RESUMO
For patients with amyotrophic lateral sclerosis (ALS), the primary therapeutic goal is to minimize morbidity. Non-invasive ventilation improves survival. We aim to assess whether Magnetic Resonance Imaging (MRI) of the cervical spinal cord predicts the progression of respiratory disorders in ALS. Brain and spinal MRI was repeatedly performed in the SOD1G86R mouse model, in 40 patients and in healthy controls. Atrophy, iron overload, white matter diffusivity and neuronal loss were assessed. In Superoxide Dismutase-1 (SOD1) mice, iron accumulation appeared in the cervical spinal cord at symptom onset but disappeared with disease progression (after the onset of atrophy). In ALS patients, the volumes of the motor cortex and the medulla oblongata were already abnormally low at the time of diagnosis. Baseline diffusivity in the internal capsule was predictive of functional handicap. The decrease in cervical spinal cord volume from diagnosis to 3 months was predictive of the change in slow vital capacity at 12 months. MRI revealed marked abnormalities at the time of ALS diagnosis. Early atrophy of the cervical spinal cord may predict the progression of respiratory disorders, and so may be of value in patient care and as a primary endpoint in pilot neuroprotection studies.
Assuntos
Esclerose Lateral Amiotrófica/patologia , Medula Cervical/patologia , Doenças Respiratórias/patologia , Medula Espinal/patologia , Esclerose Lateral Amiotrófica/metabolismo , Animais , Medula Cervical/metabolismo , Modelos Animais de Doenças , Progressão da Doença , Humanos , Imageamento por Ressonância Magnética/métodos , Bulbo/metabolismo , Bulbo/patologia , Camundongos , Córtex Motor/metabolismo , Córtex Motor/patologia , Neurônios Motores/metabolismo , Neurônios Motores/patologia , Doenças Respiratórias/metabolismo , Medula Espinal/metabolismo , Superóxido Dismutase-1/metabolismo , Substância Branca/metabolismo , Substância Branca/patologiaRESUMO
Surgical resection of gliomas involving eloquent brain areas must be maximal in order to improve patients' survival, and safe to prevent postoperative impairments. Therefore, the precise spatial relationship between the lesion and eloquent brain areas needs to be established. Functional magnetic resonance imaging and diffusion tensor imaging are robust methods with increasing indications in neurosurgery for past decade. The aim of this review article is not only to pinpoint the major limitations of these methods in order to avoid erroneous conclusions, but also to detail practical aspects associated with the main paradigms routinely used in functional magnetic resonance imaging, and to discuss recent validation of functional magnetic resonance imaging and diffusion tensor imaging results with direct electrical stimulation during awake surgery.