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1.
Medicine (Baltimore) ; 99(36): e22029, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899058

RESUMO

This study aims to describe the role of open surgical treatment for focal brainstem gliomas (FBSGs) with the assistance of multimodal neuronavigation and intraoperative neurophysiological monitoring (IOM) in children to investigate the efficacy of microsurgical treatment in pediatric FBSGs. Also the prognostic factors related to the overall survival (OS) of FBSGs to describe the patient and tumor characteristics relevant to prognosis/outcome were focused on. Clinical data of 63 pediatric patients below 16 years of age with FBSGs admitted to the Neurosurgical Unit of Beijing Tiantan Hospital from January 2012 to December 2018 were retrospectively analyzed. All patients underwent initial surgical treatment, followed by magnetic resonance diffusion tensor imaging (DTI), neuronavigation and IOM. Gross or near total resection (GTR or NTR) was achieved in 57/63 (90.5%) cases, and subtotal resection (STR) was achieved in 6/63 (9.5%) cases. Postoperative adjuvant therapy was received by 27/63 (42.9%) cases. Postoperative pathological examination revealed that 36/63 (57.1%) cases had grade I gliomas, 22/63 (34.9%) had grade II, and 5/63 (8.0%) had grade III-IV gliomas according to the WHO classification. The mean Karnofsky score preoperatively was 60, and at the time of follow-up was 90. Consecutively, 6 cases demonstrated disease progression, and 5 of these were deceased. The OS in all patients was 81.2% at 5 years. Histological grade (P < .001) and age at diagnosis (P = .023) showed significant association with prolonged OS. Multimodal neuronavigation and IOM allow very precise intracranial surgery, contributing to a maximally safe resection that might decrease the postoperative disability and mortality rate. This study also showed that pediatric FBSGs were mostly low-grade tumors with excellent surgical outcomes. Consequently, it is suggested that microsurgery can be used to treat FBSGs in children in order to provide better prognosis and survival outcomes.


Assuntos
Neoplasias do Tronco Encefálico/patologia , Glioma/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Neuronavegação/métodos , Adolescente , Quimioterapia Adjuvante , Criança , Pré-Escolar , China/epidemiologia , Imagem de Tensor de Difusão/métodos , Progressão da Doença , Feminino , Glioma/diagnóstico por imagem , Humanos , Lactente , Avaliação de Estado de Karnofsky , Masculino , Microcirurgia/métodos , Gradação de Tumores , Cuidados Pós-Operatórios , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
2.
Medicine (Baltimore) ; 99(37): e22117, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925758

RESUMO

RATIONALE: Lateral medullary syndrome is a central vestibular disorder characterized by vertigo and ataxia. We report on a patient with injury of the lateral vestibulospinal tract (VST) following lateral medullary syndrome, detected on diffusion tensor tractography (DTT). PATIENT CONCERNS: A 56-year-old male patient was diagnosed with lateral medullary syndrome due to an infarction in the posterior inferior cerebellar artery area. DIAGNOSES: Two weeks following the infarction, he was transferred to the rehabilitation department of the same university hospital with severe vertigo, ataxia (Berg balance scale: 16 point), and dysphasia. In contrast, he maintained good motor power and cognitive function (Mini-mental state test: 26 points). INTERVENTIONS: N/A OUTCOMES:: Both the patient's medial VSTs and left lateral VST were well-reconstructed. In contrast, the right lateral VST was not reconstructed. On DTT parameters of the VST, the patient's medial VSTs and left lateral VST did not differ significantly from the control subjects. LESSONS: An injury of the right lateral VST was demonstrated in a patient with lateral medullary syndrome. We believe that the result will be helpful in clinical management and research for patients with lateral medullary syndrome.


Assuntos
Síndrome Medular Lateral/complicações , Síndrome Medular Lateral/diagnóstico por imagem , Tratos Espinocerebelares/diagnóstico por imagem , Imagem de Tensor de Difusão , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
3.
Bone Joint J ; 102-B(9): 1210-1218, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862690

RESUMO

AIMS: The aim of this study was to use diffusion tensor imaging (DTI) to investigate changes in diffusion metrics in patients with cervical spondylotic myelopathy (CSM) up to five years after decompressive surgery. We correlated these changes with clinical outcomes as scored by the Modified Japanese Orthopedic Association (mJOA) method, Neck Disability Index (NDI), and Visual Analogue Scale (VAS). METHODS: We used multi-shot, high-resolution, diffusion tensor imaging (ms-DTI) in patients with cervical spondylotic myelopathy (CSM) to investigate the change in diffusion metrics and clinical outcomes up to five years after anterior cervical interbody discectomy and fusion (ACDF). High signal intensity was identified on T2-weighted imaging, along with DTI metrics such as fractional anisotropy (FA). MJOA, NDI, and VAS scores were also collected and compared at each follow-up point. Spearman correlations identified correspondence between FA and clinical outcome scores. RESULTS: Significant differences in mJOA scores and FA values were found between preoperative and postoperative timepoints up to two years after surgery. FA at the level of maximum cord compression (MCL) preoperatively was significantly correlated with the preoperative mJOA score. FA postoperatively was also significantly correlated with the postoperative mJOA score. There was no statistical relationship between NDI and mJOA or VAS. CONCLUSION: ms-DTI can detect microstructural changes in affected cord segments and reflect functional improvement. Both FA values and mJOA scores showed maximum recovery two years after surgery. The DTI metrics are significantly associated with pre- and postoperative mJOA scores. DTI metrics are a more sensitive, timely, and quantifiable surrogate for evaluating patients with CSM and a potential quantifiable biomarker for spinal cord dysfunction. Cite this article: Bone Joint J 2020;102-B(9):1210-1218.


Assuntos
Imagem de Tensor de Difusão , Compressão da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Vértebras Cervicais , Imagem de Tensor de Difusão/métodos , Discotomia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/cirurgia , Espondilose/complicações , Fatores de Tempo
4.
PLoS One ; 15(8): e0233244, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32797080

RESUMO

The role of white matter in reading has been established by diffusion tensor imaging (DTI), but DTI cannot identify specific microstructural features driving these relationships. Neurite orientation dispersion and density imaging (NODDI), inhomogeneous magnetization transfer (ihMT) and multicomponent driven equilibrium single-pulse observation of T1/T2 (mcDESPOT) can be used to link more specific aspects of white matter microstructure and reading due to their sensitivity to axonal packing and fiber coherence (NODDI) and myelin (ihMT and mcDESPOT). We applied principal component analysis (PCA) to combine DTI, NODDI, ihMT and mcDESPOT measures (10 in total), identify major features of white matter structure, and link these features to both reading and age. Analysis was performed for nine reading-related tracts in 46 neurotypical 6-16 year olds. We identified three principal components (PCs) which explained 79.5% of variance in our dataset. PC1 probed tissue complexity, PC2 described myelin and axonal packing, while PC3 was related to axonal diameter. Mixed effects regression models did not identify any significant relationships between principal components and reading skill. Bayes factor analysis revealed that the absence of relationships was not due to low power. Increasing PC1 in the left arcuate fasciculus with age suggest increases in tissue complexity, while increases of PC2 in the bilateral arcuate, inferior longitudinal, inferior fronto-occipital fasciculi, and splenium suggest increases in myelin and axonal packing with age. Multimodal white matter imaging and PCA provide microstructurally informative, powerful principal components which can be used by future studies of development and cognition. Our findings suggest major features of white matter undergo development during childhood and adolescence, but changes are not linked to reading during this period in our typically-developing sample.


Assuntos
Neuroimagem Funcional/métodos , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Leitura , Substância Branca/anatomia & histologia , Adolescente , Desenvolvimento do Adolescente/fisiologia , Axônios/ultraestrutura , Teorema de Bayes , Criança , Desenvolvimento Infantil/fisiologia , Imagem de Tensor de Difusão/estatística & dados numéricos , Feminino , Neuroimagem Funcional/estatística & dados numéricos , Voluntários Saudáveis , Humanos , Imageamento Tridimensional , Masculino , Modelos Anatômicos , Modelos Neurológicos , Imageamento por Ressonância Magnética Multiparamétrica/estatística & dados numéricos , Bainha de Mielina/metabolismo , Análise de Componente Principal/métodos , Análise de Regressão , Substância Branca/crescimento & desenvolvimento , Substância Branca/fisiologia
5.
Clin Imaging ; 67: 177-188, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32829150

RESUMO

OBJECTIVE: This study sought to assess the feasibility of diffusion tensor imaging (DTI) to noninvasively evaluate histological grade and lymph node metastasis in patients with rectal carcinoma (RC). METHODS: Thirty-seven consecutive patients with histologically confirmed RC were examined by 1.5-T MRI. DTI was performed using a single-shot echo-planar imaging sequence with b values of 0 and 1000 s/mm2 and motion-probing gradients in nine noncollinear directions. Fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) maps were compared with histopathological findings. RESULTS: The FA values (0.357 ±â€¯0.047) of the RCs were significantly lower than those of the normal rectal wall, muscle, prostate, and uterus (P < 0.001 for all), while the AD, MD, and RD values (1.221 ±â€¯0.131, 0.804 ±â€¯0.075, and 0.667 ±â€¯0.057 × 10-3 mm2/s, respectively) were also significantly lower than their respective normal values (P < 0.001 for all). The FA, AD, MD, and RD values for RC additionally showed significant inverse correlations with histological grades (r = -0.781, r = -0.750, r = -0.718, and r = -0.682, respectively; P < 0.001 for all). Further, the FA (0.430 vs. 0.611), AD (1.246 vs. 1.608 × 10-3 mm2/s), MD (0.776 vs. 1.036 × 10-3 mm2/s), and RD (0.651 vs. 0.824 × 10-3 mm2/s) (P < 0.001 for all) of the metastatic and nonmetastatic lymph nodes were significantly different. CONCLUSIONS: DTI may be clinically useful for the noninvasive evaluation of histological grade and lymph node metastasis in patients with RC.


Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias Retais/diagnóstico por imagem , Anisotropia , Imagem de Difusão por Ressonância Magnética , Imagem de Tensor de Difusão/métodos , Imagem Ecoplanar , Feminino , Humanos , Linfonodos , Metástase Linfática , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Útero
6.
J Comput Assist Tomogr ; 44(5): 687-691, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842070

RESUMO

BACKGROUND: Neonatal hypoxic-ischemic encephalopathy (HIE) is associated with dysfunctional cerebral autoregulation. Resistive index (RI) measured in the anterior cerebral artery on transfontanellar head ultrasound is a noninvasive measure of blood flow and may indicate autoregulation dysfunction. We tested whether RI was associated with brain injury on diffusion tensor imaging magnetic resonance imaging (MRI). MATERIALS AND METHODS: Seventy-five neonates who underwent therapeutic hypothermia for HIE were enrolled. Resistive index values were obtained from head ultrasound performed at the end of therapeutic hypothermia. Apparent diffusion coefficient scalars were measured on MRIs performed before day of life 10. RESULTS: Lower RI was associated with lower apparent diffusion coefficient in the centrum semiovale, basal ganglia, thalamus, and posterior limb of the internal capsule. Combining RI and Apgar scores improved the ability to distinguish injury severity on MRI relative to either metric alone. CONCLUSIONS: Low RI correlated with worse brain injury on diffusion tensor imaging and may serve as an early marker of brain injury in cooled HIE neonates.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/fisiopatologia , Feminino , Cabeça/diagnóstico por imagem , Humanos , Hipóxia-Isquemia Encefálica/epidemiologia , Hipóxia-Isquemia Encefálica/fisiopatologia , Recém-Nascido , Masculino , Fluxo Pulsátil/fisiologia
7.
Medicine (Baltimore) ; 99(32): e21601, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769915

RESUMO

RATIONALE: We report on a patient with mild traumatic brain injury (TBI) with contrecoup injury of the prefronto-thalamic tract (PTT), as demonstrated by diffusion tensor tractography (DTT). PATIENT CONCERNS: A 62-year-old female patient suffered a head trauma after falling backward. While working at a height of 85cm above the floor, she fell backward and struck the occipital area of her head on the ground. The patient experienced cognitive dysfunction and depressive mood after the head trauma. DIAGNOSES: The patient was diagnosed as mild TBI due to falling backward. INTERVENTIONS: Clinical evaluation of her brain was performed at 2 months after onset. OUTCOMES: DTT at 2 months after onset revealed narrowings in the right ventrolateral and both orbitofrontal PTTs, whereas both the dorsolateral and left ventrolateral PTTs were not reconstructed. LESSONS: Injuries of the PTTs associated with a contrecoup brain injury were demonstrated in a patient with mild TBI.


Assuntos
Lesão de Contragolpe/complicações , Tálamo/lesões , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Lesão de Contragolpe/fisiopatologia , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Pessoa de Meia-Idade
8.
Neurology ; 95(7): e781-e792, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32641518

RESUMO

OBJECTIVE: To study longitudinal recovery trajectories of white matter after sports-related concussion (SRC) by performing diffusion tensor imaging (DTI) on collegiate athletes who sustained SRC. METHODS: Collegiate athletes (n = 219, 82 concussed athletes, 68 contact-sport controls, and 69 non-contact-sport controls) were included from the Concussion Assessment, Research and Education Consortium. The participants completed clinical assessments and DTI at 4 time points: 24 to 48 hours after injury, asymptomatic state, 7 days after return-to-play, and 6 months after injury. Tract-based spatial statistics was used to investigate group differences in DTI metrics and to identify white-matter areas with persistent abnormalities. Generalized linear mixed models were used to study longitudinal changes and associations between outcome measures and DTI metrics. Cox proportional hazards model was used to study effects of white-matter abnormalities on recovery time. RESULTS: In the white matter of concussed athletes, DTI-derived mean diffusivity was significantly higher than in the controls at 24 to 48 hours after injury and beyond the point when the concussed athletes became asymptomatic. While the extent of affected white matter decreased over time, part of the corpus callosum had persistent group differences across all the time points. Furthermore, greater elevation of mean diffusivity at acute concussion was associated with worse clinical outcome measures (i.e., Brief Symptom Inventory scores and symptom severity scores) and prolonged recovery time. No significant differences in DTI metrics were observed between the contact-sport and non-contact-sport controls. CONCLUSIONS: Changes in white matter were evident after SRC at 6 months after injury but were not observed in contact-sport exposure. Furthermore, the persistent white-matter abnormalities were associated with clinical outcomes and delayed recovery time.


Assuntos
Traumatismos em Atletas/reabilitação , Concussão Encefálica/patologia , Imagem de Tensor de Difusão , Substância Branca/patologia , Adolescente , Adulto , Atletas , Traumatismos em Atletas/diagnóstico por imagem , Concussão Encefálica/diagnóstico , Concussão Encefálica/fisiopatologia , Corpo Caloso/patologia , Corpo Caloso/fisiopatologia , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Feminino , Futebol Americano/lesões , Humanos , Masculino , Substância Branca/fisiopatologia , Adulto Jovem
9.
Neurology ; 95(7): e827-e838, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32680941

RESUMO

OBJECTIVE: To determine whether neurofilament light chain protein in CSF (cNfL), a sensitive biomarker of neuroaxonal damage, reflects disease severity or can predict survival in Parkinson disease (PD). METHODS: We investigated whether disease severity, phenotype, or survival in patients with new-onset PD correlates with cNfL concentrations around the time of diagnosis in the population-based New Parkinsonism in Umeå (NYPUM) study cohort (n = 99). A second, larger new-onset PD cohort (n = 194) was used for independent validation. Association of brain pathology with the cNfL concentration was examined with striatal dopamine transporter imaging and repeated diffusion tensor imaging at baseline and 1 and 3 years. RESULTS: Higher cNfL in the early phase of PD was associated with greater severity of all cardinal motor symptoms except tremor in both cohorts and with shorter survival and impaired olfaction. cNfL concentrations above the median of 903 ng/L conferred an overall 5.8 times increased hazard of death during follow-up. After adjustment for age and sex, higher cNfL correlated with striatal dopamine transporter uptake deficits and lower fractional anisotropy in diffusion tensor imaging of several axonal tracts. CONCLUSIONS: cNfL shows usefulness as a biomarker of disease severity and to predict survival in PD. The present results indicate that the cNfL concentration reflects the intensity of the neurodegenerative process, which could be important in future clinical trials. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with PD, cNfL concentrations are associated with more severe disease and shorter survival.


Assuntos
Biomarcadores/sangue , Proteínas de Neurofilamentos/metabolismo , Doença de Parkinson/diagnóstico , Transtornos Parkinsonianos/diagnóstico , Adulto , Idoso , Imagem de Tensor de Difusão/métodos , Progressão da Doença , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/metabolismo
10.
Neurology ; 95(5): e532-e544, 2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32661099

RESUMO

OBJECTIVE: To investigate the association between ß-amyloid (Aß) load and postmortem structural network topology in decedents without dementia. METHODS: Fourteen decedents (mean age at death 72.6 ± 7.2 years) without known clinical diagnosis of neurodegenerative disease and meeting pathology criteria only for no or low Alzheimer disease (AD) pathologic change were selected from the Normal Aging Brain Collection Amsterdam database. In situ brain MRI included 3D T1-weighted images for anatomical registration and diffusion tensor imaging for probabilistic tractography with subsequent structural network construction. Network topologic measures of centrality (degree), integration (global efficiency), and segregation (clustering and local efficiency) were calculated. Tissue sections from 12 cortical regions were sampled and immunostained for Aß and hyperphosphorylated tau (p-tau), and histopathologic burden was determined. Linear mixed effect models were used to assess the relationship between Aß and p-tau load and network topologic measures. RESULTS: Aß was present in 79% of cases and predominantly consisted of diffuse plaques; p-tau was sparsely present. Linear mixed effect models showed independent negative associations between Aß load and global efficiency (ß = -0.83 × 10-3, p = 0.014), degree (ß = -0.47, p = 0.034), and clustering (ß = -0.55 × 10-2, p = 0.043). A positive association was present between Aß load and local efficiency (ß = 3.16 × 10-3, p = 0.035). Regionally, these results were significant in the posterior cingulate cortex (PCC) for degree (ß = -2.22, p < 0.001) and local efficiency (ß = 1.01 × 10-2, p = 0.014) and precuneus for clustering (ß = -0.91 × 10-2, p = 0.017). There was no relationship between p-tau and network topology. CONCLUSION: This study in deceased adults with AD-related pathologic change provides evidence for a relationship among early Aß accumulation, predominantly of the diffuse type, and structural network topology, specifically of the PCC and precuneus.


Assuntos
Envelhecimento/patologia , Peptídeos beta-Amiloides , Encéfalo/patologia , Rede Nervosa/patologia , Idoso , Idoso de 80 Anos ou mais , Encéfalo/fisiopatologia , Imagem de Tensor de Difusão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Rede Nervosa/fisiopatologia , Redes Neurais de Computação
11.
Br J Radiol ; 93(1113): 20200321, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32628097

RESUMO

OBJECTIVE: Pituitary macroadenomas (PAs) are usually defined as benign intracranial tumors. However, they may present local aggressive course. High Ki67 labelling index (LI) values have been related to an aggressive tumor behavior. A recent clinicopathological classification of PA based on local invasiveness and proliferation indexes, divided them in groups with different prognosis. We evaluated the utility of conventional MRI (cMRI) and diffusion-weighted imaging (DWI), in predicting the Ki67- LI according the clinicopathological classification. METHODS: 17 patients (12 M and 5 F) who underwent surgical removal of a PA were studied. cMRI features, quantification of T1W and T2W signal intensity, degree of contrast uptake (enhancement ratio, ER) and apparent diffusion coefficient (ADC) values were evaluated by using a 3 T scan. Statistics included Mann-Whitney test, Spearman's test, and receiver operating characteristic analysis. A value of p ≤ 0.05 was considered significant for all the tests. RESULTS: Negative correlations were observed between Ki-67 LI, ADCm (ρ = - 0.67, p value = 0.005) and ER values (ρ = -0.62; p = 0.008). ER values were significantly lower in the proliferative PA group (p = 0.028; p = 0.017). ADCm showed sensitivity and specificity of 90 and 85% respectively into predict Ki67-LI value. A value of ADCm ≤0, 711 x 10-6 mm2 emerged as a cut-off of a value of Ki67-LI ≥ 3%. CONCLUSION: Adding quantitative measures of ADC values to cMRI could be used routinely as a non-invasive marker of specific predictive biomarker of the proliferative activity of PA. ADVANCES IN KNOWLEDGE: Routinely use of DWI on diagnostic work-up of pituitary adenomas may help in establish the likely biological aggressive lesions.


Assuntos
Adenoma/diagnóstico por imagem , Antígeno Ki-67/análise , Imagem por Ressonância Magnética/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Adenoma/química , Adenoma/patologia , Adenoma/cirurgia , Núcleo Celular/química , Proliferação de Células , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Invasividade Neoplásica , Neoplasias Hipofisárias/química , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Curva ROC , Sensibilidade e Especificidade , Estatísticas não Paramétricas
14.
PLoS One ; 15(7): e0235311, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628734

RESUMO

OBJECTIVE: This study aimed to define the prevalence and predictors of non-right-handedness and its link to long-term neurodevelopmental outcome and early neuroimaging in a cohort of children born extremely preterm (<28 weeks gestation). METHODS: 179 children born extremely preterm admitted to the Neonatal Intensive Care Unit of our tertiary centre from 2006-2013 were included in a prospective longitudinal cohort study. Collected data included perinatal data, demographic characteristics, neurodevelopmental outcome measured by the Bayley Scales of Infant and Toddler Development at 2 years and the Movement Assessment Battery for Children at 5 years, and handedness measured at school age (4-8 years). Magnetic resonance imaging performed at term-equivalent age was used to study overt brain injury. Diffusion tensor imaging scans were analysed using tract-based spatial statistics to assess white matter microstructure in relation to handedness and neurodevelopmental outcome. RESULTS: The prevalence of non-right-handedness in our cohort was 22.9%, compared to 12% in the general population. Weaker fine motor skills at 2 years and paternal non-right-handedness were significantly associated with non-right-handedness. Both overt brain injury and fractional anisotropy of white matter structures on diffusion tensor images were not related to handedness. Fractional anisotropy measurements showed significant associations with neurodevelopmental outcome. CONCLUSIONS: Our data show that non-right-handedness in children born extremely preterm occurs almost twice as frequently as in the general population. In the studied population, non-right-handedness is associated with weaker fine motor skills and paternal non-right-handedness, but not with overt brain injury or microstructural brain development on early magnetic resonance imaging.


Assuntos
Encéfalo/crescimento & desenvolvimento , Desenvolvimento Infantil/fisiologia , Imagem de Tensor de Difusão/estatística & dados numéricos , Lateralidade Funcional/fisiologia , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Criança , Pré-Escolar , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/epidemiologia , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Estudos Prospectivos
15.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(7): 711-715, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32669166

RESUMO

OBJECTIVE: To study the value of fractional anisotropy (FA) of regions of interest (ROI) on magnetic resonance diffusion tensor imaging (DTI) in bilirubin-induced neurological dysfunction in neonates. METHODS: A total of 91 neonates with hyperbilirubinemia who were hospitalized from January 2017 to January 2018 were enrolled. According to the peak level of total serum bilirubin, they were divided into three groups: mild/moderate increase (n=45), severe increase (n=35), and extremely severe increase (n=11). According to the presence or absence of abnormal neurological manifestations, they were divided into two groups: neurological dysfunction (n=20) and non-neurological dysfunction (n=71). Ten healthy full-term infants were enrolled as the control group. Head DTI was performed for all neonates to measure the FA values of the bilateral globus pallidus, the anterior limb of the internal capsule, the posterior limb of the internal capsule, and the cerebellar dentate nucleus. RESULTS: The extremely severe increase group had significantly lower FA values of the globus pallidus than the control, mild/moderate increase, and severe increase groups (P<0.05). The severe increase group had significantly lower FA values of the globus pallidus than the control group (P<0.05). The extremely severe increase group had significantly lower FA values of the posterior limb of the internal capsule than the control, mild/moderate increase, and severe increase groups (P<0.05). The neurological dysfunction group had significantly lower FA values of the globus pallidus and the posterior limb of the internal capsule than the non-neurological dysfunction group (P<0.05). CONCLUSIONS: Serum bilirubin level combined with the changes in the DTI FA values of the globus pallidus and the posterior limb of the internal capsule can be used to predict the injury of cerebral nuclei and white matter fibers.


Assuntos
Imagem de Tensor de Difusão , Substância Branca , Anisotropia , Bilirrubina , Encéfalo , Imagem de Difusão por Ressonância Magnética , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética
16.
Br J Anaesth ; 125(1): 55-66, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32499013

RESUMO

BACKGROUND: Delirium frequently affects older patients, increasing morbidity and mortality; however, the pathogenesis is poorly understood. Herein, we tested the cognitive disintegration model, which proposes that a breakdown in frontoparietal connectivity, provoked by increased slow-wave activity (SWA), causes delirium. METHODS: We recruited 70 surgical patients to have preoperative and postoperative cognitive testing, EEG, blood biomarkers, and preoperative MRI. To provide evidence for causality, any putative mechanism had to differentiate on the diagnosis of delirium; change proportionally to delirium severity; and correlate with a known precipitant for delirium, inflammation. Analyses were adjusted for multiple corrections (MCs) where appropriate. RESULTS: In the preoperative period, subjects who subsequently incurred postoperative delirium had higher alpha power, increased alpha band connectivity (MC P<0.05), but impaired structural connectivity (increased radial diffusivity; MC P<0.05) on diffusion tensor imaging. These connectivity effects were correlated (r2=0.491; P=0.0012). Postoperatively, local SWA over frontal cortex was insufficient to cause delirium. Rather, delirium was associated with increased SWA involving occipitoparietal and frontal cortex, with an accompanying breakdown in functional connectivity. Changes in connectivity correlated with SWA (r2=0.257; P<0.0001), delirium severity rating (r2=0.195; P<0.001), interleukin 10 (r2=0.152; P=0.008), and monocyte chemoattractant protein 1 (r2=0.253; P<0.001). CONCLUSIONS: Whilst frontal SWA occurs in all postoperative patients, delirium results when SWA progresses to involve posterior brain regions, with an associated reduction in connectivity in most subjects. Modifying SWA and connectivity may offer a novel therapeutic approach for delirium. CLINICAL TRIAL REGISTRATION: NCT03124303, NCT02926417.


Assuntos
Encéfalo/fisiopatologia , Delírio/diagnóstico , Delírio/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Biomarcadores/sangue , Encéfalo/diagnóstico por imagem , Estudos de Coortes , Citocinas/sangue , Delírio/sangue , Imagem de Tensor de Difusão/métodos , Eletroencefalografia/métodos , Humanos , Complicações Pós-Operatórias/sangue
17.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(3): 132-145, mayo-jun. 2020. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-192417

RESUMO

ANTECEDENTES Y OBJETIVOS: La lesión axonal traumática (LAT) contribuye significativamente a la mortalidad y morbilidad tras traumatismo craneoencefálico (TCE). Sin embargo, la caracterización de la LAT supone un reto diagnóstico para las técnicas de neuroimagen habitual. La secuencia de RM tensor de difusión (diffusion tensor imaging [DTI]) es capaz de detectar el grado de difusión de las moléculas de agua tisular y así inferir la afectación traumática de la sustancia blanca. El objetivo principal de este trabajo ha sido caracterizar la LAT a través de la secuencia DTI realizada en la fase subaguda precoz en nuestra serie de pacientes con TCE moderado y grave y evaluar si existe asociación con la evolución de los pacientes. MATERIALES Y MÉTODOS: Se ha realizado RM-DTI a 217 pacientes con TCE moderado y grave en la fase subaguda precoz tras el TCE (mediana = 19 días). El método de análisis elegido es por región de interés para calcular el valor medio de fractional anisotropy (FA) en 28 haces de sustancia blanca. Los valores obtenidos en los pacientes se han comparado con aquellos medidos en 58 sujetos sanos. RESULTADOS: Los resultados principales han sido que los pacientes, independientemente de la gravedad, demostraron valores de FA significativamente inferiores al grupo control en prácticamente todos los haces estudiados. Se detectó asociación entre el valor de FA y algunas variables clínicas de interés. Adicionalmente, los valores de FA de las tres porciones del cuerpo calloso, cíngulo y pedúnculos cerebrales se correlacionaron con la evolución del paciente evaluada a los 6 y 12 meses tras el TCE. CONCLUSIONES: El DTI es una herramienta útil para caracterizar la LAT y la detección de la reducción de FA en la fase subaguda precoz se relaciona con evolución desfavorable de los pacientes a medio y largo plazo


BACKGROUND AND OBJECTIVES: Traumatic axonal injury (TAI) contributes significantly to mortality and morbidity after traumatic brain injury (TBI). Its identification is still a diagnostic challenge because of the limitations of conventional imaging techniques to characterized it. Diffusion tensor imaging (DTI) can indirectly identify areas of damaged white matter integrity by detecting water molecule diffusion alterations. Our main objective is to characterize the TAI using DTI at the early subacute stage in our series of moderate to severe TBI patients and to evaluate if there is a relationship between the information provided by the DTI and patient's outcome. MATERIALS AND METHODS: We have obtained DTI data from 217 patients with moderate to severe TBI acquired at a median of 19 days after TBI, and patient DTI metrics were compared with data obtained from 58 age-matched healthy controls. Region of interest method was applied to obtain mean fractional anisotropy (FA) value in 28 white matter fiber bundles susceptible to TAI. RESULTS: Our main results were that when we compared patients with controls, patients, regardless of TBI severity, showed significantly reduced mean FA in almost all region of interest measured. We found statistically significant correlation between FA metrics and some clinical characteristics. Additionally, the FA values of the three portions of Corpus callosum, Cingulum and cerebral peduncles measured at the early subacute stage were highly associated with outcome assessed at hospital discharge and at 6 and 12 months after TBI. CONCLUSIONS: We conclude that DTI is a useful tool to characterize TAI and the detection of FA reduction in the subacute stage after TBI is associated with long-term unfavorable outcome


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/cirurgia , Imagem de Tensor de Difusão/instrumentação , Distinções e Prêmios , Lesões Encefálicas Traumáticas/etiologia , Modelos Lineares , Intervalos de Confiança
18.
BMC Neurol ; 20(1): 236, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517723

RESUMO

BACKGROUND: Diffusion tensor imaging (DTI) is an effective method to identify subtle changes to normal-appearing white matter (WM). Here we analyzed the DTI data with other examinations, including motor evoked potentials (MEPs), histopathological images, and behavioral results, to reflect the lesion development in different degrees of spinal cord injury (SCI) in acute and subacute stages. METHOD: Except for 2 Sprague -Dawley rats which died from the anesthesia accident, the rest 42 female rats were randomized into 3 groups: control group (n = 6), moderate group (n = 18), and severe group (n = 18). Moderate (a 50-g aneurysm clip with 0.4-mm thickness spacer) or severe (a 50-g aneurysm clip with no spacer) contusion SCI at T8 vertebrae was induced. Then the electrophysiological assessments via MEPs, behavioral deterioration via the Basso, Beattie, and Bresnaha (BBB) scores, DTI data, and histopathology examination were analyzed. RESULTS: In this study, we found that the damage of WM myelin, MEPs amplitude, BBB scores and the decreases in the values of fractional anisotropy (FA) and axial diffusivity (AD) were more obvious in the severe injury group than those of the moderate group. Additionally, the FA and AD values could identify the extent of SCI in subacute and early acute SCI respectively, which was reflected in a robust correlations with MEPs and BBB scores. While the values of radial diffusivity (RD) showed no significant changes. CONCLUSIONS: Our data confirmed that DTI was a valuable in ex vivo imaging tool to identify damaged white matter tracts after graded SCI in rat, which may provide useful information for the early identification of the severity of SCI.


Assuntos
Imagem de Tensor de Difusão/métodos , Potencial Evocado Motor/fisiologia , Traumatismos da Medula Espinal/patologia , Traumatismos da Medula Espinal/fisiopatologia , Animais , Anisotropia , Feminino , Ratos , Ratos Sprague-Dawley , Substância Branca/patologia , Substância Branca/fisiopatologia
19.
Medicine (Baltimore) ; 99(22): e20492, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481462

RESUMO

To investigate the characteristics of diffusion tensor imaging (DTI) of the central nervous system in children with Tourette syndrome (TS).Fifteen children with TS (TS group) and 15 normal children (control group) were studied, and all of them underwent DTI. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) parameters were calculated using the DTIStudio software. The region of interest was delineated manually. The ADC and FA values of the bilateral caudate nucleus, bilateral globus pallidus, bilateral putamen, bilateral thalamus, and bilateral frontal lobe white matter were measured using the region of interest editor software. The differences of FA values and ADC values between the same brain areas were compared. The associations between ADC, FA values and Yale Global Tic Severity Scale (YGTSS) scores were evaluated by Pearson correlation analyses.The FA values of left globus pallidus and left thalamus were significantly lower in the TS group than in the control group (P < .05), while the ADC values of the right caudate nucleus and bilateral thalamus were significantly higher in the TS group than in the control group (P < .05). The decrease in FA in the left thalamus significantly correlated with the YGTSS score (r = 0.692; P < .05). No correlation was found between FA and ADC values in other brain regions and the YGTSS score (P > .05).After the DTI analyses, abnormalities were found in the left globus pallidus, right caudate nucleus, and bilateral thalamus in children with TS. Especially the changes in the left thalamus structure was crucial in the pathophysiological clock of TS.


Assuntos
Sistema Nervoso Central/diagnóstico por imagem , Sistema Nervoso Central/fisiopatologia , Imagem de Tensor de Difusão/métodos , Síndrome de Tourette/diagnóstico por imagem , Síndrome de Tourette/fisiopatologia , Anisotropia , Criança , Pré-Escolar , Feminino , Humanos , Masculino
20.
Maturitas ; 137: 24-29, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498933

RESUMO

BACKGROUND: Higher levels of physical activity (PA) are known to be associated with better white matter integrity measured by diffusion tensor imaging (DTI) in older adults in cross-sectional studies. However, no studies have investigated the association between PA levels and the evolution of DTI parameters (fractional anisotropy and mean diffusivity). OBJECTIVES: To examine the cross-sectional associations between PA levels and DTI parameters, then to investigate the association between baseline PA levels and the evolution of DTI parameters in older adults. METHODS: Data on magnetic resonance imaging with DTI method from the Multidomain Alzheimer's Preventive Trial (MAPT) study were used; 228 participants had data on DTI measured at three time-points over five years. Fractional anisotropy and mean diffusivity were acquired for six different brain regions. RESULTS: No significant associations were found in the cross-sectional analyses. Only one association was found: compared with active individuals, a faster worsening in the mean diffusivity of the uncinate fasciculus region was found in inactive individuals (-5.0 × 10-6 (-9.5 × 10-5, 4.9 × 10-6)). CONCLUSIONS: In this study, we found that the condition of the uncinate fasciculus region may be susceptible to changes in PA levels in older adults. Longitudinal studies that assess fitness and PA using objective measurements (e.g. cardiorespiratory fitness and accelerometry) could shed some new light on this topic.


Assuntos
Exercício Físico , Substância Branca/diagnóstico por imagem , Idoso , Anisotropia , Estudos Transversais , Imagem de Tensor de Difusão , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Prospectivos , Comportamento Sedentário
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