Pocket Anatomy of Cerebrovascular Imaging and Topography

The role of noninvasive imaging in the diagnostic workup for pulsatile tinnitus

The Neuroradiology Journal ◽

10.1177/19714009211036696 ◽

2021 ◽

pp. 197140092110366

Author(s):

Alice J Tao ◽

Neal S Parikh ◽

Athos Patsalides

Keyword(s):

Magnetic Resonance ◽

Diagnostic Yield ◽

Noninvasive Imaging ◽

Diagnostic Evaluation ◽

Pulsatile Tinnitus ◽

Factors Associated ◽

Chart Abstraction ◽

Cerebrovascular Imaging ◽

Design And Methods

Objective We sought to assess the diagnostic yield of advanced noninvasive imaging in the evaluation of patients with pulsatile tinnitus. Background Pulsatile tinnitus can be caused by high-risk cerebrovascular pathologies such as arteriovenous fistulae. The role of advanced noninvasive imaging, including magnetic resonance angiography and magnetic resonance venography, in the diagnostic evaluation of pulsatile tinnitus is not well defined. Design and methods We performed a retrospective cohort study of patients presenting for outpatient diagnostic evaluation of pulsatile tinnitus from January 2018 to March 2020 at Weill Cornell Medicine. Patients with non-pulsatile tinnitus and established etiologic diagnoses were excluded. Systematic chart abstraction was summarized using standard descriptive statistics. Univariate logistic regression was used to identify factors associated with nondiagnostic noninvasive imaging. Results A total of 187 patients (139 (74.3%) women) took part in this study, with a mean age of 48.6 years (standard deviation ( SD) = 15.5 years) and a mean body mass index (BMI) of 26.9 kg/m2 ( SD = 6.1 kg/m2). Of the 187 patients, 121 (64.7%) underwent exclusively noninvasive imaging, and 66 (35.3%) patients also had digital subtraction angiography (DSA). In patients who had exclusively noninvasive imaging, 62 (51.2%) patients received a diagnosis. In patients who underwent noninvasive and DSA imaging, 14 (21.2%) patients received a diagnosis based on DSA. Patients who were older at symptom onset (odds ratio (OR) = 1.05; 95% confidence interval (CI) 1.01–1.09) and those with a lower BMI (OR = 0.88, 95% CI 0.77–0.98) were more likely to have nondiagnostic noninvasive imaging. Conclusion Noninvasive cerebrovascular imaging often uncovers the etiology of pulsatile tinnitus. DSA remains useful for additional evaluation for patients with specific associated features.

Abstract WP339: Validation of the Fast-ed Scale Use by Paramedics in a Mobile Stroke Unit

Stroke ◽

10.1161/str.51.suppl_1.wp339 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Diogo C Haussen ◽

Raul G Nogueira ◽

Nirav Bhatt ◽

Carol Flemming ◽

Nicolas Bianchi ◽

...

Keyword(s):

Stroke Unit ◽

Hospital Setting ◽

Final Diagnosis ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Hospital Arrival ◽

Mobile Stroke Unit ◽

Standard Operating ◽

Intravenous Alteplase ◽

Cerebrovascular Imaging

Introduction: FAST-ED scale is a helpful tool to triage stroke patients in the field. However, data on the accuracy of the scale in the pre-hospital setting is lacking. We aim to validate the use of FAST-ED by paramedics in a mobile stroke unit (MSU) covering a metropolis. Methods: As part of standard operating MSU procedures, paramedics clinically evaluated patients. If the event characterized a stroke alert, the FAST-ED score was determined by the paramedic (in-person) upon patient contact, and independently by a vascular neurologist (telemedicine) immediately after the paramedic evaluation. An MSU nurse determined the NIHSS. This will allow testing of the inter-rater agreement of the FAST-ED scoring performance between on-site pre-hospital providers and remotely located vascular neurologists. Results: In the first 13 months of the MSU’s activity 193 stroke-alert patients were evaluated. 103 (53%) patients had a final diagnosis of stroke/TIA (75/28, respectively), 21 (11%) intracranial hemorrhage, and 69 (36%) were considered stroke mimics. 28 (14%) patients received intravenous alteplase. In the first 48 patients, FAST-ED was only scored by the paramedic and in 145 patients by both the physician and paramedic. FAST-ED scores matched perfectly amongst paramedics and physicians in 77 (53%) instances, while there was only 1-point difference in 51 (35%), 2-point difference in 10 (6%) and 3-point difference in two. Correlation between physician and paramedic FAST-ED scores was highly positive (rho 0.898; 2-sided p<0.001), as well as the correlation between physicians FAST-ED score and NIHSS (rho 0.853; 2-sided p<0.001). When the physician recorded FAST-ED score≥3 (n=62), the paramedics also scored FAST-ED≥3 in the vast majority of instances (n=55; 89%). After hospital arrival, cerebrovascular imaging was deemed necessary and performed in 144 patients within 24 hours of arrival. A visible large vessel occlusion was identified in 30 patients; 18 occlusions were identified with a FAST-ED≥3 while 12 were missed (10/12 had NIHSS≤5). Conclusion: The correlation of the FAST-ED scoring between vascular neurologists and paramedics was highly positive, indicating that FAST-ED is accurately and reliably utilized by paramedics in the pre-hospital setting.

4D flow MRI for non-invasive measurement of blood flow in the brain: A systematic review

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x20952014 ◽

2020 ◽

pp. 0271678X2095201

Author(s):

Alasdair G Morgan ◽

Michael J Thrippleton ◽

Joanna M Wardlaw ◽

Ian Marshall

Keyword(s):

Blood Flow ◽

Imaging Techniques ◽

Acquisition Time ◽

4D Flow ◽

Non Invasive ◽

Major Vessel ◽

Dynamic Velocity ◽

Blood Flow Dynamics ◽

Cerebrovascular Imaging

The brain’s vasculature is essential for brain health and its dysfunction contributes to the onset and development of many dementias and neurological disorders. While numerous in vivo imaging techniques exist to investigate cerebral haemodynamics in humans, phase-contrast magnetic resonance imaging (MRI) has emerged as a reliable, non-invasive method of quantifying blood flow within intracranial vessels. In recent years, an advanced form of this method, known as 4D flow, has been developed and utilised in patient studies, where its ability to capture complex blood flow dynamics within any major vessel across the acquired volume has proved effective in collecting large amounts of information in a single scan. While extremely promising as a method of examining the vascular system’s role in brain-related diseases, the collection of 4D data can be time-consuming, meaning data quality has to be traded off against the acquisition time. Here, we review the available literature to examine 4D flow’s capabilities in assessing physiological and pathological features of the cerebrovascular system. Emerging techniques such as dynamic velocity-encoding and advanced undersampling methods, combined with increasingly high-field MRI scanners, are likely to bring 4D flow to the forefront of cerebrovascular imaging studies in the years to come.

Utility of the Hijdra Sum Score in Predicting Risk of Aneurysm in Patients With Subarachnoid Hemorrhage: A Single-Center Experience With 550 Patients

Neurosurgery ◽

10.1093/neuros/nyz346 ◽

2019 ◽

Vol 86 (6) ◽

pp. 783-791 ◽

Cited By ~ 2

Author(s):

Matthew J Kole ◽

Phelan Shea ◽

Jennifer S Albrecht ◽

Gregory J Cannarsa ◽

Aaron P Wessell ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Multivariable Analysis ◽

Predictive Ability ◽

Vascular Lesion ◽

World Federation ◽

Single Center ◽

Single Center Experience ◽

Cerebrospinal Fluid Diversion ◽

Number Of Patients ◽

Cerebrovascular Imaging

Abstract BACKGROUND Subarachnoid hemorrhage (SAH) is most commonly caused by a ruptured vascular lesion. A significant number of patients presenting with SAH have no identifiable cause despite extensive cerebrovascular imaging at presentation. Significant neurological morbidity or mortality can result from misdiagnosis of aneurysm. OBJECTIVE To generate a model to assist in predicting the risk of aneurysm in this patient population. METHODS We conducted a retrospective study of all patients aged ≥18 yr admitted to a single center from March 2008 to March 2018 with nontraumatic SAH (n = 550). Patient information was compared between those with and without aneurysm to identify potential predictors. Odds ratios obtained from a logistic regression model were converted into scores which were summed and tested for predictive ability. RESULTS Female sex, higher modified Fisher or Hijdra score, nonperimesencephalic location, presence of intracerebral hemorrhage, World Federation of Neurosurgical Societies (WFNS) score ≥3, need for cerebrospinal fluid diversion on admission, and history of tobacco use were all entered into multivariable analysis. Greater modified Fisher, greater Hijdra score, WFNS ≥3, and hydrocephalus present on admission were significantly associated with the presence of an aneurysm. A model based on the Hijdra score and SAH location was generated and validated. CONCLUSION We show for the first time that the Hijdra score, in addition to other factors, may assist in identifying patients at risk for aneurysm on cerebrovascular imaging. A simple scoring tool based on patient sex, SAH location, and SAH burden can assist in predicting the presence of an aneurysm in patients with nontraumatic SAH.

Cerebrovascular Imaging (CT, MRI, CTA, MRA)

Extracranial Carotid and Vertebral Artery Disease ◽

10.1007/978-3-319-91533-3_7 ◽

2018 ◽

pp. 85-111

Author(s):

Brent Griffith ◽

Brendan P. Kelley ◽

Suresh C. Patel ◽

Horia Marin

Keyword(s):

Cerebrovascular Imaging

Well‐Defined Segment of Carbon Nanotube with Bright Red Emission for Three‐Photon Fluorescence Cerebrovascular Imaging

Advanced Optical Materials ◽

10.1002/adom.202100482 ◽

2021 ◽

pp. 2100482

Author(s):

Zhen‐Lin Qiu ◽

Mu‐bin He ◽

Ke‐Shan Chu ◽

Chun Tang ◽

Xuan‐Wen Chen ◽

...

Keyword(s):

Carbon Nanotube ◽

Red Emission ◽

Cerebrovascular Imaging ◽

Photon Fluorescence

Ultra-deep through-skull mouse brain imaging via the combination of skull optical clearing and three-photon microscopy

10.1101/2021.12.20.473469 ◽

2021 ◽

Author(s):

Mubin He ◽

Dongyu Li ◽

Zheng Zheng ◽

Hequn Zhang ◽

Tianxiang Wu ◽

...

Keyword(s):

Brain Tissue ◽

Brain Structures ◽

Brain Vessels ◽

Intact Mouse ◽

Optical Clearing ◽

Cranial Window ◽

Dual Channel ◽

Imaging Depth ◽

Cerebrovascular Imaging

Optical microscopy has enabled in vivo monitoring of brain structures and functions with high spatial resolution. However, the strong optical scattering in turbid brain tissue and skull impedes the observation of microvasculature and neuronal structures at large depth. Herein, we proposed a strategy to overcome the influence induced by the high scattering effect of both skull and brain tissue via the combination of skull optical clearing (SOC) technique and thee-photon fluorescence microscopy (3PM). The Visible-NIR-II compatible Skull Optical Clearing Agents (VNSOCA) we applied reduced the skull scattering and water absorption in long wavelength by refractive index matching and H2O replacement to D2O respectively. 3PM with the excitation in the 1300-nm window reached 1.5 mm cerebrovascular imaging depth in cranial window. Combining the two advanced technologies together, we achieved so far the largest cerebrovascular imaging depth of 1 mm and neuronal imaging depth of >700 μm through intact mouse skull. Dual-channel through-skull imaging of both brain vessels and neurons was also successfully realized, giving an opportunity of non-invasively monitoring the deep brain structures and functions at single-cell level simultaneously.

Acute cerebrovascular imaging for stroke management: a literature review

Nosotchu ◽

10.3995/jstroke.10776 ◽

2020 ◽

Vol 42 (6) ◽

pp. 495-501

Author(s):

Masatoshi Koga ◽

Manabu Inoue ◽

Kazutaka Sonoda ◽

Kanta Tanaka ◽

Masayuki Shiozawa ◽

...

Keyword(s):

Literature Review ◽

Stroke Management ◽

Cerebrovascular Imaging

Clinical role of cerebrovascular imaging

Australian Prescriber ◽

10.18773/austprescr.2001.149 ◽

2001 ◽

Vol 24 (6) ◽

pp. 134

Author(s):

Geoffrey A Donnan

Keyword(s):

Clinical Role ◽

Cerebrovascular Imaging

Abstract TMP85: Frequency and Utility of Repeat Cerebrovascular Imaging Among Hospitalized Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.tmp85 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Syed Ali Raza ◽

Vijay Javalkar ◽

Seena Dehkharghani ◽

Archana Kudrimoti ◽

Amit Saindane ◽

...

Keyword(s):

Clinical Management ◽

Multivariable Analysis ◽

Stroke Patients ◽

Non Invasive ◽

Contrast Enhanced ◽

New Findings ◽

Neurological Exam ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Cerebrovascular Imaging

Background: There are limited data on the frequency of repeat non-invasive imaging performed in the evaluation of stroke patients and its utility in patient care. Hypothesis: Stroke patients frequently undergo repeat intracranial arterial imaging with limited change in clinical management. Methods: All stroke patients admitted to a comprehensive stroke center from January 1, 2012 through December 31, 2014 were identified as part of a prospective radiology database if they underwent contrast-enhanced MR angiography (CE-MRA) of the head and subsequent CT angiography (CTA) of the head within 7 days. Two vascular neurologists reviewed medical records to confirm the diagnosis of stroke and subtype, determine the indications of the two studies, evaluate if any neurologic change occurred prompting the subsequent CTA, new findings seen on CTA and identification of any change in clinical management based on the CTA results. Results: Of 1355 stroke patients who underwent CE-MRA of the head during the study period, 195 (14%) patients underwent subsequent CTA within 7 days, including 33 patients who had non-diagnostic CE-MRA due to patient motion. Of the 162 (12%) patients with diagnostic CE-MRA who underwent subsequent CTA head (mean age 59 ± 15 years, 52% female, 61% ischemic stroke, 11% ICH, 28% SAH), 69 (43%) patients were considered to have an unnecessary CTA of the head. In multivariable analysis, factors associated with an unnecessary CTA head included no new neurological exam changes [OR 7.29; 95% CI 1.92 to 27.63] and same documented indication for CE-MRA and CTA [OR 6.47; 95% CI 3.04 to 13.78]. Changes in clinical management after CTA of the head were seen in 42% of patients who had a clinically indicated CTA versus 7% of patients with a CTA considered unnecessary (p<0.0001). Conclusions: Approximately 1 in 8 stroke patients who underwent a diagnostic CE-MRA underwent a subsequent CTA of the head within 7 days and nearly half of these CTA studies were considered unnecessary. The utility of repeat cerebrovascular head imaging with CTA of the head after a diagnostic CE-MRA is low when there is no evidence of a change in neurological exam or when the same indication is documented for both studies.