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  • 1.
    Alemany Ripoll, Montserrat
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Stenborg, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Sonninen, Pirkko
    Terent, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Detection and appearance of intraparenchymal haematomas of the brain at 1.5 T with spin-echo, FLAIR and GE sequences: poor relationship to the age of the haematoma2004In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 46, no 6, p. 435-43Article in journal (Refereed)
    Abstract [en]

    The specific appearance of blood related to time at T1- and T2-weighted spin-echo (SE) sequences is generally accepted; thus, these sequences are classically used for estimating the age of haematomas. Magnetic resonance imaging at 1.5 T, including T1- and T2-weighted SE fluid-attenuated inversion recovery (FLAIR) and T2*-weighted gradient-echo (GE) sequences, was performed on 82 intraparenchymal haematomas (IPHs) and 15 haemorrhagic infarcts (HIs) in order to analyse the appearance at different stages and with different sequences, and to investigate how reliably the age of hematomas can be estimated. The IPHs had been previously detected by CT, were spontaneous ( n=72) or traumatic ( n=10) in origin and were of different sizes (2 mm to 7 cm) and ages (from 7.5 h to 4 years after acute haemorrhagic event). The age of the lesion was calculated from the moment when clinical symptoms started or the traumatic event occurred. The 15 patients with HIs were patients with ischaemic stroke in whom there was either a suspicion of haemorrhagic transformation on CT, or haemorrhage was detected as an additional finding on MR performed for other indications. Patients with conditions that could affect the SI of blood, such as anticoagulant therapy or severe anaemia, were excluded. The signal intensity pattern of the lesions was analysed and related to their ages without prior knowledge of the clinical data. All lesions were detected with T2*-weighted GE. T1-weighted SE missed 13 haematomas and T2-weighted SE and FLAIR sequences missed five. Haemorrhagic transformation was missed in three infarcts by T1-, T2-weighted SE and FLAIR. The signal pattern on FLAIR was identical to that on T2-weighted SE. For all sequences, a wide variety of signal patterns, without a clear relationship to the age of the haematomas, was observed. There was a poor relationship between the real MR appearance of IPHs and the theoretical appearance on SE sequences. T2*-weighted GE was effective for detecting small bleedings but was not useful for estimating the age of a lesion. The FLAIR does not provide any more information than T2-weighted SE.

  • 2. Autti, Taina
    et al.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Santavuori, Pirkko
    Vanhanen, Sanna-Leena
    Poutanen, V. P.
    Haltia, Matti
    MRI of neuronal ceroid lipofuscinosis: II. Postmortem MRI and histopathological study of the brain in 16 cases of neuronal ceroid lipofuscinosis of juvenile or late infantile type1997In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 39, no 5, p. 371-7Article in journal (Refereed)
    Abstract [en]

    Postmortem MRI was carried out on the formalin-fixed brains of 14 patients with juvenile (JNCL) and two with late infantile neuronal ceroid lipofuscinosis, one of variant and the other of classical type. Two patients with JNCL had also undergone MRI during life. After MRI, specimens for histopathological analysis were taken from standard areas of the cerebral cortex, deep nuclei and white matter. The signal intensity of the periventricular white matter was usually higher than that of the peripheral white matter, a finding which correlated with the severe periventricular loss of myelin and gliosis observed histologically. The signal intensity was usually lower in the thalamus than in the putamen; in some patients the signal intensity of the thalamus was equal to or even lower than that of the white matter. However, myelin loss, gliosis, the storage process or neuronal loss in the thalamus did not correlate with the MRI findings. Since in one patient with JNCL the ante- and postmortem MRI did not differ basically, it appears probable that the periventricular changes detected in vivo on MRI are due to the severe loss of myelin and gliosis observed in this study. However, changes resulting from the fixation process must be considered, when postmortem and in vivo MRI are correlated.

  • 3. Autti, Taina
    et al.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Vanhanen, Sanna-Leena
    Santavuori, Pirkko
    MRI of neuronal ceroid lipofuscinosis: I. Cranial MRI of 30 patients with juvenile neuronal lipofuscinosis1996In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 38, no 5, p. 476-82Article in journal (Refereed)
    Abstract [en]

    We studied 30 patients with juvenile neuronal ceroid lipofuscinosis (JNCL). The patients (aged 6-25 years) and 43 age-matched healthy volunteers underwent MRI. After visual assessment, the signal intensity was measured on T2-weighted images in numerous locations. The thickness of the cortex and corpus callosum and the dimensions of the brain stem were measured. Mild to moderate cerebral atrophy was found in 14 of 30 patients, most of them over 14 years of age; 5 older patients had mild to moderate cerebellar atrophy. There was reduction in the size of the corpus callosum and brain stem. The thalamus, caudate nucleus and putamen appeared to give low signal in patients from the ages of 7, 11 and 11 years, respectively. In contrast, the signal intensity measured from the thalamus in these patients showed only a slight (insignificant) decrease compared with controls. The most significant alteration, an increase in measured signal intensity, was found in the white matter (P < 0.0001), even in the youngest patients. The MRI findings correlated significantly with decreased intelligence, speech disturbances and motor problems. Although MRI findings in JNCL do not appear very specific and the visual changes develop relatively late, the absence of pathological MRI findings in the very early stage of the disease may play a part in differential diagnosis of the different types of NCL. Furthermore, the MRI findings may be used in assessing severity and prognosis, particularly in young patients.

  • 4.
    Bajic, Dragan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Hippocampal development at gestation weeks 23 to 36: An ultrasound study on preterm neonates2010In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 52, no 6, p. 489-494Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: During fetal development, the hippocampal structures fold around the hippocampal sulcus into the temporal lobe. According to the literature, this inversion should be completed at gestation week (GW) 21. Thereafter, the hippocampal shape should resemble the adult shape. However, incomplete hippocampal inversion (IHI) is found in 19% of the common population. The aim of this study was to study fetal hippocampal development by examining neonates born preterm. METHODS: We analyzed cranial ultrasound examinations, performed as a part of the routine assessment of all preterm infants, over a 3-year period and excluded the infants with brain pathology. The final material consisted of 158 children born <35 GW. A rounded form (the ratio between the horizontal and vertical diameters of the hippocampal body <25 GW and >/=25 GW was statistically highly significant (p < 0.001). The frequency of bilateral IHI was highest in the youngest age group. In the other groups, the left-sided IHI was the most common. CONCLUSION: In about 50% of the neonates, hippocampal inversion is not completed up to GW 24; but from 25 GW onwards, the frequency and laterality of IHI is similar to that in the adult population.

  • 5.
    Bajic, Dragan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Kumlien, Eva
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Incomplete hippocampal inversion does not affect hippocampal volume in neurologically healthy subjects.2017In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. Suppl1, p. S31-32Article in journal (Refereed)
  • 6.
    Canto Moreira, Nuno
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Teixeira, J.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    The ear in fetal MRI: What can we really see?2011In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 53, no Suppl 1, p. S23-Article in journal (Refereed)
  • 7.
    Canto Moreira, Nuno
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Teixeira, João
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    The ear in fetal MRI: what can we really see?2011In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 53, no 12, p. 1001-1008Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The aim of this study was to investigate the ability to depict the components of the ear on brain-oriented fetal MRI studies.

    METHODS: Retrospective evaluation of the ear in MRI studies was performed post-mortem in 16 fetuses ranging from 15 to 22 gestation weeks (GW), and in 122 examinations in vivo of fetuses ranging from 20 to 38 GW. The cochlea, vestibular apparatus, middle ear, and external auditory canal were separately graded according to the components that were delineated.

    RESULTS: The components of the inner and middle ear were fully delineated in 100% of the post-mortem examinations, but the external auditory canals were only seen in only 25%. In the in vivo group, the imaging detail was much lower. Cochlear turns could be identified in 75% of the fetuses, the vestibule and the lateral semicircular canals in 72% andossicles in 70%. Before 25 GW, the ability to identify these individual parts was 50%, 30%, and 33%, respectively, and above it was 89%, 93%, and 90% . In most cases, the external auditory canals could only be seen after 29 GW.

    CONCLUSION: In fetal MRI studies in vivo, it is possible to depict the components of the ear in the majority of the fetuses, in such a manner as to exclude major malformations. However, MRI might not provide enough detail to rule out pathology of the ear before 25 GW, this being a critical age for pregnancy management in many countries.

  • 8.
    Canto Moreira, Nuno
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Teixeira, João
    Department of Neuroradiology, H. G. S. Antonio, Porto, Portugal.
    Themudo, Raquel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Amini, Hashem
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Measurements of the normal fetal brain at gestation weeks 17 to 23: a MRI study2011In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 53, no 1, p. 43-48Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: To obtain measurements of the normal fetal brain before 24 weeks of gestation (GW), a deadline for medical decisions on fetal viability in a large number of countries. METHODS: We retrospectively reviewed 70 normal MR examinations of fetuses aged GW 17 to 23. The fronto-occipital diameter, the cerebral bi-parietal diameter, the transverse cerebellar diameter, the vermian height, and antero-posterior diameter were measured. RESULTS: The median, maximum, and minimum values for each parameter were displayed for each individual GW. CONCLUSION: The recorded data might contribute to a better assessment of fetal health by providing normal boundaries for the brain growth.

  • 9.
    Correia de Verdier, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Normal ranges and test-retest reproducibility of flow and velocity parameters in intracranial arteries measured with phase-contrast magnetic resonance imaging2016In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 58, no 5, p. 521-531Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The purpose of the present study was to investigate normal ranges and test-retest reproducibility of phase-contrast MRI (PC-MRI)-measured flow and velocity parameters in intracranial arteries.

    METHODS: Highest flow (HF), lowest flow (LF), peak systolic velocity (PSV), and end diastolic velocity (EDV) were measured at two dates in the anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries of 30 healthy volunteers using two-dimensional PC-MRI at 3 T. Least detectable difference (LDD) was calculated.

    RESULTS: In the left ACA, HF was (mean (range, LDD)) 126 ml/min (36-312, 59 %), LF 61 ml/min (0-156, 101 %), PSV 64 cm/s (32-141, 67 %), and EDV 35 cm/s (18-55, 42 %); in the right ACA, HF was 154 ml/min (42-246, 49 %), LF 77 ml/min (0-156, 131 %), PSV 75 cm/s (26-161, 82 %), and EDV 39 cm/s (7-59, 67 %). In the left MCA, HF was 235 ml/min (126-372, 35 %), LF 116 ml/min (42-186, 48 %), PSV 90 cm/s (55-183, 39 %), and EDV 46 cm/s (20-66, 28 %); in the right MCA, HF was 238 ml/min (162-342, 44 %), LF 120 ml/min (72-216, 48 %), PSV 88 cm/s (55-141, 35 %), and EDV 45 cm/s (26-67, 23 %). In the left PCA, HF was 108 ml/min (42-168, 54 %), LF 53 ml/min (18-108, 64 %), PSV 50 cm/s (24-77, 63 %), and EDV 28 cm/s (14-40, 45 %); in the right PCA, HF was 98 ml/min (30-162, 49 %), LF 49 ml/min (12-84, 55 %), PSV 47 cm/s (27-88, 59 %), and EDV 27 cm/s (16-41, 45 %).

    CONCLUSION: PC-MRI-measured flow and velocity parameters in the main intracranial arteries have large normal ranges. Reproducibility is highest in MCA.

  • 10.
    Correia de Verdier, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Response to Letter to the Editor: "Reproducibility of flow and velocity parameters in intracranial arteries measured with phase-contrast magnetic resonance imaging; a methodological issue"2016In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 58, no 9, p. 951-951Article in journal (Refereed)
  • 11.
    Falk, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Fahlström, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Rostrup, Egill
    Berntsson, Shala
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Zetterling, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Morell, Arvid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Larsson, Henrik B W
    Smits, Anja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Discrimination between glioma grades II and III in suspected low-grade gliomas using dynamic contrast-enhanced and dynamic susceptibility contrast perfusion MR imaging: a histogram analysis approach2014In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 56, no 12, p. 1031-1038Article in journal (Refereed)
    Abstract [en]

    Introduction

    Perfusion magnetic resonance imaging (MRI) can be used in the pre-operative assessment of brain tumours. The aim of this prospective study was to identify the perfusion parameters from dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) perfusion imaging that could best discriminate between grade II and III gliomas.

    Methods

    MRI (3 T) including morphological ((T2 fluid attenuated inversion recovery (FLAIR) and T1-weighted (T1W)+Gd)) and perfusion (DCE and DSC) sequences was performed in 39 patients with newly diagnosed suspected low-grade glioma after written informed consent in this review board-approved study. Regions of interests (ROIs) in tumour area were delineated on FLAIR images co-registered to DCE and DSC, respectively, in 25 patients with histopathological grade II (n = 18) and III (n  = 7) gliomas. Statistical analysis of differences between grade II and grade III gliomas in histogram perfusion parameters was performed, and the areas under the curves (AUC) from the ROC analyses were evaluated.

    Results

    In DCE, the skewness of transfer constant (k trans) was found superior for differentiating grade II from grade III in all gliomas (AUC 0.76). In DSC, the standard deviation of relative cerebral blood flow (rCBF) was found superior for differentiating grade II from grade III gliomas (AUC 0.80).

    Conclusions

    Histogram parameters from k trans (DCE) and rCBF (DSC) could most efficiently discriminate between grade II and grade III gliomas.

  • 12.
    Finnsson, Johannes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Melberg, Atle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    1H-MR spectroscopy of adult-onset autosomal dominant leukodystrophy with autonomic symptoms2013In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 55, no 8, p. 933-939Article in journal (Refereed)
    Abstract [en]

    Adult-onset ADLD with autonomic symptoms is a rare disease with a clinical course somewhat similar to chronic progressive MS but with different imaging findings consisting of extensive white matter changes in the cerebrum and cerebellar peduncles. Patients usually present in the fourth to sixth decade with autonomic symptoms, manifesting later symptoms from the pyramidal tracts and ataxia. Here, we present magnetic resonance spectroscopy (MRS) findings in this disease. Fourteen subjects, from two non-related families, with genetic linkage to the disease were studied with magnetic resonance imaging and single-voxel MRS. Clinically, they ranged from asymptomatic to wheelchair-using. Their results were compared to those of age- and sex-matched healthy controls. One MRS was excluded due to suboptimal quality. The remaining 13 subjects manifested characteristic evidence of pathology on MRI, 11 of them exhibited extensive changes. The metabolite concentrations of total Cr, total Cho, and total NAA measured in millimolars, using internal water as a reference, were significantly lower in these 11 subjects compared to controls, and we found linear correlations between all these metabolite levels. When total Cr was used as a reference, we found no difference between subjects and controls. No lactate was detected. The decreased metabolite concentrations measured using internal water as a reference are most likely due to increased water content in the tissues, diluting all metabolites to a similar degree. This is also in agreement with the high signal intensity exhibited in the white matter on T2-weighted MR images and with the reported histopathological findings of vacuolated myelin.

  • 13.
    Finnsson, Johannes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Melberg, Atle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    MRI and clinical  follow-up in adult-onset autosomal dominant leukodystrophy (ADLD) with autonomic symptoms2012In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 54, no Suppl1, p. S61-, article id O1A-3.7Article in journal (Refereed)
  • 14.
    Finnsson, Johannes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Melberg, Atle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Proton MR spectroscopy of supraventricular white matter in adult-onset autosomal dominant leukodystrophy (ADLD) with autonomic symptoms2011In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 53, no Suppl 1, p. S50-S51Article in journal (Refereed)
  • 15.
    Finnsson, Johannes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Savitcheva, I
    Lubberink, Mark
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Section of Nuclear Medicine and PET.
    Melberg, Atle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Glucose metabolism in adult-onset autosomal dominant leukodystrophy (ADLD) with autonomic symptoms2013In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 55, no Suppl1, p. S36-, article id S.18.06Article in journal (Refereed)
  • 16.
    Finnsson, Johannes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Sundblom, Jimmy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Melberg, Atle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    O151-Longitudinal MRI Study of the Spinal Cord in Lamin B1 Autosomal Dominant Leukodystrophy: Do the first symptoms come from the spinal cord?2014In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 56, no Suppl 1, p. S246-Article in journal (Refereed)
  • 17. Fragata, Isabel
    et al.
    Canhão, Patrícia
    Alves, Marta
    Papoila, Ana Luísa
    Canto Moreira, Nuno
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Evolution of diffusion tensor imaging parameters after acute subarachnoid haemorrhage: a prospective cohort study2017In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 59, no 1, p. 13-21Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Few studies assessed diffusion tensor imaging (DTI) changes in the acute phase of subarachnoid haemorrhage (SAH). We prospectively evaluated DTI parameters in the acute phase of SAH and 8-10 days after and analysed whether changes could be related to SAH severity or to the development of delayed cerebral ischemia (DCI).

    METHODS: Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) changes over time were assessed in a prospective cohort of patients with acute SAH. Two MRI studies were performed at <72 h (MRI-1) and 8-10 days (MRI-2). DTI parameters were recorded in 15 ROIs. Linear mixed regression models were used.

    RESULTS: Forty-two patients were included. Subtle changes in DTI parameters were found between MRI-1 and MRI-2. At the posterior limb of internal capsule (PLIC), a weak evidence of a 0.02 mean increase in FA (p = 0.064) and a 17.55 × 10(-6) mm(2)/s decrease in ADC (p = 0.052) were found in MRI-2. Both FA and ADC changed over time at the cerebellum (increase of 0.03; p = 0.017; decrease of 34.73 × 10(-6) mm(2)/s; p = 0.002, respectively). Patients with DCI had lower FA values on MRI-1 and lower ADC on MRI-2, although not reaching statistical significance, compared to non-DCI patients. DTI parameters on MRI-1 were not correlated to clinical admission scales.

    CONCLUSION: ADC and FA values show subtle changes over time in acute SAH at the PLIC and cerebellum although not statistically associated with the severity of SAH or the occurrence of DCI. However, DTI changes occurred mainly in DCI patients, suggesting a possible role of DTI as a marker of DCI.

  • 18.
    Haller, Sven
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Affidea CDRC Ctr Diagnost Radiol Carouge, Geneva, Switzerland; Univ Geneva, Med Fac, Geneva, Switzerland.
    Barkhof, Frederik
    Vrije Univ Amsterdam, Med Ctr, Dept Radiol & Nucl Med, Amsterdam, Netherlands; UCL, Inst Neurol, Dept Neuroradiol, London, England.
    Peri-hippocampal developmental venous anomalies and memory loss: more than a normal variant?2018In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 60, no 6, p. 579-582Article in journal (Refereed)
  • 19.
    Haller, Sven
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Affidea CDRC Ctr Diagnost Radiol Carouge, Clos Fonderie 1, CH-1277 Carouge, Switzerland.
    Burke, Michael
    GE Healthcare GmbH, Munich, Germany.
    Mueller, Thomas L
    Pearl Technol AG, Schlieren, Switzerland.
    MR skin signal loss effect/artifact2018In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 60, no 6, p. 661-662Article in journal (Refereed)
  • 20.
    Haller, Sven
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Affidea CDRC Ctr Diagnost Radiol Carouge SA, Clos Fonderie 1, CH-1227 Geneva, Switzerland.
    Fällmar, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Susceptibility weighted imaging in dementia with Lewy bodies: will it resolve the blind spot of MRI?2016In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 58, no 2, p. 217-218Article in journal (Refereed)
  • 21.
    Haller, Sven
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Affidea Ctr Diagnost Radiol Carouge CDRC, Clos de la Fonderie 1, CH-1277 Geneva, Switzerland..
    Montandon, Marie-Louise
    Univ Hosp Geneva, Dept Psychiat, Fac Med, Med Direct, Geneva, Switzerland..
    Rodriguez, Cristelle
    Univ Hosp Geneva, Dept Psychiat, Fac Med, Med Direct, Geneva, Switzerland..
    Moser, Dominik
    Univ Hosp Geneva, Dept Psychiat, Fac Med, Med Direct, Geneva, Switzerland..
    Toma, Simona
    Univ Hosp Geneva, Dept Psychiat, Fac Med, Med Direct, Geneva, Switzerland..
    Hofmeister, Jeremy
    Univ Hosp Geneva, Dept Psychiat, Fac Med, Med Direct, Geneva, Switzerland..
    Giannakopoulos, Panteleimon
    Univ Hosp Geneva, Dept Psychiat, Fac Med, Med Direct, Geneva, Switzerland..
    Caffeine impact on working memory-related network activation patterns in early stages of cognitive decline2017In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 59, no 4, p. 387-395Article in journal (Refereed)
    Abstract [en]

    Purpose Recent evidence indicates that caffeine may have a beneficial effect on cognitive decline and dementia. The current investigation assessed the effect of acute caffeine administration on working memory during the earliest stage of cognitive decline in elderly participants. Methods The study includes consecutive 45 elderly controls and 18 individuals with mild cognitive impairment (MCI, 71.6 +/- 4.7 years, 7 females). During neuropsychological follow-up at 18 months, 24 controls remained stable (sCON, 70.0 +/- 4.3 years, 11 women), while the remaining 21 showed subtle cognitive deterioration (dCON, 73.4 +/- 5.9 years, 14 women). All participants underwent an established 2-back working task in a crossover design of 200 mg caffeine versus placebo. Data analysis included task-related general linear model and functional connectivity tensorial independent component analysis. Results Working memory behavioral performances did not differ between sCON and dCON, while MCI was slower and less accurate than both control groups (p < 0.05). The dCON group had a less pronounced effect of acute caffeine administration essentially restricted to the right hemisphere (p < 0.05 corrected) and reduced default mode network (DMN) deactivation compared to sCON (p < 0.01 corrected). Conclusion dCON cases are characterized by decreased sensitivity to caffeine effects on brain activation and DMN deactivation. These complex fMRI patterns possibly reflect the instable status of these cases with intact behavioral performances despite already existing functional alterations in neocortical circuits.

  • 22.
    Hellström, Jussi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Romanos Zapata, Romina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Libard, Sylwia
    Alafuzoff, Irina
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Ortiz-Nieto, Francisco
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Clinical value of MR spectroscopy: How often does MRS yield more information than MRI?2015In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 57, no Suppl1, p. 143-144Article in journal (Refereed)
  • 23.
    Hellström, Jussi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Romanos Zapata, Romina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Ortiz-Nieto, Francisco
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Libard, Sylwia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Alafuzoff, Irina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Evaluation of INTERPRET Decision Support System (DSS) in clinical MRS of intracranial lesions and comparison to conventional MRS analysis and MRI.2015In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 57, no Suppl1, p. 67-68Article in journal (Refereed)
  • 24.
    Johansson, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Norbäck, Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Gál, Gyula
    Cesarini, Kristina G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Tovi, Metin
    Solander, Sten
    Contant, C F
    Ronne-Engström, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Enblad, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Clinical outcome after endovascular coil embolization in elderly patients with subarachnoid hemorrhage.2004In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 46, no 5Article in journal (Refereed)
    Abstract [en]

    Subarachnoid hemorrhage (SAH) is not an unusual disease in an elderly population. The clinical outcome has improved over time. It has been suggested that elderly SAH patients would benefit from endovascular aneurysm treatment. The aim of this study was to evaluate technical results and clinical outcome in a series of elderly SAH-patients treated with endovascular coil embolization. Sixty-two patients (> or = 65 years) presenting with aneurysmal SAH underwent early endovascular coil embolization at Uppsala University Hospital between September 1996 and December 2000. In all 62 cases included in the study, endovascular coil embolization was considered the first line of treatment. Admission variables, specific information on technical success, degree of occlusion and procedural complications, and outcome figures were recorded. Clinical grade on admission was Hunt and Hess (H&H) I-II in 39%, H&H III in 27% and H&H IV-V in 34% of the patients. The proportion of posterior circulation aneurysms was 24%. Coil embolization was successfully completed in 94%. The degree of occlusion of the treated aneurysm was complete occlusion in 56%, neck remnant in 21%, residual filling in 11%, other remnant in 5% and not treated in 6%. The rate of procedural complications was 11%. Outcome after 6 months was favorable in 41%, severe disability in 36% and poor in 22%. Favorable outcome was achieved in 57% of the H&H I-II patients, 47% of the H&H III patients and 17% of the H&H IV-V patients. Endovascular aneurysm treatment can be performed in elderly patients with SAH with a high level of technical success, acceptable aneurysm occlusion results, an acceptable rate of procedural complications and fair outcome results.

  • 25. Järnum, Hanna
    et al.
    Steffensen, Elena G.
    Knutsson, Linda
    Fründ, Ernst-Torben
    Simonsen, Carsten Wiberg
    Lundbye-Christensen, Søren
    Shankaranarayanan, Ajit
    Alsop, David C.
    Jensen, Finn Taagehøj
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Perfusion MRI of brain tumours: a comparative study of pseudo-continuous arterial spin labelling and dynamic susceptibility contrast imaging2010In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 52, no 4, p. 307-317Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The purpose of this study was to compare the non-invasive 3D pseudo-continuous arterial spin labelling (PC ASL) technique with the clinically established dynamic susceptibility contrast perfusion magnetic resonance imaging (DSC-MRI) for evaluation of brain tumours. METHODS: A prospective study of 28 patients with contrast-enhancing brain tumours was performed at 3 T using DSC-MRI and PC ASL with whole-brain coverage. The visual qualitative evaluation of signal enhancement in tumour was scored from 0 to 3 (0 = no signal enhancement compared with white matter, 3 = pronounced signal enhancement with equal or higher signal intensity than in grey matter/basal ganglia). The extent of susceptibility artefacts in the tumour was scored from 0 to 2 (0 = no susceptibility artefacts and 2 = extensive susceptibility artefacts (maximum diameter > 2 cm)). A quantitative analysis was performed with normalised tumour blood flow values (ASL nTBF, DSC nTBF): mean value for region of interest (ROI) in an area with maximum signal enhancement/the mean value for ROIs in cerebellum. RESULTS: There was no difference in total visual score for signal enhancement between PC ASL and DSC relative cerebral blood flow (p = 0.12). ASL had a lower susceptibility-artefact score than DSC-MRI (p = 0.03). There was good correlation between DSC nTBF and ASL nTBF values with a correlation coefficient of 0.82. CONCLUSION: PC ASL is an alternative to DSC-MRI for the evaluation of perfusion in brain tumours. The method has fewer susceptibility artefacts than DSC-MRI and can be used in patients with renal failure because no contrast injection is needed.

  • 26. Luoma, Katariina
    et al.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Nummi, P.
    Luukkonen, Ritva
    Manninen, H.
    Riihimäki, Hilkka
    Suitability of cerebrospinal fluid for a signal intensity reference on MRI: Evaluation of signal intensity variations in the lumbosacral dural sac1997In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 39, no 10, p. 728-32Article in journal (Refereed)
    Abstract [en]

    The suitability of the cerebrospinal fluid (CSF) in the lumbosacral dural sac as an internal signal-intensity reference was studied on magnetic resonance imaging (MRI) of the lumbar spine using a surface coil and motion artefact suppression technique. A signal-intensity reference is needed when signal is compared between images, studies or subjects. Homogeneity of the CSF was estimated visually on T2-weighted images of 60 subjects at 1.5 T and of another 60 subjects at 0.1 T. Spines with a severely narrowed dural sac or marked scoliosis were excluded from the study to avoid partial volume effect. CSF was homogeneous in 82% and 73% of the examinations at 1.5 T and 0.1 T, respectively. The type and location of the local inhomogeneities did not relate to local narrowings of the dural sac. The signal intensity of CSF was measured in 108 examinations at 0.1 T after correcting the spatially-dependent signal-intensity non-uniformities with a phantom-based method. The signal-intensity difference between the CSF in the upper and lower lumbar dural sac was less than 10% in 73% of the examinations. The CSF in the lumbosacral dural sac can be a useful signal-intensity reference for estimation of the signal of the adjacent structures in patients without severe narrowing of the dural sac or marked scoliosis. It may contribute to assessing spinal disease processes.

  • 27. Norbäck, Ola
    et al.
    Gál, Gyula
    Johansson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Solander, Sten
    Tovi, Metin
    Persson, Lennart
    Ronne-Engström, Elisabeth
    Enblad, Per
    The establishment of endovascular aneurysm coiling at a neurovascular unit: report of experience during early years.2005In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 47, no 2Article in journal (Refereed)
    Abstract [en]

    The treatment of cerebral aneurysms is changing from surgical clipping to endovascular coiling (EVC) in many neurovascular centres. The aim of this study was to evaluate the technical results and clinical outcome at 6 months in a consecutive series of subarachnoid hemorrhage (SAH) patients treated with EVC, in a situation when the EVC had been established very rapidly as the first line of treatment at a neurovascular centre. The patient material comprised 239 SAH patients (155 women and 84 men, mean age 55 years, age range 16-81) allocated to EVC as the first line of treatment in the acute stage (within 3 weeks of rupture) between September 1996 and December 2000. Clinical grade on admission was Hunt & Hess (H&H) I and II in 42%, H&H III in 25% and H&H grade IV and V in 33% of the patients. The aneurysm was located in the anterior circulation in 82% of the cases. EVC was performed on days 0-3 in 77% of the cases. EVC of the target aneurysm was able to be completed in 222 patients (93%). Complete occlusion was achieved in 126 patients (53%). Procedural complications occurred in 39 patients (16%). Favourable clinical outcome was observed in 57%, severe disability in 28% and poor outcome in 14% of the patients. Favourable outcome was achieved in 77% of H&H I and II patients and in 43% of H&H III-V patients. The multivariate logistic regression analysis revealed that younger age, good neurological grade on admission, absence of intracerebral hematoma and intraventricular hematoma respectively, ICA-PcomA aneurysm location, later treatment and absence of complications were significant predictors of favourable outcome. After interventional training and installation of the X-ray system, the introduction and establishment of EVC at a neurovascular unit can be done in a short period of time and with favourable results. Future studies must concentrate on identifying factors of importance for the choice of interventional or surgical therapy. The results of this study indicate that endovascular therapy may be particularly beneficial in poor-grade patients and in patients with aneurysms in the ICA-PcomA territory.

  • 28.
    Raininko, Raili
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Thelin, L.
    Eeg-Olofsson, Orvar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Atypical focal non-neoplastic brain changes in neurofibromatosis type 1: mass effect and contrast enhancement2001In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 43, no 7, p. 586-90Article in journal (Refereed)
    Abstract [en]

    Children and young adults with neurofibromatosis type 1 often have small high-signal foci on T2-weighted images of the brain. We describe follow-up of two patients in whom one of the foci had atypical features, commonly regarded as signs of a neoplasm. In the first, one lesion showed temporary contrast enhancement and decreasing mass effect. The second developed an expanding lesion that increased minimally in size over 4.5 year's follow-up. The borderline between neoplastic and non-neoplastic lesions seems to be indistinct.

  • 29.
    Romanos Zapata, Romina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Ortiz-Nieto, Fransisco
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Differential diagnosis of brain lesions using MRI, proton MR spectroscopy (MRS) and INTERPRET Decision Making System (DSS): A comparative study2013In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 55, no Suppl1, p. S76-Article in journal (Refereed)
  • 30.
    Romanowski, CAJ
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Centre for Image Analysis.
    Leslie, DF
    Thurfjell, Lennart
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis.
    Ericson, K
    Stone-Elander, S
    Construction of a standard reference for PET studies of methionine accumulation using a computerised brain atlas1997In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 39, no 6, p. 389-393Article in journal (Refereed)
    Abstract [en]

    Positron emission tomography (PET) is valuable for assessing the biochemistry and physiology of the human brain. A computerised brain atlas has been developed which allows demonstration of anatomical regions on PET images and manipulation of these images

  • 31. Salonen, O.
    et al.
    Autti, Taina
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
    Ylikoski, A.
    Erkinjuntti, Timo
    MRI of the brain in neurologically healthy middle-aged and elderly individuals1997In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 39, no 8, p. 537-45Article in journal (Refereed)
    Abstract [en]

    Our purpose was to document the MRI appearances of the brain in healthy middle-aged to elderly subjects. T2- and proton density-weighted axial slices were obtained in 61 volunteers, 30-86 years of age. After visual inspection, signal intensities of brain structures were measured on T2-weighted images. Age-related changes became increasingly apparent after age 50. The main findings were that signal intensity of the white matter increased concomitantly with widening of the cerebrospinal fluid spaces; that basal ganglia remained stable; that high-signal foci in white matter increased in number and size after the age of 50 years; that periventricular high-signal foci were constant after the age of 65 years. Our visual impression of a decrease in signal intensity of the central grey matter with age seems to be mistaken. Pathological processes should be suspected if periventricular foci are found in middle-aged or young subjects.

1 - 31 of 31
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