ABSTRACT
OBJECTIVE: The cerebellum is involved in cognitive processing and emotion control. Cerebellar alterations could explain symptoms of schizophrenia spectrum disorder (SZ) and bipolar disorder (BD). In addition, literature suggests that lithium might influence cerebellar anatomy. Our aim was to study cerebellar anatomy in SZ and BD, and investigate the effect of lithium. METHODS: Participants from 7 centers worldwide underwent a 3T MRI. We included 182 patients with SZ, 144 patients with BD, and 322 controls. We automatically segmented the cerebellum using the CERES pipeline. All outputs were visually inspected. RESULTS: Patients with SZ showed a smaller global cerebellar gray matter volume compared to controls, with most of the changes located to the cognitive part of the cerebellum (Crus II and lobule VIIb). This decrease was present in the subgroup of patients with recent-onset SZ. We did not find any alterations in the cerebellum in patients with BD. However, patients medicated with lithium had a larger size of the anterior cerebellum, compared to patients not treated with lithium. CONCLUSION: Our multicenter study supports a distinct pattern of cerebellar alterations in SZ and BD.
Subject(s)
Antimanic Agents/adverse effects , Bipolar Disorder/pathology , Cerebellar Cortex/pathology , Lithium Compounds/adverse effects , Schizophrenia/pathology , Adult , Bipolar Disorder/diagnostic imaging , Bipolar Disorder/drug therapy , Cerebellar Cortex/diagnostic imaging , Cerebellar Cortex/drug effects , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Schizophrenia/diagnostic imaging , Schizophrenia/drug therapy , Young AdultABSTRACT
OBJECT: Automatic accurate measurement techniques are needed to increase reproducibility in the quantification of cervical cord area (CCA) with magnetic resonance (MR) imaging in the assessment of central nervous system (CNS) atrophy in multiple sclerosis (MS) patients. MATERIALS AND METHODS: Two segmentation methods were implemented: (1) spatial mean brightness level estimation (SMBLE), and (2) partial-volume modeling (PVM). These were evaluated with the inclusion of spinal cord inclination and/or partial-volume-effect corrections. An averaged manually segmented set was considered as reference. Thirty MR studies were used to compare the different methods. A set of 15 MS patients and 15 control subjects within a two-year longitudinal study were used to evaluate cord atrophy with the best method. Statistical evaluation was made by using an intraclass correlation coefficient and Bland-Altman comparisons. RESULTS: Partial-volume modeling with spinal cord inclination correction and partial-volume spinal-cord contour contribution estimation was the most accurate method. The longitudinal test showed a 4% decrease in CCA in MS patients with no significant reduction in control subjects. CONCLUSION: The automatic PVM cord-segmentation approach, taking into consideration the spinal-cord inclination and partial-volume treatment, provides reproducibility and increased accuracy in the evaluation of cord atrophy, allowing the monitoring of changes in MS patients.
Subject(s)
Atrophy/diagnosis , Magnetic Resonance Imaging/methods , Multiple Sclerosis/complications , Multiple Sclerosis/pathology , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/pathology , Adolescent , Adult , Atrophy/pathology , Calibration , Case-Control Studies , Central Nervous System/pathology , Cerebrospinal Fluid/metabolism , Female , Humans , Male , Reproducibility of Results , SoftwareABSTRACT
BACKGROUND: The optimal technique for administration of intravenous contrast medium in computed tomography (CT) remains controversial. Therefore, we analyzed the influence of variable-rate injection protocols. METHODS: A double-blind, parallel-group study was conducted in 60 patients studied with the same helical CT contrast-enhanced protocol. Patients were randomly distributed into three groups: monophasic (123 mL at 2.5 mL/s), biphasic (123 mL, 60 mL at 1.5 mL/s and then 63 mL at 2.5 mL/s), and sigmoid (0.6 mL/s ending at 2.5 mL/s). Contrast-enhancement efficacy was evaluated by attenuation coefficient measurements. RESULTS: The monophasic injection protocol produced a statistically higher liver, inferior vena cava, and portal enhancement than did the low-high biphasic and sigmoid protocols. The biphasic protocol produced a statistically higher enhancement in the superior aorta. The enhancement obtained with the monophasic protocol was always higher than or equal to those obtained with the biphasic protocol in all measurement protocols except in the superior aorta and the aortic bifurcation. CONCLUSIONS: A monophasic injection produces better parenchymal and venous enhancement. When arterial enhancement is important, a low-high biphasic protocol can be used. A sigmoid protocol, with the parameters used in our series, is significantly less effective.
