Application of a computerized language lateralization index from FMRI by a group of clinical neuroradiologists.

Background And Purpose: Deriving accurate language lateralization from fMRI studies in the clinical context can be difficult, with 10%-20% incorrect conclusions. Most interpretations are qualitative, performed by neuroimaging experts. Quantitative lateralization has been widely described but with little implementation in the clinical setting and is disadvantaged by the use of arbitrary threshold techniques.

Conventional MRI does not reliably distinguish radiation necrosis from tumor recurrence after stereotactic radiosurgery.

Distinguishing radiation necrosis (RN) from tumor recurrence after stereotactic radiosurgery (SRS) for brain metastases is challenging. This study assesses the sensitivity (SN) and specificity (SP) of an MRI-based parameter, the "lesion quotient" (LQ), in characterizing tumor progression from RN. Records of patients treated with SRS for brain metastases between 01/01/1999 and 12/31/2009 and with histopathologic analysis of a subsequent contrast enhancing enlarging lesion at the treated site at a single institution were examined.

A 5-item scale to predict stroke outcome after cortical middle cerebral artery territory infarction: validation from results of the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) Study.

Background And Purpose: Various clinical, laboratory, and radiographic parameters have been identified as predictors of outcome for ischemic stroke. The purpose of this study was to combine these parameters into a validated scale for outcome prognostication in patients with a middle cerebral artery territory infarction.

Methods: We retrospectively reviewed 129 patients over a 2-year period and considered demographic, clinical, laboratory, and radiographic parameters as potential predictors of outcome.

Effect of a prescan patient-radiologist encounter on functional MR image quality.

Background And Purpose: A substantial number of clinical fMRI examinations inadequately assess language localization or lateralization, usually due to patient movement and suboptimal participation. We hypothesized that a prescan interview of the patient by the radiologist would reduce the fraction of nondiagnostic scans.

Materials And Methods: A single noise score for each acquisition was produced from time-series data on the basis of a weighted sum of 22 factors.

Statin use is independently associated with smaller infarct volume in nonlacunar MCA territory stroke.

Background: Studies have shown an association between HMG-CoA reductase inhibitors (statins) and improved stroke outcomes, possibly secondary to neuroprotective properties.

Objective: To assess whether patients taking statins prior to ischemic stroke have smaller infarcts on magnetic resonance imaging (MRI), adjusting for other relevant clinical factors.

Design: We retrospectively reviewed the Cleveland Clinic Foundation (CCF) Neurology Inpatient Database from June 2002 through June 2004.

Changes in motor cortex activation after recovery from spinal cord inflammation.

Diseases of the spinal cord are associated with reactive changes in cerebral cortex organization. Many studies in this area have examined spinal cord conditions not associated with recovery, making it difficult to consider the value of these cortical events in the restoration of neurological function. We studied patients with myelitis, a syndrome of transient spinal cord inflammation, in order to probe cortical changes that might contribute to recovery after disease of the spinal cord.

Comparison of diameter and perimeter methods for tumor volume calculation.

Purpose: Lesion volume is often used as an end point in clinical trials of oncology therapy. We sought to compare the common method of using orthogonal diameters to estimate lesion volume (the diameter method) with a computer-assisted planimetric technique (the perimeter method).

Methods: Radiologists reviewed 825 magnetic resonance imaging studies from 219 patients with glioblastoma multiforme.

Investigation of apparent diffusion coefficient and diffusion tensor anisotrophy in acute and chronic multiple sclerosis lesions.

Background And Purpose: The various stages of multiple sclerosis (MS) are characterized by de- and remyelination as well as by inflammation. Diffusion MR imaging is sensitive to tissue water motion, which might correspond to these pathologic processes. Our purpose was to demonstrate differences in apparent diffusion coefficient (ADC) and diffusion tensor anisotropy in acute and chronic MS plaques and in normal-appearing brain.

Contrast agents in functional MR imaging.

Contrast agents have greatly expanded the role of MR imaging (MRI) to allow assessment of physiologic, or "functional," parameters. Although activation mapping generally does not require contrast agents, other forms of functional MRI, including mapping of cerebral hemodynamics (eg, perfusion imaging), are best done with the use of contrast agents. Serial echo planar images are obtained after bolus injection of lanthanide chelates.

Arteriovenous fistula simulating arteriovenous malformation.

A 36-year-old man was thought (for 20 years) to have an arteriovenous malformation that could not be excised. Repeated ligations of proximal arterial supply to the vascular lesion were only transiently beneficial and may have caused a delay in correct diagnosis because of impaired angioaccess. Once it was discovered that he had an arteriovenous fistula--probably caused by a tonsillectomy at age 6--it was possible to occlude the fistula with detachable balloons.

Wegener granulomatosis invading the cavernous sinus: a CT demonstration.

A case of localized cranial Wegener granulomatosis was imaged with high resolution computed tomography. The mass extended from the infratemporal fossa, through the basal foramina, and into the cavernous sinus, causing complete occlusion of the internal carotid artery. Computed tomography demonstrated absence of bone destruction and a normal parotid gland and nasopharynx.

Transluminal angioplasty in postsurgical stenosis of the extracranial carotid artery.

Transluminal angioplasty of the common carotid artery was beneficial in a patient with postendarterectomy recurrent stenosis due to fibrous myointimal hyperplasia. This lesion is the major cause of restenosis within the first 24 postoperative months and has histologic characteristics quite favorable for angioplasty with minimal possibility for embolic complications. Since surgery is a proven procedure with low morbidity/mortality for most patients, the authors believe transluminal angioplasty for carotid restenosis should be limited to surgically inaccessible lesions or patients presenting unacceptable operative risk, as in the case described.

Digital subtraction angiography and dynamic computed tomography in the evaluation of arteriovenous malformations and hemangioblastomas of the spinal cord.

Digital subtraction angiography (DSA) and dynamic computed tomography (DCT) were used in the evaluation of five patients with surgically approachable vascular lesions of the spinal cord, including three arteriovenous malformations (AVM), one hemangioblastoma, and one lesion with a questionable radiographic-surgical diagnosis (AVM? hemangioblastoma?). Digital subtraction angiography was positive in three of the five cases and was particularly informative in the patient with hemangioblastoma, even vis a vis arteriography, which is considered the definitive diagnostic test for these lesions. Dynamic computed tomography was positive in four of the five cases.