Prognostic impact of magnetic resonance perfusional study in cerebral metastases treated with radiosurgery.

Radiosurgery arrests metastatic growth by means of vascular thrombosis that causes tumor necrosis. We therefore evaluated whether tumor hypervascularization (studied with perfusional magnetic resonance sequences) is a positive prognostic factor predicting radiosurgery outcome. Twenty-four metastases were studied before radiosurgery with perfusional MR and then post therapy clinical and morphological status was evaluated. The group of lesions responsive to radiosurgery had the highest mean rCBV value (23.3) in comparison to the non responding lesions (14.7) with a statistically significant difference (p<0.005). High vascularization for radio-treated metastases was a positive prognostic factor because the radiosurgery thrombosis effect was more effective. Pre-treatment MR rCBv evaluation is a useful tool to establish metastatic response to radiosurgery.

MR Perfusion Imaging of Intracranial Tumors. A Retrospective Study of 218 Patients.

This retrospective study evaluated magnetic resonance (MR) perfusion imaging in the study of intracranial tumors; 218 patients were studied with 509 MR examinations. The first aim was to establish the usefulness of perfusion imaging for the differential diagnosis between neoplastic tissue and other lesions both in the first MR examination and in the post therapeutic controls (differentiation of tumor recurrence from radionecrosis). Then we evaluated the presence of infiltrating neoplastic tissue in CBV maps outside the enhancement area to differentiate infiltrating gliomas from metastases. In addition, post surgical evaluation was performed to identify residual neoplastic tissue, mainly if bleeding or inflammatory post surgical cerebral damage did not allow a definitive diagnosis with conventional morphologic images. Lastly, it was assessed whether hypervascularization (evaluated in CBV maps) is a favourable prognostic factor for a positive outcome to radiotherapy. The diagnostic gain of perfusion imaging in all these cases was established evaluating our case records.

Global Mobility Task: index for evaluating motor impairment and motor rehabilitation programs in Parkinson's disease patients.

OBJECTIVE: In this study, the validity of a motor task, i.e., the Global Mobility Task (GMT), was assessed in a group of Parkinson's disease (PD) patients. PATIENTS AND METHODS: Fifty-eight PD patients (mean age: 68.7 years) and 18 healthy subjects (mean age: 65.8 years) were enrolled in the study. The GMT measures the ability of an adult to roll over on the floor and stand up in five steps using two parameters: 'Time' and 'Score', i.e., the time needed and the ability to perform each step of the task. As the GMT has never been evaluated before, internal consistency and concurrent and discriminative validity were considered in assessing its characteristics in a group of PD patients at the beginning and at the end of a motor rehabilitation program. To determine whether the GMT could also quantify the extrapyramidal impairment, we compared data collected using this task with data obtained using clinical scales such as the Unified Parkinson's Disease Rating Scale III (UPDRS part III) and Hoehn & Yahr's score. RESULTS: Results showed that the GMT had good consistency and inter-rater reproducibility, was closely related to clinical scales and was able to detect the amelioration of extrapyramidal symptoms at the end of the motor rehabilitation program. CONCLUSION: we propose the GMT as a tool for measuring impaired mobility in PD patients and for evaluating the objective effects of motor rehabilitation programs.