Comparing Perfusion Data of CE-MRI, SWI, and CTA with MR Perfusion in Stroke.

BACKGROUND: To evaluate the perfusion status of patients with acute stroke, different imaging tools are used depending on the condition. CT-CT Angiography and MRI are indispensable imaging tools to diagnose and manage stroke patients. Susceptibility-weighted imaging (SWI) also has been used lately to evaluate vascular structures and consequences of stroke in the brain. We aimed to compare CE-MRI, SWI, and CTA with DSC-MRP in terms of perfusion. METHODS: Stroke cases of CE-MRI, SWI, CTA and DSC-MRP of 44 patients were included. Collateralization was assessed on CTA; leptomeningeal-pial collateralization (LPC) and parenchymal enhancement (PE) on CE-MRI; prominent vessel sign (PVS) and hemorrhagic transformation on SWI. Results were compared with MRP maps and the ratio of penumbra/infarct core. RESULTS: LPC was correlated with increased CBV (p<0,001), decreased CBF (p=0,026), and prolonged MTT and TTP (p=0,001 and p=0,003). LPC was observed more often in cases with infarct zones with penumbra compared to those without penumbra (p=0,024). PE was positively correlated with prolonged MTT and TTP (p=0,015 and p=0,031). Moreover, there was a positive relationship between PE and increased penumbra ratio over the infarct core (p=0,037). Ipsilateral PVS was associated with increased CBV (p=0,004) and decreased CBF (p=0,002). No relationship was found between collateralization grading on CTA and perfusion metrics or penumbra ratio. CONCLUSION: In conclusion; ipsilateral PVS can be a measure of CBV and CBF. LPC on CE-MRI can be a sign of an increase in CBV. PE can show larger penumbra. CE-MRI with SWI can be used to evaluate perfusion status.

The significance of ONSD, ONSD/ETD ratio, and other neuroimaging parameters in idiopathic intracranial hypertension.

Background: The measurement of the optic nerve sheath diameter (ONSD) has been suggested to be used in the evaluation of intracranial pressure of several etiologies. However, its potential utility in the clinical evaluation of patients with idiopathic intracranial hypertension (IIH) needs to be clarified.Methods: We recruited all the IIH patients who had been admitted to our neurology clinics and had a cranial MRI before lumbar puncture investigation. A control group of patients with migraine was also included. Studies were reviewed blindly by a radiologist, and ONSD and ONSD/ eyeball transverse diameter (ETD) for both eyes were measured.Results: Ultimately, we have enrolled 50 patients with IIH and 53 migraineurs. The right ONSD values were higher in the IIH group (p = 0.024) whereas the values of ONSD/ETD were found to be both higher in the IIH group (right: p = 0.006, left: p = 0.043). The ROC curve demonstrated an area under the curve of 0.620 (95% CI = 0.508 to 0.731) for ONSD, and it was 0.642 for ONSD/ETD. Using a cut-off of 6.3 mm, ONSD had the following performance characteristics: sensitivity 18%, specificity 81%.Conclusions: The ONSD and ONSD/ETD values may be utilizable in the evaluation processes of IIH patients; however, they do not solely reach sufficient discriminative accuracy. The potential significance of these parameters in rather monitoring the IIH patients may constitute a strictly crucial topic of interest for future research.

The Utility of Neuroimaging Parameters in Discriminating Patients of Normal-Pressure Hydrocephalus with Positive Cerebrospinal Fluid Tap Test Response from Healthy Controls.

OBJECTIVE: To investigate the frequency of previously defined neuroimaging signs of normal pressure hydrocephalus in our NPH patient group with positive cerebrospinal fluid (CSF) tap test response. METHODS: Twenty-two patients with probable NPH and 33 healthy control individuals were enrolled in this study. Previously defined 9 parameters including Evan's index, narrow high convexity sulci, dilation of the Sylvian fissures, focally enlarged sulci, enlargement of the temporal horns, callosal angle, periventricular hyperintensities, bulging of the lateral ventricular roof, and disproportionately enlarged subarachnoid space hydrocephalus were evaluated on conventional magnetic resonance imaging. A total radiological score was formed in both groups. The total radiological score, scores, and frequency of each radiological parameters were compared between patient and healthy control groups. RESULTS: The mean age of the patient group was 67.31 ± 7.27 (F/M ratio was 7/15), whereas it was 69.09 ± 4.89 (F/M ratio was 11/22) in healthy control group. The result of these analyses revealed that scores of all the radiological parameters, except callosal angle score, were found to be higher in NPH patient group. The parameters with the highest positive predictive values were narrow high convexity sulci, narrowing of callosal angle, and DESH (100%, 100%, and 100%, respectively). On the other hand, enlargement of temporal horns had the highest negative predictive value among all parameters (96%). CONCLUSION: The results of our study support the use of neuroimaging parameters as an alternative method for CSF tap test. We suggest that in the presence of narrow high convexity sulci and/or narrowing of callosal angle, the decision of shunt surgery may be made in patients with suspicion of NPH, without performing CSF tap test. Confirmation of these results, in the future, large-scale studies may certainly provide critical perspectives to be used in the clinical practice.