RESUMEN
PURPOSE: Digital tomosynthesis (DTS) is currently undergoing validation for potential clinical implications. The aim of this study was to investigate the potential for DTS as a low-dose alternative to computed tomography (CT) in imaging of pulmonary pathology in patients with cystic fibrosis (CF). METHODS: DTS and CT were performed as part of the routine triannual follow-up in 31 CF patients. Extent of disease was quantified according to modality-specific scoring systems. Statistical analysis included Spearman's rank correlation coefficient (r) and Krippendorff's alpha (α). MAJOR FINDINGS: The median effective dose was 0.14 for DTS and 2.68 for CT. Intermodality correlation was very strong for total score and the subscores regarding bronchiectasis and bronchial wall-thickening (r = 0.82-0.91, P < 0.01). Interobserver reliability was high for total score, bronchiectasis and mucus plugging (α = 0.83-0.93) in DTS. CONCLUSION: Chest tomosynthesis could be a low-dose alternative to CT in quantitative estimation of structural lung disease in CF.
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Fibrosis Quística , Fibrosis Quística/diagnóstico por imagen , Humanos , Pulmón/diagnóstico por imagen , Radiografía , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos XRESUMEN
SUMMARY: With rapid advances in neuroimaging technology, there is growing concern over potential misuse of neuroradiologic imaging data in legal matters. On December 7 and 8, 2012, a multidisciplinary consensus conference, Use and Abuse of Neuroimaging in the Courtroom, was held at Emory University in Atlanta, Georgia. Through this interactive forum, a highly select group of experts-including neuroradiologists, neurologists, forensic psychiatrists, neuropsychologists, neuroscientists, legal scholars, imaging statisticians, judges, practicing attorneys, and neuroethicists-discussed the complex issues involved in the use of neuroimaging data entered into legal evidence and for associated expert testimony. The specific contexts of criminal cases, child abuse, and head trauma were especially considered. The purpose of the conference was to inform the development of guidelines on expert testimony for the American Society of Neuroradiology and to provide principles for courts on the ethical use of neuroimaging data as evidence. This report summarizes the conference and resulting recommendations.
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Testimonio de Experto/ética , Psiquiatría Forense/ética , Neurorradiografía/ética , Guías de Práctica Clínica como Asunto , American Medical Association , Humanos , Estados UnidosRESUMEN
SUMMARY: Stroke is a leading cause of death and disability worldwide. Imaging plays a critical role in evaluating patients suspected of acute stroke and transient ischemic attack, especially before initiating treatment. Over the past few decades, major advances have occurred in stroke imaging and treatment, including Food and Drug Administration approval of recanalization therapies for the treatment of acute ischemic stroke. A wide variety of imaging techniques has become available to assess vascular lesions and brain tissue status in acute stroke patients. However, the practical challenge for physicians is to understand the multiple facets of these imaging techniques, including which imaging techniques to implement and how to optimally use them, given available resources at their local institution. Important considerations include constraints of time, cost, access to imaging modalities, preferences of treating physicians, availability of expertise, and availability of endovascular therapy. The choice of which imaging techniques to employ is impacted by both the time urgency for evaluation of patients and the complexity of the literature on acute stroke imaging. Ideally, imaging algorithms should incorporate techniques that provide optimal benefit for improved patient outcomes without delaying treatment.
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Angiografía Cerebral/normas , Ataque Isquémico Transitorio/diagnóstico , Neurorradiografía/normas , Guías de Práctica Clínica como Asunto , Radiología Intervencionista/normas , Accidente Cerebrovascular/diagnóstico , Humanos , Ataque Isquémico Transitorio/terapia , Accidente Cerebrovascular/terapia , Estados UnidosRESUMEN
The voluminous bill known as the PPACA of 2010 enabled substantial changes to our health care delivery system, some of which remain to be enacted for several years to come. While the overarching goal is to align incentives and improve quality and access, implementing PPACA initiatives in a highly complex environment is fraught with economic and political implications. The purpose of this and future AJNR Health Care Vignettes is to provide relevant updated information as it becomes available.
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Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/legislación & jurisprudencia , Patient Protection and Affordable Care Act/economía , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Registros Electrónicos de Salud , Humanos , Radiología/economía , Estados UnidosRESUMEN
BACKGROUND AND PURPOSE: Mild cognitive impairment (MCI) is a risk factor for Alzheimer disease and can be difficult to diagnose because of the subtlety of symptoms. This study attempted to examine gray matter (GM) and white matter (WM) changes with cortical thickness analysis and diffusion tensor imaging (DTI) in patients with MCI and demographically matched comparison subjects to test these measurements as possible imaging markers for diagnosis. MATERIALS AND METHODS: Subjects with amnestic MCI (n = 10; age, 72.2 +/- 7.1 years) and normal cognition (n = 10; age, 70.1 +/- 7.7 years) underwent DTI and T1-weighted MR imaging at 3T. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), and cortical thickness were measured and compared between the MCI and control groups. We evaluated the diagnostic accuracy of 2 methods, either in combination or separately, using binary logistic regression and nonparametric statistical analyses for sensitivity, specificity, and accuracy. RESULTS: Decreased FA and increased ADC in WM regions of the frontal and temporal lobes and corpus callosum (CC) were observed in patients with MCI. Cortical thickness was decreased in GM regions of the frontal, temporal, and parietal lobes in patients with MCI. Changes in WM and cortical thickness seemed to be more pronounced in the left hemisphere compared with the right hemisphere. Furthermore, the combination of cortical thickness and DTI measurements in the left temporal areas improved the accuracy of differentiating MCI patients from control subjects compared with either measure alone. CONCLUSIONS: DTI and cortical thickness analyses may both serve as imaging markers to differentiate MCI from normal aging. Combined use of these 2 methods may improve the accuracy of MCI diagnosis.
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Encéfalo/patología , Trastornos del Conocimiento/patología , Imagen de Difusión por Resonancia Magnética/métodos , Fibras Nerviosas Mielínicas/patología , Anciano , Femenino , Humanos , Masculino , Sensibilidad y EspecificidadRESUMEN
Interactions between prevalent late-life medical conditions and expansion of the cerebral ventricles are not well understood. Thirty elderly subjects received three magnetic resonance (MR) scans each, in 1997-1999, 2002-2004, and 2003-2005. A linear expansion model of MR-measured lateral ventricle volume was estimated for each subject by fitting a line to a plot of their 1997-1999 and 2002-2004 volumes as a function of time. Acceleration in ventricular expansion was defined as the deviation between the 2003-2005 volumes measured from MR and the 2003-2005 volumes predicted by the linear expansion model. Ventricular acceleration was analyzed in a multivariate model with age, race, history of heart disease, diabetes, and hypertension as fixed effects. Ventricular acceleration was significantly higher in non-whites, diabetics, and those without heart disease (p<0.05). Ventricular acceleration was higher in subjects with a history of hypertension, but the difference was not statistically significant (p=0.08). Acceleration of ventricular expansion in the elderly may be related to demographic and cardiovascular factors.
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Ventrículos Cerebrales/anatomía & histología , Imagen por Resonancia Magnética , Anciano , Análisis de Varianza , Enfermedades Cardiovasculares/patología , Enfermedades Cardiovasculares/fisiopatología , Femenino , Humanos , Estudios Longitudinales , Masculino , Valores de Referencia , Estudios Retrospectivos , Factores Sexuales , Factores de TiempoRESUMEN
We examined the contribution of 5-HT1A autoreceptors (with [11C]WAY100635 positron emission tomography) to amygdala reactivity (with blood oxygenation level-dependent functional magnetic resonance imaging) in 20 healthy adult volunteers. We found a significant inverse relationship wherein 5-HT1A autoreceptor density predicted a notable 30-44% of the variability in amygdala reactivity. Our data suggest a potential molecular mechanism by which a reduced capacity for negative feedback regulation of 5-HT release is associated with increased amygdala reactivity.
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Amígdala del Cerebelo/fisiología , Homeostasis/fisiología , Receptor de Serotonina 5-HT1A/fisiología , Adulto , Depresión/metabolismo , Retroalimentación/fisiología , Humanos , Imagen por Resonancia Magnética , Oxígeno/sangre , Piperazinas/farmacología , Tomografía de Emisión de Positrones , Piridinas/farmacología , Receptor de Serotonina 5-HT1A/efectos de los fármacos , Antagonistas de la Serotonina/farmacologíaRESUMEN
The authors investigated whether the cognitive impairments associated with white matter hyperintensities (WMH) in normal elderly subjects are exacerbated by any anticholinergic medications being taken by the subjects. Results showed serum anticholinergic activity (SAA) and WMH volume to have a synergistic interaction such that the cognitive decrements associated with increasing WMH volume were greatest in those older individuals in the highest quartile of the SAA distribution.
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Infarto Cerebral/fisiopatología , Trastornos Cerebrovasculares/fisiopatología , Trastornos del Conocimiento/inducido químicamente , Trastornos del Conocimiento/psicología , Antagonistas Muscarínicos/efectos adversos , Acetilcolina/metabolismo , Anciano , Anciano de 80 o más Años , Envejecimiento/metabolismo , Envejecimiento/patología , Encéfalo/irrigación sanguínea , Encéfalo/metabolismo , Encéfalo/patología , Infarto Cerebral/complicaciones , Infarto Cerebral/metabolismo , Trastornos Cerebrovasculares/complicaciones , Trastornos Cerebrovasculares/metabolismo , Cognición/efectos de los fármacos , Cognición/fisiología , Trastornos del Conocimiento/fisiopatología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Antagonistas Muscarínicos/sangre , Fibras Nerviosas Mielínicas/metabolismo , Fibras Nerviosas Mielínicas/patología , Pruebas Neuropsicológicas , Desempeño Psicomotor/efectos de los fármacos , Desempeño Psicomotor/fisiologíaAsunto(s)
Glicoproteínas de Membrana/genética , Proteínas de Transporte de Membrana/genética , Proteínas del Tejido Nervioso/genética , Polimorfismo Genético , Receptor de Serotonina 5-HT1A/genética , Amígdala del Cerebelo/fisiología , Femenino , Genotipo , Humanos , Neuronas/fisiología , Valores de Referencia , Proteínas de Transporte de Serotonina en la Membrana Plasmática , Estadísticas no ParamétricasRESUMEN
OBJECTIVE: To determine whether memory performance in hypertensive subjects induces diminished parietal and prefrontal blood flow activation relative to normotensive subjects but compensatory amygdala/hippocampal activation. METHODS: Thirty-seven untreated hypertensive subjects and 59 normotensive control subjects performed in two memory and one sensorimotor task while global and regional cerebral blood flow (rCBF) was assessed with [15O]water and PET. Neuropsychological, carotid artery ultrasound, and MRI assessments were obtained. RESULTS: When they were engaged in memory tasks, increases of CBF in hypertensive subjects were less than in normotensive subjects in the posterior parietal area, as expected; blunted responses were also shown within the middle posterior arterial watershed and thalamus. Relative to all other participants, hypertensive subjects that performed relatively well on verbal memory showed an enhanced rCBF response in the right amygdala/hippocampus. Furthermore, hypertensive, but not normotensive, subjects showed task-induced rCBF in the amygdala/hippocampal area that was significantly correlated with task-induced prefrontal rCBF. No confounding influences were identified from carotid artery or MRI measures. CONCLUSIONS: Memory performance in hypertensive individuals is related to a blunted regional cerebral blood flow (rCBF) response, particularly in parietal cortex. Potentially compensatory rCBF responses appear to occur in midbrain and correlate with prefrontal rCBF.
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Adaptación Fisiológica/fisiología , Isquemia Encefálica/complicaciones , Encéfalo/fisiología , Circulación Cerebrovascular/fisiología , Hipertensión/complicaciones , Trastornos de la Memoria/etiología , Amígdala del Cerebelo/diagnóstico por imagen , Amígdala del Cerebelo/fisiología , Amígdala del Cerebelo/fisiopatología , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/fisiopatología , Mapeo Encefálico , Arterias Cerebrales/diagnóstico por imagen , Arterias Cerebrales/fisiopatología , Femenino , Hipocampo/diagnóstico por imagen , Hipocampo/fisiología , Hipocampo/fisiopatología , Humanos , Hipertensión/fisiopatología , Imagen por Resonancia Magnética , Masculino , Trastornos de la Memoria/diagnóstico por imagen , Trastornos de la Memoria/fisiopatología , Memoria a Corto Plazo/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Lóbulo Parietal/diagnóstico por imagen , Lóbulo Parietal/fisiología , Lóbulo Parietal/fisiopatología , Tomografía de Emisión de Positrones , Corteza Prefrontal/diagnóstico por imagen , Corteza Prefrontal/fisiología , Corteza Prefrontal/fisiopatologíaRESUMEN
OBJECTIVES: To determine in vivo cortical acetylcholinesterase (AChE) activity and cognitive effects in subjects with mild Alzheimer's disease (AD, n = 14) prior to and after 12 weeks of donepezil therapy. METHODS: Cognitive and N-[(11)C]methyl-piperidin-4-yl propionate ([(11)C]PMP) AChE positron emission tomography (PET) assessments before and after donepezil therapy. RESULTS: Analysis of the PET data revealed mean (temporal, parietal, and frontal) cortical donepezil induced AChE inhibition of 19.1% (SD 9.4%) (t = -7.9; p<0.0001). Enzyme inhibition was most robust in the anterior cingulate cortex (24.2% (6.9%), t = -14.1; p<0.0001). Donepezil induced cortical inhibition of AChE activity correlated with changes in the Stroop Color Word interference scores (R(2) = 0.59, p<0.01), but not with primary memory test scores. Analysis of the Stroop test data indicated that subjects with AChE inhibition greater than the median value (>22.2%) had improved scores on the Stroop Color Word Test compared with subjects with less inhibition who had stable to worsening scores (t = -2.7; p<0.05). CONCLUSIONS: Donepezil induced inhibition of cortical AChE enzyme activity is modest in patients with mild AD. The degree of cortical enzyme inhibition correlates with changes in executive and attentional functions.
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Acetilcolinesterasa/efectos de los fármacos , Acetilcolinesterasa/farmacología , Enfermedad de Alzheimer/tratamiento farmacológico , Corteza Cerebral/enzimología , Inhibidores de la Colinesterasa/farmacología , Trastornos del Conocimiento/tratamiento farmacológico , Indanos/farmacología , Piperidinas/farmacología , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/complicaciones , Atención/efectos de los fármacos , Trastornos del Conocimiento/etiología , Donepezilo , Femenino , Humanos , Masculino , Tomografía de Emisión de PositronesRESUMEN
The refinement of in vivo imaging approaches to investigating the structure and function of the aging brain has provided the opportunity to strengthen our knowledge of the biological substrate of normal aging and late life neurological and psychiatric disorders. While postmortem studies are biased toward the end stages of disease, functional and structural imaging have permitted us to characterize the brain changes accompanying early Alzheimer s disease (AD). As more effective therapeutic approaches to slowing (and potentially reversing) disease progression are developed, the role of imaging in determining pre AD or high risk conditions becomes increasingly important. The goal of applying non invasive means to identify the transition state of mild cognitive impairment (MCI) is of considerable public health importance. Further, emerging imaging strategies may be used to monitor the efficacy of therapeutic regimens.
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Encéfalo/patología , Trastornos del Conocimiento/patología , Imagen por Resonancia Magnética , Anciano , Atrofia , Humanos , Enfermedad por Cuerpos de Lewy/patología , Estudios LongitudinalesRESUMEN
Functional brain imaging has provided unique and exciting opportunities to strengthen our knowledge of the biological substrate of the aging brain and neuropsychiatric disorders. Positron emission tomography (PET) is a particularly powerful tool for quantifying the neurobiological correlates of cognition, mood and behavior. Initial PET studies of aging, psychiatric disorders and neurodegenerative disease focused primarily on generalized physiological parameters such as cerebral blood flow and metabolism, and early neuroreceptor imaging studies relied on relatively non selective markers. New, selective receptor radioligands now offer a previously inaccessible means to investigate the dynamic relationships among neurochemistry, aging and psychopathology in vivo. This approach has substantial advantages over peripheral (platelet and cerebrospinal fluid) markers, neuroendocrine challenge studies, animal models, and postmortem receptor binding assays. Advances in tracer kinetic modeling, magnetic resonance imaging (MRI) to PET registration, radiochemistry techniques, instrumentation and image processing have helped pave the way for increased emphasis on functional imaging studies of neuropsychiatric disorders of the elderly. The capability to correct PET image data for the confounding effect of cerebral atrophy permits relationships among age related brain changes and neurobiological disease mechanisms to be more accurately examined in the course of normal aging and in elderly patient populations.
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Envejecimiento/metabolismo , Fármacos del Sistema Nervioso Central , Envejecimiento/patología , Enfermedad de Alzheimer/metabolismo , Enfermedad de Alzheimer/patología , Atrofia , Encéfalo/diagnóstico por imagen , Encéfalo/crecimiento & desarrollo , Encéfalo/metabolismo , Encéfalo/patología , Fármacos del Sistema Nervioso Central/farmacocinética , Circulación Cerebrovascular , Depresión/metabolismo , Depresión/patología , Humanos , Procesamiento de Imagen Asistido por Computador , Ligandos , Imagen por Resonancia Magnética , Enfermedades Neurodegenerativas/metabolismo , Enfermedades Neurodegenerativas/patología , Sistemas Neurosecretores/metabolismo , Neurotransmisores/metabolismo , Enfermedad de Parkinson/metabolismo , Enfermedad de Parkinson/patología , Radiofármacos , Receptores de Droga/metabolismo , Receptores de Neurotransmisores/metabolismo , Tomografía Computarizada de Emisión , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Introducción y desarrollo. La exploración por imágenes funcionales del cerebro ha proporcionado oportunidades únicas y estimulantes para fortalecer nuestro conocimiento del sustrato biológico del cerebro en proceso de envejecimiento y de los trastornos neuropsiquiátricos. La tomografía por emisión de positrones (PET) es una herramienta particularmente potente para cuantificar las correlaciones de la cognición, el estado de ánimo y la conducta. Los primeros estudios con PET acerca del envejecimiento, los trastornos psiquiátricos y la enfermedad neurodegenerativa se centraban principalmente en parámetros fisiológicos generalizados, como el flujo de la sangre en el cerebro y el metabolismo, y los primeros estudios de los neurorreceptores con exploración por imagen dependían de marcadores relativamente no selectivos. Los radioligandos receptores selectivos nuevos ofrecen hoy un medio hasta ahora inaccesible para investigar in vivo la dinámica de las relaciones entre la neuroquímica, el envejecimiento y la psicopatología. Este enfoque ofrece ventajas sustanciales sobre los marcadores periféricos (trombocitos y líquido cefalorraquídeo), los estudios neuroendocrinos sometidos a reto, los modelos animales y los ensayos post mortem de la unión de receptores. Conclusiones. Los avances en la modelación cinética con sustancias trazadoras, desde la resonancia magnética de alta resolución hasta los registros con PET, las técnicas radioquímicas y el procesamiento de imágenes han ayudado a despejar el camino para un mayor énfasis en los estudios de exploración por imagen funcional de los trastornos neuropsiquiátricos en las personas de edad avanzada. La capacidad para corregir los datos de las imágenes de la PET por el efecto confuso de la atrofia cerebral, permite que las relaciones entre los cambios en el cerebro relacionados con la edad y los mecanismos de la enfermedad neurobiológica se examinen con mayor precisión en el curso del envejecimiento normal y entre las poblaciones de pacientes de edad avanzada (AU)
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Humanos , Tomografía Computarizada de Emisión , Tomografía Computarizada de Emisión de Fotón Único , Receptores de Neurotransmisores , Enfermedades Neurodegenerativas , Radiofármacos , Sistemas Neurosecretores , Enfermedad de Parkinson , Receptores de Droga , Atrofia , Fármacos del Sistema Nervioso Central , Circulación Cerebrovascular , Depresión , Envejecimiento , Enfermedad de Alzheimer , Imagen por Resonancia Magnética , Procesamiento de Imagen Asistido por Computador , Neurotransmisores , Telencéfalo , LigandosRESUMEN
OBJECTIVE: This study examined whether MRI evidence of cerebrovascular disease in the form of white matter hyperintensities (WMH) was associated with decreased implicit sequence learning performance in a high-functioning group of normal elderly volunteers. METHOD: One hundred and eight community-dwelling elderly individuals received an MRI and performed an implicit sequence learning task, the serial reaction time (SRT) task. RESULTS: Hyperintensities present in the white matter were associated with a decreased learning effect. This association was found with both deep white matter and periventricular changes. Other factors affecting SRT performance (i.e., baseline reaction time and switch-cost) were not significantly related to the presence of WMH. CONCLUSIONS: The results indicate that in addition to previously identified generalized cognitive deficits, WMH are also associated with a specific decrease in the implicit learning of sequences.
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Encéfalo/patología , Trastornos Cerebrovasculares/fisiopatología , Aprendizaje , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Trastornos Cerebrovasculares/patología , Humanos , Imagen por Resonancia Magnética , Tiempo de ReacciónRESUMEN
PURPOSE: Imaging modalities to evaluate ovarian/fallopian tube cancer patients for recurrence are limited. Positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound lack the sensitivity to consistently detect recurrence or measurable disease in these patients. A new technique combines PET and CT (PET/CT) images to identify increased metabolic activity and to locate that signal with improved anatomic specificity. The objective of this study is to compare PET/CT, CT, and histologic findings in patients with recurrent ovarian/fallopian tube cancers. METHODS: Retrospective chart review of eight patients with primary ovarian (n = 6) or fallopian tube (n = 2) cancer was performed. All eight patients underwent initial cytoreductive surgery. Five patients initially received chemotherapy, one received radioactive phosphorus ((32)P), one received tamoxifen, and one received no therapy. Seven of eight patients had a suspected recurrence based on clinical examination, elevated CA-125 level, and/or abnormal CT findings; one patient requested a PET/CT. Histologic findings from surgery were correlated with PET/CT and CT findings. RESULTS: All eight patients had positive histology, and of these, seven patients had a negative CT and five patients had lesions that were correctly identified by PET/CT. CONCLUSIONS: Five of the eight (62%) patients had recurrent disease based on correlative histology with a positive PET/CT and a negative CT. These preliminary findings suggest that combined PET/CT may be an effective means of identifying patients with recurrent ovarian/fallopian tube cancer. Such patients could potentially proceed to salvage treatment and avoid the morbidity and expense of surgical assessment. Pilot studies comparing CT, PET, PET/CT, and histologic findings are underway.
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Neoplasias de las Trompas Uterinas/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Neoplasias Ováricas/diagnóstico por imagen , Anciano , Neoplasias de las Trompas Uterinas/diagnóstico , Neoplasias de las Trompas Uterinas/patología , Neoplasias de las Trompas Uterinas/cirugía , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Radioisótopos de Fósforo , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada de Emisión/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Changes in regional cerebral blood flow (rCBF) have previously been demonstrated in a number of cortical and subcortical regions, including the cerebellum, midbrain, thalamus, lentiform nucleus, and the insula, prefrontal, anterior cingulate, and parietal cortices, in response to experimental noxious stimuli. Increased anterior cingulate responses in patients with chronic regional pain and depression to noxious stimulation distant from the site of clinical pain have been observed. We suggested that this may represent a generalized hyperattentional response to noxious stimuli and may apply to other types of chronic regional pain. Here these techniques are extended to a group of patients with nonspecific chronic low back pain. Thirty-two subjects, 16 chronic low back pain patients and 16 controls, were studied using positron emission tomography. Thermal stimuli, corresponding to the experience of hot, mild, and moderate pain, were delivered to the back of the subject's right hand using a thermal probe. Each subject had 12 measurements of rCBF, 4 for each stimulus. Correlation of rCBF with subjective pain experience revealed similar responses across groups in the cerebellum, midbrain (including the PAG), thalamus, insula, lentiform nucleus, and midcingulate (area 24') cortex. These regions represented the majority of activations for this study and those recorded by other imaging studies of pain. Although some small differences were observed between the groups these were not considered sufficient to suggest abnormal nociceptive processing in patients with nonspecific low back pain.
Asunto(s)
Encéfalo/fisiopatología , Calor , Dolor de la Región Lumbar/fisiopatología , Dolor/fisiopatología , Adulto , Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular/fisiología , Depresión/fisiopatología , Depresión/psicología , Femenino , Giro del Cíngulo/diagnóstico por imagen , Giro del Cíngulo/fisiopatología , Humanos , Dolor de la Región Lumbar/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nociceptores/fisiología , Dolor/diagnóstico por imagen , Dimensión del Dolor , Corteza Prefrontal/diagnóstico por imagen , Corteza Prefrontal/fisiopatología , Escalas de Valoración Psiquiátrica , Encuestas y Cuestionarios , Tomografía Computarizada de EmisiónRESUMEN
Detection of a venous angioma at the root entry zone is important for surgical planning, so that the neurosurgeon will be aware that both veins and arteries may require microvascular decompression. In selected cases, alternative treatment may be indicated to avoid the potential surgical complication of a venous infarct. Trigeminal neuralgia typically occurs in the middle-aged to elderly population, usually the result of compression of the trigeminal nerve at its root entry zone by an ectatic, aging artery or, less commonly, a regional vein [1, 2, 3]. When associated with a venous angioma at the root entry zone, trigeminal neuralgia usually presents at a younger age [4, 5, 6]. We review the imaging examinations and clinical data of five patients with trigeminal neuralgia who had a venous angioma adjacent to the root entry zone of the trigeminal nerve, and discuss how the imaging findings affected their management.