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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
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 42 (2000), S. 184-191 
    ISSN: 1432-1920
    Keywords: Key words Ischaemic stroke ; Diffusion weighted imaging ; Fibrinolysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diffusion-weighted (DWI) echo-planar (EPI) MRI has been used for imaging acute ischaemic stroke. We used DWI and conventional spin-echo (SE) MRI to study the dynamics of ischaemic human stroke. We examined 30 patients (mean age 57.5 years, range 27–82 years, median 57 years) with a diagnosis of stroke. They were examined in the acute (120 min to 47 h, mean 15.3 h), subacute (8 days) and chronic (2–3 months) stages of ischaemia using clinical scores and MRI. Imaging was performed on an 1.5-T imager. Anisotropic DWI with diffusion gradients in all three axes, an isotropic tensor trace pulse DWI sequence and SE MRI were used. In all patients both DWI sequences showed a decrease in the apparent diffusion coefficient (ADC) in the acute stage, even when SE images did not reveal signal abnormalities. Clinical features correlated with lesion site but not size. The ADC was initially 19.6–43 % less than that of nonischaemic tissue and increased to normal after 7 days in conventionally treated patients and after 2–5 days in patients who underwent intra-arterial fibrinolysis. In the chronic stage the ADC rose by up to 254.4 %. In patients who did not undergo fibrinolysis DWI changes correlated with the final infarct size (P 〈 0.05). It was possible to differentiate acute from chronic ischaemic lesions. We conclude that DWI is a sensitive and practicable tool for detecting early cerebral ischaemia. It is possible to predict in the acute stage the final size of an infarct. DWI may be helpful for clinical decisions and for monitoring therapy.
    Type of Medium: Electronic Resource
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  • 3
    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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  • 4
    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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  • 5
    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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  • 6
    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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  • 7
    ISSN: 1432-1920
    Keywords: Key words Artery subclavian ; Artery vertebral ; Angioplasty percutaneous transluminal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We analysed the site of plaques and stenoses in the subclavian and vertebral arteries, to improve the safety of percutaneous transluminal angioplasty (PTA) in high-risk patients. These lesions were assessed on arteriograms of 35 patients with stenoses and occlusions of the subclavian and vertebral arteries; the degree of stenoses was measured. Of 19 subclavian artery stenoses 17 (89 %) were in the segment proximal to the vertebral artery; 30 (79 %) of 38 vertebral artery stenoses were on the medial wall. With this knowledge, a double-balloon technique using a simultaneous transbrachial and transfemoral approach for angioplasty of high-risk subclavian or combined subclavian and vertebral artery stenoses and occlusions was used successfully in seven patients. This new technique may broaden the endovascular therapeutic possibilities in the rare but dangerous situation where plaque extends directly from the stenotic subclavian artery into the origin of the vertebral artery.
    Type of Medium: Electronic Resource
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