scholarly journals The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2161
Author(s):  
Ji Young Lee ◽  
Kyung Mi Lee ◽  
Hyug-Gi Kim ◽  
Ho-Geol Woo ◽  
Jin San Lee ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Brain Magnetic Resonance Imaging ◽  
Distribution Patterns ◽  
Subcortical White Matter ◽  
Subacute Stroke ◽  
Rim Enhancement ◽  
Fluid Attenuated Inversion Recovery ◽  
The Masses ◽  
Cerebral Reperfusion

Purpose: The hyperintense acute reperfusion marker (HARM) is characterized by the delayed enhancement of the subarachnoid or subpial space observed on postcontrast fluid-attenuated inversion recovery (FLAIR) images, and is considered a cerebral reperfusion marker for various brain disorders, including infarction. In this study, we evaluated the cerebral distribution patterns of HARM for discriminating between an enhancing subacute infarction and an enhancing mass located in the cortex and subcortical white matter. Materials and methods: We analyzed consecutive patients who experienced a subacute ischemic stroke, were hospitalized, and underwent conventional brain magnetic resonance imaging including postcontrast FLAIR within 14 days from symptom onset, as well as those who had lesions corresponding to a clinical sign detected by diffusion-weighted imaging and postcontrast T1-weighted imaging between May 2019 and May 2021. A total of 199 patients were included in the study. Of them, 94 were finally included in the subacute infarction group. During the same period, 76 enhancing masses located in the cortex or subcortical white matter, which were subcategorized as metastasis, malignant glioma, and lymphoma, were analyzed. We analyzed the overall incidence of HARM in subacute ischemic stroke cases, and compared the enhancement patterns between cortical infarctions and cortical masses. Results: Among 94 patients with subacute stroke, 78 patients (83%) presented HARM, and among 76 patients with subcortical masses, 48 patients (63%) presented peripheral rim enhancement. Of 170 subcortical enhancing lesions, 88 (51.8%) showed HARM, and 78 (88.6%) were determined to be subacute infarction. Among 94 patients with subacute stroke, 48 patients (51%) had diffusion restrictions, and HARM was found in 39 patients (81.2%). Of the 46 patients (49%) without diffusion restriction, 39 patients (84.8%) showed HARM. Conclusions: The presence of HARM was significantly associated with subacute infarctions. For the masses, a peripheral rim enhancement pattern was observed around the mass rather than the cerebral sulci on postcontrast FLAIR.

Protection of ischemic white matter and oligodendrocytes in mice by 3K3A-activated protein C

2021 ◽  
Vol 219 (1) ◽  
Author(s):  
Mikko T. Huuskonen ◽  
Yaoming Wang ◽  
Angeliki Maria Nikolakopoulou ◽  
Axel Montagne ◽  
Zhonghua Dai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Corpus Callosum ◽  
Functional Outcomes ◽  
Protein C ◽  
Activated Protein C ◽  
Clinical Importance ◽  
Subcortical White Matter ◽  
Stroke Patients ◽  
Protease Activated Receptor 1

Subcortical white matter (WM) stroke accounts for 25% of all strokes and is the second leading cause of dementia. Despite such clinical importance, we still do not have an effective treatment for ischemic WM stroke, and the mechanisms of WM postischemic neuroprotection remain elusive. 3K3A-activated protein C (APC) is a signaling-selective analogue of endogenous blood protease APC that is currently in development as a neuroprotectant for ischemic stroke patients. Here, we show that 3K3A-APC protects WM tracts and oligodendrocytes from ischemic injury in the corpus callosum in middle-aged mice by activating protease-activated receptor 1 (PAR1) and PAR3. We show that PAR1 and PAR3 were also required for 3K3A-APC’s suppression of post–WM stroke microglia and astrocyte responses and overall improvement in neuropathologic and functional outcomes. Our data provide new insights into the neuroprotective APC pathway in the WM and illustrate 3K3A-APC’s potential for treating WM stroke in humans, possibly including multiple WM strokes that result in vascular dementia.

Abstract WP205: Pipeline for Automated White Matter Hyperintensity Segmentation in Patients With Acute Ischemic Stroke: The MRI-GENIE Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Markus D Schirmer ◽  
Adrian V Dalca ◽  
Ramesh Sridharan ◽  
Anne-Katrin Giese ◽  
Joseph P Broderick ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Large Scale ◽  
Current Knowledge ◽  
Principal Component ◽  
White Matter Hyperintensity ◽  
Brain Extraction ◽  
Fluid Attenuated Inversion Recovery ◽  
Good Agreement

Introduction: White matter hyperintensity volume (WMHv) is an important and highly heritable cerebrovascular phenotype; however, manual or semi-automated approaches to clinically acquired MRI analysis hinder large-scale studies in acute ischemic stroke (AIS). In this work, we develop a high-throughput, fully automated WMHv analysis pipeline for clinical fluid-attenuated inversion recovery (FLAIR) images to facilitate rapid genetic discovery in AIS. Methods: Automated WMHv extraction from multiple subjects relies on significant pre-processing of medical scans, including co-registration of the images. To reduce the effects of anisotropic voxel sizes, each FLAIR image is upsampled using bi-cubic interpolation. Brain extraction is performed using RObust Brain EXtraction (ROBEX). Images are then registered to an in-house FLAIR template using Advanced Normalization Tools (ANTs). The spatial covariation of WMH is learned through principal component analysis (PCA) of manual outlines from 100 subjects. Areas of leukoaraiosis are identified and separated from other lesions using the PCA modes. Volumes are then computed using non-interpolated slices for each subject. Standard deviation (SD) in WMHv (9 subjects; 6 raters each) is calculated as a measure of variability. Good agreement between automated and manual outlines is assessed in 358 subjects (automated WMHv within 3SD of manual WMHv). Results: As part of the MRI - Gen etics I nterface E xploration (MRI-GENIE) study, WMHv were calculated on a set of 2703 FLAIR images of patients from 12 independent AIS cohorts (sites). Results are shown in Figure 1. Comparing manual and automated WMHv shows that 88% of the automated WMHv fall within 3 SD from the manual WMHv, suggesting good agreement. Conclusion: WMHv segmentation using a fully-automated pipeline for analysis of clinical MRIs is both feasible and accurate. Ongoing analysis of the extracted WMHv is expected to advance current knowledge of risks and outcomes in AIS.

scholarly journals Pattern of white matter degeneration in remote brain areas from the basal ganglion lesion of ischemic stroke patients with motor impairment

2020 ◽  
Author(s):  
xuejin cao ◽  
Zan Wang ◽  
Xiaohui Chen ◽  
Yanli Liu ◽  
Xi Yang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Basal Ganglia ◽  
Diffusion Tensor ◽  
Brain Magnetic Resonance Imaging ◽  
Motor Dysfunction ◽  
Stroke Patients ◽  
Brain Areas ◽  
Ischemic Lesion ◽  
Structural Network

Abstract Background Diffusion tensor imaging (DTI) studies have revealed distinct white matter characteristic of brain following diseases. Beyond the lesion-symptom mapping, recent studies have demonstrate extensive structural and functional alterations of remote areas to local lesions caused by stroke in the brain. Here, we investigated the influences further from a global level by multivariate pattern analysis (MVPA) and network-based statistic (NBS). Methods Ten ischemic stroke patients with basal ganglia lesion and motor dysfunction and eleven demographically matched adults underwent brain Magnetic Resonance Imaging scans. DTI data was processed to obtain fractional anisotropy (FA) map and MVPA was used to explore brain regions that play an important role in classification based on FA map. White matter (WM) structural network was constructed by the deterministic fiber tracking approach according to the Automated Anatomical Labeling (AAL) atlas. NBS was used to explore differences of structural network between groups. Results MVPA applied to FA images correctly identified stroke patients with a statistically significant accuracy of 100% (P ≤ 0.001). Compared with the controls, the patients showed an FA reduction in the perilesional basal ganglia and brainstem, with a few in bilateral frontal lobes. Using NBS, we found the significant decreased FA-weighted WM subnetwork in stroke patients. Conclusions We identified some patterns of WM degeneration in the affected brain areas remote from the ischemic lesion, revealed the abnormal topological organization of WM network in stroke patients, which may be helpful for understanding of the neural mechanism of stroke sequela.

scholarly journals Changes in brain architecture are consistent with altered fear processing in domestic rabbits

2018 ◽  
Vol 115 (28) ◽  
pp. 7380-7385 ◽  
Author(s):  
Irene Brusini ◽  
Miguel Carneiro ◽  
Chunliang Wang ◽  
Carl-Johan Rubin ◽  
Henrik Ring ◽  
...  
Keyword(s):  
White Matter ◽  
Structural Integrity ◽  
Brain Magnetic Resonance Imaging ◽  
Subcortical White Matter ◽  
Resonance Imaging ◽  
Amygdala Volume ◽  
Selection For ◽  
Brain Architecture ◽  
Domestic Rabbits ◽  
Association Fibers

The most characteristic feature of domestic animals is their change in behavior associated with selection for tameness. Here we show, using high-resolution brain magnetic resonance imaging in wild and domestic rabbits, that domestication reduced amygdala volume and enlarged medial prefrontal cortex volume, supporting that areas driving fear have lost volume while areas modulating negative affect have gained volume during domestication. In contrast to the localized gray matter alterations, white matter anisotropy was reduced in the corona radiata, corpus callosum, and the subcortical white matter. This suggests a compromised white matter structural integrity in projection and association fibers affecting both afferent and efferent neural flow, consistent with reduced neural processing. We propose that compared with their wild ancestors, domestic rabbits are less fearful and have an attenuated flight response because of these changes in brain architecture.

scholarly journals Fingolimod-associated PML with mild IRIS in MS

2017 ◽  
Vol 5 (1) ◽  
pp. e415 ◽  
Author(s):  
Shuhei Nishiyama ◽  
Tatsuro Misu ◽  
Yukiko Shishido-Hara ◽  
Kazuo Nakamichi ◽  
Masayuki Saijo ◽  
...  
Keyword(s):  
White Matter ◽  
Immune Reconstitution ◽  
Jc Virus ◽  
Brain Mri ◽  
Subcortical White Matter ◽  
Precentral Gyrus ◽  
Fluid Attenuated Inversion Recovery ◽  
Viral Inclusions ◽  
Inflammatory Syndrome

Objective:To clarify the clinical, neuropathologic, and virologic characteristics of progressive multifocal leukoencephalopathy (PML) and its immune reconstitution inflammatory syndrome (IRIS) in a patient with fingolimod-treated MS.Methods:A case study.Results:A 34-year-old patient with MS using fingolimod for 4 years had a gradual progression of right hemiparesis and aphasia with a new subcortical white matter lesion in the precentral gyrus by initial MRI. Blood tests were normal, except for lymphopenia (160 cells/μL). One month after the cessation of fingolimod, brain MRI depicted a diffusely exacerbated hyperintensity on fluid-attenuated inversion recovery and diffusion-weighed imaging in the white matter with punctate gadolinium enhancement, suggesting PML-IRIS. A very low level of JC virus (JCV)-DNA (15 copies/mL) was detected in the CSF as judged by quantitative PCR. Brain tissues were biopsied from the left frontal lesion, which showed some small demyelinated foci with predominant loss of myelin-associated glycoprotein with infiltrations of lymphocytes and macrophages, but clear viral inclusion was not observed with hematoxylin-eosin staining. JCV-DNA was uniquely detectable in an active inflammatory demyelinating lesion by in situ hybridization, possibly suggesting an early phase of PML. DNA extracted from the brain sample was positive for JCV-DNA (151 copies/cell). It took 3 months to normalize the blood lymphocyte count. The patient was treated with 1 g of IV methylprednisolone for 3 days and a weekly oral dose (375 mg) of mefloquine, and her symptoms gradually improved.Conclusion:Low CSF JCV-DNA and unfound viral inclusions initially made her diagnosis difficult. The clinical course of fingolimod-associated PML may be associated with mild immune reconstitution.

scholarly journals Patterns of white matter degeneration in remote brain areas from the basal ganglion lesion of ischemic stroke patients with motor impairment

2020 ◽  
Author(s):  
xuejin cao ◽  
Zan Wang ◽  
Xiaohui Chen ◽  
Yanli Liu ◽  
Wei Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Basal Ganglia ◽  
Structural Changes ◽  
Diffusion Tensor ◽  
Brain Magnetic Resonance Imaging ◽  
Stroke Patients ◽  
Brain Areas ◽  
Ischemic Lesion ◽  
The Brain

Abstract Background: Diffusion tensor imaging (DTI) studies have revealed distinct white matter characteristics of the brain following diseases. Beyond the lesion-symptom mapping, recent studies have demonstrated extensive structural and functional alterations of remote areas to local lesions caused by stroke in the brain. Here, we further investigated the structural changes from a global level using DTI data through multivariate pattern analysis (MVPA) and network-based statistic (NBS). Methods: Ten ischemic stroke patients with basal ganglia lesions and motor dysfunctions and eleven demographically matched adults as controls underwent brain Magnetic Resonance Imaging scans. DTI data were processed to obtain fractional anisotropy (FA) maps and MVPA was used to explore brain regions that play an important role in classification based on FA maps. The white matter (WM) structural network was constructed by the deterministic fiber tracking approach according to the Automated Anatomical Labeling (AAL) atlas. NBS was used to explore differences in structural networks between groups. Results: MVPA applied to FA images correctly identified stroke patients with a statistically significant accuracy of 100% (P≤0.001). Compared with the controls, the study patients showed FA reductions in the perilesional basal ganglia and brainstem, with a few showing reductions in bilateral frontal lobes. Using NBS, we found a significant decrease in FA-weighted WM subnetwork in stroke patients. Conclusions: We identified some patterns of WM degeneration affecting brain areas remote to the ischemic lesion, revealing the abnormal organization of WM network in stroke patients, which may be helpful for the understanding of the neural mechanisms of stroke sequela.

scholarly journals Thresholds for infarction vary between gray matter and white matter in acute ischemic stroke: A CT perfusion study

2017 ◽  
Vol 39 (3) ◽  
pp. 536-546 ◽  
Author(s):  
Chushuang Chen ◽  
Andrew Bivard ◽  
Longting Lin ◽  
Christopher R Levi ◽  
Neil J Spratt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Gray Matter ◽  
Ct Perfusion ◽  
Area Under The Curve ◽  
Subcortical White Matter ◽  
Accurate Estimation ◽  
Cortical Gray Matter ◽  
Ischemic Core ◽  
Sensitivity Specificity

We aimed to investigate optimal perfusion thresholds defining ischemic core and penumbra for hemispheric-cortical gray matter (GM) and subcortical white matter (WM). A total of 65 sub-6 h ischemic stroke patients were assessed, who underwent acute computed tomography perfusion (CTP) and acute magnetic resonance imaging. CTP maps were generated by both standard singular value deconvolution (sSVD) and SVD with delay and dispersion correction (ddSVD). Analyses were undertaken to calculate sensitivity, specificity, and area under the curve (AUC) for each CTP threshold for core and penumbra in GM and WM. With sSVD, the core was best defined in GM by cerebral blood flow (CBF) < 30% (AUC: 0.73) and in WM by CBF < 20% (AUC: 0.67). With ddSVD, GM core was best defined by CBF < 35% (AUC: 0.75) and in WM by CBF < 25% (AUC: 0.68). A combined GM/WM threshold overestimated core compared to diffusion-weighted imaging, CBF < 25% from sSVD (1.88 ml, P = 0.007) and CBF < 30% from ddSVD (1.27 ml, P = 0.011). The perfusion lesion was best defined by Tmax > 5 s (AUC: 0.80) in GM and Tmax > 7 s (AUC: 0.75) in WM. With sSVD, a delay time (DT) > 3 s from ddSVD was the optimal for both GM (AUC: 0.78) and WM (AUC: 0.75). Using tissue-specific thresholds for GM/WM provides more accurate estimation of acute ischemic core.

scholarly journals Patterns of white matter degeneration in remote brain areas from the basal ganglion lesion of ischemic stroke  patients  with motor impairment

2020 ◽  
Author(s):  
Xuejin Cao ◽  
Zan Wang ◽  
Xiaohui Chen ◽  
Yanli Liu ◽  
Wei Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Basal Ganglia ◽  
Structural Changes ◽  
Diffusion Tensor ◽  
Brain Magnetic Resonance Imaging ◽  
Stroke Patients ◽  
Brain Areas ◽  
Ischemic Lesion ◽  
The Brain

Abstract Background: Diffusion tensor imaging (DTI) studies have revealed distinct white matter characteristics of the brain following diseases. Beyond the lesion-symptom mapping, recent studies have demonstrated extensive structural and functional alterations of remote areas to local lesions caused by stroke in the brain. Here, we further investigated the structural changes from a global level using DTI data through multivariate pattern analysis (MVPA) and network-based statistic (NBS). Methods: Ten ischemic stroke patients with basal ganglia lesions and motor dysfunctions and eleven demographically matched adults as controls underwent brain Magnetic Resonance Imaging scans. DTI data were processed to obtain fractional anisotropy (FA) maps and MVPA was used to explore brain regions that play an important role in classification based on FA maps. The white matter (WM) structural network was constructed by the deterministic fiber tracking approach according to the Automated Anatomical Labeling (AAL) atlas. NBS was used to explore differences in structural networks between groups.Results: MVPA applied to FA images correctly identified stroke patients with a statistically significant accuracy of 100% (P≤0.001). Compared with the controls, the study patients showed FA reductions in the perilesional basal ganglia and brainstem, with a few showing reductions in bilateral frontal lobes. Using NBS, we found a significant decrease in FA-weighted WM subnetwork in stroke patients. Conclusions: We identified some patterns of WM degeneration affecting brain areas remote to the ischemic lesion, revealing the abnormal organization of WM network in stroke patients, which may be helpful for the understanding of the neural mechanisms of stroke sequela.

scholarly journals T2 Weighted Hypointense Subcortical White Matter- A Rare Imaging Feature in Ketotic Hyperglycaemia

2021 ◽  
Author(s):  
Rudresh Hiremath ◽  
Vinyasa Nagesh ◽  
Divya Vishwanatha Kini
Keyword(s):  
White Matter ◽  
Diabetic Ketoacidosis ◽  
Imaging Finding ◽  
Neurological Complications ◽  
Type Ii Diabetes Mellitus ◽  
Subcortical White Matter ◽  
Serum Glucose ◽  
Imaging Features ◽  
Serum Bicarbonate Level ◽  
Fluid Attenuated Inversion Recovery

Diabetic ketoacidosis is a hyperglycaemic state in which serum glucose level is more than 250 mg/dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq/L, and serum ketone level is raised and dehydration is present. Insulin deficiency is the main precipitating factor. Rarely, they present with neurological complications such as focal/generalised motor seizures, hemiparesis and sensory deficits which may be associated with various imaging features. With increasing prevalence of diabetes in the last decade, it is vital to familiarise with various hyperglycaemia induced imaging abnormalities in brain in order to provide accurate diagnosis for providing prompt treatment and preventing complications. T2W/FLAIR (Fluid-attenuated inversion recovery) subcortical hypointensity in ketotic patients presenting with focal seizures had been reported rarely. Here, presented are imaging findings of a 27-year-old female patient with newly diagnosed type II diabetes mellitus and diabetic ketoacidosis with new onset seizures. T2 subcortical white matter hypointensity was noted in the right post-central gyrus. Though non specific, this imaging finding was of importance in such cases of hyperglycaemia in order to formulate further patient care.

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