HARM revisited: Etiology of subarachnoid hyperintensities in brain FLAIR MRI

2022 ◽  
pp. 174749302110647
Author(s):  
Katharina Althaus ◽  
Martin Kasel ◽  
Albert C Ludolph ◽  
Jan Kassubek ◽  
Rebecca Kassubek
Keyword(s):  
Radiological Finding ◽  
Reperfusion Therapy ◽  
Clinical Findings ◽  
Hyperintense Signal ◽  
Signal Abnormality ◽  
Fluid Attenuated Inversion Recovery ◽  
Mri Sequences ◽  
Barrier Breakdown ◽  
Neurological Conditions ◽  
Magnetic Resonance Imaging Mri

Background: The hyperintense acute reperfusion marker (HARM) describes a phenomenon with a hyperintense signal in the subarachnoid space in Fluid-Attenuated Inversion Recovery (FLAIR) magnetic resonance imaging (MRI) sequences, presumably based on blood–brain barrier breakdown in acute stroke with reperfusion. However, this imaging phenomenon was described in other medical conditions. Aim: Determination of the prevalence and associated clinical findings of this phenomenon in a large sample of patients with different neurological conditions. Methods: This is retrospective, single-center, observational study of 23,948 cerebral MRIs acquired in a Neurological University Clinic over 5 years. The prevalence of HARM, the underlying diagnosis, and damage pattern were examined by chart analysis; MRI was analyzed regarding the type of acute lesions, extent of microangiopathic lesions, and whether gadolinium-based contrast agent (GBCA) was given. Results: Among the MRI data, 84 images (0.35%) from 61 patients were HARM-positive without a subarachnoid signal abnormality in any other sequence. Etiologies were heterogeneous; 35 patients had a cerebrovascular disease (CVD; 19 patients received recanalization therapy), 12 patients had an inflammatory central nervous system (CNS) disease and 14 patients had epilepsy. GBCA was applied to 64% of the patients. Conclusion: HARM was a rare radiological finding in a range of different neurological pathologies, not limited to stroke, or to previous reperfusion therapy and was not dependent on previous GBCA administration. Our data suggest that the term is too narrow in terms of the concepts of the underlying pathology. We propose to use the term FLAIR Subarachnoid Hyperintensity (“FLASH”) phenomenon which might better reflect the observation that the radiological sign can be associated with a variety of central neurological conditions without a straightforward association with therapy.

scholarly journals Association between the Perfusion/Diffusion and Diffusion/FLAIR Mismatch: Data from the AXIS2 Trial

2015 ◽  
Vol 35 (10) ◽  
pp. 1681-1686 ◽  
Author(s):  
Anke Wouters ◽  
Patrick Dupont ◽  
Erich B Ringelstein ◽  
Bo Norrving ◽  
Angel Chamorro ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Reperfusion Therapy ◽  
Additional Information ◽  
Tissue Plasminogen ◽  
Fluid Attenuated Inversion Recovery ◽  
Independent Association ◽  
Magnetic Resonance Imaging Mri ◽  
And Diffusion ◽  
Core Volume ◽  
Stroke Trial

The perfusion-/diffusion-weighted imaging (PWI/DWI) mismatch and the diffusion/fluid attenuated inversion recovery (DWI/FLAIR) mismatch are magnetic resonance imaging (MRI) markers of evolving brain ischemia. We examined whether the DWI/FLAIR mismatch was independently associated with the PWI/DWI mismatch. Furthermore, we determined whether the presence of the DWI/FLAIR mismatch in patients with the PWI/DWI mismatch would provide additional information regarding last seen normal time (LTM). We used data from the ‘AX200 for ischemic stroke’ trial (AXIS 2 study NCT00927836). We studied the association between the presence of the DWI/FLAIR and PWI/DWI mismatch, baseline National Institute of Health Stroke Scale (NIHSS), age, ischemic-core volume, gender, intravenous (IV) tissue plasminogen activator (tPA), and perfusion-mismatch volume in univariate analysis. Significant variables ( P < 0.05) were added into the final multivariate model. We analyzed 197 patients. Seventy-two (37%) had both the PWI/DWI and the DWI/FLAIR mismatch. Patients with the double mismatch pattern had a shorter LTM than patients with the PWI/DWI mismatch alone (Median difference 90 minutes, P < 0.01). Multivariate analysis confirmed the independent association between the two mismatch patterns (odds ratio (OR) 2.6, 95% confidence interval (CI) 1.2 to 5.4). Our study implies that the DWI/FLAIR mismatch and PWI/DWI mismatch are strongly associated, independent from LTM. Furthermore, in the presence of the PWI/DWI mismatch, the DWI/FLAIR pattern indicates a shorter LTM. This could have implications in selecting patients for reperfusion therapy.

Three-dimensional MRI sequences in MS diagnosis and research

2019 ◽  
Vol 25 (13) ◽  
pp. 1700-1709
Author(s):  
Xun Yang Hu ◽  
Luckshi Rajendran ◽  
Emmanuelle Lapointe ◽  
Roger Tam ◽  
David Li ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Inversion Recovery ◽  
Susceptibility Weighted Imaging ◽  
Resonance Imaging ◽  
Phase Sensitive Inversion Recovery ◽  
3D Mri ◽  
Fluid Attenuated Inversion Recovery ◽  
Mri Sequences ◽  
Phase Sensitive ◽  
Magnetic Resonance Imaging Mri

The most recent guidelines for magnetic resonance imaging (MRI) in multiple sclerosis (MS) recommend three-dimensional (3D) MRI sequences over their two-dimensional (2D) counterparts. This development has been made possible by advances in MRI scanner hardware and software. In this article, we review the 3D versions of conventional sequences, including T1-weighted, T2-weighted and fluid-attenuated inversion recovery (FLAIR), as well as more advanced scans, including double inversion recovery (DIR), FLAIR2, FLAIR*, phase-sensitive inversion recovery, and susceptibility weighted imaging (SWI).

scholarly journals Isolated Mammillary Bodies Damage—An Atypical Presentation of Wernicke Syndrome

2018 ◽  
Vol 8 (11) ◽  
pp. 104
Author(s):  
Samar Abbas ◽  
Halim Abboud ◽  
Moussa Chalah ◽  
Chadi Sabbagh ◽  
Samar Ayache
Keyword(s):  
Anterograde Amnesia ◽  
Complete Recovery ◽  
Resonance Imaging ◽  
Wernicke Encephalopathy ◽  
Mammillary Bodies ◽  
Fluid Attenuated Inversion Recovery ◽  
Partial Colectomy ◽  
Mri Sequences ◽  
Magnetic Resonance Imaging Mri ◽  
T2 Mri

We report atypical magnetic resonance imaging (MRI) lesions in a case of Wernicke encephalopathy. The patient presented with isolated anterograde amnesia following a partial colectomy complicated by peritonitis. Fluid-attenuated inversion recovery and T2 MRI sequences were normal. However, bilateral contrast enhancement of mammillary bodies was shown on T1 gadolinium-enhanced sequences. Blood tests revealed thiamine deficiency. The diagnosis of Wernicke encephalopathy was made and thiamine supplementation was given, resulting in complete recovery of the memory functions.

scholarly journals Statistical Estimation of Accelerated Biological Brain Aging After Mild Traumatic Brain Injury in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 890-890
Author(s):  
Andrei Irimia ◽  
Jun Kim ◽  
Shania Wang ◽  
Hyung Jun Lee ◽  
Van Ngo ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Brain Aging ◽  
Rate Of Change ◽  
Time Period ◽  
Weighted Magnetic Resonance Imaging ◽  
Neurological Conditions ◽  
Magnetic Resonance Imaging Mri ◽  
Brain Age

Abstract Estimating biological brain age (BA) has the potential of identifying individuals at relatively high risk for accelerated neurodegeneration. This study compares the brain’s chronological age (CA) to its BA and reveals the BA rate of change after mild traumatic brain injury (mTBI) in an aging cohort. Using T1-weighted magnetic resonance imaging (MRI) volumes and cortical thickness, volume, surface area, and Gaussian curvature obtained using FreeSurfer software; we formulated a multivariate linear regression to determine the rate of BA increase associated with mTBI. 95 TBI patients (age in years (y): μ = 41 y, σ = 17 y; range = 18 to 83) were compared to 462 healthy controls (HCs) (age: μ = 69 y, σ = 18 y; range = 25 to 95) over a 6-month time period following mTBI. Across the initial ~6 months following injury, patients’ BAs increased by ~3.0 ± 1.2 years due to their mTBIs alone, i.e., above and beyond typical brain aging. The superior temporal and parahippocampal gyri, two structures involved in memory formation and retrieval, exhibited the fastest rates of TBI-related BA. In both hemispheres, the volume of the hippocampus decreased (left: μ=0.28%, σ=4.40%; right: μ=0.12%, σ=4.84%). These findings illustrate BA estimation techniques’ potential to identify TBI patients with accelerated neurodegeneration, whose rate is strongly associated with the risk for dementia and other aging-related neurological conditions.

scholarly journals Juxtacortical susceptibility changes in progressive multifocal leukoencephalopathy at the gray–white matter junction correlates with iron-enriched macrophages

2021 ◽  
pp. 135245852199965
Author(s):  
Kedar R Mahajan ◽  
Moein Amin ◽  
Matthew Poturalski ◽  
Jonathan Lee ◽  
Danielle Herman ◽  
...  
Keyword(s):  
White Matter ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Central Nervous System Lymphoma ◽  
Susceptibility Weighted Imaging ◽  
Resonance Imaging ◽  
Gradient Echo ◽  
Total N ◽  
Mri Brain ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri

Objective: Describe magnetic resonance imaging (MRI) susceptibility changes in progressive multifocal leukoencephalopathy (PML) and identify neuropathological correlates. Methods: PML cases and matched controls with primary central nervous system lymphoma (PCNSL) were retrospectively identified. MRI brain at 3 T and 7 T were reviewed. MRI-pathology correlations in fixed brain autopsy tissue were conducted in three subjects with confirmed PML. Results: With PML ( n = 26 total, n = 5 multiple sclerosis natalizumab-associated), juxtacortical changes on susceptibility-weighted imaging (SWI) or gradient echo (GRE) sequences were noted in 3/3 cases on 7 T MRI and 14/22 cases (63.6%) on 1.5 T or 8/22 (36.4%) 3 T MRI. Similar findings were only noted in 3/25 (12.0%) of PCNSL patients (odds ratio (OR) 12.83, 95% confidence interval (CI), 2.9–56.7, p < 0.001) on 1.5 or 3 T MRI. On susceptibility sequences available prior to diagnosis of PML, 7 (87.5%) had changes present on average 2.7 ± 1.8 months (mean ± SD) prior to diagnosis. Postmortem 7 T MRI showed SWI changes corresponded to areas of increased iron density along the gray–white matter (GM-WM) junction predominantly in macrophages. Conclusion: Susceptibility changes in PML along the GM-WM junction can precede noticeable fluid-attenuated inversion recovery (FLAIR) changes and correlates with iron accumulation in macrophages.

scholarly journals Breast involvement of hematological malignancies: imaging and clinical findings

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Gamze Durhan ◽  
Figen Demirkazık
Keyword(s):  
Hematological Malignancies ◽  
Clinical Findings ◽  
Accurate Diagnosis ◽  
Radiological Findings ◽  
Breast Masses ◽  
Appropriate Treatment ◽  
Magnetic Resonance Imaging Mri ◽  
Type 3 ◽  
And Diffusion

Abstract Background Breast involvement of hematological malignancies is a very rare entity. Accurate diagnosis is essential for appropriate treatment. The aim of this study was to clarify the clinical and radiological findings of hematological malignancy breast involvement and to describe possible pitfalls in diagnosis. Results The images of 20 patients with breast involvement of hematological malignancies were retrospectively evaluated on ultrasonography, mammography, and magnetic resonance imaging (MRI) and the findings were reported. Bilaterality was seen only in cases with secondary involvement, and there was no marked difference between primary and secondary breast involvement of hematological malignancies. All patients underwent ultrasonography examination. According to ultrasonography, breast masses were most frequently irregular in shape (11/20, 55%) with non-circumscribed margins (11/20, 55%). Posterior acoustic enhancement was noted in 14 cases (70%). Posterior shadowing was not observed in any of the patients. Mammography was available in 10 patients. Microcalcification was not observed in any patient on mammography. MRI was available in four patients. Hyperintensity in T2-weighted images, type 2 or type 3 dynamic curve, and diffusion restriction were observed in all cases. Conclusions Hematological malignancies may mimic both benign breast lesions and breast carcinoma. Familiarity with the radiological features of hematological malignancies can help accurate diagnosis.

scholarly journals Rapidly Progressive Spontaneous Spinal Epidural Abscess

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Abdurrahman Aycan ◽  
Ozgür Yusuf Aktas ◽  
Feyza Karagoz Guzey ◽  
Azmi Tufan ◽  
Cihan Isler ◽  
...  
Keyword(s):  
Epidural Abscess ◽  
Delayed Diagnosis ◽  
Clinical Findings ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Low Back ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Paraspinal Abscess ◽  
Spinal Epidural

Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

Magnetic Resonance Imaging in the Diagnosis of Disruption of the Posterior Tibial Tendon

Foot & Ankle ◽  
1987 ◽  
Vol 8 (3) ◽  
pp. 144-147 ◽  
Author(s):  
Ian J. Alexander ◽  
Kenneth A. Johnson ◽  
Thomas H. Berquist
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Soft Tissues ◽  
Diagnostic Technique ◽  
Clinical Findings ◽  
The Body ◽  
Posterior Tibial Tendon ◽  
Resonance Imaging ◽  
Posterior Tibial ◽  
Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI), a useful technique of studying soft tissues of the body, can be very effective in assessing the integrity of tendons. Usually a patient with a complete tear of the posterior tibial tendon has characteristic physical findings. In the patient presented, MRI demonstrated a complete disruption of the posterior tibial tendon, despite the absence of the commonly associated clinical findings. In view of the difficulties encountered with attempted tenography of the completely torn posterior tibial tendon, MRI provides a sensitive alternative diagnostic technique.

scholarly journals Effectiveness of low-field magnetic resonance imaging in diagnosing brachial plexus tumours in dogs – short communication

2015 ◽  
Vol 59 (2) ◽  
pp. 317-319
Author(s):  
Zbigniew Adamiak ◽  
Yauheni Zhalniarovich ◽  
Paulina Przyborowska ◽  
Joanna Głodek ◽  
Adam Przeworski
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brachial Plexus ◽  
Resonance Imaging ◽  
Gadolinium Contrast ◽  
Gadolinium Contrast Agent ◽  
Low Field ◽  
Mri Sequences ◽  
Magnetic Resonance Imaging Mri ◽  
Brachial Plexus Tumours

AbstractThe aim of the study was to identify magnetic resonance imaging (MRI) sequences that contribute to a quick and reliable diagnosis of brachial plexus tumours in dogs. The tumours were successfully diagnosed in 6 dogs by the MRI with the use of SE, FSE, STIR, Turbo 3 D, 3D HYCE, and GE sequences and the gadolinium contrast agent

Abstract TP35: Estimation of Red Blood Cells in the Thrombus Using MRI. A Phantom Study with Predetermined Thrombus Components

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ana Paula Narata ◽  
Isabelle Filipiak ◽  
Richard Bibi ◽  
Jean Philippe Cottier ◽  
Kevin Janot
Keyword(s):  
Red Blood Cells ◽  
Blood Cells ◽  
Spin Echo ◽  
In Vitro Study ◽  
Fibrin Clot ◽  
Fluid Attenuated Inversion Recovery ◽  
Magnetic Resonance Imaging Mri ◽  
C 50 ◽  
D 20

Background and Purpose: Better understanding about thrombus composition seems necessary, as treatment of acute ischemic stroke (AIS) is focus on clot chemical dissolution and mechanical extraction. We propose to evaluate whether magnetic resonance imaging (MRI) can differentiate white from red clots and estimate red blood cells percentage (RBC%) using clots with predetermined components and an index based on MRI signal intensity (SI). Material and Methods: 5 clots (A=100% fibrin, B=80% RBC, C=50% RBC, D=20% RBC, E=unknown) were fixed in gelatin-manganese solution and studied by: high-resolution 3D T1-weighted (T1MPR), T2-weighted turbo spin echo (T2TSE), T2-weighted gradient echo (T2GE), susceptibility weighted (SWI), fluid-attenuated inversion recovery (FLAIR) and diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC). SI index was calculated with clot SI and gelatin SI. Statistical analysis compared RBC-clots to fibrin-clot SI index and the correlation of RBC% and SI index in each MRI sequence. Results: Each red clot was different from clot A except clot D in FLAIR. Correlation between clots SI index and RBC concentration were found in T1MPR (r=-0.84), SWI (r=-0.79), T2GE (r=-0.72) and FLAIR (r=0.80). Linear regression resolution provided an indirect RBC estimation for clot E: 47.3 % in T1MPR, SWI 41.5%, T2GE 45.1% and FLAIR 50.9%. Histological analysis confirmed clot E composition. Conclusion: This in vitro study suggests that MRI can differentiate white from red clots except clots with low RBC% in FLAIR and also provide approximate RBC%.

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