Cerebral venous collagenosis played a role in the pathogenesis of white matter hyperintensities (WMHs) through venous ischemia. Since pathological changes of veins from intramural stenosis to luminal occlusion is a dynamic process, we aimed to create a deep medullary veins (DMVs) visual grade on susceptibility-weighted images (SWI) and explore the relationship of DMVs and WMHs based on venous drainage regions. We reviewed clinical, laboratory and imaging data from 268 consecutive WMHs patients and 20 controls. SWI images were used to observe characteristics of DMVs and a brain region-based DMVs visual score was given by two experienced neuroradiologists. Fluid attenuated inversion recovery (FLAIR) images were used to calculate WMHs volume. Logistic-regression analysis and partial Pearson's correlation analysis were used to examine the association between the DMVs score and WMHs volume. We found that the DMVs score was significantly higher in WMHs patients than in controls (p < 0.001). Increased DMVs score was independently associated with higher WMHs volume after adjusting for total cholesterol level and number of lacunes (p < 0.001). Particularly, DMVs scores were correlated with regional PVHs volumes in the same brain region most. The newly proposed DMVs grading method allows the clinician to monitor the course of DMVs disruption. Our findings of cerebral venous insufficiency in WMHs patients may help to elucidate the pathogenic mechanisms and progression of WMHs.

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Abstract. The present study aimed to investigate the value of magnetic resonance imaging (MRI) in the diagnosis of giant cell tumor of the tendon sheath (GCTTS), including localized (L-) and diffuse (D-) types. A total of 38 patients with GCTTS, including 31 with L-GCTTS and 7 with D-GCTTS, diagnosed by surgery and pathology, were retrospectively analyzed. All patients underwent MRI examination. Of the 31 patients with L-GCTTS, the tumors were located in the hand and wrist (18 patients), the ankle and foot (10 cases), the knee joint (2 cases) and the temporomandibular joint (1 case). All 31 lesions were either located in relation to a tendon or were partially/completely enveloping it and all were well marginated. With respect to the 7 D-GCTTS patients, the tumors were located in the ankle and foot (6 cases) or the hand and wrist (1 cases). All 7 lesions presented as an aggressive soft tissue mass infiltrating the tendon sheath and adipose tissue around the joint. The characteristic internal signal of GCTTS, including L-GCTTS and D-GCTTS, was demonstrated by MRI examination. MRI is currently the optimal modality for preoperative assessment of tumor size, extent and invasion of adjacent joint and tenosynovial space.

Stroke recovery with changes in volume and perfusion of grey matter (GM) tissues remains largely unknown. We hypothesized that GM atrophy co-existed with GM plasticity presenting with increased volume and perfusion in specific regions in the period of post-stroke recovery. Twelve well-recovered stroke patients with pure subcortical lesions in the middle cerebral artery-perfused zone were included. All of them underwent structural and perfusion magnetic resonance imaging (MRI) examinations at admission and a mean of 6 months after stroke onset. Differences in GM volume (GMV) on structural images and cerebral blood flow (CBF) derived from perfusion images between two examinations were compared using voxel-based morphometry. The associations between changes in GMV and CBF with clinical scores were analysed. Decreased GMV was found in post-central gyrus, pre-central gyrus, precuneus, angular gyrus, insula, thalamus and cerebellum, and increased GMV was found in hippocampus, orbital gyrus and lingual gyrus (all corrected P < 0.05) at the follow-up examination. Increased CBF was found in subcallosal cingulate gyrus, hippocampus and lingual gyrus (all corrected P < 0.05) at the follow-up examination. Only decreased GMV in the anterior lobe of cerebellum was negatively associated with improvement of Barthel index (β = -0.683, P = 0.014). Our study provides the imaging evidence of GM atrophy co-existing with GM plasticity involving in increased volume and perfusion in specific regions (including cognition, vision and emotion) in well-recovered stroke patients, which advances our understanding of neurobiology of stroke recovery.

White matter hyperintensities (WMHs) are associated with cognitive decline, but less is known about pathophysiology of cognitive decline in patients with WMHs. We investigated microvasculature and microstructure in WMHs using intravoxel incoherent motion (IVIM) and their associations with cognitive function. Thirty-two subjects with WMHs were enrolled in our study. Fast diffusion coefficient (D*), perfusion fraction (f) and slow diffusion coefficient (D) from IVIM model were compared between regions of WMHs (periventricular WMHs, PWMHs and deep WMHs, DWMHs) and surrounding normal white matter. Multivariate linear model was used to determine the independent factors associated with cognitive function assessed by the Mini Mental State Examination (MMSE) and the standardized coefficient (β) of factors was estimated. D* was significantly lower (4.95 × 10 mm/s versus 8.36 × 10 mm/s in PWMHs and 5.04 × 10 mm/s versus 8.67 × 10 mm/s in DWMHs, both P < 0.001), and f (14.64 % versus 12.01 % in PWMHs and 14.26 % versus 11.31 % in DWMHs, both P < 0.001) and D (1.02 × 10 mm/s versus 0.73 × 10 mm/s in PWMHs and 0.86 × 10 mm/s versus 0.70 × 10 mm/s in DWMHs, both P < 0.001) were significantly higher in WMHs. Only f in PWMHs was independently associated with MMSE (β = 0.443, P = 0.016). The decreased D* and increased D in WMHs were similar to previous findings. The increased f in PWMHs relating with better cognition provides the pathophysiological basis in understanding cognitive decline in patients with WMHs.