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Lack of evidence of acute ischemic tissue change in transient global amnesia on single-shot echo-planar diffusion-weighted MRI.

BACKGROUND AND PURPOSE: There is uncertainty concerning the etiology of transient global amnesia (TGA). Previous CT and MRI studies have indicated that permanent structural abnormality is rare in TGA. Diffusion-weighted (DW) MRI is very sensitive to early ischemic parenchymal changes and has recently demonstrated embolic infarction in the posterior cerebral artery territory in 2 TGA patients. We report the findings of DW MRI in 8 patients in acute stages of TGA. METHODS: Conventional and echo-planar DW MRI was performed in 2 patients in the active phase and 6 patients in the recovery phase (1 to 8 hours after cessation of anterograde memory dysfunction) of spontaneously occurring TGA. RESULTS: None of the patients showed signs of hyperintensity on DW images or hypointensity on quantitative apparent diffusion coefficient (ADC) maps to suggest regional decreases of water mobility or acute T2 changes on transverse or coronal slices. CONCLUSIONS: We were unable to detect ADC or acute T2 changes with echo-planar DW MRI in patients with TGA, which suggests that mechanisms other than ischemic infarction may cause TGA. We did not identify spreading depression-associated changes of the ADC. Further refinement of MRI sequences may be necessary to detect subtle or transient signal change in brain parenchyma.

Aged↗

Hypoperfusion in frontotemporal dementia and Alzheimer disease by arterial spin labeling MRI.

OBJECTIVES: To test if arterial spin labeling (ASL) MRI could detect a pattern of hypoperfusion in frontotemporal dementia (FTD) vs cognitively normal (CN) control subjects; to determine the regional difference of perfusion between FTD and Alzheimer disease (AD); and to determine whether hypoperfusion in FTD correlates with cognitive impairment. METHODS: We included 21 patients with FTD, 24 patients with AD, and 25 CN subjects in this cross-sectional MRI study. All subjects had MRI scans including T1-weighted structural images and ASL-MR images. RESULTS: ASL-MRI detected a pattern of hypoperfusion in right frontal regions in patients with FTD vs CN subjects, similar to PET and SPECT. FTD had higher perfusion than AD in the parietal regions and posterior cingulate. Frontal hypoperfusion in FTD correlated with deficits in judgment and problem solving. Adding frontal perfusion to gray matter (GM) atrophy significantly improved the classification of FTD from normal aging to 74%, and adding parietal perfusion to GM atrophy significantly improved the classification of FTD from AD to 75%. Combining frontal and parietal lobe perfusion further improved the classification of FTD from AD to 87%. CONCLUSION: Frontotemporal dementia and Alzheimer disease display different spatial distributions of hypoperfusion on arterial spin labeling MRI. With further development and evaluation, arterial spin labeling MRI could contribute to the differential diagnosis between frontotemporal dementia and Alzheimer disease.

Adult↗

[Study of the pre and post-synaptic dopaminergic system by DaTSCAN/IBZM SPECT in the differential diagnosis of parkinsonism in 75 patients].

INTRODUCTION: Essential tremor (ET) may be misdiagnosed as idiopathic Parkinson's disease (PD). In neurodegenerative diseases, structural imaging, such as CT or MRI, is of limited value for differentiating parkinsonian syndromes since structural changes are often only evident by the time the disease is far advanced. Most cases of symptomatic parkinsonism are vascular parkinsonism, but PD may coexist. The differential diagnosis between Alzheimer's disease (AD) and dementia with Lewy bodies (LBD) is often difficult. OBJECTIVE: To define the utility of functional neuroimaging test to establish differential diagnosis between PD and ET, drug induced parkinsonism, multiple system atrophy and vascular parkinsonism, and between AD and LBD, when clinical presentation, evolution or treatment response are atypical. PATIENTS AND METHODS: A group of 75 patients with parkinsonism was examined by clinical assessment and DaTSCAN (123I-FP-CTI, dopamine transporter protein marker) and/or IBZM SPECT (D2 receptor marker). The patients were recruited from our outpatient clinic. RESULTS: Correlation between initial clinical diagnosis and functional imaging studies (DaTSCAN and/or IBZM SPECT) in our patients did not reach that described (more than 90 %) for these techniques in previously published studies. Conclusions. According to sensitivity and sensibility reported in previous imaging studies of the pre and/or postsynaptic dopaminergic system using DaTSCAN and/ or IBZM, SPECT may be a new tool in the diagnosis of parkinsonian patients with difficult clinical diagnosis.

Adult↗

Volume reduction in prefrontal gray matter in unsuccessful criminal psychopaths.

BACKGROUND: Although studies of neurologic patients have suggested that prefrontal structural impairments may predispose to sociopathy, it is unknown whether there is a relationship between psychopathy and prefrontal volume in individuals from the community and whether any prefrontal structural impairment is specific to "unsuccessful" (caught) psychopaths as opposed to "successful" (uncaught) psychopaths. This study tests the hypothesis that psychopathy is associated with a reduction in prefrontal gray volume but that this abnormality is specific to unsuccessful psychopaths. METHOD: Prefrontal gray and white matter volumes were assessed using structural magnetic resonance imaging (MRI) in 16 unsuccessful psychopaths, 13 successful psychopaths, and 23 control subjects. RESULTS: Higher total as well as subfactor psychopathy scores (arrogant/deceptive, affective, and impulsive/unstable) were all associated with low prefrontal gray volume. Unsuccessful psychopaths, but not successful psychopaths, had a 22.3% reduction in prefrontal gray matter volume compared with control subjects. CONCLUSIONS: These results demonstrating for the first time a prefrontal structural deficit in community psychopaths provide partial support for a prefrontal theory of psychopathy but highlight an important difference between successful and unsuccessful psychopaths.

Adult↗

Mapping brain maturation.

Human brain maturation is a complex, lifelong process that can now be examined in detail using neuroimaging techniques. Ongoing projects scan subjects longitudinally with structural magnetic resonance imaging (MRI), enabling the time-course and anatomical sequence of development to be reconstructed. Here, we review recent progress on imaging studies of development. We focus on cortical and subcortical changes observed in healthy children, and contrast them with abnormal developmental changes in early-onset schizophrenia, fetal alcohol syndrome, attention-deficit-hyperactivity disorder (ADHD) and Williams syndrome. We relate these structural changes to the cellular processes that underlie them, and to cognitive and behavioral changes occurring throughout childhood and adolescence.

Adolescent↗

MR-imaging of non-Alzheimer's dementia.

Up to now, computerized tomography (CT) and MR-imaging have been used for the morphological assessment of dementia patients, while MRI has become the structure imaging modality of choice. With the advent of fast and ultrafast sequences provided by higher gradient field strengths, functional MR studies like diffusion, perfusion and activation studies become available. The greatest advantage of MR is its versatility including MR-imaging, 3D postprocessing, MR-volumetry, MR-spectroscopy, MR-angiography, MR-perfusion and diffusion imaging as well as functional MRI activation studies. The application of the multimodal MR-technology in dementia disorders has already began and has to be validated in clinical practice. The multimodality of MR represents a diagnostic challenge for the future with the hope, that the diagnostic efficacy, which has to be proven, is also followed by an improvement of patients care and prognosis.

Adolescent↗

Handedness, dichotic-listening ear advantage, and gender effects on planum temporale asymmetry--a volumetric investigation using structural magnetic resonance imaging.

Previous research has often examined whether the asymmetrical structure of the planum temporale (PT) represents an anatomical correlate of lateralized language-processing functions, gathering diverging empirical evidence by comparing PT asymmetry in subjects with differing handedness, gender, or speech lateralization. Apart from other methodological problems, direct comparisons between studies are hampered by insufficient assessment and consideration of all three potential determinants of structural cerebral asymmetry. Based on volumetric assessment of structural Magnetic Resonance Imaging (MRI) scans of 104 healthy subjects, the present study replicated earlier observations of an overall leftward PT asymmetry, which was found to prevail irrespective of handedness, gender, or dichotic-listening ear advantage. However, the mean magnitude of this leftward asymmetry was not determined by either one of these factors in itself, but varied depending on their specific combination. A clear correspondence between structural and functional asymmetry was only observed among right-handed males. In this particular subgroup, more pronounced structural asymmetry was associated with an enlarged PT on the left side, while the enhanced leftward asymmetry of female sinistrals resulted from smaller adjusted volumes of their right PT. The existence of such complex interactions suggests that future research in this area can only be expected to overcome past inconsistencies by adequately considering handedness, gender, and speech lateralization.

Auditory Cortex↗

Changes in geometry of the finger flexor tendons in the carpal tunnel with wrist posture and tendon load: an MRI study on normal wrists.

OBJECTIVES: (1) To develop a methodology to determine the trajectories of the digital flexor tendons using MRI. (2) To examine changes in tendon trajectories due to wrist posture, with and without pinch force. (3) To calculate the radius of curvature of the flexor tendons and note implications for contact forces on the median nerve. (4) To assess the use of Landsmeer's models at the wrist. DESIGN: Finger flexor tendon centroids were digitized from magnetic resonance images of the carpal tunnel and the tendon paths were determined analytically. Radii of curvature were calculated from the tendon paths. BACKGROUND: Landsmeer's models of joint-tendon interaction (Landsmeer, 1961) have been used to determine moment arms and radius of curvature of the tendon paths about articulations. An explanation for a biomechanical cause of work-related carpal tunnel syndrome originated from these models. METHODS: Three healthy male participants had their right wrist scanned while splinted in four wrist postures (flexed to 20 degrees, 45 degrees, neutral, extended to 20 degrees ) with and without maintaining a 10 N pinch grip. 20-24 cross-sectional images were used for each condition. RESULTS: Volar movement of the tendons was seen with wrist flexion and the opposite was true with extension. Tendon intersection angles were calculated between the tendon as it entered the carpal tunnel and as it exited the tunnel and were 50-65% of the wrist angle (R(2)=0.81-0.96). The radius of curvature was smallest (mean=82-127 mm) with an active pinch grip with the wrist splinted at 45 degrees of flexion (mean actual wrist angle 37 degrees ). CONCLUSIONS: The radius of flexor tendon curvature is not constant as previously assumed and is larger than previous estimates. The addition of tendon force with the wrist flexed acts to reduce the radius of curvature which further increases the contact stress on the median nerve and other wrist structures. The use of MRI to determine the tendon paths has provided new insight into the relationships between the finger flexor tendons and other structures at the wrist. RELEVANCE: These findings provide data for biomechanical models of the carpal tunnel and predict the possible pathophysiology of work-related carpal tunnel syndrome.

Adult↗

Syncope in patients with right ventricle outflow tract premature beats and no apparent structural cardiopathy.

OBJECTIVE: Study the prevalence of neurocardiogenic etiology in patients with unexplained syncope and ventricular premature beats, with right ventricle outflow tract morphology (RVOT) and no apparent structural cardiopathy. METHODS: Ninety patients (66 women, mean age 40.2 +/- 16.95 years of age) with monomorphic premature beats originated at RVOT were evaluated prospectively. Fifty-four patients reported syncopes or near-syncopes associated to palpitations or not; twenty-seven presented palpitations with no pre-syncope or syncope, and nine were asymptomatic. All patients were submitted to echocardiogram, high resolution ECG and cardiac MRI to rule out structural cardiopathy, to exertion test to rule out adrenergic dependent ventricular tachycardia, and ECG prolonged outpatient monitoring (Holter and symptomatic events monitor) to correlate symptoms and ventricular arrhythmias. Investigation on the susceptibility to neurocardiogenic syncope was evaluated by Tilt Table Test (TTT). Groups were compared regarding gender, age, premature beats frequency and complexity, at exertion or not, TTT results and clinical course. RESULTS: In the syncope and pre-syncope groups, TTT was positive for 38% of cases, and in groups with palpitations and assymptomatics, it was positive for 11% (p = 0.0257). After recommendations and treatment of neurocardiogenic syncope, 85% of syncope and pre-syncope patients and positive TTT was asymptomatic along the 40-month follow-up. Two patients with syncope and negative TTT presented spontaneous, sustained ventricular tachycardia during clinic course. CONCLUSION: The prevalence of neurocardiogenic syncope in patients with idiopathic RVOT premature beats is high. Patients with recurrent, unexplained syncope and idiopathic VE must be kept under investigation.

Adolescent↗

Shoulder magnetic resonance imaging.

MRI provides excellent soft tissue contrast and allows for multiplanar imaging in anatomic planes. Because of these advantages MRI has become the study of choice for imaging of shoulder pathology. Some structures, such as the rotator cuff, humeral head contour, and glenoid shape, are evaluated well with conventional MRI. When more sensitive evaluation of the labrum, capsule, articular cartilage, and glenohumeral ligaments is required or when a partial-thickness rotator cuff tear is suspected,magnetic resonance arthrography with intra-articular contrast can be performed. For MR arthrography contrast is injected directly into the glenohumeral joint. This article reviews the appearances of normal anatomic structures in MRI of the shoulder and disorders involving the rotator cuff and glenoid labrum.

Humans↗

Epilepsy surgery in childhood.

Epilepsy surgery in childhood can now be more readily considered as a result of enhanced presurgical investigative techniques and safer neurosurgical practice. As in adults, surgery available may be resective (focal resection or hemispherectomy) or functional. The most common procedures are temporal lobectomy and hemispherectomy, with malformative lesions and developmental tumours the next common pathology. The timing of surgery requires careful consideration, and the definition of drug resistance given specific thought in the young child. Presurgical evaluation should be noninvasive where possible, and should include optimised MRI, including 3D data set and video EEG telemetry to document seizures. Detection of temporal lobe abnormalities in temporal lobe epilepsy with MR may be enhanced using quantitative and semiquantitative techniques. Ictal and interictal SPECT may be useful in providing information about the seizure onset zone, if reviewed in conjunction with MR data and video-EEG. Interictal PET is more likely to demonstrate abnormalities relating to structural defects, but may be particularly useful in infants where incomplete myelination may restrict structural information provided by MRI. Neuropsychology testing plays a major role by the determination of verbal and nonverbal function in older children, and in the determination of cerebral dominance. Functional MRI for determination of language or motor cortex may enhance such evaluation, although it is limited to older unsedated children at present. Although the aims of the presurgical evaluation remain similar to adult practice, the range of children presenting is wide, and the aims and likely outcome of surgery require careful evaluation with the family. This aside, the benefits of seizure elimination or reduction in drug-resistant focal epilepsy prior to adolescence, as well as in certain early catastrophic epilepsies of childhood, remain self apparent.

Age Factors↗

The role of diagnostic imaging in synovial sarcoma. Our experience.

PURPOSE: Synovial sarcoma is a rare malignant mesenchymal tumour of soft tissues. It accounts for 8-10% of all soft-tissue sarcomas. The clinical symptoms at onset are often subtle and the course of the disease is slow. Therefore, diagnostic imaging is essential for the early diagnosis of a malignant tumoral lesion. The aim of this study was to assess the role and usefulness of the different imaging procedures in the diagnosis of synovial sarcoma and to present their findings. MATERIALS AND METHODS: Between 1985 and 2002, we retrospectively reviewed 35 patients (21 men and 14 women, aged 14-66 years) with synovial sarcoma treated in the Orthopaedic Oncological Surgery Division of our hospital. All patients had previously undergone conventional radiography, B-mode ultrasound, computed tomography and magnetic resonance imaging. RESULTS: Conventional radiography showed indirect signs of the neoplasm including soft-tissue swelling, calcifications and bone erosions. Ultrasound allowed the detection of focal nodular lesions but was non-specific in distinguishing malignant features. CT after intravenous injection of contrast medium demonstrated inhomogeneous enhancement in 90% of cases, suggesting an alteration in tumour microcirculation. In all cases examined, MRI enabled detection of the intrinsic structural alterations of the mass indicative of an aggressive lesion. CONCLUSIONS: Contrast-enhanced CT and MRI provide useful information on the intrinsic structure of the neoplasm, suggesting a presumptive diagnosis. Furthermore, they are necessary for tumour staging, surgical planning and follow-up. The definitive diagnosis is provided by biopsy and histology.

Adolescent↗

Cerebral fluorine-18 labeled 2-fluoro-2-deoxyglucose positron emission tomography (FDG PET), MRI, and clinical observations in a patient with infantile G(M1) gangliosidosis.

The clinical, biochemical, pathological and neuroradiological findings of a 2-year-old Saudi boy with infantile G(M1) gangliosidosis are reported. The patient had a progressive neurologic deterioration, manifesting with developmental regression, sensorimotor and psychointellectual dysfunction and generalized spasticity that started at 4 months of age. Cherry-red macula, facial dysmorphia, hepatomegaly, exaggerated startle response to sounds, skeletal dysplasia, and vacuolated foamy lymphocytes that contain finely fibrillar material in addition to lamellar membranes and electron-dense rounded bodies were seen. MRI of the brain demonstrated mild diffuse brain atrophy and features of delayed dysmyelination and demyelination. Brain FDG PET scan revealed a mild decrease in the basal ganglia uptake, and moderate to severe decrease in thalamic and visual cortex uptake, and an area of increased glucose uptake in the left frontal lobe, probably representing an active seizure focus. The functional changes indicated by FDG PET scan and the structural abnormalities shown on MRI were found to be complementary in the imaging evaluation of infantile G(M1) gangliosidosis.

Brain↗

Localization of ictal and interictal bursting epileptogenic activity in focal cortical dysplasia: agreement of magnetoencephalography and electrocorticography.

Focal cortical dysplasia (FCD) is often associated with severe partial epilepsy. In such cases, interictal frequent rhythmic bursting epileptiform activity (FBREA) on both scalp electroencephalography (EEG) and electrocorticography (ECoG) is generally accepted to be identical to the ictal epileptiform activity. We used magnetoencephalography (or Magnetic Source Imaging (MSI)) to determine the epileptogenic zone in a 6-year-old patient with histopathologically proven FCD and normal magnetic resonance imaging (MRI). MSI was used to localize the sources of both ictal activity and FRBEA, which was then compared with ECoG findings. The intracranial sources of both types of activity co-localized in the left inferior frontal and superior temporal gyri. The location and extent of the epileptogenic area determined by MSI was essentially identical to that determined directly through extra-operative ECoG. In the absence of structural abnormalities detectable on MRI, the noninvasive method of MSI provided valuable information regarding the location and extent of the primary epileptogenic area. This was critical for pre-surgical planning regarding placement of intracranial electrodes and for risk-benefit evaluation.

Cerebral Cortex↗

Surgery in temporal lobe epilepsy patients without cranial MRI lateralization.

High resolution MRI is very important in the evaluations of patients with intractable temporal lobe epilepsy in preoperative investigations. Morphologic abnormalities on cranial MRI usually indicate the epileptogenic focus. Intractable TLE patients who have normal cranial MRI or bilateral hippocampal atrophy may have a chance for surgery if a certain epileptogenic focus is determined. We evaluated the patients who were monitorized in Gazi University Medical Faculty Epilepsy Center from October 1997 to April 2004. Seventy three patients, who had a temporal epileptogenic focus, underwent anterior temporal lobectomy at Ankara University Medical Faculty Department of Neurosurgery. Twelve of them (16, 4%), did not have any localizing structural lesion on cranial MRI. Of the 12 patients examined 6 had normal findings and 6 had bilateral hippocampal atrophy. Of these 12 patients, 6 (50%) were women and 6 (50%) were men. The ages of patients ranged from 7 to 37 (mean: 24.5). Preoperatively long-term scalp video-EEG monitoring, cranial MRI, neuropsychological tests, and Wada test were applied in all patients. Five patients, whose investigations resulted in conflicting data, underwent invasive monitoring by the use of subdural strips. The seizure outcome of patients were classified according to Engel with postsurgical follow-up ranging from 11 to 52 (median: 35.7) months. Nine patients (75%) were classified into Engel's Class I and the other 3 patients (25%) were placed into Engel's Class II. One patient who was classified into Engel's Class II had additional psychiatric problems. The other patient had two different epileptogenic foci independent from each other in her ictal EEG. One of them localized in the right anterior temporal area, the other was in the right frontal lobe. She was classified in Engel's Class II and had no seizure originating from temporal epileptic focus, but few seizures originating from the frontal region continued after the surgery. In conclusion, surgery was successful in all 12 patients. We think that patients with no MRI lateralizing or localizing lesion should undergo epilepsy surgery after detailed presurgical evaluations, including invasive monitoring.

Adolescent↗

Enlargement of the amygdala in patients with a first episode of major depression.

BACKGROUND: The amygdala plays a crucial role in the mediation of affective behavior in humans and is implemented in the limbic-thalamic-cortical network that is supposed to modulate human mood. The aim of the present study was to measure the amygdala volumes in patients with a first episode of major depression. METHODS: Thirty inpatients with a first episode of depression were compared with 30 healthy volunteers matched for age, gender, handedness, and education by performing structural magnetic resonance imaging (MRI) measures of the amygdala. RESULTS: Patients showed increased amygdala volumes in both hemispheres as compared to healthy control subjects. No significant correlations were found between amygdala volumes and age, age of onset, illness duration, or severity of depression in the patient group. CONCLUSIONS: Enlarged amygdala volumes in patients with a first episode of major depression might be due to enhanced blood flow in the amygdala rather than to a neurodevelopmental structural predisposition to major depression.

Adolescent↗

Symptomatic tonsillar ectopia.

OBJECTIVE: To determine if slight descent of the cerebellar tonsils (< 5 mm below the foramen magnum; tonsillar ectopia) may cause surgically treatable symptomatology. METHODS: A consecutive series of nine symptomatic patients with tonsillar ectopia seen between December 1990 and March 1993 are reported on. The same number of age and sex matched controls were selected at random from outpatients. Twelve asymptomatic subjects with tonsillar ectopia were found among 5000 people between January 1991 and March 1996. Diagnosis of tonsillar ectopia was based on midsagittal MRI. RESULTS: Patients presented mainly with chronic intractable occipital dull pain, vertigo, and dysequilibrium. In all patients MRI showed normal brain structure except for tonsillar ectopia (-2.9 (SD 0.8) mm), which has historically been thought to be of no clinical relevance. In the control group the tonsilar position was +2.1 (SD 2.8) mm (p<0.01). Neurotologically abnormal findings were detected with a monaural speech integration test (100%), eye tracking test (56%), optokinetic nystagmus test (89%), and visual suppression test (67%) which strongly suggested a CNS lesion. In accordance with the results of MRI and precise neurotological examination, posterior fossa decompression surgery was carried out, followed by improvement of preoperative symptoms and less severity of neurotological abnormalities in all patients. CONCLUSION: Tonsillar ectopia could cause neurological symptoms in small populations, which were surgically treatable. Neurotological assessment was necessary to verify the aetiological relation between tonsillar ectopia and various symptoms.

Adult↗

Effects of ECT on brain structure: a pilot prospective magnetic resonance imaging study.

The authors describe a pilot prospective investigation of the effects of ECT on brain structure using magnetic resonance imaging (MRI). In nine patients with major depression, a course of ECT produced no acute changes in brain structure according to blind raters' assessments of cortical atrophy and global comparison of pre- and post-ECT studies. There were also no significant changes in the ventricle-brain ratios. Pre-ECT brain abnormalities were common in these patients yet were also unaffected by ECT. Future MRI studies of ECT should include more subjects and should address long-term changes and subtle brain abnormalities.

Adult↗