White Matter High Signals Interfere with Noncontrast Computed Tomography in the Early Identification of Cerebral Infarction.

BACKGROUND: We developed an image patch classification-based method to detect early ischemic stroke. The accuracy of this method was >75%. We aimed to analyze patients' image data to identify interference factors that would affect its accuracy. METHODS: We conducted a retrospective analysis of 162 patients who were hospitalized with acute ischemic stroke. Factors related to the noncontrast computed tomography (ncCT) determination results were analyzed according to the patient's sex, age, clinical symptoms, cerebral infarction volume, cerebral infarction location, and whether or not the white matter high (WMH) signal was combined. RESULTS: The volume of cerebral infarction was positively correlated with the predicted results. The correct percentages of patients with volumes >1 and <1 mL were 59.18 and 83.19%, respectively, and the difference was statistically significant (p = 0.001). The correct percentage of the internal capsule region (47.1%) was significantly lower than that of the other groups (p = 0.011). The correct percentage of lateral ventricular paraventricular infarction was significantly lower than that of non-lateral ventricle patients (70.8 vs. 85.7%). In patients with lateral ventricular paraventricular infarction, if the WMH was combined, the correct percentage will decreased further as the Fazekas level increased. The correct percentage of lateral ventricle infarction combined with Fazekas 3 was 40.0%, which was statistically significant compared with the patient having Fazekas 0 with lateral ventricular infarction (p = 0.01). CONCLUSIONS: WMH had a similar computed tomography appearance to cerebral infarction and could interfere with the prediction of the cerebral infarction region by ncCT. This result provides a reference for clinicians to choose imaging methods for identifying acute cerebral infarction areas.

Development and clinical consequences of white matter lesions in Fabry disease: a systematic review.

BACKGROUND: Fabry disease (FD) is a rare lysosomal storage disorder that might result in, amongst other complications, early stroke and white matter lesions (WMLs). More insight in WMLs in FD could clarify the role of WMLs in the disease presentation and prognosis in FD. In this systematic review we assessed the prevalence, severity, location and course of WMLs in FD. We also systematically reviewed the evidence on the relation between WMLs, disease characteristics and clinical parameters. METHODS: We searched Pubmed, EMBASE and CINAHL (inception to Feb 2018) and identified articles reporting on FD and WMLs assessed with MRI. Prevalence and severity were assessed for all patients combined and divided by sex. RESULTS: Out of 904 studies a total of 46 studies were included in the analyses. WMLs were present in 46% of patients with FD (581 out of 1276 patients, corrected mean age: 38.8 years, range 11.8-79.3) and increased with age. A total of 16.4% of patients (31 out of 189 patients, corrected mean age: 41.1 years, range 35.8-43.3 years) showed substantial confluent WMLs. Men and women showed comparable prevalence and severity of WMLs. However, men were significantly younger at time of WML assessment. Patients with classical FD had a higher chance on WMLs compared to non-classical patients. Progression of WMLs was seen in 24.6% of patients (49 out of 199 patients) during 38.1 months follow-up. Progression was seen in both men and women, with and without enzyme replacement therapy, but at an earlier age in men. Stroke seemed to be related to WMLs, but cerebrovascular risk factors, cardiac and renal (dys)function did not. Pathology in the brain in FD seemed to extend beyond the WMLs into the normal appearing white matter. CONCLUSIONS: A significant group of FD patients has substantial WMLs and male patients develop WMLs earlier compared to female patients. WMLs could be used in clinical trials to evaluate possible treatment effects on the brain. Future studies should focus on longitudinal follow-up using modern imaging techniques, focusing on the clinical consequences of WMLs. In addition, ischemic and non-ischemic pathways resulting in WML development should be studied.

White matter lesions reduce number of brain metastases in different cancers: a high-resolution MRI study.

Brain metastases are major complications of common cancers. Tumor type and proneness to the CNS are thought to define the number and size of brain metastases. It is not known if intrinsic vascular factors can also have an effect. Restricted perfusion due to cerebral small vessel disease is frequent in elderly patients and causes white matter lesions (WML). The aim of this analysis was to evaluate a possible negative effect of WML and patient age on the number and size of brain metastases (BM) of different tumor entities. Pre-therapeutic 3 T brain magnetic resonance imaging (MRI) of 200 patients with BM were analyzed. Location, size and number of BM (NoM) were determined. T2 hyperintensive WML were scored according to Fazekas-Score (grade I-III). Patients with WML grade 1 (NoM: 5.59; p = 0.009) and grade 2 (NoM: 3.68; p = 0.002) had significantly less BM than patients without WML (NoM: 6.99). This effect was present in subgroups of different tumors: NSCLC (p = 0.05), other tumors than NSCLC (p = 0.048). Age (≤65 or >65 years) was positively correlated with the degree of WML but not with number (pNoM = 0.832) or mean diameter (pmDM = 0.662) of brain metastases. While patient age did not appear to be relevant, increasing WML were associated with lower number of brain metastases in different tumor types.

Application of the radiological sciences to advance clinical and fundamental knowledge of the animal kingdom. New Horizons for Radiologists Lecture.

Many radiological techniques are useful in fundamental research. Selected clinical problems in animals as well as certain basic research projects are utilized to emphasize the potential of radiological imaging. The author describes the use of several radiological methods in studies of how birds breathe.