OBJECTIVE: Phase-contrast MRI allows detailed measurements of various parameters of CSF motion. This examination is technically demanding and machine dependent. The literature on this topic is ambiguous. Machine learning (ML) approaches have already been successfully utilized in medical research, but none have yet been applied to enhance the results of CSF flowmetry. The aim of this study was to evaluate the possible contribution of ML algorithms in enhancing the utilization and results of MRI flowmetry in idiopathic normal pressure hydrocephalus (iNPH) diagnostics. METHODS: The study cohort consisted of 30 iNPH patients and 15 healthy controls examined on one MRI machine. All major phase-contrast parameters were inspected: peak positive, peak negative, and average velocities; peak amplitude; positive, negative, and average flow rates; and aqueductal area. The authors applied ML algorithms to 85 complex features calculated from a phase-contrast study. RESULTS: The most distinctive parameters with p < 0.005 were the peak negative velocity, peak amplitude, and negative flow. From the ML algorithms, the Adaptive Boosting classifier showed the highest specificity and best discrimination potential overall, with 80.4% ± 2.9% accuracy, 72.0% ± 5.6% sensitivity, 84.7% ± 3.8% specificity, and 0.812 ± 0.047 area under the receiver operating characteristic curve (AUC). The highest sensitivity was 85.7% ± 5.6%, reached by the Gaussian Naive Bayes model, and the best AUC was 0.854 ± 0.028 by the Extra Trees classifier. CONCLUSIONS: Feature extraction algorithms combined with ML approaches simplify the utilization of phase-contrast MRI. The highest-performing ML algorithm was Adaptive Boosting, which showed good calibration and discrimination on the testing data, with 80.4% accuracy, 72.0% sensitivity, 84.7% specificity, and 0.812 AUC. Phase-contrast MRI boosted by the ML approach can help to determine shunt-responsive iNPH patients.

• MeSH
• aquaeductus cerebri MeSH
• Bayesova věta MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• normotenzní hydrocefalus * diagnostické zobrazování   MeSH
• strojové učení MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

Primary endpoint of this single-centre, prospective consecutive cohort study was to evaluate DESH score, CA, CSS and Evans index of suspected iNPH patients against the reference standard of lumbar infusion test (LIT) and external lumbar drainage (ELD) in prediction of gait response after VP shunt implantation in patients with idiopathic normal pressure hydrocephalus (iNPH). Patients were assigned to NPH and non-NPH groups based on LIT and ELD results. Age-matched controls were added for group comparison. 32 NPH, 46 non-NPH and 15 control subjects were enrolled in the study. There were significant differences in mean preoperative DESH scores of NPH, non-NPH and control groups (6.3 ± 2.3 ([±SD]) (range 2-10) vs 4.5 ± 2.4 (range 0-10) vs 1.0 ± 1.2 (range 0-4)). Differences in mean CA and Evans index were not significant between NPH and non-NPH groups. CSS showed 62.5% sensitivity, 60.87% specificity, 52.63% PPV and 70% NPV for differentiation of NPH and non-NPH groups. A CA of 68 degrees had 48.49% sensitivity, 76.09% specificity, 59.26% PPV 67.31% NPV and DESH score of 4 had 93.75% sensitivity, 41.30% specificity, 52.63% PPV and 90.48% NPV for differentiation between NPH and non-NPH groups. The groups of probable iNPH patients with gait impairment diagnosed by high DESH score or positive functional testing did not overlap and DESH score did not correlate with gait improvement after ELD. DESH score should not be used as a simple diagnostic or prognostic marker of iNPH and we could not confirm the benefit of measurement of callosal angle and cingulate sulcus sign.

• MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• neurologické poruchy chůze etiologie   chirurgie   MeSH
• neurozobrazování metody   MeSH
• normotenzní hydrocefalus diagnostické zobrazování   patologie   chirurgie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• ventrikuloperitoneální zkrat metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: To evaluate cerebral hemodynamic, metabolic and anatomic changes occurring in patients with unilateral occlusion of the internal carotid artery (ICA). MATERIALS AND METHODS: Twenty-two patients with unilateral occlusion of ICA and twenty age and sex matched healthy subjects were included in the study. Single voxel proton magnetic resonance spectroscopy (1H-MRS) of the centrum semiovale, semi-automated hippocampal volumetry in T1-weighted scans and transcranial Doppler examination (TCD) with calculation of Breath Holding Index (BHI) were performed in both groups. Metabolic, anatomic, and hemodynamic features were compared between the two groups. RESULTS: The N-acetylaspartate (NAA)/choline (Cho) ratio was significantly lower in both hemispheres of enrolled patients compared to controls (p = 0.005 for the side with occlusion, p = 0.04 for the side without occlusion). The hippocampus volume was significantly reduced bilaterally in patients compared to healthy subjects (p = 0.049). A statistically significant difference in BHI values was observed between the side with occlusion and without occlusion (p = 0.037) of the patients, as well as between BHI values of the side with occlusion and healthy volunteers (p = 0.014). DISCUSSION: Patients with unilateral ICA occlusion have reduced NAA/Cho ratio in the white matter of both hemispheres and have bilateral atrophy of hippocampus. The alteration of hemodynamics alone cannot explain these changes.

• MeSH
• arteria carotis interna * MeSH
• lidé MeSH
• magnetická rezonanční spektroskopie MeSH
• mozek MeSH
• mozkový krevní oběh MeSH
• stenóza arteria carotis * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

To assess automated volumetric analysis as a potential presurgical diagnostic tool or as a method to potentially shed light on normal pressure hydrocephalus (NPH) pathophysiology. MRI imaging according to our protocol was performed in 29 NPH patients, 45 non-NPH (but suspected) patients and 15 controls. Twenty patients underwent a second MRI 3 months after ventriculoperitoneal (VP) shunt surgery. All structures relevant to NPH diagnosis were automatically segmented using commercial software. The results were subsequently tested using ANOVA analysis. Significant differences in the volumes of the corpus callosum, left hippocampus, internal globus pallidus, grey and white matter and ventricular volumes were observed between NPH group and healthy controls. However, the differences between NPH and non-NPH groups were non-significant. Three months after, VP shunt insertion decreased ventricular volume was the only clearly significant result (p value 0.0001). Even though a detailed volumetric study shows several significant differences, volumetric analysis as a standalone method does not provide a simple diagnostic biomarker, nor does it shed a light on an unknown NPH aetiology.

• MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• normotenzní hydrocefalus diagnóza   patofyziologie   chirurgie   MeSH
• senioři MeSH
• velikost orgánu MeSH
• ventrikuloperitoneální zkrat MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Cíl: Cílem prospektivní multicentrické studie bylo zjistit, zda riziko vzniku nové ischemické léze mozku na kontrolní MR je závislé na některé z charakteristik aterosklerotického plátu detekované pomocí duplexní sonografie, MR a CTA. Materiál a metodika: Do prospektivní, observační studie byli konsekutivně zařazeni pacienti se stenózou vnitřní karotidy 70–95 % indikovaní ke karotické angioplastice se zavedením stentu (carotid angioplasty and stenting; CAS). U všech zařazených pacientů byla provedena neurologická a fyzikální vyšetření, duplexní sonografické vyšetření krčních tepen se zaměřením na vyhodnocení struktury aterosklerotického plátu v UZ B-obraze, CTA krčních a mozkových tepen a MR krku a mozku. Byla provedena univariantní a multivariantní logistická regresní analýza pro nalezení faktorů ovlivňujících riziko vzniku ischemie mozku po CAS. Výsledky: Do studie bylo zařazeno celkem 121 pacientů (93 mužů, věk 70,5 ± 7,6 let). Během 30 dní od CAS prodělali 4 pacienti CMP, 1 pacient tranzitorní ischemickou ataku, 1 pacient zemřel. Nová ischemická léze na kontrolní MR mozku byla detekována u 34 (28,1 %) pacientů. Pomocí univariantní a multivariantní logistické regresní analýzy nebyl nalezen žádný prediktor (charakteristika aterosklerotického plátu, anamnestické údaje, data z CAS) signifikantně ovlivňující riziko vzniku nové ischemie mozku. Závěr: Charakteristika aterosklerotického plátu v oblasti stenózy vnitřní karotidy neovlivňuje riziko rozvoje ischemie mozku detekované pomocí MR mozku po CAS.

Aim: The aim of a prospective multicenter study was to determine whether the risk of developing a new ischemic brain lesion on control MRI is dependent on some of the characteristics of atherosclerotic plaque detected by duplex sonography, MRI and CTA. Materials and methods: Patients with internal carotid artery stenosis (70-95%) indicated for carotid angioplasty and stenting (CAS) were consecutively included in the prospective observational study. All enrolled patients underwent neurological and physical examinations, duplex sonographic examination of the carotid arteries with evaluation of the structure of atherosclerotic plaque in the ultrasound B-mode, CTA of the cervical and cerebral arteries and MRI of the neck and brain. The univariate and multivariate logistic regression analyses were performed to identify factors affecting the risk of the onset of brain ischemia following CAS. Results: A total of 121 patients (93males, age 70.5 ± 7.6 years) were enrolled in the study. Within 30 days of the CAS, 4 patients suffered from stroke, 1 patient suffered from a transient ischemic attack and 1 patient died. A new ischemic lesion on control brain MRI was detected in 34 (28.1%) patients. Using univariate and multivariate logistic regression analysis, no predictor (atherosclerotic plaque characteristics, history data, CAS data) was found to influence the risk of the onset of new brain ischemia. Conclusion: Characteristics of atherosclerotic plaque in the area of the internal carotid artery stenosis does not affect the risk of developing brain ischemia detected by brain MRI following CAS.

• MeSH
• angioplastika MeSH
• ischemie mozku diagnostické zobrazování   prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• stenóza arteria carotis * diagnostické zobrazování   chirurgie   terapie   MeSH
• stenty MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

Background: We hypothesized that right and left temporal lobe epilepsy (RTLE and LTLE, respectively) have distinctive spatial patterns of white matter (WM) changes that can be differentiated and interpreted with the use of multiple diffusion parameters. We compared the global microstructure of fiber bundles with regard to WM alterations in both RTLE and LTLE, addressing some of the methodological issues of previous studies. Methods: Diffusion tensor imaging data from 17 patients with RTLE (age: 40.7 ± 10.4), 15 patients with LTLE (age: 37.3 ± 10.4), and 15 controls (age: 34.8 ± 11.2) were used in the study. WM integrity was quantified by fractional anisotropy (FA), mean diffusivity (MD), longitudinal diffusivity (LD), and radial diffusivity (RD). The diffusion parameters were compared between the groups in tracts representing the core of the fiber bundles. The volumes of hippocampi and amygdala were subsequently compared across the groups, while the data were adjusted for the effect of hippocampal sclerosis. Results: Significantly reduced FA and increased MD, LD, and RD were found bilaterally over widespread brain regions in RTLE. An increase in MD and RD values was observed in widespread WM fiber bundles ipsilaterally in LTLE, largely overlapping with regions where FA was lower, while no increase in LD was observed. We also found a difference between the LTLE and RTLE groups for the right hippocampal volume (with and without adjustment for HS), whereas no significant volume differences were found between patients and controls. Conclusions: It appears that patients with RTLE exhibit a more widespread pattern of WM alterations that extend far beyond the temporal lobe in both ipsilateral and contralateral hemisphere; furthermore, these changes seem to reflect more severe damage related to chronic degeneration. Conversely, more restrained changes in the LTLE may imply a pattern of less severe axonal damage, more restricted to ipsilateral hemisphere. Comprehensive finding of more prominent hippocampal atrophy in the RTLE raises an interesting issue of seizure-induced implications on gray matter and WM microstructure that may not necessarily mean a straightforward causal relationship. Further correlations of diffusion-derived metrics with neuropsychological and functional imaging measures may provide complementary information on underlying WM abnormalities with regard to functional hemispheric specialization.

• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Frameless stereotactic brain biopsy systems are widely used today. VarioGuide (VG) is a relatively novel frameless system. Its accuracy was studied in a laboratory setting but has not yet been studied in the clinical setting. The purpose of this study was to determine its accuracy and diagnostic yield and to compare this with frame-based (FB) stereotaxy. MATERIAL AND METHODS: Overall, 53 patients (33 males and 20 females, 60 ± 15 years old) were enrolled into this prospective, randomized, single-center study. Twenty-six patients were randomized into the FB group and 27 patients into the VG group. Real trajectory was pointed on intraoperative magnetic resonance. The distance of the targets and angle deviation between the planned and real trajectories were computed. The overall discomfort of the patient was subjectively assessed by the visual analog scale score. RESULTS: The median lesion volume was 5 mL (interquartile range [IQR]: 2-16 mL) (FB) and 16 mL (IQR: 2-27 mL) (VG), P = 0.133. The mean distance of the targets was 2.7 ± 1.1 mm (FB) and 2.9 ± 1.3 mm (VG), P = 0.456. Mean angle deviation was 2.6 ± 1.3 deg (FB) and 3.5 ± 2.1 deg (VG), P = 0.074. Diagnostic yield was 93% (25/27) in VG and 96% (25/26) in FB, P = 1.000. Mean operating time was 47 ± 26 minutes (FB) and 59 ± 31 minutes (VG), P = 0.140. One minor bleeding was encountered in the VG group. Overall patient discomfort was significantly higher in the FB group (visual analog scale score 2.5 ± 2.1 vs. 1.2 ± 0.6, P = 0,004). CONCLUSIONS: The VG system proved to be comparable in terms of the trajectory accuracy, rate of complications and diagnostic yield compared with the "gold standard" represented by the traditional FB stereotaxy for patients undergoing brain biopsy. VG is also better accepted by patients.

• MeSH
• biopsie přístrojové vybavení   MeSH
• design vybavení MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• interpretace obrazu počítačem přístrojové vybavení   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie přístrojové vybavení   MeSH
• mozek patologie   MeSH
• nádory mozku patologie   sekundární   chirurgie   MeSH
• neuronavigace přístrojové vybavení   MeSH
• odchylka pozorovatele MeSH
• počítačová rentgenová tomografie MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Resection of lesion closed to primary motor cortex and corticospinal tract may bring risk of postoperative neurological deficit. Radical resection of the lesion and no worsening of pateitns´ neurological picture are two main neurosurgical goals. Electrophysiological monitoring is one of the methods used to reduce such risks. MR DTI enables to noninvasively visualize the corticospinal tract. Combination of these two techniques has been studied anecdotically so far. The aim of the study is to evaluate the correlation of preoperative DTI to intraoperative electrophysiological monitoring. Intraoperative MRI enables to depict the extent of surgical procedure. 3,0T MRI enables to gain data for intraoperative DTI data. Accuracy of these data has not yet been studied. The other goal of the project is to validate these data and study the accuracy of these data. The impact of these techniques to patients´ neurological outcome will be studied as well.

Resekce nádorových ložisek v blízkosti centrální mozkové krajiny a kortikospinální dráhy přináší riziko pooperačního neurologického deficitu. Cílem neurochirurgického výkonu je odstranění patologického nálezu a zároveň nezhoršení neurologického nálezu. Elektrofyziologická monitorace během operace je jednou z technik, které potenciálně snižuje tato rizika. MR traktografie umožňuje stanovit průběh kortikospinální dráhy a následně určit její vztah k operovanému ložisku. Kombinace těchto metodik byla doposud studována jen minimálně. Cílem studie je určit korelaci předoperační traktografie s intraoperačním monitoringem. Intraoperační MRI umožňuje během operace zobrazit rozsah daného neurochirurgického výkonu. 3,0T MRI umožňuje též získat data pro intraoperační traktografii. Přesnost těchto dat ještě nebyla studována. Proto se chceme též zaměřit na validitu a přesnost těchto dat. Dále budeme analyzovat význam těchto technik na výsledný neurologický nález pacienta.

• MeSH
• magnetická rezonance intervenční MeSH
• motorické korové centrum MeSH
• nádory mozku chirurgie   MeSH
• peroperační monitorování MeSH
• pyramidové dráhy MeSH
• reprodukovatelnost výsledků MeSH
• zobrazování difuzních tenzorů MeSH
• zobrazování trojrozměrné MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• neurologie
• onkologie
• neurochirurgie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR

The choice of therapeutic strategy in supratentorial gliomas depends on histopathological diagnosis and results of neuroimaging, usually magnetic resonance (MRI). A conventional MRI is neither sensitive, nor specific enough to determine the type and grading of the brain tumor, which requires further costly examinations. The metabolic data will be correlated with the results of histological examination and semi-quantitative assessment of tumor cells count. The tissue sample will be obtained through a navigated biopsy, guided by MRSI data. The patients indicated for surgery will be included in the study. The study sample will include around 50 subjects. The project will test a mini-invasive and economically profitable diagnostic tool, which may provide a guiding for the strategy of treatment in supratentorial gliomas in the future.

Indikace léčby supratentoriálních gliomů je kromě histopatologické diagnózy závislá na výsledcích neurozobrazovacích metod, nejčastěji magnetické rezonance. Konvenční MR však není dostatečně sensitivní a specifická metoda, aby stanovila druh a stupeň mozkového nádoru, což často vyžaduje provedení dalších nákladných vyšetření. Data z metabolického vyšetření mozku budou korelována s výsledky histologického vyšetření a semikvantitativního stanovení počtu nádorových buněk. Tkáň z nádoru bude získána navigovanou biopsií s využitím MR spektroskopických dat. Do studie budou zařazeni nemocní se supratentoriálním gliomem, indikovaní k operačnímu výkonu. Studie zahrne cca 50 pacientů. Projekt otestuje miniinvazivní a ekonomicky nenáročnou diagnostickou metodu, která může být v budoucnu vodítkem pro strategii léčby supratentoriálních gliomů.

• MeSH
• biopsie MeSH
• gliom diagnóza   MeSH
• histologie MeSH
• neurochirurgické výkony MeSH
• protonová magnetická rezonanční spektroskopie MeSH
• senzitivita a specificita MeSH
• stupeň nádoru MeSH
• supratentoriální nádory diagnóza   MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• neurologie
• neurochirurgie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR