Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Arterial recanalization to restore the blood supply and limit the brain damage is the primary goal in the management of acute ischemic stroke (AIS). Since the publication of pivotal randomized clinical trials in 2015, endovascular thrombectomy has become part of the standard of care in selected cases of AIS from large-vessel occlusions up to 6 hours after the onset of symptoms. However, the association between endovascular reperfusion and improved functional outcome is not strictly time dependent. ⋯ This information is invaluable in identifying patients who are likely to benefit from reperfusion therapies and excluding those who are unlikely to benefit or are at risk of adverse effects. The approach to reperfusion therapies continues to evolve, and imaging is acquiring a greater role in the diagnostic work-up and treatment decisions as shown in recent clinical trials with extended time window. The 2018 American Heart Association/American Stroke Association guidelines reflect a paradigm shift in the management of AIS from "Time is Brain" to "Imaging is Brain." This review discusses the essential role of multimodal imaging developing from recent trials on therapy for AIS.
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Neurological and neurodegenerative diseases can affect the spinal cord (SC) of pediatric patients. Magnetic resonance imaging (MRI) allows for in vivo quantification of SC atrophy via cross-sectional area (CSA). The study of CSA values in the general population is important to disentangle disease-related changes from intersubject variability. This study aimed at providing normative values for cervical CSA in children, extending our previous work performed with adults. ⋯ We present CSA normative values in a large cohort of children, reporting on sources of intersubject variability and how to reduce them applying normalization methods previously developed.
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Differences in the microstructure of fronto-parietal white matter tracts have been associated with mathematical achievement. However, much of the supporting evidence relies on nonspecific diffusion-weighted magnetic resonance imaging, making it difficult to isolate the role of myelin in math ability. ⋯ Our results suggest that in typically developing youth, brain myelination contributes to individual differences in basic math achievement. In contrast, youth with learning challenges appear to have less capacity to leverage myelin to improve math achievement.
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The clinical differentiation of Parkinson's disease (PD) from other extrapyramidal syndromes has made a challenge in neurology. This study aimed to compare the specificity and sensitivity of brain MRI volumetry and dopamine transporter scans in differentiating PD from other extrapyramidal syndromes in the early stages of the disease. ⋯ 99m Tc-TRODAT has a higher accuracy in differentiation of early PD from non-Parkinsonian conditions, particularly essential tremor. Olfactory bulbs volumetry by using MRI can also serve as a potential alternative method in this regard.
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Acute stroke patients may have undiagnosed coronavirus disease 2019 (COVID-19) infection, transmissible to medical professionals involved in their care. Our aim was to determine the value of incorporating a chest computed tomography (CT) scan during acute stroke imaging, and the factors that influence this decision. ⋯ We identified a measurable benefit of incorporating a chest CT into the urgent imaging protocol of acute stroke patients in reducing exposure of medical professionals without appropriate precautions. The clinical impact of this benefit, however, may not be materially significant.