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Intracranial pressure (ICP) is well recognised as a critical parameter to both measure and influence in the management of the head injured patient. Since Lundberg’s seminal studies, ICP has arguably become the major focus of monitoring in head injury, as well as a number of other neurosurgical scenarios.1 Mean ICP and the features that make up the ICP waveform provide insight into the state of elastance and compliance of the injured brain, impending trends and events related to changes in intracranial pathophysiology, and also end-prognosis in traumatic brain injury (TBI).
Ultrasmall paramagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) imaging is a promising noninvasive method to identify high-risk atheromatous plaques. Iron oxide particles function as contrast-enhancing agents by creating a large dipolar magnetic field gradient that acts on the water molecules that diffuse close to the particles. Howarth reported that USPIO appeared to show a dual contrast effect with signal enhancement being seen in plaques with little inflammation and large fibrous caps. The contralateral side of symptomatic patients given USPIO were also analyzed. It was found that 95% patients showed bilateral USPIO uptake suggesting an inflammatory burden within their carotid atheroma bilaterally. Three different approaches have been adopted to make the seemly impossible task a reality: ultrashort echo times (uTE), inversion recovery on-resonance water suppression (IRON) imaging, and Gradient echo acquisition for superparamagnetic particles with positive contrast (GRASP).
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