Abstract TP208: Fazekas Scores Correspond With Specific Volumes of White Matter Hyperintensity

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ariana Andere ◽  
Anusha Boyanpally ◽  
Scott Collins ◽  
Michael Reznik ◽  
Ali Mahta ◽  
...  
Keyword(s):  
White Matter ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Volumetric Analysis ◽  
Subcortical White Matter ◽  
White Matter Hyperintensity ◽  
3D Slicer ◽  
Tertiary Care Institution ◽  
Magnetic Resonance Imaging Mri ◽  
Fazekas Scale

Background: White matter hyperintensity (WMH), also known as leukoaraiosis, is commonly visualized as abnormal T2 signal in the deep and subcortical white matter on Magnetic Resonance Imaging (MRI). It is also commonly associated with aging, diabetes, hypertension and cerebrovascular disease. The Fazekas (F) scoring system is a subjective tool commonly used to assess WMH, but no volumetric analysis has been published showing how the scores correspond to true quantities of white matter disease. Methods: MRIs performed on inpatients and outpatients at our tertiary care institution between 2015 and 2017 were reviewed and their relative WMH was scored by one author trained in using the Fazekas scale. Using 3D Slicer 4.9, manual segmentations of WMH were completed and a 3D model was created to quantify the amount of WMH. Univariate analysis and ANOVA tests were run to determine the association of each Fazekas score with volume of WMH. Results: Among the 198 patients in our study (53% female), 163 had WMH (F1 n=66, F2 n=49, F3 n=48). Ranges of WMH in each group were 0.1-8.3 mL in Fazekas 1 (mean = 3.7, SD = 2.3), 6.0-17.7 mL in Fazekas 2 (mean = 10.8, SD = 3.1), and 14.2-77.2 mL in Fazekas 3 (mean = 35.2, SD = 17.9); if 11 outliers above 50 mL were excluded, the range for Fazekas 3 was 14.2-47.0 mL (mean = 27.1, SD = 8.9). When comparing data between groups, both the comparison between F1+2 (t-value = 14.1, p<0.001) and F2+F3 (t-value = 9.62, p<0.001) were significant. Moreover, when comparing between the three groups, each range of values was found to be significant from one another (F = 151.3, p<0.001). Conclusion: When accurately trained in assigning Fazekas scores to patient’s WMH, each of the scores appears to represent an approximate range of distinct volumes for WMH. Studies have shown that the presence and extent of WMH is a predictor for future development of stroke. These results should be validated in subsequent studies.

Increased MRI-based cortical grey/white-matter contrast in sensory and motor regions in schizophrenia and bipolar disorder

2016 ◽  
Vol 46 (9) ◽  
pp. 1971-1985 ◽  
Author(s):  
K. N. Jørgensen ◽  
S. Nerland ◽  
L. B. Norbom ◽  
N. T. Doan ◽  
R. Nesvåg ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
White Matter ◽  
Linear Models ◽  
Subcortical White Matter ◽  
Precentral Gyrus ◽  
Average Group ◽  
Medication Dose ◽  
Weighted Magnetic Resonance Imaging ◽  
The Difference ◽  
Magnetic Resonance Imaging Mri

BackgroundSchizophrenia and bipolar disorder share genetic risk factors and one possible illness mechanism is abnormal myelination. T1-weighted magnetic resonance imaging (MRI) tissue intensities are sensitive to myelin content. Therefore, the contrast between grey- and white-matter intensities may reflect myelination along the cortical surface.MethodMRI images were obtained from patients with schizophrenia (n = 214), bipolar disorder (n = 185), and healthy controls (n = 278) and processed in FreeSurfer. The grey/white-matter contrast was computed at each vertex as the difference between average grey-matter intensity (sampled 0–60% into the cortical ribbon) and average white-matter intensity (sampled 0–1.5 mm into subcortical white matter), normalized by their average. Group differences were tested using linear models covarying for age and sex.ResultsPatients with schizophrenia had increased contrast compared to controls bilaterally in the post- and precentral gyri, the transverse temporal gyri and posterior insulae, and in parieto-occipital regions. In bipolar disorder, increased contrast was primarily localized in the left precentral gyrus. There were no significant differences between schizophrenia and bipolar disorder. Findings of increased contrast remained after adjusting for cortical area, thickness, and gyrification. We found no association with antipsychotic medication dose.ConclusionsIncreased contrast was found in highly myelinated low-level sensory and motor regions in schizophrenia, and to a lesser extent in bipolar disorder. We propose that these findings indicate reduced intracortical myelin. In accordance with the corollary discharge hypothesis, this could cause disinhibition of sensory input, resulting in distorted perceptual processing leading to the characteristic positive symptoms of schizophrenia.

scholarly journals Volume of white matter hyperintensities increases with blood pressure in patients with hypertension

2019 ◽  
Vol 47 (8) ◽  
pp. 3681-3689 ◽  
Author(s):  
Yu Zhao ◽  
Zunyu Ke ◽  
Wenbo He ◽  
Zhiyou Cai
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
White Matter Hyperintensities ◽  
Clinical Analysis ◽  
Primary Diagnosis ◽  
Mri Findings ◽  
Scale Scores ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Fazekas Scale

Objective Hypertension is a risk factor for development of white matter hyperintensities (WMHs). However, the relationship between hypertension and WMHs remains obscure. We sought to clarify this relationship using clinical data from different regions of China. Methods We analyzed the data of 333 patients with WMHs in this study. All included patients underwent conventional magnetic resonance imaging (MRI) examination. A primary diagnosis of WMHs was made according to MRI findings. The volume burden of WMHs was investigated using the Fazekas scale, which is widely used to rate the degree of WMHs. We conducted retrospective clinical analysis of the data in this study. Results Our findings showed that WMHs in patients with hypertension were associated with diabetes, cardiovascular diseases, history of cerebral infarct, and plasma glucose and triglyceride levels. Fazekas scale scores for WMHs increased with increased blood pressure values in patients with hypertension. Conclusion This analysis indicates that hypertension is an independent contributor to the prevalence and severity of WMHs.

scholarly journals Severity of white matter hyperintensities: Lesion patterns, cognition, and microstructural changes

2019 ◽  
Vol 40 (12) ◽  
pp. 2454-2463 ◽  
Author(s):  
Weiyi Zeng ◽  
Yaojing Chen ◽  
Zhibao Zhu ◽  
Shudan Gao ◽  
Jianan Xia ◽  
...  
Keyword(s):  
White Matter ◽  
Episodic Memory ◽  
Specific Pattern ◽  
White Matter Hyperintensity ◽  
Common Finding ◽  
Superior Cerebellar Peduncle ◽  
Brain White Matter ◽  
Brain Microstructure ◽  
Cerebellar Peduncle ◽  
Fazekas Scale

White matter hyperintensity (WMH) is a common finding in aging population and considered to be a contributor to cognitive decline. Our study aimed to characterize the spatial patterns of WMH in different severities and explore its impact on cognition and brain microstructure in non-demented elderly. Lesions were both qualitatively (Fazekas scale) and quantitatively assessed among 321 community-dwelled individuals with MRI scanning. Voxel- and atlas-based analyses of the whole-brain white matter microstructure were performed. The WMH of the same severities was found to occur uniformly with a specific pattern of lesions. The severity of WMH had a significant negative association with the performance of working and episodic memory, beginning to appear in Fazekas 3 and 4. The white matter tracts presented significant impairments in Fazekas 3, which showed brain-wide changes above Fazekas 4. Lower FA in the superior cerebellar peduncle and left posterior thalamic radiation was mainly associated with episodic memory, and the middle cerebellar peduncle was significantly associated with working memory. These results support that memory is the primary domain to be affected by WMH, and the effect may potentially be influenced by tract-specific WM abnormalities. Fazekas scale 3 might be the critical stage predicting a future decline in cognition.

Metabolic Syndrome is Associated with White Matter Hyperintensity in Stroke Patients

2017 ◽  
Vol 18 (3) ◽  
pp. 277-283
Author(s):  
Zheng Zhang ◽  
Wan-Li Zhang ◽  
Jia Li ◽  
Mei-Juan Xiao
Keyword(s):  
Metabolic Syndrome ◽  
White Matter ◽  
Acute Stroke ◽  
Old Age ◽  
Univariate Analysis ◽  
Serum Triglyceride ◽  
White Matter Hyperintensity ◽  
Acute Ischemia ◽  
Stroke Patients ◽  
Cross Sectional

Some risk factors of stroke may play a role in white matter hyperintensity (WMH). Metabolic syndrome (MetS) is a recognised risk factor of stroke, but it is controversial whether MetS is also associated with WMH. We examined the association of MetS with the prevalence of WMH in acute stroke patients. We conducted a cross-sectional study in 246 acute ischemia stroke patients. The patients with acute stroke were clinically evaluated, including waistline circumference, blood pressure, glycaemia, serum triglyceride and high density lipoprotein cholesterol level. The degree of WMH was assessed by Fluid-attenuated inversion recovery (FLAIR) sequence of magnetic resonance imaging (MRI) scans. MetS was diagnosed using the criteria by the National Cholesterol Education Adult Treatment Panel III. MetS was the independent variable evaluated in Binary regression analyses. It is found that old age (>60 years old), MetS and smoking were significantly associated with WMH in univariate analysis (p < .05). Spearman rank correlation showed that old age and MetS are related to WMH (r = 0.18, p = .005 and r = 0.18, p = .004, respectively). Hypertension is weakly but not significantly associated with WMH in correlation analysis (r = 0.11, p = .08). In multiple regression analysis, age and MetS remained independently associated with WMH (OR = 7.6, 95% CI 0.2–0.7 and OR = 11.7, 95% CI 0.1–0.5). Hypertension and hyperglycaemia tend to be associated but not significantly with WMH (p = .07, p = .08). Other MetS components such as large waist circumference and dyslipidaemia showed no association with WMH. After adjustment for age, WMH is significantly associated with MetS in stroke patients. Hypertension and hyperglycaemia tend to associated but not significantly with WMH in stroke patients.

scholarly journals Changes of Healthy Brain Tissue after Salvage Radiotherapy of Glioblastoma Multiforme

2021 ◽  
Author(s):  
Leandra De La Cruz ◽  
Xioran Chen ◽  
Ender Konugoglu ◽  
I Frank Ciernik
Keyword(s):  
White Matter ◽  
Glioblastoma Multiforme ◽  
Brain Structures ◽  
Volumetric Analysis ◽  
Recurrent Glioblastoma ◽  
Salvage Radiotherapy ◽  
Manual Segmentation ◽  
Recurrent Glioblastoma Multiforme ◽  
Before And After ◽  
Magnetic Resonance Imaging Mri

Abstract Background Salvage radiotherapy (SRT) with photons is a valid treatment option for patients suffering from recurrent glioblastoma multiforme (GBM). However, the tolerance of healthy brain to ionizing radiation (IR) is limited. The aim of this study was to determine to what extent brain structures in the radiographically tumor-free hemisphere change after repeated radiotherapy. Methods Five of 26 patients treated with SRT for local recurrence of GBM were found to have magnetic resonance imaging (MRI) studies available for complete volumetric analysis before and after primary chemo-radiation and after SRT. Manual segmentation and joint segmentation (JS) based on a convolutional neural network were used for the segmentation of the grey matter, the white matter and the ventricles in T1 MRIs. Results Qualitative results of manual segmentation and JS were comparable. After primary chemo-radiation and SRT, the volume of the contralateral ventricles increased steadily by 1.3 to 4.75 % (SD +/- 2.8 %, R 2 = 0.82; p= &lt;0.01) with a manual segmentation and by 1.4 to 7.4 % (SD 2.1 %, R 2 = 0.48; p= 0.025) with JS. The volume of the cortex decreased by 3.4 – 7.3 % except in one patient, the cortex volume increased by 2.5% (SD +/- 2.9%, R 2 =0.18; p = 0.19) when measured manually. When measured with JS GM decreased by 1.0 to 7.4%, in one case it increased by 3.0% (SD = 3.2%, p = 0.22, R 2= 0.18). The white matter remained stable when assessed with manual segmentation (p = 0.84, R 2 = 0.004) or JS (p = 0.44, R 2 = 0.07). Conclusion SRT of relapsed GBM leads to continuous changes of the tumor-free contralateral brain by means of manual segmentation or JS. The cortex seems more susceptible to repeated RT compared to the white matter. Larger cohort studies and complementary functional analysis are encouraged.

scholarly journals White Matter Hyperintensity Regression: Comparison of Brain Atrophy and Cognitive Profiles with Progression and Stable Groups

2019 ◽  
Vol 9 (7) ◽  
pp. 170 ◽  
Author(s):  
Omar M. Al-Janabi ◽  
Christopher E. Bauer ◽  
Larry B. Goldstein ◽  
Richard R. Murphy ◽  
Ahmed A. Bahrani ◽  
...  
Keyword(s):  
White Matter ◽  
Brain Atrophy ◽  
Memory Performance ◽  
Subcortical White Matter ◽  
Cognitive Status ◽  
White Matter Hyperintensity ◽  
Cognitive Profiles ◽  
Cognitive Measures ◽  
Volumetric Quantification ◽  
Over Time

Subcortical white matter hyperintensities (WMHs) in the aging population frequently represent vascular injury that may lead to cognitive impairment. WMH progression is well described, but the factors underlying WMH regression remain poorly understood. A sample of 351 participants from the Alzheimer’s Disease Neuroimaging Initiative 2 (ADNI2) was explored who had WMH volumetric quantification, structural brain measures, and cognitive measures (memory and executive function) at baseline and after approximately 2 years. Selected participants were categorized into three groups based on WMH change over time, including those that demonstrated regression (n = 96; 25.5%), stability (n = 72; 19.1%), and progression (n = 209; 55.4%). There were no significant differences in age, education, sex, or cognitive status between groups. Analysis of variance demonstrated significant differences in atrophy between the progression and both regression (p = 0.004) and stable groups (p = 0.012). Memory assessments improved over time in the regression and stable groups but declined in the progression group (p = 0.003; p = 0.018). WMH regression is associated with decreased brain atrophy and improvement in memory performance over two years compared to those with WMH progression, in whom memory and brain atrophy worsened. These data suggest that WMHs are dynamic and associated with changes in atrophy and cognition.

scholarly journals A Ferret Model of Encephalopathy of Prematurity

2018 ◽  
Vol 40 (5-6) ◽  
pp. 475-489 ◽  
Author(s):  
Thomas Wood ◽  
Daniel Moralejo ◽  
Kylie Corry ◽  
Jessica M. Snyder ◽  
Christopher Traudt ◽  
...  
Keyword(s):  
White Matter ◽  
Ex Vivo ◽  
Immunohistochemical Analysis ◽  
White Matter Injury ◽  
Therapeutic Interventions ◽  
White Matter Hyperintensity ◽  
Motor Deficits ◽  
Gait Coordination ◽  
Magnetic Resonance Imaging Mri ◽  
Saline Vehicle

There is an ongoing need for relevant animal models in which to test therapeutic interventions for infants with neurological sequelae of prematurity. The ferret is an attractive model species as it has a gyrified brain with a white-to-gray matter ratio similar to that in the human brain. A model of encephalopathy of prematurity was developed in postnatal day 10 (P10) ferret kits, considered to be developmentally equivalent to infants of 24–26 weeks’ gestation. Cross-fostered P10 ferret kits received 5 mg/kg of lipopolysaccharide (LPS) before undergoing consecutive hypoxia-hyperoxia-hypoxia (60 min at 9%, 120 min at 60%, and 30 min at 9%). Control animals received saline vehicle followed by normoxia. The development of basic reflexes (negative geotaxis, cliff aversion, and righting) as well as gait coordination on an automated catwalk were assessed between P28 and P70, followed by ex vivo magnetic resonance imaging (MRI) and immunohistochemical analysis. Compared to controls, injured animals had slower overall reflex development between P28 and P40, as well as smaller hind-paw areas consistent with “toe walking” at P42. Injured animals also displayed significantly greater lateral movement during CatWalk assessment as a result of reduced gait coordination. Ex vivo MRI showed widespread white-matter hyperintensity on T2-weighted imaging as well as altered connectivity patterns. This coincided with white-matter dysmaturation characterized by increased intensity of myelin basic protein staining, white-matter thinning, and loss of oligodendrocyte transcription factor 2 (OLIG2)-positive cells. These results suggest both pathological and motor deficits consistent with premature white-matter injury. This newborn ferret model can therefore provide an additional platform to assess potential therapies before translation to human clinical trials.

scholarly journals Threshold-based Identification of Persistent Infarction after Successful Endovascular Treatment: Re-evaluating the “Core”

2020 ◽  
Author(s):  
Raphael Meier ◽  
Paula Lux ◽  
Richard McKinley ◽  
Simon Jung ◽  
Urs Fischer ◽  
...  
Keyword(s):  
White Matter ◽  
Endovascular Treatment ◽  
Recombinant Tissue Plasminogen Activator ◽  
Volumetric Analysis ◽  
Lesion Volume ◽  
Tissue Plasminogen ◽  
Optimal Values ◽  
Magnetic Resonance Imaging Mri ◽  
Improved Accuracy

AbstractObjectivesThe objectives of this study included the volumetric analysis of persistent infarction and lesion reversal in Diffusion-Weighted Imaging (DWI), as well as the assessment of accuracy of ADC thresholds to identify regions of persistent infarction in patients with acute ischemic stroke after successful endovascular treatment (EVT).Materials and MethodsA retrospective analysis of patients with M1 or proximal M2 occlusions, treated between 01/2012 and 07/2017, who underwent successful EVT (≥TICI 2b) and both pre- and post-interventional Magnetic Resonance Imaging (MRI), led to the inclusion of N=90 patients. Administration of recombinant tissue plasminogen activator (rTPA) for intra-venous thrombolysis was performed ahead of intervention in 45 cases (N=45/90, 50%). The majority of patients (N=78/90, 86.7%) were treated with second-generation thrombectomy devices with or without intra-arterial urokinase. DWI at admission and 24-hour follow-up DWI data were co-registered. Acute ischemic changes at baseline DWI, 24-hour DWI lesion, and the affected gray/white matter regions were manually annotated. Persistent infarction was defined as acute ischemic changes on baseline DWI, which were sustained on 24-hour follow-up DWI. Based on the manual annotations, persistent infarction and DWI reversal were quantified in a voxel-wise analysis. Thresholds for the identification of persistent infarction using baseline ADC images were estimated by maximizing Youden’s J statistic (ROC-analysis).ResultsMedian age of the patients was 71.9 years (IQR 60.4–79.7 years), 55.6% were female, and NIHSS at admission was 11 (IQR 6–14). The median DWI lesion volume at baseline was 9.9 mL (IQR 3–23.6 mL) and the median DWI lesion volume around 24 hours was 12.1 mL (IQR 3.6–23.7 mL). Reversal of acute ischemic changes occurred frequently (49.8%, IQR 31.7%–65.4%; percentage of initial DWI lesion volume per subject). Sizeable DWI reversal (i.e. >10 mL and >10%) was observed in 26.7% (N=24/90) of the cases. Relative DWI reversal was significantly higher in white matter (58.6%, IQR 35.3–81.5%) than in gray matter (39.2%, IQR 24.9–56.6%; p<0.001). The volume of persistent infarction and DWI reversal were both significantly correlated with the DWI lesion volume at baseline (R=0.873–0.945, p<0.001), however, no correlations with time to reperfusion were found (relative volumes: R=-/+0.058, p=0.607). ROC analyses of ADC thresholds yielded optimal values which differed significantly for gray and white matter (p=0.003), and were lower than previously reported thresholds while having significantly improved accuracy (p≤0.015). No correlations between the estimated ADC thresholds and different covariates were found (time from imaging to reperfusion, time from baseline to follow-up imaging, volume of acute ischemic changes).ConclusionsDWI reversal occurs frequently in successfully reperfused patients treated with modern EVT. Identification of persistent infarction using ADC thresholds in baseline DWI remains challenging with notable differences for gray and white matter.

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