Magnetic resonance imaging changes following natalizumab discontinuation in multiple sclerosis patients with progressive multifocal leukoencephalopathy

2018 ◽  
Vol 24 (14) ◽  
pp. 1902-1908 ◽  
Author(s):  
Jérôme Hodel ◽  
Blanche Bapst ◽  
Olivier Outteryck ◽  
Sébastien Verclytte ◽  
Vincent Deramecourt ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Contrast Enhancement ◽  
Mass Effect ◽  
Resonance Imaging ◽  
Post Contrast ◽  
Fluid Attenuated Inversion Recovery ◽  
Multiple Sclerosis Patients ◽  
Mri Changes

Background: Detecting early progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome (PML-IRIS) is clinically relevant. Objective: Evaluating magnetic resonance imaging (MRI) changes following natalizumab (NTZ) discontinuation and preceding PML-IRIS. Methods: MRIs (including diffusion-weighted imaging (DWI), T2-weighted fluid-attenuated inversion recovery (T2-FLAIR), post-contrast T1-weighted sequences) were performed every week following PML diagnosis in 11 consecutive NTZ-PML patients. PML expansion, punctate lesions, contrast-enhancement, and mass-effect/edema were evaluated on each MRI sequence, following NTZ discontinuation. Results: PML-IRIS occurred from 26 to 89 days after NTZ discontinuation. MRI changes prior to early PML-IRIS appeared significantly more pronounced using DWI compared to T2-FLAIR imaging ( p < 0.003). Two DWI features (marked PML expansion, punctate lesions) systematically preceded contrast-enhancement. Conclusion: Subtle changes may occur on DWI preceding contrast-enhancement.

scholarly journals Correlative Magnetic Resonance Imaging and Histopathology in Small Ruminant Listeria Rhombencephalitis

2020 ◽  
Vol 11 ◽  
Author(s):  
Christina Precht ◽  
Peter Vermathen ◽  
Diana Henke ◽  
Anne Staudacher ◽  
Josiane Lauper ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Contrast Enhancement ◽  
Signal Intensity ◽  
Small Ruminants ◽  
Large Animal ◽  
Resonance Imaging ◽  
Post Contrast ◽  
Mri Features ◽  
Inflammatory Infiltrates

Background: Listeria rhombencephalitis, infection of the brainstem with Listeria monocytogenes, occurs mainly in humans and farmed ruminants and is associated with high fatality rates. Small ruminants (goats and sheep) are a large animal model due to neuropathological similarities. The purpose of this study was to define magnetic resonance imaging (MRI) features of listeria rhombencephalitis in naturally infected small ruminants and correlate them with histopathology. Secondly, the purpose of this study was to compare the results with MRI findings reported in humans.Methods: Twenty small ruminants (13 sheep and 7 goats) with listeria rhombencephalitis were prospectively enrolled and underwent in vivo MRI of the brain, including T2-weighted, fluid attenuation inversion recovery, and T1-weighted sequences pre- and post-contrast administration and postmortem histopathology. In MRI, lesions were characterized by location, extent, border definition, signal intensity, and contrast enhancement. In histopathology, the location, cell type, severity, and chronicity of inflammatory infiltrates and signs of vascular damage were recorded. In addition, histopathologic slides were matched to MRIs, and histopathologic and MRI features were compared.Results: Asymmetric T2-hyperintense lesions in the brainstem were observed in all animals and corresponded to the location and pattern of inflammatory infiltrates in histopathology. Contrast enhancement in the brainstem was observed in 10 animals and was associated with vessel wall damage and perivascular fibrin accumulation in 8 of 10 animals. MRI underestimated the extension into rostral brain parts and the involvement of trigeminal ganglia and meninges.Conclusion: Asymmetric T2-hyperintense lesions in the brainstem with or without contrast enhancement can be established as criteria for the diagnosis of listeria rhombencephalitis in small ruminants. Brainstem lesions were similar to human listeria rhombencephalitis in terms of signal intensity and location. Different from humans, contrast enhancement was a rare finding, and abscessation was not observed.

Uterine fibroid embolization can still be improved: observations on post-procedure magnetic resonance imaging

2005 ◽  
Vol 46 (5) ◽  
pp. 547-553 ◽  
Author(s):  
E. J. Dorenberg ◽  
Z. Novakovic ◽  
H.-J. Smith ◽  
G. Hafsahl ◽  
J. Å. Jakobsen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Contrast Enhancement ◽  
Uterine Fibroid ◽  
Uterine Fibroids ◽  
Resonance Imaging ◽  
Post Contrast ◽  
Uterine Fibroid Embolization ◽  
Uterine Arteries ◽  
Uterine Volume

Purpose: To evaluate the efficacy and completeness of uterine fibroid embolization (UFE) measured by changes in volume and signal intensity at magnetic resonance imaging (MRI), and to compare with clinical outcome. Material and Methods: 40 women with symptomatic uterine fibroids underwent bilateral uterine artery embolization. At MRI studies, including post-contrast sequences before and repeatedly after treatment, the uterus and dominant fibroids were evaluated for volume, location, and contrast enhancement. Prior to treatment, all myomas showed significant contrast enhancement. The mean uterine volume was 929 ml. Clinical examinations with emphasis on menorrhagia, pelvic pain, and urinary dysfunction were performed before and 6 and 12 months after treatment. Results: UFE was bilaterally successful in 38 patients. After UFE, MRI showed no enhancement of myomas in 30 patients. In 8 patients, post-procedural MRI revealed partially remaining vascularization of fibroids despite angiographically complete embolization of the uterine arteries. On average, uterine volume decreased by 46.2% at 12 months. There was significant improvement of symptoms in the majority of patients, but slightly less improvement in patients with partially remaining vascularization of myomas. Conclusion: UFE causes significant volume reduction of myomas and clinical improvement. MRI can reveal remaining vascularization in myomas despite angiographically complete embolization of uterine arteries.

Understanding progressive multifocal leukoencephalopathy: links between milky-way appearance and mismatch T2/FLAIR

2021 ◽  
pp. 197140092110193
Author(s):  
Emiliano Ruiz Romagnoli ◽  
Manuel Perez Akly ◽  
Luis A Miquelini ◽  
Jorge Funes ◽  
Tatiana Gillanders ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Milky Way ◽  
High Sensitivity ◽  
Inversion Recovery ◽  
Motor Deficit ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Fluid Attenuated Inversion Recovery

Background Magnetic resonance imaging is essential to diagnose progressive multifocal leukoencephalopathy. The broad radiological spectrum may partially be explained by genetic viral mutations and their differential neurotropism. Recent pharmacovigilance-magnetic resonance imaging studies have provided new insight into pathophysiology and radiological markers of early stages. However, how lesions evolve and why certain anatomical locations are more frequently affected remains unknown. We aim to describe a new sign – T2/fluid-attenutated inversion recovery mismatch – as a complementary marker of cavitated lesions and propose a link with the milky-way appearance, a key early sign. Furthermore, we hypothesise viral dissemination routes. Methods We conducted a retrospective longitudinal study from January 2010 to January 2020, to analyse clinical and magnetic resonance imaging features of 13 progressive multifocal leukoencephalopathy individuals at the symptomatic stage (mean age 58.3 years (SD ± 16.8) – 61.5% were women). Results The most prevalent pathology was HIV (61.5%) and motor deficit prevailed regarding other symptoms (76.9%). Frontal lobes (76.9%), middle cerebellar peduncle (61.5%), cerebellum (61.5%), and pons (53.8%) were most commonly affected, and the cortico-ponto-cerebellar pathway seemed involved in these patients. Five patients had a pure radiological pattern. Milky-way appearance was the most frequent radiological sign (58.3%). Five patients with milky-way appearance had concomitantly T2/fluid-attenuated inversion recovery mismatch ( P = 0.02). This sign showed high sensitivity and specificity (100–71%, P = 0.02) to assess evolved lesions besides diffusion. Conclusion The possible tract-dependent spread, as well as clinical and genetic, have implications on the MRI variability of progressive multifocal leukoencephalopathy. The milky-way appearance could reflect a transitional phase towards evolved lesions, the latter demonstrated by T2/fluid-attenuated inversion recovery mismatch. Both could be key magnetic resonance imaging signs to diagnose progressive multifocal leukoencephalopathy at the symptomatic stage.

scholarly journals Cardiac magnetic resonance imaging of myocardial mass and fibrosis in primary aldosteronism

2018 ◽  
Vol 7 (3) ◽  
pp. 413-424 ◽  
Author(s):  
Marianne Aa Grytaas ◽  
Kjersti Sellevåg ◽  
Hrafnkell B Thordarson ◽  
Eystein S Husebye ◽  
Kristian Løvås ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Contrast Enhancement ◽  
Primary Aldosteronism ◽  
T1 Mapping ◽  
Newly Diagnosed ◽  
Resonance Imaging ◽  
Post Contrast ◽  
Lv Mass

Background Primary aldosteronism (PA) is associated with increased cardiovascular morbidity, presumably due to left ventricular (LV) hypertrophy and fibrosis. However, the degree of fibrosis has not been extensively studied. Cardiac magnetic resonance imaging (CMR) contrast enhancement and novel sensitive T1 mapping to estimate increased extracellular volume (ECV) are available to measure the extent of fibrosis. Objectives To assess LV mass and fibrosis before and after treatment of PA using CMR with contrast enhancement and T1 mapping. Methods Fifteen patients with newly diagnosed PA (PA1) and 24 age- and sex-matched healthy subjects (HS) were studied by CMR with contrast enhancement. Repeated imaging with a new scanner with T1 mapping was performed in 14 of the PA1 and 20 of the HS median 18 months after specific PA treatment and in additional 16 newly diagnosed PA patients (PA2). Results PA1 had higher baseline LV mass index than HS (69 (53–91) vs 51 (40–72) g/m2; P < 0.001), which decreased significantly after treatment (58 (40–86) g/m2; P < 0.001 vs baseline), more with adrenalectomy (n = 8; −9 g/m2; P = 0.003) than with medical treatment (n = 6; −5 g/m2; P = 0.075). No baseline difference was found in contrast enhancement between PA1 and HS. T1 mapping showed no increase in ECV as a myocardial fibrosis marker in PA. Moreover, ECV was lower in the untreated PA2 than HS 10 min post-contrast, and in both PA groups compared with HS 20 min post-contrast. Conclusion Specific treatment rapidly reduced LV mass in PA. Increased myocardial fibrosis was not found and may not represent a common clinical problem.

scholarly journals Low-field magnetic resonance imaging of otitis media in two cats: a case report

2017 ◽  
Vol 62 (No. 2) ◽  
pp. 111-115
Author(s):  
Y. Zhalniarovich ◽  
A. Przeworski ◽  
J. Glodek ◽  
Z. Adamiak
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Otitis Media ◽  
Middle Ear ◽  
Inversion Recovery ◽  
Inversion Recovery Sequence ◽  
Resonance Imaging ◽  
Recovery Sequence ◽  
Post Contrast ◽  
Fluid Attenuated Inversion Recovery

Otitis media is a common disease in clinical veterinary practice. Although low-field magnetic resonance imaging reports for otitis media in dogs exist, in cats detailed information is missing. Radiography is helpful in diagnosing chronic inflammation, but may be insufficient during the initial phase of inflammation. For this reason, this report describes the magnetic resonance findings in two cats with otitis media. In both cases, middle ear empyema was detected. Magnetic resonance imaging of middle ear disorders in cats should contain pre- and post-contrast T1-weighted sequences in the dorsal and transverse planes, a T2-weighted sequence in the dorsal and transverse planes and a fluid-attenuated inversion recovery sequence in the dorsal or transverse planes. On pre-contrast T1-weighted images, the empyema had an intensity similar to that of brain tissue with a delicate hyper-intensity in the middle. On post-contrast T1-weighted images, the material had non-uniform enhancement in the dorsolateral compartment and circumference enhancement in the ventromedial compartment of the tympanic bulla with a hypo-intense centre. On T2-weighted images, the mass had heterogeneously increased signal intensity to brain tissue, but was less intense than cerebrospinal fluid. In the fluid-attenuated inversion recovery sequence, the pathological lesion was distinctly hyper-intense in comparison to other tissues with a narrow area of increased signal intensity in the middle of the ventromedial tympanic bulla compartment. Magnetic resonance imaging is commonly used for the visualisation of different disorders of the membranous labyrinth and allows the differentiation of chronic hematomas, empyemas and middle and internal ear neoplasia. The recommended magnetic resonance protocol of the middle ear should include pre- and post-contrast T1 sequences in the dorsal and transverse planes, the T2 sequence in the dorsal and transverse planes and the fluid-attenuated inversion recovery sequence in the dorsal or transverse planes.

Prognostic Value of Early Magnetic Resonance Imaging Patterns in Sudden Hearing Loss

2021 ◽  
pp. 1-11
Author(s):  
Giorgio Conte ◽  
Federica Di Berardino ◽  
Rodolfo Francesco Mastrapasqua ◽  
Silvia Casale ◽  
Elisa Scola ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hearing Loss ◽  
Magnetic Resonance ◽  
Hearing Threshold ◽  
Clinical History ◽  
Sudden Hearing Loss ◽  
Resonance Imaging ◽  
Post Contrast ◽  
Significant Difference ◽  
Fluid Attenuated Inversion Recovery

<b><i>Introduction:</i></b> Sudden sensorineural hearing loss (SSHL) is a relatively frequent disease, but a sensitive marker or a reliable test to identify the underlying cause is still unavailable. Neuroradiology appears to offer the most promising tools, especially magnetic resonance imaging (MRI). In a recent study from our group, we explored the ability of MRI to detect subtle changes in the inner ear compartments by means of a 3D-fluid-attenuated inversion recovery sequence, aiming at identifying 3 distinct MRI patterns (haemorrhagic, inflammatory, brain-labyrinth barrier breakdown). In the present study, we contrasted the MRI patterns at onset with relevant prognostic factors, with the audiological features of each patient’s SSHL and with treatment outcomes. <b><i>Methods:</i></b> In this retrospective study, we enrolled 50 adult subjects (54.61 ± 18.26 years) with SSHL. They underwent an MRI within 72 h from admission, and 5 audiological evaluations: at admission, on the 5th day after the start of medical therapy, at the end of the first cycle of hyperbaric oxygen therapy, then 1 and 6 months later. <b><i>Results:</i></b> Abnormalities of the MRI signal and/or post-contrast enhancement asymmetry of the cochlea (“pattern+ MRI”) correlated with worse audiological outcomes at 1 month, but the different MRI patterns were not correlated with any specific prognostic model, despite rigid protocol settings. However, a significant difference was found for low-tone SSHL, which were always “pattern<i>”</i> negative at MRI (<i>p</i> = 0.01), and for profound SSHL which demonstrated a pattern+ MRI in 80% (<i>p</i> = 0.04). At the onset of SSHL, a pattern+ MRI was found in 29/50 cases (58.0%) and was related with lesser degree of recovery of pure-tone average at 1 month and lesser chance to retain the hearing threshold benefit in the long term. Given the limited numbers of patients enrolled so far, the relative impact of comorbidities on each MRI pattern remains uncertain. At 6 months, we observed a trend of greater and more stable recovery (<i>p</i> = 0.023) and less frequent recurrence of SSHL in patients with a normal MRI. <b><i>Conclusions:</i></b> The 3 observed MRI patterns did not correlate consistently with specific audio-vestibular features or any peculiar aspect of the patient’s clinical history. Larger series of patients with SSHL are needed, possibly from multicentric studies.

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