Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 7 de 7
Filtrar
1.
Neurology ; 78(5): 302-8, 2012 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-22218278

RESUMO

OBJECTIVE: To assess the sensitivity and specificity of 3D double inversion recovery (DIR) MRI for detecting multiple sclerosis (MS) cortical lesions (CLs) using a direct postmortem MRI to histopathology comparison. METHODS: Single-slab 3D DIR and 3D fluid-attenuated inversion recovery (FLAIR) images of 56 matched fresh brain samples from 14 patients with chronic MS were acquired at 1.5 T. The images of both sequences were prospectively scored for CLs in consensus by 3 experienced raters who were blinded to histopathology and clinical data. Next, CLs were identified histopathologically and were scored again on 3D DIR and 3D FLAIR (retrospective scoring). CLs were classified as intracortical or mixed gray matter (GM)-white matter lesions. Deep GM lesions were also scored. False-positive scores were noted and, from this, specificity was calculated. RESULTS: We found a sensitivity for 3D DIR to detect MS CLs of 18%, which is 1.6-fold higher than 3D FLAIR (improves to 37% with retrospective scoring; 2.0-fold higher than 3D FLAIR). We detected mixed GM-white matter lesions with a sensitivity of 83% using 3D DIR (65% sensitivity for 3D FLAIR), which improved to 96% upon retrospective scoring (91% for 3D FLAIR). For purely intracortical lesions, 3D DIR detected more than 2-fold more than 3D FLAIR (improved to >3-fold upon retrospective scoring). The specificity of 3D DIR to MS CLs was found to be 90%. CONCLUSIONS: In this postmortem verification study, we have shown that 3D DIR is highly pathologically specific, and more sensitive to CLs than 3D FLAIR in MS.


Assuntos
Córtex Cerebral/patologia , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Esclerose Múltipla/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia , Feminino , Humanos , Imageamento Tridimensional/métodos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Proteína Proteolipídica de Mielina/metabolismo , Mudanças Depois da Morte
2.
AJNR Am J Neuroradiol ; 31(3): 541-8, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19850760

RESUMO

BACKGROUND AND PURPOSE: Recent postmortem studies in MS brain suggest that the severity of changes in DAWM can be measured by using quantitative MR imaging. This study aimed to characterize DAWM in vivo by using 4 quantitative MR imaging measures and to explore differences between MS disease types. MATERIALS AND METHODS: In 17 patients with chronic MS (7 PP, 10 SP), quantitative MR imaging was performed at 1.5T, yielding whole-brain voxelwise maps of T1, MTR, ADC, and FA. ROIs were placed to obtain values for DAWM, NAWM, and WM lesions. A general linear mixed-model analysis was used to compare T1, MTR, ADC, and FA between tissue types and disease types. RESULTS: Values of T1, MTR, ADC, and FA for DAWM were intermediate to those observed in NAWM and WM lesions. In patients with SPMS, DAWM was significantly different from both WM lesions and NAWM regarding all 4 measures, while in patients with PPMS, DAWM differed significantly from NAWM regarding T1, MTR, and FA and from lesions only regarding FA. Most interesting, DAWM differed between disease types: DAWM in patients with SPMS exhibited significantly higher T1 and lower MTR than did DAWM in patients with PPMS. CONCLUSIONS: In vivo T1, MTR, ADC, and FA reflect the variable severity of pathologic changes in DAWM in MS. Moreover, these quantitative MR imaging measures suggest that DAWM may differ between PPMS and SPMS.


Assuntos
Encéfalo/patologia , Imagem de Difusão por Ressonância Magnética , Imageamento por Ressonância Magnética , Esclerose Múltipla Crônica Progressiva/patologia , Fibras Nervosas Mielinizadas/patologia , Adulto , Mapeamento Encefálico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Crônica Progressiva/classificação , Estudos Retrospectivos
3.
Acta Neurol Scand ; 119(6): 349-55, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19254283

RESUMO

BACKGROUND: Studies combining postmortem magnetic resonance imaging (MRI) and histopathology have provided important insights into the abnormalities reflected by MRI. MATERIALS AND METHODS: A short overview of these studies applied to multiple sclerosis (MS) is provided in this review, and the Amsterdam postmortem imaging protocol is specifically highlighted. CONCLUSION: Postmortem MRI and histopathology correlation studies have enabled a direct translation of basic pathology in MS to the clinical setting, and have simultaneously served as a biological validation of new MRI techniques.


Assuntos
Encéfalo/patologia , Imageamento por Ressonância Magnética/métodos , Esclerose Múltipla/patologia , Diagnóstico por Imagem , Humanos , Mudanças Depois da Morte
5.
Brain ; 131(Pt 12): 3286-98, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18927145

RESUMO

White matter hyperintensities (WMH) are frequently seen on T(2)-weighted MRI scans of elderly subjects with and without Alzheimer's disease. WMH are only weakly and inconsistently associated with cognitive decline, which may be explained by heterogeneity of the underlying neuropathological substrates. The use of quantitative MRI could increase specificity for these neuropathological changes. We assessed whether post-mortem quantitative MRI is able to reflect differences in neuropathological correlates of WMH in tissue samples obtained post-mortem from Alzheimer's disease patients and from non-demented elderly. Thirty-three formalin-fixed, coronal brain slices from 11 Alzheimer's disease patients (mean age: 83 +/- 10 years, eight females) and 15 slices from seven non-demented controls (mean age: 78 +/- 10 years, four females) with WMH were scanned at 1.5 T using qualitative (fluid-attenuated inversion recovery, FLAIR) and quantitative MRI [diffusion tensor imaging (DTI) including estimation of apparent diffusion coefficient (ADC) and fractional anisotropy (FA), and T(1)-relaxation time mapping based on flip-angle array). A total of 104 regions of interest were defined on FLAIR images in WMH and normal appearing white matter (NAWM). Neuropathological examination included (semi-)quantitative assessment of axonal density (Bodian), myelin density (LFB), astrogliosis (GFAP) and microglial activation (HLA-DR). Patient groups (Alzheimer's disease versus controls) and tissue types (WMH versus NAWM) were compared with respect to QMRI and neuropathological measures. Overall, Alzheimer's disease patients had significantly lower FA (P < 0.01) and higher T(1)-values than controls (P = 0.04). WMH showed lower FA (P < 0.01) and higher T(1)-values (P < 0.001) than NAWM in both patient groups. A significant interaction between patient group and tissue type was found for the T(1) measurements, indicating that the difference in T(1)-relaxation time between NAWM and WMH was larger in Alzheimer's disease patients than in non-demented controls. All neuropathological measures showed differences between WMH and NAWM, although the difference in microglial activation was specific for Alzheimer's disease. Multivariate regression models revealed that in Alzheimer's disease, axonal density was an independent determinant of FA, whereas T(1) was independently determined by axonal and myelin density and microglial activation. Quantitative MRI techniques reveal differences in WMH between Alzheimer's disease and non-demented elderly, and are able to reflect the severity of the neuropathological changes involved.


Assuntos
Doença de Alzheimer/patologia , Encéfalo/patologia , Idoso , Idoso de 80 Anos ou mais , Astrócitos/patologia , Axônios/patologia , Mapeamento Encefálico/métodos , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Microglia/patologia , Estudos Prospectivos
6.
J Neurol ; 255(1): 1-10, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18004634

RESUMO

BACKGROUND: Idiopathic inflammatory demyelinating lesions (IIDL) of the brain usually present with a morphologic pattern characteristic of multiple sclerosis (MS). Atypical appearances of IIDLs also exist, however, and can pose significant diagnostic problems and uncertainty regarding prognosis and adequate therapy. We attempted to improve upon this situation by reviewing the literature. METHODS: We performed a PubMed search from January 1984 through December 2004 for articles in English reporting on IIDLs which had been considered as morphologically atypical (66 articles; 270 cases reported). From these publications 69 individual patient reports allowed the extraction of adequate information on magnetic resonance imaging (MRI) and associated disease characteristics. RESULTS: Reported atypical IIDLs most frequently manifested as large ring-like lesions (n = 27) which are now considered quite suggestive of an antibodymediated form of MS. Truly atypical IIDLs were less common and exhibited appearances which we termed megacystic (n = 8), Balolike (n = 11) and diffusely infiltrating (n = 11). Despite limitations imposed by the absence of original data the inter-rater agreement in defining these subtypes of atypical IIDLs was moderate to substantial (kappa 0.48-0.68) and we noted trends for their association with certain demographic, clinical and paraclinical variables. INTERPRETATION: We suggest that IIDLs reported as atypical in the literature can be segregated into several distinct subtypes based on their MRI appearance. The recognition of these patterns may be useful for the differential diagnosis and for a future classification. Because of the limitations inherent in our review this will have to be confirmed by a prospective registry.


Assuntos
Encéfalo/patologia , Doenças Desmielinizantes/patologia , Encefalite/patologia , Adolescente , Adulto , Idoso , Encéfalo/fisiopatologia , Cérebro/patologia , Cérebro/fisiopatologia , Doenças Desmielinizantes/classificação , Doenças Desmielinizantes/fisiopatologia , Diagnóstico Diferencial , Encefalite/classificação , Encefalite/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/patologia , Esclerose Múltipla/fisiopatologia , Fibras Nervosas Mielinizadas/patologia , Variações Dependentes do Observador , Valor Preditivo dos Testes
7.
Eur J Gynaecol Oncol ; 24(6): 473-4, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14658584

RESUMO

UNLABELLED: PURPOSE OF THE ARTICLE: In patients recurring after primary therapy for cervical cancer, treatment remains palliative. In the present article we focus on treatment results with single cytostatic drugs or combinations in randomized trials in squamous cell cervical cancer. RESULTS: In one randomized trial, monotherapy with platinum analogues lead to overall remission rates between 11% and 15% only. The median overall survival ranged between 5.6 and 6.5 months. Various combinations lead to overall remission rates between 21% and 31% and the median overall survival ranged between 7.3 and 14.3 months. The most active combinations were cisplatin/bleomycin/mitomycin C/vindesine, cisplatin/paclitaxel, and cisplatin/irinotecan. There are several smaller studies with cystostatic therapy in cervical adenocarcinoma. However, using 5-fluoruracil, ifosfamide, paclitaxel, or cisplatinum, only response rates between 15 and 30% can be achieved. Predictors of a favorable chemotherapy response include a higher performance status, higher age, extrapelvic recurrence sites (especially lung metastases), a recurrence-free interval > 1 year, and no previous radiotherapy and chemotherapy. CONCLUSION: In conclusion, palliative cytostatic therapy with single agents has moderate activity. Combinations are more active but also more toxic. In general, chemotherapy needs to be used earlier in the course of disease when tissue vascularization is preserved.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Camptotecina/análogos & derivados , Carcinoma de Células Escamosas/diagnóstico , Cuidados Paliativos , Neoplasias do Colo do Útero/tratamento farmacológico , Bleomicina/administração & dosagem , Camptotecina/administração & dosagem , Carcinoma de Células Escamosas/mortalidade , Cisplatino/administração & dosagem , Feminino , Humanos , Irinotecano , Mitomicina/administração & dosagem , Paclitaxel/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida , Neoplasias do Colo do Útero/mortalidade , Vindesina/administração & dosagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...