Preliminary evaluation of cerebral 18F-DOPA PET/CT in the differential diagnosis of brain lesions in inconclusive MR.

AIM: To evaluate the utility of brain 18F-DOPA PET/CT in the differential diagnosis of brain lesions with inconclusive MRI. MATERIAL AND METHODS: Twelve patients were studied, with a total of 16 lesions, without definitive diagnosis after brain MRI. A double acquisition PET/CT brain scan was acquired at 20 and 90min. Visual and semiquantitative assessment was performed with SUVmax calculation of the lesions and calculation of the T/S Ratio (tumor/contralateral striatum) and T/N Ratio (contralateral healthy tumor/parenchyma) for each time. RESULTS: Based on the visual assessment scale and using T/S ratio ≥1 and T/N ratio ≥1.3 to determine malignancy, the values of sensitivity (S), specificity (E) and positive predictive value (PPV) were: visual assessment (S 100%, E 33.3%, VPP 71.4%), T/S Ratio (S 90%, E 100%, VPP 100%) and T/N Ratio (S 100%, E 16.6%, VPP 66.6 %). No lesion showed an increase in SUVmax in late acquisition. 18F-DOPA PET/CT modified treatment in 75% of the patients. CONCLUSION: 18F-DOPA PET/CT is a useful tool in the study of brain lesions with inconclusive MRI. Late imaging (dual-point) has no added value in the final diagnosis. FDOPA has an impact on patient management modifying therapeutic behavior.

Valoración preliminar de la 18F-DOPA PET/TC cerebral en el diagnóstico diferencial de lesiones cerebrales con RM no concluyente.

AIM: To evaluate the utility of brain 18F-DOPA PET/CT in the differential diagnosis of brain lesions with inconclusive MRI. MATERIAL AND METHODS: Twelve patients were studied, with a total of 16 lesions, without definitive diagnosis after brain MRI. A double acquisition PET/CT brain scan was acquired at 20 and 90 minutes. Visual and semiquantitative assessment was performed with SUVmax calculation of the lesions and calculation of the T/S ratio (tumor/contralateral striatum) and T/N ratio (tumor/contralateral healthy parenchyma) for each time. RESULTS: Based on the visual assessment scale and using T/S ratio ≥ 1 and T/N ratio ≥ 1.3 to determine malignancy, the values of sensitivity (S), specificity (E) and positive predictive value (PPV) were: visual assessment (S 100%, E 33.3%, VPP 71.4%), T/S ratio (S 90%, E 100%, VPP 100%) and T/N ratio (S 100%, E 16.6%, VPP 66.6%). No lesion showed an increase in SUVmax in late acquisition. 18F-DOPA PET/CT modified treatment in 75% of the patients. CONCLUSION: 18F-DOPA PET/CT is a useful tool in the study of brain lesions with inconclusive MRI. Late imaging (dual-point) has no added value in the final diagnosis. F-DOPA has an impact on patient management modifying therapeutic behavior.

[A comparative study of pragmatic language disorders and autism spectrum disorders using magnetoencephalography]. / Estudio comparativo mediante magnetoencefalografíade los trastornos del lenguaje pragmáticoy los trastornos del espectro autista.

INTRODUCTION: Pragmatics refers to the social use of language; its precursors are already present during the process of maturing, during the preverbal stage, and become manifest when the child starts to point and to share his or her attention with another person. In cases of specific language impairment (SLI) and autism spectrum disorders (ASD) it can be altered to varying degrees. PATIENTS AND METHODS: Due to the difficulties involved in diagnosis from a clinical point of view, we carried out a study by means of magnetoencephalography (MEG) on a series of 11 patients who had SLI and another series of 9 patients with ASD, in order to determine whether MEG is capable of distinguishing these diagnoses. RESULTS: Patients with SLI displayed pathological activity in the frontal and middle temporal regions of both hemispheres. Patients with ASD showed pathological activity in the perisylvian area. Expressive-receptive SLI with pragmatic language disorder showed pathological activity that was similar to that seen in autism. CONCLUSION: MEG can be used to distinguish between SLI and ASD by studying the epileptiform activity that occurs in pervasive developmental disorders. MEG helps us to understand the continuum that exists between SLI or expressive-receptive SLI and autism.

Estudio comparativo mediante magnetoencefalografía de los trastornos del lenguaje pragmático y los trastornos del espectro autista / A comparative study of pragmatic language disorders and autism spectrum disorders using magnetoencephalography

Introducción. La pragmática es el uso social del lenguaje;sus precursores ya están presentes durante el proceso de maduración,durante la etapa preverbal, y se manifiestan cuando el niño empiezaa señalar y a compartir su atención con otra persona. Éstapuede estar alterada en los trastornos específicos del lenguaje (TEL)y en los trastornos del espectro autista (TEA). Pacientes y métodos.Debido a las dificultades diagnósticas desde el punto de vista clínico,hemos realizado un estudio con magnetoencefalografía (MEG) auna serie de 11 pacientes que presentaban un TEL y otra serie de 9pacientes con un TEA, para comprobar si la MEG es capaz de distinguirestos diagnósticos. Resultados. Los pacientes con TEL presentanactividad patológica en las regiones frontales y temporal mediade ambos hemisferios. Los pacientes con TEA presentan actividadpatológica en la zona perisilviana. Los TEL expresivo-receptivos contrastorno pragmático del lenguaje presentan una actividad patológicaparecida al autismo. Conclusión. La MEG, mediante el estudio dela actividad epileptiforme en los trastornos generalizados del desarrollo,permite distinguir los TEL con respecto a los TEA. La MEGayuda a entender el continuo entre TEL o TEL expresivo-receptivo yautismo

Introduction. Pragmatics refers to the social use of language; its precursors are already present during the processof maturing, during the preverbal stage, and become manifest when the child starts to point and to share his or her attentionwith another person. In cases of specific language impairment (SLI) and autism spectrum disorders (ASD) it can be altered tovarying degrees. Patients and methods. Due to the difficulties involved in diagnosis from a clinical point of view, we carriedout a study by means of magnetoencephalography (MEG) on a series of 11 patients who had SLI and another series of 9patients with ASD, in order to determine whether MEG is capable of distinguishing these diagnoses. Results. Patients with SLIdisplayed pathological activity in the frontal and middle temporal regions of both hemispheres. Patients with ASD showedpathological activity in the perisylvian area. Expressive-receptive SLI with pragmatic language disorder showed pathologicalactivity that was similar to that seen in autism. Conclusion. MEG can be used to distinguish between SLI and ASD by studyingthe epileptiform activity that occurs in pervasive developmental disorders. MEG helps us to understand the continuum thatexists between SLI or expressive-receptive SLI and autism

[Specific language disorders: their diagnosis, classification and study using magnetoencephalography]. / Trastornos especificos del lenguaje: diagnóstico, tipificación y estudios con magnetoencefalografía.

INTRODUCTION: Specific language disorder (SLD) is defined as a disorder in which language is slow and retarded with respect to the patient's chronological age, and which is not related to a sensory-auditory or motor deficit or to a pervasive development disorder; in other words, structural and functional neurological developmental disorders must be excluded. After many studies and attempts to reach an agreement, specific language disorders have been broadly classified into two groups: specific expressive language disorder and specific receptive-expressive language disorder. AIMS: Our objective was to study SLD using magnetoencephalography (MEG) in order to look for epileptiform manifestations in precise language areas. PATIENTS AND METHODS: We studied a sample made up of 11 patients with SLD, one of whom had Landau-Kleffner syndrome and one with cryptogenic-type SLD. The criteria used were age-dependent autism exclusion tests and specific language tests for SLD. The MSI technique was carried out on all the patients, by magnetic resonance and MEG. RESULTS: A characteristic pattern is obtained for SLD in the form of irregular spike and polyspike-wave discharges in bilateral frontal channels. The dipoles were situated mainly in the left perisylvian areas. CONCLUSIONS: The study of specific language disorders using MEG enables us to identify the SLD included in a proposed classification as primary-type specific language disorder, cryptogenic-type specific language disorder and secondary-type type specific language disorder, like Landau-Kleffner syndrome.

Trastornos específicos del lenguaje: diagnóstico, tipificación y estudios con magnetoencefalografía / Specif language disorders: their diagnosis. Classification and study using magnetoencephalography

Introducción. El trastorno específico del lenguaje (TEL) se define cono un trastorno del lenguaje lento y retrasado respecto su edad cronológica, que no tenga relación con un déficit sensorioauditivo, motor ni trastorno generalizado del desarrollo, es decir, deben excluirse las alteraciones neurológicas estructurales y funcionales del desarrollo. Los trastornos específicos del lenguaje, después de largos estudios y consenso se han clasificado en dos grandes grupos: el trastorno específico del lenguaje expresivo y el trastorno específico del lenguaje receptivo-expresivo. Objetivo. Estudiar los TEL mediante magnetoencefalografía (MEG) con el fin de encontrar manifestaciones epileptiformes en áreas precisas del lenguaje. Pacientes y métodos. Muestra formada por 11 pacientes que presentaban TEL, uno que presentaba síndrome de Landau-Kleffner y uno con TEL de tipo criptogenético. Los criterios utilizados han sido tests dependientes deedad para exclusión de autismo y tests específicos del lenguaje para TEL. A todos los pacientes se les practicó la técnica MSI, mediante resonancia magnética y MEG. Resultados. Se obtiene un patrón característico para los TEL en forma de descargas de punta y polipunta-onda irregular en canales frontales bilaterales. Los dipolos se sitúan predominantemente en áreas perisilvianas izquierdas. Conclusión. El estudio de los trastornos del lenguaje mediante la MEG nos permite identificar los TEL considerados en una propuesta de clasificación como trastorno específico del lenguaje de tipo primario, trastorno específico del lenguaje de tipo criptogenético y trastorno específico del lenguaje de tipo secundario, como el síndrome de Landau-Kleffner (AU)

Introduction. Specific language disorder (SLD) is defined as a disorder in which language is slow and retarded with respect to the patient's chronological age, and which is not related to a sensory-auditory or motor deficit or to a pervasive development disorder; in other words, structural and functional neurological developmental disorders must be excluded. After many studies and attempts to reach an agreement, specific language disorders have been broadly classified into two groups: specific expressive language disorder and specific receptive-expressive language disorder. Aims. Our objective was to study SLD using magnetoencephalography (MEG) in order to look for epileptiform manifestations in precise language areas. Patients and methods. We studied a sample made up of 11 patients with SLD, one of whom had LandauKleffner syndrome and one with cryptogenic-type SLD. The criteria used were age-dependent autism exclusion tests and specific language tests for SLD. The MSI technique was carried out on all the patients, by magnetic resonance and MEG. Results. A characteristic pattern is obtained for SLD in the form of irregular spike and polyspike-wave discharges in bilateral frontal channels. The dipoles were situated mainly in the left perisylvian areas. Conclusions. The study of specific language disorders using MEG enables us to identify the SLD included in a proposed classification as primary-type specific language disorder, cryptogenic-type specific language disorder and secondary-type type specific language disorder, like Landau-Kleffner síndrome (AU)

[Acute posterior cord lesions in multiple sclerosis. An MRI study of the clinical course in 20 cases]. / Lésions cordonales postérieures aiguës dans la sclérose en plaques.Etude clinico-évolutive et par IRM de 20 cas.

Twenty patients with multiple sclerosis (MS), 19 women and 1 man, with acute proprioceptive sensory disturbances related to the presence of plaques on the posterior columns (posterior column syndrome) at the cervical or thoracic levels of the spinal cord, were selected among 138 new patients with MS assisted in our neurological unit over the past five years. In 17 of these patients, the acute posterior cordonal syndrome was responsible for the first clinical manifestations of the disease. The other 3 patients had a history suggestive of MS. These 20 patients were followed with a minute analysis of neurological function with repeated clinical evaluation combined with repeated MRI study of the spinal cord. Brain MRI (strongly suggestive of MS in 15 patients), evoked potentials (EP) and cerebrospinal fluid electrophoresis analysis (with oligoclonal bands present in all patients were it was performed) were also obtained at least once in each patient. Spinal cord MRI demonstrated more lesions in the cervical region (90 p.100) than in the thoracic regions (10 p.100). Eighty percent of the cervical lesions were located high, between C1 and C4. The most characteristic clinical expression was the deafferentation of one upper limb, preferentially the "useless hand" (Oppenheim) or even a pseudoathetosic or dystonic limb. Propioceptive ataxia or spontaneous cervical or brachial pain were other forms of clinical expression. No major motor deficit or sphincter disorders were noted at any time in the clinical course in any of the patients. There was a good correlation between localization and morphology of the plaques detected by spinal cord MRI and clinical signs. Intrinsic medullary lesions were seen as high intensity signals on T2-weighted images which were enlarged more than the same lesion visualized on T1-weighted images after injection of paramagnetic contrast agents. This reflected the presence of edema extending beyond the main inflammatory lesion. There was also a good correlation between improvement of clinical symptoms and total or, mor frequently, partial reduction of the plaques, analyzed morphologically by successive spinal cord MRI series. The diagnosis of MS was clinically definitive in 60 p.100 of cases and laboratory-supported definitive in 40 p.100. During the follow-up period (average 36 months), 15 patients (75 p.100) presented one or more exacerbations, all of them presenting a favorable course: at last follow-up, 9 patients were asymptomatic, EDSS was 1 in 6 patients, 1.5 in 4 patients and 2 in 1 patient. This study confirms the contribution of serial spinal cord MR studies to understanding the natural history and pathophysiology of medullary forms of MS presenting as a cordonal posterior syndrome. It also shows a good relationship between the clinical manifestations and course of this form of MS and the localization and variable morphology of plaques. Finally, our results suggest the predictive benign course for this medullary form of MS that seems to be almost exclusively restricted to the female gender.