Small Vessel Lesions Research Articles

Evaluation of Small Vessel Bifurcation Stenting Using the Double-Kissing Culotte and Culotte Technique in Acute Coronary Syndrome: 12-Month Clinical Outcomes.

Patients with small vessels who undergo percutaneous coronary intervention (PCI) with subsequent multiple implantation of drug-eluting stents remain at a higher risk of unfavorable outcomes. In complex cases where maintaining flow to all side branches is part of contemporary practice, using two-stent techniques may be appropriate. This study aims to evaluate the efficacy of double-kissing (DK) culotte technique in comparison to culotte technique in the context of small-vessel therapy in patients with acute coronary syndrome (ACS). This substudy of the Lower Silesia culotte Bifurcation Registry retrospectively analyzed patients who underwent ACS-PCI using DK culotte or culotte technique for bifurcation lesions in small vessels, defined as having at least one branch with a diameter of 2.75 mm or less. The primary endpoint was target lesion failure (TLF), a composite of cardiovascular death, target vessel myocardial infarction, or clinically driven target lesion revascularization (TLR) at 1-year follow-up. The secondary endpoint included major adverse cardiac events (MACE). The DK culotte group (n = 49) and the culotte group (n = 52) were compared, with 12-month follow-up showing lower TLF in the DK culotte group (8.2% vs. 19.2%, p = 0.082). Similar results were observed for TLR (6.1% vs. 13.5%; p = 0.161), stent restenosis (4.1% vs. 9.6%; p = 0.203), and MACE (18.4% vs. 25%; p = 0.344). For bifurcation lesions with a small-diameter artery, the DK culotte technique may reduce TLF and MACE compared to the culotte technique. However, given the limited sample size and the absence of statistical significance, these findings remain preliminary and require further investigation.

Lateral temporal atrophy is a better predictor of baseline MMSE scores than hippocampal atrophy in Alzheimer’s disease: A retrospective cross-sectional study

Background: Mini-Mental State Exam (MMSE) is widely used for the cognitive assessment in Alzheimer’s disease (AD), but its interpretation could be affected by acute medical conditions, depression, or anxiety. Conversely, brain magnetic resonance imaging (MRI) is an independent diagnostic tool to evaluate specific cerebral pathology. Many studies have investigated the correlation between MRI visual scales such as hippocampal atrophy and baseline MMSE in AD patients. However, the correlation between a comprehensive MRI visual scale and baseline MMSE in people with AD remains less well known. Method: We retrospectively collected records of outpatients diagnosed with probable AD according to DSM -5 criteria. The comprehensive visual rating scale (CVRS) was used to semiquantitatively measure structural changes and vascular lesions. The relationship between MRI changes and baseline MMSE was evaluated using Bayesian model averaging (BMA). Results: A total of 65 patients, among whom 21 (32.31%) had early-onset AD, were included. Lateral temporal atrophy, level of education, and late age at onset were the strongest independent predictors of baseline MMSE. Furthermore, hippocampal atrophy was only correlated with delayed recall, while temporal atrophy was correlated with orientation, attention, language, and visual-spatial items of the MMSE. The cerebral atrophy and small vessel lesions scores of the late-onset AD group were significantly higher than those of the early-onset group, despite negligible differences in education and MMSE. Conclusion: Our study suggests lateral temporal atrophy correlates with baseline MMSE scores in people with AD better than the hippocampal atrophy. Age-related atrophy and silent small vessel disease lesions may have negligible impact on AD patients’ cognitive impairment.

Research Progress of Transcranial Color Doppler in Cerebral Small Vessel Lesions Complicated with Chronic Kidney Disease

Research Progress of Transcranial Color Doppler in Cerebral Small Vessel Lesions Complicated with Chronic Kidney Disease

Chinese expert consensus on the clinical application of drug-coated balloon (2nd Edition).

Percutaneous coronary interventions have progressed through the era of plain balloon dilation, bare-metal stent insertion to drug-eluting stent treatment, which has significantly reduced the acute occlusion and restenosis rates of target vessels and improved patient prognosis, making drug-eluting stents the mainstream interventional treatment for coronary artery disease. In recent years, drug-coated balloons (DCBs) have become a new treatment strategy for coronary artery disease, and the drugs used in the coating and the coating technology have progressed in the past years. Without permanent implant, a DCB delivers antiproliferative drugs rapidly and uniformly into the vessel wall via the excipient during a single balloon dilation. Many evidence suggests that DCB angioplasty is an effective measure for dealing with in-stent restenosis and de novo lesions in small coronary vessels. As more clinical studies are published, new evidence is emerging for the use of DCB angioplasty in a wide range of coronary diseases, and the indications are expanding internationally. Based on the latest research from China and elsewhere, the Expert Writing Committee of the Chinese Expert Consensus on Clinical Applications of Drug-Coated Balloon has updated the previous DCB consensus after evidence-based discussions and meetings in terms of adequate preparation of in-stent restenosis lesions, expansion of the indications for coronary de novo lesions, and precise guidance of DCB treatment by intravascular imaging and functional evaluation.

Angiography-Based Computational Modeling for In Vivo Assessment of Endothelial Dynamic Strain in Coronary Arteries with De Novo Lesions: Comparison of Treatment Effects of Drug-Coated Balloons Between Small and Large Arteries

Acute morphological changes in de novo coronary lesions after drug-coated balloon (DCB) angioplasty can affect endothelial mechanics and consequently clinical outcomes. Angiography-based computational modeling has been validated to assess endothelial dynamic strain (EDS) in coronary arteries in vivo. The EDS was calculated on the basis of pre- and post-DCB angiography. Parameters of quantitative coronary angiography and EDS were quantified at cross-sections in the treated segments. A total of 336 and 348 lesion cross-sections were included in the small/large vessel groups, respectively. The acute lumen gain after DCB was significantly higher in large than small vessels (relative changes: 21.3% [17.4%, 25.1%] vs. 7.4% [4.8%, 10.1%], P < 0.001). Before treatment, three indices of EDS were significantly higher in small than large vessels (for ED-EDS: 29.2% [19.8%, 44.8%] vs. 20.4% [14.3%, 30.2%]; for ES-EDS: 26.8% [18.9%, 37.7%] vs. 18.3% [13.9%, 25.4%]; for TA-EDS: 19.1% [13.9%, 27.8%] vs. 14.3% [10.5%, 20.1%], P < 0.001). After treatment, the EDS in small vessels significantly decreased (P < 0.001). ED-EDS showed the highest correlation with pre-DCB DSP (r = 0.43, P < 0.001) and post-DCB MLD (r = 0.35, P < 0.001). The levels of EDS parameters for small or large vessel lesions significantly differed. Further study is required to examine the clinical value of EDS in predicting cardiac events after DCB treatment.

Two-year outcomes of drug-coated balloon only strategy for de novo lesions in large coronary vessels

Abstract Background Drug-coated balloons (DCB) are effective for the treatment of in-stent restenosis and de novo lesions in small coronary vessels (reference vessel diameter: RVD < 3.0 mm). Recently, several studies have reported acceptable results of DCB for de novo lesions in large coronary vessels (RVD ≧ 3.0 mm). However, previous studies were limited, we investigated the clinical outcomes of the DCB only strategy for de novo lesions in large coronary vessels. Methods We retrospectively analyzed 97 patients with 107 de novo lesions (RVD ≧ 3.0 mm) who underwent DCB only angioplasty from January 2016 to December 2021. We scheduled angiographic follow-up at 6 months after procedure and analyzed quantitative coronary angiography (QCA) data. Results The mean duration of follow-up was 737.8 ± 512.6 days. Patients who met the high bleeding risk (HBR) criteria was 56 (57.7%). Procedure success rate was 97.2% (3 lesions needed bailout drug eluting stent implantation) and acute coronary occlusion was not observed. The 2-year cumulative incidences of all-cause death was 7.1%, cardiac death was 1.6%. Target vessel revascularization was 9.2%, target lesion revascularization was 4.2%, respectively. Two patients had major bleeding events (BARC type 3 or 5) within 3 months after treatment and during the DAPT period. No major bleeding events were observed during the SAPT period. Conclusion The clinical outcomes of the DCB only strategy for de novo lesions in large coronary vessels were safe and acceptable. Especially in HBR patients, DCB only strategy could be an alternative treatment option.

TCT-662 Long-Term Clinical Outcomes From 2 European Centers Following the Use of Sirolimus-Coated Balloon in Small Vessel and Long Lesions in De Novo Segments

TCT-662 Long-Term Clinical Outcomes From 2 European Centers Following the Use of Sirolimus-Coated Balloon in Small Vessel and Long Lesions in De Novo Segments

Diffuse coronary artery disease management with drug-coated balloons

Drug-coated balloons (DCB) have emerged as a valid alternative for drug-eluting stents in the treatment of in-stent restenosis and de-novo lesions in small vessels. In the past years, a significant effort has been made to investigate the role of this strategy in larger vessel disease, with promising preliminary results being reported for several clinical scenarios, including complex lesions, such as bifurcations, chronic total occlusions and diffuse, long lesions. A DCB strategy appears to be of significant interest in diffuse coronary disease, as the total stent length represents an independent predictor for target-vessel failure and a surgical approach does not seem to improve mid- and long-term results compared to optimal medical treatment. Several studies have investigated the safety and efficacy of a non-stent-based approach in this complex setting, and as promising results have been reported, it is fair to assume that reducing the amount of implanted metal in diffusely affected vessels could become the standard of care for these patients if a full or blended therapy with DCB is adopted. However, long-term results from large-scale studies are awaited to confirm these preliminary and intriguing results.

Morphological characteristics differentiate dementia with Lewy bodies from Parkinson disease with and without dementia.

Dementia with Lewy bodies (DLB) and Parkinson disease (PD) with and without dementia are entities of a spectrum of Lewy body diseases. About 26.3% of all PD patients develop dementia increasing up to 83%. Parkinson disease-dementia (PDD) and DLB share many clinical and morphological features that separate them from non-demented PD (PDND). Clinically distinguished by the temporal sequence of motor and cognitive symptoms, the pathology of PDD and DLB includes variable combinations of Lewy body (LB) and Alzheimer (AD) lesions, both being more severe in DLB, but much less frequent and less severe in PDND. The objective of this study was to investigate the morphological differences between these three groups. 290 patients with pathologically confirmed PD were reviewed. 190 of them had clinical dementia; 110 met the neuropathological criteria of PDD and 80 of DLB. The major demographic and clinical data were obtained from medical records. Neuropathology included semiquantitative assessment of LB and AD pathologies including cerebral amyloid angiopathy (CAA). PDD patients were significantly older than PDND and DLB ones (83.9 vs 77.9years, p < 0.05); the age of DLB patients was between them (80.0years), while the disease duration was shortest in DLB. Brain weight was lowest in DLB, which showed higher Braak LB scores (mean 5.2 vs 4.2) and highest Braak tau stages (mean 5.2 vs 4.4 and 2.3, respectively). Thal Aβ phases were also highest in DLB (mean 4.1 vs 3.0 and 1.8, respectively). Major findings were frequency and degree of CAA, being highest in DLB (95% vs 50% and 24%, with scores 2.9 vs 0.7 and 0.3, respectively), whereas other small vessel lesions showed no significant differences. Striatal Aβ deposits also differentiated DLB from the other groups. This and other studies of larger cohorts of PD patients indicate that the association of CAA and cortical tau-but less-LB pathologies are associated with more severe cognitive decline and worse prognosis that distinguish DLB from PDD and PDND. The particular impact of both CAA and tau pathology supports the concept of a pathogenic continuum ranging from PDND to DLB + AD within the spectrum of age-related synucleinopathies.

A retinal vessel segmentation method based improved U-Net model

There are two problems in retinal blood vessel segmentation, which are the insufficient segmentation of small vessels due to the complex curvature morphology of blood vessels and the segmentation difficulty of blood vessels due to uneven brightness background of lesion fundus images. To solve the problems, a series deformable convolution structure is proposed in this paper, which could improve theadaptive features extraction ability to the blood vessels with various shapes and sizes, enhance feature transmissions and alleviate exploding gradients. On this basis, a retinal vessel segmentation method with series deformable convolution and attention mechanism based on U-Net structure (SDAU-Net) is proposed. In SDAU-Net, the convolution module in U-Net is replaced by series deformable convolution module, the lightweight attention module and dual attention module are applied in the decoder part, which effectively improve the U-Net feature extraction ability for the small vessels with complex morphology and the retinopathy images. To verify the SDAU-Net effect, the comparative experiments are conducted on datasets of DRIVE, STARE, CHASE_DB1 and IOSTAR. The results show that SDAU-Net is superior to comparative methods in accuracy. The Se and Acc on the DRIVE and STARE are 0.8293, 0.9675, 0.8973 and 0.9833 respectively, which indicate that SDAU-Net has more advantages in small vessel segmentation and lesion images. To verify the generalization and extendibility, cross-dataset and cross-modality experiments are conducted on DRIVE, STARE and IOSTAR, the results demonstrate outstanding generalization and extendibility of SDAU-Net.

Subtyping preserved ratio impaired spirometry (PRISm) by using quantitative HRCT imaging characteristics

BackgroundPreserved Ratio Impaired Spirometry (PRISm) is defined as FEV1/FVC ≥ 70% and FEV1 < 80%pred by pulmonary function test (PFT). It has highly prevalence and is associated with increased respiratory symptoms, systemic inflammation, and mortality. However, there are few radiological studies related to PRISm. The purpose of this study was to investigate the quantitative high-resolution computed tomography (HRCT) characteristics of PRISm and to evaluate the correlation between quantitative HRCT parameters and pulmonary function parameters, with the goal of establishing a nomogram model for predicting PRISm based on quantitative HRCT.MethodsA prospective and continuous study was performed in 488 respiratory outpatients from February 2020 to February 2021. All patients underwent both deep inspiratory and expiratory CT examinations, and received pulmonary function test (PFT) within 1 month. According to the exclusion criteria and Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification standard, 94 cases of normal pulmonary function, 51 cases of PRISm and 48 cases of mild to moderate chronic obstructive lung disease (COPD) were included in the study. The lung parenchyma, parametric response mapping (PRM), airway and vessel parameters were measured by automatic segmentation software (Aview). One-way analysis of variance (ANOVA) was used to compare the differences in clinical features, pulmonary function parameters and quantitative CT parameters. Spearman rank correlation analysis was used to evaluate the correlation between CT quantitative index and pulmonary function parameters. The predictors were obtained by binary logistics regression analysis respectively in normal and PRISm as well as PRISm and mild to moderate COPD, and the nomogram model was established.ResultsThere were significant differences in pulmonary function parameters among the three groups (P < 0.001). The differences in pulmonary parenchyma parameters such as emphysema index (EI), pixel indices-1 (PI-1) and PI-15 were mainly between mild to moderate COPD and the other two groups. The differences of airway parameters and pulmonary vascular parameters were mainly between normal and the other two groups, but were not found between PRISm and mild to moderate COPD. Especially there were significant differences in mean lung density (MLD) and the percent of normal in PRM (PRMNormal) among the three groups. Most of the pulmonary quantitative CT parameters had mild to moderate correlation with pulmonary function parameters. The predictors of the nomogram model using binary logistics regression analysis to distinguish normal from PRISm were smoking, MLD, the percent of functional small airways disease (fSAD) in PRM (PRMfSAD) and Lumen area. It had a good goodness of fit (χ2 = 0.31, P < 0.001) with the area under curve (AUC) value of 0.786. The predictor of distinguishing PRISm from mild to moderate COPD were PRMEmph (P < 0.001, AUC = 0.852).ConclusionsPRISm was significantly different from subjects with normal pulmonary function in small airway and vessel lesions, which was more inclined to mild to moderate COPD, but there was no increase in pulmonary parenchymal attenuation. The nomogram based on quantitative HRCT parameters has good predictive value and provide more objective evidence for the early screening of PRISm.

Drug-Coated Balloon-Only Angioplasty Outcomes in Diabetic and Nondiabetic Patients with De Novo Small Coronary Vessels Disease

Background: It is still difficult to use drug-eluting stents for the revascularization of small arteries. For patients with diabetes, treatment with a drug-covered balloon for de novo lesions in small coronary vessels are an appealing restoration option. The cause of this research ends up to evaluate the efficacy of DCB-simplest angioplasty for treating small-vessel sickness. Place of study and duration: Conducted at Cardiology department of Hayatabad Medical Complex Peshawar for the duration from Feb 2019 to Feb 2022. Methods: A fashionable of 1198 patients with small vascular illness treated with DCB-best approach were observed at Hayatabad Medical Complex Peshawar from Feb 2019 to Feb 2022. Patients were classified as each having diabetes or now not having diabetes. Clinical and angiographical follow-up were organise at 12 months. Target lesion failure and non-primary good sized damaging cardiac activities were used as primary outcomes. Results: Diabetic patients had a greater hazard of intention lesion failure (17.9% vs. 11.4%, P=0.006), and the charge of intention lesion revascularization (9.2% vs. 4.5%, P=0.014) emerge as moreover considerably unique many of the 2 companies even as analysed independently. Adjusting for exclusive factors did now not reduce the significance of diabetes mellitus as a predictor of every TLF (HR: 2.712, CI: 1.254-5.864, P=0.011) and intention lesion revascularization (HR: 3.698, CI: 1.112-12.298, P=0.033). However, there had been no vast versions amongst companies for MACE (19% vs. 2.7%, P=0.120) or for intention vessel myocardial infarction (0.6% vs. 0.1%, P=0.110). Conclusion: Reductions in TLF and MACE fees had been seen with drug-coated balloon treatment alone. At three hundred and sixty-five days after treatment with DCBs, diabetes is an independent predictor of intention lesion failure and intention lesion revascularization in small coronary arteries. Within a year, we observed no essential variations in MACE some of the corporations.

Chronic thromboembolic pulmonary hypertension: from pathogenesis to the choice of treatment tactics

Presents data on the pathogenesis of chronic thromboembolic pulmonary hypertension (CTEPH), which serve as a rationale for approaches to the choice of treatment. CTEPH usually begins with persistent obstruction of the large and/or medium pulmonary arteries by organized thrombi. Impaired lysis of thrombi may be associated with abnormal fibrinolysis, hematological or autoimmune diseases. The molecular processes underlying the lesions of small vessels are not fully understand. The degree of small-vessel disease has a significant impact on the severity of CTEPH and postoperative outcomes. The CTEPH treatment has evolved with the development of three directions pulmonary endarterectomy, balloon angioplasty of pulmonary arteries and the use of specific therapy used for pulmonary arterial hypertension. The paper demonstrates the possibilities of a multimodal approach in the treatment of this category of patients.

Association between retinal vessel density and neuroimaging features and cognitive impairment in cerebral small vessel disease

AimsThis study aimed to investigate the associations among retinal vessel density (RVD), neuroimaging features and cognitive impairment in patients with sporadic cerebral small vessel disease (CSVD). MethodsThis was a prospective observational study. A total of forty-nine patients with CSVD were recruited. The CSVD imaging burden was calculated by using a scoring system with a total score of 4 that assigns one point each for severe white matter hyperintensities (WMH), lacune, microbleeds (MBs), and basal-ganglia perivascular space (BG-PVS). Patients with a burden score ≥ 2 were classified as having a moderate/severe burden, and those with a score ≤ 1 were classified as the having a none/mild burden. The RVD in the superficial retinal capillary plexus (SRCP) and deep retinal capillary plexus (DRCP) was evaluated by using optical coherence tomography angiography (OCTA). The associations among the RVD values, CSVD imaging features, and cognitive impairment were evaluated. ResultsPatients with a moderate/severe CSVD burden showed lower RVD values in the para-fovea and peri-fovea areas of the left DRCP than patients with none/mild burden (para-fovea, β coefficient= −0.185 [−0.351~−0.015], P = 0.003; peri-fovea, β coefficient= −0.113 [−0.208~−0.018], P = 0.021). The RVD values in the para-fovea and peri-fovea areas of the left DRCP were significantly associated with the CSVD burden score after adjusting for age and vascular risk factors (P = 0.030 and P = 0.021, respectively) and with severe WMH (para-fovea, R = −0.398, P = 0.005; peri-fovea, R= −0.443, P = 0.001) and BG-PVS (para-fovea, R = −0.445, P = 0.001; peri-fovea, R= −0.396, P = 0.005). Neither para-fovea nor peri-fovea RVD values had a marked association with cognition. ConclusionThe RVD in the left DRCP may reflect the presence of cerebral small vessel lesions and might be a useful tool for predicting the neuroimaging-based burden of CSVD.

Clinical, Radiological and Pathological Characteristics Between Cerebral Small Vessel Disease and Multiple Sclerosis: A Review.

Cerebral small vessel disease (CSVD) and multiple sclerosis (MS) are a group of diseases associated with small vessel lesions, the former often resulting from the vascular lesion itself, while the latter originating from demyelinating which can damage the cerebral small veins. Clinically, CSVD and MS do not have specific signs and symptoms, and it is often difficult to distinguish between the two from the aspects of the pathology and imaging. Therefore, failure to correctly identify and diagnose the two diseases will delay early intervention, which in turn will affect the long-term functional activity for patients and even increase their burden of life. This review has summarized recent studies regarding their similarities and difference of the clinical manifestations, pathological features and imaging changes in CSVD and MS, which could provide a reliable basis for the diagnosis and differentiation of the two diseases in the future.

PB2008: CUTANEOUS HEMORRHAGIC SYNDROME IN PATIENTS WITH AL-AMYLOIDOSIS

Background: Hemorrhages on the skin and mucosa are seen in 30-40% of patients with systemic AL amyloidosis (AL-A). The pathogenesis and clinical significance of this syndrome are poorly understood. Aims: To analyze the relationship of cutaneous and mucous hemorrhagic syndrome in AL-A patients with the hemostatic system parameters and the leading clinical syndromes. Methods: A prospective study included 49 patients with newly diagnosed systemic AL-A. 18 (37%) patients were diagnosed with stage I, 16 (33%) with stage II, and 6 (12%) and 9 (18%) with stage III and stage IV, respectively (Mayo 2004/Europian). Activated partial thromboplastin time, thrombin time, fibrinogen concentration, XIIa-dependent fibrinolysis time, antithrombin III (ATIII), D-dimer, factors VIII (FVIII), X (FX) and Von Willebrand factor (VWF) activity were determined before therapy. Patients with cutaneous hemorrhagic syndrome were included in the Group №1, and those without cutaneous hemorrhages in the Group №2. Results: Cutaneous and mucosal hemorrhagic syndrome was observed in 23 (47%) patients. Hypercoagulable syndrome (increase of fibrinogen, D-dimer, FVIII, VWF, and decrease of ATIII) was registered in 18 (78%) patients, significantly more frequently than in Group №2 patients (11 patients - 42%; p=0,01). Eight (35%) patients with skin hemorrhages developed venous and arterial thrombosis before treatment, which were absent in the control group (p=0.002). Nephrotic syndrome was present in 19 (82%) group №1 patients, nephrotic syndrome was 2 times less frequent in group №2 (10 (38%) patients, p=0,001). Patients with hemorrhages had higher urinary protein loss (5.7 g/day vs 2.4 g/day; p=0.03) and lower serum albumin values (23 g/l vs 33 g/l; p=0.001). In patients from the first group, the development of hydropericardium, hydrothorax and anasarca was more often observed (p=0.02). We didn’t find significant correlation between cutaneous hemorrhagic syndrome and involvement of other organs, content of free light chains and cardiac markers. Summary/Conclusion: Cutaneous hemorrhagic syndrome is a clinical manifestation of hypercoagulable disorders in the hemostasis system in AL-A patients and associated with a high frequency of thrombosis development. Skin hemorrhages were more often associated with severe nephrotic syndrome, which may indicate a single pathogenetic mechanism in the form of small vessel lesions.

Brain CT requests from emergency department: Reality

ObjectivesTo evaluate the most common reasons for requesting brain CT studies from the emergency department and to calculate the prevalence of urgent acute pathology on this population group. Material and methodsWe reviewed brain CT studies requested from the emergency department during October and November 2018. We recorded the following variables: age, sex, reason for requesting the study, CT findings, use of contrast agents and reasons for using them, and, in patients who had undergone previous head CT studies, whether the findings had changed. SPSS was used for statistical analyses. ResultsA total of 507 urgent brain CT studies were done (41.4% in men, 58.6% in women; mean age, 65.4±20 years).The most common reason for requesting the study was head trauma (40.5%); only 15.6% of these studies showed acute posttraumatic intracranial lesions.The second most common reason was focal neurologic symptoms (16%); only 16% of these studies showed recent ischemic infarcts or acute bleeding.No pathological findings were reported in 43.2% of the studies.The most common abnormal finding was ischemic lesions in small vessels (20%).Space-occupying lesions (both benign and malignant) were found in 3.9% of all patients. ConclusionsMost brain CT studies requested from the emergency department showed no findings that would modify the management of the patient. Overuse of urgent brain CT increases the radiology department’s workload and exposes patients to radiation unnecessarily.

Brain structural alterations and clinical features of cognitive frailty in Japanese community-dwelling older adults: the Arao study (JPSC-AD)

Cognitive frailty (CF) is a clinical condition defined by the presence of both mild cognitive impairment (MCI) and physical frailty (PF). Elderly with CF are at greater risk of dementia than those with MCI or PF alone, but there are few known clinical or neuroimaging features to reliably distinguish CF from PF or MCI. We therefore conducted a population-based cross-sectional study of community elderly combining physical, cognitive, neuropsychiatric, and multisequence magnetic resonance imaging (MRI) evaluations. The MRI evaluation parameters included white matter (WM) lesion volumes, perivascular and deep subcortical WM lesion grades, lacunar infarct prevalence, microbleed number, and regional medial temporal lobe (MTL) volumes. Participants were divided into 4 groups according to the presence or absence of MCI and PF—(1) no MCI, PF (n = 27); (2) no PF, MCI (n = 119); (3) CF (MCI + PF) (n = 21), (4) normal controls (n = 716). Unique features of CF included shorter one-leg standing time; severe depressive symptoms; and MRI signs of significantly more WM lesions, lacunar infarcts, small-vessel disease lesions, microbleeds, and reduced MTL volumes. These unique deficits suggest that interventions for CF prevention and treatment should focus on motor skills, depressive symptoms, and vascular disease risk factor control.

Differential Association of Serum n-3 Polyunsaturated Fatty Acids with Various Cerebrovascular Lesions in Japanese Men

Background: An association between a high intake of marine-derived n-3 polyunsaturated fatty acids (n-3 PUFAs) with a lower risk of coronary heart disease was previously reported. However, the association between n-3 PUFAs and cerebrovascular lesions remains unclear. We evaluated this association in a general-population-based sample of Japanese men. Methods: Participants were community-dwelling men (40–79 years old) living in Kusatsu City, Shiga, Japan. Serum concentrations of n-3 PUFAs, defined as the sum of eicosapentaenoic and docosahexaenoic acids, were measured via gas-liquid chromatography between 2006 and 2008. Magnetic resonance imaging was used to assess cerebrovascular lesions (including intracerebral large-artery stenosis, lacunar infarction, and microbleeds) and white matter lesions between 2012 and 2015. Logistic regression adjusting for conventional cardiovascular risk factors was used to estimate the odds ratio of prevalent cerebrovascular lesions per 1 standard deviation higher serum concentration of n-3 PUFAs. Results: Of a total of 739 men, the numbers (crude prevalence in %) of prevalent cerebral large-artery stenoses, lacunar infarctions, microbleeds, and white matter lesions were 222 (30.0), 162 (21.9), 103 (13.9), and 164 (22.2), respectively. A 1 standard deviation higher concentration of n-3 PUFAs (30.5 μmol/L) was independently associated with lower odds of cerebral large-artery stenosis (multivariable-adjusted odds ratio, 0.80; 95% confidential interval, 0.67–0.97). There were no significant associations of n-3 PUFAs with the other types of lesions. Conclusions: n-3 PUFAs may have protective effects against large-artery stenosis, but not small vessel lesions, in the brain.

Detecting Small Vessel Pathology in Cocaine Use Disorder.

BackgroundCocaine use is associated with an increased risk of cerebrovascular accidents. Small vessel pathology has been linked to the risk of stroke in cocaine users, but can be challenging to detect on conventional magnetic resonance (MR) scans. Fluid-attenuated inversion recovery (FLAIR) scans permit better resolution of small vessel lesions.ObjectivesFLAIR scans are currently only acquired based on the subjective judgement of abnormalities on MR scans at face value. We sought to evaluate this practice and the added value of FLAIR scans for patients with cocaine use disorder (CUD), by comparing microbleeds detected by MR and FLAIR scans. We hypothesised that microbleeds are more pronounced in CUD patients, particularly so in participants who had been selected for a FLAIR scan by radiographers.MethodsSixty-four patients with CUD and 60 control participants underwent a brain scan. The MR of 20 CUD patients and 16 control participants showed indicators of cerebral infarction at face value and were followed up by a FLAIR scan. We determined the volume of microbleeds in both MR and FLAIR scans and examined associations with various risk factors.ResultsWhile MR lesion volumes were significantly increased in CUD patients, no significant differences in lesion volume were found in the subgroup of individuals who received a FLAIR.ConclusionThe current practice of subjectively evaluating MR scans as a basis for the follow-up FLAIR scans to detect vascular pathology may miss vulnerable individuals. Hence, FLAIR scans should be included as a routine part of research studies.