London, United Kingdom 2013 1 Brain imaging A 14:30 - 14:40 Improved detectability of ischemic brainstem lesions by sagittal DWI acquisition M.H. Schoenfeld1, R. Ritzel2, J. Sedlacik3, B. Cheng4, G. Thomalla5, J. Fiehler6 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GERMANY1,Department of Diagnostic and Intervention-al Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GERMANY2, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GERMANY3, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, GERMANY4, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, GERMANY5, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, GERMANY6 Background: Most false negative findings in the use of diffusion-weighted imaging (DWI) in the detection of ischemic stroke are in patients with minor or resolving deficits clinically local-ized to the brainstem. Our goal was to compare conventional echoplanar imaging (EPI) DWI in axial plane with sagittal plane at 1.5 T for the detection of ischemic brainstem lesions. Methods: Data from patients with symptoms clinically located in the brainstem that underwent DWI both in the axial and sagittal plane was collected. Patients with the later diagnosis of a transient ischemic attack, an inflammation or a tumor of the brainstem were excluded from analysis. Axial and sagittal DWI was separately evaluated by two observers blinded for the clinical diagnosis of an ischemic stroke of the brainstem regarding (a) the presence and (b) size of DWI-lesions. Disagreement was settled in consensus. Results: 134 patients were included of which 73 patients were eligible for evaluation. 27 pa-tients did not have any pathology located in the brainstem. 46 patients were diagnosed with brainstem ischemia. Inter-observer agreement was excellent for both the evaluation of the ax-ial planes (kappa=0.83) and the sagittal planes (kappa=0.97). After consensus was reached, in 28/46 patients (60.9%) brainstem lesions were detected in axial and in sagittal planes whereas in 5 patients (10.9%) brainstem lesions were exclusively detected using the sagittal plane. All lesions undetectable in the axial plane were smaller than 5 mm in craniocaudal direction. The craniocaudal extend of the 24 lesions detected by axial DWI was evaluated by sagittal DWI and found to be <5 mm in 13 cases and >5 mm in 15 cases. The Net Reclassification Improvement for the sagittal planes compared with the axial planes was 14.6%. Conclusion: Small lesions in the brainstem can be missed in EPI-DWI. Sagittal DWI compared to axial DWI improves the detection rate of ischemic brainstem lesions with little additional ex-penditure Cerebrovasc Dis 2013; 35 (suppl 3)1-854 43 of time. 9 Small vessel stroke and white matter disease 15:50 - 16:00 Diffusion tensor imaging and cognitive decline. The RUNDMC Study. I.W.M. van Uden1, H.M. van der Holst2, A.M. Tuladhar3, M.P. Zwiers4, K.F. de Laat5, A.G.W. van Norden6, E.J. van Dijk7, FE de Leeuw8 Radboud University Nijmegen Medical Centre, department of neurology, Nijmegen, THE NETHERLANDS1,Radboud University Nijmegen Medical Centre, department of neurology, Nijmegen, THE NETHERLANDS2, Radboud University Nijmegen Medical Centre, department of neurology, Nijmegen, THE NETHERLANDS3, Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, THE NETHERLANDS4, HagaZiekenhuis, Department of Neurology, ‘s-Gravenhage, THE NETHERLANDS5, Amphia Ziekenhuis, Department of Neurology, Breda, THE NETHER-LANDS6, Radboud University Nijmegen Medical Centre, department of neurology, Nijmegen, THE NETHERLANDS7, Radboud University Nijmegen Medical Centre, department of neurol-ogy, Nijmegen, THE NETHERLANDS8 Background: Cerebral small vessel disease (SVD) is related to cognitive decline, although it does not affect every patient. Presumably, other factors, apart from SVD, play a role, such as the microstructural integrity of the normal appearing white matter (NAWM) that can be as-sessed with diffusion tensor imaging (DTI). Our objective is to investigate the relation between microstructural integrity and cognitive decline prospectively. Methods: The RUN DMC study is a prospective cohort study among 503 elderly with cerebral SVD with baseline assessment in 2006. Follow-up has been performed in 2012 with 398 indi-viduals that underwent repeated cognitive and MRI investigation. 49 Subjects had died, where-as 54 allowed for the assessment of clinical endpoints, but were not able to visit our research center during the follow up. 2 Persons were lost to follow-up. Mean follow-up time was 5.2 years. MMSE and executive function (assessed with verbal fluency) was evaluated at baseline and at follow up. DTI parameters were measured in areas of SVD and in NAWM. Linear regres-sion analysis was used to assess the relation between DTI-parameters and SVD at baseline and changes in MMSE and executive performance, with adjustments for age, gender, WML, lacunar and territorial infarcts, education and normalized total brain volume. Results: Mean age at follow up was 69.8 years (SD 8.6), and 57.2% was male. Participants with a low baseline microstructural integrity in both the NAWM and WML experienced a steeper de-cline in executive function ((beta-0.161, p=0.042) for MD in NAWM and (beta-0.168, p=0.022) for MD in WML). We also found a relation between volume of baseline SVD and MMSE after 5 year follow up (beta-0.127, p=0.012), but not with DTI parameters. Conclusion: This is the first prospective study to show that microstructural integrity of the NAWM and WML is related to cognitive decline. DTI may be useful in the identification of in-dividuals at risk for cognitive decline. 14:30-16:00 Oral Session Room 2,3,4 Brain imaging A Chairs: F. Fazekas, Austria and K. Szabo, Germany
Karger_ESC London_2013
To see the actual publication please follow the link above