New techniques in cerebral imaging

Perez-Arjona, Eimir; DelProposto, Zachary; Sehgal, Vivek; Fessler, Richard D.

doi:10.1179/016164102101199990

Cited by 19 publications

(12 citation statements)

References 16 publications

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“…As an improvement to the technique described by Ecker and colleagues in 1951 [32], DSA allows for high quality angiographic images via the digital subtraction of extraneous artifact [33]. In its use as a diagnostic tool, mild vasospasm is defined by less than 25% reduction in vessel patency.…”

Section: Clinical Diagnosis Of Cvsmentioning

confidence: 99%

Inflammation, Cerebral Vasospasm, and Evolving Theories of Delayed Cerebral Ischemia

Carr

Zuckerman

Mocco

2013

Neurology Research International

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Cerebral vasospasm (CVS) is a potentially lethal complication of aneurysmal subarachnoid hemorrhage (aSAH). Recently, the symptomatic presentation of CVS has been termed delayed cerebral ischemia (DCI), occurring as early as 3-4 days after the sentinel bleed. For the past 5-6 decades, scientific research has promulgated the theory that cerebral vasospasm plays a primary role in the pathology of DCI and subsequently delayed ischemic neurological decline (DIND). Approximately 70% of patients develop CVS after aSAH with 50% long-term morbidity rates. The exact etiology of CVS is unknown; however, a well-described theory involves an antecedent inflammatory cascade with alterations of intracellular calcium dynamics and nitric oxide fluxes, though the intricacies of this inflammatory theory are currently unknown. Consequently, there have been few advances in the clinical treatment of this patient cohort, and morbidity remains high. Identification of intermediaries in the inflammatory cascade can provide insight into newer clinical interventions in the prevention and management of cerebral vasospasm and will hopefully prevent neurological decline. In this review, we discuss current theories implicating the inflammatory cascade in the development of CVS and potential treatment targets.

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Section: Clinical Diagnosis Of Cvsmentioning

confidence: 99%

Inflammation, Cerebral Vasospasm, and Evolving Theories of Delayed Cerebral Ischemia

Carr

Zuckerman

Mocco

2013

Neurology Research International

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“…The technique was designed to improve previous angiographic methods and generate high contrast, high resolution, low artifact images using digital subtraction [24] (Figure 3). DSA is a fluoroscopic examination.…”

Section: Digital Subtraction Angiography (Dsa)mentioning

confidence: 99%

“…Moreover, DSA utilizes iodinated contrast agents and radiation. Studies must be performed judiciously in patients with known iodinated contrast allergies or renal insufficiency [24]. Finally, angiography provides no information about tissue perfusion or ischemia [16].…”

Section: Digital Subtraction Angiography (Dsa)mentioning

confidence: 99%

Advanced Imaging Modalities in the Detection of Cerebral Vasospasm

Mills

Mehta²,

Russin³

et al. 2013

Neurology Research International

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The pathophysiology of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is complex and is not entirely understood. Mechanistic insights have been gained through advances in the capabilities of diagnostic imaging. Core techniques have focused on the assessment of vessel caliber, tissue metabolism, and/or regional perfusion parameters. Advances in imaging have provided clinicians with a multifaceted approach to assist in the detection of cerebral vasospasm and the diagnosis of delayed ischemic neurologic deficits (DIND). However, a single test or algorithm with broad efficacy remains elusive. This paper examines both anatomical and physiological imaging modalities applicable to post-SAH vasospasm and offers a historical background. We consider cerebral blood flow velocities measured by Transcranial Doppler Ultrasonography (TCD). Structural imaging techniques, including catheter-based Digital Subtraction Angiography (DSA), CT Angiography (CTA), and MR Angiography (MRA), are reviewed. We examine physiologic assessment by PET, HMPAO SPECT, 133Xe Clearance, Xenon-Enhanced CT (Xe/CT), Perfusion CT (PCT), and Diffusion-Weighted/MR Perfusion Imaging. Comparative advantages and limitations are discussed.

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“…DSA was less invasive, safe, and convenient. In recent years, DSA has played a vital role in the diagnosis and treatment of cardio-cerebral vascular diseases as well as cancer and peripheral vascular diseases [5,6] .…”

Section: Introductionmentioning

confidence: 99%