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1.
Comput Biol Med ; 124: 103960, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32919186

RESUMO

Artificial intelligence (AI) has penetrated the field of medicine, particularly the field of radiology. Since its emergence, the highly virulent coronavirus disease 2019 (COVID-19) has infected over 10 million people, leading to over 500,000 deaths as of July 1st, 2020. Since the outbreak began, almost 28,000 articles about COVID-19 have been published (https://pubmed.ncbi.nlm.nih.gov); however, few have explored the role of imaging and artificial intelligence in COVID-19 patients-specifically, those with comorbidities. This paper begins by presenting the four pathways that can lead to heart and brain injuries following a COVID-19 infection. Our survey also offers insights into the role that imaging can play in the treatment of comorbid patients, based on probabilities derived from COVID-19 symptom statistics. Such symptoms include myocardial injury, hypoxia, plaque rupture, arrhythmias, venous thromboembolism, coronary thrombosis, encephalitis, ischemia, inflammation, and lung injury. At its core, this study considers the role of image-based AI, which can be used to characterize the tissues of a COVID-19 patient and classify the severity of their infection. Image-based AI is more important than ever as the pandemic surges and countries worldwide grapple with limited medical resources for detection and diagnosis.


Assuntos
Betacoronavirus , Lesões Encefálicas/epidemiologia , Infecções por Coronavirus/epidemiologia , Traumatismos Cardíacos/epidemiologia , Pneumonia Viral/epidemiologia , Inteligência Artificial , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Lesões Encefálicas/classificação , Lesões Encefálicas/diagnóstico por imagem , Técnicas de Laboratório Clínico/métodos , Comorbidade , Biologia Computacional , Infecções por Coronavirus/classificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/diagnóstico por imagem , Aprendizado Profundo , Traumatismos Cardíacos/classificação , Traumatismos Cardíacos/diagnóstico por imagem , Humanos , Aprendizado de Máquina , Pandemias/classificação , Pneumonia Viral/classificação , Pneumonia Viral/diagnóstico por imagem , Fatores de Risco , Índice de Gravidade de Doença
4.
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
5.
Radiología (Madr., Ed. impr.) ; 62(4): 320-326, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194250

RESUMO

OBJETIVO: Analizar el impacto clínico de adquirir la secuencia de susceptibilidad magnética (SWI) de forma rutinaria en los estudios de resonancia magnética (RM) cerebral. MATERIAL Y MÉTODOS: Se lleva a cabo un estudio prospectivo observacional unicéntrico durante 6 meses a pacientes a los que se le realizó una RM cerebral. Los grupos de estudio se establecieron basándose en la información clínica remitida: el grupo 1 de estudio está formado por aquellos pacientes a los que el radiólogo protocolizó la adquisición de la secuencia SWI, y el grupo 2, por aquellos a los que se les realizó la secuencia SWI sin haber sido protocolizada. Se recogen la edad, sexo y factores de riesgo (hipertensión arterial, historia de traumatismo craneal o de malformaciones vasculares intracraneales). Se analizaron los hallazgos en la secuencia de SWI, si estos eran visibles en el resto de las secuencias y si su identificación suponía cambios sustanciales en el informe radiológico del paciente. RESULTADOS: El grupo 1 estaba formado por 62 pacientes y el grupo 2, por 79. No hubo diferencias al comparar la edad y los factores de riesgo entre los dos grupos. En el grupo 1, los hallazgos de la SWI supusieron un cambio en el informe radiológico en el 34% de los pacientes, y en el grupo 2, en un 14%: las diferencias fueron estadísticamente significativas. CONCLUSIÓN: La secuencia SWI puede ayudar al radiólogo a detectar hallazgos adicionales a las secuencias convencionales en la RM cerebral, que en algunos casos suponen un cambio en el informe radiológico


OBJECTIVE: To analyze the clinical impact of routine acquisition of susceptibility-weighted imaging (SWI) in magnetic resonance imaging (MRI) studies of the brain. MATERIAL AND METHODS: This prospective observational study included all patients undergoing brain MRI including SWI during a 6-month period. Patients were divided into two groups based on the clinical information provided: Group 1 comprised patients in whom SWI acquisition formed part of the brain MRI protocol, and Group comprised patients who underwent SWI without these sequences being included in the protocol. We recorded patients' age, sex, and risk factors (hypertension, history of brain trauma or intracranial vascular malformations). We analyzed the SWI findings, whether these findings were visible on the other sequences, and whether identifying these findings resulted in substantial changes to the radiological report. RESULTS: There were 62 patients in Group 1 and 79 in Group 2. The groups were similar in age and risk factors. SWI findings resulted in substantial changes to the radiological report in 34% of the patients in Group 1 and in 14% of those in Group 2; this difference was statistically significant. CONCLUSION: SWI can help radiologists detect findings not seen on conventional brain MRI that sometimes result in substantial changes to the radiological report


Assuntos
Humanos , Imagem por Ressonância Magnética/métodos , Protocolos Clínicos , Hemorragia/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Estudos Prospectivos , Fatores de Risco
6.
PLoS One ; 15(6): e0234382, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584824

RESUMO

A brief session of rightward prismatic adaptation (R-PA) has been shown to alleviate neglect symptoms in patients with right hemispheric damage, very likely by switching hemispheric dominance of the ventral attentional network (VAN) from the right to the left and by changing task-related activity within the dorsal attentional network (DAN). We have investigated this very rapid change in functional organisation with a network approach by comparing resting-state connectivity before and after a brief exposure i) to R-PA (14 normal subjects; experimental condition) or ii) to plain glasses (12 normal subjects; control condition). A whole brain analysis (comprising 129 regions of interest) highlighted R-PA-induced changes within a bilateral, fronto-temporal network, which consisted of 13 nodes and 11 edges; all edges involved one of 4 frontal nodes, which were part of VAN. The analysis of network characteristics within VAN and DAN revealed a R-PA-induced decrease in connectivity strength between nodes and a decrease in local efficiency within VAN but not within DAN. These results indicate that the resting-state connectivity configuration of VAN is modulated by R-PA, possibly by decreasing its modularity.


Assuntos
Atenção/fisiologia , Encéfalo/fisiologia , Rede Nervosa/fisiologia , Adaptação Fisiológica , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/terapia , Estudos de Casos e Controles , Conectoma , Óculos , Feminino , Lateralidade Funcional/fisiologia , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/diagnóstico por imagem , Rede Nervosa/fisiopatologia , Dispositivos Ópticos , Transtornos da Percepção/diagnóstico por imagem , Transtornos da Percepção/fisiopatologia , Transtornos da Percepção/terapia , Adulto Jovem
7.
Sci Rep ; 10(1): 7815, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32385407

RESUMO

A high-resolution, three-dimensional, optical imaging technique for the murine brain was developed to identify the effects of different therapeutic windows for preclinical brain research. This technique tracks the same cells over several weeks. We conducted a pilot study of a promising drug to treat diffuse axonal injury (DAI) caused by traumatic brain injury, using two different therapeutic windows, as a means to demonstrate the utility of this novel longitudinal imaging technique. DAI causes immediate, sporadic axon damage followed by progressive secondary axon damage. We administered minocycline for three days commencing one hour after injury in one treatment group and beginning 72 hours after injury in another group to demonstrate the method's ability to show how and when the therapeutic drug exerts protective and/or healing effects. Fewer varicosities developed in acutely treated mice while more varicosities resolved in mice with delayed treatment. For both treatments, the drug arrested development of new axonal damage by 30 days. In addition to evaluation of therapeutics for traumatic brain injury, this hybrid microlens imaging method should be useful to study other types of brain injury and neurodegeneration and cellular responses to treatment.


Assuntos
Axônios/efeitos dos fármacos , Lesões Encefálicas/tratamento farmacológico , Lesão Axonal Difusa/tratamento farmacológico , Minociclina/farmacologia , Animais , Axônios/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos dos fármacos , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/patologia , Lesão Axonal Difusa/diagnóstico por imagem , Lesão Axonal Difusa/patologia , Modelos Animais de Doenças , Humanos , Camundongos , Imagem Óptica
8.
Am J Emerg Med ; 38(7): 1546.e1-1546.e4, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32340823

RESUMO

BACKGROUND: The Pediatric Emergency Care Applied Research Network (PECARN) criteria identify children at low risk of clinically important traumatic brain injury (ciTBI) in whom CT head (CTH) is unnecessary. We assessed compliance with PECARN at outside hospitals (OSH) among children transferred to our pediatric trauma center. METHODS: Patients <18 years transferred between May 2016 and December 2018 undergoing CTH at an OSH were reviewed. A ciTBI was defined as one requiring hospitalization ≥2 midnights, intubation >24 h, neurosurgical intervention, or causing death. RESULTS: 202 children were transferred after CTH. 53 were excluded for incomplete records (16), suspected abuse (33), or penetrating injury (4). Of the 149 included children, PECARN recommended CTH in 39 (26.2%), shared decision making in 79 (53.0%), and no imaging in 31 (20.8%). 26 children (17.4%) had a radiographic traumatic brain injury (rTBI) while only 6 (4.0%) had ciTBIs. Of those with ciTBIs, PECARN recommended CTH in 4 and shared decision making in 2. No child in whom CTH was not recommended had a ciTBI. 45 (30.2%) children had isolated extracranial injuries requiring transfer and 83 (55.7%) were transferred despite normal CTHs and no associated injuries. 2 (1.3%) children underwent non-emergent surgery for ciTBI. CONCLUSIONS: Compliance with PECARN was low among referring facilities with nearly 75% of CTHs being potentially avoidable with proper adherence and parental counseling. Deferring imaging until after transfer appears safe as no child underwent emergent intervention upon arrival. Early transfer and improved compliance with PECARN may reduce the number of CTHs performed.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Técnicas de Apoio para a Decisão , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Centros de Traumatologia
9.
Stroke ; 51(4): 1158-1165, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32126938

RESUMO

Background and Purpose- Little is known about the association between covert vascular brain injury and cognitive impairment in middle-aged populations. We investigated if scores on a cognitive screen were lower in individuals with higher cardiovascular risk, and those with covert vascular brain injury. Methods- Seven thousand five hundred forty-seven adults, aged 35 to 69 years, free of cardiovascular disease underwent a cognitive assessment using the Digital Symbol Substitution test and Montreal Cognitive Assessment, and magnetic resonance imaging (MRI) to detect covert vascular brain injury (high white matter hyperintensities, lacunar, and nonlacunar brain infarctions). Cardiovascular risk factors were quantified using the INTERHEART (A Global Study of Risk Factors for Acute Myocardial Infarction) risk score. Multivariable mixed models tested for independent determinants of reduced cognitive scores. The population attributable risk of risk factors and MRI vascular brain injury on low cognitive scores was calculated. Results- The mean age of participants was 58 (SD, 9) years; 55% were women. Montreal Cognitive Assessment and Digital Symbol Substitution test scores decreased significantly with increasing age (P<0.0001), INTERHEART risk score (P<0.0001), and among individuals with high white matter hyperintensities, nonlacunar brain infarction, and individuals with 3+ silent brain infarctions. Adjusted for age, sex, education, ethnicity covariates, Digital Symbol Substitution test was significantly lowered by 1.0 (95% CI, -1.3 to -0.7) point per 5-point cardiovascular risk score increase, 1.9 (95% CI, -3.2 to -0.6) per high white matter hyperintensities, 3.5 (95% CI, -6.4 to -0.7) per nonlacunar stroke, and 6.8 (95% CI, -11.5 to -2.2) when 3+ silent brain infarctions were present. No postsecondary education accounted for 15% (95% CI, 12-17), moderate and high levels of cardiovascular risk factors accounted for 19% (95% CI, 8-30), and MRI vascular brain injury accounted for 10% (95% CI, -3 to 22) of low test scores. Conclusions- Among a middle-aged community-dwelling population, scores on a cognitive screen were lower in individuals with higher cardiovascular risk factors or MRI vascular brain injury. Much of the population attributable risk of low cognitive scores can be attributed to lower educational attainment, higher cardiovascular risk factors, and MRI vascular brain injury.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/psicologia , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/psicologia , Imagem por Ressonância Magnética/tendências , Testes de Estado Mental e Demência , Adulto , Idoso , Lesões Encefálicas/complicações , Disfunção Cognitiva/etiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
J Clin Neurosci ; 75: 234-239, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32173155

RESUMO

Adult-onset tics represent either a secondary tic disorder ("tourettism") or a late presentation of childhood tics, which may have been previously unrecognised. Head trauma has been recognised as an infrequent cause of adult-onset tic disorder, which exhibits variable temporal relationship to the inciting injury and response to therapy. We present a patient who presented with late-onset tics seven years after a circumscribed brain injury, responding well to antidopaminergic treatment. A review of all the previously reported cases of post-traumatic tic disorder is provided. Our patient is unusual in that the injury presumed to be responsible for the development of tics was of a very focal nature, akin to previously described tic disorder following vascular insults. We discuss the rare occurrence of tourettism after such focal brain lesions and analyse the insights this provides into the anatomical substrates underlying tic disorders.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/lesões , Transtornos de Tique/diagnóstico por imagem , Adulto , Lesões Encefálicas/complicações , Lesões Encefálicas/terapia , Traumatismos Cranianos Penetrantes/complicações , Traumatismos Cranianos Penetrantes/terapia , Humanos , Masculino , Transtornos de Tique/etiologia , Transtornos de Tique/terapia
11.
Eur J Radiol ; 126: 108963, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32208296

RESUMO

PURPOSE: To test markers from conventional and diffusion Magnetic Resonance Imaging (MRI) as possible predictors of cognitive outcome following rehabilitation therapy in children with acquired brain injury (ABI). METHODS: Twenty-one children (10 boys, mean age 11.6 years, range 7.1-19.4) with stroke or traumatic brain injury underwent MRI including Diffusion Tensor Imaging (DTI) before admission to the rehabilitation centre. The conventional images were scored according to a standardised injury scoring system, and mean Fractional Anisotropy (FA) was determined within the Corpus Callosum (CC), as this structure is hypothesised to play an important role in cognition. Both conventional MRI injury scores and mean FA of the CC and its sub-regions were compared with standard functional cognitive outcome scores. Relationships between MRI indices and cognitive outcome scores were assessed using multiple regression and receiver operating characteristic (ROC) analyses. RESULTS: A backwards regression analysis revealed that the mean FA of the CC body and genu and the supratentorial injury score appear to represent the best predictors of outcome, together with the age at rehabilitation and time in rehabilitation. In the ROC analysis, the mean FA values of the CC body and genu and the infratentorial injury score provided the highest sensitivity, while the mean FA of the CC splenium showed the highest specificity for outcome. CONCLUSIONS: The conventional MRI injury scores and DTI metrics from the CC reflect cognitive outcomes following rehabilitation. Neuroimaging methods such as MRI with DTI may therefore provide important markers for cognitive recovery after brain injury.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/reabilitação , Mapeamento Encefálico/métodos , Disfunção Cognitiva/diagnóstico , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Fatores Etários , Encéfalo/diagnóstico por imagem , Lesões Encefálicas/complicações , Criança , Disfunção Cognitiva/etiologia , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores Sexuais , Suíça , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Ulus Travma Acil Cerrahi Derg ; 26(2): 212-221, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32185780

RESUMO

BACKGROUND: Pediatric head trauma is the most common presentation to emergency departments. Increased intracranial pressure (ICP) may lead to secondary brain damage in head trauma and early diagnosis of increased ICP is very important. Measurement of optic nerve sheath diameter (ONSD) is a method that can be used for determining increased ICP. In this study, we aimed to evaluate the relationship between optic nerve sheath diameter (ONSD) and Rotterdam computer tomography scores (RCTS) in pediatric patients for severe head trauma. METHODS: During January 2017-April 2018, medical records and imaging findings of children aged 0-18 years who underwent computed tomography (CT) imaging for head trauma (n=401) and non-traumatic (convulsions, respiratory disorders, headache) (n=255) complaints, totally 656 patient were evaluated retrospectively. Patients' age, sex, presentation and trauma type (high energy-low energy) were identified. Non-traumatic patients with normal cranial CT findings were considered as the control group. CT findings of traumatic brain injury were scored according to Rotterdam criteria. Patients were divided into groups according to their age as follows: 0-3 years, 3-6 years, 6-12 years and 12-18 years. RESULTS: In our study, tomographic reference measurements of the ONSD in pediatric cases were presented according to age. There was a statistically significant difference between ONSD of severe traumatic patients and the control group. Correlation between RCTS and ONSD was determined and age-specific cut-off values of ONSD for severe traumatic scores (score 4-5-6) were presented. CONCLUSION: In our study, reference ONSDs of the pediatric population for CT imaging was indicated. Our study also showed that ONSD measurement is a parameter that can be used in addition to the RCTS to determine the prognosis of the patient in severe head trauma, by reflecting increased intracranial pressure.


Assuntos
Lesões Encefálicas/classificação , Lesões Encefálicas/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Pressão Intracraniana/fisiologia , Prognóstico
13.
PLoS One ; 15(3): e0230414, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32210445

RESUMO

BACKGROUND: The exact onset of brain injury in infants with congenital heart disease (CHD) is unknown. Our aim was, therefore, to assess the association between prenatal Doppler flow patterns, postnatal cerebral oxygenation and short-term neurological outcome. METHODS: Prenatally, we measured pulsatility indices of the middle cerebral (MCA-PI) and umbilical artery (UA-PI) and calculated cerebroplacental ratio (CPR). After birth, cerebral oxygen saturation (rcSO2) and fractional tissue oxygen extraction (FTOE) were assessed during the first 3 days after birth, and during and for 24 hours after every surgical procedure within the first 3 months after birth. Neurological outcome was determined preoperatively and at 3 months of age by assessing general movements and calculating the Motor Optimality Score (MOS). RESULTS: Thirty-six infants were included. MOS at 3 months was associated with MCA-PI (rho 0.41, P = 0.04), UA-PI (rho -0.39, P = 0.047, and CPR (rho 0.50, P = 0.01). Infants with abnormal MOS had lower MCA-PI (P = 0.02) and CPR (P = 0.01) and higher UA-PI at the last measurement (P = 0.03) before birth. In infants with abnormal MOS, rcSO2 tended to be lower during the first 3 days after birth, and FTOE was significantly higher on the second day after birth (P = 0.04). Intraoperative and postoperative rcSO2 and FTOE were not associated with short-term neurological outcome. CONCLUSION: In infants with prenatally diagnosed CHD, the prenatal period may play an important role in developmental outcome. Additional research is needed to clarify the relationship between preoperative, intra-operative and postoperative cerebral oxygenation and developmental outcome in infants with prenatally diagnosed CHD.


Assuntos
Lesões Encefálicas/diagnóstico , Cardiopatias Congênitas/diagnóstico , Diagnóstico Pré-Natal , Ultrassonografia Doppler , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/cirurgia , Feminino , Idade Gestacional , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Oxigênio/uso terapêutico , Gravidez , Cirurgia Torácica , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/fisiopatologia , Artérias Umbilicais/cirurgia
14.
EBioMedicine ; 52: 102663, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32062359

RESUMO

BACKGROUND: Although thalamic magnetic resonance (MR) spectroscopy (MRS) accurately predicts adverse outcomes after neonatal encephalopathy, its utility in infants without MR visible deep brain nuclei injury is not known. We examined thalamic MRS metabolite perturbations in encephalopathic infants with white matter (WM) injury with or without cortical injury and its associations with adverse outcomes. METHODS: We performed a subgroup analysis of all infants recruited to the MARBLE study with isolated WM or mixed WM/cortical injury, but no visible injury to the basal ganglia/thalamus (BGT) or posterior limb of the internal capsule (PLIC). We used binary logistic regression to examine the association of MRS biomarkers with three outcomes (i) WM injury score (1 vs. 2/3); (ii) cortical injury scores (0/1 vs. 2/3); and (iii) adverse outcomes (defined as death, moderate/severe disability) at two years (yes/no). We also assessed the accuracy of MRS for predicting adverse outcome. FINDINGS: Of the 107 infants included in the analysis, five had adverse outcome. Reduced thalamic N-acetylaspartate concentration [NAA] (odds ratio 0.4 (95% CI 0.18-0.93)) and elevated thalamic Lactate/NAA peak area ratio (odds ratio 3.37 (95% CI 1.45-7.82)) were significantly associated with higher WM injury scores, but not with cortical injury. Thalamic [NAA] (≤5.6 mmol/kg/wet weight) had the best accuracy for predicting adverse outcomes (sensitivity 1.00 (95% CI 0.16-1.00); specificity 0.95 (95% CI 0.84-0.99)). INTERPRETATION: Thalamic NAA is reduced in encephalopathic infants without MR visible deep brain nuclei injury and may be a useful predictor of adverse outcomes. FUNDING: The National Institute for Health Research (NIHR).


Assuntos
Encefalopatias/complicações , Encefalopatias/metabolismo , Lesões Encefálicas/etiologia , Lesões Encefálicas/patologia , Metabolismo Energético , Tálamo/metabolismo , Substância Branca/patologia , Biomarcadores , Encefalopatias/diagnóstico , Lesões Encefálicas/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Masculino , Sensibilidade e Especificidade , Substância Branca/diagnóstico por imagem
15.
Eur J Radiol ; 125: 108875, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32105916

RESUMO

PURPOSE: To evaluate the correlation between optic nerve sheath diameter (ONSD) measurement with signs of increased intracranial pressure (ICP) found on computed tomography (CT) in trauma patients. MATERIALS AND METHODS: 271 consecutive head CT trauma scans performed at our trauma center were retrospectively reviewed for ONSD and CT findings. Measurement of ONSD was made at CT and, when available, with ultrasonography (US). Imaging signs of increased ICP were assessed. Association between ONSD and signs of ICP were analyzed. RESULTS: The mean ONSD on axial CT images, optic-nerve axial plane and US was 4.70 ± 0.59 mm, 4.78 ± 0.59 mm, and 3.16 ± 0.50 mm, respectively. The ONSD measured at CT was significantly higher than that measured by US(p < 0.01). No difference of ONSD measured at CT between axial and optic-nerve axial planes. Patients with CT evidence of increased ICP had significantly higher ONSD than those without imaging abnormalities (p = 0.0001-0.0064). The ONSD cutoff points for suggesting increased ICP were 4.8 mm (60.5 % sensitivity, 61.2 % specificity, 20.4 % PPV, 90.4 % NPV) at CT and 3.15 mm (97.4 % sensitivity, 13.8 % specificity, 15.7 % PPV, 97 % NPV) at US. CONCLUSION: There was a significant association between ONSD and imaging signs of increased ICP in CT with a high NPV. No difference of ONSD measurement at CT between normal and optic-nerve axial planes was observed, whereas there was a significant difference between diameter obtained at CT and US.


Assuntos
Lesões Encefálicas/complicações , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/fisiopatologia , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/fisiopatologia , Feminino , Humanos , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana/fisiologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
16.
Isr Med Assoc J ; 22(1): 27-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927802

RESUMO

BACKGROUND: Congenital heart defects (CHD) may be associated with neurodevelopmental abnormalities mainly due to brain hypoperfusion. This defect is attributed to the major cardiac operations these children underwent, but also to hemodynamic instability during fetal life. Advances in imaging techniques have identified changes in brain magnetic resonance imaging (MRI)in children with CHD. OBJECTIVES: To examine the correlation between CHD and brain injury using fetal brain MRI. METHODS: We evaluated 46 fetuses diagnosed with CHD who underwent brain MRI. CHD was classified according to in situs anomalies, 4 chamber view (4CV), outflow tracts, arches, and veins as well as cyanotic or complex CHD. We compared MRI results of different classes of CHD and CHD fetuses to a control group of 113 healthy brain MRI examinations. RESULTS: No significant differences were found in brain pathologies among different classifications of CHD. The anteroposterior percentile of the vermis was significantly smaller in fetuses with abnormal 4CV. A significantly higher biparietal diameter was found in fetuses with abnormal arches. A significantly smaller transcerebellar diameter was found in fetuses with abnormal veins. Compared to the control group, significant differences were found in overall brain pathology in cortex abnormalities and in extra axial findings in the study group. Significantly higher rates of overall brain pathologies, ventricle pathologies, cortex pathologies, and biometrical parameters were found in the cyanotic group compared to the complex group and to the control group. CONCLUSIONS: Fetuses with CHD demonstrate findings in brain MRI that suggest an in utero pathogenesis of the neurological and cognitive anomalies found during child development.


Assuntos
Lesões Encefálicas/embriologia , Feto/diagnóstico por imagem , Cardiopatias Congênitas/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/embriologia , Encéfalo/patologia , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/patologia , Estudos de Casos e Controles , Ecocardiografia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Gravidez , Diagnóstico Pré-Natal/métodos
17.
Sci Rep ; 10(1): 614, 2020 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-31953486

RESUMO

Toxicity to central nervous system tissues is the common side effects for radiotherapy of brain tumor. The radiation toxicity has been thought to be related to the damage of cerebral endothelium. However, because of lacking a suitable high-resolution vivo model, cellular response of cerebral capillaries to radiation remained unclear. Here, we present the flk:eGFP transgenic zebrafish larvae as a feasible model to study the radiation toxicity to cerebral capillary. We showed that, in living zebrafish larvae, radiation could induce acute cerebral capillary shrinkage and blood-flow obstruction, resulting brain hypoxia and glycolysis retardant. Although in vivo neuron damage was also observed after the radiation exposure, further investigation found that they didn't response to the same dosage of radiation in vitro, indicating that radiation induced neuron damage was a secondary-effect of cerebral vascular function damage. In addition, transgenic labeling and qPCR results showed that the radiation-induced acute cerebral endothelial damage was correlated with intensive endothelial autophagy. Different autophagy inhibitors could significantly alleviate the radiation-induced cerebral capillary damage and prolong the survival of zebrafish larvae. Therefore, we showed that radiation could directly damage cerebral capillary, resulting to blood flow deficiency and neuron death, which suggested endothelial autophagy as a potential target for radiation-induced brain toxicity.


Assuntos
Lesões Encefálicas/metabolismo , Endotélio/citologia , Proteínas de Fluorescência Verde/genética , Proteínas Associadas aos Microtúbulos/genética , Neurônios/citologia , Fatores de Transcrição/genética , Proteínas de Peixe-Zebra/genética , Animais , Animais Geneticamente Modificados , Autofagia , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Encéfalo/efeitos da radiação , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/etiologia , Lesões Encefálicas/genética , Células Cultivadas , Angiografia Cerebral , Técnicas de Cocultura , Irradiação Craniana/efeitos adversos , Modelos Animais de Doenças , Endotélio/efeitos da radiação , Proteínas de Fluorescência Verde/metabolismo , Microscopia Confocal , Proteínas Associadas aos Microtúbulos/metabolismo , Neurônios/efeitos da radiação , Fatores de Transcrição/metabolismo , Peixe-Zebra , Proteínas de Peixe-Zebra/metabolismo
18.
Arch Dis Child Fetal Neonatal Ed ; 105(5): 520-525, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31980445

RESUMO

OBJECTIVE: To determine whether early low-dose hydrocortisone treatment in extremely preterm infants is associated with brain damage assessed by MRI at term equivalent of age (TEA). PATIENTS AND OUTCOMES: This is a predefined secondary analysis of brain abnormalities, observed by MRI at TEA, of patients randomly assigned to receive either placebo or hydrocortisone in the PREMILOC trial. Outcomes were based on brain abnormalities graded according to Kidokoro scores. RESULTS: Among 412 survivors at TEA, 300 MRIs were performed and 295 were suitable for analysis. Kidokoro scoring was completed for 119/148 and 110/147 MRIs in the hydrocortisone and placebo groups, respectively. The distribution of the Kidokoro white matter (WM) subscore and other subscores was not significantly different between the two groups. There was, however, a significant association between a higher overall Kidokoro score and hydrocortisone treatment (5.84 (SD 3.51) for hydrocortisone and 4.98 (SD 2.52) for placebo; mean difference, 0.86; 95% CI 0.06 to 1.66; p=0.04). However, hydrocortisone was not statistically associated with moderate-to-severe brain lesions (Kidokoro overall score ≥6) in a multivariate logistic regression model accounting for potential confounding variables (adjusted OR (95% CI) 1.27 (0.75 to 2.14), p=0.38). Bronchopulmonary dysplasia at 36 weeks postmenstrual age significantly predicted both WM damage (adjusted OR (95% CI) 2.70 (1.03 to 7.14), p=0.04) and global brain damage (adjusted OR (95% CI) 2.18 (1.19 to 3.99), p=0.01). CONCLUSIONS: Early hydrocortisone exposure in extremely preterm infants is not statistically associated with either WM brain damage or overall moderate-to-severe brain lesions when adjusted for other neonatal variables. TRIAL REGISTRATION NUMBER: EudraCT number 2007-002041-20, NCT00623740.


Assuntos
Encéfalo/efeitos dos fármacos , Displasia Broncopulmonar/prevenção & controle , Hidrocortisona/administração & dosagem , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Encéfalo/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/epidemiologia , Displasia Broncopulmonar/epidemiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Hidrocortisona/efeitos adversos , Recém-Nascido , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Transtornos do Neurodesenvolvimento
19.
Adv Exp Med Biol ; 1232: 3-9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893387

RESUMO

Neonates with hypoxic-ischaemic (HI) brain injury were monitored using a broadband near-infrared spectroscopy (NIRS) system in the neonatal intensive care unit. The aim of this work is to use the NIRS cerebral oxygenation data (HbD = oxygenated-haemoglobin - deoxygenated-haemoglobin) combined with arterial saturation (SaO2) from pulse oximetry to calculate cerebral blood flow (CBF) based on the oxygen swing method, during spontaneous desaturation episodes. The method is based on Fick's principle and uses HbD as a tracer; when a sudden change in SaO2 occurs, the change in HbD represents a change in tracer concentration, and thus it is possible to estimate CBF. CBF was successfully calculated with broadband NIRS in 11 HIE infants (3 with severe injury) for 70 oxygenation events on the day of birth. The average CBF was 18.0 ± 12.7 ml 100 g-1 min-1 with a range of 4 ml 100 g-1 min-1 to 60 ml 100 g-1 min-1. For infants with severe HIE (as determined by magnetic resonance spectroscopy) CBF was significantly lower (p = 0.038, d = 1.35) than those with moderate HIE on the day of birth.


Assuntos
Lesões Encefálicas , Encéfalo , Circulação Cerebrovascular , Oximetria , Oxigênio , Espectroscopia de Luz Próxima ao Infravermelho , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Humanos , Recém-Nascido , Oximetria/instrumentação , Oximetria/métodos , Oxigênio/metabolismo
20.
Am J Perinatol ; 37(2): 137-145, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30919395

RESUMO

OBJECTIVE: The accuracy of structural magnetic resonance imaging (MRI) to predict later cerebral palsy (CP) in newborns with perinatal brain injury is variable. Diffusion tensor imaging (DTI) and task-based functional MRI (fMRI) show promise as predictive tools. We hypothesized that infants who later developed CP would have reduced structural and functional connectivity as compared with those without CP. STUDY DESIGN: We performed DTI and fMRI using a passive motor task at 40 to 48 weeks' postmenstrual age in 12 infants with perinatal brain injury. CP was diagnosed at age 2 using a standardized examination. RESULTS: Five infants had CP at 2 years of age, and seven did not have CP. Tract-based spatial statistics showed a widespread reduction of fractional anisotropy (FA) in almost all white matter tracts in the CP group. Using the median FA value in the corticospinal tracts as a cutoff, FA was 100% sensitive and 86% specific to predict CP compared with a sensitivity of 60 to 80% and a specificity of 71% for structural MRI. During fMRI, the CP group had reduced functional connectivity from the right supplemental motor area as compared with the non-CP group. CONCLUSION: DTI and fMRI obtained soon after birth are potential biomarkers to predict CP in newborns with perinatal brain injury.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Encéfalo/anatomia & histologia , Paralisia Cerebral/etiologia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Lesões Encefálicas/complicações , Hemorragia Cerebral Intraventricular/complicações , Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Pré-Escolar , Imagem de Tensor de Difusão , Feminino , Humanos , Hipóxia-Isquemia Encefálica/complicações , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Recém-Nascido , Leucomalácia Periventricular/complicações , Leucomalácia Periventricular/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem
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