Neuroimaging diagnosis for cerebral infarction An 8-year bibliometric analysis

OBJECTIVE： To identify global research trends in neuroimaging diagnosis for cerebral infarction using a bibliometric analysis of the Web of Science. DATA RETRIEVAL： We performed a bibliometric analysis of data retrieval for neuroimaging diagnosis for cerebral infarction containing the key words ＂CT, magnetic resonance imaging, MRI, transcranial Doppler, transvaginal color Doppler, digital subtraction angiography, and cerebral infarction＂ using the Web of Science. SELECTION CRITERIA： Inclusion criteria were： （a） peer-reviewed articles on neuroimaging diagnosis for cerebral infarction which were published and indexed in the Web of Science; （b） original research articles and reviews; and （c） publication between 2004-2011. Exclusion criteria were： （a） articles that required manual searching or telephone access; and （b） corrected papers or book chapters. MAIN OUTCOME MEASURES： （1）Annual publication output; （2） distribution according to country; （3） distribution according to institution; （4） top cited publications; （5） distribution according to journals; and （6） comparison of study results on neuroimaging diagnosis for cerebral infarction. RESULTS： Imaging has become the predominant method used in diagnosing cerebral infarction. The most frequently used clinical imaging methods were digital subtraction angiography, CT, MRI, and transcranial color Doppler examination. Digital subtraction angiography is used as the gold standard. However, it is a costly and time-consuming invasive diagnosis that requires some radiation exposure, and is poorly accepted by patients. As such, it is mostly adopted in interventional therapy in the clinic. CT is now accepted as a rapid, simple, and reliable non-invasive method for use in diagnosis of cerebrovascular disease and preoperative appraisal. Ultrasonic Doppler can be used to reflect the hardness of the vascular wall and the nature of the plaque more clearly than CT and MRI. CONCLUSION： At present, there is no unified standard of classification of cerebral infarction imaging. Detection of clinical super-acute cerebral infarction remains controversial due to its changes on imaging, lack of specificity, and its similarity to a space-occupying lesion. Neuroimaging diagnosis for cerebral infarction remains a highly active area of research and development.

A molecular probe carrying anti-tropomyosin 4 for early diagnosis of cerebral ischemia/reperfusion injury

In vivo imaging of cerebral ischemia/reperfusion injury remains an important challenge.We injected porous Ag/Au@SiO_(2) bimetallic hollow nanoshells carrying anti-tropomyosin 4 as a molecular probe into mice with cerebral ischemia/reperfusion injury and observed microvascular changes in the brain using photoacoustic imaging with ultrasonography.At each measured time point,the total photoacoustic signal was significantly higher on the affected side than on the healthy side.Twelve hours after reperfusion,cerebral perfusion on the affected side increased,cerebrovascular injury worsened,and anti-tropomyosin 4 expression increased.Twenty-four hours after reperfusion and later,perfusion on the affected side declined slowly and stabilized after 1 week;brain injury was also alleviated.Histopathological and immunohistochemical examinations confirmed the brain injury tissue changes.The nanoshell molecular probe carrying anti-tropomyosin 4 has potential for use in early diagnosis of cerebral ischemia/reperfusion injury and evaluating its progression.

Differentiation and diagnosis of migrating cerebral sparganosis: 2 case reports from China

Human cerebral sparganosis is a rare but neglected parasitic disease. We present details of the diagnosis of two cases of migrating cerebral sparganosis from China based on computed tomography and magnetic resonance imaging combined with epidemiological information and serology. Its differentiatial diagnosis from other parasitic diseases, tuberculoma and brain tumor by neuroimaging is briefly discribed.

Recurrent Transient Ischemic Attacks Revealing Cerebral Amyloid Angiopathy: A Comprehensive Case

This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.

Primary imaging features and recent application of PET tracers in cerebral amyloid angiopathy

Cerebral amyloid angiopathy(CAA)is a small vessel disease of the brain characterized by the progressive deposition of amyloid-β(Aβ)plaques in the walls of cerebral blood vessels.It presents with a subtle course and sudden onset,and currently,there are no specific therapeutic interventions available.Accurate diagnosis of CAA could enable targeted interventions in the early stages of the disease,potentially mitigating the disease’s effects.Herein,we review the primary imaging biomarkers used in the diagnosis of CAA,including their mechanisms,imaging characteristics,and significance.We also provide an interpretation of the latest version(v2.0)of the Boston criteria,which are commonly used in the clinical diagnosis of CAA.Additionally,this study introduces various positron emission tomography(PET)tracers for CAA and reviews their application values in the diagnosis of CAA.

Study of clinical features of amyloid angiopathy hemorrhage and hypertensive intracerebral hemorrhage

Objective: The purpose of this study was to differentiate between cerebral amyloid angiopathy (CAA) and hypertension (HTN) based on hemorrhage pattern interpretation. Methods: From June 1994 to Oct., 2000, 83 patients admitted to our service with acute intracerebral hemorrhage (ICH) were investigated retrospectively; 41 patients with his-tologically proven diagnosis of cerebral amyloid angiography and 42 patients with clear history of hypertension were investigated. Results: Patients with a CAA-related ICH were significantly older than patients with a HTN-related ICH (74.0 years vs 66.5 years, P<0.05). There was a significantly higher number of hematomas> ml in CAA (85.3%) when compared with HTN (59.5%). No basal ganglional hemorrhage was seen in CAA, but in 40.5% in HTN. In CAA-related ICH, su-barachnoid hemorrhage (SAH) was seen in 26 patients (63.4%) compared to only 11 patients (26.2%) in HTN-related ICH. Intraventricular hemorrhage was seen in 24.4% in CAA, and in 26.2% in HTN. Typical features of CAA-related ICH included lobar distribution affecting mainly the lobar superficial areas, lobulated appearance, rupture into the subarachnoid space, and secondary IVH from the lobar hemorrhage. More specifically, multiplicity of hemorrhage, bilaterality, and repeated episodes also strongly suggest the diagnosis of CAA. Multiple hemorrhages, defined as 2 or more separate he-matomas in multiple lobes, accounted for 17.1% in CAA-related ICH. Conclusion: There are certain features in CAA on CT and MRI and in clinical settings. To some extent, these features may contribute to distinguishing CAA from HTN related ICH.

CHARACTERISTIC MAGNETIC RESONANCE ENHANCEMENT PATTERN IN CEREBRAL SCHISTOSOMIASIS

Objective To describe the characteristic magnetic resonance imaging （MRI） appearance of cerebral schistosomiasis. Methods Twenty-five patients whose diagnosis of central nervous system （CNS） schistosomiasis had been pathologically （n = 8 ） and clinically （n = 17） confLrmed were randomly selected. MRI was performed on a Signal 1.5T MRI scanner before and after the intravenous administration of gadopentetate dimeghimine constrast medium. We reviewed the MRI studies obtained at the time of initial presentation, as well as follow-up studies obtained during and after medical treatment Results ImmunoLogicaL tests in L5 patients indicated schistosomiasis haematobium. Contrast-enhanced TL-weighted images in 22 cases showed central linear enhancement surrounded by multiple enhancing punctate nodules, which ap- peared “arborized”. Through operation and pathological examination, 8 cases had the granuloma formation of schistoso- mal eggs extensive surrounded by inflammation and venous congestion. And 17 cases were treated with praziquantel and corticosteroid therapy. And they were followed up for 2 months by taking MRI, which turned out to be complete resolution of the enhancing structure and edema. At follow-up, all the patients＇ initial symptoms also resolved. Conclnsion The specified MRI enhancement pattern of cerebral schistosomiasis is common in most cases of CNS schistosomiasis, so it should be taken account into the diagnosis of cerebral schistosomiasis.

Isolated cerebral mucormycosis that looks like stroke and brain abscess:A case report and review of the literature

BACKGROUND Cerebral mucormycosis is an infectious disease of the brain caused by fungi of the order Mucorales.These infections are rarely encountered in clinical practice and are often misdiagnosed as cerebral infarction or brain abscess.Increased mortality due to cerebral mucormycosis is closely related to delayed diagnosis and treatment,both of which present unique challenges for clinicians.CASE SUMMARY Cerebral mucormycosis is generally secondary to sinus disease or other disseminated disease.However,in this retrospective study,we report and analyze a case of isolated cerebral mucormycosis.CONCLUSION The constellation of symptoms including headaches,fever,hemiplegia,and changes in mental status taken together with clinical findings of cerebral infarction and brain abscess should raise the possibility of a brain fungal infection.Early diagnosis and prompt initiation of antifungal therapy along with surgery can improve patient survival.

Hemorrhagic transformation of ischemic cerebral proliferative angiopathy: A case report

BACKGROUND Cerebral proliferative angiopathy(CPA)is a rare vascular disease characterized by the presence of diffuse vascular proliferation,progressive vascular hyperflow and vasodilation of multiple vessels in the normal brain parenchyma.Unlike cerebral arteriovenous malformations,CPA has a mixed appearance between that of lesions with cell proliferation and endothelial proliferation.To date,the pathogenesis of CPA is unclear,in which changes induced by cortical ischemia in the elastic layer of the blood supply artery and smooth muscle cells may be involved.CASE SUMMARY In this article,we retrospectively analyzed a case of hemorrhagic transformation of ischemic CPA diagnosed by digital subtraction angiography and reviewed the related literature for further exploration of its pathogenesis,diagnosis and treatment.CONCLUSION The information in the present case report may facilitate further clinical research on this cerebrovascular disease.

Cerebral proliferative angiopathy in pediatric age presenting as neurological disorders:A case report

BACKGROUND Cerebral proliferative angiopathy(CPA)is a rare subtype of arteriovenous malformation.It is extremely rare in pediatric patients and has serious implications for developing children.However,reports of these disorders worldwide are limited,and no uniform reference for diagnosis and treatment options exists.We report the case of a 6-year-old with CPA having predominantly neurological dysfunction and review the literature on pediatric CPA.CASE SUMMARY We report the case of a pediatric patient with CPA analyzed using digital subtraction angiography(DSA)who presented initially with a neurological disorder as the main manifestation.This case is the basis for further discussion of the clinical presentation,pathogenesis,diagnosis,and treatment of CPA in children.After the cerebral DSA,the patient was treated conservatively with sedation,fluid replacement,and blood anticoagulation.She could not cooperate with the followup magnetic resonance imaging examination because of her young age,and her family declined further treatment because of the surgery’s high risk.She was followed up for 3 months;her symptoms did not worsen.CONCLUSION This report of rare pediatric CPA can inform and advance clinical research on congenital cerebrovascular diseases.

Cyclostationary Modeling of Surface Electromyography Signal During Gait Cycles and Its Application for Cerebral Palsy Diagnosis

Cerebral palsy(CP) is a group of permanent movement disorders that appear in early childhood.The electromyography(EMG) signal analysis and the gait analysis are two most commonly used methods in the clinic. In this paper, a cyclostationary model of the EMG signal is proposed. The model can combine the aforementioned two methods. The EMG signal acquired during the gait cycles is assumed to be cyclostationary due to the physiological characteristics of the EMG signal production. Then, the spectral correlation density is used to analyze the cyclic frequency(corresponding to the gait cycles) and spectral frequency(the frequency of EMG signal) in a waterfall representation of the two kinds of frequencies. The experiments show that the asymptomatic(normal) subjects and symptomatic subjects(with CP) can be distinguished from the spectral correlation density in a range of cyclic frequencies.

Determination of specific IgG4 for diagnosis and therapeutic evaluation of cerebral cysticercosis

To probe the significance of specific IgG4 in sera of patients with cerebral cys ticercosis for diagnosis and therapeutic evaluation Methods Specific IgG4 in sera of patients with cerebral cysticercosis was assessed using colloidal gold labeled mouse anti human IgG4 McAb as probe The results wer e compared with the CT image manifestation Results The specific IgG4 positive rate in sera of patients with cerebral cysticercosis was 97 8%, whereas sera from patients with other kinds of parasitosis or centra l nerve system disease and the control group were all negative, except for a wea k cross reaction of sera from patients with hepatic echinococoosis The determ ination of specific IgG4 in sera of patients with cerebral cysticercosis during different times of treatment showed that along with an increase in treatment tim e and improvement of clinical symptoms, specific IgG4 level gradually decreased The positive rate and intensity of specific IgG4 in sera from patients with c erebral cysticercosis were consistent with the number of cysticercus parasites i n the brain and pathologic changes, such as survival, disintegration, death and calcification Survival of cysticercus in the brain was ABSTRACTly evaluated u sing this technique Conclusions The determination of specific IgG4 in sera is a practical method for diagnosis a nd therapeutic evaluation of cerebral cysticercosis

脑小血管病的诊治现状及未来探索之路

脑小血管病(cerebral small vessel disease,CSVD)是一组临床、影像、病理综合征,主要累及颅内小血管,起病隐匿。CSVD与卒中、认知下降、情感障碍、步态异常及尿便失禁密切相关,给家庭和社会带来沉重的疾病负担和经济负担。但CSVD的致病机制仍不明确,临床诊断标准不统一,临床诊疗和试验研究面临重大挑战。本文旨在汇总当前CSVD的可能病因、发病机制和临床诊疗研究的进展及局限性,展望CSVD未来可能的临床研究方向。

血清KLF2、NOS3水平对大动脉粥样硬化型急性脑梗死患者的诊断及病情评估价值

[目的]探讨锌指样转录因子2(KLF2)、内皮型一氧化氮合酶3(NOS3)水平在大动脉粥样硬化(LAA)型急性脑梗死(ACI)患者诊断及病情评估中的价值。[方法]将150例LAA型ACI患者根据病情分为轻度组(n=36)、中度组(n=48)和重度组(n=66),另选取同期门诊健康体检者设为对照组(n=150)。比较各组血清KLF2、NOS3水平;ROC曲线分别分析血清KLF2、NOS3水平对LAA型ACI的诊断价值和对发生重度LAA型ACI的预测价值。[结果]LAA型ACI组患者血清KLF2、NOS3水平显著低于对照组(P<0.05)。轻、中、重度组LAA型ACI患者血清KLF2、NOS3水平依次显著降低(P<0.05)。血清KLF2、NOS3二者联合诊断LAA型ACI的AUC为0.858,灵敏度为73.33%,特异度为86.00%,优于KLF2、NOS3各自单独诊断(Z联合检测-KLF2=3.796,Z联合检测-NOS3=4.689,均P<0.001)。血清KLF2、NOS3二者联合预测发生重度LAA型ACI的AUC为0.878,灵敏度为77.27%,特异度为90.48%,优于KLF2、NOS3各自单独预测(Z联合检测-KLF2=2.401,P=0.016;Z联合检测-NOS3=3.070,P=0.002)。[结论]LAA型ACI患者血清KLF2、NOS3水平显著降低,且与病情严重程度显著负相关,二者联合应用对LAA型ACI诊断和病情预测具有较高的评估效能。

脑血管痉挛诊断方法的研究进展

脑血管痉挛是蛛网膜下腔出血后的常见并发症,其定义为一种特殊类型的脑动脉收缩,具体表现为脑部动脉收缩性狭窄,常伴受累血管远端分布区的血液灌注减少。此病发病隐匿,预后不佳,依据临床症状明确诊断时病程已进展到末期,错过最佳治疗时机。因此,如何有效迅速地诊断脑血管痉挛已成为临床研究的热点问题。近年来,新兴影像学技术的发展以及更多监测手段的出现,为脑血管痉挛的诊断提供了新的方法与思路。本文主要从脑血管痉挛的影像学诊断方面作一综述。

miR-27-3p、miR-128-3p及miR-140-3p表达在急性脑梗死患者诊疗中的价值研究

目的 探讨miR-27-3p、miR-128-3p及miR-140-3p表达在急性脑梗死(ACI)患者诊疗中的应用价值。方法 选取2020年1月至2022年12月南通市第三人民医院全科医学科收治的ACI患者100例作为研究对象,定义为ACI组,根据ACI患者3个月改良Rankin评分量表(mRS评分)将其分为预后良好组(mRS评分≤2分)68例与预后不良组(mRS>2分)32例,另选同期于南通市第三人民医院全科医学科体检的健康者100例作为对照组。记录各组miR-27-3p、miR-128-3p及miR-140-3p表达水平并进行比较,采用Pearson相关分析探讨两变量的相关性,通过绘制受试者工作特征(ROC)曲线评价miR-27-3p、miR-128-3p及miR-140-3p联合检测在ACI诊断中的效能,采用多因素Logistic回归分析探讨ACI预后的危险因素。结果 ACI组平均年龄、吸烟史比例、合并高血压比例、miR-140-3p与miR-128-3p及miR-27-3p表达水平均明显高于对照组(均P<0.05)。miR-27-3p、miR-128-3p及miR-140-3p联合检测用于诊断ACI的曲线下面积(AUC值)为0.965,敏感度为99.00%,特异度为98.00%,表明miR-27-3p、miR-128-3p及miR-140-3p联合检测用于诊断ACI的效能更高。预后不良组平均年龄、入院时NIHSS评分、梗死体积、吸烟史比例、合并高血压比例、miR-27-3p、miR-128-3p、miR-140-3p表达水平及3个月mRS评分均明显高于预后良好组(均P<0.05)。经Pearson相关分析表明ACI患者miR-27-3p、miR-128-3p、miR-140-3p表达水平均分别与入院时NIHSS评分、梗死体积、3个月mRS评分呈正相关(均P<0.05)。经多因素Logistic回归分析表明年龄(OR:1.546;95%CI:1.124~1.969)、入院时NIHSS评分(OR:1.721;95%CI:1.229~2.308)、梗死体积(OR:1.853;95%CI:1.436~2.786)、吸烟史(OR:1.517;95%CI:1.168~1.825)、miR-27-3p (OR:2.481;95%CI:1.452~3.201)、miR-128-3p (OR:1.692;95%CI:1.288-2.431)及miR-140-3p (OR:2.032;95%CI:1.141~1.976)均为ACI患者预后的独立危险因素(均P<0.05)。结论 ACI患者miR-27-3p、miR-128-3p及miR-140-3p表达水平均明显升高,通过三指标联合检测可提高对ACI的诊断效能,而预后不良ACI患者miR-27-3p、miR-128-3p及miR-140-3p表达水平则升高更为明显,并分别与入院时NIHSS评分、梗死体积、3个月mRS评分呈正相关,且miR-27-3p、miR-128-3p及miR-140-3p均为ACI患者预后的独立危险因素,应予以重点关注。

DRG付费下的脑梗死患者住院费用构成及影响因素分析

目的在比较广西某市医院实施疾病诊断相关分组(DRG)付费前后脑梗死患者住院费用结构变化的基础上,分析DRG对脑梗死患者住院费用的影响因素。方法收集广西某市医院2019年与2021年脑梗死住院患者病案资料,采用结构变动度分析和灰色关联分析等研究方法,对住院费用及其影响因素进行深入的分析和探讨。结果实行DRG付费后脑梗死患者出院人次增加,平均住院时间减少,总住院费用上升;脑梗死患者住院费用结构变化明显,药费占比大幅度下降,检查费呈上升趋势;关联度及关联序列排前三位的分别是药费、检查费、化验费;非参数检验结果表明,性别、年龄、医保类型、有无输血、有无手术、住院时间对脑梗死患者住院费用均有显著影响(P<0.05)。结论该院DRG付费改革观念未转,成本控制意识弱;费用结构优化后,药费占比仍高,检查费占比上升,技术劳务价值占比较低;住院时间对脑梗死患者费用影响大,时间越长费用越高。

MRI与CT影像检查在多发性脑梗死诊断中的应用分析

目的:探讨多发性脑梗死采用颅脑磁共振成像(MRI)诊断的价值。方法:选取2022年2月—2023年2月滨州市中心医院收治的120例多发性脑梗死患者的为研究对象,全部患者均经手术病理确诊,对120例患者分别采取MRI检查与CT检查,对比MRI与CT的诊断效能。结果:与CT检查相比,MRI检查对不同直径梗死病灶的检出率更高,差异有统计学意义(P<0.05);MRI检查对<24 h、24~72 h发病时间的梗死病灶的检出率更高,差异有统计学意义(P<0.05),而对>72 h病灶的检出率比较差异无统计学意义(P>0.05);MRI检查对基底节区、脑干、脑旁室、顶叶以及丘脑部位的梗死病灶检出率更高,差异有统计学意义(P<0.05)。结论:临床上采用MRI、CT检查均能有效检出多发性脑梗死,但MRI检查在多发性脑梗死的早期病灶、不同直径病灶以及不同部位病灶的诊断价值更高。

脑小血管病诊断和鉴别诊断的最新进展

脑小血管病(CSVD)是一种对我国人民健康产生严重影响的常见疾病。该疾病进展隐匿,可能被患者和临床医师忽视。近些年,对于CSVD的危险因素、发病机制、临床表现以及评价体系的研究取得一些进展。2013年,国际血管改变神经影像标准(STRIVE)协作组对CSVD的定义与描述进行了规范性的梳理。2021年,本团队发布了《中国脑小血管病诊治专家共识2021》,整合了最新的国内外研究成果。在2023年,国际STRIVE协作组进一步更新了CSVD领域的研究进展。在临床表现上,CSVD与神经退行性病变相似,特异性不够显著。尽管遗传检测和脑组织活检对于确诊有一定帮助,但由于技术和经费限制,这些方法在临床中并不常用。目前,神经影像学技术是主要用于检测CSVD引发的脑组织病变并作出诊断的手段。本文将集中讨论用于CSVD诊断的影像学标志,并深入探讨CSVD的影像鉴别诊断。

颈动脉残端综合征病例系列研究及文献回顾

目的 评价血管内介入治疗对于颈动脉残端综合征(CSS)所引起的急性缺血性卒中的临床效果。方法 本研究回顾性收集了2018年8月—2022年10月间就诊于吉林大学第一医院接受血管内介入治疗的前循环急性缺血性卒中患者,并筛选由CSS引起的急性缺血性卒中患者,收集患者人口学信息、危险因素、手术相关特征及预后,分析血管内治疗的效果。结果 共23例患者满足CSS的诊断标准,其中19例患者实现再通,7例患者实现了延伸的脑梗死溶栓分级(eTICI)3级。14例同期植入了颈动脉支架。12例患者术后出现了颅内出血,其中1例出现症状性颅内出血(sICH),并因此于院内死亡。发病90 d时,共有8例患者实现了功能独立(mRS≤2),4例患者在90 d内死亡。结论 CSS是一种临床综合征,由闭塞的颈内动脉远端栓子脱落引起的颅内动脉栓塞。血管内介入治疗是治疗CSS的有效方法。