P4-049: Serial Changes of Diffusion-Weighted Imaging (DWI) and Brain Computed Tomography (B-CT) in a Patient with Creutzfeldt-Jakob Disease with V180I Mutation

Background and purpose Validation of automatically derived acute ischemic volumes (AAIV) from e-ASPECTS on non-contrast computed tomography (NCCT). Materials and methods Data from three studies were reanalyzed with e-ASPECTS Version 7. AAIV was calculated in milliliters (ml) in all scored ASPECTS regions of the hemisphere detected by e-ASPECTS. The National Institute of Health Stroke Scale (NIHSS) determined stroke severity at baseline and clinical outcome was measured with the modified Rankin Scale (mRS) between 45 and 120 days. Spearman ranked correlation coefficients (R) of AAIV and e-ASPECTS scores with NIHSS and mRS as well as Pearson correlation of AAIV with diffusion-weighted imaging and CT perfusion-estimated ischemic “core” volumes were calculated. Multivariate regression analysis (odds ratio, OR with 95% confidence intervals, CI) and Bland–Altman plots were performed. Results We included 388 patients. Mean AAIV was 11.6 ± 18.9 ml and e-ASPECTS was 9 (8–10: median and interquartile range). AAIV, respectively e-ASPECTS correlated with NIHSS at baseline (R = 0.35, p < 0.001; R = −0.36, p < 0.001) and follow-up mRS (R = 0.29, p < 0.001; R = −0.3, p < 0.001). In subsets of patients, AAIV correlated strongly with diffusion-weighted imaging ( n = 37, R = 0.68, p < 0.001) and computed tomography perfusion-derived ischemic “core” ( n = 41, R = 0.76, p < 0.001) lesion volume and Bland–Altman plots showed a bias close to zero (−2.65 ml for diffusion-weighted imaging and 0.45 ml forcomputed tomography perfusion “core”). Within the whole cohort, the AAIV (OR 0.98 per ml, 95% CI 0.96–0.99) and e-ASPECTS scores (OR 1.3, 95%CI 1.07–1.57) were independent predictors of good outcome Conclusion AAIV on NCCT correlated moderately with clinical severity but strongly with diffusion-weighted imaging lesion and computed tomography perfusion ischemic “core” volumes and predicted clinical outcome.

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Relationship between carotid plaque characteristics and new ischemic lesions after stenting detected by computed tomography angiography

Acta Radiologica ◽

10.1177/0284185119852732 ◽

2019 ◽

Vol 61 (1) ◽

pp. 47-55

Author(s):

Hongying Qu ◽

Xiaokun Zhang ◽

Miao Zhang ◽

Yongan Gao ◽

Jie Lu

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Plaque ◽

Diffusion Weighted Imaging ◽

Irregular Surface ◽

Irregular Surfaces ◽

Diffusion Weighted ◽

Peripheral Position

Background Although carotid artery stenting achieves definite benefits, it carries a higher rate of embolization compared with carotid endarterectomy. The incidence of embolization may be related to plaque stability. Purpose To assess for any relationship between plaque characteristics and cerebral emboli following carotid artery stenting. Material and Methods Sixty-three patients with severe carotid stenosis underwent carotid artery stenting. They were divided into two groups according to whether new ischemic lesions were detected on diffusion-weighted imaging after carotid artery stenting. We evaluated the types and locations of calcification in plaques and extent of calcification. We then assessed for a correlation between each of these factors and occurrence of new lesions on diffusion-weighted imaging after carotid artery stenting. Results The locations of calcification, percentage of plaque enhancement, and the number of plaques with irregular surface or ulceration were significantly different between the two groups. A peripheral position of calcification (close to the adventitia), enhancing plaques, and plaques with irregular surfaces or ulceration were statistically significant predictors of intracerebral embolization after carotid artery stenting. No significant differences in type of plaque or degree of calcification were found between two groups. Conclusion Peripheral calcification, enhancing plaques, and plaques with irregular surfaces were risk factors for intracerebral embolization after carotid artery stenting. These plaque characteristics should be considered when choosing the optimal treatment for patients.

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Doença de Creutzfeldt-Jakob: Apresentação Atípica de uma Doença Muito Rara

Acta Médica Portuguesa ◽

10.20344/amp.13117 ◽

2020 ◽

Vol 33 (13) ◽

Author(s):

Renato Oliveira ◽

Marta Dias ◽

Inês Brás Marques

Keyword(s):

Cerebrospinal Fluid ◽

Magnetic Resonance ◽

Diffusion Weighted Imaging ◽

Negative Symptoms ◽

Sudden Onset ◽

Lower Limbs ◽

Progressive Dementia ◽

Radiological Features ◽

Diffusion Weighted ◽

Jakob Disease

Creutzfeldt-Jakob disease typically presents as rapidly progressive dementia. We describe the case of a 59-year-old male patient presenting with sudden onset of central facial palsy and dysarthria, followed by myoclonus of his left upper and lower limbs. Initial brain magnetic resonance showed hyperintensity of the right caudate and putamen on diffusion-weighted imaging and T2 sequences. Cerebrospinal fluid analysis showed increased protein count. The workup to investigate autoimmune, infectious and paraneoplastic causes was negative. Symptoms progressively worsened, with left hemiplegia, dysphagia, urinary incontinence, and, later, akinetic mutism. The follow-up brain magnetic resonance scan revealed hyperintensity of bilateral basal ganglia as well as cerebral cortical abnormalities on diffusion-weighted imaging. Electroencephalography showed periodic activity and tau protein levels in the cerebrospinal fluid were elevated. Genetic analysis showed mutation c-598G > A. The patient died four months later. We report a case of familial Creutzfeldt-Jakob disease with atypical clinical and radiological features, namely neurological focal signs with sudden onset, absence of significant cognitive impairment and unilateral radiological findings. With disease progression, characteristic clinical and radiological features led to the diagnosis.

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