THE EVALUATION OF UNILATERAL CLOSED-LIP SCHIZENCEPHALY ON COMPLEX MRI SEQUENCES

Schizencephaly is one of the rare cortical malformations that classify in the group of neurological migration defects. The appearance of the anomaly is in the form of a cleft that passes through the brain parenchyma. In mild types, the cleft does not reach the lateral ventricle. Demonstrating the presence of polymicrogyria, optimal evaluation of the cortex and determining the cleft trace are essential in the radiological evaluation of schizencephaly. Because differential diagnosis should be made with heterotopias and focal cortical dysplasia. We present a case of a 21-yearold female patient with closed-lip schizencephaly accompanied by MRI findings. Polymicrogyria is best detected in sagittal T2 sequences, while the difference of white matter and grey matter are well observed in T1 and FLAIR sequences. The benefit of diffusion-weighted images in schizencephaly is unclear. The ADC values of the grey matter adjacent to the cleft are close to the lower limit of normal. Susceptibility weighted image (SWI) sequence has no place in the evaluation of schizencephaly. It can be beneficial for the exclusion of vascular malformations, haemorrhage and differential diagnosis.

Correlation of dystonia severity and iron accumulation in Rett syndrome

Individuals with Rett syndrome (RTT) commonly demonstrate Parkinsonian features and dystonia at teen age; however, the pathological reason remains unclear. Abnormal iron accumulation in deep gray matter were reported in some Parkinsonian-related disorders. In this study, we investigated the iron accumulation in deep gray matter of RTT and its correlation with dystonia severity. We recruited 18 RTT-diagnosed participants with MECP2 mutations, from age 4 to 28, and 28 age-gender matched controls and investigated the iron accumulation by susceptibility weighted image (SWI) in substantia nigra (SN), globus pallidus (GP), putamen, caudate nucleus, and thalamus. Pearson’s correlation was applied for the relation between iron accumulation and dystonia severity. In RTT, the severity of dystonia scales showed significant increase in subjects older than 10 years, and the contrast ratios of SWI also showed significant differences in putamen, caudate nucleus and the average values of SN, putamen, and GP between RTT and controls. The age demonstrated moderate to high negative correlations with contrast ratios. The dystonia scales were correlated with the average contrast ratio of SN, putamen and GP, indicating iron accumulation in dopaminergic system and related grey matter. As the first SWI study for RTT individuals, we found increased iron deposition in dopaminergic system and related grey matter, which may partly explain the gradually increased dystonia.

Abstract TP6: Prediction of Clot Fragility and Recanalization Outcome Using Susceptibility Vessel Sign on Susceptibility Weighted Image

Introduction: Susceptibility vessel sign (SVS) on T2*-weighted imaging (T2*WI) is associated with a high proportion of RBCs. Susceptibility weighted imaging (SWI) is more sensitive to visualize SVS than T2*WI, resulting both RBC- and platelet-rich thrombi detectable. Clot composition and burden impact the success of recanalization therapy, but how SVS influences the likelihood of recanalization is still debated. Hypothesis: We assessed the hypothesis that increased conspicuity of SWI-SVS reflects high proportion of RBCs and subsequent recanalization by endovascular treatment. Methods: From total of 143 ischemic stroke patients who was performed endovascular treatment between February 2010 and June 2015, the authors collected eligible cases with the following inclusion criteria; (1) SWI performed before endovascular treatment (N=123); (2) intracranial portion of ICA, MCA, and ACA occlusion (N=93). We excluded 4 cases with SWI of poor quality and analyzed 89 cases. Clinical information including stroke subtype, use of rt-PA, and time from puncture to recanalization was analyzed. All MR images and angiographies were analyzed for the presence, location, diameter, length, and volume (diameter*length) of SWI-SVS, and TICI grade. Results: Female was 47.2% (n=42) and mean age was 68.4±13.2. SWI-SVS was identified in 77.5% (n=69) of patients. SWI-SVS was more commonly associated with cardioembolism (CE; 49 of 57, 86.0%) than with other stroke subtypes (20 of 32, 62.5%; P =0.011). SVS length (11.20±7.96 vs. 6.90±7.03 mm; P =0.013) and diameter (4.72±2.53 vs. 2.48±2.21 mm; P <0.001) were longer in CE group than the other. SVS diameter was longer in recanalization group (TICI≥2b) than in non-recanalization group (4.21±2.63 vs. 2.82±2.42 mm; P =0.040). Multivariate analysis showed that SVS diameter and volume were independent predictors of CE and recanalization, respectively (OR, 1.67 and 1.02; 95% CI, 1.15-2.41 and 1.00-1.04; P =0.007 and 0.005). Conclusions: Diameter and volume of SWI-SVS can predict cardioembolic stroke and recanalization, respectively. It may be useful for choosing the optimal treatment based on clot composition.