Marcadores moleculares y biomarcadores de imagen: importancia en el avance terapéutico de los tumores cerebrales intraaxiales / Molecular markers and image biomarkers. Importance in the therapeutic advance of intraaxial brain tumors

RESUMEN: La clasificación de los Tumores Primarios del Sistema Nervioso Central (SNC) tiene su origen en la descripción morfológica, cuyo análisis histopatológico ha permitido identificar la línea celular involucrada en estos tumores y obtener el reconocimiento de ciertas características de estas lesiones y su evolución clínica. El estudio molecular ha venido a complementar el diagnóstico inicial permitiendo reconocer entidades que no son distinguibles de otra manera y que han variado los conceptos y definiciones de varias entidades patológicas que modifican el horizonte visible de estas enfermedades. El papel de las imágenes de Resonancia Magnética (RM) en el manejo de los tumores intraaxiales se puede dividir ampliamente en el diagnóstico y la clasificación de los tumores, la planificación del tratamiento y el tratamiento posterior. El presente artículo resume la evidencia epidemiológica relacionada en la clasificación de los tumores primarios del SNC con marcadores moleculares y biomarcadores de imágenes de RM, apuntando a la importancia del uso de la investigación clínica con el manejo terapéutico.

SUMMARY: The classification of primary tumors of the Central Nervous System (CNS) has its origin in the morphological description whose histopathological analysis has allowed to identify the cell line involved in these tumors and obtain the recognition of certain characteristics of these lesions and their clinical evolution. The molecular study has come to complement the initial diagnosis allowing to recognize entities that are not distinguishable in another way and that have varied the concepts and definitions of various pathological entities modifying the visible horizon of these diseases. The role of Magnetic Resonance (MR) images in the management of intraaxial tumors can be broadly divided into the diagnosis and classification of tumors, treatment planning and subsequent treatment. The present article summarizes the epidemiologic evidence related to the classification of primary tumors of the CNS with molecular markers and MR imaging biomarkers.

Analysis of Osteoporotic Spinal Compression Fractures in Whole Spine Sagittal MR Images

OBJECTIVES: To analyze the fracture type and adjacency of accompanied fractures in acute osteoporotic spinal compression fracture using whole spine sagittal MRI (WS-MRI), and to know the relation of sagittal vertical axis (SVA), body mass index (BMI), and lumbar bone mineral density (BMD). METHODS: From June 2007 to December 2010, 167 patients who had acute spinal compression fractures confirmed by WS-MRI divide in three groups. 82 patients (M/F : 25/57) who had acute fractures only were in group 1, 79 patients who had acute and old fractures were in group 2, and 20 patients who had acute fractures after vertebroplasy were in group 3. To analyze the fracture type and adjacency of accompanied fractures in acute osteoporotic spinal compression fractures which combined chronic fracture or vertebroplasty using the WS-MRI and compared with the control group who had no spinal fractures measured the SVA. In all groups, we measured BMI, and BMD. RESULTS: In WS-MRI, 31 patients in group 1 had L1 which was the most common fracture site. Twenty two patients had chronic fractures and more than 3 remote levels at the acute fracture site in group 2 and especially among there 14 patients have each level in cervicothoracic and lumbar vertebrae. In group 3 had old fracture and adjacent fracture was 14 and 11 patients. Compared with the control group, all groups had increased SVA, especially in group 2 which has acute and chronic compression fractures. They have no significantly difference of BMI in each group, but group 2 and 3 had a significant lower BMD than group 1. CONCLUSION: Fourteen patients of coexisting fractures in acute osteoporotic spinal compression fractures with WS-MRI which could be missed in the conventional MRI. Additionally this study suggests that longer SVA causes sagittal imbalance, and BMD is more relative than BMI in refractures of chronic compression fracture patients.

STN DBS of Advanced Parkinson's Disease Experienced in a Specialized Monitoring Unit with a Prospective Protocol

OBJECTIVE: In the evaluation of patients with Parkinson's disease (PD), most neurologists only see their patients during a limited period of their fluctuating 24-hour-a-day lives. This study aimed to assess the short-term outcome of STN stimulation for patients with advanced PD evaluated in a 24-hour monitoring unit for movement disorder (MUMD) using a prospective protocol. METHODS: Forty-two patients with advanced PD consecutively treated with bilateral STN stimulation using multi-channel microelectrode recording were included in this study. All patients were evaluated using a 24-hour MUMD with a video recording/editing system and were evaluated with a prospective protocol of the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Staging, Schwab and England Activities of Daily Living, levodopa equivalent daily dose (LEDD), Short Form-36 Health Survey, and neuropsychological tests. Magnetic resonance (MR) images of the brain were performed prior to and six months after surgery. RESULTS: All patients were evaluated at three and six months after surgery. There was a rapid and significant improvement of the motor symptoms, especially in tremor and rigidity, after STN stimulation with low morbidity. Dyskinesia was markedly decreased with much lowered LEDD values by 50% after STN stimulation. 1.5T MR images were safely taken according to the manufacturer's guidelines at six months after surgery without any adverse effects in 41 patients treated with STN stimulations. CONCLUSION: Evaluations in a 24-hour monitoring unit could reduce the dose of medication efficiently to an optimal level with patients'comfort and improve the clinical symptoms in harmony with STN stimulation.

MR Images of Spontaneously Involuted Atretic Cephalocele Concomitant with Persistent Falcine Sinus in an Adult

Atretic cephalocelces are defined as skin-covered midline subscalp lesions that contain meninges and rest of glial and/or central nervous system tissue. When the straight sinus is absent or rudimentary, the falcine sinus can be recanalized to enable venous drainage. Although the atretic cephalocele or persistent falcine sinus has largely been described in the pediatric population, it is a rarely observed in the adult population. We report a unique case of spontaneously involuted atretic cephalocele coexistent with persistent falcine sinus in an adult. MR images and MR venography were useful for diagnosis and accurate anatomical depiction.

Preoperative Gadolinium-enhanced Magnetic Resonance Images on Infectious Spondylitis

OBJECTIVE: The purpose of this study is to analyze the patterns of intervertebral disc enhancement seen in infectious spondylitis, differentiate between two groups(tuberculous vs pyogenic spondylitis). METHODS: Between January 1994 and December 2002, 83patients underwent operative procedure with confirmed to histopathologic evaluation. Magnetic resonance(MR) images were obtained in all patients and were analyzed retrospectively. 57patients had tuberculosis and 26patients were infected by pyogens. The patterns of gadolinium enhancement of disc were classified into 4 types(post's classification): Type I, non-enhancing; Type II, enhancement of the peripheral rim; Type III, Type II with central area and partial endplate; Type IV, general enhancement. RESULTS: The enhancement patterns observed were as follows: Common pattern of tuberculous spondylitis was Type II, and pyogenic spondylitis was Type III.(p<0.01) This difference may result from pathophysiologic varieties of organisms. CONCLUSION: Careful preoperative MR analysis of the patterns of disc enhancement occuring in infectious spondylitis can be useful for differentiating between the tuberculous and pyogenic spondylitis.

MRI findings of acute spinal cord stab wound / 中国康复理论与实践

@#ObjectiveTo study the MR images findings of acute spinal cord stab wound injury. MethodsThe clinical material and MRI findings of 12 patients with acute spinal cord stab wound injury within 7 days were reviewed retrospectively with 1.0 T magnet. Results4 of 12 patients had the Brown-Sequards's Syndrome, the locations of wound injury are mainly within T6-8 level. MRI findings of pathway of the stab wound were seen in all cases. Many other signals including artefact of knife track, spinal cord injury, edema, hemorrhage, and hematoma of subdural and epidural were also seen in some cases. The location relationship of the hematoma to dura in distinguishing a subdural hematoma from an epidural hematoma by MR images is important, injury of the ligamentum flavum and anterior and posterior longitudinal ligaments and spinal dura can be diagnosed by either absence or interruption of the normal linear low-signal-intensity band.Conclusions MR images allows vasualization of intramedullary injury, extramedullary injury and injury to spinal ligaments and dura. T 2 -weighted images can be helpful in visualization of the knife track extending from the skin surface to the spinal canal.

Clinical and Sellar MR Findings in Central Diabets Inspidus / 대한내분비학회지

Backgrounds: Diabetes insipidus(DI) is a clinical syndrome characterized by excretion of copious volumes of dilute urine combined with persistent intake of abnormally large quantities of fluid. Central DI, caused by lack of antidiuretic hormone(ADH), most often results from lesions in the hypothalamic-neurohypophyseal axis. Magnetic resonance(MR) imaging is particularly useful in documenting the presence of a structural lesion, as opposed to assigning a diagnosis of idiopathic DI for which only symptomatic therapy is prescribed. Recently, several reports have described a specific MR finding in central DI, that is absence of normal posterior pituitary bright spot(PPBS). Methods: We retrospectivesly studied the clinical and MR findings in 25 patients with central DI, diagnosed by warter deprivation test. Results: 1) The subjects included 17 males and 8 females, between the ages of 2 and 58 years. 2) 24-hour urine volumes were 2,340~13,750 mL, and mean urine osmolarity was 147.7±65.8 mOsm/kg. The 23 subjects diagnosed complete central DI by warter deprivation test. 3) We found that the most common cause of cntral DI was infiltrative lesions of hypothalmic-neurohypophyseal axis(60%). Germ cell tumor was the single leading cause in present study, accounting for 36% of cases. The other causes were found, including pituitary apoplexy, meningitis, and trauma. Idiopathic central DI accounted for 20% of all cases. 4) Growth hormone deficiency was the most common accompanying anterior pituitary deficit, and panhypopituitarism was found in 7 cases, Hyperprolactinernia was seen in 6 cases. 5) In all patients, PPBS on Tl weighted MR images were not observed. A thickened pituitary stalk was seen in 15 cases(9 patients with germ cell tumor, 3 patients with histiocytosis X, 1 patient with tuberculosis, 2 patients with unknown origin). Conclusion: In our results, the most common causes of central DI was suprasellar infiltrative lesions. MR is currently the imaging methods of choice in the evaulation of dysfunction of the hypothalamic-neurohypophyseal system in patients with central DI. A specific MR finding, that is loss of normal PPBS allows a confirmative diagnosis of central DI.