DYNAMICS OF ARTERIAL SPIN LABELING PERFUSION MRI AND COGNITIVE PERFORMANCE AFTER REVASCULARIZATION OF CAROTID ARTERY STENOSIS PDF Download
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Author: Julian Schroeder
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Languages : en
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Several studies have suggested a correlation between impairment of cognitive function and asymptomatic carotid artery stenosis without ischemic cerebral brain lesions. Hypoperfusion has been discussed as a possible underlying pathophysiological cause. It remains unclear whether hypoperfusion alone without evidence of infarction is sufficient to cause cognitive decline. In this study, we evaluated cognitive performance and cerebral perfusion changes in patients with asymptomatic carotid artery stenosis by arterial spin labeling (ASL) perfusion MRI before and after revascularization therapy.Methods:17 asymptomatic patients with unilateral high-grade (u226570%) carotid artery stenosis without evidence of structural brain lesions underwent ASL perfusion MRI and cognitive testing (MMSE, DemTect, Clock-Drawing Test, Trail-Making Test, Stroop Test) before and 6-8 weeks after revascularization therapy by endarterectomy or stenting. Multiparametric perfusion maps (cerebral blood flow (ASL-CBF), bolus arrival time (ASL-BAT)) were calculated and analyzed by vascular territory. Relative perfusion values were calculated. Results:A significant impact of revascularization therapy was shown through multivariate analysis on all perfusion measures analyzed. MCA borderzones were identified as territories showing significant hypoperfuion at baseline post-hoc testing in both ASL-CBF and ASL-BAT. All perfusion alterations normalized after revascularization. No significant correlation of cognitive test results with perfusion parameters was observed. Cognitive Performance showed no significant change after revascularization. Conclusion:Our study was able to show perfusion alterations in asymptomatic patients with high grade carotid artery stenosis in the absence of structural brain lesions, which proved fully reversible after revascularization therapy. In this cohort of asymptomatic patients we did not observe an association of hypoperfusion with cognitive performance.
Author: Julian Schroeder
Publisher:
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Languages : en
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Book Description
Several studies have suggested a correlation between impairment of cognitive function and asymptomatic carotid artery stenosis without ischemic cerebral brain lesions. Hypoperfusion has been discussed as a possible underlying pathophysiological cause. It remains unclear whether hypoperfusion alone without evidence of infarction is sufficient to cause cognitive decline. In this study, we evaluated cognitive performance and cerebral perfusion changes in patients with asymptomatic carotid artery stenosis by arterial spin labeling (ASL) perfusion MRI before and after revascularization therapy.Methods:17 asymptomatic patients with unilateral high-grade (u226570%) carotid artery stenosis without evidence of structural brain lesions underwent ASL perfusion MRI and cognitive testing (MMSE, DemTect, Clock-Drawing Test, Trail-Making Test, Stroop Test) before and 6-8 weeks after revascularization therapy by endarterectomy or stenting. Multiparametric perfusion maps (cerebral blood flow (ASL-CBF), bolus arrival time (ASL-BAT)) were calculated and analyzed by vascular territory. Relative perfusion values were calculated. Results:A significant impact of revascularization therapy was shown through multivariate analysis on all perfusion measures analyzed. MCA borderzones were identified as territories showing significant hypoperfuion at baseline post-hoc testing in both ASL-CBF and ASL-BAT. All perfusion alterations normalized after revascularization. No significant correlation of cognitive test results with perfusion parameters was observed. Cognitive Performance showed no significant change after revascularization. Conclusion:Our study was able to show perfusion alterations in asymptomatic patients with high grade carotid artery stenosis in the absence of structural brain lesions, which proved fully reversible after revascularization therapy. In this cohort of asymptomatic patients we did not observe an association of hypoperfusion with cognitive performance.
Author: Marlene Heinze
Publisher:
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Category :
Languages : en
Pages :
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Background and Aims:There is evidence suggesting a detrimental effect of asymptomatic carotid artery stenosis on cognitive function even in the absence of ischemic cerebral lesions. Hypoperfusion has been suggested as pathophysiological mechanism causing cognitive impairment. We aimed to assess cognitive performance and cerebral perfusion changes in patients with carotid artery stenosis without ischemic lesions by contrast enhanced (CE) perfusion MRI before and after revascularization therapy.Methods:17 asymptomatic patients with unilateral high-grade (u226570%) carotid artery stenosis without evidence of structural brain lesions underwent CE perfusion MRI and cognitive testing (MMSE, DemTect, Clock-Drawing Test, Trail-Making Test, Stroop Test) before and 6-8 weeks after revascularization therapy by endarterectomy or stenting. Multiparametric perfusion maps (cerebral blood flow (CE-CBF), mean transit time (CE-MTT), cerebral blood volume (CE-CBV)) were calculated and analyzed by vascular territory. Relative perfusion values were calculated. Results:Multivariate analysis revealed a significant impact of revascularization therapy on all perfusion measures analyzed. At baseline post-hoc testing showed significant hypoperfusion in MCA borderzones as assessed by CE-MTT and CE-CBV, but not in CE-CBF. All perfusion alterations normalized after revascularization. We did not observe any significant correlation of cognitive test results with perfusion parameters. There was no significant change in cognitive performance after revascularization.Conclusions:We found evidence of traceable perfusion alterations in patients with high grade carotid artery stenosis in the absence of structural brain lesions, which proved fully reversible after revascularization therapy. In this cohort of asymptomatic patients we did not observe an association of hypoperfusion with cognitive performance.
Author: Simona Lattanzi
Publisher:
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Languages : en
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Background and Aims: The effects of carotid revascularization on the neurocognitive functioning still remains elusive. The aim of this study was to evaluate the changes in cognitive performance and their predictors in patients with symptomatic high-grade internal carotid artery (ICA) stenosis undergoing carotid endarterectomy (CEA). Methods: Participants were patients who underwent CEA and had history of transient ischemic attack within the past 6 months due to ipsilateral severe ICA stenosis. Coloured Progressive Matrices plus Complex Figure Copy Test, and phonemic plus categorical Verbal Fluency tests were performed to assess right and left hemisphere cognitive functions, respectively. Cerebral hemodynamics was assessed with transcranial Doppler ultrasonography by means of the cerebral vasomotor reactivity (CVR) to hypercapnia.Results: One hundred and ninety patients were enrolled. At 6 months from CEA, the scores obtained in the cognitive tests exploring the re-vascularized hemisphereu2019s functions and ipsilateral cerebral hemodynamics were significantly improved. At multivariate linear regression analysis, the change in cognitive performance was inversely associated with age [u00df=-0.17, 95% confidence interval (CI) -0.23 to -0.12; p
Author: Scott H. Faro
Publisher: Springer Science & Business Media
ISBN: 1441903453
Category : Medical
Languages : en
Pages : 1015
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Book Description
Functional Neuroradiology: Principles and Clinical Applications, is a follow-up to Faro and Mohamed’s groundbreaking work, Functional (BOLD)MRI: Basic Principles and Clinical Applications. This new 49 chapter textbook is comprehensive and offers a complete introduction to the state-of-the-art functional imaging in Neuroradiology, including the physical principles and clinical applications of Diffusion, Perfusion, Permeability, MR spectroscopy, Positron Emission Tomography, BOLD fMRI and Diffusion Tensor Imaging. With chapters written by internationally distinguished neuroradiologists, neurologists, psychiatrists, cognitive neuroscientists, and physicists, Functional Neuroradiology is divided into 9 major sections, including: Physical principles of all key functional techniques, Lesion characterization using Diffusion, Perfusion, Permeability, MR spectroscopy, and Positron Emission Tomography, an overview of BOLD fMRI physical principles and key concepts, including scanning methodologies, experimental research design, data analysis, and functional connectivity, Eloquent Cortex and White matter localization using BOLD fMRI and Diffusion Tensor Imaging, Clinical applications of BOLD fMRI in Neurosurgery, Neurology, Psychiatry, Neuropsychology, and Neuropharmacology, Multi-modality functional Neuroradiology, Beyond Proton Imaging, Functional spine and CSF imaging, a full-color Neuroanatomical Brain atlas of eloquent cortex and key white matter tracts and BOLD fMRI paradigms. By offering readers a complete overview of functional imaging modalities and techniques currently used in patient diagnosis and management, as well as emerging technology, Functional Neuroradiology is a vital information source for physicians and cognitive neuroscientists involved in daily practice and research.
Author: László Csiba
Publisher: Cambridge University Press
ISBN: 1107659159
Category : Medical
Languages : en
Pages : 333
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Book Description
Neurosonology is non-invasive, portable, and has excellent temporal resolution, making it a valuable and increasingly popular tool for the diagnosis and monitoring of neurological conditions when compared to other imaging techniques. This guide looks beyond the use of neurovascular ultrasound in stroke to encompass a wide range of other neurological diseases and emergencies. It offers a practical approach to the examination of patients, interpretation of ultrasound studies, and the application of neurosonology to the development of management and treatment strategies. Each chapter incorporates a thorough and clear procedural methodology alongside scanning tips for trainees; this step-by-step approach is further enhanced by example images and focused diagnostic questions. Authored and edited by international experts, this practical manual of neurosonology is an invaluable resource for neurologists, neurosurgeons, intensivists, radiologists, and ultrasonographers.
Author: Michael Brainin
Publisher: Cambridge University Press
ISBN: 1107047498
Category : Medical
Languages : en
Pages : 425
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Book Description
Fully revised throughout, the new edition of this concise textbook is aimed at doctors preparing to specialize in stroke care.
Author: Marilyn J. Cipolla
Publisher: Biota Publishing
ISBN: 1615047239
Category : Medical
Languages : en
Pages : 82
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Book Description
This e-book will review special features of the cerebral circulation and how they contribute to the physiology of the brain. It describes structural and functional properties of the cerebral circulation that are unique to the brain, an organ with high metabolic demands and the need for tight water and ion homeostasis. Autoregulation is pronounced in the brain, with myogenic, metabolic and neurogenic mechanisms contributing to maintain relatively constant blood flow during both increases and decreases in pressure. In addition, unlike peripheral organs where the majority of vascular resistance resides in small arteries and arterioles, large extracranial and intracranial arteries contribute significantly to vascular resistance in the brain. The prominent role of large arteries in cerebrovascular resistance helps maintain blood flow and protect downstream vessels during changes in perfusion pressure. The cerebral endothelium is also unique in that its barrier properties are in some way more like epithelium than endothelium in the periphery. The cerebral endothelium, known as the blood-brain barrier, has specialized tight junctions that do not allow ions to pass freely and has very low hydraulic conductivity and transcellular transport. This special configuration modifies Starling's forces in the brain microcirculation such that ions retained in the vascular lumen oppose water movement due to hydrostatic pressure. Tight water regulation is necessary in the brain because it has limited capacity for expansion within the skull. Increased intracranial pressure due to vasogenic edema can cause severe neurologic complications and death.
Author: Luca Saba
Publisher: Springer
ISBN: 9781461490289
Category : Medical
Languages : en
Pages : 0
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Book Description
Vascular Neurology, Vascular Neurosurgery and Interventional Neuroradiology are independent fields with dedicated Training Programs. Neuroimaging, and in particular what we call "Neurovascular Imaging" is a unifying factor which can be considered the intersection of these three medical specialties. With this book we aim to cover thoroughly the imaging techniques, potentialities, and present and future applications as applied to all the vascular diseases of the central nervous system from the imaging point of view. This book will comprise eight main sections: (1) The Basics, (2) Arteries of the Head and Neck (3) The basics of Intracranial Arteries (4) Diseases of the vessels (5) Stroke Imaging (6) Veins Imaging (7) Spine Imaging (8) Pediatrics.
Author: K. Michael Welch
Publisher: Academic Press
ISBN: 0127431705
Category : Medical
Languages : en
Pages : 855
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Book Description
Primer on Cerebrovascular Diseases is a handy reference source for scientists, students, and physicians needing reliable, up-to-date information on basic mechanisms, physiology, pathophysiology, and medical issues related to brain vasculature. The book consists of short, specific chapters written by international experts on cerebral vasculature, and presents the information in a comprehensive and easily accessible manner. The book also contains valuable information on practical applications of basic research. Presents topics in a comprehensive and accessible format Written by international authorities on cerebral vasculature Provides practical applications for researchers
Author: Peter Schneider
Publisher: CRC Press
ISBN: 1000611388
Category : Medical
Languages : en
Pages : 346
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Book Description
From patient selection and monitoring to follow-up care, Carotid Interventions is the first source to offer a practical how-to approach to carotid angioplasty and stenting-providing maneuvers and strategies for difficult situations, as well as step-by-step guidance on specific surgical procedures, equipment selection and instrumentation, protection
