Amit M Saindane’s research while affiliated with Emory University and other places

Introduction White matter hyperintensities (WMHs) are strongly linked to cardiovascular risk factors and other health conditions such as Alzheimer’s disease. However, there is a dearth of research on this topic in low-income countries and underserved populations, especially in the Democratic Republic of Congo (DRC) where the population is aging rapidly with increasing cardiovascular risk factors and dementia-related diseases. This study evaluates health factors associated with WMH in the elderly Sub-Saharan Africa (SSA), specifically Congolese adults. Methods In a cross-sectional study of 77 people from the DRC, participants underwent neuroimaging to analyze WMHs volume and completed clinical evaluation, laboratory-based blood exams, self-reported questionnaires, and interviews. A simple linear regression model was conducted to test the association between WMHs and potential predictors (dementia, age, sex, hypertension, diabetes, tobacco abuse, stroke, high cholesterol, cardiovascular medication, and alcohol abuse). Stepwise selection and backward elimination analyses were performed to obtain the final model. Finally, a multiple linear regression model was conducted to assess the association between WMHs and variables retained in the final model (dementia, sex, and age). Results Of the 77 individuals, 47 (61%) had dementia, 40 (52.6%) were males, and the mean age was 73 years (± 8.0 years standard deviation). In simple linear regression models, WMHs was significantly associated with dementia (expβ1 = 1.75, 95% CI = 1.14–2.71, p -value = 0.01) though it had a weak association with age (expβ1 = 1.03, 95% CI = 1.00–1.05, p -value = 0.05) and sex (male) (expβ1 = 0.66, 95% CI = 0.43–1.01, p -value = 0.05). In multiple linear regression models, WMHs was statistically significantly associated with dementia (expβ1 = 1.97, 95% CI = 1.31–2.95, p -value =0.001), male sex (expβ2 = 0.54, 95% CI = 0.36–0.80, p -value = 0.003), and age (expβ3 = 1.03, 95% CI = 1.00–1.06, p -value = 0.03). However, WMHs was not significantly associated with common cardiovascular risk factors, such as high blood pressure, diabetes, tobacco use, obesity, and high cholesterol levels. Discussion WMHs is significantly associated with dementia, sex, and age in the Congolese population. Understanding these predictors may improve our ability to diagnose, assess, and develop preventative treatments for white matter disease in SSA/DRC populations, where neuroimaging is difficult to obtain.

Background: Beginning in 2006, neuroradiologists became increasingly aware of the risk of nephrogenic system fibrosis (NSF) when patients suffering from chronic kidney disease (CKD) received gadolinium-based contrast agents (GBCAs) in conjunction with MRI scans. Radiology practices began withholding GBCAs from MRI patients with substantial CKD and instated a variety of safety measures to ensure that these individuals did not inadvertently receive GBCAs. As a result, the worldwide incidence of NSF was dramatically reduced. Since that time, a wealth of research on NSF and its etiology has found few unconfounded cases associated with those GBCAs categorized as Group II agents by the American College of Radiology. Methods: In 2023 and 2024, members of the American Society of Neuroradiology (ASNR) Standards and Guidelines Committee reviewed new research evidence on GBCA safety and its relevance to current MRI contrast administration guidelines for patients with CKD. This focused on systematic reviews and meta-analyses conducted during the past five years. Upon consideration of this literature, recommendations for administration of GBCAs to patients with CKD were formulated. Key message: For neuroimaging applications, the ASNR recommends that Group II GBCAs no longer be withheld in patients with CKD when these agents are medically indicated for diagnosis. Moreover, if Group II GBCAs are exclusively used in an MRI practice, other safety measures such as checking renal function or querying patients about chronic kidney disease can be discontinued. Abbreviations: ACR = American College of Radiology; ASNR = American Society of Neuroradiology; CKD = chronic kidney disease; GBCA = gadolinium-based contrast agent; NSF = nephrogenic systemic fibrosis.

Background White matter hyperintensities (WMHs) are strongly linked to cardiovascular risk factors and other health conditions such as Alzheimer’s disease. However, there is a dearth of research on this topic in low-income countries and underserved populations, especially in the Democratic Republic of Congo (DRC) where the population is aging rapidly with increasing cardiovascular risk factors and dementia-related diseases. This study evaluates health factors associated with WMH in the elderly Sub-Saharan Africa (SSA), specifically Congolese adults. Methods In a cross-sectional study of 77 people from the DRC, participants underwent neuroimaging to analyze WMH volume and completed clinical evaluation, laboratory-based blood exams, self-reported questionnaires, and interviews. A simple linear regression model was conducted to test the association between WMH and potential predictors (neurological status, age, sex, hypertension, diabetes, tobacco abuse, stroke, high cholesterol, cardiovascular medication, and alcohol abuse). Stepwise selection and backward elimination analyses were performed to obtain the final model. Finally, a multiple linear regression model was conducted to assess the association between WMH and variables retained in the final model (neurological status, sex, and age). Results Of the 77 individuals, 47 (61%) had dementia, 40 (52.6%) were males, and the mean age was 73 years (± 8.0 years standard deviation). In simple linear regression models, WMH was significantly associated with dementia (expβ1=1.75, 95% CI=1.14 – 2.71, p-value=0.01) though it had a weak association with age (expβ1=1.03, 95% CI=1.00 – 1.05, p-value=0.05) and sex (male) (expβ1=0.66, 95% CI=0.43 – 1.01, p-value=0.05). In multiple linear regression models, WMH was statistically significantly associated with dementia (expβ1=1.97, 95% CI=1.31 – 2.95, p-value =0.001), male sex (expβ2=0.54, 95% CI=0.36 – 0.80, p-value=0.003), and age (expβ3=1.03, 95% CI=1.00 – 1.06, p-value=0.03). However, WMH was not significantly associated with common cardiovascular risk factors, such as high blood pressure, diabetes, tobacco use, obesity, and high cholesterol levels. Conclusion WMH is significantly associated with neurological status, sex, and age in the Congolese population. Understanding these predictors may improve our ability to diagnose, assess, and develop preventative treatments for white matter disease in SSA/DRC populations, where neuroimaging is difficult to obtain.

Introduction Recent diagnostic criteria for optic neuritis include T2-hyperintensity of the optic nerve (ON), even without associated contrast enhancement. However, isolated ON-T2-hyperintensity is a nonspecific finding found in any optic neuropathy or severe retinopathy. We applied the 2022 optic neuritis diagnostic criteria to a cohort of patients with noninflammatory optic neuropathy and ON-T2-hyperintensity in at least one eye, to assess the rate of optic neuritis misdiagnosis using these criteria. Methods Retrospective study of consecutive patients who underwent brain/orbit MRI with/without contrast between 07/01/2019 and 06/30/2022. Patients with ON-T2-hyperintensity in at least one eye were included. The 2022 optic neuritis diagnostic criteria were applied to patients with noninflammatory optic neuropathies who had an ophthalmologic examination available for review. Results Of 150 patients included, 85/150 had compressive optic neuropathy; 32/150 had glaucoma; 12/150 had papilledema; 8/150 had hereditary (3), radiation-induced (3), nutritional (1), traumatic (1) optic neuropathies (none fulfilled the criteria); 13/150 had ischemic optic neuropathy and 4 fulfilled the criteria as definite optic neuritis due to contrast enhancement of the ON head. Seven additional patients would have satisfied the diagnostic criteria if red flags for alternative diagnoses had been overlooked. Discussion The application of the 2022 optic neuritis diagnostic criteria in patients with noninflammatory optic neuropathy and ON-T2-hyperintensity in at least one ON resulted in misdiagnosis of optic neuritis in only 4 patients because of ON head enhancement, all with nonarteritic anterior ischemic optic neuropathy. Neuro-ophthalmologic evaluation and exclusion of the ON head as a location in the MRI criteria would have prevented optic neuritis misdiagnosis in our study.

Background/objectives: To report a series of patients with glaucoma and optic nerve abnormalities on magnetic resonance imaging (MRI) in at least one-eye, and to determine whether these findings correlate with the severity of glaucoma. Patients and methods: Retrospective study of all patients who underwent a brain/orbits MRI without and with contrast at our institution between 07/1/2019-6/30/2022. Patients with optic nerve T2-hyperintensity and/or MRI optic nerve atrophy in at least one-eye and a diagnosis of isolated glaucoma in at least one-eye were included. Demographic information, glaucoma clinical characteristics, glaucoma severity parameters, and MRI indication were collected. Results: Fifty-six patients (112 eyes) (age 65 years-old [range 26-88]; 70% male) had isolated bilateral glaucoma with at least one-eye MRI optic nerve abnormality. The indication for MRI was atypical/asymmetric glaucoma in 91% of patients. Of the 112 eyes, 23 had optic nerve T2-hyperintensity alone; 33 had both optic nerve T2-hyperintensity and MRI optic nerve atrophy; 34 had MRI optic nerve atrophy alone; and 22 did not have abnormal optic nerve MRI-findings. None had optic nerve enhancement. A statistically significant association between optic nerve T2-hyperintensity or MRI optic nerve atrophy and glaucoma severity parameters was found. Conclusions: Glaucoma is a clinical diagnosis and MRI brain is usually not required, except in atypical or asymmetric cases. Optic nerve T2-hyperintensity and MRI optic nerve atrophy are nonspecific MRI-findings that can be found in severe glaucomatous optic nerves and should not systematically prompt investigations for another cause of optic neuropathy.

Objective Hippocampal and medial temporal lobe structure atrophy is commonly observed in patients with mild neurocognitive disorders and dementias of various neurodegenerative conditions, with the degree of atrophy in these regions correlating with cognitive performance on memory tasks. This research has been conducted largely in western and educated countries. As cognitive aging, risk factors, clinical course, and neuropathology can differ between individuals of different races and ethnicities, our goal is to determine whether these findings also generalize to patients with suspected dementias living in the Democratic Republic of the Congo (DRC). Participants and Methods Neuroimaging and cognitive data have been collected on 40 subjects with probable dementia from the DRC and 40 age-, education-, and gender-matched controls. Patients were classified into groups based on scores on the Community Screening Instrument and the Alzheimer's Questionnaire. All participants completed the African Neuropsychological Battery. T1 MPRAGE images were acquired on Siemens 1.5T scanner. Freesurfer was used to derive volumes and cortical thickness of medial temporal lobe regions. Volumes of structures were divided by intracranial vault volumes to adjust for head size. T-tests were used to compare hippocampal volumes, entorhinal cortex thickness, and perirhinal cortex thickness between subjects with probable dementia compared to healthy age-, gender-, and education-matched controls. Bivariate correlations were conducted to determine whether the volumes of these structures correlate significantly with learning and memory measures on the ANB. Results Results will be determined by the methods described previously. Conclusions Results from this study will demonstrate whether structural brain changes commonly seen in individuals with dementia living in western and educated countries also are observed in the DRC. Results will also demonstrate whether these brain changes coincide with the degree of impairments on tasks of memory, and whether these structures can be used to aid in clinical diagnosis of patients with dementia and support the use of the ANB and neuroimaging in clinical detection of dementias in the DRC.