BACKGROUND Intracranial atherosclerosis,a leading cause of stroke,involves arterial plaque formation.This study explores the link between plaque remodelling patterns and diabetes using high-resolution vessel wall imag...BACKGROUND Intracranial atherosclerosis,a leading cause of stroke,involves arterial plaque formation.This study explores the link between plaque remodelling patterns and diabetes using high-resolution vessel wall imaging(HR-VWI).AIM To investigate the factors of intracranial atherosclerotic remodelling patterns and the relationship between intracranial atherosclerotic remodelling and diabetes mellitus using HR-VWI.METHODS Ninety-four patients diagnosed with middle cerebral artery or basilar artery INTRODUCTION Intracranial atherosclerotic disease is one of the main causes of ischaemic stroke in the world,accounting for approx-imately 10%of transient ischaemic attacks and 30%-50%of ischaemic strokes[1].It is the most common factor among Asian people[2].The adaptive changes in the structure and function of blood vessels that can adapt to changes in the internal and external environment are called vascular remodelling,which is a common and important pathological mechanism in atherosclerotic diseases,and the remodelling mode of atherosclerotic plaques is closely related to the occurrence of stroke.Positive remodelling(PR)is an outwards compensatory remodelling where the arterial wall grows outwards in an attempt to maintain a constant lumen diameter.For a long time,it was believed that the degree of stenosis can accurately reflect the risk of ischaemic stroke[3-5].Previous studies have revealed that lesions without significant luminal stenosis can also lead to acute events[6,7],as summarized in a recent meta-analysis study in which approximately 50%of acute/subacute ischaemic events were due to this type of lesion[6].Research[8,9]has pointed out that the PR of plaques is more dangerous and more likely to cause acute ischaemic stroke.Previous studies[10-13]have found that there are specific vascular remodelling phenomena in the coronary and carotid arteries of diabetic patients.However,due to the deep location and small lumen of intracranial arteries and limitations of imaging techniques,the relationship between intracranial arterial remodelling and diabetes is still unclear.In recent years,with the development of magnetic resonance technology and the emergence of high-resolution(HR)vascular wall imaging,a clear and multidimensional display of the intracranial vascular wall has been achieved.Therefore,in this study,HR wall imaging(HR-VWI)was used to display the remodelling characteristics of bilateral middle cerebral arteries and basilar arteries and to explore the factors of intracranial vascular remodelling and its relationship with diabetes.展开更多
BACKGROUND Intracranial infection is a common clinical disease.Computed tomography(CT)and magnetic resonance imaging(MRI)have certain sensitivity and have good diagnostic efficacy.AIM To study the application value of...BACKGROUND Intracranial infection is a common clinical disease.Computed tomography(CT)and magnetic resonance imaging(MRI)have certain sensitivity and have good diagnostic efficacy.AIM To study the application value of MRI and CT in the diagnosis of intracranial infection after craniocerebral surgery.METHODS We selected 82 patients who underwent craniocerebral surgery(including 40 patients with intracranial infection and 42 patients without infection)during the period from April 2016 to June 2019 in our hospital.All 82 patients received CT and MRI examinations,and their clinical data were reviewed.A retrospective analysis was performed,and the coincidence rate of positive diagnosis and the overall diagnosis coincidence rate of different pathogenic infection types were measured with the two examination methods.The diagnostic sensitivity and specificity as well as the positive and negative predictive values of the two examination methods were compared.RESULTS For all types of pathogenic infections(Staphylococcus aureus,Staphylococcus hemolyticus,Staphylococcus epidermidis,and others),MRI scans had higher positive diagnostic coincidence rates than CT scans;the overall diagnostic coincidence rate,sensitivity,specificity,positive predictive value,and negative predictive values were significantly higher with MRI examinations than with CT examinations,and the differences were statistically significant(P<0.05).CONCLUSION MRI examination can accurately diagnose intracranial infection after clinical craniocerebral surgery.Compared with CT,MRI had higher diagnostic efficiency.The diagnostic sensitivity and specificity,the diagnostic coincidence rate,and the positive and negative predictive values were significantly higher with MRI than with conventional CT,which can be actively promoted.展开更多
We are reporting a long-time magnetic resonance imaging(MRI) follow-up in a rare case of cardiac left lateral wall hypertrophy. Hypertrophic cardiomyopathy(HCM) is the most common genetic cardiovascular disorder and a...We are reporting a long-time magnetic resonance imaging(MRI) follow-up in a rare case of cardiac left lateral wall hypertrophy. Hypertrophic cardiomyopathy(HCM) is the most common genetic cardiovascular disorder and a significant cause of sudden cardiac death. Cardiac magnetic resonance(CMR) imaging can be a valuable tool for assessment of detailed information on size,localization,and tissue characteristics of hypertrophied myocardium. However,there is still little knowledge of long-term evolution of HCM as visualized by magnetic resonance imaging. Recently,our group reported a case of left lateral wall HCM as a rare variant of the more common forms,such as septal HCM,or apical HCM. As we now retrieved an old cardiac MRI acquired in this patient more than 20 years ago,we are able to provide the thrilling experience of an ultra-long MRI followup presentation in this rare case of left lateral wall hypertrophy. Furthermore,this case outlines the tremendous improvements in imaging quality within the last two decades of CMR imaging.展开更多
Intracranial incidental findings on magnetic resonance imaging(MRI) of the brain continue to generate interest in healthy control,research,and clinical subjects.However,in clinical practice,the discovery of incidental...Intracranial incidental findings on magnetic resonance imaging(MRI) of the brain continue to generate interest in healthy control,research,and clinical subjects.However,in clinical practice,the discovery of incidental findings acts as a "distractor".This review is based on existing heterogeneous reports,their clinical implications,and how the results of incidental findings influence clinical management.This draws attention to the followings:(1) the prevalence of clinically significant incidental findings is low;(2) there is a lack of a systematic approach to classification;and discusses(3) how to deal with the detected incidental findings based a proposed common clinical profile.Individualized neurological care requires an active discussion regarding the need for neuroimaging.Clinical significance of incidental findings should be decided based on lesion's neuroradiologic characteristics in the given clinical context.Available evidence suggests that the outcome of an incidentally found "serious lesion in children" is excellent.Future studies of intracranial incidental findings on pediatric brain MRI should be focused on a homogeneous population.The study should address this clinical knowledge based review powered by the statistical analyses.展开更多
Objective To investigate the diagnostic value of brain magnetic resonance imaging in detecting central nervous system diseases among AIDS patients of different levels of T cells. Methods Total of 164 AIDS patients who...Objective To investigate the diagnostic value of brain magnetic resonance imaging in detecting central nervous system diseases among AIDS patients of different levels of T cells. Methods Total of 164 AIDS patients who did not receive antiviral treatment were divided into 2 groups according to their baseline CD4+ T cell counts. Group A had CD4+ T cell below or equal to 50 cells/μl(n = 81) and group B had CD4+ T cells over 50 cells/μl(n = 83). All patients underwent brain MRI scan. Imaging analysis and the prevalence of the central nervous system disorders were compared between two groups. Results Among them 48 cases were found of abnormal brain MRI, group A was higher than group B(35.8% vs. 22.9%) although without statistical significance(P = 0.065). Altogether 48 cases were diagnosed as AIDS related central nervous system disorders based on clinical symptoms, signs and laboratory findings. The prevalence of CNS disorders was higher in group A than in group B(41.9% vs. 16.8%) with statistical significance(P < 0.01). Conclusions The patients with CD4+ T cell count less than or equal to 50 cells/μl had high prevalence of CNS diseases. Brain MRI plays an important role in the diagnosis and differentiation of CNS diseases in advanced AIDS patients. This study suggests patients with low CD4+ T cell count(≤ 50/μl) should routinely undergo MRI examination.展开更多
Objective: To investigate the role of MRI in the diagnosis of intracranial germinoma. Methods: MRI features of 19 cases of intracranial germinoma confirmed by operations and pathological findings were analyzed retrosp...Objective: To investigate the role of MRI in the diagnosis of intracranial germinoma. Methods: MRI features of 19 cases of intracranial germinoma confirmed by operations and pathological findings were analyzed retrospectively. Results: Germinomas were found in the sellar region in 10 patients (including 5 males and 5 females), in the pineal region in 6 and in the thalamus and basal ganglia in 3, the 9 patients in the latter 2 groups all being males. The characteristic MRI findings of intracranial germinomas were as follows: (1) Lesions were isointense or slightly hypointense on T1WI while isointense or slightly hyperintense on T2WI. The germinomas in the sellar region and pineal region showed no edema, but lesions in the thalamus basal ganglia showed mild to moderate edema and space-occupying effects. (2) Homogeneous or inhomogeneous Gd-DTPA enhancement were seen in most of the tumors. Conclusion: Multiaxial imaging and Gd-DTPA enhancement in MRI are helpful in the diagnosis and differentiation of intracranial germinomas on the basis of the patient's gender, the location of the tumor and its imaging characteristics.展开更多
BACKGROUND Posterior reversible encephalopathy syndrome(PRES)is characterized mainly by occipital and parietal lobe involvement,which can be reversible within a few days.Herein,we report a rare case of PRES that devel...BACKGROUND Posterior reversible encephalopathy syndrome(PRES)is characterized mainly by occipital and parietal lobe involvement,which can be reversible within a few days.Herein,we report a rare case of PRES that developed after craniotomy for an unruptured intracranial aneurysm(UIA).CASE SUMMARY A 59-year-old man underwent clipping surgery for the treatment of UIA arising from the left middle cerebral artery.Clipping surgery was performed uneventfully,and he regained consciousness quickly immediately after the surgery.At the 4th hour after surgery,he developed a disorder of consciousness and aphasia.Magnetic resonance imaging revealed cortical and subcortical T2/FLAIR hyperintensities in the parietal,occipital,and frontal lobes ipsilaterally,without restricted diffusion,consistent with unilateral PRES.With conservative treatment,his symptoms and radiological findings almost completely disappeared within weeks.In our case,the important causative factor of PRES was suspected to be a sudden increase in cerebral perfusion pressure associated with temporary M1 occlusion.CONCLUSION Our unique case highlights that,to our knowledge,this is the second report of PRES developing after craniotomy for the treatment of UIA.Surgeons must keep PRES in mind as one of the causes of perioperative neurological abnormality following clipping of an UIA.展开更多
基金Supported by National Natural Science Foundation of China,No.82071871Guangdong Basic and Applied Basic Research Foundation,No.2021A1515220131+1 种基金Guangdong Medical Science and Technology Research Fund Project,No.2022111520491834Clinical Research Project of Shenzhen Second People's Hospital,No.20223357022。
文摘BACKGROUND Intracranial atherosclerosis,a leading cause of stroke,involves arterial plaque formation.This study explores the link between plaque remodelling patterns and diabetes using high-resolution vessel wall imaging(HR-VWI).AIM To investigate the factors of intracranial atherosclerotic remodelling patterns and the relationship between intracranial atherosclerotic remodelling and diabetes mellitus using HR-VWI.METHODS Ninety-four patients diagnosed with middle cerebral artery or basilar artery INTRODUCTION Intracranial atherosclerotic disease is one of the main causes of ischaemic stroke in the world,accounting for approx-imately 10%of transient ischaemic attacks and 30%-50%of ischaemic strokes[1].It is the most common factor among Asian people[2].The adaptive changes in the structure and function of blood vessels that can adapt to changes in the internal and external environment are called vascular remodelling,which is a common and important pathological mechanism in atherosclerotic diseases,and the remodelling mode of atherosclerotic plaques is closely related to the occurrence of stroke.Positive remodelling(PR)is an outwards compensatory remodelling where the arterial wall grows outwards in an attempt to maintain a constant lumen diameter.For a long time,it was believed that the degree of stenosis can accurately reflect the risk of ischaemic stroke[3-5].Previous studies have revealed that lesions without significant luminal stenosis can also lead to acute events[6,7],as summarized in a recent meta-analysis study in which approximately 50%of acute/subacute ischaemic events were due to this type of lesion[6].Research[8,9]has pointed out that the PR of plaques is more dangerous and more likely to cause acute ischaemic stroke.Previous studies[10-13]have found that there are specific vascular remodelling phenomena in the coronary and carotid arteries of diabetic patients.However,due to the deep location and small lumen of intracranial arteries and limitations of imaging techniques,the relationship between intracranial arterial remodelling and diabetes is still unclear.In recent years,with the development of magnetic resonance technology and the emergence of high-resolution(HR)vascular wall imaging,a clear and multidimensional display of the intracranial vascular wall has been achieved.Therefore,in this study,HR wall imaging(HR-VWI)was used to display the remodelling characteristics of bilateral middle cerebral arteries and basilar arteries and to explore the factors of intracranial vascular remodelling and its relationship with diabetes.
文摘BACKGROUND Intracranial infection is a common clinical disease.Computed tomography(CT)and magnetic resonance imaging(MRI)have certain sensitivity and have good diagnostic efficacy.AIM To study the application value of MRI and CT in the diagnosis of intracranial infection after craniocerebral surgery.METHODS We selected 82 patients who underwent craniocerebral surgery(including 40 patients with intracranial infection and 42 patients without infection)during the period from April 2016 to June 2019 in our hospital.All 82 patients received CT and MRI examinations,and their clinical data were reviewed.A retrospective analysis was performed,and the coincidence rate of positive diagnosis and the overall diagnosis coincidence rate of different pathogenic infection types were measured with the two examination methods.The diagnostic sensitivity and specificity as well as the positive and negative predictive values of the two examination methods were compared.RESULTS For all types of pathogenic infections(Staphylococcus aureus,Staphylococcus hemolyticus,Staphylococcus epidermidis,and others),MRI scans had higher positive diagnostic coincidence rates than CT scans;the overall diagnostic coincidence rate,sensitivity,specificity,positive predictive value,and negative predictive values were significantly higher with MRI examinations than with CT examinations,and the differences were statistically significant(P<0.05).CONCLUSION MRI examination can accurately diagnose intracranial infection after clinical craniocerebral surgery.Compared with CT,MRI had higher diagnostic efficiency.The diagnostic sensitivity and specificity,the diagnostic coincidence rate,and the positive and negative predictive values were significantly higher with MRI than with conventional CT,which can be actively promoted.
基金Supported by The German Research Foundation(DFG)the University of Wuerzburg in the funding programme Open Access Publishing
文摘We are reporting a long-time magnetic resonance imaging(MRI) follow-up in a rare case of cardiac left lateral wall hypertrophy. Hypertrophic cardiomyopathy(HCM) is the most common genetic cardiovascular disorder and a significant cause of sudden cardiac death. Cardiac magnetic resonance(CMR) imaging can be a valuable tool for assessment of detailed information on size,localization,and tissue characteristics of hypertrophied myocardium. However,there is still little knowledge of long-term evolution of HCM as visualized by magnetic resonance imaging. Recently,our group reported a case of left lateral wall HCM as a rare variant of the more common forms,such as septal HCM,or apical HCM. As we now retrieved an old cardiac MRI acquired in this patient more than 20 years ago,we are able to provide the thrilling experience of an ultra-long MRI followup presentation in this rare case of left lateral wall hypertrophy. Furthermore,this case outlines the tremendous improvements in imaging quality within the last two decades of CMR imaging.
文摘Intracranial incidental findings on magnetic resonance imaging(MRI) of the brain continue to generate interest in healthy control,research,and clinical subjects.However,in clinical practice,the discovery of incidental findings acts as a "distractor".This review is based on existing heterogeneous reports,their clinical implications,and how the results of incidental findings influence clinical management.This draws attention to the followings:(1) the prevalence of clinically significant incidental findings is low;(2) there is a lack of a systematic approach to classification;and discusses(3) how to deal with the detected incidental findings based a proposed common clinical profile.Individualized neurological care requires an active discussion regarding the need for neuroimaging.Clinical significance of incidental findings should be decided based on lesion's neuroradiologic characteristics in the given clinical context.Available evidence suggests that the outcome of an incidentally found "serious lesion in children" is excellent.Future studies of intracranial incidental findings on pediatric brain MRI should be focused on a homogeneous population.The study should address this clinical knowledge based review powered by the statistical analyses.
基金supported by grants from the Key Program of the Natural Science Foundation of Guangdong Province(S2012020010873)the Science and Technology Plan Project of Shenzhen(201302096)+2 种基金the Science and Technology Innovation Foundation of Shenzhen(CYJ20120829093552348)Shenzhen Key Fund for Emerging Infectious Diseasesthe AIDS Trust Fund of Hongkong
文摘Objective To investigate the diagnostic value of brain magnetic resonance imaging in detecting central nervous system diseases among AIDS patients of different levels of T cells. Methods Total of 164 AIDS patients who did not receive antiviral treatment were divided into 2 groups according to their baseline CD4+ T cell counts. Group A had CD4+ T cell below or equal to 50 cells/μl(n = 81) and group B had CD4+ T cells over 50 cells/μl(n = 83). All patients underwent brain MRI scan. Imaging analysis and the prevalence of the central nervous system disorders were compared between two groups. Results Among them 48 cases were found of abnormal brain MRI, group A was higher than group B(35.8% vs. 22.9%) although without statistical significance(P = 0.065). Altogether 48 cases were diagnosed as AIDS related central nervous system disorders based on clinical symptoms, signs and laboratory findings. The prevalence of CNS disorders was higher in group A than in group B(41.9% vs. 16.8%) with statistical significance(P < 0.01). Conclusions The patients with CD4+ T cell count less than or equal to 50 cells/μl had high prevalence of CNS diseases. Brain MRI plays an important role in the diagnosis and differentiation of CNS diseases in advanced AIDS patients. This study suggests patients with low CD4+ T cell count(≤ 50/μl) should routinely undergo MRI examination.
文摘Objective: To investigate the role of MRI in the diagnosis of intracranial germinoma. Methods: MRI features of 19 cases of intracranial germinoma confirmed by operations and pathological findings were analyzed retrospectively. Results: Germinomas were found in the sellar region in 10 patients (including 5 males and 5 females), in the pineal region in 6 and in the thalamus and basal ganglia in 3, the 9 patients in the latter 2 groups all being males. The characteristic MRI findings of intracranial germinomas were as follows: (1) Lesions were isointense or slightly hypointense on T1WI while isointense or slightly hyperintense on T2WI. The germinomas in the sellar region and pineal region showed no edema, but lesions in the thalamus basal ganglia showed mild to moderate edema and space-occupying effects. (2) Homogeneous or inhomogeneous Gd-DTPA enhancement were seen in most of the tumors. Conclusion: Multiaxial imaging and Gd-DTPA enhancement in MRI are helpful in the diagnosis and differentiation of intracranial germinomas on the basis of the patient's gender, the location of the tumor and its imaging characteristics.
基金Supported by Clinical Research Grant from Pusan National University Hospital in 2022.
文摘BACKGROUND Posterior reversible encephalopathy syndrome(PRES)is characterized mainly by occipital and parietal lobe involvement,which can be reversible within a few days.Herein,we report a rare case of PRES that developed after craniotomy for an unruptured intracranial aneurysm(UIA).CASE SUMMARY A 59-year-old man underwent clipping surgery for the treatment of UIA arising from the left middle cerebral artery.Clipping surgery was performed uneventfully,and he regained consciousness quickly immediately after the surgery.At the 4th hour after surgery,he developed a disorder of consciousness and aphasia.Magnetic resonance imaging revealed cortical and subcortical T2/FLAIR hyperintensities in the parietal,occipital,and frontal lobes ipsilaterally,without restricted diffusion,consistent with unilateral PRES.With conservative treatment,his symptoms and radiological findings almost completely disappeared within weeks.In our case,the important causative factor of PRES was suspected to be a sudden increase in cerebral perfusion pressure associated with temporary M1 occlusion.CONCLUSION Our unique case highlights that,to our knowledge,this is the second report of PRES developing after craniotomy for the treatment of UIA.Surgeons must keep PRES in mind as one of the causes of perioperative neurological abnormality following clipping of an UIA.
