Comparison between the radionuclide salivagram and videofluoroscopic swallowing study methods for evaluating patients with aspiration pneumonia

Objective

A videofluoroscopic swallowing study (VFSS) is generally used to assess dysphagia and aspiration, although false-negative results may be obtained. Saliva aspiration may cause false-negative VFSS findings in elderly people. A radionuclide salivagram can be useful in detecting saliva aspiration. We therefore compared these two methods for the evaluation of patients with aspiration pneumonia.

Methods

We prospectively enrolled 50 patients with aspiration pneumonia into this study. All patients underwent VFSS, and were evaluated on the Penetration-Aspiration Scale. A salivagram was performed on the day after VFSS and each patient received 1 mL Tc-99 m DTPA sublingually. Both dynamic and delayed images were obtained.

Results

Aspiration was observed in 34 % of patients by salivagram and in 42 % by VFSS. The frequency of tests that were positive for aspiration pneumonia using a combination of the two methods was 52 %. Five patients with positive aspiration findings on salivagram were negative on VFSS. The association between VFSS and salivagram findings was significant but the total agreement was 72 %. The frequency of aspiration pneumonia was significantly associated with an abnormal salivagram finding.

Conclusions

A salivagram may be a useful method for the evaluation of aspiration in elderly people, and a combination of the VFSS and salivagram methods could enable a more effective investigation of aspiration pneumonia.     

Search for compensation postures with videofluoromanometric investigation in dysphagic patients affected by amyotrophic lateral sclerosis

Purpose

This study was undertaken to verify the effectiveness of compensatory postures, suggested on the basis of the type of dysphagia identified at videofluoromanometric (VFM) investigation to ensure safe oropharyngeal transit.

Materials and methods

Eighty-one patients with amyotrophic lateral sclerosis (ALS) underwent speech therapy assessment and VFM investigation of the swallowing process. In the event of altered transit, penetration or aspiration of contrast material into the airways, compensation postures for correction of the swallowing disorder were suggested and verified during VFM examination.

Results

In 37 patients, contrast agent transport was preserved and safe; in 19, we observed penetration of the contrast agent into the laryngeal inlet without aspiration; in 24, there was aspiration (four preswallowing, eight intraswallowing, nine postswallowing, three mixed), whereas in one patient no transit was seen. Penetration without aspiration was resolved by coughing or throat clearing; aspiration was resolved in 13 patients by assuming the chin-tuck posture and in six by rotating the head; in five patients, it was not resolved. A hyperextended head posture proved to be effective to resolve lack of transit.

Conclusions

By correlating morphological with functional data, VFM enables one not only to precisely characterise the dysphagic disorder but also to identify the most appropriate compensation posture for each patient and verify its effectiveness.     

Videofluorography swallow study of patients with systemic sclerosis

Purpose

This study was undertaken to evaluate the role of the videofluorographic (VFG) swallow study in patients with systemic sclerosis.

Materials and methods

Over a 23-month period, 45 women (mean age 58 years, range 27–76 years) with a known diagnosis of systemic sclerosis and a history of dysphagia underwent a dynamic and morphological study of the oral, pharyngeal and oesophageal phases of swallowing with videofluorography. All examinations were performed with a remote-controlled digital C-arm device with 16-in image intensifier, 0.6- to 1.2-mm focal spot range and maximum tube voltage of 150 kVp in fluorography and 120 kVp in fluoroscopy. Cineradiographic sequences were acquired for the swallow study with 12 images per second and matrix 512×512 after the ingestion of boluses of high-density (250% weight/volume) barium. The evaluation of oesophageal peristalsis was documented with digital cineradiographic sequences with six images per second in the upright and supine positions during the swallowing of barium (60% weight/volume), and the water siphon test was performed with the patient in the supine position to evaluate the presence of gastro-oesophageal reflux disease (GORD). All patients subsequently underwent laryngoscopy, endoscopy and pH monitoring, and the data thus obtained were processed and compared.

Results

The VFG swallow study identified alterations of epiglottal tilting associated with intraswallowing laryngeal penetration in 26 patients (57.8%), pooling of contrast agent in the valleculae and pyriform sinuses in 23 (51.1%) and radiographic signs of nonspecific hypertrophy of the lingual and/or palatine tonsils in 18 (40%). The study of the oesophageal phase revealed the presence of altered peristalsis in all patients, and in particular, 36 patients (80%) showed signs of atony. Altered oesophageal clearing mechanisms were evident in all 45 patients, sliding hiatus hernia in 43 (93%) and GORD in 44 (97%).

Conclusions

Our study demonstrated that in patients with systemic sclerosis, there is no primary alteration of the oral or pharyngeal phase of swallowing. In addition, alterations of epiglottal tilting associated with laryngeal penetration of contrast agent were found to be secondary to chronic GORD. Indeed, in 40% of patients, radiographic signs were found that indicated nonspecific hypertrophy of the lingual tonsil and/or palatine tonsils and nonspecific signs of chronic pharyngeal inflammation, and GORD was identified in 93% of patients, which in 40% of cases extended to the proximal third of the oesophagus. The data obtained were confirmed in 85% of cases with pH monitoring and in all cases with laryngoscopy.     

Amyotrophic lateral sclerosis: sonographic evaluation of dysphagia

Purpose

The authors sought to determine the role of video ultrasonography (VUS) in the diagnostic assessment of dysphagia in patients with amyotrophic lateral sclerosis (ALS).

Materials and methods

Nine patients underwent simultaneous static and dynamic VUS examination and videofluoroscopy (VFS) of swallowing.

Results

At the static phase, VUS showed 5/9 patients had lingual atrophy. Abnormal bolus position was observed in 6/9 patients at VUS and 3/9 at VFS. Both techniques identified an inability to keep the bolus in the oral cavity in 4/9 patients. At the dynamic phase, reduced lingual movement was observed in 5/9 patients at VUS and 2/9 at VFS. Disorganised tongue movement was seen in 3/9 patients at VUS and in 2/9 at VFS. Fragmented swallowing was only visualised at VUS. Stagnation of ingested material was never visualised at VUS, whereas it was clearly depicted in 2/9 patients at VFS.

Conclusions

VUS can be integrated into the diagnostic protocol for evaluating swallowing in patients with ALS, as it has higher sensitivity than VFS in assessing the dynamic factors that represent the early signs of dysphagia.     

Chest radiography in intensive care: an irreplaceable survey?

Purpose

This study evaluated the impact and value of bedside chest X-ray in intensive care units.

Materials and methods

This observational study considered the bedside chest X-rays performed on 258 consecutive patients (160 men, 98 women; mean age, 58 years) admitted to intensive care units. Stratification of patients according to the reason for hospitalisation and analysis of the reasons for chest X-ray examinations were performed to assess the diagnostic efficacy (DE).

Results

DE for chest X-rays was 84.5%, with 15.5% of tests remaining unchanged over time. Patient stratification by disease indicated that the DE was 85.27% in transplant, 90.79% in postoperative care after general surgery, 83.89% in respiratory failure, 82.42% in polytrauma, 90.54% in postoperative care after neurosurgery, 86.6% in postoperative care after vascular surgery, 83.3% in neurological conditions and 93.4% in other diseases.

Conclusions

Chest X-rays performed at the bedside are the most widely used imaging method in the follow-up of critically ill patients. DE is approximately 84.5%. Radiologists should maintain familiarity with the interpretation of this examination.     

Long-term prognostic value of exercise technetium-99m tetrofosmin myocardial perfusion single-photon emission computed tomography

Background

Exercise ^99mTc-tetrofosmin single-photon emission computed tomography (SPECT) is a useful tool for short- and medium-term risk stratifications. Currently, the long-term prognostic application of this technique has not been evaluated.

Methods and Results

Exercise ^99mTc-tetrofosmin was performed in 655 consecutive patients. Ten patients who underwent revascularization <60?days after nuclear testing were excluded from the analysis. The present data are based on 638 patients with complete follow-up. An abnormal SPECT study was defined as the presence of fixed and/or reversible perfusion defects. End points were cardiac death, nonfatal infarction, and late coronary revascularization. A total of 344 (54%) patients had an abnormal SPECT study. Perfusion defects included fixed defects alone in 186 patients (29%) and reversible defects in 158 (25%) patients. During a mean follow-up of 11.0?±?3.3?years, 174 (27%) patients died (all-cause mortality). Nonfatal myocardial infarction occurred in 76 (12%) patients, and late coronary revascularization was performed in 194 (30%) patients. Univariable and multivariable Cox proportional hazard regression analyses showed that exercise ^99mTc-tetrofosmin SPECT provided prognostic information incremental to clinical data and exercise test data. Patients with a normal SPECT had a relatively favorable long-term prognosis, in contrast to patients with an abnormal study who had a significantly increased risk of cardiac events. The SPECT parameters abnormal scan, reversible defect, and summed rest score were strong predictors of long-term outcome.

Conclusion

Exercise ^99mTc-tetrofosmin myocardial perfusion SPECT has an incremental long-term prognostic value over clinical and stress test parameters for the prediction of major adverse cardiac events.     

Mechanical thrombectomy in acute ischemic stroke—experience from 6 years of practice

Introduction

We present our results from the first 6 years with mechanical thrombectomy in the treatment of ischemic stroke.

Methods

Every patient treated with mechanical thrombectomy for acute ischemic stroke from September 2005 to December 2011 was consecutively included in this retrospective analysis. Baseline and outcome data were retrieved from computerized records at the hospital. National Institute of Health Stroke Scale (NIHSS) score and the modified Rankin Scale (mRS) score were used as outcome parameters. Favorable outcome was defined as a mRS score of 0–2, corresponding to independence in activities of daily living. We also evaluated revascularization and severe adverse events, with focus on symptomatic intracranial hemorrhage.

Results

Good functional outcome (mRS 0–2) was achieved in 50 % (120/240) of all patients. For patients with no neurological deficit prior to stroke onset (i.e., mRS?=?0 before stroke), the proportion with good functional outcome was 54 %. Symptomatic hemorrhages occurred in 4.6 % of the cases (5.7 % in the anterior circulation).

Conclusion

In summary, our results supports that mechanical thrombectomy is a safe and effective method to restore blood flow in selected patients suffering from an acute ischemic stroke.     

qPET – a quantitative extension of the Deauville scale to assess response in interim FDG-PET scans in lymphoma

Background

Interim FDG-PET is used for treatment tailoring in lymphoma. Deauville response criteria consist of five ordinal categories based on visual comparison of residual tumor uptake to physiological reference uptakes. However, PET-response is a continuum and visual assessments can be distorted by optical illusions.

Objectives

With a novel semi-automatic quantification tool we eliminate optical illusions and extend the Deauville score to a continuous scale.

Patients and methods

SUV_peak of residual tumors and average uptake of the liver is measured with standardized volumes of interest. The qPET value is the quotient of these measurements. Deauville scores and qPET-values were determined in 898 pediatric Hodgkin’s lymphoma patients after two OEPA chemotherapy cycles.

Results

Deauville categories translate to thresholds on the qPET scale: Categories 3, 4, 5 correspond to qPET values of 0.95, 1.3 and 2.0, respectively. The distribution of qPET values is unimodal with a peak representing metabolically normal responses and a tail of clearly abnormal outliers. In our patients, the peak is at qPET = 0.95 coinciding with the border between Deauville 2 and 3. qPET cut values of 1.3 or 2 (determined by fitting mixture models) select abnormal metabolic responses with high sensitivity, respectively, specificity.

Conclusions

qPET methodology provides semi-automatic quantification for interim FDG-PET response in lymphoma extending ordinal Deauville scoring to a continuous scale. Deauville categories correspond to certain qPET cut values. Thresholds between normal and abnormal response can be derived from the qPET-distribution without need for follow-up data. In our patients, qPET < 1.3 excludes abnormal response with high sensitivity.     

What is the value of stress 99mTc-tetrofosmin myocardial perfusion imaging for the assessment of very long-term outcome in obese patients?

Objective

There are no data regarding the long-term prognostic value of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in obese patients. The aim of this study was to examine the value of stress ^99mTc-tetrofosmin MPI findings for the prediction of very long-term outcome in obese patients.

Methods

The study population consisted of 261 patients with a body mass index ≥30 kg/m² who underwent exercise or pharmacological stress ^99mTc-tetrofosmin MPI for the assessment of known or suspected coronary artery disease. Endpoints during follow-up were all-cause mortality, cardiac death, nonfatal infarction, and coronary revascularization. Kaplan-Meier survival cures were constructed and univariate and multivariate analyses were performed to identify predictors of very long-term outcome.

Results

The mean age was 59 ± 10 years, 42% of the patients was male, and the body mass index was on average 37 ± 7 kg/m². MPI findings were normal in 109 patients (42%). Myocardial perfusion abnormalities were fixed in 62 patients (24%) and reversible in 90 patients (34%). During a median 12-year follow-up, 91 (35%) patients died, and 27 (10%) had a nonfatal myocardial infarction. Survival curves were compared using the log-rank test at subsequent follow-up durations. Obese patients with a normal stress ^99mTc-tetrofosmin study had a significantly better prognosis as compared with those with an abnormal study, up to 6 years after the test was performed.

Conclusion

Stress ^99mTc-tetrofosmin MPI provides valuable prognostic information for the prediction of outcome in obese patients. Obese patients with a normal stress ^99mTc-tetrofosmin study have a significantly better prognosis as compared with those with an abnormal study, up to 6 years after the test is performed.     

Ultrasound-guided aspiration and ethanol sclerotherapy for treating endometrial cysts

Purpose

The authors sought to evaluate the effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy in treating endometrial cysts and adopt this procedure as an alternative to surgery.

Materials and methods

Fifty consecutive patients with an average age of 25.2 years [standard deviation (SD) 6.5; range 16–40 years) and US diagnosis of endometrial cyst who were pregnant or presenting with high anaesthesia risk, adhesions or who refused surgery underwent US-guided aspiration of a total of 54 endometrial cysts (40 with transabdominal approach and the remaining 14 with transvaginal approach) and ethanol sclerotherapy.

Results

The procedure was successful in all patients. Follow-up imaging was carried out at 12 h, 24 h, 15 days, 3 months, 6 months and 12 months. After 12 months, four patients (8%) showed recurrence, three of whom opted for a second session of US-guided aspiration and ethanol sclerotherapy.

Conclusions

US-guided aspiration and sclerotherapy with 95% ethanol provides a valid alternative to surgery in treating endometrial cysts.     

Acute stroke treatment using the Penumbra endovascular mechanical thrombolysis device: a single-centre experience

Purpose

Ischaemic stroke due to occlusion of large cerebral vessels has a poor prognosis. The clinical outcome is related to efficacy and timing of recanalisation of the occluded arteries. We report our experience with a thrombus aspiration device (Penumbra), and focus on pre- and postprocedural management.

Materials and methods

We retrospectively reviewed 18 consecutive patients with acute ischaemic stroke due to the occlusion of large cerebral vessels who were treated with mechanical thrombolysis at our centre between September 2009 and July 2010. Preprocedural symptoms were quantified using the National Institutes of Health Stroke Scale (NIHSS). Mechanical thrombolysis was performed with the Penumbra system. Intravenous thrombolysis was done only if <3 h had elapsed since symptom onset. Associated vessel stenoses were treated with stenting. All patients underwent neurological examination and postprocedural magnetic resonance angiography (MRA) at 3 and 6 months.

Results

Mechanical thrombolysis using the Penumbra system was performed in all cases. A total of 83% of treated vessels had a value of 2/3 according to the Thrombolysis in Cerebral Infarction (TICI) scale. In seven patients (39%) intravenous thrombolysis was unsuccessful, and salvage mechanical thrombolysis followed. Three patients died after the procedure (16.7%). Five patients (27.8%) required a stenting procedure. All patients reported a significant improvement in symptoms (mean baseline NIHSS 19.6±5.6; mean postprocedural NIHSS, 7.8±5.5 p<0.0001)

Conclusions

Our preliminary experience with the Penumbra mechanical thrombolysis system confirms previously reported results showing the efficacy and safety of the device in treating acute stroke caused by the occlusion of large intracranial vessels.     

Efficacy and safety of an early Solitaire stent retrieval technique for acute ischemic stroke

Purpose

The aim of this study was to retrospectively evaluate the efficacy and safety of early pull-back of a Solitaire stent as a thrombectomy device in patients with acute ischemic stroke.

Methods

The study group comprised 23 consecutive cases presenting with acute ischemic stroke who were treated with intra-arterial therapy using the Solitaire device as a first-line endovascular procedure. The stent was deployed to cover the thrombus and then left in place for 1–2 min. Immediate angiographic results are presented. Neurologic status was assessed according to the NIH Stroke Scale score (NIHSS) and the modified Rankin Scale (mRS) score.

Results

Successful recanalization (TICI grade ≥2b) was achieved in 21 of the 23 (91.3 %) treated vessels, and 6 of the patients showed immediate flow restoration after the deployment of the first stent. The mean number of passes for maximal recanalization was 1.96. There were no symptomatic procedure-related complications. Of the cases, 34.8 % improved by >10 points on the NIHSS at discharge; 30.4 % of cases revealed good functional outcome (mRS score 0–2) at 90 days.

Conclusions

The early retrieval technique with the Solitaire stent appears to be a safe and effective method in patients with acute ischemic stroke.     

Dose-dependent deterioration of swallowing function after induction chemotherapy and definitive chemoradiotherapy for laryngopharyngeal cancer

Aim

To evaluate the influence of clinical, treatment- and dose-dependent factors on posttreatment swallowing function after induction chemotherapy and definitive chemoradiotherapy in a group of homogeneously treated laryngopharyngeal cancer patients.

Methods

From 28 May 2008 to 15 February 2013, 45 patients with borderline inoperable laryngopharyngeal cancer that had responded well to induction chemotherapy were treated with definitive chemoradiotherapy. Median follow-up was 22 months. Swallowing function and clinical data were prospectively analyzed using the EORTC QLQ-C30 questionnaire. Swallowing structures were retrospectively delineated on the original treatment planning CT. Dose–volume histograms were calculated for swallowing structures and D_mean, D_max and V50–V64 values (in 2 Gy increments) were determined for each patient. Tumor volume and infiltration of the swallowing apparatus was defined by CT before induction chemotherapy.

Results

Of the 45 patients, 26 (57.8?%) fully regained swallowing function after chemoradiotherapy. A further 12 patients (26.7?%) were able to manage soft, pureed and/or liquid foods; the remaining 7 (15.6?%) were completely dependent on percutaneous endoscopic gastrostomy (PEG). Posttreatment swallowing function was significantly influenced by D_mean to the superior pharyngeal constrictor muscle (PCM, p?=?0.041). Correlations between late dysphagia and dose–volume relationships in the superior PCM and soft palate were also observed, which were significant from V60 (p?=?0.043) and V58 for the soft palate and superior PCM, respectively. Of the evaluated clinical and tumor-related factors, only alcohol abuse (p?=?0.024) had an influence on posttreatment swallowing function.

Conclusion

Almost 50?% of patients had deterioration of swallowing function after definitive chemoradiotherapy for laryngopharyngeal cancer. The dose to anatomical structures responsible for swallowing function appears to play a role. Therefore, in selected patients, target volume delineation for radiotherapy of laryngopharyngeal cancer should be optimized on an individual basis to spare the swallowing apparatus.     

Effectiveness of nuclear cardiology training guidelines: A comparison of trainees with experienced readers

Background

To evaluate the effectiveness of published nuclear cardiology training guidelines, the diagnostic accuracy of image interpretation by nuclear cardiology trianees was compared with that of experienced nuclear cardiologists.

Methods and Results

The accuracy of three experienced nuclear cardiologists and three trainees with level II experience following Society of Nuclear Medicine/American College of Cardiology/American Society of Nuclear Cardiology guidelines in the interpretation of 114 exercise ^99mTc-labeled sestamibi single-photon emission computed tomographic imaging studies was evaluated. Studies were selected randomly and included patients with less than 5% likelihood of coronary artery disease, as well as patients with angiographically demonstrated single and multivessel disease. Studies were interpreted by each reader without knowledge of clinical or exercise data. Each reader classified perfusion as normal or abnormal. Accuracy was assessed according to sensitivity, normalcy rate, and predictive accuracy. In addition, the ability of experienced readers and trainees to identify abnormal perfusion in patients with multivessel disease was compared. Trainees had high accuracy, comparable to experienced readers for sensitivity, normalcy rate, and predictive accuracy, as well as the ability to identify abnormal perfusion in patients with multivessel disease. In all categories, experienced interpretors demonstrated a trend toward greater accuracy with less observer variability than did trainees.

Conclusion

Structured training in nuclear cardiology following Society of Nuclear Medicine/American College of Cardiology/American Society of Nuclear Cardiology guidelines during clinical cardiology fellowship is effective, and trainees possess the skills to interpret myocardial perfusion images accurately. Interpretive skills can be expected to improve further with experience.     

Sensitivity and specificity of presumptive tests for blood,saliva and semen

Purpose

Despite their wide use, the limits of presumptive tests can be poorly understood. The aim of this study was to investigate the specificity and sensitivity of conventional, as well as innovative, presumptive tests for blood, semen and saliva.

Methods

We investigated Kastle–Meyer (KM) and leucomalachite green (LMG) tests for blood with regard to their sensitivity and specificity in the presence of oxidizing (hypochlorite) and anti-oxidizing (ascorbic acid) agents. The suitability and specificity of the red starch paper (RSP) test for saliva was assessed. Finally, the inhibitory effect of detergent on the acid phosphatase (AP) test for semen was investigated along with possible cross reactions to tea stains.

Results

Our results confirm previous findings of higher sensitivity and specificity of the KM test compared to LMG test for blood. Contrary to previous studies, no statistically significant difference was observed in the sensitivity of the tests between dry and wet stains. The novel RSP test was found to successfully detect saliva. We demonstrated that acid phosphatase (AP) testing for semen is possible on used RSP. A common multipurpose detergent had an inhibitory effect on AP tests. False positive results were obtained from tea stains. Testing different sorts of tea (black, green and herbal teas) revealed that only Camellia varieties produce positive result with the AP test, due to AP being present in the plants.

Conclusions

From our results we conclude that specific knowledge of each test, including substances that may affect the test outcome, is imperative to ensure correct interpretation of presumptive test results.     

Dysphagia after definitive radiotherapy for head and neck cancer

Background

Dysphagia is a complication of head and neck cancer patients undergoing radiotherapy (RT). We analysed frequency and severity of swallowing dysfunction and correlated these findings with dose–volume histograms (DVHs) of the pharyngeal constrictor muscles.

Methods

A total of 50 patients treated by radical RT were enrolled. DVHs of constrictor muscles were correlated with acute and late dysphagia and with the items of three quality of life questionnaires.

Results

Mean dose to superior and middle constrictor muscles (SCM, MCM), partial volume of SCM and MCM receiving a dose ≥?50 Gy dose to the whole constrictor muscles ≥?60 Gy and tumour location were associated to late dysphagia at univariate analysis. Mean dose to the MCM was the only statistically significant predictor of late dysphagia at the multivariable analysis.

Conclusion

The study shows a significant relationship between long-term dysphagia and mean doses to SCM, MCM, whole constrictor muscles, and oropharyngeal tumour. This finding suggests a potential advantage in reducing the RT dose to swallowing structures to avoid severe dysphagia.     

Relationship between vertebral artery hypoplasia and posterior circulation stroke in Chinese patients

Introduction

Vertebral artery hypoplasia (VAH), which has been found in about 10 % of normal individuals, does not produce symptoms but may be associated with an increased risk of cerebral posterior circulation ischemic (PCI) stroke. The aims of this study were to determine the prevalence of VAH in Chinese patients with cerebral infarction and investigate whether VAH is an independent risk factor for PCI stroke.

Methods

The medical records of 841 Chinese stroke patients were reviewed retrospectively. All patients underwent either cervical contrast-enhanced magnetic resonance angiography (CE-MRA) or cervical computed tomography angiography (CTA). There is no standard definition of VAH; we defined it as a vertebral artery <2 mm in diameter and the whole artery was slim or absent on CE-MRA or CTA. Univariate and multivariate logistic regression analyses were performed to identify significant independent risk factors for PCI stroke.

Results

There were 230 patients (27.3 %) diagnosed with PCI stroke and 91 patients diagnosed with VAH (10.8 %). Multivariate logistic regression analysis showed that VAH, male gender, and stenosis of the posterior circulation were independent risk factors for PCI stroke.

Conclusions

Our results show that VAH is not rare in Chinese patients with stroke and that its presence increases the risk of PCI stroke.     

Functional reorganization associated with outcome in hand function after stroke revealed by regional homogeneity

Introduction

Previous studies of task-based functional neuroimaging have shown that various patterns of functional reorganization underlie motor recovery following stroke. However, the mechanisms underlying functional reorganization that contribute to outcome differences in hand function after stroke have not been completely characterized. We, for the first time, investigate subgroups of stroke patients with different outcomes in hand function using a resting-state fMRI approach.

Methods

We selected 24 patients with subcortical stroke and divided them into two subgroups: completely paralyzed hands (CPH, 12 patients) and partially paralyzed hands (PPH, 12 patients). Twenty-four healthy controls (HCs) matched for age and handedness were also recruited. We used regional homogeneity (ReHo) method to map regional spontaneous activity across the whole brain and performed a two-sample t test between each pair of the three diagnostic groups.

Results

Compared to HCs, we found increased ReHo in the ipsilesional hemisphere in PPH and, conversely, increased ReHo in the contralesional hemisphere in CPH. Moreover, we detected decreased ReHo in the ipsilesional primary sensorimotor cortex and superior temporal gyrus, in addition to increased ReHo in the contralesional premotor cortex and ipsilesional medial frontal gyrus in CPH compared to PPH. Additionally, the ReHo index of these regions significantly correlated with the Fugl-Meyer assessment scores (hand + wrist) across all stroke patients.

Conclusions

Our study offers a new insight into relationships between functional reorganization and outcomes in hand function after subcortical stroke, and the ReHo method can provide an effective tool for evaluating the efficiency of rehabilitative therapies following stroke.     

Assessment of transient ischemic dilation (TID) ratio in gated SPECT myocardial perfusion imaging (MPI) using regadenoson, a new agent for pharmacologic stress testing

Background

Abnormal values of the transient ischemic dilation (TID) ratio are associated with severe and extensive coronary artery disease (CAD). The objective of this study was to determine the relationship between TID, determined from stress and rest ventricular volumes during regadenoson gated single-photon emission computed tomography myocardial perfusion imaging (MPI) dual isotope studies, and the extent of CAD found during coronary angiography.

Methods

195 patients who underwent dual isotope MPI with regadenoson and cardiac angiography between March 2009 and February 2010 were analyzed. TID was calculated using commercially available software, Emory Cardiac Toolbox. Mean TID values were compared across disease types. A threshold for abnormal TID was determined by adding two standard deviations (SDs) to the mean TID of the ??non-obstructive CAD?? subgroup.

Results

In the 195-patient group analyzed, the mean TID ratio for non-obstructive CAD (n?=?104) was found to be 1.09 with a SD of 0.15. In a subgroup of patients whose angiogram was within 3 months of MPI (n?=?155), the mean TIDs for non-obstructive disease (n?=?81), single-vessel disease (n?=?35), and multi-vessel disease (n?=?39) were 1.09, 1.15, and 1.19 with SDs of 0.16, 0.19, and 0.26, respectively. Those with an abnormal TID had a crude and adjusted odds ratio of 3.4 for multi-vessel disease which was statistically significant. History of diabetes was not found to be a significant confounder, effect modifier, or mediator of the relationship between the TID and the vessel disease.

Conclusion

The mean TID ratio in patients with multi-vessel disease was 1.19. The threshold for an abnormal TID was 1.39 with specificity of 95% and sensitivity of 15% for determining multi-vessel CAD status. We conclude that the level of TID in gated SPECT MPI using regadenoson is associated with the degree of CAD on angiography.     

CT interpretation by ASPECTS in hyperacute ischemic stroke predicting functional outcomes

Purpose

To determine whether the Alberta Stroke Program Early CT Scores (ASPECTS) can predict posttreatment functional outcomes in hyperacute stroke patients who receive recombinant tissue-type plasminogen activator (rt-PA) treatment within 4.5 h.

Materials and methods

We studied 162 patients treated with rt-PA within 4.5 h of clinical onset. Of those, 29 patients (17.90 %) received rt-PA treatment between 3 and 4.5 h. Systematic CT scoring with the ASPECTS method was done. The primary outcome was the correlations between ASPECTS and the functional status at 3 months follow-up using the modified Rankin Scale.

Results

Clinical variables between those who received rt-PA treatment before and after 3 h were mostly comparable except the proportion of male gender. There were 116 patients (71.60 %) who were classified as independent. Time to receive CT scan or rt-PA treatment was not significantly associated with patients’ functional status. Baseline NIHSS and ASPECTS scores were significant factors associated with dependent status or death at 3 months after rt-PA treatment. The adjusted odds ratios were 1.133 [95 % confidence interval (CI), 1.047–1.226] and 0.844 (95 % CI, 0.720–0.990), respectively.

Conclusion

The ASPECTS predicts the functional status of acute stroke patients who received rt-PA treatment within the 4.5-h golden period.