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Raininko, Raili
Publications (10 of 66) Show all publications
Wallin, E., Larsson, I.-M., Kristofferzon, M.-L., Larsson, E.-M., Raininko, R. & Rubertsson, S. (2018). Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest. Acta Anaesthesiologica Scandinavica, 62(5), 635-647
Open this publication in new window or tab >>Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 5, p. 635-647Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.

METHODS:

A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.

RESULTS:

Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.

CONCLUSIONS:

Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-340789 (URN)10.1111/aas.13074 (DOI)000429532400007 ()29363101 (PubMedID)
Available from: 2018-02-02 Created: 2018-02-02 Last updated: 2018-06-19Bibliographically approved
Finnsson, J., Lubberink, M., Savitcheva, I., Fällmar, D., Melberg, A., Kumlien, E. & Raininko, R. (2018). Glucose metabolism in the brain in LMNB1-related autosomal dominant leukodystrophy.. Acta Neurologica Scandinavica
Open this publication in new window or tab >>Glucose metabolism in the brain in LMNB1-related autosomal dominant leukodystrophy.
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2018 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: LMNB1-related autosomal dominant leukodystrophy is caused by an overexpression of the protein lamin B1, usually due to a duplication of the LMNB1 gene. Symptoms start in 5th to 6th decade. This slowly progressive disease terminates with death. We studied brain glucose metabolism in this disease using 18 F-fluorodeoxyglucose positron emission tomography (PET).

METHODS: We examined 8 patients, aged 48-64 years, in varying stages of clinical symptomatology. Two patients were investigated with quantitative PET on clinical indications after which six more patients were recruited. Absolute glucose metabolism was analyzed with the PVElab software in 6 patients and 18 healthy controls. A semiquantitative analysis using the CortexID software was performed in seven investigations, relating local metabolism levels to global glucose metabolism.

RESULTS: The clinical quantitative PET revealed low global glucose metabolism, with the most marked reduction in the cerebellum. In the PVElab analysis, patients presented low mean glucose metabolism in the cerebellum, brainstem and global grey matter. In the semiquantitative analysis, 2 patients showed a decreased metabolism in the cerebellum and 4 patients a relatively higher metabolism in parts of the temporal lobes. Since none of the patients showed an increased metabolism in the quantitative analysis, we interpret these increases as "pseudo-increases" related to a globally reduced metabolism.

CONCLUSIONS: Global reduction of grey matter glucose metabolism in this white matter disease most likely depends on a combination of cortical afferent dysfunction and, in later stages, neuronal loss. The lowest metabolism in the cerebellum is consistent with histopathological findings and prominent cerebellar symptoms.

Keywords
18F-fluorodeoxyglucose, adult-onset leukodystrophy, autosomal dominant leukodystrophy, glucose metabolism, positron emission tomography
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-362200 (URN)10.1111/ane.13024 (DOI)30192380 (PubMedID)
Available from: 2018-10-02 Created: 2018-10-02 Last updated: 2018-11-23Bibliographically approved
Abu Hamdeh, S., Marklund, N., Lewén, A., Howells, T., Raininko, R., Wikström, J. & Enblad, P. (2018). Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central mesencephalic structures.. Journal of Neurosurgery, 1-8
Open this publication in new window or tab >>Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central mesencephalic structures.
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2018 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, p. 1-8Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE Increased intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) with diffuse axonal injury (DAI) is not well defined. This study investigated the occurrence of increased ICP and whether clinical factors and lesion localization on MRI were associated with increased ICP in patients with DAI. METHODS Fifty-two patients with severe TBI (median age 24 years, range 9-61 years), who had undergone ICP monitoring and had DAI on MRI, as determined using T2*-weighted gradient echo, susceptibility-weighted imaging, and diffusion-weighted imaging (DWI) sequences, were enrolled. The proportion of good monitoring time (GMT) with ICP > 20 mm Hg during the first 120 hours postinjury was calculated and associations with clinical and MRI-related factors were evaluated using linear regression. RESULTS All patients had episodes of ICP > 20 mm Hg. The mean proportion of GMT with ICP > 20 mm Hg was 5%, and 27% of the patients (14/52) spent more than 5% of GMT with ICP > 20 mm Hg. The Glasgow Coma Scale motor score at admission (p = 0.04) and lesions on DWI sequences in the substantia nigra and mesencephalic tegmentum (SN-T, p = 0.001) were associated with the proportion of GMT with ICP > 20 mm Hg. In multivariable linear regression, lesions on DWI sequences in SN-T (8% of GMT with ICP > 20 mm Hg, 95% CI 3%-13%, p = 0.004) and young age (-0.2% of GMT with ICP > 20 mm Hg, 95% CI -0.07% to -0.3%, p = 0.002) were associated with increased ICP. CONCLUSIONS Increased ICP occurs in approximately one-third of patients with severe TBI who have DAI. Age and lesions on DWI sequences in the central mesencephalon (i.e., SN-T) are associated with elevated ICP. These findings suggest that MR lesion localization may aid prediction of increased ICP in patients with DAI.

Keywords
ADC = apparent diffusion coefficient, CPP = cerebral perfusion pressure, DAI = diffuse axonal injury, DWI = diffusion-weighted imaging, EVD = external ventricular drain, GCS = Glasgow Coma Scale, GMT = good monitoring time, GOSE = Glasgow Outcome Scale–Extended, ICC = intraclass correlation coefficient, ICP = intracranial pressure, MAP = mean arterial blood pressure, MRI, NICU = neurointensive care unit, SN-T = substantia nigra and mesencephalic tegmentum, SWI = susceptibility-weighted imaging, T2*GRE = T2*-weighted gradient echo, TBI, TBI = traumatic brain injury, diffuse axonal injury, diffusion-weighted imaging, elevated ICP, intracranial pressure, trauma, traumatic brain injury
National Category
Neurology Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-362207 (URN)10.3171/2018.4.JNS18185 (DOI)30215559 (PubMedID)
Available from: 2018-10-02 Created: 2018-10-02 Last updated: 2018-11-28Bibliographically approved
Hellström, J., Romanos Zapata, R., Libard, S., Wikström, J., Ortiz-Nieto, F., Alafuzoff, I. & Raininko, R. (2018). The value of magnetic resonance spectroscopy as a supplement to MRI of the brain in a clinical setting. PLoS ONE, 13(11), Article ID e0207336.
Open this publication in new window or tab >>The value of magnetic resonance spectroscopy as a supplement to MRI of the brain in a clinical setting
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0207336Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There are different opinions of the clinical value of MRS of the brain. In selected materials MRS has demonstrated good results for characterisation of both neoplastic and non-neoplastic lesions. The aim of this study was to evaluate the supplemental value of MR spectroscopy (MRS) in a clinical setting.

MATERIAL AND METHODS: MRI and MRS were re-evaluated in 208 cases with a clinically indicated MRS (cases with uncertain or insufficient information on MRI) and a confirmed diagnosis. Both single voxel spectroscopy (SVS) and chemical shift imaging (CSI) were performed in 105 cases, only SVS or CSI in 54 and 49 cases, respectively. Diagnoses were grouped into categories: non-neoplastic disease, low-grade tumour, and high-grade tumour. The clinical value of MRS was considered very beneficial if it provided the correct category or location when MRI did not, beneficial if it ruled out suspected diseases or was more specific than MRI, inconsequential if it provided the same level of information, or misleading if it provided less or incorrect information.

RESULTS: There were 70 non-neoplastic lesions, 43 low-grade tumours, and 95 high-grade tumours. For MRI, the category was correct in 130 cases (62%), indeterminate in 39 cases (19%), and incorrect in 39 cases (19%). Supplemented with MRS, 134 cases (64%) were correct, 23 cases (11%) indeterminate, and 51 (25%) incorrect. Additional information from MRS was beneficial or very beneficial in 31 cases (15%) and misleading in 36 cases (17%).

CONCLUSION: In most cases MRS did not add to the diagnostic value of MRI. In selected cases, MRS may be a valuable supplement to MRI.

National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-366792 (URN)10.1371/journal.pone.0207336 (DOI)30440005 (PubMedID)
Available from: 2018-11-24 Created: 2018-11-24 Last updated: 2018-11-26Bibliographically approved
Abu Hamdeh, S., Marklund, N., Lannsjö, M., Howells, T., Raininko, R., Wikström, J. & Enblad, P. (2017). Extended anatomical grading in diffuse axonal injury using MRI: Hemorrhagic lesions in the substantia nigra and mesencephalic tegmentum indicate poor long-term outcome. Journal of Neurotrauma, 5(34), 341-352
Open this publication in new window or tab >>Extended anatomical grading in diffuse axonal injury using MRI: Hemorrhagic lesions in the substantia nigra and mesencephalic tegmentum indicate poor long-term outcome
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2017 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 5, no 34, p. 341-352Article in journal (Refereed) Published
Abstract [en]

Clinical outcome after traumatic diffuse axonal injury (DAI) is difficult to predict. In this study, three magnetic resonance imaging (MRI) sequences were used to quantify the anatomical distribution of lesions, to grade DAI according to the Adams grading system, and to evaluate the value of lesion localization in combination with clinical prognostic factors to improve outcome prediction. Thirty patients (mean 31.2 years ±14.3 standard deviation) with severe DAI (Glasgow Motor Score [GMS] <6) examined with MRI within 1 week post-injury were included. Diffusion-weighted (DW), T2*-weighted gradient echo and susceptibility-weighted (SWI) sequences were used. Extended Glasgow outcome score was assessed after 6 months. Number of DW lesions in the thalamus, basal ganglia, and internal capsule and number of SWI lesions in the mesencephalon correlated significantly with outcome in univariate analysis. Age, GMS at admission, GMS at discharge, and low proportion of good monitoring time with cerebral perfusion pressure <60 mm Hg correlated significantly with outcome in univariate analysis. Multivariate analysis revealed an independent relation with poor outcome for age (p = 0.005) and lesions in the mesencephalic region corresponding to substantia nigra and tegmentum on SWI (p  = 0.008). We conclude that higher age and lesions in substantia nigra and mesencephalic tegmentum indicate poor long-term outcome in DAI. We propose an extended MRI classification system based on four stages (stage I—hemispheric lesions, stage II—corpus callosum lesions, stage III—brainstem lesions, and stage IV—substantia nigra or mesencephalic tegmentum lesions); all are subdivided by age (≥/<30 years).

Keywords
adult brain injury, axonal injury, head trauma, MRI, susceptibility weighted imaging
National Category
Clinical Medicine Neurology
Identifiers
urn:nbn:se:uu:diva-309038 (URN)10.1089/neu.2016.4426 (DOI)000391754800009 ()27356857 (PubMedID)
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2018-07-13Bibliographically approved
Ali, Z., Klar, J., Jameel, M., Khan, K., Fatima, A., Raininko, R., . . . Dahl, N. (2016). Novel SACS mutations associated with intellectual disability, epilepsy and widespread supratentorial abnormalities. Journal of the Neurological Sciences, 371, 105-111
Open this publication in new window or tab >>Novel SACS mutations associated with intellectual disability, epilepsy and widespread supratentorial abnormalities
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2016 (English)In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 371, p. 105-111Article in journal (Refereed) Published
Abstract [en]

We describe eight subjects from two consanguineous families segregating with autosomal recessive childhood onset spastic ataxia, peripheral neuropathy and intellectual disability. The degree of intellectual disability varied from mild to severe and all four affected individuals in one family developed aggressive behavior and epilepsy. Using exome sequencing, we identified two novel truncating mutations (c.2656C>T (p.Gln886*)) and (c.4756_4760delAATCA (p.Asn1586Tyrfs*3)) in the SACS gene responsible for autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). MRI revealed typical cerebellar and pontine changes associated with ARSACS as well as multiple supratentorial changes in both families as likely contributing factors to the cognitive symptoms. Intellectual disability and behavioral abnormalities have been reported in some cases of ARSACS but are not a part of the characteristic triad of symptoms that includes cerebellar ataxia, spasticity and peripheral neuropathy. Our combined findings bring further knowledge to the phenotypic spectrum, neurodegenerative changes and genetic variability associated with the SACS gene of clinical and diagnostic importance.

National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-309036 (URN)10.1016/j.jns.2016.10.032 (DOI)000389399300024 ()27871429 (PubMedID)
Funder
Swedish Research Council, 2015-02424Science for Life Laboratory - a national resource center for high-throughput molecular bioscience
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2017-11-29Bibliographically approved
Wallin, E., Rubertsson, S., Larsson, I.-M., Kristoferzon, M.-L., Larsson, E.-M. & Raininko, R. (2016). Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later. In: Insights into Imaging 7:Suppl 1, 2016: . Paper presented at ECR 2016. Springer, 7, Article ID B-0813.
Open this publication in new window or tab >>Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later
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2016 (English)In: Insights into Imaging 7:Suppl 1, 2016, Springer, 2016, Vol. 7, article id B-0813Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later,

Purpose: To document the acute MRI findings in the brain of post-cardiac arrest (CA) patients treated with therapeutic hypothermia and their relationship to patient outcome after 6 months.

Methods and Materials: MRI was performed prospectively 3-13 days (median 4) after CA in 56 patients regardless of the level of consciousness in three hospitals. The images were interpreted visually by two neuroradiologists. Apparent diffusion coefficient (ADC) was measured in predetermined areas in cerebral white matter, deep grey matter,  cerebellar grey and white matter and the brainstem. Outcome was assessed using the Cerebral Performance Categories Scale (CPC ) and dichotomized into good and poor outcome.

Results: Acute hypoxic lesions on diffusion-weighted MRI (DWI) were more common in patients with poor outcome (p=0.006) and affected mostly grey matter, deep or cortical, with or without involvement of underlying white matter. Pure white matter lesions were very few. Lesions in the occipital and temporal lobes, deep white matter and cerebellum were most associated with poor outcome. Reductions in the ADC, particularly in the occipital lobes, were more common in patients with poor outcome. None of the patients with an ADC below 604-678 x10-6 mm2/s (variation depending on the equipment and technique) in any region survived to 6 months.

Conclusion: Extensive acute lesions in cortical regions and deep grey matter in visual analysis and regions with an ADC under the level 600-680 x10-6 mm2/s are associated with poor outcome. Lesions are fewer and mainly situated in the frontal and parietal lobes in patients with good outcome.

Place, publisher, year, edition, pages
Springer, 2016
Series
Insights into imaging ; vol 7:Suppl1
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-309040 (URN)
Conference
ECR 2016
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2017-02-17Bibliographically approved
Burman, J., Raininko, R., Blennow, K., Zetterberg, H., Axelsson, M. & Malmeström, C. (2016). YKL-40 is a CSF biomarker of intrathecal inflammation in secondary progressive multiple sclerosis.. Journal of Neuroimmunology, 292, 52-57
Open this publication in new window or tab >>YKL-40 is a CSF biomarker of intrathecal inflammation in secondary progressive multiple sclerosis.
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2016 (English)In: Journal of Neuroimmunology, ISSN 0165-5728, E-ISSN 1872-8421, Vol. 292, p. 52-57Article in journal (Refereed) Published
Abstract [en]

YKL-40 (CHI3L1) is a glycoprotein predominantly produced by reactive astrocytes in chronic active MS lesions, which are common in secondary progressive MS. In this study, YKL-40 was investigated in different stages of MS and in relation to MRI findings. YKL-40 levels in CSF samples from two independent patient cohorts of MS patients were determined with ELISA. CSF YKL-40 was increased in patients with active relapsing-remitting MS and correlated with the number of gadolinium enhancing lesions. Patients with secondary progressive MS had similar high levels of YKL-40, whereas not active relapsing-remitting MS patients had YKL-40 levels comparable to healthy controls.

National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-288096 (URN)10.1016/j.jneuroim.2016.01.013 (DOI)000372561600008 ()26943959 (PubMedID)
Funder
Swedish Research CouncilTorsten Söderbergs stiftelse
Available from: 2016-04-27 Created: 2016-04-27 Last updated: 2017-11-30Bibliographically approved
Wallin, E., Larsson, I.-M., Kristofferzon, M.-L., Rubertsson, S., Larsson, E.-M. & Raininko, R. (2015). Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.. Paper presented at Congress of European Resuscitation Council 2015, Prag, Czech Republic. Resuscitation, 96(Suppl1), 147
Open this publication in new window or tab >>Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.
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2015 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Suppl1, p. 147-Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.

Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patients treated with TH.

Results: MRI of the brain was obtained at a median of 4 days  (3-13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24-30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p=0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600x10-6 mm2/s in any region survived to 6 months.

Conclusions: In visual analyses of acute MRI, extensive acute lesions were found in the cortical regions and gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.

 

Keywords
cardiac arrest, hypothermia, MRI, diffusion brain acute lesions, neurological outcome
National Category
Anesthesiology and Intensive Care Neurology Radiology, Nuclear Medicine and Medical Imaging
Research subject
Medical Science; Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-248025 (URN)
Conference
Congress of European Resuscitation Council 2015, Prag, Czech Republic
Available from: 2015-04-15 Created: 2015-03-26 Last updated: 2017-10-25
Hellström, J., Romanos Zapata, R., Libard, S., Alafuzoff, I., Wikström, J., Ortiz-Nieto, F. & Raininko, R. (2015). Clinical value of MR spectroscopy: How often does MRS yield more information than MRI?. Paper presented at 38th Annual Meeting of European Society of Neuroradiology, Neapel, Italy.. Neuroradiology, 57(Suppl1), 143-144
Open this publication in new window or tab >>Clinical value of MR spectroscopy: How often does MRS yield more information than MRI?
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2015 (English)In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 57, no Suppl1, p. 143-144Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-264483 (URN)
Conference
38th Annual Meeting of European Society of Neuroradiology, Neapel, Italy.
Available from: 2015-10-13 Created: 2015-10-13 Last updated: 2017-12-01
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