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Improving Perfusion Measurement in DSC-MR Imaging with Multiecho Information for Arterial Input Function Determination.
Newton AT, Pruthi S, Stokes AM, Skinner JT, Quarles CC
(2016) AJNR Am J Neuroradiol 37: 1237-43
MeSH Terms: Algorithms, Angiography, Digital Subtraction, Artifacts, Brain Mapping, Cerebral Arteries, Cerebrovascular Circulation, Cerebrovascular Disorders, Contrast Media, Humans, Magnetic Resonance Angiography, Perfusion
Show Abstract · Added February 16, 2018
BACKGROUND AND PURPOSE - Clinical measurements of cerebral perfusion have been increasingly performed with multiecho dynamic susceptibility contrast-MR imaging techniques due to their ability to remove confounding T1 effects of contrast agent extravasation from perfusion quantification. However, to this point, the extra information provided by multiecho techniques has not been used to improve the process of estimating the arterial input function, which is critical to accurate perfusion quantification. The purpose of this study is to investigate methods by which multiecho DSC-MRI data can be used to automatically avoid voxels whose signal decreases to the level of noise when calculating the arterial input function.
MATERIALS AND METHODS - Here we compare postprocessing strategies for clinical multiecho DSC-MR imaging data to test whether arterial input function measures could be improved by automatically identifying and removing voxels exhibiting signal attenuation (truncation) artifacts.
RESULTS - In a clinical pediatric population, we found that the Pearson correlation coefficient between ΔR2* time-series calculated from each TE individually was a valuable criterion for automated estimation of the arterial input function, resulting in higher peak arterial input function values while maintaining smooth and reliable arterial input function shapes.
CONCLUSIONS - This work is the first to demonstrate that multiecho information may be useful in clinically important automatic arterial input function estimation because it can be used to improve automatic selection of voxels from which the arterial input function should be measured.
© 2016 by American Journal of Neuroradiology.
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11 MeSH Terms
Prior Infarcts, Reactivity, and Angiography in Moyamoya Disease (PIRAMD): a scoring system for moyamoya severity based on multimodal hemodynamic imaging.
Ladner TR, Donahue MJ, Arteaga DF, Faraco CC, Roach BA, Davis LT, Jordan LC, Froehler MT, Strother MK
(2017) J Neurosurg 126: 495-503
MeSH Terms: Adolescent, Adult, Angiography, Digital Subtraction, Cerebrovascular Circulation, Child, Humans, Magnetic Resonance Imaging, Middle Aged, Moyamoya Disease, Multimodal Imaging, Severity of Illness Index, Young Adult
Show Abstract · Added March 24, 2020
OBJECTIVE Quantification of the severity of vasculopathy and its impact on parenchymal hemodynamics is a necessary prerequisite for informing management decisions and evaluating intervention response in patients with moyamoya. The authors performed digital subtraction angiography and noninvasive structural and hemodynamic MRI, and they outline a new classification system for patients with moyamoya that they have named Prior Infarcts, Reactivity, and Angiography in Moyamoya Disease (PIRAMD). METHODS Healthy control volunteers (n = 11; age 46 ± 12 years [mean ± SD]) and patients (n = 25; 42 ± 13.5 years) with angiographically confirmed moyamoya provided informed consent and underwent structural (T1-weighted, T2-weighted, FLAIR, MR angiography) and hemodynamic (T2*- and cerebral blood flow-weighted) 3-T MRI. Cerebrovascular reactivity (CVR) in the internal carotid artery territory was assessed using susceptibility-weighted MRI during a hypercapnic stimulus. Only hemispheres without prior revascularization were assessed. Each hemisphere was considered symptomatic if localizing signs were present on neurological examination and/or there was a history of transient ischemic attack with symptoms referable to that hemisphere. The PIRAMD factor weighting versus symptomatology was optimized using binary logistic regression and receiver operating characteristic curve analysis with bootstrapping. The PIRAMD finding was scored from 0 to 10. For each hemisphere, 1 point was assigned for prior infarct, 3 points for reduced CVR, 3 points for a modified Suzuki Score ≥ Grade II, and 3 points for flow impairment in ≥ 2 of 7 predefined vascular territories. Hemispheres were divided into 3 severity grades based on total PIRAMD score, as follows: Grade 1, 0-5 points; Grade 2, 6-9 points; and Grade 3, 10 points. RESULTS In 28 of 46 (60.9%) hemispheres the findings met clinical symptomatic criteria. With decreased CVR, the odds ratio of having a symptomatic hemisphere was 13 (95% CI 1.1-22.6, p = 0.002). The area under the curve for individual PIRAMD factors was 0.67-0.72, and for the PIRAMD grade it was 0.845. There were 0/8 (0%), 10/18 (55.6%), and 18/20 (90%) symptomatic PIRAMD Grade 1, 2, and 3 hemispheres, respectively. CONCLUSIONS A scoring system for total impairment is proposed that uses noninvasive MRI parameters. This scoring system correlates with symptomatology and may provide a measure of hemodynamic severity in moyamoya, which could be used for guiding management decisions and evaluating intervention response.
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Rule of 5: angiographic diameters of cervicocerebral arteries in children and compatibility with adult neurointerventional devices.
He L, Ladner TR, Pruthi S, Day MA, Desai AA, Jordan LC, Froehler MT
(2016) J Neurointerv Surg 8: 1067-71
MeSH Terms: Adolescent, Aging, Angiography, Digital Subtraction, Cerebral Angiography, Cerebral Arteries, Cerebrovascular Circulation, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Patient Safety, Thrombectomy
Show Abstract · Added March 24, 2020
BACKGROUND AND PURPOSE - The safety of using adult-sized neuroendovascular devices in the smaller pediatric vasculature is not known. In this study we measure vessel diameters in the cervical and cranial circulation in children to characterize when adult-approved devices might be compatible in children.
METHODS - For 54 children without vasculopathy (mean age 9.5±4.9 years (range 0.02-17.8), 20F/34M) undergoing catheter angiography, the diameters of the large vessels in the cervical and cranial circulation (10 locations, 611 total measurements) were assessed by three radiologists. Mean±SD diameter was calculated for the following age groups: 0-6 months, 1, 2, 3, 4, 5-9, 10-14, and 15-18 years. To compare with adult sizes, each vessel measurement was normalized to the respective region mean diameter in the oldest age group (15-18 years). Normalized measurements were compared with age and fitted to a segmented regression.
RESULTS - Vessel diameters increased rapidly from 0 to 5 years of age (slope=0.069/year) but changed minimally beyond that (slope=0.005/year) (R(2)=0.2). The regression model calculated that, at 5 years of age, vessels would be 94% of the diameter of the oldest age group (compared with 59% at birth). In addition, most vessels in children under 5, while smaller, were still potentially large enough to be compatible with many adult devices.
CONCLUSIONS - The growth curve of the cervicocerebral vasculature displays rapid growth until age 5, at which point most children's vessels are nearly adult size. By age 5, most neuroendovascular devices are size-compatible, including thrombectomy devices for stroke. Under 5 years of age, some devices might still be compatible.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Stroke after adenotonsillectomy in patients with undiagnosed moyamoya syndrome.
Ahn AK, Honeybrook A, Jordan LC, Singer RJ, Tylor DA
(2014) JAMA Otolaryngol Head Neck Surg 140: 1061-4
MeSH Terms: Adenoidectomy, Adolescent, Angiography, Digital Subtraction, Carotid Artery, Internal, Cerebral Angiography, Cerebral Infarction, Child, Child, Preschool, Constriction, Pathologic, Down Syndrome, Female, Humans, Magnetic Resonance Imaging, Male, Moyamoya Disease, Postoperative Complications, Retrospective Studies, Stroke, Tomography, X-Ray Computed, Tonsillectomy
Show Abstract · Added March 24, 2020
IMPORTANCE - Moyamoya syndrome is a rare, occlusive cerebrovascular arteriopathy with significant risk for stroke. Populations that frequently undergo otolaryngologic procedures, including patients with Down syndrome and sickle cell disease, are particularly at risk for moyamoya. The initial presentation of moyamoya syndrome as stroke in the perioperative period of an otolaryngologic procedure has not been reported.
OBSERVATIONS - A retrospective medical record review assessed the relationship of otolaryngologic operations and the onset of moyamoya symptoms. Moyamoya syndrome was present in 137 patients. Of these, 19 patients underwent otolaryngologic procedures; 3 children had strokes 2 to 4 days after adenotonsillectomy, including 2 children with Down syndrome. Intraoperative carotid artery injury was considered but was proven not to be the cause of stroke. Bilateral moyamoya disease was diagnosed in all 3 patients via vascular imaging studies; all subsequently underwent revascularization procedures.
CONCLUSIONS AND RELEVANCE - Clinicians should be aware of an elevated prevalence of moyamoya syndrome in Down syndrome and sickle cell disease populations and should consider moyamoya syndrome in the differential diagnosis of postoperative stroke. Stroke risk is magnified in the perioperative setting related to perioperative dehydration and hypotension. Awareness and screening for cerebral vasculopathy in high-risk populations could prompt measures to decrease the occurrence of postoperative strokes after adenotonsillectomies.
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Recurrent intracerebral hemorrhage from a cerebral arteriovenous malformation undetected by repeated noninvasive neuroimaging in a 4-year-old boy. Case report.
Jordan LC, Jallo GI, Gailloud P
(2008) J Neurosurg Pediatr 1: 316-9
MeSH Terms: Angiography, Digital Subtraction, Cerebral Hemorrhage, Child, Preschool, Humans, Intracranial Arteriovenous Malformations, Magnetic Resonance Angiography, Magnetic Resonance Imaging, Male
Show Abstract · Added March 24, 2020
The authors report the case of a 4-year-old boy with a spontaneous intracerebral hemorrhage (ICH) related to an arteriovenous malformation (AVM) that was not found with good-quality magnetic resonance (MR) imaging and MR angiography. Both modalities were used serially in the acute phase and at 2 and 7 months of follow-up. Digital subtraction angiography identified the peripheral AVM when the patient experienced rehemorrhaging 1 year after his initial presentation. This case illustrates the need for a complete diagnostic evaluation including conventional angiography in cases of idiopathic ICH in children.
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Safety of cerebral digital subtraction angiography in children: complication rate analysis in 241 consecutive diagnostic angiograms.
Burger IM, Murphy KJ, Jordan LC, Tamargo RJ, Gailloud P
(2006) Stroke 37: 2535-9
MeSH Terms: Adolescent, Amobarbital, Angiography, Digital Subtraction, Catheterization, Central Nervous System Vascular Malformations, Cerebral Hemorrhage, Child, Child, Preschool, Contrast Media, Databases, Factual, Female, Hemorrhage, Humans, Infant, Infant, Newborn, Injections, Intra-Arterial, Intracranial Arteriovenous Malformations, Male
Show Abstract · Added March 24, 2020
BACKGROUND AND PURPOSE - Catheter-based cerebral angiography remains an important diagnostic tool in the pediatric population, particularly considering the currently growing interest in diagnosing and treating cerebrovascular disorders in children. There are no recent estimates of the complication rate associated with modern diagnostic digital subtraction angiography (DSA) in the pediatric population. The purpose of this study was to estimate the rate of complications occurring during cerebral angiography in children.
METHODS - Data from 241 consecutive pediatric cerebral angiograms performed at a single institution were entered into an institutional review board-approved database. Information on patient demographics, DSA indication, neurovascular diagnosis, and intra procedural and postprocedural complications was collected.
RESULTS - Our population included 115 boys and 90 girls, with age ranging from 1 week to 18 years (mean+/-SD, 12+/-5 years). All angiograms were technically successful. No intraprocedural complication was noted; in particular, there was no occurrence of iatrogenic vessel injury (dissection) and no transient or permanent neurological deficit secondary to a thromboembolic event. One child with a complex dural arteriovenous fistula experienced a fatal intracranial rehemorrhage secondary to a posterior fossa varix rupture 3 hours after completion of an uneventful diagnostic angiogram. The rates of intraprocedural and postprocedural complications were therefore 0.0% (95% CI, 0.0% to 1.4%) and 0.4% (95% CI, 0.012% to 2.29%), respectively.
CONCLUSIONS - The rate of immediate complications occurring during diagnostic cerebral angiography in children is very low. No intraprocedural complication was documented in the reported series. DSA performed by experienced angiographers is a safe procedure that can provide critical diagnostic information.
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Gadolinium, carbon dioxide, and iodinated contrast material for planning inferior vena cava filter placement: a prospective trial.
Brown DB, Pappas JA, Vedantham S, Pilgram TK, Olsen RV, Duncan JR
(2003) J Vasc Interv Radiol 14: 1017-22
MeSH Terms: Aged, Angiography, Digital Subtraction, Carbon Dioxide, Contrast Media, Female, Gadolinium, Humans, Male, Middle Aged, Observer Variation, Prospective Studies, Radiography, Interventional, Renal Veins, Vena Cava Filters, Vena Cava, Inferior
Show Abstract · Added March 5, 2014
PURPOSE - To prospectively compare the diagnostic accuracy of CO(2) and gadolinium to iodinated contrast material for inferior vena cavography before inferior vena cava (IVC) filter placement.
MATERIALS AND METHODS - Forty patients underwent injection of iodinated contrast material, CO(2), and gadolinium. Iodinated contrast material was used as the standard. Caval diameter was determined with calibrated software. Three readers blinded to contrast agent used measured the distance from the superior image border to the inferior margin of the renal veins and from the inferior image border to the iliac bifurcation. The measurements with CO(2) and gadolinium were compared to those with iodinated contrast material to obtain the interobserver and intraobserver variability. The presence or absence of caval thrombus and variant anatomy was noted. The same readers reexamined 12 studies in a separate session to determine intraobserver variability and correlation.
RESULTS - Caval diameter differed by 0.4 mm or less for all three agents. Measurements with all agents were within 2 mm of each other for all patients. Gadolinium and CO(2) were not significantly different from one another in measuring caval diameter. At the initial reading, compared with iodinated contrast material, gadolinium had greater mean interobserver error in measuring the distance to the iliac bifurcation and both renal veins (range, 1.6-1.8 mm) than CO(2) (range, 0.2-1.4 mm). This finding, although statistically significant for gadolinium (P <.05), was of doubtful clinical relevance. Interobserver correlation was significantly worse for CO(2) at the levels of the iliac bifurcation (P =.02) and right renal vein (P =.008). Interobserver correlation for gadolinium was similar to that for iodinated contrast material at all levels. At repeat reading, there was significantly inferior intraobserver correlation with use of CO(2) for both renal veins (P <.05) compared to iodinated contrast material and for the left renal vein (P <.05) compared to gadolinium. Gadolinium identified three of three renal vein anomalies identified with iodinated contrast material whereas CO(2) localized one of three.
CONCLUSION - CO(2) and gadolinium had limitations when compared with iodinated contrast material. Gadolinium provided superior consistency in identifying relevant landmarks for filter placement. CO(2) demonstrated significantly greater mean correlative error than gadolinium at initial and repeat readings.
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15 MeSH Terms