Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Cerebral Venous Thrombosis : A Meta-Analysis

Objective@#: A role of diffusion-weighted imaging (DWI) in the diagnosis of cerebral venous thrombosis (CVT) is not wellunderstood. This study evaluates the effectiveness of DWI in the diagnosis of CVT. @*Methods@#: Literature search was conducted in electronic databases for the identification of studies which reported the outcomes of patients subjected to DWI for CVT diagnosis. Random-effects meta-analyses were performed to achieve overall estimates of important diagnostic efficiency indices including hyperintense signal rate, the sensitivity and specificity of DWI in diagnosing CVT, and the apparent diffusion coefficient (ADC) of DWI signal areas and surrounding tissue. @*Results@#: Nineteen studies (443 patients with 856 CVTs; age 40 years [95% confidence interval (CI), 33 to 43]; 28% males [95% CI, 18 to 38]; symptom onset to DWI time 4.6 days [95% CI, 2.3 to 6.9]) were included. Hyperintense signals on DWI were detected in 40% (95% CI, 26 to 55) of the cases. The sensitivity of DWI for detecting CVT was 22% (95% CI, 11 to 34) but specificity was 98% (95% CI, 95 to 100). ADC values were quite heterogenous in DWI signal areas. However, generally the ADC values were lower in DWI signal areas than in surrounding normal areas (mean difference−0.33×10-3 mm2/s [95% CI, −0.44 to −0.23]; p<0.00001). @*Conclusion@#: DWI has a low sensitivity in detecting CVT and thus has a high risk of missing many CVT cases. However, because of its high specificity, it may have supporting and exploratory roles in CVT diagnosis.

Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis of Cerebral Venous Thrombosis : A Meta-Analysis

Objective@#: A role of diffusion-weighted imaging (DWI) in the diagnosis of cerebral venous thrombosis (CVT) is not wellunderstood. This study evaluates the effectiveness of DWI in the diagnosis of CVT. @*Methods@#: Literature search was conducted in electronic databases for the identification of studies which reported the outcomes of patients subjected to DWI for CVT diagnosis. Random-effects meta-analyses were performed to achieve overall estimates of important diagnostic efficiency indices including hyperintense signal rate, the sensitivity and specificity of DWI in diagnosing CVT, and the apparent diffusion coefficient (ADC) of DWI signal areas and surrounding tissue. @*Results@#: Nineteen studies (443 patients with 856 CVTs; age 40 years [95% confidence interval (CI), 33 to 43]; 28% males [95% CI, 18 to 38]; symptom onset to DWI time 4.6 days [95% CI, 2.3 to 6.9]) were included. Hyperintense signals on DWI were detected in 40% (95% CI, 26 to 55) of the cases. The sensitivity of DWI for detecting CVT was 22% (95% CI, 11 to 34) but specificity was 98% (95% CI, 95 to 100). ADC values were quite heterogenous in DWI signal areas. However, generally the ADC values were lower in DWI signal areas than in surrounding normal areas (mean difference−0.33×10-3 mm2/s [95% CI, −0.44 to −0.23]; p<0.00001). @*Conclusion@#: DWI has a low sensitivity in detecting CVT and thus has a high risk of missing many CVT cases. However, because of its high specificity, it may have supporting and exploratory roles in CVT diagnosis.

Multi-parametric MRI Diagnoses Cerebellar Hemangioblastoma: A Case Report / 中国医学科学杂志(英文版)

We performed contrast-enhanced T2 fluid-attenuated inversion recovery (T2-FLAIR) and dynamic contrast enhanced MRI to illustrate the imaging characteristics of one case of hemangioblastoma. T2-FLAIR showed a large cyst located in the right cerebellum with mural nodule. The intensely enhancing cyst wall was observed on enhanced T2-FLAIR images acquired from 5.6 to 23 minutes after contrast administration, and quantitative dynamic contrast enhanced-MRI demonstrated that both the cyst wall and mural nodule presented high Ktrans, Kep and Ve values compared with the contralateral normal cerebellar tissues. The cyst showed gradual enhancement and reached the highest signal intensity at 67 minutes after contrast administration on enhanced T2-FLAIR images. In conclusion, early enhancement of cyst wall on T2-FLAIR might be the characteristic imaging findings for cystic hemangioblastoma, which may assist in the diagnosis of hemangioblastoma preoperatively.

Altered Brainstem Volume in Medication-overuse Headache: A Pilot Magnetic Resonance Imaging Evaluation / 中国医学科学院学报

Objective To investigate the altered brainstem volume in patients with medication-overuse headache(MOH). Methods The high-resolution structural images were obtained from 36 MOH patients and 32 normal controls(NC).The brainstem was segmented into midbrain,pons,and medulla,whose volume were measured respectively.Results There was a significantly smaller midbrain volume in MOH patients [(5.80±0.53) ml] than that in NC [(6.14±0.67)ml](t=2.36,P=0.02).The volumes of pons,medulla,and whole brainstem showed no significant difference in MOH patients [(13.13±1.42)ml,(4.55±0.51)ml,and(23.48±2.23)ml,respectively] compared with those in NC [(13.67±1.61) ml,(4.66±0.44) ml,and(24.47±2.56) ml,respectively](t=1.47,P=0.15;t=0.93,P=0.35;and t=1.71,P=0.09,respectively).Conclusion A smaller midbrain volume may be one of the specific features of pain pathway in MOH,and the automated brainstem subfield segmentation and volumetry may be useful tools for evaluating brainstem alternation in MOH patients.

Volume Gain of Brainstem on Medication-Overuse Headache Using Voxel-Based Morphometry / 中华医学杂志(英文版)

<p><b>Background</b>Histopathology identified the anatomical and molecular abnormalities of brainstem nuclei in migraine patients. However, the exact whole brainstem structural changes in vivo have not yet been identified in medication-overuse headache (MOH) transformed from migraine. The aim of this study was to investigate the regional volume changes over the whole brainstem in the MOH patients using voxel-based morphometry (VBM) in vivo.</p><p><b>Methods</b>High-resolution three-dimensional structural images were obtained using a 3.0-Tesla magnetic resonance system from 36 MOH patients and 32 normal controls (NCs) who were consecutively recruited from the International Headache Center, Chinese People's Liberation Army General Hospital, from March 2013 to June 2016. VBM was used to assess the brainstem structural alteration in the MOH patients, and voxel-wise correlation was performed to evaluate the relationship with the clinical characteristics.</p><p><b>Results</b>The brainstem region with increased volume located in the left ventrolateral periaqueductal gray (MNI coordinate: -1, -33, -8), ventral tegmental area (MNI coordinate: 0, -22, -12), bilateral substantia nigra (MNI coordinate: -8, -16, -12, 9, -16, -12), and trigeminal root entry zone (MNI coordinate: -19, -29, -31; 19, -32, -29) in MOH patients compared with NCs. The headache visual analog scale score was positively related with the left rostral ventromedial medulla (RVM) (MNI coordinate: -1, -37, -56; cluster size: 20; r = 0.602) in the MOH patients.</p><p><b>Conclusions</b>The regional volume gain of brainstem could underlie the neuromechanism of impaired ascending and descending pathway in the MOH patients, and the left RVM volume alteration could imply the impaired tolerance of nociceptive pain input and could be used to assess the headache disability in the MOH patients.</p>

A meta-analysis of the correlation between obesity and migraine / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the relationship between obesity and migraine.</p><p><b>METHODS</b>The online databases inlcuding PubMed, EMBASE, Wanfang, CNKI and Chinese Biological Medicine Database were searched for studies assessing the relationship between obesity and migraine according to the Cochrane Collaboration guidelines. Stata12.0 software was used for meta- analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the relationship between obesity and the risk of migraine.</p><p><b>RESULT</b>A total of 14 studies involving 193 274 individuals were included in the analysis. The results of meta-analysis showed that obese individuals had an increased risk of migraine by 19% as compared with normal weight individuals [OR, 1.19; 95% CI, 1.02-1.38; P=0.029) and by 19% as compared with non-obese individuals (OR, 1.19; 95%CI, 1.02-1.38; P=0.024).</p><p><b>CONCLUSION</b>Obesity is associated with an increased risk of migraine.</p>

Comparison of 3D pseudo-continuous arterial spin labeling and positron emission tomography-computed tomography in the brain disorders / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the diagnostic agreement of 3D pseudo-continuous arterial spin labeling (3D-pCASL) and ¹⁸F-fluorodeoxyglucose and ¹¹C-Methionine positron emission tomography-computed tomography(PET/CT) for brain disorders.</p><p><b>METHOD</b>3D-pCASL and PET/CT were performed on 7 patients with different brain disorders, and the diagnostic agreement was assessed by visual observation.</p><p><b>RESULTS</b>Four tumor lesions presented hyperperfusion on 3D-pCASL, and hypermetabolism on PET/CT. One demyelinated lesion and one metabolic lesion showed hyperperfusion on 3D-pCASL, and one infected lesion showed hypoperfusion on 3D-pCASL ;all these three lesions showed hypermetabolism on PET/CT.</p><p><b>CONCLUSION</b>3D-pCASL can non-invasively evaluate the perfusion state of the brain disorder in vivo and have a good dignostic consistency with PET/CT.</p>

Migraine-like headache and ischemic strokes in two patients with Lambl's excrescences / 中华医学杂志(英文版)

Lambl's excrescences are filiform structures attached to the edges of cardiac valves and have been associated with stroke. Here we report two patients with Lambl's excrescences who developed migraine-like headaches followed by cerebral infarction. Their Lambl's excrescences were first identified by transesophageal echocardiography. One patient was given aspirin and another had surgery for debridement of excrescences. Their outcomes were good. The migraine-like headache might be the first symptom of cerebral ischemia and might be triggered by micro-emboli originated from Lambl's excrescences. Patients with Lambl's excrescences should be closely monitored and surgery should be considered in recurrent stroke cases.

Altered regional homogeneity in spontaneous cluster headache attacks: a resting-state functional magnetic resonance imaging study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Functional neuroimaging study has opened an avenue for exploring the pathophysiology of cluster headache (CH). The aim of our study was to assess the changes in brain activity in CH patients by the regional homogeneity method using resting-state functional magnetic resonance imaging technique.</p><p><b>METHODS</b>The functional magnetic resonance imaging scans were obtained for 12 male CH patients with spontaneous right-sided headache attacks during "in attack" and "out of attack" periods and 12 age- and sex-matched normal controls. The data were analyzed to detect the altered brain activity by the regional homogeneity method using statistical parametric mapping software.</p><p><b>RESULTS</b>Altered regional homogeneity was detected in the anterior cingulate cortex, the posterior cingulate cortex, the prefrontal cortex, insular cortex, and other brain regions involved in pain processing and modulation among different groups.</p><p><b>CONCLUSION</b>It is referred that these brain regions with altered regional homogeneity might be related to the pain processing and modulation of CH.</p>

Value of tumor markers in the cerebrospinal fluid in the diagnosis of meningeal carcinomatosis / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the diagnostic value of tumor markers in the cerebrospinal fluid (CSF) for meningeal carcinomatosis (MC).</p><p><b>METHODS</b>Twenty-one MC patients (including 13 adenocarcinoma and 8 non-adenocarcinoma patients), 72 patients with tuberculous meningitis (TBM) and 23 with primary intracerebral tumors (PIT) were enrolled in this study. Blood and CSF tumor markers including CEA, CA125, CA15-3, CA19-9, CA72-4, CYFRA21-1, AFP and NSE were measured by Roche E170 electrochemiluminescence analyzer and sandwich assay.</p><p><b>RESULTS</b>CSF tumor markers CEA, CA125, CA199 and CYFRA21-1 and the serum tumor markers CEA, CA125, CA153, CA199 and AFP were significantly higher in MC group than in the other two groups. CSF CEA and CA15-3 were significantly higher in adenocarcinoma MC than in non-adenocarcinoma MC patients, but no significant differences were found in the serum tumor markers between the two groups (P>0.05). CSF tumor markers including CEA, CA125, CA15-3, CA72-4 and CYFRA21-1 were positively correlated to the serum tumor markers (P<0.05). CA199 was positively correlated to the disease course (P<0.05), and age was not correlated to any of the indexes (P>0.05).</p><p><b>CONCLUSION</b>Detection of the tumor markers in the CSF, especially CEA, CA125, CA19-9 and CYFRA21-1, may help in the early diagnosis of MC. CEA and CA15-3 can serve as indicators for differential diagnosis of adenocarcinoma and non-adenocarcinoma.</p>

Morbidity of Malignant Hyperthermia in Central Core Disease Patients Undergoing Orthopedics / 中国康复理论与实践

@#ObjectiveTo investigate the incidence of skeletal and/or articular malformations in central core disease (CCD) patients, and their risk of malignant hyperthermia (MH) in orthopedics. Methods28 unrelated patients with central core disease collected in the past 23 years were analyzed retrospectively. Results22 patients showed limb muscle weakness, while 6 patients didn't show any clinical symptom. Skeletal and/or articular malformations appeared in 21 patients, including joint contracture in 11, joint dislocation in 9, scoliosis in 12, lordosis in 5 and thoracic deformity in 1. 6 of the 10 patients could not endure orthopedic operation because of MH attack or dubitable MH attack. Calcium-induced calcium release (CICR) test performed on other 8 patients with MH family history or MH attack showed all those patients were MH susceptibilities. ConclusionSkeletal and/or articular malformations are common in CCD, as well as MH attack in orthopedics.

NF-kB expression in midbrain periaqueductal gray induced by electrical stimulation of dura near superior sagittal sinus in rats / 中华神经科杂志

Objective To investigate the role of nuclear factor-kappa B(NF-?B)protein in the nociceptive transmission of migraine attacks and NF-KB expression in the periaqueductal gray(PAG) induced by electrical stimulation of dura mater near the superior sagittal sinus(SSS)of the rats. Methods The rats were prepared by exposure of the superior sagittal sinus.The dura mater near the SSS was stimulated and NF-?B protein was detected in coronal brain sections using standard avidinbiotin immunohistochemistry.Results The number of NF-KB positive neurons in PAG expression increased to 111.7?15.7 in stimulation group,compared with 112.9?10.7 and 508.7?30.8 in blank group and sham-operated group respectively(t=-41.52 and t=-36.21,P