The cortical thickness of tricenarian cocaine users assembles features of an octogenarian brain.

It has been suggested that substance use disorders could lead to accelerated biological aging, but only a few neuroimaging studies have investigated this hypothesis so far. In this cross-sectional study, structural neuroimaging was performed to measure cortical thickness (CT) in tricenarian adults with cocaine use disorder (CUD, n1 = 30) and their age-paired controls (YC, n1 = 30), and compare it with octogenarian elder controls (EC, n1 = 20). We found that CT in the right fusiform gyrus was similar between CUD and EC, thinner than the expected values of YC. We also found that regarding CT of the right inferior temporal gyrus, right inferior parietal cortex, and left superior parietal cortex, the CUD group exhibited parameters that fell in between EC and YC groups. Finally, CT of the right pars triangularis bordering with orbitofrontal gyrus, right superior temporal gyrus, and right precentral gyrus were reduced in CUD when contrasted with YC, but those areas were unrelated to CT of EC. Despite the 50-year age gap between our age groups, CT of tricenarian cocaine users assembles features of an octogenarian brain, reinforcing the accelerated aging hypothesis in CUD.

Lumbar safety triangle: comparative study of coronal and coronal oblique planes in 3.0-T magnetic resonance imaging / Triângulo de segurança lombar: estudo comparativo dos planos coronal e coronal oblíquo em ressonância magnética 3.0-T

Abstract Objective: To compare the measurements of the lumbar safety triangle (Kambin's triangle) and the invasion of the dorsal root ganglion in the triangle in coronal and coronal oblique planes. Materials and Methods: A cross-sectional study, in which 210 3.0-T magnetic resonance images of L2-L5 were analyzed in coronal and coronal oblique planes. Exams with lumbar spine anomalies were excluded. Demographic (sex and age) and radiological variables were recorded by a single evaluator. Results: Most sample was female (57.1%), mean age 45.5 ± 13.3 (18-98 years). The measurements average, as well as the areas, gradually increased from L2 to L5. The dorsal root ganglion invaded the triangle in all images. The safety triangle average area was smaller in the coronal oblique plane than in the coronal plane. Of the seven dimensions of safety triangle obtained for each level of the lumbar spine, six were significantly smaller in the coronal oblique plane than in the coronal plane. The only dimension that showed no difference was the smallest ganglion dimension. Conclusion: The dimensions and areas investigated were smaller in coronal oblique plane, especially the area (difference > 1 mm). The analysis of the triangular zone in this plane becomes important in the preoperative assessment of minimally invasive procedures.

Resumo Objetivo: Comparar as medidas do triângulo de segurança lombar (triângulo de Kambin) e invasão do gânglio da raiz dorsal no triângulo nas incidências coronal e coronal oblíqua. Materiais e Métodos: Estudo transversal, em que foram analisadas 210 imagens de ressonância magnética 3.0-T de L2-L5 nos planos coronal e coronal oblíquo. Foram excluídos exames com anomalias da coluna lombar. Variáveis demográficas (sexo e idade) e radiológicas foram registradas por um único avaliador. Resultados: A maioria da amostra era do sexo feminino (57,1%), com idade média de 45,5 ± 13,3 (18-98 anos). A média das medidas, assim como as áreas, aumentaram gradativamente de L2 a L5. O gânglio da raiz dorsal invadiu o triângulo em todas as imagens. A área média do triângulo de segurança foi menor na incidência coronal oblíqua do que na incidência coronal. Das sete dimensões do triângulo de segurança obtidas para cada nível da coluna lombar, seis foram significativamente menores no plano coronal oblíquo do que no plano coronal. Única dimensão que não apresentou diferença foi a menor dimensão do gânglio. Conclusão: As dimensões e áreas investigadas foram menores na incidência coronal oblíqua, especialmente a área (diferença > 1 mm). A análise da zona triangular nesta incidência torna-se importante na avaliação pré-operatória de procedimentos minimamente invasivos.

The brain-esophagus axis in subjects with and without obesity assessed by esophageal acid perfusion and functional brain imaging.

Background: Gastroesophageal reflux disease (GERD) has a complex pathophysiology and a heterogeneous symptom profile. The brain-esophageal axis in GERD has been studied with functional brain imaging during the last decades, but data from obese patients was just recently reported. A comparison of such a group with non-obese subjects is lacking in the literature. This study aimed to evaluate heartburn perception and brain connectivity responses during esophageal acid stimulation in subjects with and without obesity, controlling for the presence of typical reflux symptoms. Methods: In this cross-sectional study, 25 patients with obesity (body mass index ≥30 kg/m2) and 46 subjects without obesity underwent functional magnetic resonance imaging (fMRI) of the brain with esophageal water and acid perfusion. The fMRI paradigm and connectivity were assessed. Results: About two-thirds of the participants had reflux symptoms. Heartburn perception during fMRI did not differ between subjects with and without obesity. The presence of reflux symptoms was associated with lower activation in frontal brain regions during acid perfusion compared to water perfusion. Compared to subjects without obesity, patients with obesity presented significantly lower connectivity within the anterior salience network. Corrected clusters included left caudate, left putamen and left anterior cingulate gyrus. Conclusions: The brain-esophagus axis showed differences between subjects with and without obesity. Even without symptomatic differences following esophageal acid perfusion, patients with reflux symptoms showed less brain activation in frontal areas, while obese individuals presented lower connectivity within the anterior salience network.

Neuroanatomical correlates of macrostructural receptive abilities in narrative discourse in unilateral left hemisphere stroke: A behavioural and voxel-based morphometry study.

BACKGROUND: Little is known about story retelling and comprehension abilities in groups with lower levels of education and socio-economic status (SES). A growing body of evidence suggests the role of an extended network supporting narrative comprehension, but few studies have been conducted in clinical populations, even less in developing countries. AIMS: To extend our knowledge of the impact of a stroke on macrostructural aspects of discourse processes, namely main and complementary information, in individuals with middle-low to low SES and low levels of education. Relationships were tested between the performance in story retell and comprehension and reading and writing habits (RWH). Also, the associations between retelling and comprehension measures and their structural grey matter (GM) correlates were explored. METHODS & PROCEDURES: A total of 17 adults with unilateral left hemisphere (LH) chronic ischaemic stroke without the presence of significant aphasia and 10 matched (age, education and SES) healthy controls (HC) participated in the study. Retell and comprehension tasks were performed after listening or reading narrative stories. Voxel-based morphometry (VBM) analysis was conducted on a subgroup of nine individuals with LH stroke and the 10 matched controls using structural magnetic resonance imaging (MRI). OUTCOMES & RESULTS: Retelling and comprehension abilities were not significantly different between LH and HC, nonetheless quantitively lower in LH. Exploratory correlations showed that retelling and comprehension abilities in both written and auditory modalities were correlated with naming abilities. At the neural level, written comprehension positively correlated with GM density of the LH, including areas in the temporal pole, superior and middle temporal gyrus as well as the orbitofrontal cortex, precentral and postcentral gyri. Auditory narrative comprehension was associated with GM density of the lingual gyrus in the right hemisphere. CONCLUSIONS & IMPLICATIONS: The present results suggest that retelling and comprehension of auditory and written narratives are relatively well-preserved in individuals with a LH stroke without significant aphasia, but poorer than in HC. The findings replicate previous studies conducted in groups with higher levels of education and SES both at the behavioural and neural levels. Considering that naming seems to be associated with narrative retell and comprehension in individuals with lower SES and education, this research provides evidence on the importance of pursuing further studies including larger samples with and without aphasia as well as with various SES and education levels. WHAT THIS PAPER ADDS: What is already known on this subject Story retell and comprehension of auditory and written discourse have been shown to be affected after stroke, but most studies have been conducted on individuals with middle to high SES and high educational levels. What this paper adds to existing knowledge The study reports on narrative retell and comprehension in both auditory and written modalities in groups of HC and individuals with LH brain damage, with low-to-middle SES and lower levels of education. What are the potential or actual clinical implications of this work? This study highlights the importance of taking into consideration the sociodemographic and RWH of patients when assessing discourse retell and comprehension in both auditory and written modalities. It also underlines the importance of including patients without significant aphasia following LH stroke to look at the effect of both stroke and aphasia on narrative comprehension and story retelling.

Lumbar safety triangle: comparative study of coronal and coronal oblique planes in 3.0-T magnetic resonance imaging.

Objective: To compare the measurements of the lumbar safety triangle (Kambin's triangle) and the invasion of the dorsal root ganglion in the triangle in coronal and coronal oblique planes. Materials and Methods: A cross-sectional study, in which 210 3.0-T magnetic resonance images of L2-L5 were analyzed in coronal and coronal oblique planes. Exams with lumbar spine anomalies were excluded. Demographic (sex and age) and radiological variables were recorded by a single evaluator. Results: Most sample was female (57.1%), mean age 45.5 ± 13.3 (18-98 years). The measurements average, as well as the areas, gradually increased from L2 to L5. The dorsal root ganglion invaded the triangle in all images. The safety triangle average area was smaller in the coronal oblique plane than in the coronal plane. Of the seven dimensions of safety triangle obtained for each level of the lumbar spine, six were significantly smaller in the coronal oblique plane than in the coronal plane. The only dimension that showed no difference was the smallest ganglion dimension. Conclusion: The dimensions and areas investigated were smaller in coronal oblique plane, especially the area (difference > 1 mm). The analysis of the triangular zone in this plane becomes important in the preoperative assessment of minimally invasive procedures.

Objetivo: Comparar as medidas do triângulo de segurança lombar (triângulo de Kambin) e invasão do gânglio da raiz dorsal no triângulo nas incidências coronal e coronal oblíqua. Materiais e Métodos: Estudo transversal, em que foram analisadas 210 imagens de ressonância magnética 3.0-T de L2-L5 nos planos coronal e coronal oblíquo. Foram excluídos exames com anomalias da coluna lombar. Variáveis demográficas (sexo e idade) e radiológicas foram registradas por um único avaliador. Resultados: A maioria da amostra era do sexo feminino (57,1%), com idade média de 45,5 ± 13,3 (18­98 anos). A média das medidas, assim como as áreas, aumentaram gradativamente de L2 a L5. O gânglio da raiz dorsal invadiu o triângulo em todas as imagens. A área média do triângulo de segurança foi menor na incidência coronal oblíqua do que na incidência coronal. Das sete dimensões do triângulo de segurança obtidas para cada nível da coluna lombar, seis foram significativamente menores no plano coronal oblíquo do que no plano coronal. Única dimensão que não apresentou diferença foi a menor dimensão do gânglio. Conclusão: As dimensões e áreas investigadas foram menores na incidência coronal oblíqua, especialmente a área (diferença > 1 mm). A análise da zona triangular nesta incidência torna-se importante na avaliação pré-operatória de procedimentos minimamente invasivos.

Disruption of the brain-esophagus axis in obese patients with heartburn.

Obesity is a risk factor for gastroesophageal reflux disease. Studies addressing the brain-esophagus axis in obese are lacking. In obese with and without heartburn, we assessed: (i) the brain responses to esophageal acid perfusion during functional brain imaging; (ii) esophageal impedance baseline before and after acid perfusion; and (iii) abdominal fat distribution. In this exploratory study, 26 obese underwent functional magnetic resonance imaging (fMRI) of the brain combined with esophageal acid perfusion. Esophageal impedance baseline was determined before and after fMRI, followed by tomographic quantification of the abdominal fat. Among 26 obese (54% men, 39.7 years old, 33.5 kg/m2), there were 17 with heartburn and 9 without heartburn. Before fMRI, the esophageal impedance baseline was lower in obese with heartburn than without heartburn (median 1187 vs. 1890 Ω; P = 0.025). After acid perfusion, impedance baseline decreased in obese with heartburn (from 1187 to 899 Ω; P = 0.011) and was lower in this group than in obese without heartburn (899 vs. 1614 Ω; P = 0.001). fMRI task-residual analysis showed that obese with heartburn presented higher functional connectivity in several brain regions than obese without heartburn. Abdominal fat area did not differ between obese with and without heartburn either for total (72.8 ± 4.4% vs. 70.3 ± 6.0%; P = 0.280), subcutaneous (42.2 ± 9.0% vs. 37.4 ± 9.0%; P = 0.226), or visceral (30.6 ± 7.9% vs. 33.0 ± 7.8%; P = 0.484). In subjects with obesity, the brain-esophagus axis is disrupted centrally with higher functional brain connectivity and peripherally with decreased esophageal mucosa integrity in the presence of heartburn.

Macrostructural Aspects in Oral Narratives in Brazilian Portuguese by Left and Right Hemisphere Stroke Patients With Low Education and Low Socioeconomic Status.

OBJECTIVE: Individuals with a stroke in either the left hemisphere (LH) or the right hemisphere (RH) often present macrostructural impairments in narrative abilities. Understanding the potential influence of low education and low socioeconomic status (SES) is critical to a more effective assessment of poststroke language. The first aim was to investigate macrostructural processing in low-education and low-SES individuals with stroke in the LH or RH or without brain damage. The second aim was to verify the relationships between macrolinguistic, neuropsychological, and sociodemographic variables. METHOD: Forty-seven adults with LH (n = 15) or RH (n = 16) chronic ischemic stroke and 16 matched (age, education, and SES) healthy controls produced three oral picture-sequence narratives. The macrostructural aspects analyzed were cohesion, coherence, narrativity, macropropositions, and index of lexical informativeness and were compared among the three groups. Then, exploratory correlations were performed to assess associations between sociodemographic (such as SES), neuropsychological, and macrostructural variables. RESULTS: Both the LH and the RH presented impairments in the local macrostructural aspect (cohesion), whereas the RH also presented impairments in more global aspects (global coherence and macropropositions). All five macrostructural variables correlated with each other, with higher correlations with narrativity. Naming was correlated with all macrostructural variables, as well as prestroke reading and writing habits (RWH), showing that higher naming accuracy and higher RWH are associated with better macrostructural skills. CONCLUSIONS: The present results corroborate the role of the LH in more local processing and that of the RH in more global aspects of discourse. Moreover, this study highlights the importance of investigating discourse processing in healthy and clinical populations of understudied languages such as Brazilian Portuguese, with various levels of education, SES, and RWH.

Zika virus congenital microcephaly severity classification and the association of severity with neuropsychomotor development.

BACKGROUND: Zika virus infection during pregnancy is linked to birth defects, most notably microcephaly, which is associated with neurodevelopmental delays. OBJECTIVE: The goals of the study were to propose a method for severity classification of congenital microcephaly based on neuroradiologic findings of MRI scans, and to investigate the association of severity with neuropsychomotor developmental scores. We also propose a semi-automated method for MRI-based severity classification of microcephaly. MATERIALS AND METHODS: We conducted a cross-sectional investigation of 42 infants born with congenital Zika infection. Bayley Scales of Infant and Toddler Development III (Bayley-III) developmental evaluations and MRI scans were carried out at ages 13-39 months (mean: 24.8 months; standard deviation [SD]: 5.8 months). The severity score was generated based on neuroradiologist evaluations of brain malformations. Next, we established a distribution of Zika virus-microcephaly severity score including mild, moderate and severe and investigated the association of severity with neuropsychomotor developmental scores. Finally, we propose a simplified semi-automated procedure for estimating the severity score based only on volumetric measures. RESULTS: The results showed a correlation of r=0.89 (P<0.001) between the Zika virus-microcephaly severity score and the semi-automated method. The trimester of infection did not correlate with the semi-automated method. Neuropsychomotor development correlated with the severity classification based on the radiologic readings and semi-automated method; the more severe the imaging scores, the lower the neuropsychomotor developmental scores. CONCLUSION: These severity classification methods can be used to evaluate severity of microcephaly and possible association with developmental consequences. The semi-automated methods thus provide an alternative for predicting severity of microcephaly based on only one MRI sequence.

Increased Glucose Activity in Subgenual Anterior Cingulate and Hippocampus of High Performing Older Adults, Despite Amyloid Burden.

BACKGROUND: Individuals at 80 years of age or above with exceptional memory are considered SuperAgers (SA), an operationalized definition of successful cognitive aging. SA showed increased thickness and altered functional connectivity in the anterior cingulate cortex as a neurobiological signature. However, their metabolic alterations are yet to be uncovered. OBJECTIVE: Herein, a metabolic (FDG-PET), amyloid (PIB-PET), and functional (fMRI) analysis of SA were conducted. METHODS: Ten SA, ten age-matched older adults (C80), and ten cognitively normal middle-aged (C50) adults underwent cognitive testing and multimodal neuroimaging examinations. Anterior and posterior regions of the cingulate cortex and hippocampal areas were primarily examined, then subregions of anterior cingulate were segregated. RESULTS: The SA group showed increased metabolic activity in the left and right subgenual anterior cingulate cortex (sACC, p < 0.005 corrected, bilateral) and bilateral hippocampi (right: p < 0.0005 and left: p < 0.005, both corrected) as compared to that in the C80 group. Amyloid deposition was above threshold in 30% of SA and C80 (p > 0.05). The SA group also presented decreased connectivity between right sACC and posterior cingulate (p < 0.005, corrected) as compared to that of the C80 group. CONCLUSION: These results support the key role of sACC and hippocampus in SA, even in the presence of amyloid deposition. It also suggests that sACC may be used as a potential biomarker in older adults for exceptional memory ability. Further longitudinal studies measuring metabolic biomarkers may help elucidate the interaction between these areas in the cognitive aging process.

Neuroanatomical Correlates of Macrolinguistic Aspects in Narrative Discourse in Unilateral Left and Right Hemisphere Stroke: A Voxel-Based Morphometry Study.

Background A growing body of literature has demonstrated the importance of discourse assessment in patients who suffered from brain injury, both in the left and right hemispheres, as discourse represents a key component of functional communication. However, little is known about the relationship between gray matter density and macrolinguistic processing. Purpose This study aimed to investigate this relationship in a group of participants with middle-low to low socioeconomic status. Method Twenty adults with unilateral left hemisphere (n = 10) or right hemisphere (n = 10) chronic ischemic stroke and 10 matched (age, education, and socioeconomic status) healthy controls produced three oral narratives based on sequential scenes. Voxel-based morphometry analysis was conducted using structural magnetic resonance imaging. Results Compared to healthy controls, the left hemisphere group showed cohesion impairments, whereas the right hemisphere group showed impairments in coherence and in producing macropropositions. Cohesion positively correlated with gray matter density in the right primary sensory area (PSA)/precentral gyrus and the pars opercularis. Coherence, narrativity, and index of lexical informativeness were positively associated with the left PSA/insula and the superior temporal gyrus. Macropropositions were mostly related to the left PSA/insula and superior temporal gyrus, left cingulate, and right primary motor area/insula. Discussion Overall, the present results suggest that both hemispheres are implicated in macrolinguistic processes in narrative discourse. Further studies including larger samples and with various socioeconomic status should be conducted. Supplemental Material https://doi.org/10.23641/asha.14347550.

Cortical thickness and subcortical volume abnormalities in male crack-cocaine users.

Crack-cocaine offers a higher risk of abuse than intranasal and intravenous use of cocaine. Yet, current treatments remain disappointing and our understanding of the mechanism of crack-cocaine neurotoxicity is still incomplete. Magnetic resonance images studies on brain changes of crack-cocaine addicts show divergent data. The present study investigated gray matter (GM) abnormalities in crack-cocaine dependents (n = 18) compared to healthy controls (n = 17). MRI data was analysed using FreeSurfer and voxel-based morphometry (VBM). FreeSurfer analysis showed that CD had decreased cortical thickness (CT) in the left inferior temporal cortex (lTC), left orbitofrontal cortex (lOFC) and left rostro frontal cortex (lRFC), enlargement in left inferior lateral ventricle, and smaller GM volume in right hippocampus and right ventral diencephalon. VBM analysis showed that CD had significantly decreased GM volume in left Putamen and left nucleus accumbens. Furthermore, we found a negative correlation between duration of crack-cocaine use and lTC CT. These results provide compelling evidence for GM abnormalities in CD and also suggest that duration of crack-cocaine use may be associated with CT alterations.

Control of drop attacks with selective posterior callosotomy: Anatomical and prognostic data.

OBJECTIVE: In a previous proof of concept study, selective posterior callosotomy achieved similar degree of control of drop attacks as total callosotomy, while sparing prefrontal interconnectivity. The present study aims to confirm this finding in a larger cohort and to provide anatomical and prognostic data. METHODS: Fifty-one patients with refractory drop attacks had selective posterior callosotomy and prospective follow up for a mean of 6.4 years. Twenty-seven patients had post-operative magnetic resonance imaging (MRI) and 18 had tractography (DTI) of remaining callosal fibers. Pre and postoperative falls were quantified and correlated with demographic, clinical and imaging data. RESULTS: Mean monthly frequency of drop attacks had a 95 % reduction, from 297 before to 16 after the procedure. Forty- one patients (80 %) had either complete or greater than 90 % control of the epileptic falls. Age and duration of epilepsy at surgery correlated with outcome (p values, respectively, 0.042 and 0.005). Mean index of callosal section along the posterior-to-anterior axis was 53.5 %. Extending the posterior section anterior to the midbody of the corpus callosum did not correlate with seizure control (p 0.91), providing fibers interconnecting the primary motor (M1) and caudal supplementary motor areas (SMA) were sectioned. Only one patient had a notable surgical complication which resolved in two days. CONCLUSIONS: This level III cohort study with objective outcome assessment confirms that selective posterior callosotomy is safe and effective to control epileptic falls. Younger patients with smaller duration of epilepsy have better results. A posterior section contemplating the splenium, isthmus and posterior half of the body (posterior midbody) seems sufficient to achieve complete or almost complete control of drop attacks.

Prevalence of patellar chondropathy on 3.0 T magnetic resonance imaging.

OBJECTIVE: To establish the prevalence of patellar chondropathy using 3T magnetic resonance imaging (MRI) and to correlate the findings with individual features such as gender, age, and body mass index. MATERIALS AND METHODS: Data consisted of collecting 3T MRIs of patients' knees obtained between October 2016 and September 2017, comprising a period of 12 months. These MRIs were assessed by an experienced musculoskeletal radiologist who confirmed the presence of patellar chondropathy and, when present, rated the finding into the four grades ascribed by the International Cartilage Repair Society. RESULTS: A total number of 291 patients were assessed during the period with 389 MRI scans. Of those patients, 308 (79.2%) were diagnosed with patellar chondropathy, while 81 (20.8%) were not. Chondropathy was more prevalent in the female gender, in subjects above 40 years of age, and in obese patients. When the results were weighed in International Cartilage Repair Society classification, the milder grades (1 and 2) were seen in younger men (< 30 years of age), while the more severe grades (3 and 4) were mostly present in females, those above 40 years of age, and in obese patients. CONCLUSION: There was a high prevalence of patellar chondropathy in patients who had undergone high-field knee MRIs (79.2%), being highest in the female gender and in subjects above 40 years of age. The most prevalent group was graded as 4 by the International Cartilage Repair Society classification.

OBJETIVO: Estabelecer a prevalência de condropatia patelar em exames de ressonância magnética (RM) em campo de 3,0 T e associar os achados com características como gênero, idade e índice de massa corporal. MATERIAIS E MÉTODOS: Foram coletados exames de RM de joelho em campo magnético de 3.0 T no período de outubro de 2016 a setembro de 2017. Os exames foram analisados por radiologista com experiência em radiologia musculoesquelética, que verificou a presença de condropatia patelar e a classificou entre os quatro graus, de acordo com a classificação da International Cartilage Repair Society. RESULTADOS: Foram avaliados 291 pacientes, com a realização de 389 exames de RM. Destes exames, 308 (79,2%) apresentavam condropatia patelar e apenas 81 (20,8%) não a apresentavam. A doença foi vista mais frequentemente nas mulheres, em indivíduos acima de 40 anos e em obesos. Quando classificada por graus, os mais leves (graus 1 e 2) foram mais observados em homens e jovens (< 30 anos) e os mais severos (graus 3 e 4) no sexo feminino, nos acima de 40 anos e nos obesos. CONCLUSÃO: A prevalência de condropatia patelar nos pacientes que realizaram RM foi elevada (79,2%), sendo maior no sexo feminino e nos indivíduos acima de 40 anos. Dentro da classificação da International Cartilage Repair Society, o grupo mais prevalente foi o grau 4.

Prevalence of patellar chondropathy on 3.0 T magnetic resonance imaging / Prevalência de condropatia patelar na ressonância magnética de 3,0 T

Abstract Objective: To establish the prevalence of patellar chondropathy using 3T magnetic resonance imaging (MRI) and to correlate the findings with individual features such as gender, age, and body mass index. Materials and Methods: Data consisted of collecting 3T MRIs of patients' knees obtained between October 2016 and September 2017, comprising a period of 12 months. These MRIs were assessed by an experienced musculoskeletal radiologist who confirmed the presence of patellar chondropathy and, when present, rated the finding into the four grades ascribed by the International Cartilage Repair Society. Results: A total number of 291 patients were assessed during the period with 389 MRI scans. Of those patients, 308 (79.2%) were diagnosed with patellar chondropathy, while 81 (20.8%) were not. Chondropathy was more prevalent in the female gender, in subjects above 40 years of age, and in obese patients. When the results were weighed in International Cartilage Repair Society classification, the milder grades (1 and 2) were seen in younger men (< 30 years of age), while the more severe grades (3 and 4) were mostly present in females, those above 40 years of age, and in obese patients. Conclusion: There was a high prevalence of patellar chondropathy in patients who had undergone high-field knee MRIs (79.2%), being highest in the female gender and in subjects above 40 years of age. The most prevalent group was graded as 4 by the International Cartilage Repair Society classification.

Resumo Objetivo: Estabelecer a prevalência de condropatia patelar em exames de ressonância magnética (RM) em campo de 3,0 T e associar os achados com características como gênero, idade e índice de massa corporal. Materiais e Métodos: Foram coletados exames de RM de joelho em campo magnético de 3.0 T no período de outubro de 2016 a setembro de 2017. Os exames foram analisados por radiologista com experiência em radiologia musculoesquelética, que verificou a presença de condropatia patelar e a classificou entre os quatro graus, de acordo com a classificação da International Cartilage Repair Society. Resultados: Foram avaliados 291 pacientes, com a realização de 389 exames de RM. Destes exames, 308 (79,2%) apresentavam condropatia patelar e apenas 81 (20,8%) não a apresentavam. A doença foi vista mais frequentemente nas mulheres, em indivíduos acima de 40 anos e em obesos. Quando classificada por graus, os mais leves (graus 1 e 2) foram mais observados em homens e jovens (< 30 anos) e os mais severos (graus 3 e 4) no sexo feminino, nos acima de 40 anos e nos obesos. Conclusão: A prevalência de condropatia patelar nos pacientes que realizaram RM foi elevada (79,2%), sendo maior no sexo feminino e nos indivíduos acima de 40 anos. Dentro da classificação da International Cartilage Repair Society, o grupo mais prevalente foi o grau 4.

Posterior reversible encephalopathy syndrome (PRES): Is DWI a prognosis factor?

INTRODUCTION: Posterior reversible encephalopathy syndrome is a clinicoradiologic entity with typical MR imaging showing a white matter vasogenic edema predominantly affecting the occipital and parietal lobes of the brain. The aim of this article is evaluated the importance of DWI as a prognosis factor in patients with PRES. MATERIALS AND METHODS: We reviewed data from 70 patients with PRES (35 with restricted DWI and 35 with no DWI abnormalities), that were admitted to Hospital São Lucas-PUCRS. These two groups were evaluated in age, sex, previous diseases and past medical history, use of medications, the neurologic manifestations, the highest blood pressure during the neurologic presentation and the highest creatinine during the period of observation. RESULTS: Evaluating 70 patients with PRES with a mean age of 25.4 years old (range from 2 to 74 years old; 55 female and 15 male) we identified 35 cases were brain MRI presents with restricted DWI. Restricted DWI was associated with higher mortality in 90 days (14.2% vs 0.0%; p: 0.027). CONCLUSIONS: Few articles present new data that will help clinicians in therapeutic decisions or that modify the knowledge of this syndrome. We suggested that restricted DWI is associated with a worst prognosis in PRES.

Evaluation of the lumbar safety triangle through magnetic resonance imaging / Avaliação do triângulo de segurança lombar por meio da ressonância magnética / Evaluación del triángulo de seguridad lumbar por medio de la resonancia magnética

ABSTRACT Objective: To evaluate the lumbar triangular safety zone, its boundaries and its relationship with the dorsal root ganglion through Magnetic Resonance Imaging (MRI). Methods: The boundaries, shape and dimensions of 303 triangular safety zones were analyzed in Tesla 3.0 Magnetic Resonance Imaging (MRI) coronal sections from L2 to L5, including the dorsal root ganglion. Results: The sample consisted of 101 patients with a mean age of 32 years. The height of the triangular safety zone was formed by the lateral edge of the dura mater, the width by the upper plateau of the lower vertebra and the hypotenuse by the corresponding nerve root. The mean dimensions and the area varied according to the level studied. The dorsal root ganglion invaded the dimensions of the triangle in all the images studied. Conclusion: Based on the data and the analyses performed, we concluded that knowledge of the boundaries of the triangular safety zone through MRI increases the safety of minimally invasive procedures in the lumbar spine. Level of evidence I; Diagnostic studies - Investigation of a diagnostic test.

RESUMO Objetivo: Avaliar a zona triangular de segurança lombar, seus limites e sua relação com o gânglio da raiz dorsal por meio da ressonância magnética (RM). Métodos: Foram estudados os limites, o formato e as dimensões de 303 zonas triangulares de segurança no corte coronal de RM 3.0 Tesla de L2 a L5, incluindo o gânglio da raiz dorsal. Resultados: A amostra foi composta por 101 pacientes com média de idade de 32 anos. A altura da zona triangular de segurança era formada pela borda lateral da dura-máter; a largura, pelo platô superior da vértebra inferior; e a hipotenusa, pela raiz nervosa correspondente. A média das dimensões, assim como a área, variaram conforme o nível estudado. O gânglio da raiz dorsal invadiu as dimensões do triângulo em todas as imagens estudadas. Conclusão: Baseados nos dados e nas análises realizadas, concluímos que o conhecimento dos limites da zona triangular de segurança, por meio da imagem da RM, aumenta a segurança dos procedimentos minimamente invasivos na coluna lombar. Nível de evidência I; Estudos diagnósticos-Investigação de um exame para diagnóstico.

RESUMEN Objetivo: Evaluar la zona triangular de seguridad lumbar, sus límites y su relación con el ganglio de la raíz dorsal a través de la Resonancia Magnética (RM). Métodos: Se estudiaron los límites, el formato y las dimensiones de 303 zonas triangulares de seguridad en el corte coronal de RM 3.0 Tesla de L2 a L5, incluyendo el ganglio de la raíz dorsal. Resultados: La muestra fue compuesta por 101 pacientes, con promedio de edad de 32 años. La altura de la zona triangular de seguridad estaba formada por el borde lateral de la duramadre, el ancho por la meseta superior de la vértebra inferior y la hipotenusa por la raíz nerviosa correspondiente. El promedio de las dimensiones, así como el área, variaron según el nivel estudiado. El ganglio de la raíz dorsal invadió las dimensiones del triángulo en todas las imágenes estudiadas. Conclusión: Basándose en los datos y análisis realizados, concluimos que el conocimiento de los límites de la zona triangular de seguridad a través de la imagen de RM aumenta la seguridad de los procedimientos mínimamente invasivos en la columna lumbar. Nivel de evidencia I; Estudios diagnósticos - Investigación de un examen para diagnóstico.

Violence and Latin-American preadolescents: A study of social brain function and cortisol levels.

The present study investigated exposure to violence and its association with brain function and hair cortisol concentrations in Latin-American preadolescents. Self-reported victimization scores (JVQ-R2), brain imaging (fMRI) indices for a social cognition task (the 'eyes test'), and hair cortisol concentrations were investigated, for the first time, in this population. The eyes test is based on two conditions: attributing mental state or sex to pictures of pairs of eyes (Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001). The results showed an association among higher victimization scores and (a) less activation of posterior temporoparietal right-hemisphere areas, in the mental state condition only (including right temporal sulcus and fusiform gyrus); (b) higher functional connectivity indices for the Amygdala and Right Fusiform Gyrus (RFFG) pair of brain regions, also in the mental state condition only; (c) higher hair cortisol concentrations. The results suggest more exposure to violence is associated with significant differences in brain function and connectivity. A putative mechanism of less activation in posterior right-hemisphere regions and of synchronized Amygdala: RFFG time series was identified in the mental state condition only. The results also suggest measurable effects of exposure to violence in hair cortisol concentrations, which contribute to the reliability of self-reported scores by young adolescents. The findings are discussed in light of the effects of exposure to violence on brain function and on social-cognitive development in the adolescent brain. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=qHcXq7Y9PBk.

Microsurgical Clipping of Low-Riding Basilar Bifurcation Aneurysm.

Basilar bifurcation is a challenging site for aneurysm clipping. Anatomical factors such as size and projection of the aneurysm, distance between the aneurysm neck and the dorsum sellae, and location of the basilar bifurcation contribute to surgical complexity. Endovascular treatment has been used more frequently than microsurgical clipping, especially for posterior circulation lesions. Thus, the upcoming generation of neurosurgeons will have increasingly less access to the microsurgical treatment of such lesions. We present the case of a 45-year-old female patient who presented sudden mental confusion characterized by disorientation in time, space, and person. Investigative acute cerebral magnetic resonance imaging revealed diffusion restriction in the left posterior cerebral and superior cerebellar arteries. The clinical and cardiologic investigations revealed no abnormalities, but computed tomographic angiography and digital arteriography revealed a low-riding basilar bifurcation aneurysm and a very small aneurysm in the right internal carotid artery. The wide neck precluded coil embolization, and the appropriate stent was not covered by our public health insurance. Considering the young age, surgical treatment was proposed. Microsurgical clipping was performed using the right pre-temporal approach. In this two-dimensional video, we show the steps to reach the low-riding basilar bifurcation aneurysm neck. The positioning, transzygomatic pterional craniotomy, intradural anterior clinoidectomy, and posterior cavernous sinus opening are shown, and the surrounding anatomy is illustrated.

Quantification of Abdominal Fat in Obese and Healthy Adolescents Using 3 Tesla Magnetic Resonance Imaging and Free Software for Image Analysis.

BACKGROUND AND AIMS: Computed tomography, which uses ionizing radiation and expensive software packages for analysis of scans, can be used to quantify abdominal fat. The objective of this study is to measure abdominal fat with 3T MRI using free software for image analysis and to correlate these findings with anthropometric and laboratory parameters in adolescents. METHODS: This prospective observational study included 24 overweight/obese and 33 healthy adolescents (mean age 16.55 years). All participants underwent abdominal MRI exams. Visceral and subcutaneous fat area and percentage were correlated with anthropometric parameters, lipid profile, glucose metabolism, and insulin resistance. Student's t test and Mann-Whitney's test was applied. Pearson's chi-square test was used to compare proportions. To determine associations Pearson's linear correlation or Spearman's correlation were used. RESULTS: In both groups, waist circumference (WC) was associated with visceral fat area (P = 0.001 and P = 0.01 respectively), and triglycerides were associated with fat percentage (P = 0.046 and P = 0.071 respectively). In obese individuals, total cholesterol/HDL ratio was associated with visceral fat area (P = 0.03) and percentage (P = 0.09), and insulin and HOMA-IR were associated with visceral fat area (P = 0.001) and percentage (P = 0.005). CONCLUSIONS: 3T MRI can provide reliable and good quality images for quantification of visceral and subcutaneous fat by using a free software package. The results demonstrate that WC is a good predictor of visceral fat in obese adolescents and visceral fat area is associated with total cholesterol/HDL ratio, insulin and HOMA-IR.

Selective posterior callosotomy for drop attacks: A new approach sparing prefrontal connectivity.

OBJECTIVE: To evaluate a novel approach to control epileptic drop attacks through a selective posterior callosotomy, sparing all prefrontal interconnectivity. METHODS: Thirty-six patients with refractory drop attacks had selective posterior callosotomy and prospective follow-up for >4 years. Falls, episodes of aggressive behavior, and IQ were quantified. Autonomy in activities of daily living, axial tonus, and speech generated a functional score ranging from 0 to 13. Subjective effect on patient well-being and caregiver burden was also assessed. RESULTS: Median monthly frequency of drop attacks decreased from 150 to 0.5. Thirty patients (83%) achieved either complete or >90% control of the falls. Need for constant supervision decreased from 90% to 36% of patients. All had estimated IQ below 85. Median functional score increased from 7 to 10 (p = 0.03). No patient had decrease in speech fluency or hemiparesis. Caregivers rated the effect of the procedure as excellent in 40% and as having greatly improved functioning in another 50%. Clinical, EEG, imaging, and cognitive variables did not correlate with outcome. CONCLUSIONS: This cohort study with objective outcome assessment suggests that selective posterior callosotomy is safe and effective to control drop attacks, with functional and behavioral gains in patients with intellectual disability. Results are comparable to historical series of total callosotomy and suggest that anterior callosal fibers may be spared. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that selective posterior callosotomy reduces falls in patients with epileptic drop attacks.