Abstract W P171: Findings of Magnetic Resonance Imaging and Carotid Duplex as Predictors of Recurrent Brain Infarction -Bingo Cerebral Infarction Study 1-

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kiyoshi Nakazaki ◽  
Shinichi Takeshima ◽  
Masaru Kuriyama
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cerebral Infarction ◽  
Artery Stenosis ◽  
Lacunar Infarction ◽  
Resonance Imaging ◽  
Ischemic Brain ◽  
Inversion Recovery Imaging ◽  
Carotid Duplex

Introduction: To retrospectively evaluate whether findings of magnetic resonance imaging (MRI) and carotid duplex are predictors of recurrent cerebral infarction. Methods: Between 2007 and 2010, 1324 patients underwent carotid duplex, magnetic resonance angiography, fluid-attenuated inversion recovery imaging, and T2*-weighted imaging during first admission for cerebral infarction and were discharged with a modified Rankin Scale (mRS) score of 0-3. Of the 1324 patients, 1138 (86.0%) were followed up (median age, 70 years; male:female ratio, 64%:36%). Atherothrombotic infarction, lacunar infarction, cardiogenic embolism, and other infarctions occurred in 435, 430, 246, and 27 patients, respectively. Results: The median follow-up duration was 44.5 months; 84.4% patients underwent follow-up MRI. New ischemic brain events occurred in 213 patients (18.7%). Transient ischemic attack occurred as the first new ischemic brain event in 44 patients. New asymptomatic cerebral infarction appeared in 100 patients before or without new ischemic brain events. Symptomatic cerebral infarction (SCI) recurred in 172 cases (15.1%), and the median duration between discharge and recurrence was 18.6 months (range, 0.2-69.5 months). Atherothrombotic infarction, lacunar infarction, and cardiogenic embolism recurred in 64, 64, and 42 patients, respectively. At the last follow-up, mRS score was 0-3 in 1029 patients and 27 patients died. Intracranial artery stenosis and micro-bleeding were significant predictors of SCI after lacunar infarction. Pre-admission asymptomatic old cerebral infarction was a significant predictor of SCI after 3 subtypes. Internal carotid artery stenosis >50% on carotid duplex was a significant predictor of SCI after atherothrombotic infarction. Conclusion: Findings of MRI and carotid duplex may be important predictors of recurrent cerebral infarction.

The Association Between Symptomatic Delayed Cerebral Infarction and Serum Adhesion Molecules in Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1611-1617 ◽  
Author(s):  
Hung-Chen Wang ◽  
Wei-Che Lin ◽  
Tzu-Ming Yang ◽  
Yu-Jun Lin ◽  
Nai-Wen Tsai ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Subarachnoid Hemorrhage ◽  
Magnetic Resonance ◽  
Cerebral Infarction ◽  
Adhesion Molecules ◽  
High Frequency ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Resonance Imaging ◽  
Circulating Markers

Abstract BACKGROUND: Serum concentrations of adhesion molecules may be connected to the pathogenesis of delayed cerebral infarction (DCI) after aneurysmal subarachnoid hemorrhage (SAH). OBJECTIVE: To test the hypothesis that levels of adhesion molecules are substantially increased after DCI and decreased thereafter and that these levels can predict treatment outcomes. METHODS: Serial circulating markers of adhesion molecules were examined in 21 consecutive SAH patients and 2 risk control subjects. All underwent cerebral angiography and magnetic resonance imaging to confirm the DCI. The timing of magnetic resonance imaging was fixed in the acute phase and before hospital discharge. RESULTS: Symptomatic DCI developed in 33% of the patients (7 of 21). Statistical analysis of levels of adhesion molecules between patients with and those without DCI revealed that soluble (s) L-selectin, sP-selectin, and sE-selectin concentrations significantly increased after symptomatic DCI (P = .003, .013, and .043, respectively). Only higher sL-selectin level on presentation (cutoff value > 636 ng/mL) was significantly associated with poor outcome after 6 months of follow-up. CONCLUSION: Increased sL-selectin, sP-selectin, and sE-selectin levels imply risks of symptomatic DCI after aneurysmal SAH. The high frequency of symptomatic DCI and higher sL-selectin level on presentation may be associated with worse outcomes.

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

Magnetic Resonance Imaging T2* Mapping of the Talar Dome and Subtalar Joint Cartilage 3 Years After Anterior Talofibular Ligament Repair or Reconstruction in Chronic Lateral Ankle Instability

2021 ◽  
Vol 49 (3) ◽  
pp. 737-746
Author(s):  
Yiwen Hu ◽  
Yuyang Zhang ◽  
Qianru Li ◽  
Yuxue Xie ◽  
Rong Lu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Resonance Imaging ◽  
Talar Dome ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability

Background: Cartilage degeneration is a common issue in patients with chronic lateral ankle instability. However, there are limited studies regarding the effectiveness of lateral ligament surgery on preventing talar and subtalar joint cartilage from further degenerative changes. Purpose: To longitudinally evaluate talar and subtalar cartilage compositional changes using magnetic resonance imaging T2* mapping in anatomic anterior talofibular ligament (ATFL)–repaired and ATFL-reconstructed ankles and to compare them with measures in asymptomatic controls. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2015 and December 2016, patients with chronic lateral ankle instability who underwent anatomic ATFL repair (n = 19) and reconstruction (n = 20) were prospectively recruited. Patients underwent 3.0-T magnetic resonance imaging at baseline and 3-year follow-up. As asymptomatic controls, 21 healthy volunteers were recruited and underwent imaging at baseline. Talar dome cartilage was divided into (1) medial anterior, central, and posterior and (2) lateral anterior, central, and posterior. Posterior subtalar cartilage was divided into (1) central talus and calcaneus and (2) lateral talus and calcaneus. Ankle function was assessed using the American Orthopaedic Foot & Ankle Society scores. Results: There were significant increases in T2* values in medial and lateral posterior and central talus cartilage from baseline to 3-year follow-up in patients who underwent repair. T2* values were significantly higher in ATFL-repaired ankles at follow-up for all cartilage regions of interest, except medial and lateral anterior and lateral central, compared with those in healthy controls. From baseline to 3-year follow-up, ATFL-reconstructed ankles had a significant increase in T2* values in lateral central and posterior cartilage. T2* values in ATFL-reconstructed ankles at follow-up were elevated in all cartilage regions of interest, except medial and lateral anterior, compared with those in healthy controls. ATFL-repaired ankles showed a greater decrease of T2* values from baseline to follow-up in lateral calcaneus cartilage than did ATFL-reconstructed ankles ( P = .031). No significant differences in American Orthopaedic Foot & Ankle Society score were found between repair and reconstruction procedures (mean ± SD, 19.11 ± 7.45 vs 16.85 ± 6.24; P = .311). Conclusion: Neither anatomic ATFL repair nor reconstruction could prevent the progression of talar dome and posterior subtalar cartilage degeneration; however, ankle function and activity levels were not affected over a short period. Patients who underwent ATFL repair exhibited lower T2* values in the lateral calcaneus cartilage than did those who underwent reconstruction.

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