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Posttraumatic stress disorder (PTSD) is prevalent among veterans with a history of traumatic brain injury (TBI); however, the relationship between TBI and PTSD is not well understood. We present the case of a 31-year-old male veteran with PTSD who reported TBI before entering the military. The reported injury appeared to be mild: He was struck on the head by a baseball, losing consciousness for â¼10 seconds. Years later, he developed severe PTSD after combat exposure. He was not receiving clinical services for these issues but was encountered in the context of a research study. We conducted cognitive, autonomic, and MRI assessments to assess brain function, structure, and neurophysiology. Next, we compared amygdala volume, uncinate fasciculus diffusion, functional connectivity, facial affect recognition, and baroreceptor coherence with those of a control group of combat veterans (n = 23). Our veteran's MRI revealed a large right medial-orbital prefrontal lesion with surrounding atrophy, which the study neuroradiologist interpreted as likely caused by traumatic injury. Comparison with controls indicated disrupted structural and functional connectivity of prefrontal-limbic structures and impaired emotional, cognitive, and autonomic responses. Detection of this injury before combat would have been unlikely in a clinical context because our veteran had reported a phenomenologically mild injury, and PTSD is a simple explanation for substance abuse, sleep impairment, and psychosocial distress. However, it may be that right prefrontal-limbic disruption imparted vulnerability for the development of PTSD and exacerbated our veteran's emotional response to, and recovery from, PTSD.
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Concussão Encefálica/psicologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
Objective: Research on impairments of spatial attention has primarily investigated hemispatial neglect in brain-lesioned patients, revealing decrements in the allocation of attention to right versus left egocentric or allocentric hemispace. Whereas head trauma might injure those parts of the brain that allocate vertical attention, little is known about the influence of trauma on the allocation of visuospatial attention in vertical space. Thus, the goal of this study was to learn if chronic moderate-to-severe traumatic brain injury (m/sTBI) alters the allocation of vertical visuospatial attention as assessed by the Attention Network Task (ANT). The ANT assesses the influence of Posner-type spatial cues and distractors using an Eriksen flanker task.Methods: 12 chronic m/sTBI patients and 12 demographically-matched neurologically-healthy controls (HCs) completed a version of the ANT wherein trials were coded for cue and target locations above and below central visual fixation. Trial-wise reaction times (RT) and accuracy were subjected to mixed-model ANOVAs and planned contrasts.Results: These data were subject to secondary analyses, which revealed that across groups, median RTs were significantly faster when targets occurred above than below the central visual fixation (p < .01); however, only HCs' error rates differed as a function of target altitude. Unlike controls, m/sTBI survivors did not exhibit the anticipated upward error-rate attentional bias.Conclusions: As alteration of spatial attention can be a major cause of disability, present findings suggest that m/sTBI survivors exhibit this loss of normal upward attentional bias. Future studies are need to learn if these patients might benefit from treatment.
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Atenção/fisiologia , Lesões Encefálicas Traumáticas/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Percepção Espacial/fisiologia , Percepção Visual/fisiologia , Adulto , Lesões Encefálicas Traumáticas/complicações , Disfunção Cognitiva/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Reliable assessment of tumor growth in malignant glioma poses a common problem both clinically and when studying novel therapeutic agents. We aimed to evaluate two software-systems in their ability to estimate volume change of tumor and/or edema on magnetic resonance (MR) images of malignant gliomas. Twenty patients with malignant glioma were included from different sites. Serial post-operative MR images were assessed with two software systems representative of the two fundamental segmentation methods, single-image fuzzy analysis (3DVIEWNIX-TV) and multi-spectral-image analysis (Eigentool), and with a manual method by 16 independent readers (eight MR-certified technologists, four neuroradiology fellows, four neuroradiologists). Enhancing tumor volume and tumor volume plus edema were assessed independently by each reader. Intraclass correlation coefficients (ICCs), variance components, and prediction intervals were estimated. There were no significant differences in the average tumor volume change over time between the software systems (p > 0.05). Both software systems were much more reliable and yielded smaller prediction intervals than manual measurements. No significant differences were observed between the volume changes determined by fellows/neuroradiologists or technologists.Semi-automated software systems are reliable tools to serve as outcome parameters in clinical studies and the basis for therapeutic decision-making for malignant gliomas, whereas manual measurements are less reliable and should not be the basis for clinical or research outcome studies.
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Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Diagnóstico por Imagem/métodos , Glioma/diagnóstico por imagem , Glioma/patologia , Espectroscopia de Ressonância Magnética/métodos , Automação , Gráficos por Computador , Técnicas de Apoio para a Decisão , Humanos , Imageamento por Ressonância Magnética/métodos , Radiografia , Reprodutibilidade dos Testes , Sociedades Médicas , Software , Fatores de Tempo , Resultado do Tratamento , Carga TumoralRESUMO
Survivors of severe traumatic brain injury (TBI) are at increased risk for emotional sequelae. The current study utilized the error-related negativity (ERN) and posterror positivity (Pe) components of the event-related potential (ERP) to test the hypothesis that negative affect disproportionately impairs performance-monitoring following severe TBI. High-density ERPs were acquired while 20 survivors of severe TBI and 20 demographically matched controls performed a single-trial Stroop task. Response-locked ERPs were separately averaged for correct and error trials. Negative affect was measured as the single latent factor of measures of depression and anxiety. Groups did not differ on overall level of negative affect. Control and TBI participants did not differ on error rates as a function of negative affect, but differed in response times. ERP results revealed disproportionately smaller ERN amplitudes in participants with TBI relative to controls as a function of negative affect. Pe amplitude did not differ between groups. Negative affect inversely correlated with ERN amplitude in TBI but not control participants. Overall, results support a "double jeopardy" hypothesis of disproportionate impairments in performance monitoring when negative affect is overlaid on severe TBI.
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Ansiedade/etiologia , Lesões Encefálicas/complicações , Depressão/etiologia , Potenciais Evocados/fisiologia , Adolescente , Adulto , Análise de Variância , Ansiedade/diagnóstico , Estudos de Casos e Controles , Depressão/diagnóstico , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Análise de Componente Principal , Resolução de Problemas/fisiologia , Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia , Análise de Regressão , Adulto JovemRESUMO
Prader-Willi syndrome (PWS) is a well-defined syndrome of childhood-obesity which can serve as a model for investigating early onset childhood obesity. Many of the clinical features of PWS (e.g., hyperphagia, hypogonadotropic hypogonadism, growth hormone deficiency) are hypothesized to be due to abnormalities of the hypothalamus and/or pituitary gland. Children who become severely obese very early in life (i.e., before age 4 years) may also have a genetic etiology of their obesity, perhaps with associated neuroendocrine and hypothalamo-pituitary defects, as infants and very young children have limited access to environmental factors that contribute to obesity. We hypothesized that morphologic abnormalities of the pituitary gland would be seen in both individuals with PWS and other subjects with early onset morbid obesity (EMO). This case-control study included individuals with PWS (n = 27, age 3 months to 39 years), patients with EMO of unknown etiology (n = 16, age 4-22 years; defined as body mass index greater than the 97th centile for age before age 4 years), and normal weight siblings (n = 25, age 7 months to 43 years) from both groups. Participants had 3-dimensional magnetic resonance imaging to evaluate the pituitary gland, a complete history and physical examination, and measurement of basal pituitary hormones. Subjects with PWS and EMO had a higher prevalence of pituitary morphological abnormalities than did control subjects (74% PWS, 69% EMO, 8% controls; P < 0.001). Anterior pituitary hormone deficiencies were universal in individuals with PWS (low IGF-1 in 100%, P < 0.001 PWS vs. controls; central hypothyroidism in 19%, P = 0.052, and hypoplastic genitalia or hypogonadotropic hypogonadism in 100%, P < 0.001), and was often seen in individuals with EMO (6%, P = 0.89 vs. control, 31%, P = 0.002, and 25%, P = 0.018, respectively). The presence of a hypoplastic pituitary gland appeared to correlate with the presence of anterior pituitary hormone deficiencies in individuals with EMO, but no correlation was apparent in individuals with PWS. In conclusion, the high frequency of both morphological and hormonal abnormalities of the pituitary gland in both individuals with PWS and EMO suggests that abnormalities in the hypothalamo-pituitary axis are features not only of PWS, but also frequently of EMO of unknown etiology.
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Obesidade Mórbida/epidemiologia , Hipófise/anormalidades , Síndrome de Prader-Willi/diagnóstico , Adolescente , Adulto , Idade de Início , Criança , Pré-Escolar , Humanos , Lactente , Síndrome de Prader-Willi/patologiaRESUMO
Perineural tumor spread (PNS) substantially alters a patient's prognosis and treatment plan. Therefore, it is critical that the radiologists are familiar with the course of cranial nerves commonly affected by PNS and the neuronal connections to appropriately map the extent of PNS. Limited involvement of a nerve by PNS might be resectable, whereas advanced PNS may require radiation therapy.
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Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/patologia , Imageamento por Ressonância Magnética/métodos , Humanos , Invasividade NeoplásicaRESUMO
Perineural tumour spread (PNTS) in head and neck oncology is most often caused by squamous cell carcinoma. The most frequently affected nerves are the trigeminal and facial nerves. Up to 40% of patients with PNTS may be asymptomatic. Therefore, the index of suspicion should be high when evaluating imaging studies of patients with head and neck cancer. This review describes a "quick search checklist" of easily detected imaging signs of PNTS. TEACHING POINTS: ⢠A distinctive feature of head and neck tumours is growth along nerves. ⢠Perineural tumour spread is most often caused by squamous cell carcinoma. ⢠There are several key findings for the detection of perineural tumour spread.
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PURPOSE: Accurate target definition is considered essential for sophisticated, image-guided radiation therapy; however, relatively little information has been reported that measures our ability to identify the precise shape of targets accurately. We decided to assess the manner in which eight "experts" interpreted the size and shape of tumors based on "real-life" contrast-enhanced computed tomographic (CT) scans. METHODS AND MATERIALS: Four neuroradiologists and four radiation oncologists (the authors) with considerable experience and presumed expertise in treating head-and-neck tumors independently contoured, slice-by-slice, his/her interpretation of the precise gross tumor volume (GTV) on each of 20 sets of CT scans taken from 20 patients who previously were enrolled in Radiation Therapy Oncology Group protocol 91-11. RESULTS: The average proportion of overlap (i.e., the degree of agreement) was 0.532 (95% confidence interval 0.457 to 0.606). There was a slight tendency for the proportion of overlap to increase with increasing average GTV. CONCLUSIONS: Our work suggests that estimation of tumor shape currently is imprecise, even for experienced physicians. In consequence, there appears to be a practical limit to the current trend of smaller fields and tighter margins.
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Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Laríngeas/diagnóstico por imagem , Variações Dependentes do Observador , Radioterapia (Especialidade)/normas , Tomografia Computadorizada por Raios X , Competência Clínica , Feminino , Humanos , Masculino , Neurologia/normasRESUMO
OBJECT: The goal in this article was to compare 0.1 mmol/kg doses of gadobenate dimeglumine (Gd-BOPTA) and gadopentetate dimeglumine, also known as gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA), for enhanced magnetic resonance (MR) imaging of intraaxial brain tumors. METHODS: Eighty-four patients with either intraaxial glioma (47 patients) or metastasis (37 patients) underwent two MR imaging examinations at 1.5 tesla, one with Gd-BOPTA as the contrast agent and the other with Gd-DTPA. The interval between fully randomized contrast medium administrations was 2 to 7 days. The T1-weighted spin echo and T2-weighted fast spin echo images were acquired before administration of contrast agents and T1-weighted spin echo images were obtained after the agents were administered. Acquisition parameters and postinjection acquisition times were identical for the two examinations in each patient. Three experienced readers working in a fully blinded fashion independently evaluated all images for degree and quality of available information (lesion contrast enhancement, lesion border delineation, definition of disease extent, visualization of the lesion's internal structures, global diagnostic preference) and quantitative enhancement (that is, the extent of lesion enhancement after contrast agent administration compared with that seen before its administration [hereafter referred to as percent enhancement], lesion/brain ratio, and contrast/noise ratio). Differences were tested with the Wilcoxon signed-rank test. Reader agreement was assessed using kappa statistics. Significantly better diagnostic information/imaging performance (p < 0.0001, all readers) was obtained with Gd-BOPTA for all visualization end points. Global preference for images obtained with Gd-BOPTA was expressed for 42 (50%), 52 (61.9%), and 56 (66.7%) of 84 patients (readers 1, 2, and 3, respectively) compared with images obtained with Gd-DTPA contrast in four (4.8%), six (7.1%), and three (3.6%) of 84 patients. Similar differences were noted for all other visualization end points. Significantly greater quantitative contrast enhancement (p < 0.04) was noted after administration of Gd-BOPTA. Reader agreement was good (kappa > 0.4). CONCLUSIONS: Lesion visualization, delineation, definition, and contrast enhancement are significantly better after administration of 0.1 mmol/kg Gd-BOPTA, potentially allowing better surgical planning and follow up and improved disease management.
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Neoplasias Encefálicas/patologia , Meios de Contraste , Gadolínio DTPA , Glioma/patologia , Imageamento por Ressonância Magnética , Meglumina/análogos & derivados , Compostos Organometálicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Estudos Cross-Over , Feminino , Glioma/secundário , Glioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
We describe 9 nonimmunosuppressed patients with central nervous system cryptococcosis. Morbidity and mortality were high, especially among patients with cerebral infarcts. This was attributed to delayed diagnosis and apparent sequelae of overwhelming host immune responses. We present clues suggesting the diagnosis. Increased recognition and timely diagnosis of this condition may improve outcomes.
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Antifúngicos/uso terapêutico , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/imunologia , Adulto , Infarto Cerebral/complicações , Feminino , Humanos , Terapia de Imunossupressão , Masculino , Meningite Criptocócica/diagnóstico , Pessoa de Meia-Idade , Prognóstico , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To report outcomes of patients with localized intracranial germinoma treated with low-dose craniospinal irradiation (CSI) followed by a boost to the ventricular system and primary site. METHODS AND MATERIALS: Thirty-one patients had pathologically confirmed intracranial germinoma and no spine metastases. Low-dose CSI was administered in 29 patients: usually 21 Gy of CSI, 9.0 Gy of ventricular boost, and a 19.5-Gy tumor boost, all at 1.5 Gy per fraction. Our neuroradiologist recorded three-dimensional tumor size on magnetic resonance images before, during, and after radiotherapy. RESULTS: With a median follow-up of 7.0 years, 29 of 31 patients (94%) are disease free. One failure had nongerminomatous histology; the initial diagnosis was a sampling error. Of 3 patients who did not receive CSI, 1 died. No patient developed myelopathy, visual deficits, dementia, or skeletal growth problems. In locally controlled patients, tumor response according to magnetic resonance scan was nearly complete within 6 months after radiotherapy. CONCLUSIONS: Radiotherapy alone with low-dose prophylactic CSI cures almost all patients with localized intracranial germinoma. Complications are rare when the daily dose of radiotherapy is limited to 1.5 Gy and the total CSI dose to 21 Gy. Patients without a near-complete response to radiotherapy should undergo resection to rule out a nongerminomatous element.
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Neoplasias Encefálicas/radioterapia , Irradiação Craniana/métodos , Germinoma/radioterapia , Adolescente , Adulto , Neoplasias Encefálicas/secundário , Criança , Erros de Diagnóstico , Feminino , Seguimentos , Germinoma/secundário , Humanos , Masculino , Dosagem Radioterapêutica , Teratoma/patologia , Teratoma/radioterapiaRESUMO
OBJECTIVE: Atrial fibrillation (AF) has a demonstrable effect on quality of life (QOL). Recurrent stroke occurs in 10% of patients with AF. The objective of this study was to demonstrate proof of concept that thoracoscopic pulmonary vein isolation and atrial appendage ligation (TPVIAL) could prevent recurrent stroke and could potentially improve QOL in patients with AF with a previous stroke. METHODS: The study was a National Institutes of Health-funded single-center proof-of-concept design that randomized 23 patients with AF-related stroke to TPVIAL (n = 12) or to medical management (n = 11). Quality of life was the primary outcome variable; secondary end points included restoration of rhythm, recurrent stroke, and surgical morbidity. RESULTS: Quality-of-life subscores at 3 and 6 months revealed improvements in energy and decreases in fatigue in the TPVIAL arm [baseline, 33 (19.8); 3 months, 49.5 (20.6), P = 0.01; 6 months, 55.5 (14.4), P = 0.03]. At 12-month follow-up, there were no recurrent strokes in the TPVIAL group. In the medically treated arm, two patients at 6 months (P = 0.22) and three total patients at 12 months (P = 0.09) had recurrent ischemic stroke. There was one death in the medical management arm. In the TPVIAL arm, no AF recurrence occurred in patients with paroxysmal AF, and one patient had recurrence of persistent and long-standing AF. Seven patients in the TPVIAL arm discontinued warfarin therapy for secondary stroke prevention. CONCLUSIONS: This small proof-of-concept study showed that TPVIAL improved QOL on two subscores and restored normal sinus rhythm in all but one patient, and it showed the potential to prevent secondary stroke. A larger study will be needed.
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Técnicas de Ablação/métodos , Anticoagulantes/administração & dosagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/terapia , Acidente Vascular Cerebral/prevenção & controle , Idoso , Dabigatrana/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Veias Pulmonares/cirurgia , Qualidade de Vida , Toracoscopia , Resultado do Tratamento , Varfarina/administração & dosagem , Varfarina/uso terapêuticoRESUMO
Rarely can a neurologically isolated cranial nerve III palsy be the presenting manifestation of central nervous system lymphoma. We detail the clinical, radiological, and pathological features of a previously healthy 45-year-old man presenting with an isolated, pupil-involving, right cranial nerve III palsy due to human immunodefiency virus (HIV) related non-Hodgkin lymphoma. Magnetic resonance imaging demonstrated bilateral peripheral cranial nerve III enhancement with no brain parenchymal or leptomeningeal abnormalities. Cerebrospinal fluid analysis revealed a monocytic pleocytosis with an elevated protein concentration and depressed glucose level. Morphologic and flow cytometric analysis of the cerebrospinal fluid was compatible with a large B-cell lymphoma. Serologic tests for HIV were positive. Postmortem examination of the brain revealed malignant lymphomatous cell infiltration of both cranial nerve III, diffuse leptomeningeal disease and focal superficial subependymal and subpial invasion. Based on our review of the literature, we were able to find only 10 detailed cases of cranial nerve III palsy as the presenting manifestation of central nervous system lymphoma. Furthermore, none of the previously reported cases correlated the magnetic resonance imaging findings with the gross and histopathologic observations.
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Anticorpos Anti-HIV/imunologia , HIV/imunologia , Linfoma Relacionado a AIDS/complicações , Imageamento por Ressonância Magnética , Doenças do Nervo Oculomotor/etiologia , Tomografia Computadorizada por Raios X , Autopsia , Angiografia Cerebral , Diagnóstico Diferencial , Evolução Fatal , Humanos , Linfoma Relacionado a AIDS/diagnóstico por imagem , Linfoma Relacionado a AIDS/patologia , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/diagnóstico por imagem , Doenças do Nervo Oculomotor/patologiaRESUMO
BACKGROUND AND PURPOSE: MR imaging characteristics of optic neuropathy caused by cat scratch disease have not yet been described; this lack of information may result in incorrect diagnosis and may contribute to initiation of inappropriate therapy. Our study was based on the hypothesis that cat scratch disease-related optic neuropathy has distinct MR imaging features compared with those of other types of optic neuropathies. METHODS: Eighty-two patients with various causes of optic neuropathy and available MR imaging examinations were included in this study. Two readers blinded to the diagnosis reviewed the MR images independently in regard to presence, location, and extent of optic nerve enhancement. The MR imaging findings were correlated with the final diagnosis. RESULTS: Eleven percent (9/82) of the patients received a final diagnosis of cat scratch disease. Optic nerve enhancement in patients with cat scratch disease (5/37) was localized to a 3- to 4-mm segment at the optic nerve-globe junction. All other patients with optic neuropathy (31/37) with one exception showed enhancement away from the optic nerve-globe junction or a long-segment enhancement when the optic nerve-globe junction was also involved. Four patients with cat scratch disease did not show any optic nerve MR abnormalities. CONCLUSION: Unilateral, short-segment enhancement localized to the optic nerve-globe junction is highly specific for cat scratch disease as the underlying cause of optic neuropathy and may help in establishing the diagnosis of this condition.
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Doença da Arranhadura de Gato/complicações , Imageamento por Ressonância Magnética , Doenças do Nervo Óptico/diagnóstico , Doenças do Nervo Óptico/microbiologia , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
Brain magnetic resonance image (MRI) registration alters structure orientation, size, and/or shape. To determine whether linear registration methods (image transformation to 6, 9, and 12° of freedom) alter structural volume and cognitive associations, we examined transformation alterations to the caudate nucleus within individuals diagnosed with Parkinson's disease (PD) and demographically matched non-PD peers. Volumes from native and six were expected be significantly different from 9 and 12° of freedom methods. Caudate nucleus volumes were expected to be associated with measures of processing speed and mental flexibility, but the strength of the association based on transformation approach was unknown. MRI brain scans from individuals with Parkinson's disease (n = 40) and age-matched controls (n = 40) were transformed using 6, 9, and 12° of freedom to an average brain template. Correlations controlling for total intracranial volume assessed expected structural-behavioral associations. Volumetric: Raw 9 and 12° transformed volumes were significantly larger than native and 6° volumes. Only 9 and 12° volumes revealed group differences with PD less than controls. Intracranial volume considerations were essential for native and 6° between group comparisons. Structural-Behavioral: The 9 and 12° caudate nucleus volume transformations revealed the expected brain-behavioral associations. Linear registration techniques alter volumetric and cognitive-structure associations. The study highlights the need to communicate transformation approach and group intracranial volume considerations.
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Núcleo Caudado/patologia , Cognição , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Doença de Parkinson/patologia , Doença de Parkinson/psicologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Tamanho do ÓrgãoRESUMO
BACKGROUND: There is remarkable heterogeneity in clinical Alzheimer's disease (AD) or vascular dementia (VaD). OBJECTIVES: 1) To statistically examine neuropsychological data to determine dementia subgroups for individuals clinically diagnosed with AD or VaD and then 2) examine group differences in specific gray/white matter regions of interest. METHODS: A k-means cluster analysis requested a 3-group solution from neuropsychological data acquired from individuals diagnosed clinically with AD/VaD. MRI measures of hippocampal, caudate, ventricular, subcortical lacunar infarction, whole brain volume, and leukoaraiosis (LA) were analyzed. Three regions of LA volumes were quantified and these included the periventricular (5âmm around the ventricles), infracortical (5âmm beneath the gray matter), and deep (between periventricular and infracortical) regions. RESULTS: Cluster analysis sorted AD/VaD patients into single domain amnestic (nâ=â41), single-domain dysexecutive (nâ=â26), and multi-domain (nâ=â26) phenotypes. Multi-domain patients exhibited worst performance on language tests; however, multi-domain patients were equally impaired on memory tests when compared to amnestic patients. Statistically-determined groups dissociated using neuroradiological parameters: amnestic and multi-domain groups presented with smaller hippocampal volume while the dysexecutive group presented with greater deep, periventricular, and whole brain LA. Neither caudate nor lacunae volume differed by group. Caudate nucleus volume negatively correlated with total LA in the dysexecutive and multi-domain groups. CONCLUSIONS: There are at least three distinct subtypes embedded within patients diagnosed clinically with AD/VaD spectrum dementia. We encourage future research to assess a) the neuroradiological substrates underlying statistically-determined AD/VaD spectrum dementia and b) how statistical modeling can be integrated into existing diagnostic criteria.
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Doença de Alzheimer/diagnóstico , Doença de Alzheimer/patologia , Encéfalo/patologia , Demência Vascular/diagnóstico , Demência Vascular/patologia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Doença de Alzheimer/psicologia , Análise por Conglomerados , Demência Vascular/psicologia , Diagnóstico Diferencial , Feminino , Substância Cinzenta/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Entrevista Psiquiátrica Padronizada , Análise Multivariada , Testes Neuropsicológicos , Tamanho do Órgão , Substância Branca/patologiaRESUMO
Gross tumor volume (GTV) at the primary site, as derived from pretreatment CT findings, can help predict local control of squamous cell carcinoma at different head and neck subsites after treatment with nonsurgical organ preservation. Local recurrence is more likely with large tumors than with small lesions in the same anatomic subsite, and GTV is often more strongly associated with local control than is tumor stage. This review discusses tumor volume calculation-technique, current literature, and potential clinical applications-and aims to help the reader to understand the role of GTV calculations and to integrate this knowledge into clinical practice.
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Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/terapia , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Gastrointestinais/terapia , Neoplasias do Sistema Respiratório/diagnóstico por imagem , Neoplasias do Sistema Respiratório/terapia , Humanos , Valor Preditivo dos Testes , Radiografia , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: Evaluation of images of perineural tumor spread in patients with head and neck malignancies is essential for planning treatment and determining the patient's prognosis. Although the communications between the facial and trigeminal nerves are not widely known, they may provide a route for tumor growth. The purpose of this study was to elucidate the course of the auriculotemporal nerve, as well as the clinical and imaging findings that suggest involvement of the communication between the facial nerve and the mandibular division (V(3)) of the trigeminal nerve. METHODS: Images in 15 patients with clinical or radiologic findings suggestive of perineural tumor spread along the auriculotemporal nerve were reviewed. Involvement of the main trunk of the facial nerve, auriculotemporal nerve, V(3), trigeminal cistern, and ganglion and adjacent anatomic structures were noted in each patient. RESULTS: The course of the auriculotemporal nerve was described in detail. More than 50% of patients with perineural tumor spread along the auriculotemporal nerve had clinical signs of auriculotemporal nerve dysfunction, including periauricular pain and temporomandibular joint (TMJ) dysfunction or tenderness. Images in 13 of 15 patients with such tumor spread demonstrated findings of tumor growth along V(3.). CONCLUSION: Knowledge of the course of the auriculotemporal nerve is critical in evaluating images for findings of tumor spread along this nerve. Periauricular pain, TMJ dysfunction or tenderness, and imaging signs of V(3) involvement are important indicators of potential involvement of the auriculotemporal nerve.
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Orelha/inervação , Neoplasias de Cabeça e Pescoço/diagnóstico , Imageamento por Ressonância Magnética , Couro Cabeludo/inervação , Tomografia Computadorizada por Raios X , Adulto , Idoso , Técnicas de Diagnóstico por Cirurgia , Nervo Facial/diagnóstico por imagem , Nervo Facial/patologia , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico , Sistema Nervoso/diagnóstico por imagem , Sistema Nervoso/patologia , Sistema Nervoso/fisiopatologia , Dor , Articulação Temporomandibular/fisiopatologia , Gânglio Trigeminal/diagnóstico por imagem , Gânglio Trigeminal/patologia , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/patologiaRESUMO
Cranial nerve III dysfunction in multiple sclerosis (MS) is uncommon. Seven cases of isolated cranial nerve III paresis associated with MS have been reported in the English-language literature. MR imaging was obtained in five cases demonstrating lesions within the midbrain. We present the detailed clinical and MR imaging findings of a young woman with MS and an isolated, painful pupil involving complete left cranial nerve III palsy. Initial MR imaging showed isolated enhancement of the cisternal portion of the cranial nerve III, suggesting that peripheral nervous system involvement may develop as part of the disease process in some patients with MS.
Assuntos
Doenças dos Nervos Cranianos/diagnóstico , Esclerose Múltipla/diagnóstico , Nervo Oculomotor/fisiopatologia , Adulto , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/fisiopatologia , Angiografia Cerebral , Doenças dos Nervos Cranianos/líquido cefalorraquidiano , Feminino , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla/fisiopatologia , Nervo Oculomotor/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/fisiopatologia , Intensificação de Imagem RadiográficaRESUMO
BACKGROUND AND PURPOSE: MR imaging is the method of choice for evaluating the trigeminal nerve. Detection of abnormalities such as perineural tumor spread requires detailed knowledge of the normal MR appearance of the trigeminal nerve and surrounding structures. The purpose of this study was to clarify the normal MR appearance and variations of the trigeminal ganglion, maxillary nerve (V2), and mandibular nerve (V3) with their corresponding perineural vascular plexus. METHOD: S: MR images obtained in 32 patients without symptoms referable to the trigeminal nerve were retrospectively reviewed. The trigeminal ganglion in Meckel's cave, V2 within the foramen rotundum, and V3 at the level of foramen ovale were assessed for visualization and enhancement. The configuration of the perineural vascular plexus was recorded. Correlation to cadaver specimens was made. RESULTS: The trigeminal ganglion and V3 were observed to enhance in 3-4% of patients unilaterally. V2 and V3 were well visualized 93% of the time. The perineural vascular plexus of V2 was observed 91% of the time, and that of V3 in 97% of instances. CONCLUSION: This study characterizes the normal MR appearance of the trigeminal ganglion and its proximal branches. The trigeminal ganglion, V2, and, V3 are almost always reliably seen on thin-section MR studies of the skull base. Enhancement of the perivascular plexus is routinely seen; however, enhancement of the trigeminal ganglion, V2, or V3 alone is seen only on occasion as supported by the avascular appearance of these anatomic structures in cadaver specimens.