scholarly journals Effects of Cilostazol and Isosorbide Mononitrate on Cerebral Hemodynamics in the LACI-1 Randomized Controlled Trial

Stroke ◽  
2021 ◽  
Author(s):  
Gordon W. Blair ◽  
Esther Janssen ◽  
Michael S. Stringer ◽  
Michael J. Thrippleton ◽  
Francesca Chappell ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Small Vessel Disease ◽  
Small Sample ◽  
Cerebrovascular Reactivity ◽  
Isosorbide Mononitrate ◽  
Resonance Imaging ◽  
Unique Identifier ◽  
Link Type ◽  
Cerebrovascular Function

Background and Purpose: Cerebral small vessel disease—a major cause of stroke and dementia—is associated with cerebrovascular dysfunction. We investigated whether short-term isosorbide mononitrate (ISMN) and cilostazol, alone or in combination, improved magnetic resonance imaging–measured cerebrovascular function in patients with lacunar ischemic stroke. Methods: Participants were randomized to ISMN alone, cilostazol alone, both ISMN and cilostazol, or no medication. Participants underwent structural, cerebrovascular reactivity (to 6% carbon dioxide) and phase-contrast pulsatility magnetic resonance imaging at baseline and after 8 weeks of medication. Results: Of 27 participants (mean age, 68±7.7; 44% female), 22 completed cerebrovascular reactivity and pulsatility imaging with complete datasets. White matter cerebrovascular reactivity increased in the ISMN (β=0.021%/mm Hg [95% CI, 0.003–0.040]) and cilostazol (β=0.035%/mm Hg [95% CI, 0.014–0.056]) monotherapy groups and in those taking any versus no medication (β=0.021%/mm Hg [95% CI, 0.005–0.037]). Conclusions: While limited by small sample size, we demonstrate that measuring cerebrovascular function with magnetic resonance imaging is feasible in clinical trials and that ISMN and cilostazol may improve cerebrovascular function. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02481323. URL: www.isrctn.com ; Unique identifier: ISRCTN12580546. URL: www.clinicaltrialsregister.eu ; Unique identifier: EudraCT 2015-001953-33.

scholarly journals Magnetic resonance imaging for assessment of cerebrovascular reactivity in cerebral small vessel disease: A systematic review

2016 ◽  
Vol 36 (5) ◽  
pp. 833-841 ◽  
Author(s):  
Gordon W Blair ◽  
Fergus N Doubal ◽  
Michael J Thrippleton ◽  
Ian Marshall ◽  
Joanna M Wardlaw
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Magnetic Resonance ◽  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Cerebrovascular Reactivity ◽  
Small Vessel ◽  
Resonance Imaging ◽  
Vessel Disease

Cerebral small vessel disease (SVD) pathophysiology is poorly understood. Cerebrovascular reactivity (CVR) impairment may play a role, but evidence to date is mainly indirect. Magnetic resonance imaging (MRI) allows investigation of CVR directly in the tissues affected by SVD. We systematically reviewed the use of MRI to measure CVR in subjects with SVD. Five studies (total n = 155 SVD subjects, 84 controls) provided relevant data. The studies included different types of patients. Each study used blood oxygen level dependent (BOLD) MRI to assess CVR but a different vasoactive stimulus and method of calculating CVR. CVR decreased with increasing white matter hyperintensities in two studies ( n = 17, 11%) and in the presence of microbleeds in another. Three studies ( n = 138, 89%) found no association of CVR with white matter hyperintensities. No studies provided tissue-specific CVR values. CVR decreased with age in three studies, and with female gender and increasing diastolic blood pressure in one study. Safety and tolerability data were limited. Larger studies using CVR appear to be feasible and are needed, preferably with more standardized methods, to determine if specific clinical or radiological features of SVD are more or less associated with impaired CVR.

scholarly journals Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Emilie Sleight ◽  
Michael S. Stringer ◽  
Ian Marshall ◽  
Joanna M. Wardlaw ◽  
Michael J. Thrippleton
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Small Vessel Disease ◽  
Pulse Sequence ◽  
Cerebrovascular Reactivity ◽  
Image Processing Technique ◽  
Small Vessel ◽  
Resonance Imaging ◽  
Vessel Disease ◽  
End Tidal

Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.

Magnetic resonance imaging findings and its association to electroencephalogram in children with partial epilepsy (Preprint)

2020 ◽  
Author(s):  
Huynh Quang Huy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Preschool Children ◽  
Magnetic Resonance ◽  
Brain Mri ◽  
Partial Epilepsy ◽  
Small Sample ◽  
Normal Brain ◽  
Resonance Imaging ◽  
Normal Children ◽  
Eeg Abnormalities

BACKGROUND It is important to identify the neuroimaging features that are associated with partial epilepsy in preschool children. Advances in technology recently to localize focal epileptogenic lesions, especially that of high-resolution structural imaging with magnetic resonance imaging (MRI). The recommendation that electroencephalography (EEG) should be gold criteria and that M.R.I should be optional has been questioned. OBJECTIVE The present study aims to to explore the brain lesions on MRI and its association to electroencephalogram in children with partial epilepsy. METHODS The present study was conducted among 112 preschool children with history of partial seizures. All patients underwent EEG and brain MRI. The epileptogenic lesions were identified on the basis of the signal intensities and morphological abnormalities seen on MRI. The correlation between MRI and EEG abnormalities was explored using a chi-square test. RESULTS Abnormal MRI were found in 34.8% (n = 39) of the sample. The EEG and MRI agreed with respect to classify into abnormal or normal in 48.2% (n = 54). Of the 27 patients with a normal EEG, six (22.2%) were seen to have an abnormal MRI. CONCLUSIONS A number of MRI abnormalities was found in our study of otherwise normal children, although the correlation between these results was not clear. Follow-up of these children will help us identify the important abnormalities. Despite of small sample, our results showed that a normal E.E.G findings does not predict a normal brain MRI in children with partial epilepsy.

scholarly journals Correction to: Association of dynamic susceptibility magnetic resonance imaging at initial tumor diagnosis with the prognosis of different molecular glioma subtypes

2021 ◽  
Author(s):  
Cornelia Brendle ◽  
Uwe Klose ◽  
Johann-Martin Hempel ◽  
Jens Schittenhelm ◽  
Marco Skardelly ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Tumor Diagnosis ◽  
Dynamic Susceptibility ◽  
Resonance Imaging ◽  
Link Type ◽  
Initial Tumor

A Correction to this paper has been published: https://doi.org/10.1007/s10072-021-05352-6

scholarly journals Risk factors for small-vessel disease revealed by magnetic resonance imaging of the brain.

Nosotchu ◽  
1996 ◽  
Vol 18 (1) ◽  
pp. 10-18
Author(s):  
Tatsuo Kohriyama ◽  
Shinya Yamaguchi ◽  
Eiji Tanaka ◽  
Yasuhiro Yamamura ◽  
Shigenobu Nakamura
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Resonance Imaging ◽  
Vessel Disease ◽  
The Brain

scholarly journals Serum Bicarbonate Concentration and Cognitive Function in Hypertensive Adults

2018 ◽  
Vol 13 (4) ◽  
pp. 596-603 ◽  
Author(s):  
Mirela Dobre ◽  
Sarah A. Gaussoin ◽  
Jeffrey T. Bates ◽  
Michel B. Chonchol ◽  
Debbie L. Cohen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Executive Function ◽  
Metabolic Acidosis ◽  
Cognitive Function ◽  
Magnetic Resonance ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Resonance Imaging ◽  
Bicarbonate Concentration ◽  
Link Type

Background and objectivesCognitive function worsens as kidney function declines, but mechanisms contributing to this association are not completely understood. Metabolic acidosis, a common complication of CKD, leads to neural networks overexcitation and is involved in cerebral autoregulation. We aimed to evaluate the association between serum bicarbonate concentration as a measure of metabolic acidosis, and cognitive function in hypertensive adults with and without CKD.Design, setting, participants, & measurementsFive cognitive summary scores were measured (global cognitive function, executive function, memory, attention/concentration, and language) in 2853 participants in the Systolic BP Intervention Trial (SPRINT). Multivariable linear regression models adjusted for demographics, comorbidities, systolic BP, medications, eGFR and albuminuria evaluated the cross-sectional association between bicarbonate and cognition at SPRINT baseline. In a subset (n=681) who underwent brain magnetic resonance imaging, the models were adjusted for white matter hyperintensity volume, vascular reactivity, and cerebral blood flow.ResultsThe mean age (SD) was 68 (8.5) years. Global cognitive and executive functions were positively associated with serum bicarbonate (estimate [SEM]: 0.014 [0.006]; P=0.01, and 0.018 [0.006]; P=0.003, respectively). Each 1 mEq/L lower bicarbonate level had a similar association with global cognitive and executive function as being 4.3 and 5.4 months older, respectively. The association with global cognition persisted after magnetic resonance imaging findings adjustment (estimate [SEM]: 0.03 [0.01]; P=0.01). There was no association between serum bicarbonate level and memory, attention/concentration, and language.ConclusionsIn a large cohort of hypertensive adults, higher serum bicarbonate levels were independently associated with better global cognitive and executive performance. (ClinicalTrials.gov: NCT01206062).

Abstract 01: Retinal Microvascular Signs and White Matter MRI Findings: The Atherosclerosis Risk in Communities Neurocognitive Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jennifer A Deal ◽  
Melinda C Power ◽  
Karen Bandeen-Roche ◽  
Michael Griswold ◽  
David Knopman ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
White Matter ◽  
Magnetic Resonance ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Fundus Photography ◽  
Resonance Imaging ◽  
Lacunar Infarcts ◽  
Vessel Disease ◽  
Arteriolar Narrowing

Introduction: Cerebrovascular small vessel disease, seen on brain imaging as lacunes and white matter hyperintensities (WMH), is a substrate for dementia in older adults. Diffusion tensor imaging (DTI) is thought to provide early signs of loss of white matter (WM) integrity due to microvascular disease and predicts WM hyperintensity volume. Retinal fundus photography provides surrogate measures of cerebral microvasculature. No studies have quantified the long-term association between retinal signs and DTI measures. Hypothesis: Microvascular retinal signs measured in midlife are associated with small vessel disease measured on brain magnetic resonance imaging (MRI) 18 years later, including reduced WM microstructural integrity (lower fractional anisotrophy [FA] and greater mean diffusivity [MD] by DTI), greater WM hyperintensity volume and greater lacune prevalence. Methods: In a biracial prospective cohort study, retinal signs were measured using fundus photography (1993-1995) with 3-T magnetic resonance imaging conducted in 2011-13. Multivariable-adjusted linear regression was used to quantify the relationships of retinal signs with WM measures. Prevalence of lacunar infarcts by retinal sign status was estimated using log binomial regression. Analyses were adjusted for age [linear and quadratic terms], education, sex, race, intracranial volume, body mass index, smoking, diabetes, hypertension, and ≥1 APOE ε4 alleles. Results: In 1829 men and women (60% [N=1100] female, 27% [N=489] black race, aged 50-72 years when retinal signs were measured), a binary measure comprised of two retinal signs suggestive of arteriolar damage due to hypertension (focal arteriolar narrowing and/or arteriovenous nicking) was associated with worse (lower) FA (standardized β=-0.19, 95% confidence interval [CI]=-0.35, -0.02), worse (higher) MD (β=0.15, 95% CI=0.00, 0.30), greater WM hyperintensity volume (β=0.15, 95% CI=0.01, 0.30), and greater prevalence of lacunes (prevalence ratio=1.33, 95% CI: 0.99, 1.80). Generalized arteriolar narrowing, measured as the central retinal arteriolar equivalent (CRAE, narrowest quartile vs. widest three quartiles) was associated with worse FA (β=-0.13, 95% CI=-0.24, -0.01) and worse MD (β=0.12, 95% CI=0.01, 0.23). Results did not differ by sex, race, hypertension status or APOE ε4 genotype. No associations were found for retinopathy, but only 56 participants had retinopathy. Conclusions: Consistent with prior work, and as expected based on a common underlying pathology, retinal signs predicted WM disease and lacunar infarcts 18 years later. Novel to this study, we found that retinal signs related to arteriolar damage also predicted loss of white matter microvascular integrity measured using DTI.

scholarly journals Associations Between Plasma Ceramides and Cerebral Microbleeds or Lacunes

2020 ◽  
Vol 40 (11) ◽  
pp. 2785-2793
Author(s):  
Eseosa T. Ighodaro ◽  
Jonathan Graff-Radford ◽  
Jeremy A. Syrjanen ◽  
Hai H. Bui ◽  
Ronald C. Petersen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Odds Ratio ◽  
Small Vessel Disease ◽  
High Plasma ◽  
Population Based ◽  
Cerebral Microbleeds ◽  
Small Vessel ◽  
Resonance Imaging ◽  
Logistic Regression Models

Objective: High plasma ceramide levels and ratios are associated with poor outcomes in individuals with cardiovascular disease; less is known about their relation to cerebral small vessel disease. We examined whether high plasma ceramide levels or ratios were associated with cerebral microbleeds (CMBs) and lacunes and whether associations differ by sex. Approach and Results: We included 548 participants enrolled in the MCSA (Mayo Clinic Study of Aging) with concurrent plasma ceramide assays and magnetic resonance imaging. CMBs were quantified on T2* magnetic resonance imaging and lacunes on T2 fluid-attenuated inversion recovery magnetic resonance imaging. Fasting plasma ceramides were assayed using liquid chromatography-electrospray ionization tandem mass spectrometry. We used logistic regression models adjusting for age, sex, hypertension, and diabetes mellitus to examine the relationship between ceramides and presence of a lacune; hurdle models were used for presence and number of CMBs. Each SD increase in the log ceramide C16:0/24:0 ratio was associated with greater odds of a CMB (odds ratio, 1.28 [95% CI, 1.01–1.64]). There was an interaction between sex and the ceramide C16:0/24:0 ratio ( P =0.049). The association between this ratio and presence of a CMB was stronger for women (odds ratio, 1.87 [95% CI, 1.20–3.00]) than men (odds ratio, 1.09 [95% CI, 0.80–1.46]). Several ceramides and all ceramide ratios were associated with number of CMBs. We did not find associations between plasma ceramides and lacunes. Conclusions: In a population-based sample, the plasma ceramide C16:0/24:0 ratio was associated with CMBs and was stronger for women. Plasma ceramides are differentially associated with cerebral small vessel pathologies.

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