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Regularly weighing calves helps to assess the efficiency of the rearing period and contributes to animal welfare by allowing more precise feeding and medication application in dairy farming, but many farmers do not weigh their calves regularly. Improving the feasibility of this process is, therefore, important. The use of morphometric measurements has been used to estimate the weight of cattle. However, many studies have focused on adult animals or used a wide age range. As calves experience allometric tissue growth, specific models for certain ranges might be more accurate. Therefore, the aim of this work was to develop a weight estimation model specific for pre-weaned Holstein-Friesian calves using morphometric measurements and to compare the model with another equation previously validated for the same breed with young and adult animals. From four dairy farms, 237 measurements of body weight, heart girth, abdominal girth, hip height, withers height, and body length were taken from Holstein-Friesian male and female calves. Linear and non-linear regression analysis was used to test the relationship between body weight and morphometric measurements, with age, sex, and farm as possible explanatory variables. Selected models were compared with goodness of fit and agreement tests. The final model was able to accurately predict body weight (R2 = 0.96) with a mean difference of -1.4 ± 3.24 kg. Differences in the relationship between body weight and morphometric traits were observed between farms, but not between males and females. The genetics of the animal population at farm level may be responsible for this variability and further studies are needed to understand this variability and improve weight prediction models. The developed model was able to perform better in the agreement tests than the previously validated model for Holstein-Friesian animals, suggesting that different equations should be used depending on the growth phase the animal is in. In addition, a web application has been developed to facilitate the use of the developed model by farmers. This avoids the use of calibrated weight bands, which are usually calibrated for a broader age range or for beef cattle.
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This systematic review aims to evaluate the use of intrathecal baclofen (ITB) for hereditary spastic paraparesis (HSP) treatment. An extensive search in two electronical databases was performed. We identified articles published between 1990 and 2022 (PubMed, Scopus), and applied the following inclusion criteria: diagnosis of HSP at the time of the intervention, either familial or sporadic; report on the effect of ITB in patients with HSP; test trial via either bolus injections or continuous infusion tests; and ITB pump implantation. A data extraction sheet based on the Cochrane Consumers and Communication Review Group's data extraction template was created and adapted to collect relevant data. A qualitative analysis was performed to present the results in narrative summary fashion. A total of 6 studies met our inclusion criteria. 51 patients with HSP had a pre-implantation ITB trial. The time since the diagnosis until the pump implantation ranged from 5 to 30 years. The initial bolus ranged from 20 to 50â µg and the mean doses used at steady state ranged from 65 to 705â µg. An improvement in spasticity was observed on the modified Ashworth Scale in patients treated with ITB. Although all studies reported a subjective gait improvement, not all found an objective improvement in gait. The most common side effect reported was catheter-related problems. The findings of this review support the use of ITB as an effective and a viable option for the treatment of spasticity in HSP refractory to conservative therapies.
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Baclofeno , Inyecciones Espinales , Relajantes Musculares Centrales , Baclofeno/uso terapéutico , Baclofeno/administración & dosificación , Humanos , Relajantes Musculares Centrales/uso terapéutico , Relajantes Musculares Centrales/administración & dosificación , Paraplejía Espástica Hereditaria/tratamiento farmacológico , Bombas de Infusión ImplantablesRESUMEN
OBJECTIVES: The aim of this study was to summarize the current preclinical and clinical evidence on the association between exposure to gadolinium (Gd) compounds and skin toxicity in a setting similar to clinical practice. MATERIALS AND METHODS: A search of MEDLINE and PubMed references from January 2000 to December 2022 was performed using keywords related to gadolinium deposition and its effects on the skin, such as "gadolinium," "gadolinium-based contrast agents," "skin," "deposition," and "toxicity." In addition, cross-referencing was added when appropriate. For preclinical in vitro studies, we included all the studies that analyzed the response of human dermal fibroblasts to exposure to various gadolinium compounds. For preclinical animal studies and clinical studies, we included only those that analyzed animals or patients with preserved renal function (estimated glomerular filtration rate >30 mL/min/1.73 m 2 ), using a dosage of gadolinium-based contrast agents (GBCAs) similar to that commonly applied (0.1 mmol/kg). RESULTS: Forty studies were selected. Preclinical findings suggest that Gd compounds can produce profibrotic responses in the skin in vitro, through the activation and proliferation of dermal fibroblasts and promoting their myofibroblast differentiation. Gadolinium influences the process of collagen production and the collagen content of skin, by increasing the levels of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1. Preclinical animal studies show that Gd can deposit in the skin with higher concentrations when linear GBCAs are applied. However, these deposits decrease over time and are not associated with obvious macroscopic or histological modifications. The clinical relevance of GBCAs in inducing small fiber neuropathy remains to be determined. Clinical studies show that Gd is detectable in the skin and hair of subjects with normal renal function in higher concentrations after intravenous administration of linear compared with macrocyclic GBCA. However, these deposits decrease over time and are not associated with cutaneous or histological modifications. Also, subclinical dermal involvement related to linear GBCA exposure may be detectable on brain MRI. There is no conclusive evidence to support a causal relationship between GBCA administration at the clinical dose and cutaneous manifestations in patients with normal renal function. CONCLUSIONS: Gadolinium can produce profibrotic responses in the skin, especially acting on fibroblasts, as shown by preclinical in vitro studies. Gadolinium deposits are detectable in the skin even in subjects with normal renal function with higher concentrations when linear GBCAs are used, as confirmed by both preclinical animal and human studies. There is no proof to date of a cause-effect relationship between GBCA administration at clinical doses and cutaneous consequences in patients with normal renal function. Multiple factors, yet to be determined, should be considered for sporadic patients with normal renal function who develop clinical skin manifestations temporally related to GBCA administration.
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Compuestos Organometálicos , Enfermedades de la Piel , Animales , Humanos , Medios de Contraste/toxicidad , Gadolinio DTPA , Gadolinio/toxicidad , Inhibidor Tisular de Metaloproteinasa-1 , Enfermedades de la Piel/inducido químicamente , Imagen por Resonancia Magnética , Riñón/diagnóstico por imagen , Riñón/fisiología , EncéfaloRESUMEN
CONTEXT: Horse riding (HR) has gain popularity in Portugal, thereby increasing the number of related injuries. This study identifies frequently occurring injuries in Portuguese riders, the conditions under which they occur, and preventive measures. DESIGN: A retrospective cohort study. METHODS: We included 216 Portuguese riders practicing HR at the time of the study with ≥1 year of experience. Data were obtained from a questionnaire that characterized first and second rider injuries; we opted for a systematic method to assess the riders' injuries, in a temporal order. Questions regarding demographic data, sports-related background, systematic training workload, number and characteristics of the first 2 injuries, and the need for treatment were included in the questionnaire. RESULTS: Most first and second injuries were musculoskeletal, occurred from falling off the horse during training, and primarily affected the lower limb. Rehabilitation was required in almost 50% of all cases. The occurrence of injury was significantly associated with the number of days of training per week, years of experience, height and weight of the rider, and practice of another sport. Riding different horses was also significantly associated with the number of injuries. CONCLUSIONS: The most frequently occurring injuries during HR are musculoskeletal and in the extremities. Injury prevention is essential in HR, as most riders have at least one injury while practicing. Rehabilitation should involve a physiatrist and core strengthening exercises.
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Traumatismos en Atletas , Lesiones de Repetición , Deportes , Humanos , Caballos , Animales , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/prevención & control , Portugal/epidemiología , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
Cavernous malformations (CMs) are benign vascular malformations that maybe seen anywhere in the central nervous system. They are dynamic lesions, growing or shrinking over time and only rarely remaining stable. Size varies from a few millimeters to a few centimeters. CMs can be sporadic or familial, and while most of them are congenital, de novo and acquired lesions may also be seen. Etiology is still unknown. A genetic molecular mechanism has been proposed since a cerebral cavernous malformation gene loss of function was found in both familial and sporadic lesions. Additionally, recent studies suggest that formation of CMs in humans may be associated with a distinctive bacterial gut composition (microbioma). Imaging is fairly typical but may vary according to age, location, and etiology. Follow-up is not well established because CMs patients have a highly unpredictable clinical course. Angiogenic and inflammatory mechanisms have been implicated in disease activity, as well as lesional hyperpermeability and iron deposition. Imaging and serum biomarkers of these mechanisms are under current investigation. Treatment options, including surgery or radiosurgery, are not well defined and are dependent upon multiple factors, including clinical presentation, lesion location, number of hemorrhagic events, and medical comorbidities. Our purpose is to review the imaging features of CMs based on their size, location, and etiology, as well as their differential diagnosis and best imaging approach. New insights in etiology will be briefly considered. Follow-up strategies, including serum and imaging biomarkers, and treatment options will also be discussed.
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Hemangioma Cavernoso del Sistema Nervioso Central , Hemangioma Cavernoso del Sistema Nervioso Central/diagnóstico por imagen , Hemangioma Cavernoso del Sistema Nervioso Central/etiología , Hemangioma Cavernoso del Sistema Nervioso Central/patología , Humanos , Microbioma Gastrointestinal , Biomarcadores/sangre , Edad de InicioAsunto(s)
Neoplasias Encefálicas , Núcleos Cerebelosos , Niño , Medios de Contraste , Gadolinio , Gadolinio DTPA , Globo Pálido , HumanosRESUMEN
After the initial report in 2014 on T1-weighted (T1w) hyperintensity of deep brain nuclei following serial injections of linear gadolinium-based contrast agents (GBCAs), a multitude of studies on the potential of the marketed GBCAs to cause T1w hyperintensity in the brain have been published. The vast majority of these studies found a signal intensity (SI) increase for linear GBCAs in the brain-first and foremost in the dentate nucleus-while no SI increase was found for macrocyclic GBCAs. However, the scientific debate about this finding is kept alive by the fact that SI differences do not unequivocally represent the amount of gadolinium retained. Since the study design of the SI measurement in various brain structures is relatively simple, MRI studies investigating gadolinium-dependent T1w hyperintensity are currently conducted at multiple institutions worldwide. However, methodological mistakes may result in flawed conclusions. In this position statement, we assess the methodological basis of the published retrospective studies and define quality standards for future studies to give guidance to the scientific community and to help identify studies with potentially flawed methodology and misleading results. KEY POINTS: ⢠A multitude of studies has been published on the potential of the marketed GBCAs to cause T1w hyperintensity in the brain. ⢠The gadolinium-dependent T1w hyperintensity in the brain depends on patient's history, types of GBCAs used (i.e., linear vs. macrocyclic GBCAs) and MR imaging setup and protocols. ⢠Quality standards for the design of future studies are needed to standardize methodology and avoid potentially misleading results from retrospective studies.
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Encéfalo/diagnóstico por imagen , Gadolinio DTPA/farmacología , Imagen por Resonancia Magnética/normas , Sociedades Médicas , Medios de Contraste/farmacología , Europa (Continente) , HumanosRESUMEN
Gadolinium-based contrast agents have been considered extremely safe drugs with a low incidence of acute adverse reactions. Most of the reactions are mild and physiologic. However, despite being extremely rare, acute severe adverse reactions, including anaphylaxis, may occur. In this article adverse reactions are discussed with regard to their classification, pathophysiology, symptoms, and risk factors.
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Medios de Contraste/efectos adversos , Hipersensibilidad a las Drogas/etiología , Gadolinio/efectos adversos , Insuficiencia Renal Crónica/inducido químicamente , Humanos , Factores de RiesgoRESUMEN
Clinicians, radiologists, and patients should be aware of the most up-to-date data on the risks of gadolinium-based contrast agent (GBCA) administration. In this review, we discuss in vivo gadolinium retention, particularly brain tissue retention, and potential toxic effects. GBCA pharmacokinetics and biodistribution are reviewed briefly. Based on the more recent published literature and society guidelines, general safety recommendations for clinical practice are provided.
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Medios de Contraste/efectos adversos , Medios de Contraste/farmacocinética , Gadolinio/efectos adversos , Gadolinio/farmacocinética , Imagen por Resonancia Magnética , Distribución Tisular , Enfermedad Crónica , HumanosRESUMEN
Until 2006, the main considerations regarding safety for all gadolinium-based contrast agents (GBCAs) were related to short-term adverse reactions. However, the administration of certain "high-risk" GBCAs to patients with renal failure resulted in multiple reported cases of nephrogenic systemic fibrosis. Findings have been reported regarding gadolinium deposition within the body and various reports of patients who report suffering from acute and chronic symptoms secondary to GBCA's exposure. At the present state of knowledge, it has been proved that gadolinium deposits also occur in the brain, irrespective of renal function and GBCAs stability class. To date, no definitive clinical findings are associated with gadolinium deposition in brain tissue. Gadolinium deposition disease is a newly described and probably infrequent entity. Patients presenting with gadolinium deposition disease may show signs and symptoms that somewhat follows a pattern similar but not identical, and also less severe, to those observed in nephrogenic systemic fibrosis. In this review, we will address gadolinium toxicity focusing on these 2 recently described concerns.
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Encéfalo/metabolismo , Medios de Contraste/efectos adversos , Medios de Contraste/metabolismo , Gadolinio/efectos adversos , Gadolinio/metabolismo , Disfunción Cognitiva/inducido químicamente , Medios de Contraste/química , Medios de Contraste/farmacocinética , Gadolinio/química , Gadolinio/farmacocinética , Humanos , Imagen por Resonancia Magnética , Dolor/inducido químicamente , Insuficiencia Renal Crónica/complicaciones , Enfermedades de la Piel/inducido químicamenteRESUMEN
Head and neck cancers are a diverse group of cancers with high morbidity and mortality within an area of complex anatomy. High-quality anatomic and functional imaging is essential for preoperative, chemotherapeutic, and radiotherapy planning. Early studies show that hybrid PET-MR imaging offers great potential for improving the imaging of head and neck cancers. Furthermore, advanced MR imaging techniques may also be incorporated to further enhance the diagnostic value of the combined modality.
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Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Imagen Multimodal/métodos , Tomografía de Emisión de Positrones/métodos , Cabeza/diagnóstico por imagen , Humanos , Cuello/diagnóstico por imagenRESUMEN
Over the last 2years several studies have been published regarding gadolinium deposition in brain structures in patients with normal renal function after repeated administrations of gadolinium-based contrast agents (GBCAs). Most of the publications are magnetic resonance imaging (MRI) based retrospective studies, where gadolinium deposition may be indirectly measured by evaluating changes in T1 signal intensity (SI) in brain tissue, particularly in the dentate nucleus (DN) and/or globus pallidi (GP). The direct correlation between T1 signal changes and gadolinium deposition was validated by human pathology studies. However, the variability of the MR equipment and parameters used across different publications, along with the inherent limitations of MRI to assess gadolinium in human tissues should be acknowledged when interpreting those studies. Nevertheless, MRI studies remain essential regarding gadolinium bio-distribution knowledge. The aim of this paper is to overview current knowledge of technical aspects of T1 signal intensity evaluation by MRI and describe confounding factors, with the intention to achieve higher accuracy and maximize reproducibility.
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Encéfalo/diagnóstico por imagen , Encéfalo/patología , Medios de Contraste/administración & dosificación , Gadolinio/administración & dosificación , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Mapeo Encefálico/métodos , Medios de Contraste/efectos adversos , Femenino , Gadolinio/efectos adversos , Gadolinio DTPA , Humanos , Reproducibilidad de los ResultadosRESUMEN
Gadolinium based contrast agents (GBCAs) play an important role in the diagnostic evaluation of many patients. The safety of these agents has been once again questioned after gadolinium deposits were observed and measured in brain and bone of patients with normal renal function. This retention of gadolinium in the human body has been termed "gadolinium storage condition". The long-term and cumulative effects of retained gadolinium in the brain and elsewhere are not as yet understood. Recently, patients who report that they suffer from chronic symptoms secondary to gadolinium exposure and retention created gadolinium-toxicity on-line support groups. Their self-reported symptoms have recently been published. Bone and joint complaints, and skin changes were two of the most common complaints. This condition has been termed "gadolinium deposition disease". In this review we will address gadolinium toxicity disorders, from acute adverse reactions to GBCAs to gadolinium deposition disease, with special emphasis on the latter, as it is the most recently described and least known.
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Encefalopatías/inducido químicamente , Encefalopatías/terapia , Hipersensibilidad a las Drogas/terapia , Gadolinio/efectos adversos , Dermopatía Fibrosante Nefrogénica/inducido químicamente , Dermopatía Fibrosante Nefrogénica/terapia , Enfermedades Óseas/inducido químicamente , Enfermedades Óseas/terapia , Huesos/efectos de los fármacos , Huesos/metabolismo , Encéfalo/efectos de los fármacos , Encéfalo/metabolismo , Medios de Contraste/efectos adversos , Gadolinio/metabolismo , Humanos , Artropatías/inducido químicamente , Artropatías/terapiaRESUMEN
Myelopathy describes any neurologic deficit related to the spinal cord. It is most commonly caused by its compression by neoplasms, degenerative disc disease, trauma, or infection. Less common causes of myelopathy include spinal cord tumors, infection, inflammatory, neurodegenerative, vascular, toxic, and metabolic disorders. Conditions affecting the spinal cord must be recognized as early as possible to prevent progression that may lead to permanent disability. Biopsy is rarely performed, thus the diagnosis and management rely on patient׳s history, physical examination, laboratory results, and imaging findings. Here we review the clinical presentations, pathophysiological mechanisms, and magnetic resonance imaging findings of myelopathies related to metabolic or toxic etiologies.
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Enfermedades Carenciales/complicaciones , Neuroimagen/métodos , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/etiología , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Enfermedades de la Médula Espinal/inducido químicamenteRESUMEN
PURPOSE: Plasma volume and blood volume are imaging-derived parameters that are often used to evaluation intracranial tumors. Physiologically, these parameters are directly related, but their two different methods of measurements, T1-dynamic contrast enhanced (DCE)- and T2-dynamic susceptibility contrast (DSC)-MR utilize different model assumptions and approaches. This poses the question of whether the interchangeable use of T1-DCE-MRI derived fractionated plasma volume (vp) and relative cerebral blood volume (rCBV) assessed using DSC-MRI, particularly in glioblastoma, is reliable, and if this relationship can be generalized to other types of brain tumors. Our goal was to examine the hypothetical correlation between these parameters in three most common intracranial tumor types. METHODS: Twenty-four newly diagnosed, treatment naïve brain tumor patients, who had undergone DCE- and DSC-MRI, were classified in three histologically proven groups: glioblastoma (n = 7), meningioma (n = 9), and intraparenchymal metastases (n = 8). The rCBV was obtained from DSC after normalization with the normal-appearing anatomically symmetrical contralateral white matter. Correlations between these parameters were evaluated using Pearson (r), Spearman's (ρ) and Kendall's tau-b (τB) rank correlation coefficient. RESULTS: The Pearson, Spearman and Kendall's correlation between vp with rCBV were r = 0.193, ρ = 0.253 and τB = 0.33 (p-Pearson = 0.326, p-Spearman = 0.814 and p-Kendall = 0.823) in glioblastoma, r = -0.007, ρ = 0.051 and τB = 0.135 (p-Pearson = 0.970, p-Spearman = 0.765 and p-Kendall = 0.358) in meningiomas, and r = 0.289, ρ = 0.228 and τB = 0.239 (p-Pearson = 0.109, p-Spearman = 0.210 and p-Kendall = 0.095) in metastasis. CONCLUSION: Results indicate that no correlation exists between vp with rCBV in glioblastomas, meningiomas and intraparenchymal metastatic lesions. Consequently, these parameters, as calculated in this study, should not be used interchangeably in either research or clinical practice.
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Neoplasias Encefálicas/fisiopatología , Volumen Sanguíneo Cerebral , Volumen Plasmático , Adulto , Anciano , Neoplasias Encefálicas/sangre , Neoplasias Encefálicas/clasificación , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To describe the clinical manifestations of presumed gadolinium toxicity in patients with normal renal function. MATERIALS AND METHODS: Participants were recruited from two online gadolinium toxicity support groups. The survey was anonymous and individuals were instructed to respond to the survey only if they had evidence of normal renal function, evidence of gadolinium in their system beyond 30days of this MRI, and no pre-existent clinical symptoms and/or signs of this type. RESULTS: 42 subjects responded to the survey (age: 28-69, mean 49.1±22.4years). The most common findings were: central pain (n=15), peripheral pain (n=26), headache (n=28), and bone pain (n=26). Only subjects with distal leg and arm distribution described skin thickening (n=22). Clouded mentation and headache were the symptoms described as persistent beyond 3months in 29 subjects. Residual disease was present in all patients. Twenty-eight patients described symptoms following administration of one brand of Gadolinium-Based Contrast Agent (GBCA), 21 after a single GBCA administration and 7 after multiple GBCA administrations, including: gadopentetate dimeglumine, n=9; gadodiamide, n=4; gadoversetamide, n=4; gadobenate dimeglumine, n=4; gadobutrol, n=1; gadoteridol, n=2; and unknown, n=4. CONCLUSIONS: Gadolinium toxicity appears to arise following GBCA administration, which appears to contain clinical features seen in Nephrogenic Systemic Fibrosis, but also features not observed in that condition.
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Medios de Contraste/efectos adversos , Gadolinio/efectos adversos , Imagen por Resonancia Magnética , Adulto , Anciano , Femenino , Gadolinio/orina , Gadolinio DTPA/efectos adversos , Gadolinio DTPA/orina , Compuestos Heterocíclicos/efectos adversos , Compuestos Heterocíclicos/orina , Humanos , Masculino , Meglumina/efectos adversos , Meglumina/análogos & derivados , Meglumina/orina , Persona de Mediana Edad , Compuestos Organometálicos/efectos adversos , Compuestos Organometálicos/orina , Dolor/inducido químicamente , Estudios ProspectivosRESUMEN
OBJECTIVE: The literature informs us that gadolinium can cause health issues. At least four major gadolinium disorders, including the two well-recognized nephrogenic systemic fibrosis and severe acute adverse event, have been identified. CONCLUSION: We propose naming the histopathologically proven presence of gadolinium in brain tissue "gadolinium storage condition," and we describe a new entity that represents symptomatic deposition of gadolinium in individuals with normal renal function, for which we propose the designation "gadolinium deposition disease."
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Encefalopatías/inducido químicamente , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Gadolinio/efectos adversos , Dermopatía Fibrosante Nefrogénica/inducido químicamente , Medios de Contraste/efectos adversos , Humanos , Terminología como AsuntoRESUMEN
OBJECTIVES: To evaluate the impact of previous administration of gadodiamide and neural tissue gadolinium deposition in patients who received gadobenate dimeglumine. METHODS: Our population included 62 patients who underwent at least three administrations of gadobenate dimeglumine, plus an additional contrast-enhanced last MRI for reference, divided into two groups: group 1, patients who in addition to gadobenate dimeglumine administrations had prior exposure to multiple doses of gadodiamide; group 2, patients without previous exposure to other gadolinium-based contrast agent (GBCAs). Quantitative analysis was performed on the first and last gadobenate dimeglumine MRIs in both groups. Dentate nucleus-to-middle cerebellar peduncle signal intensity ratios (DN/MCP) and relative change (RC) in signal over time were calculated and compared between groups using generalized additive model. RESULTS: Group 1 showed significant increase in baseline and follow-up DN/MCP compared to group 2 (p < 0.0001). The RC DN/MCP showed a non-statistically significant trend towards an increase in patients who underwent previous gadodiamide (p = 0.0735). CONCLUSION: There is increased T1 signal change over time in patients who underwent gadobenate dimeglumine and had received prior gadodiamide compared to those without known exposure to previous gadodiamide. A potentiating effect from prior gadodiamide on subsequent administered gadobenate dimeglumine may occur. KEY POINTS: ⢠Neural gadolinium deposition is associated with multiple administrations of less stable GBCAs. ⢠Less stable GBCA effect on subsequent more stable GBCA administrations is undetermined. ⢠Significant increase of DN/MCP was seen in patients with previous gadodiamide exposure. ⢠RC DN/MCP showed a non-significant increase in patients who received previous gadodiamide. ⢠Potentiating effects from prior gadodiamide on subsequent administered gadobenate dimeglumine may occur.
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Núcleos Cerebelosos/metabolismo , Medios de Contraste/farmacología , Gadolinio DTPA/farmacología , Gadolinio/metabolismo , Meglumina/análogos & derivados , Compuestos Organometálicos/farmacología , Adulto , Anciano , Anciano de 80 o más Años , Cerebelo/metabolismo , Medios de Contraste/administración & dosificación , Femenino , Gadolinio/farmacología , Gadolinio DTPA/administración & dosificación , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética/métodos , Masculino , Meglumina/administración & dosificación , Meglumina/farmacología , Persona de Mediana Edad , Compuestos Organometálicos/administración & dosificaciónRESUMEN
ABSTRACT Traumatic brain injury (TBI) represents a significant public health problem in modern societies. It is primarily a consequence of traffic-related accidents and falls. Other recently recognized causes include sports injuries and indirect forces such as shock waves from battlefield explosions. TBI is an important cause of death and lifelong disability and represents the most well-established environmental risk factor for dementia. With the growing recognition that even mild head injury can lead to neurocognitive deficits, imaging of brain injury has assumed greater importance. However, there is no single imaging modality capable of characterizing TBI. Current advances, particularly in MR imaging, enable visualization and quantification of structural and functional brain changes not hitherto possible. In this review, we summarize data linking TBI with dementia, emphasizing the imaging techniques currently available in clinical practice along with some advances in medical knowledge.
RESUMO O traumatismo cranioencefálico (TCE) representa um importante problema de saúde pública nas sociedades modernas. As suas principais causas são: os acidentes de trânsito e as quedas. O traumatismo leve e repetido relacionado com os esportes de contato ou o traumatismo relacionado com as ondas de choque provenientes de explosões em cenário de guerra são hoje reconhecidas como importantes causas de TCE. A mortalidade e morbilidade associada ao TCE é considerável. TCE representa o fator de risco ambiental melhor reconhecido para o desenvolvimento de demência. Com o reconhecimento recente de que até o TCE leve pode determinar déficts cognitivos, os estudos de imagem adquiriram grande importância neste contexto. Contudo, não está definido qual o melhor estudo de imagem para caracterizar o TCE. Avanços tecnológicos, como a ressonância magnética, permitem atualmente identificar e quantificar alterações intra-parenquimatosas estruturais e funcionais, não detectáveis nos estudos convencionais. Neste artigo os autores resumem os estudos que relacionam TCE e demência, dando particular ênfase às técnicas de imagem atualmente disponíveis na prática clínica, bem como alguns avanços nos métodos de imagem ainda limitados ao plano da investigação.