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  • 1
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Magnetresonanztomographie ; Diffusion ; Echo-planar ; Zerebrale Ischämie ; Key words MRI ; Diffusion ; Echo - planar ; Cerebral ischemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Magnetic resonance imaging represents today the most important tool in neuroradiology for both clinical pratice and research. MRI allows imaging of the human body in 2 or 3 dimensions with variable tissue contrast. The natural diffusion of tissue protons can now be used as a supplementary contrast mechanism. Different MRI techniques can be used to obtain clinically useful diffusion-weighted images. These techniques all require the use of strong gradient pulses in order to obtain the diffusion contrast. In the current article, the most important physical principles of diffusion measurement are presented. After a short introduction into the basic physical principles, we will present the prerequisites and limitations of clinically relevant applications today. Finally a few select examples of clinical use of these techniques in the acute diagnosis of stroke will be presented.
    Notes: Zusammenfassung Die Kernspintomographie (Magnetresonanztomographie, MRT) ist das zentrale diagnostische Instrument der Neuroradiologie für die Routinediagnostik, aber auch für Fragestellungen, die Forschung und Lehre betreffen, geworden. Zu den bereits bekannten und erprobten MR-Bildkontrasten ist die Diffusion der Protonen als neuer zusätzlicher Kontrastmechanismus hinzugekommen. In letzter Zeit wurden verschiedene kernspintomographische Techniken beschrieben, die zur Diffusionsbildgebung herangezogen werden können. Dabei verlangen MR-Diffusionssequenzen den Einsatz starker Gradientenpulse, die den Diffusionskontrast erzeugen. Andere, weniger bekannte Techniken lassen sich aber auch auf MR-Geräten mit schwächeren Gradienten einsetzen. Untersuchungen die belegen, daß Art und Ausmaß eines Schlaganfalls mit der MR-Diffusionsbildgebung sehr früh mit hoher Sensitivität nachzuweisen ist, haben diese neue MR-Bildgebungstechnik in das Zentrum von Therapiestrategien für diese häufige Erkrankung gerückt. In der vorliegenden Arbeit werden die wichtigsten physikalischen Grundlagen der MR-Diffusionsmessung vorgestellt. Die heute klinisch einsetzbaren Techniken, deren technische Voraussetzungen und Einschränkungen werden erläutert. Im abschließenden Teil wird die klinische Anwendung dieser neuen Bildgebungstechnik zur Diagnostik von akuten Hirninfarkten anhand einiger Beispiele beschrieben.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1920
    Keywords: Key words Stroke ; Magnetic resonance imaging ; Diffusion-weighted imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diffusion-weighted MRI (DWI) is becoming important for assessment of acute stroke. Until recently single-shot DWI required expensive technology such as echo-planar imaging (EPI) available only at some research sites. A new medium-field (1.0 T) short-bore MR imager has been developed with which DWI data sets can be acquired. We prospectively studied 169 patients on this 1.0 T commercial system. After conventional imaging, DWI was performed with a single-shot multi-slice sequence with b values 0 an 900 s/mm2, and with the gradients switched in three directions. The apparent diffusion coefficients were calculated with online calculation software. There were 50 patients with totally normal MRI, and 17 had strokes, these strokes were detected as areas of high signal on the images at a maximal b value. There was a drop in the ADC in ischaemic regions: in subacute infarcts, the values were between 0.41 and 0.531 × 10− 3 mm2/s. In old infarcts the ADC was 1.15 × 10− 3 mm2/s. Cerebrospinal fluid (CSF) gave low signal whereas areas in the brain had more intermediate intensities (CSF: 3.00; deep white matter: 0.75, cortical grey matter: 0.80, basal ganglia (thalamus): 0.70 and cerebellar white matter: 0.65 × 10− 3 mm2/s. Anisotropy was detected as areas of restricted diffusion along the tracts. These preliminary data show that DWI can be aquired successfully on a medium-field short-bore system. This should allow the technique to be implemented at more sites, therefore facilitating the diagnosis of acute stroke and rendering early intervention feasible.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1920
    Keywords: Key words Stroke ; Veins, cerebral, thrombosis ; Magnetic resonance imaging, diffusion-weighted
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a 20-year-old woman who suffered headaches before presenting with a state of fluctuating vigilance. MRI showed diffuse high signal in the basal ganglia bilaterally on diffusion- and T2-weighted images, which had areas of both low and high apparent diffusion coefficient, presumed to correspond to cytotoxic and vasogenic oedema. MR venography showed no flow in the deep cerebral veins or straight sinus. Heparin was given, with clinical recovery. On follow-up MRI, the appearances became normal.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1920
    Keywords: Key words Magnetic resonance imaging ; Diffusion-weighted ; Carotid artery ; Stents ; Carotid stenosis ; Angioplasty
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Carotid stenting is increasingly considered as treatment for carotid artery disease. A reliable noninvasive method is desirable for assessing the safety of the procedure. Diffusion-weighted MRI (DWI) is sensitive to early brain ischaemia which becoming widely available and might therefore serve this purpose. We prospectively studied 19 patients referred for investigation of carotid artery disease by echo-planar whole-brain DWI before and within 24 h of stenting. The images obtained at a high b value were examined by two independent blinded reviewers for new high-signal areas consistent with ischaemia. We found that 15 patients had no new changes after stenting. One patient showed enlargement of a posterior watershed lesion after the procedure, which correlated with an increase in neurological deficit. Three other patients had presumed small embolic infarcts on DWI; two were asymptomatic and one had weakness at the hand that corresponded to an embolic infarct with a lesion on DWI in the hand notch. There were no false- positive or -negative results on DWI, when compared to clinical findings. DWI is thus a new method that can demonstrate neurologically silent or asymptomatic infants. It can be used to help to assess the safety and efficacy of neurovascular intervention.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1920
    Keywords: Key words Magnetic resonance imaging ; Echo-planar sequences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To assess the value of echo-planar imaging (EPI) for ultra-fast routine clinical diagnostic MRI, we compared four different EPI sequences with conventional T2-weighted spin-echo images on a commercial clinical imager. We examined 25 randomly selected patients who posed different clinical questions. The images were interpreted by two experienced neuroradiologists blinded as to the sequence used. Image quality and diagnostic certainty were evaluated and the main diagnosis established from the EPI study was compared to that obtained from the T2-weighted images. Finally, EPI- and T2-based diagnoses were compared with the diagnosis resulting from a complete MRI examination. Apart from one sequence that was generally rated low as regards both diagnostic certainty and image quality, the EPI sequences were comparable to each other, but inferior to the T2-weighted images. However, two EPI sequences gave better diagnostic results than T2-weighted images compared to the full MRI examination. Gradient-echo EPI was particularly sensitive to haemorrhagic lesions. All normal cases were correctly identified on EPI studies. Only two pathological cases were missed; both had isolated cranial nerve lesions. The absence of false-positive results and the high sensitivity to ischaemic and mass lesions mean that EPI can be used for ultra-fast screening. However, from these initial studies, EPI seems unsuitable for neuroradiological investigation of patients who may have subtle lesions whose detection requires either special sequences or administration of contrast medium. EPI can nevertheless be used in addition to high-resolution T1-weighted images and may replace T2-weighted spin-echo sequences for special indications.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 39 (1997), S. 693-698 
    ISSN: 1432-1920
    Keywords: Key words Thalamus ; Stroke ; Magnetic resonance imaging ; Sleep
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The paramedian thalamus is believed to play an important role in the regulation of sleep, and disturbances of sleep regulation are known to occur in paramedian thalamic stroke (PTS). We examined 12 consecutive patients with PTS and sleep disturbance by MRI. Two distinct groups of patients could be defined: six presenting with severe hypersomnia (group 1) and six with slight sleepiness (group 2). On MRI, all patients had ischaemic lesions involving the paramedian thalamic nuclei, the centre of the lesions being the dorsomedial and centromedial thalamic nuclei. In group 1 the lesions were bilateral, butterfly-shaped infarcts involving the paramedian nuclei (three cases), or unilateral with an extension into the subthalamic nuclei. In group 2 the lesions were unilateral and limited to the paramedian nuclei, mainly the dorsomedial nucleus. Bilateral lesions can be attributed to a common origin in some cases for both paramedian thalamic arteries and the mesencephalic arteries.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract With the advent of chemotherapy, mortality rates in acute lymphoblastic leukaemia (ALL) have decreased, but complications in the central nervous system have appeared. These include direct involvement of the brain itself and the development of chemotherapy-related encephalopathy as a delayed reaction. In most reported cases, this encephalopathy is believed to be due to necrotising angiitis arising from the combination of chemotherapy with adjuvant radiotherapy. We report the cases of four children with ALL who had been treated with high-dose intravenous and intrathecal chemotherapy but no radiation therapy, and who were admitted to hospital because of seizures. CT of the brain revealed the presence of diffuse periventricular white matter hypodensities in all cases and subcortical hyperdense foci in three cases. MRI showed diffuse hyperintense white matter lesions on T2-weighted images in all four patients; hypointense changes were observed on susceptibility-sensitive FLASH sequences in the hyperdense foci seen on CT as well as changes that were hyperintense on T1-weighted images. It was, therefore, concluded that the lesions corresponded to a leukoencephalopathy with calcific deposits. These findings are of a pure form of methotrexate encephalopathy causing seizures.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Vitamin B12 deficiency is known to be associated with signs of demyelination, usually in the spinal cord. Lack of vitamin B12 in the maternal diet during pregnancy has been shown to cause severe retardation of myelination in the nervous system. We report the case of a 141/2-month-old child of strictly vegetarian parents who presented with severe psychomotor retardation. This severely hypotonic child had anemia due to insufficient maternal intake of vitamin B12 with associated megaloblastic anemia. MRI of the brain revealed severe brain atrophy with signs of retarded myelination, the frontal and temporal lobes being most severely affected. It was concluded that this myelination retardation was due to insufficient intake of vitamin B12 and vitamin B12 therapy was instituted. The patient responded well with improvement of clinical and imaging abnormalities. We stress the importance of MRI in the diagnosis and follow-up of patients with suspected diseases of myelination.
    Type of Medium: Electronic Resource
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