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1.
  • Wallin, Ewa, et al. (författare)
  • Acute brain lesion on MRI in relation to neorological outcome 6 months after cardiac arrest treated with hypothermia
  • 2015
  • Ingår i: Kylhjärtstopp.
  • Tidskriftsartikel (övrigt vetenskapligt)abstract
    • <p>Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.</p><p>Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patientstreated with TH.</p><p>Results: MRI of the brain was obtained at a median of 4 days (3–13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24–30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p= 0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical, and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600×10−6mm2/s in any region survived to 6months.</p><p>Conclusions: In visual analyses of acute MRI, extensive acutelesions were found in the cortical regions and deep gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.</p>
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2.
  • Wallin, Ewa, et al. (författare)
  • Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest
  • 2018
  • Ingår i: Acta Anaesthesiologica Scandinavica. - 0001-5172 .- 1399-6576. ; 62:5, s. 625-647
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>BACKGROUND:</p><p>Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.</p><p>METHODS:</p><p>A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.</p><p>RESULTS:</p><p>Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.</p><p>CONCLUSIONS:</p><p>Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.</p>
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3.
  • Wallin, Ewa, et al. (författare)
  • Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest
  • 2018
  • Ingår i: Acta Anaesthesiologica Scandinavica. - 0001-5172 .- 1399-6576. ; 62:5, s. 635-647
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>BACKGROUND:</strong></p><p>Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.</p><p><strong>METHODS:</strong></p><p>A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.</p><p><strong>RESULTS:</strong></p><p>Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.</p><p><strong>CONCLUSIONS:</strong></p><p>Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.</p>
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4.
  • Wallin, Ewa, et al. (författare)
  • Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.
  • 2015
  • Ingår i: Resuscitation. - 0300-9572 .- 1873-1570. ; 96:Suppl1, s. 147
  • Tidskriftsartikel (övrigt vetenskapligt)abstract
    • <p><em>Aim of the study: </em>To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.</p><p><em>Method: </em>A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patients treated with TH.</p><p><em>Results:</em> MRI of the brain was obtained at a median of 4 days  (3-13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24-30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (<em>p</em>=0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600x10<sup>-6</sup> mm<sup>2</sup>/s in any region survived to 6 months.</p><p><em>Conclusions</em>: In visual analyses of acute MRI, extensive acute lesions were found in the cortical regions and gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.</p><p> </p>
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5.
  • Wallin, Ewa, et al. (författare)
  • Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later
  • 2016
  • Ingår i: Insights into Imaging 7:Suppl 1, 2016. - Springer.
  • Konferensbidrag (refereegranskat)abstract
    • <p><strong> Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later,</strong></p><p><strong>Purpose: </strong>To document the acute MRI findings in the brain of post-cardiac arrest (CA) patients treated with therapeutic hypothermia and their relationship to patient outcome after 6 months.</p><p><strong>Methods and Materials: </strong>MRI was performed prospectively 3-13 days (median 4) after CA in 56 patients regardless of the level of consciousness in three hospitals. The images were interpreted visually by two neuroradiologists. Apparent diffusion coefficient (ADC) was measured in predetermined areas in cerebral white matter, deep grey matter,  cerebellar grey and white matter and the brainstem. Outcome was assessed using the Cerebral Performance Categories Scale (CPC ) and dichotomized into good and poor outcome.</p><p><strong>Results: </strong>Acute hypoxic lesions on diffusion-weighted MRI (DWI) were more common in patients with poor outcome (p=0.006) and affected mostly grey matter, deep or cortical, with or without involvement of underlying white matter. Pure white matter lesions were very few. Lesions in the occipital and temporal lobes, deep white matter and cerebellum were most associated with poor outcome. Reductions in the ADC, particularly in the occipital lobes, were more common in patients with poor outcome. None of the patients with an ADC below 604-678 x10<sup>-6</sup> mm<sup>2</sup>/s (variation depending on the equipment and technique) in any region survived to 6 months.</p><p><strong>Conclusion: </strong>Extensive acute lesions in cortical regions and deep grey matter in visual analysis and regions with an ADC under the level 600-680 x10<sup>-6</sup> mm<sup>2</sup>/s are associated with poor outcome. Lesions are fewer and mainly situated in the frontal and parietal lobes in patients with good outcome.</p>
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6.
  • Blystad, Ida, 1972- (författare)
  • Clinical Applications of Synthetic MRI of the Brain
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Magnetic Resonance Imaging (MRI) has a high soft-tissue contrast with a high sensitivity for detecting pathological changes in the brain. Conventional MRI is a time-consuming method with multiple scans that relies on the visual assessment of the neuroradiologist. Synthetic MRI uses one scan to produce conventional images, but also quantitative maps based on relaxometry, that can be used to quantitatively analyse tissue properties and pathological changes. The studies presented here apply the use of synthetic MRI of the brain in different clinical settings.</p><p>In the first study, synthetic MR images were compared to conventional MR images in 22 patients. The contrast, the contrast-to-noise ratio, and the diagnostic quality were assessed. Image quality was perceived to be inferior in the synthetic images, but synthetic images agreed with the clinical diagnoses to the same extent as the conventional images.</p><p>Patients with early multiple sclerosis were analysed in the second study. In patients with multiple sclerosis, contrast-enhancing white matter lesions are a sign of active disease and can indicate a need for a change in therapy. Gadolinium-based contrast agents are used to detect active lesions, but concern has been raised regarding the long-term effects of repeated use of gadolinium. In this study, relaxometry was used to evaluate whether pre-contrast injection tissue-relaxation rates and proton density can identify active lesions without gadolinium. The findings suggest that active lesions often have relaxation times and proton density that differ from non-enhancing lesions, but with some overlap. This makes it difficult to replace gadolinium-based contrast agent injection with synthetic MRI in the monitoring of MS patients.</p><p>Malignant gliomas are primary brain tumours with contrast enhancement due to a defective blood-brain barrier. However, they also grow in an infiltrative, diffuse manner, making it difficult to clearly delineate them from surrounding normal brain tissue in the diagnostic workup, at surgery, and during follow-up. The contrast-enhancing part of the tumour is easily visualised, but not the diffuse infiltration. In studies three and four, synthetic MRI was used to analyse the peritumoral area of malignant gliomas, and revealed quantitative findings regarding peritumoral relaxation changes and non-visible contrast enhancement suggestive of non-visible infiltrative tumour growth.</p><p>In conclusion, synthetic MRI provides quantitative information about the brain tissue and this could improve the diagnosis and treatment for patients.</p>
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7.
  • Blystad, Ida, et al. (författare)
  • Synthetic MRI of the brain in a clinical setting
  • 2012
  • Ingår i: Acta Radiologica. - Sage Publications. - 0284-1851 .- 1600-0455. ; 53:10, s. 1158-1163
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>BACKGROUND:</p><p>Conventional magnetic resonance imaging (MRI) has relatively long scan times for routine examinations, and the signal intensity of the images is related to the specific MR scanner settings. Due to scanner imperfections and automatic optimizations, it is impossible to compare images in terms of absolute image intensity. Synthetic MRI, a method to generate conventional images based on MR quantification, potentially both decreases examination time and enables quantitative measurements.</p><p>PURPOSE:</p><p>To evaluate synthetic MRI of the brain in a clinical setting by assessment of the contrast, the contrast-to-noise ratio (CNR), and the diagnostic quality compared with conventional MR images.</p><p>MATERIAL AND METHODS:</p><p>Twenty-two patients had synthetic imaging added to their clinical MR examination. In each patient, 12 regions of interest were placed in the brain images to measure contrast and CNR. Furthermore, general image quality, probable diagnosis, and lesion conspicuity were investigated.</p><p>RESULTS:</p><p>Synthetic T1-weighted turbo spin echo and T2-weighted turbo spin echo images had higher contrast but also a higher level of noise, resulting in a similar CNR compared with conventional images. Synthetic T2-weighted FLAIR images had lower contrast and a higher level of noise, which led to a lower CNR. Synthetic images were generally assessed to be of inferior image quality, but agreed with the clinical diagnosis to the same extent as the conventional images. Lesion conspicuity was higher in the synthetic T1-weighted images, which also had a better agreement with the clinical diagnoses than the conventional T1-weighted images.</p><p>CONCLUSION:</p><p>Synthetic MR can potentially shorten the MR examination time. Even though the image quality is perceived to be inferior, synthetic images agreed with the clinical diagnosis to the same extent as the conventional images in this study.</p>
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8.
  • Delgado, Anna F., et al. (författare)
  • Diffusion kurtosis imaging of gliomas grades II and III - A study of perilesional tumor infiltration, tumor grades and subtypes at clinical presentation
  • 2017
  • Ingår i: Radiotherapy and Oncology. - Elsevier. - 1318-2099. ; 51:2, s. 121-129
  • Tidskriftsartikel (refereegranskat)abstract
    • Diffusion kurtosis imaging (DKI) allows for assessment of diffusion influenced by microcellular structures. We analyzed DKI in suspected low-grade gliomas prior to histopathological diagnosis. The aim was to investigate if diffusion parameters in the perilesional normal-appearing white matter (NAWM) differed from contralesional white matter, and to investigate differences between glioma malignancy grades II and III and glioma subtypes (astrocytomas and oligodendrogliomas). Forty-eight patients with suspected low-grade glioma were prospectively recruited to this institutional review board-approved study and investigated with preoperative DKI at 3T after written informed consent. Patients with histologically proven glioma grades II or III were further analyzed (n=35). Regions of interest (ROIs) were delineated on T2FLAIR images and co-registered to diffusion MRI parameter maps. Mean DKI data were compared between perilesional and contralesional NAWM (student's t-test for dependent samples, Wilcoxon matched pairs test). Histogram DKI data were compared between glioma types and glioma grades (multiple comparisons of mean ranks for all groups). The discriminating potential for DKI in assessing glioma type and grade was assessed with receiver operating characteristics (ROC) curves. There were significant differences in all mean DKI variables between perilesional and contralesional NAWM (p=<0.000), except for axial kurtosis (p=0.099). Forty-four histogram variables differed significantly between glioma grades II (n=23) and III (n=12) (p=0.003-0.048) and 10 variables differed significantly between ACs (n=18) and ODs (n=17) (p=0.011-0.050). ROC curves of the best discriminating variables had an area under the curve (AUC) of 0.657-0.815. Mean DKI variables in perilesional NAWM differ significantly from contralesional NAWM, suggesting altered microstructure by tumor infiltration not depicted on morphological MRI. Histogram analysis of DKI data identifies differences between glioma grades and subtypes.
9.
  • Delgado, Anna F, et al. (författare)
  • Preoperative Quantitative MR Tractography Compared with Visual Tract Evaluation in Patients with Neuropathologically Confirmed Gliomas Grades II and III : : A Prospective Cohort Study
  • 2016
  • Ingår i: Radiology research and practice. - Hindawi Publishing Corporation. - 2090-1941. ; 2016:1, s. 1-15
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Purpose. Low-grade gliomas show infiltrative growth in white matter tracts. Diffusion tensor tractography can noninvasively assess white matter tracts. The aim was to preoperatively assess tumor growth in white matter tracts using quantitative MR tractography (3T). The hypothesis was that suspected infiltrated tracts would have altered diffusional properties in infiltrated tract segments compared to noninfiltrated tracts. Materials and Methods. Forty-eight patients with suspected low-grade glioma were included after written informed consent and underwent preoperative diffusion tensor imaging in this prospective review-board approved study. Major white matter tracts in both hemispheres were tracked, segmented, and visually assessed for tumor involvement in thirty-four patients with gliomas grade II or III (astrocytomas or oligodendrogliomas) on postoperative neuropathological evaluation. Relative fractional anisotropy (rFA) and mean diffusivity (rMD) in tract segments were calculated and compared with visual evaluation and neuropathological diagnosis. Results. Tract segment infiltration on visual evaluation was associated with a lower rFA and high rMD in a majority of evaluated tract segments (89% and 78%, resp.). Grade II and grade III gliomas had similar infiltrating behavior. Conclusion. Quantitative MR tractography corresponds to visual evaluation of suspected tract infiltration. It may be useful for an objective preoperative evaluation of tract segment involvement.
10.
  • Elfgren, Christina, et al. (författare)
  • fMRI activity in the medial temporal lobe during famous face processing
  • 2006
  • Ingår i: NeuroImage. - Elsevier. - 1095-9572. ; 30:2, s. 609-616
  • Tidskriftsartikel (refereegranskat)abstract
    • The current event-related fMRI study examined the relative involvement of different parts of the medial temporal lobe (MTL), particularly the contribution of hippocampus and perirhinal cortex, in either intentional or incidental recognition of famous faces in contrast to unfamiliar faces. Our intention was to further explore the controversial contribution of MTL in the processing of semantic memory tasks. Subjects viewed a sequence of famous and unfamiliar faces. Two tasks were used encouraging attention to either fame or gender. In the fame task, the subjects were requested to identify the person when seeing his/her face and also to try to generate the name of this person. In the gender task, the subjects were asked to conduct a judgement of a person's gender when seeing his/her face. The visual processing was hence directed to gender and thereby expected to diminish attention to semantic information leading only to a “passive” registration of famous and non-familiar faces. Recognition of famous faces, in both contrasts, produced significant activations in the MTL. First, during the intentional recognition (the person identification task) increased activity was observed in the anterolateral part of left hippocampus, in proximity to amygdala. Second, during the incidental recognition of famous faces (the gender classification task), there was increased activity in the left posterior MTL with focus in the perirhinal cortex. Our results suggest that the hippocampus may be centrally involved in the intentional retrieval of semantic memories while the perirhinal cortex is associated with the incidental recognition of semantic information.
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