Tumores intracraneales en el primer año de vida / Intracranial tumors in the first year of life

Resumen Introducción: Los tumores intracraneales son la segunda patología más frecuente en pacientes entre 0 y 19 años de vida. En edades más tempranas son más frecuentes los tumores de origen embrionario, con una localización infratentorial. Presentan una gran morbimortalidad dada por el efecto de masa que genera el tumor, y también por los tratamientos disponibles, presentando un gran desafío para la toma de decisiones. El método ideal para la caracterización de los mismos y seguimiento es la resonancia magnética (RM) con contraste endovenoso. Objetivo: Analizar las características imagenológicas de los tumores intracraneales en pacientes menores de 1 año y su relación con la agresividad tumoral. Método: Estudio de cohorte retrospectivo. Se incluyeron pacientes de hasta 1 año de edad con diagnóstico de tumor intracraneal y resonancia magnética disponible, evaluados entre los años 2010 y 2022. Se obtuvo la información clínica y las características imagenológicas de los tumores. Se incluyeron 11 pacientes. Los motivos de consulta más frecuentes fueron aumento del perímetro cefálico (27,3%) y vómitos (27,3%). Resultados: Encontramos seis tumores supratentoriales y cinco infratentoriales. Siete tumores tenían restricción en difusión, nueve reforzaban con contraste intravenoso y dos presentaban diseminación leptomeníngea. Se observó desviación de la línea media en ocho pacientes e hidrocefalia en seis. Encontramos seis tumores gliales (54,5%), dos tumores teratoides rabdoides, dos tumores neurales y un ependimoma anaplásico. Cinco pacientes recibieron tratamiento quirúrgico y tres tratamiento quimioterápico; los restantes no recibieron tratamiento oncológico. Siete pacientes tuvieron sobrevida a 5 años, tres con desarrollo neurológico normal y cuatro con secuelas neurológicas. Conclusiones: La detección de las lesiones y sus características radiológicas, en especial la localización, pueden asistir en el manejo de los pacientes con tumores intracraneales en el primer año de vida.

Abstract Introduction: Intracranial tumors are the second most common pathologies in patients between 0 and 19 years of age. At younger ages, embryonal tumors are more frequent, with an infratentorial location. There is a high morbimortality given by the mass effect the tumor generates, but also given the different treatments available, which creates a great challenge for decision-making. The Gold-Standard imaging method for the characterization and follow-up is MRI with contrast. Objective: To analyze the imaging findings of intracranial tumors in patients under 1 year of age and their relationship with tumor aggressiveness. Method: Retrospective cohort study. Patients ≤1 year old with a diagnosis of intracranial tumor and available magnetic resonance imaging, evaluated between the years 2010 and 2022, were included. Clinical information and imaging characteristics of the tumors were obtained. A total of 11 patients were included. The most frequent reasons for consultation were increased head circumference (27.3%) and vomiting (27.3%). Results: We found six supratentorial tumors and five infratentorial tumors. Seven tumors showed diffusion restriction, nine enhanced after intravenous contrast administration, and two presented leptomeningeal dissemination. Deviation of the midline was observed in eight patients, and hydrocephalus in six cases. Among the tumors, six were glial tumors (54.5%), two were teratoid rhabdoid tumors, two were neural tumors, and one was an anaplastic ependymoma. Five patients underwent surgical treatment, three received chemotherapy; the remaining patients did not receive oncological treatment. Seven patients had a 5-year survival, with three of them showing normal neurological development while four patients presented neurological sequelae. Conclusions: The detection of these lesions and their radiological characteristics, especially their location, can assist in the management of patients under one year of age with intracranial tumors.

Correlación entre escalas visuales de atrofia entorrinal y temporomesial con volumetría hipocampal / Correlation between visual scales of entorhinal and temporomesial atrophy with hippocampal volumetry

Resumen Objetivo: En pacientes con enfermedad de Alzheimer (EA) se han descrito cambios neuropatológicos tempranos en la corteza entorrinal, que anteceden el compromiso temporomesial. La evaluación de la atrofia hipocampal mediante escalas visuales y volumetría son herramientas útiles en la valoración de pacientes con deterioro cognitivo. Nuestro objetivo es establecer la correlación entre la evaluación visual de la atrofia de la corteza entorrinal (ACE), la atrofia temporomesial (ATM) y el volumen hipocampal. Material y métodos: Estudio retrospectivo de corte transversal. Se incluyeron pacientes con queja cognitiva y resonancia magnética (RM) cerebral. Se utilizaron escalas visuales de ACE y ATM. Se midió el volumen hipocampal mediante el software volBrain 1.0. Resultados: Se incluyeron 48 pacientes, 31 eran mujeres (64,6%). Mediana de edad: 76,5 (RIQ: 69-83). La correlación entre las escalas visuales ACE y la ATM del lado derecho fue de 0,67 p < 0,0001) y del lado izquierdo de 0,69 (p < 0,0001). Encontramos correlación negativa moderada entre la ACE y el volumen hipocampal, del lado derecho fue de –0,59 (p < 0,0001) y del lado izquierdo de –0,42 (p = 0,003). Conclusión: La escala de ACE muestra moderada correlación con la escala de ATM y con el volumen hipocampal. Su uso podría aportar información valiosa para valoración de trastornos cognitivos.

Abstract Objective: In patients with Alzheimer’s disease (AD), early neuropathological changes in the entorhinal cortex have been described, which precede temporomesial involvement. The evaluation of hippocampal atrophy using visual scales and volumetry are useful tools in the assessment of patients with cognitive impairment. Our objective is to establish the correlation between the visual evaluations of entorhinal cortex atrophy (ECA), temporomesial atrophy (TMA), and hippocampal volume. Material and methods: Retrospective cross-sectional study. Patients with cognitive complaint and brain magnetic resonance imaging (MRI) were included. ACE and TMA visual scales were used. Hippocampal volume was measured using the volBrain 1.0 software. Results: Forty-eight patients were included, 31 were women (64.6%). Median age was 76.5 (IQR: 69-83). The correlation between ECA and TMA on the right side was 0.67 (p < 0.0001) and on the left side was 0.69 (p < 0.0001). We found a negative moderate correlation between ECA and hippocampal volume, on the right side it was –0.59 (p < 0.0001) and on the left side it was –0.42 (p = 0.003). Conclusion: The ECA scale shows high correlation with the TMA scale and moderate correlation with hippocampal volume. Its use could provide valuable information for the assessment of cognitive disorders.

Accuracy of nigrosome-1 detection to discriminate patients with Parkinson's disease and essential tremor.

PURPOSE: The use of susceptibility weighted imaging in high field magnetic resonance imaging scanners can detect the nigrosome-1 area located in the caudo-lateral region of the pars compacta in the substantia nigra. This structure comprises a significant amount of dopaminergic neurons and degenerates in the early stages of Parkinson's disease. Essential tremor is a neurological condition that in some cases could be confused with the early stages of Parkinson's disease with a possible error in clinical diagnosis. Our purpose is to evaluate the accuracy of nigrosome-1 detection by high resolution magnetic resonance imaging to discriminate Parkinson's disease from essential tremor. METHODS: A case-control study compared patients with a clinical diagnosis of Parkinson's disease and essential tremor. Magnetic resonance imaging studies were performed using a 3T magnetic resonance imaging scanner. The susceptibility weighted imaging sequence was obtained in the axial plane with an isotropic voxel of 0.75 mm. Two independent neuroradiologists evaluated the images without access to clinical patient data. RESULTS: Sixteen patients were included in each group (Parkinson's disease and essential tremor). Average age: Parkinson's disease group: 71.3 (SD 6.3) and essential tremor group: 68.3 (SD 12.3). For the first evaluator, the nigrosome-1 area was absent in 15 patients with Parkinson's disease and in two with essential tremor and for the second evaluator was absent in 15 patients with Parkinson's disease and four with essential tremor. The sensitivity/specificity for the diagnosis of Parkinson's disease was 93.75%/87.5% for the first evaluator and 93.75%/75% for the second evaluator. CONCLUSION: The detection of the nigrosome-1 area is a useful tool in the differential diagnosis between Parkinson's disease and essential tremor, with high sensitivity and specificity.