Enfoque clínico-radiológico de la mielopatía no traumática / Clinical-radiological approach to nontraumatic myelopathy

Las enfermedades de la médula espinal tienen con frecuencia consecuencias devastadoras y su estudio radiológico es indispensable para su diagnóstico. La técnica de imagen fundamental para su valoración es la resonancia magnética espinal y el enfoque diagnóstico debe basarse en el contexto clínico, el tiempo de evolución y los hallazgos radiológicos, por lo que es necesario en algunos casos la ampliación del estudio a la región cerebral. El primer paso en el algoritmo diagnóstico debe ser excluir la compresión medular antes de valorar otras causas de mielopatía, entre las que se incluyen múltiples etiologías. Este artículo incluye una amplia revisión de las diferentes patologías que pueden producir mielopatías, sus manifestaciones radiológicas, diagnósticos diferenciales y algoritmos diagnósticos. Un adecuado enfoque por parte del radiólogo repercutirá en un mejor manejo y pronóstico de estos pacientes

Diseases of the spinal cord often have devastating consequences and imaging studies are indispensable for their diagnosis. The fundamental imaging technique to evaluate these diseases is magnetic resonance imaging of the spine. The diagnostic approach must be based on the clinical context, the time elapsed since the onset of symptoms and signs, and the imaging findings; for this reason, it sometimes necessary to broaden the study to include the brain. The first step in the diagnostic algorithm is to rule out spinal cord compression before evaluating other causes of myelopathy, which sometimes has multiple causes. This paper includes a broad review of the different diseases that can cause myelopathy, their imaging manifestations, their differential diagnoses, and diagnostic algorithms. Using an appropriate radiological approach will result in better management and prognosis of these patients

Clinical-radiological approach to nontraumatic myelopathy. / Enfoque clínico-radiológico de la mielopatía no traumática.

Diseases of the spinal cord often have devastating consequences and imaging studies are indispensable for their diagnosis. The fundamental imaging technique to evaluate these diseases is magnetic resonance imaging of the spine. The diagnostic approach must be based on the clinical context, the time elapsed since the onset of symptoms and signs, and the imaging findings; for this reason, it sometimes necessary to broaden the study to include the brain. The first step in the diagnostic algorithm is to rule out spinal cord compression before evaluating other causes of myelopathy, which sometimes has multiple causes. This paper includes a broad review of the different diseases that can cause myelopathy, their imaging manifestations, their differential diagnoses, and diagnostic algorithms. Using an appropriate radiological approach will result in better management and prognosis of these patients.

Coeficiente de difusión aparente cerebral: diferencias por edad, sexo, lateralidad y diferente valor b / Brain apparent diffusion coefficient: differences caused by age, sex, laterality, and distinct b value

Objetivo: Analizar el efecto de la edad, el sexo y el valor b en el coeficiente de difusión aparente (CDA) de áreas cerebrales alteradas en las enfermedades neurodegenerativas. Material y métodos: Se estudió el CDA de hipocampo, rodilla y esplenio del cuerpo calloso en 50 pacientes normales, con difusión por resonancia magnética b1.000 y b3.000s/mm2. Para cada localización se calcularon las diferencias entre los CDA b1.000 y b3.000 (diferencial de difusión [DD]). Se separaron los pacientes en grupos de edad (⩽30, 31–60 y >60 años). El análisis de las diferencias de CDA y DD entre grupos de edad y entre sexos se hizo con los tests de ANOVA y Kruskal-Wallis, y la corrección de Bonferroni. Para la correlación del CDA y el DD con la edad se utilizó el test de Pearson. Resultados: En el hipocampo derecho hubo diferencias de CDA (b1.000, p=0,011; b3.000, p=0,024) y DD (p=0,006) con la edad. Las diferencias del CDA se observaron entre los grupos de 31–60 años y >60 (p=0,009) para b 1.000, y entre<30 y 31–60 años (p=0,036) para b 3.000. El DD varió entre los >60 años y el resto. En el cuerpo calloso hubo diferencias significativas entre sexos en el DD de la rodilla (p=0,016). El DD mostró correlación con la edad en el hipocampo derecho (r=0,321, p=0,023). Conclusiones: Nuestros datos indican mayor estabilidad de los valores de CDA medidos con b3.000 durante el envejecimiento. El análisis del CDA con valor b más alto puede ser de utilidad en las enfermedades neurodegenerativas (AU)

Objective: To analyze the effects of age, sex, and b value on the apparent diffusion coefficient (ADC) in brain areas affected by neurodegenerative diseases. Material and methods: We studied the ADC of the genu and splenium of the corpus callosum and of the hippocampus in normal patients using diffusion magnetic resonance imaging (dMRI) with b1,000s/mm2 and b3,000s/mm2. We calculated the differences between the ADC (diffusion differential [DD]) with b1,000 and with b3,000 for each region. Patients were classified into the following age groups (⩽30 years old, 31–60 years old, >60 years old). We used a Kruskal-Wallis one-way ANOVA and the Bonferroni correction to analyze the differences in ADC and DD between age groups and between sexes. Pearson's chi-square test was used to correlate the ADC and DD with age. Results: In the right hippocampus, we observed differences in ADC (b1,000, p=0.011; b3,000, p=0.024) and DD (p=0.006) with age. Differences in ADC were observed between the 31–60 year-old age group and the >60 year-old age group (p=0.009) for b1,000, and between the<30 year-old age group and the 31–60 year-old age group (p=0.036) for b3,000. The DD in the >60 year-old age group was different from the rest. In the corpus callosum, there were significant differences between sexes in the DD of the genu (p=0.016). The DD was correlated with age in the right hippocampus (r=0.321, p=0.023). Conclusions: Our data indicate greater stability in mean ADC values with b3000 during aging. It might be useful to analyze the ADC with a higher b in patients with neurodegenerative diseases (AU)

[Brain apparent diffusion coefficient: differences caused by age, sex, laterality, and distinct b value]. / Coeficiente de difusión aparente cerebral: diferencias por edad, sexo, lateralidad y diferente valor b.

OBJECTIVE: To analyze the effects of age, sex, and b value on the apparent diffusion coefficient (ADC) in brain areas affected by neurodegenerative diseases. MATERIAL AND METHODS: We studied the ADC of the genu and splenium of the corpus callosum and of the hippocampus in normal patients using diffusion magnetic resonance imaging (dMRI) with b1,000 s/mm2 and b3,000 s/mm2. We calculated the differences between the ADC (diffusion differential [DD]) with b1,000 and with b3,000 for each region. Patients were classified into the following age groups (60 years old). We used a Kruskal-Wallis one-way ANOVA and the Bonferroni correction to analyze the differences in ADC and DD between age groups and between sexes. Pearson's chi-square test was used to correlate the ADC and DD with age. RESULTS: In the right hippocampus, we observed differences in ADC (b1,000, p=0.011; b3,000, p=0.024) and DD (p=0.006) with age. Differences in ADC were observed between the 31-60 year-old age group and the >60 year-old age group (p=0.009) for b1,000, and between the<30 year-old age group and the 31-60 year-old age group (p=0.036) for b3,000. The DD in the >60 year-old age group was different from the rest. In the corpus callosum, there were significant differences between sexes in the DD of the genu (p=0.016). The DD was correlated with age in the right hippocampus (r=0.321, p=0.023). CONCLUSIONS: Our data indicate greater stability in mean ADC values with b3000 during aging. It might be useful to analyze the ADC with a higher b in patients with neurodegenerative diseases.