Biomedical subjects

Hans-Jörg Wittsack

Publications and source records attributed to Hans-Jörg Wittsack.

12 recordsLinked to original sources

PubMed2006

Significance of the perfusion-diffusion mismatch in chronic cerebral ischemia.

PURPOSE: To determine whether the perfusion deficit could predict brain infarction in patients with chronic cerebral ischemia who experienced recurring episodes of neurological symptoms and showed a perfusion-diffusion mismatch on magnetic resonance (MR) images. MATERIALS AND METHODS: In 53 consecutive patients (38 males and 15 females, 62+/-13 years old) with ischemia in the middle cerebral artery (MCA) territory, lesion volumetry was performed on parametric maps of the time-to-peak, the cerebral blood volume, and diffusion-weighted (DW) images. The infarct lesions were assessed on follow-up T2-weighted (T2W) MR images after eight days. Cerebrovascular changes were determined by time-of-flight (TOF) MR angiography (MRA). Inferential and correlation statistics were used. RESULTS: Patients with chronic ischemic brain disease (N=39) who presented with a severe perfusion-diffusion mismatch in the presence of a normal cerebral blood volume had no or small brain infarctions as found on follow-up T2W images. MRA revealed widespread abnormalities of the basal cerebral arteries compatible with brain perfusion abnormalities. In contrast, in acute stroke patients (N=14) the deficit of cerebral perfusion predicted the infarct lesion in the T2W images. CONCLUSION: Our results suggest that in chronic cerebral ischemia the normal blood volume was maintained despite the depression of cerebral perfusion and recurring minor insults.

Adult↗

PubMed2006

Motor recovery as assessed with isometric finger movements and perfusion magnetic resonance imaging after acute ischemic stroke.

OBJECTIVE: Recovery from hemiparetic stroke is variable. An important goal for clinicians and clinical researchers is to identify predictors of recovery. The initial phase after acute ischemic stroke is considered to be of major importance for neurological outcome. The authors sought to determine in patients with acute ischemic stroke whether early motor recovery, as measured by repetitive isometric index-thumb oppositions, is correlated with ischemic lesion volume. METHODS: Thirty-six acute hemiparetic stroke patients with residual hand function were investigated. The European Stroke Scale (ESS) score was determined on admission and at discharge. Performance of repetitive index finger-thumb pinch movements was measured daily during the 1st 8 days after stroke onset. Brain ischemia volume was determined digitally in time-to-peak magnetic resonance images of per-fusion. RESULTS: The recovery of patients with (P = 0.002) and without (P < 0.001) thrombolysis as assessed with the ESS was paralleled by an increase in isometric grip force and movement rate (P < 0.05). Recovery was predicted by the area of moderately impaired perfusion indicated by the per-fusion mismatch volume (r = 0.578, P < 0.001). CONCLUSIONS: In acute stroke, recovery of hand function is predicted by the volume of salvageable ischemic tissue, as determined by the perfusion mismatch.

Aged↗

PubMed2005

Initial ischemic event: perfusion-weighted MR imaging and apparent diffusion coefficient for stroke evolution.

PURPOSE: To prospectively determine if the degree of acute perfusion or diffusion abnormalities measured prior to treatment onset help predict the evolution of brain infarction on magnetic resonance (MR) images. MATERIALS AND METHODS: Local ethics committee approval and informed consent were obtained. On parametric maps obtained in 64 patients (mean age, 64 years +/- 13 [standard deviation]; 37 men and 27 women) with acute middle cerebral artery infarction, lesion volumetry was performed to determine time to peak, mean transit time, cerebral blood volume, and apparent diffusion coefficient obtained within 3 hours of symptom onset. The infarct lesions were assessed on T2-weighted MR images obtained at follow-up on day 8. Cerebrovascular changes were determined on MR angiograms. Inferential and correlation statistics were used. RESULTS: A perfusion delay of more than 6 seconds relative to the nonaffected hemisphere on time-to-peak maps helped to predict the lesion volume on T2-weighted images (r = 0.686, P < .001). In contrast, neither the volume nor the degree of the diffusion abnormality helped to predict the infarct volume (r < 0.46). This was because in one subgroup of patients there was an increase and in one subgroup there was a decrease in infarct volume on the T2-weighted images (P < .001). There was a greater prevalence (P < .02) of cerebral artery abnormalities in the patients with larger infarcts. Clinically, the neurologic impairment was more severe (P < .01) and the mean arterial pressure higher (P < .04) in these patients. CONCLUSION: The results suggest that in acute stroke the severity of the initial ischemic event as determined on time-to-peak maps indicates hemodynamic compromise in addition to internal carotid artery or middle cerebral artery occlusion, because of abnormalities in other cerebral arteries.

Adult↗

PubMed2005

Partial rescue of the perfusion deficit area by thrombolysis.

PURPOSE: To investigate the evolution of the perfusion deficit area following systemic thrombolysis with recombinant tissue plasminogen activator (rtPA) in a clinical study on acute cerebral ischemia. MATERIALS AND METHODS: We performed volumetric measurements of the acute ischemic lesions in MR images of perfusion (TTP, MTT, and rCBV) and in diffusion-weighted (DW) images, as well as the manifest stroke lesions in T2-weighted MR images on day 8. We compared the data of 29 patients who were subjected to systemic thrombolysis with those of 18 patients who were not eligible for thrombolysis. RESULTS: In the treated patients there were prominent MTT/DWI and TTP/DWI mismatches (P < 0.0006). The acute TTP volumes were smaller than the acute MTT volumes, but as large as the T2 lesions on day 8. The MTT/T2 lesion volume reduction was significant (P < 0.03) in patients who received the GPIIb/IIIa receptor antagonist tirofiban (N = 13) in addition to the low-dose rtPA. This corresponded to a greater neurological improvement compared to patients who received rtPA alone (P < 0.05). In contrast, in the nontreated patients the initial MTT and TTP lesion volumes were of similar magnitude and predicted the T2 lesions on day 8. In the treated and nontreated patients the TTP lesion signified the viability threshold of acute ischemia, which corresponded to a rCBF of 25 +/- 11 mL/100 g/min. CONCLUSION: The perfusion deficit area comprises the ischemic core that is destined to undergo necrosis, and an ischemic rim that is salvageable by systemic thrombolysis.

Adult↗

PubMed2005

Multimodal metabolic imaging of cerebral gliomas: positron emission tomography with [18F]fluoroethyl-L-tyrosine and magnetic resonance spectroscopy.

OBJECT: The purpose of this study was to determine the predictive value of [18F]fluoroethyl-L-tyrosine (FET)-positron emission tomography (PET) and magnetic resonance (MR) spectroscopy for tumor diagnosis in patients with suspected gliomas. METHODS: Both FET-PET and MR spectroscopy analyses were performed in 50 consecutive patients with newly diagnosed intracerebral lesions supposed to be diffuse gliomas on contrast-enhanced MR imaging. Lesion/brain ratios of FET uptake greater than 1.6 were considered positive, that is, indicative of tumor. Results of MR spectroscopy were considered positive when N-acetylaspartate (NAA) was decreased in conjunction with an absolute increase of choline (Cho) and an NAA/Cho ratio of 0.7 or less. An FET lesion/brain ratio, an NAA/Cho ratio, and signal abnormalities on MR images were compared with histological findings in neuronavigated biopsy specimens. The FET lesion/brain ratio and the NAA/Cho ratio were identified as significant independent predictors for the histological identification of tumor tissue. The accuracy in distinguishing neoplastic from nonneoplastic tissue could be increased from 68% with the use of MR imaging alone to 97% with MR imaging in conjunction with FET-PET and MR spectroscopy. Sensitivity and specificity for tumor detection were 100 and 81% for MR spectroscopy and 88 and 88% for FET-PET, respectively. Results of histological studies did not reveal tumor tissue in any of the lesions that were negative on FET-PET and MR spectroscopy. In contrast, a tumor diagnosis was made in 97% of the lesions that were positive with both methods. CONCLUSIONS: In patients with intracerebral lesions supposed to be diffuse gliomas on MR imaging, FET-PET and MR spectroscopy analyses markedly improved the diagnostic efficacy of targeted biopsies.

Adolescent↗

PubMed2004

Development of brain infarct volume as assessed by magnetic resonance imaging (MRI): follow-up of diffusion-weighted MRI lesions.

PURPOSE: To investigate the development of ischemic brain lesions, as present in the acute stroke phase, by diffusion-weighted magnetic resonance imaging (DWI), and in the subacute and chronic phases until up to four months after stroke, in fluid-attenuated inversion recovery (FLAIR)- and T2-weighted (T2W) magnetic resonance (MR) images. MATERIALS AND METHODS: Twelve consecutive patients with their first middle cerebral artery (MCA) infarction were included. Lesion volumes were assessed on T2W images recorded with a turbo spin echo (TSE) and on images recorded with the FLAIR sequence on average on day 8 and after about four months. They were compared with acute lesion volumes in perfusion and DWI images taken within 24 hours of stroke onset. RESULTS: On day 8, lesion volumes in images obtained with FLAIR exceeded the acute infarct volumes in DWI. The chronic lesion volumes were almost identical in T2W and FLAIR images but significantly reduced compared with the acute DWI lesions. The lesion volumes assessed on DWI images correlated highly with the lesions in the images obtained with TSE or FLAIR, as did the lesions in the images obtained with FLAIR and TSE. The secondary lesion shrinkage was accompanied by ventricular enlargement and perilesional sulcal widening, as most clearly visible in the images obtained with FLAIR. CONCLUSION: Our results show that the acute DWI lesions are highly predictive for the infarct lesion in the chronic stage after stroke despite a dynamic lesion evolution most evident in MR images obtained with FLAIR.

Acute Disease↗

PubMed2004

The encoding of saccadic eye movements within human posterior parietal cortex.

Over the last few years, several functionally distinct subregions of the posterior parietal cortex (PPC) have been shown to subserve oculomotor control. Since these areas seem to overlap with regions whose activation is related to attention, we used functional magnetic resonance imaging to compare the cerebral activation pattern evoked by eye movements with different attentional loads, i.e., oscillatory saccades with different frequencies, as well as predictable, and unpredictable saccades. Our results show activation in largely overlapping networks with differing strength of activity and symmetry of involved areas. Predictable saccades having the shortest saccadic latency led to the most pronounced cerebral activity both in terms of cortical areas involved and signal intensity. Predictable and unpredictable saccades were dominated by activation within the right hemisphere, whereas oscillatory saccades showing the longest saccadic latency were dominated by activation within the left hemisphere. In all tasks, the centers of gravity of activation occurred within the posterior part of the intraparietal sulcus (IPS), while the predictable saccades additionally activated its anterior part. The enhanced activity during the execution of predictable saccades was probably related to top-down processing and/or the preparation of the upcoming eye movement. The hemispheric difference could arise from a predominant role of the right PPC for shifting spatial attention and the left PPC for shifting temporal attention. The differential encoding of saccadic eye movements within IPS indicates that the PPC splits up into different functional modules related to the particular demands of a saccade.

Adult↗

PubMed2004

Bimanual recoupling by visual cueing in callosal disconnection.

The cerebral control of bimanual movements is not completely understood. We investigated a 59-year-old, right-handed man who presented with an acute bimanual coordination deficit. Magnetic resonance imaging showed a lesion involving the entire corpus callosum, which was found on stereotactic biopsy to be an ischemic infarct. Paired-pulse transcranial magnetic stimulation indicated that the patient had a lack of interhemispheric inhibition, while intracortical inhibition in motor cortex of either side was normal. Functional magnetic resonance imaging showed activation of the left SMA, the bilateral motor cortex and anterior cerebellum during spontaneous bimanual thumb-index oppositions, which were uncoupled as evident from simultaneous electromyographic recordings. In contrast, when the bimanual thumb-index oppositions were cued by a visual stimulus, the movements of both hands were tightly correlated. This synchronized activity was accompanied by additional activations bilateral in lateral occipital cortex, dorsal premotor cortex and cerebellum. The data suggest that the visually cued movements of both hands were recoupled by action of a bihemispheric motor network.

Aged↗

PubMed2004

Correlation between anthropometric parameters and abdominal fat volumes assessed by a magnetic resonance imaging method in patients with diabetes.

BACKGROUND: Anthropometric measurements such as body mass index (BMI), waist-to-hip ratio, or waist circumference are used in clinical settings as a rough estimation of abdominal fat volumes. In contrast, abdominal magnetic resonance imaging (MRI) allows a precise and noninvasive imaging modality to measure the whole abdominal fat volumes. The main difference between the two methods is that only MRI provides detailed anatomical information about fat distribution in terms of a three-dimensional volumetric model. The aim of this study was to evaluate the relationship between selected anthropometric parameters and MRI-estimated abdominal fat volumes in patients with diabetes. METHODS: Total fat volume coverage of the abdomen was obtained in a total of 37 patients with diabetes (mean +/- SD age, 48 +/- 13 years) with a BMI of 27.9 +/- 3.6 kg/m2 and a waist-to-hip ratio of 0.94 +/- 0.01 using T1-weighted magnetic resonance images. Quantification of intraabdominal, subcutaneous, and total abdominal fat volumes was performed using a semiautomated computer-assisted analysis of the images. Anthropometric parameters (height, weight, BMI, circumference hip, waist circumference, and waist-to-hip ratio) of all patients and abdominal fat volumes estimated by the MRI method proposed were correlated. RESULTS: The volumes estimated were as follows: intraabdominal fat, 10.5 +/- 5.0 L; subcutaneous fat, 15.2 +/- 7.3 L; and total abdominal fat, 25.7 +/- 11.5 L. The correlation coefficients between BMI and the three different fat volumes were, respectively, r = 0.38, r = 0.31, and r = 0.36. For the waist-to-hip ratio the respective correlation coefficients were r = 0.46, r = 0.14, and r = 0.29. CONCLUSIONS: Correlation in patients with diabetes of abdominal fat volumes estimated with a reliable MRI method with conventionally applied anthropometric parameters revealed poor correlation coefficients. In contrast, the fat volume determination by means of the novel MRI analysis method is rapid and reliable. Therefore, this method has the potential to be of high value in studies in patients with diabetes.

Abdomen↗

PubMed2003

Brain metabolism in Alzheimer disease and vascular dementia assessed by in vivo proton magnetic resonance spectroscopy.

Proton magnetic resonance spectroscopy (MRS) allows the assessment of various cerebral metabolites non-invasively in vivo. Among 1H MRS-detectable metabolites, N-acetyl-aspartate and N-acetyl-aspartyl-glutamate (tNAA), trimethylamines (TMA), creatine and creatine phosphate (tCr), inositol (Ins) and glutamate (Gla) are of particular interest, since these moieties can be assigned to specific neuronal and glial metabolic pathways, membrane constituents, and energy metabolism. In this study on 94 subjects from a memory clinic population, 1H MRS results (single voxel STEAM: TE 20 ms, TR 1500 ms) on the above metabolites were assessed for five different brain regions in probable vascular dementia (VD), probable Alzheimer's disease (AD), and age-matched healthy controls. In both VD and AD, ratios of tNAA/tCr were decreased, which may be attributed to neuronal atrophy and loss, and Ins/tCr-ratios were increased indicating either enhanced gliosis or alteration of the cerebral inositol metabolism. However, the topographical distribution of the metabolic alterations in both diseases differed, revealing a temporoparietal pattern for AD and a global, subcortically pronounced pattern for VD. Furthermore, patients suffering from vascular dementia (VD) had remarkably enhanced TMA/tCr ratios, potentially due to ongoing degradation of myelin. Thus, the metabolic alterations obtained by 1H MRS in vivo allow insights into the pathophysiology of the different dementias and may be useful for diagnostic classification.

Aged↗

PubMed2003

A rapid and reliable semiautomated method for measurement of total abdominal fat volumes using magnetic resonance imaging.

The aim of this study was the development of a reliable and fast method to estimate total abdominal fat volumes (TAF) in diabetic subjects on the basis of T1-weighted MR images. Thirty-seven patients with diabetes were examined (age 48 +/- 13 y mean +/- SD). A semiautomated computer assisted software program was developed to quantify intraabdominal (IAF), subcutaneous (SCF), and total abdominal fat volumes (TAF). The variability of image analysis for fat measurements between two observers and within observers was assessed. Mean volumes (+/- SD) for IAF, SCF and TAF were 10.5 1 (+/- 5.0 1), 15.1 1 (+/-7.3 1) and 25.7 1 (+/-11.5 1), respectively. Inter- and intraobserver reliability was excellent (r = 0.999 to r = 1.0). Per patient, the analysis required nine minutes in addition to a scan duration of seven minutes. As this analytic method using T1-weighted MR images allows a fast and reliable quantification of TAF, IAF and SCF, it may serve as a valuable tool for respective studies in diabetic subjects.

Abdomen↗

PubMed2002

MR imaging in acute stroke: diffusion-weighted and perfusion imaging parameters for predicting infarct size.

PURPOSE: To investigate the predictive value of the ischemic lesion size, as depicted in the acute stroke phase on diffusion-weighted magnetic resonance (MR) images and time-to-peak (TTP) maps of tissue perfusion imaging, for infarct size, as derived from T2-weighted imaging in the postacute phase. MATERIALS AND METHODS: Fifty patients who underwent diffusion-weighted and perfusion imaging within 1-24 hours after stroke onset and a follow-up T2-weighted investigation after about 8 days were included. Lesion volumes were evaluated by using a semiautomatic thresholding technique. Volumetric results of acute diffusion-weighted and perfusion imaging were analyzed in comparison with follow-up T2-weighted images and in terms of the time difference between symptom onset and initial MR imaging. RESULTS: At diffusion-weighted imaging, the acute lesion defined by a signal intensity increase of more than 20%, compared with the contralateral side, showed the best correlation with the infarct size after 1 week. At perfusion imaging, the best predictor relative to the contralateral side was a delay of more than 6 seconds on TTP maps. Temporal analysis of volumetric results, which depended on the time difference between symptom onset and examination, revealed two patient subgroups. CONCLUSION: Diffusion-weighted imaging helped to predict the size of the lesion on T2-weighted images obtained after about 8 days in patients with a symptom onset of more than 4 hours (r = 0.96), while in patients with a symptom onset of less than 4 hours, perfusion imaging provided important additional information about brain tissue with impaired perfusion.

Acute Disease↗