MRI Edema Research Articles

Abstract W MP85: MRI Demonstrates Sustained Effect of Early Surgery on Perihematomal Edema

Introduction: The clinical implications of perihematomal edema (PHE) on patients with spontaneous intracerebral hemorrhage (ICH) remains an important question. While several studies describe the natural history of this inflammatory response, progression of PHE in conjunction with ICH evacuation is less understood. We compare CT- the most widely accessible image modality in ICH- with MRI- previously described to be the gold standard for assessing PHE- both to validate the use of CT in PHE measurements and to understand the effect of hematoma evacuation upon PHE mitigation at Day 7. Methods: We analyzed 43 of 123 patients from MISTIE II (29 surgical, 14 medical). 80 patients were excluded due to missing MRIs at time points T1 (pre-randomization) or T2 (Day 7). MRI edema volume was calculated by manually tracing hyperintense regions on T2-weighted FLAIR sequences and then subtracting the ICH volume measured on the closest CT. CT edema volume was calculated using a semi-automated threshold based approach. A sample set of both MRIs and CTs were assessed by a second blinded reader to assess inter-observer reliability using Pearson correlation. Results: There was no significant difference between the two treatment cohorts in age, gender, or initial ICH size. The absolute difference in PHE for surgical patients was similar for both MRI, .92cc, and CT, -3.51cc, with a mean difference of 4.44 cc (p-value=.179). For medical patients , the difference between the two time points was MRI, 29.19 cc and CT, 28.74 cc, mean difference of 0.45 cc (p-value=.92). A similar trend exists between ICH removal and edema volume as in previously published work, the less blood removed the greater the amount of edema. Both modalities were robust measures of PHE with inter-reader reliability scores calculated for MRI, .99 (95% CI, .995-.999) and CT .97 (95% CI, .922-.994). Conclusion: This analysis of a multi-site, international patient population confirms the accuracy of using CT for quantification of PHE in comparison to the previously published gold standard of MRI. In addition, patients receiving minimally invasive surgery plus tissue plasminogen activator continue to show a significant difference in edema formation compared to patients receiving standard of care at the Day 7 time point.

Neurocysticercosis Presenting as Bipolar Disorder and Chronic Papilledema: A Rare Case Report and Review

A 40 year old female presented with mania, abnormal behaviour, headache & gradual progressive diminution of vision & history of pork consumption. Anterior segment examination OU was normal. Fundus of both eyes showed B/L established papilledema. Visual Acuity was 20/125 both eyes. CT & MRI with contrast revealed multiple well defined rounded CSF density cysts with a central mural nodule representing a scolex showing ring enhancement and perilesional edema. The largest lesion was 7.7×9 mm and multiple lesions were noted in both cerebral hemisphere and internal capsular regions, right cerebellar hemisphere and pons suggestive of disseminated neurocysticercosis. B-scan revealed disc edema and increased optic nerve diameter by more than 5 mm in both eyes confirming papilledema. She was prescribed albendazole, praziquantel, steroids, mannitol, acetazolamide and lithium. With this treatment her mania and headache resolved and her vision in both eyes improved to 20/40. Fundus examination after 3 months showed resolving papilledema. CT & MRI now showed marked decrease in number and regression in size of cyst and lesions. Bipolar disorder (mania & abnormal behavior) can be the first presenting sign of neurocysticercosis and papilledema. The probable explanation for maniac presentation in neurocystecercosis is due to some changes in neurotransmitter level. Papilledema was due to raised ICP suggested by perilesional edema in CT scan & MRI, and disc edema with increased optic nerve diameter in both eyes by more than 5 mm in B-scan.

Temporal Changes in MRI Edema and Resection Cavity Dynamics Subsequent to Implantation of Cesium-131 (Cs-131) Brachytherapy in Patients With Brain Metastases: A Volumetric Analysis From a Prospective Study

Temporal Changes in MRI Edema and Resection Cavity Dynamics Subsequent to Implantation of Cesium-131 (Cs-131) Brachytherapy in Patients With Brain Metastases: A Volumetric Analysis From a Prospective Study

FRI0067 Prognostic factors for rapid radiographic progression are different between tnf and non-tnf inhibitor

BackgroundThe cause of the Rapid Radiographic Progression (RRP) is still unclear, and RRP is resistant to any biological treatment. Many prognostic factors including clinical and serologic marker, ultrasound and MRI...

SAT0397 High bone turnover assessed by 18F-fluoride PET/CT in the spine of patients with ankylosing spondylitis: No redundancy to inflammatory lesions detected by whole body MRI

BackgroundThe current paradigm of radiographic progression in ankylosing spondylitis involves resolution of an inflammatory lesion and its replacement by fat tissue followed by cartilage metaplasia and endochondral ossification. However, syndesmophytes...

SAT0025 The Association Serum Interleukin 17 and Interleukin 23 Levels with Clinical and Radiological Parameters in Rheumatoid Arthritis Patients

BackgroundRheumatoid arthritis (RA) is a chronic, inflammatory disease which causes symmetrical destructive changes in diartrodial synovial joints (1). Cytokines play an important role in RA pathogenesis. Th 17 cells are...

High bone turnover assessed by 18F-fluoride PET/CT in the spine and sacroiliac joints of patients with ankylosing spondylitis: comparison with inflammatory lesions detected by whole body MRI

BackgroundThis study compares the frequency and distribution of increased activity on 18 F-fluoride PET/CT with the presence of bone marrow edema on whole-body MR imaging in the spine and sacroiliac joints (SIJ) of patients with active ankylosing spondylitis (AS).MethodsTen patients (6 men and 4 women), between 30 and 58 years old (median 44) with active AS, were prospectively examined with both whole-body MRI and 18 F-fluoride PET/CT. Patients fulfilled modified NY criteria and had a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 4. Increased radiotracer uptake in PET/CT and bone marrow edema in whole-body MRI of spine and SIJ was evaluated independently by two blinded observers for each modality. Kappa statistics were used to compare interobserver agreement as well as scores of consensus reading of the two imaging modalities.ResultsAnalysis of interobserver agreement for PET/CT yielded a kappa value of 0.68 for spinal lesions and of 0.88 for SIJ lesions. The corresponding kappa values for the MRI modality were 0.64 and 0.93, respectively. More spinal lesions were detected by MRI in comparison to PET/CT (68 vs. 38), whereas a similar number of SIJ quadrants scored positive in both modalities (19 vs. 17). Analysis of agreement of lesion detection between both imaging modalities yielded a kappa value of only 0.25 for spinal lesions and of 0.64 for SIJ lesions.ConclusionIncreased 18 F-fluoride uptake in PET/CT is only modestly associated with bone marrow edema on MRI in the spine and SIJ of patients with AS, suggesting different aspects of bone involvement in AS.

Spontaneous spinal epidural hematoma: analysis of 23 cases

Background Spontaneous spinal epidural hematoma is a rare but disabling disease. To explore its characters and find out what factors influence the prognosis, we gave a retrospective analysis of 23 patients in our department in the past 8 years. Methods Spontaneous spinal epidural hematoma was diagnosed by taking MRIs of patients without surgical management or by histopathological examination. We registered patient's case history, laboratory examination, radiological image, treatment, pathological result, and prognosis after 3 months and gave them nonparameter analysis. Results Primary neurological status and progressive intervals have correlation with prognosis ( P < .01), and the latter less than 12 hours predict worse prognosis ( P = .032). Spinal edema in MRI predicts pessimistic prognosis ( P = .013). Long hematoma predicts worse prognosis ( P = .02). Preoperative interval, emphasized by other authors, has no statistical correlation with prognosis in this study ( P = .832). Finally, patients with a single hematoma or hematoma mingled with other spinal disturbance have the same prognosis ( P = .065). Conclusions The primary neurological status, progressive interval, spinal edema, and size of hematoma will influence the prognosis of the patient with SSEH. The major treatment is surgical intervention, and it should be operated as soon as possible to avoid the aggravation of neurological status. Conservative treatment is not considered unless patient's neurological deficiency has relieved in the early period.

Analysis of Peritumoral Edema in MRI of Meningioma

Analysis of Peritumoral Edema in MRI of Meningioma

Application of contrast agents in CT and MRI (NMR): their potential in imaging of brain tumors.

21 patients with clinical and CT diagnoses of intracranial tumor were studied by MRI (NMR) prior to and after administration of intravenous Gadolinium-DTPA. Resultant MRI images were compared with corresponding CT sections with respect to lesion detection, contrast enhancement, tumor delineation and visualization of perifocal edema. All intracranial lesions shown on CT were identified on MRI. Contrast enhancement in MRI images was achieved in 19 out of 21 patients, as it was also with CT. In these cases improved differentiation between tumor, perifocal edema and adjacent brain structures were obtained. In most cases sufficient visualization of perifocal edema in MRI required T2 weighted images (SE 1600/70) in addition to spin echo scans routinely performed prior to and after contrast medium (SE 400/30 or 800/30). No side effects were encountered following administration of Gadolinium-DTPA. The good tolerance and the efficacy justifies the use of Gadolinium-DTPA for contrast enhanced MRI imaging.