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PubMed1991

Neuroimaging of the spinal cord.

Neuroimaging of the spinal cord has taken on new dimensions in the past few years. With improvement in surface coils, elimination of artifacts, and fast scan imaging, myelography with all of its complications is on the wane. Computerized tomography is excellent for bony abnormalities, but most patients with spinal disease can be diagnosed with magnetic resonance imaging due to its excellent contrast, spatial resolution, and ability to actually see the spinal cord. However, at times CT is extremely helpful. This article reviews neuroimaging of the major diseases affecting the spine.

Humans↗
PubMed1991

Neuroimaging in Alzheimer's disease.

This article reviews the recent neuroimaging studies of patients with Alzheimer's disease. The neuroimaging procedures discussed include computerized tomography, magnetic resonance imaging, positron emission tomography, and single-photon emission computerized tomography.

Alzheimer Disease↗
PubMedDate not supplied

Neuroimaging of disseminated germ cell neoplasms.

The purpose of this study was to determine the role of neuroimaging in the management of patients with metastatic germ cell tumors. Retrospective evaluation of 299 patients treated in 1986 and 1987 for initial presentation or recurrence of testicular, retroperitoneal, and mediastinal germ cell tumors was performed to determine indications for neuroimaging, frequency and site of CNS metastases, and occurrence of other CNS abnormalities. Sixty-six patients required CNS imaging with myelography, CT, or MR. Studies were normal in 24 patients. Twenty patients had CNS metastases including 11 with intracranial metastases, eight with spine lesions, and one with both brain and spine involvement. Sixteen had cerebral or cerebellar atrophy of unclear origin and functional significance. Two patients had ventriculomegaly without symptoms of hydrocephalus. Four patients had questionable lesions that were never confirmed. None of the 25 asymptomatic patients with elevated serum tumor markers had brain metastases. Fifteen of 17 patients with focal neurologic deficits and three of six patients with seizures had CNS metastases. CNS imaging to detect germ cell tumor metastases is most useful in the presence of neurologic deficits or seizures but is not useful in patients with unexplained elevation of serum tumor markers in the absence of neurologic deficits.

Adult↗
PubMed1984

Neuroimaging in multiple sclerosis.

Conventional CT studies were the first neuroimaging tools shown to be frequently useful in the assessment of patients with multiple sclerosis. The most commonly noted abnormalities are cerebral atrophy, foci of decreased density, and contrast enhancing lesions. Hypodense lesions may represent either recent or remote sites of demyelination and this can be determined in part by the response of these abnormalities to contrast administration and by their evolution with serial CT studies. There is compelling evidence that CT enhancing lesions correspond to sites of active inflammation and demyelination. High-volume delayed CT studies increase the number of CT abnormalities seen, particularly in patients examined at the time of clinical disease activity. These studies appear to be well-tolerated in properly hydrated patients with normal renal function. NMRI studies appear to be the most sensitive way to detect MS lesions and are particularly useful in demonstrating abnormalities in the posterior fossa. Less is known of the pathologic substrate and the evolution of these NMR abnormalities. It appears likely that NMR detected lesions usually do not resolve completely and consequently changes seen with this neuroimaging technique may represent the cumulative effects of past and present disease activity.

Atrophy↗
PubMed1995

Neurosyphilis in HIV-positive and HIV-negative patients: neuroimaging findings.

PURPOSE: To evaluate and describe the neuroimaging findings of patients with neurosyphilis. METHODS: The neuroimaging studies of 35 patients with documented neurosyphilis were reviewed. Diagnosis was established in 34 patients with cerebrospinal fluid for a Venereal Disease Research Laboratory test, complemented by autopsy in 1 and brain biopsy in 1. All patients had reactive fluorescent treponemal antibody tests with absorption in their sera. Imaging studies included plain and contrast-enhanced CT of the brain, plain and gadolinium-enhanced MR, MR angiography, and conventional angiography. Imaging findings were also correlated with the relevant pathologic findings at autopsy in three additional patients with neurosyphilis who did not have brain imaging studies. RESULTS: Of the 35 patients with imaging studies, 32 tested human immunodeficiency virus (HIV)-seropositive, and 3 were HIV-seronegative. Eleven (31%) of 35 patients had normal radiographic findings. Cerebral infarctions were seen in 8 (23%) of 35 patients, and nonspecific white matter lesions in 7 (20%) of 35. Cerebral gummas and extraaxial enhancement indicating meningitis were noted in 2 (6%) of 35 patients, respectively. Arteritis was demonstrated in 2 (50%) of 4 patients who underwent either MR angiography or conventional angiography. The 3 subjects who had autopsy but not imaging studies were found to have manifestations of meningovascular syphilis, including syphilitic leptomeningitis and an obliterative endarteritis. CONCLUSION: We conclude that findings of vascular occlusive disease manifested as infarction or arteritis, enhancing cortical lesions with or without adjacent meningeal enhancement, focal or diffuse extraaxial enhancement, and white matter disease, although nonspecific, in the proper clinical setting should prompt appropriate testing for neurosyphilis, a treatable disease, in patients with and without HIV infection.

AIDS Dementia Complex↗
PubMed1995

A generalized estimating equations approach for spatially correlated binary data: applications to the analysis of neuroimaging data.

This paper proposes a generalized estimating equations approach for the analysis of spatially correlated binary data when there are large numbers of spatially correlated observations on a moderate number of subjects. This approach is useful when the scientific focus is on modeling the marginal mean structure. Proper modeling of the spatial correlation structure is shown to provide large efficiency gains along with precise standard error estimates for inference on mean structure parameters. Generalized estimating equations for estimating the parameters of both the mean and spatial correlation structure are proposed. The use of semivariogram models for parameterizing the correlation structure is discussed, and estimation of the sample semivariogram is proposed as a technique for choosing parametric models and starting values for generalized estimating equations estimation. The methodology is illustrated with neuroimaging data collected as part of the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Data Bank. A simulation study demonstrates the importance of accurate modeling of the spatial correlation structure in data with large numbers of spatially correlated observations such as those found in neuroimaging studies.

Brain↗
PubMed1993

Neuropsychological and neuroimaging aspects of latent hepatic encephalopathy (LHE).

It has become increasingly clear that many cirrhotic patients who do not display overt clinical encephalopathy, on closer examination, do demonstrate significant cognitive impairment, which often goes unrecognised. This "latent" hepatic encephalopathy (LHE) is usually characterised by memory impairment and psychomotor slowing, and is not simply attributable to the effects of alcohol. Structural neuroimaging studies (CT and MRI) have produced conflicting results. Functional neuroimaging studies (PET and SPECT) which have measured regional cerebral blood flow, however, have found evidence of increased regional cerebral activity in sub-cortical areas in LHE patients, with the degree of sub-cortical activity correlated with the severity of neuropsychological impairment.

Cognition Disorders↗
PubMed1994

Neuroimaging of premature infants.

Neuroimaging of babies born prematurely challenges each member of the imaging team. This article reviews the commonly used modalities for neuroimaging in premature infants (ultrasonography, CT, and MR imaging) and makes recommendations for their optimal implementation based on the imaging literature and the author's experience. Special care of the premature neonate in the imaging department is discussed. Suggestions are made for the proper application of current imaging technology to the frequently encountered problems of intracranial hemorrhage and periventricular leukomalacia in the neonate.

Brain↗
PubMedDate not supplied

[Neuroimaging and neurobiology of obsessive compulsive disorder: review of recent developments in research].

Morphological and functional changes seen in obsessive-compulsive disorder (OCD) are reviewed. OCD and neurology are closely linked: some neurological diseases involving basal ganglia are sometimes associated with OCD symptoms; conversely, OCD patients often present neurological soft signs. Structural neuroimaging has shown reduced caudate nucleus volume among OCD patients. Functional neuroimaging demonstrated repeatedly an activation of the caudate nucleus and orbitofrontal cortex areas which reversed after treatment. Recent studies showed a correlation between induced OCD symptoms and an increase of the blood flow of the right caudate nucleus and the orbitofrontal cortex. A circuit linking the orbital cortex, the striatum and the thalamus is probably involved in OCD symptoms. However, it is not yet possible to find a causal lesion for this trouble.

Brain↗
PubMed1995

Cavernous sinus hemangioma. Clinical and neuroimaging features.

A patient presented with an isolated left sixth nerve palsy. Magnetic resonance imaging revealed a sharply marginated 3 cm lesion in the left cavernous sinus, which was isointense to gray matter on T1-weighted images, hyperintense on T2-weighted images, and enhanced with paramagnetic contrast material. Cerebral angiography showed a homogeneous blush fed by an enlarged meningohypophyseal artery. The neuroimaging findings were thought to be most consistent with the diagnosis of a cavernous sinus meningioma. At the time of surgery, a vascular mass was encountered, and a biopsy was consistent with a cavernous hemangioma. This report describes the clinical and neuroimaging features of cavernous sinus hemangiomas that may help to differentiate them from other cavernous sinus lesions.

Abducens Nerve↗
PubMed1995

[Neuroimaging findings in intravascular malignant lymphomatosis].

We reviewed the neuroimaging studies of five patients with intravascular malignant lymphomatosis (IML). All five patients had cerebral symptoms and three had spinal cord or root symptoms. Initial brain CTs, in two patients at the onset of cerebral symptoms, were normal. Brain MR imaging, conducted in four patients during the course of IML, showed multiple white matter lesions which were hyperintense on T2-weighted images. Some of the lesions involved cerebral cortices, and some had mass effect. Serial MR imaging was performed in three patients, and the lesions decreased in size during steroid or CHOP therapy. Gd-DTPA-enhanced study which was conducted in one patient demonstrated enhancement of the white matter lesions. Review of the literature revealed various CT or MR findings; single or multiple cortical or subcortical lesions with or without mass effect, periventricular lesions, and spinal cord lesions. Lesions may or may not be enhanced. Because neuroimaging findings are non-specific, correct diagnosis is difficult to make by imaging studies alone. One should always consider the possibility of IML in the interpretation of radiological images.

Aged↗
PubMedDate not supplied

Neuroimage in infants and children with mitochondrial disorders.

Neuroimage studies of thirty-eight infants and children with mitochondrial disorders were reviewed: 24 ultrasound (US), 21 computed tomography (CT), and 27 magnetic resonance image (MRI) examinations were analyzed. Patients included seventeen with Leigh syndrome, two with Kearns-Sayre syndrome (KSS), one with myoclonus, epilepsy, and ragged red fibers (MERRF), one with Alpers disease, five with Menkes disease, two with fatty acid metabolic defect, two with Rett syndrome, and eight with unspecified mitochondrial disorders. KSS and MERRF tended to occur in older children, whereas Leigh syndrome, Menkes disease, and Alpers disease occurred in infants and young children. The deep cerebral nuclei and the cerebral white matter were commonly involved in Leigh syndrome and KSS. Subdural hematomas or effusions with profound cerebral atrophy was found in Alpers disease and Menkes disease. Tortuosities of basilar, Willis circle, and cerebral vessels were also noted in Menkes disease. MRI and CT examinations of Rett syndrome, fatty acid metabolic defect, and most of the unspecified mitochondrial disorders were normal. Our results indicate that neuroimage studies have characteristic findings for specific mitochondrial syndromes.

Adolescent↗
PubMed1996

Neuroimaging for differentiating vascular from Alzheimer's dementias.

Recent advances in the clinical and neuroimaging features of vascular dementia (VAD) versus Alzheimer type dementia (DAT) are described. The lacunar type of VAD, which is often accompanied by silent strokes and a progressive course, is easily confused with DAT. Measurements of cerebral blood flow (CBF) and metabolism (CMR) displayed as brain maps, identify VAD from DAT because of the multifocal and often subcortical nature of the infarcts in VAD, which are strikingly different from the diffuse cortical reductions of CBF and CMR in DAT. Thus, neuroimaging is important for establishing the diagnosis in these two most common forms of dementia in the elderly. A dramatic method for separating VAD from DAT is by utilizing the noninvasive acetazolamide test and xenon contrast CT scanning for measuring the cerebral vasomotor capacitance. In DAT the vasodilator reserve is increased due to the law of initial values. In VAD it is absent or severely blunted so that the differences between the two underlying causes of the dementias become readily apparent.

Aged↗
PubMed1997

The application of neuroimaging techniques to drug development.

Neuroimaging is a powerful and innovative tool for studying the pathology of psychiatric diseases and, more recently, for studying the drugs used in their treatment. Technological advances in imaging have made it possible to noninvasively extract information from the human brain regarding a drug's mechanism and site of action. Until now, our understanding of human brain pharmacology has depended primarily on indirect assessments or models derived from animal studies. However, the advent of multiple techniques for human brain imaging allows researchers to focus directly on human pharmacology and brain function. This review outlines available neuroimaging techniques and examines how these various methods have already been applied to the drug development process, as well as how they might be applied in the future.

Antipsychotic Agents↗
PubMed1998

Clinical applications of neuroimaging in psychiatry.

New techniques are dramatically expanding current clinical applications of neuroimaging in neuropsychiatry. Neuroimaging research that examines brain structure and function relationships in neuropsychiatric disorders is also enhancing our understanding of the pathophysiology of neuropsychiatric illnesses such as dementia, focal CNS insult, schizophrenia, affective disorders, and neurodevelopmental disorders.

Brain↗
PubMed1998

[Secondary encephalopathy due to exposure to organic solvents: psychopathological, neuropsychological and neuroimaging findings].

Chronic exposure to organic solvents may cause permanent cognitive impairment. The nonspecify of neurological signs as the abnormalities of neurophysiological tests and morphological neuroimaging techniques have oblige the use of clinic neuropsychology in the monitorization of the neurotoxicity cause by these substances. The new modern functional neuroimaging techniques can contribute to the diagnosis of brain lesions caused by the exposure to organic solvents. We report a case that clearly supports this hypothesis as we emphasize the correlation found between clinical symptoms and the deficits obtained after the study of cerebral blood flow with single photon emission computed tomography (SPECT).

Adult↗
PubMed1998

[Neuroimaging of hypoglycemia].

INTRODUCTION: Sustained hypoglycemia causes serious cerebral damage. The cortex, hippocampus and basal ganglia are particularly vulnerable to this. Exceptionally, there have been communications regarding neuroimaging visualization of cerebral lesions attributable to hypoglycemia only. We present the case of a woman who suffered hypoglycemic coma with permanent neurological damage. Lesions were seen on magnetic resonance (MR) and cranial computerized tomography (CT). CLINICAL CASE: A 22 year old woman with no vascular risk factors was admitted to hospital in hypoglycemic coma, after attempting suicide with oral antidiabetic drugs. The duration of the coma was unknown. On admission the glycaemia was 28 mg/dl. Cranial CT scan was normal during the first 24 hours. Cerebral MR scan one week late showed hyperintense lesions in T2, basal ganglia and left hippocampus. The cranial CT scan one year later showed diffuse atrophy, with bilateral lesions of low attenuation in the basal ganglia and dilatation of the ventricular system. CONCLUSIONS: It is unusual to see lesions secondary to hypoglycemia on neuroimaging investigations. The etiopathogenic mechanism is still unknown and it has generally been described in diabetic patients. In our case these lesions can only be attributed to hypoglycemia. MR is more sensitive than cranial CT scan for the detection of these lesions during the acute phase.

Adult↗