Interrater reliability of modified visual mri rating scale assessing atrophy and white matter changes.

Background and purpose:

Cortical atrophy and white matter changes are common findings on magnetic resonance imaging among elderly. Several visual scales have been proposed to evaluate these changes using neuroimaging. We have recently proposed a scale (Modified Visual Magnetic Resonance Rating Scale) recently which allows us to evaluate atrophy, white matter hyperintensities, basal ganglia and infratentorial infarcts together. Our aim in this study was to evaluate the interrater reliability of magnetic resonance visual assessment using this scale between two neurologists and a radiologist. 

Randomly selected 30 patients in different ages who underwent brain magnetic resonance imaging between January 2014 and March 2015 were included. Axial T1, coronal T2, and axial FLAIR sequences were visually scored by two neurologists and one radiologist separately. Sulcal, ventricular and medial temporal lobe atrophy, periventricular and subcortical white matter hyperintensities, basal ganglia and infratentorial infarcts were graded according to our scale. The interrater reliability and internal consistency analysis were evaluated by using intraclass correlation coefficient and Cronbach’s alpha tests. 

The interrater agreements vary between good to excellent. The interrater correlations are moderate to excellent. Interrater correlations were excellent between two neurologists, especially on ventricular atrophy, medial temporal atrophy, basal ganglia infarcts, infratentorial infarcts. When assessing ventricular atrophy, interrater correlations between individual raters were higher than sulcal atrophy. We found good correlations between neurologists and radiologist, and excellent correlations between the two neurologists for medial temporal atrophy. We found excellent interrater correlations between neurologists and radiologist for white matter hyperintensities.

Our scale is a reliable tool assessing both atrophy and white matter hyperintensities with a good interrater reliability. Ventricular atrophy seems to be a more reliable marker than sulcal atrophy when assessing the atrophy on neuroimaging of a patient with memory decline. We think that the total score of the scale will also guide us in clinical practice.

Modified Visual Magnetic Resonance Rating Scale for Evaluation of Patients with Forgetfulness.

BACKGROUND: As cognitive impairment increases with age, sulcal atrophy (SA) and the enlargement of the ventricles also increase. Considering the measurements on the previously proposed visual scales, a new scale is proposed in this study that allows us to evaluate the atrophy, white matter hyperintensities (WMHs), basal ganglia infarct (BGI), and infratentorial infarct (ITI) together. Our aim of this study is to propose a practical and standardized MRI for the clinicians to be used in daily practice. METHODS: A total of 97 patients older than 60 years and diagnosed with depression or Alzheimer's disease (AD) are included. Cranial MRI, Mini Mental State Examination (MMSE), detailed neuropsychometric tests, and depression scales are applied to all patients. The SA, ventricular atrophy (VA), medial temporal lobe atrophy (MTA), periventricular WMH (PWMH), subcortical WMH (SCWMH), BGI, and ITI are scored according to the scale. The total score is also recorded. RESULTS: The average age of the patients was 74.53, and the mean MMSE score was 22.7 in the degenerative group and 27.8 in the non-degenerative group. Among the patients, 50 were diagnosed with AD. All parameters significantly increased with age. In the degenerative group, SA, VA, MTA, PWMH, SCWMH, and total scores were found to be significantly higher. Sensitivities of VA, PWMH, SCWMH, and total scores, as well as both sensitivity and specificities of MTA score, were observed to be high. When they were combined, sensitivities and specificities were found to be high. CONCLUSION: The scale is observed to be predictive in discriminating degenerative and non-degenerative processes. This discrimination is important, particularly in depressive patients complaining of forgetfulness.

CONTEXTE: Dans la mesure où les manifestations de déficience cognitive ont tendance à augmenter avec le vieillissement, on constate aussi une augmentation de l'atrophie des sillons du cortex cérébral et de l'élargissement des ventricules cérébraux. En tenant compte des mesures propres à des échelles visuelles utilisées antérieurement, cette étude entend proposer une nouvelle échelle nous permettant d'évaluer en même temps des cas d'atrophie ainsi que la présence d'hyperdensités de la substance blanche, d'anomalies des ganglions de la base et d'infarctus affectant l'étage sus-tentoriel (infratentorial infarcts). L'objectif de cette étude est donc de proposer un examen d'IRM pratique et standardisé pouvant être utilisé quotidiennement par les cliniciens. MÉTHODES: Nous avons inclus dans cette étude 97 patients âgés de plus de 60 ans qui étaient soit atteints de dépression, soit de la maladie d'Alzheimer. Tous les patients recrutés ont été soumis à des examens d'IRM crâniens, au test de Folstein (ou MMSE), à un ensemble de tests neuro-psychométriques approfondis et à des échelles diagnostiques permettant d'évaluer la dépression. L'incidence de l'atrophie des sillons du cortex cérébral, de la région ventriculaire, du lobe temporal médian, des régions péri-ventriculaire et sous-corticale et de la substance blanche qu'elles contiennent, d'anomalies affectant les ganglions de base et d'infarctus à l'étage sus-tentoriel a été ainsi mesurée selon notre échelle. Le score total obtenu a aussi été enregistré. RÉSULTATS: L'âge moyen des patients était de 74,53 ans. Leur score moyen au test de Folstein était de 22,7 dans le cas du groupe de patients atteints d'une maladie dégénérative et de 27,8 dans le cas du groupe de patients n'étant pas atteints par ce type de maladie. Fait à noter, cinquante patients avaient reçu un diagnostic de maladie d'Alzheimer. Tous les paramètres évalués ont augmenté de façon notable avec l'âge. Ainsi, tant les scores obtenus dans le cas de l'atrophie des sillons du cortex cérébral, de celle affectant le lobe temporal médian, la région ventriculaire, la région péri-ventriculaire, la région sous-corticale que les scores totaux se sont révélés nettement plus élevés au sein du groupe de patients atteints d'une maladie dégénérative. La sensibilité des scores totaux et des scores évaluant l'atrophie des régions vasculaire, péri-vasculaire et sous-corticale, de même que la sensibilité et la spécificité des scores évaluant l'atrophie du lobe temporal médian, se sont révélées élevées. Lorsque combinées, la sensibilité et la spécificité sont apparues élevées. CONCLUSIONS: Notre échelle possède un caractère prédictif en ce qu'elle permet d'établir une distinction entre les processus dégénératifs et les processus non-dégénératifs. Cette capacité est particulièrement importante dans le cas de patients dépressifs qui se plaignent de perte de mémoire.

QT dispersion predicts mortality and correlates with both coronary artery calcification and atherosclerosis in hemodialysis patients.

PURPOSE: QT dispersion (QTd) was shown to be an independent predictor of mortality in hemodialysis (HD) patients. It may be hypothesized that coronary artery calcification is related to QTd in HD patients because widespread calcification may also involve the cardiac conducting system in these patients. In this study, we aimed to investigate the relationships of corrected QTd (QTcd) with coronary artery calcification score (CACS), carotid plaque score (CPS) and possible influence of these parameters on survival of HD patients. METHODS: Seventy-two HD patients (33 male, 39 female) were enrolled into the study. Mean age of the patients was 44 ± 12 years. Mean follow-up duration was 77 ± 24 months. CACS was determined by computed tomography. QTcd values were calculated as the difference of maximum and minimum QT intervals. Left ventricular mass index (LVMI) and CPS were measured by echocardiography. RESULTS: QTcd was significantly correlated with CACS (r = 0.233, p = 0.049), CPS (r = 0.354, p = 0.003) and LVMI (p = 0.011, r = 0.299). CPS was found to be significantly higher in the group with high QTcd (>60 ms) [2 (1-4) versus 0 (0-1), p = 0.02]. CACS was significantly correlated with age (r = 0.44, p < 0.001), LVMI (r = 0.52, p < 0.001) and CPS (r = 0.32, p = 0.003). In Kaplan-Meier analysis, survival of patients with high QTcd was significantly lower than the patients with low QTcd. In Cox regression analysis for predicting mortality, age, serum albumin and QTcd were found to be the independent predictors of mortality. CONCLUSIONS: QTcd independently predicted mortality, and it was significantly associated with coronary artery calcification, left ventricular hypertrophy and atherosclerosis in HD patients.

A case report of superior vena cava obstruction.

We report herein an 83-year-old gentleman with lung cancer who presented with nausea, complete atrioventricular (AV) block and presyncope. Despite a present temporary pacemaker, which had been inserted through the femoral vein 5 days previously, the patient had asystole attacks that resolved with atropine administration. Coronary angiography demonstrated no critical stenosis. Sick sinus syndrome was diagnosed, and permanent pacemaker implantation was decided. However, the guidewire could not be advanced into the superior vena cava (SVC). Right jugular venogram showed complete obstruction of the SVC. Subsequent computerized tomography also revealed its obstruction by a large lung tumor. Special attention should be given to patients with benign or malignant SVC syndrome before permanent pacemaker implantation.

Hypervolemia rather than arterial calcification and extracoronary atherosclerosis is the main determinant of pulse pressure in hemodialysis patients.

INTRODUCTION: Pulse pressure (PP) has been reported as an independent predictor of cardiovascular mortality in hemodialysis patients. In this study, we aimed to investigate association of PP with echocardiographic and vascular structural changes such as atherosclerosis and arterial calcifications in HD patients. PATIENTS AND METHODS: In this cross-sectional study, 108 chronic hemodialysis patients (49 male, 59 female, mean age: 46 ± 13 years) were included. Biochemical analyses, echocardiographic and high-resolution carotid Doppler examinations were done. Aortic wall and coronary artery calcifications were measured with electron beam computed tomography. The degree of carotid artery stenosis was measured at four different sites (communis, bulbus, interna and externa) in both carotid arteries. RESULTS: PP was strongly correlated with systolic (r: 0.82) and diastolic (r: 0.33) blood pressure, left ventricular mass index (r: 0.58), left ventricle end diastolic diameter (r: 0.38) and weakly correlated with aortic wall calcification score (r: 0.26) and carotid plaque score (r: 0.27), but not with coronary artery calcification score. Patients with carotid plaque had higher PP than patients without plaque (50 ± 16 mmHg versus 44 ± 14 mmHg, P = 0.05). Patients were divided into three groups according to aortic wall calcification score. PP was significantly higher in patients with higher aortic wall calcification (54 ± 16 mmHg) than patients with lower aortic wall calcification (44 ± 15 mmHg, P = 0.04). However, on multivariate linear regression analysis for predicting PP, the only significant factor retained was left ventricle end diastolic diameter. CONCLUSION: PP was weakly associated with large vessel calcification and atherosclerosis in hemodialysis patients. The bulk of the effect on PP seems to be due to hypervolemia.

Pediatric seizure imaging.

The objective of this article was to show the spectrum of magnetic resonance and computed tomographic abnormalities in the pediatric seizure patient. Seizure is a common indication for pediatric neuroimaging. Characteristic imaging findings can lead to a specific pathologic diagnosis. Imaging findings may be subtle. Clinical correlation and optimization of magnetic resonance imaging protocols are important for seizure imaging.

A case of acute myocarditis with evaluation of magnetic resonance imaging.

A 42-year-old male with acute chest pain referred for acute myocarditis versus myocardial infarction (MI) was examined with magnetic resonance imaging (MRI). Clinical presentation and MRI findings are reviewed.

Diagnostic features of cardiac hemangioma on cardiovascular magnetic resonance, a case report.

Cardiac hemangiomas are benign cardiac tumors that account for 5-10% of all benign tumors of the heart (Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR. Radiographics 2000; 20(4): 1073-1103). They occur in any cardiac location, including the pericardium (Brodwater B, Erasmus J, McAdams HP, Dodd L. J Comput Assist Tomogr 1996; 20(6): 954-956). Magnetic resonance imaging (MRI) has an excellent contrast resolution and multiplanar capability to allow optimal evaluation of myocardial infiltration, pericardial involvement and/or extracardiac extension (Brown JI, Barakos JA, Higgins CB. J Thorac Imaging 1989; 4(2): 58-64). This is a case report of cardiac hemangioma involving the ventricular septum with radiological and pathological correlation. It illustrates the capability of the MRI to non-invasively detect histological and flow characteristics of the tumor.

MRI demonstration of acute myocardial infarction due to posttraumatic coronary artery dissection.

A case of left ventricular lateral wall myocardial infarction in the distribution of circumflex coronary artery (LCX) was demonstrated by magnetic resonance imaging in a 55-year-old woman. Dissection of the proximal LCX due to blunt chest trauma was followed by percutaneous coronary artery stenting. MR (magnetic resonance) imaging of myocardial infarction is reviewed.

Atherosclerosis and vascular calcification are independent predictors of left ventricular hypertrophy in chronic haemodialysis patients.

BACKGROUND: Accelerated atherosclerosis and vascular calcification are common in chronic haemodialysis (HD) patients. In this study, we aimed to investigate the relationship between left ventricular hypertrophy (LVH) in HD patients and atherosclerosis and vascular calcification measured by electron beam computed tomography (EBCT). METHODS: In a cohort of 118 HD patients (52 male, 66 female, mean age: 46+/-13 years), we measured biochemical parameters, including BUN, creatinine, albumin, haemoglobin, C-reactive protein and fibrinogen levels, and performed echocardiography, high-resolution B-mode carotid ultrasonography and EBCT in 85 of them. The degree of stenosis was measured at four different sites (communis, bulbus, interna and externa) in both carotid arteries. Carotid plaque scores were calculated by summing the degrees of stenosis measured at all locations. RESULTS: LVH was detected in 89 of the patients (75%). Plaque-positive patients had higher left ventricular mass index (LVMI) than plaque-negative patients (175+/-59 vs 143+/-46 g/m2, P = 0.003). LVMI was correlated with systolic blood pressure (r = 0.62, P<0.001), pulse pressure (r = 0.58, P<0.001), haemoglobin levels (r = - 0.25, P = 0.008), carotid plaque score (r = 0.32, P = 0.001) and coronary (CACS) and aortic wall calcification score (AWCS) (r = 0.34, P = 0.002 and r = 0.43, P<0.001, respectively). Multiple linear regression analysis (model r = 0.76) showed the independent factors related to LVMI to be systolic blood pressure, pulse pressure, CACS and presence of carotid plaques. CONCLUSION: Extra-coronary atherosclerosis and vascular calcification are associated with LVH in HD patients. Whether the treatment of atherosclerosis or vascular calcification may cause regression of or even prevent LVH in HD patients remains to be seen.

Carotid atherosclerosis is a predictor of coronary calcification in chronic haemodialysis patients.

BACKGROUND: Coronary artery calcification scores (CACS) calculated by electron beam computed tomography (EBCT) have been correlated with atherosclerotic burden in the non-uraemic population. However, the validity of this test in chronic haemodialysis patients (HD) is currently uncertain. In the present cross-sectional study, associations between carotid atherosclerosis and coronary calcification in HD patients are investigated. METHODS: We studied 79 chronic HD patients (39 male, 40 female; mean age, 45+/-12 years). The mean time on HD was 68+/-54 months (range, 6-187 months). In these patients, we measured serum calcium, phosphorus, total cholesterol, cholesterol subgroups and iPTH levels. EBCT, echocardiography, and high-resolution B-mode carotid Doppler ultrasonography were also performed. RESULTS: Plaque-positive HD patients had significantly higher CACS than plaque-negative patients (851+/-199 vs 428+/-185, mean+/-SE, P = 0.006). Coronary calcification scores were correlated with serum phosphorus (r = 0.37; P = 0.001). Only 8 of the 24 HD patients without coronary calcification had carotid plaques (33%), whereas 34 of the 53 patients with coronary calcification had carotid plaques (64%) (P = 0.015). Carotid plaque scores were correlated with CACS (r = 0.40; P = 0.001). A stepwise linear regression (model r = 0.72; P<0.001) revealed that CACS (log-transformed data of CACS) was associated with age (P<0.001), time on dialysis (P = 0.004), serum phosphorus level (P = 0.016) and carotid plaque scores (P = 0.037). CONCLUSIONS: Atherosclerosis is independently associated with coronary artery calcification and with hyperphosphataemia in chronic HD patients. CACS appeared to be predictive of both coronary atherosclerosis and carotid atherosclerosis.

Three-dimensional noninvasive contrast-enhanced electron beam tomography angiography of the kidneys: adjunctive use in medical and surgical management.

OBJECTIVE: To indicate the use of 3D electron beam computerized tomography angiography (EBCTA) for renal artery lesions, vascular variants that are crucial to detect before surgery, especially partial nephrectomy and extension of the intravascular tumor. METHODS: Forty patients (30 men, 10 women, age range 13-82, mean age 54.2) underwent EBCT (GE-Imatron, C 150 ultrafast CT scanner) of the renal arteries. It is essential to review the axial images for all necessary information before the 3D technique is performed. RESULTS: Maximum intensity projection (MIP) and volume rendering (VR) images were excellent in demonstrating stenosis of the renal arteries. Accessory and main renal arteries were easily depicted, and stenosis has been shown. In our study, among 40 renal angiography patients, 21 had stenosis of the renal arteries with different percentages. A total of 12 accessory renal arteries (five left, seven right) were detected. EBCT, with its 3D techniques, was found to be accurate and useful for renal vascular anatomy as a noninvasive test to delineate renal tumors and renal anatomy prior to nephron sparing surgery because it is known to conserve normal renal parenchyma adjacent to tumor. CONCLUSION: EBCT, with its noninvasive VR and MIP techniques, is easy to apply and is functional and accurate for neoplasms, renal vascular anatomy and renal artery stenosis.

Aorta-right atrial tunnel.

Aorta-right atrial tunnel is rare. We report a case of aorta-right atrial tunnel in which the right coronary artery arose from the tunnel. Successful surgical treatment was performed.