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Massirio P, Cardiello V, Andreato C, Caruggi S, Battaglini M, Calandrino A, Polleri G, Mongelli F, Malova M, Minghetti D, Parodi A, Calevo MG, Tortora D, Rossi A, Ramenghi LA. Ventilatory Support, Extubation, and Cerebral Perfusion Changes in Pre-Term Neonates: A Near Infrared Spectroscopy Study. Neurotrauma Rep 2024; 5:409-416. [PMID: 38655113 PMCID: PMC11035839 DOI: 10.1089/neur.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Early extubation is considered to be beneficial for pre-term neonates. On the other hand, premature extubation can cause lung derecruitment, compromised gas exchange, and need for reintubation, which may be associated with severe brain injury caused by sudden cerebral blood flow changes. We used near infrared spectroscopy (NIRS) to investigate changes in cerebral oxygenation (rScO2) and fractional tissue oxygen extraction (+) after extubation in pre-term infants. This is a single-center retrospective study of NIRS data at extubation time of all consecutive pre-term neonates born at our institution over a 1-year period. Comparison between subgroups was performed. Nineteen patients were included; average gestational age (GA) was 29.4 weeks. No significant change was noted in rScO2 and cFTOE after extubation in the whole population. GA and germinal matrix hemorrhage (GMH)-intraventricular hemorrhage (IVH) showed a significant change in rScO2 and cFTOE after extubation. A significant increase in cFTOE was noted in patients with previous GMH-IVH (+0.040; p = 0.05). To conclude, extubation per se was not associated with significant change in cerebral oxygenation and perfusion. Patients with a diagnosed GMH-IVH showed an increase in cFTOE, suggesting perturbation in cerebral perfusion suggesting further understanding during this challenging phenomenon. Larger studies are required to corroborate our findings.
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Affiliation(s)
- Paolo Massirio
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Valentina Cardiello
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Chiara Andreato
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Samuele Caruggi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Marcella Battaglini
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Andrea Calandrino
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Giulia Polleri
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Federica Mongelli
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Diego Minghetti
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistic Unit, Scientific Direction, and IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
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Rotulo GA, Campanello C, Battaglini M, Bassi M, Pastorino C, Angeletti A, Brisca G, Signa S, Caorsi R, Ghiggeri GM. A Rare Pediatric Case of Allopurinol-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Successfully Treated With Intravenous Immunoglobulins. J Pediatr Pharmacol Ther 2024; 29:195-199. [PMID: 38596415 PMCID: PMC11001218 DOI: 10.5863/1551-6776-29.2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/25/2022] [Accepted: 11/28/2022] [Indexed: 04/11/2024]
Abstract
Allopurinol-induced drug reaction syndrome with eosinophilia and systemic symptoms (A-DRESS) is a well-described condition in adults, whereas it is uncommon among children. We describe a case of A-DRESS in a 16-year-old male with steroid-dependent nephrotic syndrome. He presented a life-threatening clinical course with persisting fever, skin rash, eosinophilia, lymphadenopathy, distributive shock, and herpesvirus 6 detection. The withdrawal of allopurinol and a combination of intravenous immunoglobulins (IVIGs) and systemic corticosteroids led to the patient's recovery without sequelae. Drug reaction with eosinophilia and systemic symptoms (DRESS) in pediatrics is rare and can present in a severe form. Early diagnosis and timely treatment are critical for prognostic purposes. This report suggests the potentially crucial role of IVIG in the treatment of patients with A-DRESS.
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Affiliation(s)
- Gioacchino Andrea Rotulo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (GAR, CC, M Battaglini, M Bassi, SS), University of Genoa, Genoa, Italy
- Clinical and Research Unit of Clinical Immunology and Vaccinology (GAR), IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Claudia Campanello
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (GAR, CC, M Battaglini, M Bassi, SS), University of Genoa, Genoa, Italy
| | - Marcella Battaglini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (GAR, CC, M Battaglini, M Bassi, SS), University of Genoa, Genoa, Italy
| | - Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (GAR, CC, M Battaglini, M Bassi, SS), University of Genoa, Genoa, Italy
| | - Carlotta Pastorino
- Dermatology Unit (CP), Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Andrea Angeletti
- Division of Nephrology, Dialysis, and Transplantation (AA, GMG), Giannina Gaslini Children’s Hospital, Genoa, Italy
| | - Giacomo Brisca
- Subintensive Care Unit (GB), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sara Signa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (GAR, CC, M Battaglini, M Bassi, SS), University of Genoa, Genoa, Italy
- Autoinflammatory Diseases and Immunodeficiencies Center (SS, RC), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Roberta Caorsi
- Autoinflammatory Diseases and Immunodeficiencies Center (SS, RC), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis, and Transplantation (AA, GMG), Giannina Gaslini Children’s Hospital, Genoa, Italy
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Calandrino A, Montobbio C, Bonato I, Cipresso G, Vinci F, Caruggi S, Battaglini M, Andreato C, Mongelli F, Massirio P, Brigati G, Minghetti D, Ramenghi LA. Optimizing haemoglobin measurements in VLBW newborns: Insights from a comparative retrospective study. Early Hum Dev 2024; 190:105949. [PMID: 38290276 DOI: 10.1016/j.earlhumdev.2024.105949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Haemoglobin levels assessment is a crucial part of neonatal intensive care practice, the painful experience of repeated heel pricks and venepunctures blood sampling may negatively affect neonatal clinical course. To date the reliability of haemoglobin levels obtained by point-of-care testing (POCT) analysis if compared to standard blood cell count remains controversial. MATERIALS AND METHODS Retrospective study conducted on all inborn premature infants (gestational age < 32 weeks) admitted to NICU of the IRCCS Giannina Gaslini Institute during the period May 2021-April 2023. We considered blood samplings occurred within the first 28 days of life recording the laboratory haemoglobin levels (Hblab) (reference method), the point-of-care haemoglobin levels (HbPOCT) (alternative method) and the type of puncture (arterial, venous and capillary). A Bland-Altman analysis was performed to evaluate the Hb agreement, it determines the bias (mean difference between the reference and alternative methods) and limits of agreement (LOA; lower, l-LOA; upper, u-LOA) of measures. An acceptable limit of agreement was 1 g/dl according to the existing literature. RESULTS We considered 845 blood samplings from 189 enrolled patients. The comparison between the reference and the alternative method showed a good agreement for the capillary sampling technique with l-LOA of -0.717 (-0.776; -0.659) and u-LOA of 0.549 (0.490; 0.607), these results were not achievable with the other techniques, with LOAs over ±1 g/dl threshold (venous CONCLUSIONS The reliability of capillary POCT measured haemoglobin levels may reduce clinical-related costs and the number of painful experiences, with obvious positive effects on the daily neonatal life in the NICU and on the developing brain structures.
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Affiliation(s)
- Andrea Calandrino
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Carolina Montobbio
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy.
| | - Irene Bonato
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Gaia Cipresso
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Francesco Vinci
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Samuele Caruggi
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Marcella Battaglini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Chiara Andreato
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Federica Mongelli
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Paolo Massirio
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Giorgia Brigati
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Diego Minghetti
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Luca Antonio Ramenghi
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
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Massirio P, Battaglini M, Bonato I, De Crescenzo S, Calevo MG, Malova M, Caruggi S, Parodi A, Preiti D, Zoia A, Uccella S, Tortora D, Severino M, Rossi A, Traggiai C, Nobili L, Striano P, Ramenghi LA. Early Extra-Uterine Growth Restriction in Very-Low-Birth-Weight Neonates with Normal or Mildly Abnormal Brain MRI: Effects on a 2-3-Year Neurodevelopmental Outcome. Nutrients 2024; 16:449. [PMID: 38337733 PMCID: PMC10856867 DOI: 10.3390/nu16030449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Extra-uterine growth restriction (EUGR) is a common complication and a known risk factor for impaired development in very-low-birth-weight (VLBW) neonates. We report a population of 288 patients with no or with low-grade MRI lesions scanned at a term equivalent age (TEA) born between 2012 and 2018. Griffiths Mental Development Scale II (GMDS II) at 2 and 3 years, preterm complications and weight growth were retrospectively analyzed. EUGR was defined for weight z-score ˂ 10 percentile at TEA, 6 and 12 months of correct age or as z-score decreased by 1-point standard deviation (SDS) from birth to TEA and from TEA to 6 months. Multivariate analysis showed that a higher weight z-score at 6 months is protective for the global developmental quotient (DQ) at 2 years (OR 0.74; CI 95% 0.59-0.93; p = 0.01). EUGR at 6 months was associated with worse locomotor, personal/social, language and performance DQ at 2 years and worse language and practical reasoning DQ at 3 years. In conclusion, a worse weight z-score at 6 months of age seems to be an independent risk factor for significantly reduced GMDS in many areas. These results suggest that we should invest more into post-discharge nutrition, optimizing family nutritional education.
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Affiliation(s)
- Paolo Massirio
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Marcella Battaglini
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
| | - Irene Bonato
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Sara De Crescenzo
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
| | - Maria Grazia Calevo
- Epidemiology and Biostatistic Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Mariya Malova
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Samuele Caruggi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Deborah Preiti
- Psychology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Agata Zoia
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Psychology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Sara Uccella
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (D.T.); (M.S.); (A.R.)
| | - Mariasavina Severino
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (D.T.); (M.S.); (A.R.)
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (D.T.); (M.S.); (A.R.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Cristina Traggiai
- Neonatology Unit, International Evangelical Hospital, 16122 Genoa, Italy;
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
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Andreato C, Uccella S, Battaglini M, Pacetti M, Tortora D, Ramenghi LA. The Possible Role of the Superior Sagittal Sinus in Regulating Cerebrospinal Fluid Dynamics among Preterm Infants: A Case Report and a Review of the Literature. Neuropediatrics 2024; 55:63-66. [PMID: 37913822 DOI: 10.1055/a-2202-3774] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
We report the case of a preterm of 27 weeks of gestation who developed posthemorrhagic ventricular dilatation associated to a complete thrombosis of the superior sagittal sinus, for its peculiar interest in clarifying the physiology of the cerebrospinal fluid (CSF) dynamics. The exact CSF volume that must be removed to improve cerebral hemodynamics and outcomes in infants with posthemorrhagic ventricular dilatation is unknown. According to Volpe's studies, a volume of 10 to 15 mL/kg/die of body weight is commonly chosen. The subject we report needed an excessive CSF drainage (up to 32 mL/kg/d), in presence of a functioning external ventricular drain. We review the literature on the topic, and we postulate that the superior sagittal sinus may play an active role in the CSF dynamics of the immature brain (as it happens for the adult brain).
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Affiliation(s)
- Chiara Andreato
- Department of Medical and Surgical Neuroscience and Rehabilitation, University of Genoa, Genoa, Italy
- Neonatology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sara Uccella
- Department of Medical and Surgical Neuroscience and Rehabilitation, University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marcella Battaglini
- Department of Medical and Surgical Neuroscience and Rehabilitation, University of Genoa, Genoa, Italy
- Neonatology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mattia Pacetti
- Neurosurgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luca A Ramenghi
- Department of Medical and Surgical Neuroscience and Rehabilitation, University of Genoa, Genoa, Italy
- Neonatology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Bellini C, Battaglini M, Pianta M, Houbadia Y, Calevo MG, Minghetti D, Ramenghi LA. The Transport of Respiratory Distress Syndrome Twin Newborns: The 27-Year-Long Experience of Gaslini Neonatal Emergency Transport Service Using Both Single and Double Ventilators. Air Med J 2023; 42:246-251. [PMID: 37356884 DOI: 10.1016/j.amj.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/03/2023] [Accepted: 03/08/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Twin pregnancy rates have increased in the past 30 years. We describe the experience of the Neonatal Emergency Transport Service of the Gaslini Hospital, Genoa, Italy, in the transport of twin newborns. METHODS This was a retrospective study (1996-2021); 7,852 medical charts from the Neonatal Emergency Transport Service were reviewed. We included all twin newborns who were transported with respiratory distress syndrome in the study. We split the included patients into 2 groups (group A and group B) based on if they were simultaneously ventilated by a single ventilator or by 2 different ventilators, and then each group was split by the different types of ventilation (nasal continuous positive airway pressure or intermittent positive pressure ventilation). The pH level, base excess, O2 saturation, Pco2, body temperature, plasma glucose, and Transport Risk Index of Physiologic Stability score were recorded at departure and arrival. RESULTS One hundred thirty-six patients were included (68 pairs of twins); group A consisted of 92 newborns and group B 44 newborns. Although some significant differences were observed (statistic), none of these had real clinical significance. CONCLUSION Transporting respiratory distress syndrome twin newborns is challenging. Our study provided a 27-year experience in the field. Transporting twins by a single ventilator is possible, but, in our opinion, using 2 ventilators mounted on the same transport module is the best possible choice in terms of clinical performance, logistics, and cost.
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Affiliation(s)
- Carlo Bellini
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Istituto Giannina Gaslini, Genova, Italy.
| | - Marcella Battaglini
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Istituto Giannina Gaslini, Genova, Italy
| | - Marianna Pianta
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Istituto Giannina Gaslini, Genova, Italy
| | - Yasmine Houbadia
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Istituto Giannina Gaslini, Genova, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Diego Minghetti
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Istituto Giannina Gaslini, Genova, Italy
| | - Luca Antonio Ramenghi
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother and Child, Istituto Giannina Gaslini, Genova, Italy
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7
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Vrenken H, Battaglini M, de Vos ML, Nagtegaal GJ, Teixeira BCA, Seitzinger A, Jack D, Sormani MP, Uitdehaag BMJ, Versteeg A, Comi G, Kappos L, De Stefano N, Barkhof F. Temporal evolution of new T1-weighted hypo-intense lesions and central brain atrophy in patients with a first clinical demyelinating event treated with subcutaneous interferon β-1a. J Neurol 2023; 270:2271-2282. [PMID: 36723685 PMCID: PMC10025187 DOI: 10.1007/s00415-022-11554-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate the effect of subcutaneous interferon β-1a (sc IFN β-1a) versus placebo on the evolution of T1-weighted MRI lesions and central brain atrophy in in patients with a first clinical demyelinating event (FCDE). METHODS Post hoc analysis of baseline-to-24 month MRI data from patients with an FCDE who received sc IFN β-1a 44 μg once- (qw) or three-times-weekly (tiw), or placebo, in REFLEX. Patients were grouped according to treatment regimen or conversion to clinically definite MS (CDMS) status. The intensity of new lesions on unenhanced T1-weighted images was classified as T1 iso- or hypo-intense (black holes) and percentage ventricular volume change (PVVC) was assessed throughout the study. RESULTS In patients not converting to CDMS, sc IFN β-1a tiw or qw, versus placebo, reduced the overall number of new lesions (P < 0.001 and P = 0.005) and new T1 iso-intense lesions (P < 0.001 and P = 0.002) after 24 months; only sc IFN β-1a tiw was associated with fewer T1 hypo-intense lesions versus placebo (P < 0.001). PVVC findings in patients treated with sc IFN β-1a suggested pseudo-atrophy that was ~ fivefold greater versus placebo in the first year of treatment (placebo 1.11%; qw 4.28%; tiw 6.76%; P < 001); similar findings were apparent for non-converting patients. CONCLUSIONS In patients with an FCDE, treatment with sc IFN β-1a tiw for 24 months reduced the number of new lesions evolving into black holes.
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Affiliation(s)
- H Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.
| | - M Battaglini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - M L de Vos
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - G J Nagtegaal
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - B C A Teixeira
- Department of Radiology, Federal University of Paraná, Curitiba, Paraná, Brazil
- Neuroradiology Department, Neurological Institute of Curitiba (INC/CETAC), Curitiba, Paraná, Brazil
| | - A Seitzinger
- Global Biostatistics, Merck Healthcare KGaA, Darmstadt, Germany
| | - D Jack
- Global Medical Affairs, Merck Serono Ltd, (an affiliate of Merck KGaA), Feltham, UK
| | - M P Sormani
- Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - B M J Uitdehaag
- Department of Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - A Versteeg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Biomedical Imaging Group Rotterdam, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G Comi
- Università Vita-Salute San Raffaele, Casa di Cura Privata del Policlinico, Milan, Italy
| | - L Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and Neurology Departments of Head, Spine and Neuromedicine, Biomedical Engineering and Clinical Research, University Hospital, University of Basel, Basel, Switzerland
| | - N De Stefano
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - F Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- UCL Institutes of Neurology and Healthcare Engineering, London, UK
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8
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Bellini C, Gente M, Battaglini M, Ammattatelli R, Ramenghi LA. Neonatal transport study underlines the need to improve the regionalisation of perinatal care in Italy. Acta Paediatr 2023; 112:252-253. [PMID: 36394346 DOI: 10.1111/apa.16599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Carlo Bellini
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother & Child, IRCCS Gaslini, Genoa, Italy
| | - Maurizio Gente
- Department of Pediatrics and Infant Neuropsychiatry, Neonatal Emergency Transport Service, Sapienza University of Rome, Rome, Italy
| | - Marcella Battaglini
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother & Child, IRCCS Gaslini, Genoa, Italy
| | - Rossana Ammattatelli
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother & Child, IRCCS Gaslini, Genoa, Italy
| | - Luca A Ramenghi
- Neonatal Emergency Transport Service, Neonatal Intensive Care Unit, Department Mother & Child, IRCCS Gaslini, Genoa, Italy
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9
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Clerico M, Dogliotti I, Ghione P, Zilioli VR, Merli F, Botto B, Al Essa W, Battaglini M, Grimaldi D, Cervi L, Ragaini S, Ferrero S, Peri V, De Luca G, Marzano A, Cavallo F. HBV Reactivation in Patients with Past Infection Affected by Non-Hodgkin Lymphoma and Treated with Anti-CD20 Antibody Based Immuno-Chemotherapy: A Multicenter Experience. J Pers Med 2022; 12:jpm12020285. [PMID: 35207774 PMCID: PMC8875663 DOI: 10.3390/jpm12020285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
Hepatitis B virus reactivation (HBVr) can develop in HBV surface antigen (HBsAg) positive or HBsAg-negative and anti-hepatitis B core antigen antibodies (anti-HBc) positive (past HBV infection) patients receiving immuno-chemotherapy for hematological malignancies. A higher rate of HBVr is associated with the use of rituximab (R) in patients with past HBV infection, thus justifying an antiviral prophylaxis. In this study we evaluated the incidence of HBVr in a real-life cohort of 362 anti-HBc-positive subjects affected by non-Hodgkin lymphoma (NHL), mainly receiving lamivudine (LAM) prophylaxis (93%) and all undergoing a R-containing regimen. A retrospective, multicenter, observational study was conducted in 4 Italian Hematology Departments. The primary endpoint was the incidence of virologic (HBV DNA-positive), serologic (HBsAg-positive) and clinical (ALT increase > 3 × upper limit of normal) HBVr, which occurred in five, four and one patients, respectively, with a total HBVr rate of 1.4%. None of them had to discontinue the chemotherapy program, while two patients required a delay. Treatment-related adverse events (AEs) were reported during LAM prophylaxis in three patients (0.9%). In conclusion, this study confirms the efficacy and safety of LAM prophylaxis in anti-HBc-positive patients undergoing R-containing regimens.
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Affiliation(s)
- Michele Clerico
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.C.); (S.R.); (S.F.); (V.P.); (G.D.L.)
| | - Irene Dogliotti
- Stem Cell Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Paola Ghione
- Lymphoma Program, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | | | - Francesco Merli
- Division of Hematology, Azienda Unità Sanitaria Locale—IRCCS, 42123 Reggio Emilia, Italy;
| | - Barbara Botto
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Wael Al Essa
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Marcella Battaglini
- DDINOGMI, Department University of Genoa, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Daniele Grimaldi
- Division of Hematology, A.O.S. Croce e Carle, 12100 Cuneo, Italy;
| | - Loretta Cervi
- Division of Pharmacy, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Simone Ragaini
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.C.); (S.R.); (S.F.); (V.P.); (G.D.L.)
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.C.); (S.R.); (S.F.); (V.P.); (G.D.L.)
| | - Veronica Peri
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.C.); (S.R.); (S.F.); (V.P.); (G.D.L.)
| | - Gabriele De Luca
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.C.); (S.R.); (S.F.); (V.P.); (G.D.L.)
| | - Alfredo Marzano
- Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, 10126 Turin, Italy;
| | - Federica Cavallo
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.C.); (S.R.); (S.F.); (V.P.); (G.D.L.)
- Correspondence: ; Tel.: +39-011-633-4556; Fax: +39-011-633-6507
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10
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De Stefano N, Giorgio A, Gentile G, Stromillo M, Visconti A, Battaglini M. Rapid Reduction of Lesion Accumulation in Specific White Matter Tracts as Assessed by Lesion Mapping in RRMS Patients Treated with Ifnβ-1a. Mult Scler Relat Disord 2018. [DOI: 10.1016/j.msard.2018.10.062] [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: 11/25/2022]
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11
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Storelli L, Pagani E, Rocca MA, Horsfield MA, Gallo A, Bisecco A, Battaglini M, De Stefano N, Vrenken H, Thomas DL, Mancini L, Ropele S, Enzinger C, Preziosa P, Filippi M. A Semiautomatic Method for Multiple Sclerosis Lesion Segmentation on Dual-Echo MR Imaging: Application in a Multicenter Context. AJNR Am J Neuroradiol 2016; 37:2043-2049. [PMID: 27444938 DOI: 10.3174/ajnr.a4874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/11/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The automatic segmentation of MS lesions could reduce time required for image processing together with inter- and intraoperator variability for research and clinical trials. A multicenter validation of a proposed semiautomatic method for hyperintense MS lesion segmentation on dual-echo MR imaging is presented. MATERIALS AND METHODS The classification technique used is based on a region-growing approach starting from manual lesion identification by an expert observer with a final segmentation-refinement step. The method was validated in a cohort of 52 patients with relapsing-remitting MS, with dual-echo images acquired in 6 different European centers. RESULTS We found a mathematic expression that made the optimization of the method independent of the need for a training dataset. The automatic segmentation was in good agreement with the manual segmentation (dice similarity coefficient = 0.62 and root mean square error = 2 mL). Assessment of the segmentation errors showed no significant differences in algorithm performance between the different MR scanner manufacturers (P > .05). CONCLUSIONS The method proved to be robust, and no center-specific training of the algorithm was required, offering the possibility for application in a clinical setting. Adoption of the method should lead to improved reliability and less operator time required for image analysis in research and clinical trials in MS.
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Affiliation(s)
- L Storelli
- From the Neuroimaging Research Unit (L.S., E.P., M.A.R., P.P., M.F.)
| | - E Pagani
- From the Neuroimaging Research Unit (L.S., E.P., M.A.R., P.P., M.F.)
| | - M A Rocca
- From the Neuroimaging Research Unit (L.S., E.P., M.A.R., P.P., M.F.)
- Institute of Experimental Neurology, Division of Neuroscience, Department of Neurology (M.A.R., P.P., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M A Horsfield
- Xinapse Systems (M.A.H.), Colchester, United Kingdom
| | - A Gallo
- MRI Center "SUN-FISM" and Institute of Diagnosis and Care "Hermitage-Capodimonte" (A.G., A.B.)
- I Division of Neurology, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (A.G., A.B.), Second University of Naples, Naples, Italy
| | - A Bisecco
- MRI Center "SUN-FISM" and Institute of Diagnosis and Care "Hermitage-Capodimonte" (A.G., A.B.)
- I Division of Neurology, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences (A.G., A.B.), Second University of Naples, Naples, Italy
| | - M Battaglini
- Department of Neurological and Behavioral Sciences (M.B., N.D.S.), University of Siena, Italy
| | - N De Stefano
- Department of Neurological and Behavioral Sciences (M.B., N.D.S.), University of Siena, Italy
| | - H Vrenken
- Department of Radiology and Nuclear Medicine, MS Centre Amsterdam (H.V.), VU Medical Centre, Amsterdam, the Netherlands
| | - D L Thomas
- Neuroradiological Academic Unit (D.L.T., L.M.), UCL Institute of Neurology, London, United Kingdom
| | - L Mancini
- Neuroradiological Academic Unit (D.L.T., L.M.), UCL Institute of Neurology, London, United Kingdom
| | - S Ropele
- Department of Neurology (S.R., C.E.)
| | - C Enzinger
- Department of Neurology (S.R., C.E.)
- Clinical Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology (C.E.), Medical University of Graz, Austria
| | - P Preziosa
- From the Neuroimaging Research Unit (L.S., E.P., M.A.R., P.P., M.F.)
- Institute of Experimental Neurology, Division of Neuroscience, Department of Neurology (M.A.R., P.P., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Filippi
- From the Neuroimaging Research Unit (L.S., E.P., M.A.R., P.P., M.F.)
- Institute of Experimental Neurology, Division of Neuroscience, Department of Neurology (M.A.R., P.P., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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12
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Stromillo ML, Giorgio A, Rossi F, Battaglini M, Hakiki B, Malentacchi G, Santangelo M, Gasperini C, Bartolozzi ML, Portaccio E, Amato MP, De Stefano N. Brain metabolic changes suggestive of axonal damage in radiologically isolated syndrome. Neurology 2013; 80:2090-4. [DOI: 10.1212/wnl.0b013e318295d707] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Vrenken H, Jenkinson M, Horsfield MA, Battaglini M, van Schijndel RA, Rostrup E, Geurts JJG, Fisher E, Zijdenbos A, Ashburner J, Miller DH, Filippi M, Fazekas F, Rovaris M, Rovira A, Barkhof F, de Stefano N. Recommendations to improve imaging and analysis of brain lesion load and atrophy in longitudinal studies of multiple sclerosis. J Neurol 2012; 260:2458-71. [PMID: 23263472 PMCID: PMC3824277 DOI: 10.1007/s00415-012-6762-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 11/12/2012] [Indexed: 01/14/2023]
Abstract
Focal lesions and brain atrophy are the most extensively studied aspects of multiple sclerosis (MS), but the image acquisition and analysis techniques used can be further improved, especially those for studying within-patient changes of lesion load and atrophy longitudinally. Improved accuracy and sensitivity will reduce the numbers of patients required to detect a given treatment effect in a trial, and ultimately, will allow reliable characterization of individual patients for personalized treatment. Based on open issues in the field of MS research, and the current state of the art in magnetic resonance image analysis methods for assessing brain lesion load and atrophy, this paper makes recommendations to improve these measures for longitudinal studies of MS. Briefly, they are (1) images should be acquired using 3D pulse sequences, with near-isotropic spatial resolution and multiple image contrasts to allow more comprehensive analyses of lesion load and atrophy, across timepoints. Image artifacts need special attention given their effects on image analysis results. (2) Automated image segmentation methods integrating the assessment of lesion load and atrophy are desirable. (3) A standard dataset with benchmark results should be set up to facilitate development, calibration, and objective evaluation of image analysis methods for MS.
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Affiliation(s)
- H Vrenken
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands,
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Popescu V, Battaglini M, Hoogstrate W, Verfaillie S, Sluimer I, van Schijndel R, van Dijk B, Cover K, Knol D, Jenkinson M, Barkhof F, de Stefano N, Vrenken H. Optimizing parameter choice for FSL-Brain Extraction Tool (BET) on 3D T1 images in multiple sclerosis. Neuroimage 2012; 61:1484-94. [PMID: 22484407 DOI: 10.1016/j.neuroimage.2012.03.074] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/28/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022] Open
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Portaccio E, Razzolini L, Goretti B, Battaglini M, Stromillo ML, Siracusa G, Giorgio A, Hakiki B, Giannini M, Pasto L, Sorbi S, Federico A, De Stefano N, Amato M. Cognitive Reserve Theory May Apply to the Model of Multiple Sclerosis (P03.070). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.070] [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: 11/15/2022] Open
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16
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Cree B, Madireddy L, De Stefano N, Caillier S, Stromillo ML, Battaglini M, Monet E, Cromer A, D'Antonio M, Farmer P, Lehr L, Beelke M, Baranzini S. Association of Targeted Blood Biomarkers with Interferon Beta-1a Treatment Administration, Magnetic Resonance Imaging Activity, and Treatment Response (P02.089). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.089] [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: 11/15/2022] Open
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17
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Giorgio A, Battaglini M, Rocca M, Absinta M, Barkhof F, Rovira A, Tintore-Subirana M, Chard D, Ciccarelli O, Enzinger C, Gasperini C, Frederiksen J, Filippi M, De Stefano N. Relevance of Brain Lesion Distribution and Frequency for Short-Term Conversion of Patients with Clinically Isolated Syndrome to Multiple Sclerosis (P03.033). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.033] [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: 11/15/2022] Open
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18
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Giorgio A, Stromillo ML, Bartolozzi M, Rossi F, Battaglini M, Guidi L, Maritato P, Portaccio E, Amato M, Federico A, De Stefano N. Ten-Year Brain Atrophy and Disability Changes in Patients with Multiple Sclerosis (P03.065). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Giorgio A, Stromillo ML, Rossi F, Battaglini M, Hakiki B, Portaccio E, Federico A, Amato MP, De Stefano N. Cortical lesions in radiologically isolated syndrome. Neurology 2011; 77:1896-9. [PMID: 22076541 DOI: 10.1212/wnl.0b013e318238ee9b] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the presence of cortical lesions (CLs) as detected by MRI in subjects with radiologically isolated syndrome (RIS). METHODS Fifteen subjects with RIS underwent an MRI examination, including a double inversion recovery sequence for CL assessment. T2-hyperintense white matter (WM) lesion volume (LV) and normalized volumes of brain and cortex were also obtained. RESULTS Thirty-four CLs were identified in 6 of 15 (40%) subjects with RIS and predominantly distributed in frontotemporal lobes. CLs were frequent in subjects with RIS with immunoglobulin G oligoclonal bands on CSF, cervical cord lesions, and dissemination in time on brain MRI. WM LV was higher in subjects with CLs than in those without CLs (11.5 ± 10.1 vs 3.9 ± 2.8 cm(3), p = 0.04). Indeed, CL number and volume correlated with WM LV (r = 0.57, p = 0.03 and r = 0.61, p = 0.01). All subjects with CLs were classified in a previous study as having a very high probability of having relapsing-remitting multiple sclerosis (MS) on a logistic regression analysis of quantitative MRI indices. CONCLUSIONS We found CLs in subjects with RIS, a condition characterized by the unanticipated MRI finding of WM lesions highly suggestive of MS in the absence of a clinical scenario. CLs were mainly localized to the frontotemporal lobes and were associated with important markers of evolution to MS.
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Affiliation(s)
- A Giorgio
- Department of Neurological and Behavioral Sciences, University of Siena, Siena, Italy
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20
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Dalton CM, Bodini B, Samson RS, Battaglini M, Fisniku LK, Thompson AJ, Ciccarelli O, Miller DH, Chard DT. Brain lesion location and clinical status 20 years after a diagnosis of clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 2011; 18:322-8. [PMID: 21878451 DOI: 10.1177/1352458511420269] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to investigate associations between the spatial distribution of brain lesions and clinical outcomes in a cohort of people followed up 20 years after presentation with a clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). METHODS Brain lesion probability maps (LPMs) of T1 and T2 lesions were generated from 74 people who underwent magnetic resonance imaging (MRI) and clinical assessment a mean of 19.9 years following a CIS. One-tailed t-test statistics were used to compare LPMs between the following groups: clinically definite (CD) MS and those who remained with CIS, with an abnormal MRI; people with MS and an Expanded Disability Status Scale (EDSS) ≤3 and >3; people with relapsing-remitting (RR) and secondary progressive (SP) MS. The probability of each voxel being lesional was analysed adjusting for age and gender using a multiple linear regression model. RESULTS People with CDMS were significantly more likely than those with CIS and abnormal scan 20 years after onset to have T1 and T2 lesions in the corona radiata, optic radiation, and splenium of the corpus callosum (periventricularly) and T2 lesions in the right fronto-occipital fasciculus. People with MS EDSS >3, compared with those with EDSS ≤3, were more likely to have optic radiation and left internal capsule T2 lesions. No significant difference in lesion distribution was noted between RRMS and SPMS. CONCLUSION This work demonstrates that lesion location characteristics are associated with CDMS and disability after long-term follow-up following a CIS. The lack of lesion spatial distribution differences between RRMS and SPMS suggests focal pathology affects similar regions in both subgroups.
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Affiliation(s)
- C M Dalton
- NMR Research Unit, UCL Institute of Neurology, UCL, London, UK.
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21
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Sbardella E, Tomassini V, Stromillo ML, Filippini N, Battaglini M, Ruggieri S, Ausili Cefaro L, Raz E, Gasperini C, Sormani MP, Pantano P, Pozzilli C, De Stefano N. Pronounced focal and diffuse brain damage predicts short-term disease evolution in patients with clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 2011; 17:1432-40. [DOI: 10.1177/1352458511414602] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In clinically isolated syndrome (CIS), the role of quantitative magnetic resonance imaging (MRI) in detecting prognostic markers is still debated. Objective: To evaluate measures of diffuse brain damage (such as brain atrophy and the ratio of N-acetylaspartate to creatine (NAA/Cr)) in patients with CIS, in addition to focal lesions, as predictors of 1-year disease evolution. Methods: 49 patients with CIS underwent MRI scans to quantify T2-lesions (T2-L) and gadolinium-enhanced lesion (GEL) number at baseline and after 1 year. Along with 25 healthy volunteers, they also underwent combined MRI/magnetic resonance spectroscopy examination to measure normalized brain volumes (NBVs) and NAA/Cr. Occurrence of relapses and new T2-L was recorded over 1 year to assess disease evolution. Results: Occurrence of relapses and/or new T2-L over 1 year divided patients with CIS into ‘active’ and ‘stable’ groups. Active patients had lower baseline NAA/Cr and NBV. Baseline T2-L number, GEL, NAA/Cr and NBV predicted subsequent disease activity. Multivariable logistic regression models showed that both ‘focal damage’ (based on T2-L number and GEL) and ‘diffuse damage’ (based on NBV and NAA/Cr) models predicted disease activity at 1 year with great sensitivity, specificity and accuracy. This was best when the four MRI measures were combined (80% sensitivity, 89% specificity, 83% accuracy). Conclusions: Quantitative MRI measures of diffuse tissue damage such as brain atrophy and NAA/Cr, in addition to measures of focal demyelinating lesions, may predict short-term disease evolution in patients with CIS, particularly when used in combination. If confirmed in larger studies, these findings may have important clinical and therapeutic implications.
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Affiliation(s)
- E Sbardella
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
- Department of Psychology, “Sapienza” University of Rome, Italy
| | - V Tomassini
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
- Oxford University Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford, UK
| | - ML Stromillo
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
| | - N Filippini
- Oxford University Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford, UK
- Department of Psychiatry, University of Oxford, UK
- Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - M Battaglini
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
| | - S Ruggieri
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | | | - E Raz
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | | | - MP Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Italy
| | - P Pantano
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | - C Pozzilli
- S. Andrea Hospital, “Sapienza” University of Rome, Italy
| | - N De Stefano
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
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22
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Cosottini M, Pesaresi I, Piazza S, Diciotti S, Belmonte G, Battaglini M, Ginestroni A, Siciliano G, De Stefano N, Mascalchi M. Magnetization transfer imaging demonstrates a distributed pattern of microstructural changes of the cerebral cortex in amyotrophic lateral sclerosis. AJNR Am J Neuroradiol 2011; 32:704-8. [PMID: 21436337 PMCID: PMC7965898 DOI: 10.3174/ajnr.a2356] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 08/24/2010] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE To date, damage of the cerebral cortex neurons in ALS was investigated by using conventional MR imaging and proton MR spectroscopy. We explored the capability of MTI to map the microstructural changes in cerebral motor and extramotor cortices of patients with ALS. MATERIALS AND METHODS Twenty patients with ALS and 17 age-matched healthy controls were enrolled. A high-resolution 3D SPGR sequence with and without MT saturation pulses was obtained on a 1.5T scanner to compute MTR values. Using the FMRIB Software Library tools, we automatically computed the MTR of the cerebral cortex GM in 48 regions of the entire cerebral cortex derived from the standard Harvard-Oxford cortical atlas. RESULTS The MTR values were significantly lower in patients with ALS than in healthy controls in the primary motor cortex (precentral gyrus), nonprimary motor areas (superior and middle frontal gyri and superior parietal lobe), and some extramotor areas (frontal pole, planum temporale, and planum polare). No correlation was found between regional MTR values and the severity of clinical deficits or disease duration. CONCLUSIONS MTI analysis can detect the distributed pattern of microstructural changes of the GM in the cerebral cortex of patients with ALS with involvement of both the motor and extramotor areas.
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Affiliation(s)
- M Cosottini
- Department of Neuroscience, University of Pisa, Pisa, Italy.
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23
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Bodini B, Battaglini M, De Stefano N, Khaleeli Z, Barkhof F, Chard D, Filippi M, Montalban X, Polman C, Rovaris M, Rovira A, Samson R, Miller D, Thompson A, Ciccarelli O. T2 lesion location really matters: a 10 year follow-up study in primary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 2011; 82:72-7. [PMID: 20627965 PMCID: PMC3002838 DOI: 10.1136/jnnp.2009.201574] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Prediction of long term clinical outcome in patients with primary progressive multiple sclerosis (PPMS) using imaging has important clinical implications, but remains challenging. We aimed to determine whether spatial location of T2 and T1 brain lesions predicts clinical progression during a 10-year follow-up in PPMS. METHODS Lesion probability maps of the T2 and T1 brain lesions were generated using the baseline scans of 80 patients with PPMS who were clinically assessed at baseline and then after 1, 2, 5 and 10 years. For each patient, the time (in years) taken before bilateral support was required to walk (time to event (TTE)) was used as a measure of progression rate. The probability of each voxel being 'lesional' was correlated with TTE, adjusting for age, gender, disease duration, centre and spinal cord cross sectional area, using a multiple linear regression model. To identify the best, independent predictor of progression, a Cox regression model was used. RESULTS A significant correlation between a shorter TTE and a higher probability of a voxel being lesional on T2 scans was found in the bilateral corticospinal tract and superior longitudinal fasciculus, and in the right inferior fronto-occipital fasciculus (p<0.05). The best predictor of progression rate was the T2 lesion load measured along the right inferior fronto-occipital fasciculus (p=0.016, hazard ratio 1.00652, 95% CI 1.00121 to 1.01186). CONCLUSION Our results suggest that the location of T2 brain lesions in the motor and associative tracts is an important contributor to the progression of disability in PPMS, and is independent of spinal cord involvement.
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Affiliation(s)
- B Bodini
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
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24
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Guerrera S, Stromillo ML, Mignarri A, Battaglini M, Marino S, Di Perri C, Federico A, Dotti MT, De Stefano N. Clinical relevance of brain volume changes in patients with cerebrotendinous xanthomatosis. J Neurol Neurosurg Psychiatry 2010; 81:1189-93. [PMID: 20972203 DOI: 10.1136/jnnp.2009.203364] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To quantify total and regional brain damage in subjects with cerebrotendinous xanthomatosis (CTX) using MR based quantitative measures. BACKGROUND CTX is a rare inherited disorder characterised by progressive neurological impairment. Appropriate therapy can slow disease progression. Measures of brain volume changes have been used in several neurological disorders due to their value in assessing disease outcome and monitoring patients' evolution. METHODS 24 CTX patients underwent conventional MRI to measure total and regional brain volumes. In five CTX patients who started therapy at baseline, clinical and MRI examinations were repeated after 2 years. Clinical disability, overall cognitive performance and cerebellar function were evaluated using the modified Rankin Scale (RS), Mini Mental Status Examination (MMSE) and cerebellar functional system score (CB-FSS). RESULTS Measures of normalised brain, cortical and cerebellar volumes were lower in CTX patients than in healthy controls (p<0.01). Instead, there were no differences in normalised white matter volumes between the two groups (p=0.1). At regional analysis, a significant volume decrease was found in each cortical region (p<0.01 for all regions). Normalised cortical volumes correlated closely with age (r=-0.9, p<0.0001), RS (r=-0.65, p<0.001) and MMSE (r=-0.60, p<0.01). Normalised cerebellar volumes correlated closely with CB-FSS scores (r=-0.58, p<0.01). In the five CTX patients followed over time, the annual brain volume decrease was -1.1 ± 0.2%. CONCLUSIONS Cortical volume, rather than white matter volume, is diffusely decreased in CTX patients and correlates closely with the patient's clinical status. These data provide evidence for the presence of clinically relevant neuronal-axonal damage in the brains of CTX patients.
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Affiliation(s)
- S Guerrera
- Department of Neurological and Behavioural Sciences, University of Siena, Viale Bracci 2, 53100 Siena, Italy
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25
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Ginestroni A, Battaglini M, Diciotti S, Della Nave R, Mazzoni LN, Tessa C, Giannelli M, Piacentini S, De Stefano N, Mascalchi M. Magnetization transfer MR imaging demonstrates degeneration of the subcortical and cortical gray matter in Huntington disease. AJNR Am J Neuroradiol 2010; 31:1807-12. [PMID: 20813872 DOI: 10.3174/ajnr.a2225] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE GM is typically affected in HD since the presymptomatic stage. Our aim was to investigate with MT MR imaging the microstructural changes of the residual brain subcortical and cortical GM in carriers of the HD gene and to preliminarily assess their correlation with the clinical features. MATERIALS AND METHODS Fifteen HD gene carriers with a range of clinical severity and 15 age- and sex-matched healthy controls underwent MT MR imaging on a 1.5T scanner. The MT ratio was measured automatically in several subcortical and cortical GM regions (striatal nuclei; thalami; and the neocortex of the frontal, temporal, parietal, and occipital lobes) by using FLS tools. RESULTS The MT ratio was significantly (P < .05 with Bonferroni correction for multiple comparison) decreased in all subcortical structures except the putamen and decreased diffusely in the cerebral cortex of HD carriers compared with controls. Close correlation was observed between the subcortical and cortical regional MT ratios and several clinical variables, including disease duration, motor disability, and scores in timed neuropsychological tests. CONCLUSIONS MT imaging demonstrates degeneration of the subcortical and cortical GM in HD carriers and might serve, along with volumetric assessment, as a surrogate marker in future clinical trials of HD.
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Affiliation(s)
- A Ginestroni
- Department of Clinical Physiopathology, University of Florence, Italy
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26
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Calabrese M, Battaglini M, Giorgio A, Atzori M, Bernardi V, Mattisi I, Gallo P, De Stefano N. Imaging distribution and frequency of cortical lesions in patients with multiple sclerosis. Neurology 2010; 75:1234-40. [DOI: 10.1212/wnl.0b013e3181f5d4da] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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27
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De Stefano N, Giorgio A, Battaglini M, Rovaris M, Sormani MP, Barkhof F, Korteweg T, Enzinger C, Fazekas F, Calabrese M, Dinacci D, Tedeschi G, Gass A, Montalban X, Rovira A, Thompson A, Comi G, Miller DH, Filippi M. Assessing brain atrophy rates in a large population of untreated multiple sclerosis subtypes. Neurology 2010; 74:1868-76. [DOI: 10.1212/wnl.0b013e3181e24136] [Citation(s) in RCA: 237] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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28
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Portaccio E, Stromillo ML, Goretti B, Zipoli V, Siracusa G, Battaglini M, Giorgio A, Bartolozzi ML, Guidi L, Sorbi S, Federico A, Amato MP, De Stefano N. Neuropsychological and MRI measures predict short-term evolution in benign multiple sclerosis. Neurology 2009; 73:498-503. [DOI: 10.1212/wnl.0b013e3181b351fd] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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29
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Stromillo ML, Dotti MT, Battaglini M, Mortilla M, Bianchi S, Plewnia K, Pantoni L, Inzitari D, Federico A, De Stefano N. Structural and metabolic brain abnormalities in preclinical cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy. J Neurol Neurosurg Psychiatry 2009; 80:41-7. [PMID: 18829627 DOI: 10.1136/jnnp.2008.155853] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess, by using quantitative MRI metrics, structural and metabolic brain abnormalities in subjects with preclinical cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL). BACKGROUND Brain MRI abnormalities have been occasionally reported in preclinical CADASIL subjects. However, very little is known as to when the brain tissue damage starts to accumulate, what brain regions are primarily involved and whether the brain damage is significant in subjects who have no overt clinical manifestations of the disease. METHODS Twelve subjects (mean age 40 years; range 26-55 years; males/females 6/6) with genetically proven CADASIL and no clinical signs of the disease underwent conventional MRI and proton MR spectroscopic imaging ((1)H-MRSI) to measure white matter (WM) lesion volume (LV), global and regional cerebral volumes, and WM levels of N-acetylaspartate (NAA) normalised to creatine (Cr). MR values were compared with those of 13 age- and sex-matched healthy controls. RESULTS All preclinical CADASIL showed WM lesions (range 0.2 to 26 cm(3)). They were mostly distributed in the frontal and parietal regions, with the highest probability in the corona radiata. On (1)H-MRSI examination, NAA/Cr values were lower in preclinical CADASIL than in HC, particularly in the corona radiata (p<0.01). Normalised brain and cortical volumes were also lower in preclinical CADASIL than in HC (p<0.01), particularly in the frontal cortex. CONCLUSIONS The pathological process occurring in CADASIL leads to damage of WM and neocortex much before the evidence of clinical symptoms. At this preclinical stage, this seems to take place prevalently in the frontal brain region.
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Affiliation(s)
- M L Stromillo
- Department Neurological and Behavioural Sciences, University of Siena, Viale Bracci 2, 53100 Siena, Italy
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30
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Amato MP, Portaccio E, Stromillo ML, Goretti B, Zipoli V, Siracusa G, Battaglini M, Giorgio A, Bartolozzi ML, Guidi L, Sorbi S, Federico A, De Stefano N. Cognitive assessment and quantitative magnetic resonance metrics can help to identify benign multiple sclerosis. Neurology 2008; 71:632-8. [DOI: 10.1212/01.wnl.0000324621.58447.00] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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