MyT3 18 - Neuro

MyT3 18-2
Role of diffusion tensor imaging as a biomarker for cases with a history of optic neuritis in multiple sclerosis patients
Purpose: Using DTI for assessment of optic nerve integrity in MS patients with optic neuritis, and the possible affection of the contralateral optic nerve.
Methods: Case-control cross-sectional observational study on 54 RRMS patients (17 males and 37 females; mean age: 31.35 ± 7.82 SD) according to Revised McDonald Criteria. Age and sex-matched healthy volunteers were recruited as control with a mean age of 29.54 ± 8.35 SD. Using 3 ROI for ON and one for chiasm. Comparing DTI results with previous OCT and optic nerve sheath diameter in patients records.
Results: 54 (40.3%) nerves affected and 54 non-affected optic nerves (40.3%) in the patient group and 26 (19.4%) normal control optic nerves. FA values in the proximal segment with a mean 0.52 + 0.04 SD among the control group. And 0.27 + 0.05 SD, 0.27 + 0.04 SD in affected and nonaffected eyes of patients respectively. There was a significant statistical difference between the patient and control groups for all four FA values (p < 0.001). No statistically significant difference between the FA values obtained from the affected and un-affected optic nerves within the patient group with a P-value of 0.1.
Conclusion: Quantitative DTI FA values were able to detect axonal loss in MS-related optic neuritis, with a similar degree of axonal loss in the contra lateral healthy optic nerve so it can be used for assessment of optic nerve integrity and response to therapy.
Limitations: Six months drop period between OCT and MRI data aquisition. Poor assessment of optic nerve at the orbit apex.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 18-4
A prospective study to evaluate the role of MRI with MR spectroscopy of ring-enhancing lesions in the brain
Purpose: To differentiate neoplastic from non-neoplastic brain lesions using conventional and advanced MR imaging techniques.
Methods: Contrast MRI and MRS were done on 50 patients with GE Optima 1.5 Tesla MRI-machine referred with clinically suspected space-occupying lesions (SOL) and patients with incidental/diagnosed ring-enhancing lesion by CT scan were enrolled in the study from June-18 to June-19. The data will be entered in MS EXCEL spreadsheet and analysis will be done using Statistical Package for Social Sciences (SPSS) VERSION 22.0.
Results: Out of 50 cases, 22 are tuberculomas, 16 are NCC, 5 are abscess, 5 metastasis, 1 case of pilocytic astrocytoma and 1 tumefactive demyelination. Males were predominantly affected (31 cases - 62% of the cases) than females (19 cases - 38 %). 21-30 years is the most common age group involved (28% of the cases) and seizures are the most common presenting complaint (84%). The single lesion was noted in 34 % of patients whereas the rest 66% presented with multiple cases. Follow-up CT/MRI in 26 patients show resolution of the lesion and its associated perilesional oedema.
Conclusion: MRI is non-invasive and non-radiating is an ideal imaging modality. MRS helps in the characterisation of various ring-enhancing lesions.
Limitations: MRS could not be performed in four cases due to the presence of lesion close to the bone. MRS helps in the characterisation of various ring-enhancing lesions. However, no lesion can be diagnosed based on the findings of MRS as the sole criteria.
Ethics: After obtaining a written informed consent the patient was evaluated with Contrast MRI and MRS. The gold standard for diagnosis of brain mass is biopsy with histopathologic evaluation; however, most of the patients were followed up to correlate the findings with clinical imaging follow-up.
Funding: No funding was received for this work.
MyT3 18-5
Genetic and environmental effects on the morphology and haemodynamics of the Circle of Willis: cross-sectional magnetic resonance angiography and transcranial ultrasound twin studies
Purpose: Increasing evidence supports that Circle of Willis (CoW) variants predispose to cerebrovascular ischaemia. However, results on the factors determining CoW variants are sparse and conflicting. We aimed to determine whether CoW morphology and haemodynamics are associated with genetic or environmental factors in twins.
Methods: We investigated two separate twin populations: 1) 120 volunteer members of the Hungarian Twin Registry underwent time-of-flight magnetic resonance angiography (TOF-MRA) to record hypoplasia/aplasia in each CoW artery. 2) 64 volunteer members of the Italian Twin Registry were examined by transcranial colour-coded duplex sonography to investigate CoW haemodynamics. Concordance rates of CoW variants and raw heritability of haemodynamic traits were calculated. Cardiovascular risk factors were compared within twin pairs discordant for CoW morphology using paired t-test and Fisher?s exact test.
Results: The average age was 52±21 and 43±23 years in the first and second twin group, respectively. Concordance rates were higher in dizygotic than in monozygotic twins regarding anterior (0.47 and 0.22, respectively) and posterior (0.85 and 0.69, respectively) CoW variants. Cardiovascular risk factors did not differ significantly within monozygotic twin pairs discordant for CoW morphology (p>0.05 for body-mass index, hypertension, hypercholesterolemia and smoking, respectively). Raw heritability of CoW haemodynamics was low to moderate (0.00-0.56).
Conclusion: Our results support the dominance of environmental factors on both morphology and haemodynamics of the CoW. However, no cardiovascular risk factor was identified as a predictor of CoW variants. Consequently, our results stimulate further research aiming at specifying the environmental factors affecting CoW morphology.
Limitations: Major limitations include small sample size, and low spatial resolution and flow-dependence of TOF-MRA.
Ethics: The regional ethical committees approved the study (approval number: 1046-260/2014; 189/2014, 2014/10/21). All participants signed informed consent.
Funding: No funding was received for this work.
MyT3 18-6
Discrimination of intracranial ring-enhancing lesions using diffusion-weighted imaging, MR spectroscopy and diffusion tensor imaging
Purpose: To differentiate intracranial ring-enhancing lesions using DWI, DTI and MRS.
Methods: Forty-six patients examined by (1) DWI: mean ADC value, (2) MRS: calculated Cho/Cr ratio, (3) DTI: mean fraction anisotropy.
Results: Mean ADC values in the cystic part showed no significant difference between the primary tumours and secondary tumours (P-value = 0.07), while mean ADC value measured in the centre of abscess shows a significant difference from tumours (P= 0.002). No statistically significant difference between the ADC values measured in the enhancing wall of the primary tumours, secondary tumour and abscess; (P= 0.09).While mean ADC values measured in peritumuoral oedema could differentiate tumour infiltration from vasogenic oedema show a slightly significant difference with (P-value = 0.04). In MR Spectroscopy, the mean Cho/Cr ratio of tumours (4.2 ± 1.23) was significantly higher than abscess (1.65 ± 0.45) (P=0.006). And it?s also noted that the mean value of the intralesional Cho/Cr ratio of tumour recurrence groups were significantly higher than radiation necrosis group (P-value =0.02). ROC curve analysis demonstrated a cut off value of 1.9. As regard DTI, the mean FA measured in peritumoural oedema surrounding the primary tumours demonstrates higher value than the FA measured in the peritumoural oedema of metastases, 0.235 and 0.147 respectively. ROC curve demonstrated cut-off value of 0.165.
Conclusion: DWI, MRS and DTI provided a greater confidence in differentiation of (primary from metastatic tumours), (tumours from abscesses) and (radiation necrosis from tumour recurrence).
Limitations: The studies measured ADC value from a single slice of ADC maps, which may cause observer bias. The study was performed on two MRI machines which may show slight differences and variability in results.
Ethics: Approved by Institutional Research Board, Mansoura University.
Funding: No funding was received for this work.
MyT3 18-7
The influence ?f antiretroviral therapy on brain imaging in HIV infection
Purpose: To study the neuroimaging in HIV-infected patients with different levels of ?D4 cells, plasma HIV RNA, ART status.
Methods: The eligibility criteria: HIV , performed brain MRI, an adult. Examination data of 410 patients included a history of HIV infection, opportunistic diseases, current CD4 count, plasma HIV RNA, pathogen identification in CSF. Statistic analysis included chi-square (with Yates correction), Fisher's, the Mann-Whitney, Wald criteria.
Results: Regular ART was associated with a lower incidence of: large asymmetric lesions, caudate nuclei involvement, perilesional oedema, ring contrast enhancement. Duration of ART for more than five years reduces the incidence of brain involvement in HIV, contrast enhancement, white matter lesions, the involvement of the frontal lobes and basal nuclei. Lower current CD4 cells were associated with large asymmetric lesions, the involvement of the basal ganglia and posterior fossa, perilesional oedema and mass effect, blooming artefact on T2*, ring and nodular contrast enhancement. Plasma HIV RNA above 50 copies/ml was associated with diffuse white matter lesions, large asymmetric lesions, the involvement of the cerebellum, perilesional oedema. In major cases of CNS-IRIS we observed acute inflammatory demyelination, which was characterised by the appearance of new focal lesions, as well as the increase of old ones, atypical patterns of contrast enhancement: perivascular, peripheral, nodular, leptomeningeal.
Conclusion: ART and dependent on its current ?D4 cells, plasma HIV RNA had an influence on the severity of brain structural damage. With the disease progression, the most vulnerable regions were basal ganglia and cerebellum despite ART. The atypical PML were significantly more often visualised in CNS-IRIS.
Limitations: This study was limited by its retrospective design, qualitative neuroradiological criteria, and several data were incomplete.
Ethics: The study approved by the ethics committee in accordance with the criteria ICH GCP. All patients have signed informed consent.
Funding: No funding was received for this work.
MyT3 18-8
Comparison of 3D DIR, 3D FLAIR and 2D FLAIR pulse sequences for imaging in demyelinating disorder (in multiple sclerosis) at 3 Tesla
Purpose: Comparing 3D DIR sequence with that of 3D FLAIR and 2D FLAIR sequence in order to find out the h sensitivity in the detection of multiple sclerosis (MS) lesions and in addition we would like to further evaluate which among the 3D sequences would have higher sensitivity and specificity in picking up demyelinating lesions in the brain.
Methods: Study population (minimum of 30 cases) will include patients who are being evaluated for demyelination disorders with MRI. Imaging was performed on a 3T Philips MR system using 3D DIR, 3D FLAIR sequences with the same parameters, including FOV, matrix, slice thickness, voxel size, and a number of signals averaging (NSA) in addition to routine T1, T2, diffusion-weighted and 2D FLAIR.
Results: Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented on mean ± SD (min-max) and results on categorical measurements are presented in number (%). Significance is assessed at 5 % level of significance. The following assumptions on data are made. Wilcoxon Signed rank test has been used to find the significance of the median score in two groups.
Conclusion: DIR brain imaging had the highest sensitivity in the detection of supratentorial lesions compared to3D FLAIR and 2D flair. In addition, the lesions obtained with 3D DIR images were more easily visualised.
Limitations: Patients with cardiac pacemakers and metallic implants will not be subjected to MRI. Motion disorder and claustrophobia, if severe, may make the examination difficult.
Ethics: The study is approved by a diplomate of the national board.
Funding: No funding was received for this work.
MyT3 18-9
Therapy results of pericallosal aneurysms: a retrospective unicentre study
Purpose: This retrospective unicentre study aims to compare treatment results of ruptured and unruptured pericallosal artery aneurysms (PAAs) regarding postprocedural complications, patient outcome and aneurysm recurrence after endovascular (EVT) and neurosurgical treatment (NT).
Methods: A total of 67 patients with PAA were admitted to our hospital, 44 patients with subarachnoidal haemorrhage (SAH) due to a ruptured PAA and 23 patients with unruptured PAA. The radiographic features of PAA were collected from pretreatment DSA. In addition, demographic, clinical and radiographic parameters of all patients were recorded. The outcome was measured based on the modified Rankin Scale (mRS) at six months after admission (favourable mRS score, 0-2 vs unfavourable mRS score, 3-6).
Results: Overall 46 patients underwent EVT and 21 patients NT. Six months after discharge of the SAH patients 24 had a favourable outcome (mRS 0-2) and 16 patients with unfavourable outcome (mRS 3-6). The mortality rate of patients with SAH was 10.1% (n=4) and was alike compared to former studies (11%) on patients with ruptured PAA. Overall aneurysm recurrence was found in six patients (9.4%). All patients with unruptured PAA had a favourable outcome.
Conclusion: EVT and NT of PAAs showed comparable good results, although aneurysm recurrence occurres more often after EVT.
Limitations: The crucial issue of this retrospective analysis is the lower quality/completeness of data compared with prospective data storage.
Ethics: The ethical approval for this study was provided by the local ethics committee (13-5580-BO).
Funding: No funding was received for this work.
MyT3 18-10
High-resolution MR imaging of cortical layers and their structural alterations in stroke and epilepsy patients
Purpose: We aimed to utilise a non-invasive in-vivo MR-based imaging modality and analysis framework to detect and characterise the laminar components of the human cerebral cortex in stroke and epilepsy patients compared with healthy controls (HC).
Methods: Using 3T-MRI we calculated T1-component probability maps and showed that the T1-signal of the cortex can be divided into 5-6 distinct Gaussian distributions centred at different values, which represent different cortical laminar classes. For the stroke patients, we explored in-vivo if in patients (n=20) with chronic lacunar infarct, involving the corticospinal-tracts (CST), the cortical layers of the connected primary motor cortex (M1) are differently affected. We performed tractography using the infarcts as the seed areas to reconstruct the CST and identified the connected M1. For epilepsy patients (focal cortical dysplasia (FCD) and periventricular nodular heterotopia (PNH); n=9 each) we determined the laminar composition of 78 cortical regions of interest of the automated anatomical labelling (AAL) atlas, which was divided into 1000 sub-areas with equal volume.
Results: For stroke patients we showed focal cortical thinning in the connected M1 and specifically only in its deepest laminar portion as compared to the non-affected contralateral cortex (P<0.001), supporting the concept of secondary neurodegeneration. For epilepsy patients we found widespread cortical dyslamination compared to the HC, supporting evidences of epilepsy as a network disease with disrupted brain connectivity.
Conclusion: Our findings provide a method to calculate and characterise the laminar architecture of the cortex, which was implemented to stroke and epilepsy patient groups. Our method may be used as a sensitive imaging biomarker, and could potentially elucidate pathophysiologic mechanisms and facilitate patient management towards developing individually tailored treatment.
Limitations: Not applicable.
Ethics: Approved by institutional IRB.
Funding: Not applicable.
MyT3 18-11
Application of low radiation dose combined spectrum and ASIR-V iterative reconstruction in CT scanning of ischaemic stroke: a feasibility study
Purpose: To explore the application of low-dose combined spectrum in CT scan of ischaemic stroke.
Methods: Group A (n=30) used the low-dose scan parameters: 80 kV, 50 mA, and the images were reconstructed by 50% ASIR-V. Head and neck (CTA) Scanning with Spectrum CT, 80-140 kV, 200 mA?the contrast agent volume was 20ml and the flow rate was 4ml/s. The images were reconstructed with 40 keV and 80% ASIR-V. Group B (n=30) used routine scan parameter: CTP:80 kV, 150 mA, CTA :100 kV, 350 mA, the contrast agent volume was 50ml and the flow rate was 5ml/s. The images were reconstructed by FBP. The contrast agent volume was 40ml and the flow rate was 5ml/s in CTP. The quantitative evaluation included: CTP parameters of the hypothalamic, frontal and temporal lobes without perfusion defects at the basal ganglia level, the CT and SD values of the head-neck CTA segments, and the CNR values of M1. The CTP and CTA image quality were also subjectively evaluated by two senior radiologists using a four-point grading scale.
Results: All CTP and CTA images were diagnostic. There were no significant differences in the subjective image, CTP parameters, CTA internal carotid artery and middle cerebral artery and CT value of common carotid artery. There were significant differences in SD and CNR in the common carotid artery. The effective dose and the contrast agent in group A were 58.5% and 23% lower than group B.
Conclusion: The use of low radiation dose combined spectrum and ASIR-V iterative reconstruction in CT scanning of ischaemic stroke.
Limitations: The simple size is relatively small.
Ethics: Approved by the ethics committee of our hospital.
Funding: No funding was received for this work.
MyT3 18-13
Imaging as the new yardstick for diagnosing peripheral mononeuropathies: a comparison between high-resolution ultrasound and MR neurography with an approach to diagnosis
Purpose: Peripheral neuropathies are a group of disorders which affect the peripheral nervous system and have been conventionally diagnosed using electrodiagnostic studies. This study was carried out to assess the role of imaging in diagnosing peripheral neuropathy as exact anatomical localisation of the pathology is possible using high-resolution ultrasound (HRUS) and MR neurography, the modalities assessed in this study.
Methods: A prospective study was carried out in a resource-limited setting on 180 peripheral nerves in 131 patients with symptoms of peripheral neuropathy after taking IRB approval. Each patient underwent HRUS and MR neurography, findings of which were then compared and statistically analysed assuming electrodiagnostic findings as to the gold standard.
Results: Overall, the diagnostic accuracy was highest for the proton density fat saturated (PDFS) MR sequence (93.89%) followed closely by HRUS (80%). The sensitivity was highest for PDFS sequence while the T1 MR sequence had the highest specificity. Combined diagnostic accuracy of both modalities was calculated to be 93.33% with a negative predictive value of 80%. HRUS and MRI equally detected the cases with nerve discontinuity, while neuromas were better identified on MRI.
Conclusion: With the advent of higher frequency probes and improved MR field strength, imaging of peripheral nerves is possible with better accuracy. Imaging assessment of nerves allows anatomical delineation with the identification of the exact site of involvement. This comparative study demonstrates the role of imaging in diagnosing peripheral neuropathies with the accuracy of MRI as high as 93.89% which may serve as an imaging gold standard. HRUS, being quicker, cost-effective and a comparable accuracy of 80% can serve as a reliable screening tool.
Limitations: Resource-limited setting and lack of newer sequences like DTI and DWI.
Ethics: The IRB approved.
Funding: No funding was received for this work.
MyT3 18-14
Evaluation of parameter changes in lateral lumbosacral radiography of patients with and qithout lumbar spinal stenosis in magnetic resonance imaging (MRI)
Purpose: To investigate the effect of lumbar spinal stenosis (LSS) on objective parameters reflected on radiographs and to adapt existing radiographic indexes to the diagnosis of LSS.
Methods: LSS was determined by measuring the midline anteroposterior (AP) spinal canal diameter on axial T2-weighted images in lumbosacral MRI. Fifty patients with LSS and 50 patients without LSS were classified as. Lateral lumbosacral radiographs of the patients were evaluated retrospectively and on radiographs, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L5 incidence (L5I), L5 slope (L5S), sacral table angle (STA), sagittal vertebral corpus height (SBH), sagittal vertebral corpus width(SBW), peduncular width(PW), foraminal width (FW), posterior pedicle margin (PPM) were measured, SBW/PW and SBW/PPM ratios were calculated.
Results: In the LSS group, PI was significantly higher (p = 0.029). FW (p <0.001) and PW (p <0.005) values
MyT3 18-15
Automated quantification pipeline (AQuaPi) for the non-invasive measurement of the cerebral metabolic rates of glucose using a fully-integrated PET/MRI
Purpose: To introduce AQuaPi, a fully-automated pipeline for PET/MRI to non-invasively determine the cerebral metabolic rate of glucose (CMRGlc) images.
Methods: The pipeline needs the following inputs: (1) PET list-mode data, (2) attenuation correction (AC) map, (3) MR angiography (MRA) images, (4) T1-w MRI and (5) MR navigators. The processing pipeline includes two main components: (i) an image-derived input function (IDIF) component and (ii) a quantification component (QC). The IC component calculates an IDIF by first determining a volume-of-interest through automated segmentation of the MRA, followed by MR navigator-based motion correction (MC) and an MR-based partial volume correction (PVC). The QC then uses the IDIF to generate CMRGlc images. To validate the pipeline, 10 healthy volunteers underwent [18F]FDG test-retest PET/MRI examinations in an integrated PET/MR. Arterial blood samples (AIF) were collected as a reference standard. Pseudo-CT images derived from T1-w MR were used for AC. Absolute percentage difference (APD) in regional MRGlc values (IDIF vs AIF) were determined in the following 6 brain regions: corpus callosum (CC), brainstem (BS), cerebellum (CB), thalamus (TH), anterior cingulate cortex (ACC) and the superior frontal cortex (SFC).
Results: The APD between CMRGlc values obtained from AIF and IDIF were: (5.9 ±3.2%) for CC, (5.9 ±3.3%) for BS, (5.8 ±3.4%) for CB, (5.5 ±3.1%) for ACC, (5.8 ±3.14%) for TH and (5.9 ±3.3%) for the SFC.
Conclusion: We have developed a fully-automated open-source processing pipeline which allows non-invasive determination of absolute CMRGlc values in a clinical setting.
Limitations: Inter- and intra-variability of CMRGlc is high.
Written informed consent was obtained from all the subjects along with ethics board approval.
This work was supported by the Austrian Science Fund KLI482-B31.
MyT3 18-17
Compare the characteristics of different types of spontaneous intracranial artery dissection on high-resolution MRI vessel wall imaging (recorded)
Purpose: To compare the characteristics of different types of spontaneous intracranial artery dissection on high-resolution MRI (HR-MRI) vessel wall imaging.
Methods: Fifty-six patients with approved spontaneous intracranial artery dissection were scanned on a 3T Siemens Skyra scanner with pre- and post-contrast 3D T1-weighted SPACE. Patients were divided into four groups based on the morphological characteristics of pre-contrast 3D T1-weighted SPACE imaging. Type 1 corresponded to classic dissecting aneurysms, type 2 aneurysms were segmental ectasias, type 3 aneurysms were dolichoectatic dissecting aneurysms and type 4 aneurysms were saccular aneurysms unrelated to the branching zones. Consistency of clinical staging (acute, subacute, chronic stage) and imaging types was evaluated. The characteristics of spontaneous intracranial artery dissection were evaluated including intraluminal contrast enhancement, and artery wall enhancement (grade 0, similar to that of normal vessel walls; grade 1, less than or similar to that of muscle; and grade 2, greater than that of muscle). The characteristics of spontaneous intracranial artery dissection were compared among different types.
Results: Of the 56 aneurysms, 48 were located in the vertebrobasilar system, and the other eight aneurysms were located in the anterior circulation. There were 22 patients for type 1, 10 for type 2, 14 for type 3, and 10 for type 4. Patients were classified into acute (n=18), subacute (n=18), and chronic (n=20) stages according to the time intervals from symptom onset. The clinical staging was in good consistency with imaging types (p=0.000, r=0.732). There was significantly different of intraluminal contrast enhancement and vessel wall enhancement among the four types groups (p=0.030).
Conclusion: The 3T HR-MRI reveals the vessel wall characteristics and provides distinguishing findings between different types of spontaneous intracranial artery dissection.
Limitations: This study was limited by a small number of study groups.
Ethics: n/a
Funding: No funding was received for this work.
MyT3 18-18
Brain MRI follow-up in children with tuberous sclerosis complex: is gadolinium enhancement always necessary?
Purpose: Subependymal giant cell astrocytoma (SEGA) is a brain tumour developed in 10-26% of individuals with tuberous sclerosis complex (TSC). Since they are located near the foramen of Monro, SEGAs can cause obstructive hydrocephalus, leading to increase morbidity and mortality. It is recommended to follow TSC patients with contrast-enhanced (CE) MRIs, but the repetitive use of gadolinium-based contrast agents (GBCAs) may cause gadolinium deposits. Our aim was to compare the performance of CE and non-CE MRI to diagnose SEGA.
Methods: Thirty-five TSC patients were enrolled in this retrospective single-centre study from September 2007 to January 2019 (15/35 (43%) males and 20/35 (57%) females). The inclusion criteria were: diagnosis of TSC on clinical and genetic arguments (according to international TSC consensus conference held in 2012) and at least three-brain MRIs performed for follow-up with a contrast agent injection. In total, 70 MRIs were selected (25 MRIs in the SEGA group and 65 MRIs in the non-SEGA group), two consecutive MRIs per patient were anonymised. Three radiologists performed a double-blinded review of the non-CE and CE MRI sequences. The diagnostic performances were calculated (sensitivity, specificity, positive/negative predictive values and inter and intra-observer agreements).
Results: The performances for the detection of SEGA were good and similar between the CE and non-CE MRIs. Inter-observer agreement was excellent for the two groups (range of Kappa coefficient: 0.81-0.93, p<0.001). The size of nodules near the Monro foramen, intense and heterogeneous contrast enhancement and modifications between two consecutive MRI were significantly associated with the presence of SEGA.
Conclusion: The performances of CE and non-CE MRIs are similar and excellent for detecting SEGA, raising the question of reducing unnecessary gadolinium-chelates injection for TSC patients.
Limitations: n/a
Ethics: n/a
Funding: No funding was received for this work.
MyT3 18-19
Role of transcranial ultrasound with Doppler and strain elastography in neonatal hypoxic-ischaemic encephalopathy with magnetic resonance imaging as the gold standard
Purpose: To compare and correlate the diagnostic role of neurosonography with spectral Doppler and strain elastography in neonatal hypoxic-ischaemic encephalopathy with MRI as the gold standard. To assess the role of diffusion-weighted Imaging in early identification and extent of ischemic injury.
Methods: A prospective study was conducted on 50 patients under one month age with a clinical picture of neonatal encephalopathy, a history of perinatal asphyxia and low Apgar score. All patients were graded by Sarnat and Sarnat grading. Neurosonography with spectral Doppler of the anterior cerebral artery and strain elastography was done with 3-7 MHz probe on anterior fontanelle. Elastographic scores were assigned on a five-point colour scale.3 Tesla MRI was done with DWI (diffusion-weighted images). Ultrasound findings were correlated with MRI in various areas of the brain parenchyma and the role of DWI was evaluated by SPSS v.20.0.
Results: The diagnostic accuracy, sensitivity and specificity of neurosonography compared to MRI were 82%, 82.6% and 75% respectively. DWI detected mild ischaemic changes when other MR sequences were negative. Neurosonography detected all cases of germinal matrix haemorrhage and showed better sensitivity for thalamic, basal ganglia and periventricular white matter lesions. Altered RI values of ACA were seen in 59% of moderate and severe cases. Diagnostic accuracy of Elastographic score was 76.67% with a specificity of 86.67% (95%CI;59.54%-98.34%) and sensitivity of 66.67% (95%CI;33.38%-88.18%).
Conclusion: Neurosonography is an effective screening tool for detecting ischaemic encephalopathy. Raised elasticity of periventricular white matter in neonatal encephalopathy points towards its promising role in early diagnosis. DWI detects ischaemic changes earlier than conventional MRI which is important in initiating early management.
Limitations: This study was limited by its small sample size.
Ethics: Approval was taken from the ethical committee of SMS Medical College.
Funding: No funding was received for this work.
MyT3 18-20
Correlation of childhood head injury with clinical and imaging characteristics of Dyke-Davidoff-Masson syndrome
Purpose: To investigate the correlation between childhood head injury and clinical-radiological features of Dyke-Davidoff-Masson Syndrome (DDMS).
Methods: A total of 33 patients with a diagnosis of cerebral hemiatrophy at our institution between January 2012 to July 2019 were retrospectively review. Patients of this study must fulfil the following criteria: (i) clinical presentation of seizure; (ii) radiological manifestations with ipsilateral sulcal enlargement, ipsilateral lateral ventricular dilatation, and ipsilateral calvarial thickening. The patients were distributed into two groups based on the present or absent of childhood head injury. Clinical and imaging characteristics were compared and analysed. Raw data are presented as frequencies and percentages for categories and mean for the age at presentation. Fisher?s exact test was used to assess the association between two categorical variables.
Results: There are 14 patients (eight males, six females) aged 1 to 46 years (mean age±SD=20.7±13.8) were included. There are eight patients with childhood head injury and six patients without history of childhood head injury. Clinical features recognised in these two groups are hemiplegia (87.5% vs 66.7% respectively, p=0.539), mental retardation (87.5% vs 66.7%,p=0.539) and psychiatric disorders (37.5% vs 16.7%, p=0.580). Of these patients, radiological appearances of wallerian degeneration and hyperpneumatisation of paranasal sinus (75% vs 50%, p=0.580 ); elevation of orbital roof (75% vs 33.3%,p= 0.277); hperpneumatisation of the mastoid and elevation of petrous ridge (62.5% vs 16.7%, p=0.138) were found in these two groups. The formation of porencephaly and midline structural shift were identified among the patients (87.5% vs 16.7%, p=0.026).
Conclusion: The clinical-radiological manifestations of DDMS vary widely. The patients with childhood head injury were more likely to have the formation of porencephaly and midline structural shifts.
Limitations: This study was limited by a small number of patients and by the lack of detailed history and clinical information due to the retrospective nature of this study.
Ethics: n/a
Funding: No funding was received for this work.


Alexandre Krainik (France)

Irina Trofimenko (Russian Federation)

European Society of Radiology

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