RESUMEN
Differentiation of systemic lupus erythematosus (SLE) from multiple sclerosis (MS) can be challenging, especially when neuropsychiatric (NP) symptoms are accompanied by white matter lesions in the brain. Given the lack of discriminative power of currently applied tools for their differentiation, there is an unmet need for other measures that can aid in distinguishing between the two autoimmune disorders. In this study we aimed at exploring whether brain atrophy measures could serve as markers differentiating MS and SLE. Thirty-seven relapsing-remitting MS and 38 SLE patients with nervous system manifestations, matched according to age and disease duration, underwent 1.5 Tesla magnetic resonance imaging (MRI), including volumetric sequences, and clinical assessment. Voxelwise analysis was performed using ANTS-SyN elastic registration protocol, FSL Randomise and Gamma methods. Cortical and subcortical segmentation was performed with Freesurfer 5.3 pipeline using T1-weighted MPRAGE sequence data. Using MRI volumetric markers of general and subcortical gray matter atrophy and clinical variables, we built a stepwise multivariable logistic diagnostic model to identify MRI parameters that best differentiate MS and SLE patients. We found that the best volumetric predictors to distinguish them were: fourth ventricle volume (sensitivity 0.86, specificity 0.57, area under the curve, AUC 0.77), posterior corpus callosum (sensitivity 0.81, specificity 0.57, AUC 0.68), and third ventricle to thalamus ratio (sensitivity 0.42, specificity 0.84, AUC 0.65). The same classifiers were identified in a subgroup analysis that included patients with a short disease duration. In MS brain atrophy and lesion load correlated with clinical disability, while in SLE age was the main determinant of brain volume. This study proposes new imaging parameters for differential diagnosis of MS and SLE with central nervous system involvement. We show there is a different pattern of atrophy in MS and SLE, and the key structural volumes that are differentially affected include fourth ventricle and posterior section of corpus callosum, followed by third ventricle to thalamus ratio. Different correlation patterns between volumetric and clinical data may suggest that while in MS atrophy is driven mainly by disease activity, in SLE it is mostly associated with age. However, these results need further replication in a larger cohort.
Asunto(s)
Encéfalo/diagnóstico por imagen , Vasculitis por Lupus del Sistema Nervioso Central/diagnóstico por imagen , Imagen por Resonancia Magnética , Esclerosis Múltiple Recurrente-Remitente/diagnóstico por imagen , Neuroimagen/métodos , Adolescente , Adulto , Factores de Edad , Atrofia , Encéfalo/patología , Estudios Transversales , Diagnóstico Diferencial , Evaluación de la Discapacidad , Femenino , Humanos , Vasculitis por Lupus del Sistema Nervioso Central/patología , Masculino , Persona de Mediana Edad , Esclerosis Múltiple Recurrente-Remitente/patología , Valor Predictivo de las Pruebas , Adulto JovenRESUMEN
Cognitive impairment is a significant clinical problem both in multiple sclerosis (MS) and systemic lupus erythematosus (SLE) patients. In MS cognitive dysfunction has been associated with brain atrophy and total demyelinating lesion volume. In SLE cognitive impairment is much less understood, and its link to structural brain damage remains to be established. The aim of this study was to identify the relationship between subcortical gray matter volume and cognitive impairment in MS and SLE. We recruited 37 MS and 38 SLE patients matched by age, disease duration and educational level. Patients underwent magnetic resonance imaging (MRI) and a battery of psychometric tests. Severity of cognitive impairment was similar in both cohorts despite larger white matter lesion load in MS patients. Psychometric scores were associated with global and subcortical gray matter atrophy measures and lesion load in MS, but not in SLE. In SLE, the lack of a relationship between cognitive impairment and structural damage, defined either as atrophy or white matter lesions, indicates a different causal mechanism of cognitive deficit.
Asunto(s)
Trastornos del Conocimiento/diagnóstico por imagen , Cognición , Sustancia Gris/diagnóstico por imagen , Lupus Eritematoso Sistémico/diagnóstico por imagen , Imagen por Resonancia Magnética , Esclerosis Múltiple Recurrente-Remitente/diagnóstico por imagen , Adolescente , Adulto , Atrofia , Ganglios Basales/diagnóstico por imagen , Ganglios Basales/patología , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/patología , Trastornos del Conocimiento/psicología , Estudios Transversales , Femenino , Sustancia Gris/patología , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/patología , Lupus Eritematoso Sistémico/psicología , Masculino , Persona de Mediana Edad , Esclerosis Múltiple Recurrente-Remitente/complicaciones , Esclerosis Múltiple Recurrente-Remitente/patología , Esclerosis Múltiple Recurrente-Remitente/psicología , Pruebas Neuropsicológicas , Valor Predictivo de las Pruebas , Estudios Prospectivos , Psicometría , Factores de Riesgo , Tálamo/diagnóstico por imagen , Tálamo/patología , Adulto JovenRESUMEN
BACKGROUND: Limited research has been performed concerning the effects of MR imaging on the immune system. In this study the influence of MR imaging exposure on polymorphonuclear neutrophil (PMN) adhesion was evaluated. MATERIAL AND METHODS: In vivo and in vitro studies were performed in 10 patients undergoing an MR imaging procedure, PMN adhesion to a plastic surface, as well as the expression of adhesion molecules beta 2-integrins CD11b, CD18, and L-selectin on the surface of PMN were estimated. RESULTS: Exposure to MR imaging significantly increased adhesion of isolated PMNs to plastic surfaces. PMNs from blood samples obtained from patients undergoing MR imaging as well as from blood samples placed beside patients during MR imaging did not differ from controls in adhesion to plastic surfaces. Similarly, plasma from three tested samples did not change control PMN adhesion to plastic surface. Expression of beta 2-integrins (CD11, CD18) was significantly increased in samples left beside patients during MR imaging, while significantly decreased in samples obtained from patients after MR imaging exposure when compared to control samples. Expression of the surface adhesion molecule L-selectin on the surface of PMN decreased significantly in blood samples left beside patients during MR imaging. CONCLUSION: The results indicate that the PMN adhesion properties increase under the influence of MR imaging exposure. This phenomenon may be the result of direct stimulation of polymorphonuclear neutrophils by the exposure to MR imaging.
Asunto(s)
Adhesión Celular/efectos de la radiación , Imagen por Resonancia Magnética , Neutrófilos/citología , Adulto , Anciano , Antígenos CD18/biosíntesis , Femenino , Humanos , Selectina L/biosíntesis , Antígeno de Macrófago-1/biosíntesis , Masculino , Persona de Mediana Edad , Neutrófilos/efectos de la radiación , Plásticos/metabolismoRESUMEN
Ischaemic stroke has been observed more rarely among young people in comparison to old adults. The causes of ischaemic stroke among young adults are numerous. One of them is occlusion of internal carotid artery (ICA). The aetiology of the occlusion is different from arteriosclerotic disorders. Within the last few years the authors have paid much attention to the fact that spontaneous dissection is not such a rare cause of ICA occlusion. In many cases (60-70%) of dissection recanalization and benign outcome occur. Angiography has been considered as a gold standard in establishing the diagnosis. We described a young, 16-year-old patient with ischaemic stroke. The cause occlusion of ICA, probably was dissection. The diagnosis was made by angiography MR. In our patient follow-up angiography MR demonstrated recanalisation. The outcome of the stroke was benign and hemiplegia reversed.
Asunto(s)
Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiología , Encéfalo/irrigación sanguínea , Disección de la Arteria Carótida Interna/diagnóstico , Adolescente , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Angiografía Cerebral , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
Patient, 37-years old, female, admitted to Department of Neurology, with intensive lower back pain and weakness of right lower extremity. Radiological evaluation showed developmental anomalies of spinal cord and vertebral column, with double spinal cord Th10-S1. The mechanism of described clinical symptoms is due to affixed spinal cord syndrome. According to current literature we presented the mechanism of anomaly development. The above case was classified as the second type of split cord malformations.
Asunto(s)
Vértebras Lumbares/anomalías , Defectos del Tubo Neural/diagnóstico , Sacro/anomalías , Vértebras Torácicas/anomalías , Adulto , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Imagen por Resonancia Magnética , Defectos del Tubo Neural/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Sacro/diagnóstico por imagen , Compresión de la Médula Espinal/diagnóstico , Compresión de la Médula Espinal/etiología , Vértebras Torácicas/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
The presenilin 1 (PS-1) gene, recently identified on chromosome 14q24.3, is a major gene involved into the autosomal dominant forms of early onset Alzheimer's disease (EOAD). Mutations of the PS-1 gene are responsible for the majority of familial EOAD. We found a novel mutation in a Polish family with EOAD from the Poznan region. The mutation at codon 424 in exon 12 of the PS-1 gene leads to an amino acid substitution Leu-Arg in a transmembrane domain VIII of the presenilin 1 molecule. The change is predicted to have a drastic effect on the protein function because it is associated with a very early age of onset (a range of 30-35 years) and a quick progression (about a 4-5 years duration) of the disease.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/genética , Exones/genética , Genes/genética , Mutación Puntual/genética , Adulto , Atrofia/diagnóstico por imagen , Atrofia/patología , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/patología , Codón/genética , Progresión de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Linaje , Polonia , Tomografía Computarizada por Rayos XRESUMEN
This article addresses etiology, pathogenesis and histology of papillary cystadenoma lymphomatosum (Warthin's tumor). Described are two cases of tumors with this histopathological characteristics with unusual locations. The first patient presented with a discrete lesion located in the nasopharynx, and the second with multiple post-infectious nodules located in the parotid glands bilaterally. The approach to the diagnosis and treatment of these cases is discussed.
Asunto(s)
Adenolinfoma/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico , Adenolinfoma/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasias Nasofaríngeas/cirugíaRESUMEN
Central neurocytoma is a rare tumour of the CNS. It typically occurs in intraventricular location in young adults. The authors describe central neurocytoma in a 17-year-old woman, which was situated unusually for this type of tumour in the brain parenchyma. In this paper radiological and histopathological picture is presented.
Asunto(s)
Neoplasias Encefálicas/diagnóstico , Neurocitoma/diagnóstico , Lóbulo Occipital/diagnóstico por imagen , Lóbulo Occipital/patología , Lóbulo Parietal/diagnóstico por imagen , Lóbulo Parietal/patología , Adolescente , Neoplasias Encefálicas/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Neurocitoma/cirugía , Lóbulo Occipital/cirugía , Lóbulo Parietal/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Cases of metachromatic leucodystrophy in brother and sister are presented. The clinical pattern in the female was characterised by the progressing dementia, whereas in the male the first symptom was the manic syndrome. The neurological status was normal. The cases were diagnosed by the demyelination visible in MRI pattern and in the decreased activity of arylsulphatase A in blood leukocytes.
Asunto(s)
Trastorno Bipolar/etiología , Demencia/etiología , Leucodistrofia Metacromática/genética , Leucodistrofia Metacromática/psicología , Adulto , Trastorno Bipolar/diagnóstico , Encéfalo/patología , Demencia/diagnóstico , Femenino , Humanos , Leucodistrofia Metacromática/patología , Imagen por Resonancia Magnética , Linaje , Escalas de Valoración PsiquiátricaRESUMEN
PURPOSE: To evaluate the sensitivity of various diagnostic methods in the optic neuritis. MATERIAL AND METHODS: 15 patients, 10 boys and 5 girls, aged 6-18 years, with optic neuritis have been examined. Multiple sclerosis was diagnosed in 12 cases, the etiology of 3 was unknown. The full ophthalmological examination, including static perimetry and visual evoked potentials (VEP) as well as brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed. RESULTS: MRI revealed plaques of demyelination in 11 patients; no pathological changes were observed in cases of idiopathic neuritis. In CT plaques of demyelination were found in 2 patients only. In most cases VEPs were abnormal, mainly there was prolonged latency of deflection, decreased amplitude and more rarely changes of the shape of the record. Static perimetry, with white and blue target, revealed multiple scattered absolute and relative scotoma in the 30 degrees central area. CONCLUSIONS: MRI and static perimetry were the most sensitive methods for detection of the changes in optic neuritis and these methods are also useful in cases with asymptomatic involvement of visual pathway, especially in multiple sclerosis.
Asunto(s)
Neuritis Óptica/diagnóstico , Adolescente , Niño , Potenciales Evocados Visuales , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Esclerosis Múltiple/complicaciones , Neuritis Óptica/etiología , Escotoma/diagnóstico , Escotoma/etiología , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , Pruebas del Campo VisualRESUMEN
Skull base tumour is rare and until recently was considered unresectable. The authors present a patient with skull base tumour of extra and intracranial compartment penetrating into parapharyngeal space and maxillary bone. Radiologic findings on CT, MRI, arteriography were studied. A surgical technique to expose the cranial base and intraoperative findings are described. Significant improvement occurred after incomplete tumour resection.
Asunto(s)
Neoplasias Maxilares/cirugía , Neoplasias Faríngeas/cirugía , Neoplasias de la Base del Cráneo/cirugía , Adulto , Angiografía , Femenino , Humanos , Imagen por Resonancia Magnética , Neoplasias Maxilares/diagnóstico , Invasividad Neoplásica , Neoplasias Faríngeas/diagnóstico , Neoplasias de la Base del Cráneo/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
RATIONALE AND OBJECTIVES: Limited research has been performed on the effects of magnetic resonance (MR) imaging on the immune system. To our knowledge, there are no reported studies of MR imaging effects on the polymorphonuclear neutrophil (PMN) system. Therefore, we evaluated the influence of MR imaging exposure on PMNs. METHODS: In vivo and in vitro studies were performed on 36 patients undergoing MR imaging. The following were estimated in blood samples: leukocyte and PMN count, PMN phagocytosis and bactericidal capacity, percentage of cells with expression of surface receptor for the Fc fragment of immunoglobulin G (IgG), PMN superoxide, hydrogen peroxide production, and plasma lysozyme activity. Another sample of patients was used to eliminate temperature as an influence on changes in PMN functions. RESULTS: Both in vitro and in vivo MR imaging led to a decrease in PMNs and an increase in PMN phagocytosis, bactericidal capacity, hydrogen peroxide production, and percentage of cells with expression of surface receptor for Fc IgG. Superoxide anion production did not change significantly. Elevated temperature, stress, and anxiety were excluded as influences on our results. CONCLUSION: The PMN system is affected seriously by MR imaging.
Asunto(s)
Imagen por Resonancia Magnética , Neutrófilos/fisiología , Adolescente , Adulto , Anciano , Actividad Bactericida de la Sangre , Femenino , Humanos , Peróxido de Hidrógeno/metabolismo , Técnicas In Vitro , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Muramidasa/metabolismo , Neutrófilos/inmunología , Fagocitosis , Receptores de IgG/análisis , Staphylococcus/fisiología , Superóxidos/metabolismo , TemperaturaRESUMEN
CT examinations of temporal bones were performed in 31 deaf patients from qualify diagnostic stage prepared for cochlear implants. Essential for surgical treatment anatomic details were estimated, especially canalis spiralis cochleae was paid to attention. In our group, 8 patients had some CT changes (abnormal findings) which corresponded to different stages of obliteration the cochlea. The majority of patients lost the hearing because of meningitis. In 6 implanted patients CT scan was compared with surgical findings. During the operation 1 patient with patent cochlea on CT scan had partially ossified basal turn.
Asunto(s)
Calcinosis/diagnóstico por imagen , Cóclea/diagnóstico por imagen , Cóclea/cirugía , Implantes Cocleares , Sordera/rehabilitación , Hueso Temporal/cirugía , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Calcinosis/patología , Niño , Preescolar , Cóclea/patología , Sordera/fisiopatología , Humanos , Persona de Mediana EdadRESUMEN
A rare case of intradural subarachnoid cyst in the vertebral canal was observed in a female aged 52 years. Operation was followed by marked improvement of the neurological condition. The large defect of the dura required grafting of lyophilized dura. The role of MRI in the diagnosis of this case is stressed.
Asunto(s)
Quistes Aracnoideos/diagnóstico por imagen , Vértebras Cervicales/cirugía , Quistes Aracnoideos/fisiopatología , Vértebras Cervicales/fisiopatología , Duramadre/trasplante , Femenino , Liofilización , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A case of transitional type of multiple sclerosis with large periventricular cuffs of demyelination is presented. The case suggests that in the mechanism of myelin decay a significant role might be played by the diffusion of the demyelinating factors contained in the cerebro-spinal fluid.
Asunto(s)
Enfermedades Desmielinizantes/fisiopatología , Esclerosis Múltiple/diagnóstico , Adulto , Ventrículos Cerebrales/fisiopatología , Enfermedades Desmielinizantes/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Hidrocefalia/complicaciones , Hidrocefalia/diagnóstico , Hidrocefalia/fisiopatología , Imagen por Resonancia Magnética , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/fisiopatología , Trastornos de la Personalidad/complicaciones , Trastornos de la Personalidad/diagnósticoRESUMEN
In the years 1976-1993 we have performed 90 transsphenoidal approaches for pituitary adenomas. This paper presents a detail report concerning 23 cases, operated in the last 2 years, with CT and NMR documentation. A preoperative visual deficit was very common in this group of patients. In the postoperative period the dramatic improvement of the vision was observed in 86% of cases. In our opinion the transphenoidal approach is very useful for the operation of the tumors with suprasellar expansion.
Asunto(s)
Adenoma/patología , Adenoma/cirugía , Hipófisis/patología , Hipófisis/cirugía , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/cirugía , Hueso Esfenoides/cirugía , Adenoma/complicaciones , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Hipofisarias/complicaciones , Trastornos de la Visión/etiologíaRESUMEN
In the paper authors describe fundamental physical properties of a phenomenon of the radio-frequency excitation and relaxation of nuclei ordered in a strong magnetic field and the usefulness of MRI in medical diagnostic procedures. Basic interpretations principles of MR imaging due to signal intensity differences between organs and tissues in T1- and T2- weighted sequences and proton density are presented. Both, literature review and experience of authors suggest application of MRI in otolaryngology, it is illustrated by a lot of examples. The MR imaging studies were compared with results obtained from CT in otolaryngology field.