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Xie Q, Liao YH, He WJ, Han PP, Wu J. Evaluation of Neonatal Cerebral Circulation Under Hypoxic Ischemic Risk Factors Based on Quantitative Analysis of Cerebral Veins with Magnetic Resonance Susceptibility Weighted Imaging. Clin Neuroradiol 2024; 34:859-869. [PMID: 38922421 PMCID: PMC11564194 DOI: 10.1007/s00062-024-01432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To observe the regulation of cerebral circulation in vivo based on image segmentation algorithms for deep learning in medical imaging to automatically detect and quantify the neonatal deep medullary veins (DMVs) on susceptibility weighted imaging (SWI) images. To evaluate early cerebral circulation self-rescue for neonates undergoing risk of cerebral hypoxia-ischaemia in vivo. METHODS SWI images and clinical data of 317 neonates with or without risk of cerebral hypoxia-ischaemia were analyzed. Quantitative parameters showing the number, width, and curvature of DMVs were obtained using an image segmentation algorithm. RESULTS The number of DMVs was greater in males than in females (p < 0.01), and in term than in preterm infants (p = 0.001). The width of DMVs was greater in term than in preterm infants (p < 0.01), in low-risk than in high-risk group (p < 0.01), and in neonates without intracranial extracerebral haemorrhage (ICECH) than with ICECH (p < 0.05). The curvature of DMVs was greater in term than in preterm infants (P < 0.05). The width of both bilateral thalamic veins and anterior caudate nucleus veins were positively correlated with the number of DMVs; the width of bilateral thalamic veins was positively correlated with the width of DMVs. CONCLUSION The DMVs quantification based on image segmentation algorithm may provide more detailed and stable quantitative information in neonate. SWI vein quantification may be an observable indicator for in vivo assessment of cerebral circulation self-regulation in neonatal hypoxic-ischemic brain injury.
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Affiliation(s)
- Qi Xie
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China.
| | - Yan-Hui Liao
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China
- Department of Nuclear Medicine, Meizhou, People's Hospital, 514031, Meizhou, China
| | - Wen-Juan He
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China
| | - Peng-Peng Han
- Institute of Software Application Technology, 511458, Guangzhou, China
| | - Jun Wu
- Institute of Software Application Technology, 511458, Guangzhou, China
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Martín-Noguerol T, Santos-Armentia E, Ramos A, Luna A. An update on susceptibility-weighted imaging in brain gliomas. Eur Radiol 2024; 34:6763-6775. [PMID: 38581609 DOI: 10.1007/s00330-024-10703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 04/08/2024]
Abstract
Susceptibility-weighted imaging (SWI) has become a standard component of most brain MRI protocols. While traditionally used for detecting and characterising brain hemorrhages typically associated with stroke or trauma, SWI has also shown promising results in glioma assessment. Numerous studies have highlighted SWI's role in differentiating gliomas from other brain lesions, such as primary central nervous system lymphomas or metastases. Additionally, SWI aids radiologists in non-invasively grading gliomas and predicting their phenotypic profiles. Various researchers have suggested incorporating SWI as an adjunct sequence for predicting treatment response and for post-treatment monitoring. A significant focus of these studies is on the detection of intratumoural susceptibility signals (ITSSs) in gliomas, which are indicative of microhemorrhages and vessels within the tumour. The quantity, distribution, and characteristics of these ITSSs can provide radiologists with more precise information for evaluating and characterising gliomas. Furthermore, the potential benefits and added value of performing SWI after the administration of gadolinium-based contrast agents (GBCAs) have been explored. This review offers a comprehensive, educational, and practical overview of the potential applications and future directions of SWI in the context of glioma assessment. CLINICAL RELEVANCE STATEMENT: SWI has proven effective in evaluating gliomas, especially through assessing intratumoural susceptibility signal changes, and is becoming a promising, easily integrated tool in MRI protocols for both pre- and post-treatment assessments. KEY POINTS: • Susceptibility-weighted imaging is the most sensitive sequence for detecting blood and calcium inside brain lesions. • This sequence, acquired with and without gadolinium, helps with glioma diagnosis, characterisation, and grading through the detection of intratumoural susceptibility signals. • There are ongoing challenges that must be faced to clarify the role of susceptibility-weighted imaging for glioma assessment.
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Affiliation(s)
| | | | - Ana Ramos
- Department of Neuroradiology, University Hospital, 12 de Octubre, Madrid, Spain
| | - Antonio Luna
- MRI Unit, Radiology Department, HT Medica, Carmelo Torres 2, 23007, Jaén, Spain
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3
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Xie Q, Liao YH, He WJ, Wang GQ. Incidence and clinical analysis of asymptomatic intracranial hemorrhage in neonates with cerebral hypoxic-ischaemic risk based on multisequence MR images. Sci Rep 2024; 14:14721. [PMID: 38926428 PMCID: PMC11208507 DOI: 10.1038/s41598-024-62473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
The incidence and clinical distribution of intracranial haemorrhage (ICH) in neonates at risk of cerebral hypoxia-ischaemia have not been reported in specific studies. Based on conventional magnetic resonance imaging (MRI) versus susceptibility weighted imaging (SWI), this study aimed to analyse the occurrence of asymptomatic ICH in newborns with or without risk of cerebral hypoxia-ischaemia and to accumulate objective data for clinical evaluations of high-risk neonates and corresponding response strategies. 317 newborns were included. MRI revealed that the overall incidence of ICH was 59.31%. The most common subtype was intracranial extracerebral haemorrhage (ICECH) which included subarachnoid haemorrhage (SAH) and subdural haemorrhage (SDH). ICECH accounted for 92.02% of ICH. The positive detection rate of ICECH by SWI was significantly higher than that by T1WI. The incidence of total ICH, ICECH and SAH was greater among children who were delivered vaginally than among those who underwent caesarean delivery. Asymptomatic neonatal ICH may be a common complication of the neonatal birth process, and SWI may improve the detection rate. Transvaginal delivery and a weight greater than 2500 g were associated with a high incidence of ICECH in neonates. The impact of neonatal cerebral hypoxia-ischaemia risk factors on the occurrence of asymptomatic ICH may be negligible.
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Affiliation(s)
- Qi Xie
- Department of Medical Imaging in Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 511457, China.
| | - Yan-Hui Liao
- Department of Medical Imaging in Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 511457, China
- Department of Nuclear Medicine, Meizhou People's Hospital, Meizhou, 514031, Guangdong, China
| | - Wen-Juan He
- Department of Medical Imaging in Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 511457, China
| | - Gui-Qin Wang
- Medical Record Department in Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 511457, China
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4
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de Souza DN, Jarmol M, Bell CA, Marini C, Balcer LJ, Galetta SL, Grossman SN. Precision Concussion Management: Approaches to Quantifying Head Injury Severity and Recovery. Brain Sci 2023; 13:1352. [PMID: 37759953 PMCID: PMC10526525 DOI: 10.3390/brainsci13091352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Mitigating the substantial public health impact of concussion is a particularly difficult challenge. This is partly because concussion is a highly prevalent condition, and diagnosis is predominantly symptom-based. Much of contemporary concussion management relies on symptom interpretation and accurate reporting by patients. These types of reports may be influenced by a variety of factors for each individual, such as preexisting mental health conditions, headache disorders, and sleep conditions, among other factors. This can all be contributory to non-specific and potentially misleading clinical manifestations in the aftermath of a concussion. This review aimed to conduct an examination of the existing literature on emerging approaches for objectively evaluating potential concussion, as well as to highlight current gaps in understanding where further research is necessary. Objective assessments of visual and ocular motor concussion symptoms, specialized imaging techniques, and tissue-based concentrations of specific biomarkers have all shown promise for specifically characterizing diffuse brain injuries, and will be important to the future of concussion diagnosis and management. The consolidation of these approaches into a comprehensive examination progression will be the next horizon for increased precision in concussion diagnosis and treatment.
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Affiliation(s)
- Daniel N. de Souza
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Mitchell Jarmol
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Carter A. Bell
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Christina Marini
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
| | - Laura J. Balcer
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10017, USA
| | - Steven L. Galetta
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
| | - Scott N. Grossman
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10017, USA; (D.N.d.S.); (M.J.); (C.A.B.); (C.M.); (L.J.B.); (S.L.G.)
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY 10017, USA
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Sarrà‐Rovira M, Carrera I, Maeso C, Montoliu P. Polymicrogyria in a miniature poodle dog: Clinical and MRI findings. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Deep medullary vein engorgement and superficial medullary vein engorgement: two patterns of perinatal venous stroke. Pediatr Radiol 2021; 51:675-685. [PMID: 33090246 DOI: 10.1007/s00247-020-04846-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/08/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Abstract
Perinatal venous stroke has classically been attributed to cerebral sinovenous thrombosis with resultant congestion or thrombosis of the small veins draining the cerebrum. Advances in brain MRI, in particular susceptibility-weighted imaging, have enabled the visualization of the engorged small intracerebral veins, and the spectrum of perinatal venous stroke has expanded to include isolated congestion or thrombosis of the deep medullary veins and the superficial intracerebral veins. Congestion or thrombosis of the deep medullary veins or the superficial intracerebral veins can result in vasogenic edema, cytotoxic edema or hemorrhage in the territory of disrupted venous flow. Deep medullary vein engorgement and superficial medullary vein engorgement have characteristic findings on MRI and should be differentiated from neonatal hemorrhagic stroke.
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7
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Zuccoli G. Magnetic resonance imaging of optic nerve and optic sheath hemorrhages in child abuse. Pediatr Radiol 2021; 51:997-1002. [PMID: 33999241 DOI: 10.1007/s00247-020-04891-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/23/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022]
Abstract
In abusive head trauma victims, optic nerves and optic sheath hemorrhages are commonly associated with retinal hemorrhages. Until now, optic nerve and optic nerve sheath hemorrhages related to abusive head trauma have been identified by exenteration and soft-tissue sectioning during postmortem examination. In 2013, we proposed the use of tailored high-resolution susceptibility-weighted imaging (SWI) MRI sequences to depict retinal hemorrhages in lieu of the gold standard dilated fundus exam, in select patients, and in 2017 we showed how the same high-resolution sequences used in the coronal plane can depict ruptured bridging veins in abusive head trauma. This paper describes the new potential diagnostic application of high-resolution axial and coronal SWI in the diagnosis of optic nerve and optic sheath hemorrhages.
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Affiliation(s)
- Giulio Zuccoli
- Program for the Study of Neurodevelopment in Rare Disorders (NDRD), UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Pittsburgh, PA, 15224, USA.
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8
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Gounder S, Strudwick M. Multimodality imaging review for suspected ovarian torsion cases in children. Radiography (Lond) 2020; 27:236-242. [PMID: 32713824 DOI: 10.1016/j.radi.2020.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/27/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Ovarian torsion (OT), although rare, can be described as a complete or partial twist of the ovary with impairment of blood flow. Although occurring at any age, it is more common in children and during pregnancy. Presenting symptoms are non-specific but include either persistent or intermittent acute abdominal pain, making early diagnosis difficult. Delayed diagnosis is associated with an increased need for oophorectomy. The aim of this literature review is to establish the safest and most efficacious imaging strategy for OT by comparing and contrasting evidence for current imaging modalities found in the literature. KEY FINDINGS Characteristically, OT can be identified through a combination of findings some of which includes an enlarged ovary, multiple follicles at the periphery and a "whirlpool" sign. Currently, ultrasound is the preferred primary imaging modality; although computed tomography (CT) and magnetic resonance imaging (MRI) may also be used when findings are equivocal; with MRI being the safer option. CONCLUSION Ultimately, while it is true that ovarian torsion is not a common cause of acute abdominal pain in children, it should always be considered in the differential diagnosis. Prior to selecting an imaging modality; the clinical presentation, age group, possible radiation dose and availability of the modality needs to be considered to ensure the appropriate imaging strategy. IMPLICATIONS FOR PRACTICE With new tools such as scoring systems, B-flow imaging (BFI), diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) currently being explored for possible use in the future, early diagnosis of OT may be attainable. Thus, reducing the likelihood of adverse complications and consequently the need for oophorectomy.
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Affiliation(s)
- S Gounder
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia.
| | - M Strudwick
- Centre for Advanced Imaging, University of Queensland, St Lucia, Queensland, Australia
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9
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Orman G, Valand HA, Huisman TAGM. Advanced multimodality neuroimaging of a giant, thrombosed MCA aneurysm complicated by an acute stroke in a pediatric patient. Radiol Case Rep 2020; 15:292-297. [PMID: 31956390 PMCID: PMC6962640 DOI: 10.1016/j.radcr.2019.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 12/04/2022] Open
Abstract
A 17-year-old boy presented to our quaternary hospital because of acute mental status changes following prolonged gastrointestinal illness resulting in dehydration. Neuroimaging studies with computed tomography and magnetic resonance imaging (MRI) revealed a giant thrombosed aneurysm of the left middle cerebral artery (MCA) with acute left MCA stroke. An ischemic penumbra was identified based upon the mismatch between diffusion weighted (DWI) and susceptibility weighted (SWI) MRI matching with the perfusion weighted imaging (PWI). On follow-up MRI, the core of ischemia as identified by DWI progressed into the ischemic penumbra identified by SWI. The patient had permanent moderate right hemiparesis and aphasia on last follow-up. In conclusion, thrombosis is a rare complication of a giant aneurysm in children. Advanced neuroimaging using the combination of DWI and noncontrast enhanced SWI is a valuable alternative or possibly adjunct to PWI to identify tissue at risk for progressing stroke.
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Affiliation(s)
- Gunes Orman
- Texas Children's Hospital, Edward B. Singleton Department of Radiology, 6701 Fannin Street, Houston, TX 77030, USA
| | - Hardik A Valand
- Johns Hopkins Hospital, Charlotte R. Bloomberg Children's Center, Division of Pediatric Radiology and Pediatric Neuroradiology, Baltimore, MD, USA.,American University of Integrative Science, Tucker, GA, USA
| | - Thierry A G M Huisman
- Texas Children's Hospital, Edward B. Singleton Department of Radiology, 6701 Fannin Street, Houston, TX 77030, USA.,Johns Hopkins Hospital, Charlotte R. Bloomberg Children's Center, Division of Pediatric Radiology and Pediatric Neuroradiology, Baltimore, MD, USA
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El Mekabaty A, Pearl MS, Mershon B, Berkowitz I, Gailloud P, Huisman TAGM. Susceptibility weighted imaging in infants with staged embolization of vein of Galen aneurysmal malformations. J Neuroradiol 2018; 46:214-221. [PMID: 30423378 DOI: 10.1016/j.neurad.2018.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 05/07/2018] [Accepted: 09/24/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE The vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation with a higher morbidity and mortality, especially in neonates. Ultrasound, CT and MR are usually used in diagnosis and treatment monitoring of these disorders. In this current study, we aim to examine utility of SWI in evaluation of treatment response in infants with VGAM. MATERIALS AND METHODS We performed a retrospective chart analysis of children with VGAM in our institution between January 2008 and December 2016. Inclusion criteria included; confirmed VGAM on DSA; available SWI sequence at baseline and at follow up after at least a single embolization session; age at initial MR of 18 years or younger. Signal intensity and Angioarchitecture of VGAM and cerebral veins on SWI, as well as hydrocephalus and clinical outcome were evaluated. RESULTS Of 11 patients identified with VGAM in our institution, 5 children (3 males and 2 females) satisfied the inclusion criteria. The average age at initial MR was 29 days (range 1-120). Fourteen MRI were available for review. All children had VGAM of mural type. Intramedullary veins were dilated and SWI-hypointense in all children, while subependymal and sulcal veins were dilated and SWI-hypointense in 4 patients on initial MRI. On the first available follow up MRI, cerebral veins have mostly normalized in 4 children and remained mostly dilated and SWI-hypointense in 1 child; even after complete treatment of the VGAM. CONCLUSION Our preliminary findings show that SWI seems to offer a beneficial non-invasive tool in evaluating passive venous congestion patterns in pediatric patients with VGAM. It remains to be determined in larger studies, the clinical significance of these SWI changes.
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Affiliation(s)
- Amgad El Mekabaty
- Division of Interventional Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns-Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Monica S Pearl
- Division of Interventional Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns-Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bommy Mershon
- Department of Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ivor Berkowitz
- Department of Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns-Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns-Hopkins University School of Medicine, Baltimore, Maryland, USA.
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11
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Soman S, Bregni JA, Bilgic B, Nemec U, Fan A, Liu Z, Barry RL, Du J, Main K, Yesavage J, Adamson MM, Moseley M, Wang Y. Susceptibility-Based Neuroimaging: Standard Methods, Clinical Applications, and Future Directions. CURRENT RADIOLOGY REPORTS 2017; 5. [PMID: 28695062 DOI: 10.1007/s40134-017-0204-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The evaluation of neuropathologies using MRI methods that leverage tissue susceptibility have become standard practice, especially to detect blood products or mineralization. Additionally, emerging MRI techniques have the ability to provide new information based on tissue susceptibility properties in a robust and quantitative manner. This paper discusses these advanced susceptibility imaging techniques and their clinical applications.
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Affiliation(s)
- Salil Soman
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Rosenberg 90A, 1 Deaconess Road, Boston, MA 02215, Tel: 617-754-2009
| | | | - Berkin Bilgic
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, A.A. Martinos Center for Biomedical Imaging 149 13th Street, Room 2.102, Charlestown, MA 02129, Tel: 617-866-8740
| | - Ursula Nemec
- Department of Radiology, Medical University of Vienna, Austria
| | - Audrey Fan
- Department of Radiology, Stanford School of Medicine 300 Pasteur Dr, MC 5105, Stanford, CA94305
| | - Zhe Liu
- Cornell MRI Research Lab, Cornell University, 515 East 71st St, Suite 104, New York, NY 10021, ,
| | - Robert L Barry
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, A.A. Martinos Center for Biomedical Imaging 149 13th Street, Suite 2.301, Charlestown, MA 02129 USA, Tel: 615-801-0795
| | - Jiang Du
- Department of Radiology, UCSD, 200 West Arbor Drive, San Diego, CA 92103-8226, Tel: 619-471-0519
| | - Keith Main
- Principal Scientist (SME), Research Division, Defense and Veterans Brain Injury Center, General Dynamics Health Solutions, 1335 East-West Hwy, Suite 4-100, Silver Spring, MD 20910
| | - Jerome Yesavage
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Mail Code 151-Y, 3801 Miranda Avenue, Palo Alto, California 94304, Phone (650) 852-3287
| | - Maheen M Adamson
- Department of Neurosurgery, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Defense and Veterans Brain Injury Center, VA Palo Alto Health Care System (PSC/117), 3801 Miranda Avenue (151Y), Palo Alto, CA 94304
| | - Michael Moseley
- Department of Radiology, Stanford School of Medicine, Mail Code 5488, Route 8, Rm PS059, Stanford, CA, 94305-5488, Tel: 650-725-6077
| | - Yi Wang
- Department of Radiology, Cornell Medical School, Department of Biomedical Engineering, Cornell University, 301 Weill Hall, 237 Tower Road, Ithaca, NY 14853, Tel: 646 962-2631
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12
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All that bleeds is not black: susceptibility weighted imaging of intracranial hemorrhage and the effect of T1 signal. Clin Imaging 2017; 41:69-72. [DOI: 10.1016/j.clinimag.2016.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/26/2016] [Accepted: 10/14/2016] [Indexed: 01/29/2023]
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13
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Niwa T, Aida N, Fujii Y, Nozawa K, Imai Y. Age-related changes of susceptibility-weighted imaging in subependymal nodules of neonates and children with tuberous sclerosis complex. Brain Dev 2015; 37:967-73. [PMID: 25907013 DOI: 10.1016/j.braindev.2015.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess age-related changes in susceptibility-weighted imaging (SWI) and phase images of subependymal nodules (SENs) in neonates and children with tuberous sclerosis complex (TSC). METHODS Images of 17 children (age range, 0-14years; mean, 5.5years) with TSC were retrospectively assessed. Changes in signals of SENs on SWI and filtered phase images were scored by two experienced radiologists using a three-point scale. The relation was assessed between patients' age and the average scores of SENs. The phase shift of SENs on the filtered phase image was also measured, and the correlation between age and phase shift was evaluated. Calcification in SENs on CT was compared to the finding on SWI and filtered phase image in four children. RESULTS No change in signal was found in neonates in SENs on both SWI and filtered phase image. There was a positive correlation between the average scores of SENs and patients' age on both SWI and filtered phase image (Spearman ρ=0.64, P=0.006; ρ=0.71, P=0.001, respectively). There was a negative correlation between the patients' age and mean phase shift (Spearman ρ=-0.86, P<0.001). Comparable or slight lower detectability of susceptibility changes was revealed in SENs on SWI and filtered phase image, compared to calcification on CT. CONCLUSIONS There are age-related changes in susceptibility and phase in SENs, which may reflect the appearance of calcification in children with TSC. No magnetically susceptible changes were detected in neonates, suggesting a lack of calcification.
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Affiliation(s)
- Tetsu Niwa
- Department of Radiology, Tokai University School of Medicine, Isehara, Japan; Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan.
| | - Noriko Aida
- Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yuta Fujii
- Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kumiko Nozawa
- Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yutaka Imai
- Department of Radiology, Tokai University School of Medicine, Isehara, Japan
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Abstract
CLINICAL/METHODICAL ISSUE Acceleration-deceleration rotational brain trauma is a common cause of disability or death in young adults and often leads to a focal destruction of axons. The resulting pathology, axonal shear injury is referred to as diffuse axonal injury (DAI). The DAI-associated lesions occur bilaterally, are widely dispersed and have been observed in the surface and deep white matter. They are found near to and far from the impact site. STANDARD RADIOLOGICAL METHODS When DAI is clinically suspected, magnetic resonance imaging (MRI) is the method of choice for further clarification, especially in patients where cranial computed tomography (CT) is inconspicuous. METHODICAL INNOVATIONS To investigate the presence of DAI after traumatic brain injury (TBI), a multimodal MRI approach is applied including the common structural and also functional imaging sequences. PERFORMANCE For structural MRI, fluid-attenuated inversion recovery (FLAIR) weighted and susceptibility contrast imaging (SWI) are the sequences mainly used. The SWI technique is extremely sensitive to blood breakdown products, which appear as small signal voids at three locations, at the gray-white interface, in the corpus callosum and in the brain stem. Functional MRI comprises a group of constantly developing techniques that have great potential in optimal evaluation of the white matter in patients after craniocerebral trauma. These imaging techniques allow the visualization of changes associated with shear injuries, such as functional impairment of axons and decreased blood flow and abnormal metabolic activity of the brain parts affected. ACHIEVEMENTS The multimodal MRI approach in patients with DAI results in a more detailed and differentiated representation of the underlying pathophysiological changes of the injured nerve tracts and helps to improve the diagnostic and prognostic accuracy of MRI. PRACTICAL RECOMMENDATIONS When DAI is suspected multimodal MRI should be performed as soon as possible after craniocerebral injury.
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Iwasaki H, Fujita Y, Hara M. Susceptibility-weighted imaging in acute-stage pediatric convulsive disorders. Pediatr Int 2015; 57:922-9. [PMID: 25922882 DOI: 10.1111/ped.12678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/19/2015] [Accepted: 03/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this preliminary study was to investigate the clinical use of acute-stage susceptibility-weighted imaging (SWI) in children with prolonged convulsive disorder. METHODS Ten children with prolonged convulsive disorder who underwent SWI within 2 h after termination of seizure (acute-stage SWI group) and 15 control children who underwent SWI > 2 h after their seizures terminated or for other purposes were enrolled. The cerebral venous vasculature was compared between the groups. The acute-stage SWI group was further divided into three subgroups: normal group, those with regional low signals in the cerebral veins (regional group) and those with diffuse low signals in the cerebral veins (generalized group). Inter-ictal electroencephalography (EEG) and venous blood gas findings during seizure activity were compared between these subgroups. RESULTS All patients in the acute-stage SWI group had low cerebral vein signal. Four patients were assigned to the regional group and six patients to the generalized group. Decrease of venous pH and the increase of venous pCO2 during seizure activity was more prominent in the regional group than in the generalized group. In the regional group, low-signal areas in the cerebral veins were consistent with abnormal areas on EEG; these low-signal areas resolved completely in all patients on follow-up SWI. Ten patients in the control group had normal SWI, and five had a generalized low signal. CONCLUSIONS Acute-stage SWI may be a useful alternative for identifying lateralization of seizures in children with prolonged convulsive disorder.
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Affiliation(s)
| | - Yukihiko Fujita
- Department of Pediatrics and Child Health, Nihon University School of Medicine
| | - Mitsuhiko Hara
- Department of Pediatrics, Tokyo Metropolitan Hiroo General Hospital, Tokyo, Japan
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Wagner F, Haenggi MM, Wagner B, Weck A, Weisstanner C, Grunt S, Z’Graggen WJ, Gralla J, Wiest R, Verma RK. The value of susceptibility-weighted imaging (SWI) in patients with non-neonatal hypoxic-ischemic encephalopathy. Resuscitation 2015; 88:75-80. [DOI: 10.1016/j.resuscitation.2014.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/15/2014] [Indexed: 11/26/2022]
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Polan RM, Poretti A, Huisman TAGM, Bosemani T. Susceptibility-weighted imaging in pediatric arterial ischemic stroke: a valuable alternative for the noninvasive evaluation of altered cerebral hemodynamics. AJNR Am J Neuroradiol 2014; 36:783-8. [PMID: 25477354 DOI: 10.3174/ajnr.a4187] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/13/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE SWI provides information about blood oxygenation levels in intracranial vessels. Prior reports have shown that SWI focusing on venous drainage can provide noninvasive information about the degree of brain perfusion in pediatric arterial ischemic stroke. We aimed to evaluate the influence of the SWI venous signal pattern in predicting stroke evolution and the development of malignant edema in a large cohort of children with arterial ischemic stroke. MATERIALS AND METHODS A semiquantitative analysis of venous signal intensity on SWI and diffusion characteristics on DTI was performed in 16 vascular territories. The mismatch between areas with SWI-hypointense venous signal and restricted diffusion was correlated with stroke progression on follow-up. SWI-hyperintense signal was correlated with the development of malignant edema. RESULTS We included 24 children with a confirmed diagnosis of pediatric arterial ischemic stroke. Follow-up images were available for 14/24 children. MCA stroke progression on follow-up was observed in 5/6 children, with 2/8 children without mismatch between areas of initial SWI hypointense venous signal and areas of restricted diffusion on DTI. This mismatch showed a statistically significant association (P = .03) for infarct progression. Postischemic malignant edema developed in 2/10 children with and 0/14 children without SWI-hyperintense venous signal on initial SWI (P = .07). CONCLUSIONS SWI-DTI mismatch predicts stroke progression in pediatric arterial ischemic stroke. SWI-hyperintense signal is not useful for predicting the development of malignant edema. SWI should be routinely added to the neuroimaging diagnostic protocol of pediatric arterial ischemic stroke.
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Affiliation(s)
- R M Polan
- From the Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - A Poretti
- From the Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - T A G M Huisman
- From the Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - T Bosemani
- From the Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Aellen J, Abela E, Buerki SE, Kottke R, Springer E, Schindler K, Weisstanner C, El-Koussy M, Schroth G, Wiest R, Gralla J, Verma RK. Focal hemodynamic patterns of status epilepticus detected by susceptibility weighted imaging (SWI). Eur Radiol 2014; 24:2980-8. [DOI: 10.1007/s00330-014-3284-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/22/2014] [Accepted: 06/24/2014] [Indexed: 10/24/2022]
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[Recent advances in newborn MRI]. Arch Pediatr 2014; 21:801-8. [PMID: 24837857 DOI: 10.1016/j.arcped.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 04/09/2014] [Indexed: 11/22/2022]
Abstract
The accurate morphological exploration of the brain is a major challenge in neonatology that advances in magnetic resonance imaging (MRI) can now provide. MRI is the gold standard if an hypoxic ischemic pathology is suspected in a full term neonate. In prematures, the specific role of MRI remains to be defined, secondary to US in any case. We present a state of the art of hardware and software technical developments in MRI. The increase in magnetic field strength (3 tesla) and the emergence of new MRI sequences provide access to new information. They both have positive and negative consequences on the daily clinical data acquisition use. The semiology of brain imaging in full term newborns and prematures is more extensive and complex and thereby more difficult to interpret. The segmentation of different brain structures in the newborn, even very premature, is now available. It is now possible to dissociate the cortex and basal ganglia from the cerebral white matter, to calculate the volume of anatomical structures, which improves the morphometric quantification and the understanding of the normal and abnormal brain development. MRI is a powerful tool to analyze the neonatal brain. The relevance of the diagnostic contribution requires an adaptation of the parameters of the sequences to acquire and of the image processing methods.
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Meoded A, Poretti A, Benson JE, Tekes A, Huisman TA. Evaluation of the ischemic penumbra focusing on the venous drainage: The role of susceptibility weighted imaging (SWI) in pediatric ischemic cerebral stroke. J Neuroradiol 2014; 41:108-16. [DOI: 10.1016/j.neurad.2013.04.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 03/31/2013] [Accepted: 04/04/2013] [Indexed: 11/30/2022]
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Bosemani T, Meoded A, Poretti A. Susceptibility-weighted imaging in pantothenate kinase-associated neurodegeneration. J Pediatr 2014; 164:212. [PMID: 24112863 DOI: 10.1016/j.jpeds.2013.08.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Thangamadhan Bosemani
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan, Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Avner Meoded
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan, Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan, Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bosemani T, Poretti A, Orman G, Meoded A, Huisman TAGM. Pediatric cerebral stroke: susceptibility-weighted imaging may predict post-ischemic malignant edema. Neuroradiol J 2013; 26:579-83. [PMID: 24199819 DOI: 10.1177/197140091302600512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/09/2013] [Indexed: 01/14/2023] Open
Abstract
Susceptibility-weighted imaging (SWI) is an advanced MRI technique providing information on the blood oxygenation level. Deoxyhemoglobin is increased in hypoperfused tissue characterized by SWI-hypointensity, while high oxyhemoglobin concentration within hyperperfused tissue results in a SWI iso- or hyperintensity compared to healthy brain tissue. We describe a child with a stroke, where SWI in addition to excluding hemorrhage and delineating the thrombus proved invaluable in determining regions of hyperperfusion or luxury perfusion, which contributed further to the prognosis including an increased risk of developing post-ischemic malignant edema.
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Affiliation(s)
- Thangamadhan Bosemani
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA -
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Bosemani T, Poretti A, Huisman TA. Susceptibility-weighted imaging in pediatric neuroimaging. J Magn Reson Imaging 2013; 40:530-44. [DOI: 10.1002/jmri.24410] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/22/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Thangamadhan Bosemani
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Thierry A.G.M. Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins University School of Medicine; Baltimore MD USA
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Bosemani T, Burton VJ, Felling RJ, Leigh R, Oakley C, Poretti A, Huisman TA. Pediatric hemiplegic migraine: role of multiple MRI techniques in evaluation of reversible hypoperfusion. Cephalalgia 2013; 34:311-5. [PMID: 24142848 DOI: 10.1177/0333102413509432] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hemiplegic migraine (HM) is a rare type of migraine with aura that involves motor weakness. Data on conventional and advanced neuroimaging findings during prolonged attacks of HM are limited, particularly in children. CASE A 13-year-old-female with a history of migraine had a typical attack of HM characterized by right-sided hemiplegia, deterioration of vigilance and paraphasia. MRI performed 3 hours after hemiplegia onset revealed normal diffusion tensor imaging (DTI) sequences, but perfusion weighted imaging (PWI) showed a large area of hypoperfusion within the left cerebral hemisphere and susceptibility weighted imaging (SWI) demonstrated a matching area with prominent, hypointense draining sulcal veins. Magnetic resonance angiography (MRA) revealed subtle narrowing of the left middle cerebral artery. The neuroimaging abnormalities completely resolved 24 hours after the attack onset. CONCLUSION Multiple conventional and advanced MRI techniques including SWI play a key role in an HM attack to (1) exclude acute arterial ischemic stroke and (2) further understand the pathophysiology of HM.
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Affiliation(s)
- Thangamadhan Bosemani
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bosemani T, Verschuuren SI, Poretti A, Huisman TAGM. Pitfalls in susceptibility-weighted imaging of the pediatric brain. J Neuroimaging 2013; 24:221-5. [PMID: 24015797 DOI: 10.1111/jon.12051] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 05/19/2013] [Accepted: 05/21/2013] [Indexed: 12/01/2022] Open
Abstract
Susceptibility-weighted imaging (SWI) is a recently developed high resolution 3-dimensional gradient-echo pulse sequence that accentuates the magnetic susceptibility of blood, calcium, and nonheme iron. The clinical applications of SWI in pediatric neuroimaging have significantly expanded recently. Potential pitfalls related to blood oxygenation, blood flow, magnetic field strength, and misinterpretation of localization as well as possible mimickers may be misleading and affect the correct interpretation of SWI images. Familiarity with these potential diagnostic pitfalls is important to prevent misdiagnosis and will further enhance the ability of SWI in becoming a robust and reliable technique.
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Affiliation(s)
- Thangamadhan Bosemani
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
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Messina SA, Poretti A, Tekes A, Robertson C, Johnston MV, Huisman TAGM. Early predictive value of susceptibility weighted imaging (SWI) in pediatric hypoxic-ischemic injury. J Neuroimaging 2013; 24:528-30. [PMID: 24033676 DOI: 10.1111/jon.12043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/04/2013] [Accepted: 03/31/2013] [Indexed: 11/29/2022] Open
Abstract
Susceptibility weighted imaging (SWI) provides information about the intravascular cerebral blood oxygenation level. Deoxyhemoglobin is increased in tissue with increased oxygen extraction fraction. Accordingly, the draining veins in hypoxic-ischemic brain may reveal abnormally low SWI signal. We report on a boy with hypoxic-ischemic injury (HII) after cardiac arrest and the ability of SWI to depict areas of HII by focusing on the venous cerebral drainage.
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Jensen-Kondering U, Böhm R. Asymmetrically hypointense veins on T2*w imaging and susceptibility-weighted imaging in ischemic stroke. World J Radiol 2013; 5:156-165. [PMID: 23671751 PMCID: PMC3647207 DOI: 10.4329/wjr.v5.i4.156] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/07/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the literature on the assessment of venous vessels to estimate the penumbra on T2*w imaging and susceptibility-weighted imaging (SWI).
METHODS: Literature that reported on the assessment of penumbra by T2*w imaging or SWI and used a validation method was included. PubMed and relevant stroke and magnetic resonance imaging (MRI) related conference abstracts were searched. Abstracts that had overlapping content with full text articles were excluded. The retrieved literature was scanned for further relevant references. Only clinical literature published in English was considered, patients with Moya-Moya syndrome were disregarded. Data is given as cumulative absolute and relative values, ranges are given where appropriate.
RESULTS: Forty-three publications including 1145 patients could be identified. T2*w imaging was used in 16 publications (627 patients), SWI in 26 publications (453 patients). Only one publication used both (65 patients). The cumulative presence of hypointense vessel sign was 54% (range 32%-100%) for T2* (668 patients) and 81% (range 34%-100%) for SWI (334 patients). There was rare mentioning of interrater agreement (6 publications, 210 patients) and reliability (1 publication, 20 patients) but the numbers reported ranged from good to excellent. In most publications (n = 22) perfusion MRI was used as a validation method (617 patients). More patients were scanned in the subacute than in the acute phase (596 patients vs 320 patients). Clinical outcome was reported in 13 publications (521 patients) but was not consistent.
CONCLUSION: The low presence of vessels signs on T2*w imaging makes SWI much more promising. More research is needed to obtain formal validation and quantification.
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