Asymptomatic Carotid T1-High-Intense Plaque as a Risk Factor for a Subsequent Cerebrovascular Ischemic Event

Background: Intraplaque hemorrhage, detected as a high-signal intensity on carotid MRI, is also strongly associated with ischemic events in symptomatic patients. However, in asymptomatic patients, the relationship of the T1-high intense plaque and the subsequent stroke is not clear. The aim of this study is to test the hypothesis that asymptomatic carotid T1-high intense plaque is a risk factor for a subsequent cerebrovascular ischemic event. Methods: Of the 1,353 consecutive patients, who underwent head and carotid MRI as part of their annual medical check-up, the imaging quality of 13 was poor and 150 did not present for follow-up examination, thus leaving 1,190 subjects for evaluation. Of the 1,190 patients, 96 patients had findings of high-signal intensity on carotid MRI and 1,094 patients did not. Cerebrovascular events were retrospectively evaluated. Results: During a mean follow-up period of 53 months, 4 patients with high-signal intensities on carotid MRI (4%) and 3 with no findings (0.3%) had a cerebrovascular ischemic event, with the occurrences significantly higher in the high-signal-intensity group. (p < 0.01) Cox regression analysis indicated that the presence of the high-intense plaque on carotid MRI (hazard ratio [HR] 4.2; 95% CI 1.0-17.1; p = 0.04), age (HR 1.1; 95% CI 1.0-1.2; p = 0.003), and diabetes mellitus (HR 7.2; 95% CI 1.8-27.4; p = 0.004) were associated with the occurrence of subsequent ischemic cerebrovascular events. Conclusions: Asymptomatic carotid T1-high-intense plaque might be a potential high-risk factor for a subsequent cerebrovascular ischemic event.

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Abstract 17806: The Prognostic Importance of Frequent Premature Atrial Contractions Following Ischemic Cerebrovascular Events

Circulation ◽

10.1161/circ.130.suppl_2.17806 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

John J Keaney ◽

Layan Akijian ◽

Doug Mulholland ◽

Niamh Hannon ◽

Danielle M Ní Chróinín ◽

...

Keyword(s):

Risk Factor ◽

Recurrent Events ◽

Cox Regression ◽

Holter Monitoring ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Cerebrovascular Events ◽

Significant Difference ◽

Prognostic Importance

Background: Following ischemic cerebrovascular accident (CVA) or transient ischemic attack (TIA) aggressive risk factor modification is undertaken to reduce the risk of recurrent events. Holter monitoring is advocated to facilitate the detection and treatment of Atrial Fibrillation (AF). Frequent Premature Atrial Contractions (PACs) are associated with the development of AF, but to date it is unknown whether the burden of PACs on Holters is of any prognostic importance following CVA/TIA. Objective: PACs on Holter monitoring may be a marker for recurrent cerebrovascular events post CVA/TIA. Methods: Retrospective analysis was performed on Holters of patients with CVA/TIA enrolled in a prior population based stroke study. Frequent PACs were defined as a rate of PACs ≥ 100 per 24 hours. The primary endpoint was recurrent CVA or TIA. Results: 84 cases (61.0% male) were reviewed. Mean age was 69.7 ± 12.4 years. Mean time to follow-up was 2514.6 ± 91.2 days. The average number of PACs in the frequent group (Hi-PAC, 21 patients) was 1610.8 ± 4541.4 compared with 21.8 ± 27.6 in those with less than 100 PACs (Lo-PAC, 63 patients). There was no statistically significant difference in age, gender, hypertension or diabetes between the two groups. On follow-up there were 20 recurrent events and 33 patients died. In the Hi-PAC group there were 8 (38.1%) recurrent events, and 16 (76.2%) patients died versus 12 (18.8%) and 17 (26.6%) respectively in Lo-PAC group. On Cox regression analysis the Hazard ratio (HR) for recurrent events was 2.75 (95% confidence interval (CI) 1.08 to 7.01). Kaplan Meier curves revealed a statistically significant difference in recurrance rates between the two groups (p < 0.05). There was also a statistically significant difference in overall mortality on Kaplan Meier survival analysis (p < 0.001), and with a hazard ratio on Cox regression analysis of 3.47 (95% CI 1.74 [[Unable to Display Character: –]] 6.91). There was no significant difference in incidence of MI or AF. Conclusion: Frequent PACs on Holter monitor represent a significant risk factor for both recurrent events and mortality following CVA/TIA. Further prospective studies should be performed to assess whether these patients may benefit from more aggressive anticoagulation, similar to those with AF.

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Quantitatively Measured Infrapatellar Fat Pad Signal Intensity Alteration is Associated with Joint Effusion-Synovitis in Knee Osteoarthritis

10.21203/rs.3.rs-404837/v1 ◽

2021 ◽

Author(s):

Guangfeng Ruan ◽

Yan Zhang ◽

Zhaohua Zhu ◽

Peihua Cao ◽

Xiaoshuai Wang ◽

...

Keyword(s):

Signal Intensity ◽

High Signal Intensity ◽

Joint Effusion ◽

Infrapatellar Fat Pad ◽

High Signal ◽

Fat Pad ◽

Knee Oa ◽

Suprapatellar Pouch ◽

Intensity Region

Abstract Background: Abnormal infrapatellar fat pad (IPFP) plays a detrimental role in knee osteoarthritis (OA) by producing pro-inflammatory cytokines. IPFP may interact with synovium because of their adjacent anatomical positions; however, whether abnormal IPFP can contribute to effusion-synovitis in knee OA is unclear.Methods: Among 255 knee OA patients, IPFP signal intensity alteration represented by four measurement parameters [standard deviation of IPFP signal intensity (IPFP sDev), upper quartile value of IPFP high signal intensity region (IPFP UQ (H)), ratio of IPFP high signal intensity region volume to whole IPFP volume (IPFP percentage (H)), and clustering factor of IPFP high signal intensity (IPFP clustering factor (H))] was measured quantitatively at baseline and two-year follow-up using magnetic resonance imaging (MRI). Effusion-synovitis of the suprapatellar pouch and other cavities were measured both quantitatively and semi-quantitatively as effusion-synovitis volume and effusion-synovitis score at baseline and two-year follow-up using MRI. Mixed-effects models were used to assess the associations between IPFP signal intensity alteration and effusion-synovitis over two years.Results: In multivariable analyses, all four parameters of IPFP signal intensity alteration were positively associated with total effusion-synovitis volume and effusion-synovitis volumes of the suprapatellar pouch and of other cavities over two years (all P＜0.05). They were also associated with the semi-quantitative measure of effusion-synovitis except for IPFP percentage (H) with effusion-synovitis in other cavities. Conclusion: Quantitatively measured IPFP signal intensity alteration is positively associated with joint effusion-synovitis in people with knee OA, suggesting that IPFP signal intensity alteration may contribute to effusion-synovitis and a coexistent pattern of these two imaging biomarkers could exist in knee OA patients.

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Spinal Dural AVF Two Cases with MRI Follow-up

Interventional Neuroradiology ◽

10.1177/15910199980040s143 ◽

1998 ◽

Vol 4 (1_suppl) ◽

pp. 207-212

Author(s):

S. Nishi ◽

N. Hashimoto ◽

I. Nakahara ◽

T. Iwama ◽

M. Sawada ◽

...

Keyword(s):

Spinal Cord ◽

Early Diagnosis ◽

Signal Intensity ◽

High Signal Intensity ◽

Gait Disturbance ◽

Diagnosis And Treatment ◽

High Signal ◽

Common Trunk ◽

Spinal Dural Arteriovenous Fistula

Spinal dural arteriovenous fistula (d-AVF) is one of the arteriovenous malformations that are treatable by surgery or embolization. We present two cases treated by embolization and stress the necessity of early diagnosis and treatment, and the usefulness of T2WI on MRI for follow-up after embolization. One was a 51-year-old man who presented with gait disturbance and sphincter dysfunction. MRI revealed diffuse swelling on T1WI, and intramedullary high signal intensity on T2WI. A spinal d-AVF was found through tiny radicullomeningeal arteries via the right Th12 intercostal artery that drained into engorged retromedullary veins. The spinal d-AVF was embolized with 50% NBCA. Six months after the embolization, he was able to go back to his job, T2WI showed disappearance of the high signal intensity, which was confirmed at angiography one year after the embolization. The other case was a 62-year-old man who presented with sensory disturbance and gait disturbance, MRI showed the same findings, without the flow voids on them in case 1. The high signal area in the central spinal cord was thought to be syringomyelia, in which a syrinx-subarachnoid shunt was tried in vain. On the surface of the spinal cord, abnormally engorged and tortuous vessels were found. The syrinx was not confirmed. An angiogram showed a spinal d-AVF fed by the radicullomeningeal artery through a common trunk of the Th11/12 intercostal arteries with drainage into the retromedullary vein. The spinal d-AVF was embolized. Six months after the embolization, T2WI showed a decrease of high intensity areas. Early diagnosis and treatment are important for the prognosis of spinal d-AVF, T2WI may be the best way to check for recurrence.

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The joint involvement in adult onset Still's disease is characterised by a peculiar magnetic resonance imaging and a specific transcriptomic profile

Scientific Reports ◽

10.1038/s41598-021-91613-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Piero Ruscitti ◽

Antonio Barile ◽

Onorina Berardicurti ◽

Sonia Iafrate ◽

Paola Di Benedetto ◽

...

Keyword(s):

Signal Intensity ◽

Clinical Characteristics ◽

High Signal Intensity ◽

Adult Onset Still’S Disease ◽

Joint Involvement ◽

High Signal ◽

Bone Erosions ◽

Transcriptomic Profile ◽

Synovial Tissues ◽

Bone Oedema

AbstractAdult onset Still's disease (AOSD) is a rare systemic autoinflammatory disease, characterised by fever, arthritis, and skin rash, and joint involvement is one of its clinical manifestations. The aims of this work were to assess joint involvement, to describe main patterns of involvement, and associated clinical characteristics. In this work, we aimed at assessing the joint involvement in AOSD by using MRI, to describe main patterns and associated clinical characteristics. In addition, we aimed at assessing the global transcriptomic profile of synovial tissues in AOSD to elucidate possible pathogenic pathways involved. We also evaluated the global transcriptomic profile of synovial tissues to elucidate possible pathogenic pathways involved in the disease. Thus, AOSD patients, who underwent to MRI exam on joints, were assessed to describe patterns of joint involvement and associated clinical characteristics. Some synovial tissues were collected for RNA-sequencing purposes. The most common MRI finding was the presence of synovitis on 60.5%, mainly in peripheral affected joints, with low to intermediate signal intensity on T1-weighted images and intermediate to high signal intensity on T2-fat-saturated weighted and STIR images. Bone oedema and MRI-bone erosions were reported on 34.9% and 25.6% MRI exams, respectively. Patients with MRI-bone erosions showed a higher prevalence of splenomegaly, a more frequent chronic disease course, lower levels of erythrocyte sedimentation rate, and ferritin. In AOSD synovial tissues, a hyper-expression of interleukin (IL)-1, IL-6, and TNF pathways was shown together with ferritin genes. In conclusion, in AOSD patients, the most common MRI-finding was the presence of synovitis, characterised by intermediate to high signal intensity on T2-fat-saturated weighted and STIR images. MRI-bone erosions and bone oedema were also observed. In AOSD synovial tissues, IL-1, IL-6, and TNF pathways together with ferritin genes resulted to be hyper-expressed.

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