Brain perfusion during manic episode and at 6-month follow-up period in bipolar disorder patients: Correlation with cognitive functions.

BACKGROUND: Patterns of altered cerebral perfusion and cognitive dysfunction have been described in Bipolar Disorder (BD) acute episodes and euthymia. Knowledge of the relationship between cognitive function and perfusion in a manic state and status when followed up is still limited. OBJECTIVE: To describe brain perfusion alterations and its relationship with cognitive impairment in patients with BD during manic episodes and after 6 months. METHODS: Observational-prospective study in 10 type I BD adults during moderate-severe manic episodes. We assessed sociodemographic data and clinical variables as well as cognitive function through Screening for Cognitive Impairment in Psychiatry (SCIP-S). Finally, we performed a Brain Perfusion SPECT using a Tc99m-ethyl cysteine dimer. RESULTS: During manic episodes, patients showed cognitive impairment with a mean SCIP-S score of 63.8 ± 17.16. This was positively correlated with perfusion measured as relative reuptake index (RRI) at the right temporal pole (ρ = 0.65 p = .0435) and negatively correlated with right the orbitofrontal cortex (ρ = -0.70 p = .0077) and the right subgenual cingulate cortex (ρ = -0.70 p = .0256). Episode severity measured by the Young Mania Rating Scale (YMRS) positively correlated with RRI at the right temporal pole (ρ = 0.75, p = .01). At follow-up, six patients were taking treatment and were euthymic, we found a negative correlation with the YMRS and RRI at the bilateral orbitofrontal cortex (ρ = -0.8827, p = .019). They did not show significant improvement in cognitive performance at SCIP-S, and there was negative correlation with the following of the SCIP-S subscales; processing speed with the bilateral dorsolateral prefrontal, the bilateral medial prefrontal, the left temporal pole cortex RRI, and verbal fluency with the bilateral anterior cingulate cortex RRI. CONCLUSION: Cognitive impairment was correlated with brain perfusion patterns at baseline and follow-up. Large sample size studies with longer follow-up are needed to describe the changes in perfusion and cognitive functions in BD.

[Validation of MRI and 18F-FDG-PET coregistration in patients with primary brain tumors]. / Evaluación del corregistro de imágenes de resonancia magnética y tomografía por emisión de positrones con 2-desoxy-2-flúor-d-glucosa marcada con flúor-18 en pacientes con patología tumoral cerebral.

OBJECTIVE: To evaluate the role of PET and MRI fused image study inpatients with primary brain tumors previously treated, to determine the presence of radionecrosis vs residual tumor viability. METHODS: Primary brain tumors were diagnosed by biopse and MR. 18FDG-PET scan and T1 enhanced MRI follow-up studies were performed between 3 and 5 months after treatment. The 18F-FDG uptake was semiquantitavively calculated by a region-of-interest based Tumor hotspot/normal brain tissue index. RESULTS: Fifty-seven patients were studied, 37 had high grade gliomas; 9 had oligoastrocytomas; 5 had Embrionary tumors; I had a meningyoma and I had an oliodendroglial tumor. All MR studies showed tumor enhancement, without determine wether if it was radionecrosis or tumor viability. PET/MR fused study diagnosed 21 negative studies (30%) and 36 positive results (70%). Tumor hotspot/normal brain tissue index correlated well with the visual analysis registered. CONCLUSIONS: Visual analysis in the contrast enhanced MR overestimates the tumoral area, without defining a possible diagnosis between tumor viability and radionecrosis. Metabolic activity in the 18F-FDG PET study in the enhanced area, determines the presence of residual tumor viability. Therefore, coregistration can be used to obtain a more specific diagnosis optimizing the cinical use.

Evaluación del corregistro de imágenes de resonancia magnética y tomografía por emisión de positrones con 2-desoxy-2-flúor-d-glucosa marcada con flúor-18 en pacientes con patología tumoral cerebral / Validation of MRI and 18F-FDG-PET coregistration in patients with primary brain tumors

Objetivo: Determinar la efectividad del co-registro de imágenes PET/RM (tomografía de emisión de positrones y resonancia magnética) en el diagnóstico de recidiva tumoral vs.. radionecrosis en pacientes con patología tumoral cerebral primaria previamente tratados. Material y métodos: El diagnóstico de tumor cerebral se determinó por RM e histopatología. Después de 3 a 5 meses postratamiento se realizó RM y PET como parte del seguimiento. El análisis de dichas imágenes se hizo de manera visual y semicuantitativa mediante la obtención de un índice de captación de 18F-FDG de tejido tumoral/ tejido cerebral sano. Resultados: Se estudiaron 57 pacientes; un total de 37 gliomas astrocíticos, 9 gliomas mixtos, 5 tumores embrionarios, 1 tumor meníngeo y 1 tumor oligodendroglial . Todas las imágenes de RM presentaban áreas de reforzamiento, dejando sospecha entre radionecrosis o viabilidad tumoral; con el co-registro PET/RM se diagnosticaron 21 estudios negativos (30 %) y 36 positivos (70 %). El índice tejido tumoral/tejido cerebral sano se correlacionó adecuadamente con los resultados visuales obtenidos. Conclusión: La RM sobreestima el área tumoral a valorar. La presencia de la actividad metabólica analizada mediante PET sobre las áreas de reforzamiento por RM permite determinar la presencia de viabilidad tumoral. Esto aumenta la certeza diagnóstica de ambas técnicas de imagen.

OBJECTIVE: To evaluate the role of PET and MRI fused image study inpatients with primary brain tumors previously treated, to determine the presence of radionecrosis vs residual tumor viability. METHODS: Primary brain tumors were diagnosed by biopse and MR. 18FDG-PET scan and T1 enhanced MRI follow-up studies were performed between 3 and 5 months after treatment. The 18F-FDG uptake was semiquantitavively calculated by a region-of-interest based Tumor hotspot/normal brain tissue index. RESULTS: Fifty-seven patients were studied, 37 had high grade gliomas; 9 had oligoastrocytomas; 5 had Embrionary tumors; I had a meningyoma and I had an oliodendroglial tumor. All MR studies showed tumor enhancement, without determine wether if it was radionecrosis or tumor viability. PET/MR fused study diagnosed 21 negative studies (30%) and 36 positive results (70%). Tumor hotspot/normal brain tissue index correlated well with the visual analysis registered. CONCLUSIONS: Visual analysis in the contrast enhanced MR overestimates the tumoral area, without defining a possible diagnosis between tumor viability and radionecrosis. Metabolic activity in the 18F-FDG PET study in the enhanced area, determines the presence of residual tumor viability. Therefore, coregistration can be used to obtain a more specific diagnosis optimizing the cinical use.