Iliofemoral vein thrombosis and pulmonary embolism associated with a transient ischemic attack in a patient with antiphospholipid syndrome

Several clinical conditions, such as deep vein thrombosis, cerebral infarct, pulmonary infarct, skin ulcers, renal failure, and habitual abortion, are thought to be associated with the antiphospholipid syndrome. The authors describe a 32-year-old woman who had characteristics of the antiphospholipid syndrome including increased immunoglobulin G-cardiolipin antibody titers, iliofemoral vein thrombosis, pulmonary embolism, headache, visual disturbances, and habitual abortion. During hospitalization, she suddenly experienced right-sided weakness. A Tc-99m HMPAO brain scan showed the probability of a transient ischemic attack in the left frontotemporal cortex.     

Predicting cerebral ischemic infarct volume with diffusion and perfusion MR imaging

BACKGROUND AND PURPOSE: Diffusion and perfusion MR imaging have proved useful in the assessment of acute stroke. We evaluated the utility of these techniques in detecting acute ischemic infarction and in predicting final infarct size. METHODS: Diffusion and hemodynamic images were obtained in 134 patients within a mean of 12.3 hours of onset of acute ischemic stroke symptoms. We retrospectively reviewed patient radiology reports to determine the presence or absence of lesion identification on initial diffusion- (DW) and perfusion-weighted (PW) images. Radiologists were not blinded to the initial clinical assessment. For determination of sensitivity and specificity, the final discharge diagnosis was used as the criterion standard. Neurologists were not blinded to the DW or PW imaging findings. In 81 patients, acute lesions were compared with final infarct volumes. RESULTS: Sensitivities of DW imaging and cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) perfusion parameters were 94%, 74%, 84%, and 84%, respectively. Specificities of DW imaging, CBV, CBF, and MTT were 96%, 100%, 96%, and 96%, respectively. Results were similar in 93 patients imaged within 12 hours. In 81 patients with follow-up, regression analysis yielded r(2) = 0.9, slope = 1.24 for DW imaging; r(2) = 0.84, slope = 1.22 for CBV; r(2) = 0.35, slope = 0.44 for CBF; and r(2) = 0.22, slope = 0.32 for MTT, versus follow-up volume. A DW-CBV mismatch predicted additional lesion growth, whereas DW-CBF and DW-MTT mismatches did not. Results were similar in 60 patients imaged within 12 hours. CONCLUSION: Diffusion and hemodynamic images are sensitive and specific for detecting acute infarction. DW imaging and CBV best predict final infarct volume. DW-CBV mismatch predicts lesion growth into the CBV abnormality. CBF and MTT help identify additional tissue with altered perfusion but have lower correlation with final volume.     

短暂性脑缺血发作与脑血管狭窄的相关性研究

短暂性脑缺血发作（TIA）是由各种原因引起的历时短暂并经常反复发作的脑局部供血障碍。该病是临床常见的脑血管病之一,如不及时治疗极易发展成不可逆性的脑梗死。因此,尽早找到该病的病因,继而针对病因进行积极的治疗是非常重要的。然而,该病的发病机制尚不完全清楚。众多研究表明,动脉粥样硬化引起的颅动脉狭窄是短暂性脑缺血发作的主要病因[1～3]。本研究拟结合本院自2005年1月～2008年12月诊治的短暂性缺血发作病例的状况,探讨TIA与颅动脉狭窄之间的相关性,为探讨该病的病因及临床治疗提供依据。     

Assessment of transient ischemic attack with diffusion- and perfusion-weighted imaging

BACKGROUND: Diagnosing TIA can be difficult, since evidence of brain ischemia is habitually lacking on CT and conventional MR imaging. It has been suggested that patients with acute brain infarction on neuroimaging should be considered stroke cases instead of TIA, regardless of duration of symptoms, implying that optimal diagnostic methods need to be utilized. We therefore postulated that perfusion-weighted MR imaging (PW imaging) would be useful in the diagnosis of TIA. METHODS: Retrospective analysis of 22 patients with reversible neurologic symptoms lasting less than 24 hours, assessed with DW and PW imaging. RESULTS: MR imaging was abnormal in 15 patients (68%): 12 had abnormal DW imaging, four had both DW and PW imaging defects (all with a mismatch) and three had an isolated PW imaging abnormality. There were no differences in symptom duration, stroke etiology or cardiovascular risk factors between patients with abnormal MR imaging and those with unremarkable scan. Patients with mismatch were more likely to need conventional angiography or other cerebrovascular procedures. CONCLUSION: The combined use of DW imaging and PW imaging provided evidence of brain ischemia in most patients with clinical diagnosis of TIA. Prospective studies using follow-up MR imaging are required to determine the outcome of affected tissue, as well as the clinical implications of DW-PW imaging abnormalities.     

肺心病合并短暂性脑缺血发作27例临床分析

目的探讨慢性肺源性心脏病并发短暂性脑缺血发作(TIA)的临床特点。方法对27例住院肺心病并发TIA病人分别从临床症状、体征、辅助检查以及治疗方法等方面进行回顾性分析。结果高龄、高血压、高脂血症、糖尿病、缺氧、高血黏度、心功能不全、心房颤动、反复使用糖皮质激素等与肺心病并发TIA密切相关,动脉粥样硬化是其主要病理基础。结论肺心病并发TIA是多种危险因素相互作用的结果,其临床表现不典型,易漏诊、误诊,及早病因诊断及治疗有重要意义。     

短暂性脑缺血发作患者脑血流灌注和葡萄糖代谢显像的影像分析

目的:通过观察单侧或以单侧血管受累为主的短暂性脑缺血发作患者的脑血流灌注和葡萄糖代谢的变化,了解不同发病时期脑血流灌注及葡萄糖代谢的特点。方法:将27例患者根据发病时间不同分为急性期、亚急性期及慢性期三组,比较三组患者的脑血流灌注显像及脑葡萄糖代谢显像的结果。将27例患者按照有无侧枝代偿分为两组,比较侧枝代偿与脑损伤的关系。结果:三组中脑血流灌注和葡萄糖代谢均减低的患者占51.85%,除此之外,血流灌注和葡萄糖代谢还可表现为增高、正常或接近正常。有无侧枝代偿两组患者间脑受累程度分布无显著差异(χ2=6.750,P=0.009)。结论:低灌注、低代谢是脑缺血患者的主要表现,检查距发病时间长短及是否有侧枝循环建立与灌注及代谢变化有关。     

头颈部CTA、DWI及ABCD2评分在短暂性脑缺血发作中的应用

目的 探讨头颈部CT血管造影(CTA)、磁共振弥散加权成像(DWI)及ABCD2评分对短暂性脑缺血发作(TIA)患者预后评估的应用价值.方法 对62例临床诊断为TIA的患者进行连续性研究,所有患者均行常规MRI、DWI及头颈联合CTA检查,分析头颈动脉的狭窄程度及分布.结果 7 d内发生脑梗死患者的ABCD2评分明显高于未发生脑梗死患者(z=-2.083,P=0.037).高ABCD2评分组及7 d内发生脑梗死患者的头颈部动脉重度狭窄及闭塞的血管段数明显增加(P<0.05).结论 DWI检查、头颈CTA检查及ABCD2评分有助于对TIA患者早期脑梗死的预测.     

SPECT measurement of cerebral hemodynamics in transient ischemic attack patients--evaluation of pathogenesis and detection of misery perfusion

To evaluate the cerebral hemodynamics and the pathogenesis by regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV), 42 transient ischemic attack (TIA) patients and 9 normal volunteers were studied using SPECT. We classified these patients into Group A (n = 23: no occlusion or stenosis of the internal carotid or middle cerebral artery; non large vessel disease) and Group B (n = 19: chronic occlusion or severe stenosis of the internal carotid or middle cerebral artery; large vessel disease). We obtained rCBF with 133Xe inhalation and rCBV with 99mTc-red blood cells. Of 9 normal volunteers aged 43-70 yr (mean age 59.8 +/- 8.3 yr), the mean rCBF was 45.8 +/- 5.1 (ml/100 g brain/min), the mean rCBV was 4.0 +/- 0.4 (ml/100 g brain). The examination was done by comparing the values of the affected hemispheres of Group A and Group B patients with the mean rCBF and the mean rCBV of normal volunteers. Eleven out of Group A patients and 15 out of Group B patients showed decreased rCBF. But of those patients, no patients of Group A showed increased rCBV and 6 out of 19 Group B patients showed increased rCBV. Thromboembolic mechanism which is of Group A patients and Group B patients without increased rCBV, and hemodynamic mechanism which is of Group B patients with increased rCBV were considered as the main cause of TIA. Decreased rCBF and increased rCBV in Group B patients can be assumed as the misery perfusion as reported in PET studies.(ABSTRACT TRUNCATED AT 250 WORDS)     

Global cerebral hypoperfusion in a patient with transient global amnesia

We report a 64-year-old male patient with pure transient global amnesia (TGA) who exhibited global cerebral hypoperfusion during an amnesia attack. Initial single photon emission computed tomography (SPECT) performed 3 hours after the onset of the amnesic attack revealed diffuse hypoperfusion in the cerebrum, whereas a second SPECT study, 1 month later, revealed improvement of cerebral blood flow. This case suggests that SPECT study is useful in revealing the pathophysiological mechanism of TGA and that TGA attacks are associated with global cerebral blood flow change.     

ABCD2评分结合MRA对短暂性脑缺血发作后发生脑梗死的评估价值

目的 分析ABCID2评分结合磁共振血管造影术(MRA)对短暂性脑缺血发作(TIA)后7d和30d发生脑梗死的评估价值.方法 以2008年12月-2009年10月住院的119例TIA患者作为研究对象,收集其临床资料和MRA检查结果 .按Johnston提出的7分ABCD2评分法进行评分,随访TIA后7d和30d内脑梗死发生率.采用直线回归分析ABCD2评分与TIA后短期脑梗死发生率的关系,采用ROC曲线评估ABCD2评分对TIA后短期内发生脑梗死风险进行预测的准确度;采用x2检验分析不同ABCD2评分、MRA表现与TIA后短期脑梗死发生率的关系.结果 TIA后50例(42.0%)患者在TIA后30d内发生脑梗死,其中29例(24.4%)发生于7d内.ABCD2评分与TIA后7d和30d脑梗死发生率呈正相关,ABCD2评分越高,脑梗死的发生率越高(P<0.001). ABCD2评分预测7d发生脑梗死风险的ROC曲线下面积(0.839)高于30d(0.697).低危(≤3分)、中危(4-5分)和高危(≥6分)TIA患者间脑梗死发生率的差异有统计学意义(P<0.05).TIA后7d和30d颅内动脉狭窄≥50%的患者中脑梗死的发生率与<50%的患者相比明显增加(P<0.05). ABCD2评分＜4分、颅内动脉狭窄≥50%的TIA患者7d脑梗死发生率23.7%,30d脑梗死发生率44.7%,ABCD2评分＜4分、颅内动脉狭窄<50%的TIA患者分别为0%和17.6%,前者发生脑梗死风险明显增高(P<0.05).结论 ABCD2评分法预测7d发生脑梗死风险的准确性较高,进一步结合MRA检查能提高预测的准确性.     

Comparative evaluation of cerebral blood volume and cerebral blood flow in acute ischemic stroke by using perfusion-weighted MR imaging and SPECT

PURPOSE: To investigate the relationship between relative cerebral blood volume (CBV) measured with perfusion-weighted (PW) MR imaging and relative cerebral blood flow (CBF) measured with SPECT in acute ischemic stroke. MATERIAL AND METHODS: Fifteen patients who had acute unilateral middle cerebral artery occlusion underwent both PW MR imaging and 99mTc-HMPAO SPECT with an interval less than 20 min between the two examinations within 6 h after stroke onset. Lesion-to-contralateral relative CBV and CBF ratios measured in multiple regions of interest were compared to evaluate the relationship of the two parameters. RESULTS: An overall linear relationship was found between relative CBV and relative CBF ratios (R2 = 0.54, p < 0.0001). The two parameters correlated linearly to each other in regions with evolving infarction (R2 = 0.43, p<0.0001), but not in regions without evolving infarction (R2 = 0.001, p>0.05). Regions with evolving infarction had more severe hypoperfusion (mean relative CBF ratio, 0.38 +/- 0.22) than regions without (mean relative CBF ratio, 0.70+/-0.13) (p<0.0001). CONCLUSION: A significant linear relationship existed between relative CBV and relative CBF in acute ischemic stroke, although relative CBV did not change linearly to relative CBF in mild hypoperfusion. Relative CBV can be used as an alternative to relative CBF within 6 h after stroke onset, particularly in regions with severe hypoperfusion proceeding to infarction.     

质子磁共振波谱和MR表观扩散系数在短暂性脑缺血发作中的应用

目的:利用质子磁共振波谱(1H-MRS)技术和MR表观扩散系数(ADC)分析短暂性脑缺血发作(TIA)的脑代谢改变.方法:应用多体素1H-MRS技术和弥散加权成像分别对30例TIA患者和30例正常志愿者进行检查,测量双侧大脑半球半卵圆中心ADC值和脑内代谢物氮-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)和乳酸(Lac)的峰高比率,并作统计学分析.结果:30例病例中有11例患侧ADC值(6.31±0.87×10-4mm2/s)较对侧(7.97±0.79×10-4mm2/s)及正常对照组(8.46±0.79×10-4mm2/s)显著下降, 有统计学意义差异(P＜0.01).病变侧半卵园中心NAA/Cho(1.45±0.29)、NAA/Cr(1.56±0.23)低于对侧(1.65±0.21,1.81±0.16)及正常对照组(1.62±0.18,1.80±0.12),差异有显著性意义(P＜0.01);Cho/Cr(1.20±0.16)高于对侧(1.07±0.15)及正常对照组(1.05±0.11),差异有显著性意义(P＜0.05);Lac/NAA(0.18±0.06)高于对侧(0.00±0.00)及正常对照组(0.00±0.00), 差异有显著性意义(P＜0.01). 结论:多体素1H-MRS技术可以定量反映TIA患者脑组织神经细胞的生物代谢改变,其准确性及敏感性优于ADC值,1H-MRS技术结合弥散加权成像,为TIA的诊断提供了客观的影像学依据.     

Relative cerebral blood volume measurements of low-grade gliomas predict patient outcome in a multi-institution setting

Background/purpose

The prognostic value of defining subcategories of gliomas is still controversial. This study aims to determine the utility of relative cerebral blood volume (rCBV) in predicting clinical response in patients with low-grade glioma at multiple institutions.

Materials and methods

Sixty-nine patients were studied with dynamic susceptibility contrast-enhanced perfusion MRI at two institutions. The pathologic diagnoses of the low-grade gliomas were 34 astrocytomas, 20 oligodendroglioma, 9 oligoastrocytomas, 1 ganglioglioma and 5 with indeterminate histology.Wilcoxon tests were used to compare patients in different response categories with respect to baseline rCBV. Kaplan-Meier curve and log-rank tests were used to predict the association of rCBV with time to progression.

Results

At both institutions, patients with an adverse event (progressive disease or death) had a significantly higher baseline rCBV than those without (complete response or stable disease) (p value = 0.0138).The odds ratio for detecting an adverse event when using rCBV was 1.87 (95% confidence interval: 1.14-3.08). rCBV was significantly negatively associated with time to progression (p = 0.005). The median time to progression among subjects with rCBV > 1.75 was 365 days, while there was 95% confidence that the median time to progression was at least 889 days among subjects with rCBV < 1.75.

Conclusion

Our study suggests not only that rCBV measurements correlate well with time to progression or death, but also that the findings can be replicated across institutions, which supports the application of rCBV as an adjunct to pathology in predicting glioma biology.     

椎-基底动脉系统短暂缺血发作55例的临床及影像学分析

椎-基底动脉系统短暂缺血发作(TIA)在临床中较常见,其症状以眩晕最为常见,有时仅表现为头晕、视物模糊、走路不稳等含糊症状,且就诊时症状体征多已消失,而难以诊断或不被患者及医生重视。我们对住院治疗的55例患者做了TCD及有关影像学检查。现分析报告如下。     

超敏C反应蛋白、同型半胱氨酸浓度与短暂性脑缺血发作中医辨证分型的相关性

目的：通过测定血清超敏C反应蛋白（high sensitivity C-reactive protein,hs-CRP）及同型半胱氨酸（homocysteine,Hcy）浓度,探讨其与短暂性脑缺血发作（transient ischemic attack,TIA）的相关性,并为中医临床辨证分型提供参考。方法选取180例TIA患者作为观察组和30例健康者作为对照组,将TIA患者按照中医辨证分为5型：肝风内动证、风痰上扰证、痰浊壅闭证、气虚血滞证、脉络瘀阻证。分别对TIA患者和健康对照者血清hs-CRP、Hcy进行检测,并做组间对比。结果观察组血清hs-CRP、Hcy浓度较对照组显著升高（P＜0.01）,且TIA组各中医证型中,痰浊壅闭证血清hs-CRP浓度显著高于其他4型（P＜0.05）;脉络瘀阻证血清Hcy浓度显著高于其他4型（P＜0.05）。结论血清hs-CRP、Hcy浓度的升高不仅是TIA的重要发病原因,而且也反映其严重程度,可作为TIA中医辨证分型的客观指标之一。     

Regional cerebral blood flow in a patient with Nasu-Hakola disease

We report a functional neuroimaging study of a 43-year-old woman with Nasu-Hakola disease (NHD). Regional cerebral blood flow (rCBF) images were measured with technetium-99m ethyl cysteinate dimer single photon emission computed tomography (SPECT). rCBF was decreased in the bilateral frontal lobes and thalamus. This finding was consistent with the known underlying neuropathology in patients with NHD. Brain SPECT is useful for demonstrating the pathophysiologic brain region in patients with NHD.