"Penumbra sign" in knee pain: a case of distal femur osteomyelitis

"Penumbra sign" is a characteristic finding in magnetic resonance imaging (MRI) of Brodie's abscess, a rare variant of subacute osteomyelitis. We aimed to discuss the imaging finding penumbra sign that will help in the diagnosis of osteomyelitis and may be useful to clinicians in differential diagnosis. A 26-year-old male patient presented to the emergency department with complaints of pain and limping in the right knee that did not go away. He had a history of arthroscopic debridement and percutaneous fixation surgery due to osteochondral fragment 3 years ago. There were no additional findings in the patient's vital parameters, physical examination, and medical history. X-ray imaging revealed two screws in the distal femur and a well-defined sclerotic rim surrounding a radiolucent lesion anterior to the screws. MRI revealed a lesion in the distal femoral metaphysis with low-density fluid and hyperintense granulation tissue surrounding it. After surgical abscess drainage and local debridement, bone cement was placed in the resulting cavity. Teicoplanin treatment was started. The patient was discharged and complete recovery was achieved in the second month. The diagnosis of osteomyelitis is often missed or confused with bone tumors in non-traumatic cases presenting with persistent bone pain. MRI imaging is frequently used in differential diagnosis, and detection of characteristic imaging signs such as the penumbra sign accelerates the diagnosis. In this context, emergency department clinicians, in particular, should be cautious and not forget that early treatment can be started by recognizing these signs.

Structural Design and Penumbra Analysis of Dynamic Multi-leaf Collimator Leaf End / 中国医疗器械杂志

Dynamic multi-leaf collimator, which has the function of radiation beam shaping, is a key executive component of tumor precise radiotherapy, and plays a core role in improving the accuracy, efficiency and quality of radiotherapy. A new type of collimator leaf end structure with circular arc and plane combination was studied, and collimator penumbra performance analysis model combining analytical expression and graphic analysis was developed. The influence of leaf end structure on penumbra was analyzed quantitatively, and a set of three-dimensional structure design of dynamic multi-leaf collimator was completed. The feasibility of the structural design and analysis model was verified through experimental measurements.

Multimodal MRI in evaluating white matter hyperintensity penumbras in patients with subcortical vascular cognitive impairment / 中国医学影像技术

Objective: To explore the value of different MR techniques in evaluating white matter hyperintensity (WMH) penumbra (WMH-P) in patients with subcortical vascular cognitive impairment (SVCI). Methods: A total of 29 SVCI patients underwent diffusion weight imaging (DTI), 3D-arterial spin labeling (3D-ASL) and chemical exchange saturation transfer amide proton transfer (CEST APT) scans as well as neuropsychological evaluation. WMH-P was defined in the range of 1 cm around WMH. Imaging parameters of WMH, WMH-P and normal appearing white matter (NAWM) outside WMH-P were measured and analyzed with cognitive scores. Results: There were significant differences of FA and mean diffusivity MD values among WMH, WMH-P and NAWM outside WMH-P (all P<0.05), also of cerebral blood flow (CBF) between WMH-P and NAWM outside WMH-P, as well as between WMH and NAWM outside WMH-P (all P<0.05). FA value in WMH-P and NAWM outside WMH-P was positively correlated with Montreal cognitive assessment (MoCA) scores (all P<0.05). Conclusion: 3D-ASL and DTI techniques can be used to reflect the extent and progression of white matter lesions in patients with SVCI. FA value of WMH-P can well evaluate the cognitive function of SVCI patients.

Evaluation on ischemic penumbra and prognosis of acute cerebral infarction patients with combination of three-dimensional ASL and DWI / 中国医学影像技术

Objective: To explore the value of three-dimensional arterial spin labeling (ASL) combined with diffusion weighted imaging (DWI) in evaluation on ischemic penumbra (IP) and prognosis of patients with acute cerebral infarction (ACI). Methods: Data of 45 ACI patients were retrospectively analyzed. Brain ASL images and DWI of all patients were collected. According to the improved Rankin scale (mRS) score at the end of the third month of follow-up, the patients were divided into good prognosis group, medium prognosis group and poor prognosis group. The presence of IP was assessed according to the measured maximum DWI high signal area (SDWI) and ASL abnormal perfusion area (SASL). The values of cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) of the infarct lesion (IL), brain tissue near the edge of the lesions (BNL) and the corresponding contra area were recorded, and the relative values (rCBF and rADC) of lesion side/contra were calculated. CBF and ADC values of IL of BNL and contra area in different prognostic groups were compared, as well as of rCBF and rADC in different prognostic groups. The diagnostic efficacy of rCBF of IL and BNL for evaluating poor prognosis of ACI patients were analyzed, respectively, so as the combined diagnostic efficacy. The correlation between rCBF or rADC and mRS score were analyzed. Results: Totally 40 ACI patients showed hypoperfusion in the IL areas, and IP was present in 23 of them. The difference of prognosis between patients with IP and those without IP was statistically significant (χ2=6.742, P=0.034). CBF and ADC values of IL of 3 groups, the CBF values of BNL in good and medium prognosis groups were lower than those in contra area (all P<0.05). There were statistical differences of rCBF of IL between poor prognosis group and good or medium prognosis group (both P<0.05), while no statistical difference of rCBF of BNL in 3 groups was found (F=3.20, P=0.05). AUC of rCBF of IL or BNL assessing poor prognosis of ACI was 0.92 and 0.79, the optimal cutoff values was 0.41 and 0.93, and the Youden indexs was 0.72 and 0.57, respectively. AUC of combined diagnosis was 0.94, and Youden index was 0.79. The rCBF of IL was negatively correlated with mRS score (r=-0.642, P<0.001). Conclusion: Three-dimensional ASL combined with DWI could be used to evaluate IP and prognosis of ACI patients, providing references for the formulation of ACI treatment plan.

Value of magnetic resonance angiography-diffusion weighted imaging mismatch in predicting ischemic penumbra in acute posterior cerebral infarction with basilar artery occlusion / 中国脑血管病杂志

Objective To explore the value of MRA-DWI mismatch (MDM) in predicting ischemic penumbra in acute posterior cerebral infarction with basilar artery occlusion. Methods From September 2015 to July 2018, 58 acute posterior cerebral infarction patients with basilar artery occlusion within 24 hours from symptom onset in the Department of Neurology, the Fourth Affiliated Hospital of China Medical University were retrospectively recruited. The thirty-eight patients with DWI- ASPECTS ≥7 were divided into the MDM-P group and twenty patients with DWI- ASPECTS 0. 05); the differences in NIHSS (3 [2, 12] vs. 11[4, 26], Z=2.434) and DWI-ASPECTS (8[7, 8]vs. 4[3, 5] , Z = 12.950)were statistically significant (all P 0. 05), but significant difference in reperfusion therapy (42.9% [9/21] vs. 67. 6% [25/37], χ2 =3.372) and MDM-P (85.7% [18/21] vs. 54. 1% [20/37], χ2 =5.944) (all P<0.05). Logistic regression analysis showed MRA-DWI mismatch (OR, 4. 914, 95% CI 1. 158 -20. 860, P = 0. 031) was an independent predictor of early neurological deterioration in acute posterior cerebral infarction. Conclusions MRA-DWI mismatch may be a predictor of END in acute posterior cerebral infarction with basilar artery occlusion, indicating that ischemic penumbra may be present in these patients, and it provides evidence for guiding reperfusion therapy.

Theory and technical advancement of revascularization therapy for acute ischemic stroke / 中国脑血管病杂志

Revascularization has become an effective treatment for acute ischemic stroke. New theories, techniques and instruments of revascularization are emerging. The relevant theory and technology of revascularization were discussed via summarizing the latest clinical trial results of revascularization in this article.

The Application of Multi-modal CT in Stent Embolectomy for Acute Ischemic Stroke / 中山大学学报(医学科学版)

@#【Objective】To explore the image evaluation value of multi-model CT in the treatment of acute ischemic stroke with Solitaire stent embolectomy. 【Methods】 A total of 62 patients diagnosed with acute ischemic stroke from January 2015 to June 2016 in Guangdong Second Provincial General Hospital were included in this study. Multi- model CT inspection，including CT scan（NCCT），CT angiography（CTA）and CT perfusion imaging（CTP），was performed in all patients within 3~8 h. The improved vascular TICI classification standard（mTICI）was used to assess vascular embolization，and we evaluated the responsible vessels and blood perfusion state by CTA and CTP blood vessels ，to determine the feasibility of embolectomy with Solitaire stent preliminarily. The patients underwent multi-mode CT examination 24 h after stent embolization to evaluate the responsible vessels. NIHSS was used to assess the neurological function at admission and 72 h after stent embolization.【Results】A total of 34 patients with indication of stent thrombus removal were selected by multi-mode CT examination from 62 patients. Re-examination of multi-mode CT after stent thrombus removal showed that 30 of the 34 cases（30/34，the successful rate was 88.2%）gained success in vascular recanalization. Before the stent thrombus removal of the 34 patients，CTP imaging showed ischemic penumbra（IP），and there was significant decrease in cerebral blood flow（CBF）and slight decrease in cerebral blood volume（CBV），significantly prolonged peak time （TTP） and mean transit time （MTT） compared with the contralateral image area. The difference is statistically significant（P < 0.01）. After the stent thrombus removal，the relative cerebral blood flow（rCBF）and relative cerebral blood volume（rCBV）were elevated，the relative peak time（rTTP）and relative mean transit time（rMTT）were shortened. The difference is statistically significant（P < 0.01）. Compared with admission，there is significant statistical difference in the NIHSS score of patients 72 h after operation（P < 0.01）.【Conclusion】Multi-model CT has guiding effect and important evaluation value in the treatment of acute ischemic stroke patients with Solitaire stent thrombolysis.

Progress in imaging evaluation of ischemic penumbra in acute ischemic stroke / 第二军医大学学报

Acute ischemic stroke (AIS) is the most common cerebrovascular disease with high morbidity, mortality and disability. The imaging evaluation of ischemic penumbra has great clinical implication for early diagnosis and reperfusion therapy of AIS. Here, we reviewed the evaluation methods, advangtages and disadvangtages of computed tomography (CT) and magnetic resonance imaging for ischemic penumbra, and discussed the advantages of one-stop multi-modal CT.

Characteristics of large artery atherosclerosis and cardioembolism acute ischemic stroke: A comparative study / 第二军医大学学报

Objective To investigate the difference in infarction characteristics between large artery atherosclerosis and cardioembolism acute ischemic stroke (AIS). Methods A retrospective study was done on 99 AIS patients, who were admitted to Emergency Room of our hospital and underwent multi-modal computed tomography (CT) after admission and before treatment. Forty-six of 99 AIS patients had large artery atherosclerosis and 53 had cardioembolism. The NIHSS score and GCS score on admission, infraction core and ischemic penumbra volumes and the volume difference, and vascular occlusion rates of posterior circulation and large artery were compared between the two groups. Results Compared with the cardioembolism group, the NHISS score was significantly lower and the GCS score was significantly higher in the large artery atherosclerosis group (9.5 [2.0, 16.0] vs 15.0 [6.0, 24.0], Z=2.31, P0.05). The large artery occlusion rate and posterior circulation occlusion rate were both significantly different between the large artery atherosclerosis and cardioembolism groups (30.43% [14/46] vs 50.94% [27/53] and 36.96% [17/46] vs 9.43% [5/53]; χ2=11.82 and 6.77, both P<0.001). Conclusion The clinical symptoms, cerebral changes and intracranial large artery changes are different in AIS patients with large artery atherosclerosis and cardioembolism. Etiology evaluation based on clinical features and multi-modal CT examination can help to accurately assess the ischemic state of AIS patients.

The traumatic penumbra of brain injury treated with RNAi:a multimodal magnetic resonance imaging study / 实用放射学杂志

Objective To investigate the dynamic images of traumatic penumbra(TP)in a rat model of traumatic brain injury (TBI)treated with AQP4-RNAi using multimodal MRI(MM-MRI)at 7.0 Tesla.Methods A rat model of TBI was established by the improved Feeney's method.MRI scans were performed including T2WI,DWI,ADC and SWI.The pathological changes in penumbra area were observed.All statistical analyses were performed using SPSS 21.0 software package.Results Over time rs-T2WI,rs-DWI and rs-SWI in TBI group were gradually increased.The r-ADC began to increase at one hour after trauma and reached the peak at 6 h. Then it began to fall and reached the bottom at 12 h.At each time point,the difference was statistically significant(P<0.05).Compared with RNA interference group,the rs-T2WI and rs-DWI in TBI group were decreased significantly at 6 h and 12 h(P<0.05),the r-ADC was not decreased significantly at 1 h(P>0.05)and decreased significantly at 6 h and 12 h(P<0.05).At each time point,there was no significant difference in rs-SWI(P>0.05).The area of mismatch between rs-SWI and rs-DWI was the most obvious at 6 h and 12 h,and the area of mismatch was decreased in size after treatment with AQP4-RNAi.There was no significant difference between TBI group and placebo group(P>0.05).In two groups,similar pathological changes were observed,which was depicted as vasogenic edema predominantly at 1 h and mixed edema at 6 h and 12 h. In RNA interference group,intracellular edema was markedly reduced at 6 h and 12 h,and the vasogenic edema was relieved to some extent at 12 h.Conclusion The treatment with APQ4-RNAi markedly alleviates cerebral edema.MM-MRI can reflect its pathological changes.The area of mismatch between SWI and DWI can prompt early detection of traumatic penumbra,which may provide useful information for clinical treatment.

Diffusion Tensor-Derived Properties of Benign Oligemia, True “at Risk” Penumbra, and Infarct Core during the First Three Hours of Stroke Onset: A Rat Model

OBJECTIVE: The aim of this study was to investigate diffusion tensor (DT) imaging-derived properties of benign oligemia, true “at risk” penumbra (TP), and the infarct core (IC) during the first 3 hours of stroke onset. MATERIALS AND METHODS: The study was approved by the local animal care and use committee. DT imaging data were obtained from 14 rats after permanent middle cerebral artery occlusion (pMCAO) using a 7T magnetic resonance scanner (Bruker) in room air. Relative cerebral blood flow and apparent diffusion coefficient (ADC) maps were generated to define oligemia, TP, IC, and normal tissue (NT) every 30 minutes up to 3 hours. Relative fractional anisotropy (rFA), pure anisotropy (rq), diffusion magnitude (rL), ADC (rADC), axial diffusivity (rAD), and radial diffusivity (rRD) values were derived by comparison with the contralateral normal brain. RESULTS: The mean volume of oligemia was 24.7 ± 14.1 mm³, that of TP was 81.3 ± 62.6 mm³, and that of IC was 123.0 ± 85.2 mm³ at 30 minutes after pMCAO. rFA showed an initial paradoxical 10% increase in IC and TP, and declined afterward. The rq, rL, rADC, rAD, and rRD showed an initial discrepant decrease in IC (from −24% to −36%) as compared with TP (from −7% to −13%). Significant differences (p < 0.05) in metrics, except rFA, were found between tissue subtypes in the first 2.5 hours. The rq demonstrated the best overall performance in discriminating TP from IC (accuracy = 92.6%, area under curve = 0.93) and the optimal cutoff value was −33.90%. The metric values for oligemia and NT remained similar at all time points. CONCLUSION: Benign oligemia is small and remains microstructurally normal under pMCAO. TP and IC show a distinct evolution of DT-derived properties within the first 3 hours of stroke onset, and are thus potentially useful in predicting the fate of ischemic brain.

Applied value of susceptibility-weighted imaging in acute ischemic stroke / 医疗卫生装备

Objective To evaluate the applied values of susceptibility weighted imaging (SWI) in acute ischemic stroke.Methods Totally 40 patients with acute ischemic stroke were included within 72 hours after symptom onset.They adopted multimodal magnetic resonance imaging examination,including regular magnetic resonance imaging sequence (T1WI,T2WI),time of flight MR angiography (TOF-MRA),diffusion weighted imaging (DWI) and susceptibility weighted imaging (SWI).Furthermore,12 of the 40 patients received dynamic susceptibility contrast enhanced perfusion weighted imaging (DSCPWI) examination.Results Of the 40 patients,12 ones had positive results for multiple lesions of cerebral microbleeds (CMBs) by SWI,and the detection rate was 30％.There were 24 patients showed susceptibility vessel sign (SVS) in SWI,and the susceptibility rate was 60％.In the 12 patients received DSC-PWI examination simultaneously,there were 7 cases had the anomaly range by SWI larger than that by DWI while similar to that by DSC-PWI.Conclusion SWI can show SVS and CMBs clearly,estimate ischemic penumbra,know intracranial conditions completely and supply reliable basis for individualized treatment.

Differentiation of the Infarct Core from Ischemic Penumbra within the First 4.5 Hours, Using Diffusion Tensor Imaging-Derived Metrics: A Rat Model

OBJECTIVE: To investigate whether the diffusion tensor imaging-derived metrics are capable of differentiating the ischemic penumbra (IP) from the infarct core (IC), and determining stroke onset within the first 4.5 hours. MATERIALS AND METHODS: All procedures were approved by the local animal care committee. Eight of the eleven rats having permanent middle cerebral artery occlusion were included for analyses. Using a 7 tesla magnetic resonance system, the relative cerebral blood flow and apparent diffusion coefficient maps were generated to define IP and IC, half hour after surgery and then every hour, up to 6.5 hours. Relative fractional anisotropy, pure anisotropy (rq) and diffusion magnitude (rL) maps were obtained. One-way analysis of variance, receiver operating characteristic curve and nonlinear regression analyses were performed. RESULTS: The evolutions of tensor metrics were different in ischemic regions (IC and IP) and topographic subtypes (cortical, subcortical gray matter, and white matter). The rL had a significant drop of 40% at 0.5 hour, and remained stagnant up to 6.5 hours. Significant differences (p < 0.05) in rL values were found between IP, IC, and normal tissue for all topographic subtypes. Optimal rL threshold in discriminating IP from IC was about -29%. The evolution of rq showed an exponential decrease in cortical IC, from -26.9% to -47.6%; an rq reduction smaller than 44.6% can be used to predict an acute stroke onset in less than 4.5 hours. CONCLUSION: Diffusion tensor metrics may potentially help discriminate IP from IC and determine the acute stroke age within the therapeutic time window.

The diagnostic value of ischemic penumbra with fusion images of SWI and DWI in patients with acute ischemic stroke / 实用放射学杂志

Objective To evaluate the diagnostic ability of fusion images of SWI and DWI in ischemic penumbra(IP)of patients with acute ischemic stroke(AIS).Methods 47 AIS patients were retrospective analyzed.Two neuroradiologists analyzed the fusion images of SWI and DWI respectively.SDM was defined as that the hypo-intensity signals of intramedullary or sulcal veins were dilated or increased on fusion images compared with contralateral areas.The results compared with the PDM,which was considered as the“gold standard”.Areas under the receiver operating characteristic curve(AUC)were used to assess the efficacy of SDM which determined by fusion images and compared to PDM.Chi-square test was used to analyze the consistency between the two neuroradiologists and also the consistency between SDM and PDM in IP assessment Results The fusion images of SWI and DWI had a high diagnostic efficacy compared to PDM, AUC of the two radiologists were 0.885,0.877,the diagnostic sensitivity were 84.2%,78.9% and specificity were 92.9%,96.4%respectively.There was also a high consistency in SDM assessment through fusion images between the two neuroradiologists (Kappa=0.908,P >0.05). Conclusion Fusion images of SWI and DWI have a high diagnostic efficacy in IP assessment,which may be considered as a simple approach for IP assessment in patients with AIS.

Stem Cell Therapy for Stroke, Recent Advances, Controversies and Literature Review.

Stem cells based therapy has shown to improve stroke recovery in multiple animal models. Translating these findings into clinical research can result in a potential therapeutic option for stroke. At this moment multiple animal models, different stem cells type and administration route have been used for research purposes. So far ideal timing, type of stem cells and administration routes has not yet been determined. This review summarizes current approaches and progresses in stroke stem cell therapy.

Neuronal plasticity and the changes of microenvironment at the ischemic neocortical penumbra after cere- bral artery occlusion in rats / 中国神经精神疾病杂志

Objectives To investigate the effects of nerve nutrient factors and inhibitory factors on neuronal regen? eration and axonal reconstruction at ischemic neocortical penumbra after focal cerebral ischemia in rats. Methods The rat model of middle cerebral artery ischemia was established using suture-occluded method. The pathological morpholo? gy of brain tissue was examined by using HE staining. The expression levels of GAP-43 SYN, nutrient factor (BDNF VEGF Ang1) and inhibitory factor (NogoA NogoR RhoA) were determined by using Western blotting technique. Results The number of neurons in ischemic penumbra was significantly decreased in model group (P<0.01) than in sham-operat? ed group. The expression levels of GAP-43 were significantly decreased (P<0.05) while the expression levels of NogoA NgR and RhoA in the thalamus were significantly increased (P<0.05) in model group than in sham-operated group. The expression levels of SYN and nutrient factors (BDNF VEGF Ang1) were not different between the model group and sham-operated group. Conclusion The increase in nerve inhibitory factors may contribute to the down-regulation of neu?rogenesis at ischemic neocortical penumbra after focal cerebral ischemia in rats.

Effect of active fraction from Huanglian Jiedu Decoction on activation of astrocytes and expression of Cx43 in cerebral ischemic penumbra / 中草药

Objective: To observe the effect of water extract and active fractions from Huanglian Jiedu Decoction (HJD) (total alkaloids, total favonoids, and total iridoids) on the activation of astrocytes and expression of connexin 43 (Cx43) in ischemic penumbra of rats after focal cerebral ischemia. Methods: The rat model of middle cerebral artery ischemia was established using suture-occluded method. The male SD rats were randomly divided into Sham-operation, model, water extract of HJD (800 mg/kg), total alkaloids (44 mg/kg), total flavonoids (50 mg/kg), and total iridoids (80 mg/kg) groups. They were ig administered for continuous 7 d, once daily. The histopathologic changes of brain in rats were observed by HE staining. The expression of GFAP and Cx43 was detected by immunofluorescence assay and RT-PCR was used to detect the gene expression of Cx43. Results: In the model group, the number of neurons in ischemic penumbra of rats was significantly decreased and the expression of GFAP, Cx43, and Cx43 protein was obviously increased compared with Sham-operation group (P<0.01). The three active fractions from HJD (total alkaloids, total favonoids, and total iridoids) could increase the number of neurons in the ischemic penumbra of rats and decrease the expression of GFAP, Cx43, and Cx43 protein obviously compared with the model group (P<0.05, 0.01). Conclusion: The active fractions (total alkaloids, total favonoids, and total iridoids) could inhibit the over activation of astrocytes and the expression of Cx43, so as to protect the neurons in ischemic penumbra.

Intra-arterial thrombolysis with r-tPA for the treatment of acute cerebral infarction 6 to 9 hours after onset / 中华急诊医学杂志

Objective To determine the safety and efficacy of intra-arterial recombinant tissue plasminogen activator (r-tPA) for the treatment of acute cerebral infarction (ACI) in patients under the guidance of computed tomography perfusion-based selection within a 6-9 hour window.Methods Sixtythree ACI patients selected by using computed tomography perfusion imaging (CTPI) identifying thresholds for salvageable penumbra were randomly (random number) assigned to the group treated with intra-arterial thrombolysis with r-tPA (group A,n =30) or to the group managed with conventional anti-platelet aggregation agent (group B,n =33) within a 6-9 hour window.The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale score (mRS) and Barthel Index (BI) were used for evaluating therapeutic efficacy.Global brain digital subtraction angiography (DSA) was done pre-and posttreatment to observe the recanalization of occluded vessels in the group A.All patients were monitored with CT scan within 24 hours to determine the cerebral hemorrhage,an unexpected complication of thrombolysis.Results Compared with pre-treatment,there were significant differences in NIHSS 24 hours after treatment in the group A and 7 days after treatment in both groups (P ＜ 0.01).However,there were no significant differences in NIHSS 24 hours after treatment in the group B.More improvements in NIHSS at 24 hours and 7 days after treatment were observed in the group A than those in group B (P ＜ 0.01),and more patients with favorable outcomes identified by mRS and BI in the group A than those in the group B (P =0.017 and P =0.016,respectively).In addition,twenty patients were showed successful recanalization in the group A and there were 2 cases of cerebral hemorrhage occurred in the group A,and there was no significant difference in the incidence of cerebral hemorrhage within 24 hours between the two groups (P ＞ 0.05).Conclusions Intra-arterial thrombolysis with r-tPA for treatment of acute cerebral infarction was safe and effective within a 6-9 hour window under the guidance of CTPI.

To Study efficacy and safety of citicoline in acute ischemic stroke.

Background: Stroke is a medical emergency with mortality rate higher than most forms of cancer. Acute ischemic stroke is a complex entity with variable clinical manifestations depending on the site and extent of infarction. Besides standard treatment given to the patients, neuroprotection is being targeted to antagonize molecular events that lead to irreversible ischemic injury. Methods: In this study, role of Citicoline in acute ischemic stroke was studied. It was open label study of 12 weeks duration undertaken in Medicine department (emergency unit) of Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Amritsar. Total 40 patients were randomly divided into Group 1 and Group 2. Group 1 received standard treatment for acute ischemic stroke and Group 2 received citicoline in addition to standard treatment. Patients were assessed at admission and after every 24 hours till hospital discharge. Follow up of the patients was done at three weeks, six weeks and twelve weeks after discharge using National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (MRS) and Modified Barthel Index (MBI). The data was statistically analysed using Mann Whitney test. Results: No significant difference was found between two groups with respect to MRS and MBI score throughout the study period. Statistically significant improvement was seen in citicoline group on NIHSS score by 2nd and 3rd day of admission and then on 12th week. Conclusions: Citicoline was found to be safe but with no statistically significant difference in treatment outcome between two groups.

Comparison of gamma knife validation film's analysis results of different film dose analysis software / 中华放射医学与防护杂志

Objective To compare the analytical result of different kinds of film dose analysis software for the same gamma knife,analyze the reasons of difference caused,and explore the measurements and means for quality control and quality assurance during testing gamma knife and analyzing its result.Methods To test the Moon Deity gamma knife with Kodak EDR2 film and γ-Star gamma knife with GAFCHROMIC(R) EBT film,respectively.All the validation films are scanned to proper imagine format for dose analysis software by EPSON PERFECTION V750 PRO scanner.Then imagines of Moon Deity gamma knife are analyzed with Robot Knife Adjuvant 1.09 and Fas-09 1.0,and imagines of γ-Star gamma knife with Fas-09 and MATLAB 7.0.Results There is no significant difference in the maximum deviation of radiation field size ( Full Width at Half Maximum,FWHM) and its nominal value between Robot Knife Adjuvant and Fas-09 for Moon Deity gamma knife (t = -2.133,P ＞0.05).The analysis on the radiation field' s penumbra region width of collimators which have different sizes indicated that the differences are significant (t = - 8.154,P ＜ 0.05 ).There is no significant difference in the maximum deviation of FWHM and its nominal value between Fas-09 and MATLAB for γ-Star gamma knife ( t = - 1.384,P ＞0.05 ).However,following national standards,analysis of φ4 mm width of collimators can obtain different results according to the two kinds software,and the result of Fas-09 is not qualified while MATLAB is qualified.The analysis on the radiation field' s penumbra region width of collimators which have different sizes indicates that the differences are significant ( t = 3.074,P ＜ 0.05 ).The imagines are processed with Fas-09.The analysis of imagine in the pre-and the post-processing indicates that there is no significant difference in the maximum deviation of FWHM and its nominal value ( t = 0.647,P ＞ 0.05 ),and the analytical result of the radiation field' s penumbra region width indicates that there is no significant difference as well ( t = -0.627,P ＞ 0.05 ).Conclusion The study shows that different kinds of film dose analysis software may have some differences in analysis of the same gamma knife validation film,and the results may lead to the different decisions in accordance with national standard.