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Medicine (Baltimore) ; 100(16): e25617, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879730


ABSTRACT: Using N-isopropyl-p-[123I]-iodoamphetamine(123I-IMP) and single-photon emission computed tomography (SPECT), the relationship between cerebrovascular reserve and the 123I-IMP redistribution phenomenon was investigated.The 50 patients who matched the inclusion criteria were divided into control and ischemia groups, and the redistribution phenomenon was examined on resting images. The delayed images showed higher 123I-IMP accumulation in lesions in the middle cerebral artery(MCA) area and anterior cerebral artery(ACA) area, these watershed areas in the ischemia group than in the control group, confirming that the redistribution phenomenon exists with statistical significance (Wilcoxon test; control group vs ischemic group in the ACA area[P = .002], ACA-MCA watershed area(P = .014), MCA area(P = .025), and MCA-posterior cerebral artery(PCA) watershed area(P = .002). The patients were then divided into 4 types according to the Kuroda grading system, and the difference in the redistribution phenomenon was investigated between type III and the other 3 types.Compared with type I and type II, type III had a significantly lower rate of decrease in the radioisotope (RI) count, verifying the redistribution phenomenon (Student t test: type I vs type III in the ACA area(P = .008), ACA-MCA watershed area(P = .009), MCA area(P < .001), and MCA-PCA watershed area(P = .002); type II vs type III in the ACA area(P = .004), ACA-MCA watershed area(P = .2575), MCA area(P < .001), and MCA-PCA watershed area(P < .001). No significant difference between type III and type IV was observed in any area [(Student t test: type III vs type IV in the ACA area(P = .07), ACA-MCA watershed area(P = .38), MCA area(P = .05), and MCA-PCA watershed area(P = .24)].The redistribution phenomenon is associated with resting cerebral blood flow (CBF), but not necessarily with cerebral vascular reactivity (CVR).

Isquemia Encefálica/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Iofetamina , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único , Acetazolamida/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Cerebral Anterior/diagnóstico por imagem , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Revascularização Cerebral , Circulação Cerebrovascular/fisiologia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/fisiopatologia , Cérebro/irrigação sanguínea , Cérebro/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Estudos Retrospectivos
BMC Infect Dis ; 21(1): 298, 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33761897


BACKGROUND: Severe acute respiratory syndrome virus 2 (SARS-CoV-2) is spreading globally and causes most frequently fever and respiratory symptoms, i.e. Coronavirus disease 2019 (COVID-19), however, distinct neurological syndromes associated with SARS-CoV-2 infection have been described. Among SARS-CoV-2-infections-associated neurological symptoms fatigue, headache, dizziness, impaired consciousness and anosmia/ageusia are most frequent, but less frequent neurological deficits such as seizures, Guillain-Barré syndrome or ataxia may also occur. CASE PRESENTATION: Herein we present a case of a 62-year-old man who developed a subacute cerebellar syndrome with limb-, truncal- and gait ataxia and scanning speech 1 day after clinical resolution of symptomatic SARS-CoV-2 infection of the upper airways. Apart from ataxia, there were no signs indicative of opsoclonus myoclonus ataxia syndrome or Miller Fisher syndrome. Cerebral magnetic resonance imaging showed mild cerebellar atrophy. SARS-CoV-2 infection of the cerebellum was excluded by normal cerebrospinal fluid cell counts and, most importantly, absence of SARS-CoV-2 RNA or intrathecal SARS-CoV-2-specific antibody production. Other causes of ataxia such as other viral infections, other autoimmune and/or paraneoplastic diseases or intoxication were ruled out. The neurological deficits improved rapidly after high-dose methylprednisolone therapy. CONCLUSIONS: The laboratory and clinical findings as well as the marked improvement after high-dose methylprednisolone therapy suggest a post-infectious, immune-mediated cause of ataxia. This report should make clinicians aware to consider SARS-CoV-2 infection as a potential cause of post-infectious neurological deficits with an atypical clinical presentation and to consider high-dose corticosteroid treatment in case that a post-infectious immune-mediated mechanism is assumed.

COVID-19/complicações , Ataxia Cerebelar/complicações , Cérebro/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , RNA Viral
Int. j. clin. health psychol. (Internet) ; 20(3): 200-212, sept.-dic. 2020. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-201606


BACKGROUND/OBJECTIVE: This study aims to characterize the differences on the short-term temporal network dynamics of the undirected and weighted wholebrain functional connectivity between healthy aging individuals and people with mild cognitive impairment (MCI). The Network Change Point Detection algorithm was applied to identify the significant change points in the resting-state fMRI register, and we analyzed the fluctuations in the topological properties of the subnetworks between significant change points. METHOD: Ten MCI patients matched by gender and age in 1:1 ratio to healthy controls screened during patient recruitment. A neuropsychological evaluation was done to both groups as well as functional magnetic images were obtained with a Philips 3.0T. All the images were preprocessed and statistically analyzed through dynamic point estimation tools. RESULTS: No statistically significant differences were found between groups in the number of significant change points in the functional connectivity networks. However, an interaction effect of age and state was detected on the intra-participant variability of the network strength. CONCLUSIONS: The progression of states was associated to higher variability in the patient's group. Additionally, higher performance in the prospective and retrospective memory scale was associated with higher median network strength

ANTECEDENTES/OBJETIVO: Este estudio tiene como objetivo caracterizar las diferencias en la red dinámica de conectividad funcional no dirigida entre un grupo de personas sanas y otro con deterioro cognitivo leve. Se aplicó un algoritmo de detección de puntos de cambio en redes complejas para identificarlos en registros fMRI en estado de reposo y se analizaron las fluctuaciones en las propiedades topológicas de las subredes entre puntos de cambio significativos. MÉTODO: Diez pacientes emparejados por sexo y edad en proporción 1:1 a controles sanos. Se realizó una evaluación neuropsicológica a ambos grupos y se obtuvieron imágenes funcionales con un Philips Ingenia 3.0T. Todas las imágenes fueron preprocesadas y analizadas estadísticamente a través de herramientas de estimación dinámica de puntos. RESULTADOS: No se encontraron diferencias estadísticamente significativas entre ambos grupos en el número de puntos de cambio en las redes de conectividad funcional. Se detectó un efecto de interacción entre edad y la variabilidad intra-sujeto en algunos indicadores de complejidad (strength) de la red dinámica. CONCLUSIONES: La progresión de la conectividad se asoció a una mayor variabilidad en el grupo de pacientes. Además, se puede asociar un mayor rendimiento en la escala de memoria prospectiva y retrospectiva con un mayor valor de la mediana de strength de la red

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Disfunção Cognitiva/diagnóstico por imagem , Rede Nervosa/diagnóstico por imagem , Disfunção Cognitiva/psicologia , Envelhecimento Saudável/psicologia , Imageamento por Ressonância Magnética , Cérebro/diagnóstico por imagem , Cérebro/fisiopatologia , Algoritmos
PLoS One ; 15(8): e0236196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760077


BACKGROUND: Dynamic CT angiography (dCTA) contrast extravasation, known as the "dynamic spot sign", can predict hematoma expansion (HE) in intracerebral hemorrhage (ICH). Recent reports suggest the phase of spot sign appearance is related to the magnitude of HE. We used dCTA to explore the association between the phase of spot sign appearance and HE, clinical outcome, and contrast extravasation rates. METHODS: We assessed consecutive patients who presented with primary ICH within 4.5 hours from symptom onset who underwent a standardized dCTA protocol and were spot sign positive. The independent variable was the phase of spot sign appearance. The primary outcome was significant HE (either 6 mL or 33% growth). Secondary outcomes included total absolute HE, mortality, and discharge mRS. Mann-Whitney U, Fisher's exact test, and logistic regression were used, as appropriate. RESULTS: Of the 35 patients with spot signs, 27/35 (77%) appeared in the arterial phase and 8/35 (23%) appeared in the venous phase. Thirty patients had follow-up CT scans. Significant HE was seen in 14/23 (60.87%) and 3/7 (42.86%) of arterial and venous cohorts, respectively (p = 0.67). The sensitivity and specificity in predicting significant HE were 82% and 31% for the arterial phase and 18% and 69% for the venous phase, respectively. There was a non-significant trend towards greater total HE, in-hospital mortality, and discharge mRS of 4-6 in the arterial spot sign cohort. Arterial spot signs demonstrated a higher median contrast extravasation rate (0.137 mL/min) compared to venous spot signs (0.109 mL/min). CONCLUSION: Our exploratory analyses suggest that spot sign appearance in the arterial phase may be more likely associated with HE and poorer prognosis in ICH. This may be related to higher extravasation rates of arterial phase spot signs. However, further studies with larger sample sizes are warranted to confirm the findings.

Angiografia Cerebral/métodos , Hemorragia Cerebral/mortalidade , Angiografia por Tomografia Computadorizada/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Hematoma/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Artérias/diagnóstico por imagem , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Cérebro/irrigação sanguínea , Cérebro/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , Seguimentos , Hematoma/etiologia , Mortalidade Hospitalar , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade
Psicothema (Oviedo) ; 32(3): 337-345, ago. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-199773


BACKGROUND: Graph theory has been widely used to study structural and functional brain connectivity changes in healthy aging, and occasionally with clinical samples; in both cases, during task-related and resting-state experiments. Recent studies have focused their interest on dynamic changes during a resting-state fMRI register in order to identify differences in non-stationary patterns associated with the aging process. The objective of this study was to characterize resting-state fMRI network dynamics in order to study the healthy aging process. METHOD: 114 healthy older adults were measured in a resting-state paradigm using fMRI. A sliding-window approach to graph theory was used to measure the mean degree, average path length, clustering coefficient, and small-worldness of each subnetwork, and the impact of age and time in each graph measure was assessed. RESULTS: A combined effect of age and time was detected in mean degree, average path length, and small-worldness, where participants aged 75 to 79 showed a curvilinear trend with reduced network density and increased small-world coefficient in the middle of the register. CONCLUSION: An effect of age was observed on average path length, with younger participants showing slightly lower scores

ANTECEDENTES: la Teoría de Grafos se ha utilizado para estudiar los cambios de la conectividad cerebral en el envejecimiento sano. Trabajos recientes han centrado su interés en los cambios dinámicos en registro fMRI en estado de reposo para identificar patrones no estacionarios en el proceso de envejecimiento. Este artículo tiene como objetivo caracterizar la dinámica de la red fMRI para estudiar envejecimiento saludable. MÉTODO: se registraron 114 adultos sanos mayores de 65 años en un paradigma de estado de reposo mediante señal fMRI. Se usó Teoría de Grafos para medir el grado medio de conectividad, la longitud promedio de las conexiones, el coeficiente de agrupamiento y el small-world de cada subred. Se evaluó el impacto de la edad y el tiempo en cada medida de grafo. RESULTADOS: se detectó un efecto combinado de la edad y el tiempo en diversas medidas, los participantes de 75 a 79 años mostraron una tendencia curvilínea de la densidad y agrupación de red reducidas, pero un coeficiente small-world mayor en las ventanas centrales. CONCLUSIÓN: se observó un efecto de la edad en la longitud promedio y los participantes más jóvenes mostraron puntuaciones más bajas en los indicadores de red

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Imageamento por Ressonância Magnética , Cérebro/diagnóstico por imagem , Cérebro/fisiologia , Envelhecimento Saudável/fisiologia
Am J Psychiatry ; 177(9): 834-843, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32539527


OBJECTIVE: Attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive-compulsive disorder (OCD) are common neurodevelopmental disorders that frequently co-occur. The authors sought to directly compare these disorders using structural brain imaging data from ENIGMA consortium data. METHODS: Structural T1-weighted whole-brain MRI data from healthy control subjects (N=5,827) and from patients with ADHD (N=2,271), ASD (N=1,777), and OCD (N=2,323) from 151 cohorts worldwide were analyzed using standardized processing protocols. The authors examined subcortical volume, cortical thickness, and cortical surface area differences within a mega-analytical framework, pooling measures extracted from each cohort. Analyses were performed separately for children, adolescents, and adults, using linear mixed-effects models adjusting for age, sex, and site (and intracranial volume for subcortical and surface area measures). RESULTS: No shared differences were found among all three disorders, and shared differences between any two disorders did not survive correction for multiple comparisons. Children with ADHD compared with those with OCD had smaller hippocampal volumes, possibly influenced by IQ. Children and adolescents with ADHD also had smaller intracranial volume than control subjects and those with OCD or ASD. Adults with ASD showed thicker frontal cortices compared with adult control subjects and other clinical groups. No OCD-specific differences were observed across different age groups and surface area differences among all disorders in childhood and adulthood. CONCLUSIONS: The study findings suggest robust but subtle differences across different age groups among ADHD, ASD, and OCD. ADHD-specific intracranial volume and hippocampal differences in children and adolescents, and ASD-specific cortical thickness differences in the frontal cortex in adults, support previous work emphasizing structural brain differences in these disorders.

Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Cérebro , Neuroimagem/métodos , Transtorno Obsessivo-Compulsivo , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/fisiopatologia , Transtorno do Espectro Autista/psicologia , Cérebro/diagnóstico por imagem , Cérebro/patologia , Cérebro/fisiopatologia , Criança , Feminino , Desenvolvimento Humano/fisiologia , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/fisiopatologia , Transtorno Obsessivo-Compulsivo/psicologia , Tamanho do Órgão , Psicopatologia , Relatório de Pesquisa , Análise de Sistemas
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(3): 184-192, mayo-jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198273


La inclusión de la PET 18F-FDG como biomarcador en los criterios de diagnóstico clínico de enfermedades neurodegenerativas y su indicación en el estudio precirugía en la epilepsia resistente a los fármacos permiten mejorar la especificidad del diagnóstico. La interpretación clásica de los estudios PET neurológicos se ha abordado de forma cualitativa, aunque en la última década hemos sido testigos del auge en los sistemas de evaluación cuantitativa. Este desarrollo técnico es de vital importancia en la práctica clínica, ya que mejora la especificidad y la reproducibilidad y reduce el efecto dependiente del observador derivado del análisis visual. Consideramos que es conveniente exponer la complejidad de las técnicas de procesamiento de imagen empleadas, lo que permitirá al especialista en Medicina Nuclear conocer sus ventajas e inconvenientes a la hora de incluirlas en la práctica clínica diaria

The inclusion of 18F-FDG PET as a biomarker in the diagnostic criteria of neurodegenerative diseases and its indication in the presurgical assessment for drug-resistant epilepsies allow to improve specificity of these diagnosis. The traditional interpretation of neurological PET studies has been performed qualitatively, although in the last decade, several quantitative evaluation methods have emerged. This technical development has become relevant in clinical practice, improving specificity, reproducibility and reducing the interrater reliability derived from visual analysis. In this article we update/review the main imaging processing techniques currently used. This may allow the Nuclear Medicine physician to know their advantages and disadvantages when including these procedures in daily clinical practice

Humanos , Cérebro/diagnóstico por imagem , Doenças Neurodegenerativas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Fluordesoxiglucose F18/administração & dosagem , Biomarcadores/análise , Compostos Radiofarmacêuticos/administração & dosagem , Transtornos dos Movimentos/diagnóstico por imagem , Demência/diagnóstico por imagem , Epilepsia/diagnóstico por imagem , Diagnóstico Diferencial
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(3): 151-154, mayo-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-192419


El papiloma del plexo coroideo es un tumor poco frecuente del sistema nervioso central, que representa menos del 1% de todas las neoplasias intracraneales. Las ubicaciones habituales son el ventrículo lateral en bebés y niños y el cuarto ventrículo en adultos. El tercer ventrículo es una localización inhabitual, con pocos casos recogidos en la bibliografía. Describimos el caso de un niño de 3 meses que ingresó en nuestro centro con signos de aumento de la presión intracraneal. Los estudios de neuroimagen mostraron una lesión en el tercer ventrículo, con hidrocefalia asociada. Al paciente se le extirpó completamente el tumor mediante abordaje transfrontal y cirugía de derivación ventriculoperitoneal. El curso postoperatorio del niño transcurrió sin incidentes y la imagen de resonancia magnética de seguimiento no reveló tumor residual. La histopatología de la lesión resecada confirmó el diagnóstico de papiloma del plexo coroideo. Discutimos las características clínicas, radiológicas e histológicas de este tipo infrecuente de tumores

Choroid plexus papilloma is an uncommon tumour of the central nervous system, accounting for less than 1% of all intracranial neoplasm. The usual locations are the lateral ventricle in infants and children and the fourth ventricle in adults. The third ventricle is a rare location, with few cases reported in the literature. We describe the case of a 3-month-old boy who was admitted to our centre with signs of raised intracranial pressure. Neuroimaging studies showed a third ventricular mass with associated hydrocephalus. The patient underwent complete tumour removal through a transfrontal approach and ventriculo-peritoneal shunt surgery. Postoperative course of the child was uneventful and follow-up magnetic resonance imaging revealed no residual tumour. Histopathology of the resected lesion confirmed the diagnosis of choroid plexus papilloma. We discuss the clinical, radiological and histological features of this infrequent type of tumours

Humanos , Masculino , Lactente , Papiloma do Plexo Corióideo/diagnóstico por imagem , Papiloma do Plexo Corióideo/cirurgia , Terceiro Ventrículo/cirurgia , Neuroendoscopia/métodos , Terceiro Ventrículo/patologia , Derivação Ventriculoperitoneal/métodos , Ultrassonografia , Cérebro/diagnóstico por imagem , Cérebro/patologia
J Neuroimmunol ; 344: 577247, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32388192


OBJECTIVES: There is a delicate homeostatic balance between the central nervous system and immune system. Stroke triggers an immunodepressive state to suppress a potential immune reaction directed against neuroglial tissue; however, this supposedly protective response inadvertently results in an infection-prone, and thereby a pro-inflammatory setting. In this study, we assessed the magnitude of cerebral volume loss in the unaffected contralateral hemisphere following stroke, and determined its relationship with inflammatory cascades. METHODS: The volume of the hemisphere contralateral to the ischemic insult was measured on admission and follow-up MRI's in 50 ischemic stroke patients. Information related to clinical features, infectious complications, and markers of inflammation (erythrocyte sedimentation rate, neutrophil/lymphocyte ratio, C-reactive protein) were prospectively collected, and their relationship with hemispheric volume change was evaluated using bivariate and multivariate statistics. RESULTS: The contralateral hemisphere volume decreased by a median (interquartile range) of 14 (4-32) mL after a follow-up duration of 101 (63-123) days (p < .001); the volume reduction was 0.8 (0.2-1.8) % per month with respect to baseline. Old age, atrial fibrillation, stroke severity, C-reactive protein level, neutrophil/lymphocyte ratio, and development of infections during hospitalization were significantly associated with volume loss (p < .05). Stroke severity (NIHSS score or infarct volume) and inflammation related parameters (neutrophil/lymphocyte ratio or systemic infections) remained independently and positively associated with volume loss in multivariate regression models. CONCLUSIONS: Cerebral tissue changes following stroke are not limited to the ischemic hemisphere. Apart from stroke severity, a pro-inflammatory state and post-stroke infections contribute to cerebral volume loss in the non-ischemic hemisphere.

Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico por imagem , Cérebro/diagnóstico por imagem , Mediadores da Inflamação/sangue , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 37(5): 543-546, 2020 May 10.
Artigo em Chinês | MEDLINE | ID: mdl-32335882


OBJECTIVE: To explore the clinical features and genetic variant in a child featuring megalencephalic leukoencephalopathy with subcortical cyst (MLC) type 2B. METHODS: Clinical and imaging data of the child was collected. Potential variant of hepatocyte adhesion molecule (HEPACAM) gene was detected by Sanger sequencing. The growth and development of her mother and uncle was also reviewed. RESULTS: The patient, a 1-year-and-7-month female, presented with convulsion, mental retardation and abnormally increased head circumference. Cranial MRI revealed extensive long T1 long T2 signals in the white matter of bilateral cerebral hemisphere, right anterior sac cyst, cerebral gyrus widening, and shallow sulcus. Sanger sequencing identified a c.437C>T missense variant in exon 3 of the HEPACAM gene. The same variant was detected in her mother but not father. Her mother and maternal uncle both had a history of increased head circumference when they were young. In their adulthood, the head circumference was in the normal range but still greater than the average. CONCLUSION: The heterozygous variant of the HEPACAM gene probably underlies the MLC2B in this child. The variant has derived from her asymptomatic mother, which suggested incomplete penetrance of the MLC2B.

Proteínas de Ciclo Celular , Cistos , Variação Genética , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central , Adulto , Proteínas de Ciclo Celular/genética , Cérebro/diagnóstico por imagem , Cistos/diagnóstico por imagem , Cistos/genética , Feminino , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/diagnóstico por imagem , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/genética , Humanos , Lactente
Radiología (Madr., Ed. impr.) ; 62(2): 139-147, mar.-abr. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194211


OBJETIVOS: Explorar si los niños y adolescentes con trastorno por déficit de atención e hiperactividad (TDAH) tienen alterada la conectividad funcional entre la red de control ejecutivo y la red neuronal por defecto. MATERIAL Y MÉTODOS: Estudio exploratorio de prueba diagnóstica, prospectivo, con diseño de casos y controles. Se reclutaron consecutivamente 56 participantes (29 con TDAH de tipo inatento o combinado y 27 controles) entre 7 y 16 años, de sexo masculino, dominancia derecha. Se aplicaron los criterios diagnósticos del DSM-5 como prueba de referencia y una batería de pruebas neuropsicológicas para confirmar el diagnóstico y evaluar comorbilidades. Se les realizó resonancia magnética funcional de reposo como prueba índice. La aplicación y evaluación de las pruebas fue ciega. Las regiones cerebrales se escogieron a priori y se usó técnica de región de interés. Se evaluó la conectividad funcional de la corteza del cíngulo anterior (CCA) con el precuneus (P), la corteza del cíngulo posterior (CCP) y la corteza prefrontal dorsomedial (CPDM). RESULTADOS: Las conectividades funcionales en cada una de las asociaciones evaluadas en los pacientes con TDAH comparado con los controles fueron: P_D=0,41 vs. 0,44; CCP_D=0,43 vs. 0,53; CPDM_D=0,75 vs. 0,79; P_I=0,40 vs. 0,41; CCP_I=0,48 vs. 0,53; CPDM_I=0,76 vs. 0,72). D: lado derecho I: lado izquierdo. Valor de p> 0,05. CONCLUSIÓN: La conectividad funcional cerebral en estado de reposo es menor en los pacientes con TDAH cuando se compara con controles sanos; sin embargo, la diferencia no fue estadísticamente significativa

OBJECTIVE: To explore whether children and adolescents with attention deficit/hyperactivity disorder (ADHD) have altered the functional connectivity between the executive control network and the default mode network. METHODS: Exploratory study of a diagnostic test, prospective, case and control design. A total of 56 participants were recruited consecutively (29 inattentive or combined ADHD subtype and 27 controls) between 7 and 16 years old, male, right dominance. DSM-5 was applied as reference test and a battery of neuropsychological tests to confirm the diagnosis and assess comorbidities. Resting state functional magnetic resonance imaging was performed as an index test. The application and evaluation of the tests was blind. The brain regions were chosen a priori and the region of interest technique was used. The functional connectivity of the anterior cingulate cortex (ACC) was evaluated with: the precuneus (P), the posterior cingulate cortex (PCC) and the dorsomedial prefrontal cortex (DMPC). RESULTS: The functional connectivity in each of the associations evaluated in the patients with ADHD compared with the controls were: P_D=0.41 vs 0.44; CCP_D=0.43 vs 0.53; CPDM_D=0.75 vs. 0.79; P_I=0.40 vs 0.41; CCP_I=0.48 vs 0.53; CPDM_I=0.76 vs. 0.72). D: right side I: left side. Value of p> 0.05. CONCLUSION: Cerebral functional connectivity at rest is lower in ADHD patients when compared with healthy controls, however, the difference was not statistically significant

Humanos , Masculino , Criança , Adolescente , Imageamento por Ressonância Magnética , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico por imagem , Cérebro/diagnóstico por imagem , Estudos Prospectivos , Neuroimagem
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(2): 68-74, mar.-abr. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196346


PROPÓSITO: La identificación precisa de los gliomas de bajo grado (GBG; grados I y II de la Organización Mundial de la Salud) y su diferenciación de las lesiones por inflamación cerebral (BIL) sigue siendo difícil; sin embargo, es esencial para el tratamiento. Este estudio evaluó si un protocolo de un día para la PET/TC con 18F-FDG y 13N-amonio con análisis de desacoplamiento de la captación podría diferenciar los GBG de las BIL. MATERIALES Y MÉTODOS: Veintiocho pacientes con GBG y 16 pacientes con BIL se sometieron a PET/TC con 18F-FDG y 13N-amonio el mismo día antes de cualquier tipo de terapia. La puntuación de desacoplamiento y la relación tumor/tejido normal (T/N) de 18F-FDG y 13N-amonio se calcularon en cada localización. Se utilizó la prueba t de Student para comparar valores, y el análisis de la curva ROC para establecer un valor de corte para la relación T/N y la puntuación de desacoplamiento. Se calculó el área bajo la curva (AUC) para evaluar la eficacia diferencial. RESULTADOS: Se observaron diferencias significativas en la relación T/N de 13N-amonio (p = 0,018) y en la puntuación de desacoplamiento (p = 0,003) entre los GBG y las BIL; sin embargo, la relación T/N de 18F-FDG no mostró ninguna diferencia (p = 0,413). Los valores de corte óptimos para la relación T/N de 18F-FDG, la relación T/N de 13N-amonio y la puntuación de desacoplamiento fueron 0,73, 0,97 y 2,31, respectivamente, con AUC correspondientes de 0,48, 0,68 y 0,77. Los respectivos parámetros de sensibilidad, especificidad y precisión que utilizan estos valores de corte fueron 53,6%, 62,5% y 56,8%, respectivamente, para 18F-FDG; 50,0%, 75,0% y 59,1%, respectivamente, para 13N-amonio; y 60,7%, 93,8% y 72,7%, respectivamente, para la puntuación de desacoplamiento. CONCLUSIONES: La puntuación de desacoplamiento de la captación de 18F-FDG/13N amonio se puede utilizar para discriminar entre GBG y BIL. El uso de un mapa de desacoplamiento de estos dos trazadores puede mejorar el análisis visual y la precisión del diagnóstico

PURPOSE: Accurate identification of low-grade gliomas (LGGs; World Health Organization grades I and II) and their differentiation from brain inflammation lesions (BILs) remains difficult; however, it is essential for treatment. This study assessed whether a one-day protocol for voxel-wise 18F-FDG and 13N-ammonia PET/CT with uptake decoupling analysis could differentiate LGGs from BILs. MATERIALS AND METHODS: Twenty-eight patients with LGGs and 16 patients with BILs underwent 18F-FDG and 13N-ammonia PET/CT on the same day before any type of therapy. The decoupling score and tumor-to-normal tissue (T/N) ratio of 18F-FDG and 13N-ammonia were calculated at each location. Student's t-test was used to compare values, and ROC curve analysis was used to establish a cut-off value for the T/N ratio and decoupling score. Area under the curve (AUC) was calculated to evaluate differential efficacy. RESULTS: Significant differences were observed in 13N-ammonia T/N ratio (p = 0.018) and decoupling score (p = 0.003) between LGGs and BILs; however, the 18F-FDG T/N ratio did not show any differences (p = 0.413). Optimal cut-off values for 18F-FDG T/N ratio, 13N-ammonia T/N ratio, and decoupling score were 0.73, 0.97, and 2.31, respectively, with corresponding AUCs of 0.48, 0.68, and 0.77. The respective sensitivity, specificity, and accuracy parameters using these cut-off values were 53.6%, 62.5%, and 56.8%, respectively, for 18F-FDG; 50.0%, 75.0%, and 59.1%, respectively, for 13N-ammonia; and 60.7%, 93.8%, and 72.7%, respectively, for decoupling score. CONCLUSIONS: 18F-FDG/13N-ammonia uptake decoupling score can be used to discriminate between LGGs and BILs. Use of a decoupling map of these two tracers can improve visual analysis and diagnostic accuracy

Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Neoplasias Encefálicas/diagnóstico por imagem , Encefalite/diagnóstico por imagem , Fluordesoxiglucose F18 , Glioma/diagnóstico por imagem , Radioisótopos de Nitrogênio , Tomografia Computadorizada por Raios X/métodos , Compostos Radiofarmacêuticos , Área Sob a Curva , Cérebro/diagnóstico por imagem , Cérebro/metabolismo , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/metabolismo , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Doenças Desmielinizantes/diagnóstico por imagem , Doenças Desmielinizantes/metabolismo , Encefalite/metabolismo , Fluordesoxiglucose F18/farmacocinética , Glioma/metabolismo , Glioma/patologia , Gradação de Tumores , Radioisótopos de Nitrogênio/farmacocinética , Tomografia por Emissão de Pósitrons , Curva ROC , Compostos Radiofarmacêuticos/farmacocinética , Estudos Retrospectivos , Sensibilidade e Especificidade
World Neurosurg ; 138: e478-e485, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32147552


OBJECTIVE: The objective of this study was to compare transcortical and posterior interhemispheric approaches to the atrium using a combined approach of white matter fiber dissections and magnetic resonance (MR) tractography. METHODS: Ten cerebral hemispheres were examined and dissected from the lateral-to-medial surface and from the medial-to-lateral surface, with special attention to the white matter tracts related to the atrium. MR tractography was used to show the relationship of three-dimensional white matter fibers with the atrium of the lateral ventricle and to compare with cadaveric dissection results. RESULTS: The atrium was related laterally to the superior longitudinal fasciculus II and III, middle longitudinal fasciculus, arcuate fasciculus, vertical occipital fasciculus, and sagittal stratum. Medially, it is related to the superior longitudinal fasciculus I, cingulum, sledge runner, and forceps major. CONCLUSIONS: A combined approach of cadaveric white matter fiber dissections and MR tractography were used to describe the main white matter tracts related to the posterior interhemispheric approach and the transcortical approach, providing an in-depth understanding of the three-dimensional anatomy of white matter fibers and the atrium. In the present study, among approaches examined, the posterior interhemispheric parasplenial transprecuneus approach placed fewer eloquent tracts at risk; however, traversing the sledge runner and the forceps major is unavoidable by this approach.

Cérebro/cirurgia , Ventrículos Laterais/cirurgia , Substância Branca/cirurgia , Cérebro/diagnóstico por imagem , Imagem de Tensor de Difusão , Dissecação , Humanos , Imageamento Tridimensional , Ventrículos Laterais/diagnóstico por imagem , Imageamento por Ressonância Magnética , Substância Branca/diagnóstico por imagem