In vitro investigation of poor cerebrospinal fluid suppression on fluid‐attenuated inversion recovery images in the presence of a gadolinium‐based contrast agent

Bonzano, Laura; Roccatagliata, Luca; Levréro, Florence; Mancardi, Gianluigi; Sardanelli, Francesco

doi:10.1002/mrm.21619

Cited by 9 publications

(13 citation statements)

References 7 publications

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“…4). Kastenbauer established a rat model of pneumococcal meningitis and found cochlear inflammation accompanied by severe blood-labyrinth barrier (BLB) disruption [16]. The patient's case history and imaging support the possibility that high-intensity signals on 3D-FLAIR MRI reflect minor hemorrhages or an increased concentration of protein in the inner ear, which has passed through blood vessels with increased permeability and gadolinium enhancement in one ear suggesting the breakdown of the blood-labyrinth barrier (Fig.…”

Section: Discussionmentioning

confidence: 92%

A comparison of inner ear imaging features at different time points of sudden sensorineural hearing loss with three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging

Zhu

et al. 2014

Eur Arch Otorhinolaryngol

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It has been reported that about half of patients with sudden sensorineural hearing loss (SSNHL) show high signals in the affected inner ear on three-dimensional, fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI). These signals may reflect minor hemorrhage or an increased concentration of protein in the inner ear, which has passed through blood vessels with increased permeability. Our objective was to compare the positive ratio of the high signal in affected inner ears at different time points to determine the suitable imaging time point for 3D-FLAIR MRI in SSNHL. 3D-FLAIR MRI images were taken at three times, precontrast and approximately 10 min and 4 h after intravenous injection of a single dose of gadodiamide (Gd) (0.1 mmol/kg), in 46 patients with SNHL. We compared the positive findings of the high signals in the inner ear of patients with SNHL as well as the signal intensity ratio (SIR) between the affected cochleae and unaffected cochleae at three time points. The positive ratios of the high signals in the affected inner ear at the time points of precontrast and 10 min and 4 h after the intravenous Gd injection were 26.1, 32.6, and 41.3%, respectively. The high signal intensity ratios of affected inner ears at the three time points were 1.28, 1.31, and 1.48, respectively. The difference between the positive ratios precontrast and at 10 min after the intravenous Gd injection was statistically significant (P = 0.006); the differences between the positive ratios at 4 h after the intravenous Gd injection and precontrast and between the ratios at 4 h and 10 min after the intravenous Gd injection were not statistically significant. The time effects of the median value of SIR were not significant (P = 0.064). We do not recommend 4 h after intravenous Gd injection as a time point to image the inner ear in SNHL. We believe that imaging precontrast and at 10 min after the intravenous Gd injection are suitable time points.

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Section: Discussionmentioning

confidence: 92%

A comparison of inner ear imaging features at different time points of sudden sensorineural hearing loss with three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging

Zhu

et al. 2014

Eur Arch Otorhinolaryngol

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“…These properties explain the lack of leptomeningeal enhancement seen on gadolinium-enhanced T1 MRI in MS. 10 Extravasation of very low concentrations of gadolinium into the CSF, however, shortens T1 relaxation times and results in reduced fluid signal suppression on FLAIR. 33 This results in a nearly 10-fold increase in the sensitivity of FLAIR over T1-weighted MRI for gadolinium in CSF. 34 Furthermore, the T2-weighting of FLAIR suppresses signal from high flow structures, removing cortical/meningeal vessels from view and ensuring that any visualized gadolinium must be outside of a vessel.…”

Section: Discussionmentioning

confidence: 99%

Leptomeningeal Enhancement at 7T in Multiple Sclerosis: Frequency, Morphology, and Relationship to Cortical Volume

Harrison

Wang

Fiol

et al. 2017

Journal of Neuroimaging

126

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Background and Purpose Perform an investigation of the frequency and distribution of leptomeningeal enhancement on post-gadolinium magnetization-prepared FLAIR (MPFLAIR) in multiple sclerosis (MS) on 7 Tesla (7T) MRI and to relate this finding to measures of brain structure and lesion volumes. Methods Twenty-nine participants with MS underwent 7T MRI of the brain. Three healthy volunteers (HV) were scanned for comparison. Areas of post-contrast leptomeningeal enhancement were identified. Images were segmented for brain structure and lesion volumes. The relationship between leptomeningeal enhancement and clinical and volumetric data was explored. Results Two patterns of enhancement were found: “nodular” (discrete, spherical nodules at the pial surface or subarachnoid space) and “spread/fill” (appearance of contrast spread through the subarachnoid space). Twenty-six of 29 (90%) MS participants had at least one focus of leptomeningeal enhancement. Nodular foci were present in 15/29 (51%) MS participants. Spread/fill foci were present in 22/29 (76%) MS participants. Two HVs had examples of nodular foci, but none had spread/fill enhancement. MS participants with spread/fill foci were older (48.9 years (SD 8.3)) than those without (33.3 years (SD 11.5), p = 0.005). MS participants with spread/fill foci had reduced cortical gray matter volume compared to those without (p = 0.020). Conclusions Leptomeningeal enhancement on post-contrast 7T MPFLAIR is more prevalent than prior reports at 3T – occurring at frequencies closer to histopathologic data. Spread/fill foci are associated with reduced cortical GM volumes and may represent blood-meningeal barrier breakdown near sites of meningeal inflammation, whereas nodular foci may be a normal variant.

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“…10, 11 HARM has been observed in 33% of ischemic stroke patients imaged at 24 hours post injury and is significantly associated with reperfusion, HT, and poor clinical outcome 1, 2. Treatment with thrombolytic agents significantly increases the prevalence of HARM in this population 12…”

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confidence: 99%

Blood–Brain Barrier Disruption in Humans Is Independently Associated With Increased Matrix Metalloproteinase-9

Barr

Latour

Lee

et al. 2010

Stroke

183

151

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Background and Purpose-Matrix metalloproteinases (MMP) may play a role in blood-brain barrier (BBB) disruption after ischemic stroke. We hypothesized that plasma concentrations of MMP-9 are associated with a marker of BBB disruption in patients evaluated for acute stroke. Methods-Patients underwent MRI on presentation and Ϸ24 hours later. The MRI marker, termed hyperintense acute reperfusion injury marker (HARM), is gadolinium enhancement of cerebrospinal fluid on fluid-attenuated inversion recovery MRI. Plasma MMP-9 and tissue inhibitor of matrix metalloproteinase-1 were measured by enzyme-linked immunosorbent assay. Logistic regression models tested for predictors of HARM on 24-hour follow-up scans separately for MMP-9 and the ratio of MMP-9 to TIMP-1. Results-For the 41 patients enrolled, diagnoses were: acute ischemic cerebrovascular syndrome, 33 (80.6%); intracerebral hemorrhage, 6 (14.6%); stroke mimic, 1 (2.4%); and no stroke, 1 (2.4%). HARM was present in 17 (41.5%) patients. In model 1, HARM was associated with baseline plasma MMP-9 concentration (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.001-1.019; Pϭ0.033). In model 2, HARM was associated with the ratio of MMP-9 to tissue inhibitor of matrix metalloproteinase-1 (OR, 4.94; 95% CI, 1.27-19.14; Pϭ0.021). Conclusions-Baseline MMP-9 was a significant predictor of HARM at 24-hour follow-up, supporting the hypothesis that MMP-9 is associated with BBB disruption. If the association between MMP-9 and BBB disruption is confirmed in future studies, HARM may be a useful imaging marker to evaluate MMP-9 inhibition in ischemic stroke and other populations with BBB disruption. (Stroke. 2010;41:e123-e128.)

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In vitro investigation of poor cerebrospinal fluid suppression on fluid‐attenuated inversion recovery images in the presence of a gadolinium‐based contrast agent

Cited by 9 publications

References 7 publications

A comparison of inner ear imaging features at different time points of sudden sensorineural hearing loss with three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging

A comparison of inner ear imaging features at different time points of sudden sensorineural hearing loss with three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging

Leptomeningeal Enhancement at 7T in Multiple Sclerosis: Frequency, Morphology, and Relationship to Cortical Volume

Blood–Brain Barrier Disruption in Humans Is Independently Associated With Increased Matrix Metalloproteinase-9

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