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Galgani A, Lombardo F, Martini N, Vergallo A, Bastiani L, Hampel H, Hlavata H, Baldacci F, Tognoni G, De Marchi D, Ghicopulos I, De Cori S, Biagioni F, Busceti CL, Ceravolo R, Bonuccelli U, Chiappino D, Siciliano G, Fornai F, Pavese N, Giorgi FS. Magnetic resonance imaging Locus Coeruleus abnormality in amnestic Mild Cognitive Impairment is associated with future progression to dementia. Eur J Neurol 2023; 30:32-46. [PMID: 36086917 PMCID: PMC10092028 DOI: 10.1111/ene.15556] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Human neuropathological studies indicate that the pontine nucleus Locus Coeruleus (LC) undergoes significant and early degeneration in Alzheimer's disease. This line of evidence alongside experimental data suggests that the LC functional/structural decay may represent a critical factor for Alzheimer's disease pathophysiological and clinical progression. In the present prospective study, we used Magnetic Resonance Imaging (MRI) with LC-sensitive sequence (LC-MRI) to investigate in vivo the LC involvement in Alzheimer's disease progression, and whether specific LC-MRI features at baseline are associated with prognosis and cognitive performance in amnestic Mild Cognitive Impairment. METHODS LC-MRI parameters were measured at baseline by a template-based method on 3.0-T magnetic resonance images in 34 patients with Alzheimer's disease dementia, 73 patients with amnestic Mild Cognitive Impairment, and 53 cognitively intact individuals. A thorough neurological and neuropsychological assessment was performed at baseline and 2.5-year follow-up. RESULTS In subjects with Mild Cognitive Impairment who converted to dementia (n = 32), the LC intensity and number of LC-related voxels were significantly lower than in cognitively intact individuals, resembling those observed in demented patients. Such a reduction was not detected in Mild Cognitive Impairment individuals, who remained stable at follow-up. In Mild Cognitive Impairment subjects converting to dementia, LC-MRI parameter reduction was maximal in the rostral part of the left nucleus. Structural equation modeling analysis showed that LC-MRI parameters positively correlate with cognitive performance. CONCLUSIONS Our findings highlight a potential role of LC-MRI for predicting clinical progression in Mild Cognitive Impairment and support the key role of LC degeneration in the Alzheimer clinical continuum.
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Affiliation(s)
- Alessandro Galgani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Lombardo
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, G. Monasterio Foundation-National Research Council/Tuscany Region, Pisa, Italy
| | - Nicola Martini
- Deep Health Unit, G. Monasterio Foundation-National Research Council/Tuscany Region, Pisa, Italy
| | - Andrea Vergallo
- GRC No. 21, Alzheimer Precision Medicine, Public Hospital Network of Paris, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Luca Bastiani
- Institute of Clinical Physiology of National Research Council, Pisa, Italy
| | - Harald Hampel
- GRC No. 21, Alzheimer Precision Medicine, Public Hospital Network of Paris, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Hana Hlavata
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, G. Monasterio Foundation-National Research Council/Tuscany Region, Pisa, Italy
| | - Filippo Baldacci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gloria Tognoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniele De Marchi
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, G. Monasterio Foundation-National Research Council/Tuscany Region, Pisa, Italy
| | - Irene Ghicopulos
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara De Cori
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, G. Monasterio Foundation-National Research Council/Tuscany Region, Pisa, Italy
| | - Francesca Biagioni
- Scientific Institute for Research and Health Care Neuromed, Pozzilli, Italy
| | | | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dante Chiappino
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, G. Monasterio Foundation-National Research Council/Tuscany Region, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Fornai
- Scientific Institute for Research and Health Care Neuromed, Pozzilli, Italy.,Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Clinical Medicine, Positron Emission Tomography Center, Aarhus University, Aarhus, Denmark
| | - Filippo Sean Giorgi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
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Giorgi FS, Martini N, Lombardo F, Galgani A, Bastiani L, Della Latta D, Hlavata H, Busceti CL, Biagioni F, Puglisi-Allegra S, Pavese N, Fornai F. Locus Coeruleus magnetic resonance imaging: a comparison between native-space and template-space approach. J Neural Transm (Vienna) 2022; 129:387-394. [PMID: 35306617 PMCID: PMC9007774 DOI: 10.1007/s00702-022-02486-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 10/27/2022]
Abstract
Locus Coeruleus (LC) is the main noradrenergic nucleus of the brain, which is involved in many physiological functions including cognition; its impairment may be crucial in the neurobiology of a variety of brain diseases. Locus Coeruleus-Magnetic Resonance Imaging (LC-MRI) allows to identify in vivo LC in humans. Thus, a variety of research teams have been using LC-MRI to estimate LC integrity in normal aging and in patients affected by neurodegenerative disorders, where LC integrity my work as a biomarker. A number of variations between LC-MRI studies exist, concerning post-acquisition analysis and whether this had been performed within MRI native space or in ad hoc-built MRI template space. Moreover, the reproducibility and reliability of this tool is still to be explored. Therefore, in the present study, we analyzed a group of neurologically healthy, cognitively intact elderly subjects, using both a native space- and a template space-based LC-MRI analysis. We found a good inter-method agreement, particularly considering the LC Contrast Ratio. The template space-based approach provided a higher spatial resolution, lower operator-dependency, and allowed the analysis of LC topography. Our ad hoc-developed LC template showed LC morphological data that were in line with templates published very recently. Remarkably, present data significantly overlapped with a recently published LC "metaMask", that had been obtained by averaging the results of a variety of previous LC-MRI studies. Thus, such a template space-based approach may pave the way to a standardized LC-MRI analysis and to be used in future clinic-anatomical correlations.
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Affiliation(s)
- F S Giorgi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.
| | - N Martini
- Deep Health Unit, Fondazione Toscana Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - F Lombardo
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, Fondazione Toscana Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - A Galgani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Bastiani
- Institute of Clinical Physiology of National Research Council, Pisa, Italy
| | - D Della Latta
- Deep Health Unit, Fondazione Toscana Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - H Hlavata
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, Fondazione Toscana Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | | | | | | | - N Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, UK.,Institute of Clinical Medicine, PET Centre, Aarhus University, Aarhus, Denmark
| | - F Fornai
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy. .,IRCCS Neuromed, Pozzilli, Italy.
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Giorgi FS, Lombardo F, Galgani A, Hlavata H, Della Latta D, Martini N, Pavese N, Ghicopulos I, Baldacci F, Coi A, Scalese M, Bastiani L, Keilberg P, De Marchi D, Fornai F, Bonuccelli U. Locus Coeruleus magnetic resonance imaging in cognitively intact elderly subjects. Brain Imaging Behav 2021; 16:1077-1087. [PMID: 34741273 PMCID: PMC9107398 DOI: 10.1007/s11682-021-00562-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
The locus coeruleus is the main noradrenergic nucleus of the brain and is often affected in neurodegenerative diseases. Recently, magnetic resonance imaging with specific T1-weighted sequences for neuromelanin has been used to evaluate locus coeruleus integrity in patients with these conditions. In some of these studies, abnormalities in locus coeruleus signal have also been found in healthy controls and related to ageing. However, this would be at variance with recent post-mortem studies showing that the nucleus is not affected during normal ageing. The present study aimed at evaluating locus coeruleus features in a well-defined cohort of cognitively healthy subjects who remained cognitively intact on a one-year follow-up. An ad-hoc semiautomatic analysis of locus coeruleus magnetic resonance was applied. Sixty-two cognitively intact subjects aged 60-80 years, without significant comorbidities, underwent 3 T magnetic resonance with specific sequences for locus coeruleus. A semi-automatic tool was used to estimate the number of voxels belonging to locus coeruleus and its intensity was obtained for each subject. Each subject underwent extensive neuropsychological testing at baseline and 12 months after magnetic resonance scan. Based on neuropsychological testing 53 subjects were cognitively normal at baseline and follow up. No significant age-related differences in locus coeruleus parameters were found in this cohort. In line with recent post-mortem studies, our in vivo study confirms that locus coeruleus magnetic resonance features are not statistically significantly affected by age between 60 and 80 years, the age range usually evaluated in studies on neurodegenerative diseases. A significant alteration of locus coeruleus features in a cognitively intact elderly subject might be an early sign of pathology.
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Affiliation(s)
- Filippo Sean Giorgi
- Neurology Unit, Pisa University Hospital, Pisa, Italy.
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.
| | - Francesco Lombardo
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, Fondazione "G. Monasterio", National Research Council/Tuscany Region, Pisa, Italy
| | | | - Hana Hlavata
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, Fondazione "G. Monasterio", National Research Council/Tuscany Region, Pisa, Italy
| | - Daniele Della Latta
- Deep Health Unit, Fondazione "G. Monasterio", National Research Council/Tuscany Region, Pisa, Italy
| | - Nicola Martini
- Deep Health Unit, Fondazione "G. Monasterio", National Research Council/Tuscany Region, Pisa, Italy
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, UK
- Institute of clinical Medicine, PET Centre, Aarhus University, Aarhus, Denmark
| | | | | | - Alessio Coi
- Institute of Clinical Physiology of National Research Council, Pisa, Italy
| | - Marco Scalese
- Institute of Clinical Physiology of National Research Council, Pisa, Italy
| | - Luca Bastiani
- Institute of Clinical Physiology of National Research Council, Pisa, Italy
| | - Petra Keilberg
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, Fondazione "G. Monasterio", National Research Council/Tuscany Region, Pisa, Italy
| | - Daniele De Marchi
- Cardiovascular and Neuroradiological Multimodal Imaging Unit, Fondazione "G. Monasterio", National Research Council/Tuscany Region, Pisa, Italy
| | - Francesco Fornai
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
- IRCCS Neuromed, Pozzilli, Italy
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Galgani A, Martini N, Latta DD, Vatti A, Hlavata H, Chiappino D, Vergallo A, Hampel H, Siciliano G, Pavese N, Fornai F, Lombardo F, Giorgi F. Locus coeruleus assessment by MRI: A comparison of three different approaches. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Martinuzzi A, Montanaro D, Vavla M, Paparella G, Bonanni P, Musumeci O, Brighina E, Hlavata H, Rossi G, Aghakhanyan G, Martino N, Baratto A, D’Angelo MG, Peruch F, Fantin M, Arnoldi A, Citterio A, Vantaggiato C, Rizzo V, Toscano A, Bresolin N, Bassi MT. Clinical and Paraclinical Indicators of Motor System Impairment in Hereditary Spastic Paraplegia: A Pilot Study. PLoS One 2016; 11:e0153283. [PMID: 27077743 PMCID: PMC4831837 DOI: 10.1371/journal.pone.0153283] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 03/25/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hereditary spastic paraplegias (HSP) are a composite and genetically heterogeneous group of conditions mainly expressed by the impairment of the central motor system ("pure" forms). The involvement of other components of the central nervous system or of other systems is described in the "complicate" forms. The definition of an investigation protocol capable, by assembling clinical and paraclinical indicators to fully represent the extent of the motor system impairment, would help both the clinical handling of these conditions and contribute to our understanding of their pathogenesis. METHODS We applied a clinical and paraclinical protocol which included tools exploring motor and non motor functioning, neurophysiology and MRI to a composite cohort of 70 molecularly defined HSP patients aged 3 to 65, to define for each indicator its significance in detailing the presence and the severity of the pathology. RESULTS Clinically increased deep tendon reflexes and lower limb (LL) weakness are constant findings in all patients. The "complicated" forms are characterized by peripheral motor impairment, cognitive and cerebellar involvement. The Spastic Paraplegia Rating Scale efficiently reflects the severity of functional problems and correlates with disease duration. Neurophysiology consistently documents the impairment of the central motor pathway to the LLs. Nevertheless, the upper extremities and sensory system involvement is a frequent finding. MRI diffusion tensor imaging (DTI) highlighted a significant alteration of FA and MD. Combining the sampling of the various portion of the cortico-spinal tract (CST) DTI consistently discriminated patients from controls. CONCLUSION We propose a graded clinical and paraclinical protocol for HSP phenotype definition, indicating for each tool the discriminative and descriptive capacity. Our protocol applied to 9 different forms of HSP showed that the functional impairment often extends beyond the CST. The novel DTI approach may add significant elements in disease recognition, staging and mapping.
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Affiliation(s)
- Andrea Martinuzzi
- IRCCS E. Medea, Polo Regionale di Conegliano, Conegliano (TV), Italy
- * E-mail:
| | - Domenico Montanaro
- Fondazione CNR/Regione Toscana G. Monasterio, Unit of Neuroradiology, Pisa, Italy
| | - Marinela Vavla
- IRCCS E. Medea, Polo Regionale di Conegliano, Conegliano (TV), Italy
| | | | - Paolo Bonanni
- IRCCS E. Medea, Polo Regionale di Conegliano, Conegliano (TV), Italy
| | - Olimpia Musumeci
- University of Messina, Department of Neurosciences, Messina, Italy
| | - Erika Brighina
- IRCCS E. Medea, Neurorehabilitation Department, Bosisio Parini (LC), Italy
| | - Hana Hlavata
- Fondazione CNR/Regione Toscana G. Monasterio, Unit of Neuroradiology, Pisa, Italy
| | - Giuseppe Rossi
- Institute of Clinical Physiology, National Council of Research, Unit of Epidemiology and Biostatistics, Pisa, Italy
| | - Gayane Aghakhanyan
- Fondazione CNR/Regione Toscana G. Monasterio, Unit of Neuroradiology, Pisa, Italy
| | - Nicola Martino
- ULSS 7-Pieve di Soligo, Department of Imaging, Conegliano (TV), Italy
| | | | | | - Francesca Peruch
- IRCCS E. Medea, Polo Regionale di Conegliano, Conegliano (TV), Italy
| | - Marianna Fantin
- IRCCS E. Medea, Polo Regionale di Conegliano, Conegliano (TV), Italy
| | - Alessia Arnoldi
- IRCCS E. Medea, Laboratory of Molecular Biology, Bosisio Parini (LC), Italy
| | - Andrea Citterio
- IRCCS E. Medea, Laboratory of Molecular Biology, Bosisio Parini (LC), Italy
| | - Chiara Vantaggiato
- IRCCS E. Medea, Laboratory of Molecular Biology, Bosisio Parini (LC), Italy
| | - Vincenzo Rizzo
- University of Messina, Department of Neurosciences, Messina, Italy
| | - Antonio Toscano
- University of Messina, Department of Neurosciences, Messina, Italy
| | - Nereo Bresolin
- IRCCS Fondazione Policlinico, University of Milano, Department of Neuroscience, Milano, Italy
| | - Maria Teresa Bassi
- IRCCS E. Medea, Laboratory of Molecular Biology, Bosisio Parini (LC), Italy
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Aghakhanyan G, Martinuzzi A, Frijia F, Vavla M, Hlavata H, Baratto A, Martino N, Paparella G, Montanaro D. Brain white matter involvement in hereditary spastic paraplegias: analysis with multiple diffusion tensor indices. AJNR Am J Neuroradiol 2014; 35:1533-8. [PMID: 24788132 DOI: 10.3174/ajnr.a3897] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE The hereditary spastic paraplegias are a group of genetically heterogeneous neurodegenerative disorders, characterized by progressive spasticity and weakness of the lower limbs. Although conventional brain MR imaging findings are normal in patients with pure hereditary spastic paraplegia, microstructural alteration in the cerebral WM can be revealed with DTI. Concomitant investigation of multiple intrinsic diffusivities may shed light on the neurobiologic substrate of the WM degeneration pattern in patients with pure hereditary spastic paraplegia across the whole brain. MATERIALS AND METHODS Tract-based spatial statistics analysis was performed to compare fractional anisotropy and mean, axial, and radial diffusivities of the WM skeleton in a group of 12 patients with pure hereditary spastic paraplegia and 12 healthy volunteers. Data were analyzed counting age and sex as nuisance covariates. The threshold-free cluster-enhancement option was applied, and the family-wise error rate was controlled by using permutation tests for nonparametric statistics. RESULTS In pure hereditary spastic paraplegia, group widespread fractional anisotropy decreases and radial diffusivity and mean diffusivity increases (P < .05, corrected) were found. No voxelwise difference was observed for the axial diffusivity map. Percentage of voxels within the WM skeleton that passed the significance threshold were 51%, 41.6%, and 11.9%, respectively, for radial diffusivity, fractional anisotropy, and mean diffusivity clusters. An anteroposterior pattern with preferential decrease of fractional anisotropy in the frontal circuitry was detected. CONCLUSIONS In patients with pure hereditary spastic paraplegia, alterations in multiple DTI indices were found. Radial diffusivity seems more sensitive to hereditary spastic paraplegia-related WM pathology and, in line with the lack of axial diffusivity changes, might indicate a widespread loss of myelin integrity. A decrease of fractional anisotropy alone in the frontal circuitry may reflect subtle disruption of the frontal connections.
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Affiliation(s)
- G Aghakhanyan
- From the Institute of Life Sciences (G.A.), Scuola Superiore Sant'Anna, Pisa, ItalyNeuroradiology Unit (G.A., F.F., H.H., D.M.), Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - A Martinuzzi
- Medea Scientific Institute (A.M., M.V., G.P.), Conegliano and Bosisio Parini, Treviso, Italy
| | - F Frijia
- Neuroradiology Unit (G.A., F.F., H.H., D.M.), Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - M Vavla
- Medea Scientific Institute (A.M., M.V., G.P.), Conegliano and Bosisio Parini, Treviso, Italy
| | - H Hlavata
- Neuroradiology Unit (G.A., F.F., H.H., D.M.), Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - A Baratto
- Radiology Unit (A.B., N.M.), MRI Unit, ULSS7, Conegliano, Treviso, Italy
| | - N Martino
- Radiology Unit (A.B., N.M.), MRI Unit, ULSS7, Conegliano, Treviso, Italy
| | - G Paparella
- Medea Scientific Institute (A.M., M.V., G.P.), Conegliano and Bosisio Parini, Treviso, Italy
| | - D Montanaro
- Neuroradiology Unit (G.A., F.F., H.H., D.M.), Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
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Aghakhanyan G, Lupi G, Frijia F, Hlavata H, Lombardo F, De Cori S, Canapicchi R, Vannozzi R, Montanaro D. Delayed post-traumatic fronto-ethmoidal sinus mucocele evaluated with short and long TE MR spectroscopy. Neuroradiol J 2013; 26:693-8. [PMID: 24355189 DOI: 10.1177/197140091302600613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/27/2013] [Indexed: 11/16/2022] Open
Abstract
Mucoceles are slow-growing, benign, expansile, mucoid-filled masses developing after obstruction of the sinus ostium. Late post-traumatic mucoceles are relatively rare entities and the literature is limited to single case reports. We describe an unusual case of post-traumatic fronto-ethmoidal mucocele, evaluated with computed tomography (CT), magnetic resonance imaging (MRI) and proton MR-spectroscopy ((1)H-MRS). As a contribution to the diagnostic work-up of the mucocele, (1)H-MRS demonstrates a dominant peak at 2.0 ppm at long echo time (TE) and an additional component at 3.8 ppm at short TE due to mucus glycoprotein compounds of the mucocele.
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Affiliation(s)
- Gayane Aghakhanyan
- Institute of Life Sciences, Scuola Superiore Sant'Anna; Pisa, Italy - Neuroradiology Unit, CNR/Tuscany Region G. Monasterio Foundation; Pisa, Italy -
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8
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Lombardo F, Frijia F, Bongioanni P, Canapicchi R, Minichilli F, Bianchi F, Hlavata H, Rossi B, Montanaro D. Diffusion tensor MRI and MR spectroscopy in long lasting upper motor neuron involvement in amyotrophic lateral sclerosis. Arch Ital Biol 2009; 147:69-82. [PMID: 20014653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Upper motor neuron (UMN) dysfunction in Amyotrophic Lateral Sclerosis (ALS) is not easy to identify clinically: Diffusion Tensor Imaging (DTI) and single-voxel Magnetic Resonance Spectroscopy (H-MRS) can identify markers of UMN involvement. The aim of this study was to correlate brain DTI and MRS data with clinical parameters in ALS patients (PALS). We studied 32 PALS using Magnetic Resonance Imaging. The subjects were subdivided into definite/probable (D/P) and possible/suspected (P/S). DTI indices included Fractional Anisotropy (FA) and averaged Apparent Diffusion Coefficient (avADC). Anatomical areas were sampled by positioning regions of interest along corticospinal tracts, from the precentral cortex to the bulb. H-MRS voxels were localized bilaterally in precentral regions. D/P-PALS showed significantly lower FA values than healthy controls in almost all regions, whereas P/S-PALS FA values were significantly lower only in the left precentral gray matter (GM), right precentral white matter (WM), cerebral peduncles (CP), left hemipons, and left bulbar pyramid (BP). Significantly higher avADC values were observed in the D/P-PALS right precentral GM, precentral WM, right semioval center-posterior limb of the internal capsule (SC-PLIC), and left CP; and in the precentral WM, right SC-PLIC, left CP, and right hemipons of P/S-PALS. With increasing disability, only D/P-PALS showed significantly reduced FA values in the left precentral WM and hemipons, and increased avADC values in the precentral WM. Significantly lower N-acetylaspartate (NAA)/creatine-phosphocreatine complex (Cr) and higher choline (Cho)/Cr and myoinositol (mI)/Cr ratios were found in D/P-PALS, while only higher Cho/Cr and mI/Cr ratios were found in P/S-PALS. Our data highlight the usefulness of DTI and H-MRS in assessing UMN involvement. Given FA sensitivity and specificity, despite the small number of PALS, our findings support its use as a diagnostic marker in D/P-PALS.
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Affiliation(s)
- F Lombardo
- Fondazione CNR/Regione Toscana, U.O.S. Neuroradiologia, Pisa, Italy
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Abstract
An improvement in the clinical results obtained using total body irradiation (TBI) with photon beams requires precise TBI treatment planning, reproducible irradiation, precise in vivo dosimetry, accurate documentation and careful evaluation. In vivo dosimetry using LiF Harshaw TLD-100 chips was used during the TBI treatments performed in our department. The results of in vivo thermoluminescence dosimetry (TLD) show that using TLD measurements and interactive adjustment of some treatment parameters based on these measurements, like monitor unit calculations, lung shielding thickness and patient positioning, it is possible to achieve high precision in absorbed dose delivery (less than 0.5%) as well as in homogeneity of irradiation (less than 6%).
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Affiliation(s)
- P Palkosková
- University Hospital Motol, Department of Radiation Oncology, Prague, Czech Republic
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