Intracranial atherosclerotic plaque enhancement and long-term risk of future strokes: A prospective, longitudinal study.

BACKGROUND AND PURPOSE: The prognostic significance of postcontrast enhancement of intracranial atheromatous plaque is uncertain. Prospective, long-term follow-up studies in Caucasians, using a multicenter design, are lacking. We aimed to evaluate whether this radiological sign predicts long-term new stroke in symptomatic and asymptomatic intracranial atherosclerotic disease (ICAD) patients. METHODS: This was a prospective, observational, longitudinal, multicenter study. We included a symptomatic and an asymptomatic cohort of ICAD patients that underwent 3T MRI including high-resolution sequences focused on the atheromatous plaque. We evaluated grade of stenosis, plaque characteristics, and gadolinium enhancement ratio (postcontrast plaque signal/postcontrast corpus callosum signal). The occurrence of new events was evaluated at 3, 6, 9, and 12 months and annually thereafter. The association between plaque characteristics and new stroke was studied using Cox multiple regression survival analysis and Kaplan-Meier curves. RESULTS: Forty-eight symptomatic and 13 asymptomatic patients were included. During 56.3 ± 16.9 months, 11 patients (18%) suffered a new event (seven ischemic, two hemorrhagic, and two transient ischemic attacks). A receiver operating characteristic curve identified an enhancement ratio of >1.77 to predict a new event. In a multivariable Cox regression, postcontrast enhancement ratio >1.77 (hazard ratio [HR]= 3.632; 95% confidence interval [CI], 1.082-12.101) and cerebral microbleeds (HR = 5.244; 95% CI, 1.476-18.629) were independent predictors of future strokes. Patients with a plaque enhancement ratio >1.77 had a lower survival free of events (p < .05). CONCLUSIONS: High intracranial postcontrast enhancement is a long-term predictor of new stroke in ICAD patients. Further studies are needed to elucidate whether postcontrast enhancement reflects inflammatory activity of intracranial atheromatous plaque.

[Radiological and surgical characteristics of a case of recurring spinal hydatidosis]. / Caracteristicas radiologicas y quirurgicas de un caso de hidatidosis espinal recurrente.

INTRODUCTION: Hydatidosis is an illness that is still to be found in our setting. The lungs and liver are the organs most frequently involved and it rarely extends to bones. Involvement of the spine is infrequent, but it can give rise to a high degree of disability and may recur despite apparently complete excision. Here we report a case of recurring spinal hydatidosis with radiological and surgical particularities. CASE REPORT: Our case involves a 63-year-old male living in a rural area of the northern part of Spain's central plateau. The patient had a history of surgery for spinal hydatidosis and was on treatment with mebendazole. In the months before his visit, the patient had experienced difficulty in walking and urgency incontinence. The examination revealed paraparesis that predominantly affected the right-hand side and the patient required bilateral support to be able to walk. A dorso-lumbar magnetic resonance scan showed post-surgery changes with pedicular instrumentation added later in another centre, and a hydatid cyst with involvement of the body of the D10 vertebra, epidural extension and compression of the spinal cord. The patient was submitted to a surgical procedure involving the extraction of the system of fixation and full macroscopic excision of the cyst, with partial resection of the body of the vertebra. Initially the patient displayed motor improvement and treatment with mebendazole was reintroduced in high doses. CONCLUSIONS: Spinal hydatidosis is a rare condition that, in spite of correct surgical and medical treatment, often recurs. Magnetic resonance scans show characteristic 'honeycomb' images, which are sometimes large and have their origins in the body of the vertebra. Although successive surgical interventions can become increasingly more difficult because of old instrumentation or the conservation of compromised vertebral bodies, aggressive excision is indicated while the patient still has useful neurological functioning.

Características radiológicas y quirúrgicas de un caso de hidatidosis espinal recurrente / Radiological and surgical characteristics of a case of recurring spinal hydatidosis

Introducción. La hidatidosis es una enfermedad aún presente en nuestro entorno. El pulmón y el hígado son los órganos implicados con más frecuencia y rara vez hay una extensión ósea. La afectación espinal es infrecuente y puede dar lugar a gran discapacidad y recurrir pese a exéresis aparentemente completas. Presentamos un caso de hidatidosis espinal recurrente con particularidades radiológicas y quirúrgicas. Caso clínico. Varón de 63 años, residente en un área rural de la meseta norte española. Antecedente de hidatidosis espinal intervenida y en tratamiento con mebendazol. Consultó por empeoramiento en los meses previos de su dificultad para la marcha y urgencia esfínteriana. En la exploración se objetivó una paraparesia de predominio derecho y marcha con requerimiento de apoyo bilateral. La resonancia magnética dorsolumbar mostró cambios posquirúrgicos con instrumentación pedicular posterior realizada en otro centro y quiste hidatídico con afectación del cuerpo vertebral D10, extensión epidural y compresión medular. Se llevó a cabo una intervención quirúrgica consistente en la extracción del sistema de fijación y exéresis macroscópica completa del quiste, con resección parcial del cuerpo vertebral. Se apreció una mejoría motora inicial y se reintrodujo el tratamiento con mebendazol en dosis altas. Conclusiones. La hidatidosis espinal es una entidad poco frecuente que, pese a un adecuado tratamiento quirúrgico y médico, recurre con frecuencia. La resonancia magnética muestra imágenes características en ‘panal de abeja’, en ocasiones de gran tamaño y con origen en el cuerpo vertebral. Aunque las intervenciones quirúrgicas sucesivas plantean dificultades relacionadas con instrumentaciones antiguas o la conservación de cuerpos vertebrales afectos, la exéresis agresiva está indicada mientras el paciente mantenga una función neurológica útil(AU)

Introduction. Hydatidosis is an illness that is still to be found in our setting. The lungs and liver are the organs most frequently involved and it rarely extends to bones. Involvement of the spine is infrequent, but it can give rise to a high degree of disability and may recur despite apparently complete excision. Here we report a case of recurring spinal hydatidosis with radiological and surgical particularities. Case report. Our case involves a 63-year-old male living in a rural area of the northern part of Spain’s central plateau. The patient had a history of surgery for spinal hydatidosis and was on treatment with mebendazole. In the months before his visit, the patient had experienced difficulty in walking and urgency incontinence. The examination revealed paraparesis that predominantly affected the right-hand side and the patient required bilateral support to be able to walk. A dorsolumbar magnetic resonance scan showed post-surgery changes with pedicular instrumentation added later in another centre, and a hydatid cyst with involvement of the body of the D10 vertebra, epidural extension and compression of the spinal cord. The patient was submitted to a surgical procedure involving the extraction of the system of fixation and full macroscopic excision of the cyst, with partial resection of the body of the vertebra. Initially the patient displayed motor improvement and treatment with mebendazole was reintroduced in high doses. Conclusions. Spinal hydatidosis is a rare condition that, in spite of correct surgical and medical treatment, often recurs. Magnetic resonance scans show characteristic ‘honeycomb’ images, which are sometimes large and have their origins in the body of the vertebra. Although successive surgical interventions can become increasingly more difficult because of old instrumentation or the conservation of compromised vertebral bodies, aggressive excision is indicated while the patient still has useful neurological functioning(AU)

Analysis of the pyramidal tract in tumor patients using diffusion tensor imaging.

In this work, we propose to use fiber tracking in order to analyze and quantify the state of the pyramidal tracts in patients affected by tumors. We introduce a framework that includes an automatic method to obtain the fibers involved in the pyramidal tract of any subject, in order to compare robustly fiber bundles affected by tumors with healthy fiber tracts from control subjects and also to quantify the relative state of degeneration between the fiber tracts in the two hemispheres of the same patient. The comparative analyses proposed in our methodology are based on a new set of measures on the pyramidal tract, which take into account intrinsic properties of the fibers involved in the bundle as well as the similarity with the pyramidal tract of a standard healthy subject, modeled as the average of a set of controls. In order to perform better comparison studies and to take into account more information of the whole bundle, a mapping technique is used to represent the fiber tracts in 2D. Here, we show a set of experiments using 5 tumor patients and 10 control subjects, including pre- and post-operative studies in patients that have been treated with partial or total tumor resection. The results obtained indicate the usefulness of the method showing good overall performance. A reproducibility study using several acquisitions of the same patient is also presented to validate the techniques employed.