróg zólciowych w spiralnej tomografii komputerowej bez uzycia hepatotropowego srodka kontrastujacego.

The aim of the study was to assess the quality of biliary tract imaging without cholangiographic contrast medium and to evaluate the usefulness of 3-D reformations in determination of ductal anatomic relationship. The spiral 5 mm CT liver scans were performed after a bolus of 150 ml i.v. contrast agent in 15 patients with a malignant obstructive jaundice. The biliary tract was separated from surrounding hepatic parenchyma with segmentation computer algorithm and then 3-D models were produced. In all the patients, both biliary anatomy and the localization and degree of segmental obstruction were visualized with satisfying quality. The 3-D sCT models of dilated biliary tract can be obtained without cholangiographic contrast agent and can clearly depict ductal anatomy and pathology.

[Functional magnetic resonance imaging in the assessment of motor centers in patients with brain tumors in motor area]. / Czynnosciowy rezonans magnetyczny (cMR) w ocenie osrodków ruchowych u chorych z guzami mózgu tej okolicy.

Magnetic resonance imaging (MRI) is become recognised as the most sensitive and specific imaging modality for the examination of central nervous system pathology. Blood oxygen level-dependent (BOLD) contrast imaging is a non-invasive functional MRI technique for localising active neuronal brain centres. The aim of our study was to determine usefulness of fMRI in detecting hand movements cortical activity in hemisphere with brain tumour and comparison with corresponding one. Six right-handed patients with brain tumours of central sulcus area, aged 20-50 years were examined using a commercial 1.5 T scanner. All patients underwent both conventional and functional magnetic resonance imaging (MRI) examinations. Simple hand movements were examined separately for right and left hand at a self-paced rate. Significant increase of signal intensity was found in: a) contralateral primary motor cortex in all cases during both motor tasks, b) ipsilateral primary motor cortex, supplementary motor cortex and premotor cortex of both hemispheres in a part of the cases c) displacement of the activity in the affected hemisphere in comparison to the opposite one was noticeable depending on the localisation and size of the tumour and accompanied oedema. Usefulness of functional MRI in detecting primary motor area in patients with brain tumours was proved. There is a difference between activation in affected cortex and corresponding normal cortex in the opposite hemisphere.

Patellar motion analyzed by kinematic and dynamic axial magnetic resonance imaging in patients with anterior knee pain syndrome.

Ten consecutive patients (12 knees), all women, with anterior knee pain syndrome participated in the study. The patellofemoral joints were examined with the knee in 0 degrees, 10 degrees, 20 degrees, and 30 degrees of flexion. At each knee position, kinematic and dynamic, an axial magnetic resonance (MR) image was used to focus on the sagittal plane, followed by an axial image focused through the middle of the patella. Ten healthy volunteers (20 knees) with no history of previous or current knee problems or anterior knee pain also underwent MRI scanning following the same procedure. Three angles were measured: patellar tilt angle (PTA), sulcus angle (SA), and congruence angle (CA). For statistical analyses, we used the Mann-Whitney U-test. Compared with the control knees, five patterns of malalignment were identified. The most frequently observed was tilt and lateralisation, with elevated CA and decreased PTA. In extension, the average CA for this group was 22 degrees and PTA -4.8 degrees vs -8.1 degrees and 14.3 degrees for control knees respectively. Contraction of the muscles caused tilt of the patella in symptomatic knees. This decrease of the PTA was statistically significant in extension (P < 0.05) and in 10 degrees of flexion (P < 0.05). Contraction of the thigh muscle increased CA in 30 degrees of flexion. This lateral pull was statistically significant (P < 0.05). There were no statistically significant differences of SA between the groups, regardless of muscle contraction or flexion angle. At 30 degrees of flexion, muscle contraction increased CA and decreased PTA. In our opinion, imaging in the first 30 degrees of flexion with thigh muscle contraction is necessary for a correct diagnosis.

[Acute poisoning by carbon monoxide affecting the extrapyramidal system]. / Ostre zatrucie tlenkiem wegla z zajeciem ukladu pozapiramidowego.

A case record of a 19-year old women acutely poisoned by carbon monoxide is presented. The state of the patient was very serious with loss of consciousness, cerebral oedema and acute circulatory failure, manifested by pulmonary oedema. The presence of carboxyhemoglobin in concentration of 45% was found in the blood. During the second week after the incident, extrapyramidal symptoms, manifested by hyperkinetic-hypokinetic syndrome with predominant involuntary movement, was observed. The diagnostic examinations of the central nervous system showed necrosis of globus pallidus, external capsule and a part of internal capsule.

[Herpes simplex encephalitis in children]. / Opryszczkowe zapalenie mózgu u dzieci.

Clinical course of Herpes Simplex Encephalitis were shown in this paper. 24 children in the age of 4 to 15 were treated at Polish Mother's Memorial Hospital in years 1992-1994. Value of EEG, CT scan, NMR were underlined in early diagnostic and casual treatment of diseases. All children from this analysis group survived, only 8 demonstrated late complications: epileptic attacks (3), spastic tetraparesis (1), encephalopathy and mental disturbances (1). Positive results of treatment were connected with early diagnosis and early antiviral treatment which is very important in decreasing death rate and preventing permanent injury.

Transcranial Doppler analysis of cerebral hemodynamics in primary craniosynostosis: study in progress.

BACKGROUND: Regional elevations in intracranial pressure (ICP) have been monitored adjacent to areas of cranial stenosis by some authors [9,19,20]; however, noninvasive techniques such as transcranial Doppler (TCD) would be preferable if increased ICP could be detected just as reliably. METHODS: TCD examinations of basal cerebral arteries were performed in 31 children with skull deformities. Skull X rays and computed tomography (CT) scans or magnetic resonance imaging (MRI) were analyzed for degree of cranial vault abnormality, as well as for presence or absence of intracranial pathology. Neurodevelopmental examination and clinical signs of increased ICP, if any, were recorded. RESULTS: The overall incidence of increased resistivity indices (RI) was 70%. Patients with asymmetric skull deformities (plagiocephaly) or sagittal synostosis (scaphocephaly) were statistically more prone to exhibit increased RI compared to previously reported prevalences. CONCLUSIONS: Because TCD is a convenient, rapid, accurate, and noninvasive method by which to gauge ICP, it should be considered in the preliminary work-up of a patient with craniosynostosis.

Correlation of intracranial pressure and transcranial Doppler resistive index after head trauma.

PURPOSE: To investigate the usefulness of transcranial Doppler ultrasonography in the evaluation of intracranial pressure changes after head injury. METHODS: Transcranial Doppler examinations and intracranial pressure measurements using intraparenchymal monitors were performed in 12 cases of closed head injury. Twenty-four sets of data, including the Glasgow Coma Scale, intracranial pressure, transcranial Doppler, and carbon dioxide pressure were compared. The side-to-side difference in the resistivity index was also assessed. RESULTS: There was a significant correlation between increased pressure values and resistivity index when comparing measurements from the same side. There was no correlation between carbon dioxide pressure and any transcranial Doppler parameter or intracranial pressure measurement. No significant correlation was found between the resistivity index and the Glasgow Coma Scale. End diastolic velocity was a stronger determinant of resistivity index than peak systolic velocity. CONCLUSION: The relationship of ipsilateral measurements of intracranial pressure to resistivity index is valid. The resistivity index must be analyzed within the context of the particular disease studied, especially with respect to the hemodynamic alterations. Initial findings suggest that intracranial pressure monitoring cannot be replaced by serial transcranial Doppler measurements in the treatment of the patient with acute head injury.

Cerebral blood flow velocity after head injury: transcranial Doppler evaluation. Work in progress.

To study blood flow velocity (BFV) changes, serial transcranial Doppler ultrasound (US) examinations of basal cerebral arteries were performed in 47 patients with head injury. Computed tomographic (CT) scans obtained at admission were analyzed for the presence of intracranial hemorrhages. Glasgow Coma Scale scores were obtained at admission in 46 patients. The prevalence of posttraumatic increased BFV was 77% (n = 36). Two groups of patients were identified according to the time of onset of increased BFV. They differed with respect to duration and severity of changes, Glasgow Coma Scale score, and evidence of intracranial hemorrhagic lesions. Low Glasgow Coma Scale scores were predictive of increased BFV within 72 hours after injury (P < .001). Patients with hemorrhages were significantly more prone to experience increased BFV within 72 hours (P < .05); 34% of patients who did not have hemorrhage, however, developed increased BFV. Increased BFV after head trauma is not uniformly found and cannot be explained by one pathologic mechanism.

Ultrasound; a method of brain abscess drainage monitoring.

Ultrasound guided percutaneous aspiration was performed in fourteen patients with multiple brain abscesses. A bone defect in the skull served as the site of needle insertion and served to sonographically evaluate the abscesses. Antibiotic therapy was administered in all cases. Repeat drainage was required in 5 cases. There were no complications. In 10 patients complete improvement without CNS lesions was achieved. Three patients suffered from headaches and seizures for a period of 6 weeks following the aspiration. One patient with multiple otogenic abscesses died in spite of multiple efforts to drain the abscesses. Our results demonstrate sonography to be very effective for monitoring brain abscess drainage and follow-up.

[Neurosonography-ultrasonography in diagnosis of the central nervous system]. / Neurosonografia-ultrasonografia w diagnostyce osrodkowego ukøadu nerwowego.

Diagnostic possibilities created by ultrasound in the examination of CNS are discussed. Applications of neurosonography in relation to the diagnosis of brain and spinal cord diseases are listed. Emphasis is on ultrasound monitoring of cerebral biopsy enriching precise diagnosis of CNS.

[Usefulness of trans-fontanel ultrasonography in the diagnosis of various pathological changes in the brain of infants. I. Comparison of diagnostic value of USG and CT]. / Przydatnosc ultrasonografii przezciemiaczkowej w diagnostyce niektórych zmian patologicznych w mózgu u niemowlat. Czesc I. Wartosc diagnostyczna usg w odniesieniu do TK.

Diagnostic values of ultrasound and CT scan were compared in the group of 50 children with suspected pathologic cerebral lesions. On the ground of results obtained in the 2nd part of the study (118 children) an attempt was made to evaluate in which percentage of the unselected patients the CT scan might be left out and the diagnosis made only using the ultrasound examination.

[Neurological status and psychomotor development of infants with dilated pericerebral space]. / Stan neurologiczny i rozwój psychoruchowy niemowlat z poszerzona przestrzenia okolomózgowa.

Neurologic condition and psychomotoric development were analysed in infants up to 14 months of age with dilated pericerebral space detected by ultrasound scan performed between 2nd and 5th month of life. The good prognosis was stressed in children with mild degree of dilatation of the subarachnoid space.

[Usefulness of trans-fontanel ultrasonography in the diagnosis of various pathological changes in the brain of infants. II. Evaluation of the width of cerebral ventricles and morphology of extra-cerebral fluid spaces]. / Przydatnosc ultrasonografii przezciemiaczkowej w diagnostyce niektórych zmian patologicznych mózgu u niemowlat. Czesc II. Ocena szerokosci ukladu komorowego mózgu i morfologii zewnatrzmózgowych przestrzeni plynowych.

The analysis of the morphology of the extracerebral fluid space and the assessment of the cerebral ventricles width were done on the ground of 200 ultrasound cerebral scans in infants with an open anterior fontanel. A classification of lesions according to their morphologic picture and the level of progression of disease is proposed.

[A case of favorable outcome of conservative treatment of acute otogenic cerebellar abscess]. / Przypadek ostrego usznopochodnego ropnia mózdzku leczony zachowawczo z wynikiem pomyslnym.

The authors report a case of conservatively cured abscess in the left cerebellar hemisphere demonstrated by CT. The patient was admitted in serious condition to a neurotraumatology centre. After pharmacological treatment a quick improvement of patient's health was achieved and control CT examination during his stay in hospital and after discharge from hospital confirmed the relation between clinical improvement and regression of changes in CT. The presented case points to the possibility of conservative treatment of brain abscesses if the patient meets certain clinical criteria, and CT provides the possibility of repeated checking of the dynamics of intracranial lesion.

[Evaluation of the sequelae of suppurative meningitis and meningoencephalitis by computerized tomography]. / Ocena nastepstw ropnego zapalenia opon mózgowo-rdzeniowych i mózgu w tomografii komputerowej.

The authors suggest an own classification of changes resulting from purulent encephalomeningitis based on clinical and radiological criteria calling also attention to the mechanism of development of pathological changes in various groups and their pattern in computerized tomography.