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BACKGROUND AND OBJECTIVES: Red blood cell (RBC) concentrations are known to associate with ischemic stroke. It is unclear whether RBC concentrations associate specifically with small vessel disease lacunar infarcts. We investigated the hypothesis that RBC concentrations associate with both chronic covert and acute symptomatic brain MRI lacunar infarcts. METHODS: A cross-sectional observational analysis was performed across 2 cohorts with available hematocrit (as the assessment of RBC concentration exposure) and MRI outcome data. The primary setting was a population-based cohort of stroke-free, older adult (>50 years) participants from the Northern Manhattan Study (NOMAS) enrolled between 2003 and 2009. A second replication sample consisted of patients admitted with acute stroke and enrolled into the Columbia Stroke Registry (CSR) between 2005 and 2020. Associations of hematocrit with (1) chronic, covert lacunar infarcts and (2) symptomatic (i.e., acute) lacunar strokes were separately assessed from the NOMAS and CSR cohorts, respectively, using general additive models after adjusting for relevant covariates. RESULTS: Of 1,218 NOMAS participants analyzed, 6% had chronic, covert lacunar infarcts. The association between hematocrit and these covert lacunar infarcts was U-shaped (χ2 = 9.21 for nonlinear associations; p = 0.03), with people with hematocrit extremes being more likely to have covert lacunar infarcts. Of the 1,489 CSR patients analyzed, 23% had acute lacunar strokes. In this sample, only the relationships of increased hematocrit concentrations and lacunar strokes were replicated (adjusted coefficient ß = 0.020; SE = 0.009; p = 0.03). DISCUSSION: We identified relationships of hematocrit with MRI lacunar infarcts in both stroke-free and ischemic stroke cohorts, respectively. The relationship between increased hematocrit concentrations with lacunar infarcts was replicated in both cohorts. Further studies are required to clarify the mechanisms behind the relationships of hematocrit with ischemic cerebral small vessel disease.
Assuntos
AVC Isquêmico , Noma , Acidente Vascular Cerebral Lacunar , Acidente Vascular Cerebral , Idoso , Humanos , Estudos Transversais , Hematócrito , Acidente Vascular Cerebral Lacunar/diagnóstico por imagem , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Hemoglobin concentration and diffusion-weighted imaging (DWI) ischemic lesions are separately known to be associated with poor intracerebral hemorrhage (ICH) outcomes. While hemoglobin concentrations have known relationships with ischemic stroke, it is unclear whether hemoglobin concentration is associated with DWI ischemic lesions after ICH. We sought to investigate the hypothesis that hemoglobin concentrations would associate with DWI lesions after ICH and further investigated their relationships with clinical outcomes. METHODS: Supratentorial ICH patients enrolled between 2010 and 2016 to a prospective, multicenter, observational cohort study (ERICH study [Ethnic/Racial Variations of Intracerebral Hemorrhage]) were assessed. Patients from this study with baseline, admission hemoglobin, and hospitalization magnetic resonance imaging were analyzed. Hemoglobin was examined as the primary exposure variable defined as a continuous variable (g/dL). Magnetic resonance imaging DWI ischemic lesion presence was assessed as the primary radiographic outcome. Primary analyses assessed relationships of hemoglobin with DWI lesions. Secondary analyses assessed relationships of DWI lesions with poor 3-month outcomes (modified Rankin Scale score, 4-6). These analyses were performed using separate multivariable logistic regression models adjusting for relevant covariates. RESULTS: Of 917 patients with ICH analyzed, mean baseline hemoglobin was 13.8 g/dL (±1.9), 60% were deep ICH, and DWI lesions were identified in 27% of the cohort. In our primary analyses, increased hemoglobin, defined as a continuous variable, was associated with DWI lesions (adjusted odds ratio, 1.21 per 1 g/dL change in hemoglobin [95% CI, 1.07-1.37]) after adjusting for sex, race, ICH severity, time to magnetic resonance imaging, and acute blood pressure change. In secondary analyses, DWI lesions were associated with poor 3-month outcomes (adjusted odds ratio, 1.83 [95% CI, 1.24-2.69]) after adjusting for similar covariates. CONCLUSIONS: We identified novel relationships between higher baseline hemoglobin concentrations and DWI ischemic lesions in patients with ICH. Further studies are required to clarify the role of hemoglobin concentration on both cerebral small vessel disease pathophysiology and ICH outcomes.
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Hemorragia Cerebral , Imageamento por Ressonância Magnética , Humanos , Estudos Prospectivos , Hemorragia Cerebral/complicações , Imagem de Difusão por Ressonância Magnética/métodos , HemoglobinasRESUMO
The natural history and treatment landscape of primary brain tumours are complicated by the varied tumour behaviour of primary or secondary gliomas (high-grade transformation of low-grade lesions), as well as the dilemmas with identification of radiation necrosis, tumour progression, and pseudoprogression on MRI. Radiomics and radiogenomics promise to offer precise diagnosis, predict prognosis, and assess tumour response to modern chemotherapy/immunotherapy and radiation therapy. This is achieved by a triumvirate of morphological, textural, and functional signatures, derived from a high-throughput extraction of quantitative voxel-level MR image metrics. However, the lack of standardisation of acquisition parameters and inconsistent methodology between working groups have made validations unreliable, hence multi-centre studies involving heterogenous study populations are warranted. We elucidate novel radiomic and radiogenomic workflow concepts and state-of-the-art descriptors in sub-visual MR image processing, with relevant literature on applications of such machine learning techniques in glioma management.
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Neoplasias Encefálicas/diagnóstico por imagem , Genômica/métodos , Glioma/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Glioma/genética , Glioma/patologia , Humanos , Aprendizado de Máquina , Imageamento por Ressonância Magnética , Gradação de Tumores , PrognósticoAssuntos
Coma/etiologia , Infecções por Coronavirus/complicações , Hipnóticos e Sedativos/efeitos adversos , Hipóxia Encefálica/complicações , Comunicação Interdisciplinar , Pneumonia Viral/complicações , Telecomunicações , Adulto , Idoso , Betacoronavirus , Encéfalo/diagnóstico por imagem , COVID-19 , Coma/fisiopatologia , Coma/terapia , Infecções por Coronavirus/terapia , Gerenciamento Clínico , Eletroencefalografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurologia , Pandemias , Pneumonia Viral/terapia , Encaminhamento e Consulta , SARS-CoV-2 , Adulto JovemRESUMO
BACKGROUND: Our previous work demonstrating great ease and predictability of cannulation of the major aortic arch branches with an upwardly pointing 3DR catheter, irrespective of aortic arch type, led us to hypothesize that centering or "cresting" of these vessels must occur along the superior most aspect of the aortic arch in a curvilinear fashion. METHODS: We retrospectively analyzed 111 computed tomographic scans of the chest and thoracic aorta with intravenous contrast performed at our hospital between April 2011 and May 2012 utilizing TeraRecon image reconstruction software. Four studies were excluded due to poor image quality and/or surgical changes to native aortic architecture. RESULTS: Of the 107 studies included, 104 (97.2%) demonstrated centering of the major aortic arch branches on a curvilinear line "cresting" the superior most aspect of the aortic arch irrespective of arch type. Of the three studies that did not demonstrate this "cresting," two were found to have aberrant right subclavian arteries associated with a type I aortic arch, and one had an aberrant right common carotid associated with a type II aortic arch. CONCLUSION: Operators engaging major aortic arch branches need to be mindful of the fact that these vessels are indeed centered on a line "cresting" along the superior most aspect of the aortic arch, and any algorithm that, by taking this information into account, reduces catheter manipulation in the aortic arch could potentially result in a reduction in distal atheroembolic events.
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Neurolymphomatosis is a rare neurological syndrome in lymphomas. It is reported as infiltration of peripheral nerves by lymphoma. It is important to distinguish neurolymphomatosis from other types of neuropathies, particularly infectious and inflammatory conditions. However, it is difficult to isolate a cancer-related inflammatory vasculitis and mononeuritis multiplex without definitive histopathologic examination. In this report, we describe a case of non-Hodgkin's lymphoma involving the peroneal nerve and presenting as neurolymphomatosis.
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Linfoma não Hodgkin/patologia , Nervo Fibular/patologia , Idoso , Animais , Feminino , Fluordesoxiglucose F18 , Humanos , Linfoma não Hodgkin/diagnóstico por imagem , Imageamento por Ressonância Magnética , Invasividade Neoplásica , Nervo Fibular/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos RadiofarmacêuticosRESUMO
OBJECTIVE: Perfusion CT is being increasingly used as a diagnostic tool for the evaluation of acute ischemic stroke. It can be performed rapidly and aids in the detection of salvageable tissue (penumbra) from the unsalvageable core infarct. The purpose of this article is to provide an overview of the imaging technique, interpretation pearls, and common pitfalls encountered in perfusion CT of the brain. CONCLUSION: Perfusion CT has proven to be a valuable tool in the diagnosis of acute ischemic stroke. The knowledge provided by these cases will allow the reader not only to confidently identify the presence of acute ischemic stroke, but also to recognize the common pitfalls and limitations of perfusion CT in this setting.
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Isquemia Encefálica/diagnóstico por imagem , Neuroimagem/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Circulação Cerebrovascular , Meios de Contraste , Diagnóstico Diferencial , Humanos , Interpretação de Imagem Radiográfica Assistida por ComputadorRESUMO
Kikuchi-Fujimoto disease (KFD) is an uncommon disorder that usually presents in young adults of Asian descent with fever and cervical lymphadenopathy. Clinically, this disease is often misdiagnosed as lymphoma or tuberculosis, and biopsy is needed for confirmation. The authors report an unusual case of KFD in a Hispanic male presenting with a subacute subdural hematoma, whose care was complicated by extranodal features not typically associated with KFD. The clinical, histopathologic, and radiographic manifestations of KFD are discussed.
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Hematoma Subdural/diagnóstico , Linfadenite Histiocítica Necrosante/diagnóstico , Biópsia , Encéfalo/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Drenagem , Seguimentos , Hematoma Subdural/complicações , Hematoma Subdural/terapia , Linfadenite Histiocítica Necrosante/complicações , Humanos , Rim/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Doenças Linfáticas/complicações , Doenças Linfáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
Malignant neoplasia involving contiguous vertebrae and the corresponding intervertebral discs is a rare occurrence that has similar imaging manifestations as pyogenic osteodiscitis. The authors describe the imaging manifestations of two cases of malignant neoplasia mimicking pyogenic osteodiscitis. We present a case of an 83-year-old male with metastatic non-small cell lung carcinoma and an 82-year-old female with a plasmacytoma, both within the thoracic spine. These cases illustrate how the imaging features of pyogenic osteodiscitis may parallel those of malignant neoplasia.
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Carcinoma de Células Pequenas/patologia , Discite/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias da Coluna Vertebral/secundário , Vértebras Torácicas , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Plasmocitoma/complicações , Radiografia , Neoplasias da Coluna Vertebral/diagnóstico por imagemRESUMO
Susac syndrome is a rare neurologic disorder first described by Susac et al. in 1979. Clinically, Susac syndrome consists of a triad including encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. Microinfarction is believed to be the basic histologic feature and MR is considered the best imaging modality. This case documents the typical imaging findings of Susac syndrome, as well as the unique MR imaging finding of cranial nerve enhancement.
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Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Confusão/diagnóstico , Imagem de Difusão por Ressonância Magnética/métodos , Síndrome de Susac/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adulto , Humanos , MasculinoRESUMO
Erdheim-Chester disease is a rare form of non-Langerhans histiocytosis presenting in the 5th through 7th decades of life. Osseous manifestations include symmetrical sclerosis of the long bones and, rarely, the spine. Central nervous system disease commonly affects the white matter tracts as well as the orbits, but epidural disease is rare. To the best of the authors' knowledge, simultaneous epidural and skeletal spine disease has not been reported. The MR imaging characteristics of skeletal spine disease have also not been reported. The authors describe the case of an 87-year-old man with both epidural and skeletal spine disease. The clinical characteristics, imaging manifestations, and the histological features are discussed.
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Doença de Erdheim-Chester/diagnóstico , Doença de Erdheim-Chester/patologia , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/patologia , Idoso de 80 Anos ou mais , Dor nas Costas/diagnóstico , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/patologia , Diagnóstico Diferencial , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/patologia , Doença de Erdheim-Chester/diagnóstico por imagem , Evolução Fatal , Humanos , Imageamento por Ressonância Magnética , Masculino , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Doenças da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia , Tomografia Computadorizada por Raios XRESUMO
We present an infant with macrocrania, who initially demonstrated prominent extra-axial fluid collections on sonography of the brain, compatible with benign infantile hydrocephalus (BIH). Because of increasing macrocrania, a follow-up sonogram of the brain was performed; it revealed progressive enlargement of the extra-axial spaces, which now had echogenic debris. Color Doppler US showed bridging veins traversing these extra-axial spaces, so it was initially thought that these spaces were subarachnoid in nature (positive cortical vein sign). However, an arachnoid membrane was identified superior to the cortex, and there was compression of true cortical vessels beneath this dural membrane. An MRI of the brain showed the extra-axial spaces to represent bilateral subdural hematomas. The pathogenesis of spontaneous development of the subdural hematomas, in the setting of BIH, is discussed. We also emphasize that visualizing traversing bridging veins through extra-axial spaces does not necessarily imply that these spaces are subarachnoid in origin.